Oral Orders for an Occupational Therapists

Transcription

1 Regulatory Analysis Form (1) Agency Department of State, Bureau of Professional and Occupational Affairs, State Board of Occupational Therapy Education and Licensure This space for use by IRRC %%APR-7 m; (: ;g (2) I.D. Number (Governor's Office Use) 16A-673 IRRC Number: ^L (3) Short Title Oral Orders (4) PA Code Cite (5) Agency Contacts & Telephone Numbers Primary Contact: Herbert Abramson, Esquire, Counsel, 49 Pa. Code State Board of Occupational Therapy Education and Licensure (717) Secondary Contact: Joyce McKeever, Esquire, Deputy Chief Counsel, Department of State (717) (6) Type of Rulemaking (check one) Proposed Rulemaking X_Final Order Adopting Regulation Final Order, Proposed Rulemaking Omitted (8) Briefly explain the regulation in clear and nontechnical language. (7) Is a 120-Day Emergency Certification Attached? _XNo Yes: By the Attorney General Yes: By the Governor New section 42.25(a) specifies that occupational therapists shall accept written referrals from licensed physicians or licensed podiatrists unless the urgence of the medical circumstances requires immediate treatment. In that circumstance, the occupational therapist can accept an oral order provided that the oral order is immediately transcribed, with the date and time, in the patient's medical record and the occupational therapist who took the order signs it. At subsection (b), the regulation provides that the occupational therapist in a private office setting must obtain the countersignature of the ordering physician or podiatrist within five (5) days of receiving it. At subsection (c) an occupational therapist providing services in a facility licensed by the Department of Health must have the oral order counter-signed by the ordering physician or podiatrist in accordance with applicable regulation of the Department of Health governing the licensed facility in question. (9) State the statutory authority for the regulation and any relevant state or federal court decisions. The Board has authority to adopt regulations not inconsistent with the law as it deems necessary for the performance of its duties and the proper administration of the law under Section 5(b) of the Occupational Therapy Practice Act ("Act"), Act of June 15, 1982, PX. 502, No. 140, as amended, 63 P.S. 15O5(b). Additionally, Section 14 of the Act, 63 P.S. 1514, specifies that implementation of direct occupational therapy to an individual for a specific medical condition must be based on a referral from a licensed physician or a licensed podiatrist. Page Iof8

2 Regulatory Analysis Form (10) Is the regulation mandated by any federal or state law or court order, or federal regulation? If yes, cite the specific law, case or regulation, and any deadlines for action. The regulation is not mandated by any federal or state law or court order, or federal regulation. (11) Explain the compelling public interest that justifies the regulation. What is the problem it addresses? The Board's construction of Section 14 in regulatory format will help alleviate uncertainty which currently exists in the regulated community as to whether occupational therapists may accept oral orders. The regulation makes it clear that occupational therapists in private office/private practice settings, as well as in long-term care nursing facilities and home health care agencies, licensed under the Department of Health, may accept oral orders from a physician or podiatrist. Currently, frequent delays occur in providing needed services to consumers due to the time it may take to obtain a written order for services from a physician or podiatrist. Additionally, if a physician or podiatrist telephones an oral order for occupational therapy services, occupational therapists in long-term care nursing facilities or home health care agency settings, uncertain about their ability to receive the order, may be obliged to summon a nurse, who is less conversant with the profession than the actual practitioner, but who is clearly permitted to receive oral orders from a physician or podiatrist, to receive it; occupational therapists in private office settings may believe they are unable to receive the oral order at all. Therefore, the proposed regulation makes interactions between physicians and podiatrists and occupational therapists more cost-efficient and timely, and prevents delays in providing services, thus preventing harm to consumers who require those services. (12) State the public health, safety, environmental or general welfare risks associated with nonregulation. Absent this clarification, the regulated community will continue to be without certainty as to whether occupational therapists may accept oral orders for services, and delays in providing needed services to consumers, while a written order for services is obtained, will continue to occur. Similarly, if oral orders are rendered telephonically, occupational therapists may continue to find it necessary to summon a nurse, who is less conversant with the profession than the actual practitioner, to receive the oral orders. (13) Describe who will benefit from the regulation. (Quantify the benefits as completely as possible and approximate the number of people who will benefit.) Patients who require occupational therapy services on an urgent basis will benefit from this regulation, as those services can be rendered more promptly and efficiently, without the necessity for a delay and without the intervention of a nurse to accept oral orders for the services. Page 2 of 8

