# COMAR Title 10 — Maryland Department of Health

## Subtitle 65 — Board of Massage Therapy Examiners

### Chapter 03 — Code of Ethics

**Authority:** Health Occupations Article, §§1-212, 6-102, 6-206, and 6-308, Annotated Code of Maryland

**Administrative History:** Effective date:

**Administrative History:** 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)

**Administrative History:** Regulation .02B amended effective August 5, 2024 (51:15 Md. R. 710)

**Administrative History:** Regulation .03 amended effective August 5, 2024 (51:15 Md. R. 710)

**Administrative History:** Regulation .03C amended effective January 2, 2017 (43:26 Md. R. 1446)

**Administrative History:** Regulation .04 amended effective August 5, 2024 (51:15 Md. R. 710)

**Administrative History:** Regulation .05 amended effective August 5, 2024 (51:15 Md. R. 710)

**Administrative History:** Regulation .06 amended effective August 5, 2024 (51:15 Md. R. 710)

**Administrative History:** Regulation .07 amended effective August 5, 2024 (51:15 Md. R. 710)

**Administrative History:** Regulation .08 amended effective August 5, 2024 (51:15 Md. R. 710)

**Administrative History:** Regulation .09 amended effective January 2, 2017 (43:26 Md. R. 1446); August 5, 2024 (51:15 Md. R. 710)

#### Regulation .01 Scope.

*COMAR 10.65.03.01*

This chapter applies to licensed massage therapists and registered massage practitioners.

#### Regulation .02 Definitions.

*COMAR 10.65.03.02*

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

  (1) “Licensee” means an individual who is licensed by the Board to practice massage therapy.

  (2) “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.

  (3) “Registrant” means an individual who is registered by the Board to practice massage therapy in a setting that is not a health care setting.

  (4) “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.

  (5) “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.

#### Regulation .03 Standards of Practice.

*COMAR 10.65.03.03*

A. The licensee or registrant shall be concerned primarily with the welfare of the client.

B. 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.

C. A licensee or registrant shall:

  (1) Use professional discretion and integrity in relationships with members of the public and health care community;

  (2) Engage in professional conduct at all times, with honesty, integrity, self-respect, and fairness;

  (3) Remain free from conflict of interest while fulfilling the objectives and maintaining the integrity of the massage therapy profession;

  (4) Provide accurate fee information to the client, the individual responsible for payment for treatment, and the insurer;

  (5) At all times respect the client's dignity, autonomy, and privacy;

  (6) Practice massage therapy only as defined in the scope of practice set out in Health Occupations Article, §6-101, Annotated Code of Maryland;

  (7) Cooperate with a lawful investigation conducted by the Board of Massage Therapy Examiners, including:

    (a) Furnishing information requested;

    (b) Complying with a subpoena;

    (c) Responding to a complaint at the request of the Board; and

    (d) Providing meaningful and timely access to relevant client records;

  (8) Report to the Board of Massage Therapy Examiners, or other appropriate authority, conduct in the practice of massage therapy that indicates a violation of:

    (a) This chapter;

    (b) Health Occupations Article, Title 6, Annotated Code of Maryland; or

    (c) Any other law, including but not limited to aiding or abetting the unauthorized practice of massage therapy; and

  (9) Attempt to correct others who misrepresent the licensee’s or registrant’s credentials, qualifications, education, or affiliations.

D. A licensee or registrant may not:

  (1) Misrepresent professional credentials, qualifications, education, or affiliations;

  (2) Knowingly engage in or condone behavior that:

    (a) Is fraudulent;

    (b) Is dishonest;

    (c) Is deceitful; or

    (d) Involves moral turpitude;

  (3) Engage in a commercial activity that conflicts with the duties of a licensee or registrant;

  (4) Perform massage therapy on a client if a contraindication against this treatment exists;

  (5) Discriminate against a client or a health care provider based on race, religion, age, gender, sexual orientation, national origin, or disability; or

  (6) Aid or abet any individual violating or attempting to violate any provision of law or regulation.

