Archived: Monday, July 28, 2025 4:28:45 PM

From: BPL-BoardSupport

Sent: Mon, 28 Jul 2025 12:34:23

To: MacIntosh, Weston (LARA)

Subject: FW: Public Comment Regarding Proposed Occupational Therapy – General Rules (MOAHR #2024-25 LR)

Importance: Normal

Sensitivity: None

Attachments:

LARA-OT-Board-Admin-Rules-Public-Comment-MiOTABBurge-25JULY25.pdf;

From: burge_otrl <burge_o[email protected]>

Sent: Friday, July 25, 2025 4:53 PM

To: BPL-BoardSupport <BPL-BoardSupport@michigan.gov>

Subject: Public Comment Regarding Proposed Occupational Therapy – General Rules (MOAHR #2024-25 LR)

CAUTION: This is an External email. Please send suspicious emails to [email protected]v

Good Afternoon,

Please accept the attached letter as public comment regarding the proposed administrative rules changes for Occupational

Therapy practice within the state of Michigan. Thank you in advance for your consideration and the opportunity to submit

comments electronically.

Sincerely,

Bethany Burge, MS, OTR/L

Michigan Occupational Therapy Association (MiOTA) Liaison to the Michigan LARA OT Board

miotaliaison@miota.org

Department of Licensing and Regulatory Affairs

Bureau of Professional Licensing– Boards and Committees Section

P.O. Box 30670

Lansing, MI 48909-8170

Attention: Departmental Specialist

July 25, 2025

Dear members of the Michigan Board of Occupational Therapists and the Department of Licensing and Regulatory Affairs,

Bureau of Professional Licensing– Boards and Committees Section,

My name is Bethany Burge and I am a member of the Michigan Occupational Therapy Association, also known as MiOTA, and

a volunteer serving as MiOTA’s Liaison the Michigan Licensing and Regulatory Affairs’ OT Board.

MiOTA represents the diverse nature, practice settings, and geographic regions of Michigan based practitioners, from urban

and suburban, to rural communities, including the upper peninsula. The proposed administrative rules changes have been

reviewed by MiOTA leadership and membership which includes representation of both Occupational Therapists and

Occupational Therapy Assistants. Therefore, as an advocate for access and delivery of occupational therapy services, MiOTA

understands the impact the proposed rule changes have for Occupational Therapists and the imperative nature of receiving

and offering comprehensive input.

I am here today to offer public comment regarding the proposed administrative general rules for Occupational Therapists in

Michigan. Several members, the Accreditation Council for Occupational Therapy Education, ACOTE, and the American

Occupational Therapy Association or AOTA have raised concern regarding several items included within the proposed rules

revision. Specifically related to SUBPART A. EDUCATIONAL STANDARDS AND EXAMINATION APPROVAL AND ADOPTION - R

338.1221 Rule 21. (3) which allows the OT Board to approve entry level occupational therapy and occupational therapy

assistant educational programs that are not accredited by ACOTE, pending the program is substantially equivalent. ACOTE and

AOTA have also submitted written comment in opposition to the proposed inclusion of non-accredited programs being

equated with providing similar educational standards and rigor as accredited educational institutions and providing a pathway

of eligibility for Michigan licensure. I have enclosed copies of their letters which express their concerns in greater detail. It is

imperative for patient safety and cost-effective care delivery that only competent, ethical, and trained individuals provide

medically necessary occupational therapy services in the State of Michigan. We collectively advocate for the OT Board to

reconsider this provision and maintain the requirement and recognition that occupational therapist and occupational therapy

assistant educational programs in the United States must be accredited by ACOTE to qualify for state licensure and practice.

Additionally, MiOTA members have raised concern regarding the removal of the jurisprudence exam requirement. Such

exams help ensure legal compliance, ethical standards, and that occupational therapy practitioners adhere to the specific laws

and regulations that govern our practice for continuity of safe, high-quality and appropriate services and encourage retaining

this requirement. MIOTA supports the inclusion and retainment of the jurisprudence exam to ensure all practicing

OT/OTA's within the Michigan understand, comply, and deliver ethical practice. With pending legislation related to the OT

Compact recently passed by the Michigan House of Representatives (HB 4104 & HB 4104) and is currently under review within

the Michigan Senate, the proposed jurisprudence exam related rule change may negatively impact that bill and the overall

safety and well-being for Michigan residents receiving medical services. Maintaining the jurisprudence exam requirement is

also aligned with rules governing physical therapy practice.

