ࡱ> ^`]#` ,bjbj\.\. .>>D>D$((((D$f2t1111111$44h6Z 2 2 2ggg1g1gg/1h Z(vi01620f20:6 :64161(*rg\ 2 2E"f2$ (( 2  Julie Foster, M.S., C.T.R.S. Recreation Therapists of IN, Inc 211 N. Homer Ln. Wolcott, IN 47995 October 22, 2007 Dear Ms. Casanova; This letter is in follow-up to the conversation I had with you, on behalf of Recreation Therapists of Indiana, Inc., the week of October 3rd. We would like to thank you for your response to Representative Peggy Welchs inquiry on our behalf date May 8, 2007. We were particularly pleased to see your reference to the definition of recreational therapy services qualifications [460 IAC 6-5-22] that we feel to be an accurate and appropriate definition of our services. At the same time, we continue to be concerned about the fact that this definition exists only within Indiana Administrative Code Title 460 [Division of Disability and Rehabilitative Services]. More specifically, the lack of a clear definition within Title 405 Article 1 that defines Medicaid providers and services has left the coverage of, and reimbursement for recreational therapy services ambiguous. Most confusing is the language in 405 IAC 5-22-6.b(5), that identifies criteria for prior authorization of therapy services applying to occupational therapy, physical therapy, respiratory therapy, and speech pathology. The statement that therapy rendered for diversional, recreational, vocational, or avocational purposethat can be conducted by nonmedical personnel, is not covered by Medicaid has often been interpreted to exclude recreational therapy services. As a result, we are seeking recognition of recreational therapists as Medicaid providers in Indiana under Title 405 of the Indiana Administrative Code. We believe that recreational therapy is a valuable and cost-effective service that contributes to functional outcomes in service recipients. We have attached a brief indication of the potential functional benefits of recreational therapy services in a variety of service settings. Recreational therapists are requesting to be included in the administrative code as a covered service similarly to the way Physical Therapy, Occupational Therapy, and Speech-Language Therapy are listed. In addition, we are seeking clarification between recreational therapy services and recreation services within state regulations. As noted above, IAC 405 5-22-6.b(5) has historically presented confusion. Recreation Therapists of Indiana agrees with the US Department of Labors distinction between recreational therapy and recreation services stating that Differing from diversional or recreational services, recreational therapy utilizes various interventions as a form of active treatment and defines specific goals related to the intervention. We would like to see specific clarification language that indicates this section does not preclude the coverage of qualified recreational therapy services. Finally, we are seeking greater clarification on the credentials required for recreational therapists to be recognized as a qualified provider of Medicaid services. As noted above, Title 460 of the IAC [460 IAC 6-5-22] provides a very good model; however, we continue to receive conflicting information as to whether recreational therapists must be licensed/certified by the Indiana Professional Licensing Agency in order to be recognized as qualified providers of Medicaid services. Thank you for your time and consideration on this issue. Our hope is the information provided will assist you in providing clarification regarding recreational therapy services within the Medicaid system. I have also attached a cost-benefit analysis RTI presented to Mitch Roob in 2005. Please send correspondence on this matter to Heather Sedletzeck, C.T.R.S., as I will be on maternity leave. You may contact her at:  HYPERLINK "mailto:heatherctrs@bizma.rr.com" heatherctrs@bizma.rr.com or 812-917-4259. Sincerely, Julie A. Foster, M.S., C.T.R.S. Recreational Therapist Public Policy Co-chair of Recreational Therapists of Indiana Functional Outcomes of Recreational Therapy Services Recreational therapists work with a wide variety of populations, some of which are listed below, along with the benefits/outcomes of receiving recreational therapy. Physical Rehabilitation Improvement in physical health status Reduced complications for secondary disability Improvement in long term health status Improvement in cognitive functioning Improvement in psychosocial health Reduced reliance on health care Additional health outcomes (improved life satisfaction, increased self-efficacy, increased acceptance of/adjustment to disability, improved community functioning/barrier management, ability to use recreation as coping skill for stressors related to hospitialization) Geriatrics Improvement in secondary symptoms of Alzheimers Disease and other dementia related disorders Improvements in physical health, degenerative disorders, and reduction in health risks Improvement in cognitive functioning Improvement in psychological health and social well being Mental Health Decrease in symptoms manifestation Improvement in psychosocial abilities Addictions Improvement in ability to manage stressors/triggers which threaten sobriety Improvements in social interaction and social networks Development and maintenance of sober lifestyle and identity Developmental Disabilities Improvement in physical functioning Improvement in cognitive functioning Reduction in non-adaptive or inappropriate behaviors Improvements in age-related community behaviors Establishment of friendship and social support networks Pediatrics Overall improvement in physical health status Reduction in medical complications and increases in rate of healing Alleviation of delay in development resulting from illness or neglect Improved ability to cope with hospitalization and medical procedures Improvement in learning, adjustment, and psychosocial well being Improvement in family dynamics Source: Recreational therapy: A viable option in health and rehabilitation services. American Therapeutic Recreation Asssociation (2003). Cost-Benefits of Recreational Therapy The inclusion of recreational therapy services as a treatment option to be implemented by qualified health care providers results in health care savings. These savings are generated from several opportunities: The shortage of allied health personnel has resulted in the limited availability of services in some area. In area where demand exceeds available personnel, higher salaries may be required for effective recruitment and retention. When the shortage of available allied health personnel results in higher personnel costs, it also increases the total cost of rehabilitation care. The inclusion of recreational therapy services further expands the available pool of qualified rehabilitation personnel to respond to the needs of the health care consumer at a reasonable cost. By expanding the array of treatment options, health care providers have the opportunity to choose the most effective and efficient mix of therapies to respond to the needs of the health care consumer. Such an approach is consistent with the managed care strategy and is cost-effective. The median salary for a recreational therapists in 2004 was $32,900 (Occupational Outlook Handbook, 2006-07 Edition, Recreational Therapists). This compares with 2004 median salaries for physical therapists, occupational therapists, and speech-language pathologists of $60,180, $54,660, $52,410 respectively (2006-07 Occupational Outlook Handbook, U.S. Department of Labor). Since recreational therapy personnel receive, on average, 22.5% less in salary dollars than other rehabilitation personnel, and since each of the therapies complement each other, the application of the proper mix of therapies reduces overall health care costs while responding to consumer treatment goals. In situations where recreational therapy services are delivered in a group treatment versus a 1:1 treatment format more treatment services can be delivered at the same salary expense. Recreational therapy services reduce primary and secondary disabilities with resulting savings on costly health care services. Active involvement in recreational therapy services: improve community living skills and reduce the need for extended inpatient hospitalization; improve independent functioning thus reducing demands on health care providers; improve physical functioning and fitness impacting on general health and well-being; reduce the occurrence of decubitus ulcers and the costs incurred in their treatment; positively impact on emotional status to promote recovery and enhance compliance with medical treatment; and promote the development of social skills for integration into vocational and avocational endeavors among other outcomes. The cost-benefit of such outcomes is significant. The benefits of including recreational therapy services as an aspect of comprehensive rehabilitation are significant. The costs of providing recreational therapy services are reasonable. In order to respond to the need for economical health care, recreational therapy services should continue to be provided as a rehabilitative service with expanded coverage by health care insurance. Sources: Recreational therapy: A viable option in health and rehabilitation services. American Therapeutic Recreation Asssociation (2003). 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