All proceedings of the Board in regular session shall be governed by Robert’s Rules of Order. The Board shall, as the appointing authority, direct the operation of the staff through the executive director. Board members may not have monetary, pecuniary, or other interest in the affairs of any: Staff member; or Organization engaged in business with the Board, including: Businesses; Enterprises; or Other for-profit organizations. A Board member or Board staff may not serve for compensation as an instructor in a continuing education course or program under Board cognizance over which that Board member or staff member serves in an approval capacity. Except as specifically provided in this chapter, this chapter does not limit the right of an individual to: Practice a health occupation that the individual is otherwise authorized to practice under the Health Occupations Article, Annotated Code of Maryland; or Advertise an occupation that the individual is otherwise authorized to practice under the Health Occupations Article, Annotated Code of Maryland. In this chapter, the following terms have the meanings indicated. Terms Defined. “Board” means the State Board of Massage Therapy Examiners. “Custodian of records” means an individual designated by the Board who: Is responsible for the security, storage, dissemination, and destruction of records; and Complies with: General Provisions Article, Title 4, Annotated Code of Maryland; Health Occupations Article, Title 6, Annotated Code of Maryland; and This subtitle. “Health care setting” has the meaning stated in Health-Occupations Article,§6101(c), Annotated Code of Maryland. “License” means the document issued by the Board to an individual qualified to practice massage therapy. “Licensed massage therapist (LMT)” means an individual who is licensed by the Board to practice massage therapy. “Licensee” means, unless the context requires otherwise, a licensed massage therapist or a registered massage practitioner authorized by the Board to practice massage therapy. Massage Therapy. “Massage therapy” means the use of manual techniques on soft tissues of the human body including stroking, kneading, tapping, stretching, compression, vibration, and friction. “Massage therapy” includes massage, myotherapy, and synonyms or derivatives of these terms, with or without the aid of: Cold packs; Nonlegend topical applications; or Heat limited to hot packs and heating pads. “Massage therapy” does not include the: Diagnosis of illness, disease, or injury; Adjustment, manipulation, or mobilization of any of the articulations of the osseous structures of the body or spine; or Laying on of hands, consisting of pressure or movement, with the exception of such techniques described in §B(7)(a) of this regulation on a fully clothed individual to specifically affect the electromagnetic energy or energetic field of the human body. “Massage therapy education program” means a course of study that prepares individuals in subjects related to the knowledge, techniques, skills, and abilities used in the practice of massage therapy. “Practice massage therapy” means to engage professionally and for compensation in massage therapy. “Registered massage practitioner (RMP) or registrant” means an individual who is registered by the Board to practice massage therapy in a setting that is not a health care setting. “Registration” means, unless the context requires otherwise, a document issued by the Board to practice massage therapy in a setting that is not a health care setting. “Research” means a curriculum component that systematically investigates and validates massage therapy techniques based on sources and data to provide successful outcomes for clients. “State Board of Massage Therapy Examiners Jurisprudence Examination” means the test developed by the Board to assess an applicant’s knowledge of the statute and regulations governing massage therapy in the State. An individual shall be licensed by the Board in order to practice massage therapy, and shall be registered by the Board in order to practice massage therapy in a setting that is not a health care setting, except for the following: A student enrolled in an approved education program as determined by the Board while performing massage therapy in the program; An individual who: Practices massage therapy in a recognized jurisdiction with an active license or registration in good standing; Is seeking to practice in Maryland exclusively with a visiting organization for not more than 7 consecutive days and not to exceed 30 days per calendar year; and Submits a timely request for approval to participate in an event by application at least 10 days prior to the event in accordance with Board procedures; A family member performing massage therapy on another family member; An athletic trainer while functioning in the scope of the athletic trainer's professional capacity; An individual employed by the federal government to practice massage therapy while practicing within the scope of the individual's employment; or A licensed cosmetologist or esthetician who: Operates a beauty salon; Has obtained a permit from the State Board of Cosmetology as required under Business Occupations and Professions Article, §5-501, Annotated Code of Maryland; and Limits their practice to: Being within the scope of a license issued by the State Board of Cosmetology; and The application and removal of skin products, not including massage therapy. An applicant for a license to practice massage therapy shall: Complete the application provided by the Board; Pay the application fee as specified in COMAR 10.65.07; Submit one recent 2 inch by 2 inch passport type photograph on a solid white background of the applicant; Submit a completed criminal background check; Provide evidence that the applicant is: Of good moral character; and 18 years old or older; Pass the State Board of Massage Therapy Examiners Jurisprudence Examination, which is administered by the Board, with a score of at least 75 percent; Have sent directly to the Board by the administering authority proof of having passed a Board-approved examination; Have copies of official transcripts sent directly to the Board by an institution of postsecondary education, as defined in Education Article, §10-101, Annotated Code of Maryland, and approved by the Maryland Higher Education Commission, from which the applicant graduated that documents completion of a program of at least 750 contact hours of massage therapy education in a curriculum that is: Approved by the Board; Endorsed by: The Commission on Massage Therapy Accreditation (COMTA); or An equivalent entity that accredits both institutions of postsecondary education and programs offering instruction in massage therapy; and Accredited by an institutional accreditation agency recognized by the United States Department of Education; Provide documentation of having satisfactorily completed the requirements listed in Regulation .07 of this chapter; Provide documentation of current certification of qualification in CPR, at a minimum at the Basic Life Support (BLS) level; and Have verification of status sent directly to the Board by the issuing state, if certified, licensed, or registered to practice massage therapy in another state. On or before September 30, 2024, to be a registered massage practitioner, an applicant shall: Complete the application provided by the Board; Pay the application fee as specified in COMAR 10.65.07; and Submit one recent 2 inch by 2 inch passport type photograph on a solid white background of the applicant; Submit a completed criminal background check; Provide evidence that the applicant is: Of good moral character; and 18 years old or older; Pass the State Board of Massage Therapy Examiners Jurisprudence Examination, which is administered by the Board, with a score of at least 75 percent; Have sent directly to the Board by the administering authority proof of having passed a Board-approved examination; Have copies of official transcripts sent directly to the Board by the school from which the applicant graduated that documents completion of a program of at least 600 classroom hours in massage therapy education that is: Approved by the Board; Endorsed by: The Commission on Massage Therapy Accreditation (COMTA); or An equivalent entity that accredits both institutions of postsecondary education and programs offering instruction in massage therapy; and Accredited by an institutional accreditation agency recognized by the United States Department of Education; Provide documentation of having satisfactorily completed the requirements listed in Regulation .07 of this chapter; Provide documentation of current certification of qualification in CPR, at a minimum at the Basic Life Support (BLS) level; and Have verification of status sent directly to the Board by the issuing state, if certified, licensed, or registered to practice massage therapy in another state. The Board may not issue a license or registration if the criminal history record information required under Health Occupations Article, §6-303(b), Annotated Code of Maryland, has not been received. On or after October 1, 2024, the Board may not issue an initial registration to practice as a registered massage practitioner. On or before October 31, 2026, on a request made on an application approved by the Board, the Board shall convert the registration of an individual registered by the Board as a registered massage practitioner to a license to practice massage therapy if the individual complies with regulations under this subtitle. Conversion. In order for an individual to convert from a registered massage practitioner to a licensed massage therapist, a minimum of one of the following shall be met by the conversion applicant: Has held a registration continuously in good standing for a minimum of 10 years preceding the conversion request; Attest to the accumulation of 1,000 hours of hands-on experience within the practice of massage therapy over the previous 2 years between: Work hours; and Board-approved continuing education hours; or Provide documentation verifying a total of 750 hours of massage therapy education which may include: Contact hours from a Board-approved program of study of massage therapy; or Board-approved continuing education hours. It is the burden of the conversion applicant to demonstrate that the applicant is eligible for conversion. The Board: May request additional