# Health Occupations (GHO)

## Title 1. Definitions; General Provisions

### Subtitle 1. Definitions

#### Section 1-101

(a) In this article the following words have the meanings indicated.

(a-1) "Active duty" has the meaning stated in Sec. 9-901 of the State Government Article.

(a-2) "Armed forces" has the meaning stated in Sec. 9-901 of the State Government Article.

(b) "County" means a county of this State and, unless expressly provided otherwise, Baltimore City.

(c) "Department" means the Maryland Department of Health.

(d) "Household member" means someone who is:

  (1) The individual's:

    (i) Spouse;

    (ii) Son;

    (iii) Daughter;

    (iv) Ward; or

    (v) Parent; or

  (2) The individual's relative:

    (i) Who shares the individual's legal residence; or

    (ii) Whose financial affairs are under the legal or actual control of the individual.

(e) "Includes" or "including" means includes or including by way of illustration and not by way of limitation.

(f) "Oral competency" means general English-speaking proficiency as evidenced by achievement of a passing score obtained on a Board approved standardized test.

(g) "Person" means an individual, receiver, trustee, guardian, personal representative, fiduciary, or representative of any kind and any partnership, firm, association, corporation, or other entity.

(h) "Physician" means, except in Title 14 of this article, an individual who is authorized by a law of this State to practice medicine in this State.

(i) "Secretary" means the Secretary of Health.

(j) "State" means:

  (1) A state, possession, or territory of the United States;

  (2) The District of Columbia; or

  (3) The Commonwealth of Puerto Rico.

(k) "Substantial financial interest" means:

  (1) An asset with a fair market value of $1,000 or more; or

  (2) A source of income of $500 or more in a calendar year.

(l) "Uniformed services" has the meaning stated in Sec. 9-901 of the State Government Article.

(m) "Veteran" has the meaning stated in Sec. 9-901 of the State Government Article.

#### Section 1-102

(a) It is the policy of the State that health occupations should be regulated and controlled as provided in this article to protect the health, safety, and welfare of the public.

(b) The health occupations boards established by this article, the majority of whose members are licensed or certified under this article, are created to function as independent boards, with the intent that a peer group is best qualified to regulate, control, and otherwise discipline in a fair and unbiased manner the licensees or certificate holders who practice in the State.

#### Section 1-103

(a) In this section, "Commission" means the Maryland Health Centralization Commission.

(b) There is a Maryland Health Centralization Commission.

(c) The purpose of the Commission is to provide ongoing advice and recommendations to the General Assembly on how best to increase collaboration between the Department and the health occupations boards to achieve greater efficiency, transparency, and accountability.

(d) The Commission consists of the following members:

  (1) One member of the Senate of Maryland, appointed by the President of the Senate;

  (2) One member of the House of Delegates, appointed by the Speaker of the House;

  (3) The Secretary, or the Secretary's designee;

  (4) The Deputy Secretary for Public Health Services;

  (5) The Executive Director of the State Board of Nursing, or the Executive Director's designee;

  (6) The Executive Director of the State Board of Physicians, or the Executive Director's designee;

  (7) The Executive Director of the State Board of Pharmacy, or the Executive Director's designee;

  (8) The Executive Director of the State Board of Social Work Examiners, or the Executive Director's designee;

  (9) Three members who are the executive directors, or the executive directors' designees, of health occupations boards not otherwise represented on the Commission, designated jointly by the health occupations boards not otherwise represented on the Commission; and

  (10) Any additional members appointed by the cochairs that the cochairs, in consultation with the health occupations boards, determine to be necessary to accomplish the goals of the Commission.

(e) The member of the Senate of Maryland and the member of the House of Delegates appointed under subsection (d) of this section shall cochair the Commission.

(f) The Department of Legislative Services shall provide staff for the Commission.

(g)

  (1) Each health occupation board established under this article shall designate a representative of the health occupation board to be available to work with the Commission.

  (2) Each health occupation board shall provide, as soon as practicable but not later than 10 business days after receiving a request, any information requested by the Commission.

