Occupational therapy programs tables of content

§ 42.24. Code of Ethics.
Purpose. The Board adopts the following Code of Ethics to establish and maintain a high standard of integrity and dignity in the profession and to protect the public against unprofessional conduct on the part of occupational therapists and occupational therapy assistants. The Code of Ethics is adapted from the “Occupational Therapy Code of Ethics” of the American Occupational Therapy Association (revised April 1988).

Principle I. Beneficence/autonomy. A licensee shall demonstrate a concern for the welfare and dignity of the recipients of services, including patients/clients and subjects involved in education and research activities.

(i) A licensee shall provide services without discriminating on the basis of race, creed, national origin, sex, age, handicap, disease, social status, financial status or religious affiliation.

(ii) A licensee shall inform patients/clients of the nature and potential outcomes of treatment and shall respect the right of potential patients/clients to refuse treatment.

(iii) A licensee shall secure the informed consent of potential subjects of education or research activities and shall respect their right to withdraw from participation.

(iv) A licensee shall include patients/clients in the treatment planning process.

A licensee shall maintain professional and goal-directed relationships with patients/clients and with subjects involved in education or research activities.

Except as otherwise required by law, a licensee shall protect the confidential nature of information gained from educational, practice and investigational activities unless sharing the information could reasonably be deemed necessary to protect an identifiable third party from harm.

A licensee shall take all reasonable precautions to avoid harm to patients/clients and to subjects involved in education or research activities, or detriment to their property.

(2) Principle 2. Competence. A licensee shall actively maintain high standards of professional competence.

A licensee shall function within the parameters of the licensee’s competence and the standards of the profession.

A licensee shall refer patients/clients to other service providers or consult with other service providers when additional knowledge and expertise is required.

A licensee shall accurately record and report information related to occupational therapy services provided to patients/clients.

42-14

(171316) No.216 Nov. 92 Copyright © 1992 Commonwealth of Pennsylvania

Ch. 42 BOARD OF OCCUPATIONAL THERAPY 49 § 42.31

A licensee shall require those whom the licensee supervises in the provision of occupational therapy services to adhere to this Code of Ethics.

(3) Principle 3. Public information. A licensee shall provide accurate information about occupational therapy services.

A licensee shall accurately represent the licensee’s competence and training.

A licensee may not use or participate in the use of a form of communication that contains a false, misleading, or deceptive statement or claim.

(4) Principle 4. Professional relationship. A licensee shall function with discretion and integrity in relations with colleagues and other professionals.

A licensee shall report illegal, incompetent or unethical practice by colleagues or other professionals to the appropriate authority.

Except as otherwise required by law, a licensee may not disclose confidential information when participating in reviews of peers, programs or systems.

A licensee who employs or supervises colleagues shall provide supervision as described in §§ 42.22 and 42.23 (relating to supervision of occupational therapy assistants; and supervision of applicants with temporary licenses).

Authority_The_provisions_of_this_§_42.24_issued_under_section_5(b)_of_the_act_of_June_15,_1982,_(P.L._502,_No._140)_(63_P.S._§_1505_(b))._Source'>Authority
The provisions of this § 42.24 issued under section 5(b) of the act of June 15, 1982, (P.L. 502, No. 140) (63 P.S. § 1505 (b)).
Source
The provisions of this § 42.24 adopted May 29, 1992, effective May 30, 1992, 22 Pa. B. 2381.
DISCIPLINARY PROCEEDINGS
§ 42.31. Unprofessional conduct.
An occupational therapist who engages in unprofessional conduct is subject to disciplinary action under section 16 of the act (63 P. S. § 1516). Unprofessional conduct includes, but is not limited to, the following:

Harassing, abusing or intimidating a patient, either physically or verbally.

Divulging, without patient or family consent, or both, information gained in the patient-therapist relationship to anyone not a member of the patient’s immediate family or not a health-care professional or educational team member, unless under statute or court order.

42-15

(171317) No. 216 Nov.92

49 § 42.32 DEPARTMENT OF STATE Pt. 1
Receiving a fee for referring a patient to a third person.

Accepting a patient for treatment or continuing treatment if benefit cannot reasonably be expected to accrue to the patient or client, or misleading a patient as to the benefits to be derived from occupational therapy.

