Occupational Therapy Practitioners
Advisory Council Meeting Minutes
April 12, 2012
Attendance
Members
Chris Harbaugh
Lisa Dutton
Merri Vitse
Lynnette Buckley
Mary Noska (telephonically)
MDH Staff
Tom Hiendlmayr
Barbara Miller
Kimberly Ruberg
Kyle Renell
Guests
Karen Sames
Absent
I.
Introductions
Introductions were done by those in attendance.
II.
Review and Approval of Minutes from October 13, 2011
The Minutes were approved as written.
III.
Additions/Adoption of Agenda
Hiendlmayr added the Item 6B of Online PAMs Training under New Business. With that
item added, the Agenda was adopted as proposed.
IV.
Staff Updates
A. Credentialing Report
Ruberg presented the Credentialing Report. She stated that as of March 31, 2012 there
were 3,071 licensed OTs and 966 licensed OTAs for a total of 4,037 licensed
Occupational Therapy Practitioners. Ruberg presented a report of OTP Credential
Statistics from 9/30/04 to 3/31/12 which shows an increasing numbers of practitioners.
Ruberg stated that 712 OT renewal notices were mailed out on March 30, 2012. She
noted that this is the second time this renewal group will be renewing online. Harbaugh
inquired if the issues with credit card payments have been resolved? Hiendlmayr
responded that credit card payments have been working fine.
B. Investigation and Enforcement Report
Hiendlmayr presented the Investigations and Enforcement Report for Occupational
Therapists for the third quarter. He stated there were 53 intakes which consisted of 37
allegations, 15 applications, and one inquiry for information. Thirty-six investigations
were opened. Most of the activity was PAMs related, described as “aided or abetted
another person in violation Sections 148.6401 to 148.6450.” Hiendlmayr explained those
are individuals which were supervisors of OTAs using PAMs without approval, and these
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investigations are resulting from the OTA renewal in the fall. Thirty-six investigations
were closed, and so most of the PAMs investigations were quickly turned around and put
into enforcement. Thirty-five enforcement actions were opened, and five enforcements
have closed. Information about the closed enforcements can be found on the program
website. Hiendlmayr stated that current pending investigations are 40 and current pending
enforcements are 40 for a total of 80 pending actions.
Hiendlmayr presented the Investigations and Enforcement Report for Occupational
Therapy Assistants for the third quarter. He stated there were three intakes which
consisted of one allegation and two applications. One investigation involving a PAMs
violation was opened. Eleven investigations were closed: two were dismissed with
advisements, one had insufficient evidence to show a violation, and eight were referred to
enforcement. Eight enforcements were opened, and three were closed. The three closed
investigations were PAMs related. Renell explained that many of the OTA PAMs
violations were handled the previous quarter, and then the OT supervisor violations were
primarily handled this quarter, which is why the third quarter results appear skewed
towards OTs instead of OTAs. Hiendlmayr stated that the current pending investigations
are 23 and current pending enforcements are nine for a total of 32 pending actions.
Hiendlmayr presented spreadsheets with a breakdown of pending investigations and
enforcements, which were created in response to a request made at the October 2011
advisory council meeting. He explained that the information is identified by file number,
and any information that would identify a practitioner has been redacted. The first
column is the file number. The second column is the date the investigation was opened.
The third column is a very brief caption about the violation, and the fourth column is a
brief description of the status. Sames asked if practitioners needed some education about
how to get PAMs approval? Renell responded that virtually all of the PAMs violation
determinations have appealed, and there is a common theme of ignorance as being the
basis for the violation occurring. Sames stated the MOTA has a PAMs course coming up
in May, and she wanted to know if there is anything they need to convey. Renell
responded that they need to know that all practitioners—regardless OT or OTA—need to
have to be issued approval from the Department before they use it. Sames thought that
was already common knowledge. Dutton noticed some investigations are outstanding
from 2000, and she wanted to know what would hold up an investigation for that long?
