Rule 15-19-60-8.10.2 - Supervision or Consultation1. An occupational therapy assistant issued a limited permit (see Rule 8.4.5).2. An occupational therapy assistant issued a regular license. a. A supervisory visit must be performed by the occupational therapist at least once every seventh treatment day or 21 calendar days, after the introduction of the occupational therapy assistant into the treatment process. The occupational therapist will personally render treatment, review and evaluate the treatment progress of the occupational therapy assistant, and perform a functional assessment of the patient's progress. The presence of the occupational therapy assistant is not required during the supervisory visit; however, nothing prevents the occupational therapist from requiring the occupational therapy assistant's presence at the supervisory visit based on a case-by-case assessment of each unique encounter. A supervisory meeting between the occupational therapist and the occupational therapy assistant must be completed and documented prior to the next treatment visit following the supervisory visit in order to review or change the plan of care and/or assess the occupational therapy assistant's performance. The supervisory meeting between the occupational therapist and occupational therapy assistant may be in person or via telecommunications, including audio-only communication, at the discretion of the supervising occupational therapist.b. The supervising occupational therapist must be accessible by telecommunications to the occupational therapy assistant on a daily basis while the occupational therapy assistant is treating patients. c. Regardless of the practice setting, the following requirements must be observed when the occupational therapist is supervising or consulting with the occupational therapy assistant: i. The initial visit for evaluation of the patient and establishment of a plan of care must be made by the supervising or consulting occupational therapist.ii. A joint supervisory visit must be made by the supervising occupational therapist with the patient present at the patient's residence or treatment setting once every 7 treatment days or every 21 calendar days, whichever comes first.iii. A supervisory meeting between the occupational therapist and the occupational therapy assistant(s) must occur and be documented prior to the next treatment session following the supervisory visit performed by the occupational therapist.iv. A supervisory visit should include: 1. A review of activities with appropriate revision or termination of the plan of care;2. An assessment of utilization of outside resources (whenever applicable);3. Documentary evidence of such visit, including documentation of the specific content in the communication between the occupational therapist and the assistant;4. Discharge planning as indicated.v. An occupational therapist may not supervise/consult with more than two (2) occupational therapy assistants and/or fieldwork students that are treating patients at any point in time during the occupational therapist's work day except in school settings, or settings where maintenance or tertiary type services are provided, such as the regional treatment centers under the direction of the Department of Mental Health. The number of supervisees is inclusive of all geographic locations or employing agencies.d. Regular interim communication should occur between the occupational therapist and occupational therapy assistant(s) during the treatment process over the 7-visit/21-day time period. Regular interim communication that occurs with the visits should be documented by either the occupational therapist or the occupational therapy assistant; however, the occupational therapist and occupational therapy assistant may both document the communication. The following are examples of ethical regular interim communication that should be documented between and in addition to the supervisory visit documentation: i. Example #1: An occupational therapy assistant in a position of regular employment is off work due to illness, vacation, maternity leave, cannot work on the weekends, etc., and an alternate occupational therapy assistant is employed to cover the patient caseload vacated by the regular occupational therapy assistant's absence. The regular occupational therapy assistant is not actively engaged in patient treatment at the time that the alternate occupational therapy assistant is engaging in patient treatment; therefore, the regular occupational therapy assistant's supervising occupational therapist may assume supervision of the alternate occupational therapy assistant while he/she is treating the regular occupational therapy assistant's patient caseload only until the point in time that the regular occupational therapy assistant returns to actively engage in patient treatment. Documentation of these transitions must be recorded in the client's record.ii. Example #2: The occupational therapist and/or the alternate occupational therapy assistant shall document in the medical record or official client record when an alternate occupational therapy assistant enters the treatment process if the supervising occupational therapist has had any regular interim communication with the alternate occupational therapy assistant. This communication will include information that the alternate occupational therapy assistant would need in order to treat the patient safely and effectively. A supervisory visit would only be required if it were the patient's 7th visit or 21st calendar day since the last supervisory visit. iii. Example #3: In the event that the supervising occupational therapist is unable to perform the supervisory visit on or before the patient's 7th treatment day or 21st calendar day, the occupational therapy assistant shall document this in the medical record or official client record specifying that he/she (or any other occupational therapy assistant) cannot treat the patient on the patient's 7th visit or 21st calendar day until the supervisory visit is completed. It is the responsibility of the occupational therapy assistant to ensure treatment has not exceeded the patient's 7th treatment day or 21st calendar day.e. Switching occupational therapy assistants during the 7/21 treatment cycle does not absolve the occupational therapist of their responsibility nor does it alter the 7 visit/21-day rule as the 7th visit is determined by the number of times the patient is treated by any licensed occupational therapy practitioner after the introduction of the occupational therapy assistant role into the treatment plan. A PRN occupational therapist may assume responsibility and supervision duties of a regular occupational therapist until the regular occupational therapist actively returns to the workplace as long as the added occupational therapy assistant does not result in the PRN occupational therapist exceeding the maximum of two (2) occupational therapy assistants/fieldwork students actively providing treatment under his/her supervision. If the PRN occupational therapist has performed a supervisory visit, the PRN occupational therapist is legally bound to that patient and occupational therapy assistant role until such time that the regular occupational therapist performs another supervisory visit to release the PRN occupational therapist of responsibility of that patient client.3. Occupational therapy aides: a. An occupational therapy aide is an unlicensed person who assists an occupational therapist or occupational therapy assistant as defined in Rule 8.1.3 of these regulations. An occupational therapy aide is a worker who is trained on the job.b. Duties assigned to an occupational therapy aide must be determined and directly supervised by a licensed occupational therapist or occupational therapy assistant and must not exceed the level of specific training, knowledge, skill and competence of the individual being supervised.c. The supervising occupational therapist or occupational therapy assistant is professionally responsible for the acts or actions performed by any occupational therapy aide supervised by the licensee in the occupational therapy setting.d. Documentation of all training specific to the aide's duties must be in the aide's file.e. Duties or functions which occupational therapy aides shall not perform include the following: i. Interpreting referrals or prescriptions for occupational therapy services;ii. Performing evaluative procedures;iii. Developing, planning, adjusting, or modifying treatment procedures;iv. Preparing written documentation of patient treatment or progress; andv. Act independently without the direct supervision of a licensed occupational therapist or occupational therapy assistant during patient therapy sessions.4. The supervision/consultation requirements stated in these regulations are minimal. It is the professional responsibility and duty of the licensed occupational therapist to provide the occupational therapy assistant with more supervision if deemed necessary in the occupational therapist's professional judgment.15 Miss. Code. R. 19-60-8.10.2
Miss. Code Ann. § 73-24-13