Guaranteeing the results of therapy, consultation or procedure.

Practicing while using or under the influence of alcohol, narcotics or another type of drug, chemical or material which impairs judgment or coordination.

Practicing without reasonable skill and safety to patients due to a physical or mental condition which impairs judgment or coordination or addiction to alcohol, narcotics or another type of drug, chemical or material which impairs judgment or coordination.

Practicing outside the lawful scope of occupational therapy as defined in section 3 of the act (63 P. S. § 1503) or not in accordance with section 14 of the act (63 P. S. § 1514).

Authority_The_provisions_of_this_§_42.33_issued_under_section_5(b)_of_the_act_of_June_15,_1982,_(P.L._502,_No._140)_(63_P.S._§_1505_(b))._Source'>Authority
The provisions of this § 42.23 issued under section 5(b) of the act of June 15, 1982, (P.L. 502, No. 140) (63 P.S. § 1505 (b)).
Source
The provisions of this § 42.23 adopted May 1, 1992, effective May 2, 1992, 22 Pa. B. 2334.
Cross References
This section cited in 49 Pa. Code § 42.24 (relating to Code of Ethics)..


§ 42.32. Complaint process.

A person, firm, corporation or public office may submit a written complaint to the complaints officer of the Bureau of Professional and Occupational Affairs charging a licensee with a violation under section 16(a) of the act (63 P. S. § 1516) or unprofessional conduct set forth in § 42.31 (relating to unprofessional conduct) specifying the grounds.

The complaints officer will forward the complaint to the Board prosecutor who, together with consultants or investigators who may be required, will make a preliminary determination as to whether the complaint merits consideration. If the complain on its face establishes a violation of the act, the Board prosecutor will order a reasonable inquiry or investigation that the prosecutor deems necessary to determine the truth and validity of the allegations.

The Board prosecutor will provide reports to the Board at its regular meetings on the number, nature, procedure and handling of complaints received and will give to the Board a recommendation for the disposition of a complaint. The prosecutor’s recommendations to the Board and information,

42-16

(171318) No. 216 Nov. 92   Copyright © 1991 Commonwealth of Pennsylvania

Ch. 42 BOARD OF OCCUPATIONAL THERAPY 49 § 42.32
documents, records and other materials obtained during the course of an investigation will be

considered confidential unless admitted as evidence during the course of a formal disciplinary

hearing, except that information and documents classified under statute as public information or

public documents will be made available for public inspection.

After consideration of the prosecutor’s recommendation, the Board will authorize the disposition of the complaint. If the Board authorizes dismissal, the complainant will be so notified in writing. If the Board authorizes the prosecutor to proceed with a formal hearing, the Board will determine whether the hearing will be held before the Board members or a Board member, or before a designated hearing examiner.

At any stage of the handling of a complaint, the Board prosecutor may request authorization from the Board to enter into negotiations with the respondent or his counsel to facilitate the disposition of a case by a stipulation and consent agreement. If the Board approves the stipulation and consent agreement, it will then issue an order adopting the terms and condition, subject to approval as to legality by the Office of General Counsel. Unless the stipulation and consent agreement is accepted by the Board and an order issued, the agreement and the terms of the agreement will be confidential. Admissions made by a respondent in a stipulation and consent agreement or during the course of the negotiations may not be used against him in a formal disciplinary proceeding if a prehearing settlement cannot be reached.

Prior to the approval of a stipulation and consent agreement, the Board may hold an informal conference, which will be confidential and not open to the public, to review the suggested disposition. Admissions made by a respondent at the informal conference before the Board will not be used against him in formal disciplinary proceedings. The Board prosecutor may introduce evidence other than the respondent’s admissions to prove factual matters disclosed during the informal conference or in the course of negotiating a stipulation and consent agreement.

