In this chapter, the following terms have the meanings indicated. Terms Defined. “Aide” means any individual who is not licensed by the Board to perform occupational therapy or limited occupational therapy and who provides supportive services to the occupational therapist or occupational therapy assistant under direct supervision. “AOTA” means the American Occupational Therapy Association, formerly the American Occupational Therapy Certification Board (AOTCB). “Board” means the State Board of Occupational Therapy Practice. “Case resolution conference (CRC)” means a voluntary, informal, and confidential proceeding to explore the possibility of a consent order resolution of a disciplinary matter. “Client” means a consumer, patient, or recipient of occupational therapy services. “Competence” means an individual's capacity for performance in occupational therapy principles and procedures. Competency. “Competency” means the demonstration of the pertinent knowledge of and performance skills in occupational therapy principles and procedures within the practice of occupational therapy and limited occupational therapy. “Competency” includes satisfactory completion of educational programs or experiences, specialty certification, continuing education, or all of these. “Direct supervision” means supervision provided on a face-to-face basis by a supervisor who is a licensed occupational therapist or occupational therapy assistant, during the performance of delegated client-related tasks. “Elective nonrenewal” means choosing to render one's license inactive. “Evaluation” means the ongoing process of: Data collection by a licensed occupational therapist or an occupational therapy assistant; and Interpretation of the data by a licensed occupational therapist for purposes including, but not limited to: The need for treatment; and Plans for discharge. “Expired license” means an individual’s authority to practice occupational therapy or limited occupational therapy which has not been renewed through the process of renewal or elective nonrenewal and is invalid. “Licensed” means formally authorized by the Board to practice occupational therapy or limited occupational therapy. “Licensee” means an individual who is a licensed occupational therapist or a licensed occupational therapy assistant. Limited Occupational Therapy. “Limited occupational therapy” means the therapeutic use of purposeful and meaningful goal-directed activities in collaboration with an occupational therapy assistant and an occupational therapist during the treatment of individuals that: Have a disease or disorder, impairment, activity limitation, or participation restriction that interferes with their ability to function independently in daily life roles; or Benefit from the prevention of impairments and activity limitations. “Limited occupational therapy” means that the collaboration of the occupational therapy assistant occurs under the periodic supervision of a licensed occupational therapist. “Limited occupational therapy” means that the occupational therapy assistant is authorized to: Conduct an initial screening; Collect data for an evaluation that applies the principles and procedures of occupational therapy; and Participate in a treatment program that applies the principles and procedures of occupational therapy. “Limited occupational therapy” does not include: Initiation or interpretation of evaluation data; and Initiation of a treatment program before the client has been evaluated and a licensed occupational therapist has rendered a treatment plan. “NBCOT” means the National Board for Certification in Occupational Therapy, formerly the American Occupational Therapy Certification Board (AOTCB). “Occupational therapist” means, unless the context requires otherwise, an occupational therapist that is licensed by the Board to practice occupational therapy. “Occupational therapy” means the therapeutic use of purposeful and meaningful goal-directed activities to evaluate, consult, and treat individuals that: Have a disease or disorder, impairment, activity limitation, or participation restriction that interferes with their ability to function independently in daily life roles; or Benefit from the prevention of impairments and activity limitations. “Occupational therapy assistant” means, unless the context requires otherwise, an occupational therapy assistant who is licensed by the Board to practice limited occupational therapy. “On-site supervision” means supervision provided by a supervisor who is: A licensed occupational therapist or occupational therapy assistant; and Immediately available on the premises to provide direct supervision, if needed, when client-related procedures are performed or as otherwise necessary. Periodic Supervision. “Periodic supervision” means supervision provided by a supervisor who is a licensed occupational therapist on a face-to-face basis, for each client who is being treated by the licensed occupational therapy assistant supervisee, occurring the earlier of at least: Once every 10 therapy visits; or Once every 30 calendar days. “Periodic supervision” includes: Chart review; and Meetings to discuss client treatment plans, client response to treatment, or observation of treatment, as indicated to ensure the competent and safe provision of occupational therapy services. “Reevaluation” means: The data collection by a licensed occupational therapist or an occupational therapy assistant; and Interpretation of the reevaluation data by a licensed occupational therapist after the initial evaluation, for the purpose of determining: A client's response to treatment; Changes in the client's status; The need for treatment modification; and Plans for discharge. “Reactivation” means revalidating a license previously rendered invalid by the process of elective nonrenewal. “Reinstatement” means revalidating a license previously rendered invalid. “Renewal” means validating an active license for an additional term. Screening. “Screening” means a cursory determination by an occupational therapist or occupational therapy assistant of the need for more comprehensive evaluation and treatment. “Screening” does not mean a substitute for the evaluation. “Supervision” means the provision of clinical aid, direction, and instruction, by either a licensed occupational therapist or an occupational therapy assistant, to ensure the competent delivery of occupational therapy services. “Supervisor” means an occupational therapist or occupational therapy assistant, excluding temporary licensees, who is licensed by the Board and has the responsibility of clinically supervising the provision of occupational therapy treatment services. “Temporary occupational therapy assistant licensee” means an individual licensed by the Board on a temporary basis, who: Except for completing the required certification examination, has met all other licensure requirements of this chapter; and Is licensed to practice under the on-site supervision of a licensed occupational therapist or occupational therapy assistant. “Temporary occupational therapist licensee” means an individual licensed by the Board on a temporary basis, who: Except for completing the required certification examination, has met all other licensure requirements of this chapter; and Is licensed to practice under the on-site supervision of a licensed occupational therapist. “Treatment program” means a therapeutic intervention plan designed by a licensed occupational therapist that outlines the selected approaches and types of intervention to be used to enable the client to reach identified targeted outcomes or treatment goals. “Verification” means proof of licensure, certification, registration, or continuing education: Confirmable by the Board based on documentation provided by the applicant; Obtained from a verification service provider approved by the issuing entity and accepted by the Board at its discretion; or Obtained from the entity by which the applicant is licensed, certified, registered, or educated. Except as otherwise provided in this chapter, an individual shall be licensed by the Board before the individual may practice occupational therapy or limited occupational therapy. Term and Renewal of License. An initial license is issued after successfully completing the application process and is valid for 2-1/2 years or less. At least 30 days before the expiration date of the license, the Board shall send a notice of renewal by electronic means or first-class mail to the last known electronic or physical address of each active licensee, and each licensee who is inactive by elective nonrenewal, who is eligible for renewal. In order to renew a license, the licensee shall submit to the Board a completed renewal application by the deadline for renewal. The licensee shall submit an electronic payment, money order, or check in the amount of the renewal fee established by the Board in COMAR 10.46.05.01. Incomplete applications will not be accepted. If a completed renewal application is submitted after the deadline but before the expiration, the Board shall assess a late fee as specified in COMAR 10.46.05.01. A completed renewal application received with an on-line licensure confirmation or postmark dated after the expiration date of June 30 will not be accepted. At the time of licensure renewal, a licensee who has completed the continuing competency requirement shall attest to the: Maintenance of Current Certification with the National Board of Certification in Occupational Therapy (NBCOT); or Completion of continuing competency activities, as specified in COMAR 10.46.04. At the time of licensure renewal, a licensee shall indicate a desire to: Carry over contact hours from one continuing competency time frame to another; or Utilize contact hours carried over from the previous renewal period. A licensee who is audited regarding continuing competency requirements, as specified in COMAR 10.46.04: Shall successfully complete the requirements of the audit; or May be subject to disciplinary action by the Board. Time Frames for Application Materials. The applicant shall submit all materials required by the Board in accordance with this regulation within a specified time frame from the date the application was initiated until the date the application is completed as follows: Licensure documentation not to exceed 6 months; Temporary licensure documentation, with no changes in data originally submitted, not to exceed 6 months; and Second temporary licensure documentation, with no changes in data originally submitted, not to exceed 6 months. Incomplete Applications. An application is not complete until all required material, including the required fee and supporting documentation, is received by the Board; If an applicant for licensure, reinstatement, or reactivation fails to provide the required documentation within 6 months of receipt of the initial receipt, the Board may administratively close the application. An applicant whose application is administratively closed may reapply and submit with the new application proof of compliance with: This subtitle; and Health Occupations Article, Title 10, Annotated Code of Maryland. Application Procedures for Licensure. To apply for a license, an applicant shall submit the following documentation to the Board: An application completed in accordance with the directions provided; Verification of: Initial certification or examination from the NBCOT; or Examination score from the testing agency within 60 days of examination; Proof of fingerprinting for completion of a criminal history records check; An approved form of payment in the amount of the application fee established by the Board in COMAR 10.46.05.01; If currently, or previously, authorized to practice in any other state or country, or both, verification of: Licensure; Registration; or Certification; Verification of successful completion of the Maryland Board of Occupational Therapy Jurisprudence Examination; Documentation certifying: Maintenance of Current Certification with the National Board of Certification in Occupational Therapy (NBCOT); or Completion of continuing competency activities, as specified in COMAR 10.46.04; and Additional requirements as specified in COMAR 10.46.04 for applicants with 3 or more years lapse in practice. Application Procedures for Temporary Licensure. A temporary license may be issued to an applicant who, except for completing the required certification examination, has met all other licensure requirements of this chapter. To apply for a temporary license, an applicant shall submit the following documentation to the Board: An application completed in accordance with the directions provided; Verification confirming the applicant’s eligibility and registration to take the certification examination within the eligibility activation period; Proof of fingerprinting completed for a criminal history records check; An approved