CHAPTER 206
LICENSURE OF OCCUPATIONAL THERAPISTS
AND OCCUPATIONAL THERAPY ASSISTANTS
[Prior to 3/6/02, see 645—201.3(147,148B,272C) to 645—201.7(147) and 645—201.9(272C)]
645—206.1(147) Definitions. For purposes of these rules, the following definitions shall apply:
“Active license” means a license that is current and has not expired.
“Board” means the board of physical and occupational therapy.
“Department” means the department of public health.
“Grace period” means the 30-day period following expiration of a license when the license is still considered to be active. In order to renew a license during the grace period, a licensee is required to pay a late fee.
“Inactive license” means a license that has expired because it was not renewed by the end of the grace period. The category of “inactive license” may include licenses formerly known as lapsed, inactive, delinquent, closed, or retired.
“Licensee” means any person licensed to practice as an occupational therapist or occupational therapy assistant in the state of Iowa.
“License expiration date” means the fifteenth day of the birth month every two years after initial licensure.
“Licensure by endorsement” means the issuance of an Iowa license to practice occupational therapy to an applicant who is or has been licensed in another state.
“Licensure examination” means the examination administered by the National Board for Certification in Occupational Therapy.
“Mandatory training” means training on identifying and reporting child abuse or dependent adult abuse required of occupational therapists or occupational therapy assistants who are mandatory reporters. The full requirements on mandatory reporting of child abuse and the training requirements are found in Iowa Code section 232.69. The full requirements on mandatory reporting of dependent adult abuse and the training requirements are found in Iowa Code section 235B.16.
“NBCOT” means the National Board for Certification in Occupational Therapy.
“Occupational therapist” means a person licensed under this chapter to practice occupational therapy.
“Occupational therapy assistant” means a person licensed under this chapter to assist in the practice of occupational therapy.
“Occupational therapy screening” means a brief process which is directed by an occupational therapist in order for the occupational therapist to render a decision as to whether the individual warrants further, in-depth evaluation and which includes:
	1.	Assessment of the medical and social history of an individual;
	2.	Observations related by that individual’s caregivers; or
	3.	Observations or nonstandardized tests, or both, administered to an individual by the occupational therapist or an occupational therapy assistant under the direction of the occupational therapist.
Nothing in this definition shall be construed to prohibit licensed occupational therapists and occupational therapy assistants who work in preschools or school settings from providing short-term interventions, not to exceed four months, to children prior to an evaluation, in accordance with state and federal educational policy.
“On site” means:
	1.	To be continuously on site and present in the department or facility where the assistive personnel are performing services;
	2.	To be immediately available to assist the person being supervised in the services being performed; and
	3.	To provide continued direction of appropriate aspects of each treatment session in which a component of treatment is delegated to assistive personnel.
“OT” means occupational therapist.
“OTA” means occupational therapy assistant.
“Reactivate” or “reactivation” means the process as outlined in rule 206.18(17A,147,272C) by which an inactive license is restored to active status.
“Reciprocal license” means the issuance of an Iowa license to practice occupational therapy to an applicant who is currently licensed in another state which has a mutual agreement with the Iowa board of physical and occupational therapy to license persons who have the same or similar qualifications to those required in Iowa.
“Reinstatement” means the process as outlined in 645—11.31(272C) by which a licensee who has had a license suspended or revoked or who has voluntarily surrendered a license may apply to have the license reinstated, with or without conditions. Once the license is reinstated, the licensee may apply for active status.
645—206.2(147) Requirements for licensure. The following criteria shall apply to licensure:
	206.2(1) The applicant shall complete a board-approved application packet. Application forms may be obtained from the board’s Web site (http://www.idph.state.ia.us/licensure) or directly from the board office. All applications shall be sent to Board of Physical and Occupational Therapy, Professional Licensure Division, Fifth Floor, Lucas State Office Building, Des Moines, Iowa 50319-0075.
	206.2(2) The applicant shall complete the application form according to the instructions contained in the application. If the application is not completed according to the instructions, the application will not be reviewed by the board.
	206.2(3) Each application shall be accompanied by the appropriate fees payable by check or money order to the Board of Physical and Occupational Therapy. The fees are nonrefundable.
	206.2(4) No application will be considered by the board until official copies of academic transcripts sent directly from the school to the board have been received by the board.
	206.2(5) The applicant shall provide a notarized copy of the certificate or diploma indicating the degree awarded to the applicant, if the degree is not indicated on the official transcript.
	206.2(6) The licensure examination score shall be sent directly from the examination service to the board to confirm a passing score on the examination.
