On 9/1/21, revisions and additions to the regulations in the Massage Therapy WAC Chapter 246-830 will go into effect.  One of the changes that will affect licensed massage therapists the most is that CPR will be part of our CE requirement to renew our licenses.

Historically, we only needed to have completed CPR in massage school to obtain our initial massage license. However, starting 9/1/21, it will also be a requirement to renew our massage license.  You can see the new CPR CE requirement at: WAC 246-830-475.    The new CPR subsection states:

(2)(c) Maintenance of certification in American Heart Association CPR or equivalent. A maximum of four hours is allowed per reporting period.

It is also a requirement in many insurance contracts, if you are an insurance provider.  We have always been able to use CPR for CE, but now it is a requirement.

At the time this article was written, online, classroom and online-classroom hybrid options were available and were easy to find on the internet.  If you live in a more rural area, check with your local fire stations and hospitals to see if they have resumed in-person CPR classes.

One thing about CPR classes, at the end of class you get a card showing that you passed, but it doesn’t indicate the number of hours you attended to obtain your certificate.  Our suggestion is to create a form and take it with you.  Make sure it has all of these details pre-filled in as indicated in CE WAC 246-830-475 subsection:

(4) A massage therapist must provide acceptable documentation of continuing education upon request or audit. Acceptable forms of documentation include, but are not limited to: 

(d) Other formal documentation that includes the following:

(i) Participant’s name;
(ii) Course title;
(iii) Course description;
(iv) Date or dates of course;
(v) Number of hours;
(vi) Indication of being an in-person course, self-study as referenced in subsection (3)(c) of this section, or distance learning as referenced in subsection (3)(f) of this section;
(vii) Instructor’s name or sponsor organization name or names;
(viii) Instructor or sponsor contact information; and
(ix) Signature of the program sponsor or course instructor. The self-study allowed in subsection (3)(c) of this section is exempt from this requirement.

At the end of class, all you need to do is to have your instructor write in the number of hours and then sign and date it.

ALERT: Legislature to Vote Soon on Unemployment Claims Processing Reform! Dear friend of ULP: The final hurdles have been crossed and SB 5193, an important bill, backed by ULP, which will improve many aspects of unemployment claims processing at the Employment Security Department (ESD), will be voted on at any time. Key committees in the House of Representatives have okayed the measure and any day now, it will go to the floor for a vote before the full chamber. The Senate already voted Yes on an earlier version of the bill. Some differences between the bills remain to be ironed out and then, with a Yes vote in the House, Washington will have several new provisions to protect claimants from the snarls, dead ends, and delays many encountered over the last 12 months when they were desperately in need of the unemployment benefits they had earned through their work. SB 5193 requires ESD to: Launch a training program to create a pool of adjudicators to have in reserve when unemployment claims levels surge. Use plain language, tested on claimants for comprehensibility, in all letters, alerts, and notices; Clearly explain the law behind determinations and redeterminations, the relevant facts, the reasoning, the decision and the result; Explore: thresholds that trigger automatic adjustments in staffing, a pilot to provide a caseworker approach to benefit claims, and increased language access; Dedicate a toll-free number for claimants with limited computer access or computer skills; Maintain an online data dashboard, and provide quarterly reports with performance metrics that include updates of unemployment rates, claims data, claims center phone statistics, staffing ratios, overpayment data, and other information. Report quarterly to the legislature on various other claims processing issues. Please help SB 5193 cross the finish line!

Contact your legislators today and request their support for this measure urgently needed to protect Washington's more than 3 million workers.

To find your state representatives and senator, use this link: https://app.leg.wa.gov/DistrictFinder/.

Thank you for your help in ensuring that our unemployment benefits system provides support that Washington workers and their families can count on.

Sincerely,
Anne Paxton
Attorney & Policy Director
Unemployment Law Project

On 9/1/21, revisions and additions to the regulations in the Massage Therapy WAC Chapter 246-830 will go into effect.  One of the biggest changes that will go into effect on 9/1/21, will be that 625 massage school hours will be the new minimum requirement to obtain a new massage therapy license in Washington state.  Historically, 500 hours has been the minimum hours required.  If you are already licensed in Washington State, this will not affect you, but it will affect massage schools and massage therapists transferring in from another state.

Back in 2012, the Coalition of National Massage Therapy Associations initiated the Entry-Level Analysis Project (ELAP) which analyzed our profession to determine the minimum level of coursework for a basic massage program that would keep the public safe and provide safe and competent massage therapists.  ELAP proposed a program which in total added up to 625 hours.  After much public discussion, including from WSMTA, the Board of Massage made some changes to the ELAP content to make it work for Washington State, but kept to the recommended 625 hours.