Renell responded that it depends on the circumstances. She noted the three OT
investigations from 2000 are actually the same person and circumstances. She explained
a lot of the holdup is trying to get information from employers, from the practitioner, or
from a third-party or getting additional facts which lead to additional violations. In the
case from 2000, the holdup was trying to get information from another state agency, in
this case DHS. Renell noted another instance that can cause an investigation to appear to
be open for a long time is if new information is given after the case gets to the
enforcement stage because then the case goes back into investigation status. Harbaugh
inquired if the practitioner continues to practice through the investigation? Renell
responded they can continue to practice unless the Department has grounds to issue a
cease and desist, and that could only be done with an incredibly egregious violation, like
serious and immediate and irreparable public harm. Renell explained due to the way the
database was designed that a violation can result in multiple open investigations if the
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Department receives multiple allegations about the violation. Three OTs are involved in
six investigations and one enforcement listed on the spreadsheets, and three OTAs are
involved in seven investigations. She noted that multiple investigations actions can be
combined into one enforcement action, but that design of how investigations are opened
in the database slightly skews the number of open investigations. Sames inquired whether
the practitioner with the case from 2004 described as “sexual contact” is still practicing?
Renell explained that the third column is based on how the case is presented to the
Department when the allegation is initially received. When all the facts start coming in
during the investigative stage, sometimes the actual violations for the case are not what
was presented in the allegation, and staff cannot go back into the allegation to change the
information. Dutton asked if the Program is satisfied with the investigation and
enforcement process? Renell responded that she is satisfied with the way investigations
are being done. Given the staff level, she thinks the process is going as fast as it can.
Hiendlmayr responded that he is not satisfied with the level of resources available to the
Program. In particular, over the last four to five years, it has been extremely hard to get
more staff resources. Dutton inquired why that would be the case when the Program is
collecting more than it is costing to run the program? Hiendlmayr responded that the
funds are there, but the Program’s appropriation and staff levels are legislatively capped.
So the Program is not able to access those funds without legislative approval.
C. Budget and Expenditure Report
Hiendlmayr presented the Third Quarter Budget and Expenditure Report for Fiscal Year
2012. Hiendlmayr noted that this the first fiscal report produced this year due to the statewide account program conversion. He stated expenditures totaled $123,000, and most of
that amount consists of salaries and fringe expenses. On the revenue side, outstanding
revenues are yet to be received from over 700 renewing OTs which will likely bring the
total receipts close to the budgeted amount for FY12. Hiendlmayr noted that the program
continues to run a surplus that gets added to the balance carry-forward, which is
approaching half a million dollars. Sames inquired whether the Program will ask for
either a fee reduction or fee holiday this next legislative session? Hiendlmayr responded
that he asked for that this last legislative session, but it was not internally approved. He
noted that the proposal may be favorable this next legislative session because of what has
happened with the Sunset Advisory Commission, which will be discussed under New
Business. Hiendlmayr stated the balance carry-forward amount does put into play is the
idea of a fee holiday for everyone for a biennium, but then what also should happen is a
reduction in the fees so that the Program is not continuing to generate another surplus
situation.
Hiendlmayr presented the Historical Financial Record & Projected Budget handout. He
noted the FY12 budget on the long term report should be identical to the FY12 on the 3rd
Quarter Budget Report, but it is not. He noted the difference between the two reports in
on the Computer Service & Equipment line item, and he explained that since he did the
long term report there was a change in that line item. He noted that the line time is
primarily the time of an IT developer that is responsible for keeping the Program’s online
renewal system and databases working properly.
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V.
Old Business
Hiendlmayr noted that there are no Old Business items.
VI.
