2265355 To clarify supervision and duty scope of occupational therapy aides, clarify continuing education requirements for several types of persons, and impose time limit for responses to continuing education audits.
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DEPARTMENT OF HEALTH
NOTICE OF FINAL RULEMAKING
The Director of the Department of Health, pursuant to the authority set forth in section 302(14) of the District of Columbia Health Occupations Revision Act of 1985 (Act), effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code § 3-1203.02(14) (2007 Repl.)), and Mayor’s Order 98-140, dated August 20, 1998, hereby gives notice of the adoption the following amendments to Title 17 (Business, Occupations, and Professions) of the District of Columbia Municipal Regulations (DCMR).
This rulemaking will clarify permitted duties for and supervision of occupational therapy aides, clarify continuing education requirements for persons applying for licensure as occupational therapists or occupational therapy assistants by reinstatement or reactivation, and clarify that persons who are audited for continuing education must respond within 30 days.
These rules were previously published in the D.C. Register as proposed rulemaking on November 11, 2011, at 58 DCR 9555. No written comments were received from the public in connection with this publication during the thirty (30)-day comment period and no substantive changes have been made from the rulemaking. A technical correction was made changing the term “client” in sections 6312 and 6313 to “patient” for consistency with the definition of the practice of occupational therapy. A further technical correction was made to correct the effective date of the Health Occupations Revision Act.
The Department took final rulemaking action on January 24, 2012. These final rules will be effective upon publication of this notice in the D.C. Register.
Chapter 63, OCCUPATIONAL THERAPY, of title 17, BUSINESS, OCCUPATIONS, AND PROFESSIONS, of the DCMR is amended as follows:
Title 17 DCMR is amended as follows:
Section 6303, APPLICANTS EDUCATED IN A FOREIGN COUNTRY, is amended as follows:
Subsection 6303.1 is amended to read as follows:
6303.1 The Board may grant a license to practice to an applicant who has his or her exam scores submitted from the National Board for Certification in Occupational Therapy (NBCOT) to the Board and who has completed an educational program in a foreign country whose program is approved by the World Federation of Occupational Therapists.
Subsection 6303.2 is amended as follows:
6303.2 The applicant shall be currently certified by the National Board for Certification in Occupational Therapy (NBCOT).
The current sections 6303.2-6303.4 are renumbered as 6303.3-6303.5.
Section 6304, NATIONAL EXAMINATION, subsection 6304.4 is amended to read as follows:
6304.4 An applicant who is working under a supervised practice letter and who has failed the national examination shall immediately cease working as an occupational therapist or occupational therapy assistant.
Section 6306, CONTINUING EDUCATION REQUIREMENTS, is amended to read as follows:
6306 CONTINUING EDUCATION REQUIREMENTS
6306.1 This section shall not apply to applicants for an initial license by examination, reciprocity, or endorsement, nor does it apply to applicants for the first renewal of a license granted by examination.
6306.2 A continuing education contact hour shall be valid only if it is part of a program or activity that the Board approves in accordance with § 6307.
6306.3 Practitioners applying for license renewal shall complete contact hours of qualified activities for maintaining continuing education during the two (2) year period preceding the date the license expires in the following manner:
(a) Occupational therapists shall complete a minimum of twenty-four (24) contact hours; and
(b) Occupational therapy assistants shall complete a minimum of twelve
(12) contact hours.
6306.4 An applicant under this section shall prove completion of required continuing education contact hours by submitting with the application the following information with respect to each program:
(a) The name and address of the sponsor of the program;
(b) The name of the program, its location, a description of the subject
matter covered, and the names of the instructors;
(c) The dates on which the applicant attended the program;
(d) The number of contact hours claimed;
(e) Verification by the sponsor of the applicant's completion, by signature or stamp of the sponsor; and
(f) The name of the attendee.
6306.5 An applicant for renewal of a license who fails to submit proof of having completed continuing education requirements by the date the license expired may renew the license up to sixty (60) days after expiration by submitting the proof pursuant to § 6306.4 and by paying the required additional late fee. The license shall be effective on the date of the renewal.
