Esta ley regula la práctica del masaje terapéutico y la profesión de masajista en Puerto Rico. Establece los requisitos para ejercer la profesión, crea la Junta Examinadora de Masajistas Terapéuticos de Puerto Rico para regular, investigar y sancionar a estos profesionales de la salud, y fija penalidades para la práctica ilegal del masaje terapéutico. La ley busca proteger al público garantizando profesionales certificados y capacitados, y establece normas para la competencia y los servicios ofrecidos.
(H. B. 3148) (Reconsidered) (No. 254) (Approved September 3, 2003)
To regulate the practice of massaging and the Massage Therapist profession, establish the requirements to practice said profession, create the Puerto Rico Board of Examiners of Massage Therapists, confer upon it the authority to regulate, investigate, and penalize these health professionals and establish penalties for the illegal practice of therapeutic massage, among other purposes.
Recently, different establishments that allegedly offer massage services have been appearing in the market. However, the good name of massage therapy is being used as a shield to conceal illegal practices. Masseurs without proper formal education have also proliferated, as well as schools and individuals who, without having the necessary credentials to do so, are granting certificates.
Massage is a recognized therapeutic practice as a legitimate option for preventive health care. This measure is in harmony with legislation approved in thirty (30) states of the United States. As such, said practice needs to be regulated in Puerto Rico to guarantee to the public the availability of certified professionals, duly trained to render qualified and professional services to the Puerto Rican community, thus protecting the public interest with regard to health issues. The Legislature has the responsibility to legislate to regulate this profession, in order to guarantee the people of
Puerto Rico the benefits expected when seeking solutions to the every day stress experienced by Puerto Rican families.
Section 1.- Title This Act shall be known as the "Act to Regulate the Practice of Massage Therapy in Puerto Rico."
Section 2.- Definitions: For purposes of this Act, the following terms and phrases shall have the meanings stated below:
(a) "Board" - means the Puerto Rico Board of Examiners of Massage Therapists.
(b) "Massage Therapist" - is a person who meets all the requirements of this Act and has been duly-certified by the Board to practice massaging in the jurisdiction of Puerto Rico.
(c) "Massage Therapist with Provisional License" - Any person who is certified by the Board pursuant to this Act to practice Massage Therapy according to the provisions of Section 16 of this Act.
(d) "Massage Therapy" - means a system of structured manipulation for therapeutic, preventive and remedial purposes through scientific and skilled manipulation of superficial or deep soft tissue to promote general relaxation, improve circulation, joint mobility, soothe stress and muscular tension and generally promote physical, mental and emotional wellbeing. The term and its practice include manual, mechanical and technical procedures generally accepted in the practice of massage,
including but not limited to, rubbing, stroking, rocking, pressure, tapping, kneading, stretching and other techniques developed under the concept of bodywork, which may use the application of oils, salts, compresses and other externally applied products that ease movement. Excluded from this definition are those practices and techniques that are exclusive to the profession of Physical Therapy.
(e) "Anatomy" - is the study of the gross structure of the human body. All systems of the body are included: Tegumentary, Skeletal, Muscular, Circulatory, Lymphatic, Respiratory, Digestive, Urinary, Reproductive, Endocrine, Exocrine, Nervous, and all the components of each of these systems.
(f) "Hydrotherapy" - means the use of generally accepted methods for the external application of water for its mechanical, thermal or chemical effects.
Section 3.- Creation of the Puerto Rico Board of Examiners of Massage Therapists.
Section 3.01.- Creation of the Puerto Rico Board of Examiners of Massage Therapists.
The Puerto Rico Board of Examiners of Massage Therapists is hereby created, which shall administer and supervise the compliance of this Act. This Board shall be attached to the Office for the Regulation and Certification of Health Professionals of the Department of Health. Each Board member shall be accountable to the Governor for the legitimate performance of the duties and obligations pertaining to the Office of the Board. The Governor shall have any claims or unfavorable reports regarding
the actions of the Board or any of its members investigated, and appropriate measures shall be taken, which include the dismissal of any of its member for embezzlement, abuse of power, negligence in the performance of their duties, incompetence, inability to perform official duties, the commission of a crime, or breaching the Massage Therapists Code of Ethics created by the Board.
