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Update from the Ohio Occupational Therapy
Board
Ohio Occupational Therapy Association State Conference
November 6, 2009
November 6, 2009 Ohio OTPTAT Board 2
Topics to Cover
Role of the Board Recent Rules Changes Strategic Plan Enforcement Overview Supervision and Collaboration Dialogue with ODE Commonly Asked Questions Q&A
November 6, 2009 Ohio OTPTAT Board 3
OT Section Vision Statement
The OT Section is committed to proactively: Provide education to the consumers of OT
services; Enforce practice standards for the protection of
the consumers of OT services; Regulate the profession of OT in an ever-
changing environment; Regulate ethical & multicultural competency in
the practice of OT; Regulate the practice of OT in all current &
emerging areas of service delivery
November 6, 2009 Ohio OTPTAT Board 4
Board Operations
OTPTAT Board 20 Board members (appointed by Gov) 8 full-time employees (Exec Director hired
by Board) The Board sets policy
The staff implements those policies Staff cannot make any final decisions on
discipline, waiver requests, licensing, etc., unless Board delegates action to staff
November 6, 2009 Ohio OTPTAT Board 5
Board Funding
Ohio Boards are self-funded All operations funded by licensee fees No General Revenue Funds (tax $$)
Fees are established to ensure sufficient funding for at least five year period Goal to limit fee increases while
maintaining reasonable fees Benchmark vs. other boards Recent reduction in license verification and
duplicate wall certificate fees
November 6, 2009 Ohio OTPTAT Board 6
Board Composition – OT Section
Member CityTerm
ExpiresTerm
Kim Lawler, OT, Chair Frazeysburg 2010 1st
Jean Halpin, OT, Secretary Westerville 2011 1st
Becky Finni, OT Amelia 2010 1st
Nan Shoemaker, OTA Miamisburg 2012 2nd
Mary Stover, OT Columbus 2012 2nd
All terms expire on Aug. 27 of designated year. Pursuant to ORC 4755.01, members shall not serve for more than 3 consecutive terms.
November 6, 2009 Ohio OTPTAT Board 7
Board Composition
The Board also has a public member who represents the interests of consumers Genevieve Dennison – New Richmond. 1st term expires in 2011
To seek an appointment to the Board, you need to contact the Governor’s Office and download the application
http://governor.ohio.gov
November 6, 2009 Ohio OTPTAT Board 8
How Rules are Changed
Rule review is a public process Board seeks input on initial draft before rule
language is filed Information on proposed changes sent to
listserv and posted on Board’s website Once filed, full text of the rules available at
http://www.registerofohio.state.oh.us Public hearing on proposed changes required
May 1 effective date is goal
November 6, 2009 Ohio OTPTAT Board 9
Recent Rules Changes
5 changes effective 5/1/09 4755-3-05 – Escrow of license; restoration
To ensure competence, implement additional restoration requirements if license was in escrow for more than 5 years.
Similar to endorsement and reinstatement requirements for individuals out of practice for more than 5 years.
4755-3-14 – Criminal records check Clarified the criminal records check process
for initial license applications
November 6, 2009 Ohio OTPTAT Board 10
Recent Rules Changes
4755-7-08 – Code of ethics Add additional provision related to sexual boundary
violations Added provision dealing with fraudulent
billing/documentation 4755-7-10 – Documentation
Specifies appropriate credential for documentation OT/L or OTR/L (depends on NBCOT cert.) OTA/L or COTA/L (depends on NBCOT cert.) LP/OT and LP/OTA for limited permit holders Student OT or S/OT for student occupational therapists Student OTA or S/OTA for student occ. therapy assistants
November 6, 2009 Ohio OTPTAT Board 11
Proposed Rules Changes
4755-7-01 to 4755-7-04 Replace the current rules that govern supervision
and delegation and the role of unlicensed personnel
4755-3-02 and 4755-5-04 Eliminate pocket ID cards
4755-3-06, 4755-3-11, 4755-5-02, & 4755-7-10 Eliminate Limited Permits.
November 6, 2009 Ohio OTPTAT Board 12
Criminal Records Checks
HB 104 requires the Board to receive results of FBI & BCI criminal records check before issuing license
Law went into effect on 3/24/08. Only applies to initial license applications.
No fingerprints needed for renewal, reinstatement, or restoration
November 6, 2009 Ohio OTPTAT Board 13
New Renewal Cycle
Board adopted new renewal cycle rules in fall 2007.