	206.2(7) Licensees who were issued their initial licenses within six months prior to the renewal date shall not be required to renew their licenses until the renewal date two years later.
	206.2(8) Incomplete applications that have been on file in the board office for more than two years shall be:
	a. 	Considered invalid and shall be destroyed; or
	b. 	Maintained upon written request of the candidate. The candidate is responsible for requesting that the file be maintained.
645—206.3(147) Limited permit to practice pending licensure. A limited permit holder who is applying for licensure in Iowa by taking the licensure examination for the first time and has never been licensed as an occupational therapist or occupational therapy assistant in any state, the District of Columbia, or another country must have completed the educational and experience requirements for licensure as an occupational therapist or occupational therapy assistant. The limited permit holder shall:
	1.	Make arrangements to take the examination and have the official results of the examination sent directly from the examination service to the board;
	2.	Apply for licensure on forms provided by the board. The applicant must include on the application form the name of the Iowa-licensed occupational therapist(s) who will provide supervision of the limited permit holder until the limited permit holder is licensed;
	3.	Practice only under the supervision of an Iowa-licensed OT for a period not to exceed six months from the date the application was received in the board office;
	4.	Submit to the board the name of the OT providing supervision within seven days after a change in supervision occurs; and
	5.	If the applicant fails the national examination, the limited permit holder must cease practicing immediately.
645—206.4(147) Applicant occupational therapist and occupational therapy assistant. An applicant who has never been licensed in Iowa, but has taken the licensure examination and held licensure in another state, the District of Columbia, or another country may practice under these rules prior to licensure if the complete application for endorsement and fees are on file at the board office. The occupational therapist applicant and occupational therapy assistant applicant shall:
	1.	Apply for licensure on forms provided by the board. The applicant must include on the application form the name of the Iowa-licensed OT who will provide supervision of the applicant until the applicant is licensed;
	2.	Practice only under the supervision of an Iowa-licensed OT for a period not to exceed three months from the date the application was received in the board office;
	3.	Submit to the board the name of the occupational therapist(s) providing supervision within seven days after a change in supervision occurs; and
	4.	The applicant shall not practice as an OT applicant or OTA applicant if the applicant has never passed the licensure examination.
645—206.5(147) Practice of occupational therapy limited permit holders and endorsement applicants prior to licensure.
	206.5(1) Occupational therapist limited permit holders and endorsement applicants working prior to licensure may:
	a. 	Evaluate clients, plan treatment programs, and provide periodic reevaluations only under supervision of a licensed OT who shall bear full responsibility for care provided under the OT’s supervision; and
	b. 	Perform the duties of the occupational therapist under the supervision of an Iowa-licensed occupational therapist, except for providing supervision to an occupational therapy assistant.
	206.5(2) Occupational therapy assistants, limited permit holders and endorsement applicants working prior to licensure shall:
	a. 	Follow the treatment plan written by the supervising OT outlining the elements that have been delegated; and
	b. 	Perform occupational therapy procedures delegated by the supervising OT as required in subrule 206.8(4).
645—206.6(147) Examination requirements. The following criteria shall apply to the written examination(s):
	206.6(1) The applicant for licensure as an occupational therapist shall have received a passing score on the licensure examination for occupational therapists. It is the responsibility of the applicant to make arrangements to take the examination and have the official results submitted directly from the examination service to the board of physical and occupational therapy.
	206.6(2) The applicant for licensure as an occupational therapy assistant shall have received a passing score on the licensure examination for occupational therapy assistants. It is the responsibility of the applicant to make arrangements to take the examination and have the official results submitted directly from the examination service to the board of physical and occupational therapy.
645—206.7(147) Educational qualifications.
	206.7(1) The applicant must present proof of meeting the following requirements for licensure as an occupational therapist or occupational therapy assistant:
	a. 	Occupational therapist. The applicant for licensure as an occupational therapist shall have completed the requirements for a degree in occupational therapy in an occupational therapy program accredited by the Accreditation Council for Occupational Therapy Education of the American Occupational Therapy Association. The transcript shall show completion of a supervised fieldwork experience.
	b. 	Occupational therapy assistant. The applicant for licensure as an occupational therapy assistant shall be a graduate of an educational program approved by the Accreditation Council for Occupational Therapy Education of the American Occupational Therapy Association. The transcript shall show completion of a supervised fieldwork experience.
	206.7(2) Foreign-trained occupational therapists and occupational therapy assistants. To become eligible to take the licensure examination, internationally educated occupational therapists must meet NBCOT eligibility requirements and undergo prescreening based on the status of their occupational therapy educational programs.