documentation from the conversion applicant to substantiate or clarify the applicant’s conversion application; and May not convert the registration of an applicant whose registration has been suspended or revoked. Classroom Training: LMTs. An applicant for a license to practice massage therapy shall provide documentation of having graduated with at least 750 hours of education in a Board-approved program for the study of massage therapy that includes the following areas of content: 100 hours in anatomy, physiology, and kinesiology; 200 hours in massage therapy theory; 50 hours in contraindications to massage therapy and pathology; 30 hours in professional ethics; 5 hours in health and hygiene; 5 hours in research; 175 hours in supervised hands-on techniques; 50 hours in clinical assessment and documentation; 35 hours in professional standards and business practices; and 100 hours in supervised clinical experience/practicum. Cardiopulmonary resuscitation (CPR) shall be included but does not count towards the 750-hour minimum. An applicant may attend more than one training institution, if the applicant graduates from a school requiring satisfactory completion of a minimum of 750 classroom hours in massage therapy education. Classroom Training: RMPs. An applicant for a registration to practice massage therapy shall provide documentation of graduation from a Board-approved program of at least 600 hours for the study of massage therapy that includes the following areas of content: Anatomy, physiology, and kinesiology; Massage therapy theory; Contraindications and pathology; Professional ethics; Health and hygiene; Research; Supervised hands-on techniques; and Clinical assessment and documentation. Cardiopulmonary resuscitation (CPR) shall be included but does not count towards the 600-hour minimum. An applicant may attend more than one training institution, if the applicant graduates from a school requiring satisfactory completion of a minimum of 600 classroom hours in massage therapy education. Education and Training in a Foreign Country. The Board may grant a license or registration to practice massage therapy to an applicant who completed an educational program in a foreign country if the applicant: Can demonstrate through a Board-approved certifying agency that the applicant's education and training were substantially equivalent to the requirements of §A of this regulation through a Board-approved certifying agency; and Meets the examination and other requirements of this chapter. The Board may interview an applicant under this section to determine whether the applicant's education and training meet the requirements of this chapter. An applicant shall arrange and pay for the professional translation into English of all documentation required under this chapter if the documentation is in a language other than English. The Board shall: Issue a license to an approved applicant that: Is not valid for more than 2 years, and Expires on the date set by the Board; or Notify an applicant not approved for licensure by letter which specifies the reason or reasons for disapproval. The licensee shall notify the Board of any change in the legal name or address of the licensee, in writing, within 60 days after the change occurs. The Board may not issue a license if the criminal history records information required under Health Occupations Article, §6–303(b), Annotated Code of Maryland, has not been received. Display of License. A licensee shall display the license and any current renewal license conspicuously in the space where the licensee is engaged in practice, including in any temporary space or in any exhibit location. The Board shall: Issue an initial registration until September 30, 2024, to an approved applicant that: Is not valid for more than 2 years; and Expires on the date set by the Board; or Notify an applicant not approved for registration, by a letter which specifies the reason or reasons for disapproval. The registrant shall notify the Board, in writing, of any change in the legal name or address of the registrant within 60 days after the change occurs. The Board may not issue a registration if the criminal history records information required under Health Occupations Article, §3–302.1, Annotated Code of Maryland, has not been received. Display of Registration. A registrant shall display the registration and any current renewal registration conspicuously in the space where the registrant is engaged in practice, including in any temporary space or in any exhibit location. The Board shall send each licensee a renewal notice that states the: Date on which the current license or registration expires; Latest date by which the renewal application and documentation can be received by the Board in order for the renewal license or registration to be issued before the current license or registration expires; and Amount of the renewal fee as specified in COMAR 10.65.07. At least 30 days before the current license or registration expires, the Board shall send the renewal notice by electronic means or first-class mail to the last known electronic or physical address of the licensee. Late Renewal. A late fee in addition to a renewal fee shall be applied as specified in COMAR 10.65.07, if the request is received by the Board within 30 days of the expiration date of the license or registration. Licensees shall satisfactorily complete the minimum continuing education requirements set forth under COMAR 10.65.05. The Board shall reinstate an individual whose license or registration has expired if the individual: Meets the renewal requirements of this chapter and Health Occupations Article, §6-306, Annotated Code of Maryland; Pays the late and reinstatement fees as specified in COMAR 10.65.07, if the request is received by the Board more than 30 days after the expiration date of the license or registration; and Satisfactorily completes the minimum continuing education requirements set forth under COMAR 10.65.05. A licensed massage therapist who fails to apply for licensure reinstatement within 5 years after the expiration date of the license shall meet the requirements in effect at the time of the request in order to be licensed to practice massage therapy. Except as otherwise provided in this chapter, a registered massage practitioner who fails to apply for registration reinstatement within 5 years after the expiration date of the registration shall meet the requirements in effect at the time of the request in order to be registered to practice massage therapy in a setting that is not a health care setting. In accordance with Health Occupations Article, §6-306, Annotated Code of Maryland, a request by an active licensee or registrant to transfer a license or registration to inactive status shall be granted upon receipt of the: Completed Board-approved inactive status application; and Payment of the required, non-refundable, biennial inactive status fee set forth in COMAR 10.65.07. An individual: May apply for inactive status only if the individual’s license or registration is still active at the time the inactive status application request is made; Shall renew and pay the biennial inactive status fee during each renewal period; and On inactive status is not authorized to and may not practice massage therapy. Within 5 calendar years after being placed on inactive status, an individual seeking to be reactivated shall be required, as a condition of reactivation, to submit: Proof of having completed the required CEUs of which shall have been obtained within the 2-year period immediately preceding the application for reactivation; and Documentation of current CPR requirements at the designated level. If an individual on inactive status seeks to be reactivated beyond the required 5-year period and conditions set forth under §C of this regulation, the individual shall be required to: Submit a new application; Pay the non-refundable fee set forth in COMAR 10.65.07; Submit to a criminal history records check in accordance with Health Occupations Article, §6-303, Annotated Code of Maryland; Pass the Jurisprudence Examination required by the Board with a score of at least 75 percent; and Possess documentation of current certification of qualification in CPR, at a minimum at the Basic Life Support (BLS) level. The Board shall issue a duplicate license or registration to a licensee if: The licensee has a change of name, loses or damages the original, or practices in multiple locations; and Makes the request to the Board in writing; Provides appropriate legal documentation of the change; Pays the fee as specified in COMAR 10.65.07; and Surrenders the current license or registration; The Board, as a result of its error, issues an incorrect license or registration and the licensee: Notifies the Board in writing within 6 weeks of receipt of the incorrect license or registration; and Surrenders the incorrect license or registration; or The licensee does not receive the license or registration within 2 weeks of issuance and the licensee provides a notarized statement to the Board attesting to the non-receipt of the license or registration within 30 days of the date the license or registration was issued by the Board. The requirements in §A of this regulation do not apply if the non-receipt was due to the licensee’s failure to change the licensee’s address of record with the Board. If a licensee fails to notify the Board of a change of name or address within the time required in Regulations .08B and .09B of this chapter, subject to the hearing provisions of Health Occupations Article, §6–309, Annotated Code of Maryland, the Board may impose an administrative penalty of $100. The custodian of records for the Board may find that a compelling public purpose warrants disclosure of information in an application, certification, licensing, or investigative file, regardless of whether there has been a request for the information, if the information concerns: Possible criminal activity and the disclosure is to a federal, state, or local law enforcement or prosecutorial official or authority; A possible violation of law and the disclosure is to a federal, state, or local authority that has jurisdiction over the individual whose conduct may be a violation, and the information disclosed is limited to information relevant to the possible violation by that individual; or Conduct by an individual that the Board reasonably believes may pose a risk to