PROPOSED RULES
(Occupational Therapy Practice Board)
Original Notice.
Preproposal statement of inquiry was filed as WSR 06-15-126.
Title of Rule and Other Identifying Information: WAC 246-847-010 Definitions, new section WAC 246-847-135 Standards of supervision, and WAC 246-847-130 Definition for "commonly accepted standards for the profession."
Hearing Location(s): Department of Health, Town Center 2, Room 158, 111 Israel Road S.E., Tumwater, WA 98501, on April 27, 2007, at 9:30 a.m.
Date of Intended Adoption: April 27, 2007.
Submit Written Comments to: Vicki Brown, Program Manager, Occupational Therapy Practice Board, P.O. Box 47867, Olympia, WA 98504-7867, e-mail vicki.brown@doh.wa.gov, web site http://www3.doh.wa.gov/policyreview/, fax (360) 664-9077, by April 20, 2007.
Assistance for Persons with Disabilities: Contact Vicki Brown, Program Manager, by April 20, 2007, TTY (800) 833-6388 or 711.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: WAC 246-847-010 Definitions, the proposed changes will eliminate unnecessary definitions and clarify existing definitions.
WAC 246-847-135 Standards of supervision, the proposed rule establishes standards for occupational therapy assistants and aides that are consistent with the American Occupational Therapy Association (AOTA) guidelines.
WAC 246-847-130 Definition for "commonly accepted standards for the profession," this rule is being repealed as it is being moved to the definitions section.
Reasons Supporting Proposal: The proposed changes will address concerns expressed by practitioners regarding unclear definitions and appropriate levels of supervision. The board is proposing eliminating unnecessary definitions, clarifying existing definitions and ensuring protection of the public by updating the supervision standards for occupational therapy assistants and aides to be consistent with the AOTA guidelines. The board initiated this process under an earlier CR-101 which was withdrawn because it did not clearly cover the desired scope of the rule change.
Statutory Authority for Adoption: RCW 18.59.130.
Statute Being Implemented: RCW 18.59.130.
Rule is not necessitated by federal law, federal or state court decision.
Name of Proponent: Department of health, occupational therapy practice board, governmental.
Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Vicki Brown, Program Manager, 310 Israel Road S.E., Tumwater, WA 98501, (360) 236-4865.
A small business economic impact statement has been prepared under chapter 19.85 RCW.
The proposed rule amendments in WAC 246-847-010 seek to place all definitions in one location for ease in locating. These amendments consist of:
| • | Condensed, clarified wording, grammar, structure, and formatting. |
| • | Modifying the definitions of: |
| o | Occupations - means "activities having unique meaning and purpose in an individual's life." |
| o | Direct supervision - means a person with a limited permit, "has daily, in person contact at the work site by an occupational therapist or occupational therapy assistant licensed in the state of Washington." |
| o | Professional supervision is for an occupational therapy aide as described in RCW 18.59.020(5) means "in person contact at the work site at least weekly by an occupational therapist or occupational therapy assistant licensed in the state of Washington." |
| o | Regular consultation is for an occupational therapy assistant and means "in person contact at least monthly by an occupational therapist licensed in the state of Washington with supervision available as needed by other methods." |
| o | In association is for a person with a limited permit and means "practicing in a setting in which an occupational therapist licensed in the state of Washington is available on the premises for supervision, consultation, and assistance as needed to provide protection for the client's health, safely [safety] and welfare." |
| • | Add the definition of "consultation" which means "practitioners are expected to function as consultants within the scope of practice appropriate to their level of competence." |
| • | Delete the definition of the term, "contact hour." |
| • | Moved the definition of "working days" from WAC 246-847-110 to 246-847-010(10). |
| • | Moved the definition of "Commonly accepted standard for the profession" from WAC 246-847-130 to 246-847-010(11). |
| o | Direct supervision - means a person with a limited permit, "has daily, in person contact at the work site by an occupational therapist or occupational therapy assistant licensed in the state of Washington." |
