TITLE 18. PROFESSIONAL AND OCCUPATIONAL LICENSING

BOARD OF MEDICINE

Fast-Track Regulation

Title of Regulation: 18VAC85-80. Regulations Governing the Practice of Occupational Therapy (amending 18VAC85-80-10, 18VAC85-80-26, 18VAC85-80-35, 18VAC85-80-65, 18VAC85-80-71 through 18VAC85-80-80, 18VAC85-80-100, 18VAC85-80-140; repealing 18VAC85-80-20, 18VAC85-80-90).

Statutory Authority: §§ 54.1-2400 and 54.1-2956.1 of the Code of Virginia.

Public Hearing Information: No public hearing is currently scheduled.

Public Comment Deadline: April 23, 2025.

Effective Date: May 8, 2025.

Agency Contact: Erin Barrett, Director of Legislative and Regulatory Affairs, Department of Health Professions, Perimeter Center, 9960 Mayland Drive, Suite 300, Henrico, VA 23233, telephone (804) 750-3912, FAX (804) 915-0382, or email erin.barrett@dhp.virginia.gov.

Basis: Regulations of the Board of Medicine are promulgated under the general authority of § 54.1-2400 of the Code of Virginia, which authorizes health regulatory boards to promulgate regulations that are reasonable and necessary to administer the regulatory system. Section 54.1-2956.1 of the Code of Virginia requires the board to license occupational therapists.

Purpose: The amendments reduce the regulatory burden by eliminating provisions redundant of statutory language, eliminating provisions that are no longer needed, and reducing barriers to licensure, which protects the health, safety, and welfare of citizens by ensuring a sufficient workforce of occupational therapists (OTs) and occupational therapy assistants (OTAs). The amendments are intended to eliminate redundant or outdated provisions.

Rationale for Using Fast-Track Rulemaking Process: This rulemaking is considered noncontroversial and appropriate for the fast-track rulemaking process because it reduces requirements for licensees.

Substance: The amendments remove provisions that are redundant to statute and useless directions in regulation, including provisions related to (i) public participation; (ii) outdated fee reductions; (iii) requirements to verify professional practice to obtain a license; (iv) the requirement to attest to any hours of Type 2 continuing education; (v) the board's requirement to periodically conduct random audits; (vi) redundant scope of practice provisions that are identical to language in the Code of Virginia; and (vii) language regarding maintenance of documents and closing of a practice that are related to physicians, not OTs or OTAs.

Issues: The primary advantage to the public is potentially increased numbers of practitioners obtaining a license, thereby increasing the number of practitioners available in the Commonwealth to see patients. There are no disadvantages to the public. There are no primary advantages or disadvantages to the agency or the Commonwealth.

Department of Planning and Budget Economic Impact Analysis:

The Department of Planning and Budget (DPB) has analyzed the economic impact of this proposed regulation in accordance with § 2.2-4007.04 of the Code of Virginia and Executive Order 19. The analysis presented represents DPB's best estimate of the potential economic impacts as of the date of this analysis.¹

Summary of the Proposed Amendments to Regulation. As the result of a periodic review,² the Board of Medicine (board) proposes to (i) remove text from various portions of Regulations for Licensure of Occupational Therapists (18VAC85-80), (ii) reduce required continuing education hours, and (iii) amend the requirements to reactivate or reinstate licensure.

Background. Repealing text: The board relates that each portion of text proposed for removal falls into one of the following categories: (i) a definition not used in the regulation; (ii) a reference to another regulation; (iii) is either obsolete, no longer applicable, repetitive of other regulatory text or duplicative of statute; (iv) imposes a rarely used $10 fee that costs more to administer than the amount of the fee; or (v) requires the board to periodically conduct audits that are no longer conducted in practice.

