CHAPTER 350


97-H 6233 am
Effective Without the Governor's Signature
Jul. 8, 1997


AN ACT RELATING TO BUSINESSES AND PROFESSIONS -- OCCUPATIONAL THERAPY

It is enacted by the General Assembly as follows:

SECTION 1. Sections 5-40.1-3, 5-40.1-6, 5-40.1-8, 5-40.1-9, 5-40.1-10, 5-40.1-12, 5-40.1-13 and 5-40.1-14 of the General Laws in Chapter 5-40.1 entitled "Occupational Therapy" are hereby amended to read as follows:

5-40.1-3. Definitions. -- As used in this chapter:

{DEL (1) "Board" means the board of occupational therapy practice established by this chapter.

(2) "Occupational therapist" means a person licensed to practice occupational therapy under this chapter.

(3) "Occupational therapy" means the use of purposeful activity with individuals who are limited by physical injury or illness, psychosocial dysfunction, developmental or learning disabilities, poverty and cultural differences or the aging process in order to maximize independence, prevent disability, and maintain health. The practice encompasses evaluation, treatment and consultation. Specific occupational therapy services include, but are not limited to, teaching daily living skills, developing perceptual motor skills and sensory integrative functioning; developing play skills and prevocational and leisure capacities, designing, fabricating, or applying selected orthotic and prosthetic devices or selective adaptive equipment; using specifically designed crafts and exercises to enhance functional performance; administering and interpreting tests such as manual muscle and range of motion and adapting environments for the handicapped. These services are provided individually, in groups or through social systems. DEL}

{ADD (1) "Chapter" refers to chapter 5-40.1, entitled "Occupational Therapy", of the general laws of Rhode Island, as amended.

(2) "Administrator" means the administrator of the division of professional regulation.

(3) "Board" means the board of occupational therapy within the division of professional regulation established pursuant to the provisions of section 5-40.1-4 of this chapter.

(4) "Director" means the director of the Rhode Island department of health.

(5) "Division" means the division of professional regulation.

(6) "Occupational therapy" (OT) is the use of purposeful activity or interventions designed to achieve functional outcomes which promote health, prevent injury or disability, and develop, improve, sustain, or restore the highest possible level of independence of any individual who has an injury, illness, cognitive impairment, sensory impairment, psychosocial dysfunction, mental illness, developmental or learning disability, physical disability, or other disorder or condition.

(7) Occupational therapy includes evaluation by means of skilled observation of functional performance and/or assessment through the administration and interpretation of standardized or nonstandardized tests and measurements.

(8) Occupational therapy services includes, but are not limited to:

(a) the evaluation and provision of treatment in consultation with the individual, family or other appropriate persons;

(b) interventions directed toward developing, improving, sustaining or restoring daily living skills, including self-care skills and activities that involve interactions with others and the environment, work readiness or work performance, play skills or leisure capacities or educational performance skills;

(c) developing, improving, sustaining or restoring sensorimotor, oral-motor, perceptual or neuromuscular functioning; or emotional, motivational, cognitive or psychosocial components of performance; and

(d) education of the individual, family or other appropriate persons in carrying out appropriate interventions.

These services may encompass evaluation of need and the design, development, adaptation, application or training in the use of assistive technology devices; the design, fabrication or application of rehabilitative technology, such as selected orthotic devices; training in the functional use of orthotic or prosthetic devices; the application of therapeutic activities, modalities, or exercise as an adjunct to or in preparation for functional performance; the application of ergonomic principles; the adaptation of environments and processes to enhance daily living skills; or the promotion of health and wellness.

(9) "Occupational therapist" means a person licensed to practice occupational therapy under the provisions of this chapter and the rules and regulations thereof.

(10) "Occupational therapy assistant" means a person licensed to practice occupational therapy under the provisions of this chapter and the rules and regulations thereof.

(11) "Occupational therapy aide" means a person not licensed pursuant to the statutes and rules applicable to the practice of occupational therapy, who works under the supervision of a licensed occupational therapist or occupational therapy assistant, who assists in the practice of occupational therapy and whose activities require an understanding of occupational therapy, but do not require professional or advanced training in the basic anatomical, psychological and social sciences involved in the practice of occupational therapy.

(12) "Supervision" means that a licensed occupational therapist or occupational therapy assistant shall at all times be responsible for supportive personnel and students. ADD}

5-40.1-6. Licenses required. -- {DEL (a) No person shall practice occupational therapy or hold himself or herself out as an occupational therapist or as being able to practice occupational therapy or to render occupational therapy services in this state unless he or she is licensed under the provisions of this chapter.