form of payment in the amount of the application fee established by the Board in COMAR 10.46.05.01; If currently, or previously, authorized to practice in any other state or country, or both, verification of: Licensure; Registration; or Certification; Verification of the successful completion of the Maryland Board of Occupational Therapy Jurisprudence Examination; and Documentation certifying completion of continuing competency activities, as specified in COMAR 10.46.04. Application Procedures for a Second Temporary License. A second temporary license may be issued to an applicant: Whose initial temporary license expired; and Who, except for completing the required certification examination, has met all other licensure requirements of this chapter. To apply for a second temporary license, an applicant shall submit the following documentation to the Board: Verification confirming the applicant’s eligibility and registration to take the certification examination within the eligibility activation period; An approved form of payment in the amount of the temporary license fee established by the Board in COMAR 10.46.05.01; and Updated versions of any application documents previously submitted which have expired. Application Procedures for Nonrenewal of License. Elective Nonrenewal. A licensee wishing to render a license inactive for a specified renewal term may electively nonrenew the license for that term. For each specific renewal term for which inactive status is requested, the licensee shall apply for elective nonrenewal. The Board shall send a notice of renewal by electronic means or first-class mail to the last known electronic or physical address of each inactive licensee who is eligible for renewal or elective nonrenewal. In order to electively nonrenew a license, the licensee shall submit to the Board a completed application, by the expiration date of June 30. A completed application for elective nonrenewal received with an online application confirmation or postmark dated after the expiration date will not be accepted. The licensee shall submit a money order, check, or electronic payment in the amount of the elective nonrenewal fee established by the Board in COMAR 10.46.05.01. Expiration. A license that has not been renewed through the process of renewal or elective nonrenewal is expired and invalid. Application Procedures for Reactivation or Reinstatement of License. To apply for reactivation after elective nonrenewal or reinstatement after expiration, an applicant shall submit the following documentation to the Board within the timeframe specified on the application: An application completed in accordance with the directions provided; Verification of initial certification or examination from the NBCOT; Proof of fingerprinting completed for a criminal history records check; An approved form of payment in the amount of the applicable fee established by the Board in COMAR 10.46.05.01; If currently, or previously, authorized to practice in any other state or country, or both, verification of: Licensure; Registration; or Certification; Verification of successful completion of the Maryland Board of Occupational Therapy Jurisprudence Examination; and Documentation certifying: Maintenance of current certification with the National Board of Certification in Occupational Therapy (NBCOT); or Completion of continuing competency activities as specified in COMAR 10.46.04. Additional requirements may apply for applicants with 3 or more years lapse in practice as specified in COMAR 10.46.04. Address Change. An applicant or licensee shall report a change of electronic mail address or postal address, in writing, within 30 days of the change. Failure to comply may result in assessment of a fee as specified in COMAR 10.46.05.01. Name Change. An applicant or licensee shall report a change of name, in writing, within 30 days of the change; The report of a change in name shall include documentation substantiating the name change. Verification of Maryland License. Electronic Verification. An individual may independently obtain information on the licensure status of licensees in the following ways: Upon accessing the Board’s website, an individual may view and print a licensee’s status; Upon accessing the Board’s mobile software application, an individual may view a licensee’s status; or Upon phoning the Board office, an individual may receive verbal verification of a licensee’s status. Board-Provided Verification. Upon request, the Board shall provide written documentation certifying licensure status and disciplinary history in Maryland. The request for Board verification shall include: The name of the licensee to be verified; The address where the completed verification is to be forwarded; and An approved form of payment in the amount of the verification of licensure fee established by the Board in COMAR 10.46.05.01. Occupational Therapist. An occupational therapist shall exercise sound judgment and provide adequate care in the performance of duties as provided in nationally recognized standards of practice. An occupational therapist shall document client information as follows: Evaluation; Treatment program; Progress reports; Reevaluations; and Discharge summaries, verbal orders, and clarification orders in accordance with facility policies and procedures. An occupational therapist shall immediately discontinue any treatment procedure that appears harmful to the client. Occupational Therapy Assistant. An occupational therapy assistant shall exercise sound judgment and provide adequate care in the performance of duties as provided in nationally recognized standards of practice. An occupational therapy assistant shall document client information as follows: Progress reports; Reevaluations; and Discharge summaries, verbal orders, and clarification orders in accordance with facility policies and procedures. An occupational therapy assistant may begin a treatment program after the occupational therapist has: Evaluated the client; Established an initial treatment program; and Engaged in verbal, written, or electronic communication with the occupational therapy assistant. An occupational therapy assistant may not analyze or interpret evaluation data. An occupational therapy assistant may assist and participate in the screening, evaluation, reevaluation, and discharge planning process by: Collecting data, such as records; General observation; Conducting a general interview; Using assessment tools; or All of §B(5)(a)—(d) of this regulation. An occupational therapy assistant shall communicate to the occupational therapist verbally, in writing, or electronically, the information gathered. An occupational therapy assistant shall track and report changes in the client's status that might warrant the need for reevaluation. An occupational therapy assistant shall immediately discontinue any treatment procedure that appears harmful to the client and shall notify the supervising occupational therapist. Occupational Therapist. A licensed occupational therapist may supervise the clinical practice of the following: Occupational therapist; Occupational therapy assistant; Temporary occupational therapist; Temporary occupational therapy assistant; Aide; and Occupational therapy student or occupational therapy assistant student. Unless otherwise stated, a supervisor need not be physically present on the premises at all times, but may be available by telephone or by other electronic communication means. Occupational Therapy Assistant. Subject to the requirements of this section, an occupational therapy assistant may practice limited occupational therapy under the supervision of an occupational therapist provided it is at least periodic supervision. The supervising occupational therapist working with the occupational therapy assistant shall determine the appropriate amount and type of supervision necessary, taking into consideration: Skills, experience, and education of the occupational therapy assistant and the occupational therapist; Change in a client's status; Complexity of the treatment program; and Type and requirements of practice setting. In addition to the other requirements specified by this section, supervision requires that, before the initiation of the treatment program and before a planned discharge, the supervising occupational therapist shall provide direction to the occupational therapy assistant by verbal, written, or electronic communication. An occupational therapy assistant, under the direction of the occupational therapist, is permitted to be the primary clinical supervisor for the following: Aide; Temporary occupational therapy assistant; Level I fieldwork occupational therapy student; and Level I and Level II fieldwork occupational therapy assistant student. The occupational therapy assistant may be utilized to facilitate occupational therapy student and occupational therapy assistant student learning experiences in both Level I and Level II fieldwork under the direction of the occupational therapist. The supervising occupational therapist and the occupational therapy assistant are jointly responsible for maintaining formal documentation of periodic supervision as set forth in Regulation .05 of this chapter. Temporary License to Practice Occupational Therapy. A temporary license to practice occupational therapy authorizes the licensee to practice occupational therapy with on-site supervision. The supervising occupational therapist and the temporary occupational therapist are jointly responsible for maintaining documentation of supervision as set forth in Regulation .05 of this chapter. Temporary License to Practice Limited Occupational Therapy. A temporary license to practice limited occupational therapy authorizes the licensee to practice limited occupational therapy with on-site supervision. The supervising occupational therapist or the supervising occupational therapy assistant and the temporary occupational therapy assistant are jointly responsible for maintaining documentation of supervision as set forth in Regulation .05 of this chapter. Aide. A supervising occupational therapist or occupational therapy assistant working with an aide shall provide direct supervision to the aide when the aide is performing tasks within the occupational therapy treatment program. The supervising occupational therapist or occupational therapy assistant shall assign to an aide only those tasks that do not require education or training in occupational therapy and that the aide can perform competently. The supervising occupational therapist or occupational therapy assistant is responsible for ensuring that the aide delivers service in a safe and competent manner. Prescribed tasks within the treatment program that may be performed by an aide under the direct supervision of an occupational therapist include, but are not limited to: Guarding; Positioning; Holding body parts for splinting or bracing; and Assisting with group and community reentry activities. Prescribed tasks within the treatment program that may be performed by an aide under the direct supervision of an occupational therapist or occupational therapy assistant include: Transfer practice; Assisting in routine: Functional activity; Functional exercise; and Activities of daily living (ADL) program; Applying assistive devices; Applying adaptive devices; Assisting the client with the use of assistive equipment; Assisting the client with the use of adaptive equipment; and Reality orientation for the confused client. Nontreatment activities that may be performed by an aide under the direction of an occupational therapist or occupational therapy assistant include: Clerical; Secretarial; Housekeeping; Supply maintenance; Equipment maintenance; Fabrication of straps for splinting and bracing; Fabrication of assistive devices that are not worn directly by a client; Routine transfers for transporting clients; Transporting clients; and Activities ancillary to group and individual activities. Occupational Therapy Students. An occupational therapist or occupational therapy assistant supervising a Level I or Level II fieldwork student shall have a minimum of 1 year of experience as a licensed occupational therapist or occupational therapy assistant, excluding temporary licensure. Occupational Therapy Assistant. Documentation for supervision of an occupational therapy assistant shall include, but is not limited to: Reports or summaries documenting compliance with periodic supervision that are written and signed with credentials by the occupational therapy assistant and cosigned by the supervising occupational therapist; Documentation for planned discharges from the occupational therapy treatment program that are written and signed with credentials by the occupational therapy assistant and cosigned by the supervising occupational therapist; and Documentation of demonstrated competency in the use of specific