Scope of Practice - OT - Integrative Dry Needling

Does your Scope of Practice allow Dry Needling?

U.S. Dry Needling Scope of OT Practice Decisions

The Integrative Dry Needling Institute LLC is solely an educational resource to provide the knowledge and technical skills necessary to deliver safe and effective dry needling treatment. The Integrative Dry Needling Institute LLC does not make policy, claims, or interpretation on professional licensure or scope of practice. The Integrative Dry Needling Institute LLC encourages all participants to contact their licensing board for official positions and rulings related to the practice of dry needling. It is your responsibility to know, understand and practice within the specific rules, regulations and guidelines of your state, jurisdiction and professional license.

Click on the below boxes to view the state information provided by AOTA State Affairs Group and individual state boards after communication with each state board as of the date listed by Mary Barnes MOT, CHT, CIDN,

Alabama

Although it is not mentioned in the practice act, the Board has agreed that is it within the scope of occupational therapy as long as the person has been educated or trained to provide the service.

Ann Cosby

Executive Director

Alabama State Board of Occupational Therapy

770 Washington Avenue

Suite 420

Montgomery, AL 36130-4501

334-353-4466

334-353-4465 (fax)

Alaska

Based on the workgroup recommendations, with further review by the Board of Physical Therapy and Occupational Therapy, it has been determined that the current occupational therapy scope of practice description in statute 08.84.190 does not support dry needling by occupational therapists regardless of education and training. At this time, statutory change is required to perform dry needling. Learn more and read the official statements here.

Arizona

The Board has a statement at the below link that dry needing is considered a Physical Agent Modality (PAM) used by OT’s. Link

Arkansas

March 22′

There is currently no reference to the allowance for dry needling in the Medical Practices Act found on the ASMB website (www.armedicalboard.org [armedicalboard.org]).

At the December 2017 meeting the Arkansas Occupational Therapy Examining Committee discussed dry needling. The decision of the Committee was that a statutory change to the Occupational Therapy Practice Act would be required in order for dry needling to be included in the occupational therapy scope of practice in the state.

I hope this provides the resolution you are seeking. Thank you for contacting the Arkansas State Medical Board.

Heather Owen

Licensing Supervisor

Arkansas State Medical Board

Arkansas Department of Health

1401 West Capitol, Suite 340, Little Rock, AR 72201

Office: 501-296-1802 | Fax: 501-296-1972

LicenseMonitor@armedicalboard.org

California

The OT Practice Act and regulations are silent on dry needling. However, Business and Professions Code (BPC) Section 4935(a)(1), states in part, that it is a violation “…for any person who does not hold a current and valid license to practice acupuncture under this chapter…” BPC Section 4927 defines acupuncture as “the stimulation of a certain point or points on or near the surface of the body by the insertion of needles to prevent or modify the perception of pain or to normalize physiological functions, including pain control for the treatment of certain diseases or dysfunctions of the body…”

reference:

Colorado

In May 2024, the OT Association of Colorado received the following statement from DORA regarding dry needling and posted it on oyd facebook page: “OT’s in Colorado are not permitted by statute or rule to perform dry needling, a modality that presents unique risks and requires specific training. In contrast, both physical therapists and chiropractors have explicit authorizations in statute to puncture skin with needles, and both have rules specific to dry needling that require additional training and signed client consent forms to perform the modality. Remember that the Department of Regulatory Agencies is an executive branch agency and acts to enforce laws made by the Colorado General Assembly.”

Connecticut

CT Medical Assistance Program Provider Bulletin 2022-50 Effective for dates of service July 1, 2022, moving forward, DSS added CPT codes 20560 and 20561 to the Independent PT and OT fee schedule. Providers are eligible if the services are consistent with the Department of Public Health practitioner’s scope of practice requirements. If dry needling is not within the scope of practice, the service should not be billed to CMAP.

Delaware

Good afternoon,

After reviewing the laws and regulations, dry needling is only mentioned in Physical Therapy:

https://regulations.delaware.gov/register/may2017/final/20%20DE%20Reg%20913%2005-01-17.htm

See section 15.4.

Division of Professional Regulation

861 Silver Lake Blvd., Suite 203

Dover, DE 19904

(302) 744-4500

ref:_00DC016khO._5008y3GsV5:ref

District of Columbia

During a Board meeting in September 2019, after discussion, the Board agreed that though not specified in the OT regulations, OTs who have advanced training or certification in dry needling would be allowed to practice it.

Florida

On June 1, 2023, The OT Board responded to a Petition for Declaratory Statement, which cited the Board’s existing regulations on electrical stimulation devices, ultrasound devices, and neurofeedback device, and asking for “guidance as to whether she can perform/receive reimbursement for taking CE courses and becoming certified in the modality of dry needling.” The Board ruled that dry needling is “not a statutorily accepted prescription device” and would therefore “be outside the scope of Occupational Therapy.”

