As you may know, the City of Markham has begun introducing additional business regulation for RMTs, acupuncturists and chiropractors. This would be a business license that impacts the business as an entity rather than the individual professional, and would only apply to business owners within the City of Markham. 

Recently, I met with representatives in the City of Markham to request clarification on these requirements and updates in their language to ensure they were conveying accurate information. The initial request to professionals applying for business licenses said this applied to "personal services shops". The City of Markham uses this language to apply to a variety of businesses including business run by regulated health professionals such as RMTs and chiropractors. We explained that this would cause confusion as it makes it seem as if they are unaware of the difference between regulated health professionals and unregulated practitioners. They have agreed to change their language in future communications to clarify their intent. 

In addition, this communication made it seem like they were only regulating the businesses of certain health professionals, and we asked why they were not treating all health professional businesses equally. They clarified that it is the eventual intention to apply this regulation to all health professional businesses, and they prioritized certain types of health professional businesses where they receive the most complaints about unregulated practitioners. It is the eventual intention of the City of Markham to apply this regulation to all health professional businesses. 

We were also concerned about the financial burden this might have on members in Markham. The City agreed to extend the deadline for business licenses to the end of 2024, only after they have provided the clarified communication requested. In addition they have agreed to consider lower licensing fees for professionals who have solo practices or smaller businesses. This business registration fee would not apply to RMTs with mobile practices. 

We hope to be able to share updated communication from the City of Markham in the coming weeks. We will keep members up to date with this situation as it develops. 

As you likely know, RMTs in Ontario meet all criteria for HST/GST exemption and the vast majority of practitioners in Ontario support the HST changes.

The Minister of Finance, Chyristia Freeland has confirmed that RMTs meet all criteria and that the government has received the official request for tax exemption from RMTs, and is in the process of considering this request. 

The RMTAO, along with our partners in the Canadian Massage Therapist Association (CMTA) regularly follow up with the Ministry of Finance, however, there has been no definitive movement on the exemption, nor have we received a timeline for when these processes may be completed.

To further press this issue and increase the urgency with the Minister of Finance, we are asking that our members send a letter to Minister Chrystia Freeland expressing their support for moving tax exemption for RMTs forward. 

The RMTAO has provided a template letter to send to Minister Freeland that outlines the importance of tax exemption for massage therapy and requests that she move the process forward. 

You can choose to mail this letter, or attach it to an email to Minister Freeland. If you would like to send this letter as an email you can send it to chrystia.freeland@parl.gc.ca . 

Download the letter to send to Minister of Finance Chrystia Freeland

Your support in making the Minister of Finance aware of the importance of this issue will greatly assist our efforts as we follow up with Minister Freeland in the fall of 2024. As most of you are aware, we have been able to raise the profile of this issue with the federal government. We just need to influence the Minister of Finance to be favourable to our cause to successfully obtain tax exemption for RMTs. 

The RMTAO recently sent a letter to all MPPs providing them with an update on our Pilot Project, which aims to prove the benefits of the integration of massage therapy into primary care teams.  This letter was sent to all MPPs in Canada, including important Ministers

This letter includes a review of the benefits of massage therapy, and detailed information about what the Pilot Project will evaluate. We also emphasized that this Pilot Project is the first step to the further integration of massage therapy into interprofessional primary care teams. 

The results of the Pilot Project are coming out in the coming weeks, and we will be sharing the results widely including with MPPs and other government officials. 

This letter also included the second video the RMTAO created to highlight the experiences of patients accessing massage therapy through the Pilot Project. The feedback from patients has been overwhelmingly positive, and patients who didn't previously have access have been able to access massage therapy. 

I am pleased with the progress of the Pilot Project so far, and look forward to providing additional information as it becomes available. 

Read the letter to MPPs

As you may recall, in reviewing Health Service Provider Guidelines and Frameworks, the government committed to ensuring that those injured in auto accidents continue to receive the care they need and that health service providers are compensated appropriately for their services.

The government is requesting that the Financial Services Regulatory Authority of Ontario (FSRA) review the Professional Services Guideline and the Attendant Care Hourly Rate Guideline and consider updating these guidelines based on their findings. The government will consider FSRA’s findings in future reviews of the Statutory Accident Benefits Schedule.

The RMTAO, as part of the Coalition of Health Professions in Auto Insurance (Coalition), provided a submission that advocated for an increase in fees paid under the Statuatory Accidence Benefits Schedule, which have not been updated since 2014. 

The letter from FSRA outlined that they will be reviewing auto insurance reforms, which will include public consultations beginning October 1, 2024. They encouraged the RMTAO to share feedback both before and during the consultations, and we will continue to advocate for increase fees for those that treat individuals injured in motor vehicle accidents. 

Read the response from FSRA 

On June 17, 2024 Bill C-323, a private members bill put forward by MP Stephen Ellis from Cumberland – Colchester was amended to include massage therapy to be among the health services to be exempted from the Goods and Services Tax.

Previously, Bill C-323 was limited to exempting mental health services from HST/GST. This is a very encouraging development and is a result of requests by the RMTAO to MP Ellis to include massage therapy in his Private Member’s Bill. While this does not ensure that we will be exempted in the next budget, it does link us with mental health services which the current Federal Government has previously said they will exempt from HST/GST.

IThe Bill now reads, “Bill C323, An Act to amend the Excise Tax Act (mental health services), be not now read a third time but be referred back to the Standing Committee on Finance for the purpose of reconsidering Clause 1 with the view to amend the clause so as to include massage therapy among the health services to be exempted from the Goods and Services Tax, and the committee be invited to consider reporting the bill back to the House within 15 sitting days following the adoption of this order.”

This Private Member's Bill is a very promising development, and we will keep you up-to-date as it progresses.

Last year the RMTAO, in conjunction with the CMTA, circulated a petition asking for HST/GST exemption for Massage therapy, which closed in April 2024. Over 18,000 people signed the petition, many of which were Ontario RMTs. We would like to thank all our members who contributed by sharing and signing this petition.

The petition was tabled in the House of Commons, which essentially brings it to their attention. On May 30, we received a response to the Petition from the Minister of Finance, which you can review here.

In her response, Minister Freeland outlined the Government's position on HST exemption and that massage therapist meet the required standard for exemption. In her response she states, “Health care services are not automatically added to the list of exempt health care services. A formal request to exempt the service must first be made to the Minister of Finance by the health profession providing the service. The Department of Finance Canada will then review the request to see whether the health profession meets the exemption criteria. If the exemption criteria are met, the Department will then consult with the relevant provincial and territorial associations of the profession to ensure that there is widespread support for the GST/HST exemption. It is the government’s understanding that massage therapy is now regulated in five provinces and a formal request to exempt these services has been received. The government is currently reviewing the request.”

This is correct, as the CMTA has made a formal request and we are regulated in 5 provinces. I was encouraged by her response. The Association will continue to push aggressively for exemption, regularly following up with the Ministry of Finance and other relevant government officials.

Last week I sent a letter and supporting documents to the Ontario Minister of Finance, Peter Bethlenfalvy, on the subject of the OCF-18 Form and our request to remove the requirement to have a third-party health professional certify and review this form when completed by a Registered Massage Therapist. This letter emphasized the role of RMTs as regulated health professionals, and the ways that RMTs already help individuals who have been injured in motor vehicle accidents. 

In addition, the Coalition of Health Professions in Auto Insurance (the Auto Coalition) has agreed to send a letter to the Ontario Minister of Finance to support RMTAO efforts to include RMTs in the definition of health practitioner in Section 3(1) of O.Reg 32/10: Statutory Accidental Benefits Schedule (SABS) under the Insurance Act 1990, so that RMTs can sign part 4 of the OCF-18 without sign-off from another health professional.

I will update members as we move forward with these efforts.

You can read the letter here 

We are about to circulate the second in a series of videos on the pilot project the RMTAO has undertaken in collaboration with the West Toronto Community Health Services (WTCHS).  The videos help to verify the health and cost benefits of integrating therapeutic massage (RMT) into primary health care teams. The RMTAO has developed four videos highlighting the impact of this pilot project on both practitioners and patients, which we will gradually share.

We are sharing one of these videos every 4 to 6 weeks with all Ontario MPPs, including the Minister of Health, Federal MPs including the Minister of Finance, and various government bureaucrats including the Deputy Minister of Health, and policy officials working in various ministries. These individuals are key to our advocacy efforts to integrate massage therapy into primary health care teams.  

The goal of these videos is to further promote the successes of this Pilot Project in advance of the results being released later this year. We also want to encourage these individuals to support further integration of massage therapy into primary care. 

Click here to access the second video

We encourage you to share this video on your own networks to promote the benefits of massage therapy integrated into primary care. 

Over the past two weeks, I have been travelling, together with the CMTO, across Ontario to connect with RMTs at Town Hall events.

Maureen Boon, the Registrar of the CMTO, and I were in St. Catherines on May 1 and Guelph on May 2. We were in Peterborough on May 7, Kingston on May 8 and Ottawa on May 9. 

There were significant groups in all the cities we visited so far, and many RMT communities really came together for this event, with up to 70 attending in some areas. 

Mauren and I both made presentations and fielded many questions from the attendees. I have included a copy of my presentation to give you some idea of the scope of topics covered. Click here to read my presentation. Some topics I covered in my presentation have been included our Pilot Project at West Toronto Community Health Services, Queen's Park Day, and HST exemption, among other topics. 

The questions asked of me covered a wide range of topics including Community-Based Networks, The WHTCS pilot project; RMTs working with seniors, Insurance company issues, scholarships and further education for RMTs, the value and activities of Association groups like CORPHA, CMTA, WSIB Forum, Auto Coalition Forum and HST Exemption. 

There are two Town Hall meetings remaining. Maureen and I will be in Thunder Bay on Tuesday, May 14, and Toronto on Thursday, May 16. 

Register for the Thunder Bay Town Hall
Register for the Toronto Town Hall 

The Town Hall in Toronto will be filmed and will be available on the CMTO YouTube channel after the event. 

As you have likely heard, the Canadian Federal Budget earlier this week did not include provisions to exempt massage therapy from collecting and remitting HST/GST.

Despite support from members of all the main political parties and direct appeals to the Minister of Finance herself, the budget did not address the issue, nor has the government offered indication on when the exemption will be put in place as it has for other regulated health professions meeting established criteria.

Massage therapy is a regulated health profession in Ontario. Moreover, our profession is regulated in four additional provinces: British Columbia, New Brunswick, Newfoundland and Labrador and Prince Edward Island. The Province of Saskatchewan has also enacted legislation to regulate the profession, which is only waiting for the establishment and approval of a regulatory college for it to be in force. As massage therapy is a regulated health profession in at least five provinces and our profession universally supports exemption, the criteria for removing HST/GST has been met.

After hundreds of meetings, emails, letters, phone calls and texts, RMTAO has received full support from Ontario’s Minister of Health as well as members of the Official Opposition (federally and provincially) to move forward with HST exemption. Both levels of government acknowledge that healthcare must equally provide Canadians with accessible and affordable healthcare, and, in doing so, where regulated health professions are practicing in five or more provinces, those services are eligible to be exempt from HST/GST taxes.

In addition, Massage Therapists across Canada have sent letters to their respective MPs requesting the exemption, and RMTAO has worked with federal offices and committees to put forward committee motions that would compel the government to act. A petition circulated from December 11, 2023, to April 9, 2024, garnered 18,382 signatures from across Canada in support of HST/GST exemption. With our partners at the Canadian Massage Therapist Association (CMTA), this petition will be presented to the House of Commons for review.

After the budget announcement, the RMTAO also sent a press release to a variety of media outlets to hope to bring more attention to this issue. Click here to review the press release. 

We also sent a letter to Chrystia Freeland, federal Minister of Finance, to express our disappointment with the latest budget and to reiterate our request for tax exemption. Click here to review the letter to Chrystia Freeland. 

While we are disappointed with the lack of action, the RMTAO remains steadfast in our efforts to gain exemption. We have now reached out to national and provincial media, and we will continue to press the government for an exemption to be included in the fall budget, normally released in late October or early November. If need be, we will also make HST exemption an issue for the next federal election mandated on or before October 2026.

Last week we updated many politicians and bureaucrats on the pilot project the RMTAO has undertaken in collaboration with the West Toronto Community Health Services (WTCHS) to verify the health and cost benefits of integrating therapeutic massage (RMT) into primary health care teams. The RMTAO is developing a series of at least four videos highlighting the impact of this pilot project on both practitioners and patients.

We will be sharing one of these videos every 4 weeks with all Ontario MPPs, including the Minister of Health, federal MPs including the Minister of Finance, and various government bureaucrats including the Deputy Minister of Health, and policy officials working in various ministries. These individuals have been instrumental in our advocacy efforts to integrate massage therapy into primary health care teams.

The goal of these videos is to further promote the successes of this Pilot Project in advance of the results being released later this year. We also want to encourage these individuals to support further integration of massage therapy into primary care.

Click here to access the first video.

We encourage you to share this video on your own networks to promote the benefits of massage therapy integrated into primary care.

There was some positive news in the recent Ontario Budget. As has been reported previously in the Friday File, The RMTAO has been lobbying the Minister of Finance and the Financial Services Regulatory Authority of Ontario (FSRA) through the Coalition of Health Professionals in Auto Insurance, to increase compensation rates for auto insurance for all professions.

In reviewing Health Service Provider Guidelines and Frameworks, the government is committed to ensuring that those injured in auto accidents continue to receive the care they need and that health service providers are compensated appropriately for their services. The government is requesting that the Financial Services Regulatory Authority of Ontario (FSRA) review the Professional Services Guideline and the Attendant Care Hourly Rate Guideline and consider updating these guidelines based on their findings. The government will consider FSRA’s findings in future reviews of the Statutory Accident Benefits Schedule.

The Professional Services Guideline is the guideline that sets out fees to be paid to healthcare professionals who treat injured claimants. FSRA will review the Guideline to see if increases are warranted. They are certainly warranted as there has not been an increase since 2014.

As these discussions continue the RMTAO and the Auto Coalition will continue to lobby FSRA to increase rates.

One of the positive outcomes of Queens Park Day is the increased number of MPPs and staff from various Ministries we are meeting as a result.

As a result of Queen's Park Day, I was contacted by Sean Court, Assistant Deputy Minister, Long-Term Care Policy Division and Gillian Steeve, Assistant Deputy Minister, System Planning and Partnerships both from the Ministry of Long-Term Care. Assistant Deputy Ministers are some of the most senior officials in the Ontario legislature.

I met with these ADMs this week. They wanted to discuss our Pilot Project that has introduced 2 RMTs into the West Toronto Community Health Service.

They were particularly interested in how RMTs in primary care settings can help keep seniors healthy and at home longer. After providing them with an overview of the project, we discussed how seniors benefit from massage therapy. Both ADMs were very interested in the project and in the follow up report that we will be sharing widely in the late summer. At the end of the meeting, we agreed to meet again to discuss the next steps.

It is amazing how much interest the Pilot Project is getting from Government. The Minister of Health has also expressed a strong interest as have other MPPs and Bureaucrats. The reaction from the government has been universally positive.

I will continue to update the membership on our meetings and results as we move forward.

