State licensure for occupational therapists.

Thzs is the first in a serzes of artzcles addressing critical issues facing the profession. Those issues are presented to inform members of their complexity and to provide members with specific actions they can take to support the continued strengthemng of the role of occupational therapy in health and educatzon. Thzs article was prepared by Jane D. Davy, OTR, and Mary Peters, M.S., OTR, Government and Legal Affazrs Dzvzsion, The American Occupational Therapy Association, Inc. The Issues The issues surrounding state licensure can be categorized as internal and external. AO A recognized the internal issues in the mid-70s when the Representative Assembly voted to develop a national strategy for the adoption of licensure. The issues that prompted this vote were: the increasing number of unqualified persons calling themselves occupational therapists, persons attempting to provide occupational therapy services, and the lack of a legal definition of occupational therapy. The lack of a practice definition and standards for qualified providers in state laIN has generated different standards for occupational therapy within a state as well as unresolved problems in what constitutes a reimburseable occu pa tional therapy service. Although some federal regulations such as Medicare define the qualified occupational therapist, these standards vary from setting to settilJ~ and have been lower than those of the AOTA, As our profession and reimbursement for our services grow, these problems compound and they are as much the problems of the '80s as they were the '70s. Conversely, the major external issue surrounding state licensure has just emerged. ince 1981 there has been an effort to return decision-making power to the states including the administration of health and education programs. This can only mean tha t the decisions rela ti ve to who is qualified to provide a service will increasingly rest with the state legislatures and agencies, Since our licensure efforts began, 14 states and the District of Columbia have occupational therapy practice acts. During this time new internal issues relative to the wording of licensure bills have surfaced. These issues incl ude physician referral, career mobility, and specific wording of the occupational therapy definition. Four out of 15 jurisdictions licensing occupational therapists have some type of physician referral language. In most cases these laws included physician referral to ensure the support of the state medical board and the medical community. Some state associatiolls have wrestled with the question of including career mobility [IJ the bill. Currently, four states with licensure laws have no career mobility provision, and, although Connecticut has a provision, it requires a baccalaureate degree (not necessarily in occupational therapy) to obtain a therapist level license. The wording of a licensure deflllltion is crucial. The definitioll must attempt to cover the scope of practice in general terms, but must include specific terms inherently belonging to occupational therapy. The Representative Assembly adopted a second licensure definition guide for states to use in 1981. This new definition was written by a task force of occupational therapists currently serving on occupational therapy licensure boards. Changes were made in the guideline definition to include words commonly associated with occupational therapy. The major additions to the definitioll were: "sensory integrative functioning. . exerClses ... administering and interpreting tests such as manual muscle and range of motion, .