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 17 Y, 0 N Osborne Calamas
SUMMARY ANALYSIS
The Board of Massage Therapy (Board), within the Department of Health (DOH), regulates 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 licensure
suspension for certain criminal convictions or arrests.
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 statutory measures in an effort to
obstruct the operation of IMBs without interfering with legitimate massage establishments.
CS/CS/HB 197 significantly expands the circumstances under which DOH must issue an emergency order
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 license if any employee of a massage
establishment is arrested for committing or attempting, soliciting, or conspiring to commit certain offenses,
including offenses relating to kidnapping, human trafficking, and prostitution.
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
to include sexual activity and the failure to maintain required records.
The bill appropriates $925,080 in recurring funds and $108,952 in nonrecurring funds from the Medical Quality
Assurance Trust Fund to the DOH, for implementation, and has no fiscal impact on local government.
The bill provides an effective date of July 1, 2024.
This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives .
STORAGE NAME: h0197d.HHS
DATE: 2/8/2024
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Background
Massage Therapy
Massage therapy 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 a therapeutic health care practice 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 conducting 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 There are
approximately 36,178 massage therapists licensed to practice 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
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 o f 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 February 5, 2024).
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.
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DATE: 2/8/2024
Massage Establishment Licensure
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
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). On file with the Health and Human Services Committee.
19 Rule 64B7-26.002, F.A.C.
20 See also, Board of Massage Therapy, Application for Massage Estab lishment 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 rul es.
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.
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reasons for the denial. The establishment may correct the recorded deficiencies and reapply for
licensure.37
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 Hotline42
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 percent 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 unlicensed45 massage establishments that purport to
operate as legitimate businesses, but where sexual services are illegally bought and sold. 46 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 2019.47 In 2018, a study estimated that there
were approximately 9,000 IMBs operating in the US;48 it is expected that his number has risen in the
years since.49 The Collier County Sheriff’s Office estimates that there are currently 40 IMBs operating in
Collier County.50
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
37 S. 480.043(6), F.S.
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 February 5, 2024).
40 Id.
41 International Labour Organization, Glob al Estimates of Modern Slavery: Forced Lab our and Forced Marriage (2022). Available at
https://www.ilo.org/wcmsp5/groups/public/---ed_norm/---ipec/documents/publication/wcms_854733.pdf (last visited February 5, 2024).
42 The National Human Trafficking Hotline is a free service to connect victims and survivors of sex and labor trafficking with s ervices
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, Ab out Us. Available at
https://humantraffickinghotline.org/en/about-us (last visited February 5, 2024).
43 National Human Trafficking Hotline, National Statistics (2021). Available at https://humantraffickinghotline.org/en/statistics (last visited
February 5, 2024).
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 February 5, 2024).
45 In fiscal year 2022-23, DOH conducted 169 investigations of unlicensed massage establishments. See, Department of Health,
Agency Bill Analysis for House Bill 197 (2024), p. 2. On file with the Health and Human Services Committee.
46 Chin, J. & Takahashi, L. Sex for Sale: Illicit Massage Parlors (2022). 3 rd Edition. Routledge. ISBN: 9781003228639
47 de Vries, I. Crime, place, and networks in the age of the internet: The case of online -promoted illicit massage b usinesses (2020).
Northeastern University. Available at https://repository.library.northeastern.edu/files/neu:m046sd37z/fulltext.pdf (last visited February 5,
2024).
48 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 February 5, 2024).
49 Det. Sgt. Wade Williams, Collier County Sheriff’s Office, Illicit Massage Businesses Presentation. On file with the Health and Human
Services Committee.
50 Id.
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significantly lower than the market value, serves exclusively or primarily male clientele, employees
appearing to live on site, and advertising on commercial sex websites.51
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.52
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.53
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.54 Obtaining a conviction for human trafficking related
crimes relies heavily on victim testimony which has proven difficult to obtain in IMB-related cases.55 As
a result very few police actions have resulted in prosecutions for human trafficking, thus signaling very
little accountability for traffickers.56
Under certain circumstances, IMBs may also be identified as a public nuisance and enjoined. 57
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 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.60 Such actions may result in a permanent injunction requiring
the establishment to cease ope