6-9-14
ADVOCACY ALERT
(DO NOT SEND TO THIS DOCUMENT TO CONGRESSPERSON)
"Access to Inpatient Rehabilitation Therapy Act of 2015"
H.R. 1906 has been introduced!
Congressman Glenn (GT) Thompson (R-PA) and Congressman G.K. Butterfield (D-NC) have introduced the Access to Inpatient Rehabilitation Therapy Act of 2015 (H.R. 1906).
What is the Purpose of this Act?
It is the purpose of this Act to restore reliance on the professional judgment of the treating physician and the rehabilitation team when determining whether a Medicare patient meets the intensity of therapy requirement of an inpatient rehabilitation hospital or unit. The amendment gives patients enhanced access to the appropriate mix of medically necessary therapeutic rehabilitation services in the Inpatient Rehabilitation Facility (IRF) setting, including physical therapy, occupational therapy, and, as needed, speech therapy, orthotics and prosthetics, and recreational therapy.
What does this bill do?
This bill will amend the Social Security Act by including recreational therapy among the modalities that constitute an intensive rehabilitation therapy program and can be explicitly counted toward the so-called "three hour rule" in inpatient rehabilitation hospitals and units.
Specifically, the bill adds the following new paragraph to the end of Section 1886(j) of the Social Security Act:
"(9) Including Recreational Therapy among the therapy modalities that constitute an intensive rehabilitation therapy program in a rehabilitation facility. - The Secretary shall include recreational therapy services among the therapeutic modalities that constitute an intensive rehabilitation program in determining (pursuant to applicable regulations) whether inpatient services in a rehabilitation facility are reasonable and necessary under section 1862(a)(1)(A)."
Why is this important?
By including RT under the intensity of therapy requirement, Medicare beneficiaries in inpatient rehabilitation hospitals and units will regain access to important therapies deemed medically necessary by their treating physicians and therapists. IRFs will be better able to meet the intensity of rehabilitation therapy requirement and thus reduce the risk that patients will be inappropriately diverted into less intensive post-acute settings.
Coalition of Support
Several organizations have joined the American Therapeutic Recreation Association (ATRA) in supporting this amendment including:
American Academy of Physical Medicine and Rehabilitation
American Medical Rehabilitation Providers Association
American Academy of Orthotists and Prosthetists
Brain Injury Association of America
CARF, International (Commission on Accreditation of Rehabilitation Facilities)
Council on Brain Injury
United Spinal Association
What can you do?
1. Read the Access to Inpatient Rehabilitation Therapy Act of 2015 (H.R. 1906).
2. Read the letter of support from AAPM&R.
3. Contact your Congressperson and ask them to cosponsor H.R. 1906. Please note that you may have to follow-up several times to gain approval from the Congressperson's office to cosponsor this legislation. |
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Action Requested
Step 1: Contact your U.S. Congressperson's office and find out who handles health care issues for the Congressperson. You can reach your Congressperson's office through the U.S. Capitol Switchboard at (202) 225-3121 or by going through the website: http://www.house.gov/representatives/find/
Step 2: Tell your Congressperson's health staffer about H.R. 1906 and ask him or her to sign your Congressperson on as a co-sponsor in support of H.R. 1906. Ask the health staffer for his or her direct email so you can send them a copy of the H.R. 1906 and the letter of support. See template below. (House staffers' emails are all similar: first name.last name@mail.house.gov.) If they ask who on Capitol Hill is collecting cosponsor names, tell them to contact Matt Brennen (202) 225-5121 in Congressman Thompson's office or Saul Hernandez (202) 225-3101 in Congressman Butterfield's office.
Step 3: Urge your colleagues, clients/patients, volunteers, students, etc. to do the same. We have a short window of opportunity and need as many Congressional cosponsors as possible-we need you and your colleagues to act now! This will take the entire profession's active involvement!
If you have questions about this Advocacy Alert, please contact the ATRA Public Policy Committee Co-Chairs: Thom Skalko at skalkot@ecu.edu and Richard Williams at williamsri@ecu.edu.
ATRA POSITION STATEMENT | E-MAIL TEMPLATE |
5-30-14
"Access to Inpatient Rehabilitation Therapy Act of 2014" H.R. 4755 has been introduced!
Congressman Glenn (GT) Thompson (R-PA) and Congressman G.K. Butterfield (D-NC) have introduced H.R. 4755: "Access to Inpatient Rehabilitation Therapy Act of 2014".
