Limited Occupational Therapy Treatment Without Referral

To treat patients without a referral for up to 10 visits or 30 days, whichever occurs first, a New York State licensed occupational therapist who is, at the time, currently registered to practice must have at least three years of licensed practical experience or the equivalent. Equivalent part-time experience is acceptable. Under the Regulations of the Commissioner of Education, “full time basis equivalent” means at least 4,320 clock hours of occupational therapy practice over a minimum of 36 months prior to beginning the patient’s treatment. As always, licensed practitioners may only provide occupational therapy services in the practice areas in which they are competent.

No, you must be licensed and registered to practice as an occupational therapist in New York State, but no additional application or credential is required. The individual occupational therapist is responsible for making the determination that they are qualified and eligible to treat patients without a referral for up to 10 visits or 30 days, whichever occurs first. 

Be aware, however, that Section 29.1 (b)(9) of the Rules of the Board of Regents states that it is professional misconduct to accept and perform professional responsibilities that the licensee knows (or has reason to know) they are not competent to perform. 

Prior to treating the patient, the occupational therapist must advise the patient in writing of the possibility that the treatment may not be covered by the patient’s health care plan or insurer without a referral from a physician or nurse practitioner and that the treatment may be a covered expense if rendered with a referral. The Notice of Advice must contain the following information:

1. A statement of such advice and a statement attesting that the patient has read the Notice of Advice;
2. The date treatment will begin;
3. The patient’s name and address;
4. The patient’s signature and date the patient signed the form;
5. The treating occupational therapist’s name and business address; and
6. The treating occupational therapist’s signature and the date the occupational therapist signed the form.

No, you do not need to provide a separate Notice of Advice form; it can be combined with other forms.

Yes, and it should be retained as such.

Related resources:

• Guidance on Recordkeeping
• Guidance on Meeting HIPPA/FERPA Privacy Standards 

Yes, the licensed occupational therapist who is practicing without a referral still has an obligation under the law to obtain the signed notice of advice.

You should not provide services without proper authorization. If you provide services without obtaining the required, signed patient notice, then you will be in violation of Education Law and Regulations and subject to professional misconduct charges.

Yes. The law covers all treatment settings.

Unless a treatment happens at the same visit as the initial evaluation, the initial evaluation does not count as one of the 10 visits.

The 30-day treatment period begins when the first treatment is provided and ends no more than 30 calendar days (or 10 visits) thereafter. This time period includes weekends and holidays.

An episode of care begins after the initial assessment or evaluation of the patient and the first treatment is provided. It ends when the patient is discharged from care, e.g., when the patient has reached the maximum therapeutic care or goals set during treatment; the patient decides that care is no longer necessary or wanted; or the patient self-discharges or has another medical event. 

A patient may be treated again once the episode of care is complete, there is a change in the diagnosis, or there is a new event that brings the patient back for treatment.

Yes.

No. Any occupational therapist who is licensed and currently registered in New York State and meets the noted experience requirements may render services without a referral for up to 10 visits or 30 days, whichever occurs first.
 

Once the occupational therapist who qualifies to practice without a referral has completed the patient’s evaluation, discussed the plan of care with the patient, and determined the treatment plan, they can delegate care as appropriate to an occupational therapy assistant, student, or limited permit holder. Regardless of who provides the subsequent care, treatment without a referral is limited to 10 visits or 30 days, whichever occurs first.

Important Note: the authority to practice without a referral resides with the eligible occupational therapist and does not alter the terms of practice of those to whom the care may be delegated. As always, occupational therapists remain responsible for the practice and care provided by those under their supervision. Only the authorized occupational therapist may alter the plan of care.

Related Resource: Guidance on Supervision

No. The authority to practice without a referral resides with the eligible occupational therapist.

Yes, the practical experience can be acquired in another state, but to provide treatment in New York State the occupational therapist must have an active New York State license and registration to practice.