[Congressional Record (Bound Edition), Volume 153 (2007), Part 23]
[Extensions of Remarks]
[Page 31837]
[From the U.S. Government Publishing Office, www.gpo.gov]




    THE ENSURING MEDICARE ACCESS TO RECREATIONAL THERAPY ACT OF 2007

                                 ______
                                 

                         HON. ELLEN O. TAUSCHER

                             of california

                    in the house of representatives

                      Thursday, November 15, 2007

  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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