3 Regulatory Analysis Form (14) Describe who will be adversely affected by the regulation. (Quantify the adverse effects as completely as possible and approximate the number of people who will be adversely affected.) No adverse effects are anticipated. (15) List the persons, groups or entities that will be required to comply with the regulation. (Approximate the number of people who will be required to comply.) All licensed occupational therapists will be required to comply with this regulation. Board records show 4043 persons hold occupational therapy licenses, and all of those licensees hold active licenses. (16) Describe the communications with and input from the public in the development and drafting of the regulation. List the persons and/or groups who were involved, if applicable. In drafting and promulgating the regulation the Board solicited input and suggestions from the regulated community by providing drafts to organizations and entities which represent the profession, educational institutions, and interested individuals. A list of the organizations and entities is attached. (17) Provide a specific estimate of the costs and/or savings to the regulated community associated with compliance, including any legal, accounting or consulting procedures which may be required. There are no costs to the regulated community associated with compliance. There may be savings in that the need for participation by a nurse, to accept oral orders for an occupational therapist, is eliminated, thereby reducing the number of professional personnel required to provide the ordered services to the patient. However, owing to the limitless range of pay scales, employment relationships and other related factors, the Board cannon quantify the potential savings. The regulations do not impose new legal, accounting or consulting procedures. Page 3 of 8

4 Regulatory Analysis Form (18) Provide a specific estimate of the costs and/or savings to local governments associated with compliance, including any legal, accounting or consulting procedures which may be required. Local governments would not be affected by this regulation. (19) Provide a specific estimate of the costs and/or savings to state government associated with the implementation of the regulation, including any legal, accounting, or consulting procedures which may be required. No legal, accounting or consulting activities are anticipated in connection with the implementation of this regulation. Page 4 of 8

5 rceguiaiury Miuuysis rvuu (20) In the table below, provide an estimate of the fiscal savings and costs associated with implementation and compliance for the regulated community, local government, and state government for the current year and five subsequent years. SAVINGS: Regulated Local Government State Government Total Savings COSTS: Regulated Local Government State Government Total Costs REVENUE LOSSES: Regulated Local Government State Government Total Revenue Losses Current FY $N/A FY+1 $N/A FY+2 $N/A (20a) Explain how the cost estimates listed above were derived. FY+3 $N/A FY+4 $N/A FY+5 $N/A Page 5 of 8

6 Keguiaiory Analysis (20b) Provide the past three year expenditure history for programs affected by the regulation. Program N/A FY-3 N/A FY-2 N/A FY-1 Current FY (21) Using the cost-benefit information provided above, explain how the benefits of the regulation outweigh the adverse effects and costs. There should be no adverse effects and costs associated with compliance of this regulation. (22) Describe the nonregulatory alternatives considered and the costs associated with those alternatives. Provide the reasons for their dismissal. The nonregulatory alternative to promulgating this regulation would be to clarify this issue by means of a Statement of Policy. However, in light of the Department of Health regulations requiring that individuals who accept oral and telephone orders be authorized to do so by "appropriate statutes and the State Boards in the Bureau of Professional and Occupational Affairs," 28 Pa. Code 211.3(a); 28 Pa. Code (d), a regulation codifying that authorization is deemed to be the superior alternative. (23) Describe alternative regulatory schemes considered and the costs associated with those schemes. Provide the reasons for their dismissal. Because the regulation only amends an existing regulatory scheme, the Board did not consider an alternative regulatory scheme. Page 6 of 8

