Cutting through red tape illustration (Photo illustration by Getty Images).
As Montana Gov. Greg Gianforte’s administration continues to push through one of his most prominent campaign initiatives – “Red Tape Reduction” – groups ranging from architects to licensed massage therapists have expressed concern the concept may be going too far.
The impetus behind the “Red Tape Reduction” project is to thin out the legislative and administrative strata that tends to get added with every successive legislature and administration. Rules and laws are added, but rarely are they removed in an effort to streamline and update procedures.
Many of the administrative rules are buried deeply in different departments, which determine the logistical and technical details of how to carry out the laws. Some of the policies also determine who needs a license and what qualifications are necessary. For example, state law says a hair stylist must have a license to operate, but the regulations and requirement necessary for that license are established by administrative rules.
Professional groups and trade organizations have largely been supportive of the concept of “Red Tape Reduction,” and the Gianforte administration has used it as part of a listening tour it took to all 56 of Montana’s counties, gathering input and feedback on where rules needed work.
However, in its zeal to eliminate burdensome, unclear or contradictory rules, some groups have charged that the administration has gone too far. For example, previously both accountants and architects have voiced concerns that the initiative to reduce bureaucracy would jeopardize state reciprocity, or even worse, become of sort of public hazard by allowing unqualified residents to offer services for which they have no training.
One of the groups most recently to weigh in is the state’s licensed massage therapists, who say that changes initiated by this process may eliminate necessary and critical language from state rules that would allow insurance companies to reject claims for therapeutic and necessary medical massages.
However, the Department of Labor and Industry, which is seeing much of the rules overhaul, said that the massage therapists’ concern is misplaced because the definition of what licensed massage therapists can do will remain unchanged in statute, even if administrative rules are changed and reorganized.
The crux of the massage therapists’ concern centers on eliminating language that refers to them as medical providers, something that became an issue even during the COVID-19 shutdown. Both Jennifer Roth and Deb Kimmet spoke with the Daily Montanan and expressed concern for eliminating wording and even potentially moving licensed massage therapists from medical to service providers, worrying that massages will be seen as luxury items or service tasks to be done by anyone, rather than having to complete training, tests and licensure.
“This could be a problem because it’s all based on how the insurance companies will interpret all these changes,” Roth said.
And fighting to add something back into law – especially because the legislature only meets every other year – is a lot more difficult than fighting to keep something already established, they said.
Kimmet said part of what makes the issue complicated is that different states consider the profession differently. In some cases, they’re lumped in with chiropractors. Sometimes massage therapists can be found in aesthetician offices. Sometimes, therapists work in hospital or hospice settings. The key is understanding the variety of the profession, Kimmet said.
“We’re not asking to expand our scope or make new laws,” Kimmet said. “We’re just asking to keep our long-standing label of ‘healthcare.’”
By taking that away, Kimmet worries that it will give insurance companies an excuse not to pay.
“It puts us in legal limbo,” Kimmet said. “We hear from the state: You’re just massage therapists. You don’t know. But this is not a value statement, it’s a legal statement.”
Jessica Nelson, a spokesperson for the Department of Labor and Industry, explained that all the provisions in statute will remain, especially the ones protecting healthcare. However, she said the organization of the state-run professional boards is changing.
“The concerns are unfounded,” she said. “ The provisions in place that provide defining massage therapy as a healthcare provider remain in existing Montana statute and are additionally well-defined separately in federal regulations covering healthcare providers.”
What is changing is the elimination of the “purpose” statement from statute. Nelson said of the 50 professionals listed in Chapter 37, which lists different professions and occupations, 31 have purpose statements, 19 do not.
“As part of the Red Tape Relief initiative, individual purpose statements are being removed from all individual boards and will be standardized and move to a single place in statute,” Nelson said.
She pointed to a section of code that will remain untouched by the red-tape initiative, which states that massage therapists will still perform therapeutic massages as referred by “another health care provider.” The department believes that section of the law, coupled with the techniques described in statute, are enough to remove any doubt that insurance companies may have that they’re not medical providers.
Nelson also pointed out that a licensed massage therapists are all assigned a federal identification number for insurance purposes through the Centers for Medicare and Medicaid. Those numbers will remain and will not change, meaning the method of payment will remain the same, Nelson said.
Roth said massage therapists on the state board were warned by the Governor’s Office and the Department of Labor not to speak openly about their concerns. A spokesperson for Gov. Greg Gianforte denied the office has ever made such a request when contacted by the Daily Montanan.
Roth serves on the state board, but spoke to the Daily Montanan as a single practitioner and not as a board spokesperson. She said when therapists voice their concerns to staff members, which are attorneys working for the Gianforte administration, they seem uninterested or don’t understand.
For example, she said that most people don’t know that licensed massage therapists cannot work 40 hours per week. After charting paperwork, similar to a medical provider, the physical demands of therapy are akin to a physical workout, and their bodies usually handle 20 to 30 patient hours per week. That means any loss of income or work would have an even greater impact on the bottom line of their business.
Roth said that a medical prescription for a massage isn’t like scratching some illegible words onto a notepad. Instead, those doctor’s prescriptions detail the type of injury the person sustained, what needs massage attention, and even how many sessions should be required. Roth said that when she receives such orders, there is more paperwork, more negotiation with insurance, and often a conversation with the doctor to discuss the patient.
“It’s called a medical massage for a reason,” Roth said. “Most hospitals and healthcare centers have massage rooms where therapists can come and work because it’s work that is not done by doctors or nurses. It’s more focused; more detailed and we track the progress or regress.”
She said because of the economy and inflation, many non-medical clients have chosen to forego massages.
“I have clients say to me all the time, ‘I have bills to pay so I am putting my massages on the backburner.’ And I totally get that because things are getting tight for me, too,” Roth said.
If medical massages disappear, though, many licensed massage therapists may not be able to make it – something that is at the opposite of what the “Red Tape Reduction” sets out to do.
“I get it. There are good things that are happening, for example, cleaning up the language. But some of the language is really, really important,” Roth said.
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