AMTA's Position on the Interstate Massage Compact (IMpact)

What is the Interstate Massage Compact (IMpact)?

The Interstate Massage Compact's (IMpact) purpose is to support the mobility of licensed massage therapists across the country and to ease the existing burdens of license portability. While AMTA supports greater mobility for massage therapists through use of an interstate compact, we are concerned with the barriers and restrictions currently in the IMpact that could impose unnecessary hurdles and exclude many licensed massage therapists from immediately participating in it.

For these reasons, AMTA currently opposes the IMpact, until substantial changes are made to the legislation to benefit a larger majority of massage therapists across the U.S.

Background on AMTA and the IMpact 

Since the Compact Technical Advisory Group (TAG) was formed, AMTA has had concerns about the IMpact as it was discussed and drafted, as well as with the final version. At the same time, we recognize and value the need for greater mobility in our profession. In fact, it’s one of our top strategic objectives to “establish portability for massage practice across the U.S.”

We also recognize that public disagreements within the profession can be one of the fastest ways to kill (or weaken) a legislative effort. For these reasons, we initially decided to empower our chapters to take this on state by state. Our position, communicated to all stakeholders, was to allow the supermajority of members to lead the way. If the supermajority were to vote against the IMpact, AMTA would remain neutral. If the members were to vote in favor, AMTA would support it, but we would support it with concerns, specifically the requirement of 625 clock hours of massage education.

In a letter dated October 30, 2023, FSMTB sought clarification from AMTA, “regarding its support of the IMpact (Ohio SB 56).” FSMTB stated that the 625-hour education threshold is based on the Entry Level Massage Education Blueprint, developed through empirical evidence and research by the Coalition of National Massage Therapy Organizations for the Entry Level Analysis Project (ELAP). FSMTB noted that AMTA participated in ELAP, which is correct.

While AMTA continues to support the general content of the ELAP report, we have never endorsed or supported the 625-hour recommendation. As FSMTB is aware, having also participated in ELAP, the original findings recommended well over 625 hours of massage therapy education. AMTA strongly objected to this number, as it disregarded the evidence-based findings, which conflicts with our core values and even in the words of the ELAP work group, “We encourage interested parties to focus less upon the total hours and more on recommended subject matter and subtopics.” We do not believe that there is an empirical basis for the 625-hour threshold.

Take Action: Support an Inclusive IMpact

Why AMTA Opposes the 625-Hour Requirement:

• At a time when franchises and spas are struggling to attract workers, and states are looking to create less restrictive pathways to obtain a license, especially in the healthcare and health & wellness industries, a 625-hour education requirement creates additional barriers, and in some instances, exclusions for massage therapists to take advantage of the benefits offered by the IMpact.
• The massage therapy profession was afforded this opportunity to make the process easier for military members and their families. It’s insulting that a military member or their family, who is lawfully licensed in their home state, could find themselves in a position where they are not immediately eligible to benefit from the IMpact.
• For the record, we do not believe that access to an interstate compact should be a privilege. While we are aware that other professions currently lobbying for compacts use the language “compact privilege,” those compacts differ from the IMpact because they honor state autonomy. In other words, their uniform licensing requirements simply state, “meets the requirements for licensure in the home state (state of residency).” AMTA believes that the same should hold true for the IMpact. If a massage therapist has met the requirements for licensing in their home state, and is in good standing in their state, that should be sufficient enough to apply for the IMpact.
• We understand that other professions are well ahead of our industry as it relates to consistency in education and standards. AMTA has been at the forefront of moving that needle, and will continue to invest in truly advancing the art and science of massage therapy and working with our Massage Therapy Coalition partners (including COMTA, ABMP, AFMTE, FSMTB, NCBTMB and MTF), to develop stronger and more consistent uniform standards. We do not believe that attempting to set that standard at the interstate compact level is an appropriate strategy when taking into consideration how massage therapy is currently regulated, as well as the challenges, time and money it would take to bring states below the 625-hour threshold, up to that level.  
• From an operational viewpoint, introducing unnecessary barriers does not align with the goals and objectives of AMTA. The IMpact contains various provisions for funding the Compact Commission, which is vital and essential. It is widely recognized that regulatory boards function more efficiently when there are a larger number of license holders, which allows for cost reduction and improved effectiveness. However, implementing unnecessary obstacles and exclusions, narrows the pool of eligible participants, resulting in increased costs. At what stage will costs increase so much that it becomes financially impractical for the individual massage therapist even to apply for the benefit of the IMpact?
• The U.S. Department of Education’s ruling on Financial Responsibility, Administrative Capability, Certification Procedures, Ability To Benefit (ATB) has further reinforced our position on the 625-hour requirement. Specifically, we are referring to the elimination of the 150% rule which has historically allowed schools to remain eligible for Title IV federal financial aid funding with programs up to 150% beyond the state minimum requirements for massage therapy licensure.
• Nearly 70% of our states have an educational requirement of 600 hours or below (with 22 states at 500 hours), and schools will now only be eligible to teach up to that minimum for their students to be eligible for Title IV financial aid. Setting the bar at 625 hours does not reflect the current landscape and massage education requirements across states, and will only prevent more therapists from taking advantage of this benefit.
• We understand that Title IV schools only make up roughly one-third of the schools in the nation; however, it’s important to note that they produce a significant number of the graduates entering the profession where students depend on financial aid to complete a program. It is unknown what impact this new ruling will have on non-Title IV schools. Will other programs look at ways to bring their hours down to stay competitive in this space, as schools adjust to the new rules?

Take Action: Support an Inclusive IMpact

While the 625-hour requirement is our biggest concern, AMTA also opposes the following articles  

ARTICLE 3- MEMBER STATE REQUIREMENTS

Continuing competence requirements as a condition for license renewal.

While AMTA values and promotes the need for continuing education, we also understand that at times, for reasons beyond the profession's control and instances of compromise, states do not have a continuing education requirement. 

Given that five states currently do not have a CE requirement, we feel this provision - similar to the 625-hour requirement - is restrictive based on the reality of how massage is currently regulated in the U.S., and potentially lessens the pool of available therapists to take advantage of the benefit. We do not believe that massage therapists should be denied access to a benefit solely because their home state does not have a CE requirement.

For example, as it currently stands, when we pass the pending massage therapy licensure bill in the state of Minnesota, there will not be a CE requirement. AMTA/AMTA-MN and our bill drafting coalition have debated this many times since 2017. Since massage therapy will be regulated under the nursing board, and nurses do not require continuing education, the decision was made to remove the CE requirement to mirror how nurses are regulated in the state. As long as massage therapists are regulated under the nursing board, they would not be immediately eligible to participate in the IMpact.

ARTICLE 4- MULTISTATE LICENSE REQUIREMENTS

Have passed a National Licensing Examination or the substantial equivalent which the Commission may approve by rule.

AMTA has been the leading organization in drafting and introducing licensing laws for over 80 years and one of our must haves is a psychometrically-valid measure of entry-level competency (examination).

As AMTA has consistently stated, we have to regulate for the future and be cognizant of the fact that there will be individuals who are “exempted” from meeting the requirements due to the fact that they were engaged in a particular practice before any law or requirement existed.

AMTA has always supported fair and uniform regulation that does not create an undue burden on massage therapists. It is unreasonable to ask anyone who is lawfully and duly licensed, and in good standing, in their particular state - many of whom have already taken a licensing examination - to take another “entry-level” examination as a condition to apply for a multistate license. If they have already provided adequate evidence and qualification for obtaining a license in their home state and are in good standing, then this should be sufficient.  

The requirement to take a national licensing examination creates unnecessary administrative and financial hurdles and could potentially lessen the pool of available applicants for the IMpact.

ARTICLE 2- DEFINITIONS

“National Licensing Examination” - A national examination developed by a national association of Massage Therapy regulatory boards, as defined by Commission Rule, that is derived from a practice analysis and is consistent with generally accepted psychometric principles of fairness, validity and reliability, and is administered under secure and confidential examination protocols.