| o | Professional supervision is for an occupational therapy aide as described in RCW 18.59.020(5) means "in person contact at the work site at least weekly by an occupational therapist or occupational therapy assistant licensed in the state of Washington." |
| o | Regular consultation is for an occupational therapy assistant and means "in person contact at least monthly by an occupational therapist licensed in the state of Washington with supervision available as needed by other methods." |
| SIC Industry Code and Title | # of Businesses | # of Employees | Average # of Employees for Smallest Businesses | Average # of Employees for 10% of Largest Businesses | ||||
| 8049 Offices of health practitioners, nec | 913 | 5,450 | 3 | 27 | ||||
| 8051 Skilled nursing care facilities | 281 | 26,407 | 15 | 144 | ||||
| 8052 Intermediate care facilities | 29 | 1,651 | 22 | 147 | ||||
| 8059 Nursing and personal care, nec | 110 | 4,081 | 35 | 160 | ||||
| 8062 General medical & surgical hospital | 146 | 78,593 | 11 | 2,028 | ||||
| 8069 Specialty hospitals exc. Psychiatrist | 23 | 4,106 | 15 | 168 | ||||
| 8082 Home health care services | 169 | 7,408 | 14 | 163 | ||||
| 8093 Specialty outpatient clinics, nec | 245 | 7,530 | 9 | 114 | ||||
| 8099 Health and allied services, nec | 93 | 1,484 | 143 | 64 | ||||
| Supervision or consultation | Frequency | Persons involved |
| Direct supervision | Daily | OT or OTA & Graduate with limited permit |
| Professional supervision | Weekly | OT or OTA & Aides |
| Regular consultation | Monthly | OT & OTA |
| OT - 1 hour daily | 52 X 5 = 260 X $26.28 = $6,382.80 |
| OT Assistant - 1 hour daily | 52 X 5 = 260 X $18.48 = $4,804.80 |
| OT Aide - 1 hour daily | 52 X 5 = 260 X $11.13 = $2,893.80 |
| OT new grad - 1 hour daily | 52 X 5 = 260 X $18.48 = $4,804.80 |
OT - 1 hour weekly |
52 X $26.28 = $1,366.56 |
| OT Assistant - 1 hour weekly | 52 X $18.48 = $960.96 |
| OT Aide - 1 hour weekly | 52 X $11.13 = $578.76 |
| OT new grad - 1 hour weekly | 52 X $18.48 = $960.96 |
OT - monthly |
12 X $26.28 = $315.36 |
| OT Assistant - monthly | 12 X $18.48 = $221.76 |
| OT Aide - monthly | 12 X $11.13 = $133.56 |
| OT new grad - monthly | 12 X $18.48 = $221.76 |
5. Does the Rule Impose a Disproportionate Impact on Small Businesses? If all involved parties (OT, OTA, Aide, new graduates) are hired by small and large business and the hiring businesses bear the costs of consultation or supervision, then there is a potential for a disproportionate impart [impact] on small businesses. As the employment table indicates, the average number of employees is much higher for large businesses compared to small ones. However, the existence of disproportionate impact also depends upon the number of involved parties (OT, OTA, Aide, new graduates) hired by small and large businesses.
6. How Are Small Businesses Involved in the Development of this Rule? The occupational therapy practice board held open public rules workshops in coordination with state associations. All active state licensees were invited by mail.
A copy of the statement may be obtained by contacting Vicki Brown, P.O. Box 47867, Olympia, WA 98504-7867, phone (360) 236-4865, fax (360) 664-9077, e-mail vicki.brown@doh.wa.gov.
A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Vicki Brown, P.O. Box 47867, Olympia, WA 98504-7867, phone (360) 236-4865, fax (360) 664-9077, e-mail vicki.brown@doh.wa.gov.
March 16, 2007
Vicki Brown
Program Manager
OTS-9047.6
AMENDATORY SECTION(Amending Order 300B, filed 8/24/92,
effective 9/24/92)
WAC 246-847-010
Definitions.
(1) The following terms in
((RCW 18.59.020(2) shall mean)) this section apply throughout
this chapter and have the following meanings:
(a) "Scientifically based use of purposeful activity" is
the treatment of individuals using established methodology
based upon the behavioral and biological sciences and includes
the ((analysis, application and adaptation of activities for
use with individuals having a variety of physical, emotional,
cognitive and social disorders. Use of purposeful activity
includes a process of continually modifying treatment to meet
the changing needs of an individual. Purposeful activity is
goal-oriented and cannot be routinely prescribed)) therapeutic
use of everyday life activities (occupations) with individuals
or groups for the purpose of participation in roles and
situations in home, school, workplace, community, and other
settings. "Occupations" are activities having unique meaning
and purpose in an individual's life.
