2019 -- S 0576

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LC001511

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2019

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A N   A C T

RELATING TO HEALTH AND SAFETY - LICENSING OF MASSAGE THERAPISTS

     Introduced By: Senator Joshua Miller

     Date Introduced: March 14, 2019

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

     SECTION 1. Sections 23-20.8-1, 23-20.8-2.1, 23-20.8-3, 23-20.8-4, 23-20.8-5, 23-20.8-9

and 23-20.8-11 of the General Laws in Chapter 23-20.8 entitled "Licensing of Massage

Therapists" are hereby amended to read as follows:

     23-20.8-1. Definitions.

     As used in this chapter:

     (1) "Board" means the Rhode Island State Board of Licensed Massage Therapists as

established within this chapter.

     (2) "Body works" and "body-works services" means body rubs, body stimulation,

manipulation, or conditioning of any part or parts of the body, spa services, and spa treatments

performed by any person not licensed under title 23.

     (3) “Continuing education” means a course of study subsequent to the completion of and

in addition to, an approved entry-level program of massage therapy education.

     (4) “Continuing education units” means an instructional period of at least fifty (50)

continuous minutes per hour in a recognized or approved course.

     (5) “Massage” means the systematic and scientific manipulation of the soft tissues of the

body accomplished by the use of digits, hands, forearms, elbows, knees, or feet, hand-held tool or

other external apparatus. Massage may include the use of topical applications.

     (3)(6) "Massage therapist" means a person engaged in the practice of massage and is

licensed in accordance with this chapter of the general laws of the state of Rhode Island.

     (4)(7) "Practice of massage" "Massage therapy" means the manual manipulation of the

soft tissues of the human body through the systematic application of massage techniques

including: effleurage, petrissage, compression, friction, vibration, percussion, pressure, positional

holding, movement, range of motion for purposes of demonstrating muscle excursion or muscle

flexibility, and nonspecific stretching. The term massage includes the external application of

lubricants or other topical preparations, such as water, heat, and cold, via the use of the hand,

foot, arm, or elbow, with or without the aid of massage devices, for the purpose of aiding muscle

relaxation, reducing stress, improving circulation, increasing range of motion, relieving muscular

pain, and the overall enhancement of health. Massage shall not include: the touch of genitalia;

diagnosis of illness or disease; the prescribing of drugs, medicines, or exercise; high-velocity

thrust applied to the joints or spine; electrical stimulation; application of ultrasound or any

services or procedures for which a license to practice medicine, chiropractic, occupational

therapy, physical therapy, or podiatry is required by law. use of massage for therapeutic purposes,

including, but not limited to: pain management, stress reduction, promotion of relaxation and

enhancement of general health and well-being. Massage therapy includes, but is not limited to,

evaluation of soft tissue and normal movement of the body to develop an appropriate massage

therapy session and the delivery of self-care and health maintenance information. Massage

therapy does not encompass:

     (1) Diagnosis;

     (2) The prescribing of drugs or medicines;

     (3) Spinal manipulation; and

     (4) Any service or procedure which a license or registration is required by law including,

but not limited to, the practice of medicine, chiropractic, naturopathy, physical therapy,

occupational therapy, nutrition, psychotherapy, behavioral health services or podiatry.

     (8) “Practice of massage therapy” means, the exchange of massage therapy services for

currency, goods or services.

     (9) “Topical applications” means, but is not limited to, lubricants, emollients, non-

prescription analgesics, and the use of heat and cold.

     23-20.8-2.1. Board of massage therapists.

     (a) Within the division of professional regulation of the department of health, there shall

be a state board of massage therapy examiners to be Rhode Island state board of licensed massage

therapists appointed by the director of the department of health with the approval of the governor.