What is the Purpose of this Act?
It is the purpose of this Act to restore reliance on the professional judgment of the treating physician and the rehabilitation team when determining whether a Medicare patient meets the intensity of therapy requirement of an inpatient rehabilitation hospital or unit in order for that patient to gain access to the appropriate mix of medically necessary therapeutic rehabilitation services in that setting, including physical therapy, occupational therapy, and, as needed, speech therapy, orthotics and prosthetics, and recreational therapy.
What does this bill do?
This bill will amend the Social Security Act by including recreational therapy among the modalities that constitute an intensive rehabilitation therapy program.
Specifically, the bill adds the following new paragraph to the end of Section 1886(j) of the Social Security Act:
"(9) Including Recreational Therapy among the therapy modalities that constitute an intensive rehabilitation therapy program in a rehabilitation facility. - The Secretary shall include recreational therapy services among the therapeutic modalities that constitute an intensive rehabilitation program in determining (pursuant to applicable regulations) whether inpatient services in a rehabilitation facility are reasonable and necessary under section 1862(a)(1)(A).".
Why is this important?
By including RT under the intensity of therapy requirement, Medicare beneficiaries in inpatient rehabilitation hospitals and units will regain access to important therapies deemed medically necessary by their treating physicians and therapists. IRFs will be better able to meet the intensity of rehabilitation therapy requirement and thus reduce the risk that patients will be inappropriately diverted into less intensive post-acute settings.
Coalition of Support
Several organizations have joined the American Academy of Physical Medicine and Rehabilitation (AAPM&R) in supporting this amendment including:
American Medical Rehabilitation Providers Association
American Academy of Orthotists and Prosthetists
American Therapeutic Recreation Association
Brain Injury Association of America
CARF, International (Commission on Accreditation of Rehabilitation Facilities)
Council on Brain Injury
United Spinal Association
What can you do?
1. Read the H.R. 4755: Access to Inpatient Rehabilitation Therapy Act of 2014
2. Read the letter of support from AAPM&R
3. Contact your Congressperson and ask them to sign on in support of H.R. 4755
Action Requested
Step 1: Contact your U.S. Congressperson's office and find out who handles health care issues for the Congressperson. You can reach them through the U.S. Capitol Switchboard at (202) 224-3121 or by going through the direct website: www.house.gov.
Step 2: Tell them about H.R. 4755 and ask them to sign on as a co-sponsor in support of H.R. 4755. Ask them for their direct email so you can send them a copy of the H.R. 4755 and the letter of support. (You can use this template.) If they ask for a staff contact for either of the Congressmen, tell them to contact Matt Brennan (202) 225-5121 in Congressman Thompson's office or Saul Hernandez (202) 225-3101 in Congressman Butterfield's office.
Step 3: Urge your colleagues, clients, volunteers, students, etc. to do the same. We have a short window of opportunity and all signatures need to be on the letter - so we need you and your colleagues to act fast! This will take the entire profession!
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5-4-12
Please send the email below to your Representative.
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Dear Rep. [Write name],
Please help Medicare patients receive appropriate therapy services
My name is [your name] and I’m a constituent of Representative [your Reps name]. I’m very concerned about ensuring that the residents of our district are being denied access to the appropriate rehabilitation services.
Representative Glen Thompson has drafted a sign-on letter which I would like Representative to consider signing on to make sure his constituents receive access to rehabilitation services that are already covered by Medicare/ Medicaid.
I would like Representative [your Reps name] to contact Representative Glen Thompson’s office at matthew.brennan@mail.house.gov or 225-5121 to get more information about this Clarification That Recreational Therapy is a Covered Service letter.
Sincerely yours,
[your name and contact info].
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8-26-09
Centers for Medicare and Medicaid Services Issue Final Rules:
Outcome for RT Services
Thomas Skalko, Diane Skalko, Lisa Morgan
On behalf of the ATRA Federal Public Policy Team (FPP) and the ATRA Board of Director's, we sincerely thank every professional who engaged to take action by sending letters to CMS through the regulations website and through the Medicare benefits email address provided. Many CTRS' also engaged other allied health professionals, coworkers, and consumers to submit comment on behalf of the Recreational Therapy profession. Please extend our sincere thanks to these individuals as well.