Georgia

POSITION STATEMENT ON DRY NEEDLING posted on Board website in April, 2024: https://sos.ga.gov/sites/default/files/2024-
04/Dry%20Needling%20Position%20Statement.pdf
The American Occupational Therapy Association (AOTA) notified each agency/board responsible for licensing occupational therapists (OTs) and occupational therapy assistants (OTA)s of their intent to propose an Adjunctive & Preparatory Techniques policy asserting that dry needling is an adjunctive and preparatory technique. The policy further stipulates that adjunctive and preparatory techniques, to include but not limited to dry needling, can be utilized by OTs and OTAs who possess the advanced training or certification to do so and who operate in accordance with local and state policies, rules, and regulations. As a result of AOTA’s proposed policy, the increase in courses offering dry needling certification to OTs and OTAs, and the national conversation surrounding the practice of dry needling by licensed OTs and OTAs, the Georgia State Board of Occupational Therapy has noted a substantial increase in the number of inquiries involving the legalities of the practice of dry needling by Georgia licensed occupational therapists and occupational therapy assistants. In response, the Board requested counsel to conduct a review of the laws governing the practice of occupational therapy and other professions within the State of Georgia to determine if any statutory authority exists to allow the practice of dry needling by the persons licensed under the Georgia Occupational Therapy Practice Act. After careful consideration of the statutory review, it has been determined that dry needling is not statutorily authorized in the Occupational Therapy Practice Act and is therefore not within the scope of occupational therapy within the State of Georgia. A legislative change to the Occupational Therapy Practice Act would be necessary to permit the practice of dry needling by OTs and OTAs in this state. (Emphasis added.) The Georgia State Board of Occupational Therapy is not eligible to present a Bill to the Georgia General Assembly for consideration; however, the Board may consider amendments proposed by other persons as well as any public comments relative to the proposals and release a position statement if warranted. The Board will distribute a copy of this statement to AOTA and Georgia Occupational Therapy Association (GOTA) and post a copy on the Board website for the public to review. Members of the public who are interested in identifying whether a Bill has been proposed to the legislature to amend the Occupational Therapy Practice Act are encouraged to visit the Georgia General Assembly website at https://www.legis.ga.gov/search to conduct a search using the keywords feature.

Hawaii

March 22′

Please see Hawaii Revised Statutes (“HRS”) 457G-1.5(a)(3)(N):

457G-1.5 Practice of occupational therapy. (a) The practice of occupational therapy is the therapeutic use of everyday life activities with individuals or groups for the purpose of participation in roles and situations in home, school, workplace, community, and other settings. It includes:

(3)

Interventions and procedures to promote or enhance safety and performance in activities of daily living, instrumental activities of daily living, rest and sleep, education, work, play, leisure, and social participation, including:

(N)

Application of physical agent modalities and use of a range of specific therapeutic procedures, such as wound care management, interventions to enhance sensory-perceptual and cognitive processing, and manual therapy, to enhance performance skills;

Therefore, pursuant to the above, the application of physical agent modalities is allowed. However, while you stated that AOTA determined that dry needling is a physical agent modality, the Hawaii statutes are silent regarding the use of dry needling.

Lastly, please be advised that in accordance with HAR §16-201-90, the above interpretation is for informational and explanatory purposes only. It is not an official opinion or decision, and therefore is not to be viewed as binding on the Occupational Therapy Program or the Department of Commerce and Consumer Affairs.

Thank you,

Risé Doi (she/her/hers)

Executive Officer

State of Hawaii Department of Commerce and Consumer Affairs

Professional & Vocational Licensing Division

Idaho

March 22′

The Board has not issued any guidance on Dry Needling. We are aware of AOTA’s position. Thanks.

Best Regards,

Jan Arrasmith

Education & Practice Specialist

Health Professions

Idaho Division of Occupational and Professional Licenses

Work: 208.488.7529

Jan.Arrasmith@DOPL.Idaho.gov

Illinois

Statute: 225 ILCS 75/2. Definitions.
(7) “Occupational therapy services” means services that may be provided to individuals, groups, and populations, when provided to treat an occupational therapy need, including the following:

(e) for the occupational therapist or occupational, therapy assistant possessing advanced training, skill, and competency as demonstrated through criteria that shall be determined by the Department, applying physical agent modalities, including dry needling, as an adjunct to or in preparation for engagement in occupations;

(f) evaluating and providing intervention in, collaboration with the client, family, caregiver, or others;

(g) educating the client, family, caregiver, or, others in carrying out appropriate nonskilled interventions;

(h) consulting with groups, programs, organizations, or communities to provide population-based services;

(i) assessing, recommending, and training in, techniques to enhance functional mobility, including wheelchair management;

(j) driver rehabilitation and community, mobility;

(k) management of feeding, eating, and, swallowing to enable or enhance performance of these tasks;

(l) low vision rehabilitation;

(m) lymphedema and wound care management;

(n) pain management; and

(o) care coordination, case management, and, transition services.

Statute: 225 ILCS 75/3.7 Use of dry needling.

(a) For the purpose of this Act, “dry needling”, also known as intramuscular therapy, means an advanced needling, skill or technique limited to the treatment of myofascial pain, using a single use, single insertion, sterile filiform needle (without the use of heat, cold, or any other added modality or medication), that is inserted into the skin or underlying tissues to stimulate trigger points. Dry needling may apply theory based only upon Western medical concepts, requires an examination and diagnosis, and treats specific anatomic entities selected according to physical signs. “Dry needling” does not include the teaching or application of acupuncture described by the stimulation of auricular points, utilization of distal points or non-local points, needle retention, application of retained electric stimulation leads, or other acupuncture theory.

(b) An occupational therapist or occupational therapy assistant licensed under this Act may only perform dry needling after completion of requirements, as determined by the Department by rule, that meet or exceed the following:

A) modalities using electricity. These would cover pain control, edema reduction, and muscle reeducation.

Examples include, but are not limited to, biofeedback, neuromuscular electrical stimulation/functional electrical stimulation

(NMES/FES), transcutaneous electrical nerve stimulation (TENS), high volt pulsed stimulation (HVPS), interferential, and iontophoresis;

B) thermal modalities, including superficial and deep heat and cryotherapy. Examples include, but are not limited to, hot and cold packs, ice massage, fluidotherapy, warm whirlpool, cool whirlpool, ultrasound, phonophoresis, paraffin and contrast baths, and lasers;

C) modalities using mechanical forces including touch, pressure, traction, stretch, stroke, petrissage, friction, vibration, oscillating and/or translating in different vectors/planes. Examples include, but are not limited to, soft tissue mobilization such as manual lymph drainage, elastic taping application, joint mobilization and tool assisted fascial remodeling such as assisted soft tissue mobilization

(ASYM), dynamic cupping or pneumatic compression;

D) dry needling/Intramuscular Manual Therapy.