(b) "Teaching daily living skills" is the instruction in
daily living skills based upon the evaluation of all the
components of the individual's disability and the adaptation
or treatment based on the evaluation. ((Components of a
disability are physical, sensory, social, emotional and
cognitive functions.))
(c) "Developing prevocational skills and play and
avocational capabilities" ((is not only the development of
prevocational skills and play and avocational capabilities
but)) also involves the scientifically based use of purposeful
activity.
(d) (("Designing, fabricating, or applying selected
orthotic and prosthetic devices or selected adaptive
equipment" is not specific occupational therapy services if a
person designs, fabricates, or applies selected orthotic and
prosthetic devices or selected adaptive equipment for an
individual if the device or equipment is prescribed or ordered
by a health care professional authorized by the laws of the
state of Washington to prescribe the device or equipment or
direct the design, fabrication, or application of the device
or equipment.
(e))) "Adapting environments for ((the handicapped))
individuals with disabilities" ((is the evaluation of all the
components of an individual's disability and the adaptation of
the environment of the individual based on the evaluation. Components of a disability are physical, sensory, social,
emotional and cognitive functions)) includes assessing needs,
identifying strategies, implementing and training in the use
of strategies, and evaluating outcomes. Occupational therapy
focuses on the interaction of an individual's skills and
abilities, the features of the environment, and the demands
and purposes of activities.
(2) (("Supervision" and "regular consultation" of an
occupational therapy assistant by an occupational therapist in
RCW 18.59.020(4) and "direct supervision" of a person holding
a limited permit by an occupational therapist in RCW 18.59.040(7) shall mean face to face meetings between the
occupational therapist and occupational therapy assistant and
between the occupational therapist and holder of a limited
permit occurring at intervals as determined necessary by the
occupational therapist to establish, review, or revise the
client's treatment objectives. The meetings shall be
documented and the documentation shall be maintained in each
client's treatment record. The failure to meet to establish,
review, or revise the client's treatment objectives at
sufficient intervals to meet the client's needs shall be
grounds for disciplinary action against the occupational
therapist's license and/or the occupational therapy
assistant's license to practice in the state of Washington
and/or the limited permit pursuant to WAC 246-847-160 (4) and
(14), 246-847-170 (2) and (3) and RCW 18.59.100 for conduct
occurring prior to June 11, 1986 and pursuant to RCW 18.130.180 for conduct occurring on or after June 11, 1986.
(3) "Professional supervision" of an occupational therapy aide in RCW 18.59.020(5) shall mean:
(a) Documented training by the occupational therapist of the occupational therapy aide in each specific occupational therapy technique for each specific client and the training shall be performed on the client;
(b) Face to face meetings between the occupational therapy aide and the supervising occupational therapist or an occupational therapy assistant under the direction of the supervising occupational therapist occurring at intervals as determined by the occupational therapist to meet the client's needs, but shall occur at least once every two weeks; and
(c) The occupational therapist shall observe the occupational therapy aide perform on the client the specific occupational therapy techniques for which the occupational therapy aide was trained at intervals as determined by the occupational therapist to meet the client's needs, but shall occur at least once a month.
The meetings and client contacts shall be documented and the documentation shall be maintained in the client's treatment records. The failure to meet at sufficient intervals to meet the client's needs shall be grounds for disciplinary action against the occupational therapist's license to practice in the state of Washington pursuant to WAC 246-847-160 (4) and (14), 246-847-170 (2) and (3) and RCW 18.59.100 for conduct occurring prior to June 11, 1986 and pursuant to RCW 18.130.180 for conduct occurring on or after June 11, 1986.
(4) Sections (2) and (3) of this rule shall not be effective until July 1, 1985.
(5))) "Regular consultation" as described in RCW 18.59.020(4) means in-person contact at least monthly by an occupational therapist licensed in the state of Washington with supervision available as needed by other methods which include but are not limited to phone and e-mail.
