Laws and Rules: Florida Board of Occupational Therapy

Florida Occupational Therapist and Occupational Therapy Assistant clinicians are regulated by three (3) entities, the National Board of Certified Occupational Therapy (NBCOT), the American Occupational Therapy Association (AOTA) and the Florida Board of OT (FBOT).  Each entity has its own mission and guidelines for clinicians and consumers; each entity affects the practice of OT and penalties that may be delivered for failure to meet standard differently.

NBCOTs mission is to, serve the public interest by advancing client care and professional practice through evidence-based certification standards and the validation of knowledge essential for effective practice in occupational therapy.¹
Membership to NBCOT is required when clinicians take the national examination for certification and is needed for initial licensure. With membership as a certificant, the clinician is agreeing to abide by the rules set forth by NBCOT.   After initial licensure, membership as a certificant is voluntary and highly recommended.   Failure to follow the rules may result in penalties. However those penalties may not be monetary, nor will they prevent a clinician from continuing to practice provided they have not violated the Florida Board of OT (FBOT) rules.

Similarly, AOTA is a governing body of Occupational therapy thru programs and activities that are directed toward assuring the quality of services provided by practitioners, improving access to Occupational Therapy healthcare services, and promoting the professional development of the profession by providing resources, setting standards and serving as an advocate to improve health care.²   Membership is voluntary and highly recommended.  Like NBCOT, as a member the clinician agrees to follow the rules established, failure to comply may result in penalties. However they will not be monetary, nor will they prevent a clinician from practicing provided the clinician has not violated the Florida Board of OT (FLBOT) rules.  Both the NBCOT and the AOTA may serve as a consultant to the Florida Board of OT when a clinician has violated a rule.

Every biennium and upon initial licensure in the state of Florida, clinicians provide their signature on a licensure application, indicating "they understand and agree to abide by the laws and rules related to the provision of occupational therapy services, in the State of Florida." Failure to follow the laws and rules of Florida may result in financial penalties and loss of licensure.  So, what are those laws and rules, who makes the laws and rules, and what are the areas of concern that clinicians typically get in trouble for and what are the potential penalties?

The Florida Board of Occupational Therapy website states that the Florida Board of Occupational Therapy (FLBOT) practice was established to assure the highest degree of professional conduct on the part of occupational therapists and occupational therapy assistants. The Board of Occupational Therapy is responsible for the licensure and regulation of the profession to ensure the availability of occupational therapy services are of high quality to the people of Florida.³   The Board serves the consumer of services, also known as our clients and provides the disciplinary guidelines that may be imposed on clinicians.  The purpose of discipline is to penalize and deter clinicians, from future violations and offer opportunities for rehabilitation when appropriate.  The range of punishment related to Chapters 456 and 468, in order of severity, includes:

• Letter of concern and a minimum administrative fine of $100, remedial education, and/or refund of fees billed
• Probation with conditions including
  • limiting practice settings and the requirement of supervision
    • The supervisor should ideally provide services for free. However, the licenses may also contract/pay fees for a supervisor
    • All supervisors must be approved and may be designated by the FLBOT
  • Employer and self-reports
  • Periodic appearances before the board
  • Counseling or participation in the Professional Resource Network (PRN)

Professional Resource Network (PRN) is one of the two programs designated as the State of Florida's Impaired Practitioners Programs (the other being the Intervention Project for Nurses). As such, PRN and its Medical Director serve as the Consultant to the Department of Health (DOH) and the Department of Business and Professional Regulation (DBPR) on matters relating to practitioner impairment. While working with these agencies, PRN also works closely with the DOH / DBPR Legal Departments regarding impairment related mitigation factors during disciplinary proceedings.4  The DOH and the DBPR contract with PRN to provide mandated services of the Florida Statutes in Chapters 455 and 456, as well as each individual's practice act. PRN is often an alternative to the DOH/DBPR disciplinary process. Due to increased education of licensed health care practitioners, hospitals and other employees, health care practitioners participating in PRN do so voluntarily instead of being reported to or by DOH/DBPR. This allows PRN to maintain an individual's confidentiality and limits the negative impact on his/her life.4 

