PROPOSAL
Issue Date: January 19, 2018
Volume 45 • Issue 2 • Pages 114—115
Title 10
MARYLAND DEPARTMENT OF HEALTH
Subtitle 36 BOARD OF EXAMINERS OF PSYCHOLOGISTS
Authority: Health Occupations Article, §§1–901—1–903, Annotated Code of Maryland
Notice of Proposed Action
[18-011-P]
The Secretary of Health proposes to adopt new Regulations .01—.04 under a new chapter, COMAR 10.36.10 Telepsychology. This action was considered at a public meeting on November 3, 2017, notice of which was given by publication on the Board’s website at https://health.maryland.gov/psych/Pages/boardmeeting.aspx pursuant to General Provisions Article, §3–302(c), Annotated Code of Maryland.
Statement of Purpose
In accordance with Health Occupations Article, §§1–901—1–903, Annotated Code of Maryland, the purpose of this action is to:
(1) Define the term “telepsychology”;
(2) Require that an individual be licensed with the Board as a psychologist or registered with the Board as a psychology associate in order to provide psychological services using telepsychology in Maryland if either the client or the psychologist or psychology associate is physically located in Maryland; and
(3) Establish standards of practice for telepsychology for licensed psychologists and registered psychology associates.
Comparison to Federal Standards
There is no corresponding federal standard to this proposed action.
Estimate of Economic Impact
The proposed action has no economic impact.
Economic Impact on Small Businesses
The proposed action has minimal or no economic impact on small businesses.
Impact on Individuals with Disabilities
The proposed action has no impact on individuals with disabilities.
Opportunity for Public Comment
Comments may be sent to Michele Phinney, 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 mdh.regs@maryland.gov, or fax to 410-767-6483. Comments will be accepted through February 20, 2018. A public hearing has not been scheduled.
.01 Scope.
This chapter applies to all psychologists licensed in Maryland and all psychology associates registered in Maryland who provide psychological services using telepsychology.
.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:
(i) The use of interactive audio, video, or other telecommunications or electronic media by a psychologist or psychology associate to deliver psychological services within the scope of practice of the psychologist or psychology associate; and
(ii) Psychological services that are provided to a client who is not physically present with the psychologist or psychology associate.
(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 provide psychological services using telepsychology in Maryland if either the client or the psychologist or psychology associate is physically located in Maryland.
.04 Standards of Practice for Telepsychology.
A. A psychologist or psychology associate may provide psychological services using telepsychology if the psychologist or psychology associate:
(1) Establishes a client-psychologist or client-psychology associate relationship with the client receiving psychological services using telepsychology;
(2) Limits the practice of telepsychology to areas within the psychologist’s or psychology associate’s scope of practice and competency;
(3) Limits the use of psychological testing instruments to those that are designed, validated, or appropriate for use via telepsychology; and
(4) Complies with the requirements of this chapter.
B. Before engaging in telepsychology, a psychologist and client or a psychology associate and client shall have an initial in-person session, unless the psychologist or psychology associate documents in the record the justification for not meeting in person.
C. Before providing psychological services using telepsychology, a psychologist or psychology associate shall determine that delivery of telepsychology is appropriate, considering at least the following factors:
(1) The client’s diagnosis, symptoms, and medical and psychological history;
(2) The client’s preference for receiving services via telepsychology;
(3) The nature of the services to be provided, including anticipated benefits, risks, and constraints resulting from their delivery via telepsychology.
D. Technological Requirements.
(1) A psychologist or psychology associate shall ensure that the technology used to provide telepsychology services:
(a) Is compliant with the:
(i) Health Insurance Portability and Accountability Act of 1996 (HIPAA), 42 U.S.C. §1320d et seq., as amended; and
(ii) Maryland Confidentiality of Medical Records Act, Health-General Article, Title 4, Subtitle 3, Annotated Code of Maryland;
(b) Provides a secure and private connection; and
(c) Allows for real-time, synchronous, two-way audio-visual communication.
(2) A psychologist or psychology associate shall ensure reasonable efforts to prevent unauthorized access to a client’s data through encryption or other means and to respond to any data breaches.
(3) A psychologist or psychology associate shall immediately inform a client of any breaches in the technology used to provide psychological services via telepsychology that compromised or may have compromised the client’s data.
(4) A psychologist or psychology associate shall disclose to a client any recording made of a telepsychology session.
E. Safety and Security.
(1) Before an initial telepsychology session, a psychologist or psychology associate shall make a positive identification of a client through:
(a) The initial in-person session; or
(b) The use of appropriate photographic identification, if the psychologist or psychology associate and client did not have an initial in-person session.
(2) At every telepsychology session, a psychologist or psychology associate shall obtain or confirm an alternative method of contacting the client in case of a technological failure.
(3) A psychologist or psychology associate providing psychological services via telepsychology shall establish safety protocols to be used in the case of an emergency or crisis, including local telephone numbers at the client’s location for:
(a) Police, fire, and emergency mental health and medical services;
(b) The local hospital emergency room; and
(c) An emergency contact.
(4) A psychologist or psychology associate engaged in telepsychology shall establish safety protocols to be used if:
(a) Privacy of the session is compromised, either electronically or otherwise; or
(b) The session has been, or is likely to be, affected by coercion, force, unauthorized third-party involvement, or an unsafe physical environment.
F. Informed Consent.
(1) A psychologist or psychology associate providing psychological services via telepsychology shall obtain written informed consent using appropriate language understandable to the client in accordance with COMAR 10.36.05.05B.
(2) Informed consent for telepsychology shall include:
(a) Requirements for privacy such that only the psychologist and the client, or the psychology associate and the client, shall participate in or be present during a telepsychology session, unless otherwise agreed to by the psychologist and the client or the psychology associate and the client, in which case the other individuals present shall be identified by name;
(b) Actions to be taken if the technology used for the telepsychology session is disconnected or any other technological issues arise;
(c) The emergency safety protocols required by §E(3) and (4) of this regulation; and
(d) Disclosure of the privacy and security risks of telepsychology and potential risks of disruption of telepsychology sessions.
G. A psychologist or psychology associate providing psychological services via telepsychology shall maintain records of telepsychology in accordance with COMAR 10.36.05.08C.
H. A psychologist or psychology associate providing psychological services via telepsychology shall practice at all times in accordance with the Board’s code of ethics set forth in COMAR 10.36.05.
I. A psychologist or psychology associate who provides psychological services via telepsychology in a manner inconsistent with the standards of practice enumerated in this regulation shall be subject to discipline pursuant to COMAR 10.36.08.04A(18).
DENNIS SCHRADER
Secretary of Health