Prior authorization of a formal hearing, the Board prosecutor may arrange an investigatory conference to gather factual data and to facilitate an eventual hearing. This conference will be confidential and will not be open to the public. The Board counsel and the consultant or investigator assigned to the case will be required to be present. The Board prosecutor will give timely notice of the conference to the licensee involved. The notice will include a statement of the nature of the issues to be discussed and will inform the licensee that he has the right to be represented by counsel at the conference. Statements made at the conference may not be introduced at a hearing on the merits without the consent of all parties to the hearing. Complaints may be resolved at a

42-17

(171319) No. 216 Nov. 92 Copyright © 1991 Commonwealth of Pennsylvania

Ch. 42 BOARD OF OCCUPATIONAL THERAPY 49 § 42.33
reached, supported with findings of fact and conclusions of law. An order disposing of the case will be transmitted to the parties of record. The Board will retain copies of the adjudication and order and items offered into evidence and considered in reaching a decision.

Formal disciplinary proceedings will be open to the public.

Subsections (a)–(d) supplement 1 Pa. Code §§ 35.121--35.133 (relating to hearing and transcript).

Authority
The provisions of this § 42.33 issued under section 5(b) of the act of June 15, 1982, (P.L. 502, No. 140) (63 P.S. § 1505 (b)).
Source
The provisions of this § 42.33 adopted January 27, 1989, effective January 28, 1989, 19 Pa.B. 335.

42-19

(171321) No. 216 Nov.92

MEDICARE GUIDELINES FOR OCCUPATIONAL THERAPY

The American Occupational Therapy Association

July, 1993
49 § 42.33 DEPARTMENT OF STATE Pt. 1

conference through an agreed order only if the order is ratified by the Board and approved as to

legality by the Office of General Counsel. The Board will authorize the Board counsel to set a

formal hearing in the matter, either before the Board or a designated hearing examiner, if it

determines, based upon the Board prosecutor’s summary of fact and law, that such hearing is

warranted.

Subsections (e)–(g) supplement 1 Pa. Code §§ 35.111-35.116 (relating to prehearing conferences).

Authority
The provisions of this § 42.32 issued under section 5(b) of the act of June 15, 1982, (P.L. 502, No. 140) (63 P.S. § 1505 (b)).
Source
The provisions of this § 42.32 adopted January 27, 1989, effective January 28, 1989, 19 Pa.B. 335.
§ 42.33. Formal hearings.

The board will issue the administrative complaint and rule to show cause prepared by the prosecutor to the respondent, notifying him of the following:

The factual allegations and the charges filed against him.

The time and place of the hearing.

The right to be represented by counsel.

The right to appear personally.

The right to cross-examine witnesses testifying against him.

The right to call witnesses in his own behalf.

The right to review and object to documentary evidence produced against him.

The procedure to be followed in requesting a continuance.

A verbatim transcript of the proceedings will be made.

The time of the hearing will be fixed by the Board or the designated hearing examiner as soon as convenient, but not earlier than 20 days after service of the administrative complaint and rule to show cause upon the respondent. The Board or the designated hearing examiner will issue subpoenas for the respondent only upon a showing by the respondent that a necessary witness will not appear unless subpoenaed. The Board will look to the courts of the Commonwealth to enforce its subpoenas.

Within a reasonable time after holding the hearing, under 2 Pa.C.S. §§ 501-508 and 701-704 (relating to Administrative Agency Law), the Board will prepare a written adjudication of the decision

reached, supported with findings of fact and conclusions of law. An order disposing of the case will be transmitted to the parties of record. The Board will retain copies of the adjudication and order and items offered into evidence and considered in reaching a decision.

(e) Formal disciplinary proceedings will be open to the public.

Subsections (a)–(d) supplement 1 PA Code §§ 35.121–35.133 (relating to hearing and transcript).
Authority
The provisions of this § 42.33 issued under section 5(b) of the act of June 15, 1982, (P.L. 502, No. 140) (63 P.S. § 1505 (b)).
Source
The provisions of this § 42.33 adopted January 27, 1989, effective January 28, 1989, 19 Pa.B. 335.
42-18

