update from the ohio occupational therapy board ohio occupational therapy association state...

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


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


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


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


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.


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


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


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


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


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.


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


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


Don’t Wait Until June 30 to Renew


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


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


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


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


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


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


# of Cases Investigated Per Year

0

5

10

15

20

25

30

35

40

45

2001 2002 2003 2004 2005 2006 2007 2008

Cases


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


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”



What is supervision? OAC Rule 4755-7-01

Why supervision? Supervision ensures consumer protection

Proof of supervision? Co-signature not enough Must provide evidence


25


26



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



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



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



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


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



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



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.



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).



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



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.



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



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.



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.



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.


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

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