STATE BOARD OF OCCUPATIONAL
THERAPY EDUCATION AND LICENSURE[49 PA. CODE CH. 42] Oral Orders [30 Pa.B. 2599] The State Board of Occupational Therapy Education and Licensure (Board) adopts § 42.25 (relating to oral orders) to read as set forth in Annex A.
A. Effective Date
The amendment takes effect upon publication in the Pennsylvania Bulletin.
B. Statutory Authority
The Board has authority to adopt regulations not inconsistent with the Occupational Therapy Practice Act (act) (63 P.S. §§ 1501--1519) as it deems necessary for the performance of its duties and the proper administration of the law under section 5(b) of the act (63 P. S. § 1505(b)).
C. Purpose
Section 14 of the act (63 P. S. § 1514) specifies that implementation of direct occupational therapy to an individual for a specific medical condition must be based on a referral from a licensed physician or a licensed podiatrist. The Board has long construed this to include services ordered orally by a licensed physician or licensed podiatrist. The purpose of this rulemaking is to codify the Board's interpretation of the act and outline the conditions under which an occupational therapist may implement therapy based on an oral order.
Under the regulation an occupational therapist receives written orders to implement therapy under ordinary circumstances but may accept an oral order if the urgency of the medical circumstances requires treatment to begin immediately. The occupational therapist will be required to immediately transcribe an oral order and obtain the countersignature of the prescriber within a specified period of time, either 5 days in a private setting, or in accordance with regulations of the Department of Health (Department) in a facility licensed by the Department. A detailed explanation of the purpose and background of the rulemaking may be found in the proposed rulemaking at 29 Pa.B. 3070 (June 18, 1999).
D. Compliance with Executive Order 1996-1
In accordance with Executive Order 1996-1 (February 6, 1996), in drafting and promulgating the amendment, the Board solicited input and suggestions from the regulated community by providing drafts to organizations and entities which represent the profession, educational institutions and interested individuals.
E. Summary of Comments and Responses to Proposed Rulemaking
The proposal was published at 29 Pa.B. 3070. The Board received two public comments and comments from the Independent Regulatory Review Commission (IRRC). The following is the Board's response to those comments:
The Pennsylvania Occupational Therapy Association (POTA) expressed unequivocal support for the proposed rulemaking. The POTA pointed out that under current law and regulations an occupational therapist was not prohibited from receiving an oral order in any setting except a hospital. The POTA expressed the opinion that many occupational therapists wrongly believed that they were unable to implement therapy based on an oral order in any setting. The POTA stated that when an occupational therapist is unable to receive an oral order, another professional, untrained in occuptional therapy, must serve as an intermediary between the prescriber and the occupational therapist, causing delay in treatment.
The Pennsylvania Medical Society (PMS) and IRRC addressed the requirement in § 42.25(b) that the prescriber countersign the orally delivered order within 5 days. The PMS pointed out that in private settings the site of occupational therapy might be independent of the prescriber's office and the prescriber would not typically visit the facility of the occupational therapist to countersign the order. The PMS and IRRC suggested that the regulation permit the use of a faxed or mailed copy of the order to be sent after the order is given orally. The Board has adopted this suggestion and has revised § 42.25(b) accordingly.
IRRC noted that the proposed amendment did not state what the occupational therapist should do if a timely countersignature from the physician or podiatrist was not obtained and expressed the view that the regulation should state what the occupational therapist should then do. The Board declined to adopt this suggestion. The Board notes that the regulations of the Department pertaining to oral and telephone orders in long-term nursing care facilities require the physician to countersign orders which were delivered orally, but do not specify what the health care professional is to do if the physician does not timely countersign. See 28 Pa. Code § 211.3(b) (relating to oral and telephone orders). Similarly, the licensed health care professional in a home health care agency who receives an oral order for medication and treatment is required to obtain the physician's countersignature on the order which was delivered orally, but is not required to follow a procedure specified by regulation if the physician does not timely countersign. See 28 Pa. Code § 601.31(d) (relating to acceptance of patients, plan of treatment and medical supervision). The Board does not believe that obtaining the signature of the physician or podiatrist is likely to be a problem and, if the signature is not timely obtained, the course of action should be left to the professional judgment of the therapist based on the facts of the situation, as well as the policies of the institution or setting in which the service is rendered.
IRRC also requested that the rulemaking refer to the specific regulations of the Department for time limits for obtaining a prescriber's countersignature in a long-term nursing care facility and in a home health care agency. The Board has added these references in § 42.25(c).
Additionally, the Board has made minor revisions to the final-form rulemaking to eliminate redundant phrases.
F. Fiscal Impact and Paperwork Requirements
Commonwealth--There will be no adverse fiscal impact or paperwork requirements imposed.
Political subdivisions--There will be no adverse fiscal impact or paperwork requirements imposed.
