in-20251015-IR-844250329SNA: OCCUPATIONAL THERAPY PROFESSION UPDATES

TITLE 844 MEDICAL LICENSING BOARD OF INDIANA Notice of Second Public Comment Period LSA Document #25-329 OCCUPATIONAL THERAPY PROFESSION UPDATES PURPOSE OF NOTICE The Medical Licensing Board of Indiana (board) is soliciting public comment on adding and amending rules at 844 IAC 10 concerning updates related to the occupational therapy profession. The board seeks comment on the affected citations listed and any other provisions of Title 844 that may be affected by this rulemaking. HISTORY Notice of First Public Comment Period: 20250716-IR-844250329FNA Regulatory Analysis submitted with Notice of First Public Comment Period: 20250716-IR-844250329RAA Date of First Hearing: August 20, 2025 ADDITIONAL DOCUMENTS Regulatory Analysis: 20251015-IR-844250329RAA Notice of Public Hearing: 20251015-IR-844250329PHA CITATIONS AFFECTED: 844 IAC 10-2-2; 844 IAC 10-3-2; 844 IAC 10-3-3; 844 IAC 10-5-5; 844 IAC 10-5-6; 844 IAC 10-5-13; 844 IAC 10-5-14; 844 IAC 10-6-2; 844 IAC 10-6-2.5; 844 IAC 10-7-3; 844 IAC 10-7-4 AUTHORITY:  IC 25-1-4-8; IC 25-1-8-2; IC 25-23.5-2-5; IC 25-23.5-2-6 OVERVIEW Basic Purpose and Background During the first public comment period and public hearing, several comments were received concerning fees, the supervision of occupational therapy assistants (OTAs), and documentation recorded that becomes part of a patient's permanent record. These comments resulted in changes to the proposed rule as follows: For 844 IAC 10-2-2 - The original fee of $100 that was suggested would be burdensome on occupational therapists (OTs) and OTAs as the compact commission will be charging a fee of $75 in addition to the state fee. The occupational therapy committee (committee) decided to lower the fee from $100 to $25. For 844 IAC 10-5-5 - The original proposed rule language suggested that OTAs could complete screenings and evaluations. The new rule also updates the language. For 844 IAC 10-5-6 - The original proposed rule language was not feasible for OTs. The calendar days were reversed back to seven days, and the requirement for a countersignature was made clear and less cumbersome for OTs. For purposes of IC 4-22-2-28.1, small businesses affected by this rulemaking may contact the Small Business Regulatory Coordinator: For purposes of IC 4-22-2-28.1, the Small Business Ombudsman designated by IC 5-28-17-6 is: Resources available to regulated entities through the small business ombudsman include the ombudsman's duties stated in IC 5-28-17-6, specifically IC 5-28-17-6(9), investigating and attempting to resolve any matter regarding compliance by a small business with a law, rule, or policy administered by a state agency, either as a party to a proceeding or as a mediator. SUMMARY/RESPONSE TO COMMENTS The board requested public comment from July 16, 2025, through August 15, 2025, and during the public hearing on August 20, 2025. The board received comments from the following parties by the comment period deadline: Indiana Occupational Therapy Association Brandi Baker Abigail Kifer Alyssa Ford Amanda Link Dudek Abigail Buenconsejo Brenda Howard Danielle Ogden Carol Barnes Aida Martinez Jenna Williamson Emma Lusch Katie Nagai Kullen Quinlan Kaylin Shiver Kristin Neville Kelly Packwood Thomas Fisher Laura Nolan Danielle Sparks Linda Riccio The comments received and the board's responses are summarized as follows: Comment: Under 844 IAC 10-2-2 Fees, they believe the proposed $100 state fee for compact privilege (in addition to national fees) is excessive and could deter participation. A lower fee would better support access, mobility, and professional engagement across states. Response: The committee made the decision to lower the state cost to $25.00 for the OT and OTA compact. Comment: Under 844 IAC 10-5-5, there is concern that could imply an OTA may "complete" evaluations independently. They feel it contradicts national guidance and should be clarified to indicate that OT As contribute to evaluations under the supervision of an occupational therapist. Response: The committee made the decision to remove the language “complete” and include a descriptive list that the OTA may contribute to. Comment: Under 844 IAC 10-5-6(a), there is concern for reducing the timeframe for countersigning OTA documentation from seven (7) to five (5) calendar days. This would place undue pressure on occupational therapy practitioners without improving patient care outcomes. Indiana's countersignature requirements are already more stringent than neighboring states. Response: The committee made the decision to go back to the original seven (7) calendar day requirement for countersignature and when it is needed. REQUEST FOR PUBLIC COMMENT The board is soliciting public comment on the proposed rule. Comments may be submitted in one of the following ways: COMMENT PERIOD DEADLINE All comments must be postmarked or time stamped not later than November 14, 2025. The rule, Regulatory Analysis, appendices referenced in the Regulatory Analysis, and materials incorporated by reference (if applicable) are on file at the Indiana Professional Licensing Agency, 402 West Washington Street, Room W072, Indianapolis, Indiana and are available for public inspection. Copies of the rule, Regulatory Analysis, and appendices referenced in the Regulatory Analysis are available at the Indiana Professional Licensing Agency office. This notice is the second of two (2) thirty (30) day periods in which the public may comment on the proposed rule. Following this second public comment period, the board may adopt a version of the proposed rule that is the same as or does not substantially differ from the text of the proposed rule published in this notice. EXPLANATION OF DIFFERENCES IN PROPOSED RULE In 844 IAC 10-5-2, the proposed $100 state fee for compact privilege, in addition to national fees, is excessive and could deter participation. A lower fee would better support access, mobility, and professional engagement across states. The committee make the decision to lower the state cost to $25 for the OT and OTA compact. In 844 IAC 10-5-5, there is concern that suggests an OTA may "complete" evaluations independently. The committee feels it contradicts national guidance and should be clarified to state that OTAs contribute to evaluations under the supervision of an occupational therapist. The committee removed the word “complete” and included a descriptive list that the OTA may contribute to. In  844 IAC 10-5-6(a), there is concern for reducing the timeframe for countersigning OTA documentation from seven (7) to five (5) calendar