A) modalities using electricity. These would cover pain control, edema reduction, and muscle reeducation.

Examples include, but are not limited to, biofeedback, neuromuscular electrical stimulation/functional electrical stimulation

(NMES/FES), transcutaneous electrical nerve stimulation (TENS), high volt pulsed stimulation (HVPS), interferential, and iontophoresis;

(ASYM), dynamic cupping or pneumatic compression;

D) dry needling/Intramuscular Manual Therapy.

d) The training required for the use of dry needling/intramuscular manual therapy under Section 3.7 of the Act must include: 1) Successful completion of 50 hours of college-level instruction from an accredited program… in the following areas:

A) the musculoskeletal and neuromuscular system;

B) the anatomical basis of pain mechanisms, chronic pain and referred pain;

C) myofascial trigger point theory; and

D) universal precautions.

2) Completion of at least 30 hours of didactic course work specific to intramuscular manual therapy. This requirement can be fulfilled…by didactic pre-study required for the intramuscular manual therapy practicum course. This may include, but is not limited to, distance learning such as web-based courses or webinars, required textbook assignments and pre-course work.

3) Practicum Hours.

A) Successful completion of at least 54 practicum hours in intramuscular manual therapy offered through an approved CE sponsor asdescribe whether the course offers introductory or advanced instruction in intramuscular manual therapy. Each instruction course shall include the following areas: defined in Section 1315.145. Each instructional course shall specify what anatomical regions are included in the instruction and describe whether the course offers introductory or advanced instruction in intramuscular manual therapy. Each instruction course shall include the following areas

i) intramuscular manual therapy technique;

ii) intramuscular manual therapy indications and contraindications;

iii) documentation of intramuscular manual therapy;

iv) management of adverse effects;

v) practical psychomotor competency; and

vi) the Occupational Safety and Health Administrations Bloodborne Pathogens

B) Classes qualifying for completion of the mandated 54 hours of intramuscular manual therapy shall be in one or more modules, with the initial module being no fewer than 27 hours. The 54 practicum hours must be completed within 24 months after the start of study. 4) Completion of at least 200 patient treatment sessions.

A) Occupational therapists must complete the treatment sessions under general supervision by a medical professional who has previously fulfilled the necessary dry needling/intramuscular manual therapy credentials.

B) Occupational therapy assistants must complete the treatment sessions under direct line of sight supervision by a licensed occupational therapist who has previously met the requirements for dry needling/intramuscular manual therapy credentials.

5) Successful completion of a competency examination approved by the Division. The Division will accept competency examinations administered as part of the intramuscular manual therapy practicum course work.

6) Each licensee is responsible for maintaining records of the completion of the requirements of this subsection (a) and shall be prepared to produce those records upon request by the Division.

7) Intramuscular manual therapy may be performed by a licensed occupational therapist and only be delegated to a licensed occupational therapy assistant that has met the requirements of this subsection (d) and is supervised by a licensed occupational therapist who has met the requirements of this subsection (d) and maintains direct line of sight observation and supervision of the occupational therapy assistant at all times while the treatment is rendered.

8) An occupational therapist or occupational therapy assistant shall not advertise, describe to patients or the public, or otherwise represent that dry needling/intramuscular manual therapy is acupuncture, nor shall he or she represent that he or she practices acupuncture unless separately licensed under the Acupuncture Practice Act [225 ILCS 2].

Nothing in this Section shall be construed as preventing or restricting the practices, services or activities of any person licensed in this State by any other law or occupation for which the person is licensed.

Indiana

March 22′

Indiana

Thank you for contacting the Indiana Professional Licensing Agency. Please visit our website http://www.in.gov/pla/ot.htm , where you may access the Indiana Occupational Therapy Committee Licensure Laws and Regulations, application requirements, and general license information. Please be advised that the Indiana Attorney General’s Office has advised the Professional Licensing Agency that the agency’s staff and the Indiana Occupational Therapy Committee are not in a position to give advisory opinions. The statutes and rules are published and available on our website, http://www.in.gov/pla/2518.htm for the public to reference regarding their particular situation. It will be necessary for you to contact your own legal counsel for an interpretation of the statutes and/or rules regarding your particular situation if you are unable to determine compliance on your own.

Sincerely,

Indiana Professional Licensing Agency

Indiana Occupational Therapy Committee

402 West Washington Street, Room W072

Indianapolis, Indiana 46204

Office: 317- 234-8800

Fax: 317-233-4236

www.pla.in.gov

Iowa

March 22′

Here is the offical response on dry needling from the OT board executive.

It is the current consensus of the Board that dry needling does not appear to be prohibited by the law or administrative rules. However, dry needling is an advanced skill that requires additional training beyond entry-level education and should only be performed by OTs who have completed additional education and demonstrated knowledge, skill, ability and competency in the performance of the procedure. If the Board determines that an OT Is performing dry needling outside their training or expertise it could result in the licensee being disciplined by the Board. The Board has not issued an official opinion or policy statement on the performance of dry needling by Iowa licensed OTs. The Board will continue to evaluate information regarding this issue as it becomes available.

From: IDPH, PLPublic <plpublic@idph.iowa.gov>

Date: Tue, Jan 25, 2022 at 3:01 PM

Subject: Fwd: Occupational Therapy Board

To: Gavin Nordberg <gavin.nordberg@idph.iowa.gov>o

Kansas

March 22′

Thank you for contacting the Kansas State Board of Healing Arts. This message is from the Office of the General Counsel who represents the Board. The Office of the General Counsel does not render legal advice or services to private individuals or entities. All statements are intended as general guidance and do not necessarily represent the position of the Board. No warranties or representations are made regarding the completeness or adequacy of the information provided. You should not construe this general guidance as legal advice or the establishment of an attorney-client relationship. It is necessary that you obtain independent legal counsel for an application of the law to your particular situation.

