January 2021 AMTA WA Government Relations Update
TO: AMTA-WA Members
FROM: Diana Thompson, LMT, and Susan Sherman, LMT, Government Relations Co-Chairs
RE: Massage Rules Changes Effective September 1, 2021
DATE: January 20, 2021
The following Memorandum is an overview of changes to the massage rules (Chapter 246-830 WAC) that are effective September 1, 2021. Note, that not all of the massage rules are being amended. These new rules are the culmination of over five years of ongoing work, with AMTA-WA being the lead organization that worked with the members and staff of the Board of Massage to get these rules across the finish line. AMTA-WA thanks the members of the Board as well as Board staff Megan Maxey and Renee Fullerton for their diligent work. In addition, our thanks to members of the Government Relations Committee, and AMTA-WA lobbyist Gail McGaffick, who wrote numerous memoranda on our behalf. This five-year rules project was a team effort, and we were fortunate to have a great team.
We’re proud of the work we were able to accomplish. By increasing the number of hours of education from 500 to 625, Washington joins a growing number of states in recognizing the need for more education for massage therapists to competently practice as health care providers. In fact, the majority of massage schools in this state already have programs that meet or exceed 625 hours. Finally, we are grateful for the work of the Entry Level Analysis Project, which provided a strong foundation for the rules changes.
These new rules are effective September 1, 2021. For massage schools and programs, that means they are effective for programs beginning on or after September 1, 2021. Note: the current rules are found at Chapter 246-830 WAC. That WAC Chapter will be updated on September 1, 2021.
In an overview of the changes, the Board of Massage stated that the adopted rules:
- Clarify and add necessary definitions;
• Comply with Engrossed Substitute House Bill (ESHB) 1551, which requires the board to repeal rules that require HIV/AIDS education and training as a condition of licensure;
• Create avenues for licensure by endorsement;
• Increase the minimum education and training hours from 500 hours to 625 hours;
• Clarify continuing education requirements and proof of documentation;
• Reorganize and clarifies the standard of practice limitation requirements;
• Align recordkeeping and record retention rules with national standards.
The purpose of this Memorandum is to review the rule changes section by section and highlight the significant changes for AMTA-WA members. A caveat: Not all of the massage rules were amended. In addition, we also hope to create a webinar in the Spring. Bottom line, as health care professionals, it’s important for massage therapists to understand the regulatory framework under which you work. While the statutes (Chapter 18.108 RCW) provide the foundation for massage practice in Washington State, the rules provide needed additional specificity and clarity. Finally, if you have any questions, please let us know. While we may not be able to answer all of them, we can always bring them to the Board of Massage if there is a need for further clarification or guidance. We can be reached as follows: Susan Sherman firstname.lastname@example.org ; Diana Thompson email@example.com
WAC 246-830-005—Definitions. A definition section is the most important part of any rules chapter. It defines words that are used throughout the rules. The following changes are made:
- “Apprenticeship educator and trainer.” Experience requirements were changed from five to three years to be consistent with education requirements for instructors.
- “Breast massage.” While breast massage is only allowed as authorized by WAC 246-830-555, including that sentence in a definition was not appropriate.
- “Linens.” A definition of linens was created to provide additional clarity for LMTs.
- “Massage program” and “Massage transfer program” contain changes for additional clarity.
- ” A definition of “perineum” was included for clarity.
WAC 246-830-020—Applications. This section governs the application process for licensure as a massage therapist. The following changes are made:
- The requirement for AIDS education is removed.
- Language is added to clarify that a state criminal background check is always required for licensure.
WAC 246-830-035—Licensing by endorsement for out-of-state applicants. This section explains how massage therapists who are licensed in other states or a foreign jurisdiction can become credentialed in Washington State. That process is called “endorsement.” The following changes are made:
- Endorsement applicants are given two options to qualify for licensure: (1) They must have completed a minimum of 625 hours of education and training in no fewer than 24 weeks, approved by an equivalent licensing agency; or (2) They must have completed a minimum of 500 hours of education and training, approved by an equivalent licensing agency, and have at least two years of experience and documentation of 24 hours of CE within two years prior to making application.
- If there is a gap in practice of three or more years immediately prior to applying, the applicant must provide documentation of 24 hours of CE for the two most recent years.
WAC 246-830-037—Transfer programs and transfer of credit or clock hours for prior education and training. Numerous changes were made to this portion of the rules for additional clarity and readability. Key substantive changes include:
- In order to determine whether credit or clock hours are substantially equivalent to the content offered by the massage school or program, a transfer student will be required to pass written and practical tests for each subject required by these rules (WAC 246-830-430 (1)(a) through (g). Documentation of the tests must be included in the student’s permanent file. If the transfer student cannot pass the required tests, then the student must enroll and complete the deficient components.
WAC 246-830-420—Approval of massage school, massage program, or apprenticeship program. With fifty hours in a student clinic now required for licensure, changes are made to assure appropriate supervision as follows:
- The student clinic is under the direct supervision of a faculty member/clinical supervisor who is an LMT with at least three years practical experience.
- The faculty member who is the clinical supervisor of the massage clinic must ensure a ratio of no less than one faculty member to no more than six students who are actively performing massage.
- The clinical supervisor must review and approve the student’s massage plan and observe a reasonable portion of each massage session based on the competency of the student.
- While supervising the clinic, the clinic supervisor may only supervise the students in the clinic and no other students on the premises.
- Documentation must include a copy of the supervisor feedback form in addition to the other requirements.
WAC 246-830-430—Education and training. Key changes include the following:
- Education and training hours required for licensure are increased from 500 to 625.
- Education and training programs may not be completed in less than 24 weeks to be accepted for licensure.