Continuing education: Under the current regulation, in order to renew an active license biennially, practitioners must complete at least 20 contact hours of continuing learning activities within the two-year period of licensure. At least 10 of the hours must consist of an organized program of study, classroom experience, or similar educational experience that is related to a licensee's current or anticipated roles and responsibilities in occupational therapy and is approved or provided by one of the following organizations or any of its components: Virginia Occupational Therapy Association; American Occupational Therapy Association; National Board for Certification in Occupational Therapy; local, state, or federal government agency; regionally accredited college or university; health care organization accredited by a national accrediting organization granted authority by the Centers for Medicare and Medicaid Services to ensure compliance with Medicare conditions of participation; or an American Medical Association Category 1 Continuing Medical Education program. Up to 10 of the hours may be Type 2 activities, which may include consultation with another therapist, independent reading or research, preparation for a presentation, or other such experiences that promote continued learning. Two of the Type 2 continuing education hours may be satisfied through delivery of occupational therapy services, without compensation, to low-income individuals receiving services through a local health department or a free clinic organized in whole or primarily for the delivery of health services. One hour of continuing education may be credited for three hours of providing such volunteer services as documented by the health department or free clinic. The board proposes to reduce the required number of contact hours of continuing learning activities within the two-year period of licensure from 20 to 10. In doing so, the board would eliminate the Type 2 category. All of the current Type 1 activities would count toward the requirement. As mandated by § 54.1-2400 of the Code of Virginia, delivery of occupational therapy services, without compensation, to low-income individuals receiving services through a local health department or a free clinic would also continue to count toward approved contact hours of continuing learning activities. Consultation with another therapist, independent reading or research, preparation for a presentation would not count toward the reduced 10 hours. The board also proposes to specify that up to two of the continuing education hours may be satisfied through supervision or experiences that promote the education of students. One hour of continuing education may be credited for eight hours of providing such supervision as documented by the educational institution for which supervision is performed. According to the Department of Health Professions (DHP), the board had accepted this as qualifying for Type 2 activity and felt that it would be worthwhile for both practitioners and students.

Reactivation: A licensed occupational therapist or an occupational therapy assistant who holds a current, unrestricted license in Virginia shall be issued an inactive license upon a request on the renewal application and submission of the required fee. The holder of an inactive license is not required to maintain hours of active practice or meet the continued competency requirements, and is not entitled to perform any act requiring a license to practice occupational therapy in Virginia. Under the current regulation, an inactive licensee may reactivate a license upon submission of an application as required by the board; payment of the difference between the current renewal fee for inactive licensure and the renewal fee for active licensure; and documentation of completed continued competency hours equal to the requirement for the number of years, not to exceed four years, in which the license has been inactive. In addition, if the license has been inactive for two to six years documentation must be submitted of having engaged in the active practice of occupational therapy or having completed a board-approved practice of 160 hours within 60 consecutive days under the supervision of a licensed occupational therapist. Alternatively, if the license has been inactive for six years or more and the individual has not engaged in active practice, documentation must be submitted of having completed a board-approved practice of 320 hours to be completed in four consecutive months under the supervision of a licensed occupational therapist. For licenses that have been inactive for two to six years, the board proposes to no longer impose any additional requirements (i.e., documentation of having engaged in the active practice of occupational therapy or having completed a board-approved practice of 160 hours within 60 consecutive days under the supervision of a licensed occupational therapist). For licenses that have been inactive for six years or more, instead of requiring supervised practice or evidence of having engaged in active practice, the board proposes to require the occupational therapist or occupational therapy assistant provide evidence of current certification by the National Board for Certification in Occupational Therapy (NBCOT) or retake and pass the NBCOT examination. Additionally, the board proposes to amend the required submission of documentation of completed continued competency hours equal to the requirement for the number of years, not to exceed four years, in which the license has been inactive. Now, the documentation of completed continued competency hours equal to the requirement for the number of years, not to exceed six years, in which the license has been inactive.

Reinstatement: To be reinstated, an occupational therapist or occupational therapy assistant who allows a license to lapse for a period of two years or more and then chooses to resume practice must submit to the board a reinstatement application, information on any practice and licensure or certification in other jurisdictions during the period in which the license was lapsed, and the fee for reinstatement of his licensure. Under the current regulation, an occupational therapist or occupational therapy assistant who has allowed a license to lapse for two years but less than six years, and who has not engaged in active practice, must serve a board-approved practice of 160 hours to be completed in two consecutive months under the supervision of a licensed occupational therapist. An occupational therapist or occupational therapy assistant who has allowed a license to lapse for six years or more, and who has not engaged in active practice, must serve a board-approved practice of 320 hours to be completed in four consecutive months under the supervision of a licensed occupational therapist in order to have a license reinstated. Completion of continued competency hours equal to the requirement for the number of years, not to exceed four years, in which the license has been inactive must also be accomplished. Regardless of the number of years that the license has been lapsed, instead of requiring supervised practice or evidence of having engaged in active practice, the board proposes to require the occupational therapist or occupational therapy assistant provide evidence of current certification by NBCOT or retake and pass the NBCOT examination. Analogous to the proposed amendment to the cap on required continued competency hours for reactivation, the board proposes to raise the cap on the number of required hours of continued competency for reinstatement from the required amount for four years to the required amount for six years.