Our team does recognize that CMS received a sizeable number of comments from our profession based on information shared with the ATRA office. This is a great example of how each person can take 10 minutes to help make a difference for our profession and for the consumers who benefit from our services.
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Recap of the ATRA RT Medicare Project
Over the past several years, the American Therapeutic Recreation Association has been engaged in an initiative to have the Centers for Medicare and Medicaid Services (CMS) acknowledge that recreational therapy services, when prescribed by a physician, is a covered service in Inpatient Rehabilitation Facilities (IRFs), Inpatient Psychiatric Facilities (IPFs) and Skilled Nursing Facilities (SNFs). On July 31, 2009, CMS issued final rules covering the Medicare Program: Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2010.
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Outcome for RT Services
Following an extensive campaign to seek written clarification that recreational therapy (RT) is a covered service and to seek the inclusion of RT services as an option under the 3-hour guideline for IRFs, CMS issued final rules. In summary, CMS did identify RT as a covered service, when ordered by a physician as part of the overall rehabilitation plan. This is the first time they have acknowledged this in writing, thus, meaning we met our first goal of the RT Medicare Project. This is one hurdle that we can all be excited about for the profession. CMS did not, however, include RT as a service under the 3-hour guideline as a service that could be used in place of the required physical therapy and occupational therapy, or speech-language pathology/prosthetics/orthotics therapy.
While the initiative to seek inclusion of RT in the 3-hour guideline was not successful, the written acknowledgement that RT is a covered service under Medicare for IRFs was accomplished. ATRA, however, will be exploring the interpretations by CMS and seeking clarification of feedback provided in the final rule. The final rule goes into effect for Federal Fiscal Year 2010 (October 1, 2009 - September 30, 2010). ATRA's Federal Public Policy Team will keep you informed as actions progress.
For questions or comments, please contact Lisa Morgan at lmorgan@siskinrehab.org, Dr. Thomas Skalko at skalkot@ecu.edu, or Diane Skalko at dianeskalko@gmail.com |
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6-24-09
ATRA ACTION ALERT
Inpatient Medical Rehabilitation
LAST WEEK TO REPLY!!!!!
On April 29th, 2009, the Centers for Medicare and Medicaid Services (CMS) issued its 2010 proposed rule for the inpatient rehabilitation facility (IRF) prospective payment system (PPS). CMS has also proposed to revise the Medicare Benefits Policy Manual (MBPM) provisions on coverage of IRF services and has established a separate comment period and process for these changes.
Taken together, the proposals represent one of the most comprehensive sets of rule changes governing access to inpatient rehabilitation services in years and will set the stage for IRF care for the foreseeable future.
Proposed CMS Change:
In reference to the "3-hour Rule," the removal of the phrase "other skilled rehabilitative modalities" and insertion of "... active and ongoing therapeutic intervention of at least two therapy disciplines (physical therapy, occupational therapy, speech-language pathology, or prosthetics/orthotics therapy)..." in both the IRF-PPS final rule for 2010 and the Medicare Benefits Policy Manual.
Proposed ATRA Member Actions:
Given the impact such a change will have for years to come, ATRA needs all RT professionals to:
1) Submit two comment letters to CMS (Note: Because CMS will make changes to two different rules and regulations, comments need to be submitted to two different sources); and
2) Solicit similar comments to CMS from your colleagues in your IRF setting including Physicians, Physical Therapists, Occupational Therapists, Nurses and other providers. You can share the draft letter with them.
Drafting a Comment Letter:
1) Please review the draft letter below. Add your personal information in the beginning paragraph.
2) Your comments addressing the proposed rule change must be submitted to CMS as soon as possible. While the deadline may be June 29th, we need to demonstrate an influx of responses well before that date so PLEASE DO NOT DELAY in drafting and sending your comment letter. The final deadline is no later than June 29th, 2009 at www.regulations.gov under file "CMS-1538-P".
3) Your comments addressing the proposed MBPM changes are due no later than June 30th, 2009 at mbpmcomments@cms.hhs.gov. Please send as soon as possible.
4) If you can fax or email ATRA a copy we would appreciate tracking the responses (email ceu@atra-online.com or fax 601-582-3354.)
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DRAFT LETTER
Centers for Medicare & Medicaid Services
Department of Health and Human Services
Attention: CMS-1538-P
P.O. Box 8012
Baltimore, MD 21244-8012
Re: Proposed Rule for Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2010 (42 CFR, parts 412, May 6, 2009)
To Whom It May Concern:
I am a recreational therapist practicing in XX city and XX state.
