Florida Senate - 2021                              CS for SB 352
       By the Committee on Health Policy; and Senator Rodriguez
       588-01986-21                                           2021352c1
    1                        A bill to be entitled                      
    2         An act relating to massage therapy; renaming ch. 480,
    3         F.S., as “Massage Therapy Practice”; amending s.
    4         480.031, F.S.; revising a short title; amending s.
    5         480.032, F.S.; revising the purpose of ch. 480, F.S.;
    6         reordering and amending s. 480.033, F.S.; revising and
    7         defining terms; amending ss. 477.013, 477.0135,
    8         477.0265, 480.034, 480.035, 480.041, 480.043, 480.046,
    9         480.0465, 480.047, 480.052, 480.0535, 627.6407,
   10         627.6619, 627.736, 641.31, and 823.05, F.S.;
   11         conforming provisions to changes made by the act;
   12         making technical changes; providing an effective date.
   14  Be It Enacted by the Legislature of the State of Florida:
   16         Section 1. Chapter 480, Florida Statutes, entitled “Massage
   17  Practice,” is renamed “Massage Therapy Practice.”
   18         Section 2. Section 480.031, Florida Statutes, is amended to
   19  read:
   20         480.031 Short title.—This act shall be known and may be
   21  cited as the “Massage Therapy Practice Act.”
   22         Section 3. Section 480.032, Florida Statutes, is amended to
   23  read:
   24         480.032 Purpose.—The Legislature recognizes that the
   25  unregulated practice of massage therapy poses a danger is
   26  potentially dangerous to the public in that massage therapists
   27  must have a knowledge of anatomy and physiology and an
   28  understanding of the relationship between the structure and the
   29  function of the tissues being treated and the total function of
   30  the body. Massage therapy is a therapeutic health care practice,
   31  and regulations are necessary to protect the public from
   32  unqualified practitioners. It is therefore deemed necessary in
   33  the interest of public health, safety, and welfare to regulate
   34  the practice of massage therapy in this state and, therefore;
   35  however, restrictions must shall be imposed to the extent
   36  necessary to protect the public from significant and discernible
   37  danger to health and yet not in such a manner that does not
   38  which will unreasonably affect the competitive market. Further,
   39  consumer protection for both health and economic matters must
   40  shall be afforded the public through legal remedies provided for
   41  in this act.
   42         Section 4. Section 480.033, Florida Statutes, is reordered
   43  and amended to read:
   44         480.033 Definitions.—As used in this act:
   45         (2)(1) “Board” means the Board of Massage Therapy.
   46         (5)(2) “Department” means the Department of Health.
   47         (11)(3) “Massage therapy” means the manipulation of the
   48  soft tissues of the human body with the hand, foot, knee, arm,
   49  or elbow, regardless of whether or not such manipulation is
   50  aided by hydrotherapy, including colonic irrigation, or thermal
   51  therapy; any electrical or mechanical device; or the application
   52  to the human body of a chemical or herbal preparation.
   53         (10)(4) “Massage therapist” means a person licensed as
   54  required by this act, who performs administers massage therapy,
   55  including massage therapy assessment, for compensation.
   56         (1)(5) “Apprentice” means a person approved by the board to
   57  study colonic irrigation under the instruction of a licensed
   58  massage therapist practicing colonic irrigation.
   59         (4)(6) “Colonic irrigation” means a method of hydrotherapy
   60  used to cleanse the colon with the aid of a mechanical device
   61  and water.
   62         (7) “Establishment” or “massage establishment” means a site
   63  or premises, or portion thereof, wherein a massage therapist
   64  practices massage therapy.
   65         (9)(8) “Licensure” means the procedure by which a person,
   66  hereinafter referred to as a “practitioner,” applies to the
   67  board for approval to practice massage therapy or to operate an
   68  establishment.
   69         (3)(9) “Board-approved massage therapy school” means a
   70  facility that meets minimum standards for training and
   71  curriculum as determined by rule of the board and that is
   72  licensed by the Department of Education pursuant to chapter 1005
   73  or the equivalent licensing authority of another state or is
   74  within the public school system of this state or a college or
   75  university that is eligible to participate in the William L.
