Source: http://register.dls.virginia.gov/details.aspx?id=1983
Timestamp: 2019-07-22 01:35:18
Document Index: 40929138

Matched Legal Cases: ['§ 54', '§ 54', '§ 54', '§ 54', '§ 54', '§ 54']

Vol. 25 Iss. 20 (Proposed Regulation) 18VAC85-80, Regulations Governing The Licensure Of Occupational Therapists June 08, 2009
Title of Regulation: 18VAC85-80. Regulations Governing the Licensure of Occupational Therapists (amending 18VAC85-80-10, 18VAC85-80-26, 18VAC85-80-40, 18VAC85-80-45, 18VAC85-80-50, 18VAC85-80-65, 18VAC85-80-70, 18VAC85-80-72, 18VAC85-80-73, 18VAC85-80-80, 18VAC85-80-90, 18VAC85-80-100, 18VAC85-80-110; adding 18VAC85-80-111; repealing 18VAC85-80-61).
Basis: Section 54.1-2400 of the Code of Virginia which provides the Board of Medicine the authority to promulgate regulations to administer the regulatory system.
In the Medical Practice Act (§ 54.1-2900 et seq. of the Code of Virginia), the Board of Medicine is mandated to set in regulation the requirements for licensure as an occupational therapy assistant.
Purpose: The board has reviewed the role delineations for occupational therapy and adopted regulations that specify the extent of responsibilities within the education and experience of the two levels of licensees. While the occupational therapist assistant (OTA) can be an active participant in patient care from the initial assessment through discharge decisions and planning, the occupational therapist (OT) is ultimately responsible and accountable for patient care and outcomes under clinical supervision. The role of an OTA is to perform those tasks assigned, document in the patient record, consult with the OT on patient responses and functionality, and provide for resources necessary upon discharge. The OTA renders services under the supervision of an OT that do not require the clinical decision or specific knowledge, skills and judgment of a licensed OT and do not include the discretionary aspects of the initial assessment, evaluation or development of a treatment plan for a patient. By clearly specifying the scope of practice for an OTA and the requirements of the OT for supervision, co-signing patient records and reevaluating patients, there is some assurance that the health and safety of citizens receiving occupational therapy services are protected.
Substance: The intent of the regulatory action is compliance with the statute that requires the board to establish licensure for OTAs and to promulgate regulations for that purpose. The substance of the regulation is to set the minimum criteria necessary for initial licensure and continued licensure and to establish an appropriate scope of practice for an OTA who practices in coordination with and under the supervision of an OT.
Issues: The primary advantage of this proposal to the public is more accountability for occupational therapist assistants by becoming a licensed profession. As such, their scope of practice is more defined and more inclusive, so their ability to provide services to populations of patients is enhanced. The availability of additional licensed practitioners has the potential to improve accessibility and the quality of occupational therapy services. There are no disadvantages.
There are no disadvantages of these provisions to the agency or the Commonwealth; licensure is required by law and already in effect under emergency regulations. More specificity about the scope of practice and supervision of OTAs allows board staff to direct persons with questions about those issues to the regulations.
Summary of the Proposed Amendments to Regulation. Pursuant to Chapters 64 and 89 of the 2008 Acts of the Assembly, the Board of Medicine proposes to promulgate regulations to govern the licensure of occupational therapy assistants. These proposed regulations will replace identical emergency regulations that will expire October 31, 2009.
Result of Analysis. Costs likely outweigh benefits for this licensure program.
Estimated Economic Impact. Until legislation mandated it in 2008, occupational therapy assistants were not required to be licensed. Individuals who engaged in the work of an occupational therapy assistant were, however, subject to title protection legislation that did not allow them to call themselves occupational therapy assistants (OTAs) unless they were certified by National Board of Certification in Occupational Therapy (NBCOT).
These proposed regulations, and the emergency regulations that they replace, require that OTAs pay a licensure fee of $70 and attain the identical NBCOT certification that has been required by the title protection legislation in order to attain initial licensure. NBCOT requires that candidates for initial certification:
• complete a one year certificate program or a two year associates degree program (cost will vary from program to program but will likely be at least several thousand dollars),
• complete clinical field work as required to get their degree,
• pass the national examination ($520 fee), and
• pay a certification fee that is prorated depending on when certificate holders would be eligible to renew.
