|Phone Script and Helpful Hints to get your Representative to Co-Sponsor HR 4248
March 6, 2008 – 9:45 pm
From Lisa Morgan, CTRS
Please note that this is for you and other Recreational Therapists to use only- do not fax this as a usable letter or document to your Representative or the Legislative Assistant you are working with on this project. Read all of this before calling.
Before you call, this is why we are doing all of this in brief:
We have for several years now been working to communicate with CMS (Center for Medicare and Medicaid Services) through direct phone calls, letters, and then with assistance from our congressman sending individual letters, and then Dear Colleague Letters on both the House and the Senate side asking for clarification of regulatory language of whether or not RT is a “covered service” in the three settings mentioned below. CMS continues to verbalize we are covered, but they have not made it clear to all parties what are the standards; thus, the written language in the Medicare Benefits Policy Manuel does not indicate that we are “covered”. This creates misinterpretation for the Fiscal Intermediaries who govern hospitals/agencies and for our administrators and physicians. If we can get congress to help us direct CMS to change this language, the regulatory language will provide a clear understanding to all parties involved that our service can be used as a part of the facilities plan of care for the consumers we serve. If we do not get this language changed, it will be harder for RT to be recognized or acknowledged as service that can be counted as a “covered service” to provide treatment.
What You Can Do Next to Make This Work for Our Profession
It appears that our letter campaign is not what will do the trick here for us. We need to make this more personable and begin making phone calls. Remember, Congress is there to work for us. They need us there to vote…so now it is our time to NEED THEM CO-SPONSOR our Bill HR 4248.
Here is how you do it:
Call your Representative’s office and tell them you are a “constituent” (meaning you live in their district) and ask to speak to the “Healthcare Legislative Assistant.” This person will handle requests involving our issue.
Note: Try not to let the receptionist simply record your address and concerns, as all that will be accomplished is that you will receive a mailed letter response. What you want is to talk to the staffer responsible for our issue.
If you don’t know how to find your Representative’s number go to www.house.gov under their web page for the phone # or call the Congressional Switchboard at 202- 225 –3121. Clicking on their name will take you to their web page where all relevant contact information is located.
Once you get to the LA….
Phone Script for talking to the Representatives Health Legislative Assistant:
Hello Ms/Mr. ________.
My name is _________ .
I am calling from (city, state).
I am …(your title- (i.e. a Recreational Therapist, the Dept. Coordinator or the Supervisor of Recreational Therapy) at name of your facility, or a professor of Recreational Therapy at the name of your University/College.
I am calling you today to request that Congressman/woman (name) show his/her support by “Co-Sponsoring” Bill HR 4248.
The overall purpose of this bill is to help ensure that Medicare patients consistently receive recreational therapy services when such services are prescribed by their doctor and warranted by their health condition.
Key points I would like to make regarding this bill:
1. This bill directs CMS to clarify language and issue notification re: Recreational Therapy as a “covered service” in Inpatient Rehabilitation Facilities, Inpatient Psychiatric Facilities, and Skilled Nursing Facilities in the Medicare Benefits Policy Manuel.
2. To date, this lack of clarification has led to misinterpretation by the Fiscal Intermediaries (FI’s), Administrators, and Physicians who feel that if they use RT as a covered service, then they would be doing something fraudulent in their setting. They tend to not count RT even though CMS has repeatedly said it is covered.
3. This is “Not a New Benefit or Program” for these three settings for Medicare.
4. This clarification will NOT create new Medicare coverage or additional costs to Medicare because it would not add new services to the Medicare Program. This bill is budget neutral.
5. CMS has repeatedly stated that Recreational Therapy was built in to the Prospective Payment System (PPS) when designing the payment structure. Again, this is not a new program nor does it create any additional cost in this request for clarification.
6. This resolution defines Recreational Therapy Services as skilled rehabilitation therapy (not just diversional activities) that must be provided by a qualified recreational therapist when required by a patient’s condition and prescribed by a physician as part of a facility’s plan of care for the patient.
7.Without this clarification, Medicare recipients are being denied access to receiving a service that has been recognized as a covered service by CMS. Research has proven that Recreational Therapy provides positive and effective outcomes for functional improvements and improving quality of life for patient’s returning to home and to their community. We do have supportive documentation to show outcome studies/ functional improvement for services/and cost effectiveness information that we can share with you if needed.
