This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives.
STORAGE NAME: h0197b.HCA
DATE: 1/19/2024
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: CS/CS/HB 197 Health Care Practitioners and Massage Therapy
SPONSOR(S): Health Care Appropriations Subcommittee, Healthcare Regulation Subcommittee, Lopez, V.
and others
TIED BILLS: IDEN./SIM. BILLS: SB 896
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Healthcare Regulation Subcommittee 18 Y, 0 N, As CS Osborne McElroy
2) Health Care Appropriations Subcommittee 11 Y, 0 N, As CS Aderibigbe Clark
3) Health & Human Services Committee
SUMMARY ANALYSIS
The Board of Massage Therapy (Board), within the Department of Health (DOH), regulates massage practice,
including massage therapists and massage establishments. Massage practice is the manipulation of the soft
tissues of the human body with the hand, foot, knee, arm, or elbow, whether or not such manipulation is aided
by hydrotherapy, including colonic irrigation or thermal therapy, or any electrical or mechanical device, or the
application of a chemical or herbal preparation to the human body.
DOH is required to annually inspect massage establishments for compliance with statutory requirements.
Under current law, DOH is required to issue an emergency suspension of the license of a massage
establishment or massage therapist if specified criteria are met.
Human trafficking is a form of modern-day slavery involving the transporting, soliciting, recruiting, harboring,
providing, enticing, maintaining, or obtaining another person for the purpose of exploiting that person. Illicit
Massage Businesses (IMBs) are licensed or unlicensed massage establishments that purport to operate as
legal businesses, but where sexual services are illegally bought and sold. IMBs are considered one of the
primary venues for sex trafficking involving adults and comprised the largest group of citizen calls to the
National Human Trafficking Hotline in 2019.
Florida has implemented several regulatory measures in statute in an effort to obstruct the operation of IMBs
without interfering with legitimate massage establishments.
The bill significantly expands the circumstances under which DOH is required to issue emergency orders
suspending the license of a massage therapist or of a massage establishment. The bill requires DOH to issue
an emergency suspension of a massage therapist or establishment’s license if any employee of a massage
establishment is arrested for committing or attempting, soliciting, or conspiring to commit an offense listed in s.
465.074, F.S.
The bill expressly prohibits any sexual activity within a massage establishment. The bill prohibits advertisement
by a massage therapist or establishment from being posted in any medium or website that advertises
prostitution, escort, or other sexual services. The bill outlines further requirements for the operation of massage
establishments and provides exemptions.
The bill expands the circumstances under which a massage establishment may be declared a public nuisance.
The bill appropriates $925,080 in recurring funds and $108,952 in nonrecurring funds from the Medical Quality
Assurance Trust Fund to the DOH, to address additional workload. The bill has no fiscal impact on local
government.
The bill provides an effective date of July 1, 2024. STORAGE NAME: h0197b.HCA PAGE: 2
DATE: 1/19/2024
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Background
Massage Therapy
Massage practice is the manipulation of the soft tissues of the human body with the hand, foot, knee,
arm, or elbow, whether or not such manipulation is aided by hydrotherapy, including colonic irrigation or
thermal therapy, or any electrical or mechanical device, or the application of a chemical or herbal
preparation to the human body.
1
Massage is therapeutic and a massage therapist must know anatomy
and physiology and understand the relationship between the structure and function of the tissues being
treated and the total function of the body.
2
Chapter 480, F.S., entitled the “Massage Practice Act”, governs the practice of massage therapy in
Florida. The Board of Massage Therapy (Board), within the Department of Health (DOH), regulates
massage practice.
3
The Board is responsible for establishing rules governing the licensure and practice
of massage therapists and massage establishments. This includes approving massage therapy
schools
4
, licensure exams
5
, establishing training requirements for massage therapy apprentices
6
, as
well as setting minimum standards for and periodic inspections of massage establishments.
7
DOH is
responsible for providing investigative services to ensure compliance with regulations,
8
while the Board
has disciplinary authority over massage therapist and establishment licenses.
9
Massage Therapist Licensure
A massage therapist is a person who administers massage for compensation.
