Legislature(2013 - 2014)

03/28/2014 03:30 PM L&C

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
          HB 328-BOARD/LICENSING OF MASSAGE THERAPISTS                                                                      
3:56:38 PM                                                                                                                    
CHAIR OLSON  announced that the  next order of business  would be                                                               
HOUSE  BILL NO.  328 "An  Act establishing  the Board  of Massage                                                               
Therapists; relating to the licensing  of massage therapists; and                                                               
providing for an effective date."                                                                                               
3:56:57 PM                                                                                                                    
REPRESENTATIVE  JOHNSON  made  a  motion to  adopt  Amendment  1,                                                               
labeled 28-LS1431\N.2, Martin, 3/25/14, which read as follows:                                                                  
     Page 7, line 31:                                                                                                           
          Delete ", awareness, and education by Ida P.                                                                          
          Insert "and awareness who has graduated from a                                                                        
     program  or  is a  current  member  of an  organization                                                                    
     recognized   by   the  International   Association   of                                                                    
     Structural  Integrators, including  the Rolf  Institute                                                                    
     of Structural Integration"                                                                                                 
     Page 9, line 4, following "medicines,":                                                                                    
          Insert "the practice of physical therapy,"                                                                            
CHAIR OLSON objected for the purpose of discussion.                                                                             
3:57:13 PM                                                                                                                    
REPRESENTATIVE  BEN  NAGEAK,  Alaska State  Legislature,  thanked                                                               
members for  the opportunity to ask  for support for HB  328.  He                                                               
explained  that  HB  328  would  establish  a  Board  of  Massage                                                               
Therapists  and provide  regulation for  certification.   Massage                                                               
therapists have  requested licensure  but have  also asked  for a                                                               
few changes,  which are incorporated  into amendments  "N.1" [not                                                               
yet  before   the  committee]  and  Amendment   1,  [labeled  28-                                                               
LS1431\N.2, Martin, 3/25/14, currently  under consideration].  He                                                               
asked his staff to explain the proposed amendments.                                                                             
3:57:59 PM                                                                                                                    
MARY  SCHLOSSER, Staff,  Representative  Benjamin Nageak,  Alaska                                                               
State Legislature, explained  Amendment 1.  She  referred to page                                                               
7,  line  31  of  HB  328 and  stated  that  the  Alaska  Massage                                                               
Therapist  Licensure  Coalition  (AMTLC) asked  for  this  change                                                               
because the  International Association of  Structural Integrators                                                               
(IASI) wanted  clarification that  the practice of  Rolfing would                                                               
be exempted  from this  bill.  She  noted the  Rolfing profession                                                               
has very high  standards.  Secondly, on page 9,  line 4, language                                                               
was inserted to  clarify that massage therapists  do not practice                                                               
physical  therapy.   This change  was requested  by the  physical                                                               
therapists.   In response to  a question, Ms. Schlosser  said she                                                               
wasn't familiar with other groups seeking licensure.                                                                            
CHAIR OLSON  remarked that athletic  trainers would  be addressed                                                               
in a separate licensing bill.                                                                                                   
4:00:09 PM                                                                                                                    
CHAIR OLSON  removed his objection  to Amendment 1.   There being                                                               
no further objection, Amendment 1 was adopted.                                                                                  
4:00:22 PM                                                                                                                    
VICTORIA  DANCE,  Massage  Therapist,  stated she  is  a  massage                                                               
therapist  who  works  for  a  medical office  in  Juneau.    She                                                               
previously testified  in opposition to  the bill because  it only                                                               
requires  a minimum  of 500  hours of  training since  ordinances                                                               
already  require the  same minimum  hours.   It  didn't make  any                                                               
sense to go  to the expense of  a board for licensing.   She said                                                               
she has contacted  the AMTLC to increase  the minimum requirement                                                               
for  licensure, but  the  coalition has  not  been interested  in                                                               
changing the  number of  hours so she  decided to  testify before                                                               
the committee  with her  request.   She provided  her background,                                                               
such that  she is a  massage therapist  who has been  licensed in                                                               
Arizona  since  1983.    She   was  the  director  of  Continuing                                                               
Education at the  Desert Institute of the Healing  Arts in Tucson                                                               
prior to  working as a massage  therapist in a medical  clinic in                                                               
Juneau  for the  last  five years.   She  also  holds a  Master's                                                               
Degree in Higher Education Administration.   She asked to address                                                               
the educational qualifications and aspects of HB 328.                                                                           
4:02:06 PM                                                                                                                    
MS. DANCE  suggested that the  educational requirement  should be                                                               
increased  to  600  hours  since  almost  every  standard-setting                                                               
organization  for  massage therapy  in  the  nation recommends  a                                                               
minimum  of  600 to  625  hours  training.   [The  Commission  on                                                               
Massage   Therapy   Accreditation]   (COMTA),   an   organization                                                               
recognized by  the U.S. Secretary  of Education to  specialize in                                                               
accrediting massage  therapy schools,  requires 600 hours.   [The                                                               
Entry-Level Analysis Project] ELAP  [a research project initiated                                                               
by  the Coalition  of National  Massage Therapy  Organizations in                                                               
March  2012] has  recommended a  minimum of  625 hours  training.                                                               
She also discussed training hours  with Pete Whitridge, president                                                               
of  the Alliance  for Massage  Therapy  Education, [a  non-profit                                                               
organization  established  to  serve  as  an  independent  voice,                                                               
advocate,  and  resource for  the  entire  education sector]  who                                                               
said, "There  is a  tremendous divergence  between 500  hours and                                                               
625 or  700 hours."   Mr. Whitridge  further stated  that setting                                                               
the  minimum requirement  of 500  hours  does the  state a  great                                                               
disservice  in terms  of  current  suggested practice  especially                                                               
with the  growing field of  medical massage.  He  emphasized that                                                               
