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
• 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
• 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. 4248 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