Category Archives: Laws and Regulations

Applying HST to Massage Therapy for Automobile Incidents (MVA, MVC, MVI) Health Claims

hst-624x313

It comes up every now and then that a misinformed Auto Insurance Company (Adjustor) will try to not pay the HST (GST for some Provinces) portion of billings made by an HST registered RMT. This causes many headaches for the RMT who is now forced to try and get the Insurance Company to understand that the HST is to be paid over-and-above the Fee approved by the FSCO. Many times an RMT feels they must “factor out” the HST from the amount they were paid by the Auto Insurance Company as an only option when the Adjustor never pays. This is wrong, in so many ways. It must be stopped.

“It’s not in the SABS”

This is a common go-to reason by Adjustors to supply a reason for not applying HST above the FSCO Fee. The Adjustor will hide behind this Ontario Act as a reason for non-payment of the tax. It will be indicated that “the language of the SABS does not allow for HST to be paid beyond the Fee Schedule”, or some form of that wording. They will then inform the RMT that they legally do not need to pay the HST beyond the fee as the Act protects their interest in not paying.

This is not acceptable. They take advantage of an RMT’s lack of knowledge with Acts to manipulate the situation. They force RMTs to back down and think there is no way to fight them on the issue.

The fact is; the Ontario SABS (Statutory Accident Benefits Schedule, under the Insurance Act, R.S.O. 1990, c. I.8) has nothing to do with determining the application of HST, in any way-shape-or-form. Instead the Act is superseded by The Excise Tax Act (R.C.S., 1985, c. E-15.) of Canada, which is what determines the application of GST/HST. It should not be confused with the Income Tax Act (Canada). 2014, c. 7, Sched. 14, s. 1., which does not determine the application of GST/HST. This is mentioned, as the Insurance Act references the Income Tax Act and that Insurance does not pay for it as a separate item for their clients (when claiming income loss).

“But Physiotherapists do not collect it”

Another cop-out statement. Our profession did not determine the application of the tax. It is not something we chose to do over any profession that does not collect it. It is actually a sore spot that we are even expected to collect a “service” tax for a medically recognized intervention. But, until we have 5 Provinces recognizing Massage Therapy as a medical profession, allowing us to even apply for exemption, we are stuck collecting it for the Government.

Another cop-out is when they state that other RMT’s do not charge it, or that you didn’t charge it before. This, again, has been determined by the Excise Tax Act. One who operates a Small Business (like Massage Therapy) is not required to collect the tax until such time that their revenue from sales in 4 consecutive Quarters is $30,000 or more (more on that here). So, not all RMT’s collect it, because it is not a blanket requirement by our profession as a whole, it is a requirement of the Government applied on a case-by-case determination.

Backed up by the FSCO

The Financial Standards Commission of Ontario (FSCO) is a representative of the Ontario Government through the Ministry of Finance, which means they have been granted power to speak for the Ontario Government (http://www.fsco.gov.on.ca/en/About/Pages/default.aspx). They also happen to be the branch of Government that regulates the Auto Insurance Industry.

Their stance has been previously published several times on the matter of HST being applied to Auto Insurance Fee payouts. This has been done through The Professional Services Guideline (Superintendent’s Guideline No. 03/14);

“The applicability of the HST to the services of any health care professionals or health care providers listed in this Guideline falls under the jurisdiction of the Canada Revenue Agency (CRA). If the HST is considered by the CRA to be applicable to any of the services or fees listed in this Guideline, then the HST is payable by an insurer in addition to the fees as set out in this Guideline.”

It has also been specifically published in a Bulletin released by the FSCO, on their website, in regards to the above Fee Guideline:

“Insurers are reminded that in the absence of such wording in the SABS or other such Guidelines (e.g., Minor Injury Guideline), the direction remains the same.

FSCO expects that insurers will apply the HST legislation correctly in accordance with any direction from CRA. The HST is a tax and is not part of the benefit limits set out in the SABS.” https://www.fsco.gov.on.ca/en/auto/autobulletins/2015a/Pages/a-04-15.aspx

It says it right there; they fully “expect” compliance from an Insurance Company to pay the HST on top of any fee’s that are charged to the Company that requires it. No other option.

 

Conclusion

In the application of the tax, it does not matter whether the Insurance company agrees with it, or if it is mentioned in the SABS, or even under the Insurance Act. What matters is that the Canadian Government has determined that services that have not been granted exempt status must add GST (HST in specific Provinces) as a percentage of any fee that is charged.

In short this means: On top of any fee amount that has been determined.

 

 

 

Pre-Written Form Letter:

Dear [insert adjustors name]

Re: Refusal to pay HST in regards to [INSERT FILE/CLAIM NUMBER]

I have received notification from you on [INSERT DATE] that your company, through you, refuses to pay the HST portion in addition to the fees that were invoiced for services rendered to [INSERT PATIENT NAME, FILE/CLAIM NUMBER], following and approved OCF 23 or 18 for whatever reason.

Please be advised that you are required, both by your registering body, the FSCO, and the Canadian Revenue Agency of Canada to pay the HST portion in addition to Fees that are published through the FSCO. Failure to pay the HST (which is calculated by a percentage based on the approved fee, not calculated into it) portion of the invoice (OCF 21) is in violation of the FSCO position, and Excise Tax Act (R.C.S., 1985, c. E-15.) (http://laws-lois.justice.gc.ca/eng/acts/e-15/) that the CRA enforces. This tax is required by the Government of Canada, and not by the massage therapy profession, to be paid. Further; be advised that HST, when required to collect, is applicable above and beyond not just the FSCO Guideline rate, but also any MIG Block Fees that have been published. Relative references regarding such are offered in the following quotes and the websites from which they were obtained:

“Insurers are reminded that in the absence of such wording in the SABS or other such Guidelines (e.g., Minor Injury Guideline), the direction remains the same.

FSCO expects that insurers will apply the HST legislation correctly in accordance with any direction from CRA. The HST is a tax and is not part of the benefit limits set out in the SABS.”

https://www.fsco.gov.on.ca/en/auto/autobulletins/2015a/Pages/a-04-15.aspx

“The RMTAO had contacted the Financial Services Commission of Ontario (FSCO) several months ago to clarify the application of HST on top of the customary fees applied for the services of massage therapy in the Minor Injury Guideline. We recently received a response from FSCO which they also published in a public bulletin.

The FSCO Professional Services Guideline states that “If the HST is considered by the CRA to be applicable to any of the services or fees listed in this Guideline then the HST is payable by an insurer in addition to the fees set out in this Guideline.”
https://secure.rmtao.com/default.asp?id=1151&article=55

“Harmonized Sales Tax (HST) The applicability of the HST to the services of any health care professionals or health care providers listed in this Guideline falls under the jurisdiction of the Canada Revenue Agency (CRA). If the HST is considered by the CRA to be applicable to any of the services or fees listed in this Guideline, then the HST is payable by an insurer in addition to the fees as set out in this Guideline.” https://www.fsco.gov.on.ca/en/auto/autobulletins/2014/Documents/a-08-14-1.pdf

“According to FSCO, the insurer must pay HST in addition to the amounts that are payable under the Statutory Accident Benefits Schedule (SABS) and the MIG. This means that the HST portion of the cost of massage therapy is not counted toward the MIG caps and must be paid in addition to these caps.”  http://www.massagetherapycanada.com/collaboration/hst-and-insurance-reimbursement-in-ontario-2224

In consideration of all the above; I am now restate the need for your company to pay the HST portion of the billing, which has not been delivered. If this is not delivered, or I have not heard from you with intent to deliver, within 15 business days, I will be left no option other than to issue a complaint of non-compliance with the FSCO and the CRA for refusal to pay the HST.

Thank you for your anticipated co-operation in this matter.