Specific comments regarding these issues have also been submitted in writing directly to the OT Board for review and

consideration. I highly encourage you to thoroughly review and consider all of the comments submitted by various MiOTA

members, groups, educational institutions, and advocacy agencies to encourage best practice, consistency, protects the

public, and upholds the integrity of the occupational therapy profession within the great State of Michigan. We appreciate

the diligent conversations and thoughtful deliberations that the OT Board and the Bureau staff have engaged in to draft

streamlined standards with increased transparency and thank you in advance for your consideration of these concerns.

Sincerely,

Bethany Burge, MS, OTR/L

Michigan Occupational Therapy Association Liaison to the Michigan LARA OT Board

miotaliaison@miota.org

Accreditation Council for Occupational Therapy Education (ACOTE®)

7501 Wisconsin Ave. Suite 510E, Bethesda, MD 20814

Phone: (301) 652-2682 • Email: [email protected]

Date: July 23, 2025

Michigan Board of Occupational Therapists

Department of Licensing and Regulatory Affairs

Bureau of Professional Licensing

611 W. Ottawa Street, UL-5

Lansing, MI 48933

Subject: Concerns Regarding Proposed Rule on Educational Program Equivalency

Dear Members of the Michigan Board of Occupational Therapists,

I am writing on behalf of ACOTE to express concerns regarding the proposed revisions to the

Occupational Therapy – General Rules (MOAHR #2024-25 LR), specifically the provision that

would allow the Board to approve occupational therapy and occupational therapy assistant

educational programs that are not accredited by the Accreditation Council for Occupational

Therapy Education (ACOTE), provided the Board determines the program to be “substantially

equivalent.”

ACOTE is committed to ensuring the integrity, quality, and consistency of occupational therapy

education. ACOTE accreditation is a rigorous, evidence-based process that ensures programs

meet established Standards essential for preparing competent, ethical, and safe practitioners.

Allowing non-ACOTE-accredited programs to be approved based on a subjective determination

of “substantial equivalency” undermines this process and introduces significant risks to public

safety, professional credibility, and educational consistency. Key concerns include:

•

Conflict of Interest Concerns: Granting the Board authority to approve non-accredited

programs based on subjective equivalency raises serious concerns about potential conflicts

of interest. Without independent oversight, there is a risk that decisions may be influenced

by political, financial, or institutional pressures rather than objective educational quality. This

undermines public trust and the credibility of the licensing process.

•

Lack of Transparency and Accountability: The proposed rule does not specify the criteria

or process by which the Board will assess equivalency. Without clear, objective standards,

decisions may be inconsistent and vulnerable to bias or external influence.

Risk to Public Safety and Patient Care: Occupational therapists and occupational therapy

assistants work with vulnerable populations. Graduates of programs not held to ACOTE

Standards may lack critical competencies, posing risks to the individuals they serve.

Devaluation of Accreditation Standards: This rule could incentivize the development of

substandard programs that bypass ACOTE’s rigorous review, ultimately eroding the

educational Standards that have been carefully built over decades.

Accreditation Council for Occupational Therapy Education (ACOTE®)

7501 Wisconsin Ave. Suite 510E, Bethesda, MD 20814

Phone: (301) 652-2682 • Email: [email protected]

•

National Implications: Michigan’s decision may set a precedent that other states follow,

leading to a fragmented and diluted educational landscape across the country.

I strongly urge the Board to reconsider this provision and maintain the requirement that

occupational therapy and occupational therapy assistant educational programs in the United

States be accredited by ACOTE. Doing so ensures consistency, protects the public, and

upholds the integrity of the occupational therapy profession.

Thank you for your attention to this critical matter. I welcome the opportunity to discuss these

concerns further and contribute to a solution that prioritizes quality and safety. Please contact

me at [email protected] or 240-482.4128 if you have questions or need additional

information.

Sincerely,

Teresa Brininger, PhD, MBA, OT

Director, Accreditation, ACOTE

July 23, 2025

Department of Licensing and Regulatory Affairs

Bureau of Professional Licensing – Boards and Committees Section

P.O. Box 30670

Lansing, MI 48909-8170

Attention: Dena Marks, Departmental Specialist

RE: Comments on proposed occupational therapy regulations (MOAHR #2024-25 LR)

Dear Sir or Madam:

The Michigan Occupational Therapy Association (MiOTA) is dedicated to facilitating optimal occupational

therapy services throughout Michigan, ensuring the profession’s growth and impact for years to come.

