PURPOSE: This rule specifies the requirements to operate a massage therapy business.

1. (1) Each massage therapy business owner or manager shall:

   1. (A) Employ or permit to practice on the premises only licensed or provisionally licensed massage therapists to perform massage therapy;
   2. (B) Ensure that no massage therapist in his/her employ or practicing on his/her premises perform beyond their scope of practice and expertise nor shall a massage therapy business owner direct or require a massage therapist to perform beyond their scope of practice and expertise;
   3. (C) Maintain in the records a copy of the massage therapist’s license, any certifications or advanced training, individual liability insurance and subsequent renewed licenses by documentation;
   4. (D) Ensure that each massage therapist wears appropriate clothing and practices high standards of personal hygiene;
   5. (E) Display in a conspicuous place the massage therapy business license and each massage therapist license with a photograph which has been taken within the last two (2) years;
   6. (F) Maintain policies and procedures that address but are not limited to the nature and scope of services provided and orient employees or those practicing on their premises to the practice standards as it relates to public standards and client records and maintain proof of this orientation;
   7. (G) Be responsible for maintaining client records for at least three (3) years. This includes safeguarding verbal and written confidential information of the client, unless disclosure is required by law, court order, or authorized by the client. Client records for massage therapy services not provided at a licensed massage therapy business shall be maintained by the licensed massage therapist;
   8. (H) Shall maintain proof that the massage therapy business location or premises has current general liability insurance;
   9. (I) Maintain documentation of compliance with all applicable building and fire codes prescribed by the state or local government. If no zoning codes are available establishments shall be equipped with and maintain fire extinguishers and smoke alarms that are in good working condition;
   10. (J) Maintain all equipment used to perform massage therapy services on the premises in a safe and sanitary condition;
   11. (K) Provide for safe and unobstructed human passage in the public areas of the premises;
   12. (L) Ensure compliance with the regulations of other entities which include but are not limited to the Americans with Disabilities Act (ADA), Occupational Safety and Health Administration (OSHA) and the Environmental Protection Agency (EPA);
   13. (M) Provide for the removal of garbage and refuse in a sanitary manner; and
   14. (N) Provide for safe storage or removal of flammable materials.
2. (2) All furniture in a massage therapy business must be kept clean and well maintained.
3. (3) Massage therapy shall be conducted in areas that are adequately lighted and ventilated and constructed so that they can be kept clean. Floors, walls, ceilings and windows must remain free of dust and other unclean substances and be in good repair at all times.
4. (4) The area(s) used for massage shall be used exclusively for massage and other clinical or healthcare related purposes.
5. (5) Each massage therapy business shall contain rest room facilities, including at least one water-flushed toilet, equipped with toilet tissue, from which the wastewater shall be discharged into a sewage system acceptable to the Environmental Protection Agency (EPA). Such facilities and all of the foregoing fixtures and components shall be kept clean, in good working condition, well lighted, and have adequate ventilation. Massage therapy businesses located in buildings housing multiple businesses under one roof such as arcades, shopping malls, terminals, and hotels may substitute centralized toilet facilities. Such central facilities shall be within three hundred feet (300') of the massage therapy business.
6. (6) Businesses shall be equipped with and maintain a sink for hand cleansing within a reasonable distance of the treatment room. Such sink must be kept clean and in good working condition. Massage therapists must utilize universal precautions at all times, however, a massage therapist may utilize an antibacterial waterless hand cleanser while in 20 CSR 2197-5

the confines of the massage therapy area and if leaving the area must use universal precautions before performing massage therapy on the next client.

1. (7) Massage therapy businesses shall be free of alive or dead flies, insects, and other vermin.
2. (8) No animals shall be permitted in a massage therapy treatment area at any time except service animals whose whole purpose is to provide assistance to a customer.

AUTHORITY: sections 324.240, 324.247, 324.250, 324.252, 324.255, 324.257 and 324.260, RSMo 2000 and 324.245, RSMo Supp. 2003.* This rule originally filed as 4 CSR 197-5.010. Original rule filed Feb. 25, 2000, effective Sept. 30, 2000. Amended: Filed Nov. 26, 2003, effective June 30, 2004. Moved to 20 CSR 2197-5.010, effective Aug. 28, 2006.

*Original authority: 324.240, RSMo 1998, amended 1999; 324.245, RSMo 1998, amended 1999, 2003; 324.247, RSMo 1998, amended 1999; 324.252, RSMo 1998; 324.255, RSMo 1998; 324.257, RSMo 1998, amended 1999; and 324.260, RSMo 1998, amended 1999.