procedures, activities, modalities, and techniques. Temporary License to Practice Occupational Therapy. Documentation for supervision of an occupational therapist with a temporary license shall include, but is not limited to: Evaluations cosigned by the supervising occupational therapist; Reports or summaries documenting compliance with on-site supervision that are written and signed with credentials by the temporary occupational therapist and cosigned by the supervising occupational therapist; Cosigned revised treatment programs designed in response to changes in a client's status; and Documentation for planned discharges from the occupational therapy treatment program that are written and signed with credentials by the temporary occupational therapist and cosigned by the supervising occupational therapist. Temporary License to Practice Limited Occupational Therapy. Documentation for supervision of an occupational therapy assistant with a temporary license shall include: All client records cosigned by the supervisor; Reports or summaries documenting compliance with on-site supervision that are written and signed with credentials by the temporary occupational therapy assistant and cosigned by the supervising occupational therapist or occupational therapy assistant; and Documentation for planned discharges from the occupational therapy treatment program that are written and signed with credentials by the temporary occupational therapy assistant and cosigned by the supervising occupational therapist. Aides. The supervising occupational therapist or occupational therapy assistant shall: Be responsible for the safe and competent performance of tasks assigned to the aide; and Document evidence of unsafe or incompetent performance. Occupational Therapy and Occupational Therapy Assistant Students Level I and Level II Fieldwork. Documentation for supervision of a Level I or Level II fieldwork occupational therapy or occupational therapy assistant student shall include: All client records cosigned by the supervisor; Reports or summaries documenting compliance with on-site supervision that are written and signed by the Level I or Level II fieldwork occupational therapy or occupational therapy assistant student and cosigned by the supervising occupational therapist or occupational therapy assistant; and Documentation for planned discharges from the occupational therapy treatment program that are written and signed with credentials by the Level I or Level II fieldwork occupational therapy or occupational therapy assistant student and cosigned by the supervising occupational therapist. Signature and Cosignature. Acceptable methods of authentication include a written signature or electronic signature that includes the signer's credentials. It is unlawful for an individual who has a revoked, suspended, electively nonrenewed, or expired license status for any reason to: Practice occupational therapy in the State; or Use licensing credentials as specified in Regulation .07 of this chapter. Individuals authorized to practice occupational therapy by the Board, and only those individuals, shall use the following credentials to represent licensure status to the public: Licensed occupational therapist (OT/L); Licensed occupational therapy assistant (OTA/L); Temporary occupational therapy licensee (OT/LT); and Temporary occupational therapy assistant licensee (OTA/LT). The Board may find that a compelling public purpose warrants disclosure of information in a certification, licensing, or investigative file, regardless of whether there has been a request for the information, and may disclose the information under the following circumstances: The information concerns possible criminal activity and is disclosed to a federal, state, or local law enforcement or prosecutorial official or authority; The information concerns a possible violation of law and is disclosed to a federal, state, or local authority that has jurisdiction over the individual whose conduct may be a violation and the information disclosed is limited to information relevant to the possible violation by that individual; or The information concerns conduct by an individual which the Board reasonably believes may pose a risk to the public health, safety, or welfare, and is disclosed to a law enforcement authority, administrative official, or agency that regulates the individual, or to a hospital or other health care facility where the individual has privileges. Other Disclosures. This chapter does not prevent or limit the ability of the Board to disclose general licensing information as provided in General Provisions Article, §4-333, Annotated Code of Maryland, or any information which the Board may otherwise disclose by law. General Provisions Article, §4-333(c); Health Occupations Article, §§10-101, 10-205, 10-301,10-302, 10-304, 10-311—10-313, 10-402, and 10-403; Annotated Code of Maryland Effective date: January 31, 1983 (10:2 Md. R. 109) Regulation .01 amended effective July 3, 1995 (22:13 Md. R. 968) Regulation .02 amended effective July 3, 1995 (22:13 Md. R. 968) Regulation .03 repealed effective July 20, 1992 (19:14 Md. R. 1284) Regulation .03 adopted effective July 3, 1995 (22:13 Md. R. 968) Regulation .04 adopted effective July 3, 1995 (22:13 Md. R. 968) Regulations .01—.04 repealed and new Regulation .01—.06 adopted as an emergency provision effective October 1, 2000 (27:21 Md. R. 1973); emergency status extended at 28:7 Md. R. 687; emergency status extended at 28:9 Md. R. 884; adopted permanently effective April 30, 2001 (28:8 Md. R. 761) Regulation .01 amended effective December 10, 2001 (28:24 Md. R. 2129) Regulation .03 amended effective December 10, 2001 (28:24 Md. R. 2129) Regulation .07 adopted effective December 10, 2001 (28:24 Md. R. 2129) Chapter revised effective April 21, 2008 (35:8 Md. R. 805) Regulation .01B amended effective May 17, 2010 (37:10 Md. R. 722); September 14, 2015 (42:18 Md. R. 1174); October 23, 2017 (44:21 Md. R. 984) Regulation .02 amended effective May 17, 2010 (37:10 Md. R. 722); September 14, 2015 (42:18 Md. R. 1174); October 23, 2017 (44:21 Md. R. 984) Regulation .04B amended effective September 14, 2015 (42:18 Md. R. 1174) The licensee shall: Provide appropriate services for clients without regard to age, race, creed, ethnicity, gender, lifestyle choices, impairment, disability, diagnosis, spirituality, or religious affiliation; Provide the highest quality services to the client; Show respect for the client's rights, including the right to refuse treatment; Follow all applicable laws regarding the client's privacy; Inform the client if the licensee determines that additional occupational therapy services would be beneficial; Recommend termination of services as appropriate to client needs, goals, and circumstances; Represent accurately the licensee's skills; Seek a consultation with or refer the client to an appropriate health care professional if the licensee determines that the licensee cannot effectively manage the client's needs; Exercise sound professional judgment in the use of evaluation and treatment procedures; Discontinue immediately a procedure which appears to be harmful to the client; Function with discretion and integrity in relations with other health professionals; Report to the Board a concern with the quality of the service provided by other health professionals; Ascertain whether all occupational therapy personnel within the facility are licensed if the licensee practices within a facility; Report to the Board a person whom the licensee believes to be performing or aiding and abetting the illegal practice of occupational therapy; Comply with all applicable laws dealing with occupational therapy practice; Accurately record and report all information related to continuing competency requirements as specified in COMAR 10.46.04; Provide information about fees upon request by a client; Notify the referring professional and the client if the licensee declines to carry out evaluation and treatment that has been ordered but that the licensee believes to be contraindicated or unjustified; and Comply with a lawful investigation conducted by the Board. The licensee may: Inform the patient's referring health professional if additional occupational therapy services would be beneficial to the patient; and Decline to carry out evaluation and treatment that has been requested but that the licensee believes is contraindicated or unjustified. The licensee may not: Engage in a cruel, inhumane, or degrading practice in the treatment of the client; Allow financial gain to be paramount to the delivery of service to the client; Provide a service or instruction, either for pay or gratuitously, that is not within the licensee's demonstrated competencies; or Use, or participate in the use of, a form of communication that contains or implies a: Guarantee of satisfaction, except the guarantee to return a fee if the client is not satisfied with the treatment rendered, or False, fraudulent, misleading, deceptive, or unfair statement or claim. The licensee shall avoid a relationship or an activity with the client that interferes with professional judgment and objectivity. The licensee may not: Exploit the client sexually, physically, emotionally, socially, or in another manner; or Engage in sexual misconduct which includes, but is not limited to, sexual behavior with the client or patient: Regardless of whether the behavior occurs in the context of a professional evaluation, treatment, procedure, or other service to the client or patient, or Under the pretense of diagnostic or therapeutic intent or benefit. An occupational therapist and occupational therapy assistant shall: Limit practice to the areas of competency by which proficiency has been gained through education, training, and experience; Acquire the education and training needed to address the cultural differences of diverse populations; Avoid unfair discrimination based on age, gender, race, ethnicity, culture, national origin, disability, socioeconomic status, sexual orientation, or other basis proscribed by law; Use treatment only when the occupational therapist or occupational therapy assistant knows that the circumstances are appropriate; Maintain competence by meeting the requirements of continuing education in accordance with COMAR 10.46.04; Engage in ongoing consultation with other occupational therapists and occupational therapy assistants or relevant professionals and seek appropriate education, training, and experience when developing competence in a new service or technique; and Document and maintain appropriate records of all relevant work and training used to gain competence in new techniques or services. Violation of Regulation .01 or .02 of this chapter may result in the Board taking action to reprimand the licensee or place the licensee on probation, or to suspend or revoke the licensee's license. Health Occupations Article, §§1-212 and 10-205, Annotated Code of Maryland Effective date: January 31, 1983 (10:2 Md. R. 109) Regulations .01—.03 repealed and new Regulations .01—.03 adopted effective August 7, 2000 (27:15 Md. R. 1401) Regulation .01A amended effective April 21, 2008 (35:8 Md. R. 805); April 4, 2022 (49:7 Md. R. 467) Regulation .03 recodified to be Regulation .04 and new Regulation .03 adopted effective April 2, 2012 (39:6 Md. R. 409) This chapter applies to all formal hearings before the Board of Occupational Therapy Practice. They do not apply to informal investigations, meetings, or proceedings when no formal ruling or decision is made. Written notice of a hearing shall be sent by the Board to all interested parties at least 30 days before the hearing. The notice shall state the date, time, and place of the hearing. It shall also state the issues or charges involved in the proceeding. If, by reason of the nature of the proceeding, the issues cannot be fully stated in advance of the hearing, or if subsequent amendment of the issues is necessary, they shall be fully stated as soon as practicable. Service upon a party shall be delivery of the charging document and a copy of the complaint to the party in person. Instead of personal service, the Board may serve the charging document and a copy of the complaint by registered or certified mail, restricted delivery, return receipt requested. All parties appearing at formal hearings shall have the right to appear in proper person, or by or with counsel. Prehearing Conferences. The Board may set a prehearing conference as it deems appropriate. Case Resolution Conference (CRC) Committee. One or more Board members comprise a committee which makes recommendations to the Board with regard to proposed disposition of matters before hearing. After service of charges or the response to the notice of intent to deny, the Board shall offer the respondent a case resolution conference (CRC). If there is no basis for an agreement between the respondent and the