RCW 48.43.016 “Prior Authorization Standards and Criteria—Health carrier Requirements—Definitions”.  On March 22, 2020, the Governor signed into law ESB 5887 which amends RCW 48.43.016.  This is the RCW amendment which went into effect in June 2018 which provided for 6 consecutive treatment visits for massage therapy and other occupational therapies for plans requiring preauthorization. This 2018 amendment was meant to create stability of care with Premera and Regence patients/clients processed through eviCore.  Unfortunately, health insurance companies managed to create their own interpretation of this law which created havoc when trying to provide the continuity of care for our patients/clients using these plans, for the past two years. 

With this new 2020 bill, each patient may have “six treatment visits with a contracting provider in a new episode of care for each of the following: Chiropractic, physical therapy, occupational therapy, acupuncture, Eastern medicine, massage therapy, or speech and hearing therapies”.  Whereas the health carriers were interpreting this as “six sessions total” regardless of which profession provided service, it now clearly states 6 sessions per profession. The other major change is the health carrier cannot “deny or limit coverage on the basis of medical necessity or appropriateness or retroactively deny care or refuse payment for the visits”.  If you go to https://apps.leg.wa.gov/RCW/default.aspx?cite=48.43.016, you can review the current RCW and there is a link to see the new language which went into effect on 6/11/20.

Information on SB 5169

The WSMTA Government Relations Program wants to make you aware of a bill working its way through the current WA state legislative session. Senate Bill 5169 is, “AN ACT Relating to provider reimbursement for personal protective equipment during the state of emergency related to COVID-19; adding a new section to chapter 48.43 RCW; creating new sections; providing a contingent expiration date; and declaring an emergency”.

You can read the full text of the bill here,  https://app.leg.wa.gov/billinfo/

Here are the highlights of this bill.

• The bill's primary driver is the WA State Medical Association.

• The bill provides a code to bill for insurance reimbursement for PPE. The code is 99072. The max dollar reimbursement amount is $6.57 per patient encounter.

• The bill covers “all healthcare providers”.

• The bill will only be in effect as long as the declaration of a state of emergence continues.

• It is prospective and not retroactive.

There will likely be amendments (coming from the health carriers) to the bill, as this is alluded to in the testimony before the Long Term Health Committee.  You can watch that hearing here,  https://www.tvw.org/watch/?eventID=2021011450

 Likely amendments so far are (nothing has been made public as of the writing of the update).

• Only in-person patient encounters will qualify.

• The provider must have actually incurred cost. For example, you have cost for a new mask for each patient vs you reuse the same mask for multiple patient encounters.

• Tying the mandate to the federal state of emergency rather than WA’s state of emergency.

Governor’s Proposed Operating Budget – Summary

December 2020

DOH 21 Suppl _ 21-23 Bien Gov Ops Budget.pdf

Governor’s Budget-DOH Information 12/18/2020

1. DOH Summary of Governor’s Budget. 2021 Supplemental budget as well as 21-23 Biennial Budget.(see attached)

2. The governor’s biennial budget is proposing almost everything that DOH has asked for.

3. WA COVID-19 response and vaccination program will be funded primarily through state funds, unless Congress passes additional funds for local governments.

4. There are NO proposed reductions to public health in the Governor’s budget. Despite the Governor originally asking for 15% cuts from all state agency budgets.

5. There are proposed DOH staff salary items, 1 furlough day per month and no cost of living increases. 

6. Once the Legislature convenes (1/11/2021), the House and Senate will each propose their own version of a budget and then work toward common ground.

7. Sunday, 12/20/2020 will be the last official day for Secretary of Health, John Wiesman. On Monday the new Secretary of Health, Dr. Umair A. Shah MD MPH will officially take the reins of DOH.

You may have received a notice from a DOH listserve about this Bill, if you are signed-up for certain listservs with the DOH. WSMTA has become aware that some massage therapists are confused about what/if this means for massage. I hope this helps.

Interpretation of ESHB 1608 for Massage Therapists: An Act relating to protecting patient care…

The primary intent of this Bill is aimed at healthcare providers that have the ability, in their scope of practice, to provide differential diagnosis. It is primarily about their “right” to counsel and provide information about the full array of treatment alternatives that are available in the community, without the risk of being fired or losing privileges. For example, a provider working at a Catholic Hospital who is afraid they could lose their privileges if they counsel a patient on the Death with Dignity Act, abortion, or birth control. The full text of the Bill can be found here, http://lawfilesext.leg.wa.gov/biennium/2019-20/Pdf/Bills/House%20Passed%20Legislature/1608-S.PL.pdf?q=20200813114524

What does this Bill mean for LMTs? Let us take the language of this bill and really break it down. How do we as licensed healthcare providers in WA  practice according to the letter of the law and in our patients/clients’ best interest. 

