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Interstate Compact News

  • Interstate Massage Compact -- What choices does Washington have?

    27 Dec 2023 10:02 PM | WSMTA (Administrator)

    In this fourth blog post In WSMTA’s series about the Interstate Massage Compact, we wanted to discuss more about what Washington State could do about the Compact. If you have yet to visit our Compact Web page we would highly encourage you to do so after reading this blog.  Also, if you did not read the prior blogs, you can review them at:

    Before we get started, here are several reminders:

    • Mobility: The Compact would potentially help massage therapists to work in other Member States, it does not help them to move to other Member States.  Massage therapists who want to move have to do so completely separate from joining the Compact.

    • Activation of the Compact: For the Compact to come into existence, at least 7 states must pass the Interstate Massage Compact Model Legislative Language. The first seven states that pass the Interstate Massage Compact Model Legislature language will constitute the first Compact Commission.

    • Purpose of the Compact Commission: It is this Commission that will be responsible for promulgating Rules in order to effectively and efficiently implement and administer the purposes and provisions of the Compact.


      • "The Commission’s rulemaking authority shall be liberally construed so as to effectuate the purposes, and the implementation and administration of the Compact. Provisions of the Compact expressly authorizing or requiring the promulgation of Rules shall not be construed to limit the Commission’s rulemaking authority solely for those purposes." (Compact Model Legislative Language Article 13 (A)-Construction and Servability) 

      • "The Rules of the Commission shall have the force of law in each Member State." (Compact Model Legislative Language Article 10 (B)-Rulemaking)

      • The Compact Model Legislative Language states in Article 8, section B, subsections 1 and 2:

        • "Each Member State shall have and be limited to one (1) delegate selected by that Member State’s State Licensing Authority.

        • The delegate shall be the primary administrative officer of the State Licensing Authority or their designee."


      • It also states in the Definition section in Article 2:

        • “Licensing Authority” - a State’s regulatory body responsible for issuing Massage Therapy licenses or otherwise overseeing the Practice of Massage Therapy in that State.



    Here are the four ways WSMTA perceives that Washington could proceed with the Compact: 

    1. Join the Compact now as one of the first 7 states:

      1. Why Washington would want to join now:

        • Believe Washington could influence the Commission: Washington residents would have to believe they could influence the Compact Commission to make rules that would create the following controls:

          • Manage legal and regulatory change: Put controls in that would allow Member States and the Compact to know which Remote States LMTs would work in prior to the start of their beginning to work there. This would allow states to inform Multistate Licensees when there are law and regulatory changes and to provide better monitoring for disciplinary issues.

          • Administer a jurisprudence exam: Put in controls that would allow states to administer jurisprudence exams, should they want to, to ensure that massage therapists traveling to Washington know our laws and regulations before working here. This would protect the public, reduce the liability for Multistate Licensees and keep the licensing fees lower for resident LMTs.  The state, where a disciplinary issue occurs, bears the expense of bringing a case against multistate licensees who have violated laws and regulations which directly impacts state licensing fees if disciplinary expenses raise quicker than what is budgeted.

          • Protect professionalism and the public in Washington: Ensure the safety of the general public and protect the  professionalism of massage therapy in Washington State.


        • Civilian population ease of working in other states: The Compact would make it easier for some massage therapists to work in other states – a reminder that a massage therapist still has to maintain residence in their home state as well as acquire lodging and pay for transporting their goods to where they would work in other states.

        • Military Spouse ease of moving to work in other states: The Compact would make it easier for military spouses to obtain jobs across the country (as of May 2023 there were at least 72 military spouses who are licensed as LMTs in Washington).


      2. What Issues would Washington have to circumvent to make joining it worthwhile for Washington LMTs:

        • Strong Delegate Skills: The Washington Delegate to the Compact Commission would have to have both strong negotiating skills and be in agreement with what needs to happen instead of following the FSMTB party line which has argued for the totally free movement of massage therapists without controls in place.

          • Suggestion about Delegates: WSMTA suggests that should Washington join the Compact in the early stages of developing Compact Commission Rules that it should send both the Executive Director (or other Department of Health designee) and a Board of Massage professional member so that they can both bring their strengths and perspectives. This way our profession is better represented. Only one of these people would be the official delegate and would be able to vote, but together, they would offer the best solutions, especially when it comes to the qualifications for a Multistate Licensee.


        • Washington has to convince 6 other states to fix issues: Washington would have to convince the other 6 Member Delegates to the initial Commission meetings to vote its way to pass rules requiring all Multistate Licensees to register all places of business or employers outside of their Home State with the Compact, this would enable each Remote State, should they choose, the ability to:

          • Manage legal and regulatory change: Know who may be working in their state so any legal and regulatory changes can be provided to Compact Licensees working in their states.

          • Provide a Jurisprudence exam: Administer a jurisprudence exam to Multistate Licensees who indicate they intend to work in their state.  To be effective, this exam would have to be administered before an LMT has begun working in a Remote State.  If they took the exam after they were already working in a Remote State, they could potentially be prohibited from continuing to work in that state if they can not pass the exam. Ideally, the exam should be administered prior to an LMT working in a new state in case there is an issue in their taking the exam.