(b) Only an individual may be licensed under this chapter.

(c) Only a person licensed by the state as an occupational therapist may use the words "Occupational Therapist", "licensed Occupational Therapist", "Occupational Therapist registered" in connection with his or her name or place of business; or may use other words, letters, abbreviations, or insignia indicating or implying that he or she is an occupational therapist. DEL}

{ADD Pursuant to section 5-40.1-6 of this chapter, no person shall practice occupational therapy or hold himself or herself out as an occupational therapist or occupational therapy assistant or as being able to practice as an occupational therapist or occupational therapy assistant or as being able to practice occupational therapy or to render occupational therapy services in this state unless he or she is licensed under the provisions of this chapter and the rules and regulations herein.

This chapter shall not be construed as preventing or restricting the practice, services or activities of the following:

(a) any individual licensed in this state pursuant to any other law from engaging in the profession or occupation of occupational therapy for which he or she is licensed; or

(b) any individual employed as an occupational therapist or occupational therapy assistant by the government of the United States or any agency of it, if that person provides occupational therapy solely under the direction or control of the organization by which he or she is employed; or

(c) any individual pursuing a supervised course of study leading to a degree or certificate in occupational therapy at an accredited or approved educational program, if the person is designated by a title which clearly indicates his or her status as a student or trainee; or

(d) any individual fulfilling the supervised fieldwork experience requirements, if the experience constitutes a part of the experience necessary to meet the requirements of that section.

Only an individual may be licensed under this chapter.

Only an individual licensed in this state as an occupational therapist may use the words "occupational therapist", "licensed occupational therapist", "occupational therapist registered" in connection with his or her name or place of business; or may use other words, letters, abbreviations or insignia indicating or implying that he or she is an occupational therapist.

Only an individual licensed in this state as an occupational therapy assistant may use the words "certified occupational therapy assistant", "occupational therapy assistant", "licensed occupational therapy assistant" in connection with his or her name or place of business; or may use other words, letters, abbreviations or insignia indicating or implying that he or she is an occupational therapy assistant. ADD}

5-40.1-8. Requirements for licensure. -- {DEL (a) An applicant applying for a license as an occupational therapist shall file a written application on forms provided by the board, showing to the satisfaction of the board that he or she meets the following requirements:

(1) Character: Applicant shall be of good moral character.

(2) Education: Applicant shall present evidence satisfactory to the board of having successfully completed the academic requirements of an educational program in occupational therapy accredited by the Committee on Allied Health Education and Accreditation/American Medical Association in collaboration with The American Occupational Therapy Association or other such accrediting agency as may be approved by the board.

(3) Experience: Applicant shall submit to the board evidence of having successfully completed a minimum of six (6) months of supervised fieldwork experience arranged by the recognized educational institution where he or she met the academic requirements or by the nationally recognized professional association.

(4) Examination: An applicant for licensure as an occupational therapist shall pass an examination as provided for in section 10 of this act.

(b) If an applicant is enrolled in the AOTA career mobility program and: (1) Has practiced as an occupational therapy assistant for four (4) years, and (2) had completed the requirements of section 5-40.1-8(a)(3) by January 1, 1988 and has passed the examination for occupational therapist. DEL}

{ADD (a) Any applicant seeking licensure as an occupational therapist or occupational therapy assistant in this state must:

(1) be at least eighteen (18) years of age;

(2) be of good moral character;

(3) have successfully completed the academic requirements of an education program in occupational therapy accredited by the American Occupational Therapy Association's Accreditation Council for Occupational Therapy Education or other such accrediting agency as may be approved by the board; or

(4) have successfully completed a period of supervised fieldwork experience arranged by the recognized educational institution where he or she met the academic requirements:

(i) for an occupational therapist, a minimum of twenty-four (24) weeks of supervised fieldwork experience is required;

(ii) for an occupational therapy assistant, a minimum of twelve (12) weeks is required;

(5) have successfully passed the National Certification Examination for Occupational Therapists, Registered or National Certification Examination for Occupational Therapy Assistants of the National Board for Certification in Occupational Therapy (NBCOT) or other occupational therapy certification examination as approved by the board.