Estimated Benefits and Costs: Repealing text: According to DHP, the $10 fee for an individual licensed out-of-state to register for voluntary practice itself costs more administratively to collect than $10. Thus, eliminating the fee would be beneficial in that it would both reduce cost for occupational therapists and occupational therapy assistants licensed out-of-state seeking to volunteer in Virginia, and net costs for the board. Currently, the board periodically conducts a random audit of its active licensees to determine compliance. The practitioners selected for the audit must provide all supporting documentation within 30 days of receiving notification of the audit. According to DHP, the board has only performed one or two of these audits in the last two decades, and only on two sets of its 18 types of licensees. DHP adds that the board does not have staff or the ability to conduct such audits and has not for years. Thus, the proposed repeal conforms the regulation to practice. Removing definitions that are not used in the regulation and text that either refers to another regulation or is obsolete, no longer applicable, is repetitive of other regulatory text, or is duplicative of statute would have no impact on requirements for regulated entities or the public.

Continuing education: According to DHP, the board believes that the reporting requirement for Type 2 continuing learning activity hours is unnecessarily burdensome and that most practitioners would complete activities that are included as Type 2 regardless of the requirement. Thus, eliminating the requirement for Type 2 hours would be beneficial in that it would eliminate the burden of reporting such activities. The proposed elimination of the Type 2 activity requirement is not likely to have a substantive impact on activities in practice.

Reactivation: For practitioners with licenses that have been inactive for two to six years and have not engaged in the active practice of occupational therapy (perhaps in another state) and who do not plan to work under the supervision of another practitioner, the proposal to no longer require documentation of having engaged in the active practice of occupational therapy or having completed a board-approved practice of 160 hours within 60 consecutive days under the supervision of a licensed occupational therapist would be beneficial. Eliminating the requirement would allow such practitioners to work in their preferred circumstance right away rather than find someone else to supervise them over a 60-day period. For practitioners with licenses that have been inactive for five or six years, the proposal to amend the required submission of documentation of completed continued competency hours equal to the requirement for the number of years, not to exceed four years, in which the license has been inactive. Now the requirement that documentation of completed continued competency hours equal to the requirement for the number of years, not to exceed six years, in which the license has been inactive increases the amount of continued competency hours that they must complete to reactivate their licenses. Under the proposed regulation, five hours of continuing learning activities are required per annum. Thus, the proposed increase in the cap would result in five additional hours of required continuing learning activities for those practitioners with licenses that have been inactive for five years, and 10 additional hours of required continuing learning activities for those practitioners with licenses that have been inactive for six years. Their costs in time and fees would increase commensurately. For practitioners with licenses that have been inactive for six years or more and have not engaged in the active practice of occupational therapy and who do not plan to work under the supervision of another licensed occupational therapist, the proposal to replace the requirement to work under the supervision of another practitioner with evidence of current certification by NBCOT or to retake and pass the national examination may be beneficial. According to DHP, most occupational therapists and occupational therapy assistants maintain NBCOT certification. Thus, this proposed change would benefit practitioners with licenses that have been inactive for six years or more and have not engaged in the active practice of occupational therapy and who do not plan to work under the supervision of another practitioner, but have maintained NBCOT certification, by permitting work in their preferred circumstance right away rather than find someone else to be supervised by over four months. Practitioners with licenses that have been inactive for six years or more, have not engaged in the active practice of occupational therapy, and do not have NBCOT certification but do intend to work under the supervision of another licensed occupational therapist, would be worse off under this proposal since they would meet the existing working under supervision requirement, but would not meet the NBCOT requirement.