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 1337 members in Michigan. 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 Board of

Occupational Therapists in its mission to protect the health, safety, and welfare of Michigan consumers and

the authority of the Board to create regulations to achieve this mission.

On behalf of MiOTA and AOTA, we are writing to provide comment on the Board’s proposed changes to

rules R 338.1221 and R 338.1231, both of which propose new language to allow an occupational therapist

(OT) or occupational therapy assistant (OTA) educational program not accredited by the Accreditation

Council for Occupational Therapy Education (ACOTE®) to be approved by the board “if the board

determines that it is substantially equivalent to a program accredited by the ACOTE.” MiOTA and AOTA

have serious concerns about this provision as outlined below.

Accreditation serves a vital purpose in protecting the public by establishing uniform, rigorous standards for

OT and OTA academic programs. It would also jeopardize public safety by allowing into the profession

licensees whose academic programs do not provide the same level of rigorous training and clinical

preparation as is required by an ACOTE accredited program. Further, if state licensing entities begin using

subjective standards, such as this proposal requires, to allow unaccredited programs to be acceptable for

obtaining a license, it would set a precedent potentially for other states to do the same, which would result

in a patchwork of state requirements for academic programs to meet and create significant difficulty for

graduates to become licensed, since graduation from an ACOTE-accredited program is required to be

eligible to take the National Board for Certification in Occupational Therapy (NBCOT®) exam.

Accreditation has been part of the mission of AOTA for over 100 years. ACOTE is recognized by both the

U.S. Department of Education and by the Council for Higher Education Accreditation as the accrediting

agency for occupational therapy education. As a result, it must periodically show that ACOTE standards

meet specific quality expectations that are intended to demonstrate to the public that the accreditor is

holding the programs it accredits to a specific standard that ensures students receive a high-quality

education. There is no guarantee that an academic program that is not accredited by ACOTE is undergoing

the same level of review or evaluation. As you may know, all states in the United States, plus Washington,

DC and some U.S. territories, require U.S. trained OTs and OTAs to be licensed and all jurisdictions require

an applicant to have graduated from an ACOTE–accredited academic program.

We are also not clear what problem this additional text is trying to address. We understand that current

rules R 338.1224 and R 338.1234a, which also address non-accredited academic programs, are being

rescinded so that all rules related to education program standards can be combined into a single rule for

OTs and a single rule for OTAs, but beyond that the intent of this change is not clear. For example, if the

rule is intended to provide a pathway to licensure for an applicant who graduated from an academic

program in Canada, the text of the proposed rule should reflect that. MiOTA and AOTA are glad to work

with the Board to develop language that clarifies the intent.

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 us if you have questions or need

additional information about our position.

Sincerely,

Cathleen Johnson /s/

Kristen Neville

Manager, State Affairs

AOTA

Cathleen Johnson, OTD, OTR/L

President

Michigan Occupational Therapy Association

[email protected]rg

[email protected]

MIOTA@miota@org

____________________________________________________________________________________

_______________

Department of Licensing and Regulatory Affairs

Bureau of Professional Licensing

611 W. Ottawa Street, UL-5

Lansing, MI 48933

July 24,2025

Subject: Concerns Regarding Proposed Rule on Educational Program Equivalency and

Jurisprudence Examination

Dear Members of the Michigan Board of Occupational Therapists,

I am writing on behalf of the Michigan Occupational Therapy Association(MIOTA) to

express concerns regarding the proposed revisions to the Occupational Therapy –

General Rules (MOAHR #2024-25 LR), specifically the provision that would allow the

Board to approve occupational therapy and occupational therapy assistant educational

programs that are not accredited by the Accreditation Council for Occupational Therapy

Education (ACOTE), provided the Board determines the program to be “substantially

equivalent.”

MIOTA fully supports ACOTE and DOES NOT support the proposed change to allow

graduates to receive licensure in Michigan from non-accredited institutions. This

substantially rises concern for ethical and safe practice without the oversight of a

consistent accreditation body regulating educational standards and curriculum

consistency. Further support and examples are provided in the letter submitted by

ACOTE.

Additionally, MIOTA DOES NOT support the removal of the jurisprudence examination

from the initial or renewal licensure. The examination provides oversight on general

rules, regulations, and ethical practice in Michigan. MIOTA has currently submitted and

passed legislation out of the House regarding the Occupational Therapy Interstate

Compact Privilege, which requires all providers to complete the exam and ensure

ethical understanding and practice.

Please consider re-reviewing the language pertaining to ACOTE and accreditation, as

well as reconsideration to keep the jurisprudence exam for all occupational providers to

ensure awareness of safety and ethical practice for all occupational therapists and

occupational therapy assistants (big or small).

