Washington Adopts New Massage Therapy Rules

The Washington Board of Massage revised the Washington Administrative Code (WAC) in August 2020. The rules have finally made it through the state rulemaking process and are now final. The new rules are effective September 1, 2021.

The rules amend existing sections (including definitions), the out-of-state application process, transfer programs, school approval, training hours, faculty, continuing education, standards of practice, and recordkeeping. They also create a new section on gluteal cleft and perineum massage. ABMP has summarized the proposed rule changes below:

Definitions (WAC 246-830-005)
There are two new definitions:

  • Linens: sheets, blankets, towels, gowns, pillowcases, face cradle covers, and other fabrics used while practicing massage.
  • Perineum: the tissues between the anus and scrotum or vulva.

Amendments were made to the following definitions:

  • Apprenticeship educator and trainer: massage therapists now require three years of experience, reduced from five, to become an apprenticeship educator and trainer.
  • Massage transfer program: a separate, board-approved program within a board-approved massage program or school. In other words, the board would have to approve a transfer program through an already approved program or school.

Applications (WAC 246-830-020)
The new rules require a criminal background check as part of the application process. Proof of AIDS education will no longer be required.

Licensing by endorsement for out-of-state applicants (WAC 246-830-035)
The new rules increase the minimum number of education and training hours from 500 to 625 hours for all applicants, including out-of-state applicants. Education and training hours must be completed in no less than 24 weeks. The rules allow the board to accept 500 training hours if the applicant has at least two years of experience and documentation of at least 24 hours of continuing education. However, if someone has a gap in practice of three or more years immediately preceding application by endorsement, they must provide documentation of 24 hours of hands-on continuing education in the previous two years.

Transfer programs (WAC 246-830-037)
Per the current rules, clock hours must be substantially equivalent to transfer and credit. To determine equivalency, the new rules state that the transfer programs will evaluate applicants and require written and practical tests for each subject area. If the applicant cannot pass certain subject areas, they are to enroll in and pass these subjects.

Approval of massage school, massage program, or apprenticeship program (WAC 246-830-420)
Under the new rules, the clinical supervisor of the student clinic must have at least three years of practical experience—an increase from the previously required two years. There must be one clinical supervisor to every six students who are performing massage.

Education and training (WAC 246-830-430)
The new rules increase the minimum number of education and training hours from 500 to 625 hours. Due to the increase in hours, the rules significantly alter the number of hours designated to each subject area, detailed below:

  • 90 hours of anatomy and physiology (currently 90 hours)
  • 60 hours of kinesiology (currently 40 hours)
  • 70 hours of pathology (currently 50 hours)
  • 260 hours of theory, principles, and practice of massage (currently 265)
  • 50 hours of mandatory student clinic (new subject area)
  • 55 hours of clinical/business practices (currently 55 hours)
  • 40 hours of professional ethics (new subject area)

Faculty (WAC 246-830-440)
The rules increase the minimum experience required by faculty members who teach hands-on courses from two years to three years.

Continuing education requirements (WAC 246-830-475)
The new rules make substantial additions to the requirements in the continuing education section. Here is a summary of the amendments:

  • Continuing education must be provided by an individual who has at least three years of professional experience in the subject area being taught.
  • Massage therapists who maintain an active Washington State massage license must meet all continuing education requirements, regardless of whether they reside in Washington State.
  • Two continuing education hours can be met by attending massage board meetings in person, with one hour allotted per board meeting.
  • Licensees must maintain American Heart Association CPR certification or equivalent training—four hours may be reported for this requirement.
  • The required documentation for continuing education gained through self-study (multimedia devices, books, research materials, etc.) is a one-page, single-spaced, 12-point font synopsis of what the licensee learned—this is a decrease from the previously required two-page synopsis.
  • You can no longer gain continuing education credit through providing specialized training.
  • A massage therapist must provide documentation of continuing education upon request or audit. Acceptable forms of documentation include transcripts, a letter from the course instructor or organization, a certificate of attendance or completion, or other formal documentation that includes the practitioner’s name, course title and description, course date, number of hours completed, and the instructor’s name and signature along with their organization and contact information.

Standards of practice—Limitations (WAC 246-830-550)
The new rules eliminate the text listing body parts inconsistent with the standard of practice of massage therapy, and replace the language to read as follows:
“It is not consistent with the standard of practice for a massage therapist to touch the following body parts on a client or patient except where specifically noted:
a)    The gluteal cleft (space distal to the coccyx to the anus) and perineum unless in accordance with WAC 246-830-557. For the purpose of this section and WAC 246-830-557, the perineum is defined as the tissues between the anus and scrotum or vulva;
b)    Anus or inside the rectum;
c)    Inside the urethra;
d)    Penis and scrotum;
e)    Vulva to include labia (major and minor), clitoris, bulb of vestibule, vulval vestibule, urinary meatus and the vaginal opening;
f)    Inside the vagina;
g)    Breasts, unless in accordance with WAC 246-830-555; or
h)    Inside the mouth unless an intraoral endorsement has been issued in accordance with WAC 246-830-490.”

Recordkeeping (WAC 246-830-565)
The new rules determine that “written consent” is considered valid for one year, unless revoked. Additional written and verbal informed consent is required to perform massage of the gluteal cleft or perineum to ensure the client has a clear understanding of the therapeutic rationale and treatment plan. Written consent is also required if there are any modifications made to coverage and draping techniques.

Massage of the gluteal cleft or perineum (WAC 246-830-557)
The new rules created a new section for massage of the gluteal cleft and perineum. A massage therapist may now massage the gluteal cleft and perineum if they meet the following requirements:

  1. Complete at least 16 hours of in-person education studying the body parts listed, learning indications, contraindications, therapeutic treatment techniques, expected outcomes, client or patient safety, communication, patient consent, draping techniques, sanitation, and ethical responsibilities.
  2. Obtain signed or initialed written and verbal informed consent from the client prior to performing the massage. If the client is under 18 years old, prior written consent must be from the client’s parent or legal guardian. The written consent must include a statement that the client may discontinue treatment at any time for any reason and a statement that the client has an option to have a witness present. The written consent must also provide the therapeutic rationale for the massage and be kept in the client’s records.
  3. Use appropriate draping techniques and hygienic, safe, and sanitary practices (e.g., wearing gloves during treatment unless the massage is provided over clothing or draping that creates a barrier).

As this is a completely new section, we encourage you to read this section in its entirety—it begins almost at the bottom of the page.