(h) A member of the Commission:

  (1) May not receive compensation as a member of the Commission; but

  (2) Is entitled to reimbursement for expenses under the Standard State Travel Regulations, as provided in the State budget.

(i) The Commission shall:

  (1) Provide recommendations to ensure that:

    (i) Each health occupation board remedies audit findings and violations of law, regulation, or policy; and

    (ii) Each health occupation board establishes policies and procedures for, as applicable:

      (1) The timely processing of applications;

      (2) Responding to complaints;

      (3) Conducting investigations and inspections;

      (4) Conducting criminal history records checks, including the receipt of revised criminal history information from the Central Repository after the date of an initial criminal history records check;

      (5) The collection of fees and the accounting of financial activities, including the assessment of penalties for violations of those policies and procedures;

      (6) Taking appropriate actions for license application fraud, including the assessment of fines; and

      (7) Any other areas in which action is needed, as determined by the Commission; and

  (2) Provide recommendations on:

    (i) Establishing a comprehensive licensure system that may be used by a health occupations board;

    (ii) Authorizing a health occupations board that uses the comprehensive licensure system to use license fees to support the system;

    (iii) Consolidating administrative functions to establish and enhance efficiency and control in all areas, including through the use of existing Department systems for e-mail, finance, and human resources services across all health occupations boards; and

    (iv) Increasing public awareness and usage of the Maryland Quality Reporting website of the Maryland Health Care Commission to assist individuals with selecting appropriate health care settings.

(j) On or before December 1 each year, beginning in 2026, the Commission shall report its findings and recommendations, including any draft legislation, to the Governor and, in accordance with Sec. 2-1257 of the State Government Article, the Senate Finance Committee, the House Health Committee, and the Joint Audit and Evaluation Committee.

#### Section 1-104

On or before July 1 each year, each health occupations board shall certify to the Secretary of Information Technology that the information technology systems used by the health occupations board meet the State minimum cybersecurity requirements.

### Subtitle 2. General Provisions

#### Section 1-201

(a) A requirement in this article that a document be verified means that the document shall be verified by a declaration made under the penalties of perjury that the matters and facts contained in the document are true to the best of the knowledge, information, and belief of the individual making the declaration.

(b) The verification shall be made:

  (1) Before an individual authorized to administer oaths; or

  (2) By a signed statement of verification that:

    (i) Is in the document or attached to and made part of the document; and

    (ii) States that the statement is made under the penalties for perjury.

(c) If the procedures provided in subsection (b)(2) of this section are used, the statement of verification subjects the individual making the statement to the penalties for perjury to the same extent as if the statement had been verified under oath before an individual authorized to administer oaths.

#### Section 1-202

Before any license or permit may be issued under this article to an employer to engage in an activity in which the employer may employ a covered employee, as defined in Sec. 9-101 of the Labor and Employment Article, the employer shall file with the issuing authority:

(1) A certificate of compliance with the Maryland Workers' Compensation Act; or

(2) The number of a workers' compensation insurance policy or binder.

#### Section 1-203

(a) Except as provided in subsection (c) of this section, the power of the Secretary over plans, proposals, and projects of units in the Department does not include the power to disapprove or modify any decision or determination that a board or commission established under this article makes under authority specifically delegated by law to the board or commission.

(b)

  (1)

    (i) In this subsection, "infrastructure operations" means the administrative activities of a board or commission established under this article, including tools and resources for the use and support of deliberative actions.

    (ii) "Infrastructure operations" does not include:

      (1) Policy or regulatory decisions of the board or commission; or

      (2) Licensing, investigation, or disciplinary activities.

  (2) Except as provided in paragraph (3) of this subsection, the power of the Secretary to transfer staff or functions of units in the Department does not apply to any staff of a board or commission, established under this article, or to any functions that pertain to licensing, disciplinary, or enforcement authority, or to any other authority specifically delegated by law to a board or commission.

  (3) The Secretary has authority over the infrastructure operations of the State Board of Nursing established under Title 8 of this article.