On February 22nd and 23rd, 2024, the RMTAO attended and presented at the Team Primary Care (TPC) Summit in Ottawa. The summit was attended by 200 people in-person with an additional 100 joining virtually. The feedback from participants has been overwhelmingly positive.

Team Primary Care - Training for Transformation is a unique and timely initiative that aims to accelerate transformative change in the way primary care practitioners train to work together. To do so, it brings together an extensive network of partners to enhance the capacity of interprofessional comprehensive primary care (CPC) through improved training for practitioners, supports for teams, and tools for planners and employers.

Team Primary Care aims to prepare primary care providers to work in teams, in tandem with the health system reforms needed to adopt the delivery of more and better CPC. Ultimately, by better preparing new and existing primary care practitioners, Canadians will have better access to equitable primary care close to home.

The RMTAO made a presentation at the Conference regarding our Pilot Program embedding RMTs into a primary health team and the need to include massage therapy in community health teams across Ontario. Special thanks to RMTAO members Sasha Goudriaan and Susan Shipton who presented on behalf of the RMTAO.

The first day of the conference centered on sharing insights from the 40+ projects within Team Primary Care. This featured a series of presentations by Team Primary Care leaders and co-chairs, along with two-minute rapid poster pitches from project partners. A standout moment on Day 1 was a panel discussion moderated by Jerry Maniate from Equity in Health Systems Lab, featuring Jeff Turnbull, formerly a Vice Dean of Medical Education at the University of Ottawa; Penny Paucha from Instincts at Work, and Eileen Patterson from the Health Innovation Group. The panel delved into leadership and other essential qualities necessary for effective interprofessional teamwork in practice environments.

The second day focused on charting our path forward and included breakout sessions organized by disciplines and regions to foster momentum for collective progress. A notable highlight was a provocative presentation by Steven Lewis, Adjunct Professor of Health Policy at Simon Fraser University, followed by a panel response facilitated by Louise Nasmith, Professor in the Department of Family Practice at the University of British Columbia. The panel comprised Leslee Thompson, CEO of Health Standards Organization & Accreditation Canada; Karima Velji, Assistant Deputy Minister of Health, Ministry of Health; and Preston Smith, Dean of Medicine at the University of Saskatchewan, and Incoming Dean of the University of PEI, Faculty of Medicine.

Attending this conference and presenting at it is important to demonstrate the potential value of massage therapy in team primary care, as well as to advocate for the importance of including massage therapy in primary care in the future.

As has been reported previously in the Friday File, I have been working closely with WSIB to improve fees and otherwise make it easier for RMTs to work with them.

I am happy to report that likely as a result of improvements that I have advocated for, the number of RMTs utilizing WSIB has doubled. In addition, I received the letter below from WSIB indicating how much they value the services that Ontario RMTs provide and announcing a fee increase to RMTs of 4.4% to fee for service visit rates. There will continue to be an annual CPI based increases in future years.

They have updated their website with the details of the new fees, which apply to any services provided on or after January 1, 2024.

I continue to work closely with the WSIB and look forward to continued improvements to make WSIB easier to navigate for RMTs.

Review the letter from WSIB.

I am continuing to reach out to the Federal Government and Federal Members of Parliament (MPs) to put as much pressure on them as possible to ensure they are aware of the importance of the GST/HST Exemption. Recently I wrote a letter to Minister Freeland and to every member of her Finance Committee (which includes 11 MPs) to once again ask for the removal of GST/HST from services provided by Registered Massage Therapists. A copy of this letter is available below. We have asked for a meeting with Minister Freeland which will include an RMTAO member who is a constituent in her riding to drive our point home.

Review the letter to Minister Freeland

To further support this issue, I also contacted by email several individuals whose support may be beneficial:

Pierre Poilievre, MP – who is not only the Leader of the Conservative party but also its Finance Critic.

Rachel Bendayan, MP – the Parliamentary Secretary to Minister Freeland.

Jagmeet Singh, MP – Leader of the NDP.

Hadeel Aziz – Special Assistant in Minister Freeland’s office.

Majid Jowhari, MP – The RMTAO met with him earlier this year to discuss this issue.

Andrew Otto and Jeelan Syed – Department of National Revenue at the CRA.

Finally I forwarded the letter to Stephen Ellis, the MP who introduced Bill C-323 which proposed to remove HST for services provided by psychotherapists and mental health counsellors, and has agreed to include massage therapy in this bill.

We will follow up with everyone mentioned in this update.

Recently the RMTAO sponsored a booth at the Canadian Sport Massage Therapists Association (CSMTA) National Education Conference. I had the pleasure of attending the conference and meeting many of the attendees, both at the booth and over lunches and dinners, at the receptions and between sessions. I spoke with attendees mostly about the RMTs current advocacy efforts including the fight for HST exemption, the RMT Pilot Project and our upcoming Queen's Park Day.

The attendees were largely sports Fellows/Candidate Members, and many are already members of the RMTAO, though not all. The CSMTA was founded in 1987 to enhance the performance of Canadian athletes from the grassroots to the professional level through expertly trained Registered Massage Therapists with the CSMTA Sports Fellows and Certificate Candidates designation.

The conference hosted guest speakers who included National Olympic and Para Olympic athletes while conducting many interesting in-person sessions that included athletic taping, pelvic health and relationship with sports, cycling injuries and much more.

I felt that it is important for the RMTAO to support the efforts of the CSMTA and help promote their great work. It was also important to attend the conference for the opportunity to speak with groups of both RMTAO members and non-member RMTs. The RMTAO is dedicated to supporting the work of RMTs and organizations like the CSMTA. This event serves as a reminder that there are lots of groups and RMTs that further and advocate for Massage Therapy which we are proud of and happy to support in any way possible.

As has been reported in previous Friday Files, the RMTAO has entered into a partnership with the West Toronto Community Health Services (WTCHS). This partnership is the first important step into primary care. Recently, we received our first quarterly report, which is summarized in this PowerPoint. The early feedback is very positive, both from patients and from the organization.

In addition, to further advance our goal of supporting the participation of RMTs in interprofessional teams, an organization called the Team Primary Care Interprofessional Collaborative has agreed to fund the development of curriculum to be used in educational settings for health care practitioners that provides information about massage therapy and how it fits into primary care, how it can support health outcomes, and how it can alleviate demands on other health practitioners.

Finally, I recently attended the Association of Family Health Teams of Ontario (AFTHO) conference. We plan on presenting the findings of our Pilot Project at this conference next year. The theme of the conference this year was Team Based Care. Based on this, we are very much aligned with the direction that Family Health Teams and the Ministry of Health are taking. There was a great deal of interest in the Pilot from Family Health Teams that I spoke with at the Conference, and I look forward to further discussing the Pilot with these types of groups.

I would like to welcome everyone to the 2023-2024 membership year!

Without your support we would not be able to advocate and represent you. On behalf of Operations and the Board - our heartfelt thanks. An investment in the Association is one of the most tangible ways you can invest in the future of the profession.

Many of the important advocacy initiatives that got their start this past membership year will continue throughout 2023-2024. This includes:

• Getting further results of the pilot project with West Toronto Community Health, focusing on the benefits of integrating massage therapy into primary care.
• A continuation of our letter-writing campaign to MPs regarding HST exemption, and promised update from the Ministry of Finance regarding our application for HST exemption. You can still send this template letter to your local MP in support of HST exemption.
• Expected follow-up with the Ministry of Finance regarding our request to remove the requirement for an RMT to have a listed health practitioner co-sign the OCF-18 when the RMT is treating individuals who have sustained injuries in a motor vehicle accident.

This membership year, I am also excited that we will be hosting a Queen's Park Day on February 21, 2024. This Queen's Park Day will be to brief MPPs about the benefits of massage therapy, and the role of RMTs in health care, and to support the Private Member's Bill (PMB) introduced by MPP France Gelinas to proclaim the third Wednesday in October of each year as Massage Therapy Day. This Bill will specifically recognize the role and benefits of massage therapy in the health and well-being of Ontarians.

We will also continue to introduce new and exciting educational opportunities this membership year, as well as develop new practical resources, promote the massage therapy profession, and continue to engage with members to ensure we are focusing on issues, tools and resources that matter most to you.

These are just some of our plans for the 2023-2024 membership year. I also invite any of our members to contact me at michael@rmtao.com if you have any questions or concerns.

If you haven't renewed already - you can still renew online! (be sure to log in in order to renew).

As you may know, we have been regularly following up with the Ministry of Finance to check in on the status of our application for HST Exemption.

This was somewhat delayed this summer as many important people involved were on vacation, but we have recently received an update that I would like to share.

Staff members of the Minister of Finance have confirmed that the issue of RMTs across Canada receiving HST/GST exemption is currently being looked at within their department to determine the best way forward. This includes the development of more concrete policy proposals, which the RMTAO will continue to remain involved in.

This is the first confirmation we have received that the Ministry of Finance is actively reviewing our request. We regularly follow up to ask for any updates and offer any further information that may be needed. I look forward to providing members with updates as soon as they become available.

Recently, the RMTAO, as part of the Coalition of Health Professions in Auto Insurance (Coalition), made a submission to the Ministry of Finance Consultation on Auto Insurance Reforms.

The Coalition was formed in 1990 with a membership of eight regulated health professional associations including the RMTAO. These Associations, in turn, represent over 40,000 regulated health professionals involved in the assessment and treatment of Ontarians injured in motor vehicle accidents (MVAs). The Coalition brings an important perspective -- shared across multiple health disciplines -- on the needs of claimants and consumers in a viable and sustainable auto insurance system in Ontario. Over more than three decades, we have actively participated and engaged in meaningful developments and reforms through our work with the Financial Services Regulatory Authority of Ontario (FSRA) presently, its predecessor, the Financial Services Commission of Ontario (FSCO), and the Ministry of Finance (MOF) and the Ministry of Health.

The submission is divided into two parts. Part 1 outlines key background/context that underpins the Coalition’s overall perspective on the auto insurance product, and Part 2 provides specific answers to the MOF consultation questions. Our submission is also informed by a recent survey of our combined memberships on the issue of claimant access to medical, rehabilitation and attendant care benefits in auto insurance. An important part of the submission covers the need to increase fees. I will update the membership as this MOF initiative progresses.

RMTAO has been working with France Gelinas, MPP, Nickel Belt on the introduction of a Private Member’s Bill (PMB) – Massage Therapy Day Act, 2024 - that would proclaim the third Wednesday in October of each year as Massage Therapy Day. This Bill will specifically recognize the role and benefits of massage therapy in the health and well-being of Ontarians.

MPP Gelinas will introduce the PMB on February 21, 2024. On the same day the RMTAO will be holding a Queen’s Park Day to brief MPPs on massage therapy and its benefits and role in healthcare and otherwise support the PMB. While the Queen’s Park Day is still just under 6 months away, we have already begun planning. For those of you who recall, this will be similarly organized to the Queen's Park Day the Association did in 2018. There will be more information and announcements coming once we get through our renewal period.

A PMB is legislation that is introduced in the Ontario Legislature by an MPP who is not a Cabinet Minister. A PMB follows the same legislative process as a regular government bill, that is, debate in the Legislature, review by a Legislative Committee and finally a vote on whether it should be passed.

The proposed Bill provides as follows:

Preamble

Massage therapy has been recognized for its numerous health benefits and its ability to promote relaxation, relieve stress and improve overall physical and mental well-being. Massage therapy plays an integral role in rehabilitation from injury or disease, and provides relief from the physical symptoms of depression, stress, anxiety, musculoskeletal pain and other ailments.

Registered Massage Therapists assist thousands of Ontarians to return to work from injury or illness and provide patients with a healthy, effective alternative to expensive and potentially addictive pharmaceuticals. This, in turn, can ease the burden on the publicly funded health care system.

As part of multidisciplinary health care teams, Registered Massage Therapists can work with other regulated health care professionals to ensure that their patients have the best possible outcomes.

Massage Therapy Day will serve as an occasion to promote awareness of the benefits of massage therapy, honour the work of Registered Massage Therapists, encourage individuals to explore the benefits of massage therapy and encourage others to be trained in the profession.

The objectives of Massage Therapy Day include:

1. Promote public awareness about the health benefits of massage therapy.
2. Recognize massage therapy’s contributions to improving individuals’ well-being.
3. Encourage the integration of massage therapy as part of a holistic approach to health care and foster collaboration between Registered Massage Therapists, other healthcare professionals and the general public.
4. Provide opportunities for individuals to learn about different massage therapy techniques and their potential benefits.
5. Increase the recognition of Registered Massage Therapists’ qualifications, training and skills.

Earlier this year, I advised that the Registered Massage Therapists’ Association of Ontario (RMTAO) would be working with West Toronto Community Health Services (WTCHS) in a pilot project to verify the health and cost benefits of integrating therapeutic massage into primary health care teams. The project is the first step aimed at integrating Registered massage Therapists (RMTs) into interprofessional primary care teams by adding a proven health discipline to the wellness options available to their patients.

WTCHS has uniquely positioned itself to provide its clients, and select patients referred from other models of primary care. WTCHS provides a full range of community health care and support services to keep people healthy and living in the community and avoid unnecessary hospital use.

The one-year pilot program will be evaluated using a Quadruple Aim lens, which is a framework that focuses on:

• Improved population health outcomes
• Improved care and patient experience
• Improved healthcare team well-being, and
• Lower costs/better value.

The MT pilot project findings will be shared widely with the objective of assessing the contributions of RMTs as part of integrated primary healthcare model across the province.

The MT pilot project is now underway, and we are pleased to report some of the key milestones to date:

• RMT services are being provided at two sites within the primary care team at West Toronto Community Health Services.
• Referral pathways have been implemented, and several clients have been served to date.
• The focus is on providing services to those clients who otherwise would not have access to massage therapy.
• The RMTs, clients and primary care team, have all provided very positive anecdotal feedback to date.
• The evaluation plan is being developed by a third party, taking a quadruple aim approach, and tools for data collection have been implemented.

We have been getting some feedback from some of the RMT clients in the program. The response has been overwhelmingly positive as expected. Please see a few quotes from patients:

• "Jody is wonderful - she did a fantastic job. This program has been a god send."
• "After my appt with Jody I didn't feel pain for almost a week"
• "It was a really great session. My mother really benefitted from the work done on her neck and shoulders and is scheduled to come back for more work,"
• I expect at least one client will be sending a letter expressing their appreciation for the program as well.

I look forward to sharing more results of the MT Pilot Project as they become available.

On March 10, 2023, I wrote to Ann MacKenzie, Senior Manager, Policy Interpretation at the Financial Services Regulatory Authority of Ontario (FSRA), Ontario’s auto insurance regulator, to request that FSRA remove the requirement for an RMT to have a listed health practitioner co-sign the OCF-18 when the RMT is treating individuals who have sustained injuries in a motor vehicle accident.

Ms. MacKenzie responded by informing me that FSRA has no jurisdiction to make the changes we requested, as only the government can introduce legislative and regulatory amendments to the Insurance Act and the SABS.

As a result, I recently wrote The Hon. Parm Gill, Minister of Red Tape Reduction with the Ontario Government. Our ask is to modernize regulations related to the OCF -18 and enable RMTs to sign Section 4 of the OCF-18 form themselves without requiring the sign-off of another regulated health professional.