6306.6 The Board may, in its discretion, grant an extension of the sixty (60) day period to renew after expiration if the applicant's failure to submit proof of completion was for good cause. As used in this section, “good cause” includes the following:
(a) Serious and protracted illness of the applicant; or
(b) The death or serious and protracted illness of a member of the
applicant's immediate family.
6306.7 If the license of an occupational therapist or occupational therapy assistant lapses while serving in the military whenever the United States is engaged in active military operations against any foreign power or hostile force, and the required continuing education hours were not earned during the earning period, the licensee shall be required to complete the required continuing education hours needed no later than six (6) months after discharge from active service, return to inactive military status, or return to the United States from an active war zone.
6306.8 The continuing education contact hours completed shall not be used for the next licensing period.
6306.9 The continuing education contact hours for the next licensing period shall not be prorated.
6306.10 Practitioners who are licensed to practice in a jurisdiction other than the District shall meet the requirements of this section in order to maintain licensure in the District. The licensee shall ensure that the continuing education courses fall within the relevant time period for the District of Columbia.
6306.11 Any applicant for licensure as an occupational therapist or occupational therapy assistant who applies after the renewal date shall submit proof of having completed all continuing education requirements with the application.
Section 6307, APPROVED CONTINUING EDUCATION PROGRAMS AND ACTIVITIES, is amended as follows:
Subsection 6307.2 is amended to read as follows:
6307.2 The Board shall approve continuing education programs and activities that are relevant to the practice or education of occupational therapists and occupational therapy assistants that document the following:
(a) Current subject matter with course description;
(b) Content focus;
(c) Learning outcomes;
(d) Target audience;
(e) Satisfactory completion of the course by the course participant; and
(f) The number of contact hours or continuing education units.
Subsection 6307.3 is amended to read as follows:
6307.3 The Board shall approve the following types of activities provided that they are consistent with provisions of these regulations:
(a) Activities sponsored by the state or local occupational therapy organizations;
(b) Activities sponsored by the American Occupational Therapy Association (AOTA), the American Physical Therapy Association (APTA), the American Speech-Language-Hearing Association (ASHA), and the American Society of Hand Therapists (ASHT);
(c) Activities sponsored by AOTA approved providers;
(d) Activities sponsored by an accredited healthcare facility; or
(e) Activities sponsored by an accredited college or university.
A new subsection 6307.7 is added as follows:
6307.7 The licensee shall be responsible for explaining to the Board why supervisory activities, professional volunteer activities, or serving as an instructor, speaker, publisher or editor are eligible for credit.
Section 6308, CONTINUING EDUCATION CREDITS, is amended as follows:
Subsection 6308.7 is amended to read as follows:
6308.7 The Board may grant an applicant for renewal up to six (6) contact hours for the renewal period, for participation as a primary clinical fieldwork educator for Level II occupational therapy or occupational therapy assistant fieldwork students with the following documentation:
(a) Name of student as verified by the school;
(b) Name of the school;
(c) Dates of the fieldwork; and
(d) Signature page of student evaluation excluding evaluation scores and comments on student.
Subsection 6308.8 is amended to read as follows:
6308.8 The Board may grant an applicant for renewal up to six (6) contact hours for the renewal period for serving as a supervisor for an occupational therapist or occupational therapy assistant who is in the process of reactivating his or her license. The supervisor shall provide the Board with a supervised practice letter.
The current subsections 6308.8-6308.11 are renumbered as 6308.9-6308.12.
Section 6309, SUPERVISION, is repealed and replaced with:
6309 REACTIVATION
6309.1 Reactivation shall apply to persons who are in inactive status.
6309.2 An applicant for reactivation of an occupational therapy or occupational therapy assistant license that has been inactive five (5) years or less who does not hold a license in any other jurisdiction, shall submit proof pursuant to §6307 of having completed twelve (12) contact hours in clinical coursework in an approved continuing education program for each year that the applicant was not licensed, up to a maximum of sixty (60) hours.