10
As of November 27,
2023, there are 36,178 actively licensed massage therapists in Florida.
11
To qualify for licensure as a massage therapist, an applicant must:
12
Be at least 18 years of age or have received a high school diploma or graduate equivalency
diploma;
Complete a course of study at a Board-approved massage school;
Undergo background screening; and
Pass an examination.
13
A massage therapist is required to renew his or her license every two years and must complete 24
hours of continuing education for each renewal period.
14
Massage Establishment Licensure
1
S. 480.033(3), F.S.
2
S. 480.032, F.S.
3
S. 480.035, F.S.
4
S. 480.033(3), F.S.
5
S. 480.041(1)(c), F.S.
6
S. 480.041(5), F.S.
7
Ss. 480.043(3) and (10), F.S.
8
S. 480.039, F.S.
9
S. 480.046, F.S.
10
S. 480.033(4), F.S.
11
Department of Health, FLHealthSource.gov, Public Data Portal (search by Board/Council “Board of Massage Therapy”, then by
Profession “massage therapist”, then by license status “practicing statuses only”), available at https://mqa-
internet.doh.state.fl.us/MQASearchServices/HealthCareProviders, (last visited November 27, 2023).
12
S. 480.041(1), F.S.
13
See rule 64B7-25.001, F.A.C. for Board approved examinations.
14
S. 480.0415, F.S., and rule 64B7-28.009, F.A.C. STORAGE NAME: h0197b.HCA PAGE: 3
DATE: 1/19/2024
A massage establishment is the premises wherein a massage therapist practices massage therapy.
15
A
massage establishment must be licensed by the Board and adhere to rules set by the Board regarding
facilities, personnel, safety and sanitation requirements, financial responsibility, and insurance
coverage.
16
Massage establishments must be licensed in order to operate legally.
17
There are
approximately 8,966 massage establishments licensed in Florida.
18
The Board requires the following be met for a license to be issued for a massage establishment:
19
Submit a completed application;
20
Pass an inspection by DOH;
21
and
Submit proof of property damage and bodily injury liability insurance coverage.
The application includes background screening of the establishment owner and identification of the
designated establishment manager (DEM).
22
Under current law, a DEM must be a licensed massage
therapist who holds a clear and active license without restriction. The DEM is responsible for the
operation of a massage establishment, and must be designated the manager by the rules or practices
at the establishment.
23
Massage establishment licenses may not be transferred from a licensee to another individual or
entity.
24
Board approval is required for an establishment to move locations or change names.
25
Denial of Massage Establishment Licensure
A proposed massage establishment may be denied licensure for failing to meet the standards adopted
by the Board, or if the owner or DEM has been convicted of or plead guilty or nolo contendere for a
felony or misdemeanor relating to any of the following offenses:
26
prostitution,
27
kidnapping,
28
false
imprisonment,
29
luring or enticing a child,
30
human trafficking or smuggling,
31
sexual battery,
32
female
genital mutilation,
33
lewd or lascivious offenses in the presence of a minor, elderly, or disabled person,
34
or obscene or sexual acts involving a minor.
35
DOH may investigate the proposed massage establishment based on the application contents;
36
if
DOH determines that the proposed establishment would fail to meet the standards adopted by the
Board, DOH must deny the application for licensure and provide the denial in writing with a list of
reasons for the denial. The establishment may correct the recorded deficiencies and reapply for
licensure.
37
15
S. 480.033(7), F.S.
16
S. 480.043, F.S.
17
Id.
18
Department of Health, Agency Bill Analysis for House Bill 197 (2024), p. 2. On file with the Healthcare Regulation Subcommittee.
19
Rule 64B7-26.002, F.A.C.
20
See also, Board of Massage Therapy, Application for Massage Establishment License. Available at
https://floridasmassagetherapy.gov/applications/app-bus-original-mt.pdf (last visited November 27, 2023).
21
The inspection must demonstrate that the proposed massage establishment is to be used for “massage” as defined in Section
480.033(3), F.S. and that the proposed massage establishment is in compliance with Chapters 456 and 480, F.S. and related rules.
