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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.

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