Reinstatement: For practitioners with a lapsed license who have not engaged in active practice and who do not plan to work under the supervision of another practitioner, the proposal to replace the requirement to work under the supervision of another practitioner with evidence of current certification by NBCOT or to retake and pass the national examination may be beneficial. Practitioners with a lapsed license who have not engaged in active practice and do not have NBCOT certification but do intend to work under the supervision of another licensed occupational therapist would be worse off under this proposal. Analogous with reactivation, for practitioners with licenses that have been inactive for five or six years, the proposed increase of the cap on required amount of continued competency hours increases the amount of continued competency hours that they must complete to reinstate their licenses. Thus, their costs in time and fees would increase commensurately.

Businesses and Other Entities Affected. The proposed amendments affect the 5,019 occupational therapists and 1,785 occupational therapy assistants licensed in the Commonwealth,³ and their patients and employers. According to survey data from the most recently published Virginia Healthcare Workforce Data Center report on occupational therapists,⁴ the primary type of employers of occupational therapists in the Commonwealth are distributed as follows:

Establishment Type	Percentage
General Hospital, Inpatient Department	15%
Skilled Nursing Facility	14%
K-12 School System	13%
Home Health Care	13%
Rehabilitation Facility, Outpatient Clinic	9%
Private Practice, Group	7%
Rehabilitation Facility, Residential/Inpatient	7%
General Hospital, Outpatient Department	5%
Assisted Living or Continuing Care Facility	4%
Academic Institution	3%
Private Practice, Solo	3%
Mental Health, Inpatient	1%
Other	7%

The Code of Virginia requires DPB to assess whether an adverse impact may result from the proposed regulation.⁵ An adverse impact is indicated if there is any increase in net cost or reduction in net revenue for any entity, even if the benefits exceed the costs for all entities combined. Costs would increase for practitioners who wish to reactivate or reinstate a license if a license has been inactive or lapsed for five or six years. Thus, an adverse impact is indicated.

Small Businesses⁶ Affected.⁷ The proposed amendments do not appear to substantively adversely affect small businesses.

Localities⁸ Affected.⁹ The proposed amendments do not appear to disproportionally affect any particular localities, nor introduce costs for local governments.

Projected Impact on Employment. The proposed amendments are not likely to have a substantive impact on total employment.

Effects on the Use and Value of Private Property. Depending on the circumstances, practitioners seeking to reactivate or reinstate their license may encounter either increases or decreases in cost under the proposed regulation. In net, it is unlikely that the proposed changes would have a substantial impact on hiring costs for firms. Thus, for non-solo practices, there would not likely be a substantive impact on the use and value of private property. The proposed replacement of NBCOT certification for working under supervision as a requirement for reactivation or reinstatement could allow practitioners who prefer to work solo to start doing so sooner. The proposed amendments do not affect real estate development costs.

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¹ Section 2.2-4007.04 of the Code of Virginia requires that such economic impact analyses determine the public benefits and costs of the proposed amendments. Further the analysis should include but not be limited to: (1) the projected number of businesses or other entities to whom the proposed regulatory action would apply, (2) the identity of any localities and types of businesses or other entities particularly affected, (3) the projected number of persons and employment positions to be affected, (4) the projected costs to affected businesses or entities to implement or comply with the regulation, and (5) the impact on the use and value of private property.

² See https://townhall.virginia.gov/l/ViewPReview.cfm?PRid=2148.

³ Source: https://www.dhp.virginia.gov/about/stats/2023Q3/04CurrentLicenseCountQ3FY2023.pdf.

⁴ See https://www.dhp.virginia.gov/media/dhpweb/docs/hwdc/medicine/0119OT2020.pdf.

⁵ Pursuant to § 2.2-4007.04 D: In the event this economic impact analysis reveals that the proposed regulation would have an adverse economic impact on businesses or would impose a significant adverse economic impact on a locality, business, or entity particularly affected, the Department of Planning and Budget shall advise the Joint Commission on Administrative Rules, the House Committee on Appropriations, and the Senate Committee on Finance. Statute does not define "adverse impact," state whether only Virginia entities should be considered, nor indicate whether an adverse impact results from regulatory requirements mandated by legislation.

⁶ Pursuant to § 2.2-4007.04, small business is defined as "a business entity, including its affiliates, that (i) is independently owned and operated and (ii) employs fewer than 500 full-time employees or has gross annual sales of less than $6 million."

