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Recreational Therapy Medicare Initiatives

The American Therapeutic Recreation Association (ATRA) is the largest national association of recreational therapists, health care providers who use recreational therapy interventions to improve function of individuals with illnesses or disabling conditions. Recreational therapy is a health care and human service discipline that delivers treatment services designed to restore, remediate and/or rehabilitation functional capabilities for persons with injuries, chronic illnesses and all disabilities.
March 2003.

ATRA POSITION:

Medicare beneficiaries should be assured access to a cost-effective mix of rehabilitation treatment options throughout the continuum of health care services. While recreational therapy treatment is recognized as a covered service and patients have full access to acute care and comprehensive rehabilitation services, access in outpatient and skilled nursing settings, is prohibited as a result of the Social Security Act. The field of recreational therapy is well established and recreational therapists are recognized health care providers in contemporary rehabilitation practice. Correcting the language of the Social Security Act will provide Medicare beneficiaries access to Recreational Therapy services deemed medically necessary and appropriate through out the continuum of care. The average lower direct cost of recreational therapy services will provide a rehabilitation option that can reduce the cost of health care resources utilized.

Legislative Priorities:

· Provide a technical amendment to the Social Security Act to recognize Recreational Therapy services as a medically necessary rehabilitation therapy service in inpatient hospital settings.

· Include recreational therapy as a provider of Medicare outpatient services when delivered as a medically necessary services and delivered by a nationally certified recreational therapist.

· Include the utilization of recreational therapy minutes as part of rehabilitation therapy in Medicare skilled nursing payment classification.

Regulatory Priorities:

· Affirm the appropriate utilization of recreational therapy treatment minutes in satisfying the intensity of service screening criteria (3-hour rule) within comprehensive rehabilitation.

· Include recreational therapy minutes along with other rehabilitation therapies in the Minimum Data Set (MDS) for skilled nursing facilities.

· Affirm recreational therapy’s role within Medicare’s mental health partial hospitalization Medicare incremental billing coding and coverage criteria.

· Recognize recreational therapy as a Medicare Part A inpatient service when medically necessary services are indicated.