administrative prosecutor, the matter proceeds to hearing. Generally, one or two Board members compose the CRC committee. Except for consideration of a proposed resolution of a case achieved through the CRC, the Board may not make later use of any commentary, admissions, facts revealed, or positions taken, unless the subject matter is available from other sources or is otherwise discovered. Participation in a CRC is not ordinarily a basis for recusal of a Board member from further proceedings in the case. Filing of Motions and Response. All motions shall be accompanied by a memorandum of points and authorities, and shall be filed with the Board at least 15 working days before the hearing. A copy shall be served on the opposing party. Any response shall be filed with the Board at least 10 working days before the hearing and copy served on the opposing party. Discovery on Request. By written request served on the other party and filed with the Board or the Office of Administrative Hearings, as appropriate, a party may require another party to produce, within 15 days, the following: A list of witnesses to be called; Copies of documents intended to be produced at the hearing; or Both §C(1) and (2) of this regulation. Mandatory Discovery. Each party shall provide to the other party, not later than 15 days before the prehearing conference, if scheduled, or 45 days before the scheduled hearing date, whichever is earlier: The name and curriculum vitae of any expert witness who will be testifying at the hearing; and A detailed written report summarizing the expert's testimony, which includes the opinion offered and the factual basis and reasons underlying the opinion. If the Board or the Office of Administrative Hearings, as appropriate, finds that the report is not sufficiently specific, or otherwise fails to comply with the requirements of this section, the Board or the Office of Administrative Hearings, as appropriate, shall exclude from the hearing the testimony of the expert and any report of the expert. The Board or the Office of Administrative Hearings, as appropriate, shall consider and decide arguments regarding the sufficiency of the report: At the prehearing conference, if scheduled; or Immediately before the scheduled hearing. If an expert adopts a sufficiently specific charging document as the expert's report, that adoption satisfies the requirements set forth in this section. Parties are not entitled to discovery of items other than as listed in §§C and D of this regulation. Both parties have a continuing duty to supplement their disclosures of witnesses and documents. Absent unforeseen circumstances which would otherwise impose an extraordinary hardship on a party, witnesses or documents may not be added to the list: After the prehearing conference, if scheduled; or Later than 15 days before the hearing, if no prehearing conference is scheduled. The prohibition against adding witnesses does not apply to witnesses or documents to be used for impeachment or rebuttal purposes. Construction. In hearings conducted by an administrative law judge of the Office of Administrative Hearings, this regulation shall be construed, whenever possible, as supplementing and in harmony with COMAR 28.02.01. In the event of a conflict between this regulation and COMAR 28.02.01, this regulation applies. Board Majority. Except as provided in §B of this regulation, each hearing shall be held before a majority of the Board. Delegation. The Board may delegate the authority to conduct the hearing to a committee in accordance with Health Occupations Article, §10-316, Annotated Code of Maryland, or to an administrative law judge in accordance with State Government Article, §10-205, Annotated Code of Maryland. Duties of Presiding Officer. The chairperson, or a member designated by the chairperson, shall be the presiding officer. The presiding officer shall: Have complete charge of the hearing; Permit the examination of witnesses; Admit evidence; Rule on the admissibility of evidence; Adjourn or recess the hearing from time to time. The presiding officer has discretion to set reasonable time limits on arguments and presentation of evidence. The presiding officer shall be responsible for decorum in a hearing and can suspend the proceedings as necessary to maintain decorum. Legal Advisor and Counsel for the Board. The presiding officer may request the Office of the Attorney General to participate in any hearing to present the case on behalf of the Board. Counsel presenting the case on behalf of the Board shall have the same rights with regard to the submission of evidence, examination, cross-examination of witnesses, presentation of summation and argument, and filing of objections, exceptions, and motions as does counsel for any party. The presiding officer may also request a representative of the Office of the Attorney General to act as legal advisor to the Board as to questions of evidence and law. Order of Procedure. The case on behalf of the Board shall be presented first. The respondent shall then present his case. After that, rebuttal shall be permitted. Examination of Witnesses and Introduction of Evidence. The rules of evidence in all hearings under these regulations shall be as set forth in State Government Article, §§10-208 and 10-209, Annotated Code of Maryland. Every party has the right to: Call witnesses and present evidence; Cross-examine every witness called on behalf of the Board or other party; Present summation and argument, and file objections, exceptions, and motions. When a party is represented by counsel, all submission of evidence, examination and cross-examination of witnesses, and filing of objections, exceptions, and motions shall be done and presented solely by counsel. Witnesses. The presiding officer, or any person designated by him for that purpose, may examine any witness called to testify. The presiding officer may call as a witness any person in attendance at the hearing. Any member of the Board may examine any witness called to testify. The Board shall prepare an official record which shall include all pleadings, testimony, exhibits, and other memoranda or material filed in the proceeding. A stenographic record of the proceedings shall be made at the expense of the Board. This record need not be transcribed, however, unless requested by a party, or by the Board. The cost of any typewritten transcripts of any proceedings, or part of them, shall be paid by the party requesting the transcript. Each decision and order rendered by the Board shall be in writing and shall be accompanied by findings of fact and conclusions of law. A copy of the decision and order and accompanying findings and conclusions shall be delivered or mailed promptly to each party or his attorney of record. Any party aggrieved by the decision and order may apply for rehearing within 10 days after service of the decision and order. Action on an application shall lie in the discretion of the Board. Unless otherwise ordered, neither the rehearing nor the application for it shall stay the enforcement of the order, or excuse the persons affected by it for failure to comply with its terms. On rehearing, the Board shall only consider facts not presented in the original hearing, including facts arising after the date of the original hearing, and may by new order abrogate, change, or modify its original order. Health Occupations Article, §§10-205 and 10-316; State Government Article, §§10-205 and 10-206; Annotated Code of Maryland Effective date: January 31, 1983 (10:2 Md. R. 109) Regulation .01 amended effective April 21, 2008 (35:8 Md. R. 805) Regulation .02A amended effective April 21, 2008 (35:8 Md. R. 805) Regulation .04 amended effective October 1, 2000 (27:17 Md. R. 1620); April 21, 2008 (35:8 Md. R. 805) Regulation .05 amended effective October 1, 2000 (27:17 Md. R. 1620) Regulation .05C amended effective January 30, 1995 (22:2 Md. R. 77); April 21, 2008 (35:8 Md. R. 805) This chapter applies to all occupational therapists and occupational therapy assistants seeking to obtain, renew, reactivate, or reinstate licensure in Maryland. The objectives of this chapter are to establish guidelines in order to: Maintain professional competency, or improve professional competency, or both; and Assure completion of continuing competency requirements for: Licensure; Renewal; Reactivation; or Reinstatement. In this chapter, the following terms have the meanings indicated. Terms Defined. “Competence” means an individual's capacity for performance in occupational therapy principles and procedures. Competency. “Competency” means the demonstration of the pertinent knowledge of and performance skills in occupational therapy principles and procedures within the practice of occupational therapy and limited occupational therapy. “Competency” includes satisfactory completion of an educational program or experience, specialty certification, continuing education, or all of these. Contact Hour. “Contact hour” means 1 hour spent in a continuing competency activity that meets the requirements of the Board and is approved as set forth in this chapter. “Contact hour” does not include orientations, introductions, refreshment breaks, receptions, other social gatherings, and meals which do not include an acceptable educational activity. “Contact hour approval request” means a form provided by the Board for the purpose of obtaining Board approval of contact hours. “Continuing competency committee” means a committee established and appointed by the Board to evaluate continuing competency programs and activities. “Continuing competency requirement compliance report” means a form provided by the Board for the purpose of summarizing completion of continuing competency requirements. “Occupational therapy principles” means: The use of therapeutic activities that promote independence in daily life roles; Remediation or restoration of performance abilities that are limited due to impairment in biological, physiological, psychological, or neurological processes; In order to enhance performance, the adaptation of task, process, or the environment, or the teaching of compensatory techniques; Methods and techniques for preventing disability that facilitate the development of the safe application of performance skills; Health promotion strategies and practices that enhance performance abilities; and Education, instruction, and research in the practice of occupational therapy. Occupational Therapy Procedures. “Occupational therapy procedures” means: Developing, improving, sustaining, or restoring skills in activities of daily living, work, or productive activities, including instrumental activities of daily living and play and leisure activities; Developing, remediating, or restoring sensorimotor, perceptual, cognitive, or psychological components of performance; Designing, fabricating, applying, or training in the use of assistive technology, splinting, or orthotic devices, including training in the use of prosthetic devices; Adapting environments and processes, including the application of ergonomic principles to enhance performance and safety in daily life roles; Applying physical agent modalities as adjuncts to or in preparation for purposeful activity with appropriate training, as specified; Promoting safe, functional mobility in daily life tasks; Providing intervention in collaboration with the client, the client's family, the client's caregiver, or others; Educating the client, the client's family, the client's caregiver, or others in carrying out appropriate nonskilled interventions; and Consulting with groups, programs, organizations, and communities to provide population-based services. “Occupational therapy procedures” do not include the adjustment or manipulation of any of the osseous structures of the body or spine. Occupational Therapy Role-Related Activities. “Occupational therapy role-related activities” means activities which are relevant to and that augment a licensee's professional, job-related duties and responsibilities. “Occupational therapy role-related activities” may include inservices, course work, or workshops relative to: Health care administration, management, or leadership; Other disciplines' clinical practices that relate to occupational therapy principles and procedures; Billing and regulatory issues; Health care computer programs that provide information to benefit clients or client education; or Cultural competency. “Occupational therapy role-related activities” do not include: Preparation for national or regional standardized tests, such as the Graduate Record Examination; Cardiopulmonary resuscitation (CPR); Job or facility orientation activities; Certificate or degree programs in unrelated fields; or Foreign language classes for personal use. “Provider” means a college, university, institution, organization, association, or individual that offers workshops, seminars, conferences, college-level