   76  Boyd, IV, Effective Access to Student Education Grant Program.
   77         (8)(10) “Establishment owner” means a person who has
   78  ownership interest in a massage establishment. The term includes
   79  an individual who holds a massage establishment license, a
   80  general partner of a partnership, an owner or officer of a
   81  corporation, and a member of a limited liability company and its
   82  subsidiaries who holds a massage establishment license.
   83         (6)(11) “Designated establishment manager” means a massage
   84  therapist who holds a clear and active license without
   85  restriction, who is responsible for the operation of a massage
   86  establishment in accordance with the provisions of this chapter,
   87  and who is designated the manager by the rules or practices at
   88  the establishment.
   89         (12)“Massage therapy assessment” means the determination
   90  of the course of massage therapy treatment.
   91         Section 5. Subsection (13) of section 477.013, Florida
   92  Statutes, is amended to read:
   93         477.013 Definitions.—As used in this chapter:
   94         (13) “Skin care services” means the treatment of the skin
   95  of the body, other than the head, face, and scalp, by the use of
   96  a sponge, brush, cloth, or similar device to apply or remove a
   97  chemical preparation or other substance, except that chemical
   98  peels may be removed by peeling an applied preparation from the
   99  skin by hand. Skin care services must be performed by a licensed
  100  cosmetologist or facial specialist within a licensed cosmetology
  101  or specialty salon, and such services may not involve massage
  102  therapy, as defined in s. 480.033 s. 480.033(3), through
  103  manipulation of the superficial tissue.
  104         Section 6. Paragraph (a) of subsection (1) of section
  105  477.0135, Florida Statutes, is amended to read:
  106         477.0135 Exemptions.—
  107         (1) This chapter does not apply to the following persons
  108  when practicing pursuant to their professional or occupational
  109  responsibilities and duties:
  110         (a) Persons authorized under the laws of this state to
  111  practice medicine, surgery, osteopathic medicine, chiropractic
  112  medicine, massage therapy, naturopathy, or podiatric medicine.
  113         Section 7. Paragraph (f) of subsection (1) of section
  114  477.0265, Florida Statutes, is amended to read:
  115         477.0265 Prohibited acts.—
  116         (1) It is unlawful for any person to:
  117         (f) Advertise or imply that skin care services, as
  118  performed under this chapter, have any relationship to the
  119  practice of massage therapy as defined in s. 480.033 s.
  120  480.033(3), except those practices or activities defined in s.
  121  477.013.
  122         Section 8. Subsection (4) of section 480.034, Florida
  123  Statutes, is amended to read:
  124         480.034 Exemptions.—
  125         (4) An exemption granted is effective to the extent that an
  126  exempted person’s practice or profession overlaps with the
  127  practice of massage therapy.
  128         Section 9. Subsection (2) of section 480.035, Florida
  129  Statutes, is amended to read:
  130         480.035 Board of Massage Therapy.—
  131         (2) Five members of the board shall be licensed massage
  132  therapists and shall have been engaged in the practice of
  133  massage therapy for not less than 5 consecutive years prior to
  134  the date of appointment to the board. The Governor shall appoint
  135  each member for a term of 4 years. Two members of the board
  136  shall be laypersons. Each board member shall be a high school
  137  graduate or shall have received a high school equivalency
  138  diploma. Each board member shall be a citizen of the United
  139  States and a resident of this state for not less than 5 years.
  140  The appointments are will be subject to confirmation by the
  141  Senate.
  142         Section 10. Subsections (1) and (4) and paragraph (b) of
  143  subsection (5) of section 480.041, Florida Statutes, are amended
  144  to read:
  145         480.041 Massage therapists; qualifications; licensure;
  146  endorsement.—
  147         (1) Any person is qualified for licensure as a massage
  148  therapist under this act who meets all of the following
  149  requirements:
  150         (a) Is at least 18 years of age or has received a high
  151  school diploma or high school equivalency diploma.;
  152         (b) Has completed a course of study at a board-approved
  153  massage therapy school that meets standards adopted by the
  154  board.; and
  155         (c) Has received a passing grade on a national examination
  156  designated by the board.