⁷ If the proposed regulatory action may have an adverse effect on small businesses, § 2.2-4007.04 requires that such economic impact analyses include: (1) an identification and estimate of the number of small businesses subject to the proposed regulation, (2) the projected reporting, recordkeeping, and other administrative costs required for small businesses to comply with the proposed regulation, including the type of professional skills necessary for preparing required reports and other documents, (3) a statement of the probable effect of the proposed regulation on affected small businesses, and (4) a description of any less intrusive or less costly alternative methods of achieving the purpose of the proposed regulation. Additionally, pursuant to § 2.2-4007.1 of the Code of Virginia, if there is a finding that a proposed regulation may have an adverse impact on small business, the Joint Commission on Administrative Rules shall be notified.

⁸ "Locality" can refer to either local governments or the locations in the Commonwealth where the activities relevant to the regulatory change are most likely to occur.

⁹ Section 2.2-4007.04 defines "particularly affected" as bearing disproportionate material impact.

Agency Response to Economic Impact Analysis: The Board of Medicine concurs with the economic impact analysis prepared by the Department of Planning and Budget.

Summary:

The amendments remove provisions that are redundant to statute and useless directions in regulation, including provisions related to (i) public participation; (ii) outdated fee reductions; (iii) requirements to verify professional practice to obtain a license; (iv) the requirement to attest to any hours of Type 2 continuing education; (v) the requirement that the Board of Medicine periodically conduct random audits; (vi) scope of practice provisions that are identical to language in the Code of Virginia; and (vii) language related to maintenance of documents and closing of a practice that is related to physicians, not occupational therapists or occupational therapy assistants.

18VAC85-80-10. Definitions.

A. The following words and terms when used in this chapter shall have the meanings ascribed to them in § 54.1-2900 of the Code of Virginia:

"Board"

"Occupational therapy assistant"

"Practice of occupational therapy"

B. The following words and terms when used in this chapter shall have the following meanings, unless the context clearly indicates otherwise:

"ACOTE" means the Accreditation Council for Occupational Therapy Education.

"Active practice" means a minimum of 160 hours of professional practice as an occupational therapist or an occupational therapy assistant within the 24-month period immediately preceding renewal or application for licensure, if previously licensed or certified in another jurisdiction. The active practice of occupational therapy may include supervisory, administrative, educational, or consultative activities or responsibilities for the delivery of such services.

"Advisory board" means the Advisory Board of Occupational Therapy.

"Compact" means the Occupational Therapy Interjurisdictional Licensure Compact.

"Compact privilege" means the same as the definition of the term in § 54.1-2956.7:1 of the Code of Virginia.

"Contact hour" means 60 minutes of time spent in continued learning activity.

"NBCOT" means the National Board for Certification in Occupational Therapy, under which the national examination for certification is developed and implemented.

"National examination" means the examination prescribed by NBCOT for certification as an occupational therapist or an occupational therapy assistant and approved for licensure in Virginia.

"Occupational therapy personnel" means appropriately trained individuals who provide occupational therapy services under the supervision of a licensed occupational therapist.

"Practitioner" means an occupational therapist or occupational therapy assistant licensed in Virginia or an occupational therapist or occupational therapy assistant practicing in Virginia with a compact privilege.

18VAC85-80-20. Public participation. (Repealed.)

A separate regulation, 18VAC85-11, Public Participation Guidelines, provides for involvement of the public in the development of all regulations of the Virginia Board of Medicine.

18VAC85-80-26. Fees.

A. The following fees have been established by the board:

1. The initial fee for the occupational therapist license shall be $130; for the occupational therapy assistant, it shall be $70.

2. The fee for reinstatement of the occupational therapist license that has been lapsed for two years or more shall be $180; for the occupational therapy assistant, it shall be $90.

3. The fee for active license renewal for an occupational therapist shall be $135; for an occupational therapy assistant, it shall be $70. The fees for inactive license renewal shall be $70 for an occupational therapist and $35 for an occupational therapy assistant. Renewals shall be due in the birth month of the licensee in each even-numbered year. For 2020, the fee for renewal of an active license as an occupational therapist shall be $108; for an occupational therapy assistant, it shall be $54. For renewal of an inactive license in 2020, the fees shall be $54 for an occupational therapist and $28 for an occupational therapy assistant.

4. The additional fee for processing a late renewal application within one renewal cycle shall be $50 for an occupational therapist and $30 for an occupational therapy assistant.