The requirement to have a third-party health professional certify and review insurance-related Treatment and Assessment Plans (OCF-18) of a Registered Massage Therapist is an outmoded, unnecessary and burdensome measure impacting our profession and our patients.

Aside from being unnecessary, the requirement to have another health professional sign off on an RMT’s OCF-18 represents an administrative burden for the RMT and the associated Health Practitioner that can increase costs as well delay in treatment. The HCAI website indicates that one of the strengths of the platform is to benefit patient care, but the requirement for RMTs to get sign-off on their treatment plans does the opposite.

I am also following up with the Ministry of Finance on this issue.

Review the letter I sent to the Hon. Parm Gill.

Following our July 14 update to you regarding HST exemption, we are now taking some necessary next steps to have the federal government complete its processes so that they are able to grant HST/GST exemption to Canadian RMTs.

As you likely know, RMTS in Ontario meet all criteria for the exemption and the vast majority of practitioners in Ontario support the HST changes.

As you also likely know, the RMTAO, in cooperation with other provincial associations and the Canadian Registered Massage Therapists Association, made an application for tax exemption. Our Association has followed up regularly with the relevant departments within the Federal government, and, although we have received acknowledgement of our application, so far there has been no definitive movement on the exemption, nor have we received a timeline for when these processes may be completed.

As such, we believe some encouragement is required to move this important initiative forward, and you can use this template letter to send to your MP and express your support for tax exemption.

The letter, which can be modified with your personal details can be sent to your local Minister of Parliament (MP) who can then take the message to Ottawa.

If you are not sure who your MP is, please use this link to find out. Simply insert your postal code into the appropriate box and that will tell you who they are. Find Members of Parliament - Members of Parliament - House of Commons of Canada (ourcommons.ca).

Once you have the name of your MP, click on their name and you will be directed to a page with links to their contact information.

If your MP is also a Cabinet Minister, e.g. Minister of Finance – then they should be addressed with the Honorable preceding their name, for example, The Honourable Chrystia Freeland, Minister of Health. Regular MPs can simply be addressed as Mr. or Ms. Please note that no postage is required for letters to MPs.

If you have any questions or need any assistance in writing the letter, confirming who your MP is, etc. please contact Michael Feraday, Executive Director and CEO of the RMTAO at michael@rmtao.com.

Download the Template Letter to MPs regarding HST Exemption

As mentioned a few weeks ago in the Friday File, as part of our advocacy efforts towards HST exemption, member Associations of the Canadian Massage Therapy Alliance (CMTA), like the RMTAO, are writing to their respective Members of Parliament asking for their support in our efforts to have RMTs exempt from collecting and remitting HST/GST.

As you know, the RMTAO, in our role on the CMTA, has applied to the Canadian Revenue Agency (CRA) to exempt services provided by Ontario RMTs and those who are members of other health professional associations that are part of the CMTA from HST.

The RMTAO is sending out a letter with supporting information and correspondence to the 121 MPs in Ontario in order to get their support for HST/GST exemption. You can review a draft of this letter, directed to Deputy Minister of Finance Chrystia Freeland here.

In the coming weeks, we will provide a template letter for members to send to their MPs. I will provide updates here on that initiative as soon as they become available.

As many of our members in Ontario are aware, RMTAO has applied to the Canadian Revenue Agency (CRA) to exempt services provided by Ontario RMTs and those who are members of other health professional associations that are part of the CMTA from HST.

Not only will the exemption remove some administrative burden in our RMT businesses, it aligns us with other regulated health professions, and, ultimately, may reduce costs to our patients who do not have coverage under health care plans.

For well over a year we’ve been working tirelessly with our national association, the CMTA, our counterpart provincial associations and our regulatory/government advisors to ensure the proper process has been followed to acquire the HST exemption.

At this juncture, we know we are compliant with the regulations for HST exemption and are now in a “waiting game” as the government’s “wheels” slowly churn away. A lot of you may find the waiting time a frustrating exercise, but our advisors are confident that the exemption will eventually happen, but may just not be a priority within those government offices.

That being said, there may be some things we can do as an association to help speed up the process.

While our advisors are regularly following up with Federal Ministry of Finance and CRA staff, we can also engage with our elected Members of Parliament and request that they work on behalf of us, as their constituents, to urge the tax agency to complete the HST exemption process. We will be developing a Federal Government petition to help with our lobbying efforts as well as samples of what you can say to your Members of Parliament.

As your association, the RMTAO, along with the CMTA and other provincial associations, are doing the same to keep government attention on this important initiative and to ensure that it doesn’t slip off their radar screens.

Rest assured, the RMTAO and its partners will continue to advocate on your behalf on this and other issues important to our members.

There have been a number of activities over the past few weeks that I'd like to provide updates on.

Team Primary Care

I have been working with a group of healthcare organizations at the national level called Team Primary Care. We have been advocating to the Federal Government to invest in a more comprehensive health human resources strategy to address the current shortages in the healthcare workforce. Included in this initiative is massage therapy.

Currently, there is no national database or planning to understand the number of massage therapists in Canada, when they are retiring, how many new massage therapists are entering the field, what salaries are being earned etc. This is not just a massage therapy problem but a challenge for most health professions.

As a member of Team Primary Care, we have been lobbying the Federal Government to fund these planning activities. I am happy to announce that the Honourable Jean-Yves Duclos, Minister of Health, recently announced a federal investment of $45.3 million in grant funding from Employment and Social Development Canada to the Foundation for Advancing Family Medicine. These funds will spearhead Team Primary Care: Training for Transformation, which is our initiative designed to build the capacity of interprofessional, comprehensive primary care practitioners working in teams through improved training, retention, and planning tools. This is an important step in human resource planning that will include massage therapy.

You can learn more about the work of Team Primary Care and the new funding here.

Coalition of Health Professions in Auto Insurance

As a member of the Coalition of Health Professional Associations in Auto Insurance, I have been lobbying the provincial government to increase payments to RMTs (and other health professions). Fees were set in 2014 and haven’t changed in any significant way since. The Coalition has prepared a presentation called “Reducing Red Tape in Ontario’s Auto Insurance Sector to Simplify Access to Care: Issues, Solutions and Benefits” which we will be taking to the Ministry of Finance to address a number of concerns including fees.

You can review the PowerPoint presentation making our case.

Annual Education Conference

This past weekend was our Annual Education Conference. This was our first in-person conference since the pandemic, and by all accounts, it was a great success. I would like to thank the staff, speakers and volunteers who worked hard to make this a success. I would also like to thank all those who attended for their support.

Virtual Townhall

Almost lost in all the activity of the past few weeks was the Virtual Town Hall that took place on June 1st. Over 60 people registered. I was happy to be able to offer a virtual option available to those who couldn't attend the virtual option. Some themes that came up were similar to the in-person Town Halls including updates on HST Exemption, questions about the CMTO Risk-Based Assessment, and Thank you to all those who attended and looking forward to doing a series of Town Halls next year.

As you may know, RMTs working with Health Claims for Auto Insurance (HCAI) are required to have another health professional listed as a Health Practitioner to certify and review their Treatment and Assessment Plans (OCF-18).

I contacted Ann MacKenzie, Senior Manager of Policy Interpretation at the Financial Services Regulatory Authority of Ontario (FSRA) to request that RMTs be able to sign Section 4 of the OCF-18 form themselves without requiring the sign off of another regulated health professional.

We emphasized that anyone can see an RMT of their choice without referral or prescription and that this creates a barrier for people who need massage therapy treatment after an auto accident. I will follow up on this request and provide any updates as they become available.

Another common concern that members have brought to my attention is that they've been delisted by insurance companies but aren't sure why or what to do to respond to this.

I have been able to connect with many insurance companies to help members with their individual delisting concerns, and you can still contact me at michael@rmtao.com for assistance with any individual delisting concern.

In addition, we have compiled a list of insurance company delisting hotlines that you can attempt to contact if you have any delisting issues.

Long recognized for both its therapeutic and rehabilitative benefits, formal steps are now being taken to demonstrate how massage therapy can be a key to improving the outcomes of patients with reducing or eliminating pain, improving joint mobility and reducing muscular tension by offering registered massage therapy in the context of community team-base inter-professional primary health care.

“Teaming up with West Toronto Community Health Services the 7,000-member Registered Massage Therapists Association of Ontario is piloting a program to verify the health and cost benefits of integrating therapeutic massage into primary care teams”, explains Registered Massage Therapists Association of Ontario (RMTAO) Executive Director and CEO, Michael Feraday.

Numerous studies over multiple decades have shown therapeutic massage is a safe, reliable treatment for musculoskeletal injuries and has multiple benefits in pain management without the use of drugs. Massage has also been proven beneficial in helping with depression and other forms of mental illness.

“Now we are taking steps to integrate RMTs into inter-professional primary care team to complement existing health services by adding a proven health discipline to the wellness options available to their patients,” added Feraday.

West Toronto Community Health Services (WTCHS) was created in December 2021 via an amalgamation of three health care and community support providers: Regeneration Community Services, Storefront Humber Inc. and The Four Villages Community Health Centre. WTCHS is fully funded by the province through Ontario Health. With the amalgamation, WTCHS now provides community mental health and addictions services with supportive housing, community support services for seniors and persons with disabilities, home care, and inter-professional primary health care services within a single agency. WTCHS has uniquely positioned itself to provide its clients, and select patients referred from other models of primary care, with a full range of community health care and support services to keep them healthy and living in the community and avoid unnecessary hospital use.

“We’re looking forward to seeing how access to registered massage therapy can augment pain management, rehabilitation and mental wellness as part of a holistic approach to inter-professional primary care that helps support our clients to stay healthy and well and living at home regardless of what they call home,” said Tariq Asmi, President & CEO, WTCHS.

The one-year pilot program will be evaluated using a Quadruple Aim lens, with the findings shared widely with the objective of assessing the contributions of RMTs as part of integrated primary healthcare model across the province.

If you're interested in applying for this opportunity, review the job description. We encourage all interested and qualified members to apply.

Ian Kamm, our Board Chair, and I meet semi-annually with Maureen Boon, CMTO Registrar and CMTO President, Jay Mathers.

Our most recent meeting was on May 3. Kim Westfall-Connors, outgoing CMTO President also attended. During these discussions we ensure the CMTO hears the perspective of the RMTAO as we advocate for our members on a number of issues. We also engage the CMTO on a number of issues to ensure that the CMTO has a balanced perspective. To give members an idea of the scope of the discussions, I thought I would share some of the Agenda with members.

Agenda Items

• 2024 Fee Increase
• Health History Form – proposed revisions as well as requirements in the draft standard on record keeping
• Patient Testimonials/Potential change to Advertising requirements
• Progress on defining what is “minor in nature” when it comes to the treatment of spouses
• Practice Profile: how do RMTs know if they have passed?
• Sensitive Areas consent form – concerns
• Sexual abuse symposium – to examine solutions to the prevalence of this issue
• Emergency class/registration regulations
• Professional Liability Insurance – re sexual abuse coverage as an option

I will report more fully on these themes in future advocacy updates as discussions evolve. However, I would like to close by sharing that the CMTO Council has been asked to consider a proposed increase to the 2024 General Certificate (GC) fee of $18 (from $897 to $915 or a 2% increase). I am sure that the efforts of last year on the part of membership expressing their concern over fee increases helped influence the CMTO in keeping the 2024 fee increase under the rate of inflation.

During my recent Town Hall meetings, several members expressed concern regarding the repayment of Canadian Emergency Business Account (CEBA) loans, which are due December 31, 2023.

During the pandemic, many RMTs with one or more employees utilized this program to provide much needed cash flow and to mitigate the economic impact the pandemic has had on small businesses and self-employed individuals in our sector.

There are still many challenges confronting small businesses as they struggle with recovery from the pandemic, including reduced operations for many small businesses due to the pandemic-caused shortage of RMTs. As a result, the Association is asking the Federal Government for a one-year extension to December 31, 2024, for repayment.

I will keep members updated on any updates on this situation as they're available.

Read the letter to Minister Freeland

As you may know, I recently spent two weeks travelling across Ontario to speak to RMTs about the latest RMTAO advocacy initiatives and priorities. I had engaging discussions with RMTs in cities across Ontario and was pleased with the great turnout of enthusiastic RMTs in all the cities and the thoughtful discussions all attendees engaged in.

Some common themes that came up include the CMTO practice profile and Risk-Based Assessment, questions about our quest for HST exemption, other CMTO-related concerns surrounding fees and difficulties with entry-to-practice testing, the desire for more standardization in education, and some confusion over the resources offered by the RMTAO.

Last week I shared an Advocacy Update on HST Exemption, and we will regularly include spotlights of our resources in the Friday File, including our Guideline to Risk-Based Assessment. I also regularly meet with the CMTO to discuss issues that are of concern to our members, and I still support the Accreditation of massage therapy schools, which will help with more uniform massage therapy education. For those that couldn't attend a Town Hall Meeting, I am always happy to hear from members directly with any questions or concerns.

Please contact me at michael@rmtao.com.

I met last week with Dr. Karima Velji, who is the Assistant Deputy Minister of Health at Ontario's Ministry of Health. Dr. Velji is a key person to help us in our goal of including massage therapy in government health care initiatives. This covers the inclusion of massage therapy in Family Health Teams and Ontario Health teams, which has been a big priority of mine over the past year.

She is also a big advocate and user of RMT services and very supportive of integrating RMTs into government health care in any other way possible. She is willing to be a supporter for us as we present our case to various members of the provincial government. She had a number of suggestions on how to build our business case as we advocate for this, based on her experience of what the key decision makers need to see to grant our request. She was also helpful in directing me to others at the Ministry of Health that we need to connect with in order to move this request forward.

As we continue our advocacy efforts, I will be following up on her recommendations and with the people she suggested in the following weeks and months.

If you'd like to contact me about this or any other advocacy update, feel free to contact me at michael@rmtao.com.

I have been meeting with many Members of Provincial Parliament (MPPs) over the past few months. In the past few days, I was able to get letters out to the MPPs that I haven’t already met with. The letters were to ask for meetings and to reinforce the value of massage therapy in Ontario health care. These letters and subsequent meetings have also been to request that massage therapists be integrated into Family Health Teams (FHTs) and Community Health Centres (CHCs) and highlight how this would complement the primary health care system. I will be following up the letters with calls for further meetings.

I was also in touch with The Hon. Michael Tibollo, Associate Minister for Mental Health and Addictions. Subsequently, at his request, I wrote him a letter and asked to meet with him to further brief him on the benefits of massage therapy in the relief of many of the symptoms of mental illnesses such as anxiety and depression.

Last week, I met with Kavita Mehta, CEO of the Association of Family Health Teams of Ontario. I later met with Sarah Hobbs, CEO of the Alliance for Healthier Communities, which is the association for Community Health Centres. Both meetings were to advocate that massage therapists should be integrated into Family Health Teams (FHTs) and Community Health Centres (CHCs) and how that would complement the primary health care system. I was encouraged by our discussions and happy to share that we have their support in our future efforts with the Ministry of Health and Ontario Health.