Regards,

 

[INSERT YOUR NAME AND REG #. and sign above]

Chris Semenuk

Chris Semenuk

Registered Massage Therapist at Chris Semenuk Massage Therapy - London, Ontario
Chris graduated from massage therapy school in London, Ontario, in 2000 and has been an RMT since January, 2001. Immediately, Chris gave back to the sport that got him into massage therapy by volunteering with the Western Mustangs Track & Field team, and a few years later becoming part of the Cross Country team too. He was given the role as Head of Massage Therapy, which he holds to this day. In 2015 Chris served as a Lead Medical Practitioner for the Toronto Pan Am Games. Since 2001, Chris has focused on the clinical side of Massage Therapy, and was also a professor from 2001 to 2012. The pinnacle of his education career has been building the Fanshawe College Massage Therapy program in the summers of 2011 & 2012.

In addition to supplying sports massage to the Mustangs programs, Chris has been an Assistant Coach since 2011.
Chris Semenuk

Understanding the CEU Cycle and Requirements for Ontario RMTs

Every year around October; RMTs start to stress over their CEUs. The first question always asked is: “Is this the year I am suppose to report?”. There is an easy way to figure this one out.  Your 3 year cycle will always begin on the November 1st following your registration. So IF you were registered on October 31st, 2015 your cycle begins November 1st, 2015. But if you were registered on November 1st, 2015 your cycle begins the next year on November 1st, 2016. The chart for this is located at the following CMTO link.

http://www.cmto.com/registrants/quality-assurance/ceu-cycles-and-due-dates/

The Second question will be “When is the CEU report due?” and/or “Is it due at the end of October? The answer is: The report is due by the first December 31st following the end of your cycle. This gives you 2 months between the end of your cycle and the time it is due; to compile the information that must be handed in.

In other words; you have some time to breathe still, if you started to panic in October about reporting. But if you don’t actually have all your CEUs; you do have to figure out how you will get them done before the day ends on October 31st.

Now online

The CMTO has now made reporting very easy by having an online portal that RMTs can fill in with their CEUs. Not only at the time of reporting, but all throughout your reporting cycle. This allows RMTs a place to also track their CEUs and ensure that they have what is needed before the end of the cycle rolls around.

To access this you must login to your CMTO account first. All CEU reports are kept confidential with your member account.

Why can I not Submit?

What many RMTs have noticed is that when they have reached their CEU total and want to now submit them officially, they can’t. Don’t fret about this. Your cycle does not end until Midnight on October 31st of your reporting year. Your ability to submit does not become active until, November 1st of your reporting year. This means that until November 1st officially arrives; you can still collect, and report, CEUs to the College. So if you already have your 30 CEUs logged into the site, sit back and wait for that Submit option to be active. You have not missed anything, nor have you “messed” something up.

This is most likely done to avoid having people submit totals, and then try to contact the CMTO to “add” or “modify” something. If the staff has to do this for 12000 RMTs; they will be wasting many, many hours that could be used for something else. We definitely do not want another reason for our fees to go up in any given year.

Mandatory Articles

Mandatory Articles are an easy 3 CEUs that every RMT will qualify for by reading all the CEU Articles in the TouchPoint magazine that were published during their cycle, and answering all the questions that followed. So really; all RMTs are responsible for obtaining their own 27 CEUs every cycle.

What seems to have people confused is exactly how to report them. The reason for this is; there is a two step process: First; record the CEUs earned, and second; verify you read them. In your report you can record all 3 CEUs on one line if you wish. Use ABA (activity code) CCL (competency code) and “Mandatory Articles from the TouchPoint”. try to find ‘where’ they should report them on their on-line forms. What will happen next is; after you finalize and “submit”, you will be asked to verify that you read the Mandatory Articles. This is because every single RMT will have this in common. The rest of our CEU’s will show an individual journey that each of us progressed through over a 3 year year stretch. These reports, being individualized, need to be fillable fields. There will be no individual verification for each one when you record them.

If you do not require the 3 CEUs (because you have tonnes); then you can just verify you read them without the need to record the 3 CEUs. So if you forget, and just submit; all you need to do is verify that the Mandatory Articles were read after submitting.

The CMTO is also now implementing a new component that allows RMTs to answer their Mandatory Article Questions through their CMTO account. This allows  the CMTO to have record, and proof, that did actually answer these questions.  Some RMTs will have seen this change already. What you will need to remember is that this is not enough. You are still required to have a physical record of the answers in your Portfolio. To do this you can simply print your answers and place the printout in your Portfolio.

Not Online

If you are not an RMT with direct access to the web at all times, or know someone like that, the RMT can still mail the forms to the CMTO. The catch is that the forms may be needed to be downloaded from, you guessed it, the web. An RMT can, however, request the forms be mailed to them through the Quality Assurance Committee. If this is the direction being utilized; please allow plenty of time to have them sent to you, and to send back to the CMTO. They are still required to be received by their office prior to December 31st. Considering that the CMTO offices shut down over the winter break; it is advisable to have them in prior to this break.

Chris Semenuk

Chris Semenuk

Registered Massage Therapist at Chris Semenuk Massage Therapy - London, Ontario
Chris graduated from massage therapy school in London, Ontario, in 2000 and has been an RMT since January, 2001. Immediately, Chris gave back to the sport that got him into massage therapy by volunteering with the Western Mustangs Track & Field team, and a few years later becoming part of the Cross Country team too. He was given the role as Head of Massage Therapy, which he holds to this day. In 2015 Chris served as a Lead Medical Practitioner for the Toronto Pan Am Games. Since 2001, Chris has focused on the clinical side of Massage Therapy, and was also a professor from 2001 to 2012. The pinnacle of his education career has been building the Fanshawe College Massage Therapy program in the summers of 2011 & 2012.

In addition to supplying sports massage to the Mustangs programs, Chris has been an Assistant Coach since 2011.
Chris Semenuk

Professional Portfolio Requirements for the Ontario Massage Therapist

Registered Massage Therapists in Ontario are asked by the Quality Assurance Committee of the CMTO (College of Massage Therapists of Ontario) to maintain a Professional Portfolio. This, simply put, is a place to physically collect proof of your Continuing Education activities while acting as an RMT. They require four (4) sections to be maintained at a minimum for each cycle (3 year term). Any other sections that are to be included are entirely up to the RMT to add. The process of creating, and maintaining, a Professional Portfolio does not have to be daunting.

According to the CMTO.com the four sections an RMT’s portfolio is to be divided into are:

  1. Completed Self Assessment Tool;
  2. A record of CEUs, identifying the number of Category A and Category B credits obtained, and which competency or modality each CEU relates to;
  3. Proof of CEUs collected including receipts, course attendance confirmations, conference brochures, etc.;
  4. Responses to questions from the mandatory CEU articles published in The College Standard.

Getting Started

Who sees this Portfoilio?

This is a question that gets asked a lot. Many RMT’s don’t understand why they must keep a Portfolio, and who may access it. The answer is really short; you, and the CMTO.

If you happen to be selected for a Peer Assessment, the Assessor will most likely ask for you to provide your professional portfolio. The Quality Assurance Committee may also request directly for you to submit your professional portfolio at any time. You must comply with this request in a timely manner.

They will be looking that you have completed the four sections, and they are up to date. They will also want to see that everything is contained within the same portfolio and not separate areas of your room or clinic.

Constructing the Portfolio

The simplest thing you can do for your portfolio is to keep all your papers in the same file folder (Yes, really, a single fold file folder in your cabinet) for a single, 3 year, cycle.

Files

image courtesy of Staples.ca

Another option is to use a hard cover binder to organize your items. This would be one of the most professional ways to maintain and store your originals, or hard-copies, of records for the Quality Assurance Committee. You can even include dividers to keep the four sections separate. These items, of course can be obtained from a dollar store or a business like Staples.

binders

image courtesy of Staples.ca

What is a Professional Portfolio?

A professional portfolio is more than just a requirement of the CMTO, it provides you with solid evidence that you have participated in learning. This also affords you the ability to examine your practice from a different angle.

