WSR 17-14-062
PERMANENT RULES
DEPARTMENT OF HEALTH
[Filed June 29, 2017, 11:44 a.m., effective July 30, 2017]
Effective Date of Rule: Thirty-one days after filing.
Purpose: Chapter 246-830 WAC, Massage practitioners, the department of health (department) and board of massage (board) are adopting amendments to the chapter to clarify, streamline, and modernize the regulations of licensed massage practitioners in Washington state.
Citation of Existing Rules Affected by this Order: Repealing WAC 246-830-010, 246-830-040, 246-830-401, 246-830-477, 246-830-610, 246-830-620, 246-830-630, 246-830-640, 246-830-650, 246-830-660, 246-830-670 and 246-830-680; and amending WAC 246-830-005, 246-830-020, 246-830-035, 246-830-201, 246-830-290, 246-830-420, 246-830-430, 246-830-435, 246-830-440, 246-830-450, 246-830-475, 246-830-485, and 246-830-490.
Statutory Authority for Adoption: RCW 18.108.025 (1)(a) and 18.108.085 (1)(a).
Other Authority: RCW 43.70.041 and chapter 18.108 RCW.
Adopted under notice filed as WSR 17-07-113 on March 21, 2017.
Changes Other than Editing from Proposed to Adopted Version:
Rule as Proposed in
WSR 17-07-113
Rule as Adopted
Reason for Change
WAC 246-830-005 Definitions.
WAC 246-830-005 Definitions.
 
(3) "Apprentice" means an individual enrolled in an apprenticeship program, and who is held to the same standards as students in massage schools or programs.
(3) "Apprentice" means an individual enrolled in an apprenticeship program, and who is held to the same standards as students in massage schools or massage programs.
The board and department agreed to this revision because it is a clarification of the rule.
(4) "Apprenticeship program" means education and training in massage administered by an apprenticeship educator and trainer that satisfies the education and training requirements for massage set forth in this chapter.
(4) "Apprenticeship educator and trainer" means a massage practitioner licensed under chapter 18.108 RCW with at least five current years of experience in full-time practice.
Program staff reformatted subsections four and five to keep the definitions in alphabetical order.
(5)"Apprenticeship educator and trainer" means a massage practitioner licensed under chapter 18.108 RCW with at least five current years of experience in full-time practice.
(5) "Apprenticeship program" means education and training in massage administered by an apprenticeship educator and trainer that satisfies the education and training requirements for massage set forth in this chapter.
 
(17) "Massage transfer program" "Massage transfer program" means a board approved program that allows massage programs and massage schools to accept credits and clock hours that have not been approved by the board pursuant to WAC 246-830-037.
(17) "Massage transfer program" means a board approved massage program that allows board approved massage programs and massage schools to accept credits and clock hours from massage schools, massage programs, colleges or universities that have not been approved by the board, pursuant to WAC 246-830-037.
The board and department agreed to this revision because it is a clarification of the rule.
WAC 246-830-020 Applications.
WAC 246-830-020 Applications.
 
(1) An applicant for a massage practitioner license must submit to the department:
(1) An applicant for a massage practitioner license must be eighteen years of age or older and must submit to the department:
The board and department agreed that the additional language aligns with statute.
(1)(b) Proof of successful completion of the required education and training of a massage program on an official transcript or school completion form sent directly from the applicant's school or program;
(1)(b) Proof of successful completion of the required education and training of a massage school, massage program, or apprenticeship program on an official transcript or school completion form sent directly from the applicant's massage school, massage program or apprenticeship program;
The board and department agreed to this revision because it is a clarification of the rule.
WAC 246-830-035 Licensing without examination by endorsement.
WAC 246-830-035 Licensing for out-of-state applicants.
The board and department agreed that this suggestion better reflects the intention of the rule.
(1)(b) The applicant has a massage license in good standing from the initiating jurisdiction; and
(1)(b) The applicant has a massage license in good standing as verified by the appropriate jurisdiction; and
The board and department agreed to this suggestion because individuals might not hold an active massage license in the jurisdiction in which they were initially licensed.
(3) The applicant must successfully pass one of the following examinations after their graduation date:
(3) The applicant must have successfully passed one of the following examinations after their graduation date:
The board and department agreed to this suggestion because out-of-state applicants will have already successfully passed the examination.
WAC 246-830-037 Transfer programs and transfer of prior education and clock hours.
WAC 246-830-037 Transfer programs and transfer of prior education and clock hours.
 
(1) Board approved massage schools or massage programs may operate transfer programs that accept an individual's credits or clock hours from massage schools or massage programs that have not been approved by the board, subject to the following conditions:
(1) Board approved massage schools or massage programs may operate transfer programs that accept an individual's credits or clock hours from massage schools, massage programs, colleges or universities, subject to the following conditions:
The board and department agreed to the suggestion because additional language aligns with statute.
(1)(a) The massage school or massage program from where credits or clock hours are being transferred is:
(1) (a) The massage school, massage program, college or university from where credits or clock hours are being transferred is:
The board and department agreed to the suggestion because the additional language aligns with statute
(1)(b) The massage school or massage program from where credits or clock hours are being transferred provides an official transcript;
(1) (b) The massage school, massage program, college or university from where credits or clock hours are being transferred provides an official transcript;
The board and department agreed to the suggestion because the additional language aligns with statute.
(1)(c) Courses for which credits or clock hours are granted must be substantially equivalent in content and academic rigor to the courses and clock hours presently offered by the massage school or massage program. In order to determine substantial equivalency, the massage school or massage program will evaluate the courses and clock hours. If clock hours are missing, or require additional credits for the subjects, the massage school or massage program may grant partial credit, as appropriate.
(1) (c) Courses for which credits or clock hours are granted must be substantially equivalent in content and academic rigor to the courses and clock hours presently offered by the massage school or massage program. In order to determine substantial equivalency, the massage school or massage program will evaluate the courses and clock hours. If components are missing, the massage school or massage program shall require credits or clock hours for those subjects while granting partial credit as appropriate.
The board and department agreed that this suggestion provides better readability.
(2) A transfer program must be approved by the board prior to a program enrolling a transfer student via the use of transfer credits or clock hours.
(2) A transfer program must be approved by the board prior to a massage school or massage program enrolling a transfer student via the use of transfer credits or clock hours.
The board and department agreed to this revision because it is a clarification of the rule.
(3) An authorized representative of the school or program must submit to the board a completed application packet provided by the department. Approval of a transfer program will follow the same process as outlined in WAC 246-830-420.
(3) An authorized representative of the massage school or massage program must submit to the board a completed application packet provided by the department. Approval of a transfer program will follow the same process as outlined in WAC 246-830-420.
The board and department agreed to this revision because it is a clarification of the rule.
WAC 246-830-200 Massage practitioner examination.
WAC 246-830-200 Massage practitioner examination.
 
An applicant who does not pass an examination after three attempts must provide proof to the board of having successfully completed additional clinical training or course work as determined by the board before being permitted three additional attempts to pass an exam.
The proposed rule was withdrawn.
The board and department agreed to this suggestion. It was determined by the board and department that a new section was not needed and could be incorporated into WAC 246-830-201.
WAC 246-830-201 Examination.
WAC 246-830-201 Examination.
 
An applicant for a massage practitioner license must successfully pass one of the following examinations:
An applicant for a massage practitioner license must successfully pass one of the following examinations:
No change.
(1) Federation of Massage Therapy Board and massage and bodywork licensing examination; or
(1) Federation of Massage Therapy Board and massage and bodywork licensing examination; or
No change.
(2) National certification examination for massage therapy and bodywork; or
(2) National certification examination for massage therapy and bodywork; or
No change.
(3) A board-approved examination.
(3) A board-approved examination.
No change.
 
(4) An applicant who does not pass an examination after three attempts must provide proof to the board of having successfully completed additional clinical training or course work as determined by the board before being permitted three additional attempts to pass an exam.
The board and department agreed to this suggestion. It was determined by the board and department that proposed WAC 246-830-200 could be incorporated into WAC 246-830-201.
WAC 246-830-401 Board authority.
WAC 246-830-401 Board authority.
 