As you likely know, there are some insurance plans offered by a variety of insurance companies that require a doctor's note before accessing massage therapy care. This creates a barrier for patients trying to access the massage therapy care they need, and this barrier does not exist for accessing care from other health professionals.

Recently, I wrote to the CEOs of several large insurance companies asking them to remove the option that requires a physician's note to access massage therapy treatment. I received responses from many of these companies as well as from the Canadian Life and Health Insurance Association (CLHIA).

CLHIA indicated that the insurance industry has moved significantly away from requiring a referral to access massage therapy and other treatments delivered by healthcare providers, in order for them to be reimbursed under private health plans. However, the ultimate decision on which plan controls to implement rest with the employer.

Although this is encouraging progress, we hope that the option to require a physician's note before accessing massage therapy is eliminated from all health insurance plans. CLHIA has indicated an openness to continuing to discuss this issue, and I look forward to discussing this with them further.

The RMTAO has several updates on different advocacy initiatives in different areas.

WSIB

Recently I was selected to be the Chair of the WSIB Health Professional’s Forum. In accepting the role of Chair, I want to ensure that RMTs are in the forefront of these changes and WSIB becomes easier to use and more attractive to RMTs.

Meetings with Government Officials

I had a very productive meeting with Nadia Surani, Ministry of Health Director of Primary Health Care. Nadia indicated she would be supportive of our ask to incorporate RMTs into Ontario Health Teams, Family Health Teams and Community Health Teams. She has written letters to leaders of these entities to support this. My follow up will be to meet with leaders of the corresponding Associations and Ontario Health.

Insurance Company Doctor's Note Requirement

As you may know, some insurance plans have the requirement of submitting a doctor's note before being reimbursed for massage therapy treatments.

I have reached out to three of the large insurance companies to request removal of the requirement of a doctor's note for massage therapy reimbursement on all plans. I have asked to discuss the steps necessary to achieve the removal of a prescription requirement on extended healthcare plans then I will develop that plan in response to the information received.

All three companies have followed up with me, and I have a meeting coming up with The Canadian Life and Health Insurance Association (CLHIA) who have been empowered to respond to me on this issue.

It has been a busy month for the Association from a number of perspectives. I continue to meet with MPPs to advocate for the massage therapy profession, and our greater inclusion in diverse healthcare teams and initiatives.

Recently I met with MPP France Gelinas, the NDP Health and Long-Term Care Critic, who offered her support in our advocacy efforts with the Ministry of Health. MPP Gelinas will be following up on our behalf after our upcoming meeting with Nadia Surani, Director of Primary Health Care at the Ministry of Health, which will be happening in the coming weeks.

I also had positive meetings with the Minister of Children, Community and Social Services, Merrilee Fullerton; staff of the Minister for Seniors and Accessibility, as well as MPP Mary-Margaret McMahon and MPP Chris Glover. We are gaining support for our advocacy effort with the Ministry of Health from all these MPPs.

We also continue to work closely with the Canadian Massage Therapy Association (CMTA). In late November we finalized our submission to the Minister of Finance to request HST/GST exemption by providing letters of comfort from all member Associations of the CMTA indicating that the majority of members support this initiative.

France Gelinas, MPP, and Michael Feraday, Executive Director and CEO of the RMTAO

As an active member of the Workplace Safety and Insurance Board (WSIB) Healthcare Forum, the RMTAO participated in a consultation with the WSIB. The RMTAO has been very involved in WSIB reforms that will make WSIB more accessible and financially rewarding for RMTs.

Recommendations during the consultation were made around the following themes:

• Program re-design to drive accountability and improve outcomes
• Collaboration and engagement with health care professionals
• A transparent and effective model for establishing fees

The following recommendations were concluded by the WSIB:

• Minimize barriers to early access of care, including streamlining the approval process and leveraging best practices in virtual care
• Align programs of care to ensure consistent and clear processes, and reduce the administrative burden
• Create a structure for delivering care for injury types that are not currently within the scope of the programs of care, including an effective triaging model to complex care bundled models in the community or within tertiary care where appropriate
• Explore opportunities that further drive accountability, and clearly outline required qualifications, standards and performance expectations
• Improve the assessment and reporting of functional abilities and enable better collaboration with WSIB and employers around the job duties
• Improve quality through the sharing of process and outcome metrics with associations and providers, and explore ways to incentivize key quality indicators
• Review program and fee schedules to adopt a model that ensures quality care through more competitive rates, improves transparency and reduces administration. Bundled programs should continue to be the preferred service delivery model where appropriate
• Better leverage collaborative partnerships to expand professional education, in areas such as clinical competency in occupational rehabilitation
• Explore technology-enabled information exchange and review processes and roles to ensure timely and effective communication

WSIB has committed to working with the WSIB Health Professional Forum, of which the RMTAO is an active member, in the implementation of these recommendations over the next year.

Recently I met with Maureen Boon, Registrar of the CMTO. During our discussion, I raised the issue of the many questions I get from new grads and instructors who remain confused about Prometric and their exam schedule.

In an effort to minimize confusion, I asked the CMTO to clarify the status of tests for next year. Please share with any students or new grads that might be interested.

• The MCQ is offered 4 times/year at 4 locations for a total of 40 days. This is more frequent than other professions. CMTO is also looking into adding more locations.
• In 2022, the MCQ schedule was March, June, August and December. The December sitting has 350 spots available, and 213 candidates are currently registered.
• In 2023, the MCQ schedule will be March, June, September and December. The schedule, which will be released by the end of October, aligns better with the graduation dates throughout the year.
• The OSCE is offered 2-3 days/week from May to December. OSCE spots are opened up as they fill to prevent early year graduates from booking end of year spots. It is not offered until May because it takes time to re-set the exam.
• The number of OSCE spots has increased from 1,568 in 2019 to 1,700 in 2022.
• These are high stakes exams, meaning there are processes that must be followed to ensure the integrity of the OSCE stations and the MCQ question bank.
• It is not possible to avoid delays for all candidates given the varying graduation dates. However, as noted above, capacity has increased, and efforts have been made to align the exams to ensure access.

Last week, I met with Doris Grispun, the CEO of the Registered Nurses Association of Ontario (RNAO) to discuss strategies for provider associations like the RMTAO and RNAO to deal with the trend toward Preferred Provider Networks.

As you may have heard, Shoppers Drug Mart, which is owned by Loblaws, recently purchased Lifemark Health Group, a Canadian leader in community rehabilitation, workplace health and wellness and medical assessment services.

Large corporations like Loblaws are becoming more and more involved in healthcare delivery. For example, you can earn Optimum points for booking a massage therapy appointment through the PC Health app, which can push people towards the RMTs available through that app. This can both disadvantage smaller practitioners' businesses, and also push patients to see an RMT because they're affiliated with a certain corporation, rather than choosing the RMT that works best for them.

This is a growing trend that needs to be further understood, so that we are aware of the longer-term implications of this increased privatization and corporatization of healthcare and how it might impact RMTs.

As part of my work with CORHPA (Coalition of Ontario Regulated Health Professional Associations), I have organized around 20 Associations to investigate the situation. Doris and I, on behalf of the group, will be approaching senior leadership at the Loblaws/Shoppers Drug Mart Group to get a better understanding of their long-term strategy and the impact they might have.

I will provide updates when they become available.

HST/GST Exemption

Representatives of the CMTA committee for GST Exemption met with David Hurl, Director of Policy for the Minister of Finance and Yash Nanda, Policy Advisor for the Minister of Finance to review the process of HST/GST Exemption and commit to working together on HST/GST Exemption moving forward.

After this meeting, the CMTA received a letter on behalf of Phil King, Director General, Sales and Excise Tax Division, in the Department of Finance.

The letter reaffirmed that the criteria for exempting services from HST/GST is that if a service is covered by the health care plan of two or more provinces, or is regulated as a health profession in at least five provinces, that profession may become HST exempt. Massage therapy is regulated in five provinces, so it meets this criteria. However, this is not automatic. The Minister of Finance must decide whether to propose amending the Excise Tax Act to provide for such an exemption and the amendment must be included in legislation passed by Parliament.

To assist the Minister of Finance in considering such an amendment, officials will prepare a briefing for the Minister which includes confirmation that the exemption criteria are met and also whether there is widespread support among the profession for a GST/HST exemption.

Phil King requested the CMTA provide references to the relevant provincial legislation in at least five provinces that establishes a regulatory regime for massage therapy in the province, and letters for the associations in each province and territory confirming their members’ position regarding tax exemption.

The CMTA will be actively following up to provide this requested information.

CMTO Council Meeting

The Council met on August 23 to vote on the CMTO Executive Committee’s recommendation, and feedback from the consultation on By-law No. 7: Fees for Registration, Examinations and Other Activities of the College.

Prior to the meeting 2,374 people (mostly RMTs) provided feedback to the CMTO. Just under 95% of the respondents opposed the General Registration Fee Increase. In the end, the Council approved the fee increase as presented. Maureen Boon, CMTO Registrar, did respond to most of the questions raised by the survey including questions regarding CMTO staffing, CMTO office space and the importance of massage therapy regulation. She also shared the 2nd quarter financials which showed that Complaints and Discipline are over $500,000 over budget.

If you weren’t able to observe the meeting, you can watch the recording here.

I wanted to thank all those that attended the meeting or provided the CMTO with feedback. It certainly brought an appropriate amount of scrutiny to these proceedings. On a personal note, I will say I was disappointed that fee increases could not have been moderated in some way. However, the financial report does indicate that the profession has some work to do in reducing the number of Complaints and Discipline hearings. The Association will work with the CMTO in whatever way appropriate to help improve this situation.

As mentioned in previous editions of The Friday File, I have been requesting meetings with Members of Provincial Parliament (MPPs) to gain support for RMTAO efforts to promote the massage therapy profession as a valuable and integral part of health care in Ontario.

I have met with MPPs Vincent Ke and Rudy Cuzzetto, and they were very positive about their support for massage therapy.

I have meetings scheduled with MPPs Matthew Rae, the Minister of Children, Community and Social Services Hon Merrilee Fullerton, Stephanie Bowman, Bobbi Ann Brady, Effie Triantafilopoulis, and Mike Schreiner. If any RMTAO members know or happen to be speaking to any of the above, please feel free to thank them on behalf of the RMTAO for being supportive of the profession. I am expecting to meet with many more MPPs and bureaucrats in the fall and winter.

As part of my work with HEAL (Organizations for Health Action), a Health and Human Resources Working Group was convened and one of the first projects that the group has undertaken is the creation of a survey. The goal of the survey is to help HEAL gather data that will in turn help refine our advocacy efforts and facilitate coherent and timely actions to promote retention and mitigate the HHR crisis. The RMTAO has agreed to distribute the survey to our members. The survey should go out at some point this fall. As more information is finalized, I will share with you, our members.

It has been a very busy last few weeks. First let me thank those members from Chrystia Freeland’s riding who graciously came forward to send letters to the Minister of Finance supporting GST/HST exemption for massage therapy. This is very helpful and a part of our overall strategy.

In other developments, I have been getting a number of Members of Provincial Parliament (MPPs), including Merrilee Fullerton, Minister of Children, Community and Social Service, responding to my requests for meetings to support our efforts to promote the massage therapy profession in Ontario.

In one conversation we discussed the idea of a provincially recognized Registered Massage Therapist Awareness Day to be part of Massage Therapy Awareness Week. I will report on further details and other meetings as they happen.

Last week I also did an interview on CBC Radio bringing attention to the shortage of massage therapists in Ontario.

I am also involved with several initiatives both provincially and nationally (as the Canadian Massage Therapist Alliance (CMTA) representative of HEAL) to address the growing challenges in health human resources. We are working with our partners at HEAL to assist them in developing a survey to establish some baseline data on retention within the various healthcare professions. The survey will be circulated to membership in the fall for their contribution to this national survey.

I also met with the Vice President, Insurance Service Operations for Green Shield Canada (GSC). This is the person responsible for the department that investigates claims at Green Shield and will be a helpful contact in my efforts to assist members experiencing issues related to inappropriate delisting. I will be following up directly with Green Shield, and they have provided me with a contact to forward individuals to who are having a difficult time getting a response from Green Shield on their own.

The CMTO Registrar called me Wednesday evening to advise that the release of the test results for new graduates has been delayed to August 8th. An announcement was to have been made on Thursday, July 22nd by the CMTO with more details. I am following this situation closely and will advise on developments as I learn of them.

I will update membership on all these files as things happen throughout the summer.

As part of our campaign to create awareness with the Province, I wrote letters of congratulations to all elected Members of Provincial Parliament (MPPs) in the recent Provincial Election, which also reiterated the ways that Registered Massage Therapists can help Ontarians. I am already receiving responses from MPPs asking for meetings with me.

My next step is to approach the key new cabinet members and their assistants to arrange for meetings with them. As per previous letters and advocacy, the Association is wanting to reinforce the value that massage therapy brings to Ontarians and to promote the profession with the Ministry of Health, as well as politicians, and influencers.

I will continue to update members as we meet with representatives of the provincial government.

RE GST/HST Exemption

As a follow up to my earlier letters to members of the federal government requesting tax exemption for Canadian Massage Therapists, I am sending additional letters thanking them for any responses and reiterating our arguments for tax exemption. One of the key people is Chrystia Freeland, the Federal Minister of Finance and Deputy Prime Minister, who will be an essential contact in the process of obtaining tax exemption.

In order to support our relationship building with her and further strengthen our arguments, I am looking for an RMT or two that resides in Chrystia Freeland's riding to speak with her about tax exemption.

As part of our strategy to obtain tax exemption, we believe it would be even more effective if an RMTAO member who resides in Minister Freeland’s riding, someone who could make a personal plea for GST/HST relief as a constituent in her riding, would be involved in our discussions with her. The personal touch is usually helpful. Please contact me directly at michael@rmtao.com if you are willing to assist.

The Minister’s riding office is located at 344 Bloor Street West (University-Rosedale riding). The postal code for her office is M5S 3A7. I would be pleased to speak with and assist any member who would be interested in contacting the Minister’s riding office. If you reside in that riding and are interested in helping, the RMTAO would draft a letter on your behalf and assist with any follow up.

Maureen Boon responded to my letter of May 26,2022 to Kim Westfall-Connor. You can read her response here. There is also a link to my letter here for ease of reference. The letter does not indicate any strong commitment that the CMTO will be changing their intention to raise fees. However, Maureen does acknowledge that they are open to input from RMTs and will consider that input when making their final decision.

Maureen advised that a copy of my letter will be provided to Council as part of the continuing fee discussion. They will also review all feedback from RMTs. The CMTO has also received over 1,600 responses to its consultation survey to date. Once the consultation closes on July 19, 2022, feedback will be summarized, posted to their website, and provided to Council as it considers next steps.

The CMTO has committed to continuing to meet with us regarding this and other issues going forward, and I hope in future discussions with them we are able to come to a satisfactory agreement.

We strongly encourage all RMTs in Ontario to provide their feedback on this proposed fee increase to the CMTO by July 19, 2022. The CMTO does review this feedback and is more likely to take it into account if the majority of RMTs participate. July 19 is less than a month away and I encourage all RMTs to provide feedback!

Provide your feedback

On May 26 stories ran in the CTVNews and the Ottawa Citizen stating an Ottawa Massage Therapy Clinic Owner was charged with sexual assault. It also appears the police report on the incident had inaccurate information.

