Contact: Laurie Jake, ATRA Communications Coordinator
Phone (480) 460-1525 or
Ann D Huston MPA, CTRS
Phone: (703) 683-9420

ATRA Supports Rehab Colleagues in Opposition of Proposed Local Medical Review Policies (LMRP’s)

The American Therapeutic Recreation Association joined with several national organizations representing medical rehabilitation hospitals and the professionals who practice in them including the American Academy of Physical Medicine and Rehabilitation, American Hospital Association, American Medical Rehabilitation Providers Association, American Occupational Therapy Association, American Physical Therapy Association, American Therapeutic Recreation Association, Association of Academic Physiatrists, and the Federation of American Hospitals to express strong views about CMS fiscal intermediaries and their proposed Local Medical review policies to current CMS Administrator Tom Scully.

Fiscal intermediaries that contract with the Medicare program in Georgia, Alabama, Tennessee, New Jersey, North Carolina, and Pennsylvania have promulgated draft local medical review policies (LMRPs) intended to constrain and limit the coverage guidelines set forth under the Medicare Hospital Manual, Pub.10, Coverage of Hospital Services, Section 211, Inpatient Hospital Stays for Rehabilitation Care. This effort is being pursued while CMS is in the midst of a rulemaking process to modify the inpatient prospective payment system (IPPS) exclusion criteria for rehabilitation hospitals and units known as the "75% Rule."

Given CMS' ongoing actions to revise the 75% Rule, ATRA and several other organizations consider the timing of this additional LMRP process to be inappropriate and ill advised. Because LMRPs must be consistent with all statutes, rulings, regulations, and may not conflict with CMS National Coverage Decisions or interpretive manuals, ATRA feels the fiscal intermediaries should await CMS guidance before implementing revisions to coverage policies for inpatient rehabilitation stays.

ATRA and their rehabilitation colleagues believe that the draft LMRPs published to date are seriously flawed, and do not represent appropriate interpretations of medical necessity or Medicare's intent to meet the rehabilitation needs of America's seniors. In a letter to Scully, the organizations state, “There are more clinically appropriate and administratively sound methods to define inpatient rehabilitation services and establish reasonable medical coverage guidelines that ensure all patients who truly need medical rehabilitation hospital services will receive them in the future”.

ATRA and other organizations have urged Scully and CMS to require that the intermediaries withdraw their current and planned inpatient rehabilitation LMRPs and discontinue further action in this regard until an independent panel of national clinical experts on inpatient rehabilitative care is convened - preferably under the auspices of the Institute of Medicine - and has fully examined the issues associated with medical necessity. Once that study is completed, then CMS should either commence a national coverage process or disseminate the study and its findings to the intermediaries to incorporate in local medical review policies.

Click here to read the CMS LMRP Letter

For more information, please contact the ATRA National Office at (703) 683-9420 or at www.atra-tr.org .

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The American Therapeutic Recreation Association (ATRA) was founded in 1984 to advance the profession of therapeutic recreation. ATRA is a non-profit, professional membership organization dedicating 100% of resources and efforts to promote therapeutic recreation professionals in health care and human service settings. For more information, please contact the ATRA National Office.