Maryland Department of Health 10.46.01 General Regulations; 10.46.04 Continuing Competency Requirement; and 10.46.07 Sanctioning Guidelines

PROPOSAL

Maryland Register

Issue Date: July 7, 2017

Volume 44 • Issue 14 • Pages 669—672

Title 10
MARYLAND DEPARTMENT OF HEALTH [AND MENTAL HYGIENE]

Subtitle 46 BOARD OF OCCUPATIONAL THERAPY PRACTICE

Notice of Proposed Action

[17-170-P]

The Secretary of Health proposes to:

(1) Amend Regulations .01 and .02 under COMAR 10.46.01 General Regulations;

(2) Amend Regulations .02, .04, and .07 under COMAR 10.46.04 Continuing Competency Requirement; and

(3) Amend Regulations .01 and .03, repeal existing Regulation .04, amend and recodify existing Regulation .05 to be Regulation .04, and recodify existing Regulation .06 to be Regulation .05 under COMAR 10.46.07 Sanctioning Guidelines.

This action was considered at a public meeting held on April 21, 2017, notice of which was given by publication on the Board’s website at http://health.maryland.gov/botp/Pages/Board-Meeting.aspx pursuant to General Provisions Article, §3–302(c), Annotated Code of Maryland.

Statement of Purpose

The purpose of this action is to implement a statutory requirement for criminal history records check and to accommodate the new online licensing system. This proposal will allow applicants to apply for their occupational therapy licenses online, and licensees, employers, and consumers will be able to use mobile software applications to verify licenses. In addition, the disciplinary process will be modified to eliminate the need for sanctioning worksheets. All additional changes are only clarifying in nature.

Comparison to Federal Standards

There is no corresponding federal standard to this proposed action.

Estimate of Economic Impact

I. Summary of Economic Impact. The expenditure for the Board of Occupational Therapy is the added cost of modifying the existing contract with the software developer.

No additional costs will be added to initial applications, reactivations, and reinstatements, as these amendments are only meant to adapt the method in which the Board receives the applicants’ information and provide the opportunity to apply online. In addition, no additional costs will be applied to those licensees who are audited, as the amendments only change the time in which the audits are conducted in relation to the renewal period.

There is a cost to the applicants and licensees for criminal history background checks, but this expense is not new, as it has been in effect since the statute passed more than a year ago.

	Revenue (R+/R-)
II. Types of Economic Impact.	Expenditure (E+/E-)	Magnitude


A. On issuing agency:	(E+)	$23,437
B. On other State agencies:	NONE
C. On local governments:	NONE

	Benefit (+) Cost (-)	Magnitude


D. On regulated industries or trade groups:	NONE
E. On other industries or trade groups:	NONE
F. Direct and indirect effects on public:	NONE
III. Assumptions. (Identified by Impact Letter and Number from Section II.)
A. The Board of Occupational Therapy will modify an existing contract to expand online services to include initial applications, temporary licenses, reinstatements and reactivations. The Board of Occupational Therapy has budgeted use of its Special Funds in order to pay for the expansion to online services for FY 18.

Economic Impact on Small Businesses

The proposed action has minimal or no economic impact on small businesses.

Impact on Individuals with Disabilities

The proposed action has no impact on individuals with disabilities.

Opportunity for Public Comment

Comments may be sent to Michele Phinney, Director, Office of Regulation and Policy Coordination, Maryland Department of Health, 201 West Preston Street, Room 512, Baltimore, MD 21201, or call 410-767-6499 (TTY 800-735-2258), or email to dhmh.regs@maryland.gov, or fax to 410-767-6483. Comments will be accepted through August 7, 2017. A public hearing has not been scheduled.

10.46.01 General Regulations

Authority: General Provisions Article, §4–333(h); Health Occupations Article, §§10–101, 10–205, 10–301, 10–302, 10–304, 10–311—10–313; [State Government Article, §10–617(h)(3);] Annotated Code of Maryland

.01 Definitions.

A. (text unchanged)

B. Terms Defined.

(1)—(9) (text unchanged)

(10) “Evaluation” means the ongoing process of [collecting and interpreting the data necessary for treatment planning and discharge planning]:

(a) Data collection by a licensed occupational therapist or an occupational therapy assistant; and

(b) Interpretation of the evaluation data by a licensed occupational therapist.

(11)—(13) (text unchanged)

(14) Limited Occupational Therapy.

(a) “Limited occupational therapy” means the therapeutic use of purposeful and meaningful goal-directed activities in collaboration with an occupational therapy assistant and an occupational therapist during the treatment of individuals that:

(i) Have a disease or disorder, impairment, activity limitation, or participation restriction that interferes with their ability to function independently in daily life roles; or

(ii) Benefit from the prevention of impairments and activity limitations.

(b) “Limited occupational therapy” means that the collaboration of the occupational therapy assistant occurs under the periodic supervision of a licensed occupational therapist.