(3) "In association" as described in RCW 18.59.040(7) means practicing in a setting in which an occupational therapist licensed in the state of Washington is available on the premises for supervision, consultation, and assistance as needed to provide protection for the client's health, safety and welfare.
(4) "Direct supervision" as described in RCW 18.59.040(7) means daily, in-person contact at the site where services are provided by an occupational therapist licensed in the state of Washington.
(5) "Professional supervision" of an occupational therapy aide as described in RCW 18.59.020(5) means in-person contact at the site where services are provided by an occupational therapist or occupational therapy assistant licensed in the state of Washington. If the client receives occupational services more than once a week, professional supervision must occur at least weekly. If the client receives occupational services once a week or less, professional supervision must occur at least once every two weeks.
(6) "Clients" include patients, students, and those to whom occupational therapy services are delivered.
(((6))) (7) "Evaluation" is the process of obtaining and
interpreting data necessary for treatment, which includes, but
is not limited to, planning for and documenting the evaluation
process and results. The evaluation data may be gathered
through record review, specific observation, interview, and
the administration of data collection procedures, which
include, but are not limited to, the use of standardized
tests, performance checklists, and activities and tasks
designed to evaluate specific performance abilities.
(((7))) (8) "Work site" in RCW 18.59.080 means the
primary work location.
(((8) "In association" for RCW 18.59.040(7) shall mean
practicing in a setting in which another occupational
therapist licensed in the state of Washington is available for
consultation and assistance as needed to provide protection
for the clients' health, safety and welfare.
(9) One "contact hour" is considered to be fifty minutes.
(10) "Peer reviewer" shall mean a licensed occupational therapist chosen by the licensee to review the self study plan and verify that the self study activity meets the objectives for peer reviewed self study as defined in WAC 246-847-065.)) (9) "Consultation" means that practitioners are expected to function as consultants within the scope of practice appropriate to their level of competence.
(10) "Working days" in RCW 18.59.040(5) shall mean consecutive calendar days.
(11) "Commonly accepted standards for the profession" in RCW 18.59.040 (5)(b) and 18.59.070 shall mean having passed the National Board for Certification in Occupational Therapy or its successor/predecessor organization, not having engaged in unprofessional conduct or gross incompetency as established by the board in WAC 246-847-160 for conduct occurring prior to June 11, 1986, and as established in RCW 18.130.180 for conduct occurring on or after June 11, 1986.
(12) "Occupational therapy aide" means a person who is trained by an occupational therapist or occupational therapy assistant to perform client and nonclient related tasks. Occupational therapy aides are not primary service providers of occupational therapy in any practice setting. Occupational therapy aides do not provide skilled occupational therapy services.
(13) "Client-related tasks" are routine tasks during which the aide may interact with the client but does not act as a primary service provider of occupational therapy services. The following factors must be present when an occupational therapist or occupational therapy assistant delegates a selected client-related task to the aide:
(a) The outcome anticipated for the delegated task is predictable;
(b) The situation of the client and the environment is stable and will not require that judgment, interpretations, or adaptations be made by the aide;
(c) The client has demonstrated some previous performance ability in executing the task; and
(d) The task routine and process have been clearly established.
[Statutory Authority: RCW 18.59.130. 92-18-015 (Order 300B), § 246-847-010, filed 8/24/92, effective 9/24/92; 91-11-064 (Order 171B), § 246-847-010, filed 5/16/91, effective 6/16/91; 91-05-027 (Order 112B), recodified as § 246-847-010, filed 2/12/91, effective 3/15/91. Statutory Authority: Chapter 18.59 RCW. 90-16-071 (Order 075), § 308-171-001, filed 7/30/90, effective 8/30/90. Statutory Authority: RCW 18.59.130 and 18.130.050. 87-09-044 (Order PM 645), § 308-171-001, filed 4/14/87. Statutory Authority: RCW 18.59.130(2) and 18.130.050(1). 86-17-064 (Order PM 610), § 308-171-001, filed 8/19/86. Statutory Authority: RCW 18.59.130(2) and 18.59.020(5). 86-10-004 (Order PL 588), § 308-171-001, filed 4/24/86. Statutory Authority: RCW 18.59.130(2). 85-12-010 (Order PL 529), § 308-171-001, filed 5/23/85. Statutory Authority: RCW 18.59.130(2) and 18.59.020. 85-05-008 (Order PL 513), § 308-171-001, filed 2/11/85.]