645—206.8(272C) Supervision requirements.
	206.8(1) Care rendered by unlicensed personnel shall not be documented or charged as occupational therapy unless direct in-sight supervision is provided by an OT or an OTA.
	206.8(2) Occupational therapy screening shall be directed by an occupational therapist and shall not be delegated to an unlicensed person.
	206.8(3) A licensed OTA, OTA limited permit holder or OTA applicant working prior to licensure shall be supervised by a licensed occupational therapist. The occupational therapist must be involved in the delivery of services during all aspects of service delivery, including screening, evaluation, intervention and outcome evaluation. The occupational therapist may delegate responsibilities to the occupational therapy assistant. The occupational therapist shall:
	a. 	Ensure that the OTA has a current occupational therapy license and that the OTA limited permit holder or applicant working prior to licensure has a copy of the letter from the board verifying that a current application is on file;
	b. 	Provide direct on-site and in-sight supervision for a minimum of four hours per month;
	c. 	Complete a patient evaluation prior to treatment by the licensed OTA, OTA limited permit holder, or the OTA applicant working prior to licensure. The time spent evaluating the patient by the supervising OT shall not be considered time spent supervising;
	d. 	Complete a written treatment plan outlining which elements have been delegated to the licensed OTA, OTA limited permit holder, or OTA applicant working prior to licensure;
	e. 	Monitor patient progress;
	f. 	Complete an evaluation of the treatment plan and write a discharge plan; and
	g. 	Assign to the licensed OTA, OTA limited permit holder, or OTA applicant only those duties and responsibilities for which the assistant, limited permit holder, or applicant has been specifically trained and is qualified to perform.
	206.8(4) Supervision of an OT limited permit holder or an OT applicant. An OT limited permit holder or an OT applicant working prior to licensure shall be supervised by a licensed OT. The supervisor shall:
	a. 	Ensure that the OT limited permit holder or OT applicant working prior to licensure has a copy of the letter from the board verifying that a current application is on file;
	b. 	Provide one-to-one supervision for a minimum of two hours per week.
The applicant who is practicing prior to licensure may perform the duties of the occupational therapist under the supervision of an Iowa-licensed occupational therapist, except for providing supervision to an occupational therapy assistant.
	206.8(5) Occupational therapist limited permit holders and occupational therapist applicants working prior to licensure may evaluate clients, plan treatment programs, and provide periodic reevaluations only under supervision of a licensed occupational therapist who shall bear full responsibility for care provided under the occupational therapist’s supervision.
645—206.9(147) Occupational therapy assistant responsibilities. An occupational therapy assistant shall:
	1.	Follow the treatment plan written by the supervising occupational therapist outlining which elements have been delegated;
	2.	Maintain a plan of supervision; and
	3.	Maintain documentation of supervision on a daily basis that shall be available for review upon request of the board.
645—206.10(147) Licensure by endorsement. An applicant who has been a licensed occupational therapist or occupational therapy assistant under the laws of another jurisdiction shall file an application for licensure by endorsement with the board office. The board may receive by endorsement any applicant from the District of Columbia, another state, territory, province or foreign country who:
	1.	Submits to the board a completed application;
	2.	Pays the licensure fee;
	3.	Shows evidence of licensure requirements in the jurisdiction in which the applicant has been licensed that are similar to those required in Iowa;
	4.	Submits official results from the appropriate professional examination sent directly from the examination service to the board;
	5.	Provides official copies of the academic transcripts sent directly from the school to the board;
	6.	Provides verification of license(s) from every jurisdiction in which the applicant has been licensed, sent directly from the jurisdiction(s) to the board office. Web-based verification may be substituted for verification direct from the jurisdiction’s board office if it provides:
	●	Licensee’s name;
	●	Date of initial licensure;
	●	Current licensure status; and
	●	Any disciplinary action taken against the license; and
	7.	Shows evidence of one of the following:
	●	Completion of 30 hours for an occupational therapist and 15 hours for an occupational therapy assistant of board-approved continuing education during the immediately preceding two-year period;
	●	The practice of occupational therapy for a minimum of 2,080 hours during the immediately preceding two-year period as a licensed occupational therapist or occupational therapy assistant;
	●	Serving as a full-time equivalent faculty member teaching occupational therapy in an accredited school of occupational therapy for at least one of the immediately preceding two years; or
	●	Successfully passing the examination within a period of one year from the date of examination to the time application is completed for licensure.
Individuals who were issued their licenses by endorsement within six months of the license renewal date will not be required to renew their licenses until the next renewal two years later.
