The Florida Senate
BILL ANALYSIS AND FISCAL IMPACT STATEMENT
(This document is based on the provisions contained in the legislation as of the latest date listed below.)
Prepared By: The Professional Staff of the Committee on Appropriations
BILL: CS/SB 632
INTRODUCER: Health Policy Committee and Senator Bradley
SUBJECT: Occupational Therapy
DATE: February 8, 2022 REVISED:
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Rossitto-Van
Brown HP Fav/CS
Winkle
2. Howard Money AHS Recommend: Favorable
3. Howard Sadberry AP Favorable
Please see Section IX. for Additional Information:
COMMITTEE SUBSTITUTE - Substantial Changes
I. Summary:
CS/SB 632 significantly expands the scope of practice of the occupational therapist and the
occupational therapy assistant.
The bill replaces the current definition of “occupational therapy” with a new definition that
introduces the concepts of the therapeutic use of occupations with individuals, groups, or
populations, along with their families or organizations, to support participation, performance,
and function in the home, school, workplace, community, and other settings for clients who
have, or are at risk of developing, an illness, injury, disease, disorder, condition, impairment,
disability, activity limitation, or participation restriction.
The bill creates new terms and definitions for occupational therapy.
The bill deletes a list of “occupational therapy services” from current law, makes reference to
“the practice of occupational therapy” instead of “occupational therapy,” and adds the following
services to the practice of occupational therapy:
 The assessment, treatment, and education of or consultation with individuals, groups, and
populations whose abilities to participate safely in occupations, including activities of daily
living, instrumental activities of daily living, rest and sleep, education, work, play, leisure,
and social participation, are impaired or have been identified as being at risk for impairment
due to issues related to, but not limited to, developmental deficiencies, the aging process,
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learning disabilities, physical environment and sociocultural context, physical injury or
disease, cognitive impairments, or psychological and social disabilities;
 Methods or approaches to determine abilities and limitations related to performance of
occupations, including, but not limited to, the identification of physical, sensory, cognitive,
emotional, or social deficiencies; and
 Specific occupational therapy techniques used for treatment which include, but are not
limited to, training in activities of daily living; environmental modification; assessment of the
need for the use of interventions such as the design, fabrication, and application of orthotics
or orthotic devices; selecting, applying, and training in the use of assistive technology and
adaptive devices; sensory, motor, and cognitive activities.
The bill exempts clinical social workers, marriage and family therapists, and mental health
counselors from the application of the Occupational Therapy Practice Act and exempts
occupational therapists and occupational therapy assistants from the application of the
Psychological Services Act in chapter 490, Florida Statutes, and the Clinical, Counseling, and
Psychotherapy Act in chapter 491, Florida Statutes.
The bill also exempts any person fulfilling an occupational therapy doctoral capstone experience
that involves clinical practice or projects, from the requirements of the Occupational Therapy
Practice Act if he or she registers with the Department of Health (department) before
commencing the capstone experience.
The bill authorizes a licensed occupational therapist to use the title “occupational therapist
doctorate” or “O.T.D.” if the occupational therapist has earned a doctoral degree.
The bill is projected to have an insignificant negative fiscal impact on the department; however,
the agency can absorb this impact within existing resources. See section V of this analysis.
The bill provides an effective date of July 1, 2022.
II. Present Situation:
The Department of Health
The Legislature created the Department of Health (department) to protect and promote the health
of all residents and visitors in the state.1 The department is charged with the regulation of health
practitioners for the preservation of the health, safety, and welfare of the public. The Division of
Medical Quality Assurance (MQA) is responsible for the boards2 and professions within the
department.3
1
Section 20.43, F.S.
2
Under s. 456.001(1), F.S., “board” is defined as any board, commission, or other statutorily created entity, to the extent such
entity is authorized to exercise regulatory or rulemaking functions within the department or, in some cases, within the MQA.
3
Section 20.43, F.S.