        • Washington has to convince 6 states on issues related to professionalism and protecting the public: Washington would have to convince the other 6 Member Delegates to the initial Commission meetings to vote its way to pass rules regarding the content of 625 educational hours, and other issues, along with the above requirements to check in to help protect the professionalism and reputation of massage therapists in Washington as well as to protect the public.


      3. What are the outcomes that could happen if Washington is one of the first seven states to join the Compact?

        • Rolling the dice on outcome: Washington would likely get some of what it wants in Commission Rulemaking, but not likely all it wants. Other states have much different priorities than Washington does as massage is treated as a personal service in many states.  There is absolutely no way to predict what would happen in this scenario, it would be a complete roll of the dice that joining the Compact would be helpful to Washington LMTs.

        • Compact Rules would significantly impact state’s if a state joins: The Compact Commission has a lot of authority to do as they wish, and these Rules they create will have the same force in Washington as our Washington Administrative Code does (WAC). Do we, as a profession/state, want to give away that authority/power when we have no idea what Rules will be written?

        • If the outcome is not good for Washington, withdrawing might not be possible: If we join the Compact hoping to help create Commission Rules in a way that benefits our state and other states as we have described above and we cannot get what we want, it could be very difficult to withdraw.

          • The Washington State Legislature would have to create a statute repealing the law it created to enact the Compact.  Legislators who helped to create the legislation to join Washington in the Interstate Massage Compact may not be willing to repeal it.

          • Or there could be other lobbyists that have stronger influence than massage therapists to keep us in the Compact.  The nurses in Washington were forced to join the Nurse Licensure Compact against their will by a stronger lobbyist group, the same could occur to keep our state in, if massage therapists wanted out.


    2. Join the Compact later:

      1. Why would Washington want to join later?

        • Washingtonians believe that they would not convince enough Commission delegates to vote their way in setting up the Commission Rules to make it worth joining.  Washington may join later if the Rules change.

        • The Compact does not offer a great enough benefit to offset the negatives and may choose to join at a later time.

        • Washington may remain out of the Compact initially, while still trying to influence the initial Compact Commission Delegates who do set up the initial Compact and join later if the Rules change enough to make it worth Washington joining.


      2. Discuss the issues that our state would have to circumvent to make the option happen:

        • Washington does have to watch the legislative processes to make sure that some other lobby group does not try to enter Washington into the Compact against the will of massage therapists.  This is what happened to the Washington nurses, they were forced to join the Compact by a lobbyist group stronger than theirs.


      3. What are the outcomes that could happen?

        • At the least, Washington has to do nothing to remain outside of the Compact.

        • At the most, Washington may have to fight off lobbyists of other interest groups that want Washington to join the Compact when Washington is not ready.

        • At the most, it would have to activate legislators to join the Compact at some time in the future should the Commission Rules offer a favorable environment for Washington to join.


    3. Not join the Compact:

      1. Why would Washington choose to not join the Compact?

        • Washingtonians believe that they would not convince enough Commission delegates to vote their way in setting up the Commission Rules to make it worth joining.

        • The Compact does not offer a great enough benefit to offset the negatives.


      2. Discuss the issues that our state would have to circumvent to make the option happen:

        • Washington does have to watch the legislative processes to make sure that some other lobby group does not try to enter Washington into the Compact against the will of massage therapists.  This is what happened to the Washington nurses, they were forced to join the Compact by a lobbyist group stronger than theirs.


      3. What are the outcomes that could happen?

        • At the least, Washington remains outside of the Compact.

        • At the most, Washington may have to fight off lobbyists of other interest groups that want Washington to join the Compact.


    4. Modify the Model Language prior to 7 states ratifying the Compact Model Legislative Language and activating the Compact.

      1. Why would Washington want to Modify the Model Language?

        • By modifying the Compact Legislative Model Language and activating the Compact with the modified Legislative Language, Washington could join the Compact knowing that the issues that exist with the Compact are resolved, prior to joining, instead of taking a chance that it could resolve them after joining the Compact.


      2. Discuss the issues that our state would have to circumvent to make the option happen:

        • At the time of publication there is one state that has passed the existing Compact Model Legislative Language and there are 3 that are at different stages of having their state legislatures review the Compact Model Legislative Language for approval.

        • To make this option happen, LMTs would need to volunteer to support efforts to talk with other states, to convince them to modify  the Compact Legislative Model Language for their state or initiate the modified Compact Legislative Model Language if it were not already in process.


      3. What are the outcomes that could happen?

        • If Washington could get enough states to change to the modified Compact Model Legislative Language, Washington could join knowing that the Compact would offer greater benefits to all parties involved.

        • If Washington could not get enough states to change to the modified Compact Model Legislative Language, then Washington would not initially join the Compact.

    Military Spouses:

    If Washington chooses to remain outside of the Compact, or the Compact is never activated, Washington legislators seem amenable to helping military spouses to more easily become licensed in Washington for the duration of their spouses deployment.  There are other states that have enacted laws creating a simpler pathway to licensure for military spouses that Washington could copy.

    Conclusion:

    These are the options that WSMTA believes are available at this time.  The first option is the most complicated and the riskiest, so we advise everyone to read through the details carefully. If you have any questions, comments or have ideas about other options, please contact us at gr@mywsmta.org.