(b) Application for licensure to practice occupational therapy in this state either by endorsement or by examination shall be made on forms provided by the division, which shall be completed, notarized and submitted to the board thirty (30) days prior to the scheduled date of the board meeting. Such application shall be accompanied by the following documents:

(1) three (3) affidavits from responsible persons attesting to the applicant's good moral character;

(2) for U.S. citizens: a certified copy of birth record or naturalization papers;

(3) for non-U.S. citizens: documented evidence of alien status, such as immigration papers or resident alien card or such other verifying papers acceptable to the administrator;

(4) documented evidence and supporting transcripts of qualifying credentials as set forth in this section;

(5) one (1) unmounted passport photograph of the applicant (head and shoulder view) approximately 2x3 inches in size;

(6) a statement from the board of occupational therapy in each state in which the applicant has held or holds licensure or is otherwise subject to state regulation, to be submitted to the board of this state attesting to the licensure status of the applicant during the time period the applicant held licensure in said state;

(7) the results of the written national examination; and

Applicants seeking licensure as occupational therapists or occupational therapy assistants shall be required to pass the national written examination of the National Board for certification in occupational therapy (NBCOT) approved by the board to test the applicant's fitness to engage in the practice of occupational therapy pursuant to the provisions of this chapter.

The date, time and place of examinations shall be available from the National Board for Certification in Occupational Therapy (NBCOT).

(c) In case of failure of any applicant to satisfactorily pass an examination, such applicant shall be entitled to re-examination.

(d) Occupational therapists and occupational therapy assistants who are licensed or otherwise regulated to practice under laws of another state or territory or the District of Columbia may, upon receiving a receipt from the division, perform as an occupational therapist or occupational therapy assistant under the supervision of a qualified and licensed occupational therapist or occupational therapy assistant. If such an applicant fails to receive licensure when the board reviews the application, all aforementioned privileges shall automatically cease.

(e) Applicants from foreign occupational therapy schools must meet the requirements of the National Board for Certification in Occupational Therapy (NBCOT) and present evidence of passage of the National Certification Examination for Occupational Therapists or the National Certification Examination for Occupational Therapy Assistants of the NBCOT. Furthermore, applicants must meet all of the appropriate requirements for licensure to the satisfaction of the board and in accordance with the statutory and regulatory provisions herein. ADD}

{ADD 5-40.1-9. Graduate practice. -- ADD} (a) {DEL Any graduate of an approved occupational therapy school who has filed a completed application for licensure may, upon receiving a receipt from the division of professional regulations, perform as an occupational therapist under the supervision of an occupational therapist licensed in this state. During this period, such an applicant shall identify himself or herself only as a "graduate occupational therapist". DEL} {ADD Any individual who graduates from an approved occupational therapy school who has filed a completed application for licensure, may upon receiving a receipt from the division, perform as an occupational therapist or occupational therapy assistant, under the supervision of an occupational therapist licensed in this state, only until the next scheduled examination. ADD}

(b) If such an applicant shall fail to take the next succeeding examination without due cause or fail to pass the examination and received a license, all aforementioned privileges shall automatically cease. {ADD Furthermore, an individual referred to herein shall, during the interim period (between time of application and examination) identify himself or herself only as a "graduate occupational therapist" or "graduate occupational therapy assistant". ADD}

{ADD 5-40.1-10. Examination. -- The applicant shall be required to pass with a grade determined by the board, an examination approved by the board {DEL . DEL} {ADD pursuant to section 5-40.1-8(a)(5). ADD} {DEL The approved exam is the existing National Registration Examination. It is the applicant's responsibility to arrange to take the examination following successful completion of those requirements listed in section 5-40.1-8 (a)(1) and (a)(3) (b) & (c) and to present to the board evidence of successful completion of the exam. DEL}

5-40.1-12. Renewal of licenses -- Inactive status. -- (a) {DEL All licenses under this chapter shall be subject to biennial renewal and unless renewed in the manner prescribed and upon payment of a renewal fee. The board may establish regulations governing continuing education for license renewal. The division may provide for late renewal of a license upon payment of a late renewal fee. DEL} {ADD Upon the recommendation of the board, the director shall issue to applicants who have satisfactorily met the licensure requirements herein, a license to practice occupational therapy in this state. Said license, unless sooner suspended or revoked, shall expire on the thirty-first (31st) day of March, of each even year (biennially).

