BILL ANALYSIS                                                                                                                                                                                                    �







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        |Hearing Date:June 13, 2011         |Bill No:AB                         |
        |                                   |619                                |
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                      SENATE COMMITTEE ON BUSINESS, PROFESSIONS 
                               AND ECONOMIC DEVELOPMENT
                          Senator Curren D. Price, Jr., Chair
                                           

                        Bill No:        AB 619Author:Halderman
                        As Amended:June 7, 2011  Fiscal:    No

        
        SUBJECT:   Massage therapy.
        
        SUMMARY:  Changes the name of the Massage Therapy Organization to the 
        "California Massage Therapy Council" (CAMTC) and makes a number of 
        clarifying, conforming and technical changes to Massage Therapy Act 
        (Act) regarding the approval of schools providing training and 
        curriculum in massage, reimbursements of costs incurred by the CAMTC 
        for denying a massage certificate or disciplining a certificate 
        holder, the advertising and display of the massage certificate, and 
        the granting of a conditional certificate.  Provides for severability 
        of provisions within the Act so that the invalidity of one provision 
        shall not affect other provisions within the Act.    

        Existing law:
        
       1)Provides for certification of massage practitioners and massage 
          therapists, as defined, by the Massage Therapy Organization 
          (MTO) and specifies that the MTO is a nonprofit organization 
          meeting specified requirements, and imposes certain duties on 
          the MTO.  (Business and Profession Code (BCP) �� 4600 (e), 
          4600.5 (a) and (b)(2))

       2)Provides that the MTO is to be governed by a board of directors 
          (Board) which shall include:  (BCP � 4600.5 (b)(1))

           a)   Two representatives from each professional society, 
             association, or other entity whose membership is comprised of 
             massage therapists and that chooses to participate in the MTO 
             and that has a dues-paying membership in California of at 
             least 1,000 individuals for the last three years and that 





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             shall have by-laws that requires its members to abide by a 
             code of ethics.

           b)   One member selected by each statewide association of 
             private postsecondary schools incorporated on or before 
             January 1, 2010, whose members schools have together had at 
             least 1,000 graduates in each of the previous three years 
             from approved and registered, as defined, massage therapy 
             programs. 

           c)   One member selected by the League of California cities.

           d)   One member selected by the California State Association of 
             Counties.

           e)   One member selected by the Department of Consumer Affairs.

           f)   One member appointed by the California Community College 
             Chancellor's Office.

       3)Provides that the above mentioned entities may choose  not  to 
          exercise the right of selection of a member to serve on the MTO 
          Board and allows for the MTO's bylaws to establish a process for 
          appointing other professional directors as determined by the 
          Board.  (BCP � 4600.5 (b)(1))

       4)Requires the MTO to issue a "  massage practitioner  " certificate to 
          an applicant, who submits a written application and provides 
          satisfactory evidence that he or she meets all of the specified 
          education, experience or examination requirements, or has a 
          current valid license from a local jurisdiction and meets other 
          education and/or experience requirements.  (BCP � 4601 (b))

       5)Requires the MTO to issue a "  massage therapist  " certificate to an 
          applicant who submits a written application and provides with 
          satisfactory evidence that he or she meets all of the specified 
          education, experience or examination requirements.  
       (BCP � 4601 (c))

       6)Requires the MTO to issue a certificate to an applicant who meets 
          the other qualifications provided for and holds a current and 
          valid registration, certification, or license from any other 
          state whose licensure requirements meets or exceeds those 
          defined above.  (BCP � 4601 (d))

       7)Provides that the MTO shall determine whether or not a school 





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          provides education that meets the requirements of certification 
          and requires the MTO to investigate, if necessary, whether or 
          not an applicant has actually completed the education he or she 
          claims in his or her application and to conduct oral interviews, 
          if necessary, of any applicant to make any investigation to 
          establish that the information received is accurate and 
          satisfies any criteria established pursuant to the Act.  (BCP � 
          4601 (g))

