Location: Indiana, United States

I became a Professor Emeritus after serving 29 years as a recreational therapy faculty member at Indiana University. I'm a long-time Hoosier, having grown up in Hanover, Indiana. My RT practitioner work was in psych/mental health. After completing my Ph.D. at the University of Illinois, my first faculty position was at the University of North Texas. RT has been a wonderful profession for me as I have had the opportunity to serve as an author and national leader.

Monday, February 25, 2008

ATRA Alert Senate Bill

URGENT Alert to ATRA Members

Seeking Senate Support for ATRA Medicare Initiative!!

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,, We are open to providing any assistance as needed.

Please Act Now!! Contact Your Senators!!


Reach your Senators through the Senate switchboard at 202-224-3121.


Log on to 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.



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!


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.


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.


February __, 2008

The Honorable [Your Senator’s Name]
Re: Securing Rec. Therapy Provisions in Finance Cmte. Medicare Bill
U.S. Senate
Washington, D.C. 20510

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 act by March 7.

Please keep us informed and copy us on your letters and responses. Send to,, We are open to providing any assistance as needed.


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