On or before the first (1st) day of March of each even year, the administrator of the division shall mail an application for renewal of license to every individual to whom a license has been issued or renewed during the current licensure period. Every individual so licensed who desires to renew his or her license shall file with the division such renewal application duly executed together with the evidence of continuing education requirements as delineated below and the renewal fee of fifty dollars ($50.00) made payable by check to the general treasurer, state of Rhode Island, on or before the thirty-first (31st) day of March of each even year.

On application for renewal of license, occupational therapists and occupational therapy assistants must show proof of participation in twenty (20) hours biennially in presentations, clinical instruction, publications, research, inservice programs, American Occupational Therapy Association-recognized conferences, university course, and/or self-study courses.

Upon receipt of such renewal application and payment of fee, the director, upon the recommendation of the board, shall grant a renewal license effective the thirty-first (31st) day of March for a period of two (2) years, unless sooner suspended or revoked.

Any individual who allows his or her license to lapse by failing to renew it on or before the thirty-first (31st) day of March of the next even year as provided above, may be reinstated by the director upon receiving a receipt from the division for payment of the current renewal fee plus an additional twenty-five dollars ($25.00) made payable by check to the general treasurer, state of Rhode Island.

Any individual using the title "occupational therapist" or "occupational therapy assistant" during the time his or her license has lapsed shall be subject to the penalties provided for violation of those regulations and this chapter. ADD}

(b) {DEL Upon request, the division shall grant inactive status to a licensee who does not intend to practice his or her profession within this state during the period covered by the inactive status. That person may be reinstated without payment of a penalty fee upon application and presentation of evidence of completion of such requirements for continuing education as may be required of applicants for license renewal. DEL} {ADD An individual licensed as an occupational therapist or occupational therapy assistant in this state who does not intend to engage in the practice of occupational therapy within this state during any year, may upon request to the division, have his or her name transferred to an inactive status and shall not be required to register biennially or pay any fee as long as he or she remains inactive.

Any individual whose name has been transferred to an inactive status pursuant to this section, may be restored to active status to practice occupational therapy without a penalty fee, upon the filing of an application for licensure renewal, requirements, the licensure renewal fee of twenty dollars ($20.00) made payable by check to the general treasurer, state of Rhode Island, and such other information as may be requested by the division. ADD}

5-40.1-13. Fees. -- When an application is submitted to the division of professional regulation for a license to practice occupational therapy in Rhode Island, the applicant shall pay a {ADD non-refundable ADD} fee of fifty dollars ($50.00) to the {ADD general treasurer, state of Rhode Island. ADD} {DEL state department of health. DEL} A biennial renewal fee of fifty dollars ($50.00) shall be submitted with renewal application on or before the {DEL thirty-first DEL} {ADD first (1st) ADD} day of March of each even year {ADD pursuant to the requirements of section 5-40.1-12(a) and any ADD} {DEL Any DEL} person who allows his or her license to lapse by failing to renew it in the manner prescribed shall pay {DEL an DEL} {ADD the ADD} additional fee of twenty-five dollars ($25.00) {DEL . DEL} {ADD as referred to in section 5-40.1-12(a). ADD}

5-40.1-14. Grounds for refusal to renew, suspension or revocation of license. -- (a) The board may deny a license or refuse to renew a license or may suspend or revoke a license or may impose probationary conditions if the licensee has been found guilty of unprofessional conduct which has endangered or is likely to endanger the health, welfare, or safety of the public. Such unprofessional conduct includes:

(1) Obtaining a license by means of fraud, misrepresentation, or concealment of material facts;

(2) Being found guilty of fraud or deceit in connection with his or her services rendered as an occupational therapist {ADD or occupational therapy assistant ADD};

{DEL(3) Being convicted of any crime, felony, or misdemeanor, involving moral turpitude, in which case the record of conviction or a certified copy thereof, certified by the clerk of the superior court or by the judge in whose court the conviction is had, shall be conclusive evidence. DEL} {ADD(3) Commission of a felony, whether or not involving moral turpitude, or a misdemeanor involving moral turpitude. In either case, conviction by a court of competent jurisdiction or a plea of "no contest" is conclusive evidence that a felony or misdemeanor was committed. ADD}

(4) Violating any lawful order, rule or regulation rendered or adopted by the board; {DEL and DEL}

{ADD(5) Failing to report in writing to the board any disciplinary decision issued against the licensee or the applicant in another jurisdiction within thirty (30) days of the disciplinary decisions; and ADD}

{DEL(5) DEL} {ADD (6) ADD}Violating any provision of this chapter.