courses, graduate-level courses, telecommunication network courses, or video-taped presentations that maintain or improve professional competency. “Verification” means proof of licensure, certification, registration, or continuing education: Confirmable by the Board based on documentation provided by the applicant. Obtained from a verification service provider approved by the issuing entity and accepted by the Board at its discretion; or Obtained from the entity by which the applicant is licensed, certified, registered, or educated. A licensee shall retain supporting documents relative to continuing competency requirements for a period of 4 years after the date of renewal for inspection by the Board. These documents may be audited by the Board at any time. A licensee shall retain physical agent modality documentation for the duration of the licensee's professional career in occupational therapy, in accordance with COMAR 10.46.06. At the time of licensure, renewal, reactivation, or reinstatement, a licensee shall attest to completion of the required contact hours during the specified time frame. A licensee's submission of any false statement regarding continuing competency requirements shall result in formal disciplinary action by the Board. A licensee's failure to substantiate contact hours upon request of the Board shall result in formal disciplinary action by the Board. Time Frame. Licensure Time Frame. The Board shall stagger the terms of licenses. A license is valid for a 2-year term and expires as follows: Licensees originally licensed in even-numbered years are issued a license that expires on June 30 of even-numbered years; and Licensees originally licensed in odd-numbered years are issued a license that expires on June 30 of odd-numbered years. Continuing Competency Time Frame. Continuing competency requirements shall be completed within the applicable licensure time frame. The licensee may not carry over contact hours from one continuing competency time frame to another without written consent from the Board. Requirements Regarding Contact Hours. The occupational therapist or occupational therapy assistant shall certify a minimum of 24 contact hours of competency activities obtained within the 2-year period preceding the application for licensure, reactivation, or reinstatement. The 24 contact hours referred to in §B(1) of this regulation shall consist of: A minimum of 16 contact hours related to occupational therapy principles and procedures; and A maximum of 8 contact hours through occupational therapy role-related activities. The occupational therapist or occupational therapy assistant shall provide the necessary documentation to the Board upon request. Exceptions. Maintenance of Current Certification with the National Board of Certification in Occupational Therapy (NBCOT). The Board recognizes the maintenance of current NBCOT certification as fulfilling the requirements of §B(1) and (2) of this regulation. Documentation. The licensee shall provide verification of maintenance of current NBCOT certification. Licensed Less Than 1 Year. An occupational therapist or occupational therapist assistant who has had a license less than 1 year before renewal is exempt from continuing competency requirements for the first renewal period. Requesting Licensure with 3 or More Years Lapse in Practice. When an applicant applies for licensure, renewal, reactivation, or reinstatement, and meets all requirements for licensure, renewal, reactivation, or reinstatement, but has not graduated from an accredited occupational therapy program or practiced occupational therapy within the past 3 years or more, the Board shall require verification of the applicant's efforts toward maintaining and updating occupational therapy clinical competency. If an individual has been out of practice for between 3 and 8 years, the individual shall: Complete a Board-approved self-assessment; Complete a Board-approved professional development plan; Attend a minimum of 24 contact hours related to occupational therapy principles and procedures within the 24 months preceding application for licensure, renewal, reactivation, or reinstatement; Provide verification of a minimum of 30 hours of observation of service delivery, receipt of mentoring, or a combination of both with an actively licensed occupational therapist within the 24 months preceding application for licensure, renewal, reactivation, or reinstatement; and Document completion of established goals and activities in occupational therapy with an actively licensed occupational therapist within the 24 months preceding application for licensure renewal, reactivation, or reinstatement. If an individual has been out of practice for longer than 8 years, the individual shall: Complete the requirements in §C(2)(b) of this regulation; and Provide verification of 6 additional contact hours related to occupational therapy principles and procedures. Before the deadline to complete continuing competency, a licensee may request an extension to the specified time frame for completing continuing competency requirements by submitting: A letter of request; Documentation substantiating the basis of the request, for example, medical documentation; and A plan for completing the requirement. The Board preapproves contact hours provided by: The American Occupational Therapy Association (AOTA); The Maryland Occupational Therapy Association (MOTA); AOTA-approved providers; and The National Board for Certification in Occupational Therapy (NBCOT). Provider Procedures for Board Approval. A provider offering a program related to occupational therapy principles and procedures who wishes to obtain Board review of contact hours being offered to participants in the provider's programs shall submit to the Board at least 60 days in advance of the program: A contact hour approval request; An hour-by-hour agenda of the course; A course description; A description of the qualifications of the presenter or speaker, or both; A sample of the certificate of completion that will be provided to course participants; and A money order, check, or electronic payment in the amount of the course review fee established by the Board in COMAR 10.46.05. Upon review of the completed application, the Board shall notify the provider as to whether or not the program has been approved, and, if approved, the number of contact hours awarded. A provider shall furnish a certificate of completion to all participants, specifying the following information: Name of the participant; Name of the provider; Dates of the course and completion; Title and location of the course; Number of contact hours awarded by the Board; and Signature of the provider or representative. Licensee Procedures for Board Approval. A licensee participating in a program related to occupational therapy principles and procedures who wishes to obtain Board approval of contact hours not previously reviewed shall submit to the Board the following materials: A contact hour approval request; An hour-by-hour agenda of the course; A course description; A description of the presenter's qualifications; and A sample of the certificate of completion that will be provided to course participants. Upon review of the completed application, the Board shall notify the licensee as to whether or not the course has been approved, and, if approved, the number of contact hours awarded. The Board may not review occupational therapy role-related activities for pre-approval. A licensee may accrue contact hours by being involved in a broad variety of programs and activities to maintain professional competency. A minimum of 16 hours is required to be earned through continuing competencies related to occupational therapy principles and procedures. A maximum of 8 hours may be earned through occupational therapy role-related activities. Continuing competency activities that are approved by the Board include activities described in §E of this regulation in which the licensee may participate, present, or complete independently. Continuing Competency Activities — Specific Requirements. Workshops, Seminars, Conferences. A licensee may attend workshops, seminars, lectures, or professional conferences and receive 1 contact hour per 1 hour of attendance. Every 2 years, a licensee may apply a maximum of: 24 hours toward the continuing competency requirement related to occupational therapy principles and procedures; and 8 hours toward the continuing competency option for role-related activities. Documentation. The licensee shall provide: A continuing competency requirement compliance report; and A certificate of completion. Additional Documentation. In addition to the requirements of §E(1)(c) of this regulation, for courses not preapproved, a licensee shall include the following additional documentation: The date, location, and hour-by-hour agenda of the course; A course description; A description of the presenter's qualifications; and A certificate of completion. University, College, Adult Education Courses. A licensee may attend formal academic courses in occupational therapy or related topics at a university or college and receive 8 contact hours per credit hour earned. Every 2 years, a licensee may apply a maximum of: 24 hours toward the continuing competency requirement related to occupational therapy principles and procedures; and 8 hours toward the continuing competency option for role-related activities. Documentation. The licensee shall provide: A continuing competency requirement compliance report; An original, official transcript indicating successful completion of the course; and A description of the course from the school catalogue or course syllabus. Fellowship Training. A licensee may attend fellowship training in a specific area and receive 24 contact hours (a minimum of 12 full-time weeks). Every 2 years, a licensee may apply a maximum of: 24 hours toward the continuing competency requirement related to occupational therapy principles and procedures; and 8 hours toward the continuing competency option for role-related activities. Documentation. The licensee shall provide: A continuing competency requirement compliance report; A certificate awarded from the accredited organization; The dates of attendance; and A description of the training. Specialty Certification. A licensee may attain a specialty certification (for example, certified hand therapist) and receive 1 contact hour per 1 hour of education. Every 2 years, a licensee may apply a maximum of: 20 hours toward the continuing competency requirement related to occupational therapy principles and procedures; and 8 hours toward the continuing competency option for role-related activities. Documentation. The licensee shall provide: A continuing competency requirement compliance report; and A certificate of completion. Physical Agent Modalities (PAMS). A licensee may participate by following the requirements for applying PAMS as set forth in COMAR 10.46.06. Every 2 years, a licensee may apply a maximum of: 24 hours toward the continuing competency requirement related to occupational therapy principles and procedures; and 8 hours toward the continuing competency option for role-related activities. Documentation. The licensee shall provide: A continuing competency requirement compliance report; A certificate of completion; An official grade report or transcript; A course syllabus; and Written verification from the educator of five patient treatments. Auditing. A licensee may audit formal occupational therapy academic course work and receive 4 contact hours per credit hour. Every 2 years, a licensee may apply a maximum of: 12 hours toward the continuing competency requirement related to occupational therapy principles and procedures; and 8 hours toward the continuing competency option for role-related activities. Documentation. The licensee shall provide: A continuing competency requirement compliance report; A letter from the instructor regarding the time spent in the classroom/lab from an accredited college/university; and A report by the licensee on the learning objectives accomplished. Internet Learning. A licensee may participate in on-line courses and receive 1 contact hour per 1 hour of education. Every 2 years, a licensee may apply a maximum of: 16 hours toward the continuing competency requirement related to occupational therapy principles and procedures; and 8 hours toward the continuing competency option for role-related activities. Documentation. The licensee shall provide: A continuing competency requirement compliance report; An abstract of the content; and Verification of course completion from the course provider. Informal Self-Study. A licensee may participate through journal articles, or other reading opportunities with assessment, text books, video and audio tape, television, electronic media, seminars, workshops, and presentations and receive 1 contact