Legislature(2013 - 2014)SENATE FINANCE 532

04/17/2014 01:30 PM FINANCE

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Moved SCS CSHB 193(FIN) Out of Committee
Moved CSHB 305(FIN) Out of Committee
Moved CSHB 121(FIN) Out of Committee
Moved CSHB 328(L&C) Out of Committee
Moved CSHB 143(FIN) Out of Committee
Heard & Held
Scheduled But Not Heard
<Above Item Removed from Agenda>
Moved HB 231 Out of Committee
<Above Item Removed from Agenda>
Scheduled But Not Heard
<Above Item Removed from Agenda>
+ Bills Previously Heard/Scheduled TELECONFERENCED
CS FOR HOUSE BILL NO. 328(L&C)                                                                                                
     "An Act establishing the Board of Massage Therapists;                                                                      
     relating to the licensing of massage therapists; and                                                                       
     providing for an effective date."                                                                                          
2:41:51 PM                                                                                                                    
AMANDA  UNSER,  CHAIR,  AMERICAN MASSAGE  THERAPY  LICENSING                                                                    
COALITION, ANCHORAGE (via  teleconference), briefly spoke in                                                                    
support of HB  328. She related that  the massage therapists                                                                    
were aware  that licensing fees  were associated  with state                                                                    
REPRESENTATIVE  BENJAMIN  NAGEAK,   introduced  HB  328  and                                                                    
related that  it established a  board of massage  therapy to                                                                    
provide    regulation    for   certification,    educational                                                                    
standards, promote  a code of  ethics, public  safety, self-                                                                    
regulation, accountability,  business development, grievance                                                                    
process and increased  access to therapy. He  added that the                                                                    
legislation would  allow massage therapist to  directly bill                                                                    
VICTORIA   DANCE,  SELF,   JUNEAU,  related   her  extensive                                                                    
experience  in  the  massage  therapy  profession.  She  had                                                                    
serious concerns  and "pragmatic" issues with  the bill. She                                                                    
shared  that  the coalition  had  only  surveyed 43  massage                                                                    
therapists out  of an estimated  600 in the state,  and that                                                                    
17  respondents  only  favored licensing  if  "it  was  done                                                                    
right."  She thought  that  the  bill was  a  good start  in                                                                    
bringing  state licensure  into alignment  with other  state                                                                    
licensing programs.  She believed  that the  legislation did                                                                    
not  reflect  current  competency  industry  standards,  the                                                                    
licensing fees  would be high,  and that the bill  would not                                                                    
enable therapists  to directly bill insurance.  She detailed                                                                    
that  the   Entry  Level  Analysis  project   established  a                                                                    
competency  standard for  massage therapists  of 625  hours.                                                                    
The  recommendations  were  established  after  HB  328  was                                                                    
introduced. She relayed  that 500 hours of  education was an                                                                    
arbitrary  standard  based  on relaxation  massage  and  not                                                                    
medical  or  therapeutic  massage. She  continued  that  the                                                                    
licensing fee would  be very high, which  created a hardship                                                                    
for entry  level therapists.  Fifty-three percent  of states                                                                    
had licensing fees  set at $100 to $150.  She cautioned that                                                                    
investigations could lead to high  licensing fees due to the                                                                    
existence  of  "massage  parlors." The  licensing  board  in                                                                    
Arizona  had to  deal with  approximately 12  investigations                                                                    
each year related  to massage parlors and  the West Virginia                                                                    
board recently  undertook an  investigation that  costs $200                                                                    
thousand that  resulted in increased  fees. She  pointed out                                                                    
that  Washington was  the only  state massage  therapy board                                                                    
that  had  a mandate  to  bill  third party  insurance.  She                                                                    
worried  that  the bill  was  not  the adequate  vehicle  to                                                                    
authorize   third  party   insurance  billing   for  massage                                                                    
therapists.  She summarized  that  the  legislation did  not                                                                    
adequately   address    public   protection    by   allowing                                                                    
educational licensing requirements under  625 hours and that                                                                    
the  fees  were  too  high for  entry  level  and  part-time                                                                    
2:52:47 PM                                                                                                                    
Ms. Unser  addressed the concerns  raised by Ms.  Dance. She                                                                    
maintained  that 500  hours was  the  national standard  and                                                                    
that the  board would  be implementing  continuing education                                                                    
standards. The  coalition estimated that the  licensing fees                                                                    
would  be   $225  each  year,  which   was  within  national                                                                    
standards. The  fees were equivalent  to performing  four to                                                                    
eight massages over  a two year period and were  a tax write                                                                    
off.  She offered  that  investigations  related to  massage                                                                    
parlors  were criminal  and  not  board investigations.  She                                                                    
assured  the committee  that individual  insurance companies                                                                    