Composition of board members: The board shall consist of seven (7) members who reside in the

state of Rhode Island,. At all times at least four (4) members shall be massage therapists in good

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standing, and shall have engaged in the practice of massage therapy for not less than five (5)

years. of whom shall be licensed pursuant to this chapter and one of whom One member shall be

a member of the general public, and who does not have financial interest in the profession, or is

married to or in domestic partnership with someone in the profession. At no time shall more than

one board member be an owner of, an instructor of, or otherwise affiliated with a board-approved

massage therapy school or a course of instruction. The four (4) members who are licensed

pursuant to this chapter shall represent both solo practitioners as well as members of a group

practice.

     (b) The initial board shall be appointed for staggered terms, the longest of which shall not

exceed three (3) years. After the initial appointments, all terms shall be for two (2) years and a

member may be reappointed for a second (2nd) term. All terms shall be for two (2) years. No

member shall serve more than three (3) consecutive terms. Upon the death, resignation or

removal of any member, the director of the department of health, with the approval of the

governor, shall appoint to fill vacancies, as they occur, a qualified person to serve on the board

for the remainder of his or her term or until his or her successor is appointed and qualified.

     (c) The board shall elect, at its first meeting of the calendar year, from its members a

chair and such other officers as it deems appropriate and necessary to conduct business. The chair

shall preside at meetings of the board and shall be responsible for the performance of all duties

and functions of the board and shall perform those duties customarily associated with the position

in addition to other duties assigned by the board. The board shall designate a member to serve in

the absence of the chair.

     (d) The chair and any other officer shall serve a term of one year commencing with the

day of his or her election and ending upon the election of his or her successor.

     (d)(e) The director of the department of health may remove any member of the board for

the neglect of any duty required by law or for any incompetent, unprofessional, or dishonorable

conduct. Before beginning his or her term of office, each member shall take the oath prescribed

by law, a record of which shall be filed with the secretary of state.

     (f) A board member may be suspended or removed by the director of the department of

health for unprofessional conduct, refusal or inability of a board member to perform his or her

duties as a member of the board in an efficient, responsible and professional manner, conviction

of a felony or of a crime related to the practice of the health care profession, failure to meet the

qualifications of this statute, or committing any act prohibited by this statute.

     (g) Members of the board shall not receive compensation for their attendance at official

meetings of the board, or attendance at any meeting that would constitute official board business,

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including teleconference calls or other board responsibilities.

     (c)(h) The board shall meet at least quarterly thereafter, shall hold a meeting and elect a

chairman. The board may hold additional meetings at the call of the chair or at the written request

of any three (3) members of the board. The board may appoint such committees as it considers

necessary to carry out its duties. A majority of the sitting members of the board shall constitute a

quorum. The chair of the board shall have the authority to call other meetings at his or her

discretion.

     (i) The board may appoint such committees as it considers necessary to carry out its

duties.

     (j) A quorum shall be necessary to conduct official board business or any committee

thereof. A majority of the members shall constitute a quorum. The board may enter into

executive (closed) session according to relevant law.

     23-20.8-3. Practice of massage -- License required -- Use of title limited --

Qualifications for licenses continuing education -- Fees.

     (a) A person shall not practice, or hold himself or herself out to others as practicing

massage therapy, or as a massage therapist, without first receiving from the board a license to

engage in that practice.

     (b) A person shall hold himself or herself out to others as a massage therapist when the

person adopts or uses any title or description, including: "massage therapist," "masseur,"

"masseuse," "massagist," "massotherapist," "myotherapist," "body therapist," "massage

technician," "massage practitioner," or any derivation of those terms that implies this practice.

     (c) It shall be unlawful to advertise the practice of massage therapy using the term

massage therapy, or any other term that implies a massage technique or method, in any public or

private publication or communication by a person not licensed by the state of Rhode Island

department of health as a massage therapist. Any person who holds a license to practice as a

massage therapist in this state may use the title "licensed, massage therapist" and the abbreviation

"LMT." No other persons may assume such title or use such abbreviation or any other word,

letters, signs, or figures to indicate that the person using the title is a licensed, massage therapist.

A massage therapist's name and license number must conspicuously appear on all of the massage

therapist's advertisements print and electronic material. A massage therapist licensed under this

chapter must conspicuously display his or her have available his or her license in his or her

principal place all places of business practice. If the massage therapist does not have a principal

place of business, or conducts business in any other location, he or she must have a copy of his or

her license available for inspection while performing any activities related to massage therapy.