    Our next step is to send out a poll, to see how LMTs are feeling about the Compact.  The poll will be emailed out within the next several days.  In the interim, if you have not read all of the materials WSMTA has created about the Compact, we encourage you to do so, so you are fully informed when answering the poll questions.

    Thank you!

  • Interstate Massage Compact -- Mobility and Structural Issues (Part 1)

    21 Dec 2023 9:23 PM | Robbin Blake (Administrator)

    In this blog post about the Interstate Massage Compact, we wanted to discuss more about what mobility means within the Compact (Part 1), as well as focus on some of the structural issues that we see with this Massage Compact (Part 2). If you have yet to visit our Compact Web page we would highly encourage you to do so after reading this blog.  Also, if you did not read the prior blog, you can view it at: Interstate Massage Compact--What It Is and Professional Issues

    We use a lot of examples in this blog.  Please remember that at the time of publication, the Interstate Massage Compact is not active and the states we reference are not Member States or non-Member States of the Interstate Massage Compact at this time, these are all examples.

    Some useful definitions: In this blog we will be using the following terms quite a bit:

    • Home State: means the Member State which is a Licensee’s primary state of residence where the Licensee holds an active Single-State License.
    • Member State: any State that has adopted this Compact.
    • Multistate License: a license that consists of Authorizations to Practice Massage Therapy in all Remote States pursuant to this Compact, which shall be subject to the enforcement jurisdiction of the Licensing Authority in a Licensee’s Home State.
    • Remote State: any Member State, other than the Licensee’s Home State.
    • Single-State License: a current, valid authorization issued by a Member State’s Licensing Authority allowing an individual to fully practice Massage Therapy, that is not a restricted, student, provisional, temporary, or inactive practice authorization and authorizes practice only within the issuing State.

    If the Interstate Massage Compact was already in existence, then an LMT who joined the Compact would have a Multistate License which would authorize them to practice in any other Member State which had joined the Compact.  The state in which this LMT lived is the LMT’s Home State and any other Member State this LMT works in outside of their Home State is considered to be a Remote State.  This LMT’s Single-State License is the license of their Home State. 

    For example, I live in Washington, which would be my Home State and I have a Single-State License here which is my Washington massage therapy license.  If I apply for and obtain a Multistate License, because I want to work in Ohio, which is another member of the Compact, then Ohio would be a Remote State to me.  I then hold two licenses:  my Washington State massage license and my Compact Multistate License.

    Obtaining a Multistate License: Before an individual LMT can join the Compact, the State where they live, has to join first.  Once their state joins, and if the LMT meets the Compact eligibility requirements, then that LMT can choose to join the Compact if they want to.  If a state joins the Compact, it is up to the individual LMTs in that state to make a decision to join the Compact – just because a state becomes a Member State of the Compact, the massage therapists in that state do not automatically also become members.  They have to individually meet the Compact requirements and individually apply to join.  Here are some examples:

    • My Home State is not part of the Compact: If the state in which I live does not join the compact, then I cannot join the Compact.
    • My Home State, which was part of the Compact, decides to withdraw: If the state in which I live withdraws from the Compact, then I and all LMTs who reside in that state and have Multistate Licenses will lose our Multistate Licenses and cannot join the Compact while living in that state.
    • My Home State is part of the Compact and I want to work in another Member State (also known as a Remote State): I apply for my Multistate License in my Home State.  Once I obtain it, I can then work in any other Member State of the Compact.  I must maintain my residence and my Single-State License in my Home State, but I can work in any other state that belongs to the Compact.

    A Multistate License allows you to work in another state, it does not assist you to move to another state: This is the most misunderstood part of most Compacts.  All healthcare Compacts, to our knowledge, have this same stipulation.  Joining the Compact does not help LMTs to move from one state to another and transfer their massage license, it only permits them to work in other Member States while they maintain their residence in their Home State.  Here are some situational examples:

    • My Home State is a Member State and I want to work in a non-Member State:  In this example, my Home State is Washington and I want to work in Idaho, which in this example is not part of the Compact.  I would have to obtain an Idaho massage license to work there.  Having a Multistate License will not allow me to work in Idaho since Idaho is a non-Member State.  If I have no desire to work in other states outside of Washington and Idaho and Idaho never joins the Compact, then it would make sense for me to maintain my Washington massage license, obtain my Idaho License and not join the Compact.

    • My Home State is a Member State and I want to work in two Remote States:  In this example, my Home State is Washington and I want to work in Arizona where I like to spend winters and Wisconsin where I have family, both of these states are also member states.  My Home State is Washington and I have my Washington State License.  I join the Compact and obtain my Multistate License.  Winter comes and I travel to Arizona and do massage there. I live in a motorhome with my husband and we travel back to Washington in spring.  During summer, I travel to Wisconsin and do massage there while I stay with my brother’s family for a few months and then I return back to Washington.  In this example, I maintain my Washington massage license and I join the Compact and obtain a Multistate License to work in other Member States.

