Legislative and Regulatory Issues in Therapeutic Recreation

1. Legislative and Regulatory Issues in Therapeutic Recreation Chapter 20 HPR 453

2. Houle (1980) included legal support as a distinct characteristic of a profession • Skalko (1998) contends that the TR profession must work to influence public policy and healthcare regulation • Compton (1997) stated that if TR was to survive it must become more politically astute

3. 40 Year History • 1966 – Creation of NRPA and NTRS • Early legislative effort reflected society’s to advance the condition of all persons • 1970 – Legislative advocacy declared to be a priority for NTRS • 1973 – Rehabilitation Act of 1973 – considered to be the “civil rights law for disabled persons” – contained references to recreation being an integral part of comprehensive rehabilitation

4. 1975 – Sen Ted Kennedy Education for all Handicapped Children Act strongly supported by recreation and Phys Ed professionals • NTRS’ legislative efforts managed by a legislative committee and volunteer support • 1984 – ATRA formed and public policy coordinated by Team appointed by the Pres • 1993 – ATRA hires legislative counsel in DC

5. TR continues to depend heavily on Grassroots support • Consistent targets for TR legislative action have been • Rehabilitation, • Education • Nursing Home Reform

6. Rehabilitation • Used to be viewed as vocational preparation and training • Rehabilitation Act of 1973 introduced “comprehensive rehabilitation” • Fullest possible participation in life, including living independently in the community • Congress then more receptive to considering the role of recreation in rehabilitation and independent living

7. NTRS testimony influenced the US Senate to amend the law in 1978 to include “special recreation demonstration projects” • Intended to increase mobility and socialization of disabled persons through activities such as camping, sports and the arts • Amended again due to personal testimony • Extended and expanded the role of recreation in independent living and community integration

8. TR personnel recognized as bonafide rehab personnel eligible for rehab training monies • Congress recognized TR as a means to reach desirable goals in the overall rehab process

9. Education • 1975 - Education for All Handicapped Children Act • Mandated a free and appropriate education for all children with disabilities in a least restricted environment • Crafted so recreation would appear as a content area “related” to special education • If a child’s eval indicated a need their IEP would include assessment of leisure functioning, TR, Leisure Ed, or rec programs in the school or the community • Recreation was rarely found to be included in the IEP but recommended for after school programs

10. In 1991 the law was retitled to Individuals with Disabilities Education Act (IDEA) with the intent of TR transitioning a child from school into adult life (full inclusion) • TR still not fully utilized in schools but progress is being made

11. Long-Term Care • OBRA regulations weakened nursing home requirements for activities and the staff who provided them • TR lobbying efforts eventually earned TR important recognition and respect • MDS 2.0 (1998) contained Section T to distinguish Recreation Therapy from Activity (diversional) services • MDS 3.0 – RT in Section along with other rehab svcs

12. Accessibility • Americans with Disabilities Act (1990) is one of the most significant pieces of legislation to impact access to recreation activities for people with disabilities • No specific provisions for TR but prohibits disability discrimination in employment, govt services, public accommodations, telecommunications, and certain other services, like insurance

13. Legislative Process • 3 fundamental processes related to introducing, passing and implementing law • Authorization • Appropriation • Regulation

14. Authorization • Law under which a program is established or continued (reauthorization) for a stated number of years (perhaps 5) • Specifies the aim and conduct and ceiling on the monies • Extensive lobbying by TR when laws such as Rehabilitation Act or IDEA have been up for reauthorization • Oral and written comments to change statuatory language (success and lack of on pg 330)

15. Appropriation • Means by which authorized programs are funded by Congress for that year • Funding may not include funding amounts in Authorization • Originates in House and followed by one in the Senate • When different compromised and taken back to the House • TR lobbying for special recreation funding has been successful due to providing for people with disabilities

16. Regulation • Organization, rules and procedures to distribute funds and monitor conduct of programs • Proposed regulatory changes are announced in Federal Register and public is invited to comment • In 1991 NIDRR was successful in securing funding for research projects such as Benefits of Therapeutic Recreation: A Consensus View

17. ATRA Medicare Project • Regulatory language implies that RT is a covered service in skilled nursing, IP Rehab and IP Psych facilities • Beneficiaries often denied services due to inaccurate interpretations of fiscal intermediaries • H.R. 4248 Ensuring Medicare Access to Recreational Therapy Act of 2007 • Bottom line - Requiresresources ($) and coordinated Grassroots efforts

18. Essentials for Legislative and Regulatory Action • Building and Maintaining Coalitions – Strength in numbers – consumers, providers, advocacy groups • Kennedy Foundation • President’s Committee on Employment of the Handicapped • National Easter Seals Society • National Rehabilitation Caucus • Coalition for Citizens with Disabilities • National Coalition for Nursing Home Reform • Alliance for Disability Sport and Recreation

19. 1986 – NTRS, ATRA, the NCPERH formed the Legislative Coalition for Therapeutic Recreation • Unified Voice for lobbying efforts • Disbanded when ATRA hired legislative counsel