See rule 64B7-26.002, F.A.C.
22
Supra, note 20.
23
S. 480.033(6), F.S.
24
S. 480.043(9), F.S.
25
Id.
26
S. 480.043, F.S.
27
Ch. 796, F.S.
28
S. 787.01, FS.
29
S. 787.02, F.S.
30
S. 787.025, F.S.
31
Ss. 787.06 and 787.07, F.S.
32
S. 794.011, F.S.
33
S. 794.08, F.S.
34
Ss. 800.004 and 825.1025(2)(b), F.S.
35
S. 827.071 and Ch. 847 F.S.
36
S. 480.043(5), F.S.
37
S. 480.043(6), F.S. STORAGE NAME: h0197b.HCA PAGE: 4
DATE: 1/19/2024
Human Trafficking
Human trafficking is a form of modern-day slavery involving the transporting, soliciting, recruiting,
harboring, providing, enticing, maintaining, or obtaining another person for the purpose of exploiting
that person.
38
Human trafficking can affect individuals of any age, gender, or nationality; however, some
people are more vulnerable than others. Significant risk factors include recent migration or relocation,
substance use, mental health concerns, and involvement in the child welfare system.
39
Victims of human trafficking are often subjected to force, fraud, or coercion for the purpose of sexual
exploitation or forced labor.
40
It is estimated that at any given time in 2021, there were approximately
27.6 million people engaging in forced labor.
41
In 2021, the National Human Trafficking Hotline
42
identified 16,710 trafficking victims in the US, of which 1,253 were in Florida;
43
however, these figures
do not reflect the true scope and scale of the issue which cannot be easily quantified due to the
underground nature of the issue. An analysis of data collected by the Hotline showed that
approximately 6% of reported victims in 2021 were associated with illicit massage, health, and beauty
services.
44
Illicit Massage Businesses
Illicit Massage Businesses (IMBs) are licensed or unlicensed massage establishments that purport to
operate as legal businesses, but where sexual services are illegally bought and sold.
45
IMBs are
considered one of the top venues for sex trafficking involving adults and comprised the largest group of
citizen calls to the National Human Trafficking Hotline in 2019.
46
In 2018, a study estimated that there
were approximately 9,000 IMBs operating in the US;
47
it is expected that his number has risen in the
years since.
48
The Collier County Sheriff’s Office estimates that there are currently 40 IMBs operating in
Collier County.
49
IMBs are successful in part due to their ability to operate in plain sight. They are often located in strip
malls and present themselves publicly as legitimate massage establishments. Markers of an IMB
include: opaque or covered windows, locked front doors with a buzzer to enter, listed prices
significantly lower than the market value, serves exclusively or primarily male clientele, employees
appearing to live on site, and advertising on commercial sex websites.
50
38
S. 787.06, F.S.
39
National Human Trafficking Hotline. Human Trafficking: What Human Trafficking is, and isn’t. Available at
https://humantraffickinghotline.org/en/human-trafficking (last visited November 27, 2023).
40
Id.
41
International Labour Organization, Global Estimates of Modern Slavery: Forced Labour and Forced Marriage (Sep. 2022). Available
at https://www.ilo.org/wcmsp5/groups/public/---ed_norm/---ipec/documents/publication/wcms_854733.pdf (last visited November 27,
2023).
42
The National Human Trafficking Hotline is a free service to connect victims and survivors of sex and labor trafficking with services
and supports to find help and safety. The Hotline also receives tips about potential situations of sex and labor trafficking and facilitates
reporting that information to the appropriate authorities. See also, National Human Trafficking Hotline, About Us. Available at
https://humantraffickinghotline.org/en/about-us (last visited November 27, 2023).
43
National Human Trafficking Hotline, National Statistics (2021). Available at https://humantraffickinghotline.org/en/statistics (last visited
November 27, 2023).
44
Polaris, Analysis of 2021 Data from the National Human Trafficking Hotline. Available at https://polarisproject.org/wp-
content/uploads/2020/07/Polaris-Analysis-of-2021-Data-from-the-National-Human-Trafficking-Hotline.pdf (last visited November 27,
2023).