Section 3.02.- Objectives The main objective of the Board is to protect the general publicespecially those persons who receive the services regulated by this Act, from illegal and occupational practices that tend to reduce unfair competition and result in an enhancement of the services available for the Puerto Rican consumer who wishes to achieve an optimum degree of health and general welfare.
The secondary objectives of the Board include upholding the minimum standards regarding the competence of the practitioners and upholding certain standards with regard to the services that are provided to the public. To comply with its objectives, the Board shall develop standards to guarantee professional competence, shall prepare a revalidation examination for the Massage Therapist profession using the existing national parameters and to grant a license to the persons who approve the examination. The Board shall establish guidelines, set the standards for continuing education in the profession and shall follow-up such claims filed against the practitioners regulated by the Board; shall establish mechanisms to hear claims according to the rules established by this Act; shall promulgate rules and regulations; and adjudicate disciplinary determinations, and impose sanctions on the practitioners when necessary.
Section 3.03.- Appointments The Board shall consist of five (5) members appointed by the Governor of the Commonwealth of Puerto Rico and confirmed by the Senate of Puerto Rico, of which three (3) shall be Massage Therapists with five (5) years of experience in the practice of massage, and one (1) private citizen to represent the public interest who has never been a Massage Therapist, and the remaining member shall be a representative of the Department of Health. No member of the Board may hold an elective office in any association that represents the Massage Therapists. All the member of the Board shall be residents and domiciled in the Commonwealth of Puerto Rico. The Secretary of Health shall certify the three (3) members of the Board that shall be Massage Therapists.
The Board shall perform all the investigations required to comply with the provisions of this Act.
Section 3.04.- Terms Each member shall serve for a term of (4) years and may be appointed for up to two (2) consecutive terms; provided, however, that when a member has been initially designated to fill a vacancy, said member may continue to serve for only one additional complete term. Of the members of the first Board designated by the Governor, one (1) shall be appointed for two (2) years, two (2) for three (3) years, and the remaining two (2) for four (4) years. Any person who is appointed to fill a vacancy on the Board shall remain in office for the remainder of the term of the former member. Each term shall expire on the date specified in the designation. However, the Board member shall continue to be qualified to participate in the proceedings of the Board, unless and until the Governor designates the substitute and said substitute takes office.
Section 3.05.- Duties and Powers of the Board In addition to any other duties and powers provided in this Act, the Board shall have the following:
(a) Issue, renew or deny licenses to practice the profession of Massage Therapist, pursuant to the provisions of this Act.
(b) Suspend, revoke or deny the renewal of licenses to practice the profession as Massage Therapist, after a hearing to determine the existence of violations of the legal precepts established in this Act or of the regulations adopted by the Board.
(c) Prepare, evaluate and administer examinations twice (2) a year in April and October, for those who aspire to obtain a Massage Therapist license, as provided in the regulations adopted by the Board. The Board shall determine the date and site of said examinations. The Board shall establish by regulations the specific and general subject matter to be covered in the licensing examination. The relative weight assigned to each subject, the evaluation criteria to be used by the examiner, and the points required to pass the examination must be specified. The Board shall establish the necessary mechanisms to ensure that the examination adequately measures the skill, level of competence and knowledge of the aspirant, in practice as well as of theory.
(d) Keep an updated professional registry of all licenses issued, which shall contain the full name and personal information of the Massage Therapist to whom the license is issued, the date of issue, the number and the term of effectiveness of the license, as well as the status of said licenses. Said registry shall be available to the public.
(e) Keep a record of all its proceedings.
(f) Adopt an official seal which shall to be used to stamp all licenses issued, as well as all official documents of the Board.
