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 licensure. 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 insurance. 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 therapists. 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 year. Senator Bishop referenced Section 10 on page 10. He wondered whether the section contained the "grandfathering provisions." 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 RECONVENED 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 RECONVENED 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 licensure. 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 recommendation. 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 hours. Vice-Chair Fairclough reported that the AMTA standard was 500 hours. 3:14:24 PM AT EASE 3:17:41 PM RECONVENED 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 RECONVENED