The RMTAO has reached out to both of these news outlets as well as the Ottawa Police Department correct their misinformation. We are very concerned that both the police report and the following journalists noted the clinic as 'Massage Therapy Clinic' instead of more accurately calling it a multidisciplinary clinic. It could be perceived that the journalists were going for shock value by denigrating our profession.

The charged person is a co-owner of the clinic, not a health practitioner, and was not treating the alleged victim.

We are very concerned that Massage Therapy has been singled out of the 9 medical services offered by the clinic. This could have possibly originated from journalists copying straight from police reports, which had similar errors or from the journalists not exercising journalistic care.

The RMTAO hopes to receive a response from these news outlets shortly and intends to respond to every news story that portrays the profession in a negative light.

Sunlife/Lumino

I am happy to report that Sunlife will be demonetizing Lumino. This means that Lumino services and listings will be provided without charge. As many will recall, this was an area of concern to many members as it created the impression that Lumino would give preferential treatment to those that advertised with them.

Lumino has credited part of the decision to the RMTAO (and other Associations) who provided them with a great deal of feedback on the negative impression charging for this service was creating. Thanks to all the members that wrote me expressing their concerns which I was able to pass on to Sunlife.

CMTA

The Canadian Massage Therapist Association (CMTA) held their AGM on March 6, 2022. Gordon MacDonald, the Executive Director of the Registered Massage Therapists' Association of British Columbia (RMTBC) was re-elected as Chair and the other members of the executive leadership were re-elected as well.

I will be continuing as Chair of the GST/HST Exemption Committee. I will also be joining a newly created committee to advocate with the insurance industry on behalf of the CMTA. I will be providing updates on both initiatives as developments happen.

HST/GST Exemption Campaign

I wanted to provide a quick update on the HST/GST exemption campaign. I have been receiving responses to the letters we sent on February 24 sent to 13 Ministers and officials of the Federal Government, requesting HST Exemption.

Each week we have been receiving responses and acknowledgments to those letters from various recipients including a response from the Minister of Finance Chyristia Freeland on March 8 and a response from Randy Boissonnault, the Associate Minister of Finance on April 4. I have also been connected with different officials regarding next steps. All of this is encouraging. I have recently reached out to those individuals and will be providing further updates.

Letter to Peter Bethlenfalvy, Ontario Minister of Finance on behalf of the RMTAO and the Coalition of Health Professions in Auto Insurance (the “Coalition”)

The RMTAO and seven other healthcare Associations sent a letter to the Ontario Minister of Finance requesting a meeting to discuss how to improve auto insurance and address a number specific concerns including:

• the need to safeguard access to timely and robust medical rehabilitation accident benefits, at a time when the COVID pandemic is overburdening Ontario’s health system
• the government’s long-standing commitment to restore the $2 million benefit for catastrophically injured patients
• the need for expanded coverage for non-catastrophically injured patients
• the long-standing backlogs at the License Appeals Tribunal and the Market Conduct Branch
• optimizing stakeholder engagement in principle-based regulation of the auto insurance sector

I will keep members updated on any updates on this situation as they're available.

Some of you will remember, as shared in previous Friday files, that the Workplace Safety and Insurance Board (WSIB) hired Health consultants to do an independent review. As part of this review, they engaged the RMTAO and a number of our members who agreed to participate.

This past week, the WSIB shared the direction they plan to go in with me and others that participated in this process. While we have a long way to go, I was encouraged with what I heard from WSIB. They seemed to have listened to the input they received. They are now looking to revise their approach much more inclusively which will be a positive development for Massage Therapists.

Their goals are to focus on the customer which will include a strong focus on community care, services and programs where the majority of our population receive care and include recommendations from the Health Consultants Report.

WSIB is looking at the following areas to improve in the area of Program Optimization and Redesign:

• Access
• Program Structure
• Workplace Integration
• Performance & Accountability
• Education & Training
• Communication & Collaboration
• Worker Journey

They also indicated that they will continue to reach out to the Associations more than they have in the past for their engagement as they work through this redesign. I will also add that input towards fees was a big part of the feedback they received, and they acknowledged this as important.

I will continue to update members on developments as they become available.

I have volunteered to be part of a Task Force which is leading an initiative for better health workforce data in Canada. This is an important issue not only for RMTs, as it affects all healthcare workers in Canada. The pandemic has exacerbated critical staffing shortages causing excessive workloads; these are a direct result of inadequate planning. Health workers are carrying an enormous mental health burden, for which we risk unprecedented attrition from the health workforce. This will inevitably lead to less access to safe, high-quality care and increased wait times for patients.

This initiative is being led by the Canadian Health Workforce Network (CHWN) and is supported by HEAL (Organizations for Health Action). Previously we submitted a call to action to the Government of Canada to support health workers by making significant and immediate investments to enhance the data infrastructure that provinces, territories, regions, and training programs need to better plan for and support the health workforce.

We recently developed our Terms of Reference which are as follows.

The HEAL Health Human Resources (HHR) task force is to coordinate HEAL’s efforts to address the Health Human Resources. The ultimate goal of HEAL during this period is to facilitate coherent and timely action by healthcare workers, administrators, FPT authorities, to help contain and mitigate the crisis. Specifically, it will:

• Be a source of information sharing for what is happening on the ground and within member associations- what are the trends, emerging needs, emergency demands.
• Identify and plan joint actions in areas of relevance to the majority of HEAL members (advocacy, information sharing, education).
• Assist in preparing information briefings to be shared during co-chairs’ regular meetings with elected officials and/or F/P/T health authorities.
• Ensure regular reporting and information sharing with members.
• Propose and implement actions and communication with other stakeholders as appropriate (industry, researchers, media…)

I will be sharing future developments with members as they become available.

I will be providing updates on two important issues this week:

Traditional Chinese Medicine and Acupuncture

As many of you may have heard, the Ontario Government has backed down from their plan to deregulate Traditional Chinese Medicine and Acupuncture. Thank you to everyone who contacted me on this issue. The RMTAO was very active in efforts to have this reversed and it is gratifying to know that advocacy efforts to reverse this were effective. The proposal to deregulate was done without any consultation with the health professions that it would affect and the relevant regulatory college. From that perspective this was an issue that affects all regulated health professions. I am meeting with other Associations to consider the long term implications of this and how we might act collectively to prevent this in the future.

CMTO Meeting

As many of you are aware, I speak almost weekly with Maureen Boon, the Registrar of the College of Massage Therapists of Ontario (CMTO) to discuss and resolve issues affecting our members.

This past week, we had a more formal meeting between Kim Westfall-Connor, the CMTO Council President, Maureen Boon, Ian Kamm, the RMTAO Board Chair, and myself. These regularly scheduled meetings of the executive of both organizations help improve communications and give us a chance to proactively discuss issues that affect the profession.

Some of the topics discussed were peer assessment, treatment of spouses and regulatory reform. There will be a lot of follow up as a result of the meeting which I will share with membership in my Friday File updates as it develops.

I will be providing updates on two important issues this week:

Deregulation of Traditional Chinese Medicine and Acupuncture

On Monday, February 28, 2022, the provincial government introduced legislation to deregulate traditional Chinese medicine and acupuncture and move to a voluntary oversight model. Acupuncture will be returned to the public domain, which means it will no longer be a controlled act. This process will take place over the next 18 months so there is no immediate change as a result of this.

On hearing this news, I was immediately in touch with the CMTO who has been told by the Ministry that there is no intention to deregulate other professions. The CMTO will also be meeting with the Ministry to sort out any issues related to the deregulation that might affect RMTs who also practice acupuncture. I have also been in touch with our Board Executive and other Associations to make sure the Association is on top of these and any future developments that might affect the profession. The College of Traditional Chinese Medicine Practitioners and Acupuncturists of Ontario has also reached out to me in consultation.

I will continue to work with our partners on this situation, and I will provide more updates as soon as they become available.

GST/HST Exemption

This past week, the CMTA made a formal request to the Minister of Finance to exempt massage therapy from HST/GST. The request was also shared with 13 other Federal Ministers and bureaucrats. A Pre-Budget Consultation recommending that massage therapy, as a valued health care service, be treated like other comparable health services and exempt the GST/HST was also submitted supporting this request.

I would like to thank the membership for your patience over the past few years. While COVID and a transition in CMTA leadership resulted in a delay in our progress, the Association has worked tirelessly to get this initiative back up and running and moving forward. Most of the materials and activity has been the result of the Association's involvement including the writing of the requests just sent out.

The delay may have worked in our favour as the recently elected Federal Government and, in particular, the Deputy Prime Minister and Minister of Finance Chrystia Freeland, looks favourably on our request and has implemented an approach that make it much more straightforward from the Federal government’s perspective.

Ultimately this will need to be included in a federal government budget. Once this step is completed, officials from the Department of Finance will reach out to the relevant provincial and territorial associations of the profession to ensure that there is widespread support for the GST/HST exemption among RMTs.

At that time, the CMTA will have each provincial Association reach out to their provincial government to write letters of support. The CMTA has strong representation across Canada which will help strengthen the provincially directed effort. I will be following this process closely and will be reaching out to the Minister of Finance to follow up.

The Ministry of Health recently announced proposals for governance reform of Ontario's Health Regulatory Colleges. The Coalition of Ontario Regulated Health Professional Associations (CORHPA), of which the RMTAO is a member, wrote a letter to the Ministry of Health outlining our concerns with the administrative and financial burdens this would place on regulatory Colleges. We also expressed support for self-regulation and pointed out the negative impact these proposed changes can have on self-regulation.

I have discussed these proposed changes with Maureen Boon, the CMTO Registrar. We agreed that the RMTAO, in working with CORHPA, could advocate about items that concerned the CMTO. The CMTO is also working directly with the Ministry on the proposed reforms.

The RMTAO supports the CORHPA letter, and I will provide an update as soon as it is available.

Review the CORHPA letter regarding regulatory modernization proposals.

Prometric

Recently the Association has received feedback about the need for more transparency regarding the dates and results of exams from Prometric. I brought this issue up with Prometric and was encouraged to hear they are working towards improving their processes. I wanted to share their feedback with membership and especially student members.

The following is a summary of their response to me:

Last year was Prometric’s first year administering tests. They struggled to get their processes more streamlined, but they have been working to improve them throughout the last year. Going into this year OSCE results will be held for all candidates through June 2022. This means candidates that take their OSCE exam between May 2 and the end of June will all receive their results around the second week of July. This period allows the Prometric development team to confirm the items are presenting as they should. After this period, OSCE scores will be released every other Friday. For MCQ results, they are released six weeks after the last day in the exam window.

There has been an encouraging development in the progress towards HST/GST exemption. The Honourable Chrystia Freeland, Deputy Prime Minister and Minister of Finance, has confirmed that she is open to a formal request to exempt HST/GST for Massage Therapy, as the profession meets all the criteria required by the Federal Government.

Letters on behalf of the Canadian Massage Therapist Association (CMTA) will be going out to an extensive list of Ministers and bureaucrats in the next few weeks to make this a formal request to the Minister of Finance and the relevant Deputy Ministers and Associate Ministries. Ultimately this will likely need to be included in a federal government budget, and although the CMTA makes annual pre-budget submissions requesting HST exemption, this will further strengthen those requests.

Once this step is completed, officials from the Department of Finance Canada will reach out to the relevant provincial and territorial associations of the profession to ensure that there is widespread support for the GST/HST exemption among RMTs. At that time, the CMTA will have each provincial Association reach out to their provincial government to write letters of support. Since the CMTA represents such a large group of RMTs in Canada, this is a great way to show the support for this initiative.

We are eager to move forward in this process.

I attended the Coalition of Ontario Regulated Health Professional Associations (CORHPA) meeting this week. CORHPA is the group that all the professional healthcare associations in Ontario belong to. I am happy to share that during the last two years, I have seen growing activism on the part of CORHPA, not only to share best practices and network but to collectively advocate for all health professionals. Many associations have similar challenges and speaking collectively helps the RMTAO in our advocacy efforts.

The most recent meeting was particularly useful. Among other topics, we discussed of the potential impacts of the upcoming Ontario Budget, Bill 124, COVID measures, vaccinations, screening etc. Discussions of this nature help me keep up to date with any changes or developments in these areas which I can then share with members. CORHPA is also setting up a meeting with Matthew Anderson, President and CEO with Ontario Health. These are all opportunities for me to initially meet with these key healthcare leaders.

The most recent meeting also included a presentation by Joan Weir, VP at the Canadian Life and Health Insurance Association (CLHIA). CLHIA represents the large insurance companies at the national level. Although they do not speak for individual companies, they are an important player in our advocacy efforts with insurance companies. I had a chance to speak with Joan and was happy to learn that she is open to meeting soon to discuss issues affecting RMTAO members. Normally she deals with national organizations like the CMTA.

According to her presentation, massage therapy represents $800,000 million in supplementary health claims. This makes massage therapy one of the largest claims categories just behind vision claims at $1 billion. Joan shared that the industry is increasingly moving in the direction of relying more heavily on electronic claims, digital transformation, patient navigation etc.

In response to these trends, I proposed and was given the go-ahead to form a working group to discuss how to collectively responds to these types of initiatives. This includes responding to initiative's like Lumino, created by Sunlife, which many members have been concerned about. As Chair of the group, I am organizing our first meeting of concerned Association leaders to develop a collective plan of action.

I was on a call with the Ministry immediately before Christmas about the announcement from the Ontario Government called: Ontario Extending Call to Arms to Businesses, Volunteers and Retired Health Professionals, which was made December 22. I spoke with Maureen Boon, our new Registrar, right after the call and the CMTO put out an announcement before Christmas supporting RMTs volunteering for this initiative.

I think this is a call for volunteers to help out with processing people through public health clinics. There is also mention of funding opportunities to set up vaccine clinics and allowing more individuals to safely administer the COVID-19 vaccine etc. However, these initiatives are in the planning stage only and do not have an immediate impact for RMTs. The Ministry may evolve the program to train and allow RHPs that aren’t permitted to do a controlled act like an injection in the future but right now that is not planned. For most this is an extension of the call for volunteers to help public health units rather than set up new clinics and is more of a reinforcement of the earlier call for volunteers that was done last year. I will monitor this to see what kind of uptake there is and if the current plan changes.

OPA COVID Psychological Support Program

As most will know, I do a lot of work with other health care associations. One of the benefits is that it has led to further opportunities for assistance as we work more closely together.

The Ontario Psychological Association has recently extended a program the provides psychological support for RMTs and other health care workers. The program is currently limited to health care workers working in Toronto, but they are hoping to extend it more broadly. Below is a summary with details of how to access the support:

With the rise in COVID cases and the impact it is having on our hospitals and long-term care homes, the Ontario Psychological Association (OPA) is offering psychological support services to frontline workers in the healthcare sector that are living and/or working in Toronto via the COVID-19 Psychological Support program. Any frontline worker in the healthcare sector that is living and/or working in Toronto could be eligible for up to 6 virtual mental health sessions with a registered psychologist, at no cost.

To access this service, individuals can call or text 211 to be connected to a community navigator who will match them to an appropriate psychologist via the OPA referral portal askforhelptoday.ca. Individuals can also speak to their family physician, nurse practitioner, or family health team to access the program.