45
Chin, J. & Takahashi, L. (2022). Sex for Sale: Illicit Massage Parlors. 3
rd
Edition. Routledge. ISBN: 9781003228639
46
de Vries, I. (2020). Crime, place, and networks in the age of the internet: The case of online-promoted illicit massage businesses.
Northeastern University. Available at https://repository.library.northeastern.edu/files/neu:m046sd37z/fulltext.pdf (last visited November
27, 2023).
47
Polaris, Human Trafficking in Illicit Massage Businesses (2018). Available at
https://massagetherapy.nv.gov/uploadedFiles/massagetherapy.nv.gov/content/Resources/FullReportHumanTraffickinginIllicitMassageB
usinesses.pdf (last visited November 27, 2023).
48
Det. Sgt. Wade Williams, Collier County Sheriff’s Office, Illicit Massage Businesses Presentation. On file with the Healthcare
Regulation Subcommittee.
49
Id.
50
Supra, note 47. STORAGE NAME: h0197b.HCA PAGE: 5
DATE: 1/19/2024
The majority of people trafficked through IMBs are women of Chinese or South Korean origin who have
recently arrived in the US. They are typically 35-55 years of age, have no more than a high school level
education, and speak little to no English.
51
Law Enforcement Response to IMBs
Traditional police techniques for controlling crime have proven to be largely ineffective in reducing the
presence of IMBs and their impact on victims of human trafficking. Traditional tactics such as sting
operations, undercover work, and reactive investigations are still relied on heavily for addressing
human trafficking and IMBs; however, these approaches have been shown to be ineffective in holding
traffickers accountable and decreasing the risk of victimization.
52
Police response to human trafficking has been criticized for not being victim-oriented; few victims of
human trafficking are identified by police as they often do not self-identify as victims, fear retribution
from their exploiter, and mistrust the authorities.
53
Obtaining a conviction for human trafficking related
crimes relies heavily on victim testimony which has proven difficult to obtain in IMB-related cases.
54
As
a result very few police actions have resulted in prosecutions for human trafficking, thus signaling very
little accountability for traffickers.
55
Under certain circumstances, IMBs may also be identified as a public nuisance and enjoined.
56
When
such a nuisance exists, the Attorney General, state attorney, city attorney, county attorney, or any
citizen of the county where the nuisance exists may bring a nuisance abatement action in the name of
the state to enjoin the nuisance, the person maintaining it, and the owner or agent of the premises
where the nuisance is located.
57
Such actions may result in a permanent injunction requiring the
establishment to cease operation or abate any such nuisance.
Massage establishments may be declared a public nuisance under current law if they are operating
outside of legal hours, serving as a person’s principal domicile,
58
or are unable to provide the required
identification and licensure documents upon the request of a law enforcement officer or DOH
investigator.
59
Regulatory Response to IMBs
Florida has implemented several regulatory measures in an effort to obstruct the operation of IMBs
without interfering with legitimate massage establishments. These regulations include:
Massage establishments are not authorized to operate between 12am and 5am;
60
Sexual misconduct
61
is explicitly prohibited in massage establishments;
62
Advertisements must include the license number of the individual massage therapist or
establishment being advertised;
63
Persons employed in a massage establishment must be able to produce government
identification upon request by a DOH or law enforcement investigator;
64
and
51
Supra, note 47.
52
Vries, I. de, & Farrell, A. (2022). Explaining the Use of Traditional Law Enforcement Responses to Human Trafficking Concerns in
Illicit Massage Businesses. Justice Quarterly, 1-26. doi:10.1080/07418825.2022.2051587
53
Farrell, A., et al., (2019). Failing victims? Challenges of the police response to human trafficking. Criminology & Public Policy,
18: 649– 673. Available at https://onlinelibrary.wiley.com/doi/epdf/10.1111/1745-9133.12456 (last visited November 27, 2023).
54
Supra, note 52.
55
Supra, note 53.
56
S. 823.05, F.S.
57
S. 60.05, F.S.
58
See, s. 480.0475, F.S.