(g) Hold public or administrative hearings, resolve controversies in matters under its jurisdiction, issue orders pursuant to its resolutions and agreements, take statements or oaths, issue summons requiring the appearance of witnesses and furnishing of data, documents, or reports as deemed necessary by the Board to issue, deny, suspend or revoke a license. The Board, through the Secretary of Justice, may appear in any Court of First Instance of Puerto Rico and request the Court to order the compliance of any of its orders or summons, under penalty of contempt.
(h) Submit to the Governor, through the Secretary of Health, an annual report of its works, specifying the number of licenses issued, denied, suspended or revoked.
(i) Promote for continuing education of the Massage Therapists and determine the requirements pertinent thereto pursuant to the provisions established in Act No. 11 of June 23, 1976, as amended, known as the "Health Services Integral Reform Act of Puerto Rico."
(j) Prepare and publish a handbook with all the information related to the examinations it offers. A copy of said handbook shall be remitted to every person who requests it and pays the amount to be determined later by the Board, by an Internal Revenue voucher. The Board may review, from time to time, the cost of acquisition of said handbook, based on the expenses of
preparation and publication thereto, but the amount charged shall never exceed the true cost of such expense.
(k) Establish, by regulations, the course or study requirements and the specific subject matter needed to practice the profession as Massage Therapist. (1) To adopt, no later than sixty (60) days following the effective date of this Act, the regulations for the application of this Act, which shall establish, without it being understood as a limitation, the requirements and procedures for the issuing or renewal of licenses, as well as the procedure for holding public or administrative hearings. Such regulations shall not take effect until the procedures for their adoption established by Act No. 170 of August 12, 1988, as amended, known as the "Uniform Administrative Procedures Act of the Commonwealth of Puerto Rico," are met.
(m) A Code of Ethics to regulate the profession shall be adopted no later than six (6) months following the effective date of this Act. The abovementioned regulations must be submitted to public hearings prior to their approval.
Section 3.06.- Suspension or Dismissal of Board Members Any Board member shall be suspended or dismissed by the Governor for incurring any of the following acts:
(a) Transgression, negligence, illegal acts, behavior that entails moral turpitude, or dishonesty, incompetence or dereliction of duty. Any member subject to a disciplinary hearing shall be disqualified to deal with the business of the Board until a
favorable adjudication is issued with regard to the charges, or there is any other resolution of the matter.
(b) Holding an elective position in any professional association that represents Massage Therapists.
(c) Being absent without justification to three (3) consecutive meetings, or failing to attend at least half of the regular meetings during any calendar year, shall incur dereliction of duty and it shall automatically be deemed as having resigned his/her position on the Board.
(d) Losing the license to practice as a Massage Therapist.
Section 3.07.- Official Meetings; Quorum
(a) The Board shall hold regularly convoked monthly meetings to address its affairs, as well as any time the Chairperson of the Board deems necessary, or at the request of the majority of the Board members.
(b) Annually, the Board shall elect a President, a Vice-President and a Secretary from among its members. Each official shall hold said office for one (1) year, and may be redesignated, but not for more than two (2) consecutive terms.
(c) The Board shall elect three (3) of its members to constitute a Disciplinary Committee. Said Committee shall be in charge of holding hearings on complaints and disciplinary measures, and shall present its findings and conclusions to the Board no later than sixty (60) days after its hearing for it to make its determination.
(d) A simple majority of the members shall constitute quorum to address the business of the Board. Quorum of the Board
members is required for the certification and licensing of applicants. All five (5) members of the Board shall be present when suspending or revoking a license. All other actions shall be approved by simple majority vote.
Section 3.08.-Remuneration Each member of the Board shall receive seventy five (75) dollars for each meeting they attend, but shall never receive more than one thousand five hundred $(1,500)$ dollars during any calendar year.
Section 4.- Requirements to Obtain a Massage Therapist License Any person who requests a Massage Therapist license pursuant to this Act shall submit evidence, verified by oath to the satisfaction of the Board, proving his/her compliance of the following requirements:
(a) Be over eighteen (18) years of age.