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     (d)(1) The board shall, by rule, establish requirements for continued continuing

education. The board may establish such requirements to be completed and verified biennially or

annually. The board shall require no more than twelve (12) hours biennially or six (6) hours

continuing education units annually.

     (2) Applicants for biennial annual licensure renewal shall meet continuing education

requirements as prescribed by the board. On application for renewal of license, massage

therapists shall attest to completion of six (6) hours continuing education units annually in scope

of practice-specific offerings that may include, but not be limited to:

     (i) Formal presentations;

     (ii) Conferences;

     (iii) Coursework from a regionally massage school or program, accredited

college/university; and/or

     (iv) Self-study course, such as online courses awarding one education hour for each hour

completed or online coursework.

     Such programs or offerings shall be approved or sponsored by a board-approved

organization. The board shall require no more than two (2) hours of ethics or standards of practice

biennially.

     (3) A licensee who fails to complete the continuing education requirements described

herein may be subject to disciplinary action pursuant to § 5-40-13.

     (4) A license may be denied to any applicant who fails to provide satisfactory evidence of

completion of continuing education relevant to massage therapy as required herein.

     (5) The board may waive the requirement for these educational requirements continuing

education if the board is satisfied that the applicant has suffered hardship, which may have

prevented meeting the educational requirements.

     (e) The fee for original application for licensure as a massage therapist and for annual

license renewal shall be as set forth in § 23-1-54. Fees for all other licenses under this chapter

shall be fixed in an amount necessary to cover the cost of administering this chapter.

     (f) Any person applying for a license under this chapter shall undergo a national criminal

background check. Such persons shall apply to the bureau of criminal identification of the state

police or local police department for a nationwide national criminal records background check.

Fingerprinting shall be required. Upon the discovery of any disqualifying information as defined

in subsection (g), the bureau of criminal identification of the state police or the local police

department shall inform the applicant, in writing, of the nature of the disqualifying information

and, without disclosing the nature of the disqualifying information, shall notify the board, in

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writing, that disqualifying information has been found. In those situations in which no

disqualifying information has been found, the bureau of criminal identification shall inform the

applicant and the board in writing of this fact. An applicant against whom disqualifying

information has been found may request that a copy of the national criminal background report be

sent to the board, which shall make a judgment regarding the licensure of the applicant. The

applicant shall be responsible for payment of the costs of the national criminal records

background check.

     (g) "Disqualifying information" means those offenses, including, but not limited to, those

offenses defined in chapters 34, 34.1, and 37 of title 11, and § 23-17-37.

     (h) Notwithstanding the above, any city or town may, by ordinance, regulate the opening,

the presence, the location, and the operation of any body-works business or any business

providing body-works services. Provided, however, no ordinance may impose additional

qualifications beyond those adopted by the department of health pursuant to this chapter

respecting criminal background checks for persons applying for a license.

     23-20.8-4. Establishment -- Board of massage therapists -- Powers and duties.

     Subject to the provisions of this chapter, the board shall have the following powers and

duties authority to implement, intercept and enforce this statute including, but not limited to, the

authority to:

     (1) Adopt rules and regulations governing the licensure of massage therapists in a manner

consistent with the provisions of this chapter and in accordance with the procedures outlined in

the Administrative Procedures Act and promulgated in accordance with state law;

     (2) Evaluate the qualifications of applicants for licensure;

     (3) Assess entry-level competence through the use of an examination approved by the

board;

     (4) Recommend the issuing or renewal of a license to applicants or licensed massage

therapists who meet the qualifications of the statute and all rules applicable to this chapter as

promulgated by the board;

     (2)(5) Establish and enforce standards of professional and ethical conduct for licensed

massage therapists;

     (3)(6) Adopt rules that endorse equivalent licensure examinations of another state or

territory of the United States, the District of Columbia, or a foreign country and that may include

licensure by reciprocity; hold hearing, as necessary, in accordance with the Administrative

Procedures Act.