hour per 1 hour of education. Every 2 years, a licensee may apply a maximum of: 12 hours toward the continuing competency requirement related to occupational therapy principles and procedures; and 8 hours toward the continuing competency option for role-related activities. Documentation. The licensee shall provide: A continuing competency requirement compliance report; An abstract of content from the provider; or Verification of completion from the course provider. In-Service Training. A licensee may attend an employer-provided occupational therapy in-service training program on principles, procedures, or occupational therapy related continuing education and receive 1 contact hour per 1 hour of education. Every 2 years, a licensee may apply a maximum of: 12 hours toward the continuing competency requirement related to occupational therapy principles and procedures; and 8 hours toward the continuing competency option for role-related activities. Documentation. The licensee shall provide: A continuing competency requirement compliance report; The date, location, and hour-by-hour outline or abstract of content from the in-service provider; The course description; The presenter's qualifications; and Verification of participation from the in-service provider. Mentoring. A licensee may receive 1 contact hour per 4 hours of: Mentoring an occupational therapy colleague to improve the skills of the protege, including the role as disciplinary monitor; Mentoring licensed occupational therapy professionals to improve their clinical skills; Mentoring other health care professionals to improve staff clinical skills; Mentoring management/administrative/academic skills as an occupational therapy professional; or Being mentored in a formally structured independent, concentrated, didactic or applied learning experience overseen by a mentor. Every 2 years, a licensee may apply a maximum of: 8 hours toward the continuing competency requirement related to occupational therapy principles and procedures; and 8 hours toward the continuing competency option for role-related activities. Documentation. The licensee shall provide: A continuing competency requirement compliance report; and The goals, objectives, and analysis of performance. Presentations by Licensee of Occupational Therapy Education Programs, Workshops, Seminars, and In-Services. A licensee may: Make presentations for local organizations, associations, or groups on an occupational therapy related topic; Make professional presentations at state, national, or international workshops, seminars, or conferences; or Provide professional in-service training or instruction for occupational therapists, occupational therapy assistants, or related professionals. Contact hours are earned at twice the amount of the actual presentation time. Every 2 years, a licensee may apply a maximum of: 16 hours toward the continuing competency requirement related to occupational therapy principles and procedures; and 8 hours toward the continuing competency option for role-related activities. Documentation. The licensee shall provide: A continuing competency requirement compliance report; An hour-by-hour schedule of the presentation; and An announcement of the meeting, or letter of acknowledgement from the professional sponsoring the event, or both. Presentations of the content are credited only once per renewal cycle. Development of Instructional Materials. A licensee may develop instructional materials using alternative media such as video, audio, or software programs to advance professional skills of others (not for proprietary use) and receive 1 contact hour per 3 hours of work. Every 2 years, a licensee may apply a maximum of: 12 hours toward the continuing competency requirement related to occupational therapy principles and procedures; and 8 hours toward the continuing competency option for role-related activities. Documentation. The licensee shall provide: A continuing competency requirement compliance report; A description of the program; and Media or software materials. Poster Presentations. A licensee may present posters for state, national, or international workshops, seminars, or conferences and receive contact hours at twice the amount of the actual presentation time. Every 2 years, a licensee may apply a maximum of: 12 hours toward the continuing competency requirement related to occupational therapy principles and procedures; and 8 hours toward the continuing competency option for role-related activities. Documentation. The licensee shall provide: A continuing competency requirement compliance report; and A copy of the presentation or program listing. Presentations of the content are credited only once per renewal cycle. Academic Guest Lecturer. If it is not a licensee's primary role, a licensee may teach one occupational therapy related academic course per semester and receive twice the contact hours per credit hour taught. Every 2 years, a licensee may apply a maximum of: 16 hours toward the continuing competency requirement related to occupational therapy principles and procedures; and 8 hours toward the continuing competency option for role-related activities. Documentation. The licensee shall provide: A continuing competency requirement compliance report; The date and lecture or academic course title; The name of the institution; A letter from the instructor regarding the time spent in the classroom; Course or lecture goals and objectives; and Number of hours actually taught. Presentations of the content are credited only once per renewal cycle. Fieldwork Supervision. If it is not a licensee's primary role, a licensee may directly supervise the fieldwork of Level I or Level II occupational therapy students and receive 2 contact hours per Level I occupational therapy student or 8 contact hours per Level II occupational therapy student. Every 2 years, a licensee may apply a maximum of: 16 hours toward the continuing competency requirement related to occupational therapy principles and procedures; and 8 hours toward the continuing competency option for role-related activities. Documentation. The licensee shall provide: A continuing competency requirement compliance report; and Verification from each student's college. Text Book or Articles Published or Accepted for Publication. A licensee may participate through: Publication of an occupational therapy or related professional textbook; Professional manuscript published or reviewed (edited) for textbooks; Publication of chapter or chapters in an occupational therapy or related professional textbook; Publication of an occupational therapy article in a peer-reviewed publication; or Publication of an occupational therapy article in a nonpeer-reviewed publication. Every 2 years, a licensee may apply a maximum of: 20 contact hours from authorship, editorship, coauthorship, coeditorship, or all of these, of a book for occupational therapists or relating to occupational therapy; 10 contact hours for authorship or editorship of a chapter of a publication; 8 contact hours for authorship or editorship of an occupational therapy article or abstract in a peer-reviewed publication; or 4 contact hours for authorship or editorship of an occupational therapy-related article or abstract in a nonpeer-reviewed publication. Documentation. The licensee shall provide: A continuing competency requirement compliance report; and A copy of the published work. Research Projects. A licensee may participate through extensive scholarly research activities or extensive outcome studies (defined as research associated with, for example, grants, postgraduate studies, or peer-reviewed journals). Every 2 years, a licensee may apply a maximum of: 10 contact hours per research project as approved by the Board toward the continuing competency requirement related to occupational therapy principles and procedures; and 8 hours toward the continuing competency option for role-related activities. Documentation. The licensee shall provide: A continuing competency requirement compliance report; and Copies of research proposals and final results of the research to the continuing competency committee for approval and determination of the number of contact hours earned. Evaluator. A licensee may participate through quality assurance or program evaluation studies completed and published in a journal or newsletter. Every 2 years, a licensee may apply a maximum of: 4 contact hours per study for quality assurance or program evaluation studies completed and published toward the continuing competency requirement related to occupational therapy principles and procedures; and 8 hours toward the continuing competency option for role-related activities. Documentation. The licensee shall provide: A continuing competency requirement compliance report; and A copy of the evaluation study to the continuing competency committee for approval and determination of the number of contact hours earned. Reviewer/Editor. A licensee may review professional journal articles, papers, textbook chapters, or professional association conference presentations and receive 1/2 contact hour for each paper or proposal reviewed. Every 2 years, a licensee may apply a maximum of: 16 contact hours toward the continuing competency requirement related to occupational therapy principles and procedures; and 8 hours toward the continuing competency option for role-related activities. Documentation. The licensee shall provide: A continuing competency requirement compliance report; and Confirmation from the sponsoring journal, publisher, or organization, including the number of reviews completed. Professional Study Group. A licensee may participate through professional study groups or online study groups designed to advance knowledge through active participation and receive 1 contact hour per 3 hours of study. Every 2 years, a licensee may apply a maximum of: 12 contact hours toward the continuing competency requirement related to occupational therapy principles and procedures; and 8 hours toward the continuing competency option for role-related activities. Documentation. The licensee shall provide: A continuing competency requirement compliance report; Group attendance records; Study group goals; and Analysis of goal attainment and learning. Jurisprudence Examination. A licensee may participate by successfully completing the Board's Jurisprudence Examination and receive 1 contact hour. Every 2 years, a licensee may apply a maximum of 1 contact hours toward the continuing competency requirement related to occupational therapy principles and procedures. Documentation. The licensee shall provide: A continuing competency requirement compliance report; and A certificate of completion. Volunteer Services. A licensee may volunteer occupational therapy services in areas of the licensee's expertise to community organizations, individuals, and populations, or volunteer on occupational therapy professional and related boards, associations, and committees for setting standards and the promotion of occupational therapy, and receive 1 contact hour per 1 hour of volunteering. Every 2 years, a licensee may apply a maximum of: 8 contact hours toward the continuing competency requirement related to occupational therapy principles and procedures; and 8 hours toward the continuing competency option for role-related activities. Documentation. The licensee shall provide: A continuing competency requirement compliance report; A verification letter from the organization to which services were volunteered; and A letter describing outcomes of the volunteer service provided. Formal Self-Study. A licensee may participate in formal self-study activities through an independent, concentrated didactic, or applied learning experience, or both. The copyright on the materials used for study may not precede the submission date by more than 5 years. Every 2 years, a licensee may apply a maximum of: 16 contact hours toward the continuing competency requirement related to occupational therapy principles and procedures; and 8 hours toward the continuing competency option for role-related activities. Documentation. The licensee shall provide: A continuing competency requirement compliance report; and A certificate of completion or provider-signed summary to include subject area, credentials of supervisor, didactic resources, clinical experience, time frame, and relevance to licensee's professional practice. At the Board's discretion, the Board shall audit the continuing competency documentation of a number of randomly selected licensees. The Board shall send notification of audit to audited licensees. A licensee is subject to an audit of the licensee’s continuing competency documentation by the Board as a condition of renewal of licensure. An audited licensee shall successfully complete the requirement of the audit by the specified deadline. The Board may take formal disciplinary action