Although more and more states are moving to 625 hours as the new minimum number of massage school hours, most states have not.  Because many states still require only a minimum of 500 hours, credentialed massage therapists from other states can transfer in to Washington State if they meet the following new revised requirements found in WAC 246-830-035 Licensing by endorsement for out-of-state applicants (just click on the link, make sure to look at the revised wording effective 9/1/21).

Over the upcoming weeks, we will bring you more details about the WAC revisions and updates.  The Department of Health has the CR-103 language (shows the revisions) posted on the Massage Therapist landing page which you can read at: https://www.doh.wa.gov/LicensesPermitsandCertificates/ProfessionsNewReneworUpdate/MassageTherapist (just scroll down the landing page to the third bullet under “Current Topics” titled “Rule Making Activity” and click on the link for the CR-103 document).  If you would like to see the current WACs listed with full language next to the revised language that is effective 9/1/20, click on this link, Massage Therapy WAC Chapter 246-830, and open one of the sections, such as  “Definitions”.  First, the current language will be listed and then the revised language.  Not all sections were revised, so you might see some sections that do not have revisions.

To see the latest news from the most recent Board of Massage meeting click here.

RCW 48.43.016 “Prior Authorization Standards and Criteria—Health carrier Requirements—Definitions”.  On March 22, 2020, the Governor signed into law ESB 5887 which amends RCW 48.43.016.  This is the RCW amendment which went into effect in June 2018 which provided for 6 consecutive treatment visits for massage therapy and other occupational therapies for plans requiring preauthorization. This 2018 amendment was meant to create stability of care with Premera and Regence patients/clients processed through eviCore.  Unfortunately, health insurance companies managed to create their own interpretation of this law which created havoc when trying to provide the continuity of care for our patients/clients using these plans, for the past two years. 

With this new 2020 bill, each patient may have “six treatment visits with a contracting provider in a new episode of care for each of the following: Chiropractic, physical therapy, occupational therapy, acupuncture, Eastern medicine, massage therapy, or speech and hearing therapies”.  Whereas the health carriers were interpreting this as “six sessions total” regardless of which profession provided service, it now clearly states 6 sessions per profession. The other major change is the health carrier cannot “deny or limit coverage on the basis of medical necessity or appropriateness or retroactively deny care or refuse payment for the visits”.  If you go to https://apps.leg.wa.gov/RCW/default.aspx?cite=48.43.016, you can review the current RCW and there is a link to see the new language which went into effect on 6/11/20.

Information on SB 5169

The WSMTA Government Relations Program wants to make you aware of a bill working its way through the current WA state legislative session. Senate Bill 5169 is, “AN ACT Relating to provider reimbursement for personal protective equipment during the state of emergency related to COVID-19; adding a new section to chapter 48.43 RCW; creating new sections; providing a contingent expiration date; and declaring an emergency”.

You can read the full text of the bill here,  https://app.leg.wa.gov/billinfo/

Here are the highlights of this bill.

• The bill's primary driver is the WA State Medical Association.

• The bill provides a code to bill for insurance reimbursement for PPE. The code is 99072. The max dollar reimbursement amount is $6.57 per patient encounter.

• The bill covers “all healthcare providers”.

• The bill will only be in effect as long as the declaration of a state of emergence continues.

• It is prospective and not retroactive.

There will likely be amendments (coming from the health carriers) to the bill, as this is alluded to in the testimony before the Long Term Health Committee.  You can watch that hearing here,  https://www.tvw.org/watch/?eventID=2021011450

 Likely amendments so far are (nothing has been made public as of the writing of the update).

• Only in-person patient encounters will qualify.

• The provider must have actually incurred cost. For example, you have cost for a new mask for each patient vs you reuse the same mask for multiple patient encounters.

• Tying the mandate to the federal state of emergency rather than WA’s state of emergency.

Governor’s Proposed Operating Budget – Summary

December 2020

DOH 21 Suppl _ 21-23 Bien Gov Ops Budget.pdf

Governor’s Budget-DOH Information 12/18/2020

1. DOH Summary of Governor’s Budget. 2021 Supplemental budget as well as 21-23 Biennial Budget.(see attached)

2. The governor’s biennial budget is proposing almost everything that DOH has asked for.

3. WA COVID-19 response and vaccination program will be funded primarily through state funds, unless Congress passes additional funds for local governments.

4. There are NO proposed reductions to public health in the Governor’s budget. Despite the Governor originally asking for 15% cuts from all state agency budgets.