I would like to take this opportunity to respond to the Proposed Rule for the Inpatient Rehabilitation Facility (IRF) Prospective Payment System for Fiscal Year 2010. My principal concern relates to the proposed changes to the so-called "Three Hour Rule" that is used as a guideline for determining a patient's need for a relatively intense level of therapy services.
Under the current Three Hour Rule, the physician and rehabilitation team are given flexibility to determine, on a priority basis, which skilled modalities are appropriate for each patient in the IRF setting. A number of specific therapies are explicitly identified as "skilled modalities," including but not limited to physical therapy (PT), occupational therapy (OT), speech language pathology (ST), and orthotics and prosthetics (O&P). Until recently, over half the fiscal intermediaries permitted recreational therapy services to be counted as a skilled modality for purposes of qualifying under the Three Hour Rule.
The proposed changes restrict the current language of the Three Hour Rule by limiting the therapies that may be counted toward the total amount of therapy time to PT, OT, ST and O&P only, leaving no discretion for clinicians to determine the appropriate mix of therapy services for each patient. The modification, as proposed, excludes recreational therapy, despite the fact that recreational therapy provided in an IRF must be medically necessary and ordered by a physician as part of the patient's treatment plan.
Elimination of recreational therapy as counting toward the Three Hour Rule will have a negative impact on access to this important therapy and is not reflective of current practices in inpatient rehabilitation. Furthermore, such an exclusion is not consistent with CMS policy on medical necessity and deference to the judgment of the treating physician. Recreational therapy, when provided by a qualified recreational therapy professional (nationally certified and/or state licensed), has proven to have a statistically positive effect on Functional Independence Measure (FIM) score gains for both stroke and spinal cord injury patients (See Williams, R., et al, 2007 and Hawkins, B., 2009) and is commonly utilized with a variety of other patient populations.
I am therefore requesting that CMS explicitly include recreational therapy in the list of therapy services that may be counted under the Three Hour Rule when ordered by a physician as part of a patient's plan of care and provided by a qualified recreational therapy professional (nationally certified and/or state licensed). This should be reflected in both the regulations and the Medicare Benefits Policy Manual. Furthermore, I would like to offer my support to the position and request made by Congresswoman Tauscher and Congressman Thompson in their letter to Ms. Charlene M. Frizzera, Acting Administrator for CMS dated May 4, 2009.
Thank you for your consideration of my views.
Sincerely,
Your name
Title
Mailing Address
City, State, Zip
Telephone number
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6-5-09
NEW YORK LICENSURE ACTION ALERT
Contact your NY Assembly Member and ask them to support our bill by entering your zip code at http://assembly.state.ny.us no later then June 22nd
BILL NUMBER:A8073
TITLE OF BILL: An act to amend the education law, in relation to the
licensure of recreational therapists; and to amend chapter 676 of the
laws of 2002, amending the education law and the social services law
relating to licensing mental health practitioners, in relation to
preventing prohibitions or limitations on the activities or services
of certain persons
PURPOSE OR GENERAL IDEA OF BILL: This legislation establishes a system
for the licensing of therapeutic recreation specialists to ensure
recreational therapy is performed by trained professionals and
establishes standards for recreational therapy to preserve the quality
of patient care.
SUMMARY OF SPECIFIC PROVISIONS: The education law is amended by adding
a new article 156-A. Article 156-A sets standards for evaluation and
treatment authorization, prevents persons lacking a license from
practicing therapeutic recreation, prohibits coercing a licensed
recreational therapist under certain circumstances, establishes
eligibility requirements for licensure and license renewal, creates
disciplinary procedures to guide the revocation, suspension or denial
of a license and sets guidelines for the recognition of licenses from
other jurisdictions.
JUSTIFICATION: Therapeutic recreation specialists provide vital
treatment for individuals with disabilities or illnesses. Using a
variety of techniques, including arts and crafts, animals, sports,
games, dance and movement, therapists improve and preserve the
physical, mental, and emotional health of their patients. Given the
important nature of their work, it is essential that high professional
standards are set for therapeutic recreation specialists by creating a
proper system for licensing to make sure that recreation therapy is
performed by qualified individuals.
