645—208.5(148B) Supervision requirements.
	208.5(1) Care rendered by unlicensed assistive personnel shall not be documented or charged as occupational therapy unless direct on-site supervision is provided by an OT or in-sight supervision is provided by an OTA.
	208.5(2) Occupational therapist supervisor responsibilities. The supervisor shall:
	a. 	Provide supervision to a licensed OTA, OT limited permit holder and OTA limited permit holder any time occupational therapy services are rendered. Supervision may be provided on site or through the use of telecommunication or other technology.
	b. 	Ensure that every licensed OTA, OT limited permit holder and OTA limited permit holder being supervised is aware of who the supervisor is and how the supervisor can be contacted any time occupational therapy services are rendered.
	c. 	Assume responsibility for all delegated tasks and shall not delegate a service that exceeds the expertise of the OTA or OTA limited permit holder.
	d. 	Provide evaluation and development of a treatment plan for use by the OTA.
	e. 	Ensure that the OTA, OT limited permit holder and OTA limited permit holder under the OT’s supervision have current licenses to practice.
	f. 	Ensure that the signature of an OTA on an occupational therapy treatment record indicates that the occupational therapy services were provided in accordance with the rules and regulations for practicing as an OTA.
	208.5(3) The following are functions that only an occupational therapist may provide and that shall not be delegated to an OTA:
	a. 	Interpretation of referrals;
	b. 	Initial occupational therapy evaluation and reevaluations;
	c. 	Identification, determination or modification of patient problems, goals, and care plans;
	d. 	Final discharge evaluation and establishment of the discharge plan;
	e. 	Assurance of the qualifications of all assistive personnel to perform assigned tasks through written documentation of their education or training that is maintained and available at all times;
	f. 	Delegation of and instruction in the services to be rendered by the OTA, including but not limited to specific tasks or procedures, precautions, special problems, and contraindicated procedures; and
	g. 	Timely review of documentation, reexamination of the patient and revision of the plan when indicated.
	208.5(4) Supervision of unlicensed assistive personnel. OTs are responsible for patient care provided by unlicensed assistive personnel under the OT’s supervision. Unlicensed assistive personnel shall not provide independent patient care unless each of the following standards is satisfied:
	a. 	The supervising OT shall physically participate in the patient’s treatment or evaluation, or both, each treatment day;
	b. 	The unlicensed assistive personnel shall provide independent patient care only while under the on-site supervision of the supervising OT;
	c. 	Documentation made in occupational therapy records by unlicensed assistive personnel shall be cosigned by the supervising OT; and
	d. 	The supervising OT shall provide periodic reevaluation of the performance of unlicensed assistive personnel in relation to the patient.
	208.5(5) Minimum frequency of OT interaction. At a minimum, an OT must directly participate in treatment, either in person or through a telehealth visit, every twelfth visit for all patients and must document each visit. The occupational therapist shall participate at a higher frequency when the standard of care dictates.
	208.5(6) Occupational therapy assistant responsibilities.
	a. 	The occupational therapy assistant shall:
	(1)	Provide only those services for which the OTA has the necessary skills and shall consult the supervising occupational therapist if the procedures are believed not to be in the best interest of the patient;
	(2)	Gather data relating to the patient’s disability during screening, but shall not interpret the patient information as it pertains to the plan of care;
	(3)	Communicate any change, or lack of change, that occurs in the patient’s condition and that may need the assessment of the OT;
	(4)	Provide occupational therapy services only under the supervision of the occupational therapist;
	(5)	Provide treatment only after evaluation and development of a treatment plan by the occupational therapist;
	(6)	Refer inquiries that require interpretation of patient information to the occupational therapist;
	(7)	Be supervised by an occupational therapist, either on site or through the use of telecommunication or other technology, at all times when occupational therapy services are being rendered;
	(8)	Receive supervision from any number of at least one occupational therapist; and
	(9)	Record on every patient chart the name of the OTA’s supervisor for each treatment session.
	b. 	The signature of an OTA on the occupational therapy treatment record indicates that occupational therapy services were provided in accordance with the rules and regulations for practicing as an OTA.
	208.5(7) Unlicensed assistive personnel. Unlicensed assistive personnel may assist an OTA in providing patient care in the absence of an OT only if the OTA maintains in-sight supervision of the unlicensed assistive personnel and the OTA is primarily and significantly involved in that patient’s care.
	208.5(8) The occupational therapy limited permit holder may evaluate clients, plan treatment programs, and provide periodic reevaluations under supervision of a licensed occupational therapist who shall bear full responsibility for care provided under the occupational therapist’s supervision.
[ARC 7984C, IAB 5/15/24, effective 7/1/24]