• Suspension until the licensee appears before the Board to demonstrate current competency and ability to practice safely and compliance with any previous Board orders
• Licensure with conditions
• Denial of licensure
• Permanent Revocation

As clinicians, it is important to both understand the laws and rules that govern our practice in Florida and also to have an awareness of where to find resources that facilitate the practice of occupational therapy within the boundaries of the laws and rules.  The Department of Health in conjunction with the Florida Board of Occupational Therapy provide links to resources on their website.   These resources include the General Laws that direct the provision of health care including Occupational Therapy under the Chapter 456 Florida Statutes, and more specific laws and rules related to Occupational Therapy in Chapter 468, Part III, Florida Statutes and Chapter 64 B11, of the Florida Administrative Code.

Chapter 456 outlines the States Governmental regulations for all healthcare providers who may pose a risk to the public’s health, safety and welfare.  Chapter 456 is divided into 86 sections.5

You can access Chapter 456 here

Chapter 468, Part II, of the Florida Statutes, also known as the Florida Occupational Therapy Practice Act, is divided into 14 sections.  The Administrative Codes of section B11 are designed to define the statutes further.

The first section of the Practice Act section 468.201 defines the purpose of the OT Practice Act. Its purpose is to protect clients, customers and the public from unprofessional and unsafe clinical practice.  The OT Practice Act defines the minimum standards for safe and effective provision of OT by OTR’s, OTD’s, COTA’s, etc. in any setting.  Its intent is to prohibit clinicians who fall below the minimum standards and present a danger to the public from practicing in Florida. 

Section 468.203 provides definitions of providers, defines Occupational Therapy including who we are and what we do. Briefly explaining the assessment and use of assistive technologies and rehabilitative technologies including the purpose of Physical Agent Modalities (PAMs) and the requirement for special training in the use of these services.  In an AOTA position paper, Physical Agent Modalities are defined as those procedures and interventions that are systematically applied to modify specific client factors when neurological, musculoskeletal, or skin conditions are present that may be limiting occupational performance. PAMs use various forms of energy to modulate pain, modify tissue healing, increase tissue extensibility, modify skin and scar tissue, and decrease edema/inflammation. PAMs are used in preparation for or concurrently with purposeful and occupation-based activities.^6,8  

Specific categories of physical agents include: 

• Superficial thermal agents, deep thermal agents, and electrotherapeutic agents and mechanical devices. 
  • Superficial thermal agents include but are not limited to hydrotherapy/whirlpool, cryotherapy (cold packs, ice), Fluidotherapy™, hot packs, paraffin, water, infrared, and other commercially available superficial heating and cooling technologies. 
  • Deep thermal agents include but are not limited to therapeutic ultrasound, phonophoresis, short-wave diathermy, and other commercially available technologies. 
  • Electrotherapeutic agents use electricity and the electromagnetic spectrum to facilitate tissue healing, improve muscle strength and endurance, decrease edema, modulate pain, decrease the inflammatory process, and modify the healing process. Electrotherapeutic agents include but are not limited to biofeedback, neuromuscular electrical stimulation (NMES), functional electrical stimulation (FES), transcutaneous electrical nerve stimulation (TENS), high-voltage galvanic stimulation for tissue and wound repair (ESTR), high-voltage pulsed current (HVPC), direct current (DC), iontophoresis, and other commercially available technologies.^6,8
  • Mechanical devices include but are not limited to vasopneumatic devices and continuous passive motion (CPM).  

AOTA further advises clinicians to read the state licensure law and regulations for any language related to modalities.  Although the Florida Board does not specify that OTs or OTAs must obtain a certain “set” of modality certifications; appropriate training/certification should be sought for the modalities that the OT or OTA intends to use in practice. The Board’s regulations specifically address the type of training required if an OT or OTA would like to use Electrical Stimulation or Ultrasound Devices in practice.⁷ It is further recommended that clinicians be able to provide certification/education of current practice knowledge related to the PAMs provided.  Paperwork regarding certification in PAMS or education related to PAMs does not need to be submitted to the Florida Board of OT, however, must be available upon request.  Lastly, this section of the Practice Act identifies members of the OT team including OT’s, OTA’s and OT Aides and stipulates that only those that are licensed in the practice of OT may provide OT.  This section describes supervision requiring that all changes to the plan of care established by the supervision OT may be changed by an OTA. However, this can only occur with collaboration and permission from the OT to change the plan of care.

