Nebraska Occupational Therapy Association scores major win with Practice Act modernization

In 2018, the Nebraska Occupational Therapy Association (NOTA) set out to elevate its presence in state advocacy at the Capitol in Lincoln. As part of this initiative, NOTA restructured its board of directors, expanding positions and increasing representation across practice areas. A key change was the creation of a Vice President of Policy and Advocacy role to serve as a liaison between the association, its members, and a newly hired professional lobbyist. This strategic investment aimed to raise the profile of occupational therapy among state policymakers and enhance the association’s ability to pass beneficial legislation.

In just six years, NOTA has built an impressive legislative track record, including bills that improved Medicaid and private insurance payment policies and the successful passage of OT licensure compact legislation.

In 2023, NOTA launched its most ambitious initiative yet: modernizing the Nebraska Occupational Therapy Practice Act—a statute that had not been updated in many years.

Navigating Nebraska’s Unique Credentialing Review Process

Nebraska’s “407 Process,” a statutorily required credentialing review, must be completed before legislation altering a health profession’s scope of practice can be introduced. Administered by the Nebraska Department of Health and Human Services and the Nebraska Board of Health, the process involves three independent review bodies, each producing advisory reports for the Legislature’s Health and Human Services Committee.

NOTA submitted its letter of intent in January 2024 and began a comprehensive review to determine the most appropriate amendments. This included:

• Reviewing the 2022 AOTA Model Practice Act

• Conducting needs assessments, surveys, and focus groups with members
• Collaborating with AOTA’s State Affairs Group for guidance and comparative state law analysis
• Engaging with other state associations for professions such as physical therapists, speech-language pathologists, chiropractors, athletic trainers, and acupuncturists
  

This stakeholder engagement was critical. It helped NOTA prioritize member concerns and address potential opposition early in the process.

From Application to Legislation

The 407 Process officially began with a hearing on November 18, 2024, following NOTA’s application submission on October 30. The Occupational Therapy Technical Review Committee was convened to review the application, approved it with a favorable report in January 2025. Additional supportive reports followed in March from the State Board of Health and the Director of the Division of Public Health.

These recommendations were incorporated into a placeholder bill, which was introduced in January 2025. After a March hearing and committee approval, the bill was merged with legislation affecting marriage and family therapists and childcare providers. The combined bill (Legislative Bill 257) passed the Unicameral Legislature on May 14 and was signed into law by the Governor on May 20.

Key Updates to the Practice Act

The updated statute reflects modern, evidence-based occupational therapy practices. Key changes include:

• Clarification of Scope: The law now explicitly includes interventions that support occupational performance, such as physical agent, instrument assisted and mechanical modalities, including dry needling. The Nebraska Board of Occupational Therapy will determine necessary training requirements.
• Expanded OTA Practice: OTAs can now be trained in and use the full range of physical agent modalities (PAMs), eliminating redundant training for already-competent practitioners.
• Recognition of Mental Health Services: The statute now clearly states that mental health services fall within the OT scope of practice.

A Strategic Victory Years in the Making

This legislative success is the culmination of years of strategic planning, board restructuring, and investment in professional advocacy. Previous wins—such as payment reform and OT Compact legislation—helped build momentum and credibility, laying the groundwork for this landmark achievement.

Collaborations such as this between NOTA and the AOTA State Affairs Group supports state advocacy priorities, elevates the voice of the occupational therapy profession at the state level, and ensures that OT services remain an integral part of the spectrum of healthcare services available in Nebraska.