The Florida Senate
BILL ANALYSIS AND FISCAL IMPACT STATEMENT
(This document is based on the provisions contained in the legislation as of the latest date listed below.)
Prepared By: The Professional Staff of the Committee on Fiscal Policy
BILL: CS/SB 896
INTRODUCER: Fiscal Policy Committee and Senator Martin
SUBJECT: Health Care Practitioners and Massage Therapy
DATE: February 16, 2024 REVISED:
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Rossitto-Van
Brown HP Favorable
Winkle
2. Gerbrandt McKnight AHS Favorable
3. Rossitto-Van
Yeatman FP Fav/CS
Winkle
Please see Section IX. for Additional Information:
COMMITTEE SUBSTITUTE - Substantial Changes
I. Summary:
CS/SB 896 expands the Department of Health’s (DOH) authority to suspend the license of a
massage therapist or massage establishment when an employee of the establishment is arrested
for committing or attempting, soliciting, or conspiring to commit certain offenses, such as
prostitution, kidnapping, or human trafficking. The bill authorizes the State Surgeon General to
suspend the license of any licensee upon probable cause that the licensee has committed sexual
misconduct.
The bill expressly prohibits sexual activity in a massage establishment and authorizes the DOH
and law enforcement to investigate massage establishments for new required and prohibited acts
to assist in identifying persons who may be engaging in human trafficking.
The bill appropriates eight full-time equivalent positions and the sums of $925,080 in recurring
and $108,952 in nonrecurring funds from the Medical Quality Assurance Trust Fund to the DOH
for the purpose of implementing the bill.
The bill provides an effective date of July 1, 2024.
BILL: CS/SB 896 Page 2
II. Present Situation:
Massage Therapy Practice
Chapter 480, F.S., is the “Massage Therapy Practice Act” and governs the practice of massage
therapy in Florida. A massage therapist is a health care practitioner licensed under ch. 480, F.S.
The Board of Massage Therapy (Board) is within the Department of Health (DOH) and regulates
the practice of massage therapy.1 As of June 30, 2023, there were 55,409 total licensed massage
therapists and establishments.2
Massage therapy is the manipulation of the soft tissues of the human body with the hands, feet,
arms, or elbow, whether or not the manipulation is aided by hydrotherapy, and includes colonic
irrigation, thermal therapy, the use of any electrical or mechanical device, or the application of
chemical or herbal preparations to the human body.3
According to the DOH, in Fiscal Year 2022-2023, in Florida, there were 191 Board-approved
licensed massage therapy schools, 34,515 in-state, active licensed massage therapists, and 8,966
massage establishments with active licenses.4
Massage Therapy Licensure
An individual seeking licensure as a massage therapist in Florida must:
Submit an application and the appropriate licensing fee;
Be at least 18 years of age or have a high school diploma or high school equivalency
diploma;
Submit to background screening and be found to not have been convicted or found guilty of,
or to have pled nolo contendere to, a specific list of crimes; and
Meet specific education and training requirements, as discussed below.5
Massage Establishment Licensure
A massage establishment is the premises wherein a massage therapist practices massage
therapy.6 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.7 Massage establishments must be licensed to operate legally.8
1
Section 480.035, F.S.
2
Department of Health, House Bill 197 2024 Agency Legislative Bill Analysis (Oct. 24, 2023) (On file with the Senate
Committee on Health Policy).
3
Section 480.033, F.S.
4
Department of Health, Medical Quality Assurance, Annual Report and Long-Range Plan, Fiscal Year 2022-2023, pgs. 27
and 31, available at https://www.floridahealth.gov/licensing-and-regulation/reports-and-publications/annual-reports.html
(last visited Feb. 16 2024).
5
Section 480.041, F.S. See also, Fla. Admin. Code R. 64B7-25, (2023).
6
Section 480.033(7), F.S.
7
Section 480.043, F.S.
8
Id.
BILL: CS/SB 896 Page 3
The Board requires the following to be met before a massage establishment license may be
issued:9
A completed application and appropriate licensing fee;10
A DOH inspection;11 and
Proof of property damage and bodily injury liability insurance coverage. 12
The application includes background screening of the establishment owner and requires the
identification of a designated establishment manager (DEM).13 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.14
Massage establishment licenses may not be transferred from a licensee to another individual or
entity.15 Board approval is required for a massage establishment to move locations or change
names.16
A proposed massage establishment may be denied a license for failing to meet the standards
adopted by the Board, or if the owner or DEM has been convicted of, or plead guilty to, or plead
nolo contendere to, a felony or misdemeanor relating to any of the following offenses:17
Prostitution;18
Kidnapping;19
False imprisonment;20
Luring or enticing a child;21
Human trafficking or smuggling;22
Sexual battery;23
Female genital mutilation;24
Lewd or lascivious offenses in the presence of a minor, elderly, or disabled person;25 or
9
Fla. Admin. Code R. 64B7-26.002, (2023).
10
See Board of Massage Therapy, Application for Massage Establishment License. Available at
https://floridasmassagetherapy.gov/applications/app-bus-original-mt.pdf (last visited Feb. 16, 2024).
11
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 chs. 456 and 480, F.S., and
related rules. See Fla. Admin. Code R. 64B7-26.002, (2023).
12
Fla. Admin. Code R. 64B7-26.002, (2023).
13
See Board of Massage Therapy, Application for Massage Establishment License. Available at
https://floridasmassagetherapy.gov/applications/app-bus-original-mt.pdf (last visited Feb. 16, 2024).
14
Section 480.033(6), F.S.
15
Section 480.043(9), F.S.
