HOUSE OF REPRESENTATIVES
TWENTY-SEVENTH LEGISLATURE, 2014
STATE OF HAWAII
A BILL FOR AN ACT
relating to occupational therapy practice.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. The legislature finds that occupational therapists treat patients with injuries, illnesses, or disabilities through the therapeutic use of everyday life activities. Occupational therapy assistants assist occupational therapists in providing occupational therapy.
Although the regulation of occupational therapy practice is codified in chapter 457G, Hawaii Revised Statutes, the language in this chapter is incomplete in relation to certain aspects of the profession, and does not require licensure of occupational therapists or occupational therapy assistants. The legislature notes that Hawaii is the last state in the country to license occupational therapists and one of the last three states to license occupational therapy assistants.
The legislature further finds that occupational therapists and occupational therapy assistants should be licensed in Hawaii in order to protect public health, safety, and the welfare of the patients served by occupational therapists and occupational therapy assistants. Licensing of occupational therapists and occupational therapy assistants will ensure that occupational therapy in Hawaii is provided by only qualified occupational therapists and occupational therapy assistants and will help meet insurer payer requirements, as some insurers require occupational therapy to be provided by licensed individuals.
Accordingly, the purpose of this Act is to improve the regulation of occupational therapists and occupational therapy assistants by establishing an occupational therapy program and licensing requirements for occupational therapists and occupational therapy assistants, including provisions relating to the practice of occupational therapy, qualifications, titles, supervision of occupational therapy assistants, exemptions, issuance of permanent and temporary licenses, licensure renewal, and revocation or suspension of licenses.
SECTION 2. Chapter 457G, Hawaii Revised Statutes, is amended by adding nine new sections to be appropriately designated and to read as follows:
"§457G-A Occupational therapy program. There is established an occupational therapy program within the department to be administered by the director.
§457G-B Practice of occupational therapy; qualifications; titles. (a) Occupational therapists and occupational therapy assistants shall have completed the educational requirements and supervised field work established by the Accreditation Council for Occupational Therapy Education and shall have passed a national certification examination administered by the National Board for Certification in Occupational Therapy.
(b) No person shall practice occupational therapy gratuitously or for pay, offer to practice occupational therapy, offer occupational therapy, or represent, advertise, or announce, either publicly or privately, that the person is an occupational therapist, unless the person is appropriately licensed under this chapter.
(c) No person shall use, in connection with the person's name or business, the words "occupational therapist licensed", "registered occupational therapist", "licensed occupational therapist", "occupational therapist", or "doctor of occupational therapy", or the letters "OT", "OTR", "OTD", "OT/L", "OTR/L", or "OTD/L", or any other words, letters, abbreviations, or insignia indicating or implying that the person is an occupational therapist unless the person is appropriately licensed as an occupational therapist under this chapter.
(d) No person shall use the title "occupational therapy assistant licensed", "licensed occupational therapy assistant", the letters "OTA/L" or "COTA/L", or any other words, letters, abbreviations, or insignia indicating or implying that the person is an occupational therapy assistant unless that person is appropriately licensed as an occupational therapy assistant under this chapter.
§457G-C Supervision of occupational therapy assistants. (a) An occupational therapy assistant may practice occupational therapy only under the supervision of an occupational therapist who is licensed to practice occupational therapy in the State. The occupational therapist shall be responsible for occupational therapy evaluation, appropriate reassessment, treatment planning, interventions, and discharge from occupational therapy based on standard professional guidelines. Supervision of an occupational therapy assistant by an occupational therapist shall be a shared responsibility. The supervising occupational therapist and the supervised occupational therapy assistant shall have legal and ethical responsibility for ongoing management of supervision, including providing, requesting, giving, or obtaining supervision.
(b) The supervising occupational therapist shall:
(1) Determine the frequency, level, and nature of supervision with input from the occupational therapy assistant; and
(2) Base the supervision determination on a variety of factors, including the clients' required level of care, treatment plan, and experience and pertinent skills of the occupational therapy assistant.
(c) The supervising occupational therapist shall supervise the occupational therapy assistant to ensure that the occupational therapy assistant:
(1) Does not initiate or alter a treatment program without prior evaluation by and approval of the supervising occupational therapist;
(2) Obtains prior approval of the supervising occupational therapist before making adjustments to a specific treatment procedure; and
(3) Does not interpret data beyond the scope of the occupational therapy assistant's education and training.
§457G-D Exemptions. (a) Nothing in this chapter shall be construed to prohibit any person from acting within the scope of a license issued to that person under any other law; provided that the person shall not claim to be an occupational therapist or occupational therapy assistant, or that the person is performing occupational therapy, unless the person is also licensed under this chapter.