     (4)(7) Maintain a complete record of all licensed massage therapists, ensure licensee

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compliance with all established requirements. The board will make an annual report to the

governor which shall contain duties performed, actions taken and appropriate recommendations.

     (8) The board will make an annual report to the governor that shall contain duties

performed, actions taken and appropriate recommendations.

     (9) Consult The board will consult and advise other regulatory entities as necessary

regarding issues pertaining to massage therapy practice, education and/or issues related to the

regulation of massage therapists.

     (10) Upon receipt of a complaint, the department of health shall authorize the

investigation of any allegations of wrongdoing undertaken by any person, entity, license or

organization related to the practice of massage therapy.

     (11) The board shall review investigative reports deemed necessary by the director and

make appropriate recommendations to the director for action including, but not limited to,

issuance of a letter of concern or warning of the possible infraction of this statute; suspension for

a period not to exceed ninety (90) days of any license issued under the authority of this chapter;

and may, after due notice and hearing revoke the license if it is found that the person practicing

massage therapy is in violation of those rules and regulations or any provision of this chapter. The

holder of a license shall upon its revocation promptly surrender it to the board or its designee.

     23-20.8-5. Application for license -- Issuance or denial of license -- Minimum

qualifications.

     (a) Every person desiring to begin the practice of massage therapy, except exempt

persons as provided in this chapter, shall present satisfactory evidence to the division of

professional regulation of the department of health that he or she is:

     (1) Over Is over eighteen (18) years of age;

     (2) Of good moral character (via background check Has submitted to a national criminal

background check in accordance with § 23-20.8-3);

     (3) Has successfully completed an educational program, meeting minimum requirements

established by the board, including at least five hundred (500) six hundred fifty (650) hours of

supervised in-class, hands-on and supervised coursework and clinical work; and

     (4) Has successfully completed an examination approved by the board. Any examination

approved by the board must meet generally recognized standards including development through

the use of a job-task analysis and must meet appropriate psychometric standards.

     (b) The department may grant a license to any applicant satisfying the requirements of

subsections (a)(1) and (a)(2) § 23-20.8-5(a), has completed all appropriate forms, paid all

appropriate fees and has met substantially equivalent standards in obtaining a valid license,

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permit, certificate or registration issued by any other state or territory of the United States or by a

foreign country.

     (c) The department shall, within sixty (60) days from the time any application for a

license is received, grant the applications and issue a license to practice massage therapy for a

year from that date if the department is satisfied that the applicant complies with the rules and

regulations promulgated in accordance with this chapter. An applicant, whose national criminal

records background check reveals a conviction for any sexual felony offense, including, but not

limited to, those offenses defined in chapters 34 and 37 of title 11, shall be denied a license under

this chapter.

     (d) The fee for original application for licensure as a massage therapist and the fee for

annual license renewal shall be determined by the board and shall not exceed one hundred dollars

($100) department of health.

     23-20.8-9. Persons exempt.

     Nothing contained in this chapter shall prohibit:

     (1) A person who is otherwise licensed certified or registered in accordance with the

general laws of Rhode Island, from performing service within his/her or authorized scope of

practice and who does not hold himself/herself out to be a massage therapist.

     (2) A person duly licensed, certified, or registered in nonresident massage therapist

holding a valid license, permit, certificate or registration issued by another state or territory of the

United States, the District of Columbia, or a foreign country when incidentally in this state to

provide service as part of an emergency response team working in conjunction with disaster relief

official or as part of a charity event.

     (3) Nonresident practitioners A nonresident massage therapist holding a valid license,

permit, certificate or registration issued by any other state or territory of the United States, the

District of Columbia or by a foreign country and temporarily practicing massage in this state for a

period not exceeding thirty (30) days for the purpose of presenting educational or clinical

programs, lectures, seminars or workshops to massage therapists.

     (4) Graduates A graduate from an approved educational program, may practice massage

therapy only under the supervision of one, assigned, onsite licensed massage therapist. Graduates

have ninety (90) days from the date on the application fee receipt, to meet licensure requirements

of this state in accordance with regulations prescribed by the board.

