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

Members & Publications


August 29, 2022

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. As a long-time advocate for this bill, AAPM&R is thrilled for its introduction to Congress.

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.

“Inpatient rehabilitation care allows for patients to access an intensive, multidisciplinary treatment plan led by a rehabilitation physician in order to meet the complex needs of IRF patients,” said American Academy of Physical Medicine & Rehabilitation President Deborah Venesy, MD, in a press release from Reps. Courtney and Thomas. “We are grateful to Representatives Courtney and Thompson for their leadership in introducing the Access to Inpatient Rehabilitation Therapy Act to ensure that the full spectrum of skilled therapy is readily available to patients based on their unique medical and functional needs.”

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.

National organizations that currently support this bill include:

American Academy of Physical Medicine and Rehabilitation

American Medical Rehabilitation Providers Association

American Therapeutic Recreation Association

Association of Rehabilitation Nurses

Brain Injury Association of America

Christopher & Dana Reeve Foundation

National Association of State Head Injury Administrators

United Spinal Association

Legislation Introduced to Alleviate Impact of Conversion Factor Cut for 2021

Nov 09, 2020

Last month, two bills were introduced in the House proposing solutions to the estimated 10.6% Physician Fee Schedule conversion factor cut expected to go into effect January 1, 2021.  The bills offer some relief to the cut, but do not reflect a comprehensive or long-term solution.  AAPM&R has therefore chosen to remain neutral regarding these bills. 

Your Academy continues to advocate for a permanent solution to the conversion factor cut while maintaining the important payment increases to office and outpatient evaluation and management services.