Maryland

Counselors

We are not aware of any specific rules and regulations of the practice of telemental health services for Counselors.

Source 

Social Workers

Social Workers

Title 10 MARYLAND DEPARTMENT OF HEALTH

Source

Subtitle 42 BOARD OF SOCIAL WORK EXAMINERS

10.42.10 Teletherapy

Authority: Health Occupations Article, §§1-901—1-903, Annotated Code of Maryland

.01 Scope.

This chapter:

A. Applies to a:

(1) Licensed certified social worker-clinical (LCSW-C);

(2) Licensed certified social worker (LCSW) under the supervision of an LCSW-C; or

(3) Licensed masters social worker (LMSW) under the supervision of an LCSW-C.

B. Does not prohibit the following from using electronic means as defined under Regulation .02B(4)(a) within their scope of practice: (1) A licensed bachelor social worker (LBSW) under supervision; (2) A licensed bachelor social worker (LBSW) practicing independently; (3) A licensed certified social worker (LCSW); or (4) A licensed masters social worker (LMSW) practicing independently.

.02 Definitions.

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

B. Terms Defined.

(1) “Board” means the Maryland Board of Social Work Examiners.

(2) “Client” means the individual, couple, family, group, business, agency, school, organization, or association that the licensed social worker provides, or has provided, with professional services.

(3) “Synchronous” means simultaneously or quickly enough to allow two or more individuals to conduct a conversation.

(4) Teletherapy.

(a) “Teletherapy” means the use of interactive audio, video, or other telecommunications or electronic media by a licensed social worker to deliver psychotherapy:

(i) Within the scope of practice of an LCSW-C, an LCSW under the supervision of an LCSW-C, or an LMSW under the supervision of an LCSW-C; and

(ii) At a location other than the location of the client;

(b) “Teletherapy” does not include:

(i) An audio-only telephone conversation between an LCSW-C, an LCSW under the supervision of an LCSW-C, or an LMSW under the supervision of an LCSW-C, and a client;

(ii) An electronic mail message between an LCSW-C, an LCSW under the supervision of an LCSW-C, or an LMSW under the supervision of an LCSW-C, and a client;

(iii) A facsimile transmission between an LCSW-C, an LCSW under the supervision of an LCSW-C, or an LMSW under the supervision of an LCSW-C, and a client; or

(iv) A text message or other type of message sent between an LCSW-C, an LCSW under the supervision of an LCSW-C, or an LMSW under the supervision of an LCSW-C, and a client by a short message service or multimedia messaging service.

 .03 Licensure.

The following Board-approved licensees may provide psychotherapy using teletherapy if the client is in Maryland:

A. An LCSW-C;

B. An LCSW under the supervision of an LCSW-C; or

C. An LMSW under the supervision of an LCSW-C.

 .04 Standards of Practice for Teletherapy.

Before providing teletherapy services, a licensee who is permitted to use teletherapy under this chapter:

A. Shall:

(1) Develop and follow a procedure to:

(a) Verify the identification of the client receiving teletherapy services;

(b) Obtain informed consent specific to teletherapy services using appropriate language understandable to the client;

(c) Prevent access to data by unauthorized persons through encryption or other means;

(d) Notify clients in the event of a data breach;

(e) Ensure that the teletherapy practitioner provides a secure and private teletherapy connection and complies with federal and state privacy laws;

(f) Establish safety protocols to be used in the case of an emergency, including contact information for emergency services at the client’s location;

(g) Obtain or confirm an alternative method of contacting the client in case of a technological failure;

(h) Determine whether the client is in Maryland and identify the client’s specific location;

(i) For an initial teletherapy interaction only, disclose the name, location, Maryland license number, and contact information of the LCSW-C, the LCSW, or the LMSW; and

(j) Identify all individuals present at each location and confirm they are permitted to hear the client’s health information; and

(2) Be held to the same standards of practice and documentation as those applicable for in-person sessions; and

B. May not treat a client based solely on an online questionnaire.

.05 Client Evaluation.

A. A licensee who is permitted to use teletherapy under this chapter shall perform a client evaluation adequate to establish diagnoses and identify underlying conditions or contraindications to recommended treatment options before providing subsequent teletherapy services.

