Your Voice, Your Power: Advocating for Comprehensive Essential Rehabilitation Services

Alexis McKenney

Advocacy is a powerful force, one fueled by passion and commitment. Whether advocating for yourself, a family or friend, or a client, undeniable excitement comes with helping secure deserved services. In this blog, we invite you, whether you are a practitioner, client, or concerned about a loved one, to join a mission of urgency, empowerment, and change as we unravel the mystery of Medicare and Centers for Medicare and Medicaid Services (CMS).

We hope to harness that sense of urgency and excitement, channel it into advocacy, and pave the way toward a more comprehensive rehabilitation experience; one that includes vital services such as Recreational Therapy.

Your voice holds power. Together, we can ignite our voices and create the sort of change that our healthcare services need.

Medicare Simplified

Understanding Medicare and the nuances of CMS services is pivotal in advocating for comprehensive rehabilitation. Medicare, a federally funded health insurance program, caters to individuals aged 65 and older, younger people with disabilities, and patients with end-stage renal disease. It encompasses distinct parts, each covering specific healthcare services:

- Part A: Hospital insurance

- Part B: Medical insurance

- Part C: Medicare Advantage plans

- Part D: Prescription drug coverage

Understanding Essential Rehabilitation Services

Essential rehabilitation services refer to therapeutic interventions and treatments crucial for individuals recovering from injuries, illnesses, or conditions that impact their physical, mental, or cognitive abilities. These services aim to improve or restore functional abilities, mobility, independence, and overall quality of life.

Essential rehabilitation services include, but are not limited to recreational therapy, physical therapy, occupational therapy, and respiratory therapy, and speech-language pathology.

Several key factors contribute to determining the essential nature of rehabilitation services, including, for example, clinical necessity, evidence-based effectiveness and treatment goals, functional improvement and independence, safety and risk mitigation, and patient-centered focus and sustainability.

Clinical Necessity

Essential rehabilitation services are determined and customized based on the clinical needs of the person receiving them. These services are vital for addressing impairments, functional limitations, and disabilities that impact daily life activities and overall well-being.

Evidence-Based Effectiveness and Treatment Goals

Essential rehabilitation services have a robust research base demonstrating their effectiveness in facilitating recovery and improving outcomes. Scientific research and clinical studies validate the benefits and impact of these services on the treatment goals.

Functional Improvement and Independence

A team of providers typically works together to provide rehabilitation services. Essential services improve a person's functional abilities, including mobility, and increase independence. These services aim to enhance a person's ability to perform activities of daily living.

Safety and Risk Mitigation

Rehabilitation services that prioritize safety and minimize the risks associated with the rehabilitation process are essential. Individuals who provide these services hold professional credentials and adhere to appropriate guidelines, standards, and best practices to ensure well-being.

Patient-Centered Focus and Sustainability

Practitioners who provide essential rehabilitation services prioritize the preferences and input of the individual and their family or support network. They involve the client in decision-making and empower them to participate actively in rehabilitation decisions and processes.

Practitioners consider the long-term impact of therapy on a person's life and aim for sustained benefits beyond the immediate rehabilitation period. They focus on building skills and strategies that promote independence and improved quality of life.

Understanding the "Three-Hour Rule"

The "Three-Hour Rule," established by CMS, plays a vital role in determining eligibility for inpatient rehabilitation facility (IRF) treatment. It mandates a patient's active engagement and benefit from at least three hours of rehabilitation therapy per day, five days a week.

The Rule specifies that therapy should come from a combination of a limited number of essential rehabilitation disciplines, including physical therapy, occupational therapy, and speech-language pathology services. Consequently, people needing additional services receive only the above-listed services rather than the continuum of services demonstrated to be most effective. Examples of essential rehabilitation services not currently covered include recreational therapy and respiratory therapy.

Recent History

Before 2010, the rules set by CMS for IRFs recognized specific treatments like physical, occupational, and speech therapies, and the use of orthotics and prosthetics, as included in the Three-Hour Rule. However, the physician and rehabilitation team could prescribe additional therapeutic modalities, such as recreational therapy.

In 2010, CMS changed these rules. They made it so that only physical, occupational, and speech therapies, orthotics, and prosthetics could count towards the three-hour requirement. Other important therapies, like recreational therapy, psychological support, respiratory therapy, and neuropsychological services, were no longer considered part of this count. With that, physicians and the rehabilitation team could no longer prescribe them.

Advocating for Rights

As a rehabilitation services consumer or provider, you have an important role to play in ensuring patients receive the full range of therapies. Educating yourself on CMS regulations, recognizing the value of sometimes overlooked therapies like recreational therapy, and engaging with others to spread awareness, are ways you can help make a difference.

Educate Yourself

Whether you are a consumer or a rehabilitation service provider, understanding CMS rules and the services is a foundational step. Take time to read beyond this article and research and familiarize yourself with the rules and regulations governing rehabilitation.

Recognize the Role of Recreational Therapy and Speak Up

If you are unfamiliar with recreational therapy, know it is a vital rehabilitation therapy. Recreational therapy enhances physical and mental well-being, promoting socialization, cognitive development, and overall quality of life. Recreational Therapists use activity-based interventions to address what is needed to achieve and maintain psychological and physical health. In other words:

“Recreational Therapists use the activities that you enjoy to help you get better.”

As a consumer, understanding the importance of other essential rehabilitation therapies, such as recreational therapy, positions you to confidently communicate with your healthcare provider if you believe you are not receiving the necessary therapies. Highlight the importance of specific therapies in your rehabilitation journey.

Engage Others and Advocate for Policy Changes

If you are a patient or client, join support groups or communities focused on rehabilitation and Medicare to secure personal support as well as take a role in helping others learn more about the types of services they should be receiving.

If you are a rehabilitation service provider, engage with colleagues to educate them on available essential rehabilitation services. You might find they are simply unaware of the value of the additional services not included in the current Three-Hour Rule guidelines.

Consider reaching out to your Congressional representative to advocate for policy changes such as one proposed that emphasizes the importance of recreational therapy in rehabilitation. The Access to Inpatient Rehabilitation Therapy Act, scheduled to be introduced soon, is one such initiative. This act is bipartisan legislation drafted to assure Medicare recipients additional access to essential rehabilitation therapies.

Conclusion

Understanding the rights of anyone needing essential rehabilitation services is central to advocating a more inclusive Three-Hour rule. By actively involving yourself, educating others, and pushing for policy changes, you can ensure anyone who should receive the best possible rehabilitation care receives it. One such service is recreational therapy, a therapy with a vital role in enhancing the rehabilitation process and improving the overall well-being of individuals. Your advocacy can be a significant catalyst in shaping a more expansive, inclusive, and effective rehabilitation system.