8. HR 4248 is a result of a long series of actions of requests to CMS to offer clarifying language in the regulations. The Senate and the House have both sent a number of sign-on letters and other communications to CMS asking for this to be done administratively (without then the need to pass a law) but CMS has ignored these requests to date. I can provide you with supportive documentation to back this up. (HINT to therapist…if the LA says they are going to call CMS to investigate, explain they will be wasting their time as you can share w/ them numerous letters from both Congress and the Senate and CMS—these can e found on the ATRA website).
I would like to bring to the attention of the representative that roughly (how many) Medicare recipients in the state of might be impacted by his/her decision on this issue. (Hint to therapist…if you do not know the number in your state, click on the email prior to call to get. This is a 2004 report, but can be very useful information still. Here is the website:
By directing CMS to clarity the current language, this will have a significant impact on an individual’s ability to regain functional skills to integrate back into the least restrictive environment. (Give a brief example of someone you have made a difference through your service provided!! For instance, the 45 y/o female executive that experienced a right CVA. The condition impacted her ability to engage in meaningful activity and involvement in the community. Through the various interventions I used in treatment, i.e. community reintegration, relaxation training, community resources, she learned what it would take to be productive and active again. Although unable to resume her previous employment, she now owns a ceramic shop and involves herself in a range of community volunteer activities that give back to the community. I would give the LA more detail on how we got to that point.)
Say to the LA, “Can I and the constituents of your district count on the congressman’s /woman’s support by his/her co-sponsorship of this bill. When can I expect an answer yes or no for this request?
What is your email address (referring to the Health Legislative Assistant)?
Thank you for your time to listen to me and hear my concerns. This is very important to many people in the congressman/woman’s district. We hope we can count on his/her support by co-sponsoring HR 4248.
End of call.
Here are some helpful hints:
* Never say “reimbursement” for RT.
* Never place emphasis about RT’s losing jobs or looking to add more RT jobs.
* Do not refer to RT as a more cost effective service as this gets in to turf wars w/other disciplines (that is not the purpose of this bill).
* Do not make up stuff just so you can provide an answer. You want to remain credible to the representative and their staff.
* If you don’t know something or have a credible answer, politely say, “I will look into this and get back with you”.
* Don’t let the LA tell you that congress does not try to tell CMS what to do!!
* You are advocating for the consumer.
* Describe how this impacts the medicare beneficiary.
* Clarification allows Administrators and Physicians to utilize RT services as a part of prescribed treatment as determined by the facilities plan of care.
* This is about clarification of RT as a “Covered Service” under the PPS system.
* This is budget neutral.
* Ask the Federal Public Policy Team or RTMP State Reps for assistance as needed.
* Medicare Beneficiaries are being denied access to services that are already being paid for under the current PPS system.
* Understand that this is about inpatient only in these three settings. This has nothing to do with outpatient therapy at this point.
* Explain on the phone, you need to make sure the congressman and the LA understand how important it is for them to help you with this issue.
How is Congress getting away with not Co-Sponsoring our Bill?
Many that have responded are essentially putting us off as described in these examples…
Examples of “Put Off” Comments:
House of Representatives will do all they can to avoid saying no to you. They have a multitude of responses they like to use when responding to you. They hope that you will not be wise enough to understand these comments. Their wish is that you think they plan on really doing something in the future when in reality; they have no intention of taking action. They like to divert you from your REAL ASK that was for the congressman/ woman to “CO-SPONSOR H.R. 4248”.
Here are examples:
1. Keep your thoughts/views in mind.
2. Will support the bill in it’s current form
3. Have supported the PT bill
4. It has been referred to the Ways and Means and Energy and Commerce; I do not sit on that committee.
5. I will vote in favor when the bill comes to the floor.
6. I supported the CHAMP ACT.
7. Want to see what others are doing that sit on the committees the bill is referred to.
8. Has the CBO (Congressional Budget Office) scored this bill yet?
Our job is to know this means we have to keep being persistent. We need to keep communicating with them that what we are asking for is a “yes” or “no” to co-sponsor our bill. We cannot stop at the Put Off comments and think we are done. We have to keep exploring their thoughts. We have to find out by digging more with them with our own questions…like what information is unclear to them? What do they have concerns about re: the clarity of what we are asking?
If we get a “no” response, we have to ask, what can they do for us as a constituent in their district. We need to ask, would they reconsider their decision…is there information we could give them that would make this clearer or that would make it easier for them to make a positive decision.
The Federal Public Policy Team has a lot of resources in our toolbox we can use. Please let us help if you get stuck or uncertain what to say or do. Don’t give up until you have a “yes” or “no”.
Thank you for helping us secure our future as Recreational Therapists.
Useful website information that you can use to give your LA and Representative
(EDITORS NOTE: ATRA is now located at www.atra-online.com)
If you do not get a return call or a response after 2 tries, call the district office and discuss the lack of response.