B. If the evaluation is adequate to comply with §A of this regulation, a licensee who is permitted to use teletherapy under this chapter may use:

(1) Live synchronous audio-visual communication;

(2) Other methods of performing social work remotely; or

(3) A social work evaluation performed by another licensee who is permitted to use teletherapy under this chapter providing coverage.

 .06 Discipline.

A. The Board shall use the same standards in evaluating and investigating a complaint and disciplining a licensee who is permitted to use teletherapy under this chapter as it would use for a licensee who is permitted to use teletherapy under this chapter who does not use teletherapy technology.

B. The failure of a licensee who is permitted to use teletherapy under this chapter to comply with this chapter shall constitute unprofessional conduct and may be subject to disciplinary action by the Board in accordance with COMAR 10.42.09.

Marriage and Family Therapists

We are not aware of any specific rules and regulations of the practice of telemental health services for MFTs.

Psychologists

Source

10.36.10.02

.02 Definitions.

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

B. Terms Defined.

(1) “Board” means the Maryland Board of Examiners of Psychologists.

(2) “Client” means the individual, couple, family, group, business, agency, school, organization, or association that the psychologist or psychology associate provides, or has provided, with professional services.

(3) “Psychologist” means an individual who is licensed by the Board to practice psychology.

(4) “Psychology associate” means an individual who is registered by the Board to practice psychology under the supervision of a licensed psychologist.

(5) Telepsychology.

(a) “Telepsychology” means the use of interactive audio, video, or other telecommunications or electronic media by a psychologist or psychology associate who engages in the practice of psychology at a location other than the location of the client.

(b) “Telepsychology” does not include:

(i) An audio-only telephone conversation between a psychologist or psychology associate and a client;

(ii) An electronic mail message between a psychologist or psychology associate and a client;

(iii) A facsimile transmission between a psychologist or psychology associate and a client; or

(iv) A text message or other type of message sent between a psychologist or psychology associate and a client by a short message service or multimedia messaging service."

.03 Licensure.

"An individual shall be licensed with the Board as a psychologist or registered with the Board as a psychology associate in order to engage in the practice of psychology using telepsychology in Maryland if one or both of the following occurs:

A. The individual practicing telepsychology is physically located in Maryland: or

B. The client is in Maryland."

.04 Standards of Practice for Telepsychology.

"A. Before providing telepsychology services, a psychologist or psychology associate shall develop and follow a procedure to:

(1) Verify the identification of the client receiving telepsychology services;

(2) Obtain informed consent specific to telepsychology services using appropriate language understandable to the client;

(3) Prevent access to data by unauthorized persons through encryption, or other means;

(4) Notify clients in the event of a data breach;

(5) Ensure that the telepsychology practitioner provides a secure and private telepsychology connection and complies with federal and state privacy laws;

(6) Establish safety protocols to be used in the case of an emergency, including contact information for emergency services at the client’s location; and

(7) Ensure that any psychological testing instruments used are designed, validated, or appropriate for use via telepsychology.

B. A psychologist or psychology associate shall:

(1) Obtain or confirm an alternative method of contacting the client in case of a technological failure;

(2) Determine whether the client is in Maryland and identify the client’s specific location;

(3) For an initial telepsychology interaction only, disclose the psychologist’s or psychology associate’s name, location, license number, and contact information;

(4) Identify all individuals present at each location and confirm they are permitted to hear the client’s health information; and

(5) Be held to the same standards of practice and documentation as those applicable for in-person sessions.

C. A psychologist or psychology associate may not treat a client based solely on an online questionnaire."

.05 Evaluation for Telepsychology Services.

"A. Before engaging in the practice of psychology using telepsychology, a psychologist or psychology associate shall evaluate the client to determine that delivery of telepsychology is appropriate considering at least the following factors:

(1) The client’s:

(a) Diagnosis;

(b) Symptoms;

(c) Medical and psychological history; and

(d) Preference for receiving services via telepsychology; and

(2) The nature of the services to be provided, including anticipated:

(a) Benefits;

(b) Risks; and

(c) Constraints resulting from their delivery via telepsychology.

B. The client evaluation set forth in §A of this regulation shall take place at an initial in-person session, unless the psychologist or psychology associate documents in the record the reason for not meeting in person."

