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    Maryland Register

    Issue Date:  December 21, 2018

    Volume 45 • Issue 26 • Page 1265-1266

    Title 10 

    Subtitle 27 BOARD OF NURSNG

    10.27.17 Teletherapy

    Authority: Health Occupations Article, §§1-901, 1-902, and 8-205(a)(2)—(5), Annotated Code of Maryland

    Notice of Proposed Action


    The Secretary of Health proposes to adopt new Regulations .01—.06 under a new chapter, COMAR 10.27.17 Teletherapy. This action was considered at a public meeting of the Board of Nursing held on September 26, 2018, notice of which was given by publication on the Board’s website beginning January 1, 2018, through September 26, 2018, pursuant to General Provisions Article, §3-302(c), Annotated Code of Maryland.

    Statement of Purpose

    The purpose of this action is to regulate the nonclinical practice of teletherapy for a certified registered nurse practitioner/psychiatric mental health (CRNP/PMH) and a psychiatric mental health/advanced practice registered nurse (PMH/APRN) and define certain terms. CRNP/PMHs and PMH/APRNs are the two advanced practice registered nurse specialties that provide behavioral health services. The proposal provides nonclinical guidelines and standards for teletherapy services to ensure patient safety and privacy. The regulations implement the requirements of S.B. 1106 of 2017.

    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 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 mdh.regs@maryland.gov, or fax to 410-767-6483. Comments will be accepted through January 22, 2019. A public hearing has not been scheduled.

    .01 Scope.

    This chapter applies to all certified registered nurse practitioners/psychiatric mental health (CRNP/PMH) and psychiatric mental health/advanced practice registered nurses (PMH/APRN) in Maryland, with a specialty certification in psychiatric mental health, who will be providing behavioral health services using teletherapy.

    .02 Definitions.

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

    B. Terms Defined.

    (1) “Certified registered nurse practitioner/psychiatric mental health (CRNP/PMH)” means a certified registered nurse practitioner who:

    (a) Is certified by the Board as a certified registered nurse practitioner in the practice of psychiatric mental health; and

    (b) Autonomously and independently engages in activities authorized by this chapter and in accordance with COMAR 10.27.07.

    (2) “Psychiatric mental health/advanced practice registered nurse (PMH/APRN)” means an advanced practice registered nurse who:

    (a) Is certified by the Board as a clinical nurse specialist in the practice of psychiatric mental health; and

    (b) Autonomously and independently engages in activities authorized by this chapter and in accordance with COMAR 10.27.12.

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

    (4) Teletherapy.

    (a) “Teletherapy” means the delivery of behavioral health services by a CRNP/PMH or a PMH/APRN at a location other than the location of the client through the use of synchronous interactive audio, video, audio-visual, or other telecommunications or electronic technology.

    (b) “Teletherapy” does not include:

    (i) An audio-only telephone conversation between the CRNP/PMH or PMH/APRN and a client;

    (ii) An electronic mail message between a CRNP/PMH or PMH/ APRN and a client; or

    (iii) A facsimile transmission between a CRNP/PMH or PMH/APRN and a client.

    .03 Licensure.

    An individual shall be licensed as a registered nurse in Maryland, or have an active multistate licensure privilege to practice as a registered nurse in Maryland, and be certified by the Board as a CRNP/PMH or PMH/APRN in order to provide teletherapy services in Maryland if either the client or the CRNP/PMH or PMH/APRN is physically located in Maryland. 

    .04 Teletherapy.

    A. In order to provide teletherapy services to a client, a CRNP/PMH or PMH/APRN shall have: 

    (1) Established a client-therapist relationship;

    (2) Performed a mental status assessment;

    (3) Established a diagnosis;

    (4) Developed a treatment plan; and

    (5) Obtained an informed written consent from the client to provide teletherapy.

    B. Before providing teletherapy services, the CRNP/PMH or PMH/APRN shall develop a procedure to:

    (1) Verify the identity of the client receiving teletherapy services;

    (2) Ensure that all medical records are protected from unauthorized access through encryption or other means;

    (3) Ensure that the CRNP/PMH or PMH/APRN provides a secure and private teletherapy connection and complies with federal and state privacy laws;

    (4) Notify a client in the event of a data breach in accordance with the Health Insurance Portability and Accountability Act (HIPAA) and the Maryland Confidentiality of Medical Records Act; and

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

    C. At the outset of each teletherapy session, the CRNP/PMH or PMH/APRN shall:

    (1) Identify all individuals present at each location and confirm that they are permitted to hear personal health information;

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

    (3) Determine whether the client is in Maryland.

    .05 Standards of Practice.

    A.  A CRNP/PMH or PMH/APRN providing teletherapy services shall be held to the same standards of practice and documentation as those applicable in in-person health care settings.

    B.  A CRNP/PMH or PMH/APRN may not treat a patient or prescribe medication based solely on an online questionnaire.

    .06 Discipline.

    A. The Board shall use the same standards in evaluating and investigating a complaint and disciplining a CRNP/PMH or PMH/APRN who provides teletherapy as it would use for a CRNP/PMH or PMH/APRN who is not.

    B. A CRNP/PMH or PMH/APRN who provides teletherapy services and fails to comply with this chapter may be subject to discipline under Health Occupations Article, §8-316, Annotated Code of Maryland.

    Secretary of Health