Supervision of Occupational Therapy Assistants and Occupational Therapy Assistant Limited Permit Holders

PURPOSE: This rule defines the supervision requirements for occupational therapy assistants and occupational therapy assistant limited permit holders. (1) An occupational therapy assistant and/or occupational therapy assistant limited permit holder shall assist an occupational therapist in the delivery of occupational therapy services in compliance with all state and federal statutes, regulations, and rules. (2) The occupational therapy assistant or occupational therapy assistant limited permit holder may only perform services under the direct supervision of an occupational therapist. (A) The manner of supervision shall depend on the treatment setting, patient/client caseload, and the competency of the occupational therapy assistant and/or occupational therapy assistant limited permit holder as determined by the supervising occupational therapist. At a minimum, supervision shall include consultation of the occupational therapy assistant and/or occupational therapy assistant limited permit holder with the supervising occupational therapist prior to the initiation of any patient’s/client’s treatment plan and modification of treatment plan. (B) More frequent face-to-face supervision may be necessary as determined by the occupational therapist or occupational therapy assistant and/or occupational therapy assistant limited permit holder dependent on the level of expertise displayed by the occupational therapy assistant and/or occupational therapy assistant limited permit holder, the practice setting, and/or the complexity of the patient/client caseload. (C) Supervision shall be an interactive process between the occupational therapist and occupational therapy assistant and/or occupational therapy assistant limited permit holder. It shall be more than peer review or co-signature. The interactive process shall include but is not limited to the patient/client assessment, reassessment, treatment plan, intervention, discontinuation of intervention, and/or treatment plan. (D) The supervising occupational therapist or the supervisor’s designee must be available for immediate consultation with the occupational therapy assistant and/or occupational therapy assistant limited permit holder. The supervisor need not be physically present or on the premises at all times. (3) The supervising occupational therapist has the overall responsibility for providing the necessary supervision to protect the health and welfare of the patient/client receiving treatment from an occupational therapy assistant and/or occupational therapy assistant limited permit holder. The supervising occupational therapist shall— (A) Be licensed by the board as an occupational therapist; (B) Not be licensed as a limited permit holder; (C) Not be under restriction or discipline from any licensing board or jurisdiction; (D) Not have more than four (4) full-time equivalent (FTE) occupational therapy assistants under his/her supervision at one time; (E) Be responsible for all referrals of the patient/client; (F) Be responsible for completing the patient’s evaluation/assessment. The occupational therapy assistant and/or occupational therapy assistant limited permit holder may contribute to the screening and/or evaluation process by gathering data, administering standardized tests and reporting observations. The occupational therapy assistant and/or occupational therapy assistant limited permit holder may not evaluate independently or initiate treatment before the supervising occupational therapist’s evaluation/assessment; (G) Be responsible for developing and modifying the patient’s treatment plan. The treatment plan must include goals, interventions, frequency, and duration of treatment. The occupational therapy assistant and/or occupational therapy assistant limited permit holder may contribute to the preparation, implementation and documentation of the treatment plan. The supervising occupational therapist shall be responsible for the outcome of the treatment plan and assigning of appropriate intervention plans to the occupational therapy assistant and/or occupational therapy assistant limited permit holder within the competency level of the occupational therapy assistant and/or occupational therapy assistant limited permit holder; (H) Be responsible for developing the patient’s discharge plan. The occupational therapy assistant and/or occupational therapy assistant limited permit holder may contribute to the preparation, implementation and documentation of the discharge plan. The supervising occupational therapist shall be responsible for the outcome of the discharge plan and assigning of appropriate tasks to the occupational therapy assistant and/or occupational therapy assistant limited permit holder within the competency level of the occupational therapy assistant and/or occupational therapy assistant limited permit holder; and (I) Ensure that all patient/client documentation becomes a part of the permanent record. (4) The supervising occupational therapist has the overall responsibility for providing the necessary supervision to protect the health and welfare of the patient/client receiving treatment from an occupational therapy assistant and/or occupational therapy assistant limited permit holder. However, this does not absolve the occupational therapy assistant and/or occupational therapy assistant limited permit holder from his/her professional responsibilities. The occupational therapy assistant and/or occupational therapy assistant limited permit holder shall exercise sound judgement and provide adequate care in the performance of duties. The occupational therapy assistant and/or occupational therapy assistant limited permit holder shall— (A) Not initiate any patient/client treatment program or modification of said program until the supervising occupational therapist has evaluated, established a treatment plan and consulted with the occupational therapy assistant and/or occupational therapy assistant limited permit holder; (B) Not perform an evaluation/assessment, but may contribute to the screening and/or evaluation process by gathering data, administering standardized tests and reporting observations; (C) Not analyze or interpret evaluation data; (D) Track the need for reassessment and report changes in status that might warrant reassessment or referral; (E) Immediately suspend any treatment intervention that appears harmful to the patient/client and immediately notify the supervising occupational therapist; and (F) Ensure that all patient/client documentation prepared by the occupational therapy assistant and/or occupational therapy assistant limited permit holder becomes a part of the permanent record. (5) The supervisor shall ensure that the occupational therapy assistant and/or occupational therapy assistant limited permit holder provides occupational therapy as defined in section 324.050, RSMo appropriate to and consistent with his/her education, training, and experience. AUTHORITY: sections 324.050, 324.056, 324.065.2, and 324.086, RSMo 2016.* This rule originally filed as 4 CSR 205-4.010. Original rule filed Aug. 4, 1998, effective Dec. 30, 1998. Amended: Filed March 14, 2001, effective Sept. 30, 2001. Amended: Filed Oct. 30, 2002, effective April 30, 2003. Amended: Filed June 25, 2004, effective Dec. 30, 2004. Moved to 20 CSR 2205-4.010, effective Aug. 28, 2006. Amended: Filed Nov. 6, 2019, effective May 30, 2020. *Original authority: 324.050, RSMo 1997, amended 1999, 2008; 324.056, RSMo 1997, amended 1999; 324.065, RSMo 1997, amended 2009; and 324.086, RSMo 1997, amended 1999, 2001, 2009.