Refer to the source provided for all requirements and limitations.

Psychiatrists

Source

10.32.05.02

““Telehealth” means the use of interactive audio, video, audio-visual, or other telecommunications or electronic technology by a Maryland licensed physician or licensed allied health practitioner to deliver clinical services within the scope of practice of the Maryland licensed physician or licensed allied health practitioner at a location other than the location of the patient.

(b) “Telehealth” does not include:

(i) An audio-only telephone conversation between a Maryland licensed physician or licensed allied health practitioner and a patient;

(ii) An electronic mail message between a Maryland licensed physician or licensed allied health practitioner and a patient; or

(iii) A facsimile transmission between a Maryland licensed physician or licensed allied health practitioner and a patient.

(9) “Telehealth devices” means devices that gather visual or other data and remotely sends the images or data to a telehealth practitioner in a different location from that of the patient.

(10) “Telehealth practitioner” means a Maryland licensed physician or licensed allied health practitioner performing telehealth services within their respective scope of practice.”

Maryland Professional Regulation/Health & Safety Online Prescribing

Source

10.32.05.04

.04 Specific Telehealth Requirements.

“A. Before performing telehealth services, a telehealth practitioner shall develop and follow a procedure to:

(1) Verify the identification of the patient receiving telehealth services;

(2) Except for interpretive services, obtain oral or written acknowledgement from a patient or person in interest as defined by Health-General Article, §4-301(m), Annotated Code of Maryland, to perform telehealth services;

(3) Prevent access to data by unauthorized persons through encryption or other means;

(4) Notify patients in the event of a data breach;

(5) Ensure that the telehealth practitioner provides a secure and private telehealth connection that complies with federal and state privacy laws; and

(6) Establish safety protocols to be used in the case of an emergency.

B. Except when providing store and forward telehealth services, remote patient monitoring, or other asynchronous telehealth services, a telehealth practitioner shall:

(1) Obtain or confirm an alternative method of contacting the patient in case of a technological failure;

(2) Confirm whether the patient is in Maryland and identify the practice setting in which the patient is located;

(3) For an initial patient-telehealth practitioner interaction only, disclose the telehealth practitioner’s name, contact information, and medical specialty; and

(4) Identify all individuals present at each location and confirm they are allowed to hear personal health information.

C. The requirements set forth under §§A and B of this regulation may be delegated.”

Source

10.32.05.05

.05 Patient Evaluation.

“A. A telehealth practitioner shall perform a synchronous, audio-visual patient evaluation adequate to establish diagnoses and identify underlying conditions or contraindications to recommended treatment options before providing treatment or prescribing medication.

B. Subject to Regulation .06 of this chapter, the requirements of §A of this regulation do not apply to:

(1) Interpretive services where a prior patient evaluation was performed by another provider;

(2) Remote patient monitoring; or

(3) Asynchronous telehealth services for a patient who has had a prior synchronous, audio-visual telehealth patient evaluation or in-person patient evaluation that complies with the requirements of §A of this regulation.

C. To comply with §A of this regulation, a telehealth practitioner may use:

(1) A surrogate examiner; or

(2) A patient evaluation performed by another licensed health care practitioner providing coverage.”

Source

10.32.05.06

.06 Standard Related to Telehealth.

“A. A telehealth practitioner shall be held to the same standards of practice and documentation as those applicable in in-person health care settings.

B. A telehealth practitioner may not treat a patient or prescribe medication based solely on an online questionnaire.

C. A telehealth practitioner may not prescribe opioids for the treatment of pain through telehealth except if the patient is in a health care facility as defined in Health-General Article, §19-114(d)(1), Annotated Code of Maryland.”

Refer to the source provided for all requirements and limitations.

Nurses

“As a party state to the Nurse Licensure Compact (NLC), Maryland issues multistate licenses to nurses and applicants who reside in the state and recognizes multistate licenses issued by other party states, for practice in Maryland. A nurse holding a multistate license is entitled to practice in any NLC party state, but must comply at all times with the laws of the state where he or she is currently practicing.”

“It should be noted that not every state in the US is an NLC party state; a map of participating states, as well as further resources related to the NLC, are available on the Nurse Licensure Compact website.”

Refer to the source provided for all requirements and limitations.