the public health, safety, or welfare, and the disclosure is to: A law enforcement authority; An administrative official; An Agency that regulates the individual; or A hospital or other health care facility where the individual has privileges. Other Disclosures. This regulation does not prohibit or limit the ability of the custodian of records for the Board to disclose: General licensing information as provided in General Provisions Article, §4-333(c), Annotated Code of Maryland; or Any information that the Board may otherwise disclose by law. The Board may approve any program of studies provided by an accredited State educational institution for: Licensed massage therapists; and Registered massage practitioners. The Board shall: Maintain a list of educational institutions in this State that currently provide an approved licensed massage therapist or registered massage practitioner program; Set standards for approval of programs licensing massage therapists or registered massage practitioners at educational institutions in this State; and Survey approved massage therapy programs and schools as necessary. General Provisions Article, §4-333(c); Health Occupations Article, §§6-101, 6-102, 6-201—6-206, 6-301—6-306, and 6-504; Annotated Code of Maryland Effective date: Regulations .01 and .02 adopted effective January 2, 2017 (43:26 Md. R. 1446) Regulations .01, .05, and .07 recodified from COMAR 10.43.17 to be Regulations .03, .07, and .09 effective January 2, 2017 (43:26 Md. R. 1446) Regulations .02—.04, .06, and .08—.10, amended and recodified from COMAR 10.43.17 to be Regulations .04—.06, .08, and .10—.12 effective January 2, 2017 (43:26 Md. R. 1446) Regulation .04B amended effective December 25, 2023 (50:25 Md. R. 1088) Regulation .05B amended effective December 25, 2023 (50:25 Md. R. 1088) Regulation .06 amended effective December 31, 2018 (45:26 Md. R. 1247); December 25, 2023 (50:25 Md. R. 1088) Regulation .06F amended effective August 18, 2025 (52:16 Md. R. 847) Regulation .07 amended effective December 25, 2023 (50:25 Md. R. 1088) Regulation .07A amended effective December 31, 2018 (45:26 Md. R. 1247) Regulation .08 amended effective December 25, 2023 (50:25 Md. R. 1088) Regulation .09 amended effective December 25, 2023 (50:25 Md. R. 1088) Regulation .10 amended effective December 25, 2023 (50:25 Md. R. 1088) Regulations .11 and .12 recodified from COMAR 10.43.17 to be Regulations .13 and .14 effective January 2, 2017 (43:26 Md. R. 1446) Regulation .11 amended effective December 25, 2023 (50:25 Md. R. 1088) Regulation .12 amended effective December 25, 2023 (50:25 Md. R. 1088) Regulation .13 amended effective December 25, 2023 (50:25 Md. R. 1088) Regulation .14 amended effective December 25, 2023 (50:25 Md. R. 1088) Regulation .15 adopted effective April 9, 2018 (45:7 Md. R. 345) Regulation .15 amended effective December 25, 2023 (50:25 Md. R. 1088) Regulation .16 adopted effective December 31, 2018 (45:26 Md. R. 1247) Regulation .16 repealed effective December 25, 2023 (50:25 Md. R. 1088) This chapter applies to all contested case hearings before the Board of Massage Therapy Examiners or before the Office of Administrative Hearings. It does not apply to conferences or other informal investigations or proceedings. Written notice of a hearing shall be sent by the Board to all interested parties at least 30 days before the hearing. The notice shall state the date, time, and place of the hearing. It shall also state the issues or charges involved in the proceeding, provided, however, that if by reason of the nature of the proceeding, the issues cannot be fully stated in advance of the hearing, or if subsequent amendment of the issues is necessary, they shall be fully stated as soon as practicable. Service upon a party shall be by delivery of the charging document and a copy of the complaint to the party in person. Instead of personal service, the Board may serve the charging document and a copy of the complaint by registered or certified mail, restricted delivery, return receipt requested. Every party appearing at formal hearings has the right to appear in proper person, or by or with counsel. Pre-hearing Conferences. The Board may set a pre-hearing conference as it deems appropriate. Oaths and Subpoenas. The Board may administer oaths and compel the attendance of witnesses and the production of physical evidence before it from witnesses upon whom process is served anywhere within the State as in civil cases in the circuit court of the county or of Baltimore City, by subpoena issued over the signature of the President or Secretary and the seal of the Board. Upon a request by a party and statement under oath that the testimony or evidence is necessary to their defense, the Board shall issue a subpoena on their behalf. All motions filed by a party with the Board or the Office of Administrative Hearings, as appropriate, shall be accompanied by a memorandum of points and authorities and shall be filed at least 15 days before the hearing. A copy shall be served on the opposing party. Any response shall be filed with the Board or the Office of Administrative Hearings, as appropriate, at least 7 days before the hearing and a copy shall be served on the opposing party. Discovery on Request. By written request served on the other party and filed with the Board or the Office of Administrative Hearings, as appropriate, a party may require another party to produce, within 15 days, the following: A list of witnesses to be called; Copies of documents intended to be produced at the hearing; or Both §A(1) and (2) of this regulation. Mandatory Discovery. Each party shall provide to the other party not later than 15 days before the prehearing conference, if scheduled, or 45 days before the scheduled hearing date, whichever is earlier: The name and curriculum vitae of any expert witness who will testify at the hearing; and A detailed written report summarizing the expert’s testimony, which includes the opinion offered and the factual basis and reasons underlying the opinion. If the Board or the Office of Administrative Hearings, as appropriate, finds that the report is not sufficiently specific, or otherwise fails to comply with the requirements of this section, the Board or the Office of Administrative Hearings, as appropriate, shall exclude from the hearing the testimony and any report of the expert. The Board or the Office of Administrative Hearings, as appropriate, shall consider and decide arguments regarding the sufficiency of the report: At the prehearing conference, if scheduled; or Immediately before the scheduled hearing. If an expert adopts a sufficiently specific charging document as the expert’s report, that adoption satisfies the requirements set forth in this section. Parties are not entitled to discovery of items other than as listed in §§D and E of this regulation. Both parties have a continuing duty to supplement their disclosures of witnesses and documents. Absent unforeseen circumstances which would otherwise impose an extraordinary hardship on a party, witnesses or documents may not be added to the list: After the prehearing conference, if scheduled; or Later than 15 days before the hearing, if no prehearing conference is scheduled. The prohibition against adding witnesses does not apply to witnesses or documents to be used for impeachment or rebuttal purposes. Construction. In hearings conducted by an administrative law judge of the Office of Administrative Hearings, this regulation shall, whenever possible, be construed as supplementing and in harmony with COMAR 28.02.01. In the event of a conflict between this regulation and COMAR 28.02.01, this regulation applies. Duties of Presiding Officer. The Board shall conduct hearings before a quorum of the Board. For purposes of a hearing under this chapter, four Board members present and entitled to vote shall constitute a quorum. Board action shall be by majority vote of all the members then serving. The President, or the President’s designee, shall be the presiding officer, and shall have complete charge of the hearing, permit the examination of witnesses, admit evidence, rule on the admissibility of evidence, and adjourn or recess the hearing from time to time. The presiding officer may set reasonable time limits in arguments and presentation of evidence. The presiding officer shall be responsible for decorum in hearings and can suspend the proceedings as necessary to maintain decorum. Legal Advisor and Counsel for the Board. The presiding officer may request the Office of the Attorney General to participate in any hearing to present the case on behalf of the Board, and, upon such a request, this counsel has all the rights with regard to the: Submission of evidence, examination and cross-examination of witnesses; Presentation of summation and argument; and Filing of objections, exceptions, and motions as counsel for any party. The presiding officer may also request a representative of the Office of the Attorney General to act as legal advisor to the Board as to questions of evidence and law. Order of Procedure. The State shall present its case first. Then the respondent shall present his case. After this the State may present rebuttal. Examination of Witnesses and Introduction of Evidence. The rules of evidence in all hearings under these regulations shall be as set forth in State Government Article, §§10-208 and 10-209, Annotated Code of Maryland. Every party has the right on every genuine issue to: Call witnesses and present evidence; Cross-examine every witness called by the agency, or other party; Submit rebuttal evidence, present summation and argument; and File objections, exceptions, and motions, except that when a party is represented by counsel, all the submissions of evidence, examination and cross-examination of witnesses, and filing of objections, exceptions, and motions shall be done and presented solely by this counsel. The presiding officer, or the presiding officer’s designee, may examine: A witness called by a party; and An individual in attendance at the hearing. A member of the Board may examine a witness called by a party. The Board may submit evidence from an investigative file to other administrative and criminal investigative offices to assist in the investigation and prosecution of a case. The Board shall prepare an official record, which shall include all pleadings, testimony, exhibits, and other memoranda or material