7 (24) Are there any provisions that are more stringent than federal standards? If yes, identify the specific provisions and the compelling Pennsylvania interest that demands stronger regulation. (25) How does this regulation compare with those of other states? Will the regulation put Pennsylvania at a competitive disadvantage with other states? The regulation will not put Pennsylvania at a competitive disadvantage with other states. The regulation simply makes explicit the Board's long-standing interpretation of the enabling act. A number of licensees were uncertain about whether and under what circumstances they might implement occupational therapy upon an oral order issued by a physician or podiatrist. The regulations of the surrounding states do not appear to distinguish between oral and written orders. In Ohio an occupational therapist receives and interprets referrals or prescriptions for occupational therapy services. OAC Ann (1999). New Jersey onlymentionsthataphysician'sorderrefersapatient to occupational therapy service. NJAC 8:43G-29.13(b) (1999). In New York a physician may issue a written orderorareferralfbroccupationaltherapyservices. 10NYCRR 752-Ll(d)(1999). West Virginia only states that an occupational therapist may treat patients upon a referral from a physician, psychologist, dentist, or podiatrist. W.Va. Code (1999). The Maryland and Delaware codes do not appear to address the issue of referral, order, or prescription at all (26) Will the regulation affect existing or proposed regulations of the promulgating agency or other state agencies? If yes, explain and provide specific citations. The regulation provides clarification for long term care nursing facilities and home health care agencies, licensed under the Department of Health, in their utilization of occupational therapy services for their patients. Department of Health regulations for both long term nursing care facilities and home health care agencies provide that a nurse, physician, "or other individual authorized by appropriate statutes and the State Boards in the Bureau of Professional and Occupational Affairs" may receive a physician's oral order for services. 28 Pa. Code (long term care facilities); 28 Pa. Code (home health care agencies). Similarly, the addition is consistent with Department of Public Welfare medical assistance regulations governing reimbursement to home health agencies for services provided to medical assistance recipients. Those regulations specifically permit an occupational therapist to receive oral orders from a physician pertaining to the occupational therapists specialty. 55 Pa. Code The addition of makes it clear that occupational therapists are individuals "authorized by appropriate statutes and the State Boards in the Bureau of Professional and Occupational Affairs" to receive a physician's oral order for services, and it eliminates ambiguity and uncertainty for these treatment settings. (27) Will any public hearings or informational meetings be scheduled? Please provide the dates, times, and locations, if available. The Board has not scheduled public hearings or informational meetings. The Board already solicited inputfrommajor professional associations representing licensees (see Item 16), and is willing to hear input from interested parties at any of its regularly scheduled meetings. Page 7 of 8

8 Regulatory Analysis Form (28) Will the regulation change existing reporting, record keeping, or other paperwork requirements? Describe the changes and attach copies of forms or reports which will be required as a result of implementation, if available. The regulation's requirement that an oral order must be immediately transcribed in the patient's medical record and counter-signed by the ordering physician or podiatrist in accordance with applicable regulations of the Department of Health governing the licensed facility in which the occupational therapist provides the ordered services places a minimal burden, in terms of paperwork requirements, on the licensee and the ordering physician or podiatrist. Since careful and detailed record keeping is an essential aspect of all health care professionals' practice, and since Department of Health regulations already require counter-signing of an oral order within a specified period of time, licensees and ordering physicians or podiatrists would be keeping such records even in the absence of this specific regulation imposing the requirement. (29) Please list any special provisions which have been developed to meet the particular needs of affected groups or persons including, but not limited to, minorities, elderly, small businesses, and farmers. The Board has perceived no special needs of any subset of its licensees for whom special provisions should be made. (30) What is the anticipated effective date of the regulation; the date by which compliance with the regulation will be required; and the date by which any required permits, licenses or other approvals must be obtained? The regulation will be effective on publication of the final form regulation in the Pennsylvania Bulletin. (31) Provide the schedule for continual review of the regulation. The Board conducts ongoing review of its regulations to evaluate their continued efficacy. Page 8 of 8

9 FACE SHEET FOR FILING DOCUMENTS WITH THE LEGISLATIVE REFERENCE BUREAU (Pursuant to Commonwealth Documents Law) e /f ~n /9 DO NOT WRITE IN THIS SPACE Copy below is hereby approved as to form and legality. Attorney General (DEPUTY ATTORNEY GENERAL) DATE OP APPROVAL Copy below is hereby certified to be a true and correct copy of a document Issued, prescribed or promulgated by: State Board of Occupational Therapy Education and Licenaure (AGENCY) DOCUMENT/FISCAL NOTE NO. DATE OF ADOPTION; A)* faujlb*. Hanna Gruen Copy below is approved as to form and legality. Executive or Independent Agenciesy 6>O date LTB OP API APPROVAL (Deputy General Counsel (Clilyl Cviunsel/ Independent Agremy (Strike inapplicable [ ] Check if applicable Copy not approved. Objections attached. Chairperson (EXECUTIVE OFFICER, CHAIRMAN OR SECRETARY) [ ] Check if applicable. No Attorney General approval or objection within 30 day after submission. NOTICE OF FINAL RULEMAKING COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF STATE BUREAU OF PROFESSIONAL AND OCCUPATIONAL AFFAIRS STATE BOARD OF OCCUPATIONAL THERAPY EDUCATION AND LI CENSURE 49 PA. CODE, CHAPTER 42 ORAL ORDERS