Maryland Professional Regulation/Health & Safety Online Prescribing

Source

10.32.05.04

.04 Specific Telehealth Requirements.

“A. Before performing telehealth services, a telehealth practitioner shall develop and follow a procedure to:

(1) Verify the identification of the patient receiving telehealth services;

(2) Except for interpretive services, obtain oral or written acknowledgement from a patient or person in interest as defined by Health-General Article, §4-301(m), Annotated Code of Maryland, to perform telehealth services;

(3) Prevent access to data by unauthorized persons through encryption or other means;

(4) Notify patients in the event of a data breach;

(5) Ensure that the telehealth practitioner provides a secure and private telehealth connection that complies with federal and state privacy laws; and

(6) Establish safety protocols to be used in the case of an emergency.

B. Except when providing store and forward telehealth services, remote patient monitoring, or other asynchronous telehealth services, a telehealth practitioner shall:

(1) Obtain or confirm an alternative method of contacting the patient in case of a technological failure;

(2) Confirm whether the patient is in Maryland and identify the practice setting in which the patient is located;

(3) For an initial patient-telehealth practitioner interaction only, disclose the telehealth practitioner’s name, contact information, and medical specialty; and

(4) Identify all individuals present at each location and confirm they are allowed to hear personal health information.

C. The requirements set forth under §§A and B of this regulation may be delegated.”

Source

10.32.05.05

.05 Patient Evaluation.

“A. A telehealth practitioner shall perform a synchronous, audio-visual patient evaluation adequate to establish diagnoses and identify underlying conditions or contraindications to recommended treatment options before providing treatment or prescribing medication.

B. Subject to Regulation .06 of this chapter, the requirements of §A of this regulation do not apply to:

(1) Interpretive services where a prior patient evaluation was performed by another provider;

(2) Remote patient monitoring; or

(3) Asynchronous telehealth services for a patient who has had a prior synchronous, audio-visual telehealth patient evaluation or in-person patient evaluation that complies with the requirements of §A of this regulation.

C. To comply with §A of this regulation, a telehealth practitioner may use:

(1) A surrogate examiner; or

(2) A patient evaluation performed by another licensed health care practitioner providing coverage.”

Source

10.32.05.06

.06 Standard Related to Telehealth.

“A. A telehealth practitioner shall be held to the same standards of practice and documentation as those applicable in in-person health care settings.

B. A telehealth practitioner may not treat a patient or prescribe medication based solely on an online questionnaire.

C. A telehealth practitioner may not prescribe opioids for the treatment of pain through telehealth except if the patient is in a health care facility as defined in Health-General Article, §19-114(d)(1), Annotated Code of Maryland.”

Refer to the source provided for all requirements and limitations.

Private Pay Telehealth Parity Law

Source: MD Insurance Code Annotated Sec. 15-139(c)(1)

"(c) Coverage. --
(1) An entity subject to this section:
(i) shall provide coverage under a health insurance policy or contract for health care services appropriately delivered through telehealth; and
(ii) may not exclude from coverage a health care service solely because it is provided through telehealth and is not provided through an in-person consultation or contact between a health care provider and a patient.

...

(d) Reimbursement and deductible. -- An entity subject to this section:
(1) shall reimburse a health care provider for the diagnosis, consultation, and treatment of an insured patient for a health care service covered under a health insurance policy or contract that can be appropriately provided through telehealth"

Refer to the source provided for all requirements and limitations.

Payment Parity

We are not aware of any explicit payment parity.

Permission for the Temporary Practice of Clinicians Licensed Outside the State

We are not aware of any permission that allows for services delivered by out-of-state providers.

Note: As this is a free resource and Rules and Regulations regarding Telehealth are always changing, we appreciate any updates or corrections. They can be emailed to us at [email protected] with a link to the source or a citation of the rule or regulation.

Telemental Health Training Certificate Program

Telemental health is not a separate service from mental health services. All state licensing boards require that licensed clinicians follow all the regulations for practicing under their license no matter what medium of communication is used. All licensing boards also require that clinicians only practice within the boundaries of their competence. This usually requires education, continuing education, and/or supervision in telemental health. Complete our telehealth training program to cover all the essential competencies of providing telemental health services and earn the THTC (Telemental Health Training Certificate).