The board reviews and approves massage schools, massage programs and apprenticeship programs to assure preparation for safe practice as a massage practitioner by requiring massage schools, massage programs and apprenticeship programs to meet minimum standards. The board also sets standards for licensure by endorsement and massage transfer programs.
The rule was stricken.
The board and department agreed that this rule isn't necessary because it is more restrictive than what the board's authority is in the statute.
WAC 246-830-420 Approval of massage school, massage program, or apprenticeship program.
WAC 246-830-420 Approval of massage school, massage program, or apprenticeship program.
 
(1) To qualify as a board approved massage school, massage program or apprenticeship program, an authorized representative of the school or program must submit to the board a completed application packet provided by the department. A completed application packet must include, but not be limited to:
(1) To qualify as a board approved massage school, massage program or apprenticeship program, an authorized representative of the massage school, massage program or apprenticeship program must submit to the board a completed application packet provided by the department. A completed application packet must include, but not be limited to:
The board and department agreed to this revision because it is a clarification of the rule.
(1)(d) A student clinic must be supervised by the clinical supervisor who is a licensed massage practitioner with at least two-years practical experience.
(1)(d) A student clinic must be supervised by a clinical supervisor who is a licensed massage practitioner with at least two-years practical experience.
The board and department agreed that change corrects the sentence's grammar.
(1)(e) Health, sanitation, and facilities must be maintained in accordance with local ordinances. The following documentation must be submitted:
(1)(e) Health, sanitation, and facilities must be maintained in accordance with local ordinances and these rules. The following documentation must be submitted:
The board and department agreed to this revision because it is a clarification of the rule.
(1)(h)(iv) Designation of an authorized representative of the school.
(1)(i) Designation of an authorized representative of the school or program.
~ The board and department agreed to this revision because it is a clarification of the rule.
~ Program corrected the sequencing under subsection one to indicate a new sub-subsection.
(5)(b) Notify the board of any changes in overall curriculum plan or curriculum content changes prior to implementation by filing an addendum. The board may grant or deny the proposed change; and
(5)(b) Notify the board of any changes in overall curriculum plan or curriculum content changes under section (1)(a) prior to implementation by filing an addendum. The board may grant or deny the proposed change; and
Program staff added this clarification to indicate that changes to a board approved massage program are specific to subsection (1)(a).
WAC 246-830-440 Curriculum—Academic standards—Faculty—Student clinic.
WAC 246-830-440 Curriculum—Academic standards—Faculty—Student clinic.
 
(2) Academic standards. The massage school, massage program, or apprenticeship program trainer must regularly evaluate the quality of its instruction and have a clearly defined set of standards of competence required of its students. Promotion to each successive phase of the program and graduation is dependent on mastery of the knowledge and skills presented in the massage school, massage program, or apprenticeship program.
(2) Academic standards. The massage school, massage program, or apprenticeship program educator and trainer must regularly evaluate the quality of its instruction and have a clearly defined set of standards of competence required of its students. Promotion to each successive phase of the massage program and graduation is dependent on mastery of the knowledge and skills presented in the massage school, massage program, or apprenticeship program.
The board and department agreed to this revision because it is a clarification of the rule.
(3) Faculty. An apprenticeship trainer and faculty member must be qualified by training and experience to give effective instruction in the subject(s) taught. An apprenticeship trainer and faculty member who teaches hands on courses must have a minimum of two-years experience in the subject matter being taught. The apprenticeship trainer and faculty member should develop and evaluate the curriculum instructional methods and facilities; student discipline, welfare, and counseling; assist in the establishment of administrative and educational policies, and scholarly and professional growth. A massage school, massage program, or apprenticeship program must not discriminate on the basis of sex, race, age, color, religion, physical handicap, or national or ethnic origin in the recruitment and hiring of faculty.
(3) Faculty. An apprenticeship program educator and trainer and faculty member must be qualified by training and experience to give effective instruction in the subject(s) taught. An apprenticeship trainer and faculty member who teaches hands on courses must have a minimum of two-years experience in the subject matter being taught. The apprenticeship trainer and faculty member should develop and evaluate the curriculum instructional methods and facilities; student discipline, welfare, and counseling; assist in the establishment of administrative and educational policies, and scholarly and professional growth. A massage school, massage program, or apprenticeship program must not discriminate on the basis of sex, race, age, color, religion, physical handicap, national or ethnic origin, or other basis prohibited by law in the recruitment and hiring of faculty.
The board and department agreed to this revision because it is a clarification of the rule.
The board and department agreed to this suggestion to include proposed language that will align and comply with state and federal discrimination laws.
WAC 246-830-490 Intraoral massage training.
WAC 246-830-490 Intraoral massage education and training.
The board and department agreed to this revision because it is a clarification of the rule.
(2) Supervised training must be obtained from a massage practitioner endorsed in intraoral massage or from an individual who is licensed, certified, or registered and who has performed intraoral massage services within their authorized scope of practice.
(2) Supervised education and training must be obtained from a massage practitioner endorsed in intraoral massage or from an individual who is licensed, certified, or registered and who has performed intraoral massage services within their authorized scope of practice.
The board and department agreed to this revision because it is a clarification of the rule.
WAC 246-830-515 Operation of a massage business.
WAC 246-830-515 Operation of a massage business.
 
A person who owns or operates a massage business may be subject to legal action for practice without a license under RCW 18.130.190 if the massage business advertises massage and the massage business employs individuals to provide massages who are not licensed under this chapter.
A person who owns or operates a massage business may be subject to legal action for practice without a license under RCW 18.130.190 if the massage business advertises massage and the massage business employs individuals to provide massages who are not licensed under chapter 18.108 RCW.
The board and department agreed with the suggestion because a person is licensed under the statutory requirements, not the WAC.
WAC 246-830-550 Scope of practice—Limitations.
WAC 246-830-550 Standards of practice—Limitations.
 
(2) A massage practitioner must maintain evidence of the completion of at least sixteen specialized in-person contact hours of education and training if they are performing massage in the perineal area in addition to obtaining prior written informed consent.
(2) A massage practitioner must maintain evidence of the completion of at least sixteen specialized in-person contact hours of education and training if they are performing massage in the perineal area in addition to obtaining prior written and verbal informed consent. This written consent may be included within an overall general consent to massage document, if clearly delineated and either specifically initialed or signed.
The board and department agreed to include the suggestions because it enhances public protection.
WAC 246-830-555 Breast massage.
WAC 246-830-555 Breast massage.
 
(1)(b) Use appropriate draping techniques as identified in WAC 246-830-560 (draping section).
(1)(b) Use appropriate draping techniques as identified in WAC 246-830-560.
The board and department agreed to this suggestion because it is a formatting correction.
(3)(b) An additional written and signed or initialed consent from the client or patient for massage of the nipple and areolas.
(3)(b) An additional prior written and verbal informed consent from the client or patient for massage of the nipple and areolas. This written consent may be included within an overall general consent to massage document, if clearly delineated and either specifically initialed or signed.
The board and department agreed to add the word "prior" because it enhances public protection.
The board and department agreed to include "written and verbal informed consent" because it enhances public protection.
The board and department agreed to include the last suggested sentence because it enhances public protection.
WAC 246-830-560 Draping.
WAC 246-830-560 Coverage and draping.
The board and department agreed to this revision because it is a clarification of the rule.
(2) Massage practitioners must use safe and functional coverage and draping practices during the practice of massage when the client or patient is disrobed. The drape(s) must be sufficient to ensure the genitals and the gluteal cleft below tip of coccyx, anus and rectum are not exposed, and the breast area is not exposed except as allowed in subsections (3) and (4) of this section. Safe and functional coverage and draping means:
(2) Massage practitioners must use safe and functional coverage and draping practices during the practice of massage when the client or patient is disrobed. The drape(s) must be sufficient to ensure the genitals and the gluteal cleft distal to the coccyx, anus and rectum are not exposed, and the breast area is not exposed except as allowed in subsections (3) and (4) of this section. Safe and functional coverage and draping means:
The board and department agreed to the suggestion because it accurately reflects medical terminology.
(2)(b) Massage or movement of the body does not expose genitals or gluteal cleft below tip of coccyx, anus and rectum, or does not expose the breast area except as allowed in subsections (3) and (4) of this section.
(2)(b) Massage or movement of the body does not expose genitals or gluteal cleft distal to the coccyx, anus and rectum, or does not expose the breast area except as allowed in subsections (3) and (4) of this section.
The board and department agreed to the suggestion because it accurately reflects medical terminology.
(3) With informed and written consent of the client or patient, the gluteal and breast drapes may be temporarily moved in order to perform therapeutic treatment of the area.
(3) With prior written, verbal, and signed informed consent of the client or patient, the gluteal and breast drapes may be temporarily moved in order to perform therapeutic treatment of the area.
The board and department agreed to the suggestion to add "prior" because it enhances public protection.
The board and department agreed to include "written, signed, and verbal informed consent" because it enhances public protection.
WAC 246-830-565 Recordkeeping.
WAC 246-830-565 Recordkeeping.
 