While we disagree that any duly licensed massage therapists should have to take an entry-level exam as a condition to apply for a multistate license, we know that this should not be a sole reason to not support the IMpact. If an entry-level exam is to be required under the IMpact, the definition must be revised. 

The current definition of "National Licensing Examination" is very narrow and does not capture the spirit of regulating for the future. The law must be revised to redefine "National Licensing Examination" to retain the focus an examination with fair, valid, and reliable results, but remove the condition that such an examination be developed by a "national association of massage therapy regulatory boards," since only one exists. We all know that our existence as organizations is not guaranteed, and that at any given moment we could cease to exist, or could be shut down for a variety of reasons. 

Writing clearly-defined and flexible legislation is crucial in the rulemaking process as it ensures accountability, transparency, effective governance and flexibility in an evolving landscape. Narrowly-defined and ambiguous statutes can hinder decision-making processes and lead to confusion. Inconsistencies and lack of precision in enactments can result in difficulties in interpreting and following the law. 

One such example, stems from the IMpact as currently written “a national examination developed by a national association of massage therapy regulatory boards, as defined by Commission Rule.” This definition appears to exclude anyone who has previously taken the NCBTMB licensing examination, as it is not a national association of regulatory boards. We understand that the Compact Commission has some flexibility in determining "a substantially equivalent" exam, but the language is too open to interpretation as written, and could potentially exclude this population moving forward.

We have a lot of experience in the rulemaking process, and have seen that as regulators come and go, so does the interpretation of the law. This is why clearly-defined and flexible provisions in the IMpact are imperative.

As we stated over the last several years, our position has been to allow our membership, on a state-by-state basis, to guide our involvement in supporting and advocating for passage of the IMpact. To date, one chapter has reached out to AMTA national to begin the formal process of determining our position. Coincidentally, that is the lone state that has passed the IMpact.

During this time period, the overwhelming majority of conversations AMTA has had with our chapters, regulatory board members and others has been around issues of concern and/or outright opposition to the IMpact in its current form. 

While AMTA fully supports the concept of an interstate compact and has been advocating for ease of mobility for decades, being a truly member driven organization, we listen to our membership. With that, effective immediately, the AMTA official position on the Interstate Massage Compact (IMpact) is to oppose as it is currently written.

Moving Toward an Interstate Compact that Benefits More Massage Therapists

AMTA remains committed to working with stakeholders across the profession, our partners in the Coalition, and massage educators to achieve an interstate compact that benefits more massage therapists in the profession across the U.S. This includes working in unison to:

• Establish Education Benchmarks: AMTA will work with stakeholders to establish appropriate education benchmarks to ensure public safety and to prepare our students to navigate the evolving massage therapy landscape, shaped by research and the growing demands of consumers and patients in the healthcare arena.
• Develop Education Standards for States: To prioritize public safety, we need to continue to work on a state-by-state basis to create minimum education standards to effectively prepare and train our massage therapy students while respecting the autonomy and specific needs of each state.
• Create Standards of Practice: Uniform Standards of Practice (SOP) are crucial for maintaining safety, professionalism, and integrity in the massage therapy profession. These standards will provide the foundation for ethical conduct between massage therapists and clients, help ensure client well-being, and support the ongoing development and elevation of the practice of massage therapy.

In closing, AMTA fully supports the mobility of the massage therapy profession, but we will continue to oppose any legislative effort that creates arbitrary hurdles, and restricts or excludes, educated massage therapists who have met the requirements for licensure in their home state. When our Coalition partners are ready to join us in listening to the needs of the massage therapy profession, and truly collaborate to modify the IMpact so it benefits more massage therapists, then AMTA will work extensively to get it passed in all 50 states. 

AMTA will continue to keep you informed on our efforts as we strive for an interstate compact that is more accessible for massage therapists across the country. 

Take Action: Support an Inclusive IMpact