59
See, s. 480.0535, F.S.
60
S. 480.0475, F.S.
61
Rule 64B7-26.010, F.A.C. specifies that the statutory prohibition of sexual misconduct extends to sexual activity occurring within any
massage establishment.
62
S. 480.0485, F.S.
63
S. 480.0465, F.S.
64
S. 480.0535, F.S. STORAGE NAME: h0197b.HCA PAGE: 6
DATE: 1/19/2024
Massage establishments are required to have a set procedure for reporting suspected human
trafficking and conspicuously post a sign with the relevant procedures.
65
Discipline of Massage Therapists and Establishments
The Board has disciplinary authority over massage therapists and massage establishment licenses.
66
The purpose of imposing fines and penalties is to protect the public by assuring compliance with an
agency’s rules.
67
DOH is required to inspect licensed massage establishments on an annual or more
frequent basis. Such inspections include, but are not limited to, assessing whether the establishment is
in compliance with the requirements for facilities operation, personnel, safety, sanitary requirements,
and existing insurance coverage.
68
Section 456.073, F.S., outlines the process for disciplinary proceedings for professionals licensed
under DOH, including massage therapists. Disciplinary proceedings begin when a complaint is filed.
DOH investigates complaints for legal sufficiency,
69
and if DOH determines a complaint to be legally
sufficient all investigative findings are submitted to a panel to be assessed for probable cause.
70
Upon
making a finding of probable cause, DOH is required to file a formal complaint, and may choose to
prosecute the complaint pursuant to Chapter 120, F.S.
71
The case may be referred to the Board for a hearing, or to the Division of Administrative Hearings to be
heard before an administrative law judge if there are any disputed issues of material fact.
72
A judge may
submit a recommended order,
73
but the final determination of whether or not a licensee has violated the
laws and rules regulating the profession is a conclusion to be determined by the Board.
74
The Board
considers the findings of fact and conclusions of law contained in the formal complaint, reviews the
investigative materials, and determines the appropriate penalty for the violation.
The Board has established disciplinary guidelines specifying the range of penalties based upon the
severity and repetition of specific offenses.
75
The board is provided some discretion to deviate from
disciplinary guidelines based on mitigating or aggravating circumstances.
76
Dependent upon the
severity of the massage therapist’s or establishment’s infraction, the Board may impose any of the
following pursuant to the Board’s disciplinary guidelines: letter of concern, reprimand, fines, license with
conditions, probation, suspension, revocation and/or fines.
77
During fiscal year 2022-23, 229 Administrative Complaints were filed related to massage therapists and
massage establishments.
78
Of those complaints, 70 were related to sexual misconduct.
79
Emergency/Summary Suspensions
Under current law, DOH is authorized to issue an emergency suspension, restriction, or limitation of a
license if the following criteria are met:
80
65
S. 480.043, F.S.
66
S. 480.046, F.S.
67
S. 120.695, F.S.
68
Rule 64B7-26.004, F.A.C.
69
S. 456.073(1), F.S.; a complaint is legally sufficient if it contains ultimate facts that show that a violation of Ch. 456, F.S., of any of the
practice acts relating to the professions regulated by the department, or of any rule adopted by the department or a regulatory board in
the department has occurred.
70
S. 456.073(4), F.S.
71
Id.
72
S. 456.073(5), F.S.
73
See, s. 120.52, F.S.
74
Supra, note 72
75
See s. 456.079, F.S.
76
Id.
77
Rule 64B7-30, F.A.C
78
Department of Health, Agency Bill Analysis for House Bill 197 (2024), p. 3. On file with the Healthcare Regulation Subcommittee.
79
Id.
80
S. 120.60(6), F.S. STORAGE NAME: h0197b.HCA PAGE: 7
DATE: 1/19/2024
The procedure provides at least the same procedural protection as is given by other
statutes, the State Constitution, or the United States Constitution;
The agency takes only that action necessary to protect the public interest under the
emergency procedure; and
The agency states in writing at the time of, or prior to, it’s specific action the specific
facts and reasons for finding an immediate danger to the public health, safety, or welfare
and its reasons for concluding that the procedure used is fair under the circumstances.