       8)Provides that prior to issuing a certificate to the applicant or 
          designating a custodian of records the MTO shall obtain 
          fingerprints, which may be in an electronic format, from an 
          applicant for certification as a massage therapist or massage 
          practitioner for the purpose of conducting a criminal background 
          check, and specifies that the Department of Justice (DOJ) shall 
          provide the MTO with the specified information relating to an 
          applicant's criminal history.  (BCP � 4601.3) 

       9)Provides that the MTO may discipline a certificate holder by any, 
          or a combination of, the following methods:  a) probation with 
          conditions; b) suspending the certificate for a period not to 
          exceed one year; c) revoke the certificate; d) provide for 
          conditional certificate suspension; e) any other appropriate 
          action as authorized by its by-laws.  (BCP � 4602 (a))

       10)Requires the MTO to suspend a certificate if the holder has been 
          arrested and charged with any sexually related or 
          prostitution-related crime and to notify the holder and his or 
          her employer of the suspension, and if the charges result in a 
          conviction, the MTO shall permanently revoke the certification; 
          however, if the holder is acquitted of the charges, the MTO 
          shall re-instate the certification.  (BCP � 4602 (c))

       11)Requires the MTO to provide specified information regarding 
          certificate holders to any local law enforcement or other agency 
          that regulates massage therapy, and likewise the MTO shall 
          accept and review any information pertaining to a certificate 
          holder provided by local law enforcement or other agency that 
          regulates massage therapy, and shall have the responsibility to 
          take any actions as authorized under the Act and are warranted 
          by the information.  (BCP � 4602.5)

       12)Provides for various grounds for discipline against a 
          certificate holder or for denial of a certificate to an 
          applicant, including:  unprofessional conduct; procurement of 
          certificate by fraud; misrepresentation or mistake; conviction 





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          of a felony or misdemeanor substantially related to their 
          qualifications, functions or duties, or committing any 
          fraudulent, dishonest, or corrupt act that is substantially 
          related; and, committing any act punishable as a sexually 
          related crime.  (BCP � 4603)

       13)Provides that no certificate holder or certificate applicant may 
          be disciplined or denied a certificate except according to 
          specified due process procedures which have been set forth in 
          the articles or bylaws of the MTO and that a certificate 
          applicant or certificate holder who is denied of disciplined 
          shall be liable for any charges incurred, services actually 
          rendered or fees incurred by the MTO in the denial of the 
          certificate or discipline of the certificate holder.  (BCP � 
          4603.1)

       14)Provides that the MTO may grant a massage practitioner 
          certificate to any person who meets specified education and 
          experience requirements and who has either been granted a permit 
          or license from a California local city or county or from 
          another state.  (BCP � 4604 (a))

       15)Provides that the MTO may also grant a conditional certificate 
          to allow the applicant sufficient opportunity to comply with 
          additional education and practice hours and shall within 5 years 
          provide proof of completion of the additional hours required, 
          and upon successful completion of the additional hours shall be 
          issued a certificate.  However, the MTO shall immediately revoke 
          the conditional certificate if the time period specified expires 
          without proof of completion of the requirements for education 
          and practice hours.  (BPC � 4604 (c))

       16)Provides that the holder of a certificate issued by the MTO 
          shall be able to practice massage in any city, county, or city 
          and county, consistent with the Act and the qualification 
          established by his or her certification, and shall not be 
          required to obtain any other license, permit, or other 
          authorization, except as provided under the Act.  (BPC � 4612 
          (a))

       17)Provides that a city, county, or city and county shall not enact 
          an ordinance that requires a license, permit, or other 
          authorization to practice massage by an individual who is 
          certified pursuant to the Act and who is practicing consistent 
          with the qualifications established by his or her certification 
          and provides that no provision of any ordinance enacted by a 