(b) Be a citizen of the United States or a legal resident.
(c) Show evidence of having been domiciled in the Commonwealth of Puerto Rico for six (6) months prior to the application.
(d) Have passed a course of one thousand $(1,000)$ hours in a Therapeutic Massage school authorized by official entities of the Commonwealth of Puerto Rico. Hold a high school diploma or its equivalent. The courses shall include the following subjects that apply to Massage Therapy: (1) Anatomy and Physiology (2) Clinical Pathology (3) Medical Terminology (4) History, theory and techniques of massage therapy combining eastern and western knowledge (5) Structural Kinesiology
(6) Hydrotherapy (7) Professional Ethics (8) Cardiopulmonary Resuscitation Techniques (CPR) (9) Elective subject matter that includes the above listed subjects.
(e) Have passed a State - certified examination on Cardiopulmonary Resuscitation (CPR) and holding an effective CPR techniques certification.
(f) Have complete the workshop on HIV offered by the Department of Health or the Agency concerned for such purpose.
(g) Presents a Negative Criminal Certificate issued by the Puerto Rico Police.
(h) Not having incurred any of the actions or infractions which would entail disciplinary measures pursuant to this Act.
(i) Presents a Health Certificate issued annually by the Department of Health
(j) Have passed the revalidation examination offered by the Massage Therapists Examining Board. The aspirant shall have five (5) opportunities to pass the revalidation examination.
(k) Negative Certificate from the Child Support Administration (ASUME, Spanish acronym). (1) Certificate of no debts from the Department of the Treasury.
Section 5.- Renewal of the Massage Therapist License The license shall be renewed every three (3) years. The following requirements shall be met for the renewal of the license:
(a) Filing a request to the Board on the form provided by it.
(b) Present a current Certificate of Cardiopulmonary Resuscitation (CPR) and First Aid.
(c) Present a Negative Certificate of Penal Record issued by the Puerto Rico Police.
(d) Present a Health Certificate issued by the Department of Health.
(e) Show evidence of not owing income tax debts to the Department of the Treasury.
(f) Have complied with the required continuing education courses established in the Board regulations.
(g) Payment of administrative fees to the Secretary of the Treasury.
(h) Applicants trained abroad shall present proof of their training in an accredited institution that is compatible with subsection
(e) of this Section.
(i) Negative Certificate from the Child Support Administration (ASUME, Spanish acronym).
If the renewal application is filed ninety (90) days after its expiration, the applicant shall submit a sworn statement stating that he/she has not rendered professional massage services, as defined by this Act, during said period. Any violation shall be subject to the sanctions applicable under this Act and its regulations.
After one (1) year has elapsed from its expiration without said license having been renewed and without the Massage Therapist having initiated the steps to renew it, the license shall be cancelled and the Massage Therapist involved shall have to comply anew with all the requirements established in Section 4 of this Act.
Section 6.- Inactive Massage Therapist Licenses Any Massage Therapist who, for any reason no longer wishes to actively practice the profession, may turn in the license as inactive to the Board, prior to the expiration date thereof if so desired.
No Massage Therapist whose license has been surrendered to the Board may practice the profession until the following requirements are met:
(a) Request reactivation of said license from the Board, in writing, on the form provided by the same.
(b) Present evidence of having met the continuing education requirements established in this Act.
(c) Pay the fee for the renewal of the license established in the regulations of the Board.
Section 7.- Registration of a Massage Business A massage business must be registered with the Board pursuant to the stipulations stated in this Section. The applicant shall present a certificate issued by the Deputy Secretary of Regulations and Certification of Health Facilities. Said certification shall include the following:
(a) The name and address of the business. If a corporation, the name and address of any person who, directly or indirectly, owns or controls most of the shares of the business; the name and address of the directors, and a statement indicating that franchise taxes are current, and that the corporation is exempted from the payment of franchise taxes.
(b) Name and address of the sole owner or the partners, if it is any other type of organization, the name and address of the owners.
(c) Name and address of the persons in administrative positions.