5. There are proposed DOH staff salary items, 1 furlough day per month and no cost of living increases. 

6. Once the Legislature convenes (1/11/2021), the House and Senate will each propose their own version of a budget and then work toward common ground.

7. Sunday, 12/20/2020 will be the last official day for Secretary of Health, John Wiesman. On Monday the new Secretary of Health, Dr. Umair A. Shah MD MPH will officially take the reins of DOH.

You may have received a notice from a DOH listserve about this Bill, if you are signed-up for certain listservs with the DOH. WSMTA has become aware that some massage therapists are confused about what/if this means for massage. I hope this helps.

Interpretation of ESHB 1608 for Massage Therapists: An Act relating to protecting patient care…

The primary intent of this Bill is aimed at healthcare providers that have the ability, in their scope of practice, to provide differential diagnosis. It is primarily about their “right” to counsel and provide information about the full array of treatment alternatives that are available in the community, without the risk of being fired or losing privileges. For example, a provider working at a Catholic Hospital who is afraid they could lose their privileges if they counsel a patient on the Death with Dignity Act, abortion, or birth control. The full text of the Bill can be found here, http://lawfilesext.leg.wa.gov/biennium/2019-20/Pdf/Bills/House%20Passed%20Legislature/1608-S.PL.pdf?q=20200813114524

What does this Bill mean for LMTs? Let us take the language of this bill and really break it down. How do we as licensed healthcare providers in WA  practice according to the letter of the law and in our patients/clients’ best interest. 

As healthcare providers we have the right and responsibility to provide accurate information to our patients/clients. This bill is spelling out that we MUST present information in a way that…

1. Is with-in our scope of practice, education, training, and experience.

2. With-in the accepted standard of care.

3. Medically accurate

So, let’s look at the definitions that are in WA state statute.

"Health care provider" means a person who is licensed, certified, registered, or otherwise authorized by the law of this state to provide health care in the ordinary course of business or practice of a profession. RCW 70.02.010   

"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 a thrusting force, nor does it include genital manipulation.

“Medically accurate” means information that is verified or supported by research in compliance with scientific methods, published in peer-review journals, recognized as accurate and objective by professional organizations.

We know this Bill applies to us, as we meet the definition of healthcare provider. If we are going to provide information to, or counsel our patients/clients, we need to make sure that information and counsel stays within scope and is medically accurate. Our scope of practice is limited to external manipulation or pressure of soft tissues for therapeutic purposes and within that limit we need to make sure we focus on passing along information that is supported by research and recognized as accurate. 

This Bill does not speak to this but, remember, you can always suggest that your patient go back to their physician, get a second opinion or try another provider type if they are not making progress.

I hope this helps to clear up any questions that you might have had about this new statute. If you have further questions about your scope of practice limitations, please contact Megan Maxey, Program Manager for Board of Massage at Megan.Maxey@doh.wa.gov.

Marybeth Berney

WSMTA President

The regular session of the 2020 Washington State Legislature officially ended on March 12. With our state being hit hard by Covid-19, I would not be surprised to see the Governor call a special session at some point. If a special session is called, it will not affect the bills that WSMTA has been following this session. Here is an update on those bills.

SSB 5097: This bill passed both the House and the Senate and is awaiting the Governors signature. This bill will amend RCW 18.108.045. It will require all licensed massage therapists and certified reflexologist to have available for inspection some form of government issued photo identification. The name on the identification must match the name on the massage license or reflexology certificate. The exact language is below.

A massage therapist licensed under this chapter or a reflexologist certified under this chapter must have government issued photo identification on his or her person or have it be available for inspection by city, county, or state law enforcement or department personnel at all times he or she practices massage therapy or reflexology. The name of the massage therapist or reflexologist on the government-issued photo identification must match the name on the massage therapy license or reflexology certification.

HB 1082: This was a companion bill to SSB 5097. The language was essentially the same as SSB 5097. So, when SSB 5097 passed the House and Senate, HB 1082 no longer needs to continue its journey.

HB 2294: This was a bill that would have expanded the definition of who is covered by RCW 9A.36.031 to include all healthcare providers. Previously, only doctors and nurses in a hospital setting were covered healthcare providers in this RCW. This bill died in the House Public Safety Committee. The Committee members were very reluctant to expand the definition of this RCW to include more special groups. The exact language is below.

A person is guilty of assault in the third degree (a class C felony, instead of simple assault which is a gross misdemeanor) if he or she, under circumstances not amounting to assault in the first or second degree: (i) Assaults a healthcare provider regulated under Title 18 RCW who was performing health care duties at the time of the assault.