The Board will require OTAs to renew their licenses biennially. Candidates for renewal will have to complete 20 hours of continuing education and pay a $70 fee. Individuals who are more than 30 day late in renewing their licenses will be subject to a late fee. Any OTA who allows his or her license to lapse for two or more years will have to reinstate that license. Individuals whose licenses have been lapsed for at least two years but not more than six years will have to complete a Board approved practice of 160 hours and pay a reinstatement fee of $90. Individuals whose licenses have been lapsed for more than six years will have to complete a Board approved practice of 320 hours and pay the reinstatement fee.
Additionally, the Board proposes to change supervision requirements in these regulations. Prior to the promulgation of emergency regulations, occupational therapists have to meet with their personnel (including OTAs) to review and evaluate treatment and progress of individual patients every fifth treatment session or 21 calendar days, whichever occurs first. These proposed regulations, and the emergency regulations that they replace, allow occupational therapists to meet with their personnel every 10 treatment sessions or every 30 calendar days, whichever occurs first. For facilities with larger occupational therapy programs, this change may allow occupational therapists to supervise a greater number of OTAs at one time. This may allow these facilities to realize some savings on labor costs as they may be able to have a staff consisting of a greater number of lower paid OTAs supervised by a fewer number of higher paid occupational therapists. This staff substitution effect, however, will be limited by other regulatory language that limits the number of OTAs occupational therapists may supervise to three.
OTAs that are subject to these regulations will incur the education (both initial and continuing education) and examination costs, as well as fees, listed above. Additionally, these individuals will incur opportunity costs for time spent gaining credentials needed for licensure rather than working in their chosen field and opportunity costs for time spent maintaining licensure. To the extent that non-certified individuals have been able to do the job of an occupational therapy assistant, even if they could not legally call themselves OTAs, these increased costs may lead to fewer people working in this field as some of these individuals may choose to not seek licensure. This may increase the price of OTA services in the Commonwealth (increase the wage that licensed OTAs can demand).
These costs must be weighed against any possible benefit that might be gained by requiring licensure. The individuals who need occupational therapy might benefit, for instance, if the requirements for licensure increase OTA competency and decrease any instances of harm done to patients by incompetent practice. OTAs who gain licensure may benefit from higher wages if this licensure program serves as a barrier to entry for this field. Additionally, some businesses that have need for a larger number of occupational therapy personnel may save on labor costs due to less frequently required reviews and evaluations of individual patients’ treatment plans and progress.
The Department of Health Professions (DHP) reports that the Board of Health Professions completed a study on the appropriate level of regulation for OTAs in 2001. This study concluded that there was not enough risk of harm to patients to warrant licensure. This finding combined with the fact that OTAs must still practice under the supervision of an occupational therapist, who has "ultimately responsible and accountable for patient care and occupational therapy outcomes," points to a conclusion that the public will get minimal benefit from this licensure program. Because of this, the costs of this licensure requirement likely outweigh its benefits.
Businesses and Entities Affected. The Department of Health Professions (DHP) reports that there are currently 204 OTAs that are licensed by the Board.
Projected Impact on Employment. The legislation that mandates this regulatory action may have the effect of decreasing the number of individuals who choose to work in this field.
Small Businesses: Costs and Other Effects. Small businesses in the Commonwealth who employ OTAs may incur extra labor costs if this licensure program decreases the number of OTAs that are available for hire.
Small Businesses: Alternative Method that Minimizes Adverse Impact. There are likely no alternatives available to the Board that would minimize costs for small businesses. Any meaningful changes to the costs associated with this licensure program would require legislative action.
The agency does not concur with the conclusion of the economic impact analysis that the costs of licensure of occupational therapy assistants outweigh the benefits.
First, the economic analysis does not account for the fact that licensure is a mandate of the Code of Virginia, not a result of this regulatory proposal. The EIA appears to be an analysis of the legislation passed by the General Assembly in 2008 rather than an analysis on regulations adopted by the Board of Medicine. By adopting the COTA (Certified Occupational Therapy Assistant) certification as the criteria for licensure, the board has accepted the credential already specified and already held by persons who call themselves occupational therapy assistants (OTAs); therefore no additional education and examination is required to qualify for licensure.
Second, the economic analysis does not take into account the increased responsibilities for OTAs and additional occupational therapy services that OTAs will be able to perform – services that are presently reserved for licensed occupational therapists, who are higher-salaried individuals. The primary intent of the legislative action was to more fully utilize the professional services of OTAs by distinguishing them from unlicensed personnel. It is entirely possible that the costs of occupational therapy services will be reduced since the proposed (and emergency) regulations permit providers to employ OTAs to perform the following occupational therapy tasks:
1. Participation in the evaluation or assessment of a patient by gathering data, administering tests and reporting observations and client capacities to the occupational therapist;
2. Participation in intervention planning, implementation and review;
3. Implementation of interventions as determined and assigned by the occupational therapist;
4. Documentation of patient responses to interventions and consultation with the occupational therapist about patient functionality;
5. Assistance in the formulation of the discharge summary and follow-up plans; and
6. Implementation of outcome measurements and provision of needed patient discharge resources.
Third, by the proposed regulation, unlicensed occupational therapy personnel may now be supervised by an OTA, thus increasing the utilization of OTAs at a lower cost for services.