The State Surgeon General, or their designee, is required to conduct any proceedings for the purposes
of a summary (emergency) suspension or restriction of a health care practitioner or facility license.
81
DOH is required to immediately suspend the license of any health care practitioner who has plead guilty
or nolo contendere to or has been convicted of the following offenses:
Felony Medicare or Medicaid fraud under ch. 409, F.S.;
Felony fraud under ch. 817, F.S.;
Felony drug offenses under ch. 893, F.S., and equivalent charges under federal law;
Misdemeanors or felonies under federal law relating to the Medicaid program;
Felonies under s. 784.086, F.S., relating to reproductive battery; and
Felonies under ch. 782, F.S., relating to homicide.
DOH also has the authority to immediately suspend the license of any health care practitioner who
tests positive for any drug on any government or private-sector preemployment or employer-order
confirmed drug test, provided that the health care practitioner does not have a lawful prescription for
the drug.
Summary Suspension of Massage Therapist and Massage Establishment Licenses
DOH is required to suspend the license of a massage therapist or establishment when a therapist, or a
person with any ownership interest in a massage establishment has pled guilty or nolo contendere to,
or has been convicted of any offense related to prostitution or related acts under s. 796.07, F.S., or a
felony under:
82
Section 787.01, F.S., relating to kidnapping;
Section 787.02, F.S., relating to false imprisonment;
Section 787.025, F.S., relating to luring or enticing a child;
Section 787.06, F.S., relating to human trafficking;
Section 787.07, F.S., relating to human smuggling;
Section 794.011, F.S., relating to sexual battery;
Section 794.08, F.S., relating to female genital mutilation;
Former section 796.03, F.S., relating to procuring a person under the age of 18 for prostitution;
Former section 796.04, F.S., relating to forcing, compelling, or coercing another to become a
prostitute;
Section 796.05, F.S., relating to deriving support from the proceeds of prostitution;
Section 796.07(4)(a)3, F.S., relating to a felony of the third degree for a third or subsequent
violation of section 796.07, F.S., relating to prohibiting prostitution and related acts;
Section 800.04, F.S., relating to lewd or lascivious offenses committed upon or in the presence
of persons less than 16 years of age;
Section 825.1025(2)(b), F.S., relating to lewd or lascivious offenses committed upon or in the
presence of an elderly or disabled person;
Section 827.071, F.S., relating to sexual performance by a child;
Section 847.0133, F.S., relating to the protection of minors;
Section 847.0135, F.S., relating to computer pornography;
81
S. 456.073(8), F.S.
82
S. 456.074(4), F.S. STORAGE NAME: h0197b.HCA PAGE: 8
DATE: 1/19/2024
Section 847.0138, F.S., relating to the transmission of material harmful to minors to a minor by
electronic device or equipment; and
Section 847.0145, F.S., relating to the selling or buying of minors.
Under current law, DOH cannot issue a summary suspension absent a conviction or the entry of a
guilty or nolo contendere plea by the licensee.
Between January 1, 2020, and December 31, 2022:
83
13 massage establishment licenses were revoked related to sexual misconduct
23 massage establishment licenses were revoked for aiding and abetting unlicensed massage
therapists
Massage establishments are also required to maintain a designated establishment manager (DEM) on
file with DOH as a condition of their licensure. DOH is authorized to issue a summary suspension to an
establishment who fails to identify a new DEM within 10 days of terminating the previous DEM.
84
Under current law, DOH is required to annually report to the Legislature the total number of
administrative complaints and description of disciplinary actions taken against health care professionals
and establishments licensed and regulated by DOH.
85
Such figures are required to be categorized by
profession, but not by the cause for the complaint or disciplinary action, such as sexual misconduct or
failure to maintain a DEM.
Effect of the Bill
Investigations and Enforcement
The bill significantly expands DOH’s authority to issue emergency orders suspending the license of a
massage therapist and massage establishment.
