Thursday May 28, 2020

Hi Members,

There is a lot going on and often it seems like the guidance from our state and local leadership creates more questions than answers!

Today we are going to focus on what is happening right now and do our best to provide specific advice for LMTs and RMPs. We want you to have it all in one place so you can better understand the situation.

The Governor's orders from yesterday's press conference did not create any changes for massage, although it did note that LMTs in health care settings are allowed to return to work, in relation to last week's announcement from the Secretary of Health. This created change for some LMTs and I will provide all the details and guidance we have on that below.

Many are thinking about reopening and what is required - we will detail that for LMTs in health care right now, and encourage everyone to look at the Guidelines for reopening from the FSMTB which are recommended by the Maryland Board of Massage Therapy Examiners - and are helpful for all of us practicing massage whenever one returns to work.

What we aren't going into today is the two tier system or the NAICS category "massage parlor" those have been thoroughly discussed in newsletters within the past week.

And finally, we are here to provide guidance and advocacy - AMTA-MD cannot tell you what to do, we are the local chapter of your trade organization.

Please remember that we are not your licensing board, we are not a government agency.

Your licensing board is the Maryland Board of Massage Therapy Examiners, they oversee the legal statute and regulations around our practices.

AMTA-MD gathers our information primarily from governmental sources and tries to bring clarity for our membership.

Your questions are always welcomed.

Take good care,

Amelia

Amelia Mitchell, LMT, LLCC, BCTMB

Board Member and Government Relations Committee Chair

for

David Madon, Mark Hamilton, and Chelsea Adams-Cook

Your AMTA-Maryland Chapter Board

An Registered Massage Practitioner is not allowed to work in any setting at this time. They are not considered to be health care providers so are included in any closure that discusses "massage parlors" or massage services, or spas and salons.

We do not know what stage "massage parlors" and related businesses fall under. When RMPs are allowed back to work there will be greatly increased needs for PPE and sanitation. An overview of that is below.

Because these are not health care settings you may not return to work at this time. Please read all of the information above for RMPs as the guidance is the same.

This also includes outcalls, home or site visits, and chair massage, Independent Contractors generally fall in this category as well.

If you work for a doctor's office, in a PT or Chiro office, or similar that is easy to understand, it is a health care setting. It is owned and operated by a licensed health care provider or licensed agency.

If you are an LMT who owns their own business as a sole practitioner and handles all of the scheduling, payments, and pays rent (not a commission split) or owns their place of business, your office will qualify as a health care setting.

An LMT who owns a larger massage business and only employs LMTs and other Maryland Licensed Health Care Providers, ie: PTs, Acupuncturist, LCPCs your office can also be considered a health care setting. (No yoga instructors, estheticians, personal trainers, RMPs or other non-licensed non-health care providers)

Yes you MAY go back to work if you and your employer are following all of the rules for health care facilities outlined by the Secretary of Health. See below for the full line by line guidance.

Confirm that you may return to work in your county or local jurisdiction. The Governor has given local areas the freedom to slow down the re-opening process.

AMTA-MD has been reaching out to various counties and members have also share the information they have received. This is what we have today. When we get new information it will be shared. All are required to get this approval, we limited our search to the counties that slowed reopening, if you are not working in a listed are we do suggest that any LMT who is reopening get guidance from their local jurisdiction.

The Secretary requires all health care providers to "exercise their independent professional judgment in determining what procedures are appropriate to perform, which appointments should occur, and which patients to see in light of widespread COVID-19 community transmission."

Take a few minutes to read that over and understand that as a health care provider you are held to a higher level of responsibility.

"Any licensed healthcare facility or healthcare provider resuming elective and non-urgent medical procedures in a healthcare setting shall have at least one week’s supply of PPE for themselves, staff, and as appropriate, for patients."

This may be your responsibility or supplied by employer. Either way it is not optional.

Please note - everyone must be wearing masks, both clients and therapists.

Details on all of this is below in the line by line guidance.

Finally, the owners or managers of the facility, you if it is yours, are required to certify to the Secretary of Health that you have met the guidelines. This certification must be emailed to them and posted prominently in your office space.

Here is a link for the Certification of Compliance form required it is also on the MBMTE website and all the instructions are included. Managing Authority would be the owner and the health care facility would be the business name.