Fourth, since the OTA is now a licensed individual, the requirement for review and evaluation of services for individual patients by the occupational therapist has been extended from at least once every fifth treatment to once every tenth treatment session or every 30 calendar days, rather the previous requirement of every 21 days. Again, these changes will enable more occupational therapy services to be provided by a lower paid professional, so institutions such as long-term care may employ more OTAs for direct patient services with an OT as the supervisor of those services.
18VAC85-80-10. Definitions.
"Practice of occupational therapy"
"ACOTE" means the Accreditation Council for Occupational Therapy Education.
"Active practice" means a minimum of 160 hours of professional practice as an occupational therapist or an occupational therapy assistant within the 24-month period immediately preceding renewal or application for licensure, if previously licensed or certified in another jurisdiction. The active practice of occupational therapy may include supervisory, administrative, educational or consultative activities or responsibilities for the delivery of such services.
"Advisory board" means the Advisory Board of Occupational Therapy.
"Contact hour" means 60 minutes of time spent in continued learning activity.
"NBCOT" means the National Board for Certification in Occupational Therapy, under which the national examination for certification is developed and implemented.
"National examination" means the examination prescribed by NBCOT for certification as an occupational therapist or an occupational therapy assistant and approved for licensure in Virginia.
"Occupational therapy personnel" means appropriately trained individuals who provide occupational therapy services under the supervision of a licensed occupational therapist.
3. The fee for active license renewal for an occupational therapist shall be $135 and; for inactive license renewal shall be $70 and an occupational therapy assistant, it shall be $70. The fees for inactive license renewal shall be $70 for an occupational therapist and $35 for an occupational therapy assistant. Renewals shall be due in the birth month of the licensed therapist licensee in each even-numbered year.
18VAC85-80-40. Educational requirements.
C. An applicant who does not meet the educational requirements as prescribed in subsection A or B of this section but who has received certification by the NBCOT as an occupational therapist or an occupational therapy assistant shall be eligible for licensure in Virginia and shall provide the board verification of his education, training and work experience acceptable to the board.
18VAC85-80-45. Practice by a graduate awaiting examination results.
A. A graduate of an accredited occupational therapy educational program may practice with the designated title of "Occupational Therapist, License Applicant" or "O.T.L.-Applicant" until he has taken and received the results of the licensure examination from NBCOT or for one year six months from the date of graduation, whichever occurs sooner. The graduate shall use one of the designated titles on any identification or signature in the course of his practice.
B. A graduate of an accredited occupational therapy assistant educational program may practice with the designated title of "Occupational Therapy Assistant-License Applicant" or "O.T.A.-Applicant" until he has taken and received the results of the licensure examination from NBCOT or for six months from the date of graduation, whichever occurs sooner. The graduate shall use one of the designated titles on any identification or signature in the course of his practice.
18VAC85-80-50. Examination requirements.
A. An applicant for licensure to practice as an occupational therapist shall submit evidence to the board that he has passed the certification examination for an occupational therapist and any other examination required for initial certification from the NBCOT.
B. An applicant for licensure to practice as an occupational therapy assistant shall submit evidence to the board that he has passed the certification examination for an occupational therapy assistant and any other examination required for initial certification from the NBCOT.
18VAC85-80-61. Certification of occupational therapy assistants. (Repealed.)
Effective July 26, 2005, a person who holds himself out to be or advertises that he is an occupational therapy assistant or uses the designation "O.T.A." or any variation thereof shall have obtained initial certification by the National Board for Certification in Occupational Therapy (NBCOT) as a certified occupational therapy assistant.
18VAC85-80-65. Registration for voluntary practice by out-of-state licenses licensees.
Any occupational therapist or an occupational therapy assistant who does not hold a license to practice in Virginia and who seeks registration to practice under subdivision 27 of § 54.1-2901 of the Code of Virginia on a voluntary basis under the auspices of a publicly supported, all volunteer, nonprofit organization that sponsors the provision of health care to populations of underserved people shall:
Renewal of Licensure; Reinstatement
18VAC85-80-70. Biennial renewal of licensure.
