Standards of Practice

PURPOSE: This regulation establishes standards of practice for massage therapists including massage therapists performing chair or on-site (outcall) massage therapy. (1) A licensee shall practice within the scope of their education and training and not misrepresent professional qualifications relating to licensure, education, experience, or areas of competence. (2) A licensee shall recommend or refer a client to another licensed health care professional when appropriate and not delegate professional responsibilities to a person that is not qualified. (A) For the purpose of this rule, a client is defined as one who utilizes the services of a licensed massage therapist. A client does not include the licensee’s immediate family members or significant other. (3) A licensee shall conduct business with honesty and integrity to include the following: (A) Maintain professional liability insurance; (B) Advertise massage therapy services or instruction that is accurate and free of deception, sexual suggestiveness, or explicit sexuality; (C) When providing massage therapy, not dress or behave in a provocative manner; (D) Prior to treatment, disclose the fee schedule. When offering gratuitous services or discounts in connection with massage therapy services, clearly and conspicuously disclose whether additional charges may be incurred for related services and the cost of such related services; (E) Post the license with a current photograph at the licensee’s place of business and/or employment; (F) Maintain accurate client records and store records for at least three (3) years from the last date of service and in a manner that secures client confidentiality. Client records for massage therapy not provided at a licensed massage therapy business shall be maintained and stored securely by the licensee; (G) Shall not engage in any verbally or physically abusive behavior with a client; (H) Shall not engage in sexual conduct with a client(s) during a massage session; (I) Shall not exercise influence within a licensee-client relationship for the purpose of engaging a client in sexual activity during a massage session; (J) Shall not take unfair advantage of the client for financial gain; (K) Shall not massage the genitals; (L) Shall not massage the breast unless ordered by a physician prescription or by documented clinical indication to be included in the client’s record with the massage performed by a licensee that is certified or has advanced training in techniques related to therapeutic treatment of mammary tissue; (M) Notify the board of any violation of the Standards of Practice of which the licensee has information and knowledge; and (N) Within the limits of the law, cooperate with any investigative proceeding. (4) Unless waived, in writing and signed by the client, and prior to providing massage therapy, a licensee shall document or update client information to include: (A) Purpose for visit to include presence of pain; (B) Allergies, preexisting conditions, recent surgeries, and current medication; (C) If the client is currently under the care of any health or mental healthcare professional; (D) Date, type, and length of massage therapy service(s); (E) Outcome assessment; (F) Consent for treatment that is signed and dated by client; and (G) Licensee’s signature and date. (5) When providing massage therapy a licensee shall: (A) During any massage requiring the client to undress, provide privacy for the client; (B) Provide appropriate draping during the massage which includes draping at the gluteal cleft and genitals on males and females and the breasts on females; (C) Modify or terminate the massage at the client’s request regardless of prior consent; (D) Exercise the right to refuse to provide massage therapy to any person; (E) Utilize universal precautions at all times. This includes hand washing with an antibacterial agent before and after each client and not knowingly exposing clients to contagious diseases. An antibacterial waterless hand cleanser can be used while in the confines of the massage therapy area and when leaving the area, the licensee must reapply the antibacterial waterless hand cleanser before providing massage therapy. For the purpose of this rule, universal precautions is defined as an approach to infection control as defined by the Center for Disease Control (CDC) to treat all human blood and certain body fluids as if they were known to be infectious for Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV) and other blood borne pathogens; and (F) Provide adequate space around massage chair/table to allow for proper body mechanics and to minimize the spread of infection between tables/chairs. AUTHORITY: sections 324.245 and 324.262, RSMo 2016.* This rule originally filed as 4 CSR 197-3.010. Original rule filed Feb. 25, 2000, effective Sept. 30, 2000. Amended: Filed Nov. 26, 2003, effective June 30, 2004. Moved to 20 CSR 2197-3.010, effective Aug. 28, 2006. Rescinded and readopted: Filed Aug. 21, 2007, effective March 30, 2008. Amended: Filed Aug. 21, 2019, effective Feb. 29, 2020. *Original authority: 324.245, RSMo 1998, amended 1999, 2003, 2006 and 324.262, RSMo 1998, amended 1999, 2006.