    • My Home State is a Member State and I want to work for a large multistate employer in another Member State:  In this example, my Home State is in Washington and an employer hires me to work in their Casino Hotel in Las Vegas, Nevada and Nevada is another member of the Compact.  In all situations, I have to maintain my home residence in Washington, which means I would have to obtain secondary housing in Las Vegas, as I can only work in Nevada, I can’t move there as part of the Compact.  Someone, either myself or my employer would need to pay for temporary housing while I work in Las Vegas.  I would also have to bring the necessary clothing and household goods with me to stay there for a period of time (or purchase them in Nevada) which would be an added relocation expense.

    • I move to another Member State:  In the instance that I move my residence to Nevada because I’ve been working at the Casino Hotel for a while and they offered me a regular job, I will have to do the following:

      • Obtain a Single-State License in the Member State you move to:  I would need to obtain a Single-State License from Nevada through their “Licensure by Endorsement” process (I will discuss this process in the next section). This means that with my Washington massage License, I am able to apply to the Nevada State Board of Massage for a Nevada massage License.

      • Obtain a new Compact Multistate License:  It is possible the Compact Commission, once created, could create different rules about this, but at this time a Compact License is obtained through your home state.  If you move, your Home State changes which means that I would also need to obtain a new Multistate License through Nevada.  It is possible the Compact Commission could create rules allowing me to transfer my Home State designation within the Commission and therefore I could transfer my Multistate License to Nevada as my new home state, but since the Compact does not yet exist, this would be speculation.  

    These are things to consider when deciding to join the Compact, if it is ever activated and our state joins:

    • Is it cheaper to obtain a Single-State massage License, or is it cheaper to join the Compact and obtain a Multistate License if you only want to work in one additional state?

    • Are all of the states you want to work in Member States of the Compact?  If not, then you should do an analysis to determine if it’s cheaper to join the compact or to obtain a license for each state you want to work in.

    • Who pays to relocate you to the new work location, including the personal items needed for an extended stay?  If you are not self-employed, is it you or your employer paying for the relocation?  A reminder this cannot be a permanent change of residence, otherwise you would have to obtain a new massage license in the state you have changed your residence to.

    • If you are not staying with relatives, friends or living in a vacation dwelling that you or your family own, who pays for your lodging while working in a Remote State?  Since you are required to maintain your residence in your Home State, working in other states requires additional lodging expenses for you.  If you are not self-employed, is it you or your employer paying for these expenses?

    As we have stated, the Compact helps you to work in other states, it does not help you to move to other states.  Moving from one state to another, if you already have a massage license, is done through “Licensure by Endorsement”.  This process will not change should the Interstate Massage Compact go into effect.

    Licensure by endorsement – moving from state to state: As we mentioned in the prior blog and in the section before, the system that is currently in place that enables licensed massage therapists to move to another state and transfer their massage license, is called “Licensure by Endorsement”.  This system will remain in place even should the Compact become activated.  Generally, for most states, Licensure by Endorsement, means that the massage therapist moving to your state has:

    • a massage license in good standing from the state they are moving from,

    • the equivalent educational requirement in the state they are moving to, and

    • passed a test, such as MBLEX, NCBTMB or a state-based test

    For a licensed massage therapist wanting to move to Washington or live in another state and work in Washington, they would do so by licensure by endorsement. WAC 246-830-035 provides for licensed massage therapists from other states that have substantially equivalent requirements to be granted a license in Washington. If the massage therapist comes from a state that does not have substantially equivalent requirements there is WAC 246-830-037 Transfer Programs, that will guide the massage therapist in getting the additional education they need to qualify for a Washington massage license.

    The purpose of licensure by endorsement:  Almost all states that regulate massage want massage therapists moving to their states or working in their states from another state to be compatible with the massage therapists licensed in their state.  The only way they can do this is to set standards via Licensure by Endorsement, which is, as we described above, based on a level of base education equivalent to the state you are going to move to (or work in), having a massage license in good standing and having passed an exam. 

    In the prior blog, we talked about professionalism and why the 625-hour educational requirement to join the Compact will affect some massage therapists and overall what it means to our profession here in Washington.  This is why what comprises 625 hours of massage education is very important and why we want massage therapists to make this determination and not regulators.  To read more about this topic, refer to the prior blog at: Interstate Massage Compact--What It Is and Professional Issues

    Now we are going to turn our attention to the issues created by taking the Nurse Licensure Compact and using it as the basis for the Interstate Massage Compact.  This blog is continued in the Interstate Massage Compact -- Mobility and Structural Issues (Part 2).

  • Interstate Massage Compact -- Mobility and Structural Issues (Part 2)

    21 Dec 2023 8:55 PM | Robbin Blake (Administrator)

    This is the continuation of the Interstate Massage Compact -- Mobility and Structural Issues (Part 1) blog.  If you have not read the Mobility section, please read it first by clicking the above link.  Part 2 continues the discussion on Structural Issues of the Interstate Massage Compact.

    Creation of the Interstate Massage Compact based on the Nurse Licensure Compact (NLC): There were 14 organizations in addition to the Federation of State Massage Therapy Boards (FSMTB) and the Council of State Governments (CSG) that worked together to develop the Interstate Massage Compact. WSMTA does not know why the Nurse Licensure Compact was chosen to be the Compact model to base the Interstate Massage Compact on.  But they did.  If it had been WSMTA’s choice, we would have chosen the Compact Model the Physical Therapists have.