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          city, county, or city and county that is in effect before the 
          effective date of this Act, and that requires a license, permit, 
          or other authorization to practice massage, may be enforced 
          against an individual who is certified under the Act.  (BPC � 
          4612 (a))
       18)Provides that nothing in the Act shall prevent a city, county, 
          or city and county from adopting or enforcing any local 
          ordinance governing zoning, business licensing, and reasonable 
          health and safety requirements for massage establishments or 
          businesses that employs or uses persons who are  not   certified  
          pursuant to the Act.  
       (BPC � 4612 (a)) 

       19)Provides that a local government may subject any massage 
          business or establishment to reasonable inspections to verify 
          conformance with local ordinances and fire, health, and safety 
          requirements, and may also require the operator of a massage 
          business to notify it of any change in business name, 
          management, or transfer of ownership to another person.  (BPC � 
          4612 (b))

       20)Provides that an operator or a massage business that is 
          certified by the MTO and/or uses only individuals certified by 
          the MTO shall be responsible for the conduct of his or her 
          employees and shall be subject to suspension of any required 
          local business license or permit if violations of the Act or a 
          local ordinance occur.  (BPC � 4612 (c))

        21)Subjects the Act and the MTO to review by the former Joint 
           Committee on Boards, Commissions and Consumer Protection and 
           repeals the provisions of the Act on January 1, 2016.  (BPC �� 
           4615, 4620)

        This bill:

        1) Changes the name of the Massage Therapy Organization to the 
           "California Massage Therapy Council" (CAMTC).

        2) Clarifies that schools, as defined, which provide education, 
           training and curriculum in massage, shall be approved by the CAMTC 
            and  if they meet other specified requirements. 

        3) Eliminates the liability on the part of a certificate applicant or 
           certificate holder for any charges incurred, services actually 
           rendered or fees incurred by the CAMTC in the denial of the 
           certificate or discipline of the certificate holder.





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        4) Provides that the CAMTC shall be sued only in the county of its 
           principal office. 

        5) Provides that a certificate holder shall include the name under 
           which he or she is certified and his or her certificate number in 
           any and all advertising and shall display his or her certificate at 
           his or her place of business.

        6) Specifies that a conditional certificate provided by the CAMTC 
           shall be immediately nullified rather than revoked, without further 
           action by the CAMTC, if the time period specified by the CAMTC 
           expires without proof of completion of the requirements for 
           additional education and practice hours.

        7) Authorizes the CAMTC to revoke the massage certificate of an owner 
           or operator of a massage establishment or business, as specified, 
           if his or her employees violate provisions of the Act.

        8) Provides that the Act shall be liberally construed to effectuate 
           its purposes and that if any provisions of the Act are held invalid 
           that the invalidity shall not affect other provisions or 
           applications of the Act and that it can be given effect without the 
           invalid provisions or application, and to this end the provisions 
           of the Act are severable.

        9) Subjects the Act and the CAMTC to review by the newly created Joint 
           Sunset Review Committee of the Legislature.

        FISCAL EFFECT:  None.  This measure is keyed "non-fiscal" by 
        Legislative Counsel.
        
        COMMENTS:
        
        1.Purpose.  This measure is sponsored by the  American Massage Therapy 
          Association - 
        CA Chapter  (AMTA-CC).  According to the Sponsor, over 40,000 massage 
          professionals practice in California.  Some are independent 
          practitioners while many others are employees of spas and 
          chiropractors.  In the almost two years that statewide voluntary 
          massage certification has been in place, over 26,000 have applied 
          for certification, and thus far 20,000 have successfully 
          demonstrated proof of qualification for certification.  Moving 
          forward, the Sponsor sees the need for some technical and clean-up 
          changes to improve the original law,  SB 731  (Oropeza, Chapter 384, 
          Statutes of 2008).





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        This measure first names the organization which currently administers 
          the statewide certification of massage therapists as the "California 
          Massage Therapy Council" (CAMTC).  This will remove any possible 
          confusion when references are made to "Massage Therapy Organization" 
          which is responsible for implementing the Massage Therapy Act.