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5-22-09
ATRA ACTION ALERT
Inpatient Medical Rehabilitation
On April 29th, 2009, the Centers for Medicare and Medicaid Services (CMS) issued its 2010 proposed rule for the inpatient rehabilitation facility (IRF) prospective payment system (PPS). CMS has also proposed to revise the Medicare Benefits Policy Manual (MBPM) provisions on coverage of IRF services and has established a separate comment period and process for these changes.
Taken together, the proposals represent one of the most comprehensive sets of rule changes governing access to inpatient rehabilitation services in years and will set the stage for IRF care for the foreseeable future.
Proposed CMS Change:
In reference to the "3-hour Rule," the removal of the phrase "other skilled rehabilitative modalities" and insertion of "... active and ongoing therapeutic intervention of at least two therapy disciplines (physical therapy, occupational therapy, speech-language pathology, or prosthetics/orthotics therapy)..." in both the IRF-PPS final rule for 2010 and the Medicare Benefits Policy Manual.
Proposed ATRA Member Actions:
Given the impact such a change will have for years to come, ATRA needs all RT professionals to:
1) Submit two comment letters to CMS (Note: Because CMS will make changes to two different rules and regulations, comments need to be submitted to two different sources); and
2) Solicit similar comments to CMS from your colleagues in your IRF setting including Physicians, Physical Therapists, Occupational Therapists, Nurses and other providers. You can share the draft letter with them.
Drafting a Comment Letter:
1) Please review the draft letter below. Add your personal information in the beginning paragraph.
2) Your comments addressing the proposed rule change must be submitted to CMS as soon as possible. While the deadline may be June 29th, we need to demonstrate an influx of responses well before that date so PLEASE DO NOT DELAY in drafting and sending your comment letter. The final deadline is no later than June 29th, 2009 at www.regulations.gov under file "CMS-1538-P".
3) Your comments addressing the proposed MBPM changes are due no later than June 30th, 2009 at mbpmcomments@cms.hhs.gov. Please send as soon as possible.
4) If you can fax or email ATRA a copy we would appreciate tracking the responses (email national@atra-tr.org or fax 601-582-3354.
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RECREATIONAL THERAPY
UPDATE ON
CONGRESSIONAL SIGN ON LETTER
PLEASE CALL YOUR REPRESENTATIVE's HEALTH LA TODAY!!
DEADLINE TOMORROW
MAY 1, 2009
Dear RT Colleagues:
We currently have 14 Co-Sponsors for our Congressional Sign On Letter. Please CALL your Representative's Health Legislative Assistant ASAP to make your final request for asking for the support of your Representative to support and sign on to this very important initiative. Calling is your only option at this point. This is our chance for Recreational Therapy to be officially recognized as a "Covered Service" in Inpatient Rehab, Inpatient Psych, and Skilled Nursing Facilities in the Medicare Benefits Policy Manual (MBPM). Please click on the attachment for Talking Points on what to say when you call.
The following U.S. Representatives have signed on to our Congressional Sign-On Letter:
Sponsors: Rep. Tauscher (D-CA) and Rep. G. Thompson (R-PA)
Co-Sponsors:
New This Week:
Gerlach (R-PA) Gordon (D-TN) Platts (R-PA) Lummis (R-WY) Rehberg (R-MT).
From Last Week:
Ehlers (R-3rd MI)
P. King (R-3rd NY)
Wamp (R-3rd TN)
Coble (R-6th NC)
W. Jones (R-3rd NC)
Schakowsky (D-9th IL)
Baldwin (D-2nd WI)
Butterfield (D-1st NC)
Farr (D-17th CA)
Please call or email us if you need help or do not understand what to do. We will help you! It is VERY IMPORTANT that we get more Co-Sponsors to support this issue and agree to sign on to our letter that will be sent to CMS (Center for Medicare and Medicaid Services).
Lisa Morgan: 423-634-1674 or lisajomorgan@comcast.net or lmorgan@siskinrehab.org Dr. Thom Skalko: 252-347/6840 or SKALKOT@ecu.edu Diane Skalko: 252-347-6839 or SKALKOD@ecu.edu
PLEASE ACT TODAY and FRIDAY. DON'T GIVE UP!!!
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RT PROGRAM AT FLORIDA INTERNATIONAL U. TO CLOSE
Recreational Therapists and Friends of Recreational Therapy:
Last week, the Provost at Florida International University announced that he intended to close the Recreation and Sport Management Program, in which the Recreational Therapy Program is a track. He stated that he wanted the faculty to graduate all of the students in one year. This announcement was made without warning and the faculty members were not given any chance to put forth an argument.