10 Oral Orders November 17, 1999 The State Board of Occupational Therapy Education and Licensure ("Board") amends its regulations at 49 Pa. Code by adding 42.25, as set forth in Annex A, relating to oral A. Effective Date The amendments take effect upon publication in the Pennsylvania Bulletin. B. Statutory Authority The Board has authority to adopt regulations not inconsistent with the law as it deems necessary for the performance of its duties and the proper administration of the law under Section 5(b) of the Occupational Therapy Practice Act ("Act"), Act of June 15, 1982, P.L. 502, as amended, 63 P.S. 1505(b). C. Purpose Section 14 of the Act, 63 P.S. 1514, specifies that implementation of direct occupational therapy to an individual for a specific medical condition must be based on a referral from a licensed physician or a licensed podiatrist. The Board has long construed this to include services ordered orally by a licensed physician or licensed podiatrist. The purpose of this rulemaking is to codify the Board's interpretation of the Act and outline the conditions under which an occupational therapist may implement therapy based on an oral order. Under the regulation an occupational therapist receives written orders to implement therapy under ordinary circumstances but may accept an oral order if the urgency of the medical circumstances requires treatment to begin immediately. The occupational therapist will be required to immediately transcribe an oral order and obtain the countersignature of the prescriber within a specified period of time, either five days in a private setting, or in accordance with regulations of the Department of Health in a facility licensed by the Department of Health. A detailed explanation of the purpose and background of the rulemaking may be found in the publication of proposed rulemaking at 29 Pa (June 18, 1999) D. Compliance with Executive Order In accordance with the requirements of Executive Order (February 6, 1996), in drafting and promulgating the regulation the

11 Oral Orders November 17, 1999 Board solicited input and suggestions from the regulated community by providing drafts to organizations and entities which represent the profession, educational institutions, and interested individuals. E. Summary of Comments and Responses to Proposed Rulemakinq The Regulations were published at 29 Pa.B.3070 (June 18, 1999). The Board received two public comments and comments from the Independent Regulatory Review Commission, The following is the Board's response to those comments. The Pennsylvania Occupational Therapy Association (POTA) expressed unequivocal support for the proposed rulemaking. POTA pointed out that under current law and regulations an occupational therapist was not prohibited from receiving an oral order in any setting except a hospital. POTA expressed the opinion that many occupational therapists wrongly believed that they were unable to implement therapy based on an oral order in any setting. POTA stated that when an occupational therapist is unable to receive an oral order, another professional, untrained in occuptional therapy, must serve as an intermediary between the prescriber and the occupational therapist, causing delay in treatment. The Pennsylvania Medical Society (PMS) and IRRC addressed the requirement in 42.25(b) that the prescriber countersign the orally delivered order within five days. PMS pointed out that in private settings the site of occupational therapy might be independent of the prescriber's office and the prescriber would not typically visit the facility of the occupational therapist to countersign the order. PMS and IRRC suggested that the regulation permit the use of a faxed or mailed copy of the order to be sent after the order is given orally. The Board has adopted this suggestion and has revised 42.25(b) accordingly. IRRC noted that the proposed regulation did not state what the occupational therapist should do if a timely countersignature from the physician or podiatrist was not obtained and expressed the view that the regulation should state what the occupational therapist should then do. The Board declines to adopt this suggestion. The Board notes that the regulations of the Department of Health pertaining to oral and telephone orders in long term nursing care facilities require the physician to countersign orders which were delivered orally, but do not specify what the health care professional is to do if the physician does not timely countersign. 28 Pa. Code 211.3(b). Similarly, the licensed health care professional in a home health care agency who receives an oral

12 Oral Orders November 17, 1999 order for medication and treatment is required to obtain the physician's countersignature on the order which was delivered orally, but is not required to follow a procedure specified by regulation if the physician does not timely countersign. 28 Pa. Code (d). The Board does not believe that obtaining the signature of the physician or podiatrist is likely to be a problem and, if the signature is not timely obtained, the course of action should be left to the professional judgment of the therapist based on the facts of the situation, as well as the policies of the institution or setting in which the service is rendered. IRRC also requested that the rulemaking refer to the specific regulations of the Department of Health for time limits for obtaining a prescriber's countersignature in a long term nursing care facility and in a home health care agency. The Board has added these references in 42.25(c). Additionally the Board has made minor revisions to the rulemaking to eliminate redundant phrases. F. Fiscal Impact and Paperwork Requirements Commonwealth - There will be no adverse fiscal impact or paperwork requirements imposed. Political subdivisions - There will be no adverse fiscal impact or paperwork requirements imposed. Private sector - There is no adverse fiscal impact associated with this amendment. The regulation's requirement that an oral order must be immediately transcribed in the patient's medical record and countersigned by the ordering physician or podiatrist places a minimal burden, in terms of paperwork requirements, on the licensee and the ordering physician or podiatrist. Because careful and detailed record keeping is an essential aspect of all health care practice and because the Department of Health regulations already require oral orders to be countersigned within a specific period of time, licensees and ordering physicians or podiatrists would keep such records even in the absence of the specific regulation imposing the requirement. G. Sunset Date The Board continuously monitors its regulations. no sunset date has been assigned. Therefore,