BILL: CS/SB 632 Page 3
Occupational Therapy
Current law defines occupational therapy as “the use of purposeful activity or interventions to
achieve functional outcomes.”4
Occupational therapy is performed by licensed occupational therapists (OTs), licensed
occupational therapy assistants (OTAs) who work under the responsible supervision and control5
of a licensed OT, and occupational therapy aides who are not licensed but assist in the practice of
occupational therapy under the direct supervision of a licensed OT or licensed OTA.6 However,
physicians, physician assistants, nurses, physical therapists, osteopathic physicians or surgeons,
clinical psychologists, speech-language pathologists, and audiologists are permitted to use
occupational therapy skills and techniques as part of their professions when they practice their
profession under their own practice acts.7
Occupational therapy services include, but are not limited to:
 The assessment,8 treatment, and education of, or consultation with, the individual, family, or
other persons;
 Interventions directed toward developing daily living skills, work readiness or work
performance, play skills or leisure capacities, or enhancing educational performance skills;
and
 Providing for the development of: sensory-motor, perceptual, or neuromuscular functioning;
range of motion; or emotional, motivational, cognitive, or psychosocial components of
performance.9
These services may require an assessment to determine the need for the use of the following
interventions:
 The design, development, adaptation, application, or training needed to use the assistive
devices;
 The design, fabrication, or application of rehabilitative technology such as selected orthotic
devices;
 Training in the use of assistive technology;
 Orthotic or prosthetic devices;
 The application of physical modalities as an adjunct to or in preparation for activity;
 The use of ergonomic principles;
 The adaptation of environments and processes to enhance functional performance; or
4
Section 468.203(4), F.S.
5
Section 468.203(8), F.S. Responsible supervision and control by the licensed OT includes providing both the initial
direction in developing a plan of treatment and periodic inspection of the actual implementation of the plan. The plan of
treatment must not be changed by the supervised individual without prior consultation and approval of the supervising OT.
The supervising OT is not always required to be physically present or on the premises when the occupational therapy
assistant is performing services; however, supervision requires the availability of the supervising occupational therapist for
consultation with and direction of the supervised individual.
6
Section 468.203, F.S.
7
Section 468.225, F.S.
8
Section 468.203(4)a.2., F.S., defines “assessment” to mean the use of skilled observation or the administration and
interpretation of standardized or non-standardized tests and measurements to identify areas for occupational therapy services.
9
Section 468.203(4), F.S.; Fla. Admin. Code R. 64B11-4.001 (2021).
BILL: CS/SB 632 Page 4
 The promotion of health and wellness.10
Occupational Therapists and Occupational Therapy Assistants
Education
There are four levels of educational programs available to individuals desiring to enter the
profession of occupational therapy in an institution accredited by the Accreditation Council for
Occupational Therapy Education (ACOTE), which is the certifying arm of the American
Occupational Therapy Association (AOTA), as follows:
 The Doctoral-Degree-Level Occupational Therapist (Ph.D.);11
 Master’s-Degree-Level Occupational Therapist (OTR);
 Baccalaureate-Degree-Level Occupational Therapy Assistant (certified occupational therapy
assistant or COTA); and
 Associate-Degree-Level Occupational Therapy Assistant (also a COTA).12
The ACOTE requirements for accreditation for occupational therapy curriculum vary by degree
levels, but all levels must include theory, basic tenets of occupational therapy, and supervised
educational fieldwork for accreditation. Examples of some required theory and basic tenets for
occupational therapy accreditation include:
 Theory:
o Preparation to Practice as a Generalist;
o Preparation and Application of In-depth Knowledge;
o Human Body, Development, and Behavior;
o Sociocultural, Socioeconomic, Diversity Factors, and Lifestyle Choices; and
o Social Determinants of Health.
 Basic Tenets:
o Therapeutic Use of Self;
o Clinical Reasoning;
o Behavioral Health and Social Factors;
o Remediation and Compensation;13
o Orthoses and Prosthetic Devices;14
10
Id.
11
National Board of Certification in Occupational Therapy (NBCOT), 2018 Accreditation Council for Occupational Therapy
Education (ACOTE®) Standards and Interpretive Guide (effective July 31, 2020) August 2020 Interpretive Guide Version,,
at pp. 20 and 49, available at https://acoteonline.org/wp-content/uploads/2020/10/2018-ACOTE-Standards.pdf (last visited
Nov. 15, 2021). The Ph.D. in occupational therapy requires a minimum of six years of full time academic education and a
Doctorial Capstone which is an in-depth exposure to a concentrated area, which is an integral part of the program’s
curriculum design. This in-depth exposure may be in one or more of the following areas: clinical practice skills, research
skills, scholarship, administration, leadership, program and policy development, advocacy, education, and theory
development. The doctoral capstone consists of two parts: the capstone experience and the capstone project.
12
Id.at p. 1.
