Following is the complete text of a letter sent to Michael Miiller, who is Chief of Staff in Christine Kehoe's Sacramento office, from the coalition that met on August 12 to revise AB 1388.
"We had a good, productive meeting with various members of the massage community representing AMTA, ABMP, CAMBS and another pair of schools on Tuesday Aug 12. Here are the basic goals we came up with for the legislation. We'll be glad to help turn these into appropriate language. Let us know if any of them are likely to cause difficulties as we move forward with the legislation. Our group strongly feels that many of the points here (as well as features such as preemption already in the bill language) are necessary for us to support the legislation - some others are negotiable.
First off, our goals. We want to allow massage therapists to practice with the least amount of, and most appropriate, regulation. We want massage therapists to be able to move freely, preferably even across state lines (we seek reciprocity). We want to establish education requirements that are minimally sufficient to prepare individuals to practice massage without being excessive, and to require appropriate continuing education. We want to enhance public trust in massage. And we want to separate massage from prostitution.
We believe two tiers - one for Massage Practitioners and one for Massage Therapists - makes the most sense for California. We come to this unanimous conclusion from examining the breadth of massage training possessed by the 25,000+ people practicing massage in California, our collective judgment as to what education is necessary for someone to begin practicing massage safely and knowledgeably, and our knowledge of the experience and capabilities of the 206 schools in the state. Our recommendation does not just endorse the status quo - if it is adopted, many schools will have to increase the length and depth of their programs. It will also require all practitioners to keep expanding their skills and knowledge. At the same time, our recommendations will permit continued program variety and ready entry into the field by diverse populations.
We think the first tier should require 250 hours of supervised instruction from a state approved or registered school. This is towards the high end of the 100 to 300 hour programs that 70% of California massage schools offer; it's also the number of supervised instruction hours required in Texas, another state with a very large number of massage therapists. It's worked well there for years.
This 250-hour education level is a number that is achievable both for those people just beginning their professional careers as well as for individuals who may be trying to support families and maintain other jobs while making a career change. Setting the bar there will also reduce reliance on government financial aid programs. A 250-hour education requirement also works for students of all ages who possess kinesthetic skills and aptitude for massage, but who find traditional academic learning methodologies challenging.
Specifically, we suggest:
Tier I:
Requirement: 250 hours of supervised instruction from a school approved/registered
by the BPPVE. Comparable training received in other states would be acceptable
providing the school is state-approved. Education must be completed in increments
of no less than 100 hours to count toward the 250-hour requirement.
Permitted Titles: Massage Practitioner, Bodywork Practitioner, Massage and Bodywork Practitioner, or any of those terms preceded by "licensed" or "California licensed".
We also want a second level or tier that will facilitate reciprocity with other states, i.e. portability of massage licenses. That level would require that an applicant meet at least one of the following:
Tier II:
Requirement: 500 hours of supervised instruction from a school approved/registered
by the BPPVE. Comparable training received in other states would be acceptable,
providing the attended school is state-approved. Education must be completed
in increments of no less than 100 hours to count toward the 500-hour requirement;
OR
Passing an appropriate national certification exam. There should be several
options of national certification examinations in massage or bodywork: the Board
may select specific approved examinations, but our goal is to be inclusive;
OR
Qualifying for Tier I plus an additional 750 hours of work experience. Alternatively,
an applicant for an upgrade to Tier II may substitute additional massage education
received for work experience; each additional classroom or seminar education
hour shall count for three hours of massage work experience. The Massage Board
shall review documentation of additional experience or education and certify
that a requisite combination of education and/or experience has been completed
to warrant promotion to Tier II.
Permitted Titles: any Tier I title, plus Massage Therapist, Bodywork Therapist, Massage and Bodywork Therapist, Bodyworker, or any of those terms preceded by "licensed" or "California licensed".
We believe that market forces will probably allow Tier II therapists to charge more, and will help maintain the respectability of massage. It is important to our group to assure that there is an avenue for an individual to move from the lower tier to the higher tier that does not require taking a specific examination beyond those incorporated into the curricula of state approved or registered schools an individual has attended.
There are two aspects to grandfathering - qualification and implementation.