A. An occupational therapist or an occupational therapy assistant shall renew his license biennially during his birth month in each even-numbered year by:
1. Paying to the board the renewal fee prescribed in 18VAC85-80-26;
2. Indicating that he has been engaged in the active practice of occupational therapy as defined in 18VAC85-80-10; and
3. Attesting to completion of continued competency requirements as prescribed in 18VAC85-80-71.
B. An occupational therapist or an occupational therapy assistant whose license has not been renewed by the first day of the month following the month in which renewal is required shall pay an additional fee as prescribed in 18VAC85-80-26.
A. A licensed occupational therapist or an occupational therapy assistant who holds a current, unrestricted license in Virginia shall, upon a request on the renewal application and submission of the required fee, be issued an inactive license. The holder of an inactive license shall not be required to maintain hours of active practice or meet the continued competency requirements of 18VAC85-80-71 and shall not be entitled to perform any act requiring a license to practice occupational therapy in Virginia.
C. An occupational therapist or occupational therapy assistant who has had an inactive license for six years or more and who has not engaged in active practice, as defined in 18VAC85-80-10, shall serve a board-approved practice of 320 hours to be completed in four consecutive months under the supervision of a licensed occupational therapist.
D. The board reserves the right to deny a request for reactivation to any licensee who has been determined to have committed an act in violation of § 54.1-2915 of the Code of Virginia or any provisions of this chapter.
A. An occupational therapist or an occupational therapy assistant who held an unrestricted license issued by the Virginia Board of Medicine or by a board in another state as a licensee in good standing at the time the license expired or became inactive may be issued a restricted volunteer license to practice without compensation in a clinic that is organized in whole or in part for the delivery of health care services without charge in accordance with § 54.1-106 of the Code of Virginia.
B. To be issued a restricted volunteer license, an occupational therapist or occupational therapy assistant shall submit an application to the board that documents compliance with requirements of § 54.1-2928.1 of the Code of Virginia and the application fee prescribed in 18VAC85-80-26.
18VAC85-80-80. Reinstatement.
A. An occupational therapist or an occupational therapy assistant who allows his license to lapse for a period of two years or more and chooses to resume his practice shall submit a reinstatement application to the board and information on any practice and licensure or certification in other jurisdictions during the period in which the license was lapsed, and shall pay the fee for reinstatement of his licensure as prescribed in 18VAC85-80-26.
B. An occupational therapist or occupational therapy assistant who has allowed his license to lapse for two years but less than six years, and who has not engaged in active practice as defined in 18VAC85-80-10, shall serve a board-approved practice of 160 hours to be completed in two consecutive months under the supervision of a licensed occupational therapist.
C. An occupational therapist or an occupational therapy assistant who has allowed his license to lapse for six years or more, and who has not engaged in active practice, shall serve a board-approved practice of 320 hours to be completed in four consecutive months under the supervision of a licensed occupational therapist.
D. An applicant for reinstatement shall meet the continuing competency requirements of 18VAC85-80-71 for the number of years the license has been lapsed, not to exceed four years.
E. An occupational therapist or an occupational therapy assistant whose license has been revoked by the board and who wishes to be reinstated shall make a new application to the board and payment of the fee for reinstatement of his license as prescribed in 18VAC85-80-26 pursuant to § 54.1-2408.2 of the Code of Virginia.
18VAC85-80-90. General responsibilities.
A. An occupational therapist renders services of assessment, program planning, and therapeutic treatment upon request for such service. The practice of occupational therapy may include supervisory, administrative, educational or consultative activities or responsibilities for the delivery of such services.
B. An occupational therapy assistant renders services under the supervision of an occupational therapist that do not require the clinical decision or specific knowledge, skills and judgment of a licensed occupational therapist and do not include the discretionary aspects of the initial assessment, evaluation or development of a treatment plan for a patient.
18VAC85-80-100. Individual responsibilities.
A. An occupational therapist provides assessment by determining the need for, the appropriate areas of, and the estimated extent and time of treatment. His responsibilities include an initial screening of the patient to determine need for services and the collection, evaluation and interpretation of data necessary for treatment.
B. An occupational therapist provides program planning by identifying treatment goals and the methods necessary to achieve those goals for the patient. The therapist analyzes the tasks and activities of the program, documents the progress, and coordinates the plan with other health, community or educational services, the family and the patient. The services may include but are not limited to education and training in activities of daily living (ADL); the design, fabrication, and application of orthoses (splints); guidance in the selection and use of adaptive equipment; therapeutic activities to enhance functional performance; prevocational evaluation and training; and consultation concerning the adaptation of physical environments for individuals who have disabilities.