(c) “Limited occupational therapy” means that the occupational therapy assistant is authorized to:

(i) Conduct an initial screening;

(ii) Collect data for an evaluation that applies the principles and procedures of occupational therapy; and

(iii) Participate in a treatment program that applies the principles and procedures of occupational therapy.

(d) “Limited occupational therapy” does not include:

(i) Initiation or interpretation of evaluation data; and

(ii) Initiation of a treatment program before the client has been evaluated and a licensed occupational therapist has rendered a treatment plan.

[(14)] (15)—[(15)] (16) (text unchanged)

(17) “Occupational therapy” means the therapeutic use of purposeful and meaningful goal-directed activities to evaluate, consult, and treat individuals that:

(a) Have a disease or disorder, impairment, activity limitation, or participation restriction that interferes with their ability to function independently in daily life roles; or

(b) Benefit from the prevention of impairments and activity limitations.

[(16)] (18)—[(18)] (20) (text unchanged)

[(19)] (21) “Reevaluation” means [the collection and interpretation of data,]:

(a) The data collection by a licensed occupational therapist or an occupational therapy assistant; and

(b) Interpretation of the reevaluation data by a licensed occupational therapist after the initial evaluation, for the purpose of determining:

[(a)] (i)—[(d)] (iv) (text unchanged)

[(20)] (22)—[(22)] (24) (text unchanged)

[(23)] (25) Screening.

(a) “Screening” means a cursory [evaluation to determine] determination by an occupational therapist or occupational therapy assistant of the need for more comprehensive evaluation and treatment.

(b) (text unchanged)

[(24)] (26) “Supervision” means the provision of clinical aid, direction, and instruction, by either a licensed occupational therapist or an occupational therapy assistant, to ensure the competent delivery of occupational therapy services.

[(25)] (27) “Supervisor” means an occupational therapist or occupational therapy assistant, excluding temporary licensees, who is licensed by the Board and has the responsibility of clinically supervising the provision of occupational therapy treatment services.

[(26)] (28) “Temporary occupational therapy assistant licensee” means an individual licensed by the Board on a temporary basis, who:

(a) Except for completing the required certification examination, has met [the education and experience] all other licensure requirements of this chapter; and

(b) (text unchanged)

[27] (29) “Temporary occupational therapist licensee” means an individual licensed by the Board on a temporary basis, who:

(a) Except for completing the required certification examination, has met [the education and experience] all other licensure requirements of this chapter; and

(b) (text unchanged)

[28] (30) (text unchanged)

[29] (31) “Verification” means [current official confirmation] proof of licensure, certification, registration, or continuing education [obtained directly from]:

(a) Confirmable by the Board based on documentation provided by the applicant;

[(a)] (b) [A] Obtained from a verification service provider approved by the issuing entity and accepted by the Board at its discretion; or

[(b)] (c) [The] Obtained from the entity by which the applicant is licensed, certified, registered, or educated.

.02 Licensure.

A. (text unchanged)

B. Term and Renewal of License.

(1)—(9) (text unchanged)

(10) A licensee who is audited regarding continuing competency requirements, as specified in COMAR 10.46.04 [, shall]:

(a) Shall successfully complete the requirements of the audit [to be eligible for renewal of licensure]; or

(b) May be subject to disciplinary action by the Board.

C. (text unchanged)

D. Incomplete Applications.

(1) An application is not complete until all required material, including the required fee and supporting documentation, is received by the Board;

(2) If an applicant for licensure, reinstatement, or reactivation fails to provide the required documentation within 6 months of receipt of the initial receipt, the Board may administratively close the application.

(3) An applicant whose application is administratively closed may reapply and submit with the new application proof of compliance with:

(a) This subtitle; and

(b) Health Occupations Article, Title 10, Annotated Code of Maryland.

[D.] E. Application Procedures for Licensure. To apply for a license, an applicant shall submit the following documentation to the Board [within the time frame specified on the application]:

(1)—(2) (text unchanged)

[(3) Two letters attesting to the applicant’s moral character, compliant with forms provided by the Board;]

(3) Proof of fingerprinting for completion of a criminal history records check;

(4) (text unchanged)

(5) If currently, or previously, authorized to practice in any other state or country, or both, [documentation from the appropriate authority of that state or country verifying] verification of:

(a)—(c) (text unchanged)

(6) Verification of successful completion of the Maryland Board of Occupational Therapy Jurisprudence Examination; [and]

(7) Documentation certifying:

(a) (text unchanged)

(b) Completion of continuing competency activities, as specified in COMAR 10.46.04; and

(8) Additional requirements as specified in COMAR 10.46.04 for applicants with 3 or more years lapse in practice.

[E.] F. Application Procedures for Temporary Licensure.

(1) A temporary license may be issued to an applicant who, except for completing the required certification examination, has met [the education and experience] all other licensure requirements of this chapter.