(1) A massage practitioner providing professional services to a client or patient, must document services provided. Documentation should be appropriate to the venue, the type and complexity of those services, and in sufficient detail to support and enable anticipated continuity of care. The documentation must include:
(1) A massage practitioner providing professional services to a client or patient must document services provided. Documentation should be appropriate to the venue, the type and complexity of those services and, when applicable, in sufficient detail to support and enable anticipated continuity of care. The documentation must include:
The board and department agreed to the suggestions because it provides clarification of the intent of the rule and enhances public protection.
(a) Client or patient name and contact information;
(b) Health history sufficient to ascertain if there are cautions or contraindications to safe application of massage therapy, and an update of the current health status at each session;
(c) Date massage therapy is provided and the duration of treatment;
(d) The types of techniques and modalities applied;
(e) The location or areas of the body that received massage therapy;
(f) Written consent to treat;
(g) If breast massage is performed, an additional written consent to treat per WAC 246-830-555, and documentation of a therapeutic rationale;
(h) If breast massage of the nipples and areolas are involved, documentation of the prescription or referral per WAC 246-830-555 (3)(a), or an additional written consent to treat per WAC 246-830-555 (3)(b);
(i) Documentation of any written consent or any modification in coverage and draping as required by WAC 246-830-560; and
(j) For massage therapy where the focus is on treating a health condition, the following additional information is required:
(i) Symptoms, for example, pain, loss of function, and muscle stiffness;
(ii) Evaluation and findings, for example, movement, posture, palpation assessment and findings;
(iii) Outcome measures, for example, improvement in symptoms, movement, posture, palpation, and function; and
(iv) Treatment plan for future sessions.
(a) Client or patient name and contact information or name and contact information of a parent or guardian if a client or patient is a minor;
(b) Age of client or patient;
(c) Health history sufficient to ascertain if there are cautions or contraindications to safe application of massage therapy, and an update of the current health status at each session;
(d) Date massage therapy is provided and the duration of treatment;
(e) The types of techniques and modalities applied;
(f) The location or areas of the body that received massage therapy;
(g) Written consent to treat;
(h) If breast massage is performed, an additional written consent to treat per WAC 246-830-555, and documentation of a therapeutic rationale;
(i) If breast massage of the nipples and areolas are involved, documentation of the prescription or referral per WAC 246-830-555 (3)(a), or an additional written consent to treat per WAC 246-830-555 (3)(b);
(j) Documentation of any written consent or any modification in coverage and draping as required by WAC 246-830-560;
(k) For massage therapy where the focus is on treating a health condition, the following additional information is required:
(i) Symptoms, for example, pain, loss of function, and muscle stiffness;
(ii) Evaluation and findings, for example, movement, posture, palpation assessment and findings;
(iii) Outcome measures, for example, improvement in symptoms, movement, posture, palpation, and function; and
(iv) Treatment plan for future sessions; and
(l) If performing massage in the perineal area, an additional written and verbal informed consent to treat per WAC 246-830-550(2).
The board and department agreed to the suggestions because it provides clarification of the intent of the rule and enhances public protection.
Program staff corrected the sub-subsection sequencing.
The board and department agreed to the suggestion because it enhances public protection.
(3) Correspondence relating to any referrals concerning the evaluation or treatment of the client or patient must be retained in the client or patient record.
(3) Correspondence relating to any referrals by other health care providers concerning the diagnosis, evaluation or treatment of the client or patient must be retained in the client or patient record.
The board and department agreed to the suggestion because it provides clarification of the intent of the rule.
WAC 246-830-570 Record retention.
WAC 246-830-570 Record retention.
 