(c)

  (1) Notwithstanding Sec.Sec. 8-205(b)(5) and 8-205.1 of the State Government Article and except as provided in subsection (d) of this section, the Secretary and the Office of Administrative Hearings, in consultation with stakeholders and other interested parties, shall adopt regulations for the supervision of each board or commission that is composed in whole or in part of individuals participating in the occupation or profession regulated by the board or commission, including the review by the Office of Administrative Hearings described under this subsection, in order to:

    (i) Prevent unreasonable anticompetitive actions by the board or commission; and

    (ii) Determine whether the actions of the board or commission further a clearly articulated State policy to displace competition in the regulated market.

  (2) In accordance with regulations adopted under this subsection, the Office of Administrative Hearings:

    (i) Shall review a decision or action of a board or commission that is referred to the Office in order to determine whether the decision or action furthers a clearly articulated State policy to displace competition in the regulated market;

    (ii) May not approve a decision or action of a board or commission that does not further a clearly articulated State policy to displace competition in the regulated market; and

    (iii) In conjunction with the Office of the Attorney General, shall establish a process:

      (1) By which the Office of Administrative Hearings reviews decisions or actions of a board or commission;

      (2) That is independent of the process by which the Office of Administrative Hearings hears adjudicated, contested cases; and

      (3) That includes:

      (A) The types of decisions or actions of a board or commission that may be referred to the Office of Administrative Hearings for review;

      (B) Qualifications and specialized training requirements for administrative law judges conducting reviews as required under this subsection;

      (C) Checks for identification and management of potential conflicts when the Office of Administrative Hearings conducts a contested case hearing in accordance with Title 10, Subtitle 2 of the State Government Article; and

      (D) Appropriate standards and guidelines for conducting reviews as required under this subsection.

  (3) A board or commission may not implement a decision or a final action of the board or commission until after the Office of Administrative Hearings has conducted the review required under this subsection.

  (4) The process specified under paragraph (2)(iii) of this subsection shall require the Office of Administrative Hearings to:

    (i) Review the merits of the decision or action of a board or commission;

    (ii) Assess whether the decision or action furthers a clearly articulated State policy to displace competition in the regulated market; and

    (iii) Issue expeditiously a written decision approving, disapproving, or modifying the decision or action or remanding the decision or action back to the board or commission for further review.

  (5) The decision or action implemented by a board or commission shall comply with the written decision of the Office of Administrative Hearings.

  (6) The Office of Administrative Hearings may not authorize an administrative law judge to review the decision or action if the judge is appointed by, under the oversight of, or a member of a board or commission whose action is the subject of review.

  (7) Each board or commission shall be responsible for the costs associated with the review by the Office of Administrative Hearings of decisions or actions of the respective board or commission.

(d) Subsection (c) of this section does not apply to:

  (1) A decision or determination of a board or commission concerning ministerial acts;

  (2) The internal operations of a board or commission;

  (3) Investigations;

  (4) Charges; and

  (5) As it relates to an individual regulated by a board or commission:

    (i) Consent orders; and

    (ii) Letters of surrender.

#### Section 1-204

(a) In this section the following words have the meanings indicated.

  (1) "Health occupation" means nurses, cytotechnologists, hospital pharmacists, occupational therapists, physical therapists, radiation technologists, and respiratory therapists who are licensed or certified under this article or by the Department.

  (2) "Hospital or related institution" means a hospital or related institution, as defined in Sec. 19-301 of the Health - General Article.

  (3) "Area of shortage" means those health occupations for which the average statewide employment vacancy rate at hospitals or related institutions exceeds 7 percent.

(b) Each year, the Secretary shall:

  (1) Survey hospitals and related institutions for areas of shortage; and

  (2) Project for each of the subsequent 5 years:

    (i) Average statewide employment vacancy rates expected in areas of shortage; and

    (ii) The number of students expected to graduate from programs leading to licensure or certification in those areas of shortage based on information provided by appropriate State education officials.

(c) Each board or commission established under this article shall provide the Secretary with any information the Secretary may require to conduct the activities under subsection (b) of this section.