- The number of hours required for each subject are:
- 90 hours of anatomy and physiology;
- 60 hours of kinesiology;
- 70 hours of pathology;
- 260 hours of theory, principles, and practice of massage;
- 50 hours of a mandatory student clinic;
- 55 hours of clinical/business practices; and
- 40 hours of professional ethics.
WAC 246-830-440—Curriculum—Academic standards—Faculty—Student clinic. Key changes include the following:
- Changes are made to conform to the increase in hours of education and training required by WAC 246-830-430.) (Education and training)
- Faculty members must have three years’ experience in the subject matter being taught.
- Anti-discrimination language is strengthened to include gender, sexual orientation, and gender expression.
- Student clinic language is updated to reflect that it is a mandatory program. In addition, it is again stated that: “A faculty member in the role of a clinical supervisor must ensure a ratio of no less than one faculty member to no more than six students who are actively performing massage.”
WAC 246-830-475—Continuing education requirements. Numerous changes are made to improve clarity and readability as well as establish clear documentation requirements. There is no change in the number of CE hours required. It remains at 24 hours every two years. Key changes include:
- Continuing education instructors must have three years of professional experience in the subject area being taught.
- It is clarified that a minimum of eight hours must be in person and directly supervised involving the participation of direct application of massage therapy. Please note that this in-person requirement is temporarily waived due to the pandemic.
- A minimum of four hours must be in professional ethics, client or patient communication, professional roles and boundaries, or Washington state massage laws and rules period two of those four hours may be met by attending Board of Massage meetings in person. A maximum of one hour is allowed per Board meeting. While AMTA-WA requested removal of the words “in person” they were not accepted because of concerns that someone could log into a webinar, but not attend.
- Maintenance of certification in American Heart Association CPR or equivalent is required. A maximum of four hours is allowed per reporting.
- The remaining hours of continuing education are defined as a list of activities reasonably related to massage therapy knowledge, skills, and business practices.
- Please read this rule carefully to understand the different categories of CE courses allowed and the documentation requirements of each.
WAC 246-830-550—Standards of practice—Limitations. This is one of the most important sections in the rules. It revises for additional clarity and readability the limitations on the practice of massage. Please read it carefully. Key changes include:
- Massage of the gluteal cleft and perineum is only allowed in accordance with WAC 246-830-557.
- Massage of the breasts is only allowed in accordance with WAC 246-830-555.
- Intraoral massage requires an endorsement and is only allowed in accordance with WAC 246-830-490.
WAC 246-830-555—Breast massage. Key changes include:
- Additional requirements as well as clarifying language is included concerning the type of written and verbal informed consent that is required by clients or patients, to include the parent if a patient is under 18 years of age, before breast massage can be commenced.
WAC 246-830-557—Massage of the gluteal cleft or perineum. This is a NEW SECTION. What that means is that it is entirely new language. It is included to provide maximum clarity for the strict parameters under which massage of the gluteal cleft or perineum is allowed. Key components include:
- Before an LMT is allowed to perform a massage of the gluteal cleft or perineum, the LMT must have evidence of completion of at least 16 hours of specific in-person education and training in massage in these specific areas. The list of topics that are required as a part of that education and training are included in this rule.
- Before an LMT is allowed to perform massage of the gluteal cleft or perineum, there are requirements for signed or initialed written and verbal informed consent from the client or patient, to include the parent if the patient is under 18 years of age.
- There are specific requirements for the written consent to include a statement that the client or patient may discontinue the treatment at anytime; the client or patient has the option to have a witness present and that the witness must be provided by the client or patient; and that there must be a therapeutic rationale for massaging the gluteal cleft or perineum that is acknowledged by the client or patient.
- An LMT is required to use hygienic, safe, and sanitary practices including wearing gloves during treatment and training unless the treatment or training is provided over clothing or draping that provides a barrier to transmission of biologically hazardous material and infectious disease.
- If massage of the gluteal cleft or perineum is part of your practice, please read this rule carefully.
WAC 246-830-560—Coverage and draping. Even if you think you know all there is to know about coverage and draping, please read this rule thoroughly. While the changes are mostly updating and clarifying, the bottom line of the changes is to emphasize to LMTs the importance of coverage and draping, especially when performing breast massage or massage of the gluteal cleft and perineum.
WAC 246-830-565—Recordkeeping. Even if you think you know all there is to know about recordkeeping, please read this rule thoroughly. Key changes include:
- A written consent is considered valid for one year unless revoked.
- If performing a massage of the gluteal cleft or perineum, an additional written and verbal informed consent to treat is required to detail that the client or patient has a clear understanding of the therapeutic rationale, treatment plan, and areas to be massaged for that region per WAC 246-830-557(4). (WAC for massage of gluteal cleft and perineum.)
- There is a new requirement for documentation of any written consent or any modification in coverage and draping as required by WAC 246-830-560 (WAC for coverage and draping).
WAC 246-830-570—Record retention. Key changes include:
- Massage therapists will not be in violation of subsections one and two of this rule if the massage therapist is unable to access the records after a good faith attempt has been made to obtain the records. AMTA-WA strongly advocated for this provision because of problems some LMTs have with accessing records.
- Language is also added that nothing in this section is intended to infringe on any rights or remedies related to unfair trade practices. AMTA-WA objected to this language because we thought that it was unclear, but the Board decided to include it anyway. As stated in the Concise Explanatory Statement, “the intent is to protect the public from unfair business practices.” AMTA-WA will be asking for more clarification.
- Note that LMTs are required to comply with chapter 70.02 RCW, concerning Medical Records. That chapter of the RCW contains over 40 different statutes. The Board has committed to providing guidance to LMTs as to which specific statutes should be adhered to.