    Due to our Compact being based on the NLC, WSMTA feels that massage therapists holding a license through the Interstate Massage Compact will potentially:

    • be put at a greater risk of causing harm to the general public
    • face greater risk of civil, criminal and regulatory charges
    • experience an increase in Washington massage licensing fees, and

    • negatively impact the reputation of the massage therapy profession in Washington State (discussed in the prior blog)

    About the Nurse Licensure Compact (NLC):  The original Nurse Licensure Compact was created in 2000.  The original Compact was dissolved and shortly after the dissolution, the current Nurse Licensure Compact (NLC) was created in 2018.  The NLC was developed for RNs and LPN/VNs.

    Until 2023, Washington had remained out of the NLC, the nurses choosing not to join.  However, employer interests (hospitals and large medical clinics, etc.) had stronger lobbyists and were able to convince Washington State Legislators to have our state join the NLC against the nurses' will.  More about this is stated in the Similarity of issues between the Nurse Licensure Compact (NLC) and the Interstate Massage Compact: section on WSMTA’s Compact webpage.

    Here are characteristics of the NLC:

    • The NLC model allows Compact Licensees to work freely among the compact states without ever reporting where they work to the Compact or with the state regulatory agencies in the states they work.

    • It relies on nurses to discover and to learn on their own, the regulatory requirements in the states they work in.  This regulatory self-education can occur before or after they begin work in a Remote State depending on how diligent each individual nurse is.

    • When nurses move their residence, the Nurse Licensure Compact requires them to transfer their Single-State License from their Home State to the new state they move their residence. The NLC, like the Interstate Massage Compact, does not help nurses to move from state to state, it helps them to work in other Compact Member States separate from the state they reside in.

    Differences between nurses and massage therapists:  There are some very large structural differences between the employment of nurses and massage therapists:

    • The American Association of Colleges of Nurses estimates that there are 5.2 million RNs. In 2022, AMTA estimated there were 346,587 licensed massage therapists.

    • Nurses generally work for larger employers, such as hospitals, medical clinics, nursing facilities, hospice, travel nurse organizations, etc.  LMTs generally work for themselves, or small employers which may or may not be in a healthcare setting, many LMTs hold several different massage positions.  Infrequently, a massage therapist will work for a large destination hotel or resort.  Or even more infrequently follow a band, dance company or sports team across the country.

    • Nurses generally work for employers that have HR departments and have formal onboarding processes for new hires whereas the majority of places an LMT might work at do not have these or have significantly less formal processes.

    • For nurses, government regulations and the opportunity for malpractice suits generally tend to create a stronger need to know state laws and regulations and to follow rules created by their employers.  This same atmosphere does not generally exist with massage therapists as they are much more independent.

    These structural differences mean that while nurses have the freedom to move from state to state, they will more than likely have employers who make sure they are on-boarded and follow the laws and regulations in the state they are working in because these laws and regulations are more likely to be built into the fabric of their employment as nurses.  Whereas massage therapists often work on their own or may work for employers who may not know the laws and regulations as they pertain to massage therapists because their places of employment might not also be owned or managed by massage therapists or other allied healthcare professionals.

    About the Physical Therapy (PT) Compact:  Because of the employment differences between nurses and massage therapists, WSMTA would have preferred to have had the Physical Therapy Compact Model used for the basis of the Interstate Massage Compact instead of the NLC.  Structurally, our profession is more similar to physical therapists.  While more PTs are employees than massage therapists, generally there are more similarities between how we work, what we do and where we work versus between nurses and LMTs.

    The Physical Therapy (PT) Compact, Occupational Therapists (OT) Compact and 4 other Healthcare Compacts all require Compact Licensees to obtain"CompactPrivilege" for each state they choose to work in. This means that for every Compact Member State that a PT wants to work in, they must contact their Compact, request Compact Privilege for that state by paying a small fee, and then take a jurisprudence exam (if the state requires it).Like the Nurse Licensure Compact and the Interstate Massage Compact, the PT Compact Compact helps Multistate Licensees to work in Compact Member States, it does not help them to move from one Compact Member State to another.

    The benefits of Compact Privilege:

    • It allows the regulatory agency in each Compact Member State to know who has the ability to work in their state.

    • It allows the regulatory agency in each Compact Member State to notify Compact Privilege holders in their state when laws, regulations and rules have changed.

    • For those Member States that require a jurisprudence exam, the exam ensures that PTs working in their state know the laws, regulations, and rules of their state prior to working in their state.

    • By ensuring that Compact Licensees know the laws and regulations prior to working in a given state, it helps to reduce issues related to scope of practice and practice act differences as well as reduce potential regulatory and criminal issues a therapist could experience if they practice without knowing the legal requirements in each state they work in.

    While the Nurse Licensure Compact relies on larger employers to notify nurses of laws, regulations and practice acts in the state they are working, Compact Privilege is a more reliable substitute for employers, and it also helps the state regulatory agencies know who could be practicing in their state.  The state regulatory agencies for nurses do not know which Multistate nurses work in their state because nurses are not required to notify either their Compact or state regulatory agencies where they work.