set  policies  regarding  accepting  massage  therapists  as                                                                    
preferred providers  and most  allowed the  practice. Online                                                                    
courses for  CPR and continuing  education were  included in                                                                    
the bill to provide rural  therapists easier and less costly                                                                    
access to complete required continuing education.                                                                               
Vice-Chair  Fairclough  cited  page  3  of  the  bill  under                                                                    
"Qualification for  a License."  She related that  Ms. Dance                                                                    
indicated that  the 625 hour  educational standard  was only                                                                    
recently changed  and asked for confirmation  that 500 hours                                                                    
remained the national standard.                                                                                                 
Ms. Unser  assured Vice-Chair  Fairclough that  the American                                                                    
Massage Therapy Association  (AMTA), Associated Bodywork and                                                                    
Massage Professionals  (ABMT), and the  National Association                                                                    
of Massage Therapy upheld the 500 hour standard.                                                                                
Senator Olson  wondered what types  of complaints  were made                                                                    
against massage therapists.                                                                                                     
MARY,  SCHLOSSER,  STAFF,  REPRESENTATIVE  BENJAMIN  NAGEAK,                                                                    
replied that  issues of sexual inappropriateness  related to                                                                    
massage parlors could possibly happen.  She related that she                                                                    
never had a complaint after receiving massage therapy.                                                                          
Co-Chair  Kelly thought  that complaints  concerning massage                                                                    
parlors would be a criminal issue.                                                                                              
Vice-Chair Fairclough  noted that  Ms. Dance  indicated that                                                                    
only Washington  allowed third  party billing.  She inquired                                                                    
whether massage  therapy had its  own medical codes  and how                                                                    
billing would work.                                                                                                             
Ms. Unser responded that specific  codes for massage therapy                                                                    
procedures existed.  She voiced that insurance  companies do                                                                    
recognize  massage  therapists  as third  party  billers  in                                                                    
states that have state  licensure. Each individual insurance                                                                    
company   had  different   requirements  regarding   massage                                                                    
billing  that could  include a  doctor's referrals,  medical                                                                    
necessity, or limited number of treatments.                                                                                     
Co-Chair Kelly  asked what average  licensing fees  in other                                                                    
states were.                                                                                                                    
Ms. Unser responded  that the national average  was $250 per                                                                    
Senator  Bishop  referenced  Section   10  on  page  10.  He                                                                    
wondered whether  the section contained  the "grandfathering                                                                    
Ms. Unser  replied in the affirmative.  She interjected that                                                                    
according  to   previous  testimony   by  the   Division  of                                                                    
Insurance  direct  billing  would be  guided  by  individual                                                                    
insurance policies.                                                                                                             
3:01:15 PM                                                                                                                    
AT EASE                                                                                                                         
3:02:37 PM                                                                                                                    
Co-Chair Kelly CLOSED public testimony                                                                                          
Ms.  Schlosser  referenced   the  document  titled,  "States                                                                    
Regulating Massage  Therapy" (copy on file)  which contained                                                                    
a  map of  the U.S.  designating the  states that  regulated                                                                    
massage therapy and noted that  Alaska was behind the curve.                                                                    
She   maintained   that   licensing    was   a   matter   of                                                                    
professionalism and  public safety. She stated  that without                                                                    
licensure  any  cases  of  inappropriate  touch  had  to  be                                                                    
pursued as a civil case.                                                                                                        
3:03:55 PM                                                                                                                    
AT EASE                                                                                                                         
3:05:13 PM                                                                                                                    
Co-Chair  Kelly  inquired  whether the  legislation  allowed                                                                    
massage therapist to directly bill insurance companies.                                                                         
MARTY  HESTER,  DEPUTY   DIRECTOR,  DIVISION  OF  INSURANCE,                                                                    
DEPARTMENT OF  COMMERCE, COMMUNITY AND  ECONOMIC DEVELOPMENT                                                                    
(via teleconference), responded that  HB 328 amended Title 8                                                                    
and the  changes did  not alter  or affect  Title 21  of the                                                                    
insurance code.  The department did  not anticipate  a cause                                                                    
and effect relationship between Title 21 and HB 328.                                                                            
Vice-Chair  Fairclough  inquired  whether the  bill  allowed                                                                    