If they simply repeat that this is important and the Congressman/woman will wait for it to come to the floor, repeat you are asking for their support by becoming a co-sponsor.
If they state they do not co-sponsor bills, simply go to their website.
1. Go to www.house.gov and click on representatives on left.
2. Go to your state and you can get their name and web site.
3. Most legislators list what bills they have co-signed.
By the way…you can go there first to see what they have signed on to in the past so you have some history to report back to the LA.
Send a follow-up letter urging their support and co-sponsorship after the phone conversation.
Return the call as you promised.
Ask when the Congressman/woman will be in district and ask to schedule an appointment to discuss this request. Bring a colleague to offer moral support.
Remember!!!!! They work for YOU!!!
Where there's a Wii, there's a way
By JIM DEVINE
Union Leader Correspondent
Saturday, Feb. 9, 2008
SALEM – A Wii bit of rehab appears to go a long way.
Combining routine rehabilitation therapy with Nintendo's Wii video game system, Northeast Rehab Center has found a way to get its patients eager to work out at physical therapy each day.
"It's addictive," Wendi Sullivan, a 24-year-old rehab patient said. "You don't want rehab to stop. Therapy could go all day and I wouldn't care. You just get a good workout."
Sullivan, who came to Northeast Rehab to restore upper body strength and walk with a walker, said the game has made it a lot easier to get through three, two-hour therapy sessions each day.
Using controllers that mimic a user's motion on the television screen, Sullivan has become a boxer and tennis player while exercising arm strength with weights attached to her wrists.
Click here to view rest of article
CTRSs Threatened in Inpatient Rehabilitation Facilities
Background The Centers for Medicare and Medicaid Services (CMS) has given local authority to their contractors (also known as Fiscal Intermediaries and Medicare Administrative Contractors) to make local coverage decisions.
Current Issue The National Government Services Company, Part A Fiscal Intermediary has issued a Final Local Coverage Determination (LCD) that could be detrimental to the coverage of recreational therapy. The LCD removed Recreational Therapy (known in CMS regulations as Therapeutic Recreation) from the list of identified skilled rehabilitative modalities which can be used to meet the “3-Hour Rule” for Inpatient Physical Rehabilitation Facilities (IRF). Even though Recreational Therapy (RT) can still be utilized to meet or assist in meeting the “3-Hour Rule” this LCD removed the clear reference to RT as an allowable therapy to meet this criteria.
ATRA Action ATRA issues this call to action for all Certified Therapeutic Recreation Specialists (CTRSs), other health care providers that support recreational therapy and the general public to object to this requirement in the final LCD.
To review the specific LCD, go to: http://www.ugsmedicare.com
National Government Services, as a Part A Fiscal Intermediary covers a broad range of states including
ATRA has prepared a draft response and encourage all interested individuals to mail a hard copy signed to the Dr. Tim Passmore, 186 Colvin Center, Oklahoma State University, Stillwater, OK 74078 or send an electronic version with electronic signature to tim.passmore @ okstate.edu NO LATER THAN February 14th, 2008. (see attached draft letter). Your documents are vital and will be utilized in conjunction with other documents to file an appeal to National Government Services known as a Reconsideration Process which will require National Government Services to review the provide evidence and issue a formal response to the request for reconsideration of the issued final draft LCD for IRF. The request will ask National Government Services to add back RT back to the list of therapies identified in the final LCD which can be counted toward the “3-Hour Rule”.
ATRA Talking Points:
- National Government Service (NGS) consolidated 5 FIs to form the current FI NGS. Of those 5 FIs 3 had issued LCDs which included RT in the listing of therapies which could meet the “3-Hour Rule” – these documents will be provided to NGS as part of the Reconsideration Process.
- CMS has issued through various communications approval of the use of RT to meet or assist in meeting the “3-Hour Rule”. These documents will also be provided to NGS as part of the Reconsideration Process.
- JCAHO Definitions (January 2006)
- It is ATRA’s position that CMS and specifically the National Government Service identify Recreational Therapy in the list of therapies which may be counted toward the third screening criteria for IRF stays known as the “3-Hour Rule”.
Please email a copy of your letter to ATRA so we may follow up with the National Government Services. Please send your letter via attachment to Dr. Tim Passmore, 186 Colvin Center, Oklahoma State University, Stillwater, OK 74078 or send an electronic version with electronic signature to tim.passmore @ okstate.edu
The deadline to this response is February 14th, 2008.
Use your personal stationary for your personal response. Please ask your administrators to submit a letter on our behalf using facility letterhead.