Who has responsibility for your occupational therapist???

Corporate practice and the health care professions in New York State might not be on the top of everyone's interest list but there are some things that professionals and the public need to be aware of. 

In New York State and in many other states for that matter there are restrictions on who can hire professionals to provide services.  These kinds of laws prohibit any random person from starting a corporation and hiring OTs or PTs or any professional and billing for those services.  The reason why those laws exist are because people think that there is potential for abuse/fraud/unethical choices when professionals are not 'owned' and 'supervised' by people within their own professions.

Now of course just because an OT hires and OT or a PT hires a PT that does not guarantee that unethical things won't happen.  Still, there is generic concern so these laws were enacted to prevent abuse.  So, in order for PTs and OTs to both be hired by a corporation there needs to be representation of ownership in the corporate structure.  That means that there has to be an OT 'owner' and PT 'owner.'  Even when one of those 'owners' only has a small or even fractional controlling interest in the company, having their name within the corporate ownership structure means that SOMEONE is responsible for the fact that the corporation is hiring and employing people from that profession. 

Corporations in NY State have long struggled with compliance with these general business laws and have been subject to scrutiny over time by the Office of the Professions.  It was relatively common to see some professional start a corporation that they owned themselves (generally a P.C. designation) and then hire or contract other professionals illegally.  Not for profits also ran afoul of the law because they are not technically owned by a person/professional but rather are managed by and answer to a Board of Directors - and sometimes NONE of those Directors represented the professions that were hired by the agency.  So, there were some problems with the law and how it interacted with the way that many corporations were structured for providing services.

The Office of the Professions, using the State's coercive powers, slapped some wrists and caused some corporations to restructure.  Other corporations just held their breath, dove deep, phoned their State representatives, and prayed for the day that the law might change.  Well that day has come.

The NY State Education Department is now granting waivers (for a hefty fee, of course) for those agencies who are providing multidisciplinary professional services in a currently 'illegal' structure.  The specific waivers I am referring to are not broad and apply specifically to Early Intervention Agencies and Special Education Schools. 

Should anyone care?

Well, supporters of these waivers will tell you that the exigent problem of non-compliant not-for-profit agencies mandated this action.  This is one of those 'IT IS FOR THE CHILDREN' arguments.  If these agencies were not provided with waivers then thousands of children across the state would not have OT or PT or speech therapy services.  I can understand the need to address this to some degree, and I don't really oppose the concept of an otherwise regulated not-for-profit educational entity given some slack, but something much more insidious got slipped into these regulations.

You see, the law now allows ANY early intervention "agency" that is DOH approved to get one of those waivers.  That means that the person who previously had to change their corporate structure does not need to do that.  So the speech therapist can now hire OTs and PTs all the while operating under a previously illegal corporate structure like a for-profit PC. 

I think there is a BIG difference between a waiver being potentially provided for a not-for-profit educational agency and a for-profit solo practitioner.  The not-for-profit is still answering to a full BoD and is probably under a lot of SED scrutiny in general.  The for-profit solo practitioner answers to themselves and an IPRO audit every three years.

These waivers that are now available to the small for-profit solo practitioners or businesspeople to hire professionals outside of their own fields does not protect the public, and in fact flies in the face of longstanding general business corporation law in New York State.

This is a trend in NY State - we are giving up 'control' of our practice to outside forces.  The recently enacted occupational therapy laws allow supervision of COTAs by non-occupational therapy professionals.  Now this new waiver allows occupational therapists to be hired and supervised by non-occupational therapy professionals.  I am using occupational therapy as an example; this problem cuts across many professions.

Corporate ownership of professionals was illegal in New York State for many years.  Until now.

Consumers should begin to ask: Who owns this agency, and who is making sure that the services I am receiving are consistent with standards of the health care professions?  It is a fair question that I hope more consumers will learn to ask.


Barbara @therextras said…
Very informative. Thank you, Chris. You have a knack for explaining things.
Agree with Barbara. Very informative and explained well. Even more informative for me since I too live in NY state.

Makes me so curious as to why all of this is only being addressed at the early intervention level where we can make greater differences. There is no legislation regarding school based therapy services? Or maybe I am just not aware. Not complaining - just curious...
The reason why this is targeted at EI and other designated private for-profit and not for profit educational entities is because there is nothing that addresses this 'class' of agency within the Public Health Law. Hospitals, public schools and some other specifically named entities are already exempt from the corporate practice restrictions. There are many private 'agencies' or 'groups' providing EI services that were not previously exempt from the restrictions. Until now - with concerns noted above!

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