November 26, 2018
45 • Issue 24 • Page 1171-1172
MARYLAND DEPARTMENT OF HEALTH
Subtitle 32 BOARD OF PHYSICIANS
Authority: Health Occupations
Article, §§1-903, 14-205, 14-301, and 14-601,
Annotated Code of Maryland
The Secretary of Health proposes to repeal existing
Regulations .01—.07 and adopt new Regulations .01—.07 under COMAR
10.32.05 Telehealth. This action was considered at a public meeting of the
Board of Physicians on September 26, 2018, notice of which was provided by
posting on the Board’s website,
https://www.mbp.state.md.us/forms/September26FullAgenda.pdf from September 11,
2018, through September 26, 2018, pursuant to General Provisions Article,
§3-302(c), Annotated Code of Maryland.
The purpose of this action is to improve patient safety, to
authorize other health occupations under the Board’s jurisdiction to do
telehealth, and to reflect technological innovations and the increasing use of
telehealth in more settings. These regulations also implement the requirements
of S.B. 1106 (Ch. 610, Acts of 2017) Health Care Practitioners — Use of Teletherapy.
There is no corresponding federal standard to this proposed
The proposed action has no economic impact.
on Small Businesses
The proposed action has minimal or no economic impact on small
Individuals with Disabilities
The proposed action has no impact on individuals with
Comments may be sent to Jake Whitaker, Acting Director, Office of
Regulation and Policy Coordination, Maryland Department of Health, 201 West
Preston Street, Room 512, Baltimore, MD 21201, or call 410-767-6499 (TTY
800-735-2258), or email to firstname.lastname@example.org, or fax to 410-767-6483.
Comments will be accepted through December 26, 2018. A public hearing has not
This chapter governs the practice of medicine
using telehealth as an adjunct to, or replacement
for, in-person patient visits.
A. In this chapter, the following terms have the meanings
B. Terms Defined.
(1) “Asynchronous” means not occurring at the same time.
(2) “In-person” means within the physical
presence of the patient.
(3) “Interpretive services” means reading and analyzing images,
tracings, or specimens through telehealth or giving interpretations
based on visual, auditory, thermal, or ultrasonic patterns or other patterns as
may evolve with technology.
(4) “Remote patient monitoring” means the use of telehealth
devices to collect medical and other forms of health data from patients that
are securely provided to a telehealth practitioner in a different location for
assessment, recommendation, and diagnosis.
(5) “Store and forward telehealth services” means a type of
asynchronous telehealth service involving a response or interpretation of
digital images, documents, audio, or video transmitted electronically through
(6) “Surrogate examiner” means an individual examining a
patient at the direction of a telehealth practitioner during a synchronous
audio-visual telehealth encounter and providing the telehealth practitioner
with observations and information.
(7) “Synchronous” means simultaneously or quickly enough to
allow two or more individuals to conduct a conversation.
Telehealth” means the use of interactive audio, video,
audio-visual, or other telecommunications or electronic technology by a
licensed health care practitioner to deliver clinical services within the scope
of practice of the health care practitioner at a location other than the
location of the patient.
“Telehealth” does not include:
(i) An audio-only telephone conversation between a health
care practitioner and a patient;
(ii) An electronic mail message between a health care
practitioner and a patient; or
(iii) A facsimile transmission between a health care
practitioner and a patient
“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 the patient.
0) “Telehealth practitioner” means a Maryland licensed
physician or licensed allied health practitioner performing telehealth services
within their respective scope of practice.
Except as specified in Health Occupations Article, §14-302,
Annotated Code of Maryland, an individual shall be a telehealth practitioner in
order to practice telehealth if one or both of the following occurs:
A. The individual practicing telehealth is physically
located in Maryland; or
B. The patient is in Maryland.
ecific Telehealth Requirements.
A. Before providing 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(l), 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
(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
(2) Confirm whether the patient is in Maryland
and identify the patient’s practice setting;
(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 permitted to hear personal health information.
C. The requirements
set forth under §§A and B of this regulation may
.05 Patient Evaluation.
A. Except when providing
asynchronous telehealth services or remote patient monitoring, a
telehealth practitioner shall perform a patient evaluation adequate to
establish diagnoses and identify underlying conditions or contraindications to
recommended treatment options before providing treatment or prescribing
B. If the evaluation is adequate to comply with §A of this
regulation, a telehealth practitioner may use:
(1) A surrogate exa
(2) Telehealth devices;
(3) Live synchronous audio-visual communication;
(4) Other methods of performing a medical examination
(5) A patient evaluation performed by another licensed
health care practitioner providing coverage.
.06 Standard Related to Telehe
A. A telehealth practitioner shall be held to the same
standards of practice and documentation as those applicable in in-person health
B. A telehealth practitioner may not treat a patient or
prescribe medication based solely on an online questionna
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 Mar
.07 Telehealth Practitioner Discipline.
A. The Board shall use
the same standards in evaluating and investigating a complaint and disciplining
a licensee who practices telehealth as it would use for a licensee who does not
use telehealth technology in the licensee’s practice.
B. The failure of a telehealth practitioner to comply with
Regulations .04—.06 of this chapter shall constitute unprofessional conduct.
ROBERT R. NEALL
Secretary of Health
201 W. Preston Street, Baltimore, MD 21201-2399
(410) 767-6500 or 1-877-463-3464