13 Oral Orders November 17, 1999 H. Regulatory Review Under Section 5.1 (a) of the Regulatory Review Act, Act of June 30, 1989, P.L. 73, No. 19 (71 P.S ), the Board submitted a copy of the notice of proposed rulemaking, published at 29 Pa.B. 3070, to the Independent Regulatory Review Commission and to the Chairpersons of the House Professional Licensure Committee and the Senate Consumer Protection and Professional Licensure Committee for review and comment. In compliance with section 5(c) of the Regulatory Review Act, the Board also provided IRRC and the Committees with copies of the comments received as well as other documentation. In preparing these final-form regulations the Board has considered the comments received from IRRC and the public. These final-form regulations were (deemed) approved by the House and Senate Committee on. IRRC met on, and (deemed) approved the amendments in accordance with section 5(e) of the Regulatory Review Act. I. Contact Person Further information may be obtained by contacting Clara Flinchum, Administrative Assistant, State Board of Occupational. Therapy Education and Licensure, P.O. Box 2649, Harrisburg, Pennsylvania , (717) J. Findings The Board finds that: (1) Public notice of proposed rulemaking was given under sections 201 and 202 of the act of July 31, 1968 (P.L. 769, No. 240) (45 P.S and 1202) and the regulations promulgated thereunder at 1 Pa. Code 7.1 and 7.2. (2) A public comment period was provided as required by law and all comments were considered. (3) These amendments do not enlarge the purpose of proposed rulemaking published at 29 Pa.B (4) These amendments are necessary and appropriate for administration and enforcement of the authorizing act identified in Part B of this preamble.

14 Oral Orders November 17, 1993 The Board, acting under its authorizing statute, orders that: (a) The regulations of the Board, 49 Pa. Code Chapter 42, are amended by adding to read as set forth in Annex A. (b) The Board shall submit this order and Annex A to the Office of General Counsel and to the Office of Attorney General as required by law. (c) The Board shall certify this order and Annex A and deposit them with the Legislative Reference Bureau as required by (d) This order shall take effect on publication in the Pennsylvania Bulletin. HANNA GRUEN, Chairperson

15 Oral Orders October 21, 1999 ANNEX A TITLE 49. PROFESSIONAL AND VOCATIONAL STANDARDS PART I. DEPARTMENT OF STATE SUBPART A. PROFESSIONAL AND OCCUPATIONAL AFFAIRS CHAPTER 42. STATE BOARD OF OCCUPATIONAL THERAPY EDUCATION AND LICENSURE MINIMUM STANDARDS OF PRACTICE Oral Orders (a) An occupational therapist shall accept a referral in the form of a written order from a licensed physician or licensed podiatrist in accordance with Section 14 of the Act (63 P.S. 1514) unless the urgency of the medical circumstances requires immediate treatment. In such circumstances, an occupational therapist may accept an oral order for occupational therapy from a licensed physician or licensed podiatrist, provided that the oral order is immediately transcribed, including the date and time, in the patient's medical record and signed by the occupational therapist taking the order, (b) The countersignature of the licensed physician or licensed podiatrist shall be obtained within five j-5-h days of receipt of the oral order in the case of an occupational therapist providing ordered services in a private office setting. IN THE CASE OF AN OCCUPATIONAL THERAPIST PROVIDING SERVICES IN A SETTING THAT IS INDEPENDENT OF THE PRESCRIBING PHYSICIAN'S OR PODIATRIST'S OFFICE, THE COUNTERSIGNATURE ON A WRITTEN COPY OF THE ORDER MAY BE MAILED OR FAXED TO THE OCCUPATIONAL THERAPIST. (C) In the case of an occupational therapist providing services in a facility licensed by the Department of Health, the countersignature of the licensed physician or licensed podiatrist shall be obtained in accordance with applicable regulations of the Department of Health governing the licensed facility in which the occupational tiiciapist piwvxd^o Lh6 ord^i^a s^ivic^s, INCLUDING, BUT NOT LIMITED TO, 28 PA. CODE SS (RELATING TO ORAL AND TELEPHONE ORDERS IN A LONG TERM CARE NURSING FACILITY) AND (RELATING TO CONFORMANCE WITH PHYSICIAN ORDERS UNDER STANDARDS FOR HOME HF.ALTH CARE AGENCIES).

