Ethical Point Breaks for Medicaid Schoolbased Services

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Ethical Point Breaks for MedicaidSchool-based
Services
Lauren Holahan, MSOT Occupational Therapy
Medicaid Consultant
Laurie Ray, MPT Physical Therapy Medicaid
Consultant

• North Carolina Department of Public Instruction
• Exceptional Children Division

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Objectives

• The participants will be able to
• Identify and describe at least three areas of
  ethical tension in school-based Medicaid cost
  recovery
• Cite references from legislation, policy, and
  regulations related to ethical issues in
  school-based Medicaid cost recovery
• Describe method to address an ethical concern,
  using a specific, real-life situation

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What Are Ethics?

• PRESCRIPTIVE

• DESCRIPTIVE

• Customs habits of being
• Conduct
• Comportment

• Systems of moral principles
• Rules of behavior
• Professional Codes

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Ethical Maturity

• Recognizes ethical tension
• Uses ethics vocabulary
• Employs a reliable strategy
• Operates with a sense of possibility
• (Barnitt, 1997 Opacich, 1996)

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Ethical Reasoning

• Understand and adhere to applicable codes of
  ethics
• Identify applicable ethical principles, core
  values and attitudes
• Use these principles to resolve ethical dilemmas
• Apply consistent ethical decision-making process
• Reflect on results of ethical decision-making

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Sowhats all the fuss?
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ISSUE 1FAPE
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ISSUE 2LEAST RESTICTIVE ENVIRONMENT
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ISSUE 3SERVICE DELIVERY DECISIONS
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ISSUE 4MEDICAL NECESSITY
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ISSUE 5MOONLIGHTING
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ISSUE 6CONTRACTING
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Okaywe get what all the fussis aboutnow
what?
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Ethical Decision-Making

• Ready
• Be open
• Sort sift
• Know your aim
• Set
• Take a deep breath
• Avoid rushing
• Check the law
• (Morris, 2003)

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GO! Informal Approaches

• Family/Friend Test
• Transparency Test
• TV Test
• Smell Test
• Other Persons Shoes Test
• Why Test
• Other Questions

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GO! A Formal Process

• Define the issue with facts
• Identify stakeholders
• Identify applicable ethical principles
• Identify options/possible courses of action
• Evaluate consequences of each option
• Have team discussion
• Make decision
• Implement decision
• Evaluate the decision
• (AOTA, 2005 Bernstein, 2000 Carbo, 2004 )

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Questions and Thoughtful Responses
Thank you for your kind attention!
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• LAURIE RAYNorth Carolina Department of Public
  Instruction, Physical Therapy Medicaid
  Consultant
• 919-636-1827
• laurie_ray_at_med.unc.eduhttp//www.med.unc.edu/ahs/
  physical/schoolbasedpt
• LAUREN HOLAHANNorth Carolina Department of
  Public Instruction, Occupational Therapy
  Medicaid Consultant919-843-4466
• lauren_holahan_at_med.unc.edu http//www.med.unc.edu
  /wrkunits/2depts/ahs/ocsci/ schoolbasedot.htm