(3) All records must be secured with properly limited access.
(3) A massage practitioner must also comply with record retention requirements of chapter 70.02 RCW.
The board and department agreed to the suggestion to include proposed language that will align and comply with state and federal record retention laws.
(4) After the retention period, the massage practitioner may dispose of the record. Disposal must be done in a secure and confidential manner in compliance with HIPAA as applicable and that includes:
(4) All records must be secured with properly limited access in compliance with chapter 70.02 RCW and the Health Insurance Portability and Accountability Act (HIPAA).
(5) After the retention period, the massage practitioner may dispose of the record. Disposal must be done in a secure and confidential manner in compliance with chapter 70.02 RCW and HIPAA and must include as appropriate:
A final cost-benefit analysis is available by contacting Megan Maxey, Department of Health, P.O. Box 47852, Olympia, WA 98504-7852, phone (360) 236-4945, fax (360) 236-2901, email megan.maxey@doh.wa.gov.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 5, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 9, Amended 13, Repealed 12.
Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 14, Amended 13, Repealed 12.
Date Adopted: June 28, 2017.
John Wiesman, DrPH, MPH
Secretary
Reynaldo Guajardo, LMT
Board of Massage Chairman
AMENDATORY SECTION (Amending WSR 03-11-033, filed 5/15/03, effective 6/15/03)
WAC 246-830-005 Definitions.
((For the purpose of administering chapter 18.108 RCW, the following definitions shall apply:
(1) "Massage" is as defined in RCW 18.108.010.
(2) "Massage school" is an institution which has the sole purpose of offering training in massage therapy.
(3) "Massage program" is training in massage therapy offered by an academic institution which also offers training in other areas of study. A program is an established area of study offered on a continuing basis.
(4) "Apprenticeship program" is defined for the purposes of this chapter as training in massage administered by an apprenticeship trainer that satisfies the educational requirements for massage set forth in WAC 246-830-430, 246-830-440, and 246-830-450. This training shall be offered by an apprenticeship trainer to no more than three apprentices at one time and shall be completed within two years.
(5) "Apprenticeship trainer" is defined as a massage practitioner licensed in the state of Washington with not less than five current years of experience in full-time practice.
(6) "Apprentice" is defined as an individual enrolled in an apprenticeship program, and shall be held to the same standards as students in schools or programs.
(7) "Student" means an individual currently enrolled in an approved school, program, or apprenticeship program, who is practicing massage solely for the purposes of education as is incidental to their current course work and who is not receiving compensation for said practice.
(8) "Direct supervision" means a faculty member is on the premises, is quickly and easily available and the client has been examined by the faculty member at such time as acceptable massage practice requires.
(9) "Animal" means any species normally recognized as treatable by veterinary medicine.
(10) "Large animal" means any species commonly recognized as livestock and exotics. Livestock includes horses, cattle, swine and sheep.
(11) "Small animal" means any species commonly recognized as domesticated. Domesticated includes canine, feline and other small animals.)) The definitions in this section apply throughout the chapter unless the context clearly requires otherwise.
(1) "Animal" means any species normally recognized as treatable by veterinary medicine.
(2) "Animal massage therapist" means an individual licensed to practice massage therapy under chapter 18.108 RCW with additional education and training in animal massage therapy as required under this chapter and holds the animal massage therapist endorsement required by RCW 18.108.230.
(3) "Apprentice" means an individual enrolled in an apprenticeship program, and who is held to the same standards as students in massage schools or massage programs.
(4) "Apprenticeship educator and trainer" means a massage therapist licensed under chapter 18.108 RCW with at least five current years of experience in full-time practice.
(5) "Apprenticeship program" means education and training in massage administered by an apprenticeship educator and trainer that satisfies the education and training requirements for massage set forth in this chapter.
(6) "Board" means the Washington state board of massage.
(7) "Breast massage" means the specific and deliberate manipulation of breast tissue. Massage of the surrounding chest and shoulder muscles such as massage of the intercostal, pectoral, or axillary muscles is not considered breast massage. Breast massage is only allowed as authorized by WAC 246-830-555.
(8) "Department" means the Washington state department of health.
(9) "Direct supervision" means supervision by a faculty member who is a clinical supervisor of the massage school or massage program and is on the premises, in the student clinic and is readily available to students and clients or patients.
(10) "Evaluation" means the assessment of soft tissue in order to facilitate decision making regarding effective forms and techniques of massage, and identifying cautions and contraindications to ensure client or patient safety. Evaluation does not mean diagnosis.
(11) "Intraoral massage" means the manipulation or pressure of soft tissue inside the mouth or oral cavity for therapeutic purposes.
(12) "Massage" and "massage therapy" mean a health care service involving the external manipulation or pressure of soft tissue for therapeutic purposes. Massage therapy includes techniques such as tapping, compressions, friction, reflexology, Swedish gymnastics or movements, gliding, kneading, shaking, and fascial or connective tissue stretching, with or without the aids of superficial heat, cold, water, lubricants, or salts. Massage therapy does not include diagnosis or attempts to adjust or manipulate any articulations of the body or spine or mobilization of these articulations by the use of thrusting force, nor does it include genital manipulation. See WAC 246-830-550 for additional limitations on massage practice.
(13) "Massage business" means the operation of a business where massages are given.
(14) "Massage program" or "program" means education and training in massage therapy approved by the board. A program is an established area of study offered on a continuing basis.
(15) "Massage school" or "school" means an institution which has the sole purpose of offering education and training in massage therapy approved by the board.
(16) "Massage therapist" means an individual licensed as a massage therapist under chapter 18.108 RCW.
(17) "Massage transfer program" means a board approved massage program that allows board approved massage programs and massage schools to accept credits and clock hours from massage schools, massage programs, colleges or universities that have not been approved by the board, pursuant to WAC 246-830-037.
(18) "Secretary" means the secretary of the department of health or the secretary's designee.
(19) "Student" means an individual currently enrolled in a massage school, massage program or apprenticeship program who is practicing massage solely for the purposes of education and training as part of their current course work and who is not receiving compensation for said practice.
NEW SECTION
WAC 246-830-015 Professional title.
In accordance with chapter 18.108 RCW, effective July 1, 2017, all references to "massage practitioner" in this chapter mean "massage therapist." After July 1, 2017, all individuals licensed to practice massage therapy under chapter 18.108 RCW will retain the title of massage practitioner until their next license renewal but will remain subject to the provisions of this chapter.
AMENDATORY SECTION (Amending WSR 92-02-018, filed 12/23/91, effective 1/23/92)
WAC 246-830-020 Applications.
((Application forms for licensure shall be prepared by the secretary and shall provide for the statement of all information required for the license in question. An applicant shall be required to furnish to the secretary a current photograph of passport size, approximately two inches by two inches, with the original application and satisfactory evidence to establish that all requirements for the license have been fulfilled by the applicant, including the requirement that the applicant be of good moral character and is not in violation of chapter 18.130 RCW.)) (1) An applicant for a massage therapist license must be eighteen years of age or older and must submit to the department:
(a) A completed application on forms provided by the department;
(b) Proof of successful completion of the required education and training of a massage school, massage program, or apprenticeship program on an official transcript or school completion form sent directly from the applicant's massage school, massage program or apprenticeship program;
(c) Proof of successful completion of a board approved examination under WAC 246-830-201;
(d) Proof of successful completion of the Washington state massage jurisprudence examination;
(e) Proof of successful completion of four clock hours of AIDS education as required by chapter 246-12 WAC, Part 8;
(f) Proof of certification in American Red Cross first aid and American Heart Association CPR or the equivalent. CPR training must be in person;
(g) The required nonrefundable application fee in WAC 246-830-990; and
(h) If required by the department, fingerprint cards for a national or state fingerprint based background check pursuant to RCW 18.130.064(2).
(2) The secretary may request additional supporting documentation as necessary.
(3) The secretary will not grant a license under this chapter to any person who has been convicted of violating RCW 9A.88.030, 9A.88.070, 9A.88.080, or 9A.88.090 or equivalent local ordinances within the eight years immediately preceding the date of application, except as provided in RCW 9.97.020.
AMENDATORY SECTION (Amending WSR 98-05-060, filed 2/13/98, effective 3/16/98)
WAC 246-830-035 Licensing ((without examination)) for out-of-state applicants.
(((1) A license to practice massage shall be issued without examination provided an individual holds a current license to practice massage in another jurisdiction that has examination and education requirements substantially equivalent to those in Washington.
(2) An individual applying for a license without examination shall submit to the department:
(a) A completed application on a form provided by the department;
(b) The required nonrefundable application fee;
(c) Documentation that the examination and education requirements of the other jurisdiction are substantially equivalent to those in Washington;
(d) Successful completion of an open book test provided by the department which demonstrates a working knowledge of Washington law as contained in chapters 18.108 and 18.130 RCW, and chapter 246-830 WAC;
(e) Applicants must complete four clock hours of AIDS education as required in chapter 246-12 WAC, Part 8;
(f) Written certification from all jurisdictions in which the applicant has practiced massage verifying that the applicant has a record of good standing and has not been the subject of any disciplinary action.
(3) Restrictions:
(a) All applicants shall be subject to the grounds for denial or issuance of a license conditioned on the applicant's compliance with an order entered pursuant to RCW 18.130.160;
