Update from the Ohio Occupational Therapy Board

1. Update from the Ohio Occupational Therapy Board Ohio Occupational Therapy Association State Conference November 6, 2009

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 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 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 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 Ohio OTPTAT Board

6. Board Composition – OT Section 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 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 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 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 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. 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 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 Ohio OTPTAT Board

14. Don’t Wait Until June 30 to Renew 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: board@otptat.ohio.gov • State which listserv you’d like to join 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 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 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 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 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 Ohio OTPTAT Board

21. # of Cases Investigated Per Year Ohio OTPTAT Board

22. Types of Cases Investigated – 2004-08 • Practice on expired license (EXP) & aiding/abetting unlicensed practice (ULP) account for largest % of cases • Fraudulent billing cases increasing 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” 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 Ohio OTPTAT Board

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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 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 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 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 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 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 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. 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). 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 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. 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 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. 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. 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. Ohio OTPTAT Board

41. Contacting the Board • Email: board@otptat.ohio.gov • 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 Ohio OTPTAT Board