Maryland Register
Issue Date:  July 7, 2017
Volume 44 • Issue 14 • Pages 665—667
Title 10
10.09.49 Telehealth Services
Authority: Health-General Article, §§2-104(b) and 15-105.2(b), Annotated Code of Maryland; Ch. 280, Acts of 2013
Notice of Proposed Action
The Secretary of Health proposes to amend Regulations .02, .04—.07, and .09—.11 under COMAR 10.09.49 Telehealth Services.
Statement of Purpose
The purpose of this action is to update regulations related to covered services, participant eligibility, provider conditions for participation, confidentiality, limitations, and reimbursement, based on administrative simplifications and clarifications. An additional purpose of this proposal is to expand permitted distant site providers in an effort to increase access to substance use disorder services via telehealth.
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, or fax to 410-767-6483. Comments will be accepted through August 7, 2017. A public hearing has not been scheduled.
.02 Definitions.
A. (text unchanged)
B. Terms Defined.
(1) (text unchanged)
[(2) “Campus” means the physical area immediately adjacent to the provider’s main buildings, other areas, and structures that are not strictly contiguous to the main buildings but are located on the same property, and any other areas determined on an individual-case basis by the Department to be part of the provider’s campus.]
[(3)] (2)[(8)] (7) (text unchanged)
[(9)] (8) “Medically necessary” means that the service or benefit is:
(a)—(c) (text unchanged)
(d) Not primarily for the convenience of the [consumer] participant, family, or provider.
[(10)] (9)[(11)] (10) (text unchanged)
(11) “Participant” means an individual who is certified as eligible for, and is receiving, Medical Assistance benefits.
[(12) “Professional fee” means:
(a) For somatic services, the Departmental fee schedule for clinical somatic services, that is incorporated by reference in COMAR; or
(b) For behavioral health services, the Departmental fee schedule for clinical behavioral health services, that is incorporated by reference in COMAR]
[(13)] (12)[(16)] (15) (text unchanged)
[(17)] (16) Store and Forward Technology.
(a) “Store and [Forward] forward technology” means the transmission of medical images or other media captured by the originating site provider and sent electronically to a distant site provider, who does not physically interact with the patient located at the originating site.
(b) “Store and forward technology” does not mean dermatology, ophthalmology, or radiology services according to COMAR
[(18)] (17)[(21)] (20) (text unchanged)
.04 Service Model.
A.—C. (text unchanged)
D. [Professional services] Services rendered via telehealth are reimbursed on a fee-for-service basis.
.05 Covered Services.
Under the Telehealth Program, the Department shall cover:
A. Medically necessary services covered by the Maryland Medical Assistance Program rendered by a registered distant site provider that shall be:
(1) Distinct from services provided by the originating site provider; [and]
(2) (text unchanged)
(3) Clinically appropriate to be delivered via telehealth;
B. Services provided via telehealth to the same extent and standard of care as services provided in person;
[B.] C. The transmission fee paid to a registered originating site, except when the originating site is not a Medicaid payable provider; and
D. As determined by the provider’s licensure or credentialing board, telehealth services performed within the scope of a provider’s practice.
.06 Participant Eligibility.
A participant is eligible to receive telehealth services if the individual:
A. (text unchanged)
B. Consents to telehealth services unless there is an emergency that prevents obtaining consent, which the originating site shall document in the participant’s medical record; and
C. Is present at the originating site at the time the telehealth service is rendered[; and].
[D. When treated for behavioral health services, is authorized to receive behavioral health treatment services through the Public Behavioral Health System, except for behavioral health services provided in a hospital emergency department.]
.07 Provider Conditions for Participation.
A.—C. (text unchanged)
D. Permitted Distant Site [Rendering] Providers. [The following provider types may register as distant site providers to render behavioral or somatic services via telehealth:]
(1) Effective October 1, 2017, the following provider sites may register as distant site providers eligible to deliver services via telehealth within the rendering provider’s scope of practice:
(a) A community-based substance use disorder provider;
(b) An opioid treatment program; or
(c) An outpatient mental health center.
(2) The following rendering provider types licensed to practice in Maryland may register as distant site providers to render behavioral or somatic services via telehealth:
[(1)] (a)[(5)] (e) (text unchanged)
.09 Confidentiality.
The originating and distant site providers:
A.—B. (text unchanged)
C. Shall occupy a space or area that meets the minimum standards for privacy expected for a patient-provider interaction;
[C.] D.[D.] E. (text unchanged)
.10 Limitations.
A.—B. (text unchanged)
C. [] Store and [Forward] forward technology[] does not meet the Maryland Medical Assistance Program’s definition of telehealth. The Maryland Medical Assistance Program covers services such as dermatology, ophthalmology, and radiology according to COMAR
D. (text unchanged)
E. The Department may not reimburse a provider for the following:
(1) (text unchanged)
(2) Communications between providers where the participant is not physically present at the originating site; [or]
(3) Telehealth services delivered where either:
(a) (text unchanged)
(b) The originating site is not a permitted originating site provider as set forth in Regulation .07 of this chapter; or
(4) Behavioral health and substance use disorder services that did not receive prior authorization from the Department or its ASO.
F.—I (text unchanged)
[J. The Department may not reimburse for telehealth services delivered by an originating and distant site provider located in different facilities in the same campus.]
.11 Reimbursement.
A. (text unchanged)
[B. There are two categories of fees the Department shall reimburse a registered telehealth provider, as applicable:
(1) Originating site transmission fee; and
(2) Distant site professional fee performed via telehealth.]
[C.] B. (text unchanged)
[D.] C. Distant Site [Professional Fee] Reimbursement.
(1) The distant site [professional fee] shall be reimbursed:
(a) For somatic services provided via telehealth, as set forth in COMAR; [or]
(b) For behavioral health services provided via telehealth, as set forth in COMAR; or
(c) For substance use disorder services provided via telehealth, as set forth in COMAR
(2) [Professional fees charged for telehealth services] Services delivered via telehealth shall be billed with the telehealth GT modifier.
(3) Services delivered via telehealth shall be within the provider’s scope of practice as determined by its governing licensure or credentialing board.
Secretary of Health