Renew by profession, not last name OTs renew on June 30 of odd years OTAs renew on June 30 of even years All licensees now in correct cycle CE audit conducted at completion of renewal
~25% of licensees randomly selected for audit
November 6, 2009 Ohio OTPTAT Board 14
Don’t Wait Until June 30 to Renew
November 6, 2009 Ohio OTPTAT Board 15
Listserv
Each Section has its own listserv Important news announced on listserv
Rules changes New information posted to website
To join, send an email to:
[email protected] State which listserv you’d like to join
November 6, 2009 Ohio OTPTAT Board 16
Strategic Planning
OT Section held strategic planning retreat in October 2006
Follow up retreats held in June 2008 & 2009 Identified and prioritized regulatory areas of
focus for 2009-2010 Education of the occupational therapy
community re: Use of Aides as Service Extenders
Review & restructuring of the code of ethics
November 6, 2009 Ohio OTPTAT Board 17
Strategic Planning
Proposed rules changes based on previous planning retreats Restructuring of supervision & delegation rules Elimination of limited permits Elimination of pocket ID cards
Public hearing on proposed changes in March 2010
November 6, 2009 Ohio OTPTAT Board 18
Enforcement Activities
Law limits the violations for which the board can take disciplinary action (ORC 4755.11)
Law limits the types of disciplinary action the board may take Ex: The Board had no authority to levy fines
prior to enactment of HB 403 in April 2007
November 6, 2009 Ohio OTPTAT Board 19
Disciplinary Process
Licensees are guaranteed due process rights All actions must follow ORC Chapter 119
Board receives & investigates complaint Board member, enforcement staff, AAG
review investigation findings Issue Notice of Opportunity for Hearing if
violation occurred Most investigations settled via consent
agreement in lieu of formal hearing
November 6, 2009 Ohio OTPTAT Board 20
Disciplinary Process
If licensees chooses a hearing: Administrative hearing conducted by Hearing
Examiner (the judge) Full Board reviews Hearing Examiner findings
(the jury) Board issues Adjudication Order
Specifies the violation and disciplinary action taken
Licensee may appeal order to common pleas court
November 6, 2009 Ohio OTPTAT Board 21
# of Cases Investigated Per Year
0
5
10
15
20
25
30
35
40
45
2001 2002 2003 2004 2005 2006 2007 2008
Cases
November 6, 2009 Ohio OTPTAT Board 22
Types of Cases Investigated – 2004-08
EXP
PracticePrior
ULP
Mis/Neg.
CEU
Scope
Billing
Other
Practice on expired license (EXP) & aiding/abetting unlicensed practice (ULP) account for largest % of cases
Fraudulent billing cases increasing
November 6, 2009 Ohio OTPTAT Board 23
Supervision versus Collaboration
Supervision does NOT always indicate collaboration
BUT… Collaboration does indicate supervision Is there more to collaboration than…
“Continue with established OT treatment plan, per collaboration & discussion with OT/L”
November 6, 2009 Ohio OTPTAT Board 24
Supervision versus Collaboration
What is supervision? OAC Rule 4755-7-01
Why supervision? Supervision ensures consumer protection
Proof of supervision? Co-signature not enough Must provide evidence
November 6, 2009 Ohio OTPTAT Board 25
25
November 6, 2009 Ohio OTPTAT Board 26
26
November 6, 2009 Ohio OTPTAT Board 27
Supervision versus Collaboration
Evidence of collaboration/supervision within treatment documentation
Examples: Consulted with OT/L on 10/23/09 regarding
the possible updates to client treatment plan. /s/ Jane Doe, OTA/L
Per consultation with OT/L on 10/24/09, new STG to be added: Clt. will don pullover shirt with min A 3 out of 4 OT Treatment Sessions. /s/ Jane Doe, OTA/L
November 6, 2009 Ohio OTPTAT Board 28
Supervision versus Collaboration
Collaboration: Interactive process must include, but is not
limited to, review of the following Client assessment Reassessment Treatment plan Intervention Discontinuation of the intervention and/or
treatment plan
November 6, 2009 Ohio OTPTAT Board 29
Supervision versus Collaboration
Collaboration Who is responsible? ALL OT practitioners
How often? Supervisor & limited permit holder
(OT/OTA) must meet in person 1x/week OTA’s in first year of practice – minimum
of 1x/week OTA’s beyond first year of practice –
minimum of 1x/month
November 6, 2009 Ohio OTPTAT Board 30
Supervision versus Collaboration
PRN OT’s who evaluate and co-sign OTA notes only Responsible to provide supervision of any
occupational therapy personnel providing services
Unless transfer of OT care is documented, the OT of record is responsible for providing the supervision to occupational therapy personnel providing services
November 6, 2009 Ohio OTPTAT Board 31
Commonly Asked Questions - #1
I feel my employer is setting unrealistic productivity standards. Are there caseload requirements for occupational therapy practitioners?