Your portfolio is a collection of documentation that represents your learning experiences and outcomes. These documents will include: Your reflections, and answers, for the Mandatory CEU articles, records of CEUs you have obtained, proof of the CEU activities that you participated in, and your personalized Self Assessment Tool (SAT). This portfolio is most commonly utilized during a Peer Assessment, but can also be requested to be sent to the CMTO usually via the Quality Assurance committee.

Your portfolio is your responsibility to maintain as the CMTO recognizes that massage therapists are self-sufficient and competent members of their profession. You are expected to self-direct the maintenance of this important portfolio and are held fully accountable for it.

What does the portfolio do for me?

Your portfolio will benefit you by providing a place for you to reflect upon the activities you have participated in, the learning you have amassed, and fuse these into your active practice. You will have a tangible way to reflect not only upon your learning, but your preferred learning. It can chart a direction that you are steering your practice towards and answer that all important question; “where is my career going?”

A list of some of the things your portfolio can assist with

  • Identify areas of existing strength
  • Identify sort and long-term goals
  • Prioritize your future goals
  • Create plans to accomplish your identified goals
  • Gauge the impact of your learning on your practice

This can also be used to

  • Aid with your performance review (employee or independent contractor)
  • Prepare your CV (Curriculum Vitae, aka: Resume)
  • Prepare a Business Plan

Why have Professional Development?

First, and foremost, it is mandated by government legislation that all health care professions maintain high levels of competence and professional standards. But there is more to it than that.

As a health professional you have agreed to give the best possible care to your patients. You cannot do this by falling behind and remaining stagnant. You owe it to your patients to constantly update your knowledge, refresh your skills, and learn new things. Professional Development is, really, about being the best you can be for your patients.

The contributions of professional development to your practice are wide ranging. They allow therapists to maintain their relevance within the profession, as well as with other health care professions. It gives RMTs an ability to actually anticipate the changes that are occurring and to develop a plan to respond to these changes.

Self Assessment Tool (SAT)

The SAT was developed by the QA Committee of the CMTO to “help registrants (RMTs) identify competencies and areas that they feel need improvement and to develop a plan to address them”. This SAT is to be completed every three years (CEU cycle) by each and every registrant. The outcome of this completion is to be shared to the QA Committee.

The SAT is actually a personally subjective questionnaire developed with input from peers (what did you think those survey monkey things were for?) of the profession. It is intended to help you identify your current skill levels, and develop plans for self-improvement and enhancement. The CMTO is now switching to allowing RMTs to complete this tool online, but you are still required to print off a copy and maintain it in your physical Professional Portfolio.

This document will form the first section of your Professional Portfolio. It will not be fully completed until such time that you are near the end of your CEU cycle. It is expected that you begin this document at, or near, the onset of your cycle. To aid you with your current cycle; you can make a copy of pages 11, 12 and 13 from the SAT of your last cycle. This can be your reference for what you have planned to complete in the current cycle. If it is your first cycle, ie: new to the profession, you are expected to print off an SAT and complete it according to where you believe your entry-level skills rate. This will, again, serve the basis for guiding, and tracking, your activities in your cycle. Key point: do not wait til the end of your cycle.

The CEU Record

During your 3 cycle the QA Committee expects you to accumulate 30 CEU’s. These are calculated at 1 CEU for every 2 hours of activity. 20 must be obtained from Category A and the remaining 10 can be from Category A or B.

In this second section of the Portfolio you simply need to represent the sum of your CEU efforts. Therefore it can be a really short section using just the CEU Reporting Form (available as a download from cmto.com). In essence; at least two pages in length.

The CMTO is now having RMTs maintain a virtual copy their CEU Record in their personal portals at cmto.com. But, again, they are wanting you to have physical copies (printouts) maintained in your Portfolio.

Proof of CEU Activities

protectorThis third section will be the expanded version of the CEU Record section. This is where you will keep your receipts, course attendance record, brochures, copies of certificates, peer conferencing, articles read, seminars presented, articles written, (eg: The author is getting CEU’s for writing this), research Project work, etc…

 

If you are using a binder of some kind, then in this section you can keep “sleeves” in which to place smaller items, or items you don’t wish to damage with hole punches (ie: certificate originals). These can be as simple as a page protector.

Mandatory Articles

With the publication of each TouchPoint magazine from the CMTO, there are articles that are denoted as “Mandatory Articles”. Each RMT is expected to read these articles and complete a short questionnaire about each one. By reading, and responding to, all the articles in a cycle an RMT will earn 3 Category A CEU’s, maximum (meaning you now only need to get 17 Category A CEUs minimum).

The questionnaire may require a short essay answer to be written to show you obtained useful information from the article and can supply critical thinking when discussing it. Print out a copy of the questions asked and reference the source they came from. Place this printout, directly followed by the answer sheet, into your portfolio. Get these done as soon as you can, as the QA committee may request your Portfolio at any time, and they want to see you are up to date with the articles. This will also be true when a Peer Assessor comes to visit you.

Extras

That is it, really, and anything else beyond the above discussed 4 sections will be added at your own desire. Do not be surprised when your peer assessor skips right over the extras. It is’t a slight to you; they just do not require it as part of their check-list when they visit you. So, right now, you have the information needed to meet your minimum requirements for a Professional Portfolio.

 

References: cmto.com

Everything that is required for your professional portfolio base comes from the CMTO directly and can be found on their professional website. Any references that are used in this document are from the CMTO directly via their website. You can visit them at www.cmto.com to find these references. To create this document, of course, the author has navigated the website already and consolidated it for you. As of the publication date; all information is accurate to what has been released by the CMTO.

Chris Semenuk

Chris Semenuk

Registered Massage Therapist at Chris Semenuk Massage Therapy - London, Ontario
Chris graduated from massage therapy school in London, Ontario, in 2000 and has been an RMT since January, 2001. Immediately, Chris gave back to the sport that got him into massage therapy by volunteering with the Western Mustangs Track & Field team, and a few years later becoming part of the Cross Country team too. He was given the role as Head of Massage Therapy, which he holds to this day. In 2015 Chris served as a Lead Medical Practitioner for the Toronto Pan Am Games. Since 2001, Chris has focused on the clinical side of Massage Therapy, and was also a professor from 2001 to 2012. The pinnacle of his education career has been building the Fanshawe College Massage Therapy program in the summers of 2011 & 2012.

In addition to supplying sports massage to the Mustangs programs, Chris has been an Assistant Coach since 2011.
Chris Semenuk

How to Report CMTO CEUs Online

The CMTO allows you to report your CEU cycle via their website, instead of filling it out on paper. However, the process looks different than what you see on the paper form. Totally confused about how to complete the CMTO CEU Reporting form online? You’re not alone. Here are the basics of the process:

Go to the Registrant Login area

cmto-registrant-login

Enter your User ID and Password

cmto-login

Select CEU, and CEU Reporting

ceu-tabs

Click “View / Edit” next to your current cycle

ceu-view-edit

Click the “Enter Activity” button

activity-button

Fill in the details for the activity

This is where a lot of people are getting confused, since the details on the online form are different from the paper reporting form:

record-ceu-activity

The first two fields, Activity Type and Activity Category are significantly different from the paper form, where the CEU codes (which can be found at http://www.cmto.com/registrants/quality-assurance/continuing-education/ceus-reporting/ ) are typically entered by themselves. The Activity Type drop down field replaces what we would normally enter as the Activity Code:

ceu-activity-code

If you look at the CMTO’s list of Activity Codes, you’ll see each item in that list corresponds to one of the Activity Types in the drop down list provided:

AAW Attending workshops, seminars or courses – provide name of course, date attended, learning obtained
APW Presenting workshops, seminars or courses – can include preparation time, limited to only the first presentation of the information
ACO Membership on committees – limited to committees of the organizations listed in the guidelines
ACN Serving as an examiner, peer assessor, subject matter expert, or investigator – limited to contract positions with the College
ARE Participate in conducting or collaborating in formal research – identify the research project and how it relates to the practice of massage therapy
AWR Submitting articles for publication – provide the name of the article and periodical it was submitted to; may include the research time for the creation of the article
APE Conferring with peers – provide name of peer, their designation, outline the topics discussed
ABA Reviewing books, articles or videos – provide the name of the publication reviewed, the learning outcome and how it relates to the practice of massage therapy

The Activity Type tells the CMTO what type of activity you are entering. Did you attend a class? Did you read a book? Were you preparing a course? And so on. By itself, it doesn’t determine whether an activity counts toward category A or category B, just the medium of learning.

