Federal Regulation Call to Action – Long Term Care Proposed Rule

The Centers for Medicare and Medicaid Services (CMS) recently published the proposed rule: “Reform of Requirements for Long-Term Care Facilities” (CMS-3260-P). The rule proposes revisions to the standards of care that nursing facilities must meet in order to receive federal funding. 

Director of Activities Qualifications

Within the proposed rule they are seeking comments on the Director of Activities Qualifications. They are specifically requesting comments on whether the requirements for the director of the activities program remain appropriate and what should serve as minimum requirements for this position. Although CMS is not proposing specific changes at this time, it is the appropriate time to share information with them. To improve recognition of music therapists’ qualifications to serve as activities directors within Long Term Care (LTC) facilities, we are proposing CMS add music therapists to the regulatory language.    


Specialized Rehabilitative Services

CMS seeks to expand the list of designated specialized rehabilitative services available to LTC residents. Expanding the list of specialized rehabilitation services ensures that residents will receive specialized services included as an option to address care and services provided in the LTC setting. The listing of specialized rehabilitative services specified within this section is not exhaustive; however, we would like to see music therapy specifically listed within the regulation. 


How Can You Help?


We ask that you please join us in submitting comments to CMS via email urging the agency to include music therapists as meeting the requirements of directors of activity within long term care facilities and specifically listing music therapy as a specialized rehabilitative service available to long term care residents.


Suggested revisions are included below. Please request these specific changes, which have been worded to fit the CMS regulation format. Feel free to adapt the intro, rationale language, and closing to reflect your personal situation.  





You may submit electronic comments on this regulation to http://www.regulations.gov. In commenting, please refer to file code CMS-3260-P. 


Cut and paste link below in browser:



Click the blue “Comment Now” button. Cut and paste your comments and follow the directions given on the website.


Script (please adapt language below as needed and remove words in CAPS before sending)






Submitted Via Regulations.gov


Centers for Medicare & Medicaid Services

Department of Health and Human Services

Attention: CMS-3260-P

PO Box 8010

Baltimore, MD 21244


RE: (CMS-3260-P) – Medicare and Medicaid Programs; Reform of Requirements for Long-Term Care Facilities; Proposed rule (Federal Register, July 16, 2015)

My name is [INSERT NAME] and I am a [INSERT POSITION— i.e., MUSIC THERAPIST] from [CITY and STATE]. I appreciate the opportunity to submit comments on the above-referenced proposed rule. I seek to comment on the quality of care and quality of life and specialized rehabilitative services sections of the proposed rule.

II. Provisions of Proposed Regulation


I. Quality of Care and Quality of Life (§ 483.25)


I support the proposal to reorganize the current §483.25 section to include services and care that is provided in a manner intended to “support achievement of a resident’s individualized goals for attaining or maintaining his or her highest practicable physical, mental, and psychosocial well-being (42196).” To that end, I feel it is appropriate that the requirements for Directors of Activity reflect the potential needs of every long term care resident. Currently regulation (F249) §483.15(f)(2); lists the requirements for Activity Director.


Recommended revision in BOLD:


§483.15(f)(2) The activities program must be directed by a qualified professional who–


(i) Is a qualified therapeutic recreation specialist or an activities professional who–


(A) Is licensed or registered, if applicable, by the State in which practicing; and


(B) Is eligible for certification as a therapeutic recreation specialist or as an activities professional by a recognized accrediting body on or after October 1, 1990; or


(ii) Has 2 years of experience in a social or recreational program within the last 5 years, 1 of which was full-time in a patient activities program in a health care setting; or


(iii) Is a qualified occupational therapist, or occupational therapy assistant; or


(iv) Is a qualified music therapist who is eligible for board certification through the Certification Board for Music Therapists;


(v) Has completed a training course approved by the State.


· I believe that the national education, clinical training, and board certification requirements established for the music therapy profession fully qualify music therapists to serve as Activity Directors within long-term care facilities.


· Services provided or directly supervised by qualified music therapists who hold the national music therapy board certification credential referred to as Music Therapist-Board Certified (MT-BC) have a significant positive impact on quality of care and quality of life.


· Board Certified Music Therapists are trained and skilled in conducting assessments, defining treatment plan goals, implementing procedures, evaluating and making appropriate modifications and accommodations to address multiple needs of residents, and documenting residents’ response to treatment.


Q. Specialized Rehabilitative Services (§ 483.65)


I support the proposed relocation and expansion of the list of designated specialized rehabilitative services (42263). Expanding the list of specialized rehabilitation services ensures that residents will receive specialized services included as an option to address care and services provided in the LTC setting. Currently, the list of Specialized Rehabilitative Services (§ 483.45) is being revised and relocated to the new section, Specialized Rehabilitative Services (§ 483.65) and adds a specific listing of respiratory therapists as a specialized rehabilitation service available to residents. I recognize that the listing of specialized rehabilitative services within this section is not exhaustive, but believe that residents will benefit from the addition of music therapy to this list of potential services.


Recommended revision in BOLD:


§ 483.65 Specialized rehabilitative services.


(a) Provision of services. If specialized rehabilitative services such as but not limited to physical therapy, speech-language pathology, occupational therapy, respiratory therapy, music therapy, and rehabilitative services for mental illness and intellectual disability or services of a lesser intensity as set forth at § 483.120(c), are required in the resident’s comprehensive plan of care, the facility must—



· The Minimum Data Set (MDS) 3.0 currently lists music therapy under Section O. Special Treatments and Procedures, O0400. Therapies, F. Recreational Therapy (includes recreational and music therapy). This listing recognizes the important service that music therapy provides within LTC treatment programs.

· Specifically adding music therapy to this list will improve facility recognition of potential specialized rehabilitative services.


I greatly appreciate your attention to my suggested revisions. Please contact me if you require additional information regarding these comments.



Rebecca Preddie
Federal Programs Analyst
American Music Therapy Association
8455 Colesville Rd. #1000

Silver Spring, MD 20910

(301) 589 – 3300 Phone

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