  157         (4) Upon an applicant’s passing the examination and paying
  158  the initial licensure fee, the department shall issue to the
  159  applicant a license, valid until the next scheduled renewal
  160  date, to practice massage therapy.
  161         (5) The board shall adopt rules:
  162         (b) Providing for educational standards, examination, and
  163  certification for the practice of colonic irrigation, as defined
  164  in s. 480.033 s. 480.033(6), by massage therapists.
  165         Section 11. Subsection (14) of section 480.043, Florida
  166  Statutes, is amended to read:
  167         480.043 Massage establishments; requisites; licensure;
  168  inspection; human trafficking awareness training and policies.—
  169         (14) Except for the requirements of subsection (13), this
  170  section does not apply to a physician licensed under chapter
  171  457, chapter 458, chapter 459, or chapter 460 who employs a
  172  licensed massage therapist to perform massage therapy on the
  173  physician’s patients at the physician’s place of practice. This
  174  subsection does not restrict investigations by the department
  175  for violations of chapter 456 or this chapter.
  176         Section 12. Paragraphs (a), (b), (c), (f) through (i), and
  177  (o) of subsection (1) of section 480.046, Florida Statutes, are
  178  amended to read:
  179         480.046 Grounds for disciplinary action by the board.—
  180         (1) The following acts constitute grounds for denial of a
  181  license or disciplinary action, as specified in s. 456.072(2):
  182         (a) Attempting to procure a license to practice massage
  183  therapy by bribery or fraudulent misrepresentation.
  184         (b) Having a license to practice massage therapy revoked,
  185  suspended, or otherwise acted against, including the denial of
  186  licensure, by the licensing authority of another state,
  187  territory, or country.
  188         (c) Being convicted or found guilty, regardless of
  189  adjudication, of a crime in any jurisdiction which directly
  190  relates to the practice of massage therapy or to the ability to
  191  practice massage therapy. Any plea of nolo contendere shall be
  192  considered a conviction for purposes of this chapter.
  193         (f) Aiding, assisting, procuring, or advising any
  194  unlicensed person to practice massage therapy contrary to the
  195  provisions of this chapter or to department or board a rule of
  196  the department or the board.
  197         (g) Making deceptive, untrue, or fraudulent representations
  198  in the practice of massage therapy.
  199         (h) Being unable to practice massage therapy with
  200  reasonable skill and safety by reason of illness or use of
  201  alcohol, drugs, narcotics, chemicals, or any other type of
  202  material or as a result of any mental or physical condition. In
  203  enforcing this paragraph, the department shall have, upon
  204  probable cause, may authority to compel a massage therapist to
  205  submit to a mental or physical examination by physicians
  206  designated by the department. Failure of a massage therapist to
  207  submit to such examination when so directed, unless the failure
  208  was due to circumstances beyond her or his control, constitutes
  209  shall constitute an admission of the allegations against her or
  210  him, consequent upon which a default and final order may be
  211  entered without the taking of testimony or presentation of
  212  evidence. A massage therapist affected under this paragraph
  213  shall at reasonable intervals be afforded an opportunity to
  214  demonstrate that she or he can resume the competent practice of
  215  massage therapy with reasonable skill and safety to clients.
  216         (i) Gross or repeated malpractice or the failure to
  217  practice massage therapy with that level of care, skill, and
  218  treatment which is recognized by a reasonably prudent massage
  219  therapist as being acceptable under similar conditions and
  220  circumstances.
  221         (o) Practicing massage therapy at a site, location, or
  222  place which is not duly licensed as a massage establishment,
  223  except that a massage therapist, as provided by rules adopted by
  224  the board rule, may provide massage therapy services, excluding
  225  colonic irrigation, at the residence of a client, at the office
  226  of the client, at a sports event, at a convention, or at a trade
  227  show.
