ATRA Ethics in Review
PRINCIPLE 8:
Compliance with Laws and Regulations
Mary Ann Keogh Hoss, CTRS

    Therapeutic recreation personnel are responsible for complying with local, state, and federal laws and  ATRA policies governing the profession of therapeutic recreation.

     In the field of therapeutic recreation with a predominance of individuals working in medical centers and their extensions with a variety of populations, the standards/regulations from Joint Commission and Medicare (Health Care Financing Administration) are overwhelmingly addressed.  However, therapists may or may not realize there are many laws which can govern the population, the service provided, and indeed the property where the service occurs.

     This information will serve only as a guide to trigger questions for the reader in their own setting, Nationally there are four laws and one executive order which can impact delivery of services to individuals.  There may be numerous other ones but these are the primary ones.

     Public Law 101-336 “The Americans with Disability Act” (ADA) was signed by President Bush on July 26, 1990.  The ADA extends to persons with disabilities the same protection of their rights that are enjoyed by members of all other minorities.  It establishes a clear and comprehensive prohibition of discrimination on the basis of disability.

     Public Law 91-596 “Occupational Safety and Health Act of 1970” (OSHAct) as amended.  This law established OSHA, the Occupational Safety &W Health Administration.  Under President Nixon, legislation was passed to prevent illness and injury in the workplace.  OSHA standards apply to all private employers without exception, Federal employees, state and local employees in states with approved plans are covered by separate occupational safety and health programs.  State program must be at least as effective as the Federal program and are subject to continuing Federal monitoring and evaluation.

     Public Law 105-17 “Individuals with Disabilities Education Act” (IDEA) IDEA mandates outcome oriented education processes that promote community participation of individuals with disabilities.  The purposes of this title are:
 

• To ensure that all children with disabilities have available to them a free appropriate public education that emphasizes   special education and related services designed to meet their unique need and prepare them for employment and independent living;

• To ensure that the rights of children with disabilities and   parent of such children are protected; and

• To assist States, localities, educational service agencies, and   Federal agencies to provide for the education of all children with disabilities;

• To assist States in the implementation of a statewide, Comprehensive, coordinated, multidisciplinary, Interagency system of early intervention services for infants and toddlers  with disabilities and their facilities;

• To ensure that educators and parents have the necessary tools   to improve educational results for children with disabili-  ties by supporting systemic-change activities, coordinated   research and personnel preparation; coordinated technical assistance, dissemination, and support; and technology development and media services; and

•  To assess, and ensure the effectiveness of efforts to educate  children with disabilities

     An Executive Order dated February 1998 on Patient Bill of Rights established that governmental agencies would have in place by the end of 1999 a bill of rights.

     Public Law 10209569 The Rehabilitation Act of 1973 as amended.  The act replaced the Vocational Rehabilitation Act and extended and revised grants to states for vocational rehabilitation services with special emphasis on services to individuals with the most severe disabilities.  It expanded Federal responsibilities for research and training programs and established special responsibilities for research and training programs and established special responsibilities in Health, Education Welfare (new Health and Human Services) for coordination of all programs with respect to individuals with disabilities.

     At first glance, one can be overwhelmed by what can appear to be a number of overlapping or contradictory laws.  The therapist needs to identify where they are able to locate information regarding laws that pertain to the execution of their duties and services with a specific population in a specific type of setting.  So a few ideas of where to access this information are:
 

• Conferences:  local, state and national both within the  profession and in allied professions

• Attorney Generals office both federal and state the internet place of employment

• National and local advocacy groups such as NAMI, ARC

• Publications both within the field and within the broader area of rehabilitation

• Networking with other professionals both within the field  and  within Rehabilitation state legislative hotlines

• ATRA documents for Therapeutic Recreation personnel  are available through the administrative Office at PO Box   15215, Hattiesburg MS, 39402  (TR Services brochure,  Educational/Career brochure, Standards for the Practice of Therapeutic Recreation & Self Assessment Guide (and  Addendum), and Guidelines for Competency Assessment)

• New or pending legislation may appear in the ATRA News-  letter which is published bi-monthly.

    Within each state, different programs are determined to be entitlement.  The therapist should have a working knowledge of what programs are entitlement within their own state.  In some states there will be a state department which would oversee the profession or there will be a state department which will oversee a service provision to specific populations.  These departments can be most helpful in relating codes and administrative regulations regarding services to the specific population.

     There is a major movement nationally for a patient bill of rights/patient protection legislation to be enacted.  It is thought that before the end of this legislative year there will be specific legislation out.  There may already be specific legislation within the therapists own local or state legislature which provides for protection/advocacy laws.

     Generally, in a place of employment there will be an individual or individuals who have a responsibility to be familiar with the laws governing the population served.  Generally these individuals within the organization will have copies of applicable laws and standards which must be met as they usually serve as the individuals to address standard and regulatory compliance.  They can be most helpful in identifying any laws that may pertain to the specific delivery of a service.

     As a therapist, there must be an ongoing commitment to say current with legislation pertaining to the population served in the setting where delivery occurs.

REFERENCES/PRINCIPLE 8
Carter, Marcia Jean “Themes from the Past and Implications for  the Future” JOPERD Oct 1997, Vol 68 Number 8, pgs 27,28

Dart, Justin  “ADA:  Landmark Declaration of Equality” Worklife  a Publication  on Employment and People with Disabilities Fall 1990, Volume  3, Number 3, pg 1