(d) The type of existing branches or services, or under consideration, as follows: A blueprint of the massage establishment being considered, including a sketch of the following elements: entrances and exists, width and length of the business area, total amount of square footage, location of the restrooms, and the number of massage tables.
(e) Inspection Report of the Fire Chief stating that said business meets the parameters established by Law.
(f) Proof that the business is separated from any room for residential purposes or dormitory, whether totally or partially, and that said separation is achieved by means of a solid wall or a solid door that remains closed during hours of service.
The Board shall not consider an application for registration as officially submitted until the applicant, who, in turn, shall be the owner, or a partner of the business, has paid the license fees. The application must include the corresponding payment. The Board shall issue the registration certificate no later than thirty (30) days after the date of delivery of all the documents.
No massage business shall offer its services until it has been registered in the Board, and it has been issued the registration certification and granted the license. The massage business shall place the certificate in a visible place, in such a way that it can be examined by the public. A Massage Therapist who has not obtained the Massage Therapist license issued by the Board, can not be hired by any massage business.
A massage business is subject to inspection by authorized Board personnel at any time it deems pertinent in order to verify its compliance of the Law. The Board shall decide whether or not the business under consideration complies with this Act.
Section 8.- Suits Related to Massage Businesses All massage businesses shall notify the Board in writing of any suit (civil or criminal) related to the operation of the massage business, its owner, employees, officials, directors, or any salaried personnel, within ten (10) days after the massage business, its owner, employees, officials, directors, or any salaried personnel have filed the suit or has been notified of a suit. The massage business shall remit an official copy of the petition or complaint that has been filed in court, with the written notification.
Section 9.- Denial of Renewal, Suspension of License The Board may deny, renewal, suspend or revoke a license, of its own accord (motu propio) or at the request of a party, upon filing of the charges, and an administrative hearing, pursuant to the provisions of Act No. 170 of August 12, 1988, as amended, to any Massage Therapist who:
(a) Fails to meet the requirements to obtain a license under this Act.
(b) Has practiced the profession of Massage Therapist illegally.
(c) Has obtained, or attempted to obtain a Massage Therapist license through fraud or deceit.
(d) Has incurred manifest incompetence in the exercise of the profession in prejudice of a third party.
(e) Has rendered professional Massage Therapist services with an expired license.
(f) Has incurred in any conduct prohibited in this Act.
(g) Has been declared as mentally impaired by a Court with jurisdiction, provided that the license may be granted when said person gives evidence of being capable, upon a statement to such effects issued by a court with jurisdiction, if said person meets the requirements established in this Act.
(h) Is addicted to narcotic drugs or is a habitual drunkard, provided, that the license may be issued as soon as said person gives evidence of being capable, if he/she meets the remaining requirements established in this Act.
(i) Has been convicted of a felony or misdemeanor against decency involving moral turpitude, that has not been expunged from the criminal records, or which cannot be expunged as provided in Act No. 137 of July 1, 1975, as amended.
Section 10.- Right to Reconsideration and Appeal The renewal of a License or certification cannot be denied, suspended or revoked for the reasons indicated in the above Sections without prior written notification, nor the offer of an opportunity for a formal hearing regarding said denial, suspension or revocation. The notification to such purposes shall be issued no later than thirty (30) days from the date of the decision of the Board. Said notice shall be in writing and must include an admonition regarding the statute of limitations for requesting the Hearing and the procedure to request it.
When the license or certification of a practitioner has been suspended, the Board may revoke said suspension when it determines to its satisfaction that said licensed or certified practitioner is capable of exercising the profession with reasonable skill and safety. As a condition for the restitution of a suspended license or relief from probation, the Board may impose any disciplinary or corrective measure it deems pertinent and has been previously established in this Act.
When an application has been denied or rejected and the applicant deems that the Board acted unfairly and that more rigorous rules have been imposed that are different from those imposed on other applicants or license
holders, or that have otherwise contributed or caused the denial or rejection of the application, the applicant may appeal pursuant to Act No. 170 of August 12, 1988, as amended, known as the "Uniform Administrative Procedures Act of the Commonwealth of Puerto Rico."