Thank you for your time and reconsideration of the proposed language,

Denise Hoffman, OTD, OTRL, BCP, FMIOTA, FAOTA (MIOTA Advocacy and Legislative

Director)

Archived: Monday, July 28, 2025 4:34:57 PM

From: BPL-BoardSupport

Sent: Mon, 28 Jul 2025 19:53:34

To: MacIntosh, Weston (LARA)

Subject: FW: Public Comment of Opposition to LARA Proposed Rules

Importance: Normal

Sensitivity: None

Attachments:

LARA opposition signed .docx; ~WRD0777.jpg;

Here you go, Wes!

Kim

From: Denise Hoffman <[email protected]>

Sent: Friday, July 25, 2025 1:15 PM

To: BPL-BoardSupport <BPL-BoardSupport@michigan.gov>

Subject: Public Comment of Opposition to LARA Proposed Rules

CAUTION: This is an External email. Please send suspicious emails to [email protected]

Dear Members of the Michigan Board of Occupational Therapists,

On behalf of the Michigan Occupational Therapy Association (MIOTA), I am writing to formally express our strong

opposition to the proposed non accredited occupational therapy programs AND to the removal of the jurisprudence

exam.

MIOTA fully supports ACOTE and DOES NOT support the proposed change to allow graduates to receive licensure in

Michigan from non-accredited institutions as proposed revisions to the Occupational Therapy – General Rules

(MOAHR #2024-25 LR), specifically allowing the Board to approve occupational therapy and occupational therapy

assistant educational programs that are not accredited by the Accreditation Council for Occupational Therapy Education

(ACOTE), provided the LARA Board determines the program to be “substantially equivalent.” This substantially raises

concern for ethical and safe practice without the oversight of an accreditation body regulating educational standards and

curriculum consistencies aligned evidenced based research. Please refer to additional comments of concern and

examples in the letter submitted by ACOTE.

Additionally, MIOTA DOES NOT support the removal of the jurisprudence examination from the initial or renewal

occupational therapy licensure. The jurisprudence exam serves a critical function in ensuring that newly licensed

occupational therapists (OTs) and occupational therapy assistants (OTAs) possess a working knowledge of the

specific legal and regulatory framework under which they must practice in our state. Removing this requirement would

significantly weaken our shared mission of protecting the public by ensuring competent and ethically grounded

practitioners.

Our key concerns are as follows:

1. Public Protection and Accountability:

Occupational therapy professionals must understand and adhere to state-specific laws and rules that govern

their scope of practice, supervision requirements, and professional conduct. The jurisprudence exam reinforces

this accountability and ensures that all licensees have reviewed and internalized these responsibilities.

2. Consistency and Professionalism:

The jurisprudence exam promotes uniformity in understanding the legal expectations across the profession. It

also serves as a clear signal of professionalism and readiness to uphold the standards required by the licensing

board.

3. Preventing Unintentional Violations:

Without formal assessment, new practitioners may overlook critical legal requirements, leading to unintended

violations that could harm clients or result in disciplinary actions. A jurisprudence exam helps mitigate these

risks through structured learning and assessment.

4. Alignment with Other Professions:

Many other licensed healthcare professions in Michigan, including physical therapy, require jurisprudence exams

as part of their licensure process. Maintaining this requirement for occupational therapy ensures alignment and

reflects the profession’s commitment to high standards.

5. Impacts Current Proposed Legislation:

HB 4103 and 4104, Occupational Therapy Compact, legislation to manage shortages and support the

needs of Michigan consumers is advocating for current legislation in the Senate which will require out

of state occupational therapist and assistance to take the jurisprudence exam, hence removing this

exam will impact pending legislation and ethical practice for consumers in areas of shortages and

limited access to care.

We recognize the board's intention to streamline licensure procedures and reduce barriers; however, we believe

eliminating the jurisprudence exam and removing accreditation standards compromises public safety and professional

integrity more than it improves efficiency. We urge the board to explore alternative solutions—such as updating or

modernizing the exam format—rather than eliminating it entirely.

MIOTA is a representation of voices from all areas of occupational therapy practice and all geographic locations in

Michigan providing a realistic understanding of the diversity of needs throughout the state. MIOTA remains committed to

working collaboratively with the licensing board to support a fair, effective, and rigorous licensure process that upholds

the values of safety, competence, and ethical care.

Thank you for considering our position. We welcome the opportunity to provide further input and participate in any future

discussions regarding this matter.