5. The fee for a letter of good standing or verification to another jurisdiction for a license shall be $10.

6. The fee for reinstatement of licensure pursuant to § 54.1-2408.2 of the Code of Virginia shall be $2,000.

7. The handling fee for a returned check or a dishonored credit card or debit card shall be $50.

8. The fee for a duplicate license shall be $5.00, and the fee for a duplicate wall certificate shall be $15.

9. The fee for an application or for the biennial renewal of a restricted volunteer license shall be $35, due in the licensee's birth month. An additional fee for late renewal of licensure shall be $15 for each renewal cycle.

10. The fee for issuance of a compact privilege or the biennial renewal of such privilege shall be $75 for an occupational therapist and $40 for an occupational therapy assistant.

B. Unless otherwise provided, fees established by the board shall not be refundable.

18VAC85-80-35. Application requirements.

An applicant for licensure shall submit the following on forms provided by the board:

1. A completed application and a fee as prescribed in 18VAC85-80-26.

2. Verification of professional education in occupational therapy as required in 18VAC85-80-40.

3. Verification of practice as required in 18VAC85-80-60 and as specified on the application form.

4. Documentation of passage of the national examination as required in 18VAC85-80-50.

5. 4. If licensed or certified in any other jurisdiction, verification that there has been no disciplinary action taken or pending in that jurisdiction.

18VAC85-80-65. Registration for voluntary practice by out-of-state licensees.

Any occupational therapist or an occupational therapy assistant who does not hold a license to practice in Virginia and who seeks registration to practice under subdivision 27 of § 54.1-2901 of the Code of Virginia on a voluntary basis under the auspices of a publicly supported, all volunteer, nonprofit organization that sponsors the provision of health care to populations of underserved people shall:

1. File a complete application for registration on a form provided by the board at least five business days prior to engaging in such practice. An incomplete application will not be considered;

2. Provide a complete record of professional licensure in each state in which he the applicant has held a license and a copy of any current license;

3. Provide the name of the nonprofit organization, and the dates and location of the voluntary provision of services; and

4. Pay a registration fee of $10; and 5. Provide a notarized statement from a representative of the nonprofit organization attesting to its the nonprofit organization's compliance with provisions of subdivision 27 of § 54.1-2901 of the Code of Virginia.

18VAC85-80-71. Continued competency requirements for renewal of an active license.

A. In order to renew an active license biennially, a licensee shall complete at least 20 10 contact hours of continuing learning activities as follows: 1. A minimum of 10 of the 20 hours shall be in Type 1 activities, which shall consist of an organized program of study, classroom experience, or similar educational experience that is related to a licensee's current or anticipated roles and responsibilities in occupational therapy and approved or provided by one of the following organizations or any of its components:

a. 1. Virginia Occupational Therapy Association;

b. 2. American Occupational Therapy Association;

c. 3. National Board for Certification in Occupational Therapy;

d. 4. Local, state, or federal government agency;

e. 5. Regionally accredited college or university;

f. 6. Health care organization accredited by a national accrediting organization granted authority by the Centers for Medicare and Medicaid Services to ensure compliance with Medicare conditions of participation; or

g. 7. An American Medical Association Category 1 Continuing Medical Education program.

2. No more than 10 of the 20 hours may be Type 2 activities, which may include consultation with another therapist, independent reading or research, preparation for a presentation, or other such experiences that promote continued learning. B. Up to two of the Type 2 continuing education hours may be satisfied through delivery of occupational therapy services, without compensation, to low-income individuals receiving services through a local health department or a free clinic organized in whole or primarily for the delivery of health services. One hour of continuing education may be credited for three hours of providing such volunteer services as documented by the health department or free clinic.

B. C. Up to two of the continuing education hours may be satisfied through supervision or experiences that promote the education of students. One hour of continuing education may be credited for eight hours of providing such supervision as documented by the educational institution for which supervision is performed.

D. A licensee shall be exempt from the continuing competency requirements for the first biennial renewal following the date of initial licensure in Virginia.

C. E. The licensee shall retain in the licensee's records all supporting documentation for a period of six years following the renewal of an active license.

D. The board shall periodically conduct a representative random audit of its active licensees to determine compliance. The licensees selected for the audit shall provide all supporting documentation within 30 days of receiving notification of the audit.