The bill requires DOH to issue an emergency order suspending the license of the offending massage
therapist and the affiliated massage establishment upon qualifying circumstances. Under current law
DOH has the discretion to suspend the license of the massage therapist or establishment dependent
on the facts of a specific case.
The bill also expands the type of events which constitute cause for the emergency suspension of a
license. The bill requires DOH to issue an emergency suspension upon the arrest of any massage
establishment employee for committing or attempting, soliciting, or conspiring to commit an offense
listed in s. 465.074, F.S. This expands the requirements of current law which require an emergency
suspension only after a massage therapist or individuals involved in the management or ownership of
the establishment has been convicted or found guilty of a qualifying offense.
The bill requires DOH to issue an emergency order suspending the license of any licensee upon a
finding that probable cause exists to believe that the licensee has committed sexual misconduct
86
and
that such violation constitutes an immediate danger to the public.
The bill requires DOH investigators to request valid government identification from all employees in the
establishment at the time of inspection. If any employee of a massage establishment is unable to
83
Supra, note 78.
84
S. 480.043(12), F.S.
85
S. 456.026, F.S. See also, Department of Health, Division of Medical Quality Assurance Annual Report and Long-Range Plan (2023).
Available at https://www.floridahealth.gov/licensing-and-regulation/reports-and-publications/MQAAnnualReport2022-2023.pdf (last
visited December 4, 2023).
86
See s. 456.063(1), F.S. Sexual misconduct in the practice of a health care profession means violation of the professional relationship
through which the health care practitioner uses such relationship to engage or attempt to engage the patient or client, or an immediate
family member, guardian, or representative of the patient or client in, or to induce or attempt to induce such person to engage in, verbal
or physical sexual activity outside the scope of the professional practice of such health care profession. STORAGE NAME: h0197b.HCA PAGE: 9
DATE: 1/19/2024
provide a valid form of government identification, the bill requires DOH to notify a federal immigration
office of such.
The bill also expands DOH’s reporting requirements regarding massage therapists and establishments.
Under current law, the number of complaints, investigations, and disciplinary actions taken are required
to be reported for all professions regulated by DOH, but the cause of action is not required to be
reported. Under the bill, DOH must separately categorize complaints, investigations, and disciplinary
actions against massage therapists and establishments by the specific statutory violations being
alleged.
The bill expands the circumstances under which a massage establishment may be declared a public
nuisance; under the bill, massage establishments violating regulations pertaining to sexual activity in a
massage establishment and the maintenance of certain records may be declared a nuisance and
abated or enjoined.
Requirements of Massage Therapists and Establishments
The bill expressly prohibits any sexual activity in a massage establishment, as opposed to specifically
sexual misconduct, and prohibits the use of an establishment to arrange for sexual activity in another
location. The bill broadly defines sexual activity to include any direct or indirect contact by any
employee or person, or between any employees or persons, with the intent to abuse, humiliate, harass,
degrade, or arouse, or gratify the sexual desire of, any employee or person, or which is likely to cause
such abuse, humiliation, harassment, degradation, or arousal, or sexual gratification.
Under the bill, massage establishments are generally required to:
Cover no more than 50 percent of any outside windows into the reception area;
Ensure that outside windows into the reception area allow for at least 35 percent light
penetration;
Post signage outside of the establishment including the establishment’s name, license number,
and telephone number as provided to DOH;
Maintain specified employee records in English or Spanish;
Conspicuously display 2-inch by 2-inch photos of all employees with licensure information; and
Maintain complete records of each service provided, with the full name, address, and telephone
number of the patient for at least one year after the provision of the service.
The bill provides exemptions to certain requirements for massage establishments within public lodging
establishments as defined in s. 509.013(4), F.S., and facilities wherein a health care practitioner
licensed under chs. 457, 458, 459, or 460, F.S.,
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employs a massage therapist. The bill also permits
health care practitioners licensed under these sections to serve as the designated establishment
manager of a massage establishment.
The bill requires employees of a massage establishment are required to be fully clothed while in the
establishment. Massage establishments within a public lodging establishment as defined in s.