** Word document is attached with these comments of opposition from MIOTA.

Kind Regards,

Denise Hoffman, OTD, OTRL, BCP, FMiOTA

Michigan Occupational Therapy Association

Legislative & Advocacy Director

[email protected]

Cell:269-330-2113

MiOTA Advocacy Action

Lansing Lobby Day 2025

"Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only

thing that ever has."

Margaret Mead

124 W Allegan St #1900

Lansing, MI 48933

MIOTA@miota@org

___________________________________________________________________________________________________

Department of Licensing and Regulatory Aﬀairs / Bureau of Professional Licensing

611 W. Ottawa Street, UL-5

Lansing, MI 48933

July 24,2025

Subject: Concerns Regarding Proposed Rule on Educational Program Equivalency and Jurisprudence

Examination

Dear Members of the Michigan Board of Occupational Therapists,

On behalf of the Michigan Occupational Therapy Association (MIOTA), I am writing to formally

express our strong opposition to the proposed non accredited occupational therapy programs AND

to the removal of the jurisprudence exam.

MIOTA fully supports ACOTE and DOES NOT support the proposed change to allow graduates to

receive licensure in Michigan from non-accredited institutions as proposed revisions to the

Occupational Therapy – General Rules (MOAHR #2024-25 LR), speciﬁcally allowing the Board to

approve occupational therapy and occupational therapy assistant educational programs that are

not accredited by the Accreditation Council for Occupational Therapy Education (ACOTE), provided

the LARA Board determines the program to be “substantially equivalent.” This substantially rises

concern for ethical and safe practice without the oversight of an accreditation body regulating

educational standards and curriculum consistencies aligned evidenced based research. Please

refer to additional comments of concern and examples in the letter submitted by ACOTE.

Additionally, MIOTA DOES NOT support the removal of the jurisprudence examination from the

initial or renewal occupational therapy licensure. The jurisprudence exam serves a critical function

in ensuring that newly licensed occupational therapists (OTs) and occupational therapy assistants

(OTAs) possess a working knowledge of the speciﬁc legal and regulatory framework under which

they must practice in our state. Removing this requirement would signiﬁcantly weaken our shared

mission of protecting the public by ensuring competent and ethically grounded practitioners.

Our key concerns are as follows:

1. Public Protection and Accountability:

Occupational therapy professionals must understand and adhere to state-specific laws

and rules that govern their scope of practice, supervision requirements, and professional

conduct. The jurisprudence exam reinforces this accountability and ensures that all

licensees have reviewed and internalized these responsibilities.

2. Consistency and Professionalism:

The jurisprudence exam promotes uniformity in understanding the legal expectations

across the profession. It also serves as a clear signal of professionalism and readiness to

uphold the standards required by the licensing board.

3. Preventing Unintentional Violations:

Without formal assessment, new practitioners may overlook critical legal requirements,

leading to unintended violations that could harm clients or result in disciplinary actions. A

jurisprudence exam helps mitigate these risks through structured learning and

assessment.

4. Alignment with Other Professions:

Many other licensed healthcare professions in Michigan, including physical therapy, require

jurisprudence exams as part of their licensure process. Maintaining this requirement for

occupational therapy ensures alignment and reflects the profession’s commitment to high

standards.

5. Impacts Current Proposed Legislation:

HB 4103 and 4104, Occupational Therapy Compact, legislation to manage shortages and

support the needs of Michigan consumers is advocating for current legislation in the Senate

which will require out of state occupational therapist and assistance to take the

jurisprudence exam, hence removing this exam will impact pending legislation and ethical

practice for consumers in areas of shortages and limited access to care.

We recognize the board's intention to streamline licensure procedures and reduce barriers;

however, we believe eliminating the jurisprudence exam and removing accreditation standards

compromises public safety and professional integrity more than it improves efficiency. We urge the

board to explore alternative solutions—such as updating or modernizing the exam format—rather

than eliminating it entirely.

MIOTA is a representation of voices from all areas of occupational therapy practice and all

geographic locations in Michigan providing a realistic understanding of the diversity of needs

throughout the state. MIOTA remains committed to working collaboratively with the licensing board

to support a fair, effective, and rigorous licensure process that upholds the values of safety,

competence, and ethical care.

Thank you for considering our position. We welcome the opportunity to provide further input and

participate in any future discussions regarding this matter.

Sincerely,

Denise Hoﬀman, OTD, OTRL, BCP, FMIOTA, FAOTA

MIOTA Advocacy and Legislative Director