13
Supra note 11, p. 29. Remediation and Compensation includes the design and implement intervention strategies to
remediate and/or compensate for functional cognitive deficits, visual deficits, and psychosocial and behavioral health deficits
that affect occupational performance.
14
Supra note 11, p. 30. Orthoses and Prosthetic Devices requires the assessment of the need for orthotics, and design,
fabricate, apply, fit, and train in orthoses and devices used to enhance occupational performance and participation.
BILL: CS/SB 632 Page 5
o Functional Mobility;15
o Community Mobility;16
o Technology in Practice;17
o Dysphagia18 and Feeding Disorders;
o Superficial Thermal, Deep Thermal, and Electrotherapeutic Agents and Mechanical
Devices; and
o Effective Communication.
Fieldwork education required for ACOTE accreditation must include traditional and non-
traditional subject matter, as well as emerging settings to strengthen the ties between didactic and
fieldwork education, and at two levels:
 Level I Fieldwork: required for Ph.D., OTR, and COTA candidates, could be met through
one or more of the following instructional methods:
o Simulated environments;
o Standardized patients;
o Faculty practice;
o Faculty-led site visits; and
o Supervision by a fieldworker instructor.
 Level II Fieldwork:
o Ph.D. and Masters Candidates - require a minimum of 24 weeks of full-time Level II
fieldwork. Level II fieldwork can be completed in one setting if reflective of more than
one practice area, or in a maximum of four different settings.
o Bachelors and Associates Candidates - require a minimum of 16 weeks full-time Level II
fieldwork. Level II fieldwork may be completed in one setting if reflective of more than
one practice area, or in a maximum of three different settings.19
The ACOTE also requires for accreditation that schools maintain an average passage rate of 80
percent or higher (regardless of the number of attempts) on the National Board for Certification
in Occupational Therapy (NBCOT) examination, over the three most recent calendar years, for
graduates attempting the national certification exam within 12 months of graduation from the
program.20
The Doctoral Capstone for a Ph.D. in Occupational Therapy
According to the ACOTE standards, the doctoral capstone is a required element of an
occupational therapy Ph.D. curriculum. The goal of the doctoral capstone is to provide an in-
depth exposure to one or more of the following: clinical practice skills, research skills,
15
Id. Functional Mobility- provides recommendations and training in techniques to enhance functional mobility, including
physical transfers, wheelchair management, and mobility devices.
16
Supra note 11, p. 30. Community Mobility designs programs that enhance community mobility, and implement
transportation transitions, including driver rehabilitation and community access.
17
Supra note 11, p. 31. Technology in Practice requires the demonstration of knowledge of the use of technology in practice,
which must include: electronic documentation systems; virtual environments; and telehealth technology.
18
Tabor’s Cyclopedia Medical Dictionary, 17th Edition, pub. 1993, F.A. Davis and Co., Dysphonia is the inability to swallow
or difficulty swallowing.
19
Supra note 11, p. 41.
20
Supra note 11.
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administration, leadership, program and policy development, advocacy, education, and theory
development.
The doctoral capstone consists of two parts:
 Capstone project is completed by the Ph.D. candidate who demonstrates his or her ability to
relate theory to practice and to synthesize in-depth knowledge in a practice area that relates
to the capstone experience.
 Capstone experience is a 14-week, full-time, in-depth exposure in a concentrated area that
may include on-site and off-site activities that meets developed goals and objectives of the
doctoral capstone.
The candidate begins his or her capstone experience after the completion of all coursework and
Level II fieldwork and after the preparation of a complete literature review, needs assessment,
goals/objectives, and an evaluation plan aligning with the curriculum design and sequence of the
doctoral capstone experience.
The Ph.D. candidate’s capstone project must demonstrate the synthesis and application of the
knowledge he or she has gained. The doctoral capstone experience must be a minimum of 14
weeks (560 hours). It may be completed on a part-time basis but must be consistent with the
individualized specific objectives of the capstone project. No more than 20 percent of the 560
hours may be completed off site from the mentored practice setting(s), to ensure a concentrated
experience in the designated area of interest. Time spent off-site may include independent study
activities such as research and writing. Prior fieldwork or work experience may not be
substituted for this doctoral capstone experience.
Every doctorial capstone project must have a valid written memorandum of understanding,
signed by all parties to the doctoral capstone experience which, at a minimum, includes
individualized specific objectives, plans for supervision or mentoring, and