16 MOUNT ALOYSIUS COLLEGE One College Drive Cresson, PA PENNSYLVANIA COLLEGE OF TECHNOLOGY One College Avenue Williamsport, PA THE PENNSYLVANIA STATE UNIVERSITY Tulpehocken Road Post Office Box 7009 Reading, PA Susan McFadden NBCOT 800 S. Frederick Avenue, Suite 200 Gaithersburg, MD la Wooldridc AOTf 4 Reseafc'rTPfeee.^Suite 160 Ropkville, MD 20850*3226 Mary Ellen Carter, Program Manager AOTA - State Government Affairs 4720 Montgomery Lane Post Office Box Bethesda, MD Debbie Barnhart Occupational Therapy Department CHAMBERSBURG HOSPITAL 112 North 7th Street, P.O. Box 6005 Chambersburg, PA Sue Parker, President POTA 234 Walnut Road Strafford, PA 19087

17 RANGOS SCHOOL OF HEALTH SCIENCES DUQUESNE UNIVERSITY 227 Health Sciences Building Pittsburgh, PA COLLEGE MISERICORDIA Division of Health Sciences 301 Lake Street Dallas, PA ELIZABETHTOWN COLLEGE One Alpha Drive Elizabethtown, PA TEMPLE UNIVERSITY College of Allied Health Programs 3307 North Broad Street Philadelphia, PA THOMAS JEFFERSON UNIVERSITY Edison Building, Room South 9th Street Philadelphia, PA UNIVERSITY OF PITTSBURGH School of Health & Rehab 116 Pennsylvania Hall Pittsburgh, PA UNIVERSITY OF SCRANTON Scranton, PA Lillian Briola, Director COMMUNITY COLLEGE OF ALLEGHENY CO. Boyce Campus 595 Beatty Road Monroeville, PA HARCUM COLLEGE BrynMawr, PA LEHIGH CO. COMMUNITY COLLEGE 4525 Education Park Drive Schnecksville, PA

18 Kari Montgomery Administrative Assistant OT WEEK 4720 Montgomery Lane, Suite 603 Bethesda, MD EJ. Brown, Editor of OT MERION PUBLICATIONS 650 Park Avenue, West King of Prussia, PA Louise Fawcett, Ph.D. NATIONAL COMMISSION ON CC IN OCCUPATIONAL THERAPY Post Office Box 234 Lake Elmo, MN

19 ' '-*<-" 7UT.1IUIU PROPOSED RULEMAKING STATE BOARD OF OCCUPATIONAL THERAPY EDUCATION AND LICENSURE [49 PA. CODE CH. 42] Oral Orders [29Pa.B.3O7O] The State Board of Occupational Therapy Education and Licensure (Board) proposes to add (relating to oral orders), to read as set forth in Annex A. A. Effective Date The proposed regulation would be effective upon publication of the final-form regulation in the Pennsylvania Bulletin. B. Statutory Authority The Board has authority to adopt regulations not inconsistent with the law as it deems necessary for the performance of its duties and the proper administration of the law under section 5(b) of the Occupational Therapy Practice Act (act) (63 P. S. 1505(b)). C. Background and Purpose Section 14 of the act (63 P, S, 1514) specifies that implementation of direct occupational therapy to an individual for a specific medical condition must be based on a referral from a licensed physician or a licensed podiatrist. The Board construes this to include services ordered orally by a licensed physician or licensed podiatrist. The proposed regulation clarifies that occupational therapists may accept oral orders under the statute, and codifies the Board's longstanding interpretation of section 14 of the act. The Board's construction of section 14 of the act in regulatory format will help alleviate uncertainty which currently exists in the regulated community as to whether occupational therapists may accept oral orders. The proposed regulation makes it clear that occupational therapists in private office/private practice settings, as well as in long-term care nursing facilities and home health care agencies, licensed under the Department of Health, may accept oral orders from a physician or podiatrist. Currently,frequentdelays occur in providing needed services to consumers due to the time it piay take to obtain a written order for services from a physician or podiatrist. Additionally, if a physician or podiatrist telephones an oral order for occupational therapy services, occupational therapists in long-term care nursing facilities or home health care agency settings, uncertain about their ability to receive the order, may be obliged to summon a nurse, who is less conversant with the profession than the actual practitioner but who is clearly permitted to receive oral orders from a physician or podiatrist, to receive it; occupational therapists in private office settings may believe they are unable to receive the oral order at all. I of 4 10/13/99 12:19 PM