The next field, Activity Category is where we select the Competency or Modality code of the activity.

ceu-activity-category

The activity category is the subject or topic of the course / book / paper, and determines whether or not the activity falls under category A or B for the purpose of meeting our requirements. The category codes are divided into two major sections: competencies and modalities.

Competencies are all items related to the practice of massage therapy, but they aren’t necessarily specific techniques (modalities). They include things like Business Acumen and Anatomy, and are all category A. The list of competencies is:

CBA Business Acumen
CBD Business Development
CCF Client Focus
CCR Client Relations
CCC Communications
CCL Compliance
CCO Conflict Resolution
CIR Interprofessional Relations
COL On – going Learning
CPS Problem Solving and Decision Making
CRM Records Management
CSM Self Management
CAN Anatomy
CPY Physiology
CPA Pathology
CTH Massage Theory
CTE Massage Techniques
CCA Client Assessment
CPT Pre- treatments
CTX Applying Treatments
CHY Hydrotherapy
CRE Remedial Exercise
COC On- going Client Evaluation
CHK Health- care Services Knowledge
CPH Public Health

The second major division, Modalities, is divided into category A and category B. Category A modalities are considered directly within the scope of practice (and can be billed as massage therapy), and category B modalities are considered complimentary.

Category A modalities include:

MAR Active Release
MAC Acupressure
MAP Acupuncture
MAQ Aquatic Massage Therapy
MAN ANLI Assessments
MBA Baths
MCP Cold Packs
MCS Cranial Sacral Therapy including Unwinding
MDC Deep Connective Tissue
MDM Deep Muscle
MET Esalen Tissue
MHP Hot Packs
MST Hot Stone Therapy
MIH Indie Head Massage (Indian Head Massage is a different modality and is not eligible for CEUs)
MIM Infant massage
MMT Integrative Manual Therapy
MJB Joint Mobilization
MLS Labour support
MLL Lomi Lome
MLD Manual Lymph Drainage
MMM Meridian Massage
MME Muscle Energy
MMR Myofascial Release
MNT Neuromuscular Therapy
MNI NISA
MOB Orthobionomy
MPN PNF
MRF Reflexology
MRE Remedial Exercise including exercise therapy
MRO Rolfing
MSH Shiatsu including Moxibustion
MSM Sports Massage including athletic taping & bracing
MSC Strain/Counterstrain
MSI Structural Integration
MSW Swedish
MTH Traditional Thai / Thai Yoga Massage
MTP Trigger Point Therapy
MTN Tui Na
MVM Visceral Manipulation

Category B modalities include:

MAT Alexander Technique
MKN Kinesiology
MAM Aromatherapy
MMD Meditation
MFD Feldenkrais
MPL Pilates
MEL Electrical therapy techniques including:  IFC, TENS, Therapeutic Ultrasound, Pulsed High Frequency, Low Intensity Laser
MRI Reiki (1st degree only)
MTC Tai Chi
MTT Therapeutic Touch
MTH Touch for Health
MGI Guided Imagery
MTR Trager
MHT Healing Touch
MYO Yoga
MIT Inhalation Therapy

The dropdown list for Activity Category combines all the competency and modalities codes into a single list. You’ll want to pick the competency or modality that best reflects what was covered in the course / book / activity you are claiming.

The next field, Description, is where you type your description of the course, the book you read, the article you reviewed, etc. For a course, you’ll want to include who the instructor was, where it was held, how long it was, and other relevant details. If you were conferring with peers, you’ll want to include their names, where the conference was, and what was discussed. For books and articles, the bibliographical information like author, title, publication, and edition should be included.

Learning Outcome is the field in which you type what you learned during the activity and how it relates to massage therapy and your practice. You’ll want to indicate why you think the activity falls into the category you picked.

The field Activity Completed Date lets you enter which date you actually participated in the activity.

Units Claimed is where you enter the number of credits you are hoping to get for the activity. The credits are calculated at a rate of 1 credit per 2 hours. If you took a 6 hour course, you can claim 3 credits for it. If you read and researched a particular topic for 9 hours, you can claim 4.5 hours for it, and so on.

When you have finished entering the activity’s details, click the Save button. Repeat the process for every activity you want to claim.

 What about the Mandatory TouchPoint articles?

You don’t have to enter the mandatory articles as an activity***. When you submit your CEU Reporting Form after entering all of your activities, you’ll be prompted with a pop up which includes a check box, asking to confirm that you have read the mandatory article and completed their questions. When you check this box and confirm your form submission, the mandatory articles are added to the form for you automatically. You don’t need to submit your answers to the questions (unless the QA department explicitly asks you to), they’ll be checked by your peer assessor during your assessment.

***EDIT: Thank you to Justin Lewis for pointing that if you want to claim the 3 CEU credits for completing the mandatory articles, you DO need to add them as an activity. You will still be prompted with the pop up asking you to verify that you read them either way, but you won’t get the CEU credits for them unless you enter them as an activity. The codes to use are ABA (reviewing articles), and CCL (compliance). You can claim a maximum of 3 credits for the mandatory articles.

 

I hope this helps you complete you CEU cycle a bit more easily!

Chris Semenuk

Chris Semenuk

Registered Massage Therapist at Chris Semenuk Massage Therapy - London, Ontario
Chris graduated from massage therapy school in London, Ontario, in 2000 and has been an RMT since January, 2001. Immediately, Chris gave back to the sport that got him into massage therapy by volunteering with the Western Mustangs Track & Field team, and a few years later becoming part of the Cross Country team too. He was given the role as Head of Massage Therapy, which he holds to this day. In 2015 Chris served as a Lead Medical Practitioner for the Toronto Pan Am Games. Since 2001, Chris has focused on the clinical side of Massage Therapy, and was also a professor from 2001 to 2012. The pinnacle of his education career has been building the Fanshawe College Massage Therapy program in the summers of 2011 & 2012.

In addition to supplying sports massage to the Mustangs programs, Chris has been an Assistant Coach since 2011.
Chris Semenuk

Massage Therapy Non-Compete Clauses

Before I begin, I just want to put up a disclaimer that I am not a lawyer, and nothing in this post should be construed as formal legal advice. If you need legal guidance, seek out the assistance of a contract lawyer.

non-compete clause massage therapy

Massage therapists seeking out independent contractor positions often run into “non-compete” clauses in their contracts, and aren’t quite sure how those clauses work, or why they exist. On various massage therapy forums, you’ll see RMTs asking questions like:

  • “Are non-compete clauses legal?”
  • “Are non-compete clauses enforceable?”
  • “Don’t clients have a right to pick their massage therapist?”
  • “Who owns the client, the massage therapist or the clinic?”
  • “Don’t I (or my clinic) have to tell clients where I will be relocating to?”

The aim of this post is to help address some of these concerns, and to (hopefully) answer some of those questions.

What are non-compete clauses?

Generally speaking, a non-compete clause in a contract is a “restrictive covenant”1… an agreement between business owner and employee / IC that places restrictions on the massage therapist regarding working somewhere else during (and for a period after) their employment at the business. These clauses typically include specifics on distance and time, such as not opening a new clinic within so many kilometers of the business for a period of 1 year after they leave.

The goal of a non-compete clause in a massage contract is to prevent a massage therapist from building up a client base at one business, then leaving and having all of those clients leave with them. One of a massage clinic’s most valuable assets is their client list – they are the source of income for a clinic, and so the clinic wants to protect that asset.

