Bipartisan “Three-Hour Rule” Bill Introduced to Improve Rehabilitation Therapy for Medicare Patients

From AAPM&R:   On August 26, 2022, Representatives Joe Courtney (D-CT) and Glenn “GT” Thompson (R-PA) introduced a bipartisan bill, co-sponsored by Representative G.K. Butterfield (D-NC), that would preserve expanded access to skilled rehabilitation therapies for Medicare patients, after the conclusion of the public health emergency.

H.R. 8746, the Access to Inpatient Rehabilitation Therapy Act of 2022, would amend the Social Security Act to restore physician judgment to prescribe the appropriate mix of skilled modalities that constitute an intensive rehabilitation therapy program in an inpatient rehabilitation hospital or unit.

The ‘Three Hour Rule’

The Centers for Medicare and Medicaid Services (CMS) requires that Medicare beneficiaries need a “relatively intense” course of rehabilitation treatment to qualify for an inpatient rehabilitation facility (IRF) stay. CMS defines “relatively intense” as three hours of skilled therapy per day, five days per week, the so-called, “three-hour rule”. In 2010, CMS revised the IRF regulations and narrowed the three-hour rule so that only physical therapy, occupational therapy, speech therapy, and/or orthotics and prosthetics are countable toward the three-hour rule. Other skilled therapies including recreational therapy, psychological services, respiratory therapy, and neuropsychological services are no longer counted, limiting their availability in many rehabilitation hospitals.

During the public health emergency, the three-hour rule has been waived entirely for IRFs. Data from 2020 demonstrates that despite this broad flexibility, IRF admissions have not increased, nor has there been a significant decrease in therapy minutes provided in IRFs. It is critical to ensure that flexibility continues after the end of the PHE so patients can access the most appropriate, individualized care for their conditions.

H.R. 8746 would restore all physician-prescribed therapies as part of a patient’s coverage, adding flexibility for the physician and rehabilitation team to determine the appropriate mix of skilled services to provide a more tailored treatment plan to meet individual patient needs.