2009)) revised these prior regulations, effective January 1, 2010, by limiting the Three Hour Rule to recognize only four services (namely, physical, occupational, and speech therapy as well as orthotics and prosthetics) and removing the discretion of the physician and the rehabilitation team to count other therapeutic services needed by the patient toward satisfaction of the Three Hour Rule. As a result, recreational therapy services are often not available to patients who require medically necessary recreational therapy as part of their plan of care. (6) Recreational therapy is a treatment service designed to restore, remediate, and rehabilitate a patient’s level of functioning and independence in life activities, to promote health and wellness as well as to reduce or eliminate the activity limitations and restrictions to participation in life situations caused by an illness or disabling condition. Recreational therapy in the inpatient rehabilitation hospital and unit setting is provided by qualified recreational therapists when required by the patient’s condition and prescribed by a physician as part of a patient’s plan of care. (b) Purpose It is the purpose of this Act to restore reliance on the professional judgment of the treating physician and the rehabilitation team when determining whether a Medicare patient meets the intensity of therapy requirement of an inpatient rehabilitation hospital or unit in order for that patient to gain access to the appropriate mix of medically necessary therapeutic rehabilitation services in that setting, including physical therapy, occupational therapy, and, as needed, speech therapy, orthotics and prosthetics, and recreational therapy. 3. Including recreational therapy among the therapy modalities that constitute an intensive rehabilitation therapy program in determining the medical necessity of services in an inpatient rehabilitation facility (IRF) (a) In general Section 1886(j) of the Social Security Act ( 42 U.S.C. 1395ww(j) ) is amended by adding at the end the