The scope of practice for occupational therapy is outlined in K.S.A 65-5402. While the Board has not had an occasion to take an official position on whether dry needling is within an OT’s scope of practice, it is likely not within the scope of practice for an OT in Kansas as the law is currently written or interpreted.

Other professional licensure scopes (i.e. PTs pursuant to K.S.A. 65-2923 and K.A.R. 100-29-18 and L.Ac (acupuncture) under K.S.A. 65-7602(i)) include dry needling specifically in their statutes . An OT practicing those procedures may be considered engaged in the unlicensed practice of these professions.

Here is a link to the Kansas Occupational Therapy Practice Act, K.S.A. 65- 5401 et seq, and its regulations:

http://www.ksbha.org/documents/publications/PracticeHandbook_OTOTA.pdf

It might be a good idea to reach out to the KOTA (www.kotaonline.org) to see where they are at with the matter, as it might be something that is already on their radar.

Sincerely,

The Office of the General Counsel

Kentucky

March 22′

The Board regrets to inform you that it is not authorized to issue advisory opinions. This means any answer volunteered by the Board would be neither authoritative nor binding on any court, licensee, or future board.

We recommend you consult The Kentucky Occupational Therapy Practice Act, which can be found in Chapter 319A of the Kentucky Revised Statutes, and the Board’s administrative regulations, which can be found in Chapter 28 of Title 201 of the Kentucky Administrative Regulations. You might also consult an attorney.

The Board is aware of a position paper about dry needling from the AOTA, but cannot provide an opinion. https://www.aota.org/Practice/Manage/Scope-of-Practice-QA/dry-needling.aspx

Thanks,

Chessica Nation

Administrative Section Supervisor

Department of Professional Licensing

P.O. Box 1360

Frankfort, KY 40602

http://dpl.ky.gov

Louisiana

March 22′

The Occupational Therapy Advisory Committee (OTAC) of the Louisiana State Board of Medical Examiners (LSBME) is currently reviewing our Rules for needed updated language and changes. The issue of dry needling, and other modalities with a high risk of potential harm, has been researched and discussed in partnership with the Louisiana Occupational Therapy Association. No specific language has been drafted yet. We have been following the AOTA’s recent decisions.

OTAC provided an Advisory Opinion on Dry Needling to the LSBME in 12/2020 in which we stated that dry needling is within the scope of occupational therapy, but is not an entry-level skill, and that it requires continuing education and certification in order to protect the public from harm.

Sincerely,

Darbi Philibert, Chair, and

Ingrid Franc, Co-Chair

OT Advisory Committee of the Louisiana State Board of Medical Examiners

Maine

March 22′

Thank you for your message. The board has not issued any guidance on the use of dry needling. We will present your email to the board at the next meeting. Tentatively scheduled for March 18, 2022 at 9am.

Board meeting information can be found at https://www.maine.gov/pfr/professionallicensing/professions/board-occupational-therapy-practice/home/board-meeting-information

Thank you,

Tammy Reed

Office Specialist I

Office of Professional & Occupational Regulation

35 State House Station

Augusta, ME 04333-0035

Ph (207) 624-8624

Fax (207) 624-8637

Hearing Impaired /TTY (888) 577-6690

www.maine.gov/professionallicensing

Maryland

Proposed regulations (published January 2024):
.01 Scope.
This chapter establishes standards for the provision of dry needling as an intervention performed by occupational therapists who are certified hand therapists (CHTs).
.02 Definitions.

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

(1) “Board” means the Maryland Board of Occupational Therapy Practice.

(2) “Dry needling” means a physical agent modality as defined in COMAR 10.46.06.03, also known as intramuscular manual therapy, that:

(a) Involves the insertion of one or more solid needles, a mechanical device, into the muscle and related tissues to effect change in muscle and related tissues of the hand, wrist, elbow, and shoulder;

(b) Requires ongoing evaluation, assessment, and re-evaluation of the impairments;

(d) Is not performed for:

(i) The purposes of acupuncture and East Asian medicine as defined in Health Occupations Article, §1A-101, Annotated Code of Maryland; or

(ii) Any purpose outside the scope of occupational therapy.

.03 Minimum Education and Training Necessary to Perform Dry Needling.

A. In order to perform dry needling, an occupational therapist shall be a certified hand therapist in good standing, in addition to having completed at least 52 total hours of further instruction, which includes:
(1) A total of at least 27 hours of instruction in the following dry-needling-specific course content areas:

(a) Theory and application of dry needling to the hand, wrist, elbow, and shoulder;

(b) Dry needling technique to the hand, wrist, elbow, and shoulder;

(d) Infection control, the Occupational Safety and Health Administration’s Bloodborne Pathogen Protocol, and safe handling of needles;

(e) Emergency preparedness and response procedures related to complications associated with dry needling; and

(f) Appropriate documentation of dry needling; and (2) At least 25 hours of practical, hands-on instruction in the application and technique of dry needling, under the supervision of a licensed health care practitioner competent in dry needling procedures who has: (a) Completed the requisite course work under §A(1) of this regulation; and (b) Practiced dry needling for at least 5 years.

B. The instruction required under §A(1) of this regulation shall be provided by a continuing education course approved by the Board.