filed in the proceeding. If after a hearing, a licensee is found to have violated any of the provisions of Health Occupations Article, §6-308, Annotated Code of Maryland, the Board shall be entitled to reimbursement of costs by the licensee including any or all of the following items: Services rendered by court reporters; Transcription of the hearing record by court reporters; Expenses related to witnesses appearing for the State; Obtaining or reproducing documents, exhibits, or other evidentiary items; Hearing-related per diems and expenses for Board members; and Other expenses directly related to the investigation and prosecution of the disciplinary action against the licensee. Every decision and order rendered by the Board shall be in writing and shall be accompanied by findings of fact and conclusions of law. A copy of the decision and order and accompanying findings and conclusions shall be delivered or mailed promptly to each party or attorney of record. Any party aggrieved by the decision and order rendered may apply for rehearing within 10 days after service on him of the decision and order. Action on an application shall lie in the discretion of the Board. Unless otherwise ordered, neither the rehearing nor the application for it shall stay the enforcement of the order, or excuse the person affected by it for failure to comply with its terms. The Board may consider facts not presented in the original hearing, including facts arising after the date of the original hearing, and may by new order abrogate, change, or modify its original order. Any person whose license or registration has been revoked or suspended by the Board, or any person placed on probation or reprimand under the regulations in this chapter, may appeal the Board’s decision as provided by law. Health Occupations Article, §§6-206, 6-309, and 6-310; State Government Article, §10-206; Annotated Code of Maryland Effective date: January 2, 2017 (43:26 Md. R. 1446) Regulation .06B amended effective August 5, 2024 (51:15 Md. R. 710) Regulation .09 amended effective August 5, 2024 (51:15 Md. R. 710) This chapter applies to licensed massage therapists and registered massage practitioners. In this chapter, the following terms have the meanings indicated. Terms Defined. “Licensee” means an individual who is licensed by the Board to practice massage therapy. “Non bona fide treatment” means when a licensee or registrant treats or examines a client in a way that involves sexual contact, but there is no therapeutic reason for the procedure, or the procedure falls outside of reasonable massage therapy. “Registrant” means an individual who is registered by the Board to practice massage therapy in a setting that is not a health care setting. “Sexually exploitative relationship” means when sexual contact occurs in an existing therapeutic relationship between the massage therapist and the client or between the instructor and the student, or within a period of time after formal termination of the therapeutic or instructor-student relationship where the client or student may still be vulnerable to the power imbalance that exists in the relationship between the licensee or registrant and the client or student, even if the relationship may appear to be mutually consensual. “Therapeutic deception” means when a licensee or registrant misrepresents sexual conduct as a legitimate form of treatment or instruction to a client or a student. The licensee or registrant shall be concerned primarily with the welfare of the client. A licensee or registrant who suffers from a physical, mental, or emotional impairment, including chemical abuse, which impacts the licensee’s or registrant’s ability to practice massage therapy, shall proactively seek professional treatment and shall refrain from the practice of massage therapy until such time as the impairment no longer exists or reasonable accommodations can be made. A licensee or registrant shall: Use professional discretion and integrity in relationships with members of the public and health care community; Engage in professional conduct at all times, with honesty, integrity, self-respect, and fairness; Remain free from conflict of interest while fulfilling the objectives and maintaining the integrity of the massage therapy profession; Provide accurate fee information to the client, the individual responsible for payment for treatment, and the insurer; At all times respect the client's dignity, autonomy, and privacy; Practice massage therapy only as defined in the scope of practice set out in Health Occupations Article, §6-101, Annotated Code of Maryland; Cooperate with a lawful investigation conducted by the Board of Massage Therapy Examiners, including: Furnishing information requested; Complying with a subpoena; Responding to a complaint at the request of the Board; and Providing meaningful and timely access to relevant client records; Report to the Board of Massage Therapy Examiners, or other appropriate authority, conduct in the practice of massage therapy that indicates a violation of: This chapter; Health Occupations Article, Title 6, Annotated Code of Maryland; or Any other law, including but not limited to aiding or abetting the unauthorized practice of massage therapy; and Attempt to correct others who misrepresent the licensee’s or registrant’s credentials, qualifications, education, or affiliations. A licensee or registrant may not: Misrepresent professional credentials, qualifications, education, or affiliations; Knowingly engage in or condone behavior that: Is fraudulent; Is dishonest; Is deceitful; or Involves moral turpitude; Engage in a commercial activity that conflicts with the duties of a licensee or registrant; Perform massage therapy on a client if a contraindication against this treatment exists; Discriminate against a client or a health care provider based on race, religion, age, gender, sexual orientation, national origin, or disability; or Aid or abet any individual violating or attempting to violate any provision of law or regulation. A licensee or registrant shall: Use professional judgment in the use of evaluation and treatment procedure; Decline to administer treatment when the treatment is contraindicated or unjustified; Terminate a professional relationship with a client in an appropriate manner, such as: Providing the client with sufficient notice to permit the client to obtain the services of another professional; or Assisting the client by providing referrals, if appropriate. Maintain legible, organized written records of treatment of any client under the care of the licensee or registrant for at least 5 years after termination of treatment and as provided by applicable provisions of Health-General Article, Title 4, Subtitle 3, Annotated Code of Maryland; Make the written records available to the client upon request, in compliance with applicable laws for disclosure of medical records; Make referrals only to other qualified and duly licensed or certified health care providers or practitioners, or both; Accurately inform clients, other health care professionals, and the public of the limitations of massage therapy; Adequately assess the client to determine if contraindications against massage therapy exist and refer the client to an appropriate health care practitioner; and Exercise independent professional judgment in the treatment or evaluation, or both, of clients, regardless of whether the client was referred by another health care provider. A licensee or registrant may not: Accept a client for treatment, or continue unnecessary treatment, when the client cannot be reasonably expected to benefit from the treatment; Receive remuneration from, or provide remuneration to, or split a fee with another health care provider or individual, or both, for either making or accepting a referral of the client to the health care provider or individual, or both; Make a guarantee or promise about the efficacy of a particular treatment, the licensee’s or registrant’s practice, or the results of a treatment unless supported by scientific principles accepted by the profession as determined by the governing board; or Exploit the professional relationship by: Continuing treatment unnecessarily; or Charging for a service: Not provided; or Different from those actually provided. A licensee or registrant shall: Maintain professional boundaries, even when the client, staff member, or student initiates crossing the professional boundaries of the professional relationship; and Respect and maintain professional boundaries and respect the client's, staff member’s, or student’s reasonable expectation of professional conduct. A licensee or registrant may not: Exploit a relationship with a client, staff member, or student for the licensee’s or registrant’s personal advantage, including, but not limited to, a personal, sexual, romantic, or financial relationship; Engage in a sexually intimate act with a client; or Engage in sexual misconduct that includes, but is not limited to: Therapeutic deception; Non bona fide treatment; or A sexually exploitative relationship. A licensee or registrant shall: Respect and maintain the privacy and confidentiality of the client; Disclose the client's record or information about the client only with the client's consent or as required by law; Adequately safeguard confidential client information, including storage and disposal of records; Provide sufficient information to a client to allow the client to make an informed decision regarding treatment, including: The purpose or nature of an evaluation or treatment regimen; Alternatives to treatment; Side effects and benefits of a proposed treatment regimen and the alternatives to that treatment; The estimated cost of treatment and alternatives to treatment; The right of the client to withdraw from treatment at any time, including the risks associated with withdrawing from treatment; and The client's right to decline to participate in treatment if an aspect of the treatment will be recorded, documented, photographed, observed, or otherwise used in an educational program; Obtain the full informed consent of a client participating in a human research program, without a direct or implied penalty for the client's refusal to participate in the program, and with due regard for the client's autonomy and dignity; Comply with applicable federal and State laws for human research programs; and Comply with applicable provisions of