E. F. Failure to comply with these requirements may subject the licensee to disciplinary action by the board.

F. G. The board may grant an extension of the deadline for continuing competency requirements for up to one year for good cause shown upon a written request from the licensee prior to the renewal date.

G. H. The board may grant an exemption for all or part of the requirements for circumstances beyond the control of the licensee, such as temporary disability, mandatory military service, or officially declared disasters.

18VAC85-80-72. Inactive licensure.

A. A licensed occupational therapist or an occupational therapy assistant who holds a current, unrestricted license in Virginia shall, upon a request on the renewal application and submission of the required fee, be issued an inactive license. The holder of an inactive license shall not be required to maintain hours of active practice or meet the continued competency requirements of 18VAC85-80-71 and shall not be entitled to perform any act requiring a license to practice occupational therapy in Virginia.

B. An inactive licensee may reactivate his license upon submission of the following:

1. An application as required by the board;

2. A payment of the difference between the current renewal fee for inactive licensure and the renewal fee for active licensure;

3. If the license has been inactive for two to six years, documentation of having engaged in the active practice of occupational therapy or having completed a board-approved practice of 160 hours within 60 consecutive days under the supervision of a licensed occupational therapist; and

4. 3. Documentation of completed continued competency hours equal to the requirement for the number of years, not to exceed four six years, in which the license has been inactive.

C. An occupational therapist or occupational therapy assistant who has had an inactive license for six years or more and who has not engaged in active practice, as defined in 18VAC85-80-10, shall serve a board-approved practice of 320 hours to be completed in four consecutive months under the supervision of a licensed occupational therapist provide evidence of current certification by NBCOT or retake and pass the national examination.

D. The board reserves the right to deny a request for reactivation to any licensee who has been determined to have committed an act in violation of § 54.1-2915 of the Code of Virginia or any provisions of this chapter.

18VAC85-80-73. Restricted volunteer license.

A. An occupational therapist or an occupational therapy assistant who held an unrestricted license issued by the Virginia Board of Medicine or by a board in another state as a licensee in good standing at the time the license expired or became inactive may be issued a restricted volunteer license to practice without compensation in a clinic that is organized in whole or in part for the delivery of health care services without charge in accordance with § 54.1-106 of the Code of Virginia.

B. To be issued a restricted volunteer license, an occupational therapist or occupational therapy assistant shall submit an application to the board that documents compliance with requirements of § 54.1-2928.1 of the Code of Virginia and the application fee prescribed in 18VAC85-80-26.

C. The licensee who intends to continue practicing with a restricted volunteer license shall renew biennially during his birth month, meet the continued competency requirements prescribed in subsection D of this section, and pay to the board the renewal fee prescribed in 18VAC85-80-26.

D. The holder of a restricted volunteer license shall not be required to attest to hours of continuing education for the first renewal of such a license. For each renewal thereafter, the licensee shall attest to obtaining 10 five hours of continuing education during the biennial renewal period with at least five hours of Type 1 and no more than five hours of Type 2 as specified in 18VAC85-80-71.

18VAC85-80-80. Reinstatement.

A. An occupational therapist or an occupational therapy assistant who allows his a license to lapse for a period of two years or more and chooses to resume his practice shall submit a reinstatement application to the board and information on any practice and licensure or certification in other jurisdictions during the period in which the license was lapsed, and shall pay the fee for reinstatement of his licensure as prescribed in 18VAC85-80-26.

B. An occupational therapist or occupational therapy assistant who has allowed his a license to lapse for two years but less than six years, and who has not engaged in active practice as defined in 18VAC85-80-10, shall serve a board-approved practice of 160 hours to be completed in two consecutive months under the supervision of a licensed occupational therapist or more shall provide evidence of current certification by NBCOT or retake and pass the national examination.

C. An occupational therapist or an occupational therapy assistant who has allowed his license to lapse for six years or more, and who has not engaged in active practice, shall serve a board-approved practice of 320 hours to be completed in four consecutive months under the supervision of a licensed occupational therapist.

D. C. An applicant for reinstatement shall meet the continuing competency requirements of 18VAC85-80-71 for the number of years the license has been lapsed, not to exceed four six years.

E. D. An occupational therapist or an occupational therapy assistant whose license has been revoked by the board and who wishes to be reinstated shall make a new application to the board and payment of the fee for reinstatement of his the license as prescribed in 18VAC85-80-26 pursuant to § 54.1-2408.2 of the Code of Virginia.