645—206.11(147) Licensure by reciprocal agreement. The board may enter into a reciprocal agreement with the District of Columbia or any state, territory, province or foreign country with equal or similar requirements for licensure of occupational therapists or occupational therapy assistants.
645—206.12(147) License renewal.
	206.12(1) The biennial license renewal period for a license to practice as an occupational therapist or occupational therapy assistant shall begin on the sixteenth day of the birth month and end on the fifteenth day of the birth month two years later. The board shall send a renewal notice by regular mail to each licensee at the address on record at least 60 days prior to the expiration of the license. The licensee is responsible for renewing the license prior to its expiration. Failure of the licensee to receive the notice does not relieve the licensee of the responsibility for renewing the license.
	206.12(2) An individual who was issued a license within six months of the license renewal date will not be required to renew the license until the subsequent renewal two years later.
	206.12(3) A licensee seeking renewal shall:
	a. 	Meet the continuing education requirements of rule 645—207.2(272C) and the mandatory reporting requirements of subrule 206.12(4). A licensee whose license was reactivated during the current renewal compliance period may use continuing education earned during the compliance period for the first renewal following reactivation; and
	b. 	Submit the completed renewal application and renewal fee before the license expiration date.
	206.12(4) Mandatory reporter training requirements.
	a. 	A licensee who in the scope of professional practice regularly examines, attends, counsels or treats children in Iowa shall indicate on the renewal application completion of two hours of training in child abuse identification and reporting in the previous five years or condition(s) for waiver of this requirement as identified in paragraph “e.”
	b. 	A licensee who in the scope of professional practice regularly examines, attends, counsels or treats adults in Iowa shall indicate on the renewal application completion of two hours of training in dependent adult abuse identification and reporting in the previous five years or condition(s) for waiver of this requirement as identified in paragraph “e.”
	c. 	A licensee who in the scope of professional practice regularly examines, attends, counsels or treats both adults and children in Iowa shall indicate on the renewal application completion of training in abuse identification and reporting for dependent adults and children in the previous five years or condition(s) for waiver of this requirement as identified in paragraph “e.”
Training may be completed through separate courses as identified in paragraphs “a” and “b” or in one combined two-hour course that includes curricula for identifying and reporting child abuse and dependent adult abuse. The course shall be a curriculum approved by the Iowa department of public health abuse education review panel.
	d. 	The licensee shall maintain written documentation for five years after mandatory training as identified in paragraphs “a” to “c,” including program date(s), content, duration, and proof of participation.
	e. 	The requirement for mandatory training for identifying and reporting child and dependent adult abuse shall be suspended if the board determines that suspension is in the public interest or that a person at the time of license renewal:
	(1)	Is engaged in active duty in the military service of this state or the United States.
	(2)	Holds a current waiver by the board based on evidence of significant hardship in complying with training requirements, including an exemption of continuing education requirements or extension of time in which to fulfill requirements due to a physical or mental disability or illness as identified in 645—Chapter 207.
	f. 	The board may select licensees for audit of compliance with the requirements in paragraphs “a” to “e.”
	206.12(5) Upon receiving the information required by this rule and the required fee, board staff shall administratively issue a two-year license and shall send the licensee a wallet card by regular mail. In the event the board receives adverse information on the renewal application, the board shall issue the renewal license but may refer the adverse information for further consideration or disciplinary investigation.
	206.12(6) Persons licensed to practice as occupational therapists or occupational therapy assistants shall keep their renewal licenses displayed in a conspicuous public place at the primary site of practice.
	206.12(7) Late renewal. The license shall become a late license when the license has not been renewed by the expiration date on the wallet card. The licensee shall be assessed a late fee as specified in 645—subrule 210.1(3). To renew a late license, the licensee shall complete the renewal requirements and submit the late fee within the grace period.
	206.12(8) Inactive license. A licensee who fails to renew the license by the end of the grace period has an inactive license. A licensee whose license is inactive continues to hold the privilege of licensure in Iowa, but may not practice as an occupational therapist or occupational therapy assistant in Iowa until the license is reactivated. A licensee who practices as an occupational therapist or occupational therapy assistant in the state of Iowa with an inactive license may be subject to disciplinary action by the board, injunctive action pursuant to Iowa Code section 147.83, criminal sanctions pursuant to Iowa Code section 147.86, and other available legal remedies.
645—206.13(272C) Exemptions for inactive practitioners. Rescinded IAB 9/14/05, effective 10/19/05.
645—206.14(272C) Lapsed licenses. Rescinded IAB 9/14/05, effective 10/19/05.
