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Legislative Update February 15, 2019

Friday, February 15, 2019   (0 Comments)
Posted by: Michael Mandell
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Since the Legislature convened on January 14th, committees have been busy hearing many of the over 2,000 bills that have been introduced thus far. It’s a very busy session, and in particular, there are lots of BIG bills. The following is an overview of legislation and topics of interest to LMTs:


Independent contractors. Multiple bills have been introduced to severely restrict who can be an independent contractor in Washington State. Proponents say their intention was to help independent contractors who they believed were being taken advantage of by some employers. Opponents, to include the business community, very clearly stated their strong opposition to any legislation that would limit a person’s ability to be an independent contractor. While there are growing indications that these bills will not progress, AMTA-WA urges members to contact their legislators with this simple message: “Please do not support any legislation that would restrict my ability to be an independent contractor in Washington State.” If you want to include some personal details about your own situation, that’s always appreciated by legislators. And of course, always be respectful. There has been a lot of turnover in the Legislature, so if you’re  uncertain who your legislators are, just click here.


Licensure fees increase expected for LMTs. AMTA-WA just received notification that the  Department of Health (DOH) expects to raise initial licensure and renewal fees for LMTs on October 1, 2019 from $125 to $210 for an initial application, and from $90 to $150. While a stakeholder workshop will be held on February 28th, there will only be 20 minutes allocated to an overview of costs that are triggering the proposed increases. A formal public hearing on these increases will be held sometime in April. As soon as AMTA-WA has this information, we will share it with you.


As has been mentioned in earlier articles, the Board of Massage has a deficit that needs to be paid. What we did not know was that the deficit was in excess of $2 million! And that without fee increases it was projected to grow to almost $5 million by 2025. AMTA-WA is surprised and saddened that the deficit was allowed to become this large without someone sounding the alarm. While we know that the bulk of the money was spent on illegal massage practice, if AMTA-WA had known that a deficit of this size was in process of building, we would have proactively engaged with DOH. We do know that going forward, it will be different. DOH itself acknowledges that it needs to more proactively provide information to the various stakeholders on budget issues. And you can be assured that AMTA-WA will be tracking the Board of Massage’s budget very closely and asking for frequent reports. In addition, our goal is to work with DOH to bring down the overall costs, for items such as attorney fees. We have much work to do.


B&O tax increase. The pressure continues on the Legislature to find an additional $4 billion for fiscal years 2019-21. We all thought that K-12 was fully funded at the end of 2018. It was not. So, even though revenues increased overall since the last budget by almost $1.5 billion, it’s not enough to solve the shortfall. As a result, the Governor and some legislators are looking to make up the shortfall by increasing the B&O tax from 1.5% to 2.5%, as well as enacting a tax on capital gains. AMTA-WA opposes any increase in the B&O tax for two main reasons: (1) it is the most regressive tax because it’s on gross receipts; and (2) it’s particularly unfair to health care providers who have no way to pass on increased costs. This is another issue where it’s important to make your voices heard.


Requiring identification for LMTs. Legislation has progressed in both the House and the Senate that would require LMTs and reflexologists to have photo identification available for inspection by local and state law enforcement as well as the Department of Health. This legislation was introduced at the request of the City of Vancouver. Vancouver’s law enforcement is committed to stopping illegal massage and reflexology operations in their city. They requested the legislation in order to help them determine who is legally entitled to practice as an LMT and reflexologist and who is not. While this legislation is no ones first choice, it is important to support those law enforcement jurisdictions that are willing to work to stop illegal massage.


Prior Authorization. Legislation was introduced by our friends the chiropractors to “fix” legislation introduced in 2018 concerning prior authorization and access to care. The language below shows the changes. AMTA-WA is supporting the legislation.

(2) A health carrier may not require prior authorization for an initial evaluation and management visit and up to six consecutive treatment visits with a contracting provider in a new episode of care of chiropractic, physical therapy, occupational therapy, East Asian medicine, massage therapy, or speech and hearing therapies ((that meet the standards of medical necessity and are subject to quantitative treatment limits of the health plan)). No carrier may deny or limit coverage for such initial six visits on the basis of medical necessity or appropriateness if the patient's chiropractor or other primary care provider has determined that such visits are medically necessary. Notwithstanding RCW 48.43.515(5) this section may not be interpreted to limit the ability of a health plan to require a referral or prescription for the therapies listed in this section.


Health Care Benefit Management. AMTA-WA worked with our friends, the chiropractors and others, to help perfect the language in SB 5601. In short, the legislation establishes standards for regulatory oversight of benefit managers. This legislation is long overdue, but unfortunately it represents what is called a “heavy lift.” While it’s not expected to progress this year, the hope is that it will lay the foundation for progress in 2020. AMTA-WA supports this legislation.

Here’s the intent section of the legislation which explains why this legislation is so important for both patients and providers:

“The legislature finds that growth in managed health care systems has shifted substantial authority over health care decisions from providers and patients to health carriers and benefit managers. Benefit managers acting as intermediaries between carriers, health care providers, and patients exercise broad discretion to affect health care services recommended and delivered by providers and the health care choices of patients. Regularly, these benefit managers are making care decisions on behalf of carriers and their decision makers routinely live outside of Washington and may not hold any Washington health care provider license. Benefit managers do not function as carriers. Therefore, it is in the best interest of the public to create a separate chapter for benefit managers.


The legislature intends to protect and promote the health, safety, and welfare of Washington residents by establishing standards for regulatory oversight of benefit managers.



Foot Zone Therapy. Legislation was introduced to exempt Foot Zone therapy from the definition of reflexology. Both the Washington Reflexology Association and AMTA-WA oppose this legislation. It has not been scheduled for a hearing.


Notification to Patients of Provider Sexual Misconduct. Legislation is moving forward that would require patient notification when a license holder has been sanctioned for unprofessional conduct involving sexual misconduct during the period the license holder is subject to the order or stipulation. Disciplinary authorities are given the authority to adopt rules to exempt certain types of sexual misconduct from the requirements of this act.


Treatment and Prevention of Opioid Use Disorder. The Governor introduced legislation that would assure that Washingtonians have access to treatment for opioid use disorder. In addition, the following section is a confirmation of the importance of alternatives to opioids.

“(1) In order to support prevention of potential opioid use disorders, the authority must develop and recommend for coverage nonpharmacologic treatments for acute, subacute, and chronic noncancer pain and must report to the governor and the appropriate committees of the legislature, including any requests for funding necessary to implement the recommendations under this section. The recommendations must contain the following elements:

(a) A list of which nonpharmacologic treatments will be covered;

(b) Recommendations as to the duration, amount, and type of treatment eligible for coverage;

(c) Guidance on the type of providers eligible to provide these treatments; and

(d) Recommendations regarding the need to add any provider types to the list of currently eligible medicaid provider types.

(2) The authority must ensure only treatments that are evidence-based for the treatment of the specific acute, subacute, and chronic pain conditions will be eligible for coverage recommendations.”



By Susan Sherman, LMT, ART, Government Relations Co-Chair




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