6309.3 An applicant for reactivation of an occupational therapy license that has been inactive for more than 5 (five) years, who does not hold an active license in any other jurisdiction, shall submit proof pursuant to § 6307 of having completed the following:
(a) Twelve (12) contact hours in clinical coursework in an approved continuing competence program for each year that the applicant was not licensed, up to a maximum of sixty (60) hours. Twenty-four (24) of those contact hours shall have been completed within two (2) years prior to the date the application is submitted; and
(b) One hundred sixty (160) hours of supervised clinical training by a licensed occupational therapist within the two (2) months prior to the date
the application is submitted.
6309.4 An applicant for reactivation of a license to practice as an occupational therapy assistant that has been inactive for more than five (5) years, who does not hold an active license in any other jurisdiction, shall submit proof pursuant to § 6307 of having completed the following:
(a) Six (6) contact hours in an approved continuing education program for each year that the applicant was not licensed, up to a maximum of thirty (30) hours. Twelve (12) contact hours within two (2) years prior to the date the application is submitted; and
(b) One hundred sixty (160) hours of supervised clinical training within the two (2) months prior to the date the application is submitted.
6309.5 An applicant for reactivation of an occupational therapy license who holds an active license in any other jurisdiction shall not be required to submit proof of continuing education contact hours with the application.
6309.6 An applicant for reactivation of an occupational therapy assistant license who holds an active license in any other jurisdiction shall not be required to submit proof of continuing education contact hours with the application.
6309.7 An applicant for reactivation of an occupational therapy or occupational therapy assistant license whose license has been inactive for less than five (5) years and who holds a license in another jurisdiction shall not be required to submit proof of continuing education contact hours with the application.
Section 6310, SUPERVISION OF PRACTICE FOR OCCUPATIONAL THERAPY ASSISTANTS, is repealed and replaced with:
6310 REINSTATEMENT
6310.1 Reinstatement shall apply to persons with expired licenses.
6310.2 A person may not apply for reinstatement if his or her license has been expired for more than five (5) years.
6310.3 An applicant for reinstatement of a license to practice as an occupational therapist who holds an active license in any other jurisdiction shall submit proof of having completed twelve (12) contact hours in an approved continuing education program for each year that the applicant was not licensed, up to a maximum of sixty (60) hours. Twenty-four (24) hours must have been completed within two (2) years prior to the date the application is submitted.
6310.4 An applicant for reinstatement of a license to practice as an occupational therapist who does not hold an active license in any jurisdiction shall submit proof pursuant to § 6307 of having completed the following:
(a) Twelve (12) contact hours in clinical coursework in an approved continuing education program for each year that the applicant was not licensed up to a maximum of sixty (60) hours. Twenty-four (24) contact hours shall have been completed within two (2) years prior to the date the application is submitted; and
(b) One hundred sixty (160) hours of supervised clinical training by a licensed occupational therapist within two (2) months prior to the date the application is submitted.
6310.5 An occupational therapy assistant applicant for reinstatement who holds a current license in any other jurisdiction shall submit proof of having completed six (6) contact hours in an approved continuing education program for each year that the applicant was not licensed up to a maximum of thirty (30) hours. Twelve (12) contact hours must have been completed within two (2) years prior to the date the application is submitted.
6310.6 An applicant for reinstatement of a license to practice as an occupational therapy assistant who does not hold a current license in any other jurisdiction, shall submit proof pursuant to § 6307 of having completed the following:
(a) Six (6) contact hours in an approved continuing education program for each year that the applicant was not licensed up to a maximum of thirty (30) hours. Twelve (12) contact hours must have been within two (2) years prior to the date the application is submitted; and
(b) One hundred sixty (160) hours of supervised clinical training
within the two (2) months prior to the date the application is submitted.
