to inpatient rehabilitation hospital patients as part of their plan of care. (8) Skilled, therapeutic modalities in addition to physical therapy, occupational therapy, speech language pathology services, and orthotic and prosthetic services that should be counted toward the Three Hour Rule include recreational therapy services, respiratory therapy, and other skilled modalities as determined by the Secretary when such skilled services are medically necessary and prescribed by a physician as part of the patient’s plan of care. (b) Purpose The purpose of this Act is to restore reliance on the professional judgment of the treating physician, in consultation with 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, rehabilitation services in that setting. This Act retains the current requirement that the patient must need at admission physical therapy, occupational therapy, speech language pathology services, or orthotic and prosthetic services but permits the patient’s physician to modify the intensive rehabilitation therapy program after admission to include additional necessary therapy modalities. 3. Physician judgement to determine the therapy modalities that constitute an intensive rehabilitation therapy program in determining the medical necessity of services in an inpatient rehabilitation facility (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 following new paragraph: (9) Physician judgement to determine the therapy modalities that constitute an intensive rehabilitation therapy program in a rehabilitation facility In the case of a claim for payment under the prospective payment system under this subsection with respect to a discharge of an individual, in implementing section 412.622 of title 42, Code of Federal Regulations (or any successor to such