1. Update From the Athletic Trainers Section Ohio Occupational Therapy, Physical Therapy, and Athletic Trainers Board

2. May 16, 2009 Ohio OTPTAT Board2 Topics Why States Regulate Professions The Purpose of Regulatory Boards Recent Rules Changes Investigative/Disciplinary Process Other Common Questions/Issues

3. May 16, 2009 Ohio OTPTAT Board3 Why Regulate? To ensure protection of public health, safety, and welfare. Role of occupational licensing boards is to protect the public, not the licensee. Mission of the OTPTAT Board: To actively promote and protect the health of the citizens of Ohio through effective regulation of the professions of occupational therapy, physical therapy, and athletic training.

4. May 16, 2009 Ohio OTPTAT Board4 Forms of Regulation Registration (least restrictive) Certification Licensure (most restrictive) Good Resource on Professional Regulation Schmitt, Kara and Shimberg, Benjamin. (1996). Demystifying Occupational and Professional Regulation: Answers to Questions You May Have Been Afraid to Ask. Lexington, KY: The Council on Licensure, Enforcement and Regulation.

5. May 16, 2009 Ohio OTPTAT Board5 Why Have Licensure? Professions seek licensure to: Ensure minimum qualifications. Restrict practice. Strengthen entry into practice. Public protection. Legitimize profession. Public recognition; Reimbursement recognition States seek licensure to: Protect public health, safety, and welfare.

6. May 16, 2009 Ohio OTPTAT Board6 The Purpose of Regulatory Boards Establishing requirements for entry into profession. Adopting administrative rules. Disciplining licensees. Assuring continued competence of licensees.

7. May 16, 2009 Ohio OTPTAT Board7 Establishing Entry Requirements Education/Experience needed for licensure. E.g.: Graduation from accredited program. Assessing initial competence. Entrance examination. Passing score indicates individual is minimally competent to practice at an entry level.

8. May 16, 2009 Ohio OTPTAT Board8 Adopting Administrative Rules The law (Ohio Revised Code) is adopted by the legislature. The law delegates rule making authority to the regulatory board. Rules (Ohio Administrative Code) are adopted by the Board. Board must have statutory authority for all rules. Rules meant to clarify and implement the law. In Ohio, rules reviewed at least 1x every 5 years.

9. May 16, 2009 Ohio OTPTAT Board9 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 the Board’s website. Once filed, full text of the rules is available at: http://www.registerofohio.state.oh.us Public hearing on proposed changes required. Board’s goal is new rules go into effect on May 1.

10. May 16, 2009 Ohio OTPTAT Board10 Recent Rules Changes Key Changes Effective on May 1, 2008. 4755-42-01 – Use of title. Clarified (based on change in HB 403) that only individuals licensed by the Board may call themselves an athletic trainer or engage in the practice of athletic training. 4755-43-11 – Approval of an event. Procedure for AT Section approval of an event at which non-Ohio licensed athletic trainers will perform athletic training.

11. May 16, 2009 Ohio OTPTAT Board11 Approval of an Event Based on change made in HB 403 Allows ATs not tied to a traveling team to temporarily provide services w/o Ohio license. Non-Ohio licensed services may only be provided at an event approved by the AT Section. Ex: U.S. Track and Field Championships Not: AT from LSU traveling with and providing services to the AT’s visiting athletes.

12. May 16, 2009 Ohio OTPTAT Board12 Substantive 2009 Rules Changes Changes Effective May 2009 4755-41-01 – Code of Ethics Adds provisions related to verbal and sexual harassment 4755-43-06 – License Reinstatement Alters the CE requirement for reinstatement Any reinstatement apps submitted w/in 1 month of expiration Amt of CE needed to renew = amt for reinstatement

13. May 16, 2009 Ohio OTPTAT Board13 Substantive 2009 Rules Changes 4755-45-01 - Continuing Education Reduce amount needed from 50 hours to 25 hours Makes appropriate adjustments to category limits Grants credit for NATA accredited post- professional AT education program Eliminates credit for CPR/First Aid Still requires at least 1 hours of ethics each renewal

14. May 16, 2009 Ohio OTPTAT Board14 Renewal Cycle Change All AT’s will renew in even-numbered years. New expiration date… September 30. If you last renewed on 5/15/08. Renewed thru 9/30/10. Will pay $80 in 2010. Do 25 hrs of CE between 5/16/08 and 9/30/10. If you last renewed on 5/15/09. Renewed thru 9/30/10. Will pay $40 in 2010. Do 12 hrs of CE between 5/16/09 and 9/30/10. Licensees will get 4 free months due to change.

15. May 16, 2009 Ohio OTPTAT Board15 Disciplining Licensees Aside from licensure, discipline is most important function of boards. The law limits the violations that the board can take disciplinary action for and limits types of disciplinary action. Ex: Ohio OTPTAT Board had no authority to levy fines prior to April 6, 2007 (HB 403).