Clearly, hard decisions need to be made during difficult economic times; however, recreational therapy is too often considered unnecessary and easy to cut. This should trouble anyone who sees the value in preparing students to provide services to people with disabilities, illnesses or limitations. Too often those individuals who need and deserve our services are forgotten.
For those of you who work in the profession but live outside of Florida, you might be wondering how this affects you. Consider this--Florida International University is the last program in the state of Florida, a large state with a solid job market. As qualified recreational therapists grow scarce, jobs will close. As jobs close, the profession will struggle. What is to keep other institutions from following suit? This cycle could easily repeat itself in states throughout the country.
You should be concerned!
If you are interested in contacting administrators at FIU and voicing your thoughts on the importance of keeping the program open, please feel free to write me back and I will be happy to provide you with the contact information.
Thank you,
Alexis McKenney
I've added Alexix McKenney's info here:
Recreational Therapy Program Coordinator
University Park, ZEB 248 B
Miami, FL 33199
Phone: (305) 348-3905
FAX: (305) 348-1515
mckenney@fiu.edu
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ATRA ACTION ALERT
(4-13-09) Hello again. We have two conference calls scheduled for tomorrow to discuss and help with our most recent Recreational Therapy Action Alert. Please feel free to join us if you have any questions or would like to hear a brief update on where we are at this point. Our time is very limited for this newest Action Alert.
Here is the info for the calls:
"Update on our 2009 Action Alert with Congress"
Tuesday- April 14, 2009
1st Call: 12:00 pm EST (11 am CST, 10 am MST, 9 am PST)
2nd Call: 6:30 pm EST (5:30 pm CST, 4:30 pm MST, 3:30 pm PST)
Call in number: 1-712-580-1800
Access Code: 604906# (please enter this code when prompted)
We are here to help!!!
Thanks,
Lisa Morgan, CTRS
Federal Public Policy
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ATRA ACTION ALERT
Dear RT Colleagues:
(4-8-09) Please find attached talking points for the ATRA Medicare Project and two letters. One letter is an example letter to your Congressional Representative to request that they sign-on to a Dear Colleague Congressional Letter to the Centers for Medicare and Medicaid Services (CMS) sponsored by Congresswoman Ellen Tauscher (D-CA) and Congressman Glenn Thompson (R-PA). You will need to personalize this letter.
The second letter is a copy of the Dear Colleague Letter that is available for your Congressional Representative to support. Do not make changes to this letter. Download the letter from the link on the left of this article.
Please act now!
Congress is on Easter Break, April 3-17. Call your Congressional Representative's local office (That will be the office listed near your home. See the link below.). Ask to speak to the local Legislative Aide that covers healthcare issues. Ask them if you can email, fax, or deliver the cover letter and Dear Colleague Letter. Use the talking points if you need but do not send the talking points document.
The Best option: Go visit your Representative or his/her Legislative Aide in their local office while they are on Easter Break (April 3-17).
It is crucial that every recreational therapist get their Congressional Representative to sign on to the Dear Colleague Letter. Please click on the following link to find your Congressional Representatives contact information. Click: www.house.gov. In the top left hand corner, enter in your zip code and you will find out who is your Congressional Representative.
When you receive confirmation that your Representative will sign on please report this by
emailing lmorgan@siskinrehab.org
Or calling 423-634-1674
It is essential that you send this communication to your Representative while they are in District. Now is the time for recreational therapists to take action on behalf of their profession. You have a role and responsibility. Please take a moment to act.
Sincerely,
ATRA Federal Public Policy Team
Thomas Skalko, Diane Skalko, and Lisa Morgan
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SAMPLE LETTER
Please cut and paste the sample letter below into a word file in order to personalize prior to sending to your representative.
(put today's date here)
Dear Honorable (add name of your representative):
I am a practicing recreational therapist at (insert agency). I want to make you aware of an on-going issue that affects Medicare recipients. Attached is a Dear Colleague Letter sponsored by Congresswoman Ellen Tauscher and Congressman Glenn Thompson to the Centers for Medicare and Medicaid Services (CMS). The letter addresses issues regarding the regulations and manual provisions governing recreational therapy services provided to Medicare beneficiaries. We are concerned that Medicare coverage of recreational therapy services provided in inpatient rehabilitation hospitals and units (IRFs), inpatient psychiatric hospitals and units (IPFs), and skilled nursing facilities (SNFs) may be unclear to beneficiaries and providers, thereby creating inconsistent access to these services for Medicare beneficiaries across the country.
