Washington State Rules RELATED TO Breast massage
adopted into law early September 2021
BREAST MASSAGE DEFINITION: WAC 246-830 005 definitions
(7) "Breast massage" means the specific and deliberate manipulation of breast tissue pursuant to WAC 246-830-555. Massage of the surrounding chest and shoulder muscles such as massage of the intercostal, pectoral, or axillary muscles is not considered breast massage.
STANDARDS OF PRACTICE - LIMITATIONS: WAC 246-830-550 Standards of practice—Limitations
(1) 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.
(2) A massage therapist shall not engage in sexual misconduct as described in WAC 246-16-100. Sexual misconduct will constitute grounds for disciplinary action.
BREAST MASSAGE RULE: WAC 246-830-555 Breast massage
(1) Prior to performing breast massage, a massage therapist must:
(a) Acquire prior signed or initialed written and verbal informed consent from the client or patient. If the client or patient is under eighteen years of age, prior written consent must be obtained from a parent or legal guardian of the client or patient. The written consent for breast massage may be included within an overall general consent to massage document, if clearly delineated and either specifically initialed or signed. The written consent must:
(i) Be documented and maintained with the client or patient records per WAC 246-830-565 and 246-830-570;
(ii) Include a statement that the client or patient may discontinue the treatment at any time for any reason; and
(iii) Include a statement that the client or patient has the option to have a witness present, and that the witness must be provided by the client or patient.
(b) Use appropriate draping techniques as identified in WAC 246-830-560.
(2) In addition to the requirements identified in subsection (1) of this section, a massage therapist must maintain evidence of the completion of at least sixteen hours of specialized in-person education and training in breast massage beyond the minimum competencies. Education and training in breast massage includes, but is not limited to, breast anatomy and physiology, pathology, indications, contraindications, cautions, therapeutic treatment techniques, draping, appropriate therapist-client or therapist-patient boundaries, expected outcomes, and client or patient safety related to breast massage.
(3) In addition to the requirements in subsections (1) and (2) of this section, prior to performing a massage of the breast that includes the nipples and areolae, a massage therapist must obtain documentation as follows:
(a) A written prescription or referral from a licensed medical health care provider for this specific treatment; or
(b) Prior signed or initialed written and verbal informed consent from the client or patient or from the parent or legal guardian if the client or patient is under eighteen years of age for massage of breast that includes the nipples and areolae. This written consent may be included within the consent for breast massage document.
DRAPING RULE: WAC 246-830-560 Coverage and draping
(1) A massage therapist must:
(a) Allow a client or patient privacy to dress or undress except as may be necessary in emergencies or custodial situations; and
(b) Always provide the client or patient a gown or draping except as may be necessary in emergencies.
(2) Massage therapists must use safe, functional, and hygienic coverage and draping practices that comply with WAC 246-830-500 during the practice of massage when the client or patient is disrobed. The drape or drapes must be sufficient to ensure the genitals and the gluteal cleft distal to the coccyx, anus and rectum are not exposed, and the breast area is not exposed except as allowed in subsections (3) and (4) of this section. Safe, functional, and hygienic coverage and draping means:
(a) The massage therapist explains, maintains and respects coverage and draping boundaries;
(b) Massage or movement of the body does not expose genitals or gluteal cleft distal to the coccyx, anus and rectum, or does not expose the breast area except as allowed in subsections (3) and (4) of this section; and
(c) All linens that are used with the client or patient are kept and maintained in accordance with WAC 246-830-500.
(3) With prior signed or initialed written and verbal informed consent from the client or patient, the gluteal cleft and breast drapes may be temporarily moved in order to perform therapeutic treatment of the area consistent with WAC 246-830-550, 246-830-555, and 246-830-557. In addition, with informed and written consent, a client or patient may choose to have their upper torso undraped during the entire massage.
(4) If variations to this coverage and draping rule occur, a massage therapist must:
(a) Maintain evidence of education and training in specific modalities that require variations in coverage and draping;
(b) Receive voluntary and informed consent of the client or patient prior to any variation of coverage or draping; and
(c) Document in the client's or patient's record the rationale for any variation of coverage or draping.