16. May 16, 2009 Ohio OTPTAT Board16 Disciplinary Process Licensees guaranteed due process rights. All actions must follow ORC Chapter 119. Board receives and investigates complaint. Board member, enforcement staff, AAG review investigation findings. Notice of Opportunity for Hearing issued. Administrative hearing conducted by Hearing Examiner. Full Board reviews Hearing Examiner findings.

17. May 16, 2009 Ohio OTPTAT Board17 Disciplinary Process Board issues Adjudication Order. Specifies the violation and the disciplinary action taken. Licensee may appeal order to court of common pleas. Most investigations settled via consent agreement in lieu of formal hearing.

18. May 16, 2009 Ohio OTPTAT Board18 What Do We Investigate? Physical abuse/injuries to a patient Patient neglect Falsification of documentation* Billing fraud* Failure to complete documentation prior to ending employment Mental impairment issues Drug/alcohol abuse Competency issues Criminal convictions Unprofessional behavior Unlicensed practice Failure to complete CEU’s required for license renewal Falsifying an application

19. May 16, 2009 Ohio OTPTAT Board19 Number of Cases Investigated Per Year

20. May 16, 2009 Ohio OTPTAT Board20 Most Common Violations CEU violations Unlicensed practice/improper use of title Practice prior to licensure Practice on an expired license Sexual misconduct Scope of practice issues Illegal advertising/soliciting of patients

21. May 16, 2009 Ohio OTPTAT Board21 Continuing Education Violations Standard Consent Agreement Terms Placed on probation until all consent agreement requirements met. Submit proof of completion of the number of deficient continuing education hours within 120 days of the effective date of the agreement. Pay fine within 90 days of the effective date of the agreement. Provide employer with copy of the agreement. Employer must acknowledge receipt of agreement. Agree to be audited on next renewal.

22. May 16, 2009 Ohio OTPTAT Board22 Fine Schedule for CE Violations # of Hours Deficient First Offense Fine Second Offense Fine Up to 5 Hours$100$200 6-25 Hours$200$400 26-50 Hours*$300$600

23. May 16, 2009 Ohio OTPTAT Board23 Tips To Stay Out Of Trouble Familiarize yourself with the laws and rules. Visit the Board’s website to stay abreast of any law changes. Use the Board’s website to verify that your license is in good standing. Notify the Board of any address or employment change within 30 days. (If you don’t, you may not receive your renewal information and end up practicing on an expired license, subjecting yourself to disciplinary action). DO YOUR CEU’s. If you have questions or concerns, contact the Board.

24. May 16, 2009 Ohio OTPTAT Board24 Things To Keep In Mind…. If you renew your license and do not receive a new pocket ID card with an updated expiration date, verify your licensure status with the Board prior to commencing practice after your expiration date. As healthcare professionals, you have an ethical obligation to report any behavior you believe is unethical and/or illegal. Disciplinary actions are public record and are permanent; be aware of your practice act and any changes that occur over the years.

25. May 16, 2009 Ohio OTPTAT Board25 Other Common Questions/ Issues OTPTAT v. BOC v. OATA ? What is the mission of the AT Section? Is there a licensure grace period? Can AT’s bill For services? Will I be subjected to a criminal records check? What is the role of the team physician? Standard Operating Procedures?

26. May 16, 2009 Ohio OTPTAT Board26 Other Common Questions/ Issues What is the role of the AT for visiting teams Injury, RTP, pre-game taping/treatments, documentation What is the role of the coach in taping injuries What happens when a team arrives and needs athletes taped, but has no referral from their AT or physician – can we legally tape them? Role of AT’s in Clinic

27. May 16, 2009 Ohio OTPTAT Board27 OTPTAT v. BOC v. OATA The Alphabet Soup of the Profession OTPTAT is your state regulatory agency. It licenses individuals and enforces the practice act. BOC is a certification entity. Certification allows a practitioner to use the credentials ATC. It is not mandatory that you hold certification. OATA is the state professional association. Along with the NATA, it advocates on the state/federal level for the profession.

28. May 16, 2009 Ohio OTPTAT Board28 Licensure Grace Period There is NO licensure grace period. Between graduation and receiving a license, a new graduate is an UNLICENSED SUPPORT PERSON. Individuals licensed as AT’s in a state other than Ohio can only work as unlicensed support personnel until the Board issues an Ohio AT license. Help keep prospective licensees out of trouble!

29. May 16, 2009 Ohio OTPTAT Board29 Criminal Records Checks HB 104 requires the Board to receive results of FBI and BCI records checks before issuing license. Only applies for initial applications. Not a requirement for license renewal. Ink rolled fingerprints for out of state applicants can take 3-4 months. Be aware of this time frame if you’re hiring from out of state. No license issued until Board receives the criminal records check results.

30. May 16, 2009 Ohio OTPTAT Board30 Change of Address Ohio law requires all licensees to notify the Board, in writing, of a change of address within THIRTY days of the change. Failure to notify the Board, could result in the delay of the processing of your renewal application.

31. May 16, 2009 Ohio OTPTAT Board31 Role of the Team Physician Referral relationship must exist between AT and team physician for care of that team’s athletes. Revised Code section 4755.60 and Administrative Code rule 4755-42-02. ATs employed by colleges, universities, high schools, other scholastic institutions, and professional organizations/clubs function under this referral relationship.