Section 468.204 establishes the rulemaking authority of the Board of OT, further explaining when repealing or challenging a rule may be done.  It also provides in section 120.54 of the Florida Statutes the lengthy process of making a rule. Administrative code 64B further describes citations and the associated processes involved when receiving a citation from the Florida Board of OT, including timelines that must be followed. 

Section 468.205 specifies that the Florida Board of OT is comprised of 7 members, each appointed by the Governor and confirmed by the Senate.  Members include 4 Occupational Therapists, 1 Occupational Therapy Assistant and 2 consumers that are not associated with the provision of Occupational Therapy.  Each clinician must have a license that is in good standing and a minimum 4 years of experience prior to serving on the board. Each of the members can serve two, four-year terms. The Board also has full-time support staff. 

Section 468.207 States that only those with a license to practice Occupational Therapy may do so.

Section 468.209 provides the requirements for licensure.  Signifying that applicants for licensure must be of moral character, completed an educational program recognized by the board, accredited by AOTA.  Applicants must have completed fieldwork and passed an examination by NBCOT. This section identifies the times that a clinician may practice with a temporary license and provisions that must be met if a clinician is returning to active practice after being out of practice within the last 5 years.

Section 468.211 Describes the process and payment of fees to the board for licensure, including the number of times the examination may be taken, three (3), before the applicant must receive additional training, with two (2) more opportunities to pass the exam, before they are no longer able to take the examination and apply for licensure. 

Section 468.213 indicates that clinicians that have been licensed in another state and are in good standing may be licensed in the State of Florida by endorsement if the requirements in that state are equal to the licensure requirements in Florida.

Section 468.215 states that upon meeting the requirements for licensure and providing payment for licensure, a license will be issued.  This section identifies the words and letters that may be used by a clinician and that are protected by the Florida Board of OT. They include the terms “Occupational Therapist Registered, OTR,”  “Licensed Occupational Therapist, LOT” and “Occupational Therapist, OT.”  For Occupational Therapy Assistants the terms “Certified Occupational Therapy Assistant, COTA,” “Licensed Occupational Therapy Assistant, LOTA” and “Occupational Therapy Assistant.”

Section 468.217 identifies grounds for denial of a license, refusal to renew a license, suspend and revocation of a license or disciplinary actions, this section covers not only what violations may occur for OT clinicians, but also violations that may occur to ANY professional that has a license to practice.

Section 468.219 indicates that licensure must be renewed biennially and that CEU requirements may not exceed 30 contact hours biennially.  Currently in the State of Florida, clinicians are required to complete 26 CEUs, 2 CEUs must be related to Laws and Rules, and 2CEU’s must be related to Medical Errors.  First-time renewal licensees are also required to take a 1-hour HIV/AIDS Course. Chapter 64B11-5.001 further identifies types of CEUs and maximum contact hours that can be utilized. This includes tasks such as home study, student supervision, pro-bono work, presenting/instruction and authorships.

Section 468.221 provides a list of items for which the Florida Board of Occupational Therapy may charge a fee.  These include an application fee, examination fee, renewal of active and inactive licenses, reactivation fees, and delinquency fees.

Section 468.223 identifies practices that will result in penalties.  This list is not all-inclusive; it includes practicing without a license,  use of the words occupational therapist, occupational therapy assistant and the letters associated with OT without a valid license, use of anothers license, giving false or forged information to the Board of OT, attempting to use a revoked, suspended, inactive or deliquent license, employing unlicensed persons to provide OT services, concealing information related to any OT statute, and the practice of OT when one has been convicted of a capital felony involving death and/or a life sentence and/or a misdemeanor of the second degree.  Examples of second-degree misdemeanors include⁸:

• Simple Assault
• Criminal Mischief (where damage is $200 or less)
• Petit Theft (first offense)
• Simple Trespass
• Driving on a Suspended License with Knowledge (first offense)
• Attaching Tag Not Assigned
• No Valid Driver’s License
• Disorderly Conduct
• Disorderly Intoxication
• Loitering or Prowling
• No Motorcycle Endorsement
• Harassing Phone Calls
• Expired Tag More Than 6 Months (second offense)

Section 468.225 recognizes exemptions.  These exemptions from licensure include students on fieldwork and other professions that may use OT as part of or incidental to their profession, including physicians, physician assistants, nurses, physical therapists, osteopathic physicians or surgeons, clinical psychologists, speech-language pathologists, or audiologists.  An example may be a Speech-Language Pathologist identifying adaptive devices that may facilitate feeding/eating. 

You can access the Florida Occupational Therapy Practice Act, Chapter 468, Part II, Florida Statutes and Chapter 64 B11, of the Florida Administrative Codes, in its entirety here 

Current licenses expire at midnight, eastern time on the eve of February 28th,  every odd year. Ninety (90) days prior to expiration, the department of health will mail a renewal postcard. Prior to expiration, it is important to verify your address, and verify that your completed CEUs have been recorded.  The State of Florida requires all licensees report CEU hours to CE Broker.  Also, prior to renewal, there are two (2) surveys that MUST be completed to proceed with renewal.   The online renewal process takes approximately 10-15 minutes to complete, and payment may be paid by Credit Card.   Fees for licenses renewed prior to expiration range from $55.00 to $160.00, most can expect to pay $60.00. Fees for those renewing after expiration range from $115.00-$265.00.⁹

Florida seeks to become the most veteran-friendly state in the nation, launching the VALOR (Veterans Application for Licensure Online Response) System on July 1, 2014, to expedite licensing for military veterans. The state also extended fee waiver eligibility for health care practitioner licenses to 60 months after honorable discharge and included military spouses.⁹  To qualify applicants must hold an active, unencumbered license as a military health care practitioner in a U.S. jurisdiction, or serve as a military health care practitioner in a profession for which licensure in a state or jurisdiction is not required to practice in the United States Armed Forces. If the applicants active, unencumbered license is not verifiable online, the Florida Department of Health will request that the licensing entity send official license verification to the department of health.¹⁰

Effective January 24, 2018, Each NEW applicant for licensure shall pay an application fee in the amount of $100.00 in the form of a check or money order payable to the Department of Health. This application fee is nonrefundable and may not be used for more than one year from the original submission of the application. After one year from the date of the original submission of an application, a new application and new fee shall be required from any applicant who desires to be considered for licensure. The application shall be made on “State of Florida Application for Licensure as an Occupational Therapist or Occupational Therapy Assistant,” DH-MQA 1152 (revised 10-17), hereby adopted and incorporated by reference, to view this application click here or you may choose to apply through the online application here

In April 2017, clarification was provided regarding requirements for obtaining continuing education credits for pro bono services. Final Rule states – A licensee may receive up to six (6) hours per biennium of continuing education credit through the performance of pro bono services to the indigent as provided in Section 456.013(9), F.S., or to underserved populations, or in areas of critical need within the state where the licensee practices. In order to receive credit under this rule, licensees must make a written request to the Board and receive approval prior to performing pro bono services in advance. One (1) hour credit shall be given for each two (2) hours worked. In the written request, licensees shall disclose the type, nature and extent of services to be rendered, the facility where the services will be rendered, the number of patients expected to be serviced, and a statement indicating that the patients to be served are indigent. If the licensee intends to provide services in underserved or critical need areas, the written request shall provide a brief explanation as to those facts.¹² (Find link here)

January 10, 2017, The Board developed disciplinary guidelines which shall be imposed upon applicants or licensees whom it regulates under Part III, Chapter 468, F.S. The purpose of this rule is to notify applicants and licensees of the ranges of penalties which will routinely be imposed unless the Board finds it necessary to deviate from the guidelines for the stated reasons given within this rule.12 Each range includes the lowest and highest penalty and all penalties falling between. The purposes of the imposition of discipline are to punish the applicants or licensees for violations and to deter them from future violations; to offer opportunities for rehabilitation, when appropriate; and to deter other applicants or licensees from violations. The violation and penalties are as follows:

