Protection and Advocacy for Assistive Technology Promotes System Change in Iowa (IA UCEDD)

April 30, 2012

How many exceptions to policy does it take to change a system? Just a couple, if you're counting the number of times Iowans with disabilities, and their family members and advocates, have pursued formal cases for exceptions to Medicaid policy to cover the cost of enclosed beds to protect their health and safety. But according to Professor John Allen of the University of Iowa College of Law, it takes a lot more when you're "fighting from the margins" to change an established practice of exclusions and limitations of services. A larger process of ongoing appeals, negotiation and discussion must lead beyond exceptions to policy to the making of new administrative rules. "It's really important," says Allen, "to have the consumer perspective at the rule development stage." For 19 years, with the support of the state's Assistive Technology Legal Project, consumers in Iowa have fought for change when coverage for enclosed beds was denied to them. Now, there are coverage criteria for Medicaid approval of these beds, and providing them to Iowa families is Medicaid's rule, not the exception.

When the Technology Related Assistance for Individuals with Disabilities Act (the "Tech Act") was reauthorized in 1994, Congress required all states to create assistive technology protection and advocacy programs-all states except Iowa, because the state already had a program. In 1993, Iowa's Assistive Technology Legal Project (ATLP) began working with the Clinical Law Program of the University of Iowa College of Law on behalf of individuals who needed legal services related to assistive technology (AT). Since then ATLP, which is based at Iowa's UCEDD, the Center for Disabilities and Development (CDD) at the University of Iowa, has served more than 400 people, and each case of individual advocacy has contributed to ongoing statewide efforts for policy change and system transformation.

ATLP provides a range of services and various levels of help for consumers, but no matter what level of help is needed, the consumers are always in charge. Sometimes the help can be as simple as providing clarification of a complex rule: for example, a person who meets the ambulation requirement for getting a lift chair, but still requires the use a wheelchair, can get both. Other times, help can mean negotiating on behalf of a consumer, such as getting a contractor to make good when a home modification has gone bad. ATLP provides formal representation to help appeal decisions and case representation in court through its contracts with the Clinical Law Program and also with Iowa Legal Aid. Iowans receive free legal help to deal with AT issues, including denials of AT equipment claims by Medicare Part B, Medicaid or private insurance, dual eligibility (Medicare and Medicaid), or difficulty getting AT equipment for nursing home residents.

Since ATLP was founded, well over 200 students from the Clinical Law Program have gained experience representing individuals with disabilities who have AT needs. Because students are involved in all aspects of the cases, starting with initial interviews, they leave law school not only with a substantial understanding of assistive technology, but also with a broad exposure to healthcare systems and practices. The students also receive training on a wide range of AT devices from staff at the Iowa Program for Assistive Technology and from CDD clinics, including wheelchair seating/positioning, augmentative and alternative communication, and occupational therapy. As a result, the ATLP has built community capacity in Iowa by increasing the number of attorneys in the state who are trained to represent consumers about assistive technology.

To extend the reach of pre-service training, ATLP collaborated with the Iowa Center for Assistive Technology Education and Research at the University of Iowa to develop a web-based lecture on AT legal issues for students from the UI College of Education programs in rehabilitation counseling, teacher education and student services. This lecture, "Assistive Technology Law for the Non-Lawyer," includes topics, such as basic legal literacy, the Assistive Technology Act of 1998, Iowa Medicaid and durable medical equipment coverage, other public funding sources, and federal and state laws related to AT.

Most commonly, Iowans and their family members who have legal questions related to assistive technology find out about ATLP through Iowa COMPASS, the state's information and referral service for disability-related programs and services. Then COMPASS makes referrals to ATLP. Iowans who have questions related to AT, or who need AT referrals, should get in touch with Iowa COMPASS at: www.iowacompass.org/.

Members of the AUCD Network who would like to learn more about Iowa's Assistive Technology Legal Project may get in touch with Jennifer Britton at jennifer-britton@uiowa.edu.