(d) Each year, the Secretary shall report to the General Assembly, in accordance with Sec. 2-1257 of the State Government Article, the Governor, and the Maryland Higher Education Commission on the number and types of areas of shortage and the projected statewide employment vacancy rates in hospitals and related institutions.

#### Section 1-205

Each health occupation board may consider regional and national averages of health occupations licensing fees when the board evaluates the amount that constitutes a reasonable fee for the issuance and renewal of licenses and its other services.

#### Section 1-207

The Department, in consultation with the Medical and Chirurgical Faculty of Maryland, the Maryland Hospital Association, the Maryland Association of Health Maintenance Organizations, the Health Facilities Association of Maryland, the Maryland Association of Nonprofit Homes for the Aging, the Maryland State Dental Association, the Maryland Nurses Association, the Maryland Funeral Directors Association, the Maryland Podiatrists Association, the affected boards, the Association for Practitioners for Infection Control, and a consumer of health care services, shall develop a notice written in layman's language that explains the Centers for Disease Control and Prevention's guidelines on universal precautions.

#### Section 1-207.1

(a) In this section, "health care practitioner" means a person who is licensed, certified, or otherwise authorized under this article to provide health care services in the ordinary course of business or practice of a profession.

(b) The Department shall:

  (1) Identify, in consultation with stakeholders who wish to participate, up-to-date, evidence-based, written information relating to attention-deficit/hyperactivity disorder that:

    (i) Has been reviewed by medical experts, mental health care practitioners, and national and local organizations specializing in the provision of services for the treatment of attention-deficit/hyperactivity disorder;

    (ii) Is designed for use by health care practitioners and the families of children and adolescents who are diagnosed with attention-deficit/hyperactivity disorder;

    (iii) Is culturally and linguistically appropriate for potential recipients of the information; and

    (iv) Includes:

      (1) Treatment options for attention-deficit/hyperactivity disorder, including medication usage, behavioral health services, and nonpharmacological intervention strategies; and

      (2) Contact information for national and local education programs and support services; and

  (2) Post the information identified by the Department under item (1) of this subsection in printable form on the Department's Web site that may be accessed by health care practitioners engaged in treating children and adolescents for attention-deficit/hyperactivity disorder.

#### Section 1-208

(a)

  (1) In this section the following words have the meanings indicated.

  (2)

    (i) Except as otherwise provided in this paragraph, "health care practitioner" means a physician or any other person licensed or certified under this article and reimbursed by a third party payor.

    (ii) Subject to the provisions of subparagraph (iii) of this paragraph, "health care practitioner" does not include a physician or other person licensed or certified under this article who is compensated by a health maintenance organization on a salaried or capitated basis.

    (iii) The exclusion provided under subparagraph (ii) of this paragraph applies only when the physician or other licensed or certified person is rendering care to a member or subscriber of the health maintenance organization on a salaried or capitated system basis.

  (3) "Third party payor" means any person that administers or provides reimbursement for health care benefits on an expense incurred basis including:

    (i) A health maintenance organization issued a certificate of authority in accordance with Title 19, Subtitle 7 of the Health - General Article;

    (ii) A health insurer or nonprofit health service plan authorized to offer health insurance policies or contracts in this State in accordance with the Insurance Article; or

    (iii) A third party administrator registered under the Insurance Article.

  (4) "Uniform claims form" means the claim or billing form for reimbursement of services rendered by a health care practitioner adopted by the Insurance Commissioner under Sec. 15-1003 of the Insurance Article.

(b) When submitting a claim or bill for reimbursement to a third party payor, a health care practitioner shall use the uniform claims form.

(c) The uniform claims form submitted under this section:

  (1) Shall be properly completed; and

  (2) May be submitted by electronic transfer.

(d) The Secretary may impose a penalty not to exceed $100 on any health care practitioner that violates the provisions of this section.

#### Section 1-209

(a) Each board shall assess each applicant for a license or a renewal of a license a fee established in accordance with the provisions of Sec. 19-111 of the Health - General Article.