As healthcare providers we have the right and responsibility to provide accurate information to our patients/clients. This bill is spelling out that we MUST present information in a way that…

1. Is with-in our scope of practice, education, training, and experience.

2. With-in the accepted standard of care.

3. Medically accurate

So, let’s look at the definitions that are in WA state statute.

"Health care provider" means a person who is licensed, certified, registered, or otherwise authorized by the law of this state to provide health care in the ordinary course of business or practice of a profession. RCW 70.02.010   

"Massage" and "massage therapy" mean a health care service involving the external manipulation or pressure of soft tissue for therapeutic purposes. Massage therapy includes techniques such as tapping, compressions, friction, reflexology, Swedish gymnastics or movements, gliding, kneading, shaking, and fascial or connective tissue stretching, with or without the aids of superficial heat, cold, water, lubricants, or salts. Massage therapy does not include diagnosis or attempts to adjust or manipulate any articulations of the body or spine or mobilization of these articulations by the use of a thrusting force, nor does it include genital manipulation.

“Medically accurate” means information that is verified or supported by research in compliance with scientific methods, published in peer-review journals, recognized as accurate and objective by professional organizations.

We know this Bill applies to us, as we meet the definition of healthcare provider. If we are going to provide information to, or counsel our patients/clients, we need to make sure that information and counsel stays within scope and is medically accurate. Our scope of practice is limited to external manipulation or pressure of soft tissues for therapeutic purposes and within that limit we need to make sure we focus on passing along information that is supported by research and recognized as accurate. 

This Bill does not speak to this but, remember, you can always suggest that your patient go back to their physician, get a second opinion or try another provider type if they are not making progress.

I hope this helps to clear up any questions that you might have had about this new statute. If you have further questions about your scope of practice limitations, please contact Megan Maxey, Program Manager for Board of Massage at Megan.Maxey@doh.wa.gov.

Marybeth Berney

WSMTA President

The regular session of the 2020 Washington State Legislature officially ended on March 12. With our state being hit hard by Covid-19, I would not be surprised to see the Governor call a special session at some point. If a special session is called, it will not affect the bills that WSMTA has been following this session. Here is an update on those bills.

SSB 5097: This bill passed both the House and the Senate and is awaiting the Governors signature. This bill will amend RCW 18.108.045. It will require all licensed massage therapists and certified reflexologist to have available for inspection some form of government issued photo identification. The name on the identification must match the name on the massage license or reflexology certificate. The exact language is below.

A massage therapist licensed under this chapter or a reflexologist certified under this chapter must have government issued photo identification on his or her person or have it be available for inspection by city, county, or state law enforcement or department personnel at all times he or she practices massage therapy or reflexology. The name of the massage therapist or reflexologist on the government-issued photo identification must match the name on the massage therapy license or reflexology certification.

HB 1082: This was a companion bill to SSB 5097. The language was essentially the same as SSB 5097. So, when SSB 5097 passed the House and Senate, HB 1082 no longer needs to continue its journey.

HB 2294: This was a bill that would have expanded the definition of who is covered by RCW 9A.36.031 to include all healthcare providers. Previously, only doctors and nurses in a hospital setting were covered healthcare providers in this RCW. This bill died in the House Public Safety Committee. The Committee members were very reluctant to expand the definition of this RCW to include more special groups. The exact language is below.

A person is guilty of assault in the third degree (a class C felony, instead of simple assault which is a gross misdemeanor) if he or she, under circumstances not amounting to assault in the first or second degree: (i) Assaults a healthcare provider regulated under Title 18 RCW who was performing health care duties at the time of the assault.

022120 Board of Massage Meeting Notes.pdf

Congratulations to everyone!  WSMTA attended the August 21, 2019 City of Bremerton Council meeting and the City Council passed the Bremerton City Ordinance 5373 -- Chapter 5.14 Massage and Reflexology Businesses ordinance without any changes.  Click here for the final language of the ordinance.

WSMTA thanks the City of Bremerton City Council, Chief of Police and City Attorney for all of their work.  WSMTA would also like to especially acknowledge the efforts of the Chief of Police in helping develop the current City of Bremerton Chapter 5.14 Massage and Reflexology Businesses ordinance language and getting it into the City Council's system so quickly.  He also really went out of his way to meet and talk with some of the members of the local Bremerton massage therapy community who had expressed concerns, he kept them informed of what was happening with the ordinance and listened to their input.