        Other changes include:

           a)   Clarifies the responsibility for approving schools which train 
             and educate massage therapists.  Confusion arises because a 
             school may be approved by another agency or entity, and that this 
             school should automatically be given approval by the CAMTC.  It 
             has always been the intent of the Act that the CAMTC has ultimate 
             responsibility to provide approval of the school for purposes of 
             accepting the required number of hours for certification.  

           b)   Specifies that litigation will be in the county of the CAMTC's 
             office.  The current language regarding current fees and 
             appealing disciplinary actions is replaced with clarified 
             language that includes a requirement that should CAMTC be sued it 
             will occur in its own county.  This is a common requirement, as 
             indicated by the Sponsor.  The Sponsor believes it would become 
             very costly should the organization be sued in various locations. 
              This ensures the funds of the organization are spent effectively 
             and wisely in legal matters.

           c)   Clarifies that a conditional certificate automatically ends 
             when time expires.  This item as explained by the Sponsor will 
             clarify that conditional certificates are automatically nullified 
             should the requirements for the certificate not be met in the 
             time allotted.  This will assure that no formal action would be 
             required by the CAMTC should an applicant decide not to pursue 
             the certification or for whatever reason not complete the process 
             for certification.  The conditional certification would simply 
             end.

           d)   Provides that the owner/operator of a massage 
             business/establishment could have their certificate from CAMTC 
             revoked for employee misconduct.  According to the Sponsor, 
             current law states that a certified massage therapist who is an 
             owner or operator of a massage business is responsible for the 
             conduct of their employees.  This ensures a professional 
             environment for the consumer and the employees.  This amendment 
             would put teeth in the requirement by adding that the 
             owner/operator may lose their statewide certification should they 





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             allow unprofessional conduct by their employees.

           e)   Provides for a severability clause.  The Sponsor indicates 
             that this is a technical clause which is common and ensures 
             that if for some reason one part of the massage therapy 
             chapter is held invalid that does not mean the entire chapter 
             is invalid, on the section in question.

        2.Background. 

           a)   The Practice of Massage Therapy in California.  Massage 
             has grown into the third most requested Complementary and 
             Alternative Practice; only chiropractic and relaxation 
             techniques are more popular, according to the American 
             Massage Therapy Association, California Chapter  (AMTA-CA).  
             Massage is used for managing stress, enhancing 
             self-awareness, maintaining health, increasing athletic 
             performance, rehabilitating from injuries, and as an adjunct 
             to medical treatment for a wide variety of conditions.

           Estimates based on surveys, professional affiliations, and 
             liability insurance show that up to 40,000 massage therapists 
             are currently practicing in California.  Exact numbers are 
             hard to pinpoint given the high turnover rate of the 
             profession.  Some massage therapists are independent 
             practitioners while a large number of others are employees of 
             spas and chiropractors.

           According to the AMTA-CA, 220 schools in California are now 
             approved to offer instruction in massage, with programs 
             ranging from 100 hours to 1,000 hours.  In addition to the 
             large number of proprietary schools approved by the Bureau of 
             Private Post-Secondary and Vocational Education or nationally 
             accredited, massage as a vocation is now taught in 
             cosmetology schools, trade schools, and several community 
             colleges.

           Titles used in California by the massage profession include:  
             massage therapist, massage practitioner, certified massage 
             therapist, massage technician, bodyworker, masseur, masseuse, 
             myotherapist, Nationally Certified in Therapeutic Massage and 
             Bodywork.  Where no local regulations exist, any title can be 
             used.

           The National Certification Board for Therapeutic Massage and 
             Bodywork (NCBTMB) certifies massage therapists and 





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             bodyworkers on behalf of the profession.  NCBTMB developed 
             and administers the National Certification Examination for 
             Therapeutic Massage and Bodywork.  There is also a nationally 
             recognized certification exam for practitioners for 
             certification in Asian bodywork therapies.  This is 
             administered by the National Certification Commission for 
             Acupuncture and Oriental Medicine.