massage therapists to directly bill insurance.                                                                                  
Mr.  Hester responded  that the  bill did  not mandate  what                                                                    
insurance policies should cover. The  bill did not mandate a                                                                    
particular type of coverage or the extent of the coverage.                                                                      
Vice-Chair  Fairclough  understood  that the  bill  did  not                                                                    
mandate  massage  coverage  but wondered  whether  the  bill                                                                    
prevented coverage.                                                                                                             
Mr.  Hester specified  that the  Affordable  Care Act  (ACA)                                                                    
mandated  preventive and  rehabilitative care  services. The                                                                    
state's  benefit  plan was  based  on  a Premera  plan  that                                                                    
included massage  therapy. State  insurance plans  that were                                                                    
compliant  with  the  ACA were  required  to  cover  massage                                                                    
therapy. However,  the ACA  did not  specify to  what extent                                                                    
the services should be covered.                                                                                                 
Co-Chair  Kelly inquired  whether insurance  companies would                                                                    
cover massage  therapy services  if the  state did  not have                                                                    
Mr. Hefter responded that massage  coverage was dependent on                                                                    
the individual policy.                                                                                                          
Vice-Chair Fairclough noted for  the record the she obtained                                                                    
the report  titled "The Core  Entry Level  Analysis Project"                                                                    
from the  Entry Level Analysis  project by the  Coalition of                                                                    
National   Massage   Therapy  Organizations   completed   in                                                                    
December, 2013.  She relayed that  the project's  goals were                                                                    
to  define knowledge  and skill  components  of entry  level                                                                    
education  and  recommendations,  recommend  the  number  of                                                                    
minimum  hours  of education…  for  the  safe and  competent                                                                    
practice of  massage professionals." She confirmed  that the                                                                    
report did  recommend 625 hours of  educational training but                                                                    
was   uncertain   whether   the  board   had   adopted   the                                                                    
Ms. Schlosser  replied that  report was  a "survey"  and had                                                                    
not  been adopted  yet; as  a result  the national  standard                                                                    
remained at 500 hours. She  added that, once established the                                                                    
massage board had the ability  to add additional educational                                                                    
Vice-Chair Fairclough  reported that  the AMTA  standard was                                                                    
500 hours.                                                                                                                      
3:14:24 PM                                                                                                                    
AT EASE                                                                                                                         
3:17:41 PM                                                                                                                    
Co-Chair Meyer returned as Chair.                                                                                               
Senator  Dunleavy  observed  that  some  massage  therapists                                                                    
wanted  to be  licensed while  others did  not. He  wondered                                                                    
whether licensing  could be optional and  what the sponsor's                                                                    
thoughts were regarding optional licensing.                                                                                     
Ms. Schlosser responded that the  objective of licensing was                                                                    
to  set  a standard.  She  related  that the  sponsor's  and                                                                    
coalition's intent  was to set standards  for the profession                                                                    
in Alaska.                                                                                                                      
Co-Chair Kelly  believed that massage  therapy professionals                                                                    
wanted  to   set  a  standard   to  gain  legitimacy   as  a                                                                    
"professional  health   field"  and  that   the  legislation                                                                    
furthered that goal.                                                                                                            
Vice-Chair Fairclough  discovered that some  states required                                                                    
more than 500  hours of educational training  and noted that                                                                    
Arizona required  700 hours. However,  it appeared  that the                                                                    
majority of states required 500 hours.                                                                                          
Vice-Chair Fairclough  MOVED to REPORT CSHB  328(L&C) out of                                                                    
committee   with   individual    recommendations   and   the                                                                    
accompanying fiscal  note. There being NO  OBJECTION, it was                                                                    
so ordered.                                                                                                                     
CSHB  328(L&C) was  REPORTED  out of  committee  with a  "do                                                                    
pass"  recommendation  and  with  one  previously  published                                                                    
fiscal impact note: FN1 (CED).                                                                                                  
3:20:09 PM                                                                                                                    
AT EASE                                                                                                                         
3:24:01 PM                                                                                                                    

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