(b) Nothing in this chapter shall be construed to prohibit students in an educational program for occupational therapists or occupational therapy assistants from participating in activities that are conducted as part of the educational program and are under the guidance and supervision of a licensed occupational therapist.
(c) Nothing in this chapter shall be construed to prohibit a person licensed as an occupational therapist in another state or foreign country from practicing occupational therapy in this State if the person is part of an educational demonstration or instructional program or seminar sponsored by an educational institution, hospital, medical care program, the Occupational Therapy Association of Hawaii, or any other similar person or group, for the duration of the program or seminar and confined to the purpose of the program or seminar.
(d) Nothing in this chapter shall be construed to prohibit an occupational therapist who is practicing in the United States Armed Services, United States Public Health Service, or Department of Veteran Affairs pursuant to federal regulations for state licensure of health care providers from practicing as an occupational therapist; provided that if the person, while federally employed as an occupational therapist, engages in the practice of occupational therapy outside the course and scope of the person's federal employment, the person shall be required to obtain a license in accordance with this chapter.
§457G-E Powers and duties of the director. In addition to any other powers and duties authorized by law, the director shall have the powers and duties to:
(1) Grant, deny, renew, refuse to renew, restore, terminate, reinstate, condition, restrict, suspend, or revoke a license issued pursuant to this chapter;
(2) Grant permission to a person to practice occupational therapy and to use the title of "licensed occupational therapist" or a description indicating that the person is a licensed occupational therapist in this State;
(3) Grant permission to a person to practice as an occupational therapy assistant and to use the title of "licensed occupational therapy assistant" or a description indicating that the person is a licensed occupational therapy assistant in this State;
(4) Adopt, amend, or repeal rules pursuant to chapter 91 as the director finds necessary to carry out this chapter;
(5) Administer, coordinate, and enforce this chapter;
(6) Prepare and administer examinations pursuant to the requirements of this chapter;
(7) Establish the criteria for successful passage of an examination administered pursuant to this chapter;
(8) Discipline a licensed occupational therapist or licensed occupational therapy assistant on grounds specified by this chapter or chapter 436B or for any violation of rules adopted by the director pursuant to this chapter;
(9) Refuse to license a person for failure to meet the licensing requirements in this chapter or for any reason specified by this chapter as grounds to discipline an occupational therapist or occupational therapy assistant; and
(10) Appoint an advisory committee composed of practicing occupational therapists and occupational therapy assistants to assist with the implementation of this chapter.
§457G-F Permanent license. An applicant for a permanent license to practice as an occupational therapist or occupational therapy assistant shall submit proof of educational qualifications and any other information required by the director on an application form prescribed by the director. The director shall maintain a current list of schools of occupational therapy that are approved by an agency recognized by the United States Department of Education or Council on Postsecondary Accreditation.
In the case of foreign-trained persons, the applicant shall have completed the National Board for Certification in Occupational Therapy occupational therapist eligibility determination process and shall have passed a national certification examination administered by the National Board for Certification in Occupational Therapy.
§457G-G Temporary license. (a) An applicant for a permanent license under section 457G-F may also apply for a temporary license, pending approval of a permanent license, by providing the following to the director:
(1) Evidence that the applicant has submitted an application to take the national certification examination administered by the National Board for Certification in Occupational Therapy within six months from the time of initial application for licensure; or
(2) Evidence that the applicant has taken the national certification examination administered by the National Board for Certification in Occupational Therapy and is awaiting results.
(b) An applicant shall be supervised throughout the period of temporary licensure by an occupational therapist with a permanent active license and shall submit to the director the name and license number of each licensed supervising occupational therapist.
(c) A temporary license shall be in force until the earliest of the following occurs:
(1) The sixth month following the date of issuance of the temporary license;
(2) The date the temporary licensee leaves the supervision of the occupational therapist authorized under the temporary license;
(3) The date on which the director revokes the temporary license pursuant to 457G-I;
(4) The applicant fails to successfully pass the national certification examination administered by the National Board for Certification in Occupational Therapy; or
(5) The date on which the applicant receives a permanent license.
§457G-H Biennial renewal; failure to renew; inactive license. (a) The biennial renewal fee shall be paid to the department on or before December 31 of each even-numbered year. Failure, neglect, or refusal of any licensee to pay the biennial renewal fee on or before this date shall constitute a forfeiture of the license. A forfeited license may be restored upon written application within one year from the date of forfeiture and the payment of the delinquent fee plus an amount equal to fifty per cent of the delinquent fee.