What are non-solicitation clauses?

Non-solicitation clauses are similar, but different from non-compete clauses. They don’t place limitations on the massage therapist’s ability to work / operate a business elsewhere, but they do limit the therapist from soliciting business from the clients they saw at the previous location2. An example of solicitation would be calling, emailing, or mailing their previous clients telling them where they are working now, and that they can come there for appointments instead of the previous location.

Often, you’ll see non-solicitation clauses and non-compete clauses in the same contract.

Are non-compete clauses legal or enforceable?

It’s not illegal to include non-compete clauses in contracts.

How enforceable a particular non-compete clause is will depend on a number of factors. A previous employer can’t legally prevent you from earning a living, so in order for a non-compete clause to be enforceable, the terms of the clause have to be reasonable3. If the clinic is located in a small town with a population of 10000 people covering a total area of 25 kilometers, a clause saying the massage therapist cannot work or operate a business within a radius of 25 kilometers from the previous location wouldn’t be reasonable. What is reasonable will depend on location, time frame, other stipulations in the clause, and personal circumstance for the therapist, among other factors. It’s also worth noting that, in general, courts tend to find non-solicitation clauses more reasonably enforceable than non-compete clauses.

With that being said, you shouldn’t rely on a non-compete clause being unenforceable. There is no guarantee that the court will side with you, and signing a contract without the intent to adhere to the terms of the contract isn’t ethical. Remember that a contract is an agreement between you and the business owner conducted in good faith – if you have a concern about anything in a contract, negotiate with the business owner to change the terms of the contract before you sign it. You sign a contract with the understanding that the business owner will hold up their end of the bargain, you should strive to do the same.

If you’re not sure whether a particular clause is reasonable for your location and circumstance, contact a contract lawyer to review it with you before signing – each situation is unique.

Who owns the client? The clinic or the RMT?

No one “owns” the client. Any client is free to seek out health care treatment wherever and from whomever they want, regardless of a contract between two parties.

However, the client list is a business asset, and can be owned by either party. A business can retain ownership over that list. It’s important to outline who retains ownership of it in the contract.

The same applies for the client’s treatment notes and other relevant documentation. The client owns the information in the notes, but the notes themselves might belong to the massage therapist, or the clinic, depending on what is outlined in the contract. The client can, of course, request copies at any time to use at their discretion, and the clinic / RMT must oblige the request. Even if you created the treatment notes, the contract might stipulate they remain property of the clinic once you leave, so make sure to negotiate terms you are comfortable with before signing.

What about the CMTO policies? Don’t we have to tell clients where we are going?

The CMTO policy regarding leaving a practice is:

The departing Massage Therapist has a responsibility to contact clients and notify them that he/she is leaving the practice. This may be done in person, by telephone or by letter. The purpose of this contact is to assist the client with the transfer of care to another provider, if necessary, and to advise them of how they can access their health record in the future.”4.

There is no requirement for the clinic or the RMT to tell the client where they will be practicing, only that they are leaving the current pratice, to arrange for continuing care if necessary (this can be with a different therapist), and where they can access their records in the future.

The CMTO also notes “In the event that the business owner will not permit the RMT to personally contact the clients, the therapist can make an arrangement to have someone from the clinic contact the clients to assist them with continuity of care”. There is no requirement for the clinic to let the RMT contact the clients directly, or to give them access to the client list once they depart. They are also not required to tell the client where the RMT is now working, just that they are no longer working at the clinic.

It’s important to remember that the clinic itself isn’t responsible for ensuring you are meeting your regulatory requirements. If something in a contract would prevent you from meeting your obligations, you’re responsible for changing those terms to ensure you’re not performing professional misconduct.

 

If you have any further questions about a particular clause, I would encourage you to contact a lawyer directly instead of relying on information from peers (including me). Each situation is unique, so what is true for one massage therapist might not be the case for another. You want to make sure you know what you’re agreeing to before you sign a contract at any clinic or place or employment.

Chris Semenuk

Chris Semenuk

Registered Massage Therapist at Chris Semenuk Massage Therapy - London, Ontario
Chris graduated from massage therapy school in London, Ontario, in 2000 and has been an RMT since January, 2001. Immediately, Chris gave back to the sport that got him into massage therapy by volunteering with the Western Mustangs Track & Field team, and a few years later becoming part of the Cross Country team too. He was given the role as Head of Massage Therapy, which he holds to this day. In 2015 Chris served as a Lead Medical Practitioner for the Toronto Pan Am Games. Since 2001, Chris has focused on the clinical side of Massage Therapy, and was also a professor from 2001 to 2012. The pinnacle of his education career has been building the Fanshawe College Massage Therapy program in the summers of 2011 & 2012.

In addition to supplying sports massage to the Mustangs programs, Chris has been an Assistant Coach since 2011.
Chris Semenuk

  1. “Non Competition Agreements”, retrieved from “http://www.toronto-employmentlawyer.com/employment-law-practice/non-compete-agreement” on December 9th, 2014
  2. “Non-Solicitation Agreements”, retrieved from “http://www.toronto-employmentlawyer.com/employment-law-practice/non-solicitation-agreement” on December 9th, 2014
  3. “How enforceable are non-competition and non-solicitation agreements in employment contracts?”,  retrieved from “http://employmentlawottawa.com/2013/10/31/how-enforceable-are-non-competition-and-non-solicitation-agreements-in-employment-contracts/” on December 9th, 2014
  4. “Practice Advice”, retrieved from the “Leaving a Practice” tab at “http://www.cmto.com/registrants/practice-advice/” on December 9th, 2014

Understanding the FSCO Service Provider role

FSCO HCAI fees for RMTs
It is very clear that many RMTs, and other Health Care Professionals, oppose the new Financial Services Commission of Ontario’s (FSCO) Service Provider License Registration being applied to RHPA Professionals and the accompanying fees. That topic has been discussed many times over, and will be discussed many times over. But; it is being rolled out, without question, on December 1st, 2014. All MVA Service Providers must be registered by November 30th, 2014 and are asked to have their application submitted by August 31st, 2014. So now it is time to focus on; what does it mean to RMTs and “how do you fit in”?

Do I need to register with FSCO?

The only Registration that you must legally maintain to practice is through the CMTO. The FSCO registration is only for Clinics/Service Providers wishing to bill an Auto Insurance Company directly through Health Claims for Auto Insurance (HCAI) and have them pay the RMT directly. The registration has nothing more to do with HCAI or the Insurance Companies.

The FSCO states a “Service Provider” must get a License to bill through HCAI. For all intents and purposes; the FSCO defines a Service Provider as:

1- Sole Proprietor

2- Corporation

3- Partnership

4- Limited Partnership

Can I still submit MVA Treatment Plans if I am not registered?

You can still use HCAI and submit the OCF 23 and OCF 18 without registering with FSCO. These are not affected by the changes that are happening with the Auto Insurance Industry through FSCO Registration.

If I am not registered; how do I get paid?

Billing the patient directly, and having them submit their invoices to their Insurance Company, will be the easiest way to avoid the FSCO registration. It is only the submission of the OCF 21 (invoice) through HCAI that requires obtaining a license.

Registering for the FSCO Service Provider License

Those are the easy questions, and answers, for people not wishing to register with the FSCO and not submit on-line direct billing in the future. The rest of this article will focus on helping people understand how to be part of the FSCO model if they do elect to do billing directly with HCAI.

Sole Proprietor

The first thing that has to be done is to identify what kind of business you own; for most RMTs, that will be the Sole Proprietorship. This means; you have a single-person operation and make the decisions about how your business operates. It will also mean that you will be required to pay the full $337 application fee, the $128 annual fee for each unique business location that you will be at, and finally $15 for each unique statutory benefit claimant. Unique claimant means each patient, and each time they have a MVA; not the number of OCFs that were submitted.