(b) A denial, refusal to renew, suspension, revocation, or imposition of probationary conditions upon the license may be ordered by the board or the director of the department of health after a hearing in the manner provided by the Administrative Procedures Act, chapter 35 of title 42.

{ADD (c) The American Occupational Therapy Association's "Occupational Therapy Code of Ethics" shall be adopted as a public statement of the values and principles used in promoting and maintaining high standards of behavior in occupational therapy. These state:

(1) occupational therapy personnel shall demonstrate a concern for the well-being of the recipients of their services;

(2) occupational therapy personnel shall respect the rights of the recipients of their services;

(3) occupational therapy personnel shall achieve and continually maintain high standards of competence;

(4) occupational therapy personnel shall comply with laws and association policies guiding the profession of occupational therapy;

(5) occupational therapy personnel shall provide accurate information about occupational therapy services; and

(6) occupational therapy personnel shall treat colleagues and other professionals with fairness, discretion, and integrity. ADD}

SECTION 2. Chapter 5-40.1 of the General Laws entitled "Occupational Therapy" is hereby amended by adding thereto the following sections:

{ADD 5-40.1-20. Rules governing practices and procedures. -- ADD} {ADD All hearings and reviews required under the provisions of this chapter and the rules and regulations thereof, shall be held in accordance with the provisions of the rules and regulations promulgated by the Rhode Island department of health, entitled, "Rules and Regulations Governing Practices and Procedures Before the Rhode Island Department of Health (R42-35-PP)". ADD}

{ADD 5-40.1-21. Supervision. -- ADD} {ADD A licensed occupational therapist shall exercise sound judgment and provide adequate care in the performance of duties. A licensed occupational therapist is permitted to supervise the following: occupational therapists, occupational therapy assistants, occupational therapy aides, care extenders, occupational therapy students, and volunteers.

A licensed occupational therapy assistant shall exercise sound judgment and provide adequate care in the performance of duties. A licensed occupational therapy assistant is permitted to supervise the following: occupational therapy aides, care extenders, students, and volunteers.

Subject to the requirements of this section, a licensed occupational therapy assistant may practice limited occupational therapy only under the supervision of a licensed occupational therapist. Supervision requires at a minimum that the supervising licensed occupational therapist meet in person with the licensed occupational therapy assistant to provide initial direction and periodic on-site supervision. The supervising licensed occupational therapist working with the licensed occupational therapy assistant shall determine the amount and type of supervision necessary in response to experience and competence of the licensed occupational therapy assistant and complexity of the treatment program. The supervisor and the licensed occupational therapy assistant are jointly responsible for maintaining records, including patient records, to document compliance with this regulation.

A licensed occupational therapy assistant:

may not initiate a treatment program until the patient has been evaluated and the treatment planned by the licensed occupational therapist;

may not perform an evaluation, but may assist in the data gathering process and administer specific assessments where clinical competency has been demonstrated, under the direction of the licensed occupational therapist;

may not analyze or interpret evaluation data;

may participate in the screening process by collecting data and shall communicate the information gathered to the licensed occupational therapist;

shall monitor the need for reassessment and report changes in status that might warrant reassessment or referral under the supervision of the licensed occupational therapist; and

shall immediately discontinue any treatment procedure which appears harmful to the patient and immediately notify the supervising occupational therapist.

An occupational therapy aide is a worker who is trained on the job. A licensed occupational therapist or licensed occupational therapy assistant using occupational therapy aide personnel to assist with the provision of occupational therapy services must provide close supervision in order to protect the health and welfare of the consumer. The primary function of an occupational therapy aide functioning in an occupational therapy setting is to perform designated routine tasks related to the operation of an occupational therapy service. Such tasks may include, but are not limited to, routine department maintenance, transportation of patients/clients, preparation or setting up of treatment equipment and work area, assisting patients/clients with their personal needs during treatment, assisting in the construction of adaptive equipment, and carrying out a predetermined segment or task in the patient's care.

The licensed occupational therapist or occupational therapy assistant shall not delegate to an occupational therapy aide:

performance of occupational therapy evaluation procedures;

initiation, planning, adjustment, modification, or performance of occupational therapy procedures requiring the skills or judgment of a licensed occupational therapist or licensed occupational therapy assistant;

making occupational therapy entries directly in patients' or clients' official records; and

acting on behalf of the occupational therapist in any matter related to occupational therapy which requires decision making or professional judgment. ADD}

SECTION 3. This act shall take effect upon passage.



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