ATRA's Medicare Project
As an ATRA member, I really appreciate all the work Thom, Diane, and Lisa and the entire ATRA team has put into the Medicare Project. Below is what I received as an ATRA member on the outcomes with CMS:
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.
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 firstname.lastname@example.org, Dr. Thomas Skalko at email@example.com, or Diane Skalko at firstname.lastname@example.org