New Guidance for LMTs
Definition of Health Care Settings
Tuesday June 2, 2020

Hello Members,

We have heard the questions and concerns about how the reopening for LMTs is being interpreted by different businesses and settings. We reached out directly to the Maryland Board of Massage Therapy Examiners and this is what we have been advised:

Health Care Settings:
LMTs are healthcare providers and are able to work in their offices and that of other healthcare providers.   If the business is currently using 100 % LMTs for its staff, it is by definition a healthcare setting and allowed to reopen.  RMPs cannot work in a healthcare setting and by extension work for a LMT.

The significantly broadens the guidance we received last week and impacts many more LMTs and their work settings. Please remember that all the Secretary of Health's requirements must be followed. You can find that amended directive on the MBMTE website. AMTA has included our line by line guidance below.

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
RMPs First - Specific Guidance
An Registered Massage Practitioner is not allowed to work in any setting at this time.

RMPs 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.

According to the guidance above, locations that only bring back LMTs at this time are allowed to open.

We do not know what stage "massage parlors" and related businesses fall under.
OK - I'm a LMT who works in a Health Care Setting
per the Guidance above
What Else do I NEED TO DO?
Local Jurisdiction Approval
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. These are the counties we have information about.

  • Montgomery County allowed LMTs in health care settings on Monday June 1st.
  • Prince George's County is reported to be closed for all massage therapy including health care settings. We are seeking further information.
  • Baltimore County is OPEN for LMTs in a Health Care Setting - County Executive Olszewski earned our gratitude with this detailed interpretive guidance.
  • Anne Arundel County allowed LMTs in a health care setting last week.
  • Frederick County allowed LMTs in a health care setting this past weekend.
  • Howard County allowed LMTs in a health care setting today.
  • Baltimore City - we do not have any information, we have made inquiries and are waiting on a response. Proceed with caution - get a yes before opening.
Ethical Requirements
A Weeks Supply of PPE
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.
Screen for COVID-19 - Infection Control
Social Distancing - Exclude Those at Higher Risk
This will require additional time and detail for intakes, a much higher standard for cleaning and disinfection, and Personal Protective Equipment for therapists, and masks for clients. Social distancing is required for clients and staff before and after sessions.


CERTIFY to the SECRETARY of HEALTH
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.


All of this can be interpreted as the LMT's responsibility as we are the licensed health care providers. While it would be agreed that employers need to fully provide all that is needed to return to work safely, it is the LMTs responsibilty to follow the Secretary of Health's guidance in all of these areas.

Line by Line Guidance for LMTs
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.

  • Note: PPE requests to any State or local health or emergency management agency will be denied for elective and non-urgent medical procedures.
  • Note: The healthcare facility or healthcare provider must be able to procure all necessary PPE for its desired services via standard supply chains.
  • Note: For hospitals with COVID-19 patients, MDH will determine a daily PPE per patient use rate for PPE requests.
  • Note: “Healthcare setting” means: (1) the office of a healthcare provider licensed under the Health Occupations Article; or (2) a healthcare facility as defined in § 19-114 of the Health-General Article.

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
  • Note: All healthcare providers and staff shall wear appropriate face coverings, to include cloth face coverings, surgical face masks or N-95 masks, respirators, and/or face shields.
  • Note: Patients should wear a face covering whenever possible.
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 secretary.health@maryland.gov 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.
We hope this is helpful,
please take a deep breath
and read over the sections that pertain to your situation if you have questions.
You can reply to this email with further questions.