    Issues created by the Compact Model selected for massage therapists:  WSMTA believes that the Interstate Massage Compact would remove too much regulatory authority from the Member States and the Compact Commission and it would give too much freedom of movement to the Multistate Licensee (the massage therapist).  Without controls built in to ensure the safety of the public and the Multistate Licensee, it will create extra expense and liability for Member States, Multistate Licensees and the Compact in the following ways:

    • Multistate Licensees would not know the latest changes to laws and regulations: When any law or regulation changes in a state, the state does not have the ability to notify the Multistate Licensees practicing in its state of the changes which could lead to:

      • liability issues for the Multistate Licensees

      • added disciplinary expenses for the Multistate Licensee and Remote State they work in

      • additional expenses either to the Compact Member States or Compact to work around this issue

      • increased licensing fees to the resident massage therapists in a Compact Member State, since the Remote State's regulatory agency is financially responsible for any disciplinary action

    • Problems managing Multistate Licensees with disciplinary Issues: When a nurse in the Nurse Licensure Compact is facing disciplinary action, it is possible that the nurse could continue to illegally work in the Remote State because both the Compact and the regulatory agency of the state the nurse is working in do not know where the nurse is working due to the way their Compact model was created.  Since the Interstate Massage Compact is based on the Nurse Licensure Compact we could have this same issue.
    • Problems and expenses related to tracking large-scale licensure fraud: The large fraud case involving around 7600 illegal nursing degrees that was disclosed in February 2023 required a large-scale effort involving the FBI, national media and each state’s regulating agency to track down the thousands of nurses that were able to illegally become licensed.  Since nurses work for a relatively small number of employers (hospitals, clinics, travel nurses, hospice, etc.) and massage therapists work either for themselves or for a very large number of small employers, it would be really difficult to track down LMTs if a similar fraud situation happened with LMTs.  Most likely, the regulatory world would have to depend on the illegally gained licenses expiring and not being able to renew to remove any such fraudulent LMTs from practice.
    • Potential disciplinary and legal issues due to the lack of a jurisprudence exam given prior to practicing in a remote state: Because licensed massage therapists are healthcare providers in Washington State, we have considerably more and differing kinds of regulations and laws to navigate than all other states.  This has three implications:
      • Potential for Increased Washington State Licensing Fees: Washington State LMTs could have higher licensing fees, since issues related to misconduct by Multistate Licensees will be borne by the state the misconduct occurs in.
      • Greater Risk to the Public: The general public is at greater risk of harm from Multistate Licensees who do not know our laws and regulations.  Over time, this may impact the public's view of our value and professionalism in helping people to recover from their issues.
      • Greater Risk to Multistate Licensees: Multistate Licensees are at greater risk for having regulatory, civil or criminal charges brought against them as well as having their massage licenses sanctioned if they are not aware of all scope of practice issues and all laws and regulations in the Compact Member states they will be working in prior to working in those states.

    Conclusion: WSMTA is a big supporter of greater portability in the massage profession. We wholeheartedly endorse the idea of greater standardization in the regulation of the massage profession. But let's make sure that it benefits and uplifts the professionalism of massage as both wellness and treatment.

    Let’s also make sure that it doesn’t increase expenses to in-state massage therapists as well as create greater liability and financial risk for the Multistate Licensees, Member States and Compact.

    This was a quick overview of how the Compact would create mobility for massage therapists and an outline of the issues created by the structural differences between nurses and massage therapists. For a more in-depth dive please take a look at our Compact web page.

    Next week, we will be discussing the Compact options available to our state and then shortly after that we will be sending out a poll to find out what your thoughts are about the Compact and if the Compact would personally help you in your situation and how it would help you. This information will then be passed on to Washington Legislators.

    Thank you in advance for your time and dedication to educating yourself about the issues.

  • Interstate Massage Compact--What It Is and Professional Issues

    18 Dec 2023 10:37 AM | Marybeth Berney (Administrator)

    In this blog post about the Interstate Massage Compact we wanted to give you a brief overview of what Compacts are and why they exist, as well as focus on a few of the professional issues that we see with this Massage Compact in particular. If you have yet to visit our Compact Web page we would highly encourage you to do so after reading this blog.

    Current system in Washington: The system that is currently in place for licensed massage therapists wanting to come from other states to Washington to work is called, “Licensure By Endorsement”. WAC 246-830-035 provides for licensed massage therapists from other states that have substantially equivalent requirements to be granted a license in Washington. If the massage therapist comes from a state that does not have substantially equivalent requirements there is WAC 246-830-037 Transfer Programs, that will guide the massage therapist in getting the additional education they need to qualify for a Washington massage license. 

    Why do we have Occupational Licensure Compacts:  Through licensure compacts, states establish uniform standards to lower barriers to multi-state practice while preserving a state's practice act and initial licensure process. States that meet the eligibility criteria join interstate compacts by agreeing to the uniform provisions through the legislative process. Essentially, the goal is to create a more streamlined process for licensed professionals to work in multiple states without having to get a license in each state that they want to work in.

    Massage Licensure Compact:  The Interstate Massage Compact was created via a partnership between the Department of Defense (DoD), Council of State Governments (CSG) and the Federation of State Massage Therapy Boards (FSMTB). This Compact does not become effective until seven states pass legislation to enter into the Compact agreement. 

