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)