     (5) Persons A massage therapist who provide acceptable evidence of being currently

licensed to practice massage therapy by examination or endorsement under the laws of other

states or territories of the United States, and the District of Columbia, or by a foreign country

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have a grace period of forty-five (45) days from the date on the application fee receipt to meet

licensure requirements of this state in accordance with regulations prescribed by the board. The

original privilege to work forty-five (45) days from the date on the application fee receipt shall

not be extended or renewed.

     (6) A nonresident massage therapist holding a valid license, permit, certificate or

registration issued by any other state or territory of the United States, the District of Columbia or

by a foreign country when in this state as part of a charity/event where massage is appropriate.

Nothing in the article shall be construed to prevent or restrict the practice of any person in this

state who uses touch, words and directed movement to deepen awareness of existing patterns of

movement in the body as well as to suggest new possibilities of movement while engaged within

the scope of practice of a profession with established standards and ethics, provided that his or

her services are not designated or implied to be massage or massage therapy. Such practices

include, but are not limited to, the Feldenkrais Method/rs or somatic education, the Rolf Institute's

Rolf Movement Integration, the Trager Approach/rs to movement education, and Body-Mind

Centering/rs. Practitioners must be recognized by or meet the established standards of either a

professional organization or credentialing agency that represents or certifies the respective

practice based on a minimal level of training, demonstration of competency and adherence to

ethical standards.

     (7) Nothing in the section shall be construed to prevent or restrict the practice of any

person in this state who uses touch to affect the energy systems, acupoints or Qi meridians

(channels of energy) of the human body while engaged within the scope of practice of a

profession with established standards and ethics, provided that his or her service is not designated

or implied to be massage or massage therapy. Such practices include, but are not limited to,

Polarity, Polarity Therapy, Polarity Bodywork Therapy, Rosen Method, Asian Bodywork

Therapy, Acupressure, Jin Shin Do/rs, Qi Gong, Reiki and Shiatsu. Practitioners must be

recognized by or meet the established standards of either a professional organization or

credentialing agency that represents or certified the respective practice based on a minimal level

of training, demonstration of competency and adherence to ethical standards.

     23-20.8-11. Penalties.

     (a) Any person who practices massage or acts in any capacity where a license is required

by this chapter, without a license provided for in this chapter, shall be guilty of a misdemeanor

and subject to a fine of up to one thousand dollars ($1,000) or thirty (30) days in jail.

     (b) Any owner, operator, manager, or licensee in charge of or in control of a massage

therapy establishment practice who knowingly employs a person who is not licensed as a massage

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therapist, or who allows an unlicensed person to perform, operate, or practice massage is guilty of

a misdemeanor and subject to a fine of up to one thousand dollars ($1,000) and thirty (30) days in

jail.

     (c) The practice of massage by a person without a license issued under this chapter is

declared to be a danger to the public health and welfare. In addition to any other civil, criminal, or

disciplinary remedy, the attorney general or prosecuting attorney of any municipality where the

person is practicing, or purporting to practice, may maintain an action to enjoin that person from

practicing massage until this person secures a valid license.

     (d) [Deleted by P.L. 2008, ch. 100, art. 6, § 1].

     SECTION 2. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO HEALTH AND SAFETY - LICENSING OF MASSAGE THERAPISTS

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     This act would make sweeping changes to the law on massage therapy licensing

including the following: It would change the composition of the board of licensed massage

therapists so that a majority of its members would be licensed massage therapists. It would

require that the department of health investigate complaints and have the board review their

report. It would remove the mandatory $1000 fine and jail time for a conviction for practicing

massage therapy without a license. It would increase the required hours of education from 500 to

650. It would specify that massage therapy does not encompass diagnosis, prescribing medicines,

or any service such as chiropractic, naturopathy, physical therapy, occupational therapy, nutrition,

psychotherapy, behavioral health services or podiatry.

     This act would take effect upon passage.

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