Section 11.- Penalties Any person who practices the profession of Massage Therapist without the corresponding license, or who employs another person who does not hold a license for such practice shall incur a misdemeanor and shall be sanctioned with imprisonment fir a tern that shall not exceed six (6) months, or a fine that shall not exceed five thousand $(5,000)$ dollars, or both penalties, at the discretion of the Court.
The Board shall suspend the license of any massage business that hires a person that does not have the corresponding license after being sentenced, for a term of one (1) year; and if said business is a recidivist, it shall permanently lose the right to practice the profession in Puerto Rico.
Section 12.- Prohibited Practices The following situations shall serve as the grounds upon which the disciplinary measures set forth in Section 9 may be taken against a Massage Therapist, pursuant to this Act:
(a) To attempt to obtain a license to practice as a Massage Therapist through bribery or misrepresentation.
(b) To have been found guilty or have been convicted of any offense that is directly related to the practice of massaging or the skill to practice it in Puerto Rico, the United States, or a foreign country.
(c) To publish fraudulent and/or misleading advertisements regarding the massage services or practice offered.
(d) To fail to include the massage license number or use a false number in any type of advertisement or promotion.
(e) To support, assist, procure or advise any unlicensed and/or unauthorized person to practice as a Massage Technician or Therapist in Puerto Rico in contravention to this Act.
(f) To fraudulently, deceitfully or falsely represent the practice of massage.
(g) To fail to offer safe and competent massage due to illness, use of alcohol, narcotic drugs or controlled substances, or even any prescribed drug, if it gives grounds to believe that the person is not professionally, physically or mentally fit to work. Provided that failure to offer safe massaging comprises an action that may aggravate any preexisting condition, or cause some type of harm, as well as any type of massage performed in contravention to the indications of the massage profession. To reinforce this clause, the Board shall have the authority, under probable cause or sufficient evidence, to request that the Massage Therapist be submitted to a physical and/or mental examination, as the case may be, with a physician or health professional designated by the Board. A Massage Technician or Therapist affected by this paragraph shall be given reasonable opportunities to demonstrate his/her competence to return to the practice with enough skills to protect the health of his/her customers.
(h) To be accused repeatedly of malpractice for failing to render quality care and expertise established as accepted by the Board in the professional services.
(i) To work and/or offer services beyond the parameters established by Law and to accept professional responsibilities that the Therapist knows, or has reason to know he/she is not qualified to perform.
(j) To breach the rules of this Section of the Act, and/or an express order or decision of the Board, previously arranged at a disciplinary hearing.
(k) To fail to maintain the equipment used by the Massage Therapist clean and in acceptable hygienic condition.
Section 13.- Disciplinary Measures If the Board should find that a Massage Therapist has incurred one or more of the abovementioned faults, it may impose one or more of the following disciplinary measures:
(a) Deny the license to the applicant.
(b) Revoke and/or suspend his/her license. Any person whose license has been suspended or revoked by the Board shall return it to the Board. If the suspended or revoked license has been lost, the person shall establish this fact for the record by means of a sworn statement. The Board shall publish the suspension or revoking of said license within seven (7) days subsequent to the decision.
(c) Issue a reprimand or censure for the record.
(d) Impose a separate administrative fine, as provided in Act No. 137 of July 1, 1975, as amended, for each of the charges and/or offenses.
Section 14.- Exhibition and/or Display of the License Every Massage Therapists and Provisionally Licensed practitioners shall conspicuously display their certificate of registration or license with their photograph in their office, cubicle or in the workplace or business. The title granted by the certification or license may be abbreviated as LMT (TML, in Spanish).
Section 15.- Grandfather Clause From the date on which this Act takes effect, up to one (1) year after, when its effectiveness shall expire automatically, any person who applies for a Massage Therapist license shall receive it once the Board approves the application, if the following requirements are met:
(a) Be eighteen (18) years of age or older.