against the licensee if a licensee: Fails to cooperate with an audit or a request from the Board regarding continuing competency documentation; or Submits a false statement regarding continuing competency. Health Occupations Article, §§10-205 and 10-311, Annotated Code of Maryland Effective date: July 29, 1985 (12:15 Md. R. 1520) Regulation .02A amended effective March 27, 1995 (22:6 Md. R. 474) Regulation .03 amended effective March 27, 1995 (22:6 Md. R. 474) Regulations .04—.07 repealed and new Regulations .04—.07 adopted effective March 27, 1995 (22:6 Md. R. 474) Regulations .01—.07 repealed and new Regulations .01—.08 adopted effective October 2, 2000 (27:19 Md. R. 1726) Chapter revised effective April 21, 2008 (35:8 Md. R. 805) Regulation .02B amended effective February 21, 2011 (38:4 Md. R. 264); February 29, 2016 (43:4 Md. R. 332); October 23, 2017 (44:21 Md. R. 984) Regulation .04 amended effective February 21, 2011 (38:4 Md. R. 264); February 29, 2016 (43:4 Md. R. 332) Regulation .04A amended effective October 23, 2017 (44:21 Md. R. 984) Regulation .04C amended effective May 27, 2013 (40:10 Md. R. 917) Regulation .05 amended effective February 21, 2011 (38:4 Md. R. 264) Regulation .05A amended effective February 29, 2016 (43:4 Md. R. 332) Regulation .06 amended effective February 21, 2011 (38:4 Md. R. 264); February 29, 2016 (43:4 Md. R. 332) Regulation .07C amended effective February 29, 2016 (43:4 Md. R. 332) Regulation .07E adopted effective October 23, 2017 (44:21 Md. R. 984) The fees established by the Board are as follows: Address change, failure to notify the Board — $50; Application for initial licensure (includes first temporary license and is nonrefundable) — $200; Application for second temporary license — $50; Continuing Competency Provider Contact Hour review — $30; Insufficient Funds — $35; Reactivation of license after elective nonrenewal — $245; Reinstatement — $450; Elective nonrenewal — $25; Renewal, late fee (applicable to renewal made after the renewal deadline) — $100; Renewal, occupational therapist license — $270; Renewal, occupational therapy assistant license —$210; Verification of licensure — $20; Interstate occupational therapy licensure compact fee — $125. At the time of license renewal an occupational therapist shall pay a fee for health care professionals assessed by the Maryland Health Care Commission (MHCC), as specified in COMAR 10.25.02. Health Occupations Article, §§10-205 and 10-206, Annotated Code of Maryland Effective date: July 20, 1992 (19:14 Md. R. 1284) Regulation .01 amended as an emergency provision effective October 1, 1993 (20:20 Md. R. 1566); amended permanently effective April 2, 1994 (20:22 Md. R. 1708) Regulation .01 amended effective November 3, 1997 (24:22 Md. R. 1552); August 21, 2000 (27:16 Md. R. 1526) Regulation .01 amended and Regulation .02 adopted as an emergency provision effective August 31, 2001 (28:19 Md. R. 1681); adopted permanently effective December 10, 2001 (28:24 Md. R. 2129) Regulation .01 amended effective March 15, 2004 (31:5 Md. R. 449) Regulation .01 repealed and new Regulation .01 adopted effective April 21, 2008 (35:8 Md. R. 805) Regulation .01M adopted effective October 27, 2025 (52:21 Md. R. 1024) Regulation .02 amended effective April 21, 2008 (35:8 Md. R. 805) This chapter sets forth the requirements for licensed occupational therapists and licensed occupational therapy assistants to apply and use electrical and superficial physical agent modalities as related to, or in preparation for, purposeful activity, with appropriate education to ensure the safe and competent provision of occupational therapy services. A licensee who is credentialed as a certified hand therapist is exempt from the requirements set forth in this chapter. In this chapter, the following terms have the meanings indicated. Terms Defined. “Didactic education” means an educational activity: That includes a method of evaluating and testing the knowledge of the licensee relative to electrical physical agent modalities; and Relevant to the practice of electrical physical agent modalities in occupational therapy including: In-service education; Conferences; Workshops; Seminars; Formal graduate academic education; or Formal undergraduate academic education. “Direct clinical education” means supervised instruction provided on a face-to-face basis by the educator during the application of electrical physical agent modalities to a client. “Educator” means an individual who has successfully met the competency requirements as set forth in this chapter and provides didactic or direct clinical education, or both, but does not need to be an occupational therapist or occupational therapy assistant. Electrical Physical Agent Modalities. “Electrical physical agent modalities” means therapeutic modalities which induce heat or electrical current beneath the skin. “Electrical physical agent modalities” includes, but is not limited to: Therapeutic ultrasound; Phonophoresis; Iontophoresis; and Electromuscular stimulation (FES), including biofeedback, transcutaneous electrical nerve stimulation (TENS) and laser light therapy. “Superficial physical agent modalities” means therapeutic modalities including, but not limited to: Hot packs; Cold packs; Paraffin; Fluidotherapy; and Icing. An occupational therapist, or occupational therapy assistant under the periodic supervision of an occupational therapist, who wishes to use occupational therapy procedures involving electrical physical agent modalities shall maintain, for the duration of the licensee's professional career, verification of didactic education and clinical requirements. Didactic Education. For each electrical physical agent modality, didactic education shall include: Principles of physics related to specific properties of light, water, temperature, sound, and electricity; Physiological, neurophysiological, and electrophysiological changes which occur as a result of the application of the selected modality; The response of normal and abnormal tissue to the application of the modality; Indications and contraindications related to the selection and application of the modality; The guidelines for treatment or administration of the modality within the philosophical framework of occupational therapy; The guidelines for educating the patient, including instructing the patient about the process and possible outcomes of treatment, including its risks and benefits; Safety rules and precautions related to the selected modality; Methods of documenting the effectiveness of immediate and long-term effects of treatment; Characteristics of equipment including safe operation, adjustment, and care of the equipment; and Application and storage of patient specific pharmacological agents. Clinical Requirements. Before applying physical agent modalities to a client under this chapter, a licensee shall: Complete 15 contact hours of continuing education relative to electrical physical agent modalities which includes a minimum of: 5 contact hours specific to ultrasound; and 5 contact hours specific to electromuscular stimulation; and After completing all 15 contact hours of education, a licensee shall apply a minimum of five client treatments within the context of a therapeutic treatment program for each specific modality under the direct clinical education of an educator as defined in this chapter. The occupational therapist does not need to meet the competency requirements as set forth in this chapter in order to develop a treatment plan which includes recommendations for use of physical agent modalities. The therapeutic parameters for physical agent modalities shall be established by the occupational therapist or occupational therapy assistant administering the modality. The occupational therapist or occupational therapy assistant is responsible for maintaining verification of education relative to electrical physical agent modalities. Verification shall include: Identification of the specific courses or training where the therapist learned content related to each subject area as specified in Regulation .04B of this chapter; Proof of 15 contact hours of didactic education by virtue of a certificate of completion or proof of education, if applicable; An official grade report or official transcript to verify academic education; Written verification from an educator that five client treatments have been completed under direct clinical education for each specific modality; and Additional verification requested by the Board as deemed necessary. A licensee shall retain verification documentation and direct clinical education relative to electrical physical agent modalities for the duration of the licensee's professional career in occupational therapy. A licensee's submission of any false statement regarding physical agent modality competency requirements shall result in formal disciplinary action by the Board. A licensee may apply superficial physical agent modalities including, but not limited to, hot packs, cold packs, paraffin, fluidotherapy, and icing. At the Board's discretion, the Board may audit a number of randomly selected licensees. The Board shall send notification of audit to audited licensees. A licensee is subject to an audit of the licensee's physical agent modalities documentation by the Board before renewal of licensure. An audited licensee shall successfully complete the requirement of the audit by the specified deadline. Health Occupations Article, §10-101, Annotated Code of Maryland Effective date: Regulations .01—.06 adopted as an emergency provision effective June 1, 2001 (28:12 Md. R. 1102); adopted permanently effective September 17, 2001 (28:18 Md. R. 1621) Chapter revised effective April 21, 2008 (35:8 Md. R. 805) Regulation .01 amended effective May 17, 2010 (37:10 Md. R. 722) Regulation .03B amended effective May 17, 2010 (37:10 Md. R. 722) Regulation .04A, C amended effective May 17, 2010 (37:10 Md. R. 722) Regulation .05B amended effective May 17, 2010 (37:10 Md. R. 722) Regulation .06A amended effective May 17, 2010 (37:10 Md. R. 722) Regulation .08A amended effective May 17, 2010 (37:10 Md. R. 722) Chapter revised effective September 14, 2015 (42:18 Md. R. 1174) This chapter shall be used by the Board and the Maryland Office of Administrative Hearings as a framework for imposing discipline. The Board and the Maryland Office of Administrative Hearings shall take into consideration a range of activity within certain types of conduct rather than assigning particular sanctions to each specific violation. The Board is aware that there may be conduct by a licensee that does not fall squarely within a particular grid contained in Regulation .06 of this chapter. In that event the Board will use its best judgment to determine the appropriate sanction. The Board and the Maryland Office of Administrative Hearings shall make determinations that maximize the protection of the public’s health while maintaining the rights of licensees. In this chapter, the following terms have the meanings indicated. Terms Defined. “Board” means the Maryland State Board of Occupational Therapy Practice. “Conditions” means requirements in a public or non-public order that a licensee is required to satisfy which include but are not limited to: Treatment and counseling for an emotional or physical illness; Submission to drug and alcohol testing; Abstinence from specified drugs; Abstinence from alcohol; Remedial training; Inspection; Monitoring; Evaluation; Supervision; Testing of clinical skills; Submission of written reports; A demonstration of knowledge or competency; Limitation of practice; Limitation on the administration of specified drugs to patients; The provision of pro bono occupational therapy to the poor, elderly, or disabled; Obeyance of Maryland Occupational Therapy Practice Act, federal, state, and local laws; and The payment of a civil penalty. “Conduct” means behavior or action or a failure to behave or act that results in a violation of the Maryland Occupational Therapy Practice Act or the regulations adopted by the Board. This chapter shall be used by the Board as a guide for sanctioning licensees in formal and informal actions and proceedings. Except as provided in Regulation .05 of this chapter, the Board shall impose a sanction not less severe than the minimum listed in Regulation .06 of this chapter, nor more severe than the maximum listed in Regulation .06 of this chapter. When conduct results in multiple violations of the Maryland Occupational Therapy Practice Act and the regulations adopted by the Board, the Board shall consider sanctions that are greater than those imposed for a single violation. This chapter is not applicable to disciplinary matters reviewed by the Board that are initially closed. Unless otherwise indicated, the period of a suspension may be stayed in whole or in part. A respondent placed on suspension or probation shall have conditions