(b) An individual who has failed the Washington state licensing examination shall not be eligible for licensing without examination.
(4) If application for licensing without examination is denied, the applicant may apply for licensing as set forth in RCW 18.108.070.
(5) A license issued without examination is subject to an original license fee and all other renewal requirements set forth in this chapter.)) (1) A massage therapist applicant holding a massage license in another state or foreign jurisdiction may be granted a Washington massage license if:
(a) The board determines the other state's or foreign jurisdiction's education and training requirements are substantially equivalent to Washington's. Substantial equivalency means a course of study at a massage school or massage program that requires a minimum of five hundred hours approved by the equivalent licensing agency or agencies in the state or foreign jurisdiction in which it is located at the time of applicant's graduation;
(b) The applicant has a massage license in good standing as verified by the appropriate jurisdiction; and
(c) If there is a gap in practice of three or more years immediately prior to applying for a license by endorsement, the applicant must provide documentation of twenty-four hours of hands on delivery of massage therapy services.
(2) If an applicant does not meet the requirements of this section, then the applicant may fulfill the remaining education and training requirements as outlined in WAC 246-830-037.
(3) The applicant must have successfully passed one of the following examinations:
(a) Federation of State Massage Therapy Board massage and bodywork licensing examination;
(b) National certification examination for therapeutic massage and bodywork; or
(c) A board-approved examination.
(4) The applicant must satisfy the requirements in WAC 246-830-020 (1)(a) through (h).
NEW SECTION
WAC 246-830-037 Transfer programs and transfer of prior education and clock hours.
(1) Board approved massage schools or massage programs may operate transfer programs that accept an individual's credits or clock hours from massage schools, massage programs, colleges or universities, subject to the following conditions:
(a) The massage school, massage program, college or university from where credits or clock hours are being transferred is:
(i) Accredited by a national or regional education accreditation organization;
(ii) Approved by a state authority with responsibility for oversight of educational or vocational programs; or
(iii) Approved by a state agency that regulates massage schools or massage programs and is a member of the federation of state massage therapy boards.
(b) The massage school, massage program, college or university from where credits or clock hours are being transferred provides an official transcript;
(c) Courses for which credits or clock hours are granted must be substantially equivalent in content and academic rigor to the courses and clock hours presently offered by the massage school or massage program. In order to determine substantial equivalency, the massage school or massage program will evaluate the courses and clock hours. If components are missing, the massage school or massage program shall require credits or clock hours for those subjects while granting partial credit as appropriate. Documentation of the massage school's or massage program's decision-making rationale must be maintained in the student's file; and
(d) Documentation of all previous formal education and training applicable to completion of a massage school or massage program is included in each student's permanent file.
(2) A transfer program must be approved by the board prior to a massage school or massage program enrolling a transfer student via the use of transfer credits or clock hours.
(3) An authorized representative of the massage school or massage program must submit to the board a completed application packet provided by the department. Approval of a transfer program will follow the same process as outlined in WAC 246-830-420.
(4) Approval of a transfer program is valid for three years after initial approval and every five years for reapproval. The board may place restrictions on or may revoke or suspend approval of a transfer program that fails to comply with the requirements in this section or in RCW 18.108.028.
((EXAMINATION))
AMENDATORY SECTION (Amending WSR 91-01-077, filed 12/17/90, effective 1/31/91)
WAC 246-830-201 ((Scope of)) Examination.
(((1) The examination for a massage practitioner's license shall, except as noted in subsection (2) of this section, consist of written questions as well as a practical demonstration of massage therapy.
(2) An applicant handicapped by blindness will not be subject to a written examination. A blind applicant will be asked questions orally to appropriately test the range and depth of his/her knowledge of the subjects shown in subsection (3) of this section.
(3) Questions will be sufficient in number to satisfy the board of massage that the applicant has been given an adequate opportunity to express his or her knowledge relating to subjects as stated in RCW 18.108.073(2).
(4) The practical demonstration of massage will be conducted before the examiner(s) and the applicant will be required to perform massage therapy. The following will be evaluated:
(a) Professional manner,
(b) Lubrication,
(c) Overall demonstration of work: Pressure, rhythm, smoothness, organization,
(d) Interaction with client,
(e) Effleurage,
(f) Petrissage,
(g) Friction,
(h) Vibration,
(i) Tapotement,
(j) Joint demonstration and Swedish gymnastics,
(k) Specific muscle demonstration,
(l) Client endangerment,
(m) Draping and turning,
(n) Treatment of various conditions.)) An applicant for a massage therapist license must successfully pass one of the following examinations:
(1) Federation of Massage Therapy Board and massage and bodywork licensing examination; or
(2) National certification examination for massage therapy and bodywork; or
(3) A board-approved examination.
(4) An applicant who does not pass an examination after three attempts must provide proof to the board of having successfully completed additional clinical training or course work as determined by the board before being permitted three additional attempts to pass an exam.
AMENDATORY SECTION (Amending WSR 94-13-181, filed 6/21/94, effective 7/22/94)
WAC 246-830-290 Documents in a foreign language.
All application documents submitted in a foreign language ((shall)) must be accompanied by an accurate translation of those documents into the English language. Translated documents ((shall)) must bear a notarized affidavit certifying that the translator is competent in both the language of the document and the English language and that the translation is a true and complete translation of the foreign language original. ((Costs of translation of all documents shall be at the expense of)) The applicant is responsible for the costs of translating the documents.
AMENDATORY SECTION (Amending WSR 95-11-108, filed 5/23/95, effective 6/23/95)
WAC 246-830-420 Approval of massage school, massage program, or apprenticeship program.
((The board may accept proof of a national professional association's approval of a school or program based on standards and requirements which are substantially equivalent to those identified in this chapter, in lieu of the requirements contained in this chapter. Approval in this manner may be requested on a form provided by the department. The board will consider for approval any school, program, or apprenticeship program which meets the requirements as outlined in this chapter.
(1) Approval of any other school or program may be requested on a form provided by the department.
(2) Application for approval of a school or program, shall be made by the authorized representative of the school or the administrator of the apprenticeship agreement.
(3) The authorized representative of the school or the administrator of the apprenticeship program may request approval of the school or program, as of the date of the application or retroactively to a specified date.
(4) The application for approval of a school, program, or apprenticeship program shall include, but not be limited to, documentation required by the board pertaining to: Syllabus, qualifications of instructors, training locations, and facilities, outline of curriculum plan specifying all subjects and length in hours such subjects are taught, class objectives, and a sample copy of one of each of the following exams: Anatomy, physiology, and massage therapy.
(5) Any school, program, or apprenticeship program that is required to be licensed by private vocational education (see chapter 28C.10 RCW or Title 28B RCW), or any other statute, must complete these requirements before being considered by the board for approval.
(6) The board will evaluate the application and, if necessary, conduct a site inspection of the school, program, or apprenticeship program, prior to granting approval by the board.
(7) Upon completion of the evaluation of the application, the board may grant or deny approval or grant approval conditioned upon appropriate modification to the application.
(8) In the event the department denies an application or grants conditional approval, the authorized representative of the applicant's school or program may request a review within thirty days of the board's adverse decision/action. Should a request for review of an adverse action be made after thirty days following the board's action, the contesting party may obtain review only by submitting a new application.
(9) The authorized representative of an approved school, program or the administrator of an apprenticeship agreement shall notify the board of significant changes with respect to information provided on the application within sixty days.
(10) The board may inspect or review an approved school, program, or apprenticeship program at reasonable intervals for compliance. Approval may be withdrawn if the board finds failure to comply with the requirements of law, administrative rules, or representations in the application.
(11) The authorized representative of a school, program or administrator of an apprenticeship agreement must immediately correct the deficiencies which resulted in withdrawal of the board's approval.)) (1) To qualify as a board approved massage school, massage program or apprenticeship program, an authorized representative of the massage school, massage program or apprenticeship program must submit to the board a completed application packet provided by the department. A completed application packet must include, but not be limited to:
(a) A curriculum designed to meet or exceed the requirements listed in WAC 246-830-430. The following documentation must be submitted:
(i) Table of courses offered;
(ii) Syllabus for each course that includes course title, subject matter, course hours, all instructor(s) name(s), measurable course objectives, methods of evaluation, course schedule, and textbooks or other instructional materials;
(iii) A sample copy of each of the following exams: Anatomy and physiology, pathology, kinesiology, practicum criteria, ethics and professionalism, and laws pertaining to massage;
(iv) Statement describing how a student will obtain first-aid and CPR training; and
(v) Institutional philosophy or mission statement.
(b) A plan for how the massage school, massage program or apprenticeship program will evaluate its academic standards. The following documentation must be submitted:
(i) Statement or policy on minimum standards for measuring student progress; and
(ii) Copies of policies and procedures, to include a policy on nondiscrimination.
(c) Documentation explaining how the massage school or massage program determines training and experience qualifications for faculty members. The following documentation must be submitted:
(i) Policy on minimum competency standards for instructors and a statement that all massage school, massage program or apprenticeship program instructors meet those standards;
(ii) Resumes for each instructor; and
(iii) A listing of all instructors and the courses each instructor plans to teach.
(d) A student clinic must be supervised by a clinical supervisor who is a licensed massage therapist with at least two-years practical experience. The clinical supervisor is responsible for reviewing the health history of the student's client or patient, and must review and approve the student's massage plan.
The following documentation must be submitted:
(i) A copy of policies pertaining to student clinic;
(ii) Disclosure statement form provided to client or patient;
(iii) Copy of client or patient intake and screening form; and
(iv) Copy of client or patient feedback form.
(e) Health, sanitation, and facilities must be maintained in accordance with local ordinances and these rules. The following documentation must be submitted:
(i) Floor plan of facility;
(ii) Floor plan of student clinic;
(iii) Equipment in classroom;
(iv) Equipment in student clinic; and
(v) List of library contents and computer or online resources available to students.
(f) A copy of policies on faculty and student conduct.
(g) Records must be stored in a secured location and be made available upon a student's written request. The following documentation must be submitted:
(i) A copy of a sample transcript; and
(ii) A policy on release of student records consistent with applicable law(s).
(h) Eligibility to operate a massage school or massage program. The following documentation must be submitted:
(i) Verification that the school is approved to operate in the state of Washington by the workforce training and education coordinating board;
(ii) Verification that the school is licensed by private vocational education (see chapter 28C.10 RCW or Title 28B RCW); or
(iii) Verification that the program is part of a college or university that is nationally or regionally accredited.
(i) Designation of an authorized representative of the school or program.
(2) The board may conduct a site inspection of the massage school, massage program or apprenticeship program prior to granting approval.
(3) The board may grant or deny approval or grant conditional approval contingent upon changes to the application requested by the board.
(4) To maintain approval status with the board, a massage school, massage program or apprenticeship program must apply for reapproval during the third year after initial approval and during the fifth year for each reapproval thereafter. Failure to apply for renewal by the expiration date of the massage school, massage program or apprenticeship program approval will mean that the approval is expired and no longer valid.
(5) In order to maintain board approval, a massage school, massage program or apprenticeship program must:
(a) Comply with any changes in training standards and guidelines adopted by the board;
(b) Notify the board of any changes in overall curriculum plan or curriculum content changes under subsection (1)(a) of this section prior to implementation by filing an addendum. The board may grant or deny the proposed change; and
(c) Notify the board of changes in authorized representative or instructors within thirty days of such change.
(6) An apprenticeship program is limited to no more than three apprentices per apprenticeship educator or trainer, and the apprenticeship must be completed within two years.
NEW SECTION
WAC 246-830-422 Denial, suspension, or revocation of approval for a massage school, massage program, transfer program or apprenticeship program.
(1) When the board determines that a massage school, massage program, transfer program or apprenticeship program fails to meet the standards for education and training as required in this chapter, the board may:
(a) Deny approval to a new massage school, massage program, transfer program or apprenticeship program; or
(b) Suspend or revoke approval of an approved massage school, massage program, transfer program or apprenticeship program.
(2) The board may conduct a review or site visit to investigate any allegation that a massage school, massage program, transfer program or apprenticeship program has not met, or has failed to maintain, the standards set forth in this chapter including, but not limited to:
(a) Selling or offering to sell transcripts, or providing or offering to provide transcripts, without requiring attendance, or full attendance;
(b) Failure to require students to attend all of the classes listed on the transcript or school completion form;
(c) Failure to require students to attend all of the hours listed on the transcript or school completion form;
(d) Engaging in fraudulent practices including, but not limited to, the creation of fake documents to aid or abet students seeking licensure, aiding or abetting a student in cheating on the licensing examination, aiding or abetting students to use false documents or to present false testimony in hearings, aiding or abetting students in engaging in fraudulent practices with respect to hearings, making false claims, or otherwise engaging in fraudulent practices;
(e) Violating or attempting to violate, directly or indirectly, or assisting in or abetting the violation of any statute or rule applicable to a massage school, massage program, transfer program or apprenticeship program;
(f) Failure to create or maintain accurate records including, but not limited to, student attendance records and student transcripts or school completion form;
(g) Failure to identify transfer credit or clock hours from other institutions including name of other institution(s), credit or clock hours transferred, and class requirements met by transfer credit or clock hours on transcripts or school completion form;
(h) A finding by a state or local agency, or a private certifying, permitting, or accreditation agency related to massage, that a massage school, massage program, transfer program or apprenticeship program has engaged in any of the conduct identified in this subsection; or
(i) Failure of a massage school, massage program, transfer program or apprenticeship program that has requested board approval to meet or maintain the requirements for approval set forth in this chapter.
(3) Board approval expires and is no longer valid if the massage school, massage program, transfer program or apprenticeship program does not submit an application for renewal prior to the expiration date of the board's approval.
NEW SECTION
WAC 246-830-423 Reinstatement of approval for a massage school, massage program, transfer program or apprenticeship program.
The board may consider reinstatement of a massage school, massage program, transfer program or apprenticeship program upon submission of satisfactory evidence that the massage school, massage program, transfer program or apprenticeship program meets the standards contained in WAC 246-830-420.
NEW SECTION
WAC 246-830-425 Appeal rights when the board has denied, suspended, or revoked approval.
(1) A massage school, massage program, transfer program or apprenticeship program that has been denied approval or had its approval suspended or revoked may appeal the board's decision according to the provisions of chapter 34.05 RCW, the Administrative Procedure Act, Parts IV and V, and chapter 246-11 WAC.
(2) The board adopts the model procedural rules for adjudicative proceedings as adopted by the department and contained in chapter 246-11 WAC.
AMENDATORY SECTION (Amending WSR 95-11-108, filed 5/23/95, effective 6/23/95)
WAC 246-830-430 Training.
(1) A massage ((education program shall)) school, massage program or apprenticeship program education and training must have a curriculum and system of education and training consistent with its particular area of practice. The education and training in massage therapy ((shall)) will consist of a minimum of five hundred hours. An hour of education and training is defined as fifty minutes of actual instructional time. Certification in American Red Cross first aid and American Heart Association CPR or the equivalent ((shall be)) is required. CPR training must be in person. This requirement is in addition to the five hundred hours of education and training in massage therapy. These five hundred hours are not to be completed in less than six months and ((shall)) must consist of the following:
(a) One hundred thirty hours of anatomy, physiology, and kinesiology including palpation, range of motion, and physics of joint function. There must be a minimum of forty hours of kinesiology.
(b) Fifty hours of pathology including indications and contraindications consistent with the particular area of practice.
(c) Two hundred sixty-five hours of theory and practice of massage to include techniques, remedial movements, body mechanics of the ((practitioner)) therapist, and the impact of techniques on pathologies. A maximum of fifty of these hours may include time spent in a student clinic. Hydrotherapy ((shall)) must be included when consistent with the particular area of practice.
(d) Fifty-five hours of clinical/business practices, at a minimum to include hygiene, recordkeeping, medical terminology, professional ethics, business management, human behavior, client or patient interaction, and state and local laws.
(2) To receive credit in an apprenticeship program for previous education and training, this education and training must have been completed within the five-year period prior to enrollment in the apprenticeship program.
(3) A student((s)) attending ((schools and)) a massage school, massage program, transfer program or apprenticeship program((s)) outside the state of Washington ((shall acquire a working knowledge of the laws of Washington state applying to massage therapy)) must pass a jurisprudence exam.
(4) A massage school, massage program, transfer program or apprenticeship program may exempt a student from curriculum requirements when the student's successful performance on an examination that the massage school, massage program, transfer program or apprenticeship program administers demonstrates that the student has attained competency in that subject area as a result of prior postsecondary learning or training.
AMENDATORY SECTION (Amending WSR 03-11-033, filed 5/15/03, effective 6/15/03)
WAC 246-830-435 Animal massage training.
(1) For the purpose of animal massage ((practitioner)) therapist endorsement as provided in chapter 18.108 RCW, board approval will be given to any education and training program that consists of a minimum of one hundred hours. An hour of education and training is defined as fifty minutes out of a clock hour of actual instructional time. These one hundred hours must consist of the following:
(a) Twenty-five hours of animal massage technique;
(b) Twenty-five hours of animal kinesiology;
(c) Twenty hours of animal anatomy and physiology;
(d) Four hours of animal first aid which includes knowledge of normal vital signs, identification of emergency or life threatening situations, emergency first-aid application, and legal boundaries of emergency situations; and
(e) Twenty-six hours of proper handling techniques which must include instruction on the ability to control the animal to minimize risk of harm to the animal and the animal massage ((practitioner)) therapist.