(b) Each board shall transfer the fees assessed under this subsection to the Maryland Health Care Commission Fund on a quarterly basis.

#### Section 1-210

(a) By August 31 of each year, each health occupations board authorized to issue a license or certificate under this article shall provide to the Department of Assessments and Taxation a list of persons issued licenses or certificates under this article during the previous fiscal year, to assist the Department of Assessments and Taxation in identifying new businesses within the State.

(b) The list provided under this section shall:

  (1) Be provided free of charge; and

  (2) Include, for each person on the list:

    (i) The name and mailing address of the person; and

    (ii)

      (1) The federal tax identification number of the person, if known; or

      (2) If the person does not have a federal tax identification number, the Social Security number of the person, if known.

#### Section 1-211

A person who is licensed, certified, or otherwise authorized to practice a health occupation under this article may not practice the health occupation on an animal unless the person:

(1) Is a licensed pharmacist practicing pharmacy under Title 12 of this article;

(2) Is a licensed acupuncturist practicing in accordance with Sec. 2-301(g)(11) of the Agriculture Article; or

(3) Provides care to an animal in accordance with Sec. 2-304(e) of the Agriculture Article.

#### Section 1-212

(a) Each health occupations board authorized to issue a license or certificate under this article shall adopt regulations that:

  (1) Prohibit sexual misconduct; and

  (2) Provide for the discipline of a licensee or certificate holder found to be guilty of sexual misconduct.

(b) For the purposes of the regulations adopted in accordance with subsection (a) of this section, "sexual misconduct" shall be construed to include, at a minimum, behavior where a health care provider:

  (1) Has engaged in sexual behavior with a client or patient in the context of a professional evaluation, treatment, procedure, or other service to the client or patient, regardless of the setting in which professional service is provided;

  (2) Has engaged in sexual behavior with a client or patient under the pretense of diagnostic or therapeutic intent or benefit; or

  (3) Has engaged in any sexual behavior that would be considered unethical or unprofessional according to the code of ethics, professional standards of conduct, or regulations of the appropriate health occupations board under this article.

(c) Subject to the provisions of the law governing contested cases, if an applicant, licensee, or certificate holder violates a regulation adopted under subsection (a) of this section a board may:

  (1) Deny a license or certificate to the applicant;

  (2) Reprimand the licensee or certificate holder;

  (3) Place the licensee or certificate holder on probation; or

  (4) Suspend or revoke the license or certificate.

(d) This section does not negate any other disciplinary action under a health occupations board's statutory or regulatory provisions.

(e)

  (1)

    (i) Each year, each health occupations board shall submit a statistical report to the Secretary, indicating:

      (1) The number of complaints of sexual misconduct received;

      (2) The number of licensees, certificate holders, and complainants involved in the complaints of sexual misconduct listed separately by category;

      (3) The number of complaints of sexual misconduct still under investigation;

      (4) The number of complaints of sexual misconduct that were closed with no disciplinary action;

      (5) The number of complaints of sexual misconduct that resulted in informal or nonpublic action;

      (6) The number of complaints of sexual misconduct that were referred to the Office of the Attorney General for prosecutorial action;

      (7) The number of complaints of sexual misconduct that resulted in each of the following:

      (A) License revocation;

      (B) Suspension;

      (C) Probation;

      (D) Reprimand; and

      (E) Denial of licensure;

      (8) The number of complaints of sexual misconduct that were forwarded to law enforcement for possible criminal prosecution; and

      (9) For any other actions taken regarding complaints of sexual misconduct, a detailed breakdown of the types of actions taken.

    (ii) The report shall cover the period beginning October 1 and ending the following September 30 and shall be submitted by the board not later than the November 15 following the reporting period.

  (2) The Secretary shall compile the information received from the health occupations boards and submit an annual report to the General Assembly, in accordance with Sec. 2-1257 of the State Government Article, not later than December 31 of each year.

#### Section 1-212.1

(a)

  (1) In this section the following words have the meanings indicated.