Answer OT practice act does not specify # of clients on
occupational therapy caseload Regardless of practice setting, OT’s must provide
adequate supervision & assure that treatments follow safe & ethical standards
Licensees must protect the public by reporting any conduct they consider unethical, illegal or incompetent
November 6, 2009 Ohio OTPTAT Board 32
Commonly Asked Questions - #2
What are a PRN therapist’s responsibilities related to transfer of care?
Answer If the evaluating OT will no longer be available to
provide and supervise OT care, the client must be transferred to another OT The transfer must be documented
Each OT practice should determine a system for transfer of care
If client isn’t transferred, the evaluating OT is responsible for client’s OT program, including supervising OT personnel providing services
November 6, 2009 Ohio OTPTAT Board 33
Commonly Asked Questions - #3
How can I care for my clients when I’m on vacation?
Answer If the evaluating OT will no longer be available to
provide and supervise OT care, the client must be transferred to another OT The transfer must be documented
Termination of care does not include an OT going on vacation or taking regularly scheduled days off. In those situations, another OT would be providing coverage.
November 6, 2009 Ohio OTPTAT Board 34
Commonly Asked Questions - #4
I got a new job at a different facility. Does this mean that I’m abandoning my current clients?
Answer Abandonment is the inappropriate termination of the
therapist/client relationship by the OT. Abandonment is generally alleged when the
relationship is severed w/o reasonable notice at a time when treatments are still needed.
A facility that refuses to fill a vacant OT position does not constitute abandonment on part of the OT (provided that the OT gave reasonable notice).
November 6, 2009 Ohio OTPTAT Board 35
Commonly Asked Questions - #5
In school-based practice, can the IEP be used as the OT treatment/intervention plan?
Answer IEP goals & objectives written by educational
team DO NOT constitute the OT intervention plan
In addition to IEP goals/objectives addressed by OT practitioner, OT plan should include: Intervention approaches, types of interventions to be
used, outcomes, & any additional OT goals not listed in IEP
November 6, 2009 Ohio OTPTAT Board 36
Commonly Asked Questions - #6
What about supervisory ratios for OTAs in school based therapy?
Answer A full-time OT may supervise no more than 4 full-time
OTAs and/or LP holders. If OT only provides client evals & supervision w/o separate caseload, the OT may supervise 6.
This ratio may not be acceptable in school setting. OT is ultimately responsible for all clients/students served by the OTA. OTA does not maintain separate caseload.
OT must provide appropriate supervision and assure that treatments are rendered according to safe & ethical standards.
November 6, 2009 Ohio OTPTAT Board 37
Commonly Asked Questions - #7
Can OTAs complete home assessments?Answer OTAs can gather objective information and
report observations, with or without the patient and/or OT present.
It is the responsibility of the OT to interpret the data gathered by the OTA and make recommendations.
OT/OTA collaboration must be reflected in client documentation
November 6, 2009 Ohio OTPTAT Board 38
Commonly Asked Questions - #8
Can an OTA perform a discharge summary?
Answer An OTA may gather and summarize objective
information; however, they may not interpret this data.
It is the OT’s responsibility to interpret the data gathered by the OTA and make the recommendations for discharge plan development.
The collaboration between OT & OTA must be reflected in client documentation.
November 6, 2009 Ohio OTPTAT Board 39
Commonly Asked Questions - #9
How should the supervising OT co-sign the supervisee’s documentation?
Answer If client documentation includes any type of
treatment grid, a single co-signature and date of review on the form is sufficient.
For any hand-written documentation, each entry must be co-signed with name, credential, and date.
November 6, 2009 Ohio OTPTAT Board 40
Commonly Asked Questions - #10
What about electronic signatures?
Answer Electronic signatures are acceptable if security and
integrity are maintained. A copy of the individual’s name, handwritten signature,
and electronic signature must be on file where the electronic signature is used.
The supervising OT must co-sign and reference the dates of the entries into the client record. If needed, the OT may make a separate entry referencing
the date(s) of the note(s) being reviewed.
November 6, 2009 Ohio OTPTAT Board 41
Contacting the Board
Email: [email protected] Internet: http://otptat.ohio.gov Phone: 614-466-3774 Fax: 614-995-0816 Mail:
Ohio OTPTAT Board
77 S. High Street, 16th Floor
Columbus, OH 43215-6108