18VAC85-80-90. General responsibilities. (Repealed.)

A. An occupational therapist renders services of assessment, program planning, and therapeutic treatment upon request for such service. The practice of occupational therapy includes therapeutic use of occupations for habilitation and rehabilitation to enhance physical health, mental health, and cognitive functioning. The practice of occupational therapy may include supervisory, administrative, educational or consultative activities or responsibilities for the delivery of such services.

B. An occupational therapy assistant renders services under the supervision of an occupational therapist that do not require the clinical decision or specific knowledge, skills and judgment of a licensed occupational therapist and do not include the discretionary aspects of the initial assessment, evaluation or development of a treatment plan for a patient.

18VAC85-80-100. Individual responsibilities Responsibilities.

A. An occupational therapist provides assessment by determining the need for, the appropriate areas of, and the estimated extent and time of treatment. His The occupational therapist's responsibilities include an initial screening of the patient to determine need for services and the collection, evaluation, and interpretation of data necessary for treatment.

B. An occupational therapist provides program planning by identifying treatment goals and the methods necessary to achieve those goals for the patient. The therapist analyzes the tasks and activities of the program, documents the progress, and coordinates the plan with other health, community, or educational services, the family, and the patient. The services may include but are not limited to education and training in basic and instrumental activities of daily living (ADL); the design, fabrication, and application of orthoses (splints); the design, selection, and use of adaptive equipment and assistive technologies; therapeutic activities to enhance functional performance; vocational evaluation and training; and consultation concerning the adaptation of physical, sensory, and social environments.

C. An occupational therapist provides the specific activities or therapeutic methods to improve or restore optimum functioning, to compensate for dysfunction, or to minimize disability of patients impaired by physical illness or injury, emotional, congenital or developmental disorders, or by the aging process.

D. An occupational therapy assistant is responsible for the safe and effective delivery of those services or tasks delegated by and under the direction of the occupational therapist. Individual responsibilities of an occupational therapy assistant may include:

1. Participation in the evaluation or assessment of a patient by gathering data, administering tests, and reporting observations and client capacities to the occupational therapist;

2. Participation in intervention planning, implementation, and review;

3. Implementation of interventions as determined and assigned by the occupational therapist;

4. Documentation of patient responses to interventions and consultation with the occupational therapist about patient functionality;

5. Assistance in the formulation of the discharge summary and follow-up plans; and

6. Implementation of outcome measurements and provision of needed patient discharge resources.

E. The practice of occupational therapy may include supervisory, administrative, educational, or consultative activities or responsibilities for the delivery of such services.

18VAC85-80-140. Patient records.

A. Practitioners shall comply with the provisions of § 32.1-127.1:03 of the Code of Virginia related to the confidentiality and disclosure of patient records.

B. Practitioners shall provide patient records to another practitioner or to the patient or his the patient's personal representative in a timely manner and in accordance with provisions of § 32.1-127.1:03 of the Code of Virginia.

C. Practitioners shall properly manage and keep timely, accurate, legible, and complete patient records.

D. Practitioners who are employed by a health care institution, school system, or other entity in which the individual practitioner does not own or maintain his the practitioner's own records shall maintain patient records in accordance with the policies and procedures of the employing entity.

E. Practitioners who are self-employed or employed by an entity in which the individual practitioner does own and is responsible for patient records shall: 1. Maintain maintain a patient record for a minimum of six years following the last patient encounter with the following exceptions:

a. 1. Records of a minor child, including immunizations, shall be maintained until the child reaches the age of 18 years of age or becomes emancipated, with a minimum time for record retention of six years from the last patient encounter regardless of the age of the child;

b. 2. Records that have previously been transferred to another practitioner or health care provider or provided to the patient or his the patient's personal representative; or

c. 3. Records that are required by contractual obligation or federal law may need to be maintained for a longer period of time.

2. From October 19, 2005, post information or in some manner inform all patients concerning the time frame for record retention and destruction. Patient records shall only be destroyed in a manner that protects patient confidentiality, such as by incineration or shredding.

F. When a practitioner is closing, selling or relocating his practice, he shall meet the requirements of § 54.1-2405 of the Code of Virginia for giving notice that copies of records can be sent to any like-regulated provider of the patient's choice or provided to the patient.