Below is the complete Amended Directive from Secretary of Health Neall on May 19, 2020. AMTA-MD has provided further info and explanations below each section in Light Blue italicized text. This is all the specifics for what is mentioned above.

The full document can be found here: Amended Directive May 19, 2020

B. Resumption of Elective and Non-Urgent Medical Procedures – Conditions

All licensed healthcare facilities and healthcare providers may resume elective and non-urgent medical procedures and appointments at 7:00 A.M., May 7, 2020 provided all of the following measures are in place:

Licensed Massage Therapists are considered Health Care Providers by statute and it is interpreted that they can return to work in a health care setting only – if following all the additional guidance below. RMPs are not included in this guidance.

I. Healthcare providers licensed under the Health Occupations Article shall exercise their independent professional judgment in determining what procedures are appropriate to perform, which appointments should occur, and which patients to see in light of widespread COVID-19 community transmission.

This means that LMTs may decide for themselves what is safe and what procedures are required for safety (in addition to those required and listed below.) This does not force us back to work, it allows us to return to work.

II. Any licensed healthcare facility or healthcare provider resuming elective and non-urgent medical procedures in a healthcare setting shall have at least one week’s supply of PPE for themselves, staff, and as appropriate, for patients.

III. Social distancing requirements must be strictly maintained in all settings where people must wait in order to minimize direct contact between individuals within the healthcare setting and use of non-traditional alternatives is encouraged (e.g., call ahead registration; waiting in a car until called).

There are many sources for good ideas on how to manage this within the massage setting.

IV. All healthcare workers, patients, and others must be screened for COVID-19 symptoms upon arrival for shift or visit. Staff must stay home if they are showing COVID-19 symptoms.

 

V. All healthcare facilities and healthcare providers must plan for and implement enhanced workplace infection control measures in accordance with the most current CDC guidelines: https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control.html

There is also a lot of good information about what Personal Protective Equipment is helpful and important in a massage setting with Masks being required, and face shields, gloves, and gowns or changeable clothing highly suggested. See the FSMTB guidelines linked at the beginning of this newsletter.

VI. Any healthcare facility or healthcare provider who is unable to provide PPE for themselves, staff, and patients where appropriate shall immediately restrict operations to urgent and non-elective procedures and appointments.

We must have sufficient PPE for everyone to be open.

 

C. Certification and Other Matters

 

I. A healthcare facility’s managing authority or the responsible healthcare provider shall certify to MDH via [email protected] that all of the above conditions for resumption of elective and non-urgent medical procedures have been met prior to resuming operations. A copy of this self-certification notice shall be posted prominently in the facility for the attention of patients and staff.

The LMT or the Health Care Facility must certify to the state that these conditions have been met and post that certification on site.

 

II. Complaints about a healthcare facility’s implementation of these measures may be directed to the Office of Health Care Quality at https://health.maryland.gov/ohcq/Pages/Complaints.aspx . A healthcare provider’s failure to comply with the terms of this order shall be considered to constitute unprofessional conduct, and written complaints about such failures may be directed to the appropriate health occupation board.

 

III. MDH does not construe the immunity provisions in Pub. Safety Art. § 14-3A-06 or Health Gen. Art. § 18-907 to apply to a healthcare provider or facility performing non-COVID-19 related procedures or appointments.

This guidance from the MDH does not provide immunity or protection from any lawsuits.

6. Personal Protective Order Conservation

Subject to availability, all healthcare providers are required to immediately implement the U.S. Centers for Disease Control and Prevention’s Strategies to Optimize the Supply of PPE and Equipment, to include, but not limited to:

A. Use facemasks beyond the manufacturer-designated shelf-life during patient care activities.

B. Implement limited re-use of facemasks. The healthcare provider must not touch the outer surfaces of the mask during care, and mask removal and replacement must be done in a careful and deliberate manner.

C. Prioritize facemasks for:

I. Provision of essential surgeries and procedures;

II. During care activities where splashes and sprays are anticipated;

III. During activities where prolonged face-to-face or close contact with a potentially infectious patient is unavoidable; and

This is one concern for Massage settings – extended time with close contact

IV. Performing aerosol generating procedures, if respirators are no longer available.

 

D. Exclude healthcare providers at higher risk for severe illness from COVID-19 from contact with known or suspected COVID-19 patients.

A reminder that returning to work for those in high-risk categories might not be the best choice at the moment. There are provisions for this within the unemployment rules, although we certainly cannot guarantee coverage.