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)