(b) Upon written request of a licensee, the director may place the licensee's active license on an inactive status. During the inactive period, a licensee shall not engage in the practice of occupational therapy. The license may be reactivated at any time by making a written request to the director and by payment of the renewal and any other applicable fees. A licensee's inactive status shall not deprive the director of the director's authority to institute or continue any disciplinary or enforcement action against the licensee.
§457G-I License revocation or suspension; probation of licensee. (a) In addition to any other actions authorized by law, any license issued under this chapter may be revoked or suspended by the director at any time for any cause authorized by law, including but not limited to the following:
(1) Obtaining a fee on the assurance that a manifestly incurable disease can be permanently cured;
(2) Wilfully betraying patient confidentiality;
(3) Making an untruthful and improbable statement in advertising one's practice or business;
(4) False, fraudulent, or deceptive advertising;
(5) Being habituated to the excessive use of drugs or alcohol or being or having been addicted to, dependent on, or a habitual user of, a narcotic, barbiturate, amphetamine, hallucinogen, or other drug having similar effects;
(6) Practicing occupational therapy while the ability to practice is impaired by alcohol, drugs, or mental instability;
(7) Procuring a license through fraud, misrepresentation, or deceit, or knowingly permitting an unlicensed person to practice occupational therapy;
(8) Professional misconduct, gross negligence, or manifest incapacity in the practice of occupational therapy;
(9) Conduct or practice contrary to the ethics of the profession of occupational therapy in the United States;
(10) Violation of the conditions or limitations upon which a temporary license is issued or an exemption is granted; or
(11) Violation of this chapter or the rules adopted pursuant thereto.
(b) To reinstate a suspended license, or to grant licensure to an applicant whose license was previously revoked, the director may require further education or training or require proof of competence in performance.
(c) In lieu of revoking or suspending a license, the director may place the licensee on probation, the terms of which may require observation of the licensee by an appropriate group or society of occupational therapists."
SECTION 3. Section 457G-1, Hawaii Revised Statutes, is amended as follows:
1. By adding five new definitions to be appropriately inserted and to read:
""Educational institution" means public schools as defined under chapter 302A, privately operated schools of lower education, and colleges, the University of Hawaii, and other universities.
"Foreign-trained person" means a person who has completed an educational program or course of study in occupational therapy in an institution located outside the United States.
"Occupational therapist" means a person who is licensed to practice occupational therapy in this State.
"Occupational therapy" means the therapeutic use of everyday life activities with individuals or groups for the purpose of participation in roles and situations in home, school, workplace, community, and other settings. It includes:
(1) Evaluation of factors affecting activities of daily living, instrumental activities of daily living, rest and sleep, education, work, play, leisure, and social participation, including:
(A) Client factors, including body functions, such as neuromusculoskeletal, sensory-perceptual, visual, mental, cognitive, and pain factors; body structures, such as cardiovascular, digestive, nervous, integumentary, genitourinary systems, and structures related to movement; values; beliefs; and spirituality;
(B) Habits, routines, roles, rituals, and behavior patterns;
(C) Occupational and social environments, cultural, personal, temporal, and virtual contexts and activity demands that affect performance; and
(D) Performance skills, including motor and praxis, sensory-perceptual, emotional regulation, cognitive, communication, and social skills;
(2) Methods or approaches selected to direct the process of interventions, including:
(A) Establishment, remediation, or restoration of a skill or ability that has not yet developed, is impaired, or is in decline;
(B) Compensation, modification, or adaptation of activity or environment to enhance performance or prevent injuries, disorders, or other conditions;
(C) Retention and enhancement of skills or abilities without which performance in everyday life activities would decline;
(D) Promotion of health and wellness, including the use of self-management strategies, to enable or enhance performance in everyday life activities; and
(E) Prevention of barriers to performance and participation, including injury and disability prevention; and
(3) Interventions and procedures to promote or enhance safety and performance in activities of daily living, instrumental activities of daily living, rest and sleep, education, work, play, leisure, and social participation, including:
(A) Therapeutic use of occupations, exercises, and activities;
(B) Training in self-care, self-management, health management and maintenance, home management, community reintegration, work reintegration, school activities, and work performance;
(C) Development, remediation, or compensation of neuromusculoskeletal, sensory-perceptual, visual, mental, and cognitive functions; pain tolerance and management; and behavioral skills;
(D) Therapeutic use of self, including one's personality, insights, perceptions, and judgments, as part of the therapeutic process;
(E) Education and training of individuals, including family members, caregivers, groups, populations, and others;
(F) Care coordination, case management, and transition services;
(G) Consultative services to groups, programs, organizations, or communities;
(H) Modification of environments, such as home, work, school, or community, and adaptation of processes, including the application of ergonomic principles;
(I) Assessment, design, fabrication, application, fitting, and training in seating and positioning; assistive technology; adaptive devices; orthotic devices; and training in the use of prosthetic devices;
(J) Assessment, recommendation, and training in techniques to enhance functional mobility, including management of wheelchairs and other mobility devices;
(K) Low vision rehabilitation;
(L) Driver rehabilitation and community mobility;
(M) Management of feeding, eating, and swallowing to enable eating and feeding performance;
(N) Application of physical agent modalities and use of a range of specific therapeutic procedures, such as wound care management, interventions to enhance sensory-perceptual and cognitive processing, and manual therapy, to enhance performance skills; and
(O) Facilitating the occupational performance of groups, populations, or organizations through the modification of environments and the adaptation of processes.