New Business
A. Legislative Update
• HF2555, SF2304 – Sunset Advisory Commission
Hiendlmayr presented a summary of the provisions of the Sunset Review Bill that
pertained to the Health Occupations Program (HOP). Hiendlmayr explained that the
Sunset Review process was the result of legislation passed in 2010 that sets a schedule
for reviewing all executive branch agencies and scheduling them for sunset unless the
legislature acts to reauthorize their activity and operations. He noted the first group of
agencies to go through the process was the health licensing boards and several
commissions and councils. On the handout, Hiendlmayr summarized some of the
provisions where the licensing done by the Department was written into some of the
directives that are in the Sunset Review Bill. He noted that the proposed provisions in the
House and Senate bills are not the same. The first two provisions state that fee changes
have to be approved by Legislature, and fees collected can only be used for the programs
administered. The Sunset Review Commission was concerned about what was happening
with the e-licensing surcharge and the transfers of funds from the state government
special revenue fund to the general fund. Hiendlmayr stated that a sitting legislature
cannot bind a future legislature, but the Commission is making it clear that they do not
think transfers should be done in the future. The third provision requires disciplinary
information on the website as well as information about criminal convictions and any
malpractice judgments. HOP already provides disciplinary actions on the website.
However, HOP does not have a reporting requirement for malpractice judgments or
criminal convictions. The fourth provision from the House bill would require the
Commissioner to conduct a federal criminal background check at the expense of the
applicant on initial applications, and the House bill would also require that the
Commissioner and the health licensing boards conduct a study to look at imposing a
similar requirement on existing regulated individuals. The fourth provision from the
Senate bill has a requirement for the Commissioner and the health licensing boards to
conduct a study and make recommendations for establishing uniform criminal history
background check requirements applicable to initial applicants and regulated individuals.
Hiendlmayr noted that on the Senate side there is some opposition to imposing a criminal
background check on all health licensed practitioners. Hiendlmayr stated the Department
has not taken a position on the bill.
• HF2294 – Prior Authorization Amendment
Hiendlmayr presented the proposed Prior Authorization Amendment. Sames stated the
amendment stemmed from prior authorization becoming an issue where sometimes it was
taking four to six weeks for patients needing services to receive prior authorization. The
amendment proposed that if prior authorization is not made within ten days, then services
would be considered to be approved. Due to the current backlog, DHS decided to suspend
the prior authorization requirement for the rest of this calendar year. Sames noted that it
is currently unknown what will happen January 2, 2013 in terms of whether the situation
will go back to the same authorization agent and/or the same backlog of problems. Sames
stated that the amendment is on the House side, but not on the Senate side.
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B. Online PAMs Training
Hiendlmayr presented an inquiry letter from CIAO about the degree of acceptability for
online video or distance learning mediums to satisfy the PAMs course requirements.
Sames inquired if a practitioner has applied for PAMs approval in the past using an
online provider? Harbaugh stated all of the applications in the past have been in-person
courses because of the lab component. Harbaugh asked if CIAO was inquiring whether
the book learning component could be online while provide an in-person lab component?
Hiendlmayr responded that he believes that is their inquiry based on the term “didactic”
in the letter. Noska explained that she is in the process of taking a course from them on
dysphagia which does have a two-day lab component. Harbaugh inquired whether the
online course could be taken at the practitioner’s own pace? Noska stated that she had a
two-week timeline for the online portion, and she will be taking the lab component soon.
She could review the online information until she felt prepared to take the lesson test, and
the practitioner cannot go on to the next lesson until they passed the test. She stated the
course also required two written assignments, which went to a professor for review.
Buckley and Harbaugh agreed that the lab component for a PAMs course is very
important. Buckley stated she would like to see the course objectives and the course
structure. Dutton stated that the response should be asking CIAO for the course material,
and the Council agreed with that response.
C. Personal Announcement
Hiendlmayr shared that he will be leaving his position at the Department of Health in
early July. A successor has not been appointed at the present time.
Next Meeting
July 19, 2012
2:30 P.M. to 4:30 P.M.
Snelling Office Park
St. Croix Room
1645 Energy Park Drive
Saint Paul, MN 55108
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