(2) Any school or training program that is required to be licensed by private vocational education (see chapter 28C.10 RCW or Title 28B RCW), or any other statute, must complete those requirements before the board will consider the training for approval.
AMENDATORY SECTION (Amending WSR 95-11-108, filed 5/23/95, effective 6/23/95)
WAC 246-830-440 Curriculum—Academic standards—Faculty—Student clinic.
(1) The curriculum of the ((school, program,)) massage school, massage program, transfer program or apprenticeship program ((shall)) must be designed and presented to meet or exceed the ((requirement of)) required five hundred hours.
(2) Academic standards. The ((school, program)) massage school, massage program, or apprenticeship program educator and trainer ((shall)) must regularly evaluate the quality of its instruction and have a clearly defined set of standards of competence required of its students. Promotion to each successive phase of the massage program and graduation ((shall be)) is dependent on mastery of the knowledge and skills presented in the massage school, massage program, or apprenticeship program.
(3) Faculty. An apprenticeship program educator and trainer((s)) and faculty member((s shall)) must be qualified by training and experience to give effective instruction in the subject(s) taught. An apprenticeship trainer and faculty member who teaches hands on courses must have a minimum of two-years experience in the subject matter being taught. The apprenticeship trainer and faculty member should develop and evaluate the curriculum instructional methods and facilities; student discipline, welfare, and counseling; assist in the establishment of administrative and educational policies, and scholarly and professional growth. A massage school((s)), massage program((s)), or apprenticeship program((s shall)) must not discriminate on the basis of sex, race, age, color, religion, physical handicap, ((or)) national or ethnic origin, or other basis prohibited by law in the recruitment and hiring of faculty.
(4) Student clinic (optional program). ((The clinical facilities shall)) Any setting in which a student clinic occurs must be adequate in size, number, and resources to provide for student practice of massage on the general public. ((There shall)) A clinic must be properly equipped rooms for consultations, massage therapy or treatment, and equipment as required in the practice of massage. A faculty member who is a ((licensed)) massage ((practitioner and adequately experienced)) therapist with at least two-years of experience in massage therapy must ((be present in the clinic at all times the clinic is open and in)) provide direct supervision ((of,)) as a clinical supervisor, per WAC 246-830-420 (1)(d), and have final decisions in((,)) the massage ((therapy)) treatment which is rendered to clients or patients by students. A faculty member in the role of a clinical supervisor must ensure a ratio of no less than one faculty member to ten students who are actively performing massage treatment.
AMENDATORY SECTION (Amending WSR 95-11-108, filed 5/23/95, effective 6/23/95)
WAC 246-830-450 Health, sanitation, and facility standards.
((All schools, programs, and apprenticeship programs shall)) A massage school, massage program, or apprenticeship program must have adequate facilities and equipment available for students learning massage therapy. All facility equipment ((shall)) must be maintained in accordance with local rules and ordinances in addition to those ((imposed)) required by chapter 246-830 WAC. Instructional and practice equipment ((shall)) must be similar to that found in common occupational practice. ((An adequate reference library, appropriate to the subjects being taught, shall be available.)) A massage school, massage program, or apprenticeship program will provide students with access to a variety of current and up-to-date reference and information resources that are pertinent to massage education and training.
AMENDATORY SECTION (Amending WSR 09-11-016, filed 5/7/09, effective 6/7/09)
WAC 246-830-475 Continuing education requirements.
(1) To renew a license, ((licensed)) a massage ((practitioners)) therapist must complete twenty-four hours of continuing education every two years.
(a) A minimum of eight hours must be direct supervised massage skills training; and
(b) A minimum of four hours must be in professional ethics, communication, ((and/or)) or Washington state massage laws and regulations. Two of these hours must include professional roles and boundaries; and
(c) The remaining twelve hours may be met by meeting the requirements in subsection (2) of this section.
(2) For the purposes of this chapter, continuing education is defined as any of the following activities that involve direct application of massage therapy knowledge, skills, and business practices:
(a) Attendance at a local, state, national, or international continuing education program.
(b) First aid, CPR, or emergency related classes.
(c) Self-study through the use of multimedia devices or the study of books, research materials, and/or other publications.
(i) Multimedia devices. The required documentation for this activity is a letter or other documentation from the organization. A maximum of twelve hours is allowed per reporting period.
(ii) Books, research materials, and/or other publications. The required documentation for this activity is a two-page synopsis of what was learned written by the licensee. A maximum of two hours is allowed per reporting period.
(d) Teaching a course for the first time, not to exceed eight hours.
(e) Business and management courses not to exceed eight hours.
(f) Specialized training. Training must be provided for a fee by an individual who has no less than three years of expertise in that area.
(g) Distance learning. Distance learning includes, but is not limited to, correspondence course, webinar, print, audio/video broadcasting, audio/video teleconferencing, computer aided instruction, e-learning/on-line-learning, or computer broadcasting/webcasting. A maximum of twelve hours is allowed per reporting period.
(h) Active service on massage related boards or committees. A maximum of twelve hours is allowed per reporting period.
AMENDATORY SECTION (Amending WSR 00-07-086, filed 3/15/00, effective 4/15/00)
WAC 246-830-485 Somatic education training program exemption.
(1) The secretary ((will consider approval for)) may approve an exemption from this chapter ((any)) for an individual who has completed a somatic education and training program that has a professional organization with a permanent administrative location that oversees the practice of somatic education and training and that has the following:
(a) Standards of practice;
(b) A training accreditation process;
(c) An instructor certification process;
(d) A ((practitioner)) therapist certification process;
(e) A code of ethics or code of professional conduct.
(2) An authorized representative ((shall)) must submit a request for approval of a program on forms provided by the secretary.
(3) The secretary ((or designee)) in consultation with the board will evaluate the education and training program and grant approval or denial. If denied, applicants will be given the opportunity to appeal through the brief adjudicative hearing process as authorized in chapter 246-10 WAC.
(4) The secretary may request from an approved education and training program, and the program ((shall)) must provide, updated information every three years to ensure the program's compliance with this rule. Approval may be withdrawn if the program fails to maintain the requirements of this rule. Where a determination has been made that the program no longer meets the requirements of this rule and a decision is made to withdraw approval, an approved program may appeal through the brief adjudicative proceeding as authorized in chapter 246-10 WAC.
(5) Organizations representing multiple training programs such as the International Alliance of Healthcare Educators, must obtain an exemption for each training program to ensure clarity regarding what is and is not exempt as a somatic education program.
AMENDATORY SECTION (Amending WSR 08-17-001, filed 8/6/08, effective 9/6/08)
WAC 246-830-490 Intraoral massage education and training.
((Licensed)) A massage ((practitioners)) therapist may perform intraoral massage after completing specific intraoral massage education and training and after receiving an intraoral massage endorsement to their massage ((practitioner)) therapist license.
To qualify for an intraoral massage endorsement ((you)) a massage therapist must complete the following education and training:
(1) Sixteen hours of direct supervised education and training, which must include:
(a) Hands-on intraoral massage techniques, cranial anatomy, physiology, and kinesiology; ((and))
(b) ((Hygienic practices, safety and sanitation; and
(c))) Pathology and contraindications((.)); and
(c) Hygienic practices, safety and sanitation. Hygienic practices, safety and sanitation includes, but is not limited to:
(i) Gloves ((shall)) must be worn during treatment and training which involves intraoral procedures((.));
(ii) Fresh gloves ((shall)) must be used for every intraoral client or patient contact((.));
(iii) Gloves that have been used for intraoral treatment must not be reused for any other purpose; and
(iv) Gloves ((shall)) must not be washed or reused for any purpose. The same pair of gloves ((shall)) must not be used, removed, and reused for the same client or patient at the same visit or for any other purpose. ((Gloves that have been used for intraoral treatment shall not be reused for any other purpose; and))
(2) Supervised education and training must be obtained from a ((licensed)) massage ((practitioner)) therapist endorsed in intraoral massage or from an individual who is licensed, certified, or registered and who has performed intraoral massage services within their authorized scope of practice.
((DISCIPLINARY))
MASSAGE BUSINESS
NEW SECTION
WAC 246-830-500 Equipment and sanitation.
(1) A massage therapist using hydrotherapies including, but not limited to, cabinet, vapor or steam baths, whirlpool, hot tub or tub baths must have available adequate shower facilities.
(2) All cabinets, showers, tubs, basins, massage or steam tables, hydrotherapy equipment, and all other fixed equipment used must be thoroughly cleansed using an effective bactericidal agent.
(3) Combs, brushes, shower caps, mechanical, massage and hydrotherapy instruments, or bathing devices that come in contact with the body must be sterilized or disinfected by modern and approved methods and instruments. Devices, equipment or parts thereof having been used on one person must be sterilized or disinfected before being used on another person.
(4) Impervious material must cover, full length and width, all massage tables or pads, pillows, bolsters, and face cradles directly under fresh sheets and linens or disposable paper sheets.
(5) A massage therapist must provide single service materials or clean linen such as sheets, towels, gowns, pillow cases, and all other linens used in the practice of massage. Linens must be stored in a sanitary manner.
(6) All towels and linens used for one client or patient must be laundered or cleaned before they are used on any other client or patient.
(7) All soiled linens must be immediately placed in a covered receptacle.
(8) Soap and clean towels must be provided by the massage therapist for use by massage therapists, clients or patients and any employees.
