Now is the Time: Advocate for Recreational Therapy!

On Friday, August 26, Representatives Joe Courtney (CT) and GT Thompson (PA) introduced a long awaited piece of legislation: HR 8746, Access to Inpatient Rehabilitation Therapy Act. This legislation would add Recreational Therapy to the skilled therapeutic modalities that could be provided under the three hour rule. We encourage everyone in the SMART CEUs Hub family to contact their representatives TODAY. Advocate for our profession and our valuable clients. Let them know how important RT is for recovery!

In a recent article from the American Academy of Physical Medicine and Rehabilitation, the ‘Three Hour Rule’ is explained: “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.” Take some initiative to speak to your administrators about this important issue. Contact your legislators and let them know how this bill can positively impact individuals needing our services. Now is the time!


Courtney, Thompson Introduce Bipartisan Bill to Improve Rehab Therapy for Medicare Patients

Bipartisan “Three-Hour Rule” Bill Introduced to Improve Rehabilita- tion Therapy for Medicare Patients (

H.R.8746 – Access to Inpatient Rehabilitation Therapy Act of 2022

Three Hour Rule Bill Introduced to Expand Therapies – RCPA (

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Faith, Hope and Cancer: The Journey of a Childhood Cancer Survivor

SMART CEU’s Hub is honored to celebrate the new book by one of our SMART instructors. Carolyn Koncal Breinich has written several excellent courses for our platform and now shares her insight and inspiring life story.

Book Description:

Carolyn’s life changed the moment she heard the words, “You have leukemia.” This is Carolyn’s story of being diagnosed with cancer as a teenager, surviving treatment and then navigating life afterwards. She survived a major medical mistake, experienced miracles, discovered the healing power of dolphins, lost friends, fumbled her way through relationships, and overcame depression that came later in life.

Her story will make readers laugh, cry and feel inspired. It will help cancer patients realize they are not alone. Healthcare workers will gain a deeper understanding on how to work with children and young adults diagnosed with a life-threatening illness. Family and friends will understand the importance of their role in their loved one’s journey. All readers will discover how important faith and hope truly are, especially when it seems there is nothing else.

About the Author

Carolyn was diagnosed with Acute Lymphocytic Leukemia in 1994, five days before her 14th birthday. Carolyn earned her bachelor’s in zoology from The Ohio State University and her master’s in recreational therapy from The University of Toledo. Carolyn is a dual certified recreational therapist/child life special- ist and has worked with pediatric cancer patients in a hospital, outpatient clinic, and in the camp setting. Carolyn has always been a strong advocate for childhood cancer survivors, has volunteered with various cancer organizations, and presented at conferences on the needs of childhood cancer patients. Carolyn self-published her memoir, Faith, Hope and Cancer: The Journey of a Childhood Cancer Survivor, with a goal to share her story of what it was like to grow up as a childhood cancer survivor. Carolyn wants to make sure future survivors don’t have to go through what she experienced.