Private sector--There is no adverse fiscal impact associated with this amendment. The regulation's requirement that an oral order must be immediately transcribed in the patient's medical record and countersigned by the ordering physician or podiatrist places a minimal burden, in terms of paperwork requirements, on the licensee and the ordering physician or podiatrist. Because careful and detailed recordkeeping is an essential aspect of all health care practice and because the Department regulations already require oral orders to be countersigned within a specific period of time, licensees and ordering physicians or podiatrists would keep the records even in the absence of the specific regulation imposing the requirement.
G. Sunset Date
The Board continuously monitors its regulations. Therefore, no sunset date has been assigned.
H. Regulatory Review
Under section 5(a) of the Regulatory Review Act (71 P. S. § 745.5(a)), the Board submitted a copy of the notice of proposed rulemaking, published at 29 Pa.B. 3070, to IRRC and to the Chairpersons of the House Professional Licensure Committee and the Senate Consumer Protection and Professional Licensure Committee for review and comment.
In compliance with section 5(c) of the Regulatory Review Act, the Board also provided IRRC and the Committees with copies of the comments received as well as other documentation. In preparing this final-form regulation, the Board has considered the comments received from IRRC and the public.
Under section 5.1(d) of the Regulatory Review Act (71 P. S. § 745.5a(d)), this final-form regulation was deemed approved by the House and Senate Committee on April 18, 2000. IRRC met on May 11, 2000, and approved the amendment in accordance with section 5.1(e) of the Regulatory Review Act.
I. Contact Person
Further information may be obtained by contacting Clara Flinchum, Administrative Assistant, State Board of Occupational Therapy Education and Licensure, P. O. Box 2649, Harrisburg, PA 17105-2649, (717) 783-1389.
J. Findings
The Board finds that:
(1) Public notice of proposed rulemaking was given under sections 201 and 202 of the act of July 31, 1968 (P. L. 769, No. 240) (45 P. S. §§ 1201 and 1202) and the regulations promulgated thereunder at 1 Pa. Code §§ 7.1 and 7.2.
(2) A public comment period was provided as required by law and all comments were considered.
(3) This final-form rulemaking does not enlarge the purpose of the proposed rulemaking published at 29 Pa.B. 3070.
(4) This final-form rulemaking is necessary and appropriate for administration and enforcement of the authorizing act identified in Part B of this Preamble.
K. Order
The Board, acting under its authorizing statute, orders that:
(a) The regulations of the Board, 49 Pa. Code Chapter 42, are amended by adding § 42.25 to read as set forth in Annex A.
(b) The Board shall submit this order and Annex A to the Office of General Counsel and to the Office of Attorney General as required by law.
(c) The Board shall certify this order and Annex A and deposit them with the Legislative Reference Bureau as required by law.
(d) This order shall take effect on publication in the Pennsylvania Bulletin.
HANNA GRUEN,
Chairperson(Editor's Note: For the text of the order of the Independent Regulatory Review Commission relating to this document, see 30 Pa.B. 2688 (May 27, 2000).)
Fiscal Note: Fiscal Note 16A-673 remains valid for the final adoption of the subject regulation.
Annex A TITLE 49. PROFESSIONAL AND
VOCATIONAL STANDARDSPART I. DEPARTMENT OF STATE Subpart A. PROFESSIONAL AND
OCCUPATIONAL AFFAIRSCHAPTER 42. STATE BOARD OF
OCCUPATIONAL THERAPY EDUCATION AND LICENSUREMINIMUM STANDARDS OF PRACTICE § 42.25. Oral orders.
(a) An occupational therapist shall accept a referral in the form of a written order from a licensed physician or licensed podiatrist in accordance with section 14 of the act (63 P. S. § 1514) unless the urgency of the medical circumstances requires immediate treatment. In these circumstances, an occupational therapist may accept an oral order for occupational therapy from a licensed physician or licensed podiatrist, if the oral order is immediately transcribed, including the date and time, in the patient's medical record and signed by the occupational therapist taking the order.
(b) The countersignature of the licensed physician or licensed podiatrist shall be obtained within 5 days of receipt of the oral order in the case of an occupational therapist providing ordered services in a private office setting. In the case of an occupational therapist providing services in a setting that is independent of the prescribing physician's or podiatrist's office, the countersignature on a written copy of the order may be mailed or faxed to the occupational therapist.
(c) In the case of an occupational therapist providing services in a facility licensed by the Department of Health, the countersignature of the licensed physician or licensed podiatrist shall be obtained in accordance with applicable regulations of the Department of Health governing the facility, including 28 Pa. Code §§ 211.3 and601.31 (relating to oral and telephone orders; and acceptance of patients, plan of treatment and medical supervision).
[Pa.B. Doc. No. 00-888. Filed for public inspection May 26, 2000, 9:00 a.m.]