C. All instruction required under this regulation shall include an assessment of competency.

D. The instruction required under §A(1) of this regulation shall be offered:

(1) In person at a face-to-face session; or

(2) In real time through electronic means that allow for simultaneous interaction between the instructor and the participants

E. An occupational therapist may not fulfill any portion of the practical, hands-on instruction required under §A(2) of this regulation with online or distance learning.

F. An occupational therapist shall have practiced occupational therapy for at least 2 years, in addition to having been certified as a hand therapist, before performing dry needling in the State.

G. Registration.

(1) An occupational therapist shall be registered with the Board as having the appropriate education and training required by this regulation to be approved to practice dry needling.

(2) In order to be registered to practice dry needling, an occupational therapist shall submit a completed application on a form supplied by the Board with proof of the hand therapist certification.

(3) In order to continue to practice dry needling, an approved occupational therapist shall submit proof of their certified hand therapy recertification.

H. An occupational therapist who practices dry needling without the education and training required by this regulation shall be subject to discipline pursuant to COMAR 10.46.07.
.04 Standards of Practice in Performing Dry Needling.
A. An occupational therapist shall:

(1) Fully explain dry needling to the patient in advance of treatment; and

(2) Obtain written informed consent specific to dry needling that shall be included in the patient’s medical record

B. An occupational therapist shall perform dry needling to the hand, wrist, elbow, and shoulder in a manner consistent with standards set forth in the Maryland Occupational Safety and Health Act, Labor and Employment Article, Title 5, Annotated Code of Maryland.

C. An occupational therapist shall document the provision of dry needling services in accordance with the documentation requirements set forth under COMAR 10.46.01.03.

D. An occupational therapist who practices dry needling in a manner inconsistent with the standards of practice enumerated in this regulation shall be subject to discipline pursuant to COMAR 10.46.07.

E. Dry needling is not within the scope of practice of limited occupational therapy and shall only be performed by a licensed occupational therapist with a hand therapy certification.

Massachusetts

June 22′

Dry needling has been under review by the MA Board. The information will be posted to the Board’s website when it becomes available.

Board of Allied Health

6/20/22– Hello,

The response is the same, nothing has changed.

-Board of Allied Health

Michigan

June 22′

In a position statement, the ASHT was unable to reach a conclusion on the use of dry needling but acknowledged that dry needling is used by occupational therapists and physical therapists. This statement recognizes that dry needling is within the scope of occupational therapy, yet the state practice acts still dictate regulation for dry needling so if dry needling is not in the public health code the State of Michigan has not added this to OT/OTA scope of practice.

http://legislature.mi.gov/doc.aspx?mcl-368-1978-15-183

Document Type Description

Section 333.18301 Section Definitions; principles of construction.

Section 333.18303 Section Promulgation of rules; restricted use of words or titles; practice of occupational therapy or occupation therapy assistant; license required; exceptions.

Section 333.18305 Section Michigan board of occupational therapists; creation; membership; terms.

Section 333.18307 Section Licensure as occupational therapist; rules.

Section 333.18309 Section Licensure as occupational therapy assistant; rules.

Section 333.18311 Section Assistance.

Section 333.18313 Section Continuing education or competence requirements; rules.

Section 333.18315 Section Third party reimbursement or mandated worker’s compensation benefits not required

Respectfully,

Kaye T

#team10269

Minnesota

In my communications from AOTA today regarding motions 10 and 11 at the AOTA representative assembly, it is my understanding that the Commission on Practice was directed to revise position statements on Physical Agents and Mechanical Modalities and adjunctive/preparatory techniques.

These statements were to be developed and made available by the fall 2022 meeting.

In my understanding of them, this does not mean that the revised statements are currently available.

Ultimately, the board is unable to issue guidance statements specific to this as it is not written into Minnesota State statutes 148.6404 governing Scope of Practice (https://www.revisor.mn.gov/statutes/cite/

148.6404). I would encourage you to closely review the scope of practice and in particular the last item in scope of practice (c): (c) “Occupational therapy services must be based on nationally established standards of practice.”

Statute are silent on this particular named technique as it is on multiple techniques used by OT’s (e.g. myofascial release, craniosacral therapy, interactive metronome, etc), neither specifically allowing or disallowing them. Any practitioner using any particular technique must ensure they have the proper training and competence to deliver the technique safely and with first and foremost regard for client and public protection.

Regards, Chris Chris Bourland Executive Director

MN Board of OT Practice
335 Randolph Avenue Suite 240

St. Paul, MN 55102

Mississippi

Rule 8.2.3 Definitions.
The following terms shall have the meaning set forth below, unless the context otherwise requires:

16. Dry needling shall mean a physical agent modality that aims to restore and/or optimize the neuro-muscular-skeletal systems. Dry needling involves the use and insertion of solid filiform needles for the treatment of musculoskeletal pain and soft tissue dysfunction by increased blood flow, decreased banding, decreased spontaneous electrical activity, biomechanical and central nervous system changes.
Rule 8.2.4 Requirements to perform dry needling.
As with all other physical agent modalities in occupational therapy, dry needling is to be utilized in the therapeutic process in order to ultimately achieve improved function and therefore not to be applied as a stand-alone treatment. Dry needling does not include the stimulation of auricular or distal points. Dry needling is not part of an occupational therapist’s academic or clinical preparation for entry-level practice; therefore, this rule establishes the minimum standards required for an occupational therapist to be deemed competent to perform dry needling.

1. Dry needling shall be performed only by an occupational therapist who is competent by education and training to perform dry needling as specified in this regulation. Online/virtual/remote study and/or self-study for dry needling instruction shall not be considered appropriate training.