days. This would place undue pressure on OT practitioners without improving patient care outcomes. Indiana's countersignature requirements are already more stringent than neighboring states. Based on this information, the committee made the decision to change the calendar day requirement back to the original seven (7) calendar days requirement, and included language defining when the countersignature is needed. PROPOSED RULE Sec. 2. (a) The board shall charge and collect the following fees: Application for license $100 Application for compact privilege $25, in addition to the compact commission fee established by the occupational therapy compact commission License renewal $100 biennially Temporary permit $50 Verification of license $10 Duplicate wall license $10 (b) Applicants required to take the national examination for licensure shall pay a fee directly to a professional examination service in the amount set by the examination service. Sec. 2. The committee shall issue a license by examination to an applicant who completes the following: Sec. 3. The committee may issue a license by endorsement to an applicant who completes the following: Sec. 5. (a) The occupational therapist has full responsibility for providing occupational therapy services. Supervision of an occupational therapy assistant is a shared collaborative process. The supervising occupational therapist has the legal and ethical responsibility to provide supervision, and the occupational therapy assistant has the legal and ethical responsibility to obtain supervision. (b) Under the supervision of an occupational therapist, an occupational therapy assistant may: The occupational therapy assistant may not independently develop the intervention plan or initiate treatment. Sec. 6. (a) The occupational therapist shall countersign within seven (7) calendar days all documentation written recorded by the occupational therapy assistant, which will become part of the patient's permanent record. A countersignature is required when the occupational therapy assistant contributes to the following:  (b) The occupational therapist's countersignature confirms that the occupational therapy assistant's documentation is accurate. Sec. 13. (a) The supervising occupational therapist shall be reasonably available and responsible at all times for the direction and action of the person supervised when services are performed by the holder of a temporary permit issued under IC 25-23.5-5-11(a)(3). Unless the supervising occupational therapist is on the premises to provide constant supervision, the holder of the temporary permit shall meet once each working day to review all patients' treatments with the supervising occupational therapist. This meeting must may include the actual virtual presence of the supervising occupational therapist. or the designated occupational therapist At least twenty percent (20%) of the meetings with the supervising or delegate occupational therapist must be in person. The patient's care shall always be the responsibility of the supervising occupational therapist. Reports written by the holder of a temporary permit issued under IC 25-23.5-5-11(a)(3) for inclusion in the patient's permanent record shall must be countersigned by the supervising occupational therapist, who may enter any remarks, revisions, or additions as the supervising occupational therapist deems appropriate. The supervising occupational therapist shall countersign within seven (7) five (5) calendar days all documentation written by the holder of the temporary permit issued under IC 25-23.5-5-11(a)(3). (b) The supervising occupational therapist shall, within fourteen (14) five (5) calendar days, notify the committee in writing when the supervising relationship with the holder of the temporary permit has changed or been terminated. The notification to the committee shall must indicate the reason for the change or termination in supervision. It shall be the responsibility of Within five (5) calendar days of a change or termination of a supervising relationship, the holder of the temporary permit to shall notify the committee in writing of the name and license number of a new supervisor supervising occupational therapist. Sec. 14. (a) An occupational therapist may not supervise more than three (3) holders of temporary permits issued under IC 25-23.5-5-11(a)(3) at one (1) time. (b) The supervising occupational therapist shall maintain documentation of the supervision of each temporary permit holder. (c) Documentation must include the following: Sec. 1.5. "Occupational therapy aide" means an individual who supports and assists the occupational therapist and occupational therapy assistant by performing specifically delegated tasks. Sec. 2. An occupational therapy aide may contribute to indirect patient services through the provision of by providing the following: An aide, with direct on-site supervision of a licensed occupational therapist or, when appropriate, a licensed occupational therapy assistant, may provide direct patient service. An occupational therapy aide may provide limited direct patient services only when the supervising occupational therapist or occupational therapy assistant is in direct verbal and visual contact with the patient. Before providing the direct patient services, the occupational therapy aide must have documented proof of competence to provide the patient service. Sec. 3. (a) During each two (2) year license period, an occupational therapist or occupational therapy assistant must shall complete at least eighteen (18) hours of continuing competency of which courses, with at least nine (9) hours must be being in category I courses. (b) An occupational therapist or occupational therapy assistant may not earn more than nine (9) category II credit hours towards toward the requirements under this section. (c) All eighteen (18) hours of the continuing competency requirements courses may be obtained through distance learning methods. (d) If an individual's license has been expired for longer than three (3) years and the individual seeks reinstatement, the individual shall complete at least twenty-seven (27) hours of continuing education units (CEUs) within the preceding three (3) years, with at least fourteen (14) hours being in category I courses. The committee may require additional CEUs, remediation, or training under IC 25-1-8-6. Sec. 4. (a) As used in this rule, "category I continuing competency courses" includes the following, and must be at least one (1) contact hour in length: (b) As used in this rule, "category II continuing competency activities" includes the following: