Legislative and Regulatory Issues in Therapeutic Recreation Chapter 20 HPR 453

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

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

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

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

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

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

▫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

Education 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

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

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

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

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

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)

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

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

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 Ensuring Medicare Access to Recreational Therapy Act of 2007 Bottom line - Requires resources ($) and coordinated Grassroots efforts

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

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