(171320) No. 216 Nov. 92

MEDICARE GUIDELINES FOR OCCUPATIONAL THERAPY

The American Occupational Therapy Association

July, 1993

MEDICARE MANUALS REFERENCE LIST
Title Number
Carriers Manual HCFA-Pub. 14

Coverage Issues Manual HCFA-Pub. 6

Health Maintenance Organization/Competitive Medical

Plan Manual HCFA-Pub. 75

Home Health Agency Manual HCFA-Pub. 11

Hospice Manual HCFA-Pub. 21

Hospital Manual HCFA-Pub. 10

Intermediary Manual HCFA-Pub. 13

Outpatient Physical Therapy Provider Manual HCFA-Pub. 9

Peer Review Organization Manual HCFA-Pub. 19

Provider Certification State Operations Manual HCFA-Pub. 7

Provider Reimbursement Manual HCFA-Pub. 15

Regional Office Manual HCFA-Pub. 23

Renal Dialysis Facility Manual (Non-Hospital Operated) HCFA-Pub. 29

Skilled Nursing Facility Manual HCFA-Pub. 12

To order HCFA Medicare manuals, call the Government Printing Office (GPO) at [phone] for subscription you want. Mail requested should be addressed to:

Superintendent of Documents

PO Box 371915

Pittsburgh, PA 15250-79540

COVERAGE OF OCCUPATIONAL THERAPY SERVICES
Refer to: Carriers Manual (sec. 2217)

Intermediary Manual (sec. 3101.9)

HHA Manual (sec. 205.2 A., D.)

Hospital Manual (sec. 210.9 A., B.)

OPT/CORF Manual (sec. 403.3 A., B.)

SNF Manual (sec. 230.3 C.)

Occupational Therapy

General - Occupational therapy is medically prescribed treatment concerned with improving or restoring functions which have been impaired by illness or injury or, where function has been permanently lost or reduced by illness or injury, or to improve the individual’s ability to perform those tasks required for independent functioning. Such therapy may involve:

the evaluation, and reevaluation as required, of a patient’s level of function by administering diagnostic and prognostic tests:

the selection and teaching of task-oriented therapeutic activities designed to restore physical function, e.g. the use of wood-working activities on an inclined table to restore shoulder, elbow, and wrist range of motion lost as a result of burns;

the planning, implementing, and supervising of individualized therapeutic activity programs as part of overall “active treatment” program for a patient with a diagnosed psychiatric illness, e.g., the use of sewing activities which require following a pattern to reduce confusion and restore reality orientation in a schizophrenic patient;

the planning and implementing of therapeutic tasks and activities to restore sensory-integrative function, e.g., providing motor and tactile activities to increase sensory input and improve response for a stroke patient with functional loss resulting in a distorted body image;

the teaching of compensatory techniques to improve the level of independence in the activities of daily living, e.g., teaching a patient who has lost the use of an arm to pare potatoes and to chop vegetables with one hand, teaching an upper extremity amputee how to functionally utilize a prosthesis, teaching a stroke patient new techniques to enable him to perform feeding, dressing, and other activities as independently as possible, or teaching a hip fracture/hip replacement patient techniques of standing tolerance and balance to enable him or her to perform such functional activities as dressing and homemaking tasks;

the designing, fabricating, and fitting or orthotic and self-help devices, e.g.,; making a hand splint for a patient with rheumatoid arthritis to maintain the hand in a functional position or constructing a device which would enable an individual to hold a utensil and feed himself independently; and

vocational and prevocational assessment and training.

Only a qualified occupational therapist has the knowledge, training and experience required to evaluate and, as necessary reevaluate a patient’s level of funciton, determine whether an occupational therapy program could reasonably be expected to improve, restore, or compensate for lost function and, where appropriate, recommend to the physician a plan of treatment. However, while the skills of a qualified occupational therapist are required to evaluate the patient’s level of function and to develop a plan of treatment, the implementation of the plan may also be carried out by a qualified occupation therapy assistant functioning under the general supervision of the qualified occupational therapist. (“General supervision” requires initial direction and periodic inspection of the actual activity; however, the supervisor need not always be physically present or on the premises when the assistant is performing services).
Coverage Criteria - To constitute covered occupational therapy for Medicare purposes the services furnished to a beneficiary must be:
prescribed by a physician,

performed by a qualified occupational therapist or a qualified occupational therapy assistant under the general supervision of a qualified occupational therapist, and