(b) Present a high school diploma, or its equivalent.
(c) Be a graduate of an accredited Massage Therapy institution with at least five hundred (500) hours of instruction through classes, workshops or seminars.
(d) Have practiced massaging for five (5) years prior to the approval of this Act.
(e) Have passed the "National Certification Board for Therapeutic Massage and Bodywork" examination, or the revalidation examination offered by the Board. Any Therapist as established in this Act, who has been practicing for ten (10) years or more, who has been studying the subject matter required by the examination through classes, workshops and seminars, shall be exempted from complying with the provision stated in this subsection.
(f) Present a Criminal Record Certificate issued by the Puerto Rico Police Department.
(g) Present proof having current professional liability insurance.
(h) Present a Health Certificate.
(i) Present an up to date CPR license and evidence of having taken the HIV workshop required for other health professionals.
(j) Present proof of United Stated citizenship or a Resident Visa and a work permit in effect.
(k) To show evidence of being domiciled in the Commonwealth of Puerto Rico for at least six (6) months prior to submitting the application.
Section 16.- Provisional License Every person that does not meet the training requirements established by the Board, but meets all other requirements, may obtain a non-renewable Provisional two (2) years License that will allow them to work as Massage Therapists for said term until completing studies of not less than one thousand $(1,000)$ Massage Therapist contact hours, or as indicated by the Board, in a massage school duly accredited by the General Council on Education. This shall apply to every therapists graduated from a Massage Therapy school who is practicing their profession or who at the time of the approval of this Act, was enrolled in a course of five hundred (500) hours or less.
Section 17.- Funds The sum of ten thousand $(10,000)$ dollars is hereby appropriated to the Department of Health, charged to the General fund, to defray the operating expenses of the Board and the necessary expenses for the implementation of this Act during the fiscal year that the Board is constituted. Said appropriation shall be recurrent in subsequent years and shall be consigned in the Operational Expense Budget of the Department of Health.
Section 18.- Reciprocity The Board is hereby authorized to establish reciprocity agreements on:
(a) The granting of licenses without examination directly with several states or territories of the United States, or any foreign country in which substantially similar requirements to those set forth in this Act, are required to obtain a Massage Therapist license, and in which a similar concession is provided for persons licensed by the Commonwealth of Puerto Rico.
(b) Prior residence of six (6) months.
Section 19.- Exceptions Excluded from the requirements of this Act, shall be the practice of massage within osteopathic medicine, physical therapy, naturopathy, or any other branch of medicine in which the practice of massage has been regulated by Law, provided this is within the context of the regular medical treatment, and not as part of a therapeutic massage business.
Unless these massages are incidental to the practice of the profession, any person who is prepared in the field of aesthetics, cosmetology or hair cutting who wishes to practice bodily or therapeutic massage professionally,
must meet the requirements of this Act, if they wish to provide massage services or any of its modalities.
Section 20.- Severability Clause If any Section, paragraph, clause or part of this Act were found unconstitutional by a Court of competent jurisdiction, the ruling issued to such effects shall not invalidate the remaining parts thereof, but its effects shall be limited to the Section, paragraph clause or part that was found to be unconstitutional.
Section 2.- Effectiveness This Act shall take effect immediately after its approval.
I hereby certify to the Secretary of State that the following Act No. 254 (H.B. 3148) (Reconsidered) of the $5^{ ext {th }}$ Session of the $14^{ ext {th }}$ Legislature of Puerto Rico:
AN ACT to regulate the practice of massaging and the Massage Therapist profession, establish the requirements to practice of said professions, create the Puerto Rico Board of Examiners of Massage Therapists, confer upon it the authority to regulate, investigate, and penalize these health professionals and establish penalties for the illegal practice of therapeutic massage, among other purposes, has been translated from Spanish to English and that the English version is correct.
In San Juan, Puerto Rico, today $23^{ ext {rd }}$ of November of 2004.
Elba Rosa Rodríguez-Fuentes Director