An example of a Sole Proprietor with multiple locations:

Joe Scapulat Massage Therapist works at Charles Mandibulane DC, Jennifer Hyoidson Physiotherapy, and also out of his home. Joe only treats MVA’s from the Chiropractic Office and Physiotherapy Clinic. In 2013, Joe treated a total of 14 patients. Therefore, Joe’s initial Licensing fee will be:

Application …………….$337.00

DC Location ……………$128.00

Physio Location ………..$128.00

14 x $15 ………………..$210.00

TOTAL ………………$803.00

Joe will need to pay $803.00 in his first year to be licensed through the FSCO. In subsequent years, it will be a minimum of $256.00 before the claimant fees are assessed, assuming he continues to provide post MVA care at 2 clinics.

The regulatory fee (defined as; the annual fee and the claimant fee) can be prorated though in the year of application. The application fiscal year for the FSCO Service Provider License is April 1 through to March 31 in the subsequent year.

The first year regulatory fee will be from Dec 1, 2014 to March 31, 2015; or 4 months. Therefore Joe’s fee would be prorated to $492.33 ($337 + $155.33) in that scenario.

Business models other than Sole Proprietorship

If your business type is any other besides Sole Proprietor, then the fees will be calculated in very much the same way, except they will be assessed to the business entity; and thus can be shared by all partners, or taken out of the profits of the business, or however the people who run the business decide to absorb it.

We will run another example below for these types of businesses. The Clinic has three locations, and each location accepts 2 new MVA patients per week, on average, for a total of 312 unique claimants per year.

Application …………….$337.00

Central Location ………$128.00

North Location ………..$128.00

East Location ………….$128.00

312 x $15 …………….. $4680.00

TOTAL ……………… $5401.00

Per clinic……………….$1800.33

For any of these business types, if you are the registrant, you will need to appoint a Principle Representative. This person will be responsible for filling out the application and complete the attestation. When you have decided who this will be, they can go to http://www.fsco.gov.on.ca/en/Pages/default.aspx and learn more.

Avoiding paying the full fee and minimizing your risk

This is most likely the section that a majority of RMTs will wish to follow, if you are looking to avoid paying the fees, or wanting to reduce the fees you could pay.

A RMT who works at a clinic, or multiple clinics, or even if they are a Sole Proprietor, has the ability to utilize said clinic’s FSCO License through their HCAI account. This means that you can still be an Independent Contractor and provide services at/for a clinic without having to register your own HCAI account.

Dependent Provider

In HCAI terms, this is for a practitioner who will supply services for a registered facility/service provider, but will have no capacity to access the HCAI system.

As the provider you, in simple terms, allow the facility to send in all forms electronically on your behalf through HCAI. You also agree to provide services on behalf of the facility and not submit forms yourself. But remember; it does not preclude you from supplying services to another facility/clinic and having them submit forms for you.

In this scenario you will most likely want to submit a paper version whatever form you want to use to the facility’s staff member who is the HCAI administrator. Be certain that the treatment plan has been approved by a Health Practitioner (OCF 23 or OCF 18) to start or continue a claim. The administrator can then transcribe the form for you into HCAI. They will also need to transcribe the appropriate follow-up invoices (OCF 21) for the submitted Treatment Plan.

To register with a facility under this type of arrangement the RMT must sign a Dependent Provider Form. Read this over, and determine further if this seems like the best option for your relationship with a facility/clinic/provider.

http://hcaiinfo.ca/Health_Care_Facility_Provider/documents/DEC%20Enrolment/DependentProviderTermsandConditions.pdf

Affiliated Provider

As an Affiliated Provider through HCAI you will be able to access the HCAI system. You will be provided with an HCAI User-ID that will allow you to use their system.

Being this type of provider means that; you will provide service for, and on behalf of, a registered facility. You will be able to access HCAI for submitting all forms, including the OCF 21, through the facility’s HCAI portal. Th facility will determine how much access you have. You may just have basic access to submit and view forms, or you may be granted access to manage the system. This will be between you and the facility.

You will still make paper versions of the OCF forms to keep for your records. These will help you to complete the online versions for submitting.

To register with a facility under this type of arrangement the RMT must sign an Affiliated Provider Form. Read this over and determine further if this seems like the best option for your relationship with a facility/provider.

http://www.hcaiinfo.ca/Health_Care_Facility_Provider/documents/forms/AppendixA_AffiliatedProviderForm.pdf

For both Provider types

By being either an Affiliated Provider or a Dependent Provider for all your MVA claims, you will not have to sign up individually to obtain a Service Provider License. This, of course, means that you will not have to pay the $377.00 fee to apply, nor the $128.00 annual fee. But it does not mean that you should outright expect to pay nothing.

For each MVA claim that you are part of, there will be a fee component that is assessed to the facility because of you. It will be crucial that you negotiate the terms of providing service ahead of time. Not having a clearly defined contract can result in you being levied with many fees that you did not plan/save for.

Some of the fees you will need to pre-determine how they will be absorbed, and who will absorb them, are the; 1) application fee 2) annual fee 3) per claimant fee.

It is my opinion that the clinic should be absorbing the one-time application fee of $337.00; as it is a “forever fee” and will essentially become less and less of an impact the longer the clinic exists. Plus it will apply to all providers who ever work for/with them, and it would be unfair for you to pay part of this fee when a subsequent provider will not. The fee should be considered part of the split the facility keeps from you and is thus paid from that revenue.

The yearly licensing fee should be absorbed the same way as the application fee, in my opinion. It should be absorbed by the clinic and considered part of the split collected by all providers in their facility.

By being a provider for the clinic you will be paying the facility monies already for rent/administrative fees. Therefore by having you provide a valuable service such as MVA care; you will already be making their investment worth more and pay them back more.

The $15.00 per claimant fee is the only real fee that is assessed sporadically and non-fixed; on a yearly basis. This is, in reality, the fee that needs to be negotiated as to how, and who, will pay. If you are the only provider on a claim then your claimant will generate a $15.00 assessed fee that will be charged to the facility in the following year. You can negotiate that this is part of your agreed upon split/rent, or you can agree to pay it separately. If you pay a split percentage to the facility; it is my opinion that it should be absorbed by the facility. If you pay rent, it is then my opinion that you should pay this fee to the facility above your rent.

Interpreting the Unique Statutory Benefit Claimant component

The FSCO has not been exactly clear on the interpretation of this component of their new licensing structure. But it does appear that it means for a single claimant who presents to the facility (Licensed Service Provider) for a unique MVA that they were involved in. This would mean that the $15 fee is assessed once per facility, per claimant, regardless of the number of providers who are involved in the case. Therefore the $15 will be assessed only once, and theoretically shared, amongst the providers.

Below is a chart to show the benefit of having a single registered provider over having multiple Licensed Service Providers within a single facility.

Examples

Clinic ‘A’ has 4 independent Service Providers; each with their own FSCO License. The Physiotherapist who owns the clinic has registered as the main facility. In a single year the clinic sees 100 individuals for post MVA care and each therapist is involved at some point.

Therapist Physiotherapist(Owner) Chiropractor Massage Therapist Kinesiologist
Annual License $128 $128 $128 $128
Per Claimant $1500 $1500 $1500 $1500
Totals $1628 $1628 $1628 $1628

Total collected by FSCO from Clinic ‘A’………………………..$6512.00

Clinic ‘B’ has decided to have the same set up and use 4 therapists to provide services to patients also. But the Physiotherapist who owns this clinic has decided to have each contractor work as an Affiliated Provider under her facility name. All the other parameters are the same as Clinic ‘A’.

Therapist Physiotherapist(Owner) Chiropractor Massage Therapist Kinesiologist
Annual License $128 $0 $0 $0
Per Claimant $1500 $0 $0 $0
Totals $1628 $0 $0 $0

Total collected by FSCO from Clinic ‘A’………………………..$1628.00

By pooling the resources of the professionals all working together, Clinic ‘B’ has saved $4884.00 in a single year over its twin clinic for the 100 unique claimants seen. This strategy, as I see it, is the most beneficial to everyone involved. This makes the Clinic ‘B’ model a strong point to negotiate from for your own contract to help cut costs. More importantly though; the whole Medical Team should look to adopt and take advantage of this model within a single facility.