reasonable and necessary for the treatment of the individual’s illness or injury.
Occupational therapy designed to improve function is considered reasonable and necessary for the treatment of the individual’s illness or injury only where an expectation exists that the therapy will result in a significant practical improvement in the individual’s level of functioning within a reasonable period of time. Where an individual’s improvement potential is insignificant in relation to the extent and duration of occupational therapy services required to achieve improvement, such services would not be considered reasonable and necessary and thus would be excluded from coverage by Sec. 1862(a)(1) of the Social Security Act. If a valid expectation of improvement exists at the time the occupational therapy program is instituted, the services would be covered even though the expectation may not be realized. However, in such situations the services would be covered only up to the time at which it would be reasonable to conclude that the patient is not going to improve. Once a patient has reached the point where not further significant practical improvement can be expected, the skills of an occupational therapist in designing a maintenance program and making infrequent but periodic evaluation of its effectiveness would be covered, the services of an occupational therapist or occupational therapy assistant in carrying out the program are not considered reasonable and necessary for the treatment of illness or injury and such services are excluded from coverage under Sec. 1862(a)(1).
Generally speaking, occupational therapy is not required to effect improvement or restoration of function where a patient suffers a temporary loss or reduction of function (e.g., temporary weakness which may follow prolonged bed rest following major abdominal surgery) which could reasonably be expected to spontaneously improve as the patient gradually resumes normal activities. Accordingly, occupational therapy furnished in such situations would not be considered reasonable and necessary for treatment of the individual’s illness or injury and the services would be excluded from coverage by Sec. 1862(a)(1).
Occupational therapy may also be required for a patient with a specific diagnosed psychiatric illness. Where such services are required they would be covered, assuming the coverage criteria set forth above are met. However, it should be noted that where an individual’s motivational needs are not related to a specific diagnosed psychiatric illness, the meeting of such needs does not usually require an individualized therapeutic program. Rather, such needs can be met through general activity programs or the efforts of other professional personnel involved in the care of the patient, patient motivation being an appropriate and inherent function of all health disciplines which is interwoven with other functions performed by such personnel for the patient. Accordingly, since the special skills of an occupational therapist or occupational therapy assistant are not required, an occupational therapy program for such individuals would not be considered reasonable and necessary for the treatment of an illness or injury, and services furnished under such a program would be excluded from coverage by Sec. 1862(a)(1). See below for discussion regarding coverage of patient activity programs.
As indicated, occupational therapy includes vocational and prevocational assessment and training. When services provided by an occupational therapist or assistant are related solely to specific employment opportunities, work skills or work settings, they are not reasonable or necessary for the diagnosis or treatment of an illness or injury and are excluded from coverage under the program by Sec. 1862(a)(1). However, care should be exercised in applying this exclusion because the assessment of level of function, especially in activities of daily living, are services which occupational therapists provide for both vocational and nonvocational purposes. For example, an assessment of sitting and standing tolerance might be nonvocational for a mother of young children or a retired individual living alone, but would be a vocational test for a sales clerk. Training an amputee in the use of a prosthesis for telephoning is necessary for every-day activities as well as for employment purposes. Major changes in life style may be mandatory for an individual with a substantial disability; the techniques of adjustment cannot be considered exclusively vocational or nonvocational.
Supplies
Occupational therapy frequently necessitates the use of various supplies e.g., looms, ceramic tiles, leather, etc. The cost of such supplies may be included in the occupational therapy cost center.
Patient Activity Programs [Hospital, SNF (inpatient) settings]
In the inpatient setting, organized patient activity programs are utilized to provide diversion and general motivation to inpatients. Although occupational therapists and occupational therapy assistants may be involved in directing and supervising such programs, these activity programs are part of a generalized effort directed to the health and welfare of all patient and such programs do not constitute occupational therapy and no ancillary charges may be recognized for such services. However, since these programs do constitute an integral part of good inpatient care they would be considered covered services related to the routine care of patients, providing: (a) the program is on ordinarily furnished by the SNF to its inpatients, and (b) it is of a type in which Medicare patients requiring a covered level of care may reasonably be expected to participate. For example, patients requiring the level of care covered under the program might engage in games such as checkers or chess, handicrafts such as sewing or weaving, and they might attend movies, etc. But, it would not be expected that such patient would be able to go on field trips, engage in strenuous athletics, or participate in other activities which are inappropriate for patient requiring the level of care covered under the program. (The capacities of physically healthy psychiatric patient would vary from those of patients whose ailments are physical.)