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

2. Ohio OTPTAT Board2 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

3. November 6, 2009 Ohio OTPTAT Board3 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

4. November 6, 2009 Ohio OTPTAT Board4 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

5. November 6, 2009 Ohio OTPTAT Board5 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

6. November 6, 2009 Ohio OTPTAT Board6 Board Composition – OT Section MemberCity Term Expires Term Kim Lawler, OT, ChairFrazeysburg20101 st Jean Halpin, OT, SecretaryWesterville20111 st Becky Finni, OTAmelia20101 st Nan Shoemaker, OTAMiamisburg20122 nd Mary Stover, OTColumbus20122 nd All terms expire on Aug. 27 of designated year. Pursuant to ORC 4755.01, members shall not serve for more than 3 consecutive terms.

7. November 6, 2009 Ohio OTPTAT Board7 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

8. November 6, 2009 Ohio OTPTAT Board8 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

9. November 6, 2009 Ohio OTPTAT Board9 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

10. November 6, 2009 Ohio OTPTAT Board10 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

11. November 6, 2009 Ohio OTPTAT Board11 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.

12. November 6, 2009 Ohio OTPTAT Board12 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

13. November 6, 2009 Ohio OTPTAT Board13 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

14. November 6, 2009 Ohio OTPTAT Board14 Don’t Wait Until June 30 to Renew

15. November 6, 2009 Ohio OTPTAT Board15 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

16. November 6, 2009 Ohio OTPTAT Board16 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

17. November 6, 2009 Ohio OTPTAT Board17 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

18. November 6, 2009 Ohio OTPTAT Board18 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

19. November 6, 2009 Ohio OTPTAT Board19 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

20. November 6, 2009 Ohio OTPTAT Board20 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

21. November 6, 2009 Ohio OTPTAT Board21 # of Cases Investigated Per Year

22. November 6, 2009 Ohio OTPTAT Board22 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

23. November 6, 2009 Ohio OTPTAT Board23 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”

24. November 6, 2009 Ohio OTPTAT Board24 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

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27. November 6, 2009 Ohio OTPTAT Board27 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

28. November 6, 2009 Ohio OTPTAT Board28 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

29. November 6, 2009 Ohio OTPTAT Board29 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

30. November 6, 2009 Ohio OTPTAT Board30 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

31. November 6, 2009 Ohio OTPTAT Board31 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

32. November 6, 2009 Ohio OTPTAT Board32 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

33. November 6, 2009 Ohio OTPTAT Board33 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.

34. November 6, 2009 Ohio OTPTAT Board34 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).

35. November 6, 2009 Ohio OTPTAT Board35 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

36. November 6, 2009 Ohio OTPTAT Board36 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.

37. November 6, 2009 Ohio OTPTAT Board37 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

38. November 6, 2009 Ohio OTPTAT Board38 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.

39. November 6, 2009 Ohio OTPTAT Board39 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.

40. November 6, 2009 Ohio OTPTAT Board40 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.

41. November 6, 2009 Ohio OTPTAT Board41 Contacting the Board Email: board@otptat.ohio.govboard@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