Action Alert from ATRA

ATRA recently send out this ACTION ALERT that I am passing along:
CTRSs Threatened in Inpatient Rehabilitation Facilities

Background The Centers for Medicare and Medicaid Services (CMS) has given local authority to their contractors (also known as Fiscal Intermediaries and Medicare Administrative Contractors) to make local coverage decisions.

Current Issue The National Government Services Company, Part A Fiscal Intermediary has issued a Final Local Coverage Determination (LCD) that could be detrimental to the coverage of recreational therapy. The LCD removed Recreational Therapy (known in CMS regulations as Therapeutic Recreation) from the list of identified skilled rehabilitative modalities which can be used to meet the “3-Hour Rule” for Inpatient Physical Rehabilitation Facilities (IRF). Even though Recreational Therapy (RT) can still be utilized to meet or assist in meeting the “3-Hour Rule” this LCD removed the clear reference to RT as an allowable therapy to meet this criteria.

ATRA Action ATRA issues this call to action for all Certified Therapeutic Recreation Specialists (CTRSs), other health care providers that support recreational therapy and the general public to object to this requirement in the final LCD.

To review the specific LCD, go to: http://www.ugsmedicare.com/providers/LCD/CONSOLIDTED_NGS/l25714_final_lcd_ngs.htm
National Government Services, as a Part A Fiscal Intermediary covers a broad range of states including:
Indiana
Illinois
Kentucky
Maine
Massachusetts
New Hampshire
Michigan
Virginia
West Virginia
American Samoa
Vermont
Connecticut
Delaware
New York
Ohio
Wisconsin
California
Guam
Hawaii
Nevada

ATRA has prepared a draft response and encourage all interested individuals to mail a hard copy signed to the Dr. Tim Passmore, 186 Colvin Center, Oklahoma State University, Stillwater, OK 74078 or send an electronic version with electronic signature to tim.passmore@okstate.edu NO LATER THAN February 14th, 2008. (see attached draft letter). Your documents are vital and will be utilized in conjunction with other documents to file an appeal to National Government Services known as a Reconsideration Process which will require National Government Services to review the provide evidence and issue a formal response to the request for reconsideration of the issued final draft LCD for IRF. The request will ask National Government Services to add back RT back to the list of therapies identified in the final LCD which can be counted toward the “3-Hour Rule”.

ATRA Talking Points:
Ø National Government Service (NGS) consolidated 5 FIs to form the current FI NGS. Of those 5 FIs 3 had issued LCDs which included RT in the listing of therapies which could meet the “3-Hour Rule” – these documents will be provided to NGS as part of the Reconsideration Process.
Ø CMS has issued through various communications approval of the use of RT to meet or assist in meeting the “3-Hour Rule”. These documents will also be provided to NGS as part of the Reconsideration Process.
Ø JCAHO Definitions (January 2006)
Ø It is ATRA’s position that CMS and specifically the National Government Service identify Recreational Therapy in the list of therapies which may be counted toward the third screening criteria for IRF stays known as the “3-Hour Rule”.

Please email a copy of your letter to ATRA so we may follow up with the Mutual of Omaha. Please send your letter via attachment to Dr. Tim Passmore, 186 Colvin Center, Oklahoma State University, Stillwater, OK 74078 or send an electronic version with electronic signature to tim.passmore@okstate.edu
The deadline to this response is February 14th, 2008.

Use your personal stationary for your personal response. Please ask your administrators to submit a letter on our behalf using facility letterhead.