20 i r\ WUUCIHI, UUl. IW. 77-7UH Therefore, the proposed regulation makes interactions between physicians or podiatrists and occupational therapists more cost-efficient and timely, and prevents delays in providing services, thus preventing harm to consumers who require those services. The proposed regulation also provides clarification for long-term care nursing facilities and home health care agencies, licensed under the Department of Health, in their utilization of occupational therapy services for their patients. Department of Health regulations for both long term nursing care facilities and home health care agencies provide that a nurse, physician, "or other individual authorized by appropriate statutes and the State Boards in the Bureau of Professional and Occupational Affairs" may receive a physician's oral order for services. 28 Pa. Code (long term care facilities); 28 Pa. Code (home health care agencies). Similarly, the proposed addition is consistent with Department of Public Welfare medical assistance regulations governing reimbursement to home health agencies for services provided to Medical Assistance recipients. Those regulations specifically permit an occupational therapist to receive oral orders from a physician pertaining to the occupational therapist's specialty. 55 Pa. Code The proposed addition of makes it clear that occupational therapists are individuals "authorized by appropriate statutes and the State Boards in the Bureau of Professional and Occupational Affairs" to receive a physician's oral order for services, and it eliminates ambiguity and uncertainty for these treatment settings. D. Description of Proposed Regulation New 42.25(a) specifies that occupational therapists shall accept written referrals from licensed physicians or licensed podiatrists unless the urgency of the medical circumstances requires immediate treatment. In that circumstance, the occupational therapist can accept an oral order if the oral order is immediately transcribed, with the date and time, in the patient's medical record and the occupational therapist who took the order signs it. In subsection (b), the proposed regulation provides that the occupational therapist in a private office setting must obtain the countersignature of the ordering physician or podiatrist within 5 days of receiving it; in the case of an occupational therapist providing services in a facility licensed by the Department of Health, the oral order must be countersigned by the ordering physician or podiatrist in accordance with applicable regulations of the Department of Health governing the licensed facility in question. E. Compliance with Executive Order In accordance with Executive Order (February 6,1996), in drafting and promulgating the proposed regulation the Board solicited input and suggestionsfromthe regulated community by providing drafts to organizations and entities which represent the profession, educational institutions and interested individuals. F. Fiscal Impact and Paperwork Requirements 1. Commonwealth-There will be no adverse fiscal impact or paperwork requirements imposed. 2. Political subdivisions-there will be no adverse fiscal impact or paperwork requirements imposed. 3. Private sector There is no adverse fiscal impact associated with this proposed regulation. The proposed regulation's requirement that an oral order must be immediately transcribed in the patient's medical record and countersigned by the ordering physician or podiatristin accordance with applicable regulations of the Department of Health governing the licensed facility in which the occupational therapist provides the ordered services places a minimal burden, in terms of paperwork requirements, on the licensee and the ordering 2 Of 4 10/13/99 12:19 PM

21 . UUIIVVIII, L/UV. MV> //"/Ut physician or podiatrist. However, because careful and detailed recordkeeping is an essential aspect of all health care professionals' practice, licensees and ordering physicians or podiatrists would be keeping the records even in the absence of the specific regulation imposing the requirement. G. Sunset Date The Board continuously monitors its regulations. Therefore, no sunset date has been assigned. H. Regulatory Review Under section 5(a) of the Regulatory Review Act (71 P. S (a))> on June 3, 1999, the Board submitted a copy of this proposed regulation to the Independent Regulatory Review Commission (IRRC) and the Chairpersons of the House Professional Licensure Committee and the Senate Consumer Protection and Professional Licensure Committee (Committees). In addition to submitting the proposed regulation, the Board has provided IRRC and the Committees with a copy of a detailed Regulatory Analysis Form prepared by the Board in compliance with Executive Order , "Regulatory Review and Promulgation. 1 ' A copy of this material is available to the public upon request. If IRRC has objections to any portion of the proposed regulation, it will notify the Board within 10 days of the close of the Committees' review period. The notification shall specify the regulatory review criteria which have not been met by that portion. The Regulatory Review Act specifies detailed procedures for review, prior to final publication of the regulation, by the Board, the General Assembly and the Governor, of objections raised. I. Public Comment Interested persons are invited to submit written comments, suggestions or objections regarding the proposed regulation to Ruth D. Dunnewold, Counsel, State Board of Occupational Therapy Education and Licensure, 116 Pine Street, P. O. Box 2649, Harrisburg, PA , within 30 of publication of this proposed rulemaking. Please reference No. 16A-673 (Oral Orders), when submitting comments. Fiscal Note: 16A-673. No fiscal impact; (8) recommends adoption. Annex A HANNA GRUEN, Chairperson TITLE 49. PROFESSIONAL AND VOCATIONAL STANDARDS PART I. DEPARTMENT OF STATE Subpart A. PROFESSIONAL AND OCCUPATIONAL AFFAIRS CHAPTER 42. STATE BOARD OF OCCUPATIONAL THERAPY EDUCATION AND LICENSURE Oral orders. MINIMUM STANDARDS OF PRACTICE 3of4 10/13/99 12:19 PM