    One of the largest issues WSMTA has with the Interstate Massage Compact has to do with the model selected -- the Nurse Licensure Compact.  

      • WSMTA believes this model was selected by the committee essentially because it was deemed the simplest. It created mobility with the least amount of effort/involvement for the states involved. What most folks do not understand is that your mobility is only temporary. A multistate licensee can work in another Compact state but the Compact does not help them should they want to move to another state. This was a major misunderstanding for nurses and seems to be for massage therapists as well. 

      • WSMTA also believes that this model would remove too much regulatory authority from the states, transfer regulatory control to the Compact Commission and provide too much unregulated freedom of movement to the Multistate Licensee (the massage therapist).  Without controls built in to ensure the safety of the Multistate Licensee and the public, it could also create extra expense for Member States, Multistate Licensees and the Compact. 

      • If WSMTA had been asked to give input in the beginning of this process we would have advocated for modeling the Massage Compact after the Physical Therapy and Occupational Therapy Compacts. Those Compacts have something that is referred to as “Compact Privilege”. The primary benefits of “Compact Privilege” are:

      • The regulatory agency in each Compact state knows which Multistate Licensees are working in their state. Making it easier to keep them updated with regulatory changes and find them should there be complaints against them.

      • States that require a jurisprudence exam (like Washington) can administer that exam prior to the multistate licensee working in that state. Thus ensuring that they are aware of the scope of practice and any other unique regulatory requirements that the state might have.

    In conversations with a representative with CSG we did learn that the Interstate Massage Compact Legislative Model Language can be amended, but seven states would have to agree to the amended language for the Compact to be activated. And any states that had already passed the current language would have to go through their legislative process to amend the language to match, if they wanted to participate in the amended Compact.

    Multistate License Qualification:  The term for an Interstate Massage Compact license is “Multistate License”.  The first question you might ask yourself, if you are curious about a multi state massage license is, “Do I qualify for a Multistate License?” Here are the qualifications contained in the Legislative Model Language, by clicking HERE, but we are going to focus on the following,

    • 625 hours of massage education

    • Required national exam

    • Variety of regulations and scope of practices from state to state

    • Classification of massage therapists

    The answer to the question, “do I qualify for a Multistate License”  for many massage therapists in Washington that have received a license more recently will likely be a simple “yes”. You attended a massage education program of at least 625 hours and you took the MBLEx and received your Washington massage license. As long as you do not have a criminal record, your license is in good standing and you pay a fee you could apply for and receive a Multistate License.

    But the answer for many Washington massage therapists who have been licensed for a loooong time is not so straight forward. Take me for example.  I attended a massage program in 1984 that was 48 hours long. I did A&P, and other basic sciences in college. I took a state created written exam and a state created practical exam and received my massage license from the Washington Department of Licensing in 1985. In 1992 I took the NCBTMB exam to become nationally certified. The way the Compact language reads right now I would have to cross my fingers that the Compact Commission, once formed, would maybe create some Rules that might help me. Will they allow me to cobble together 577 hours of continuing education in massage to make up the difference between 48 hours and 625 hours? Will they allow my taking of the NCBTMB certification exam to qualify as a national exam (currently the only national exam that meets the definition in the legislative model is the MBLEx). I am not the only very experienced, successful massage therapist in WA in this situation! A very well known Washington massage therapist and educator attended a 60 hour massage program, took the state written and practical exam and has had a thriving practice ever since. She would have to cross her fingers too and hope the Compact Commission Rules will give her, the ability to cobble together 565 hrs. of massage continuing education and she would have to pay to take and pass the MBLEx if she wanted to be able to obtain a multistate massage license within this Compact.

    625 Hours of Massage Education: What should be required in lieu of 625 hrs. in a massage education program? In the examples above the number of hours of continuing education to reach 625 hours is a very significant number of hours. 

    • What should those hours consist of to make sure that a massage therapist is adequately trained to provide safe and effective massage?  
    • Can a certain number of hours in certain subjects really predict competence? 
    • Would years of practice be a better predictor? 
    • If  the Compact comes into existence and a Compact Commission is formed will the Commission have the expertise to make these important decisions on behalf of the massage profession when many of the Commission members might be regulators and not massage professionals?

    The committee that developed the Compact language chose 625 hours because of the Entry Level-Level Analysis Project (ELAP). ELAP is a great piece of work that helped to define what the entry-level minimum education should be for a massage therapist to practice safely.  Many massage therapy organizations came together to sponsor this work so it has the support of the vast majority of the massage community.

    The ELAP analysis stated that it was a particular content/curriculum of education that was of primary importance, and that it would take about 625 hours to deliver that content. The question and potential problem for the massage profession has to do with the massage therapist who graduated from a 60 hour program and might be allowed to make up the difference of 565 hours with random massage continuing education content. Is that really going to protect public safety? 

    • What makes a massage therapist competent and safe? This is an age-old question that still does not have a great answer.

    • Is it 625 hours of massage education?
    • Is it a particular curriculum?
    • Is it a certain number of years of practice?
    • Or is it some combination of all of the above?
    • Or is it the passage of a particular national exam?