#### Regulation .04 Relationship with Client.

*COMAR 10.65.03.04*

A. A licensee or registrant shall:

  (1) Use professional judgment in the use of evaluation and treatment procedure;

  (2) Decline to administer treatment when the treatment is contraindicated or unjustified;

  (3) Terminate a professional relationship with a client in an appropriate manner, such as:

    (a) Providing the client with sufficient notice to permit the client to obtain the services of another professional; or

    (b) Assisting the client by providing referrals, if appropriate.

  (4) 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;

  (5) Make the written records available to the client upon request, in compliance with applicable laws for disclosure of medical records;

  (6) Make referrals only to other qualified and duly licensed or certified health care providers or practitioners, or both;

  (7) Accurately inform clients, other health care professionals, and the public of the limitations of massage therapy;

  (8) Adequately assess the client to determine if contraindications against massage therapy exist and refer the client to an appropriate health care practitioner; and

  (9) 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.

B. A licensee or registrant may not:

  (1) Accept a client for treatment, or continue unnecessary treatment, when the client cannot be reasonably expected to benefit from the treatment;

  (2) 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;

  (3) 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

  (4) Exploit the professional relationship by:

    (a) Continuing treatment unnecessarily; or

    (b) Charging for a service:

      (i) Not provided; or

      (ii) Different from those actually provided.

#### Regulation .05 Professional Boundaries.

*COMAR 10.65.03.05*

A. A licensee or registrant shall:

  (1) Maintain professional boundaries, even when the client, staff member, or student initiates crossing the professional boundaries of the professional relationship; and

  (2) Respect and maintain professional boundaries and respect the client's, staff member’s, or student’s reasonable expectation of professional conduct.

B. A licensee or registrant may not:

  (1) 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;

  (2) Engage in a sexually intimate act with a client; or

  (3) Engage in sexual misconduct that includes, but is not limited to:

    (a) Therapeutic deception;

    (b) Non bona fide treatment; or

    (c) A sexually exploitative relationship.

#### Regulation .06 Records, Confidentiality, and Informed Consent.

*COMAR 10.65.03.06*

A licensee or registrant shall:

A. Respect and maintain the privacy and confidentiality of the client;

B. Disclose the client's record or information about the client only with the client's consent or as required by law;

C. Adequately safeguard confidential client information, including storage and disposal of records;

D. Provide sufficient information to a client to allow the client to make an informed decision regarding treatment, including:

  (1) The purpose or nature of an evaluation or treatment regimen;

  (2) Alternatives to treatment;

  (3) Side effects and benefits of a proposed treatment regimen and the alternatives to that treatment;

  (4) The estimated cost of treatment and alternatives to treatment;

  (5) The right of the client to withdraw from treatment at any time, including the risks associated with withdrawing from treatment; and

  (6) 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;

E. 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;

F. Comply with applicable federal and State laws for human research programs; and

G. Comply with applicable provisions of Health-General Article, Title 4, Subtitle 3, Annotated Code of Maryland.

#### Regulation .07 Education and Training.

*COMAR 10.65.03.07*

A. A licensee or registrant shall:

  (1) Recognize the licensee’s or registrant’s limitations and qualifications and practice massage therapy within the limits of these limitations and qualifications;

  (2) 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

  (3) Maintain a current license or registration to practice massage therapy.

B. The licensee or registrant may not perform a treatment or provide a service which:

  (1) The licensee or registrant is not qualified to perform; or

  (2) Is beyond the scope of the licensee’s or registrant’s education, training, capabilities, experience, and scope of practice.

#### Regulation .08 Ethical, Legal, and Professional Responsibilities of Massage Therapist and Practitioners.

*COMAR 10.65.03.08*

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.

#### Regulation .09 Penalties.

*COMAR 10.65.03.09*

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.