Recreational therapy is a health care discipline that delivers treatment services designed to restore, remediate and/or rehabilitation functional capabilities for persons with injuries, chronic illnesses and all disabilities. Recreational therapists utilize a wide range of therapeutic modalities, community-based interventions, and rehabilitative techniques to assist patients in developing functional skills for daily living and community involvement.
The language of the regulations and manual provisions issued by the Centers for Medicare and Medicaid Services (CMS) leaves considerable ambiguity on the inclusion of recreational therapy services as covered benefits in these three settings. If the Medicare program is paying for these services through prospective payment rates, patients who need recreational therapy ought to be able to access these benefits. In the inpatient rehabilitation hospital/unit context, this ambiguity could be resolved by CMS simply by clarifying that recreational therapy meets the definition of the 3-hour per day therapy guideline that appears in Section 110.4.3 of the Medicare Benefits Policy Manual (MBPM), Relatively Intensive Level of Rehabilitation Services.
The Dear Colleague Letter requests that CMS amend the Medicare Benefits Policy Manual to clarify coverage of recreational therapy in these three inpatient settings will ensure that Medicare beneficiaries have consistent access to these services across the country. Thank you for your consideration of my concerns on this matter and I look forward to your response and support.
Please contact Roger Murray with Rep. Tauscher (6-8543, roger.murray@mail.house.gov or Matthew Brennan with Rep. Glenn Thompson (5-5121, matthew.brennan@mail.house.gov.
Sincerely,
(Your Name and Credentials)
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ATRA ACTION ALERT
Seeking Senate Support for ATRA Medicare Initiative!!
(posted 2-25-08) As you are aware, HR 4248, the “Ensuring Medicare Access to Recreational Therapy Act of 2007,” is currently being promoted in the U.S. House of Representatives and ATRA recently asked members to contact their Congressmen in support of that bill.
Now, ATRA needs you to contact your Senators to request their support for similar provisions to address RT policy in the Senate Finance Committee Medicare bill. You can do so by phone, e-mail or letter. Please act by March 7. We will continue to update you on our progress at that time.
Please keep us informed and copy us on your letters and responses. Send to lmorgan@siskinrehab.org, diane.baumann@psysolutions.com, skalkot@ecu.edu. We are open to providing any assistance as needed.
Please Act Now!! Contact Your Senators!!
WHO TO CONTACT:
FOR PHONE CALLS:
Reach your Senators through the Senate switchboard at 202-224-3121.
FOR E-MAILS AND FAXED LETTERS:
Log on to www.senate.gov to locate the contact and e-mail information for your Senators. Once you get to their website, use the “contact” button or menu pull-down to access fax and e-mail contact information.
“Web forms:” You will find that nearly all Senate offices have forms to fill out for constituent e-mails. When you get to these web forms, be sure to:
1) Fill out all the relevant boxes of requested information (this gives the office the means to process your e-mail efficiently);
2) Type in a header: “Attn: Healthcare LA” at the top of the space provided;
3) Next cut-and-paste your message (see attachment) below the header.
WHAT TO SAY OR WRITE:
FOR PHONE CALLS:
Note: When you talk to staff, you will not have a long time to discuss your request as they usually have very, busy schedules. Please be sure to cover the following proven steps to ensure all relevant details are covered, to optimize your time and to achieve a successful result.
Review this alert and the brief summary below (or the attached letter) so that you know what you want to say before you call.
Call the Senate office, tell them you are a “constituent” (meaning you live in their state/district) and ask to speak to the “Healthcare Legislative Assistant.” This person will handle requests involving our issue.
Note: Try not to let the receptionist simply record your address and concerns as all that will be accomplished is that you will receive a mailed letter response. What you want is to talk to the staffer responsible for our issue.
Begin by identifying yourself, your profession and/or any facility that you work with; this demonstrates up front that you are a significant constituent/voter for that Senate office.
Then, summarize our issue (using the summary below) and what it means to you and ATRA. Focus on what is most relevant to you as the more comfortable you are with your message, the better it will be relayed.