    • As stated above, with the current Compact language will the Compact Commission members have the skill set to make these vital decisions when many, if not most, of the members might be regulators and not massage professionals or massage educators?

    Jurisprudence exams and differing scope of practices: The current Compact language does not allow states to administer a jurisprudence exam to Multistate Licensees. The onus for making sure a Multistate Licensee knows the rules in all the states that they might work in falls to the individual. Most massage therapists have no idea how different the regulations for massage are from one state to another. They likely do not even know where to look to find the regulations. 

    • If a Multistate Licensee is coming to Washington from Mississippi will they even be aware that they have to research massage regulations as well as regulations for all healthcare providers? 

    • Do they know about getting informed consent? 

    • Do they know how to chart and assess for function? 

    • If they are coming from Oregon are they aware that intervaginal work is not in scope in Washington? 

    • If they are coming from Florida, are they aware that colonic irrigation, lasers and other electronic devices like electric stimulation are not in scope in Washington?

    • Unaware massage therapists with good intentions could be set-up to not only fail but have regulatory or even criminal allegations brought against them simply because they are ignorant to our state's laws and regulations. 

    • And oh, by the way, the cost of disciplinary action by the Washington Department of Health will fall directly on the license fees that Washington LMT’s pay for their Washington massage license.

    Health care provider vs personal service provider: In Washington, massage therapists are somewhat unique in that they are classified as healthcare providers. In most states massage therapists are personal service providers. 

    • As we have seen in the examples above, the massage therapist coming to work in Washington from another state where they were trained as a personal service provider could have some very large gaps in their educational background and their understanding of the regulatory minefield of being a healthcare provider. 

    • Will other massage therapists, like this massage therapist, perhaps work or comport themselves in a way that could undermine the decades that many of us in Washington have dedicated to raising the professionalism of massage? 

    In Washington we have finally won the respect of other healthcare providers and massage consumers. We have shown that we can help people to relax and unwind and we can successfully treat their musculoskeletal issues too! Let’s not just give that away for the sake of portability.

    Conclusion: WSMTA is a big supporter of greater portability in the massage profession. We wholeheartedly endorse the idea of greater standardization in the regulation of the massage profession. But let's make sure that it benefits and uplifts the professionalism of massage as both wellness and treatment.

    If we allow anyone with just any random level of massage education to work in Washington then why did we increase the minimum education hours from 500 to 625, why do we have Licensure By Endorsement and Transfer Programs?

    WSMTA supports the many military families that spend some time in Washington. The Washington Legislature and the Board of Massage are already hard at work making it easier for these families to move from one deployment to another and more easily obtain a professional license.

    This was a very quick perusal of a few of the professional issues with this particular Compact. For a more in-depth dive please take a look at our Compact web page.

    Later this week we will be sending you information about some of the structural issues with this Compact and what some possible solutions might be to those issues. After that we will be sending out a poll to find out what your thoughts are about the Compact and if the Compact would personally help you in your situation and how it would help you. This information will then be passed on to Washington Legislators.

    Thanks in advance for your time and dedication to educating yourself about the issues.

  • Interstate Massage Compact -- Issues & Details

    13 Dec 2023 8:00 PM | Robbin Blake (Administrator)

    In January 2023, the lobbyist for a large national massage therapy chain initiated legislation to enter Washington into the Interstate Massage Compact at a time when almost all Washington massage therapists knew nothing about the Compact.  WSMTA was instrumental in having this legislation pulled from the 2023 legislative session so our profession could have greater input in 2024.

    WSMTA was tasked to research the compact, review the variety of healthcare compacts available, talk to the Washington State physical therapist and nurse associations to determine how their respective compacts work for them.  We have created a page on our website that provides:

    • Issues about the Compact – these are in the lavender section of the webpage

    • Details about the Compact – these are in the blue section of the webpage

    • Discussion on the four ways that Washington State could act with regards to the Interstate Massage Compact

    WSMTA's Compact webpage can be found at: Interstate Massage Compact

    It is important for all massage therapists in our state to learn about the Compact.  As Washington nurses experienced earlier this year, it's not always a profession's choice to enter a compact.  Washington nurses were entered into their Nurse Licensure Compact against their will because the lobbyists for large employers of nurses (e.g. hospitals and large clinics) had greater influence and money than their own.  We would like LMTs in our state to know what the details of the Interstate Massage Compact are as well as the issues, so you can make informed decisions.

    Over the next several weeks we will email out more information about the Compact.  For now, we encourage you to go to our webpage to read about the issues and details about the Compact.  We provided links so everyone can see the original source documents for the Compact for those intrepid explorers who want more. If you have limited time, we recommend that you start with reading the issues first (lavender boxes) and then as you are able to, go back and read through the details (blue boxes) about the Compact.

    We need massage therapists to be as informed as possible to help determine the pathway our state should take, which is discussed towards the end of this webpage in the section, What should Washington State do about the Interstate Massage Compact?

    Thank you in advance for taking the time to visit our webpage.  If you have any questions, or would like to leave comments, please contact us at gr@mywsmta.org.

    Sincerely,

    The Government Relations Program

    Robbin, Marybeth and Stephanie

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