Health-General Article, Title 4, Subtitle 3, Annotated Code of Maryland. A licensee or registrant shall: Recognize the licensee’s or registrant’s limitations and qualifications and practice massage therapy within the limits of these limitations and qualifications; Obtain additional training, information, and supervision as needed to perform a new technique or service in a new specialty area or when employing a new treatment modality; and Maintain a current license or registration to practice massage therapy. The licensee or registrant may not perform a treatment or provide a service which: The licensee or registrant is not qualified to perform; or Is beyond the scope of the licensee’s or registrant’s education, training, capabilities, experience, and scope of practice. A licensee or registrant may not construe a failure to specify a particular ethical, legal, or professional duty in this chapter as a denial of the existence of other ethical, legal, or professional duties or responsibilities that are equally as important and as generally recognized in the profession. If a licensee or registrant violates a regulation in this chapter, the Board may take action pursuant to Health Occupations Article, §6–308, Annotated Code of Maryland. The Board may also impose a penalty not exceeding $5,000. Health Occupations Article, §§1-212, 6-102, 6-206, and 6-308, Annotated Code of Maryland Effective date: Chapter recodified from COMAR 10.43.18 to COMAR 10.65.03 under new Subtitle, Board of Massage Therapy Examiners, Code of Ethics, effective January 2, 2017 (43:26 Md. R. 1446) Regulation .02B amended effective August 5, 2024 (51:15 Md. R. 710) Regulation .03 amended effective August 5, 2024 (51:15 Md. R. 710) Regulation .03C amended effective January 2, 2017 (43:26 Md. R. 1446) Regulation .04 amended effective August 5, 2024 (51:15 Md. R. 710) Regulation .05 amended effective August 5, 2024 (51:15 Md. R. 710) Regulation .06 amended effective August 5, 2024 (51:15 Md. R. 710) Regulation .07 amended effective August 5, 2024 (51:15 Md. R. 710) Regulation .08 amended effective August 5, 2024 (51:15 Md. R. 710) Regulation .09 amended effective January 2, 2017 (43:26 Md. R. 1446); August 5, 2024 (51:15 Md. R. 710) This chapter governs advertising by licensees or registrants of the Board of Massage Therapy Examiners in Maryland. In this chapter, the following terms have the meanings indicated. Terms Defined. “Advertising” means calling to the attention of the public the services one has to offer. “Board” means the Board of Massage Therapy Examiners. “Licensee” means an individual who is licensed by the Board to practice massage therapy. “Registrant” means an individual who is registered by the Board to practice massage therapy in a setting that is not a health care setting. A licensee or registrant may advertise massage services subject to the provisions of this chapter. The licensee or registrant shall state in the advertisement that the: Licensee is a “State of Maryland licensed massage therapist”; or Registrant is a “State of Maryland registered massage practitioner”. An advertisement shall state at a minimum the: Licensee’s or registrant’s practice or business name; Licensee’s or registrant’s name; Licensee’s or registrant’s status as a licensee or registrant; and Practice or business address and telephone number. An advertisement may not include statements that: Contain misrepresentations of facts; Misrepresent any professional qualifications, education, experience, or affiliation; or Make representations or implications that the licensee or registrant is willing to provide services that are illegal under the laws or regulations of Maryland or the United States. An individual who is a registrant or a business entity that employs or contracts with registrants may not advertise that the individual or business entity provides health-related therapeutic massage services. An individual may not advertise that the individual practices massage therapy in Maryland if: The individual is otherwise qualified to practice massage therapy in any other state or country that has substantially similar requirements for authorization to practice massage therapy and the individual is in this State for not more than 7 days; The individual's application for a license or registration is pending before the Board. An individual whose license or registration has been suspended or revoked by the Board may not advertise or initiate any advertising during the period of suspension or revocation. A licensee or registrant may not engage in solicitation, including, but not limited to, in-person, telephone, electronic, or direct mail solicitation, that: Amounts to fraud, undue influence, intimidation, or over reaching; or Contains statements which would be improper under Regulation .03C of this chapter. A licensee or registrant shall be accountable under this chapter if the licensee or registrant uses an agent, partnership, professional association, health maintenance organization, or any other entity or means to implement actions prohibited by this chapter. A violation of this chapter may result in disciplinary action against the licensee or registrant under Health Occupations Article, Title 6, Annotated Code of Maryland. Health Occupations Article, §§6-101, 6-102, 6-206, and 6-401, Annotated Code of Maryland Effective date: Chapter recodified from COMAR 10.43.19 to COMAR 10.65.04 under new Subtitle, Board of Massage Therapy Examiners, Advertising, effective January 2, 2017 (43:26 Md. R. 1446) Regulation .01 amended effective January 2, 2017 (43:26 Md. R. 1446); August 5, 2024 (51:15 Md. R. 710) Regulation .02B amended effective January 2, 2017 (43:26 Md. R. 1446); August 5, 2024 (51:15 Md. R. 710) Regulation .03 amended effective January 2, 2017 (43:26 Md. R. 1446); August 5, 2024 (51:15 Md. R. 710) Regulation .04 amended effective August 5, 2024 (51:15 Md. R. 710) Regulation .05 amended effective August 5, 2024 (51:15 Md. R. 710) Regulation .06 amended effective January 2, 2017 (43:26 Md. R. 1446); August 5, 2024 (51:15 Md. R. 710) By October 31 of each renewal year, licensees and registrants shall satisfactorily complete a minimum of 24 continuing education hours within the previous 24 months as follows: 3 hours in professional ethics or jurisprudence; 3 hours in communicable disease education; 16 hours in massage-related courses as approved by the Board; and 2 hours in diversity, cultural competency, or implicit bias training. In addition to the requirements of §A of this regulation, at the time of renewal, a licensee or registrant shall possess documentation of current certification of qualification in CPR at, a minimum, the Basic Life Support (BLS) level. The Board shall: Base approval of continuing education programs solely on content; Ensure that continuing education programs are directed toward improvement, advancement, and extension of professional skill and knowledge related to massage therapy. A course or program offered by a pre-approved provider is approved without further review and is exempted from the requirements of Regulation .04 this chapter, provided that the course or program pertains to the human anatomy and includes any of the following topics: Massage practice modalities, application, scope, and philosophy; Contraindications; Massage therapy theory, technique, studies, and research; Professional ethics, jurisprudence, and risk management; Recordkeeping and professional business practices; Diversity, communications, and cultural competency; and Any other topic determined by the Board to meet the professional and educational requirements of the licensees and registrants. Pre-approved Providers. Unless the requirement of §B of this regulation are not met or accreditation status of the pre-approved provider, including all sub-providers, schools, courses, and programs approved or sanctioned by the pre-approved provider unless otherwise prohibited, is not retained, the following shall be considered pre-approved providers: FSMTB; ABMP; NCBTMB; AOBTA; AMTA; National and State massage therapy organizations accredited by the federal or state government or a Board recognized accreditation society; Accredited state schools and U.S. Military Commands; and Such other Board-approved providers. Up to 12 credit hours may be achieved for formal, authorized representation at a national, regional, or local convention or meeting relating to any of the above-cited organizations. Courses may be completed in live, home study, or online format. Individuals issued initial licensure or registration within 12 months of the renewal date are exempt from the continuing education requirements in Regulation .01 of this chapter for the first renewal cycle. Licensees or registrants with documented hardships, and seeking an exemption, waiver, or extension from the continuing education requirements in Regulation .01 of this chapter, shall petition the Board in writing at least 90 days before the renewal date. The Board shall review the petition for an exemption, waiver, or extension and respond in writing to the licensee or registrant. A program or institution seeking Board approval shall submit the following in writing at least 60 days before the starting date of the program or course: Title, location, and date of program or course; If electronically administered, website, database, or system used; Credit hours requested; Names and professional and educational qualifications of instructors; Name of attendance certifying officer and method of certification; Required texts or course books used; Program or course syllabus; and List of any sponsor of the program or course. The Board shall notify the requestor in writing of the Board's decision to approve or disapprove a program or course. The Board shall conduct a biennial audit of continuing education and shall notify audited licensees and registrants by mail or electronic means that the audited licensees and registrants shall produce satisfactory evidence of completion of the continuing education requirements. Licensees and registrants shall maintain accurate records, including continuing education course certifications, and if audited, shall present this documentation upon request to the Board. Health Occupations Article, §6-206, Annotated Code of Maryland Effective date: Chapter recodified from COMAR 10.43.20 to COMAR 10.65.05 under new Subtitle, Board of Massage Therapy Examiners, Continuing Education