Eligibility requirements:

1. Must be a frontline/essential worker in any industry.
2. Must work and/or reside in Toronto
3. Must be at risk of exposure to COVID-19 in the workplace
4. Must have no coverage or limited coverage to psychological services (i.e., $500, or less). If workers have more than $500 and less than $1,000, they will be asked to exhaust their benefits before relying on this funding. Persons with more than $1,000 should use their benefits only.

For those outside the Toronto boarders, the OPA is diligently working with the Ontario government to implement this program province-wide since their financial commitment earlier this fall. Should a frontline healthcare worker outside Toronto be in need, they can find a specialized psychologist using our referral portal here.

There are two primary advocacy issues to discuss for this week.

Sun Life Portal

A number of members have raised concerns that the yet to be fully implemented Sun Life Portal has a requirement that claims need to be submitted on the same day that the service is rendered. I have reached out to Sun Life to express my concerns with this policy. I am happy to report that Sun Life acknowledges this is a challenge and they are working on making changes to address this. I am hopeful that this will be addressed shortly and I will follow up with Sun Life on this concern. In the meantime, members can submit any claims that are not for the same day through Telus, as Sun Life has extended the window for the transition until the end of January.

Meeting with David Lamb, Director Capacity & Workforce Planning, Ministry of Health

As a member of Coalition of Ontario Regulated Health Professional Associations (CORHPA), I met this week with David Lamb. David is working to address provincial health workforce capacity planning which includes addressing not only recruitment but issues related to retention and burnout of health professionals.

These are some of the biggest challenges facing the health professions right now. I strongly expressed to David the Association's desire not only to support solutions to these challenges as they relate to our profession but also the potential role RMTs could play in helping the Ministry address this - especially from a retention and burnout of health professionals’ perspective. I know David, having worked with him in the past. He expressed an interest in further meetings to discuss this issue specifically. I am looking forward to following up with him in the new year.

As you are likely aware, the next provincial election will be called for June 2, 2022. This is an opportunity for the RMTAO and RMTs to reinforce with the political parties and their candidates the value they bring and the importance of the work RMTs do. This is also an opportunity to advocate for a more significant role for RMTs in healthcare. To that end, I have sent the leaders of all 3 major parties letters advocating for the profession which are linked below, and have asked for meetings with each of them. This is all part of a broader strategy of the Association to integrate RMTs more effectively into the healthcare system.

The first stage of this campaign was the “Queens Park Day” organized a few years ago. Since then, the RMTAO has been sending all MPPs and other key influencers ‘Patient Stories’ every month. These stories emphasize the vital role RMTs play in providing health services to Ontarians and the need for RMTs to play a more significant role in Ontario healthcare. The Association will follow up on these initiatives when the election campaign gets underway. At that time, we will be asking our members to assist us in influencing their local candidates.

Pre-Election Letter to Premier Doug Ford

Pre-Election Letter to Steven Del Duca

Pre-Election Letter to Andrea Horwath

The Association has received many inquiries from members who have not been contacted by Lumino/Sun Life about registering for their new portal. The RMTAO has been assisting members with this issue on an individual basis as members reached out to us, but because of the large number of emails, I reached out to Lumino/Sun Life to express our concerns. I am happy to report that they got back to me.

Lumino/Sun Life has decided to extend the TELUS deadline from November 29th to January 30th (the first day you can only submit through Sun Life). This will allow everyone the chance to get registered, spend some time on the new platform to get comfortable while still being able to submit on TELUS Health eClaims, if needed.

To clarify, Sun Life only contacted those people from a select list that was provided through TELUS. This would explain why not everyone has been contacted. For the folks that have not received anything, you can use the following link where you can register. However, this link should just be used if you DID NOT receive a communication from Sun Life directly: https://acces.sunlife.ca/s/login/SelfRegister?language=en_CA.

Some of you may recall that, as posted in the Friday File on June 11th, I had a chance to speak with the then Federal Health Minister Patty Hajdu. At that time, Minister Hajdu shared information on the health initiatives planned by the Federal Government. She also discussed the heavy burden placed on health care professionals during the pandemic and the struggles with burnout that many health care workers are experiencing.

As a follow up, I sent the Minister a letter advocating for RMTs and highlighting how RMTs can play a role in assisting in any federal recovery plans.

Post-election, a new Federal Health Minister has been appointed. This week I wrote to the new Minister of Health Jean-Yves Duclos reinforcing our position and reiterating our offer of support.

Read the letter to the new Minister of Health

Recently the Ontario government introduced legislation that would ban the practice of imposing non-compete clauses on employees, a growing trend that the province’s Labour Minister says is often used to intimidate workers. The Association has sent an advocacy letter to Labour Minister Monte McNaughton supporting this legislation.

The legislation, which would be the first such ban in Canada, is primarily meant to make Ontario more attractive to talented workers like RMTs who often face these clauses in employment contracts.

The new legislation would also block the increasing imposition of non-compete clauses on lower-wage workers, a practice becoming more common that many say depresses wages and reduces labour mobility.

A non-compete clause typically attempts to ban an employee from taking their talents to a competitor after leaving their job – sometimes for years. The growing use of these clauses has been flagged as a problem across North America. The inappropriate use of non-compete clauses may unfairly limit worker mobility. Non-compete clauses are often used to intimidate employees.

Despite being common in employment contracts in Ontario, both among RMTs and for other professions, non-compete clauses are already almost never upheld when challenged in Ontario courts. But most employees are often unaware of this, leaving them vulnerable.

Mr. McNaughton has said the proposed changes, which would amend the Employment Standards Act, would still allow companies to forbid departing employees from using intellectual property or confidential information, and non-compete clauses would still be allowed in some cases where a business is sold. The changes would also still allow for agreements that block ex-employees from soliciting their former employer’s clients, which are also common and more often upheld in court.

Mr. McNaughton said he plans to introduce what he says will be more improvements for workers. He said his goals are to boost paycheques and to create more opportunities for workers to find jobs with pensions and benefits. Although these are all developments that could be beneficial, the Association needs to follow these developments closely to ensure they result in outcomes that would be beneficial to RMTs.

As a follow up to last week's advocacy update regarding creating a profile on the Lumino Health Portal, I received an opinion on the issue from the CMTO. Their response to me was as follows:

Thank you for bringing your concern to our attention. We can appreciate how RMTs may perceive advertising opportunities like these as conflicts of interest and would recommend that careful consideration should always be given to participating in these types of activities. However, with the information that is available, it is unlikely that participation in this program would directly result in a conflict of interest.

According to CMTO’s Standard of Practice for Conflict of Interest (2022), RMTs must not provide or receive a monetary benefit for referring a client to or from any other business. Further, in order for a conflict of interest to occur, it must be evident that an RMT placed their own personal or financial interest before a client’s best interest.

It would appear as though the insurer is offering an advertising opportunity to RMTs who are willing to pay for online presence in their directory. It does not appear to be an offer to solicit or encourage clients to seek Massage Therapy treatment for the purposes of collecting service fees. The choice of RMT and the decision to seek Massage Therapy care do not seem to be directly influenced by this program. Instead, it increases visibility and booking convenience. If the insurer were offering to solicit or encourage clients to seek Massage Therapy treatment to collect service fees, then paying the service fee could be perceived as contravening the expectations of the Standard. Therefore, if RMTs wish to participate in these types of programs, it would be very important to confirm that the program does not exploit clients or compromise their best interests for the purposes of benefitting the financial interests of others (e.g., an RMT’s or an insurer’s).

I am continuing to have discussions with Lumino/Sunlife regarding my concerns that this type of advertising is causing confusion with members, as well as other issues with Lumino/Sunlife that members bring to my attention.

Recently concerns were raised with me from a number of members about a notice circulated by the Lumino/Sunlife marketing department about creating a Lumino Health profile. They are advertising that creating a Lumino Health profile will result in attracting more customers. This is nothing new. However, what is new is that they have a new payment plan where you only pay when it attracts new patients to you.

I have reached out to Sunlife to ask for clarification about this change and am making them aware of the concerns that have been raised by members. I have had a number of conversations with Lumino about the confusion and concern this service is raising with members.

I have also reached out to the CMTO sure that this does not in anyway contravene the CMTO Standard of Practice - Conflict of Interest, as there have been many concerns that this will contravene that standard.

As soon as I have a more definitive information from the CMTO, I will share that with members. It is important to note that members are under no obligation to create a Lumino Health Profile. It is separate from Sunlife Insurance and using it or not using it does not affect your ability to process claims.

The portal is a relatively new service being marketed by Lumino, a division of Sunlife. It is therefore a comparatively untried new service. If you have any questions or concerns, please email me at michael@rmtao.com. I would like to get as much information about this as possible before going back to Lumino about these additional concerns.

This week I have been able to get answers to a variety of questions that members have recently had.

Many members have asked about whether RMTs working in environments such as spas or gyms that would typically require proof of vaccination for their clients. I have spoken to my contacts in the Ministry of Health who have provided clarification on this issue. In general RMTs can treat both vaccinated and unvaccinated individuals based on their assessments, but the question came up about how that applies to RMTs working in locations that can't have unvaccinated patrons on the premises.

RMTs working in businesses that are required to ensure that all people entering their premises are vaccinated according to the Government guidelines, such as spas and gyms, would have to adhere to this same rule, so whoever the business owner designates to check vaccination status would have to check this for people visiting the RMT on the premises as well.

However, if an RMT has a separate entrance and works in a clearly defined and separated space this does not apply as the space is only for massage therapy services, which do not require proof of vaccination. This would apply if you have a private office not directly connected to the gym or other non-essential business. This also means that your patients may not enter the non-essential service space (e.g. the gym or spa) through the RMT space via a side door.

Patients who wish to enter the gym or other non-essential business must enter that space through the normal entrance and show proof of vaccination there. There is a responsibility on the part of the RMT to ensure patients or visitors do not use their private entrance to enter the gym or other non-essential business space.

A number of members have also asked whether they have access to rapid COVID tests. The government is providing access to rapid COVID test for organizations, and RMTs and other health professionals are one of the groups that qualify. You can read more about this initiative here.

Finally, I am pleased to announce that the RMTAO is preparing to celebrate Massage Therapy Awareness Week October 24 to the 30. During that week, we will be sharing a variety of compelling and inspiring stories from patients about their experiences with massage therapy, as well as a guideline to help you celebrate in your practice.

I would like to welcome everyone to a new membership year. Thank you all for renewing. We really appreciate your support especially during what has been a very challenging time. An investment in the Association is one of the most tangible ways you can invest in the future of the profession.

We have a lot of great plans for the coming membership year that I would like to share. We are increasing our emphasis on our advocacy which includes ramping up our HST/GST exemption advocacy with the Canadian Massage Therapist Alliance now that the election is over. Some of our other objectives for this upcoming membership year are:

• Engaging with the government to promote the importance of massage therapy for the health and well-being of Canadians and push for the general interests of RMTs in Ontario.
• Connecting with other healthcare professions to position massage therapy as a strong complement to other healthcare professions and become part of the circle of care of patients.
• Engaging with insurance companies to educate them on importance of massage therapy for health and wellness of Canadians and uphold the interests of RMTs.

We are also continuing to improve our Education Program and have some great upcoming webinars for the rest of 2021. We also plan to have some in person sessions towards the end of this new membership year, COVID permitting.

We will continue to develop campaigns to educate the general public on the importance of massage therapy to their health and wellbeing. I am also looking forward to doing a number of regional townhalls next spring to have the opportunity to connect directly with members across Ontario. We will also continue to support and facilitate the development of additional massage therapy research and ensure RMTs have access to research and are able to understand and apply it.

These are just some of our plans for the 2021-2022 membership year. I also invite any of our members to contact me at michael@rmtao.com if you have any questions or concerns.

And if you haven't renewed already - you can still renew online at RMTAO.com.

In my role as Chair of the Canadian Massage Therapist Alliance (CMTA) Working Group focusing on the tax exemption campaign, we have taken several steps in our federal tax exemption campaign.

The first of these steps was to migrate the RMTACT website information to the CMTA website to further centralize our campaign and highlight the CMTA as the leader in this campaign.

You can view the RMTACT website at https://www.crmta.ca/project-rmtact/

This website includes an overview of the campaign, our key messages that we will use to argue for tax exemption for massage therapists, and facts abou t the importance of massage therapy.

The site also includes massage therapy stories which we will be using to highlight the importance of massage therapy to health care to government officials.

You can share your story or encourage your patients to share their stories as a way to show your support of this campaign. You can also show your support by signing up for updates, which is an option at the bottom of every page of the RMTACT website.

Although the COVID-19 pandemic caused some delay, and the federal government had little time for other priorities, tax exemption for massage therapists has still remained a priority for the CMTA. The federal election and a potential change in government will also change our strategy slightly.

However, we are preparing plans so that after the election the CMTA will be able to arrange meetings with various MPs across Canada, the Minister of Finance and Deputy Minister and other policy makers in Ministry of Finance and Ministry of Health who can have influence over these decisions.

In 2019 we surveyed RMTs across Canada to ascertain the financial impact of RMTs collecting tax to the federal government and we will continue to use that information in our meetings going forward.

We will provide you with updates on any meetings as they happen and will also begin to create regular posts outlining important information regarding this campaign including the impact tax exemption will have on patients, the impact tax exemption will have on RMTs and further opportunities for you to help.

The evolving COVID-19 situation has resulted in some recent changes from the province and the Ministry of Health. These changes do not directly affect most RMTs. However, the RMTAO continues to work closely with the Ministry of Health and the CMTO to monitor the situation so that we can make members aware of changes as they happen.

The new Directive (Directive 6) mandates hospitals and home and community care service providers to have a COVID-19 vaccination policy for employees, staff, contractors, students and volunteers, and for ambulance services to have a COVID-19 vaccination policy for paramedics. These policies include mandatory vaccination of employees. This does not affect RMTs unless you work in one of these environments.

I want members to be aware that all employers are able to mandate their own vaccination policies as long as they are aligned with the government guidelines outlined in Directive 6.

I would appreciate hearing from members by email if your employer has established a mandatory vaccination policy at your workplace outside of those specific settings named in Directive 6. If this happens, contact me at michael@rmtao.com.

The Association supports RMTs being vaccinated and following the safety guidelines set out by the Ministry and the CMTO. The Delta variant is extremely transmissible especially for the unvaccinated.

For those wishing to know more about Directive 6 the following link will be helpful.

The Association received a number of questions about the CMTO's new changes to their website. This included concerns about mandatory reporting of employment termination, terms used to indicate people were not general certificate holders, and additional information provided about CMTO investigations. I contacted the CMTO with these concerns and can provide the following information to hopefully help clarify.

Mandatory reporting from employers is only for registrants who were terminated and the employer has reasonable grounds to believe that they are incompetent, incapacitated, or have sexually abused a client. Simply firing someone is not reportable. This means that unethical or abusive clinic owners cannot report unsubstantiated dismissals.

The reasoning for termination can be easily accessed – e.g., the fact the RMT holds an Inactive certificate – is easily found by clicking on ‘View’. There’s not much space on the results page of the register, so they are limited as to how much information they can display there.

