[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4248 Introduced in House (IH)]







110th CONGRESS
  1st Session
                                H. R. 4248

 To ensure access to recreational therapy in inpatient rehabilitation 
   facilities, inpatient psychiatric facilities, and skilled nursing 
                 facilities under the Medicare Program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           November 15, 2007

Mrs. Tauscher (for herself and Mr. English of Pennsylvania) introduced 
  the following bill; which was referred to the Committee on Ways and 
 Means, and in addition to the Committee on Energy and Commerce, for a 
 period to be subsequently determined by the Speaker, in each case for 
consideration of such provisions as fall within the jurisdiction of the 
                          committee concerned

_______________________________________________________________________

                                 A BILL


 
 To ensure access to recreational therapy in inpatient rehabilitation 
   facilities, inpatient psychiatric facilities, and skilled nursing 
                 facilities under the Medicare Program.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Ensuring Medicare Access to 
Recreational Therapy Act of 2007''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) Recreational therapy is a critical health care service 
        that--
                    (A) restores, remediates, and rehabilitates 
                functional capacity for persons with injuries, chronic 
                illnesses, and disabilities;
                    (B) is provided by a qualified recreational 
                therapist and is prescribed and supervised by a 
                physician as part of a treatment plan; and
                    (C) has been demonstrated by evidence-based 
                research to improve the physical, cognitive, social, 
                and emotional functioning of individuals who receive 
                the service.
            (2) The Centers for Medicare & Medicaid Services (in this 
        Act referred to as ``CMS'') has explicitly stated in preamble 
        language to Federal regulations and in correspondence with 
        Members of Congress that recreational therapy provided in 
        inpatient rehabilitation facilities (each in this Act referred 
        to as an ``IRF''), inpatient psychiatric facilities (each in 
        this Act referred to as an ``IPF''), and skilled nursing 
        facilities (each in this Act referred to as a ``SNF'')--
                    (A) is a covered service under title XVIII of the 
                Social Security Act;
                    (B) is an important service in supporting improved 
                outcomes for Medicare beneficiaries; and
                    (C) is a skilled rehabilitative modality included 
                in the bundle of services as part of the payment rate 
                for IRFs, IPFs, and SNFs under the respective Medicare 
                prospective payment systems for these settings.
            (3) Out of concern for potential liability for fraud and 
        abuse, many IRF, IPF, and SNF facility administrators are 
        declining to offer recreational therapy services because they 
        lack clear regulatory guidance on the inclusion of recreational 
        therapy services in the mix of services built into the 
        prospective payment systems for these settings.
            (4) In order to ensure that Medicare beneficiaries have 
        access to this critical service, there is a compelling need for 
        CMS to inform IRF, IPF, and SNF administrators, as well as the 
        fiscal intermediaries who process claims for payment, through 
        the issuance of regulations or through publication in the 
        Medicare Benefits Policy Manual, that recreational therapy 
        provided in IRFs, IPFs, and SNFs is covered by the respective 
        Medicare part A prospective payment system when required by the 
        patient's condition and prescribed by a physician as a part of 
        the facility's plan of care for the patient.
            (5) Policy clarifications issued by CMS will not impose an 
        additional burden on the Medicare Hospital Insurance (HI) Trust 
        Fund, as the costs of providing recreational therapy services 
        to patients are already built into the prospective payment 
        systems for the respective settings.

SEC. 3. ENSURING ACCESS TO PRESCRIBED RECREATIONAL THERAPY IN CERTAIN 
              SETTINGS.

    (a) In General.--Not later than 180 days after the date of the 
enactment of this Act, the Secretary of Health and Human Services, 
acting through the Administrator of CMS, shall issue a notice of 
proposed rulemaking, or issue a transmittal amending the Medicare 
Benefits Policy Manual, or both, specifying that--
            (1) recreational therapy is a covered service under title 
        XVIII of the Social Security Act in IRFs, IPFs, and SNFs;
            (2) recreational therapy is a skilled rehabilitative 
        modality included in the bundle of services as part of the 
        payment rates for IRFs, IPFs, and SNFs under Medicare's 
        respective prospective payment systems for these inpatient 
        settings; and
            (3) any recreational therapy that is provided to a Medicare 
        beneficiary in an IRF, IPF, or SNF prescribed by a physician as 
        part of the facility's plan care for the patient must be 
        provided by a qualified recreational therapist.
    (b) Construction.--Nothing in subsection (a) shall be construed as 
affecting the payment rates otherwise established for IRFs, IPFs, or 
SNFs under the Medicare program.
                                 <all>