A state board increased fees on massage therapists this week, one by $250 and 250%, raising concerns from those who brought attention to mismanagement and fees issued by a previous board.
The fee increase is the latest development in a years-long debate about how dozens of occupational boards that license various professions in the state are managed, are funded through varying licensing fees and whether they should be consolidated.
In 2024, the Legislature disbanded the massage therapy board because of significant management issues. It was temporarily put under the management of the Alabama Board of Nursing and licensing fees were set in law. This year, the law was revised to give the nursing board the ability to set “reasonable fees.”
The increase from $100 to $350 for an establishment license that must be renewed every two years is not reasonable, Kristie Williams, a massage therapist in north Alabama, said.
Williams has two locations, so the new establishment fee increase will cost her $700 every two years. That’s on top of her therapist’s license.
“Only franchises will be able to afford these multiple locations,” Williams told Alabama Daily News. “Small businesses will not be able to expand.”
Williams also questions why the increases were done through an emergency rule and effective immediately, instead of going through the regular process that would have allowed for public comment.
Honor Ingels, a spokesman for the nursing board, told ADN the increases were needed quickly because the nursing board, which has its own licensing fee-based revenue, is covering a majority of the massage therapy licensing board’s expenses. He said its previous fees were too low.
“The previous fee schedule established by statute did not accurately comport to the staff work and the (nursing board’s) expense in reviewing, regulating and licensing a massage therapy establishment,” Ingels said. “These fees were increased — they don’t come near covering what it costs us to license somebody as an establishment — but to more closely support the work of the staff so that we’re able to carry out the legislative mandate we have to protect the public and to ensure that everybody is practicing safely and lawfully.”
Williams said recently, renewing her establishment licenses hasn’t required in-person inspections. Some are done via photos sent to the board. She doesn’t understand why that will cost $350 per site.
The emergency rules also specify that therapists who rent space in facilities that already have an establishment license must acquire their own separate $350 license.
Ingels said the establishment fee is on par with those from other boards.
In August 2023, there were 696 establishment licenses, required anywhere massages are performed, according to a report by the Alabama Department of Examiners of Public Accounts, which regularly audits government agencies. That means the increased fee will generate about $243,000 for the board every two years.
Other fees were also increased by the board, including initial licenses for massage therapists, $100 to $150, and renewals, $100 to $125. Those are reasonable, Williams said.
This year’s legislation, which went into effect June 1, also struck previous language that said expenditures of the board may not exceed the revenues of the board in any fiscal year.
Under the previous fee structure, the massage board’s income was “so low that they could not pay the employees, let alone pay rent and pay all the various administrative expenses that a state agency has,” Ingels said.
It probably shouldn’t be paying for all those things, at least not on its own, says Sen. Chris Elliott, R-Josephine. Since 2023, Elliott has sponsored legislation to consolidate some of the state’s occupational boards and their management, which can now be done by contracted third parties, under one umbrella agency. He’ll bring the bill back for a fourth attempt next year, he said Wednesday.
There shouldn’t be debate about which board fees and funds belong to, but how to most effectively deliver occupational regulation for minimum fees.
“We have all these silos and fiefdoms, and ‘this is mine’ and ‘I need this for a new building,’ or ‘we need this to pay off our former executive director,’” he said about a recent settlement by the state pharmacy board.
“This is why we need one single place where some, probably about one-third or more, of the occupations that are licensed by the state and who are not big enough to stand on their own can get one place that can handle the administrative functions for them,” Elliott said.
The massage board was in the red when the nursing board took it over via legislation last year. Ingels said the nursing board is trying to get it fiscally sound to again stand on its own.
That shouldn’t be done on the backs of small business owners, Williams said.
If the state can’t afford an agency that it demands she report to, then there is no need for it, she said.
Meanwhile, it’s not massage therapists’ fault the board was in a financial hole, Williams said.
Before the 2024 legislation dismantled the previous massage board, a 2023 audit by the Alabama Department of Examiners of Public Accounts identified 13 problems with its operations. Some of those problems included Executive Director Keith Warren, a private contractor who has managed more than a dozens boards, being paid his monthly fee before services were provided, noncompliance with open meeting laws, waiting two months after a board member resigned to notify the Secretary of State and issuing a license to someone who hadn’t met requirements.
The board was also still charging unauthorized fees to licensees, despite a law passed earlier that year prohibiting it.
Separately, ADN reporting last year showed Warren had double billed the massage board and two others for services over multiple years.
“It shouldn’t be us who have to pay for this mistake,” Williams said.