2. An occupational therapist must meet the following requirements in order to be deemed competent to perform dry needling:

a. A minimum of 3 years clinical experience as a licensed occupational therapist

b. Documented successful completion of dry needling course(s) of study approved by the Department that includes:

(i) A minimum of 50 hours face-to-face instruction; an online study is not allowed. Advanced dry needling (i.e., craniofacial, spine, abdominal, etc..,) will require more advanced training than the minimum requirements. It is the responsibility of each occupational therapist to acquire specialty certification through additional training beyond the minimum requirements.

(ii) Each course shall specify which anatomical regions/structures are included in the certification and whether the instruction was introductory or advanced concepts in dry needling

(iii) Every course instructor must be a licensed healthcare provider and have a minimum of two years of experience performing dry needling

(iv) A practical examination and a written examination with a passing score

(v) Anatomical review for safety and effectiveness

(vi) Indications and contraindications for dry needling

(vii) Management of adverse effects
(vii) Evidence-based instructions on the theory of dry needling
(ix) Sterile needle procedures which shall include the standards of the U.S. centers for disease control or the U.S. occupational safety and health administration.
c. An occupational therapist performing dry needling in his/her practice must have written informed consent for each patient that is maintained in the patient’s chart/medical record. The patient must sign and receive a copy of an informed consent form created by the therapist. The consent form must, at a minimum, clearly state the following information:

(i) Risks and benefits of dry needling

(ii) The occupational therapist’s level of education and training in dry needling

(iii) The occupational therapist will not dry needle any auricular or points distal to the identified treatment area

3. Each licensed occupational therapist performing dry needling must have a written physician’s order for dry needling or receive verbal authorization from the patient’s physician approving dry needling that is documented in the patient’s chart/medical record.

4. When dry needling is performed, the occupational therapist must document in the patient’s daily/encounter/procedure note. The note shall indicate how the patient tolerated the intervention as well as the outcome of the intervention, including any adverse reactions/events that occurred if any.

5. Dry needling shall not be delegated and must be performed only by a qualified, licensed occupational therapist who has met the minimum standards in this section.

6. Dry needling is not to be performed by an occupational therapy assistant under any circumstances including certification training or supervision.

7. After completion of the Department approved dry needling course, the occupational therapist will submit proof of certification. This will include confirmation of passing scores on written and practical exams. The Department must review and approve documents prior to beginning use of dry needling. This also includes any advanced courses that may follow.

8. Failure of an occupational therapist who is performing dry needling to provide written documentation that confirms he/she has met the requirements of this section shall be evidence that the occupational therapist is not competent and not permitted to perform dry needling. An occupational therapist performing dry needling in violation of this section shall be subject to disciplinary action as specified in Rule 8.8.1(1), (2), (6), (20), and (21).

Missouri

Missouri does not have any regulations regarding dry needling.

Montana

March 22′

Under Montana laws, dry needling is not included under the scope of practice of occupational therapists or assistants. AOTA is a professional association and not a state licensing body so its guidance and opinions do not necessarily match individual state regulations and scopes of practice for licensees. The Montana board has been discussing dry needling as a general topic with regard to where other states are going, but only the Legislature would have the authority to add it to the scope of licensure in Montana.

If you have questions on whether dry needling falls under the scope of an OT in other states I would recommend you contact those state licensing boards as well. If you are interested in being added to this board’s interested parties list to received notices of meeting agendas and proposed rulemaking let us know and we can add your e-mail.

Lucy Richards

Executive Officer

Board of Barbers and Cosmetologists | Board of Behavioral Health|

Board of Occupational Therapy Practice |

Board of Speech-Language Pathologists & Audiologists |

Montana Department of Labor & Industry

Business Standards Division

PHONE (406) 841-2394

dlibsdotp@mt.gov

Nebraska

2016 Attorney General Opinion regarding whether dry needling is within the scope of practice of PTs, OTs, and athletic trainers. Its conclusion was that dry needling was not in the scope of practice for OTs.

Nevada

Advisory Notice posted on the occupational therapy licensing board website: ADVISORY NOTICE Occupational Therapy Scope of Practice Dry Needling The provision of Dry Needling IS NOT authorized as being within the Scope of Practice of Occupational Therapy in Nevada. The Nevada Legislative Counsel Bureau, in response to an inquiry by Senator Parks, regarding whether dry needling was within the scope of practice of physical therapy, issued an opinion regarding dry needling in the State of Nevada. Pertinent sections of that opinion reads in part: “After thoroughly examining all the relevant statutory provisions in NRS Title 54, and after interpreting those statutory provisions in a manner that best promotes the protective public policy of NRS Title 54 and best carries out the intent

New Hampshire

March 22′

Licensees should only perform services if the licensee has had training and has demonstrated competency with the skill and is in compliance with the professions scope of practice, rules, and code of ethics here:

Http:/www.gencourt,State.nh.us/rules/state_agencies/occ100-500html

Jessica M. Whelehan | Board Administrator

NH Office of Professional Licensure and Certification

7 Eagle Square, Concord, New Hampshire 03301

www.oplc.nh.gov

New Jersey

March 22′

The board does not have any guidance on the use of dry needling by Occupational Therapists. This is not covered under the modalities scope of practice.

New Mexico

Board discussed dry needling in late 2019 and early 2020. The Board decided not to draft dry needling regulations because there wasn’t enough documentation of its effectiveness at the time. However, the Board notes that the law and rules do not prohibit its use

New York

Good morning,
OTs and OTAs may not perform dry needling in NYS
Thank you,
State Board for Occupational Therapy
New York State Education Department
89 Washington Avenue
Second Floor, West Wing
Albany, New York 12234
518-474-3817 ext. 100
518-473-0532 (fax)
www.op.nysed.gov/prof/ot

North Carolina

OT Board FAQ posted on its website regarding dry needling: Question: What is the Board’s position on dry needling?
Answer: At its July 22, 2019, Board meeting, the Board agreed that dry needling is not within the scope of practice of occupational therapy, at this time.

