Your Help Needed Right Away!

ATRA leader Lisa Morgan sent me a reminder to post regarding the Congressional Sign On Letter for CMS. It follows:

CRITICAL ACTION ALERT
CONGRESSIONAL SIGN ON LETTER

DEADLINE MAY 1, 2009

Dear RT Colleagues:

Our time is running out to get our U.S. House of Representatives to Sign on our Congressional Sign On Letter that will be sent to CMS. We absolutely have to move quick as we can to get our U.S. Representative to sign on to this letter by May 1st, 2009.
Please see the following list of who has signed on in support as of today.

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:
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)

If your Representative has already signed on in support, please send him or her a thank you letter. If you have talked with the Representative> '> s Health Legislative Assistant, please express your appreciation to them for helping you through this process.

For all others Representatives, please follow up with your US Representative> '> s Healthcare Legislative Assistant ASAP. It is critical that you talk to the LA in person via phone to explain our issue and emphasize what it is that we are asking for at this time. Please use the Talking Points to help you explain.

The talking points follow:
ATRA RECREATIONAL THERAPY MEDICARE PROJECT
TALKING POINTS
(NOTE: This is ONLY for use by Recreational Therapists.
Do NOT distribute to Congressional staff.)

Recreational Therapy

 Recreational therapy is recognized as a critical health service that:

• Restores, remediates, and rehabilitates functional capacity for persons with injuries, chronic illnesses and disabilities;

• Is provided by a qualified recreational therapist and is prescribed and supervised by a physician as part of a treatment plan; and

• Has been demonstrated by evidence-based research to improve the physical, cognitive, social and emotional functioning of individuals who receive the service.


 Recreational therapists are health care providers trained and qualified to design interventions and modalities to achieve a specific medical and functional outcome.

The Problem

 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) is unclear to beneficiaries and providers and creates inconsistent access to these services for Medicare beneficiaries across the country.

 CMS has provided written documentation to Congress (but not providers) concluding that recreational therapy is a covered service in IRFs, IPFs and SNFs and its costs are included in the prospective payment systems in each setting.

 CMS has repeatedly refused to provide clear, unequivocal guidance to providers recognizing recreational therapy as a covered service in IRFs, IPFs and SNFs.

 This lack of clarity has created confusion among administrators, fiscal intermediaries and Medicare Administrative Contractors. This misinterpretation often leads to Medicare beneficiaries being denied access to recreational therapy services when prescribed by a physician as part of the plan of care.

The Solution

 Ask your Representative to “co-sign” the Congressional letter (or send their own version) when it is ready for support and signatures.

House sign-on letter champions are: Reps. Tauscher (D-CA) and Thompson (R-PA).

 For IRFs, the letter directs CMS to simply clarify 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.

 In addition, for IPFs and SNFs, the letter requests that CMS publish its often-stated recognition that recreational therapy is a covered service and that the costs of providing these services are incorporated into the prospective payment systems in these settings.

 This clarification will not cost the Federal Government more than is currently spent for patients in these settings because the services are already covered in each setting and the costs for the services are already built into each respective prospective payment system.


Make sure you point out that you will remain in touch with the health staff member regarding their decision to support the letter (or send their own).


If you have not sent your letter of request yet, it is real important that you call your Local Office or the Washington DC Office and ask for the name and email address of your Representative> '> s Healthcare Legislative Assistant. Explain to this LA what our issue is and that you would like to send your letter to them explaining the issue in detail along with the actual Congressional Sign On letter for their review. Tell them that our Deadline is May 1st. This is why you would like to send the information directly to the LA so that they can present to your Representative and ask for their support prior to the deadline. If you fax your letter only at this point or send through the congressman/woman> '> s website, it may get lost in the large amount of information the offices receive and will not be able to be processed before our deadline.

If you need help on what to do, please ASK! Email or call one of the following to assist you:

Lisa Morgan: 423-634-1674 or lisajomorgan@comcast.net
mailto:lisajomorgan@comcast.net> or lmorgan@siskinrehab.org
mailto:lmorgan@siskinrehab.org> Dr. Thom Skalko: 252-347/6840 or
SKALKOT@ecu.edu > Diane Skalko: 252-347-6839
or SKALKOD@ecu.edu

Thank you!

ATRA Federal Public Policy