22 nttp:// < htm! (a) An occupational therapist shall accept a referral in the form of a written order from a licensed physician or licensed podiatrist in accordance with section 14 of the act (63 P. S. 1514) unless the urgency of the medical circumstances requires immediate treatment. In these circumstances, an occupational therapist may accept an oral order for occupational therapy from a licensed physician or licensed podiatrist, if the oral order is immediately transcribed, including the date and time, in the patient's medical record and signed by the occupational therapist taking the order. (b) The countersignature of the licensed physician or licensed podiatrist shall be obtained within 5 days of receipt of the oral order in the case of an occupational therapist providing ordered services in a private office setting. In the case of an occupational therapist providing services in a facility licensed by the Department of Health, the countersignature of the licensed physician or licensed podiatrist shall be obtained in accordance with applicable regulations of the Department of Health governing the licensed facility in which the occupational therapist provides the ordered services. [Pa.B. Doc. No Filed for public inspection June 18,1999,9:00 a.m.] No part of the information on this site may be reproduced for profit or sold for profit. This material has been drawn directly from the official Pennsylvania Bulletin full text database. Due to the limitations of HTML or differences in display capabilities of different browsers, this version may differ slightly from the official printed version. webmasterccbpabulletin. com 4of4 10/13/99 12:19 PM

23 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF STATE BUREAU OF PROFESSIONAL AND OCCUPATIONAL AFFAIRS STATE BOARD OF OCCUPATIONAL THERAPY EDUCATION AND LICENSURE Post Office Box 2649 Harrisburg, Pennsylvania (717) April 7, 2000 The Honorable John R. McGinley, Jr., Chairman INDEPENDENT REGULATORY REVIEW COMMISSION 14 th Floor, Harristown Market Street Harrisburg, Pennsylvania Re: Final Rulemaking State Board of Occupational Therapy Education and Licensure Oral Orders: 16A-673 Dear Chairman McGinley: Enclosed is a copy of afinalrulemaking package of the State Board of Occupational Therapy Education and Licensure pertaining to oral orders. The Board will be pleased to provide whatever information the Commission may require during the course of its review of the rulemaking. Very truly yours, HG/HA:bjd Enclosure Hanna Gruen, Chairman State Board of Occupational Therapy Education and Licensure FOR MORE INFORMATION, VISIT US THROUGH THE PENNSYLVANIA HOMEPAGE AT OR VISIT US DIRECTLY AT

24 c: John T. Henderson, Jr., Chief counsel Department of State Dorothy Childress, Commissioner Bureau of Professional and Occupational Affairs Joyce McKeever, Deputy Chief Counsel Department of State Herbert Abramson, Senior Counsel in Charge Bureau of Professional and Occupational Affairs State Board of Occupational Therapy Education and Licensure FOR MORE INFORMATION, VISIT US THROUGH THE PENNSYLVANIA HOMEPAGE AT OR VISIT US DIRECTLY AT

25 TRANSMITTAL SHEET FOR REGULATIONS SUBJECT TO THE REGULATORY REVIEW ACT ID.NUMBER: 16A-673 K CF! V F.D SUBJECT: State Board of Occupational Therapy Education and #%^ B -""3raM3^i AGENCY: DEPARTMENT OF STATE REV it" U..VSSICU Proposed Regulation TYPE OF REGULATION X Final Regulation Final Regulation with Notice of Proposed Rulemaking Omitted 120-day Emergency Certification of the Attorney General 120-day Emergency Certification of the Governor Delivery of Tolled Regulation a. With Revisions b. Without Revisions FILING OF REGULATION DATE SIGNATURE DESIGNATION U-Hoo _txi/; _ - Jbfe- HOUSE COMMITTEE ON PROFESSIONAL LICENSURE hjjh^jola'mvuj iltijofu^ SENATE COMMITTEE ON CONSUMER PROTECTION & PROFESSIONAL LICENSURE i bc yjtf j g A v ^' INDEPENDENT REGULATORY REVIEW COMMISSION ATTORNEY GENERAL LEGISLATIVE REFERENCE BUREAU March 29,2000