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 Appropriations Subcommittee on Health and Human Services
BILL: PCS/CS/SB 990 (686124)
INTRODUCER: Appropriations Subcommittee on Health and Human Services; Health Policy Committee;
and Senator Bradley
SUBJECT: Occupational Therapy
DATE: March 26, 2021 REVISED:
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Rossitto-Van
Brown HP Fav/CS
Winkle
2. Howard Kidd AHS Recommend: Fav/CS
3. AP
Please see Section IX. for Additional Information:
COMMITTEE SUBSTITUTE - Substantial Changes
I. Summary:
PCS/CS/SB 990:
 Expands the scope of practice of the occupational therapist and the occupational therapy
assistant;
 Provides that any person who is issued a license as an occupational therapist by the state of
Florida may use the words “occupational therapist doctorate” to denote his or her
registration;
 Amends the definition of “occupational therapy” to include the therapeutic use of
occupations with individuals, groups, or populations, along with their families or
organizations, to support participation, performance, and function in roles and situations 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;
 Defines the following terms:
o Activities of daily living;
o Behavioral health services;
o Health Management;
o Instrumental activities of daily living;
o Mental health services;
o Occupations; and
BILL: PCS/CS/SB 990 (686124) Page 2
o Occupational Performance;
 Adds all of the following to the practice of occupational therapy:
o Assessment, treatment, and education of, and consultation with, individuals, groups, and
populations whose abilities to participate safely in various occupations are impaired or at
risk for impairment due to issues related to, but not limited to, developmental
deficiencies, the aging process, learning disabilities, physical environment and
sociocultural context, physical injury or disease, cognitive impairments, and
psychological and social disabilities.
o 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.
o Specific techniques used for treatment that involve, 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; therapeutic exercises; manual
techniques; physical agent modalities; behavioral health services; and mental health
services.
 Deletes a list of “occupational therapy services” from current law.
The Department of Health’s Division of Medical Quality Assurance may experience an increase
in workload associated with additional complaints that can be absorbed within existing
resources.
The bill takes effect on July 1, 2021.
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
Occupational Therapy
Current law defines occupational therapy as the use of purposeful activities or interventions to
achieve functional outcomes. For individuals with a limiting physical injury or illness, a
cognitive impairment, a psychosocial dysfunction, a mental illness, a developmental or learning
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
department, MQA.
3
Section 20.43, F.S.
BILL: PCS/CS/SB 990 (686124) Page 3
disability, or an adverse environmental condition, achieving a functional outcome means to
maximize their independence and maintain their health.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 occupational therapy
assistant.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, 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.
 Providing for the development of:
o Sensory-motor, perceptual, or neuromuscular functioning;
o Range of motion; or
o Emotional, motivational, cognitive, or psychosocial components of performance.
 Using devices subject to federal regulation8 and identified by the Board of Occupational
Therapy (Board) as expressly prohibited, except by an occupational therapist or occupational
therapy assistant who has received Board-specified training.9
These services require skilled assessment10 to determine the need for use as interventions
including:
 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;
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; but, 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
21 C.F.R. s. 801.109, references devices, that because of their potential for harmful effect, or the method of their use, or the
collateral measures necessary to the device, they are not safe to use except under the supervision of a practitioner.
9
Fla. Admin. Code R. 64B11-4.001 (2020).
10
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.
BILL: PCS/CS/SB 990 (686124) Page 4
 The use of ergonomic principles;
 The adaptation of environments and processes to enhance functional performance; or
 The promotion of health and wellness.
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), that 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
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
Mar. 2, 2021). The Ph.D. in occupational therapy requires a minimum of six years of full time academic education and a
Doctorial Capstone that is an in-depth exposure to a concentrated area that 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. 31. 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: PCS/CS/SB 990 (686124) 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 and 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.
o Supervision by a fieldworker instructor.
 Level II Fieldwork:
o Ph.D. & 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 BS & AA 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 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, must be 80 percent or higher (regardless of the number
of attempts).20
Licensure
To be licensed as an occupational therapist, or occupational therapy assistant, an individual must:
 Apply to the department and pay appropriate fees;21
 Be of good moral character;
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,
that 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.
21
Section 468.219, F.S.
BILL: PCS/CS/SB 990 (686124) Page 6
 Have graduated from an ACOTE/AOTA accredited occupational therapy program, or
occupational therapy assistant program;
 Have completed a minimum of six months of supervised fieldwork experience for
occupational therapists, and a minimum of two months for occupational therapy assistants, at
a recognized educational institution or a training program approved by the education
institution where you met the academic requirements; and
 Have passed an examination approved by the NBCOT22 for occupational therapists.23,24
An additional path to licensure as an occupational therapist is also available to applicants who
have practiced as a state-licensed or American Occupational Therapy Association-certified
occupational therapy assistant for four years and who, prior to January 24, 1988, have completed
a minimum of six months of supervised occupational-therapist-level fieldwork experience. Such
individuals may take the examination approved by the NBCOT to be licensed as an occupational
therapist without meeting the educational requirements for occupational therapists to have
graduated from a program accredited by the ACOTE/AOTA.25
Endorsement is yet another path to licensure for an occupational therapist, or occupational
therapist assistant, that the Board may waive the examination requirement and grant a license to
any person who presents proof of:
 A current certification as an occupational therapist or occupational therapy assistant by a
national certifying organization if the Board determines the requirements for such
certification to be equivalent to the requirements for Florida licensure; or
 A current licensure as an occupational therapist or occupational therapy assistant i