Section 6311, CONTINUING EDUCATION CREDIT AUDIT, is repealed and replaced with:
6311 ENDORSEMENT
6311.1 The Board shall issue a license by endorsement to an occupational therapist or an occupational therapy assistant who has a valid unrestricted license in good standing from another jurisdiction of the United States and who meets all other requirements of this section.
6311.2 An applicant for licensure as an occupational therapist or an occupational therapist assistant by endorsement shall submit with a completed application the following:
(a) Official, certified proof of active licensure in at least one (1) jurisdiction;
(b) Proof of good standing from all jurisdictions in which the occupational therapist ever held a license in the United States;
(c) Official, certified proof, from the body administering the examination, that the applicant has passed the Board-approved occupational therapy or occupational therapy assistant national licensure examination (as relevant to the license); and
(d) Proof that the applicant is a graduate of a professional occupational therapy
or occupational therapy assistant education program, as relevant to the license, accredited by an agency that the United States Department of Education recognizes for that purpose, or that the Board approves.
Section 6312, LAWFUL PRACTICE, is repealed and replaced with:
6312 RESPONSIBILITIES
6312.1 An occupational therapist shall exercise sound judgment and provide adequate care in the performance of duties in accordance with nationally recognized standards of practice while treating patients or supervising the treatment of patients.
6312.2 An occupational therapist shall be responsible for managing all aspects of the occupational therapy care of each patient. An occupational therapist shall provide the following:
(a) The initial evaluation and treatment plan for each patient and all supporting documentation;
(b) Periodic reevaluation for each patient and all supporting documentation; and
(c) The documented discharge of the patient, including the response to the intervention at the time of discharge.
6312.3 An occupational therapist shall:
(a) Directly supervise all students training to be occupational therapists or
(b) Countersign all documentation that the students draft.
6312.4 An occupational therapist or occupational therapy assistant supervising a student shall be responsible for all of the students’ actions performed within the scope of practice during the time of supervision and shall be subject to disciplinary action for any violation of the Act or this chapter by the person supervised.
A new section 6313 is added to read as follows:
6313 STANDARDS OF PRACTICE FOR OCCUPATIONAL THERAPY ASSISTANTS
6313.1 An occupational therapy assistant shall exercise reasonable judgment and provide adequate care in the performance of duties in accordance with nationally recognized standards of practice.
6313.2 An occupational therapy assistant may only practice under the general supervision of a licensed occupational therapist who is authorized to practice in the District of Columbia. The occupational therapist must be available on an as-needed basis and must be available to be on-site in the event of a clinical incident within two (2) hours.
6313.3 An occupational therapist shall provide the following:
(a) Direct supervision of an occupational therapy assistant prior to initiating
treatment programs and before planned discharges for patients;
(b) An initial and, at a minimum, bimonthly direction to the occupational therapy assistant; and
(c) Documentation for verification of supervision and direction.
6313.4 A supervising occupational therapist shall delegate duties and responsibilities for the care of patients to the occupational therapy assistant with consideration given
to the following:
(a) The level of skill shown by the occupational therapy assistant;
(b) The ability to use identified intervention in a safe and effective manner;
(c) Experience of the occupational therapy assistant and work setting demands; and
(d) The complexity and stability of the patient population to be treated.
6313.5 An occupational therapy assistant shall assist in the collection and some of the documentation of patient information pertaining to the evaluation and treatment of a patient. The extent of this involvement shall be based on the demonstrated competency of the occupational therapy assistant. This demonstrated competency shall be documented and maintained on file by the supervising occupational therapist.
6313.6 An occupational therapy assistant shall not supervise another occupational therapy assistant.
6313.7 An occupational therapy assistant shall immediately inform the supervising occupational therapist and discontinue treatment if the procedure appears to be harmful to the patient.
A new section 6314 is added to read as follows:
6314 OCCUPATIONAL THERAPY AIDES
6314.1 An occupational therapy aide shall be permitted to do the following:
(a) Under direct supervision, set up materials for treatment for the occupational therapist or occupational therapy assistant or Level II fieldwork students; and
(b) Under immediate supervision of an occupational therapist, activities of daily living, transfer activities, hot or cold packs, and paraffin baths.