ICRC investigations aren’t on the public register, only some ICRC outcomes and referral of allegations of professional misconduct to discipline.

A glossary of terms used on the register is provided to help keep the public from jumping to the assumption that a person under investigation in guilty. It’s important that people review the glossary to fully understand what they are reading on the register.

The change made to the website are in line with all regulated colleges who deal with the same issues. The information currently shown on College Registers is the result of changes to the RHPA and discussions held several years ago with Ministry regarding transparency. A system wide requirement to broaden the conduct information available through the public register was implemented.

Hopefully this helps clarify some of the concerns expressed by members. We maintain a positive relationship with the CMTO and continue to meet with them regularly to bring them member concerns in this area as well as other issues, and they are always willing to consider our feedback. As always, if you have further questions or concerns let us know and we will advocate on your behalf.

As many of you know from my Advocacy Updates in the Friday File, I represent the Canadian Massage Therapist Alliance (CMTA) at the national level along with other federal health professional associations as part of a group called Organizations for Health Action (HEAL). This has provided me with the opportunity to advocate for Registered Massage Therapists with Patty Hajdu, the Federal Minister of Health and her Ministry.

The Federal Government is interested in establishing national standards for long-term care. The COVID-19 pandemic sadly exposed many of the weaknesses in in long-term care system. The federal government plans to introduce national standards for long- term care which they believe will help reform the system. I am advocating that massage therapy need to play a greater role in providing care to improve the wellbeing of seniors in long-term care.

To help support this effort, the office of the Minister of Health would like to consult some of our members who have experience in providing care to long-term care residents, along with other health professionals who work in long-term care as they work on their standards.

If you work in long-term care and are interested in participating, contact me directly at michael@rmtao.com.

Your involvement would be appreciated and helps the massage therapy profession advance in the goal of providing Canadians with improved healthcare.

Prometric

Recently I became aware that there was a delay in the release of OSCE results from Prometric which has caused a great deal of concern and frustration for our student members.

Both CMTO and Prometric have responded my inquiries for clarification and to get this issue resolved. This year, the process of gathering data for several weeks prior to releasing OSCE results, which is normally done only once at the beginning of the test year, had to be completed twice due to the expanded number of case scenarios developed for the higher volume of OSCE candidates in 2021. This has resulted in a delay in releasing scores for candidates taking the exam in May and June that wouldn’t normally occur.

Because the number of candidates in May/June was lower than anticipated, more time is needed in August to gather the required data to finalize the scores. Prometric has confirmed that they will not push back the release date again. They have also let us know that more information will be added to their website so that candidates can better understand the reason for the delay in releasing scores.

Each OSCE item requires a minimum number of candidate views and data before a cut score can be set. For the last year and a half, the pandemic has made it difficult to achieve the required volume needed to confirm the cut scores. With that said, the volume requirements will be met the second week of August, the cut score meetings are set early the week of the 16th, and the scores will be released by August 20th. This date will not be pushed back again.

Going forward, after the release of the scores on August 20th, all OSCE results will be released on the Friday after the exam administration. All information will be released directing candidates to the website.

CMTO Registrant Portal

As you would have been informed recently, the CMTO updated their Public Register as well as their Registrant Portal. I have been getting a fair amount of feedback about revisions made to the CMTO Registrant Portal and changes as to how people are to access their portal.

This includes a 2-step verification process and a number of issues have surfaced with that process. I have reached out to the CMTO with the goal of working with them to ensure that things run smoothly with the updated site. I also encourage you to review the information the CMTO recently sent to ensure you understand the new processes.

I would like to encourage members to email me directly at michael@rmtao.com with any challenges or thoughts you might have on how the site is working. The more information we have the more we can be of assistance in getting this resolved quickly.

I have mentioned in past Friday File Advocacy Updates that I am involved (on behalf of the RMTAO) with other Associations to collectively advocate on issues important to our members and RMTs in general. This is especially important when advocating with the insurance industry.

These collaborations have led to the creation of an Inter-professional Extended Health Coverage Advisory Advocacy Collaboration. This consists of the Associations that utilized extended health plans in order to provide healthcare services to their clients. We have now met three times over the last six months with the goal of deciding where we should focus our advocacy with insurance companies. In our last meeting, we decided to primarily focus on the following three issues:

Inadequacy of fees including:

• Fee schedules
• Extended health care funding for some health professionals does not reflect fee guides (and has not changed in years)
• Fee codes may not reflect nature of assessment, treatment and care (i.e., not all care is compatible with discrete/piecework funding codes)
• Very large inter- and intra-variation in EHC coverage among health professionals (with some having little to none) that frustrates patients (and often lead to poor patient satisfaction ratings)
• Lack of Insurer understanding re practice costs for some professions

Scopes of practice (and corresponding scope creep)

• Provincially legislated scopes of practice are limited by decisions made by third parties (e.g., funding and coverage related)
• Insurers use internal policies to decide what is in scope, constitutes a form of “shadow regulation”
• In some cases, insurers simply do not recognize recent (but well established) scope expansions

Audits, delisting and shadow regulation

• Inappropriate efforts by insurers to find fraud (e.g., using misleading communications on forms and/or invalid data)
• No transparency regarding delisting and relisting of providers and clinics (with no deference to regulatory colleges)
• Insurer policy changes that are out of step with the broader health policy landscape

The next steps are to do some due diligence about work being done on the national level before developing strategies on how to best address these concerns. I am very involved in this group and have volunteered my time and commitment to help the working groups as they evolve. We will next meet after the summer when most people are back from vacations etc.

Recently, the Association has been fielding questions from members about potential changes to screening protocols or other changes to safety guidelines as Ontario gradually opens up, especially as it relates to new travel rules. I continue to monitor this situation closely and will advise membership of any changes to the current status. I have been in touch with the CMTO and Ministry of Health to ensure I have the most up-to-date information, and will continue to do so.

There have been no updates to the Ministry Patient Screening Guidance tool as of today and therefore the guidance has not changed. A patient’s travel status is still relevant – an individual must be granted an exemption from quarantine by the federal government which includes being fully vaccinated and meeting other conditions at the point of entry (i.e. being asymptomatic, meet the testing requirements, etc.).

The Ministry has indicated that they are in the process of updating the screening guidance to reflect an individual's vaccination status and hope to have the updates done soon.

Therefore, based on feedback from the CMTO and Ministry of Health, RMTs must continue to follow the guidance in CMTO’s COVID-19 Pandemic Practice Guidance document, until any changes from the Ministry are published. In cases where clients reach out to ask about the best timing for scheduling appointments following international travel, the CMTO advice remains to wait until at least 14 days after the date of return.

Any changes from the Ministry will be adapted by the CMTO and communicated to RMTs right away. If and when changes are made, we will also be communicating and reiterating those changes for our members right away and will be available to answer any questions and provide any assistance required in making those changes.

Recently Prometric cancelled the MCQ exam scheduled for June and advised that the next test would not take place until December.

A number of student members contacted the Association for assistance.

As a result, I reached out to a number of people and contacted both Prometric and advised the CMTO of the situation to let them know that this would have significant repercussions for past graduates and those about to graduate.

After making Prometric aware of this problematic situation, I am happy to advise that they were very prompt in their response and that they are working to add another MCQ exam window in October. They are just waiting for a last-minute confirmation of the dates, and then they will be making this available for candidates to schedule.

Although October is an improvement to waiting until December, I will continue to advocate that they take the burden on new graduates into consideration and make as many exam slots available as soon as possible. I will continue to follow up and send updates as they happen.

On Monday, I met with the AVP and Director of Fraud, Risk Management at Sun Life Financial. These are the most senior people at Sun Life that deal with issues related to delisting.

I will be meeting with similar Executives of other insurance companies to ensure we have better direct lines of communication with the large insurance companies. I can also share that the Insurance Industry as a whole is working on guidelines that would promote greater transparency on the part of the insurance industry with providers. A timetable has not been confirmed for this but it is actively being worked on by the Canadian Health and Life Insurance Association (CHLIA), which is the national association for the industry.

Sun Life did share that some of the biggest issues concerning delisting from Sun Life is when providers keep poor not es - that is note-taking does not adhere to CMTO standards. Another issue to keep in mind is that it is important to respond and otherwise respond promptly to Sun Life when they are investigating an issue. I hope that members find this helpful in their dealings with Sun Life.

A few weeks ago, in a previous Advocacy Update, I mentioned the RMTAO is lending its support for an initiative for better health workforce data in Canada. This initiative is being led by the Canadian Health Workforce Network (CHWN). This type of information will be helpful in recruitment and retention and in other ways outlined below.

This past Wednesday, I participated in a planning session of this group. Given the importance of this initiative to our profession, I have subsequently volunteered to be a working member of this advocacy network.

Our call to action is a follows:

We call on the Government of Canada to support health workers by making significant and immediate investments to enhance the data infrastructure that provinces, territories, regions and training programs need to better plan for and support the health workforce.

Although COVID 19 has heightened our concerns, many health workforce-planning issues predate the pandemic. COVID-19 has sharply exposed a lack of clear answers to the most basic questions about Canada’s health workers. What do we know about them? How well do they reflect the diversity of Canada, in terms of Indigenous or racial identity and language of service? What do we know about the scope of their work? How do and can they work together? How can they be recruited, trained and retained where they are most needed? In some critical sectors, such as home, long-term care and mental health care, we don’t even know how many workers there are.

Pre-pandemic, we knew the health workforce was overstretched and that there was growing concern about accessing timely care close to home. Long wait times are largely caused by shortages of health workers.

The pandemic has exacerbated critical staffing shortages causing excessive workloads; these are a direct result of inadequate planning. Health workers are carrying an enormous mental health burden, for which we risk unprecedented attrition from the health workforce. This will inevitably lead to less access to safe, high quality care and increased wait times for patients.

Until barriers to effective health workforce planning are addressed through better and more accessible health workforce data, we can expect inadequate planning for population needs now and into the future, inefficient deployment of health workers, persistent maldistribution of services, and a perpetuation of current inequities.

We are well into our patient story advocacy campaign targeting the Ministry of Health, all MPPs and other influencers and selected media.

As has been previously reported in the Friday File, we started this campaign in January 2021 to send out stories from patients that underscored the value RMTs bring to their patients, the health system and the overall health and wellness of Ontarians.

We will send out our sixth patient story on July 2. As follow up, I am reaching out to key people in the government relating to this initiative. The goal is to better integrate massage therapy into the emerging vision of health care in Ontario, which embraces a team-based, wellness approach. I think we all know RMTs have a lot to offer in support of this vision.

Ontario Health, Ontario Health Teams, Family Health Teams and Community Health Teams are all important players in this space. While it will take time to advocate and enact change in the health system, my early meetings have been encouraging. I will continue to provide members with updates as we move forward especially now that key influencers and decision makers are more accessible as we emerge from the pandemic.

This week I thought I would share perspectives on several initiatives I participated in recently.

As a member of the WSIB Healthcare Forum, I have regular meetings with representatives of WSIB. During a meeting this week, WSIB expressed a desire to get input from the Forum on challenges Healthcare providers struggle with in working with WSIB. There was some acknowledgement of the issues like low fees, communications challenges etc. which has resulted in a reluctance of many health providers to be involved with WSIB. WSIB is developing a process to get direct input from the WSIB Forum and individual healthcare providers into these challenges. As this process is defined, I will share more information.

As the representative of the CMTA with HEAL, I also had the opportunity this week to participate in a conference call with Patty Hajdu, the Federal Health Minister. The focus of the call was to discuss Federal post-Covid recovery plans. Minister Hajdu shared information on the health initiatives in the Federal Budget. Also discussed was the heavy burden placed on health care professionals during the pandemic and the struggles with burnout that many health care professionals are experiencing. I will be sending the Minister a letter in the near future advocating for RMTs and highlighting how RMTs can play a role in assisting in any federal recovery plans.

Also at the national level, the RMTAO is lending its support for an initiative for better health workforce data in Canada. This is being led by the Canadian Health Workforce Network (CHWN) and is an effort to have a federal agency like Stats Canada or Canadian Institute for Health Information (CIHI) collect health workforce data that can be used for more effective planning. One of the issues the RMTAO has struggled with is in getting good data on Massage Therapists. Past surveys conducted by the RMTAO have not been well subscribed. This is a challenge that many associations have.

There is evidence to suggest that health care professionals would be more willing to share information with an independent Federal Agency. The information could be used to help address a number of issues like equity issues around compensation and for better workforce planning. As this initiative gains momentum, I will continue to keep members informed.

As the Ontario government has been accelerating the role out for the 2nd doses of the COVID-19 vaccine, the RMTAO is following this situation closely. We have been advocating with the Ministry directly and involved in conference calls with ministry representatives to ensure RMTs and other health professionals remain a priority to receive their second dose.

We have been told that there may be changes that would allow RMTs and similar health professionals to receive their second dose at an accelerated rate. In the meantime, there are several health units and even individual hospitals that are distributing second doses at an even more accelerated rate than the province announced.

The current schedule ensures RMTs will maintain their priority as it is based on when you received your first dose. The current schedule below does not incorporate RMTs who received their first dose prior to March 8. We continue to seek clarity on this situation, but we advise you to contact your public health unit or hospital where you received your first dose for more details.

The RMTAO will continue to monitor this situation and advise members accordingly.

The following is the current schedule for eligibility to book a second dose appointment:

• Week of May 31: individuals aged 80+
• Week of June 14: individuals aged 70+
• Week of June 28: individuals who received their first dose between the week of March 8 to April 18, on a “first-in, first-out” basis. For example, this included individuals with the highest-risk health conditions and special education workers.
• Week of July 19: individuals who received their first dose between the week of April 19 to May 9, on a “first-in, first-out” basis. For example, this included individuals aged 50 and over, as well as individuals with high-risk health conditions.
• Week of August 2: individuals who received their first dose between the week of May 10 to May 30, on a “first-in, first-out” basis. For example, this included individuals who cannot work from home and individuals who have at-risk health conditions.
• Week of August 9 to 16: individuals aged 12 to 25
• Week of August 9: individuals who received their first dose from the week of May 31 onwards on a “first-in, first out” basis, respecting the recommended intervals.

Currently, the AstraZeneca COVID-19 vaccine is being offered at an accelerated pace with a 10-week interval for individuals who received their first dose between March 10 to March 19, 2021.

In addition, beginning the week of May 31st, all individuals who received their first dose of the AstraZeneca vaccine from March 10 onwards will be eligible to receive a second dose of the AstraZeneca vaccine at a 12-week interval, with appointment dates based on the timing of their first dose.

Second dose appointments can be rebooked through the provincial booking system, and through pharmacies.

I had the opportunity to engage with a large number of educators during the past month.

I was invited to attend The Canadian Council Massage Therapy Schools (CCMTS) Virtual AGM and a follow up meeting with the CMTO.

Discussions covered a number of topics including challenges with Prometric and planned changes with the Standards of Practice. During the meeting I was asked to assist CCMTS in their advocacy efforts with The Honourable Ross Romano, Minister of Colleges and Universities who omitted Registered Massage Therapists in a memorandum listing programs that support the healthcare workforce.