C. An occupational therapist provides the specific activities or therapeutic methods to improve or restore optimum functioning, to compensate for dysfunction, or to minimize disability of patients impaired by physical illness or injury, emotional, congenital or developmental disorders, or by the aging process.
D. An occupational therapy assistant is responsible for the safe and effective delivery of those services or tasks delegated by and under the direction of the occupational therapist. Individual responsibilities of an occupational therapy assistant may include:
1. Participation in the evaluation or assessment of a patient by gathering data, administering tests, and reporting observations and client capacities to the occupational therapist;
2. Participation in intervention planning, implementation, and review;
18VAC85-80-110. Supervisory responsibilities of an occupational therapist.
A. Delegation to unlicensed occupational therapy personnel an occupational therapy assistant.
1. An occupational therapist shall be responsible for supervision of occupational therapy personnel who work under his direction ultimately responsible and accountable for patient care and occupational therapy outcomes under his clinical supervision.
2. An occupational therapist shall not delegate the discretionary aspects of the initial assessment, evaluation or development of a treatment plan for a patient to unlicensed occupational therapy personnel nor shall he delegate any task requiring a clinical decision or the knowledge, skills, and judgment of a licensed occupational therapist.
3. Delegation shall only be made if, in the judgment of the occupational therapist, the task or procedures do not require the exercise of professional judgment, can be properly and safely performed by an appropriately trained unlicensed occupational therapy personnel occupational therapy assistant, and the delegation does not jeopardize the health or safety of the patient.
4. Delegated tasks or procedures shall be communicated to an occupational therapy assistant on a patient-specific basis with clear, specific instructions for performance of activities, potential complications, and expected results.
B. The frequency, methods, and content of supervision are dependent on the complexity of patient needs, number and diversity of patients, demonstrated competency and experience of the assistant, and the type and requirements of the practice setting. The occupational therapist providing clinical supervision shall meet with the occupational therapy personnel to review and evaluate treatment and progress of the individual patients at least once every fifth tenth treatment session or 21 30 calendar days, whichever occurs first. For the purposes of this subsection, group treatment sessions shall be counted the same as individual treatment sessions.
C. An occupational therapist shall not may provide clinical supervision for more than up to six occupational therapy personnel, to include no more than three occupational therapy assistants at any one time.
D. An occupational therapist shall be responsible and accountable for the services provided by occupational therapy personnel under his clinical supervision. The occupational therapy assistant shall document in the patient record any aspects of the initial evaluation, treatment plan, discharge summary, or other notes on patient care performed by the assistant, and the supervising occupational therapist shall review and countersign within 10 days of such information being recorded.
18VAC85-80-111. Supervision of unlicensed occupational therapy personnel.
A. Unlicensed occupational therapy personnel may be supervised by an occupational therapist or an occupational therapy assistant.
B. Unlicensed occupational therapy personnel may be utilized to perform:
2. Certain routine patient-related tasks that, in the opinion of and under the supervision of an occupational therapist, have no potential to adversely impact the patient or the patient's treatment plan.
Instructions for Completing an Occupational Therapist Licensure Application (rev. 12/07).
Application for a License to Practice as an Occupational Therapist (rev. 12/07).
Instructions for Completing an Occupational Therapy Assistant Licensure Application (eff. 11/08).
Application for a License to Practice as an Occupational Therapy Assistant (eff. 11/08).
Form A, Occupational Therapy Assistant, Claims History Sheet (eff. 11/08).
Form B, Occupational Therapy Assistant, Activity Questionnaire (eff. 11/08).
Form C, Clearance from Other State Boards (rev. 10/07).
Form C, Occupational Therapy Assistant, Clearance from Other State Boards (eff. 11/08).
Form L, Certificate of Professional Education (rev. 8/07).
Form L, Occupational Therapy Assistant, Certificate of Professional Education (eff. 11/08).
Board Approved Practice, Occupational Therapist Traineeship (rev. 8/07).
Instructions for Completing Reinstatement of Occupational Therapy Licensure (rev. 8/07).
Reinstatement Application Instructions for Occupational Therapy Practitioner Licensure after Mandatory Suspension, Suspension or Surrender (rev. 10/07).
Application for Reinstatement of Licensure to Practice Occupational Therapy (rev. 8/07).
Instructions for Supervised Practice, Occupational Therapy Reinstatement (rev. 8/07).
Supervised Practice Application, Occupational Therapy Reinstatement (rev. 8/07).
Continued Competency Activity and Assessment Form (rev. 4/00).
VA.R. Doc. No. R09-1387; Filed May 20, 2009, 11:25 a.m.