Requirements, effective January 2, 2017 (43:26 Md. R. 1446) Regulation .01 amended effective August 5, 2024 (51:15 Md. R. 710) Regulation .02B, C amended effective August 5, 2024 (51:15 Md. R. 710) Regulation .03B, C amended effective August 5, 2024 (51:15 Md. R. 710) Regulation .04C, D amended effective August 5, 2024 (51:15 Md. R. 710) The licensee or registrant shall maintain accurate, legible, and organized client records for every client, regardless of the procedure or modality employed. Sufficient information to be obtained and recorded shall include, at a minimum: Name, address, and other appropriate contact information; Summarized client history; Summarized reason for appointment or referral, including referral documentation, including forwarded reports and correspondence, if applicable; Billing and insurance documentation, if applicable; and Massage session summary in standard SOAP format, or its equivalent, which includes, at a minimum: Initial client assessment, including contraindications noted; Summarized therapy plan; and Progress notes, reflecting: summary of techniques used and response to techniques. The licensee or registrant shall keep all client files secure and confidential in accordance with the provisions of Health-General Article, Title 4, Subtitle 3, Annotated Code of Maryland. Client files are the property of the: Licensee or registrant when working as a sole proprietor or independent contractor; or Practice owner if the practitioner is an employee. Client files shall be released in a timely manner when authorized by the client in writing or compelled by law or regulation. The licensee or registrant may assess fees for duplicating client records for the patient or for another health care provider in accordance with Health-General Article, §4-403, Annotated Code of Maryland. Health Occupations Article, §6-206, Annotated Code of Maryland Effective date: Chapter recodified from COMAR 10.43.21 to COMAR 10.65.06 under new Subtitle, Board of Massage Therapy Examiners, Record Keeping, effective January 2, 2017 (43:26 Md. R. 1446) Regulation .01A amended effective August 5, 2024 (51:15 Md. R. 710) Regulation .02 amended effective August 5, 2024 (51:15 Md. R. 710) This chapter governs licensees or those who are applying for licensure or registration by the Board. The following fees are established by the Board and are non-refundable: Application fee . . . $150; License fee . . . $200; State examination fee . . . $275; Reexamination fee . . . $300; Biennial renewal fee . . . $250; Conversion to license fee. . .$100 Late renewal fee (within 30 days of license or registration expiration, in addition to renewal fee) . . . $200; Reinstatement fee (after 31 days of expiration of license or registration, inclusive of a reinstatement fee, renewal fee, and late fee) . . . $475; Inactive renewal fee . . . $50; Reactivation fee (inclusive of a reactivation fee and renewal fee) . . . $350; Duplicate license or registration fee . . . $40; Duplicate license or registration ordered at renewal . . . $20; Verification fee . . . $50; Penalty for returned checks . . . $50; Mailing labels or rosters . . . $200; Penalty for failure to maintain correct name or address with the Board . . . $100; Continuing Education Course processing fee per submission . . . $40; Paper copy of laws and regulations . . . $40. Fees are nonrefundable with the exception of the examination fee. The examination fee may be refunded at the discretion of the Board if the applicant’s written request is received by registered mail at least 14 days before the examination. Health Occupations Article, §§6-206 and 6-207, Annotated Code of Maryland Effective date: Regulations .01, .03, .04 adopted effective January 2, 2017 (43:26 Md. R. 1446) Regulation .01 amended effective December 25, 2023 (50:25 Md. R. 1088) Regulation .02 recodified from COMAR 10.43.06.03 effective January 2, 2017 (43:26 Md. R. 1446) Regulation .02 amended effective December 25, 2023 (50:25 Md. R. 1088) Regulation .03 repealed and Regulation .04 recodified to be Regulation .03 effective December 25, 2023 (50:25 Md. R. 1088) This chapter establishes the procedures to be followed by examination applicants who have special needs because of a handicap or religious convictions. An applicant with a disability may request modifications in examination materials or procedures by making a written request to the Board that includes: The applicant’s name; The date of the examination to be modified; A letter from the appropriate medical professional that: Confirms the disability; and Provides information describing the accommodations required; and A letter from the applicant’s education program, indicating what modifications, if any, were granted by the program. The applicant shall send the request for modification and supporting documentation to the Board by the application deadline. The Board reserves the right to review each special needs application and evaluate each on its individual merit. The applicant may be required to bear the cost of special arrangements or procedures to accommodate the applicant’s special needs. Health Occupations Article, §§6-206 and 6-302, Annotated Code of Maryland Effective date: January 2, 2017 (43:26 Md. R. 1446) This chapter shall be used by the Board and the Maryland Office of Administrative Hearings as a framework for imposing discipline. The Board and the Maryland Office of Administrative Hearings shall take into consideration a range of activity within certain types of conduct rather than assigning particular sanctions to each specific violation. The Board is aware that there may be conduct by a licensee or registrant that does not fall squarely within a particular guideline contained in Regulation .06 of this chapter. In that event, the Board will use its best judgment to determine the appropriate sanction. The Board and the Maryland Office of Administrative Hearings shall make determinations that maximize the protection of the public’s health while maintaining the rights of licensees and registrants. In this chapter, the following terms have the meanings indicated. Terms Defined. “Board” means the Maryland State Board of Massage Therapy Examiners. “Conditions” means requirements in a public or nonpublic order that a licensee or registrant is required to satisfy which include but are not limited to: Treatment and counseling for an emotional or physical illness; Submission to drug and alcohol testing; Abstinence from specified drugs; Abstinence from alcohol; Remedial training; Inspection; Monitoring; Evaluation; Supervision; Testing of clinical skills; Submission of written reports; A demonstration of knowledge or competency; Limitation of practice; Limitation on the administration of specified drugs to patients; The provision of pro bono massage therapy to the poor, elderly, or disabled; Obeyance of Maryland Massage Therapy Act, federal, State, and local laws; and The payment of a civil penalty. “Conduct” means behavior or action or a failure to behave or act that results in a violation of the Maryland Massage Therapy Act or the regulations adopted by the Board. This chapter shall be used by the Board as a guide for sanctioning licensees and registrants in formal and informal actions and proceedings. Except as provided in Regulation .05 of this chapter, the Board shall impose a sanction not less severe than the minimum listed in Regulation .06 of this chapter, nor more severe than the maximum listed in Regulation .06 of this chapter. When conduct results in multiple violations of the Maryland Massage Therapy Act and the regulations adopted by the Board, the Board shall consider sanctions that are greater than those imposed for a single violation. This chapter does not apply to disciplinary matters reviewed by the Board that are initially closed. Unless otherwise indicated, the period of a suspension may be stayed in whole or in part. A respondent placed on suspension or probation shall have conditions attached to the suspension or probation which focus on the conduct and steps needed to assure public protection. Consent orders shall: Include an acknowledgement of the violation or violations; and Indicate that the respondent accepts personal responsibility for the respondent’s behavior. If the conduct is not described in Regulation .06 of this chapter, the Board shall use its judgment to determine appropriate sanctions. A departure from the sanctioning guidelines alone may not be grounds for any hearing or appeal of any Board action before the Board or the Maryland Office of Administrative Hearings. The sanctioning guidelines are not applicable to: Individuals seeking an initial license; or The summary suspension of a license under State Government Article, §10-226, Annotated Code of Maryland. Notwithstanding the sanctioning guidelines, a respondent may surrender a license. Sanctions in a particular case may fall outside the range of the sanctioning guidelines established by the Board. Depending on the facts and circumstances of each case, and to the extent that the facts and circumstances apply, the Board may consider the following aggravating and mitigating factors in determining whether the sanction in a particular case should fall outside the range of the sanctioning guidelines: Aggravating Factors: Previous criminal or administrative discipline history; Whether the offense was committed deliberately or with gross negligence or recklessness; Whether the offense has the potential for, or caused, serious patient harm; Whether the offense was part of a pattern of detrimental conduct; Whether the respondent pursued the respondent’s financial gain over the patient’s welfare; Whether the patient was especially vulnerable; Whether the respondent attempted to hide error or misconduct from patients or others; Whether the respondent: Concealed, falsified, or destroyed evidence; or Presented false testimony or evidence; Whether the respondent willfully and without legal justification failed to cooperate with a lawful investigation conducted by the Board; and Whether previous attempts to rehabilitate the respondent were unsuccessful; and Mitigating Factors: Absence of a prior disciplinary record; The passage of time since any prior offenses; Whether the respondent self-reported to the Board; Cooperation with the Board’s investigation; Full disclosure to the Board; Implementation of remedial measures to correct or mitigate harm arising from the