I have sent the Minster a letter on behalf of the Association expressing our objection to this, asking him to include massage therapy on this list of health care professions. The CCMTS also asked me to participate in a panel discussion on “The State of Massage Therapy across Canada” at their annual conference that takes place later today.

I also attended the Annual Meeting of the MT Subcommittee for Ontario Colleges. I was invited to provide an update and overview of the RMTAO. One of the topics discussed was concerns with the new Peer Assessment which is an issue that the RMTAO is actively looking into. Building our relationships with the various educational institutions, students and supporting new grads is an area the Association is very active in.

We are offering new grads a significant membership discount to make membership more affordable during the pandemic. We introduced a new grad toolkit and the school ambassador program is very active - which are just some of the supports the RMTAO has in place for students and new graduates.

As mentioned in a previous Advocacy Update, I was appointed Chair of the CMTA Working Group focusing on the tax exemption campaign.

The working group brings together the leadership of many massage therapy associations including the Executive Directors for the Associations of BC, Saskatchewan, New Brunswick and Nova Scotia. We had our second committee meeting this week.

Our focus is to make a strong national case for HST/GST exemption which we feel will make for a much stronger campaign with the Federal Government.

This website includes an overview of the campaign, our key messages that we will use to argue for tax exemption for massage therapists, and facts about the importance of massage therapy.

A national campaign that reflects the benefits to all provinces is nuanced accordingly so that it will resonate more strongly with the Federal Government than a campaign that more narrowly focuses on Ontario. Each region will be slightly different in its communication campaign.

We are meeting regularly and our next stages are:

• Development of key messages
• Creation of a communication campaign – Content Calendar
• Development of list of key influencers at the Federal level
• Regular, direct contact of key influencers by members of the committee asking for support of the initiative with the required follow up

The RMT/Act website is about to go live once again as part of the new CMTA website. We will be developing an RMT/Act Re-launch communication shortly as well as other key messages and benefit statements as next steps in our process.

Recently, the WSIB Health Practitioners Forum met to review progress and discuss changes at the executive level of the WSIB. I wanted to provide members with some background on the Forum’s activities as I have not previously discussed this forum.

The group consists of Associations that represent Physiotherapist, Optometrists, Chiropractors, Psychologists, Occupational Therapists and Social Workers among others. Over the years, the group has worked to address concerns with WSIB such as low fees, slow payment, bureaucratic & slow approvals, WSIB unilateralism.

Progress in all of these areas has been made with the introduction of a "Programs of Care” funding model, shortened receivables, speed claim approvals and practitioner access, automatic annual fee-for-service increases tied to the Consumer Price Index, electronic submission of bills, reports, etc. and electronic payments.

While improvements have been made, we need to continue to work collectively with the WSIB to make further progress.

I also wanted to share that the Coalition of Regulated Health Professional Associations (CORHPA) met this week. This is the group that represents all the Regulated Health Professional Associations in Ontario.

A significant topic at the meeting was Lumino, the online portal developed by Sunlife. Over the last year, members have expressed a number of concerns with Lumino. Many other Associations have similar concerns. At the meeting, CORHPA decided to develop a working group to look into these concerns. I am happy to share that I was chosen as Chair of this working group. While a timetable and membership in the group has yet to be confirmed, I am encouraged by this development and look forward to developments in this group over the coming 12 months.

The RMTAO is committed to work collectively where needed to advance the interests of our members.

As mentioned in a previous advocacy update, I participated in the Massage Therapy Research Summit on February 22, 2021 as one of fourteen participants from across Canada and 1 from the USA, representing a variety of backgrounds, perspectives, and experiences in relation to research for and on massage therapy.

Based on the discussions, the group has a refreshed vision for the research branch of the massage therapy profession. It is proposed that the refreshed vision is underpinned by guiding principles. The following potential guiding principles emerged during the Summit discussion:

1. Collaboration – productive engagement across provinces and with international partners in the MT profession, and with non-MT colleagues positioned in other health care disciplines.
2. Shared responsibility – the research vision is the responsibility of all MT stakeholders – researchers, educators, associations, regulators, and practitioners.
3. Communication – to enable continuity of efforts and continue to build on our efforts, effective communication among MT stakeholders is needed.
4. Change management – creating a culture where research is valued requires change and change is challenging.

Further, it is a process that needs to be effectively supported and managed to succeed. The refreshed vision is encapsulated in the following statements:

1. Quality MT research is conducted and supported in academic and practice contexts.
2. A wide breadth of research methods and approaches are used to explore the full complexity of Massage Therapy intervention and profession.
3. MT research directly responds to knowledge and information needs of MT stakeholders.
4. A Canadian massage therapy research foundation is established that funds MT research and supports translation of MT research findings.
5. MT researchers are effectively supported in their unique and individual (research) education and career paths.
6. Research on MT is translated for, accessible to, and used by massage therapists.
7. Knowledge, skills and attitudes of massage therapists are informed by research, beginning in their education and throughout their careers.
8. MT research activity is led and coordinated through a centralized hub.

The grand vision for MT research may be expressed as an aspirational statement: Research-informed knowledge is embedded in how MTs are educated and how they work, enabling continuous improvement in the MT profession.

The next steps include the development of an action plan to prioritization and identify action items for the vision statements, define stakeholder roles and develop key metrics to assess and measure success.

I will continue to apprise members of developments as this foundational work continues.

There are many student members of the RMTAO, and the issues they faced with entry-to-practice exams has impacted them greatly. In January, the CMTO outsourced their testing (OSCEs and MCQs) to a company called Prometric. While Prometric has been involved in CMTO testing for many years, this was the first time all aspects, including logistics have been handled in this way.

Unfortunately, the transition had many challenges. As part of our advocacy efforts, the Association has been working hard to resolve these challenges. To do so, I have worked closely with the CMTO and then with Prometric directly. Over the last few months, I spoke with the CMTO, Prometric and representatives of a number of the schools as well as students. Members of the Board were also helpful in addressing this issue.

Prometric admitted that the logistic al challenges due to the transition from CMTO to Prometric were significant and took ownership for them. There were also issues related to COVID – i.e. going to half capacity; last minute cancellations (this happened once) etc. that affected testing. Many of the issues were related to poor planning and poor communication on Prometric's part. There were no issues reported that were related to the quality or integrity of the actual testing itself.

As of March 3, Prometric advised that they were able to resolve all the outstanding issues and that students should not encounter future issues. It would be helpful to know if there are any examples that contradict this, so that I can bring them to Prometric in any future discussions.

They have or will be honouring all refunds and currency conversion discrepancies. They will continue to conduct testing right into December to allow for all those who missed out and to address the backlog.

Prometric conducted 3 sessions for the various schools to provide feedback and/or raise their concerns to help resolve issues. I have reached out to students and representatives of various schools who have confirmed that things are now working in an acceptable manner. However, if any members are aware of any challenges that are current or ongoing, please let me know and I will take these up with Prometric to make sure the issues are addressed quickly.

The Canadian Massage Therapy Alliance (CMTA) conducted their AGM last week. RMTAO Board Chair Ian Kamm and I attended on behalf of the RMTAO.

The meeting was doubly important because of our concerns with the progress of the HST/GST Tax Exemption Campaign which the CMTA took on in November 2019. This advocacy campaign was turned over to the CMTA by the RMTAO as a national effort was essential in convincing the Federal Government that this was an issue that is important to the majority of provinces.

The Management Executive of the CMTA provided a status on the project. The Federal Government’s understandable, yet almost single-minded, focus to the COVID-19 Pandemic meant that the CMTA was not able to meet with many MPs and Senior Civil Servants as planned. It also meant that the Federal Government has not produced a Federal Budget since 2019 – which is typically required to change tax collection requirements.

In November 2020, the CMTA decided to transition the RMT/Act website to another provider under the direct control of the CMTA. I am pleased to report that, not only will the RMT/Act website become operational in the next 30-60 days but the CMTA will also launch their own website which will provide greater insight into CMTA activities.

Furthermore, I am satisfied to report that I was appointed as the Chair of the CMTA Committee managing the HST/GST initiative. I am meeting with my CMTA committee colleagues next week and I am confident that we will be able move forward aggressively and quickly.

Part of our plan is to support the campaign with an aggressive communication plan similar to what happened in 2019. I was on a conference call this week with Mona Fortier, Associate Minister of Finance, who advised that the new budget due out next week will, understandably, be primarily concerned with measures that support economic recovery from the pandemic. However, she did offer that although the Covid crisis is still very severe, the Federal Government is now starting to focus on other issues – which is encouraging news for the HST/GST campaign.

Ian and I both advocated for greater transparency from the CMTA, which was strongly endorsed. To accomplish this, the CMTA will be meeting more regularly, activate its own website, and delegate major initiatives to working committees to ensure objectives are completed in a timely manner.

As many members are aware, the RMTAO works with a number of groups of other associations that have similar interests to the RMTAO. I have been very active in supporting and working with these collectives. One of the most active groups in advocating with the insurance industry is the Coalition of Health Professions in Auto Insurance (the Coalition).

Recently the Coalition set our strategic priorities for our advocacy for the coming year. They are listed below. This was my first opportunity to be involved in this strategic discussion and I was pleased to be able to ensure that all of the priorities would be relevant to our members. It is also indicative of the common issues all our associations have in dealing with insurance companies and the value of working together with a collective voice. The list is not in order of priority or comprehensive of all priorities.

Inadequacy of fees

• Fee schedules of EHC funding for some health professionals does not reflect fee guides (and has not changed in years)
• Fee codes may not reflect nature of assessment, treatment and care (i.e., not all care is compatible with discrete/piecework funding codes)
• Very large inter- and intra-variation in EHC coverage among health professionals (with some having little to none) that frustrates patients (and often lead to poor patient satisfaction ratings)

Audits, delisting and shadow regulation

• Inappropriate efforts by insurers to find fraud (e.g., using misleading communications on forms and/or invalid data)
• No transparency regarding delisting and relisting of providers and clinics (with no deference to regulatory colleges)
• Insurer policy changes that are out of step with the broader health policy landscape (e.g., some insurers eliminating EHC coverage for physiotherapy for 65+ because physio is covered by OHIP in some instances)

Insurers entry into business of health care delivery

• Marketing of services, defining basket of care, and owning health care
• Misleading marketing (e.g., full mental health coverage but providing only limited online services)
• Use of patient satisfaction reviews within preferred provider networks – poor survey/questionnaire construction; providers rated for things beyond their control
• Opportunities that may exist to leverage efforts of some providers (e.g., Sunlife via Lumino) to position themselves as a leader in supporting health and wellbeing of Canada

These issues impact the practices of RMTs and of other health professionals across Ontario. I look forward to the opportunity to work with the other associations as part of the Coalition to advocate to address these issues.

I belong to several collectives of Ontario health care associations in order to work together with them to advocate on behalf of our members with insurance companies and the government.

One of these groups is the Coalition of Health Professional Associations in Ontario Automobile Insurance Services (the “Coalition”). The Coalition includes Associations with similar interests to the RMTAO like the Ontario Chiropractic Association, Ontario Physiotherapy Association, Ontario Dental Association, etc.

Collectively, this group represents over 40,000 health professionals in Ontario and as such we can collectively advocate more strongly with the insurance industry and regulatory bodies that govern insurance industry practices.

Currently the Financial Services Regulatory Authority (FSRA) is in the process of revising their regulations. I have been working with the Coalition in drafting a letter with various responses to proposed changes. Currently, we are drafting a response to changes to the proposed Unfair and Deceptive Acts or Practices (UDAP) Rule.

Read the Coalition Letter

The 2021 Massage Therapy Research Summit was held recently. The RMTAO was a major sponsor of the Summit. I was one of the 17 individuals invited to attend to discuss the vision for Canadian massage therapy research.

The primary focus of the Summit was to develop a refreshed Canadian MT research vision and establish key priorities within that vision. We will share the detailed results of the Summit shortly after they are published.

Research is a fundamental component to promote massage therapy as a credible profession. RMTs need support to embrace an evidence-based practice and develop new research. This is the vision that was developed.

Others in attendance were all important contributors in massage therapy research: Amanda Baskwill RMT, PhD; Ann Blair Kennedy LMT, BCTMB, DrPH; Scotty Butcher, PhD, PT, RCEP, CF-L1, CMMT; Cathy Fournier RMT, PhD(c); Donelda Gowan, RMT, MSc, PhD; Lori Green; Bodhi Haraldsson RMT; Rob Hemsworth BPE, RMT; Ania Kania-Richmond RMT, PhD; Suzanne Michaud BA, RMT; Marvin Mohring BKin, RMT, Med; Kalyani Premkumar, MBBS, MD, MSc(Med Ed), PhD, MBA; Eric Purves MSc, RMT; Stacey Neilson BA(Hons.), RMT; Bryn Sumpton, BScN.

Last week we began what will be weekly updates on the extensive advocacy efforts the Association is involved in. We will be providing the weekly update in the Friday file under the heading of ‘"Advocacy Update”.

This week, Premier Ford made a comment at a press conference stating that he believed that all 80+ year olds should be vaccinated before he believes RMTs should be vaccinated.

The Premier’s comments contradicted Ontario's COVID-19 vaccination plan, which lists frontline regulated health professionals such as RMTs as High Priority health care workers to be included in phase 1 of vaccinations. RMTs in many jurisdictions have already been vaccinated following the guidelines in this plan.

I was able to speak with Global News on Tuesday to respond to the Premier’s comments. I highlighted the importance of sticking to the vaccination plan developed by the Ministry of Health several months ago. I also highlighted the importance RMTs in providing health care to Ontarians.

This coverage was on Global news on Tuesday at 6 p.m which you can watch here and at 11 p.m, and also included an interview we arranged with an RMT and comments from public health officials confirming that RMTs should be vaccinated as part of phase 1 with other High Priority Health Professionals.

The position of the Association is to support the province's vaccination plan, which includes RMTs as High Priority health care professionals as part of phase 1.

A letter went out Thursday to the Premier reinforcing our position and asking him to respond.

To reassure members, and dispel any misconceptions, the Ministry Emergency Operation Centre replied to me personally reaffirming that the plan as outlined on their websites is still very much in effect and proceeding. I will also add that I have received supportive letters from CEOs of other health professional associations offering their support.

Download the Letter to the Premier and other Ministers

The Coalition of Ontario Regulated Health Professional Associations (CORHPA), which represents 20 regulated health professional associations in Ontario including the RMTAO, recently sent a letter to the Ontario Minister of Finance and Minister of Economic Development, Job Creation and Trade advocating for regulated health professionals to qualify for initiatives recently introduced to help small businesses survive the COVID-19 pandemic.

This includes the Main Street Relief Grant for Personal Protective Equipment (PPE) and the Ontario Small Business Support Grant.

The Main Street Relief Grant for Personal Protective Equipment (PPE) allows small businesses to access funds to pay for the PPE they need to be able to operate safely, and the Ontario Small Business Support Grant helps small businesses survive the financial pressures of the COVID-19 pandemic. Regulated health professionals do not qualify as they were not forced to shut down during the province-wide shutdown, however many health professional businesses were financially negatively impacted.

Along with our partners in the Coalition we support the inclusion of Regulated Health Professionals in these financial supports.

Download the Coalition Letter to the Minister of Finance and Minister of Economic Development, Job Creation