           According to the AMTA-CA, consumers do not know the difference 
             between a purchased certification and a certification that 
             requires a specific amount of training.  Different 
             jurisdictions have different standards which would indicate 
             that there is no local government agreement about what 
             standards are necessary and sufficient.

           b)   Prior Law and Regulation in California Cities and Counties 
             of Massage Businesses.   AB 3325   (McAllister, Chapter 1352, 
             Statutes of 1976) enacted the prior local authority to 
             regulate the business of massage.  In an analyses of that 
             bill, it is stated that the purpose of the bill is to clearly 
             state that local governments have the authority to regulate 
             the operation of massage businesses through licensing 
             procedures if they so desire.

           The law allowed cities and counties to condition the issuance 
             of a massage license upon proof that the massage personnel 
             and the owners or operator of such businesses have not been 
             convicted of certain sex-related crimes.  It was argued by 
             some that this legislation was enacted to deal in part with 
             the adult-oriented sex business, but in doing so, legitimate 
             massage businesses were subject to local ordinances that 
             inappropriately and oppressively regulated them as "adult 
             entertainment."  Some examples are restrictive zoning, 
             excessive fees, VD tests, required showers and separate 
             restrooms, and prohibited home visits.  Because local 
             jurisdictions controlled the regulation of massage, local 
             ordinances could be vastly different.

           The perception of massage as a vice resulted in many cities 
             requiring expensive conditional use permits.  Restricting 
             massage businesses from opening within 1,000 feet of schools, 
             churches, or residences effectively zoned massage out of many 
             small cities.  Proponents of state regulation argued that 
             local regulation treats professionals and "massage parlors" 
             alike and that consumers have a problem knowing how to 
             distinguish legitimate massage practitioners from "massage 





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             parlors."

           c)   Current Regulation of Massage Therapists and Their 
             Businesses.  
           In February 2003, Assembly Member Kehoe introduced  AB 1388  , 
             which was sponsored by the AMTA-CA.  As introduced, the bill 
             would have established the Massage Therapy and Bodyworks 
             Commission in the Department of Consumer Affairs to register 
             and regulate massage therapists and bodyworkers.  It was 
             referred to the Assembly Business and Professions Committee; 
             however, it died in that Committee without being heard.  
             Although there was significant discussion surrounding the 
             issue of state regulation of massage therapy, interested 
             parties could not reach any type of agreement as to what the 
             regulatory scheme should be.

           In January 6, 2005, the issue of whether California should 
             shift the regulation of massage therapists from the local 
             level to the state level and what type of regulatory 
             oversight should be provided was submitted to review by the 
             Joint Committee on Boards, Commissions and Consumer 
                                                                               Protection (Joint Committee).  This was part of the "sunrise 
             review process" which provides that any new proposals to 
             create new licensure or regulatory categories, change 
             licensing requirements, modify scope of practice, or create a 
             new licensing board may be referred to the Joint Committee by 
             the standing committees of the Legislature.  (Sunrise review 
             is also  required  under Section 9148 et seq. of the Government 
             Code for any new categories of licensure or creation of a new 
             licensing board.)  This permits an opportunity for all 
             interested parties to participate in discussing both the pros 
             and cons of such a proposal and for the Joint Committee to 
             make recommendations to the Legislature regarding these 
             proposals.

           The Joint Committee found that massage therapy is "regulated in 
             California by a chaotic mish-mash of local vice ordinances 
             primarily aimed at controlling illicit 'massage parlors.'  In 
             essence, the current system sought to regulate illegal 
             activity in the guise of professional licensing."  The Joint 
             Committee concluded that the current system fails to serve 
             either the public or the profession and that it is 
             appropriate to streamline the regulation of massage therapy 
             at the state level in order to create a more uniform 
             standard.  The Joint Committee, on April 12, 2005, issued its 
             recommendation and stated that regulation of massage 





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             therapists should be shifted from the current local 
             jurisdiction approach to a state-based approach to provide 
             for more uniform standards.  It was also recommended that the 
             state-based approach should be flexible enough to serve the 
             needs of the public, the profession, as well as the 
             legitimate interests of the local governments who currently 
             use existing law for legitimate public policy purposes.