North Dakota

Statement on OT Board website: The Board does not regulate or require certification for OT’s performing specific modalities, including dry needling. It is the responsibility of the OT to be proficient in the specific modality he/she is practicing. Should a complaint or lawsuit arise involving an OT’s application of a specific modality, the OT would be responsible for proving his/her proficiency and appropriateness of application of the modality.

Ohio

Licensing board determined in 2012 that “There is nothing in the Ohio Occupational Therapy Practice Act that prohibits an occupational therapist from completing dry needling (intramuscular manual therapy) as part of the occupational therapy treatment/intervention plan, provided that the occupational therapist has received training, and demonstrated and documented competence in this activity.”

https://otptat.ohio.gov

Oklahoma

March 22′

Unknown at this time.

Oregon

Webpage on Oregon OT Licensing Board website: Can OT’s practice Dry Needling in Oregon? No In May, 2023, the AOTA Representative Assembly adopted a new policy, E.18: Interventions to Support Occupations. Regarding dry needling, the document states the following: “AOTA asserts that interventions to support occupations including but not limited to physical agent modalities (PAMs), dry needling, and other techniques may be used in preparation for, or concurrently with occupations and activities or interventions that ultimately enhance a client’s engagement in occupation.” (Emphasis added.) In Oregon, licensed acupuncturists are the only professionals that can legally practice dry needling. The Oregon Medical Board and its Acupuncture Advisory Committee regulate the practice of acupuncture in Oregon. They concluded that “dry needling” is acupuncture and can only be performed by a licensed acupuncturist. Their rules state that no person may practice acupuncture without a license. 847-070-0007 Practice of Acupuncture
(1) No person may practice acupuncture without first obtaining a license to practice medicine and surgery or a license to practice acupuncture from the Oregon Medical Board. Other professions have challenged the rule but have not been successful:
In 2017, the Oregon Board of Physical Therapy paid for a very costly review by the Dept. of Justice General Counsel Division. However, the opinion was dry needling is not within the scope of a PT. In 2011, the Board of Chiropractic Examiners adopted a rule authorizing chiropractors to practice dry needing which led to the decision of the Oregon Appeals Court Commissioner to stay the dry needling rule. In 2013, the Oregon Court of Appeals concluded that dry needling is not within the chiropractic scope of practice, and the rule was rescinded.

Pennsylvania

March 22′

Please note that neither the Board or Board Counsel is permitted to provide legal advice to anyone but the Board (which includes answering specific questions), and neither the Board nor Board Counsel may provide advisory opinions, including interpretations of the law or the Board’s regulations. Therefore, you may wish to consult with a private attorney for legal advice.

The Occupational Therapy Practice Act and the Board’s regulations, which adopt the 2015 American Occupational Therapy Association (AOTA)’s Code of Ethics, may be found at https://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/OccupationalTherapy/Pages/Board-Laws-and-Regulations.aspx.

The Board does not currently have regulations on dry needling.

Rhode Island

March 22′

We do not have any record of the Board issuing guidance on the use of dry needling.

South Carolina

March 22′

Waiting for a response

South Dakota

March 22′

At this time we have not issued any guidance on the use of dry needling by occupational therapists in South Dakota as OTs are not allowed to use dry needling within our state. I thank you for the research and the follow-up of what each state is doing. It is greatly appreciated.

Best,

Brooke Blaalid, MSW, MA

Management Analyst

SD Board of Medical & Osteopathic Examiners

101 N. Main Avenue, Suite 301

Sioux Falls, SD 57104

www.sdbmoe.gov

email: sdbmoe@state.sd.us

Tennessee

Statute: Tennessee Code Annotated §63-13-103 Chapter Definitions.
As used in this chapter, unless the context otherwise requires:
(6) “Dry needling” means a skilled intervention that uses a thin filiform needle to penetrate the skin and stimulate underlying neural, muscular, and connective tissues for the management of neuromusculoskeletal conditions, pain, and movement impairments;
(10)(B) Occupational therapy services are provided for the purpose of promoting health and wellness to those clients who have, or are at risk of developing, illness, injury, disease, disorder, impairment, disability, activity limitation or participation restriction and may include:

(i) Training in the use of prosthetic devices;

(ii) Assessment, design, development, fabrication, adaptation, application, fitting and training in the use of assistive technology and adaptive and selective orthotic devices;

(iii) Application of physical agent modalities with proper training and certification;

(iv) Assessment and application of ergonomic principles;

(v) Adaptation or modification of environments, at home, work, school or community, and use of a range of therapeutic procedures, such as wound care management, techniques to enhance sensory, perceptual and cognitive processing and manual therapy techniques, to enhance performance skills, occupational performance or the promotion of health and wellness; and

(vi) Practice of dry needling of the upper limb, with proper training and certification; (D) “Occupational therapy practice” includes specialized services provided by occupational therapists or occupational therapy assistants who are certified or trained in areas of specialization that include, but are not limited to, hand therapy, neurodevelopmental treatment, dry needling of the upper limb, sensory integration, pediatrics, geriatrics and neuro-rehabilitation, through programs approved by AOTA or other nationally recognized organizations;

Regulation: Tennessee Rules and Regulations Rule 1150-02-.21 DRY NEEDLING TO THE UPPER LIMB

(1) In order to perform dry needling to the upper limb, an occupational therapist must obtain all of the educational instruction described in paragraphs (2)(a) and (2)(b) herein. All such educational instruction must be obtained in person and may not be obtained online or through video conferencing.

(2) Mandatory Training – Before performing dry needling to the upper limb, a practitioner must complete educational requirements in each of the following areas:
(a) Fifty (50) hours of instruction, to include instruction in each of the four (4) areas listed herein, which are generally satisfied during the normal course of study in occupational therapy school or continuing education from a Board-approved continuing education provider:

1. Musculoskeletal and Neuromuscular systems;

2. Anatomical basis of pain mechanisms, chronic pain, and referred pain;

3. Trigger Points; and

4. Universal Precautions.
(b) Twenty-four (24) hours of dry needling instruction that includes specific instruction of the upper limb defined as hand, wrist, elbow, and shoulder girdle.
1. The twenty-four (24) hours must include instruction in each of the following six (6) areas:

(i) Dry needling technique;

(ii) Dry needling indications and contraindications;

(iii) Documentation of dry needling;

(iv) Management of adverse effects;

(v) Practical psychomotor competency; and

(vi) Occupational Safety and Health Administration’s Bloodborne Pathogens Protocol.

2. Each instructional course shall specify what anatomical regions are included in the instruction and describe whether the course offers introductory or advanced instruction in dry needling.

3. Each course must be pre-approved or approved by the Board or its consultant, or the Board may delegate the approval process to recognized health-related organizations or accredited occupational therapy educational institutions.
(c) A newly licensed occupation therapist shall not practice dry needling to the upper limb for at least one (1) year from the date of initial licensure unless the practitioner can demonstrate compliance with paragraph (2) through his or her pre-licensure educational coursework.
(3) Any occupational therapist who obtained the requisite twenty-four (24) hours of instruction as described in paragraph (2)(b) in another state or country must provide the same documentation to the Board, as described in paragraph (2)(b), that is required of a course provider. The Board or its consultant must approve the occupational therapist’s dry needling coursework before the therapist can practice dry needling in this state.

(4) Dry needling to the upper limb may only be performed by a licensed occupational therapist and may not be delegated to an occupational therapy assistant or support personnel.

(5) An occupational therapist practicing dry needling to the upper limb must supply written documentation, upon request by the Board, that substantiates appropriate training as required by this rule.

(6) All occupational therapy patients receiving dry needling to the upper limb shall be provided with information from the patient’s occupational therapist that includes a definition and description of the practice of dry needling and a description of the risks, benefits, and potential side effects of dry needling.

Texas

Statement from the OT board: “The occupational therapy practitioners must know how to perform and demonstrate proficiency in, as noted, any modalities, techniques, or procedures performed; however, please note that the Texas Board does not specify certifications they must hold for specific modalities, etc.
The occupational therapy practitioners are responsible for all of the modalities, techniques, or procedures that are used and the use of such must comply with the OT Act and Rules.”

Utah

March 22′

Per Utah Code (law) only Medical Doctors, Osteopathic Doctors, Naturopathic Doctors, Physical Therapists, Acupuncture, and Chiropractors are allowed to dry needle.

Thanks,

Jeff

DOPL 7

Website: www.dopl.utah.gov | Email: b7@utah.gov

Division of Occupational & Professional Licensing

Phone: 801-530-6755 or 801-530-6628

P.O. Box 146741 Salt Lake City, UT 84114

Vermont

March 22′

The Vermont Advisor Board has not rendered an opinion.

Judith.roy@vermont.gov

Thank you

Judith Roy

Office of Professional Regulation

Licensing Board Specialist for:

Athletic Trainers

Auctioneers

Occupational Therapists

Physical Therapists

Property Inspectors

Radiologic Technology Board

Real Estate Appraiser Board

Real Estate Commission

Address: 89 Main Street, 3rd Floor

Montpelier, VT 05620-3402

Phone: 802-828-3228

Fax: 802-828-2465

Website: https://sos.vermont.gov/opr/

Virgina

At the June 13, 2023 meeting of the OT Advisory Committee, it was reaffirmed that dry needling does not appear to be within the OT scope of practice and that a legislative change would be needed to allow OTs to perform dry needling.

Washington State

March 22′

I am the program manager for the OT program. There has not been a statutory change on dry needling for OTs. If there is guidance, it would be from years ago as I have been with the program for 8 years. I am currently unable to access any old files so I can’t look for older guidance.

This was a contentious issue when it was brought before the physical therapy board. I imagine it will be a big issue for OTs in the near future.

Kathy

KATHY WEED

Program Manager

Health Systems Quality Assurance

Washington State Department of Health

Kathy.weed@doh.wa.gov

360-236-4883 | www.doh.wa.gov

Gender Pronouns: she/her

Wisconsin

According to the state OT association, the OT Board’s position is that if an OT wanted to provide dry needling or any other treatment, the OT would need to have documented evidence of proper training, skills, and abilities to use the treatment in their practice setting.

West Virginia

March 22′

Thank you for contacting the WV Board of Occupational Therapy. The Board continues to support the current published position statement of AOTA, that dry needling is not within the scope of practice for occupational therapists.

Sincerely,

Vonda K. Malnikoff

Executive Secretary, WVBOT

1063 Maple Dr., Suite 4B

Morgantown, WV 26505

304-285-3150

vmalnikoff@wvbot.org

Wyoming

Rule: Occupational Therapy Board Chapter 3, Section 6. Dry Needling
(a) Licensed occupational therapists may use dry needling techniques on patients. Occupational therapists must be able to demonstrate that they have received dry needling training that meets the Board’s requirements.

(i) Dry needling training under this section must include a minimum of twenty-four (24) hours of live, face-to-face post professional instruction in dry needling.

(ii) Dry needling training under this section must include, but is not limited to, anatomy, training in indications for dry needling, contraindications for dry needling, potential risks, proper hygiene, proper use and disposal of needles, and appropriate selection of clients.

(iii) Occupational therapists who practice dry needling must retain written records of receiving dry needling training and present these records to the Board upon request.
(b) Occupational therapy assistants or other support personnel may not perform dry needling techniques

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