  228         Section 13. Section 480.0465, Florida Statutes, is amended
  229  to read:
  230         480.0465 Advertisement.—Each massage therapist or massage
  231  establishment licensed under the provisions of this act shall
  232  include the number of the license in any advertisement of
  233  massage therapy services appearing in a newspaper, airwave
  234  transmission, telephone directory, or other advertising medium.
  235  Pending licensure of a new massage establishment pursuant to the
  236  provisions of s. 480.043(7), the license number of a licensed
  237  massage therapist who is an owner or principal officer of the
  238  establishment may be used in lieu of the license number for the
  239  establishment.
  240         Section 14. Paragraphs (a), (b), and (c) of subsection (1)
  241  of section 480.047, Florida Statutes, are amended to read:
  242         480.047 Penalties.—
  243         (1) It is unlawful for any person to:
  244         (a) Hold himself or herself out as a massage therapist or
  245  to practice massage therapy unless duly licensed under this
  246  chapter or unless otherwise specifically exempted from licensure
  247  under this chapter.
  248         (b) Operate any massage establishment unless it has been
  249  duly licensed as provided herein, except that nothing herein
  250  shall be construed to prevent the teaching of massage therapy in
  251  this state at a board-approved massage therapy school.
  252         (c) Permit an employed person to practice massage therapy
  253  unless duly licensed as provided herein.
  254         Section 15. Section 480.052, Florida Statutes, is amended
  255  to read:
  256         480.052 Power of county or municipality to regulate massage
  257  therapy.—A county or municipality, within its jurisdiction, may
  258  regulate persons and establishments licensed under this chapter.
  259  Such regulation may shall not exceed the powers of the state
  260  under this act or be inconsistent with this act. This section
  261  may shall not be construed to prohibit a county or municipality
  262  from enacting any regulation of persons or establishments not
  263  licensed pursuant to this act.
  264         Section 16. Subsections (1) and (2) of section 480.0535,
  265  Florida Statutes, are amended to read:
  266         480.0535 Documents required while working in a massage
  267  establishment.—
  268         (1) In order to provide the department and law enforcement
  269  agencies the means to more effectively identify, investigate,
  270  and arrest persons engaging in human trafficking, a person
  271  employed by a massage establishment and any person performing
  272  massage therapy therein must immediately present, upon the
  273  request of an investigator of the department or a law
  274  enforcement officer, valid government identification while in
  275  the establishment. Any of the following is a valid government
  276  identification for the purposes of this section is:
  277         (a) A valid, unexpired driver license issued by any state,
  278  territory, or district of the United States.;
  279         (b) A valid, unexpired identification card issued by any
  280  state, territory, or district of the United States.;
  281         (c) A valid, unexpired United States passport.;
  282         (d) A naturalization certificate issued by the United
  283  States Department of Homeland Security.;
  284         (e) A valid, unexpired alien registration receipt card
  285  (green card).; or
  286         (f) A valid, unexpired employment authorization card issued
  287  by the United States Department of Homeland Security.
  288         (2) A person operating a massage establishment must:
  289         (a) Immediately present, upon the request of an
  290  investigator of the department or a law enforcement officer:
  291         1. Valid government identification while in the
  292  establishment.
  293         2. A copy of the documentation specified in paragraph
  294  (1)(a) for each employee and any person performing massage
  295  therapy in the establishment.
  296         (b) Ensure that each employee and any person performing
  297  massage therapy in the massage establishment is able to
  298  immediately present, upon the request of an investigator of the
  299  department or a law enforcement officer, valid government
  300  identification while in the establishment.
  301         Section 17. Section 627.6407, Florida Statutes, is amended
  302  to read:
  303         627.6407 Massage.—Any policy of health insurance that
  304  provides coverage for massage shall also cover the services of
  305  persons licensed to practice massage therapy pursuant to chapter
  306  480, where the massage therapy, as defined in chapter 480, has
  307  been prescribed by a physician licensed under chapter 458,
  308  chapter 459, chapter 460, or chapter 461, as being medically
  309  necessary and the prescription specifies the number of
  310  treatments.