Most importantly, ask for the Senator “demonstrate his support on the issue by contacting the Finance committee and Senator Bingaman’s staff in support of this issue.” This is your “ask” and forgetting to make it is the biggest mistake made by advocates!
FOR E-MAILS AND LETTERS:
We suggest putting the attached letter to the attention of the “Healthcare Legislative Assistant.” This person will handle requests involving our issue.
Personalize the draft letter in the space provided by identifying yourself and describing your profession, and/or any facility that you work with and then the organization (ATRA); all of which demonstrates up front that you are a significant constituent/voter of that legislative office. You can also summarize what the issue means to you, your practice and/or facility.
Then either fax your letter to your Senator or attach the text of your letter to the email/web form you send to your Senator.
Note: We suggest e-mails and faxes over regular postal mail as there is considerable delay (weeks) in receipt of postal mail in Senate offices due to increased security.
BRIEF SUMMARY:
Overview: We need Senators help to ensure that Medicare patients consistently receive recreational therapy services when such services are prescribed by their doctors and warranted by their health condition. This can be done by supporting the inclusion of a provision in the Senate Finance Committee’s Medicare bill directing CMS to publicly clarify current Medicare coverage and payment policy.
In specific:
- We want language directing CMS to issue notification in the Medicare Benefits Policy Manual (or by regulation) that recreational therapy is a covered Medicare service in inpatient rehabilitation facilities (IRFs), inpatient psychiatric facilities (IPFs), and skilled nursing facilities (SNFs).
- In addition, such language would recognize that the costs of providing recreational therapy services have already been built into the prospective payment systems for each of these three settings.
- Finally, such language would define recreational therapy services as skilled rehabilitation therapy (not just diversional activities) that must be provided by a qualified recreational therapist when required by a patient’s condition and prescribed by a physician as part of a facility’s plan of care for the patient.
- It is important to note that this clarification will not create new Medicare coverage or additional costs to the Medicare program because it would not add new services to the Medicare program.
- The Senate has sent a number of sign-on letters and other communications to CMS asking for this to be done administratively (without then the need to pass a law) but CMS has ignored these requests to date.
DRAFT LETTER:
February __, 2008
The Honorable [Your Senator’s Name]
U.S. Senate
Washington, D.C. 20510
Re: Securing Rec. Therapy Provisions in Finance Cmte. Medicare Bill
Dear Senator [Your Senator’s Last Name],
I am seeking your support for the inclusion of legislative language in the Senate Finance Committee’s Medicare bill that will help ensure that Medicare inpatients receive recreational therapy services when such services are prescribed by their doctors and warranted by their health condition.
[Write a short paragraph describing who you are, where you live, what you do and where you work.]
Recreational therapy (RT) is recognized as a skilled healthcare service that restores, remediates, and rehabilitates functional capacity in persons with injuries, chronic illnesses and disabilities. It is provided by certified recreational therapists and is prescribed and supervised by a physician as part of an inpatient facility’s treatment plan for individual patients.
However, beneficiary access to recreational therapy services in inpatient settings throughout the country is very inconsistent largely due to a lack of clarity in CMS’s regulations and manual provisions. This lack of clarity has created the widespread misconception that recreational therapy services are not covered in inpatient settings of care, despite the fact that CMS has repeatedly stated that they are both covered and included in existing prospective payment systems. This is a budget neutral clarification that does not add new services or additional costs to the Medicare program.
Congress has repeatedly requested CMS to clarify its recreational therapy policy to providers, but while CMS has responded to every congressional inquiry stating that recreational therapy is covered and included in existing payment systems, CMS has not communicated this same message to fiscal intermediaries, facility administrators, treating physicians in these settings, and other relevant entities. As a result, many of them are misinterpreting CMS guidance and denying recreational therapy, to the detriment of patients.
Public, formal clarification by CMS of recreational therapy coverage and payment policy in these inpatient settings, as directed by this provision, is all that is needed to ensure that Medicare inpatients who need recreational therapy services receive appropriate access to these vital rehabilitative therapies.
Senators Baucus and Grassley are well aware of the legislative language described above and we ask that you convey your support for inclusion of this language in the Senate Medicare bill to ensure that Medicare patients have consistent access to recreational therapy services. If I can answer any questions, please do not hesitate to contact me. Thank you.
PLEASE CONTACT YOUR SENATORS A.S.A.P!!
THANK YOU FOR YOUR HELP!!
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