(9) All equipment must be clean, well maintained and in good repair.
NEW SECTION
WAC 246-830-510 Hygiene.
To maintain a professional standard of hygiene in their practice, a massage therapist must:
(1) Cleanse their exposed body part used for applying treatment, before and after each treatment, using a sink with hot water or a chemical germicidal product;
(2) Maintain a barrier of unbroken skin on their exposed body part used for applying treatment during each treatment and in the case of broken skin use a finger cot, glove or chemical barrier product to cover the affected area during treatment; and
(3) Wear clothing that is clean.
NEW SECTION
WAC 246-830-515 Operation of a massage business.
A person who owns or operates a massage business may be subject to legal action for practice without a license under RCW 18.130.190 if the massage business advertises massage and the massage business employs individuals to provide massages who are not licensed under chapter 18.108 RCW.
PRACTICE REQUIREMENTS AND LIMITATIONS
NEW SECTION
WAC 246-830-550 Standards of practice—Limitations.
(1) It is not consistent with the standard of practice for a massage therapist to touch the following body parts on a client or patient:
(a) Gluteal cleft distal to the coccyx, anus and rectum;
(b) Inside the mouth unless an intraoral endorsement has been issued;
(c) Penis;
(d) Prostate;
(e) Scrotum;
(f) Vagina, to include:
(i) Intravaginal;
(ii) Labia (majors and minors);
(iii) Clitoris;
(iv) Urethra; or
(g) Breasts, unless in accordance with WAC 246-830-555.
(2) A massage therapist must maintain evidence of the completion of at least sixteen specialized in-person contact hours of education and training if they are performing massage in the perineal area in addition to obtaining prior written and verbal informed consent. This written consent may be included within an overall general consent to massage document, if clearly delineated and either specifically initialed or signed.
(3) A massage therapist must not engage in sexual misconduct as described in WAC 246-16-100. Sexual misconduct will constitute grounds for disciplinary action.
NEW SECTION
WAC 246-830-555 Breast massage.
(1) Prior to performing breast massage, a massage therapist must:
(a) Acquire a prior signed written consent. The written consent for breast massage may be included within an overall general consent to massage document, if clearly delineated and either specifically initialed or signed. The written consent must:
(i) Be maintained with the client or patient's records;
(ii) Include a statement that the client or patient may discontinue the treatment at any time for any reason;
(iii) If the client or patient is under eighteen years of age, prior written consent must be obtained from a parent or legal guardian; and
(iv) Include a statement that the client or patient has the option to have a witness present, and that the witness must be provided by the client or patient.
(b) Use appropriate draping techniques as identified in WAC 246-830-560.
(2) In addition to the requirements identified in subsection (1) of this section, a massage therapist must maintain evidence of the completion of at least sixteen hours of specialized in-person education and training in breast massage beyond the minimum competencies. Education and training in breast massage includes, but is not limited to: Breast anatomy and physiology, pathology, indications, contraindications, therapeutic treatment techniques, draping, appropriate therapist-client or patient boundaries, expected outcomes, and client or patient safety related to breast massage.
(3) In addition to the requirements in subsections (1) and (2), prior to performing a massage of the nipples and areolas, a massage therapist must obtain additional documentation as follows:
(a) A written prescription or referral from a licensed medical health care provider for this specific treatment; or
(b) An additional prior written and verbal informed consent from the client or patient for massage of the nipple and areolas. This written consent may be included within an overall general consent to massage document, if clearly delineated and either specifically initialed or signed.
NEW SECTION
WAC 246-830-560 Coverage and draping.
(1) A massage therapist must:
(a) Allow a client or patient privacy to dress or undress except as may be necessary in emergencies or custodial situations; and
(b) Always provide the client or patient a gown or draping except as may be necessary in emergencies.
(2) Massage therapists must use safe and functional coverage and draping practices during the practice of massage when the client or patient is disrobed. The drape(s) must be sufficient to ensure the genitals and the gluteal cleft distal to the coccyx, anus and rectum are not exposed, and the breast area is not exposed except as allowed in subsections (3) and (4) of this section. Safe and functional coverage and draping means:
(a) The massage therapist explains, maintains and respects coverage and draping boundaries; and
(b) Massage or movement of the body does not expose genitals or gluteal cleft distal to the coccyx, anus and rectum, or does not expose the breast area except as allowed in subsections (3) and (4) of this section.
(3) With prior written, verbal, and signed informed consent of the client or patient, the gluteal and breast drapes may be temporarily moved in order to perform therapeutic treatment of the area. In addition, with informed and written consent, a client or patient may choose to have their upper torso undraped during the entire massage.
(4) If variations to this coverage and draping rule occur, a massage therapist must:
(a) Maintain evidence of education and training in specific modalities that require variations in coverage and draping;
(b) Receive voluntary and informed consent of the client or patient prior to any variation of coverage or draping; and
(c) Document in the client's or patient's record the rationale for any variation of coverage or draping.
(5) Any written consent required by this section may be included within an overall general consent to massage document, if clearly delineated and either specifically initialed or signed.
NEW SECTION
WAC 246-830-565 Recordkeeping.
(1) A massage therapist providing professional services to a client or patient must document services provided. Documentation should be appropriate to the venue, the type and complexity of those services and, when applicable, in sufficient detail to support and enable anticipated continuity of care. The documentation must include:
(a) Client or patient name and contact information or name and contact information of a parent or guardian if a client or patient is a minor;
(b) Age of client or patient;
(c) Health history sufficient to ascertain if there are cautions or contraindications to safe application of massage therapy, and an update of the current health status at each session;
(d) Date massage therapy is provided and the duration of treatment;
(e) The types of techniques and modalities applied;
(f) The location or areas of the body that received massage therapy;
(g) Written consent to treat;
(h) If breast massage is performed, an additional written consent to treat per WAC 246-830-555, and documentation of a therapeutic rationale;
(i) If breast massage of the nipples and areolas are involved, documentation of the prescription or referral per WAC 246-830-555 (3)(a), or an additional written consent to treat per WAC 246-830-555 (3)(b);
(j) Documentation of any written consent or any modification in coverage and draping as required by WAC 246-830-560; and
(k) For massage therapy where the focus is on treating a health condition, the following additional information is required:
(i) Symptoms, for example, pain, loss of function, and muscle stiffness;
(ii) Evaluation and findings, for example, movement, posture, palpation assessment and findings;
(iii) Outcome measures, for example, improvement in symptoms, movement, posture, palpation, and function;
(iv) Treatment plan for future sessions; and
(l) If performing massage in the perineal area, an additional written and verbal informed consent to treat per WAC 246-830-550(2).
(2) Client or patient records must be legible, permanent, and recorded within twenty-four hours of treatment. Documentation that is not recorded on the date of service must designate both the date of service and the date of the chart note entry. Corrections or additions to the client's or patient's records must be corrected by a single line drawn through the text and initialed so the original entry remains legible. In the case of computer-organized documentation, unintended entries may be identified and corrected, but must not be deleted from the record once the record is signed and completed or locked. Errors in spelling and grammar may be corrected and deleted.
(3) Correspondence relating to any referrals by other health care providers concerning the diagnosis, evaluation or treatment of the client or patient must be retained in the client or patient record.
(4) Client or patient records should clearly identify the massage therapist who is the provider of services by name and signature or electronic signature and date of service.
NEW SECTION
WAC 246-830-570 Record retention.
(1) A massage therapist who treats clients or patients eighteen years of age and older must keep client or patient records for at least three years from the date of last treatment.
(2) A massage therapist who treats clients or patients under the age of eighteen years old must keep client or patient records for at least three years after the client or patient reaches eighteen years old.
(3) A massage therapist must also comply with record retention requirements of chapter 70.02 RCW.
(4) All records must be secured with properly limited access in compliance with chapter 70.02 RCW and the Health Insurance Portability and Accountability Act (HIPAA).
(5) After the retention period, the massage therapist may dispose of the record. Disposal must be done in a secure and confidential manner in compliance with chapter 70.02 RCW and HIPAA and must include as appropriate:
(a) Shredding;
(b) Deleting, erasing, or reformatting electronic media; and
(c) Other readable forms of media that are defaced or rendered unusable or unreadable.
CREDENTIAL STATUS
NEW SECTION
WAC 246-830-575 Expired credential—Return to active status.
(1) A person holding an expired credential may not practice until the credential is returned to active status.
(2) If the credential has been expired for less than three years, he or she must meet the requirements of chapter 246-12 WAC, Part 2.
(3) If the credential has been expired for three years or more, he or she must comply with chapter 246-12 WAC, Part 2, and submit proof of completion of twenty-four hours of continuing education which was completed within the past two years of the date of application for renewal.
NEW SECTION
WAC 246-830-580 Inactive credential.
A massage therapist may obtain an inactive credential as described in chapter 246-12 WAC, Part 4.
REPEALER
The following sections of the Washington Administrative Code are repealed:
WAC 246-830-010
Meetings of the board.
WAC 246-830-040
Equipment and sanitation.
WAC 246-830-477
Inactive credential.
WAC 246-830-610
Definitions.
WAC 246-830-620
Mandatory reporting.
WAC 246-830-630
Health care institutions.
WAC 246-830-640
Massage practitioner associations or societies.
WAC 246-830-650
Health care service contractors and disability insurance carriers.
WAC 246-830-660
Professional liability carriers.
WAC 246-830-670
Courts.
WAC 246-830-680
State and federal agencies.