16
Id.
17
Section 480.043, F.S.
18
Chapter 796, F.S.
19
Section 787.01, F.S.
20
Section 787.02, F.S.
21
Section 787.025, F.S.
22
Sections 787.06 and 787.07, F.S.
23
Section 794.011, F.S.
24
Section 794.08, F.S.
25
Sections 800.004 and 825.1025(2)(b), F.S.
BILL: CS/SB 896 Page 4
Obscene or sexual acts involving a minor.26
The DOH may investigate the proposed massage establishment based on the application
contents.27 If the DOH determines that the proposed massage establishment fails to meet the
standards adopted by the Board, the 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.28
Professional Discipline of Massage Therapists and Massage Establishments
It is the responsibility of the Board to discipline its licensees regulated under ch. 480, F.S., for
any acts that violate ss. 480.041, 480.043, 480.0485, 480.046, and 456.072, F.S., or ch. 64B7,
Florida Administrative Code. In doing so, it must issue an order imposing appropriate penalties
on the massage therapist or massage establishment within the ranges recommended in the
disciplinary guidelines of ss. 456.072(2) and 480.046, F.S., and ch. 64B7, Florida Administrative
Code, after consideration of the listed aggravating and mitigating factors. Discipline may include
any combination of the following:
Letter of concern or guidance;
Reprimand;
Conditional license;
Probation;
Suspension of license;
Revocation of license; and/or
Fines.
During Fiscal Year 2022-2023, 229 administrative complaints were filed related to massage
therapists and massage establishments.29 Of those, 70 were related to sexual misconduct.30
DOH Emergency Action Orders
The DOH is authorized under s. 456.074, F.S., to immediately suspend the license of any health
care practitioner who has pleaded guilty, or nolo contendere to, or has been convicted of, any 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.
26
Section 827.071 and ch. 847 F.S.
27
Section 480.043(5), F.S.
28
Section 480.043(6), F.S.
29
Department of Health, House Bill 197 2024 Agency Legislative Bill Analysis (Oct. 24, 2023) (On file with the Senate
Committee on Health Policy).
30
Id.
BILL: CS/SB 896 Page 5
The DOH may only issue an emergency suspension order (ESO), an emergency restriction order
(ERO), or an order limiting a practitioner’s license if the procedure leading to the order was fair
under the circumstances and meets the following criteria:
The procedure provided at least the same procedural protection as is given by other statutes,
the State Constitution, or the U.S. Constitution;
The DOH took only the action necessary to protect the public health, safety, and welfare
under the emergency procedure; and
The DOH stated, in writing, with particularity, at the time of or before the emergency action,
the specific facts and reasons for finding that the practitioner or regulated facility presented
an immediate danger to the public health, safety, or welfare and its reasons for concluding
that the procedure used was fair under the circumstances.31
The State Surgeon General, or his or her designee, may issue the emergency action and is
required to conduct a proceeding to make a finding that a healthcare practitioner or regulated
facility presents an immediate danger to the public health or safety and that the least restrictive
means of protecting the public welfare is an action against the health care practitioner’s or
facility’s license.32
Emergency Actions Specific to Massage Therapist and Massage Establishment License
The DOH under s. 456.074(4), F.S., is required to issue an ESO of the license of a massage
therapist or massage establishment when a therapist, or a person with any ownership interest in a
massage establishment, has been convicted, or found guilty of, or has entered a plea of guilty or
nolo contendere to, regardless of adjudication, prostitution or related acts under s. 796.07, F.S.,
or a felony under any of the following or similar provisions in another jurisdiction:33
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 s. 796.03, F.S., relating to procuring a person under the age of 18 for prostitution;
Former s. 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 s. 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;
31
Section 120.60(6), F.S.
32
Sections 456.073(8) and 120.60(6), F.S.
33
Section 456.074(4), F.S.
BILL: CS/SB 896 Page 6
Section 847.0133, F.S., relating to the protection of minors;
Section 847.0135, F.S., relating to computer pornography;
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.
Without a conviction or the entry of a guilty or nolo contendere plea by the licensee, the DOH
cannot issue an ESO.
The DOH is required to annually report to the Legislature the total number of administrative
complaints and a description of disciplinary actions taken against healthcare professionals and
establishments licensed and regulated by the DOH.34 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.
Massage establishments are also required to maintain a DEM on file with DOH as a condition of
their licensure. The DOH is authorized to issue an ESO to an establishment that fails to identify a
new DEM within ten days of terminating the previous DEM.35
Human Trafficking
Human trafficking is a form of modern-day slavery involving the transporting, soliciting,
recruiting, harboring, providing, enticing, maintaining, or obtaining another person to exploit that
person.36 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 abuse, mental health concerns, and involvement in the child welfare
system.37
Victims of human trafficking are often subjected to force, fraud, or coercion for sexual
exploitation or forced labor.38 It is estimated that at any given time in 2021, approximately 27.6
million people were engaging in forced labor.39 In 2021, the National Human Trafficking
Hotline40 (hotline) identified 16,710 trafficking victims in the U.S., of which 1,253 were in
34
Section 456.026, F.S. See 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 Feb. 16, 2024).
35
Section 480.043(12), F.S.
36
Section 787.06, F.S.
37
U.S. Department of Health and Human Services, Administration of Children and Families, National Human Trafficking
Hotline. Human Trafficking: What Human Trafficking is, and isn’t. Available at
https://humantraffickinghotline.org/en/human-trafficking (last visited Feb. 16, 2024).
38
Id.
39
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 Feb. 16, 2024).
40
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-u