6314.2 An occupational therapy aide shall not be permitted to do the following under any circumstance:
(a) Interpret care plans;
(b) Participate in care conferences;
(c) Provide any hands-on care except as specified above;
(d) Interpret referrals;
(e) Perform evaluation procedures;
(f) Initiate or adjust treatment programs;
(g) Assume responsibility for planning treatment care; or
(h) Document care given to include checklists or other forms of documentation as appropriate.
A new section 6315 is added to read as follows:
6315 CONTINUING EDUCATION AUDIT
6315.1 The Board may audit up to twenty percent (20%) of the number of licensees to determine compliance with the continuing education contact hour requirements.
6315.2 Upon notification by the Board that a licensee has been selected for an audit, the licensee shall submit the required documentation within thirty (30) days of receipt of the notice.
A new section 6316 is added to read as follows:
6316 LAWFUL PRACTICE
6316.1 An occupational therapist or occupational therapy assistant licensed to practice in the District of Columbia shall adhere to the AOTA’s Code of Ethics for the practice of occupational therapy as it may be amended from time to time.
6316.2 An occupational therapist may purchase, store, and administer topical and aerosol medications as part of the practice of occupational therapy as defined herein, as long as the purchasing, storing, and administration of these medications are carried out pursuant to all laws and regulations of the Federal Government and the District of Columbia.
6316.3 An occupational therapist shall use the letters “OT”, “OTR”, “LOT”, “OTR/L” or any other similar title or description in connection with the occupational therapist's name or place of business to denote licensure pursuant to the Act.
6316.4 A business providing and billing for occupational therapy services pursuant to the Act shall only advertise or otherwise promote an occupational therapist that is licensed.
6316.5 An occupational therapy assistant shall use the letters “OTA”, “COTA”, “OTA/L”, “COTA/L”, or any other similar title or description in connection with the occupational therapy assistant's name or place of business to denote licensure pursuant to the Act.
6316.6 An applicant for licensure shall not engage in any type of practice until an application for licensure and a supervised practice form are submitted to the Board.
6316.7 An applicant may practice for no more than sixty (60) days under a supervised practice form. The supervised practice form shall not be renewed.
6316.8 An occupational therapy aide shall not be permitted to use any credentials.
6316.9 Students shall identify themselves as such to patients. An occupational therapy student shall sign all documentation with the notation “occupational therapy student” or “OT student,” and occupational therapy assistant students shall sign all documentation with the notation “occupational therapy assistant student” or “OTA student.”
Section 6399, DEFINITIONS, subsection 6399.1 is amended as follows:
The definition of “Direct supervision” is deleted in its entirety and is replaced with:
Direct supervision - supervision in which an occupational therapist is personally present and immediately available within the treatment area to give aid, direction, and instruction when occupational therapy procedures or activities are performed.
The definition of “General supervision” is deleted in its entirety and is replaced with:
General supervision - supervision in which the supervisor is available on the premises
or by communication device at the time the supervisee is practicing, and can be on-site in the event of a clinical emergency within two (2) hours.
The definition of “occupational therapy” is deleted in its entirety and is replaces with:
Occupational therapy- (i) The therapeutic use of everyday life activities with individuals or groups, with or without compensation, for the purpose of participation in roles and situations in homes, schools, workplaces, communities, and other settings to promote health and welfare for those who have or are at risk for developing an illness, injury, disease, disorder, condition, impairment, disability, activity limitation, or participation restriction; (ii) Addressing the physical, cognitive, psycho-social, sensory, or other aspects of performance in a variety of contexts to support engagement in everyday life activities that affect health, well-being, and quality of life; (iii) The education and training of persons in the direct care of patients through the use of occupational therapy; and (iv) The education and training of persons in the field of occupational therapy.
The following definition is added after “Occupational therapy”
Occupational therapy aide - a person who has received on-the-job training in occupational therapy and is employed in an occupational therapy setting under the immediate supervision of a licensed occupational therapist.