  (2)

    (i) "Conversion therapy" means a practice or treatment by a mental health or child care practitioner that seeks to change an individual's sexual orientation or gender identity.

    (ii) "Conversion therapy" includes any effort to change the behavioral expression of an individual's sexual orientation, change gender expression, or eliminate or reduce sexual or romantic attractions or feelings toward individuals of the same gender.

    (iii) "Conversion therapy" does not include a practice by a mental health or child care practitioner that:

      (1) Provides acceptance, support, and understanding, or the facilitation of coping, social support, and identity exploration and development, including sexual orientation-neutral interventions to prevent or address unlawful conduct or unsafe sexual practices; and

      (2) Does not seek to change sexual orientation or gender identity.

  (3) "Mental health or child care practitioner" means:

    (i) A practitioner licensed or certified under Title 14, Title 17, Title 18, Title 19, or Title 20 of this article; or

    (ii) Any other practitioner licensed or certified under this article who is authorized to provide counseling by the practitioner's licensing or certifying board.

(b) A mental health or child care practitioner may not engage in conversion therapy with an individual who is a minor.

(c) A mental health or child care practitioner who engaged in conversion therapy with an individual who is a minor shall be considered to have engaged in unprofessional conduct and shall be subject to discipline by the mental health or child care practitioner's licensing or certifying board.

(d) No State funds may be used for the purpose of:

  (1) Conducting, or referring an individual to receive, conversion therapy;

  (2) Providing health coverage for conversion therapy; or

  (3) Providing a grant to or contracting with any entity that conducts or refers an individual to receive conversion therapy.

(e) The Department shall adopt regulations necessary to implement this section.

#### Section 1-213

(a) A license or permit is considered renewed for purposes of this section if the license or permit is issued by a unit of State government to a person for the period immediately following a period for which the person previously possessed the same or a substantially similar license.

(b) Before any license or permit may be renewed under this article, the issuing authority shall verify through the Office of the Comptroller that the applicant has paid all undisputed taxes and unemployment insurance contributions payable to the Comptroller or the Secretary of Labor or that the applicant has provided for payment in a manner satisfactory to the unit responsible for collection.

.

#### Section 1-214

To the extent practicable, the members appointed to each health occupations board authorized to issue a license or certificate under this article shall reasonably reflect the geographic, racial, ethnic, cultural, and gender diversity of the State.

#### Section 1-215

(a) Each health occupations board authorized to issue a license or certificate under this article shall notify all licensees or certificate holders of board vacancies.

(b) Except as otherwise provided in this article, a health occupations board may give notice of a board vacancy by electronic mail or a notice on the board's Web site.

#### Section 1-216

The health occupations boards authorized to issue a license or certificate under this article shall develop collaboratively a training process and materials for new board members that include training in cultural competency.

#### Section 1-217

The Secretary shall confirm the appointment of each administrator or executive director to each health occupations board authorized to issue a license or certificate under this article.

#### Section 1-218

Each health occupations board authorized to issue a license or certificate under this article shall collect racial and ethnic information about the applicant as part of the board's licensing, certifying, or renewal process.

#### Section 1-219

(a) In this section, "health care practitioner" means a person who is licensed, certified, or otherwise authorized to practice a health occupation under this article.

(b) Subject to the hearing provisions that govern the discipline of a health care practitioner by each respective health occupations board, a health occupations board may reprimand, place on probation, or suspend or revoke a license or certificate of any health care practitioner under the board's jurisdiction who fails to comply with Sec. 14-3A-03(c) of the Public Safety Article.

#### Section 1-220

(a) Each health occupation board may develop a secure electronic system for the distribution of a renewed license, permit, certification, or registration required to be issued under this title.

(b) The system shall:

  (1) Be accessible to the public for the purpose of verification of a current license, permit, certification, or registration; and

  (2) Provide the licensee, permit holder, certificate holder, or registrant the option of printing a verification of the status of their license, permit, certification, or registration.

