Board of Massage Meeting Notes July 8, 2016

Opened the meeting with approval of the agenda. There was mention of the Public Comment portion, that has happened at every meeting, being excluded from the meeting this time. Hhmmm...

Presentation on members of the public not interrupting the meeting and speaking out of turn. (The crowd has definitely gotten a little passionate about massage regulation!) There was even a power point on proper decorum.

A new online licensing project was presented by Dan Renfro. The Department of Health is field testing this system starting at the end of 2016 and hopefully it will start being rolled out in the middle of 2017. In addition to being able to apply for health care licenses online, this will also include a health work force survey. This will gather information to attempt to measure whether or not licensed medical practitioners are actually utilizing their licensees, as well as where they are physically working and any other statistics Big Brother finds entertaining. The survey will NOT be required to become licensed.

Blake Maresh shared the rule making process for the draft code revisions to become official. Incredibly, this all started in 2014. A comprehensive review of WAC 246-830 has not happened in over 20 years, and is happening now because RCW 43.70.041 (enacted in 2013) requires this comprehensive review of every health care code to happen every 5 years. This humble reporter has to give Blake props - he has done a ton of work to keep this train on the track.

He went on to delineate that the mission of the Board of Massage is to “protect the public and maintain MINIMUM standards to safely and competently provide massage services. Quite compelling…. It’s important for the Board to remember this lofty goal when revising the regulations. (Blake lost a couple points in the Peanut Gallery polls at this point...)

The Rules Process:

First, the CR-101 process notifies the office of the code reviser and "stakeholders” (people affected) as to what rule is being changed and why. This happened back in 2014.

Then rules development happens (Sisyphean task currently taking almost 2 years). This has transpired through the “Rules Workshops” that we have been having every 2 months. Apparently there is not any requirement to have these, so we should consider ourselves lucky to be a part of this process. Compared to other departments, 12 rules workshops is excessive. (Sensing a wee bit of attitude here.)  

Then CR-102 happens. The text of the new rules will be released to the public. Then 20 days of public comment happens, then public hearings happen.  The DOH must prepare an explanatory statement that discusses comments around the rules, and also examines the potential costs of these new rules - particularly the effects on small businesses. 

Surprisingly, CR-103 is the next step. This is a rule making order form. The board can then make minor changes to the rule. No major changes can happen at that point. CR-103 must happen within 6 month of 102, unless you file a continuance. This is all laid out in the Administrative Procedures Act,  APA chap 34.05 of WAC, in case you need some light reading.

The good news is that this is not an all-or-nothing process. The Board could decide to proceed with 9 of 10 sections reviewed and then go back to the CR-101 process for certain sections that still need work or debate.

Then, there was a brief summary of the code changes made thus far and a timetable was set. The Department of Health is pushing for the rules development to be finished at the September 9 meeting.

  • Fall 2016: significant analysis has to happen at the Dept of Health (costs, justification, etc)
  • Early 2017: a CR-102 will be filed
  • Spring 2017: public comment and public hearings will happen, likely two public hearings.
  • June 2017: a brand new code will be born!
  • And by the way, if this process doesn't move forward to finish by July 1, 2017, we have to do this all over again next year because of the passing of HB 2425 changing LMP to LMT. Not sure why, but Blake seems to really know his stuff, so it's best to take him at his word.

Rules Development

So the previous presentation made a significant impact on the rest of the meeting. Now the Board wants to back track on the 625 minimum hours requirement for beginning massage education. Much back and forth discussion, centering around:

A- we need to move forward and this particular change needs a lot more research and is taking too much time. One of the things needed is the justification as to how more hours of training will actually protect the public, but NOT limit the access to the profession (anti-trust: Supreme Court case against NC dental board in Feb 2015).  

B- but we need to move forward because 625 hours *IS* the new minimum competency to protect the public, as discussed ad nausea at previous meetings. (Soooo glad Pat Archer and Dawn Schmidt are not at this meeting right now. They have submitted copious information to the Board about ELAP and how WA State needs to move forward with the increased training requirement. They would surely be having aneurysms by now and those can be messy...)

It was decided to stick with the newly proposed 625 with a very loose breakdown of the hours to give schools more flexibility in creating programs. Send to the public for comment. (Vote Yes on 625!)

Discussed license by endorsement. Sticking with the decision to require 500 hours plus 3 years in active practice in order to transfer a license from another state.

Discussed transfer of education hours from outside of Washington: The goal is to try to accept as many transfer credits as possible, so students do not have to re-take classes unnecessarily. Particularly, the Board wants students from other health care professions to be able to transfer their basic science credits to massage schools. The text was tweaked to approve transfer "from state accredited schools" and hopefully that takes care of it.

Reviewed definitions section:

At this point in the discussion, your moxie reporter was called upon to provide input on said definition. With much needed assistance from esteemed members of the Peanut Gallery (Barbara Helynn Heard and Wendell Dyck) the following definition was submitted for public response.

Breast massage means the specific and deliberate manipulation of breast tissue. Massage of the surrounding bony and muscular tissues, such as massage of the sternum, is not considered breast massage. 

Discussed education requirements again: no changes. They confirmed that they will put forward the draft with the change to 625 hours and see what the Public has to say.

Discussed the breast massage section:

Will add a requirement for specialty training in breast massage at a minimum of 20 contact hours (16 hours in person) and to change "diagnosed medical condition" to "therapeutic condition" or something like that. Lots of struggle for verbiage at this point. The goal here is to avoid the unintended consequence of every patient having to get a diagnosis from a doctor in order to get breast massage.

Holy cow! Batting 1,000! Once again, this (apparent?) legal scholar's suggested edits were incorporated into the options afforded to Joan Q Public for input and approval as “Version B"!!

(Possibly meeting notes are less than articulate after this point due to swooning from joy.)

Draping section:
No changes. Emphatically. Therapists should prepare to have a boiler plate consent form for undraping glutes and pectorals that all their clients sign. It's everyone's right to spend their time as they see fit, but more letter writing on this particular issue will likely be wasted.

Record keeping:
Discussed who is responsible for maintaining the records that will now be required for every massage encounter. There is concern about how to get copies of records in the event of complaints against therapists. This was deferred to the legal department for clarification.

Again discussed an exemption to record keeping for chair massage. Nothing changed. It's important to note here that sentiment is more open that MAYBE there could be a small exception for some chair massage to have reduced record keeping requirements, but the Board is going to need to see some example regulation wording to contemplate if this could work. 

Public Comment:
No public comment was allowed at this meeting…. no doubt because people got a little unruly at the last meeting. (This time it was NOT yours truly :-) So written comments are the way to submit your input going forward. If you have strong opinions on different sections of the code, I recommend a "one email, one topic" strategy to get your email processed most accurately and your virtual voice heard.

Please please please send in written comment to massagerulescomments@doh.wa.gov ! Please support “Version B” in the Breast Massage section. (Version “B” is Better for Breasts!)
Here is a link to download and read the draft documents for yourself and see which you like, but come on, you know who you love ;-)

The Board will be sending a rep to the FSMTB meeting in Cleveland. Public Member Tony drew the short straw.

They are going to discuss the "annual policy review" at next meeting. Not sure what that means.

They will stop the teleconference meetings, due to decrease in the amount of schools to review.  (This is from the procedural change in no longer reviewing out-of-state schools for in-state approval, which happened 2 or 3 meetings ago, which is a huge improvement in the process.)

Meeting adjourned!

Remember to email your comments to massagerulescomments@doh.wa.gov by August 17!!

In case you missed it, we do have a handy link to the current draft of WAC Chapter 246-830 for your perusal.