The bigger the “facility” the smaller the costs.

How to help each other

Several RMTs will actually be Sole Proprietors working in a single location with other Sole Proprietor RMTs. Each of you will be required to pay the fee’s yourself separately, unless you decide to work together.

The principal RMT who is renting the space should be appointed as the FSCO Principal Representative. All other RMTs can then use that RMT’s HCAI account and become Affiliated Providers, at the same address, under them. You will all essentially become partners for post MVA care. As partners, it should be arranged to split the Application Fee and the Annual Fee equally. Each person should pay their own “per claimant” fees.

If you choose to do this; another option is to form an actual company. The cost of registering a business in Ontario, and using it to sign up for HCAI and a FSCO Service Provider License, can be cheaper than even 2 people obtaining separate Licenses. The name can be a “generic” Ontario business name with unique numbers following it assigned by the Government. Ie: Woodstock Massage Therapy Clinic 9876543212345 (Not verified as being unique). Only use this option if you are comfortable with creating and running a separate business entity as you will need to: create a bank account, do payroll/payouts (for each RMT), submit business taxes, etc..

______________________

Sources

www.fsco.gov.on.ca

www.hcaiinfo.ca

Chris Semenuk

Chris Semenuk

Registered Massage Therapist at Chris Semenuk Massage Therapy - London, Ontario
Chris graduated from massage therapy school in London, Ontario, in 2000 and has been an RMT since January, 2001. Immediately, Chris gave back to the sport that got him into massage therapy by volunteering with the Western Mustangs Track & Field team, and a few years later becoming part of the Cross Country team too. He was given the role as Head of Massage Therapy, which he holds to this day. In 2015 Chris served as a Lead Medical Practitioner for the Toronto Pan Am Games. Since 2001, Chris has focused on the clinical side of Massage Therapy, and was also a professor from 2001 to 2012. The pinnacle of his education career has been building the Fanshawe College Massage Therapy program in the summers of 2011 & 2012.

In addition to supplying sports massage to the Mustangs programs, Chris has been an Assistant Coach since 2011.
Chris Semenuk

How The Canadian Anti-Spam Law Impacts RMTs

Massage Therapists get a lot of email

anti spam law and RMTs

If you’re anything like me, you likely get a LOT of email advertising courses, products and services for registered massage therapists. On the whole, I can appreciate that business owners who offer services or products to RMTs need to let their potential customers know about what they’re selling… it’s an essential part of doing business. However, I’ve noticed that some vendors get a bit overly enthusiastic in their email marketing.

I am sure many of you are in the same boat.

Like myself, some of you may have heard about the new Anti-Spam Legislation that is coming into effect on July 1st, 2014. At a cursory glance, this law promises to help cut back on the amount of unsolicited emails Canadians receive. The basic idea is that Canadians are supposed to consent to receiving email from a business, and that businesses have to follow a set of guidelines laid out in the law for determining whether they have received permission to email a person about services the business offers.

A quick breakdown of the anti-spam law

Article 6 of the anti-spam law outlines what type of email is prohibited:

“6. (1) It is prohibited to send or cause or permit to be sent to an electronic address a commercial electronic message unless
(a) the person to whom the message is sent has consented to receiving it, whether the consent is express or implied; and
(b) the message complies with subsection (2).
(2) The message must be in a form that conforms to the prescribed requirements and must
(a) set out prescribed information that identifies the person who sent the message and the person — if different — on whose behalf it is sent;
(b) set out information enabling the person to whom the message is sent to readily contact one of the persons referred to in paragraph (a); and
(c) set out an unsubscribe mechanism in accordance with subsection 11(1).”

In plain English, anyone receiving a commercial (business related) email must have consented to receiving it. Also, the person sending the message must be clearly identified, a way to contact that person must be included in the message, and a way of ‘unsubscribing’ (choosing to no longer receive messages from this person about this topic) has to be included in the message itself.

There are a few exceptions to the prohibitions such as:

  • if the sender and recipient have a personal or family relationship
  • if the message is an inquiry or application related to a service the recipient is receiving from the sender
  • if the message is a quote for a service that was requested by the recipient
  • if the message is a receipt or proof-of-transaction for a service the recipient purchased
  • if the message is a warranty or security issue related to a product or service the recipient purchased
  • if the message is factual information about a subscription that the recipient receives (ex: a notice that a subscription is almost up)
  • if the message is about an employment relationship between the sender and the recipient (job offer, etc).
  • if the message delivers a product the recipient ordered (ex: a product code for a digital download of a game or program)

There are a few more obscure ones, but that list summarizes the important ones.

Express and Implied Consent

Article 10 talks about the requirements for express and implied consent.

Express consent:

“10. (1) A person who seeks express consent for the doing of an act described in any of sections 6 to 8 must, when requesting consent, set out clearly and simply the following information:
(a) the purpose or purposes for which the consent is being sought;
(b) prescribed information that identifies the person seeking consent and, if the person is seeking consent on behalf of another person, prescribed information that identifies that other person; and
(c) any other prescribed information.”

Basically, to meet the requirements for express consent, a business has to tell the person why they are asking for consent (ex: to send emails for marketing purposes), identify who is asking for consent, and any other information that might be required in order to start sending messages.

Implied consent is a bit more insidious:

“(9) Consent is implied for the purpose of section 6 only if
(a) the person who sends the message, the person who causes it to be sent or the person who permits it to be sent has an existing business relationship or an existing non-business relationship with the person to whom it is sent;
(b) the person to whom the message is sent has conspicuously published, or has caused to be conspicuously published, the electronic address to which the message is sent, the publication is not accompanied by a statement that the person does not wish to receive unsolicited commercial electronic messages at the electronic address and the message is relevant to the person’s business, role, functions or duties in a business or official capacity;
(c) the person to whom the message is sent has disclosed, to the person who sends the message, the person who causes it to be sent or the person who permits it to be sent, the electronic address to which the message is sent without indicating a wish not to receive unsolicited commercial electronic messages at the electronic address, and the message is relevant to the person’s business, role, functions or duties in a business or official capacity; or
(d) the message is sent in the circumstances set out in the regulations.”

To summarize a bit more plainly, a business has implied consent to contact a person if:

  • the sender and recipient have an existing business relationship
  • the recipient’s email address is published publicly without a disclaimer saying they don’t want to be contacted, and the message is somehow related to the recipient’s business or position
  • the recipient gave their email address to the sender without telling them they didn’t want to be contacted
  • the message abides by all the other rules in the law

You might be able to see how the requirements for implied consent will impact your business already.

How the anti-spam law impacts our businesses

Once this law comes into effect, there are two angles that impact massage therapists – the email they send out to their clients and their communities, and the email they receive about courses, products, etc.

Sending email to existing clients

For the most part, you (should) have implied consent to contact your existing clients via email, since you already have a business relationship with them. The anti-spam law sets out a few definitions for business relationship, but the definition that covers most client-therapist situations is: “the purchase or lease of a product, goods, a service, land or an interest or right in land, within the two-year period immediately before the day on which the message was sent, by the person to whom the message is sent from any of those other persons“. As long as you’ve provided service the client within the last two years, you have implied consent to email them.

That’s the good news. Now, for the not-so-good news…

Receiving email from vendors and CEU course instructors

This is the implication of the anti-spam law that most RMTs I’ve talked to seem the most excited about – the idea that they’ll get less advertising for massage related products or services in their email.

… unfortunately, they’re probably out of luck.

Registered massage therapists, by definition, appear on a public register maintained by the CMTO. This register includes their contact information, such as their email address. It also doesn’t have a disclaimer saying that they don’t want to be contacted. Many also feature their email address on business cards, brochures websites, online directories, social media websites, and other publicly accessible areas.