645—206.15(147) Duplicate certificate or wallet card.
	206.15(1) A duplicate wallet card or duplicate certificate shall be required if the current wallet card or certificate is lost, stolen or destroyed. A duplicate wallet card or a duplicate certificate shall be issued only under such circumstances.
	206.15(2) A duplicate wallet card or duplicate certificate shall be issued upon receipt of the completed application for duplicate license and payment of the fee as specified in rule 645—210.1(147,148B).
	206.15(3) If the board receives a completed application for duplicate license stating that the wallet card or certificate was not received within 60 days after being mailed by the board, no fee shall be required for issuing the duplicate wallet card or duplicate certificate.
645—206.16(147) Reissued certificate or wallet card. The board shall reissue a certificate or current wallet card upon receipt of a written request from the licensee, return of the original document and payment of the fee as specified in rule 645—210.1(147,148B).
645—206.17(17A,147,272C) License denial.
	206.17(1) When the board denies an applicant licensure, the board shall notify the applicant of the denial in writing by certified mail, return receipt requested, or in the manner of service of an original notice, and shall cite the reasons for which the application was denied.
	206.17(2) An applicant who has been denied licensure by the board may appeal the denial and request a hearing on the issues related to the licensure denial by serving a written notice of appeal and request for hearing upon the board by certified mail, return receipt requested, not more than 30 days following the date of mailing of the notification of licensure denial to the applicant. The request for hearing shall specifically describe the facts to be contested and determined at the hearing.
	206.17(3) If an applicant who has been denied licensure by the board appeals the licensure denial and requests a hearing pursuant to this rule, the hearing and subsequent procedures shall be held pursuant to the process outlined in Iowa Code chapters 17A and 272C and 645—Chapter 11.
645—206.18(17A,147,272C) License reactivation. To apply for reactivation of an inactive license, a licensee shall:
	206.18(1) Submit a reactivation application on a form provided by the board.
	206.18(2) Pay the reactivation fee that is due as specified in 645—Chapter 210.
	206.18(3) Provide verification of current competence to practice occupational therapy by satisfying one of the following criteria:
	a. 	If the license has been on inactive status for five years or less, an applicant must provide the following:
	(1)	Verification of the license(s) from every jurisdiction in which the applicant is or has been licensed and is or has been practicing during the time period the Iowa license was inactive, sent directly from the jurisdiction(s) to the board office. Web-based verification may be substituted for verification from a jurisdiction’s board office if the verification includes:
	1.	Licensee’s name;
	2.	Date of initial licensure;
	3.	Current licensure status; and
	4.	Any disciplinary action taken against the license; and
	(2)	Verification of completion of 15 hours of continuing education for an occupational therapy assistant and 30 hours of continuing education for an occupational therapist within two years of application for reactivation.
	b. 	If the license has been on inactive status for more than five years, an applicant must provide the following:
	(1)	Verification of the license(s) from every jurisdiction in which the applicant is or has been licensed and is or has been practicing during the time period the Iowa license was inactive, sent directly from the jurisdiction(s) to the board office. Web-based verification may be substituted for verification from a jurisdiction’s board office if the verification includes:
	1.	Licensee’s name;
	2.	Date of initial licensure;
	3.	Current licensure status; and
	4.	Any disciplinary action taken against the license; and
	(2)	Verification of completion of 30 hours of continuing education for an occupational therapy assistant and 60 hours of continuing education for an occupational therapist within two years of application for reactivation; or evidence of successful completion of the professional examination required for initial licensure completed within one year prior to the submission of an application for reactivation.
645—206.19(17A,147,272C) License reinstatement. A licensee whose license has been revoked, suspended, or voluntarily surrendered must apply for and receive reinstatement of the license in accordance with 645—11.31(272C) and must apply for and be granted reactivation of the license in accordance with 206.18(17A,147,272C) prior to practicing occupational therapy in this state.
These rules are intended to implement Iowa Code chapters 17A, 147, 148B and 272C.
[Filed 2/14/02, Notice 10/3/01—published 3/6/02, effective 4/10/02]
[Filed 11/26/03, Notice 9/17/03—published 12/24/03, effective 1/28/04]
[Filed 8/22/05, Notice 6/22/05—published 9/14/05, effective 10/19/05]◊
[Filed 5/19/06, Notice 3/29/06—published 6/21/06, effective 7/26/06]
[Filed 11/30/07, Notice 9/26/07—published 12/19/07, effective 1/23/08]
[Filed 5/28/08, Notice 3/26/08—published 6/18/08, effective 7/23/08]
◊	Two or more ARCs