509.013(4), F.S., and chartered with the American Association for Nude Recreation
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as a clothing-
optional establishment are exempt from this requirement.
The bill requires all advertisements for a massage therapist or establishment to include the physical
address and telephone number of the establishment as provided to DOH. Massage establishments with
more than five locations are exempt from this requirement. Massage therapists, establishments, and
employees of massage establishments are prohibited from advertising in any medium or website that
expressly or implicitly advertises prostitution, escort, or other sexual services. The bill deletes the
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Health care practitioners licensed under these sections include acupuncturists, allopathic physicians, osteopathic physicians, and
chiropractic physicians.
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See the American Association for Nude Recreation – Florida Region website for more information. Available at https://aanr-
florida.org/ (last visited November 28, 2023). STORAGE NAME: h0197b.HCA PAGE: 10
DATE: 1/19/2024
statutory clause allowing new massage establishments with pending licensure to advertise using the
license number of a massage therapist.
The bill changes quorum of Board of Massage Therapy from four members to a majority of members of
the Board.
The bill provides an effective date of July 1, 2024.
B. SECTION DIRECTORY:
Section 1: Amends s. 456.026, F.S., relating to annual report concerning finances, administrative
complaints, disciplinary actions, and recommendations.
Section 2: Amends s. 456.074, F.S., relating to certain health care practitioners; immediate
suspension of license.
Section 3: Amends s. 480.033, F.S., relating to definitions.
Section 4: Amends s. 480.035, F.S., relating to the Board of Massage Therapy.
Section 5: Amends s. 480.043, F.S., relating to massage establishments; requisites; licensure;
inspection; human trafficking awareness training and policies.
Section 6: Amends s. 480.0465, F.S., relating to advertisement.
Section 7: Amends s. 480.0475, F.S., relating to massage establishments; prohibited practices.
Section 8: Amends s. 480.0535, F.S., relating to documents required while working in a massage
establishment.
Section 9: Amends s. 823.05, F.S., relating to places and groups engaged in certain activities
declared a nuisance; abatement and enjoinment.
Section 10: Provides an appropriation.
Section 11: Provides an effective date of July 1, 2024.
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNMENT:
1. Revenues:
None.
2. Expenditures:
According to DOH, they will experience a significant increase in workload associated with additional
complaints, investigations, and prosecution cases resulting from the provisions of the bill. The bill
appropriates eight additional full-time equivalent positions and $925,080 in recurring funds and
$108,952 in nonrecurring funds from the Medical Quality Assurance Trust Fund to the DOH to
address this additional workload.
The total annual cost of $1,034,032 consists of the following:
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Salary - $846,102/Recurring
Salary Rate – 593,954 Units of Rate
Expense - $71,000/Recurring + $53,272/Non-Recurring
Human Resources - $2,878/Recurring
Contracted Services - $5,100/Recurring $55,680/Non-Recurring
B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
1. Revenues:
None.
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Department of Health, Agency Bill Analysis for House Bill 197 (2024), p. 11. On file with the Healthcare Regulation Subcommittee. STORAGE NAME: h0197b.HCA PAGE: 11
DATE: 1/19/2024
2. Expenditures:
None.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
Massage therapy establishments may experience a negative fiscal impact as a result of the
requirements of the bill.
D. FISCAL COMMENTS:
None.
III. COMMENTS
A. CONSTITUTIONAL ISSUES:
1. Applicability of Municipality/County Mandates Provision:
Not applicable. The bill does not appear to affect county or municipal governments.
2. Other:
None.
B. RULE-MAKING AUTHORITY:
The Board of Massage Therapy has the rulemaking authority necessary to adopt the rules pursuant to
this bill.
C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
IV. AMENDMENTS/COMMITTEE SUBSTITUTE CHANGES
On January 18, 2024, the Health Care Appropriations Subcommittee adopted an amendment and
reported the bill favorably as a committee substitute. The amendment appropriates 8.0 full-time equivalent
positions and the associated salary rate and budget to the Department of Health for the implementation of this
bill.
This analysis is drafted to the committee substitute as passed by the Health Care Appropriations
Subcommittee.