For qualifications, the current language in AB 1388 is close; we suggest that
you retain the inclusion for those already locally licensed, and change the
second part to read "A person who is not locally licensed as of January 1, 2005,
but who can provide documentation of having completed a 100 hour course in massage
at a state approved or registered school and of having provided at least 450
hours of massage to members of the public for compensation."
As to implementation, experience in other states suggests that it will take 12 to 18 months for a Board to be appointed, for them to organize and hire staff, and to develop, implement and publicize license application and review procedures. Some grace period will be necessary to deal with the 25,000+ massage practitioners in California. Provisional licenses will help; they won't solve all the logistical problems. We believe it makes sense to give existing practitioners 18 months from the date the bill becomes effective to assemble and present their documentation under the grandfathering rules.
We'd like the Board to have seven members; two should be members of the general public, five should be massage professionals with at least three years experience in the profession. Massage members would have to hold current licenses (or, in the case of the initial Board, be eligible for licenses and apply for them in a timely manner). If school owners, directors, or teachers are on the Board, that constituency should not dominate the Board. Perhaps a maximum of two from that category would be sensible. We would hope to get representation of a broad array of Therapists and Practitioners on the Board, but don't suggest overly complicating the process by imposing additional restrictive rules - already, three state officials each will have some Board appointment power.
We want the Board to have term limits - a maximum of two terms per member. We think three-year terms are ideal, though four-year terms are acceptable if that is the more common length of term for California health boards.
We believe that certain practices (reflexology, Trager Method, and the like) which might be mistakenly thought to be massage should be exempt from massage licensure, which is consistent with both the desire of representatives of those practices and our understanding of what is massage. The language in section 4603.1 of AB 1388 is pretty close; sections (a) and (b) regarding respectively reflexology and Feldenkrais, Trager, Alexander Technique and Body-Mind Centering - look fine. A better variant of (c) would be: "Persons engaged in a profession with established standards and ethics using methods which involve only techniques which are specifically intended to affect the human energy field(s) or system(s), including but not limited to Polarity Therapy, Reiki, Touch for Health or Jin Shin Do, in which their services are not designated or implied to be massage or massage therapy, shall be exempt from this Act."
We favor requiring 24 hours of continuing education every two years, with the option to carry up to 12 additional hours over into the next two-year period when an individual has taken more than 24 hours of continuing education in a given licensing period. We can help you put together an initial list of qualifying continuing education providers, including California massage schools approved/ registered by the BPPVE, to include in the Bill, and also want the Board to be able to approve other bodies as appropriate continuing educators. We don't want each specific continuing education class to have to be approved by BPPVE: that would be cumbersome. We also don't want to restrict continuing education to classes taught in California: many massage professionals take classes in other states (e.g. at professional conventions) that meet very high standards.
The current bill language will serve; we'd prefer the language used in Kentucky's
statute:
"Practice of massage therapy" means the application, by a massage therapist
or practitioner licensed by the Board, of a system of structured touch, pressure,
movement and holding to the soft tissues of the body with the intent to enhance
or restore the health and well-being of the client. The practice includes the
application of water, heat, cold, lubricants, salt scrubs, or other topical
preparations; the use of electromechanical devices that mimic or enhance the
actions of the hands; and determination of whether massage therapy is appropriate
or contraindicated, or whether referral of the client to another health care
practitioner is appropriate.
The name of the commission or Board should be "Massage and Bodywork" rather than "Massage and Bodyworks".
Section 4607 (b) (3), allowing for the revocation of a license if someone is being sued for violations related to massage, seems open to abuse. We'd rather it wasn't there. The Board can clearly ignore it if they want (since it says they may revoke, not must revoke, a license for that reason); it just feels like an unfair clause because suits may easily be filed even when they lack merit.
License fees should be set to reflect the actual cost of operating a massage Board and issuing licenses. As a guideline, the median fee of the 33 states that have licensing is $50 per year.
This represents a solid consensus, in general, of our discussion group. There weren't a lot of close votes. We look forward to talking or meeting with you on this if you have any questions. We hope Assemblymember Kehoe finds our arguments persuasive.
Sincerely
Beverly May
AMTA-CA Legislative Co-Chair
27 August 2003