Since our email addresses are public, those vendors and CEU course instructors have implied consent to contact us about massage therapy related services, since their products relate to our role as massage therapists and the services we offer. As a result, they can continue to send us unsolicited messages.

However, there is a silver lining! According to the law, implied consent doesn’t exempt them from needing to include a method to unsubscribe from future messages. If there is a particular vendor that you don’t want to hear from, simply respond to their message with a request not to send you any more email, and they’ll be required to stop.

How to report spam

A new Spam Reporting Centre has been established for victims of spam to report messages and companies that violate the new regulations. The centre isn’t active yet, but is expected to be set up later this year.

Keep in mind the law is new – many businesses are unaware of how it impacts their business, or that some of their routine activities might be a problem. If you’re receiving unsolicited email, your first step should be to contact the sender and ask them to stop. Even without the law to back you up, vendors are people too, and most of them don’t want to annoy their customers.

For more information, you can find the full text of the new law here. I contacted Industry Canada (the coordinating body responsible for the law) to make sure my interpretation of the implied consent information was accurate – they’re a great resource if you have any questions or need clarification too!

Chris Semenuk

Chris Semenuk

Registered Massage Therapist at Chris Semenuk Massage Therapy - London, Ontario
Chris graduated from massage therapy school in London, Ontario, in 2000 and has been an RMT since January, 2001. Immediately, Chris gave back to the sport that got him into massage therapy by volunteering with the Western Mustangs Track & Field team, and a few years later becoming part of the Cross Country team too. He was given the role as Head of Massage Therapy, which he holds to this day. In 2015 Chris served as a Lead Medical Practitioner for the Toronto Pan Am Games. Since 2001, Chris has focused on the clinical side of Massage Therapy, and was also a professor from 2001 to 2012. The pinnacle of his education career has been building the Fanshawe College Massage Therapy program in the summers of 2011 & 2012.

In addition to supplying sports massage to the Mustangs programs, Chris has been an Assistant Coach since 2011.
Chris Semenuk

Privacy Laws and RMT Digital Record Keeping

Confused about how health care information privacy laws relate to digital record keeping? You’re not alone. Registered Massage Therapists are starting to use a ton of different software programs to manage their professional lives. Everything from scheduling appointments  to emailing clients and submitting benefits claims is becoming more and more reliant on technology. The options for products to help us accomplish these tasks are endless – how do you know which products are safe to use, and which ones may put us at risk of violating a privacy law or CMTO regulation?

Let’s break it down into some easily digestible steps.

1. Familiarize yourself with PHIPA

PHIPA - Privacy Law for Massage TherapistsGet familiar with your obligations as a massage therapist when it comes to health information. The CMTO outlines many requirements for us, but it’s important to know that there are other privacy laws that RMTs have to be compliant with too. This step is probably the most challenging for most (the language used in the law can be intimidating), but knowing what you’re responsible for is the most essential step to making sure you meet those obligations.

The Personal Health Information Protection Act (PHIPA) was enacted in 2004. PHIPA covers the use of health care information for non commercial operations, such as providing  client care or sharing information with other health care providers. Under this law, RMTs are considered health information custodians, which makes us responsible for the information we gather about our clients. It’s important to note that this Act is specific to Ontario.

2. Pick services which store data in the country

Canadian Maple LeafPHIPA doesn’t specify that records have to be kept in the country, but it does have security requirements we need to follow to prevent unauthorized access to, or disclosure of, our client’s health records. Specifically:

A health information custodian shall take steps that are reasonable in the circumstances to ensure that personal health information in the custodian’s custody or control is protected against theft, loss and unauthorized use or disclosure and to ensure that the records containing the information are protected against unauthorized copying, modification or disposal. ” 2004, c. 3, Sched. A, s. 12 (1).

The issue with storing information in another country has to do with that requirement. Businesses operating in other countries don’t have to follow the same privacy laws that massage therapists in Ontario do. This can lead to trouble if the privacy laws in that country allow those businesses to share information more freely, or if other agencies in that country can access the information without getting consent – or even letting the health information custodian know it’s being accessed.

There is a law in the USA called the USA Patriot Act, which grants incredibly broad powers to a number of government agencies regarding the access of any records stored in the USA. In 2004, the privacy commissioner of British Columbia David Loukidelis spoke out against the law, and mentioned that “that once information is sent across borders, it’s difficult, if not impossible, to control”. Since RMTs are responsible for the privacy of the information they gather from patients, and for controlling access to it, storing the information in the US is a definite privacy “don’t”.

3. Check the Terms of Service and Privacy Policy

privacyEven if you’re using a record keeping system in the country, it’s up to you to figure out if the system is compliant with privacy laws. If there’s a violation, you’ll be the one that’s responsible, so check before you start to use a record keeping system!

How information is collected and used is something that is normally covered in a company or product’s Terms of Service and / or Privacy Policy. Some systems use the information you provide to build e-mail lists, gather information  for sale to marketing agencies, or other less-than-complaint purposes. Read through the Terms of Service and Privacy Policy for the company you want to use, to make sure your clients’ information won’t be compromised without your knowledge.

4. Follow best-practice password standards

password thiefAccounts on even the most secure systems can be compromised by poor passwords. Using dictionary words, common patterns, short passwords, and other easy-to-avoid pitfalls can be the difference between making sure your clients’ data is safe, and having their information leaked.

When in doubt, use a password that meets (at least) the following criteria:

  • isn’t a dictionary word (ex: house, princess, computer, password)
  • has at least 1 uppercase and 1 lower case letter
  • has at least 1 number
  • has a non-alphanumeric character (@, !, #, etc.)
  • is at least 8 characters long

Don’t use the same password as you do on other online services, and make sure not to share your account information. If you’re sharing a system with multiple therapists, reception staff, or other users, make sure each one can get their own login! If you use the ClinicWise Clinic Management Database system, this can be done by creating Sub Accounts for each user.

5. Use services that encrypt data

encrypt data massage therapy privacyInformation that you enter into a web-based program doesn’t go right from point A (your computer) to point B (the server computer the program is running on) and back again. It actually passes through a series of computers, in a sort of information relay.

When you hear websites talking about SSL or encryption, they’re talking about converting the information that’s being sent from your computer to the server computer into a format that doesn’t let those extra, relay computers make sense of the information. For instance, instead of the information looking like “credit card number: 4520 ….”, to those other computers it looks like “aZ56Rlf0s2 ….”. This helps to prevent the information from being read or accessed with your knowledge or consent, which means you’re compliant with privacy laws.

The easy way to tell if a website uses encryption for data is to look at the URL (www address) for the website. The address will always start with one of two things; http or https. If you see the s, then the information being sent to the site is encrypted. If you’re not sure, contact the company that makes the system.

One easy way to make sure you’re staying compliant is by using the ClinicWise Clinic Management Database system. However, regardless of which massage therapy clinic program you decide to use, make sure to check up on their privacy practices!

Have any privacy law compliance tips of your own? Share them in the comments!

Chris Semenuk

Chris Semenuk

Registered Massage Therapist at Chris Semenuk Massage Therapy - London, Ontario
Chris graduated from massage therapy school in London, Ontario, in 2000 and has been an RMT since January, 2001. Immediately, Chris gave back to the sport that got him into massage therapy by volunteering with the Western Mustangs Track & Field team, and a few years later becoming part of the Cross Country team too. He was given the role as Head of Massage Therapy, which he holds to this day. In 2015 Chris served as a Lead Medical Practitioner for the Toronto Pan Am Games. Since 2001, Chris has focused on the clinical side of Massage Therapy, and was also a professor from 2001 to 2012. The pinnacle of his education career has been building the Fanshawe College Massage Therapy program in the summers of 2011 & 2012.

In addition to supplying sports massage to the Mustangs programs, Chris has been an Assistant Coach since 2011.
Chris Semenuk