Earning the ATP

A Question of Ethics

So far in our quest to prepare for RESNA’s Assistive Technology Professional (ATP) exam, we’ve been dealing with relatively immutable topics. For instance, my humerus is still my humerus, and it’s in the same place now as it was when I started studying anatomy a year ago. True, no two MS or ALS clients present exactly alike, but we still have general expectations of how they’ll progress and what seating & mobility needs they’ll have, based on what we know of other patients with the same diagnoses.

This month, we venture into territory that’s a bit more of a gray, evolving area: Ethics and policy.

Ethics & Policy Go Hand in Hand

For this column, we’ll define “ethics” as the professional conduct expected and required of an ATP. In addition to RESNA’s ethics standards, the Fundamentals of Assistive Technology (edited by Michelle L. Lange, OTR, ABDA, ATP, and one of our main textbooks) chapter on Professional Conduct & Public Policy lists and discusses the ethics and standards of the National Registry of Rehabilitation Technology Suppliers (NRRTS).

Ethics, as well as public policy and legislation, are always evolving in response to the changing needs of society — and in some cases, in response to advancing technology. It wasn’t too long ago that people with disabilities were routinely sequestered in hospitals or other institutions, in part because the technology to enable them to live at home wasn’t available. Once technology caught up, certain folks dared to imagine people with disabilities integrating more fully into their communities by going to school, work, church and everywhere that everyone else could go.

Public policy and legislation such as the Americans with Disabilities Act and the New Freedom Initiative sought to eliminate barriers — and as such are important for complex rehab professionals to know about. But assuming that your day job isn’t on Capitol Hill, how can you keep up to date on policy changes that can affect you and your clients?

Staying in the Current Events Loop

Permobil’s Darren Jernigan is this month’s official mentor — and as director of government affairs, he spends a lot of time working with Medicaid programs. Asked how complex rehab suppliers can keep up with changes to Medicaid programs, Jernigan said strategies can vary from state to state. “For instance,” he says, “Kentucky has a DME e-mail list that you can sign up for, and it will shoot you a blast when the policy changes. There are several states that do that. That’s the most effective way to know exactly what’s going on.”

Jernigan also suggests the following:

  • Check with your state to see if it has an e-mail list similar to Kentucky’s. If it does, sign up to receive those policy-change notices.
  • Ask your state association if it has a rehab division that you can join.
  • Find your state’s DME medical guide online; Jernigan says every state has one.
  • Ask the seating & mobility manufacturers you work with if they have government liaisons available to field your questions about policy changes.

“If you have specific denials from Medicaid, there are federal laws that govern Medicaid,” Jernigan adds. “Each state has a protection and advocacy network that (suppliers) can contact.”

As for ethics, go to resna.org, and click on Certification. The organization’s standards of practice and code of ethics are available as pdf documents — and they’re two more professional and exam resources to tap.

An Ethical Question: Is It OK to Use Another ATP’s Client Evaluation as Your Own?

As we were talking over the professional ethics portion of the ATP exam, Permobil Director of Government Affairs Darren Jernigan mentioned an ethical dilemma he’d heard about involving Texas’ Medicaid program.

“In Texas,” Jernigan notes, “they just passed their own certification legislation (in 2008).” Among the requirements now, he says, is the involvement of a therapist in the assessment process for complex rehab. But Jernigan has heard of instances in which “when an ATP turns in (an evaluation) and recommends a chair, (Medicaid) turns around and puts that chair out to bid. They’ll take that evaluation and send that evaluation to other dealers.”

In that scenario, a therapist was involved in the initial assessment. But then that assessment is shopped around to other suppliers who, presumably, haven’t evaluated the client and haven’t worked with the therapist involved in the evaluation.

Says Jernigan, “Now the problem is that these dealers who have certified people on staff: Is it ethical for them to take some other certified person’s (assessment)? I think in the RESNA standards, they can’t do that.”

So our next step was posing the question to Anjali Weber, the director of certification at RESNA.

Says Weber, “This brings up a very interesting situation and many questions in my mind as related to ethical practice. The first thing I would question is why Medicaid is sharing proprietary information and is putting a quote ‘out for bid.’ That to me raises a number of flags.

“As for ATP 2,” she continues, “whether they know that ATP 1 did an assessment or not, I believe it is their obligation to reassess the client entirely with the recommendations from the medical professionals before they can consider submitting something to Medicaid. The RESNA Standards of Practice are to ensure that the welfare of individuals served professionally is paramount, and that ATPs shall use every reasonable resource and present reasonable options available to ensure that the consumer’s identified needs are met.

“I would never provide a bid for equipment using anyone else’s specifications or measurements,”Weber says. “Underbidding steals from another professional’s time and effort.”

Mobility Management is looking further into this situation in Texas, so stay tuned for an update.

This article originally appeared in the February 2010 issue of Mobility Management.

About the Author

Laurie Watanabe is the editor of Mobility Management. She can be reached at lwatanabe@1105media.com.

Mobility Management Podcast