32. May 16, 2009 Ohio OTPTAT Board32 Role of the Team Physician This relationship should consist of: A protocol of care communicated between the team physician and the athletic trainer This relationship should include procedures for: Prevention, recognition, assessment, management, treatment, disposition, and reconditioning of athletic injuries.

33. May 16, 2009 Ohio OTPTAT Board33 Role of the Team Physician A referral relationship between a team physician and an athletic trainer requires interaction by both parties. In general practice, athletic trainers administer first aid and team physicians initiate referrals for continued treatment. This relationship is maintained by on-going verbal and written communication.

34. May 16, 2009 Ohio OTPTAT Board34 Standard Operating Procedures AT’s professional responsibility to have written policies and procedures. AT’s encouraged to review current policies and procedures with their employers to determine if the existing policies are within the scope of athletic training practice. AT Section has no guidelines re: policy and procedure content. AT Section does advocate that all AT’s have written policies and procedures to guide the day-to-day operations of athletic training care.

35. May 16, 2009 Ohio OTPTAT Board35 Standard Operating Procedures If no athletic training policies and procedures exist, please establish them and put them in writing. Standard operating policies and procedures should be reviewed and approved by a team physician or an organization’s medical director.

36. May 16, 2009 Ohio OTPTAT Board36 Role of the AT for Visiting Teams Athletic trainers may provide visiting teams, traveling without an athletic trainer or a team physician, with first aid and emergency coverage only. They should not provide treatments without an appropriate referral or make return to participation decisions for visiting athletes.

37. May 16, 2009 Ohio OTPTAT Board37 Role of the Coach in Taping Injuries Taping an athlete can be accomplished by many different individuals, such as athletic trainers, physical therapists, physicians, coaches, and even other athletes. Athletes sometimes request to be taped by a prophylactic measure or as a ritual for participation. Prophylactic taping is not care of an injury It does not call for the degree of skill in selection of taping method or application, as might be used by a licensed health care practitioner.

38. May 16, 2009 Ohio OTPTAT Board38 Role of the Coach in Taping Injuries Why an individual is being taped is determining factor in deciding who is permitted to tape an athlete. If a taping or strapping/wrapping procedure or application is necessary as part of a regime of the care of an injury, this is only to be done by a licensed health care practitioner. With increasing the standards of care for athletes, there are situations that call for taping as care of an injury, as required to participate, as determined by a referral source. Such a directive or prescribed method of care should only be applied by a licensed health care practitioner.

39. May 16, 2009 Ohio OTPTAT Board39 How may an AT function in the Clinic Setting? Under an AT Referral from an accepted practitioner, the AT functions independently and is responsible for documentation Provide athletic training services (evaluation and treatment) based upon physician referral

40. May 16, 2009 Ohio OTPTAT Board40 How may an AT function in the Clinic Setting? Under a PT Referral, the athletic trainer functions as “Other Licensed Personnel” AT cannot be assigned own physical therapy caseload without supervising PT having direct contact with each patient each visit. Under a PT referral, “Other Licensed Personnel” have limits on making adjustments to the established plan of care

41. May 16, 2009 Ohio OTPTAT Board41 Billing For Services Billing is not within the Board’s jurisdiction, unless billing fraud is suspected. Nothing in the practice act prevents AT’s from billing for services. Contact the OATA, or the NATA, or refer to the CPT codes listed under physical medicine for billing advice.

42. May 16, 2009 Ohio OTPTAT Board42 Billing, Medicare and BWC The Board has no jurisdiction over billing/Medicare/BWC matters, unless fraud is suspected. The Board cannot assist in clarification of Medicare/BWC issues. The Board does not give billing advice.

43. May 16, 2009 Ohio OTPTAT Board43 Listserv Used to notify licensees & interest parties of: Website changes Public hearings Laws/Rules changes Timely and Cost-effective To join the listserv: Send email request to board@otptat.ohio.govboard@otptat.ohio.gov State that you want to join the AT list.

44. May 16, 2009 Ohio OTPTAT Board44 Board Composition – AT Section MemberCityTerm ExpiresTerm Vince O’Brien AT Section Chair Columbus20092nd Rebekah Bower AT Section Secretary Centerville20111st Aaron GalpertWadsworth20101st Brian HortzPataskala20111st Randy WroblePowell20101st All terms expire on Aug. 27 of designated year. Pursuant to ORC 4755.01, members shall not serve for more than 3 consecutive terms.

45. May 16, 2009 Ohio OTPTAT Board45 Board Composition The Board also has a public member who represents the interests of consumers. Genevieve Dennison – New Richmond. 1 st 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

46. May 16, 2009 Ohio OTPTAT Board46 Contacting the Board Email: board@otptat.ohio.gov Internet: http://otptat.ohio.govhttp://otptat.ohio.gov Phone: 614-466-3774 Fax: 614-995-0816 Mail: Ohio OTPTAT Board 77 S. High Street, 16 th Floor Columbus, OH 43215-6108

47. May 16, 2009 Ohio OTPTAT Board47 Questions?