"Occupational therapy assistant" means a person who is licensed to practice occupational therapy under the supervision of and in partnership with an occupational therapist."
2. By deleting the definition of "occupational therapy services".
services" include: (1) The assessment of needs and provision
of treatment in consultation with the individual, family, or other appropriate
persons; (2) Interventions directed toward
developing, improving, ascertaining, enhancing, or restoring: (A) 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; or (B) Sensorimotor, oral-motor,
perceptual, or neuromuscular functioning; or emotional, motivational,
cognitive, or psychosocial components of performance; (3) The education of the individual,
family, or other appropriate persons in carrying out appropriate interventions; (4) Design, development, adaptation,
application, or training in the use of: (A) Assistive technology devices;
and (B) Rehabilitative technology such
as orthotic or prosthetic devices; (5) The application of physical agent
modalities as an adjunct to, or in preparation for, purposeful activity; (6) The application of ergonomic
principles, and the adaptation of environments and processes to enhance functional
performance; and (7) The promotion of health and wellness."]
SECTION 4. Section 457G-1.5, Hawaii Revised Statutes, is repealed.
§457G-1.5 Practice of
occupational therapy; qualifications; registration. (a) No person
shall represent, advertise, or announce oneself, either publicly or privately,
as an occupational therapist, nor use, in connection with the person's name or
place of business, the words "occupational therapist",
"certified occupational therapist", "occupational therapist
registered", or the letters "OT", "COT", or
"OTR", or any other words, letters, abbreviations, or insignia
indicating or implying that such person is an occupational therapist unless
such person registers the person's name and business address biennially with
the department of commerce and consumer affairs in a manner established by
rules adopted pursuant to chapter 91, and meets the qualifications of section
457G-2. (b) The department shall maintain and
biennially update a list of the names and business addresses of the
occupational therapists who are registered under subsection (a). (c) Nothing in this chapter shall be
construed to prohibit a registered occupational therapist from utilizing
occupational therapy support personnel to assist in the practice of occupational
therapy; provided that the occupational therapy support personnel shall work
under the supervision of or in consultation with the registered occupational
therapist. "Occupational therapy support
personnel" includes a person certified by the National Board for
Certification in Occupational Therapy, and who uses the title
"occupational therapy assistant" or "certified occupational
therapy assistant", the letters "COTA" or "OTA", or
any other titles, letters, abbreviations, or insignia indicating or implying
that the person is an occupational therapy assistant. (d) A registration granted under this
chapter shall mean that the person has met requirements that include minimum
practice standards to provide protection to the public and is permitted to use
the title and engage in the practice as an occupational therapist. In the
granting of permission to engage in this profession, and consistent with
section 436B-2, the definition for "license" is inclusive of a
registration issued under this chapter and, as such, an occupational therapist
that holds a registration shall be similarly regarded as an occupational
therapist that holds a license."]
SECTION 5. Section 457G-2, Hawaii Revised Statutes, is repealed.
of occupational therapists. Occupational therapists shall have completed
the educational requirements and supervised field work experience required for
certification by the National Board for Certification in Occupational Therapy,
and shall have passed a national certification examination administered by that
SECTION 6. Section 457G-3, Hawaii Revised Statutes, is repealed.
The attorney general or the director of the office of consumer protection may
bring proceedings to enjoin any violation of this chapter."]
SECTION 7. In codifying the new sections added by section 2 of this Act, the revisor of statutes shall substitute appropriate section numbers for the letters used in designating the new sections in this Act.
SECTION 8. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
SECTION 9. This Act shall take effect upon its approval.
Occupational Therapy; Occupational Therapists; Occupational Therapy Assistants; Regulation; Licensing
Improves the regulation of occupational therapists and occupational therapy assistants by establishing an occupational therapy program and licensing requirements for occupational therapists and occupational therapy assistants.
The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.