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American Therapeutic Recreation Association
Position Statement
MDS 2.0 and Future Versions

Approved: January 21, 1998
Reviewed: May 30, 2000

It is the position of the American Therapeutic Recreation Association (ATRA) that recreational therapy services should be included under Section P1, as an ancillary Therapy Service on the MDS 2.0 or any future versions of the MDS.

The treatment services are consistent with Medicare Regulation Section 212-1 (HCFA Publication 10) definition of active treatment. These services are furnished under an individualized plan of treatment, reflect a reasonable expectation to improve the patient's condition and are supervised and evaluated by a physician. Recreational therapy is specifically recognized as a primary rehabilitation therapy in many state health service plans.

Excluding recreational therapy data from the case mix index calculation essentially excludes valuable and cost effective rehabilitation services that accurately reflect residents' needs. Recreational therapy treatment can cost-effectively restore functional capacities and assist individuals to increase their abilities to maximize independence, increase productivity and manage their disabilities - all which are vital to health and well being and the prevention of secondary health complications.

The recognition of recreational therapy as an ancillary rehabilitation service also provides for consistency with contemporary rehabilitation practices. Recreational therapy is identified as one of the physical and psychosocial rehabilitation services in the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standards. Recreational therapists are designated as members of the comprehensive core treatment team in acute brain injury, post-acute brain injury and the inpatient rehabilitation standards of the Commission on Accreditation of Rehabilitation Facilities (CARF).

Long-term care settings are the area of emerging rehabilitation therapy services. Within this area, recreational therapy has an established place for treatment and reporting of data within the minimum data set (MDS). Research indicates that specific recreational therapy interventions can reduce agitation and increase physical, cognitive and psychological functioning. Given the state of the art of medicine, the utilization of recreational therapy treatment data for the calculation of the case mix index is appropriate and timely. Since recreational therapy rehabilitation is a primary service in hospital settings, it is logical that as rehabilitation in long-term care increases, traditional therapies such as recreational therapy should be available. The exclusion of recreational therapy from the case mix index calculation often results in the therapy not being available as a treatment option for long term care settings. When this happens, the most appropriate, and cost effective mix of treatment services for nursing home residents is not utilized.

Therefore, the American Therapeutic Recreation Association believes that in order to provide appropriate therapy to the residents of long-term facilities, recreational therapy should be included in the Minimum Data Set (MDS) 2.0, under section P1 as an ancillary treatment option when medically appropriate.

Approved by the ATRA Board of Directors
January 21, 1998

For more information, please contact the American Therapeutic Recreation Association at (703) 683-9420 or www.atra-tr.org.

American Therapeutic Recreation Association
1414 Prince Street, Suite 204 * Alexandria, VA 22314 * (703) 683-9420 * (703) 683-9431 FAX * www.atra-tr.org