misconduct; Timely good-faith efforts to make restitution or to rectify consequences of misconduct; Evidence of rehabilitation or rehabilitative potential; Absence of premeditation to commit the offense; Absence of potential harm to the public; Absence of adverse impact; Whether the offense was an isolated incident and not likely to recur; How and when the respondent has been involved in community service and the value of the community service to the community; and Voluntary admissions of misconduct. The following guidelines shall be used by the Board as a guide for sanctioning a licensee or registrant in formal and informal actions and proceedings: Abuse — Physical and Emotional. Criminal Convictions or Plea of Nolo Contendere. Disciplined by Another Licensing or Disciplinary Authority. Diversion of Controlled Substances or Prescription Drugs. Failure to Renew a License When the Licensee or Registrant Has Continued to Practice. Noncompliance with Board Orders. Incompetent Practice or Misconduct. Sexual Misconduct. Substance Abuse. Unauthorized Practice. Unethical Conduct. Health Occupations Article, §§1-606, 6-308, and 6-309, Annotated Code of Maryland Effective date: January 2, 2017 (43:26 Md. R. 1446) Chapter revised effective August 5, 2024 (51:15 Md. R. 710) This chapter governs the practice of massage therapy using telehealth as an adjunct to, or replacement for, in-person client visits. Nothing in this chapter restricts or limits reimbursement requirements pursuant to Health-General Article and Insurance Article, Annotated Code of Maryland. In this chapter, the following terms have the meanings indicated. Terms Defined. “Asynchronous” means not occurring in real time. “Board” means the Maryland Board of Massage Therapy Examiners. Health Care Services. “Health care services” means to provide client instruction through telehealth using: Techniques that include, but are not limited to, stretching, movement, breathing, and self-massage; and Applications, such as nonlegend topicals and hot and cold packs or pads. “Health care services” does not include: Mental health counseling; or Nutritional counseling. “In-person” means within the physical presence of the client. “Synchronous” means occurring in real time. “Telehealth” has the meaning stated in Health Occupations Article, §1-1001, Annotated Code of Maryland. “Telehealth practitioner” means a Maryland licensed massage therapist or a registered massage practitioner performing telehealth services within their respective scope of practice as defined under Health Occupations Article, §6-101, Annotated Code of Maryland. Subject to the provisions of Health Occupations Article, Title 6, Annotated Code of Maryland, a telehealth practitioner shall be licensed or registered in Maryland when providing telehealth services to a client located in the State. Before performing telehealth services, a telehealth practitioner shall develop and follow a procedure to: Verify the identification of the client receiving telehealth services through use of: A government-issued photograph identification; Documentation of the client’s: Date of birth; and Home address; or Except for registered massage therapists, an insurance, Medicaid, or Medicare card; For an initial client-telehealth practitioner encounter, disclose the telehealth practitioner’s: Name; Maryland license or registration number; and Contact information; Obtain oral or written consent from a client or client’s parent or guardian if State law requires the consent of a parent or guardian, including informing clients of the risks, benefits, and side effects of the recommended health care services; Securely collect and transmit a client’s medical health information, clinical data, clinical images, laboratory results, and self-reported medical health and clinical history, as necessary, and prevent access to data by unauthorized persons through encryption or other means; Notify clients in the event of a data breach; Ensure that the telehealth practitioner provides a secure and private communication modality that complies with federal and state privacy laws; and Establish safety protocols to be used in the case of an emergency, including contact information for emergency services at the client’s location. Except when providing asynchronous telehealth services, a telehealth practitioner shall: Obtain or confirm an alternative method of contacting the client in case of a technological failure; Confirm whether the client is in Maryland and identify the specific practice setting in which the client is located; and Identify all individuals present at each location and confirm they are allowed to hear the client’s health information. A telehealth practitioner shall be held to the same standards of practice and documentation as those applicable for in-person massage therapy practice appointments. A telehealth practitioner shall: Perform a synchronous or asynchronous clinical client evaluation that is appropriate for the client and the condition with which the client presents before providing health care services through telehealth; and If clinically appropriate for the client, provide or refer a client to: In-person treatment; or Another type of telehealth service. A telehealth practitioner may not treat a client based solely on an online questionnaire. The Board shall use the same standards of evaluating and investigating a complaint about and in disciplining a telehealth practitioner who practices telehealth as it would use for a licensee or registrant who does not use telehealth technology in the licensee’s or registrant’s practice. The failure of a telehealth practitioner to comply with this chapter shall constitute unprofessional conduct and may be subject to disciplinary action by the Board Health Occupations Article, §§1-1001—1-1006 and 6-206, Annotated Code of Maryland Effective date: September 18, 2023 (50:18 Md. R. 799) In this chapter, the following terms have the meanings indicated. Terms Defined. “Approval” means the status granted to a massage therapy education program that is in compliance with the regulations of the Board. “Board-recognized massage therapy accreditation agency (BRMTA)” means an institutional accreditation agency recognized by the United States Department of Education (USDOE). “Clinical faculty” means a clinical faculty member of a program who is licensed or registered to practice massage therapy in the State of Maryland. Clinical Learning Experience. “Clinical learning experience” means faculty planned and guided learning activities designed to assist students to: Meet course objectives; and Apply massage therapy knowledge and skills in the direct care of clients. “Clinical learning experience” includes: Direct care of clients within the relevant practice setting; and Clinical support activities such as student clinics. “Conditional approval” means a limited-time status that: Is imposed by the Board if the Board finds evidence that the curriculum has failed to meet or maintain the regulations or requirements, or both, set by the Board; and Allows the curriculum to continue to operate subject to the curriculum conforming to the Board’s requirements and recommendations within a time period set by the Board. “Controlling institution” means an organization that offers a massage therapy education curriculum. “Cooperating clinical entity” means an entity that provides the facilities and clinical resources for clinical learning experiences in massage therapy, with the massage therapy faculty or the clinical massage therapy faculty of the program responsible for the planning, implementation, and evaluation of these experiences. “Endorsement” means having a curriculum approved by: COMTA; or An equivalent entity that accredits both institutions of higher education and programs offering instruction in massage therapy. “Initial approval” means the approval period from the first admission of massage therapy students to the program through the first full implementation of the curriculum and graduation. “Licensed massage therapist” means an individual who is licensed by the Board to practice massage therapy. “Massage therapy faculty” means an individual who is employed to teach the practice of massage therapy full-time or part-time in a massage therapy education program. “MBLEx” means the Massage and Bodywork Licensing Examination, a national entry-level licensure exam, governed and administered by the Federation of State Massage Therapy Boards (FSMTB). “MHEC” means Maryland Higher Education Commission. Program. “Program” means a massage therapy educational program. “Program” includes: A college; or A school. “Regional massage therapy education accrediting agency” means an accrediting agency that operates in a specific geographic region of the United States and accredits post-secondary institutions and primary and secondary schools. “Registered massage practitioner” means an individual who is registered by the Board to practice massage therapy in a setting that is not a health care setting. “USDOE” means the United States Department of Education. The Board shall approve any massage therapy education curriculum in Maryland whose program has been granted accreditation by a BRMTA, provided the curriculum meets all requirements of this chapter. A program that has been accredited by a BRMTA shall submit to the Board within 30 days of that accreditation: Evidence of current accreditation and endorsement status; Accreditation reports; and Any correspondence related to the status of the curriculum’s accreditation and endorsement. The Board shall continue to grant approval to curricula in Maryland provided that there is evidence of continuing accreditation by a BRMTA, and endorsement, and that those curricula continue to meet all requirements of this chapter. The Board shall be notified in writing within 10 business days of any change in accreditation or endorsement status by the massage therapy program. Withdrawal of accreditation or endorsement, accreditation or endorsement with warning, or failure to meet the requirements of this chapter or the standard for performance on the licensing examination shall be cause for Board review of the curriculum in accordance with Regulations .07B and C and .08 of this chapter. A curriculum on which the Board has taken action under Regulations .07B and C and .08 of this chapter shall be reported to MHEC. Qualifications of Massage Therapy Faculty. Unless otherwise provided