           The recommended regulatory regime for massage therapy was 
             modeled after regulatory regimes for tax preparers (BPC � 
             22250 et seq.) and interior designers (BPC � 5800 et seq.) 
             which provide for statutorily created non-profit corporations 
             that have the authority to certify qualified individuals in 
             their respective professions.

            SB 412  (Figueroa) was introduced in 2005 and was sponsored by 
             the AMTA-CA.  SB 412 became a two-year bill and lengthy 
             discussions took place with the League of Cities, California 
             State Association of Counties, local law enforcement, those 
             representing private and public massage schools, massage and 
             related massage therapy associations and organizations, 
             chiropractic and physical therapy associations.  This 
             measure, however, failed passage on the Assembly Floor at the 
             end of Session in 2006, because of the opposition from both 
             the chiropractic and physical therapy profession regarding 
             the definition of "massage therapy."

            SB 731  (Oropeza, Chapter 384, Statutes of 2008) was then 
             introduced in 2008, and was almost identical in every aspect 
             to SB 412.  The only difference was in the definitions of 
             "approved" and "registered schools" and in the definition of 
             massage therapy.  SB 731 which implemented the Massage 
             Therapy Act, shifted the regulation of massage therapists 
             from local jurisdictions to a state-based approach and 
             created a voluntary statewide certification of massage 
             therapists and the Massage Therapy Organization (MTO) with 
             the authority to implement a certification program.  The 
             purpose of the MTO was to make the process of certification 
             the same throughout the state, rather than different in each 
             city and county.  The California statewide voluntary massage 
             certification program allowed for work in multiple California 
             locations without the need for multiple permits or fees and 
             multiple and differing requirements to provide massage 
             therapy services.







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           Recently the MTO was renamed the CAMTC by the organization.  As 
             indicated, the CAMTC evaluates the qualifications of massage 
             professionals and issues certifications in California.  There 
             are two levels of certification, Certified Massage Therapist 
             (CMT) and Certified Massage Practitioner (CMP), each with 
             different educational requirements.  If a CMT or CMP violates 
             terms of certification, CAMTC can suspend or revoke their 
             certification.  Although California law grants title 
             protection, there is not defined scope of practice for 
             massage professionals.  Local cities and counties cannot 
             require local massage licenses/permits of CAMTC CMTs or CMPs, 
             but they can require permits dealing with reasonable health 
             and safety concerns.  They will also generally require a 
             business license of the business owner, independent 
             contractor, or tenant.

        3.Arguments in Support.  The  Associated Bodywork & Massage 
          Professionals  (ABMP) is in support of this measure and points 
          out that the primary benefit of the passage of SB 731 was to 
          provide massage therapists some financial relief from 
          restrictive and discriminatory local ordinances and from having 
          duplicative processes to practice in multiple locations.  The 
          ABMP indicates that the current certification program of CAMTC 
          is working with over 20,000 individuals having met the 
          qualifications for certification and are enjoying the economic 
          benefit of having to obtain only one credential to practice 
          massage anywhere in California.  The ABMP believes these are 
          needed technical changes which will improve the Act.

        The  California Police Chiefs Association, Inc.  is in support and 
          indicates that these are clean-up provisions �to the Act] that 
          are agreed upon by both the law enforcement community and the 
          body-work community.  The Police Chiefs "look forward to 
          continuing to work collaboratively in order to assure the 
          elevation of the body work profession while exorcizing the 
          prostitution and human traffic elements that have attempted to 
          invade the profession."
        

        SUPPORT AND OPPOSITION:
        
         Support:  

        American Massage Therapy Association - California Chapter (Sponsor)
        Associated Bodywork and Massage Professionals





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        California Police Chiefs Association, Inc.
         
        Opposition:  None on File as of June 8, 2011.



        Consultant:Bill Gage