April 18, 2025

Erin Barrett

Director of Legislative and Regulatory Affairs

Virginia Department of Health Professions

Perimeter Center

9960 Maryland Drive, Suite 300

Henrico, VA 23233

RE: Comments on proposed amendments to 18 VAC 85-80-72 and 18 VAC 85-80-80

Dear Ms. Barrett:

The American Occupational Therapy Association (AOTA) is the national professional association representing the interests of more than 213,000 occupational therapists, occupational therapy assistants, and students of occupational therapy, including 1417 members in Virginia. The practice of occupational therapy is science-driven, evidence-based, and enables people of all ages to live life to its fullest by promoting health and minimizing the functional effects of illness, injury, and disability. AOTA supports the Occupational Therapy Advisory Board of the Board of Medicine in its mission to protect the health, safety, and welfare of Virginia consumers and the authority of the Board to create regulations to achieve this mission.

On behalf of AOTA, I am writing to provide comment on the proposed changes to the Board’s inactive status, 18 VAC 85-80-72, and reinstatement requirements, 18 VAC 85-80-80. As you know, the proposed amendments remove the requirement for completion of a certain amount of supervised practice hours for individuals seeking to reactivate an inactive license or reinstate a lapsed license. Instead, an individual whose license has been inactive for six years or more and an individual whose license has been lapsed for 2 years or more would be required to either show evidence of current certification from the National Board for Certification in Occupational Therapy (NBCOT®) or retake and pass the NBCOT certification exam. This new requirement is problematic in several ways:

• First, if a licensee converts their Virginia license to inactive status or allows their license to lapse because they have accepted a job in another state, then showing evidence of current licensure in that other state should be sufficient to demonstrate competency to return to practice in Virginia. For example, many AOTA members live in Virginia but are employed and licensed as occupational therapy practitioners in the District of Columbia and Maryland.
• Second, licensees convert their license to inactive or let their license lapse for many reasons, including illness, family emergency, or loss of a job. It would be financially onerous to require someone who is seeking to reactivate a license or re-enter the profession after such an occurrence to then re-take and pass the NBCOT exam at a cost of several hundred dollars. There could also be a situation where a recent graduate of an OT or OTA academic program obtains a job in Virginia for a brief period of time, then takes a job in another state, only to have to resume practice in Virginia. The rules as proposed would require this individual to have to re-take the NBCOT exam when they passed it for the first time only several years before.
• Third, since Virginia does not require current NBCOT certification to renew a license, many licensees in the state might chose not to renew their NBCOT certification for this reason, in which case they would have to retake the exam if they need to reinstate their license. Furthermore, according to NBCOT’s website, “beginning January 1, 2027, any individual who has allowed their certification to lapse for 9+ years must submit a completed application and fee of $515 USD, undergo a background check, and pass the current entry-level NBCOT certification exam.”
• Fourth, AOTA’s official document Guidelines for Reentry Into the Field of Occupational Therapy  recommends that regulators require supervised hours of practice be completed if a license has been lapsed for at least three years, not two as is proposed in the Virginia regulation. See below:

4. For practitioners who have been out of practice for 3 or more years, complete a minimum of 10  hours of documented supervised service delivery in occupational therapy for each year out of practice, to a maximum of 80 hours.

• Fifth and last, in 2017, the Virginia legislature passed and the Governor signed H 1484 (Chapter 411) to prohibit the Board of Medicine from determining that current certification from NBCOT, AOTA, the Virginia Occupational Therapy Association, or any state or local government agency as “sufficient to fulfill continuing learning requirements for occupational therapists.” See below:

Be it enacted by the General Assembly of Virginia:

§ 2. That the Board of Medicine shall not deem maintenance of any certification provided by the Virginia Occupational Therapy Association; the American Occupational Therapy Association; the National Board for Certification in Occupational Therapy; a local, state, or federal government agency; a regionally accredited college or university; or a health care organization accredited by a national accrediting organization granted authority by the Centers for Medicare and Medicaid Services to assure compliance with Medicare conditions of participation as sufficient to fulfill continuing learning requirements for occupational therapists.

Since retaking the NBCOT exam or maintaining current certification with NBCOT is proposed to replace completion of supervised practice hours, and the supervised practice hours were intended to serve as continuing learning for individuals who have been out of the profession, we believe that the Board’s proposed regulation conflicts with the statute.

We propose that the Board delete the revision to 18 VAC 85-80-72 Inactive licensure that would require an occupational therapist or occupational therapy assistant to provide evidence of current certification with NBCOT and replace it with the following amendments:

B. An inactive licensee may reactivate his license upon submission of the following:3. If the license has been inactive for two to six years, documentation of having engaged in the active practice of occupational therapy or having completed a board-approved practice of 160 hours within 60 consecutive days under the supervision of a licensed occupational therapist; and

4. Documentation of completed continued competency hours equal to the requirement for the number of years, not to exceed four six years, in which the license has been inactive; or

4. Evidence of licensure in another state or jurisdiction during the inactive licensure period.

C. An occupational therapist or occupational therapy assistant who has had an inactive license for six years or more and who has not engaged in active practice, as defined in 18VAC85-80-10, shall  serve a board-approved practice of 320 hours to be completed in four consecutive months under the supervision of a licensed occupational therapist shall retake and pass the national exam.

We also propose that the Board delete the revision to 18 VAC 85-80-80 Reinstatement that would also require an occupational therapist or occupational therapy assistant to provide evidence of current certification with NBCOT and replace it with the following amendments:

B. An occupational therapist or occupational therapy assistant who has allowed his license to lapse for two years but less than six years, and who has not engaged in active practice as defined in 18VAC85-80-10, shall serve a board-approved practice of 160 hours to be completed in two consecutive months under the supervision of a licensed occupational therapist meet the continuing competency requirements of 18VAC85-80-71 for the number of years the license has been lapsed, not to exceed six years.

C. An occupational therapist or an occupational therapy assistant who has allowed his license to lapse for six years or more, and who has not engaged in active practice, shall serve a board- approved practice of 320 hours to be completed in four consecutive months under the supervision of a licensed occupational therapist shall retake and pass the national examination.

D. An applicant for reinstatement shall meet the continuing competency requirements of 18VAC85- 80-71 for the number of years the license has been lapsed, not to exceed four years who has engaged in active practice in another state or jurisdiction during the time period the license was lapsed shall provide evidence of licensure in the other state or jurisdiction for the same time period.

These amendments remove the previously required hours of supervised practice for reinstatement applicants, which the Board also proposed, and instead requires applicants who have practiced in another state while their Virginia license was lapsed or inactive to show proof of active licensure in the other state. If the licensee was not practicing in another state, then the licensee is required to complete the mandated continuing competency requirements for the number of years the license was lapsed or inactive to a maximum of 6 years. If the license is lapsed or inactive for longer than 6 years, then the applicant must retake and pass the NBCOT exam.

Thank you for the opportunity to comment on the proposed changes and if it would be helpful, we could be available at a future meeting to discuss our proposal. Please contact me at kneville@aota.org or 240-800-5981 if you have questions or need additional information about AOTA’s position.

Sincerely,

Kristen Neville

Manager, State Affairs, AOTA

cc: Savanah Howe, OTR/L, QMHP-A, President, Virginia Occupational Therapy Association President