IEPs, 504s, and School-Based OT – Oh My!

What’s the difference between an IEP and a 504 plan, anyway? And how does school-based OT fit into it all? While you might’ve touched on this briefly in your grad school training, if your experience was anything like mine, you didn’t learn all of the intricacies of the special education system until you started working in the schools! What’s even trickier is that various states and districts may interpret the laws that govern school-based practice differently, and some may even be misinterpreting federal law. One of the first things I teach in my course for school-based OTs is allllllll of the laws, rules, and regulations that affect school-based OT. Being familiar with them is key to providing ethical, high-quality services to the students that need us!


The biggest law in special education is the Individuals with Disabilities Education Act (IDEA). IDEA was first introduced in 1975 as the Education for All Handicapped Children Act (EHA). Its core tenant is all children are entitled to a Free and Appropriate Public Education (FAPE) in their Least Restrictive Environment (LRE). This law lays the framework for the IEP (Individualized Education Plan) process. Are you sick of acronyms yet? 😛

Before this law, many children with disabilities were not allowed to attend public school and instead were placed in institutions where they received little educational benefit.

What does IDEA say about OT?

IDEA defines OT as:

“Occupational therapy—

(i) Means services provided by a qualified occupational therapist;

(ii) Includes—

(A) Improving, developing, or restoring functions impaired or lost through illness, injury, or deprivation;

(B) Improving ability to perform tasks for independent functioning if functions are impaired or lost; and

(C) Preventing, through early intervention, initial or further impairment or loss of function.” 

Further, IDEA goes on to state that certain things related to OT must be included in an IEP:

“(4) A statement of the special education and related services and supplementary aids and services, based on peer-reviewed research to the extent practicable, to be provided to the child, or on behalf of the child, and a statement of the program modifications or supports for school personnel that will be provided to enable the child—

(i) To advance appropriately toward attaining the annual goals;

(ii) To be involved in and make progress in the general education curriculum in accordance with paragraph (a)(1) of this section, and to participate in extracurricular and other nonacademic activities;

(iii) To be educated and participate with other children with disabilities and nondisabled children in the activities described in this section;”

So, to put it succinctly: IDEA legally defines OT and requires that we include it in an IEP if a student requires it to benefit from their education. Simple enough, right?

Now here’s the point that many new therapists to the school system miss: it’s not enough to just think that a student may benefit from OT. That student also has to qualify for special education in general (meaning they have a disability that fits in one of the 13 eligibility categories also defined by IDEA AND that this disability affects their educational progress). It’s a little more complicated than just evaluating a kid for OT in the outpatient setting – it’s a much more holistic decision that requires the whole team to determine if the student does require special education services. 

Most students receiving OT services in the school system do so through an IEP. However, there is another type of plan that school-based OTs should also be familiar with: the 504.

Section 504

Section 504 of the Rehabilitation Act was first introduced in 1973. The Rehabilitation Act is a law that protects individuals with disabilities in various contexts. Section 504 specifically prevents discrimination against individuals with disabilities in an educational context. In other words, it ensures children have equal access to an education, with accommodations and modifications as necessary. 

Specifically, it states:

“No otherwise qualified individual with a disability … shall solely by reason of her or his disability be excluded from the participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance.”

“(j) Handicapped person — (1) Handicapped persons means any person who (i) has a physical or mental impairment which substantially limits one or more major life activities, (ii) has a record of such an impairment, or (iii) is regarded as having such an impairment.”

The definition of disability in Section 504 is much more broad than IDEA, so a student may qualify for this plan even if they don’t qualify under IDEA. This type of plan is especially relevant for students who have a disability but may not be as academically impacted as those who qualify for an IEP. Typically, Section 504 is used for general education students with disabilities who require some accommodations to access their education, but do not require special education. 

For example: a student with a spinal cord injury requires access to an elevator, increased time during passing periods, and the option to use speech-to-text, but is working at grade level without special education supports. 

What does Section 504 say about OT?

“All elementary and secondary school students who are qualified individuals with disabilities, as defined by Section 504, and who need special education and/or related aids and services are entitled to FAPE. Under Section 504, FAPE is the provision of regular or special education and related aids and services that are designed to meet the individual educational needs of students with disabilities as adequately as the needs of non-disabled students are met and are based on adherence to procedures governing educational setting, evaluation and placement, and procedural safeguards.”

While it is less common, a student on a 504 plan may require related services such as occupational therapy. This may take the form of an OT helping develop accommodations, consultative services, and in rare cases, direct services.

It’s important to note that IDEA is a function of special education and Section 504 is a facet of general education. Since no special education funds can be used for general education programs, a district may have to consider what steps to take if a provider’s salary is solely funded in this manner. 

However, what districts should NOT do is state that they do not provide OT services for students on 504 plans. There is no legal basis to support this, and in fact, it goes against the most common legal interpretation of this law. 

Truthfully, many districts state that they will not allow related services such as OT on 504 plans not because they have a legal basis for doing so, but because this allows them to save money. As the 504 process is technically part of “general education” and not “special education,” districts cannot get reimbursed for any services provided for 504 students in the way that they do in special education for students on IEPs.

And while the scenario is rare that a student would require school-based OT and not special education in general, it does exist. This is why it’s so important for OTs to know the laws that govern their own practice. We all have a duty to be responsible for knowing how to ethically and legally practice OT in our specialty area, and we can’t always take a district’s interpretation of a federal law at face value. 

I hope this explanation demystified the differences between IEPs and 504 plans and how we all fit into them! If you’re looking to become a master of school-based practice and all of the fun laws that come along with it, I’d love to have you join my course, The Dynamic School OT! Knowing how to interpret the various federal and state laws that affect school-based OT is just one of the many topics we cover in this comprehensive course. If you have any questions, feel free to reach out to me at

Do you have any questions? Come discuss in my Facebook group!

Scroll to Top