it is important at the  beginning of a massage therapist's career                                                               
to  have   additional  training  and  context   of  medicine  and                                                               
insurance billing, which is not possible in a 500-hour program.                                                                 
MS.  DANCE  explained that  a  500-hour  program teaches  massage                                                               
therapists  the   basics  of   Swedish  massage   techniques  for                                                               
relaxation and  introduces them to  a potpourri of  techniques to                                                               
later study during continuing education  credits.  She emphasized                                                               
her belief  that it is  not possible to teach  massage therapists                                                               
much  beyond  the basic  protocols  in  an entry  level  500-hour                                                               
training  program.    The American  Manual  Medicine  Association                                                               
(AMMA),  [a non-profit  corporation  serving all  members of  the                                                               
health care community who serve  the public health through manual                                                               
therapy] recommends  a minimum  of 600 hours  of training.   Some                                                               
state boards,  including Ohio's,  are currently in  a predicament                                                               
since  these states  must now  amend their  enabling statutes  in                                                               
order to increase  the minimum qualifications for  licensure.  In                                                               
fact, only  14 states currently  require as  few as 500  hours of                                                               
training, she said.  She characterized  this bill as one that has                                                               
been modeled  after a  boiler plate from  the early  2000s, which                                                               
needs updating.                                                                                                                 
CHAIR OLSON  asked whether she  has shared her concerns  with the                                                               
bill sponsor.                                                                                                                   
MS. DANCE related she has  recently provided the sponsor's office                                                               
with her concerns.                                                                                                              
4:04:58 PM                                                                                                                    
MARTY HESTER, Deputy Director,  Division of Insurance, Department                                                               
of Commerce,  Community & Economic Development,  asked to address                                                               
the  applicability to  health insurance  policies.   He explained                                                               
that HB 328  does not amend Title 21, the  Alaska insurance code.                                                               
It would not  change the ability of an insurer  to write a policy                                                               
that  did  not  cover  massage  or  that  required  a  doctor  or                                                               
chiropractor  to prescribe  a  massage in  order  to qualify  for                                                               
coverage.   The  licensure  will  not change  the  ability of  an                                                               
insurer  to  require  that  billing   be  processed  through  the                                                               
prescribing doctor's  office or in a  particular manner; however,                                                               
the Patient  Protection and Affordable  Care Act  (PPACA) applies                                                               
to  all class  providers and  prohibits provider  discrimination.                                                               
One  provision of  PPACA  prevents  insurers from  discriminating                                                               
against entire  classes of  health care  providers if  the health                                                               
care providers are  willing to abide by the  terms and conditions                                                               
of participation and are acting  within the scope of practice and                                                               
in compliance with the state licensure requirements.                                                                            
4:06:50 PM                                                                                                                    
REPRESENTATIVE SADDLER  asked for clarification on  the insurance                                                               
MR. HESTER  said a question  arose as to whether  massage therapy                                                               
would  specifically be  covered under  health insurance  policies                                                               
and if  a massage  therapist could bill  an insurer  directly for                                                               
the services  they provided.  He  explained that HB 328  does not                                                               
change  the insurance  code to  affect  those items  nor does  it                                                               
change the PPACA  mandating the insurer to  provide that coverage                                                               
for massage therapy.                                                                                                            
REPRESENTATIVE JOSEPHSON said none of this surprised him.                                                                       
4:08:02 PM                                                                                                                    
REPRESENTATIVE SADDLER asked whether it  would be the status quo,                                                               
and massage therapy will not be covered by insurance.                                                                           
MR. HESTER  said it  depends on the  insurance plan.   Currently,                                                               
Premera Blue Cross Blue Shield  provides massage therapy coverage                                                               
but  Aetna or  other insurance  coverage may  differ.   This bill                                                               
doesn't mandate the coverage these plans offer.                                                                                 
4:08:39 PM                                                                                                                    
REPRESENTATIVE  SADDLER related  his  understanding  that HB  328                                                               
does not change insurance law to  mandate or not, that it depends                                                               
on the  policy and it  does not  affect the [PPACA's]  mandate to                                                               
cover massage therapy.                                                                                                          
MR. HESTER answered yes.                                                                                                        
REPRESENTATIVE JOSEPHSON related his  understanding that it would                                                               
depend on whether  a doctor prescribed the massage  therapy as to                                                               
the insurance coverage.  He  suggested it might change the result                                                               
if  a doctor  prescribed  the massage  rather  than someone  just                                                               
going to a massage therapist.                                                                                                   
MR. HESTER answered that it  would depend on the health insurance                                                               
the individual has as to  the insurance coverage or reimbursement                                                               
for massage therapy.                                                                                                            
4:09:28 PM                                                                                                                    
CHAIR  OLSON  removed his  objection.    There being  no  further                                                               
objection, Amendment 1 was adopted.                                                                                             
CHAIR  OLSON,  after first  determining  no  one else  wished  to                                                               
testify, closed public testimony on HB 328.                                                                                     
REPRESENTATIVE JOSEPHSON  asked whether  the two  amendments were                                                               
incorporated into the bill.                                                                                                     
The committee took a brief at-ease.                                                                                             
4:11:29 PM                                                                                                                    
CHAIR OLSON explained that members  did not have adequate time to                                                               
consider amendment [N.1] in members'  packets so it will be taken                                                               
up at a later date.                                                                                                             
[HB 328 was held over.]                                                                                                         

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