(a) In which state(s) the individual is licensed to perform occupational therapy services and the license number(s); and
(b) The name, address, and telephone number of at least one facility or employer where the individual has been engaged in the practice of occupational therapy within the preceding four years; or
(c) If the exemption is claimed ((pursuant to)) under RCW 18.59.040 (5)(b), the individual ((shall)) must submit a
signed notarized statement attesting to:
(i) Having passed the ((American Occupational Therapy
Certification Board)) National Board for Certification in
Occupational Therapy examination or its successor/predecessor
organization; and
(ii) Having engaged in occupational therapy practice within the preceding four years, including the name, address, and telephone number of at least one facility or employer during this period;
(iii) Not having engaged in unprofessional conduct ((or
gross incompetency as established in WAC 246-847-160 for
conduct occurring prior to June 11, 1986 and as established
in)) under RCW 18.130.180 ((for conduct occurring on or after
June 11, 1986; and not having been convicted of a crime
involving moral turpitude or a felony relating to the
profession of occupational therapy)); and
(d) A signed notarized statement describing when the occupational therapy services will be performed, where the occupational therapy services will be performed, and how long the individual will be performing occupational therapy services in this state.
(2) A ninety-day temporary permit must be received by the occupational therapist prior to rendering of occupational therapy services.
(((3) "Working days" in RCW 18.59.040(5) shall mean
consecutive calendar days.))
[Statutory Authority: RCW 18.59.130. 92-18-015 (Order 300B), § 246-847-110, filed 8/24/92, effective 9/24/92; 91-11-064 (Order 171B), § 246-847-110, filed 5/16/91, effective 6/16/91; 91-05-027 (Order 112B), recodified as § 246-847-110, filed 2/12/91, effective 3/15/91. Statutory Authority: RCW 18.59.130(2) and 18.59.050(1). 86-17-064 (Order PM 610), § 308-171-103, filed 8/19/86. Statutory Authority: RCW 18.59.130(2) and 18.59.040 (5)(b). 86-10-004 (Order PL 588), § 308-171-103, filed 4/24/86. Statutory Authority: RCW 18.59.130(2). 85-12-010 (Order PL 529), § 308-171-103, filed 5/23/85.]
(1) Licensed occupational therapy assistants must be supervised through regular consultation by an occupational therapist licensed in the state of Washington. Regular consultation must be documented and the documentation must be kept in a location determined by the supervising occupational therapist or occupational therapy assistant.
(2)(a) A limited permit holder must work in association with an occupational therapist licensed in the state of Washington with a minimum of one year of experience. "In association with" shall include consultation regarding evaluation, intervention, progress, reevaluation and discharge planning of each assigned patient at appropriate intervals and documented by cosignature of notes by the supervising occupational therapist.
(b) Limited permit holders who have failed the examination must be directly supervised by an occupational therapist licensed in the state of Washington with a minimum of one year of experience. Direct supervision must include consultation regarding evaluation, intervention, progress, reevaluation and discharge planning of each assigned patient at appropriate intervals and documented by cosignature of notes by the supervising occupational therapist.
(3) Occupational therapy aides must be professionally supervised and trained by an occupational therapist or an occupational therapy assistant licensed in the state of Washington. Professional supervision must include documented supervision and training.
(a) The occupational therapist or occupational therapy assistant shall train the occupational therapy aide on client and nonclient related tasks at least once a month.
(b) When performing client related tasks, the occupational therapist or occupational therapy assistant must ensure the occupational therapy aide is trained and competent in performing the task on the specific client.
(c) The documentation must be maintained in a location determined by the supervising occupational therapist or occupational therapy assistant.
(4) Definitions can be found in WAC 246-847-010.
[]
The following section of the Washington Administrative Code is repealed:
| WAC 246-847-130 | Definition of "commonly accepted standards for the profession." |