(2) To apply for a temporary license, an applicant shall submit the following documentation to the Board [within the time frame specified on the application]:

(a) (text unchanged)

(b) [An application confirmation from the NBCOT certifying] Verification confirming the applicant’s eligibility and registration to take the certification examination within the eligibility activation period;

[(c) Two letters attesting to the applicant’s moral character, compliant with forms provided by the Board;]

(c) Proof of fingerprinting completed for a criminal history records check;

(d) (text unchanged)

(e) If currently, or previously, authorized to practice in any other state or country, or both, [documentation from the appropriate authority of that state or country verifying] verification of:

(i)—(iii) (text unchanged)

(f)—(g) (text unchanged)

[F.] G. Application Procedures for a Second Temporary License.

(1) A second temporary license may be issued to an applicant:

(a) (text unchanged)

(b) Who, except for completing the required certification examination, has met [the education and experience] all other licensure requirements of this chapter.

(2) To apply for a second temporary license, an applicant shall submit the following documentation to the Board [within the time frame specified on the application]:

(a) [An application confirmation from the NBCOT certifying] Verification confirming the applicant’s eligibility and registration to take the certification examination within the eligibility activation period;

(b) An approved form of payment in the amount of the [second] temporary license fee established by the Board in COMAR 10.46.05.01; and

[G.] H. (text unchanged)

[H.] I. Application Procedures for Reactivation or Reinstatement of License.

(1) To apply for reactivation after elective nonrenewal or reinstatement after expiration, an applicant shall submit the following documentation to the Board within the timeframe specified on the application:

[(1)] (a)—[(2)] (b) (text unchanged)

[(3) Two letters attesting to the applicant’s moral character, compliant with forms provided by the Board;]

(c) Proof of fingerprinting completed for a criminal history records check;

[(4)] (d) (text unchanged)

[(5)] (e) If currently, or previously, authorized to practice in any other state or country, or both, [documentation from the appropriate authority of that state or country verifying] verification of:

[(a)] (i)—[(c)] (iii) (text unchanged)

[(6)] (f) (text unchanged)

[(7)] (g) Documentation certifying:

[(a)] (i)—[(b)] (ii) (text unchanged)

(2) Additional requirements may apply for applicants with 3 or more years lapse in practice as specified in COMAR 10.46.04.

[I.] J. Address Change.

(1) (text unchanged)

(2) Failure to comply [results] may result in assessment of a [penalty] fee as specified in COMAR 10.46.05.01.

[J.] K. (text unchanged)

[K.] L. Verification of Maryland License.

(1) Electronic Verification. An individual may independently obtain information on the licensure status of licensees in the following ways:

(a) Upon accessing the Board’s website, an individual may view and print a licensee’s status; [or]

(b) Upon accessing the Board’s mobile software application, an individual may view a licensee’s status; or

[(b)] (c) (text unchanged)

(2) (text unchanged)

10.46.04 Continuing Competency Requirement

Authority: Health Occupations Article, §§10-205 and 10-311, Annotated Code of Maryland

.02 Definitions.

A. (text unchanged)

B. Terms Defined.

(1)—(10) (text unchanged)

(11) “Verification” means [current official confirmation] proof of licensure, certification, registration, or continuing education [obtained directly from]:

(a) Confirmable by the Board based on documentation provided by the applicant.

[(a)] (b) [A] Obtained from a verification service provider approved by the issuing entity and accepted by the Board at its discretion; or

[(b)] (c) [The] Obtained from the entity by which the applicant is licensed, certified, registered, or educated.

.04 Licensure and Contact Hour Requirements.

A. Time Frame.

(1) Licensure Time Frame.

(a) (text unchanged)

(b) [Before July 1, 2016, the Board shall renew the licenses of licensees originally licensed in years ending in odd numbers for a 1-year term and the licenses of licensees originally licensed in years ending with even numbers for a 2-year term.

(i)—(ii) (text unchanged)

(2)—(3) (text unchanged)

B.—C. (text unchanged)

.07 Audit of Continuing Competency.

A.—D. (text unchanged)

E. The Board may take formal disciplinary action against the licensee if a licensee:

(1) Fails to cooperate with an audit or a request from the Board regarding continuing competency documentation; or

(2) Submits a false statement regarding continuing competency.

10.46.07 Sanctioning Guidelines

Authority: Health Occupations Article, §1-606, Annotated Code of Maryland

.01 Scope.

A.—B. (text unchanged)

[C. The Board shall complete a worksheet for each complaint considered by the Board that is not initially closed.]

[D.] C. The Board is aware that there may be conduct by a licensee that does not fall squarely within a particular grid contained in Regulation .06 of this chapter. In that event the Board will [so indicate on the worksheet and] use its best judgment to determine the appropriate sanction.

[E.] D. (text unchanged)

.03 Application.

A.—G. (text unchanged)

H. If the conduct is not described in Regulation .06 of this chapter, the Board shall use its judgment to determine appropriate sanctions [and shall so state in the sanctions worksheet].

I.—K. (text unchanged)

[.05] .04 Aggravating and Mitigating Factors.

A. (text unchanged)

[B. If the sanctions imposed by the Board fall outside the range of the sanctioning guidelines the Board shall state its reasons on its worksheet.]

[C.] B. (text unchanged)

DENNIS SCHRADER
Secretary of Health