  311         Section 18. Section 627.6619, Florida Statutes, is amended
  312  to read:
  313         627.6619 Massage.—Any policy of health insurance that
  314  provides coverage for massage shall also cover the services of
  315  persons licensed to practice massage therapy pursuant to chapter
  316  480, where the massage therapy, as defined in chapter 480, has
  317  been prescribed by a physician licensed under chapter 458,
  318  chapter 459, chapter 460, or chapter 461, as being medically
  319  necessary and the prescription specifies the number of
  320  treatments.
  321         Section 19. Paragraph (a) of subsection (1) of section
  322  627.736, Florida Statutes, is amended to read:
  323         627.736 Required personal injury protection benefits;
  324  exclusions; priority; claims.—
  325         (1) REQUIRED BENEFITS.—An insurance policy complying with
  326  the security requirements of s. 627.733 must provide personal
  327  injury protection to the named insured, relatives residing in
  328  the same household, persons operating the insured motor vehicle,
  329  passengers in the motor vehicle, and other persons struck by the
  330  motor vehicle and suffering bodily injury while not an occupant
  331  of a self-propelled vehicle, subject to subsection (2) and
  332  paragraph (4)(e), to a limit of $10,000 in medical and
  333  disability benefits and $5,000 in death benefits resulting from
  334  bodily injury, sickness, disease, or death arising out of the
  335  ownership, maintenance, or use of a motor vehicle as follows:
  336         (a) Medical benefits.—Eighty percent of all reasonable
  337  expenses for medically necessary medical, surgical, X-ray,
  338  dental, and rehabilitative services, including prosthetic
  339  devices and medically necessary ambulance, hospital, and nursing
  340  services if the individual receives initial services and care
  341  pursuant to subparagraph 1. within 14 days after the motor
  342  vehicle accident. The medical benefits provide reimbursement
  343  only for:
  344         1. Initial services and care that are lawfully provided,
  345  supervised, ordered, or prescribed by a physician licensed under
  346  chapter 458 or chapter 459, a dentist licensed under chapter
  347  466, a chiropractic physician licensed under chapter 460, or an
  348  advanced practice registered nurse registered under s. 464.0123
  349  or that are provided in a hospital or in a facility that owns,
  350  or is wholly owned by, a hospital. Initial services and care may
  351  also be provided by a person or entity licensed under part III
  352  of chapter 401 which provides emergency transportation and
  353  treatment.
  354         2. Upon referral by a provider described in subparagraph
  355  1., followup services and care consistent with the underlying
  356  medical diagnosis rendered pursuant to subparagraph 1. which may
  357  be provided, supervised, ordered, or prescribed only by a
  358  physician licensed under chapter 458 or chapter 459, a
  359  chiropractic physician licensed under chapter 460, a dentist
  360  licensed under chapter 466, or an advanced practice registered
  361  nurse registered under s. 464.0123, or, to the extent permitted
  362  by applicable law and under the supervision of such physician,
  363  osteopathic physician, chiropractic physician, or dentist, by a
  364  physician assistant licensed under chapter 458 or chapter 459 or
  365  an advanced practice registered nurse licensed under chapter
  366  464. Followup services and care may also be provided by the
  367  following persons or entities:
  368         a. A hospital or ambulatory surgical center licensed under
  369  chapter 395.
  370         b. An entity wholly owned by one or more physicians
  371  licensed under chapter 458 or chapter 459, chiropractic
  372  physicians licensed under chapter 460, advanced practice
  373  registered nurses registered under s. 464.0123, or dentists
  374  licensed under chapter 466 or by such practitioners and the
  375  spouse, parent, child, or sibling of such practitioners.
  376         c. An entity that owns or is wholly owned, directly or
  377  indirectly, by a hospital or hospitals.
  378         d. A physical therapist licensed under chapter 486, based
  379  upon a referral by a provider described in this subparagraph.
  380         e. A health care clinic licensed under part X of chapter
  381  400 which is accredited by an accrediting organization whose
  382  standards incorporate comparable regulations required by this
  383  state, or
  384         (I) Has a medical director licensed under chapter 458,
  385  chapter 459, or chapter 460;
  386         (II) Has been continuously licensed for more than 3 years
  387  or is a publicly traded corporation that issues securities
  388  traded on an exchange registered with the United States
  389  Securities and Exchange Commission as a national securities
  390  exchange; and
  391         (III) Provides at least four of the following medical
  392  specialties:
  393         (A) General medicine.
