The Ensuring Medicare Access to Recreational Therapy Act of 2007

Floor Speech

Mrs. TAUSCHER. Madam Speaker, I rise today to speak on behalf of the many Medicare beneficiaries who require therapeutic rehabilitative services.

* I first developed an interest in rehabilitation issues after someone in my own family was forced to cope with a disabling paralytic disease. I saw the benefits of recreational therapy first hand, through the therapy my father received, and I want to be sure everyone has access to the same treatment already covered by Medicare.

* Recreational therapy can be a vital service for the ill and the disabled. In many cases, it is a critical means for improving the functioning, independence, and quality of life of persons with illness or disability. Recreational therapy is always prescribed and supervised by a physician as part of a patient's rehabilitative plan of care.

* It has long been a priority of mine to remove existing barriers to Medicare beneficiaries' access to recreational therapy. For years, I have worked alongside therapists in trying to help those with illnesses or disabling conditions gain consistent access to these services.

* In the past, dozens of my colleagues and I have sought clarification from the Centers for Medicare and Medicaid Services (CMS) on its policy on coverage and payment of recreational therapy services in three inpatient settings: rehabilitation hospitals (IRFs), psychiatric hospitals (IPFs) and skilled nursing facilities (SNFs).

* CMS regulations and policy manuals currently lack sufficient clarity on the treatment of recreational therapy provided in these inpatient settings. As a result, widespread confusion and misperceptions surround the recreational therapy benefit under Medicare. Out of concern for potential liability for fraud and abuse, many IRF, IPS, and SNF facility administrators are declining to offer recreational therapy, creating inconsistent access to these vital services for patients throughout the country.

* CMS has responded to each Congressional inquiry made on this issue, but to date CMS has not clarified its coverage and payment policy of recreational therapy services to fiscal intermediaries, facility administrators, treating physicians, and other relevant entities. In order to ensure that patients are able to receive appropriate rehabilitative services, CMS must formally clarify its policy.

* For the sake of Medicare beneficiaries in need of recreational therapy, it is time to require CMS to do so.

* To be sure, CMS has confirmed in writing that it considers recreational therapy to be a covered service in each of these three inpatient settings. CMS has also confirmed that the costs of these services have been built into the prospective payment systems for IRFs, IPFs, and SNFs and, therefore, Medicare is already paying to provide recreational therapy services to beneficiaries who need them. Yet access to recreational therapy is not assured.

* To remedy this situation, I am introducing the Ensuring Medicare Access to Recreational Therapy Act of 2007, with Representative Phil English, to make certain that patients who need recreational therapy services, as prescribed by their physician and as warranted by their health condition, have consistent access to these medically necessary services.

* Our bill simply directs CMS to clarify current coverage and payment policy by issuing notification that recreational therapy is a covered inpatient service in IRFs, IPFs, and SNFs and that the cost of providing such services has already been built into the prospective payment systems for these inpatient settings. This clarification will serve Medicare beneficiaries far better than the current CMS guidance on this issue.

* It is important to note that this legislation will not create new coverage, or add any financial burden to the Medicare program. It will, however, ensure access to rehabilitative care so that individuals with disabilities, injuries, or chronic conditions may regain their maximum level of independent function.

* I urge my colleagues to please join us in the fight to remove these arbitrary and unnecessary barriers to consistent access to recreational therapy services for all the Medicare beneficiaries who need them.

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