attached to the suspension or probation which focus on the conduct and steps needed to assure public protection. Consent orders shall: Include an acknowledgement of the violation or violations; and Indicate that the respondent accepts personal responsibility for the respondent's behavior. If the conduct is not described in Regulation .06 of this chapter, the Board shall use its judgment to determine appropriate sanctions. A departure from the sanctioning guidelines alone may not be grounds for any hearing or appeal of any Board action before the Board or the Maryland Office of Administrative Hearings. The sanctioning guidelines are not applicable to: Individuals seeking an initial license; or The summary suspension of a license under State Government Article, §10-226, Annotated Code of Maryland. Notwithstanding the sanctioning guidelines, a respondent may surrender a license. Sanctions in a particular case may fall outside the range of the sanctioning guidelines established by the Board. Depending on the facts and circumstances of each case, and to the extent that the facts and circumstances apply, the Board may consider the following aggravating and mitigating factors in determining whether the sanction in a particular case should fall outside the range of the sanctioning guidelines: Aggravating factors: Previous criminal or administrative discipline history; Whether the offense was committed deliberately or with gross negligence or recklessness; Whether the offense has the potential for, or caused, serious patient harm; Whether the offense was part of a pattern of detrimental conduct; Whether the respondent pursued the respondent's financial gain over the patient’s welfare; Whether the patient was especially vulnerable; Whether the respondent attempted to hide error or misconduct from patients or others; Whether the respondent: Concealed, falsified, or destroyed evidence; or Presented false testimony or evidence; Whether the respondent willfully and without legal justification failed to cooperate with a lawful investigation conducted by the Board; and Whether previous attempts to rehabilitate the respondent were unsuccessful; and Mitigating factors: Absence of a prior disciplinary record; The passage of time since any prior offenses; Whether the respondent self-reported to the Board; Cooperation with the Board’s investigation; Full disclosure to the Board; Implementation of remedial measures to correct or mitigate harm arising from the misconduct; Timely good-faith efforts to make restitution or to rectify consequences of misconduct; Evidence of rehabilitation or rehabilitative potential; Absence of premeditation to commit the offense; Absence of potential harm to the public; Absence of adverse impact; Whether the offense was an isolated incident and not likely to recur; How and when the respondent has been involved in community service and the value of the community service to the community; and Voluntary admissions of misconduct. The following guidelines shall be used by the Board as a guide for sanctioning licensees in formal and informal actions and proceedings: Abuse — Physical and Emotional. Criminal Convictions or Plea of Nolo Contendere. Disciplined by Another Licensing or Disciplinary Authority. Diversion of Controlled Substances or Prescription Drugs. Failure to Renew a License When the Licensee Has Continued to Practice. Noncompliance with Board Orders. Incompetent Practice or Misconduct. Sexual Misconduct. Substance Abuse. Unauthorized Practice. Unethical Conduct. Health Occupations Article, §§1-606 and 10-315, Annotated Code of Maryland Effective date: April 16, 2012 (39:7 Md. R. 494) Chapter revised effective October 23, 2017 (44:21 Md. R. 984) This chapter governs the practice of occupational therapy or limited occupational therapy using telehealth as an adjunct to, or replacement for, in-person patient visits. Nothing in this chapter restricts or limits reimbursement requirements pursuant to Health-General Article and Insurance Article, Annotated Code of Maryland. In this chapter, the following terms have the meanings indicated. Terms Defined. “Asynchronous” means not occurring in real time. “Board” means the Maryland Board of Occupational Therapy Practice. “In-person” means within the physical presence of the patient. “Synchronous” means occurring in real time. “Telehealth” has the meaning stated in Health Occupations Article, §1-1001, Annotated Code of Maryland. “Telehealth practitioner” means: A Maryland licensed occupational therapist or limited occupational therapist performing telehealth services within their respective scope of practice; or An occupational therapist or limited occupational therapist with a compact privilege in Maryland performing telehealth services within their respective scope of practice. Subject to the provisions of Health Occupations Article, §10-301, Annotated Code of Maryland, a telehealth practitioner shall be licensed in Maryland or hold a compact privilege when providing telehealth services to a patient located in the State. Before providing telehealth services, a telehealth practitioner shall develop and follow a procedure to: Verify the identification of the patient receiving telehealth services through use of: A government-issued photograph identification; An insurance, Medicaid, or Medicare card; or Documentation of the patient’s: Date of birth; and Home address; For an initial patient-telehealth encounter, disclose the telehealth practitioner’s: Name; Maryland license number and type or compact privilege number, if applicable; and Contact information; Obtain oral or written consent from a patient or patient’s parent or guardian if State law requires the consent of a parent or guardian, including informing patients of the risks, benefits, and side effects of the recommended treatment plan; Securely collect and transmit a patient’s medical health information, clinical data, clinical images, laboratory results, and self-reported medical health and clinical history, as necessary, and prevent access to data by unauthorized persons through encryption or other means; Notify patients in the event of a data breach; Ensure that the telehealth practitioner provides a secure and private communication modality that complies with federal and state privacy laws; and Establish safety protocols to be used in the case of an emergency, including contact information for emergency services at the patient’s location. Except when providing asynchronous telehealth services, a telehealth practitioner shall: Obtain or confirm an alternative method of contacting the patient in case of a technological failure; Confirm whether the patient is in Maryland and identify the specific practice setting in which the patient is located; and Identify all individuals present at each location and confirm they are allowed to hear the patient’s health information. A telehealth practitioner shall be held to the same standards of practice and documentation as those applicable for in-person occupational therapy practice appointments. An occupational therapist who practices telehealth shall: Perform a synchronous or asynchronous clinical patient evaluation that is appropriate for the patient and the condition with which the patient presents before providing a treatment plan through telehealth; and If clinically appropriate for the patient, provide or refer a patient to: In-person treatment; or Another type of telehealth service. A telehealth practitioner may not treat a patient based solely on an online questionnaire Administrative History. The Board shall use the same standards of evaluating and investigating a complaint about and in disciplining a telehealth practitioner who practices telehealth as it would use for a licensee who does not use telehealth technology in the licensee’s practice. The failure of a telehealth practitioner to comply with this chapter shall constitute unprofessional conduct and may be subject to disciplinary action by the Board. Health Occupations Article, §§1-1001—1-1006, Annotated Code of Maryland Effective date: September 18, 2023 (50:18 Md. R. 797) This chapter establishes standards for the provision of dry needling as an intervention performed by occupational therapists who are certified hand therapists (CHTs). In this chapter, the following terms have the meanings indicated. Terms Defined. “Board” means the Maryland Board of Occupational Therapy Practice. “Dry needling” means a physical agent modality as defined in COMAR 10.46.06.03, also known as intramuscular manual therapy, that: Involves the insertion of one or more solid needles, a mechanical device, into the muscle and related tissues to effect change in muscle and related tissues of the hand, wrist, elbow, and shoulder; Requires ongoing evaluation, assessment, and re-evaluation of the impairments; Is only utilized in parts of the body with neuromuscular or musculoskeletal links to the impairments; and Is not performed for: The purposes of acupuncture and East Asian medicine as defined in Health Occupations Article, §1A-101, Annotated Code of Maryland; or Any purpose outside the scope of occupational therapy In order to perform dry needling, an occupational therapist shall be a certified hand therapist in good standing, in addition to having completed at least 52 total hours of further instruction, which includes: A total of at least 27 hours of instruction in the following dry-needling-specific course content areas: Theory and application of dry needling to the hand, wrist, elbow, and shoulder; Dry needling technique to the hand, wrist, elbow, and shoulder; Dry needling indications and contraindications; Infection control, the Occupational Safety and Health Administration’s Bloodborne Pathogen Protocol, and safe handling of needles; Emergency preparedness and response procedures related to complications associated with dry needling; and Appropriate documentation of dry needling; and At least 25 hours of practical, hands-on instruction in the application and technique of dry needling, under the supervision of a licensed health care practitioner competent in dry needling procedures who has: Completed the requisite course work under §A(1) of this regulation; and Practiced dry needling for at least 5 years. The instruction required under §A(1) of this regulation shall be provided by a continuing education course approved by the Board. All instruction required under this regulation shall include an assessment of competency. The instruction required under §A(1) of this regulation shall be offered: In person at a face-to-face session; or In real time through electronic means that allow for simultaneous interaction between the instructor and the participants. An occupational therapist may not fulfill any portion of the practical, hands-on instruction required under §A(2) of this regulation with online or distance learning. An occupational therapist shall have practiced occupational therapy for at least 2 years, in addition to having been certified as a hand therapist, before performing dry needling in the State. Registration. An occupational therapist shall be registered with the Board as having the appropriate education and training required by this regulation to be approved to practice dry needling. In order to be registered to practice dry needling, an occupational therapist shall submit a completed application on a form supplied by the Board with proof of the hand therapist certification. In order to continue to practice dry needling, an approved occupational therapist shall submit proof of their certified hand therapy recertification. An occupational therapist who practices dry needling without the education and training required by this regulation shall be subject to discipline pursuant to COMAR 10.46.07. An occupational therapist shall: Fully explain dry needling to the patient in advance of treatment; and Obtain written informed consent specific to dry needling that shall be included in the patient’s medical record. An occupational therapist shall perform dry needling to the hand, wrist, elbow, and shoulder in a manner consistent with standards set forth in the Maryland Occupational Safety and Health Act, Labor and Employment Article, Title 5, Annotated Code of Maryland. An occupational therapist shall document the provision of dry needling services in accordance with the documentation requirements set forth under COMAR 10.46.01.03. An occupational therapist who practices dry needling in a manner inconsistent with the standards of practice enumerated in this regulation shall be subject to discipline pursuant to COMAR 10.46.07. Dry needling is not within the scope of practice of limited occupational therapy and shall only be performed by a licensed occupational therapist with a hand therapy certification. Health Occupations Article, §§10-101 and 10-205, Annotated Code of Maryland Effective date: September 16, 2024 (51:18 Md. R. 810)