  394         (B) Radiography.
  395         (C) Orthopedic medicine.
  396         (D) Physical medicine.
  397         (E) Physical therapy.
  398         (F) Physical rehabilitation.
  399         (G) Prescribing or dispensing outpatient prescription
  400  medication.
  401         (H) Laboratory services.
  402         3. Reimbursement for services and care provided in
  403  subparagraph 1. or subparagraph 2. up to $10,000 if a physician
  404  licensed under chapter 458 or chapter 459, a dentist licensed
  405  under chapter 466, a physician assistant licensed under chapter
  406  458 or chapter 459, or an advanced practice registered nurse
  407  licensed under chapter 464 has determined that the injured
  408  person had an emergency medical condition.
  409         4. Reimbursement for services and care provided in
  410  subparagraph 1. or subparagraph 2. is limited to $2,500 if a
  411  provider listed in subparagraph 1. or subparagraph 2. determines
  412  that the injured person did not have an emergency medical
  413  condition.
  414         5. Medical benefits do not include massage therapy as
  415  defined in s. 480.033 or acupuncture as defined in s. 457.102,
  416  regardless of the person, entity, or licensee providing massage
  417  therapy or acupuncture, and a licensed massage therapist or
  418  licensed acupuncturist may not be reimbursed for medical
  419  benefits under this section.
  420         6. The Financial Services Commission shall adopt by rule
  421  the form that must be used by an insurer and a health care
  422  provider specified in sub-subparagraph 2.b., sub-subparagraph
  423  2.c., or sub-subparagraph 2.e. to document that the health care
  424  provider meets the criteria of this paragraph. Such rule must
  425  include a requirement for a sworn statement or affidavit.
  427  Only insurers writing motor vehicle liability insurance in this
  428  state may provide the required benefits of this section, and
  429  such insurer may not require the purchase of any other motor
  430  vehicle coverage other than the purchase of property damage
  431  liability coverage as required by s. 627.7275 as a condition for
  432  providing such benefits. Insurers may not require that property
  433  damage liability insurance in an amount greater than $10,000 be
  434  purchased in conjunction with personal injury protection. Such
  435  insurers shall make benefits and required property damage
  436  liability insurance coverage available through normal marketing
  437  channels. An insurer writing motor vehicle liability insurance
  438  in this state who fails to comply with such availability
  439  requirement as a general business practice violates part IX of
  440  chapter 626, and such violation constitutes an unfair method of
  441  competition or an unfair or deceptive act or practice involving
  442  the business of insurance. An insurer committing such violation
  443  is subject to the penalties provided under that part, as well as
  444  those provided elsewhere in the insurance code.
  445         Section 20. Subsection (37) of section 641.31, Florida
  446  Statutes, is amended to read:
  447         641.31 Health maintenance contracts.—
  448         (37) All health maintenance contracts that provide coverage
  449  for massage must also cover the services of persons licensed to
  450  practice massage therapy pursuant to chapter 480 if the massage
  451  is prescribed by a contracted physician licensed under chapter
  452  458, chapter 459, chapter 460, or chapter 461 as medically
  453  necessary and the prescription specifies the number of
  454  treatments. Such massage services are subject to the same terms,
  455  conditions, and limitations as those of other covered services.
  456         Section 21. Subsection (3) of section 823.05, Florida
  457  Statutes, is amended to read:
  458         823.05 Places and groups engaged in certain activities
  459  declared a nuisance; abatement and enjoinment.—
  460         (3) A massage establishment as defined in s. 480.033 s.
  461  480.033(7) which operates in violation of s. 480.0475 or s.
  462  480.0535(2) is declared a nuisance and may be abated or enjoined
  463  as provided in ss. 60.05 and 60.06.
  464         Section 22. This act shall take effect July 1, 2021.