A cursory review of the 2016 and 2017 Florida Department of Health Disciplinary and Administrative actions indicate that approximately 15 OTs, 4 OTAs have violated the OT Practice Act and have received penalties from the Florida Board of Occupational therapy.¹⁴ The most frequent violations for OT’s are Medicare and Medicaid Fraud; this includes complaints related to inaccurate billing for minutes of therapy, submission of progress notes for treatments that did not occur, and lack of documentation regarding treatments provided. Also noted are the use of drugs and alcohol while working, retail theft, and mortgage fraud. The least frequent complaint is failure to provide adequate supervision to an OTA.

Respectively, for OTAs in the same time frame, the most frequent violation and complaint filed is failure to pass a pre-employment drug screen, failure to report DUI as required by the Florida Board of OT, and lastly Medicare fraud. Each of the violators received fines varying from approximately $100.00 to $10,000.00 with licensure penalties that ranged from probation, participation in Drug and Rehabilitation counseling (PRN) programs to permanent revocation of the license to practice Occupational therapy.

NBCOT indicates that from January 2016 through November 2017 collectively 13 OT and OTA clinicians in the state of Florida were found in violation of some law or rule that applied to either the NBCOT Code of Conduct and/or the Laws and Rules of practice for OT in FL.¹

The Division of Health Quality Assurance protects Floridians through oversight of health care providers. The Division is funded with more than $49 million in state and federal funds. Health Quality Assurance licenses and/or certifies and regulates 40 different types of health care providers, including hospitals, nursing homes, assisted living facilities, and home health agencies. As a measure of safety to consumers, all healthcare providers are required to undergo a Criminal Background check as part of the employment process. This process must be renewed every five (5) years. The average processing time is 6-10 days.¹⁴

Collectively there are over one-hundred (100) laws and rules that apply to the provision of Occupational Therapy services. Therapists need to understand the regulatory bodies that protect the consumer, the laws and rules that clinicians are bound to and the range of punishments that can be applied. These regulatory bodies include AOTA, NBCOT and the Florida Board of OT. However, only the Florida Board of OT can assess violations AND institute financial penalties. Clinicians are required to review the Florida Laws and Rule biannually and become up to date with recent changes. Recent changes include; fees for new licensure applicants; clarification for obtaining CEUs when providing pro bono services and disciplinary guidelines of violations and ranges of penalties to be imposed for the purpose of punishment for clinicians that violate the Florida Laws and Rules. It is important that clinicians become familiar with the enforcement process and the most frequent violations to avoid disciplinary and corrective actions and facilitate provision of excellent care for consumers.

1. Therapy, N. B. (2017). (Visit Source). Retrieved February 1, 2018
2. © 2018 American Occupational Therapy Association. (2018). (Visit Source). Retrieved March 23, 2018
3. flrules.org (Visit Source) Retrieved December 2017
4.  Professional Resource Network. (n.d.).  (Visit Source)  Retrieved February 4, 2018  
5. Legislature, T. F. (2018). (Visit Source). Retrieved October 12, 2017
6. Bracciano, A. (2008). Physical agent modalities: Theory and application for the occupational therapist. NJ: Slack.
7. floridasoccupationaltherapy.gov. (Visit Source) (n.d.). Retrieved March 25, 2018
8. Scott D. McPhee, D. O. (2008). Physical Agent Modalities: A Position Paper. In C. o. Practice (Ed.), November/December 2008, Volume 62, Number 6 (p. 692). AJOT.
9. Shestokas, D. J. (2013, January 26). (Visit Source). Retrieved March 19, 2018
10. floridasoccupationaltherapy.gov (Visit Source) Retrieved October 17, 2017
11. © 2018 FL HealthSource, F. D. (2018). (Visit Source). Retrieved February 11, 2018 
12. www.floridahealth.gov. (Visit Source) Retrieved January 5, 2018
13. www.floridahealth.gov. (Visit Source) Retrieved Jan 30, 2018 
14. © 2018 Florida Agency for Health Care Administration. (2018). (Visit Source). Retrieved March 23, 2018