in this chapter, massage therapy faculty shall: Be currently licensed or registered to practice massage therapy in Maryland; Be academically and professionally qualified; Maintain expertise appropriate to their teaching responsibilities; Have a minimum of 5 years of clinical experience as a licensed massage therapist or registered massage practitioner; and Have an unencumbered license or registration for the past 5 years. Non-massage therapy faculty or a licensed massage therapist or a registered massage practitioner not meeting the requirements for massage therapy faculty may teach selected portions of the curriculum that: Are unrelated to the practice of massage therapy; and Relate to their areas of expertise. Waiver. A program experiencing a faculty shortage or a demonstrable difficulty in hiring appropriate faculty may petition the Board for a waiver of any provision of this regulation in massage therapy. The petition for a waiver of any requirement in massage therapy faculty qualification shall include documentation that the institution has made good faith attempts to hire massage therapy faculty. Qualifications of Clinical Massage Therapy Faculty. Unless otherwise provided in this chapter, a clinical massage therapy faculty member shall: Be currently licensed or registered to practice massage therapy in Maryland; Have a minimum of 5 years of clinical experience practicing massage therapy; Have the clinical experience necessary to function effectively and safely in the clinical massage therapy area of responsibility; and Have an unencumbered license or registration for the past 5 years. All facilities used for clinical learning experiences shall comply with all applicable federal, state, and local requirements. Cooperating clinical entities shall have: Clinical massage therapy faculty on-site and physically available for consultation with massage therapy student; and A dedicated student area for training demonstrations. Students participating in clinical learning experiences shall be clearly identified as students. The curriculum shall meet criteria as stated under COMAR 10.65.01.07. Changes in course offerings that will alter the curriculum, objectives, outcomes, competencies, or conceptual framework of the program shall: Be reported to the Board in the annual report; and Include the following information: The rationale for changes; and The methods of evaluation to be used to determine the effect of the change. Clinical learning experiences shall be sufficient in quantity and quality to provide opportunities for students to achieve the stated objectives, outcomes, or competencies. Students shall have sufficient opportunities to develop the knowledge, skills, and abilities essential for a safe and effective massage therapy practice. Evaluation methods and tools used for measuring students’ knowledge, skills, and abilities shall be developed and implemented in order to ensure satisfactory progression of students. The program shall develop and implement a Board-approved evaluation plan for evaluating the total massage therapy education program not less than every 5 years for curricula that are accredited by a BRMTA. The evaluation plan shall include: All components of the curriculum; Evaluation time intervals; Student, graduate, faculty, cooperating clinical entities, and administration participation; Instruments or methods used; and Evidence that prior recommendations from the Board have been acted upon. The evaluation process shall provide evidence that the program is meeting its objectives or outcomes as well as the changing needs of massage therapy and society. The outcome of evaluation includes: Recommendations for necessary curriculum revisions; and Direction for future action. A program shall submit the following to the Board no later than July 1 of each year: An annual report detailing the program; A program catalog; Any annual reports to the BRMTA; Any correspondence related to the status of the program’s accreditation; A summary of practices followed in safeguarding the health and well-being of students; Accurate and complete data including, but not limited to, number of enrollments, admissions, graduates, and faculty; and A report detailing: Annual pass rates for first-time candidates who have taken the MBLEx exam; and Student retention and program completion rates. Annually the Board shall: Review each program’s annual report, supporting documentation, and the licensure examination performance of first-time candidates from each program; and If necessary, conduct a survey or site visit, issue recommendations, place a program on conditional approval, or issue a formal notice of violation and withdraw approval in accordance with Regulation .08 of this chapter. Approval may be reduced to conditional status for the following reasons: Noncompliance with this chapter; Failure to hire faculty who meet the qualifications as stated in Regulation .03 of this chapter; Failure to submit records and reports to the Board in a timely manner; Failure to implement the approved curriculum; In accordance with §D of this regulation, failure to maintain the required passing rate on the licensing examination by first-time candidates; Failure to annually document that all faculty have current licenses; and Other activities or situations, as determined by the Board, that indicate a program is in jeopardy of violating statutory and regulatory requirements and standards. Below Standard Performance on Licensure Examination. A program shall maintain a minimum pass rate of 65 percent for first-time candidates. The Board shall issue a warning to a program when the pass rate of first-time candidates is below 65 percent. For the first year a program does not meet the 65 percent pass rate requirements of §D(1) of this regulation and following the warning in §D(2) of this regulation, the program shall, within 30 calendar days, provide to the Board: A report that identifies the factors believed to have contributed to the below standard performance; and An action plan to be approved by the Board. Second Successive Year Not in Compliance. For the second successive year that a program is not in compliance with §D(1) of this regulation, the program shall: Be placed on conditional approval; and Provide the Board with a report analyzing all aspects of the educational program and identifying areas that may be contributing to the below standard performance. The Board’s professional staff may conduct a survey visit to the school and provide a report to the Board. If compliance with the minimum licensure examination performance standard for first-time candidates is not made by the program within 1 examination year from the date of conditional approval, approval may be withdrawn. At least 30 days before issuing a formal notice of violation of regulations to a program, the Board shall notify the chief administrator of: The controlling institution, if applicable; and The massage therapy education program that the Board is considering issuing a formal notice of violation. During the 30-day period, the Board shall provide the chief administrator of the controlling institution, if applicable, and the massage therapy education program with an opportunity to meet with representatives of the Board to discuss the Board’s proposed action against the program. The program shall notify the Board within the 30-day period if it is interested in meeting with the Board. If the program requests a meeting, the Board shall make the arrangements. At the meeting, the program shall submit to the Board a plan with a proposed timeframe for correcting the violations. The Board shall: Evaluate the plan; Approve or modify the plan; and Have discretion to make changes to the timeframes for correcting violations or other components of the plan. The program shall correct the violations within the timeframes approved by the Board. Approval may be withdrawn for the following reasons: Noncompliance with any of the regulations in this chapter; Failure to: Hire faculty who meet the qualifications as stated in Regulation .03 of this chapter; Submit records and reports to the Board in a timely manner; Implement the approved curriculum; Comply with the Board’s requirements within the specified timeframes; Maintain the required passing rate on the MBLEx exam by first-time candidates; and Annually document that all faculty have current licenses; and Other activities or situations, as determined by the Board, that indicate a program is not meeting statutory and regulatory requirements and standards. Withdrawal of Approval. If the program does not correct the violations within the approved timeframes, the Board shall begin proceedings to remove the program from its list of institutions that offer approved massage therapy education programs in Maryland pursuant to Health Occupations Article, §§6-308—6-310, Annotated Code of Maryland. New Program Requirements. The Board shall cooperate with MHEC when approving and reviewing curricula. Approval. Upon review of an application for curriculum approval, the Board may: Grant approval; Place the curriculum on provisional approval; Request revisions of the curriculum to align with the Board’s statute and regulations; or Deny the application. Approval: Is required before the admission of students; and Requires concurrence of the Maryland Higher Education Commission. Provisional Approval. A program seeking accreditation or endorsement may be granted provisional approval to graduate students if the program submits: Proof of application status for accreditation or endorsement; An application for provisional curriculum approval; and Otherwise meets the requirements of this regulation. A program may not operate under provisional status for longer than 2 years. Upon request, the Board shall provide consultation concerning closing of a program. Upon the decision by a program to close, and at least 90 days before closing, the program shall notify the Board of its intent, giving the following information: Date and reason for closing; Plans for phasing out the program, including a teach-out program; Disposition of the records of students, graduates, and faculty; and Title of the position of the individual to be responsible for the records and the name of the agency in which the records will be located. Health Occupations Article, §6-302(b)(3)(i) and (c)(3)(i), Annotated Code of Maryland Effective date: December 25, 2023 (50:25 Md. R. 1088)