(5) Any written consent required by this section may be included within an overall general consent to massage document, if clearly delineated and either specifically initialed or signed.
RECORD KEEPING RULES: WAC 246-830-565 Recordkeeping
(1) A massage therapist providing professional services to a client or patient must document services provided. Documentation should be appropriate to the venue, the type and complexity of those services and, when applicable, in sufficient detail to support and enable anticipated continuity of care. The documentation must include:
(a) Client or patient name and contact information or name and contact information of a parent or guardian if a client or patient is under eighteen years of age;
(b) Age of client or patient;
(c) Health history sufficient to ascertain if there are cautions or contraindications to safe application of massage therapy, and an update of the current health status at each session;
(d) Date massage therapy is provided and the duration of treatment;
(e) The types of techniques and modalities applied;
(f) The location or areas of the body that received massage therapy;
(g) Written informed consent to treat. A written consent is considered valid for one year unless revoked;
(h) If breast massage is performed, an additional written consent to treat per WAC 246-830-555, and documentation of a therapeutic rationale;
(i) If breast massage that includes the nipples and areolae is involved, documentation of the prescription or referral per WAC 246-830-555 (3)(a), or an additional written consent to treat per WAC 246-830-555 (3)(b);
(j) If performing massage of the gluteal cleft or perineum, an additional written and verbal informed consent to treat is required to detail that the client or patient has a clear understanding of the therapeutic rationale, treatment plan, and areas to be massaged for that region per WAC 246-830-557(4);
(k) Documentation of any written consent or any modification in coverage and draping as required by WAC 246-830-560; and
(l) For massage therapy where the focus is on treating a health condition, the following additional information is required:
(i) Symptoms, for example, pain, loss of function, and muscle stiffness;
(ii) Evaluation and findings, for example, movement, posture, palpation assessment and findings;
(iii) Outcome measures, for example, improvement in symptoms, movement, posture, palpation, and function; and
(iv) Treatment plan for future sessions.
(2) Client or patient records must be legible, permanent, and recorded within twenty-four hours of treatment. Documentation that is not recorded on the date of service must designate both the date of service and the date of the chart note entry. Corrections or additions to the client's or patient's records must be corrected by a single line drawn through the text and initialed so the original entry remains legible. In the case of computer-organized documentation, unintended entries may be identified and corrected, but must not be deleted from the record once the record is signed and completed or locked. Errors in spelling and grammar may be corrected and deleted.
(3) Correspondence relating to any referrals by other health care providers concerning the diagnosis, evaluation or treatment of the client or patient must be retained in the client or patient record.
(4) Client or patient records should clearly identify the massage therapist who is the provider of services by name and signature or electronic signature and date of service.
RECORD RETENTION RULES: WAC 246-830-570 Record retention
(1) Massage therapist records for clients or patients eighteen years of age and older must be retained by, or be otherwise accessible to the massage therapist for at least three years from the date of last treatment.
(2) Massage therapist records for clients or patients under the age of eighteen years old must be retained by, or be otherwise accessible to the massage therapist for at least three years after the client or patient reaches eighteen years old.
(3) The record retainer of the massage therapist records for clients or patients shall comply with record retention requirements of chapter 70.02 RCW, Medical records—Health care information access and disclosure.
(4) All records must be secured with properly limited access in compliance with chapter 70.02 RCW and the Health Insurance Portability and Accountability Act (HIPAA).
(5) After the retention period, records may be disposed of pursuant to this subsection. Disposal must be done in a secure and confidential manner in compliance with chapter 70.02 RCW and HIPAA and must include as appropriate:
(b) Deleting, erasing, or reformatting electronic media; or
(c) Rendering other readable forms of media unusable or unreadable.
(6) Nothing in this section shall be intended to infringe upon any rights or remedies related to unfair trade practices as those found in chapter 19.86 RCW, the Unfair Business Practices Act.
(7) A massage therapist will not be in violation of subsections (1) and (2) of this section if the massage therapist is unable to access the records after a good faith attempt has been made to obtain the records.