(c) Except as otherwise provided by law, a board that develops and implements a system authorized under subsection (a) of this section shall:

  (1) Discontinue to send by first-class mail:

    (i) A renewal notice for a license, permit, certification, or registration; and

    (ii) A renewed license, permit, certification, or registration;

  (2) Send by electronic means:

    (i) A renewal notice for a license, permit, certification, or registration; and

    (ii) A renewed license, permit, certification, or registration; and

  (3) Continue to send by first-class mail an initial license, permit, certification, or registration.

(d) If a board chooses to send renewal notices or renewed licenses, permits, certifications, or registrations exclusively by electronic mail under subsection (c) of this section, the board shall, on request of the licensee, permit holder, certificate holder, or registrant, send by first-class mail:

  (1) The renewal notice;

  (2) The renewal application; or

  (3) The renewed license, permit, certification, or registration.

#### Section 1-221

(a) In this section, "health care practitioner" means a person who is licensed, certified, or otherwise authorized under this article to provide health care services in the ordinary course of business or practice of a profession.

(b) This section applies only to a health care practitioner who practices in:

  (1) A freestanding ambulatory care facility;

  (2) A physician's office; or

  (3) An urgent care facility.

(c) Except as provided in subsection (d) of this section, when providing health care to a patient, a health care practitioner shall wear a badge or other form of identification displaying in readily visible type:

  (1) The health care practitioner's first name, nickname, last name, or full name that is commonly used in the office or facility; and

  (2) The type of license of the health care practitioner.

(d) A badge or other form of identification is not required to be worn if:

  (1)

    (i) The patient is being seen in the office of a health care practitioner who is a solo practitioner; and

    (ii) The name and license of the health care practitioner can be readily determined by the patient from a posted license or sign in the office; or

  (2) The patient is being seen in:

    (i) An operating room or other setting where surgical or other invasive procedures are performed; or

    (ii) Any other setting where maintaining a sterile environment is medically necessary.

(e)

  (1) Each health occupations board may adopt regulations to implement this section.

  (2) The regulations, when necessary for the patient or health care practitioner's safety or for therapeutic concerns may provide exemptions from wearing a badge or other form of identification.

  (3) A violation may be reported to the health occupations board that licensed or certified the health care practitioner.

  (4) In response to a reported violation, a health occupations board may send an advisory letter or a letter of education to the health care practitioner.

(f) An advisory letter or letter of education sent by a health occupations board under this section is confidential and may not be publicly reported as a disciplinary action.

#### Section 1-221.1

(a) In this section, "health care practitioner" means a person who is licensed, certified, or otherwise authorized under this article to provide health care services in the ordinary course of business or practice of a profession.

(b) A health care practitioner, or a student or trainee in an educational or training program to become a health care practitioner, may not perform a pelvic, prostate, or rectal examination on a patient who is under anesthesia or unconscious unless:

  (1) The health care practitioner, student, or trainee obtained informed consent from the patient for the examination;

  (2) The performance of the examination is within the standard of care for the patient;

  (3) The patient is unconscious and the examination is required for diagnostic or treatment purposes; or

  (4) An emergency exists, it is impractical to obtain the patient's consent, and the examination is required for diagnostic or treatment purposes.

(c) A health occupations board, in accordance with the hearing procedures that govern the discipline of the health care practitioner under the board's jurisdiction, may reprimand, place on probation, or suspend or revoke a license or certificate of a health care practitioner under the board's jurisdiction who fails to comply with the requirements of this section.

#### Section 1-222

(a)

  (1) In this section the following words have the meanings indicated.

  (2) "Advisory committee" means a committee established by statute or regulation that functions as a subunit of a health occupations board.

  (3) "Health occupations board" means a board authorized to issue a license, certificate, or registration under this article.

(b) An individual may not serve concurrently as a member of a health occupations board or an advisory committee and as an elected officer of a professional association organized under the laws of the State that represents and advocates for the interests of the individuals regulated by that health occupations board.

#### Section 1-223

(a) In this section, "controlled dangerous substance" has the meaning stated in Sec. 5-101 of the Criminal Law Article.

(b) On treatment for pain, a health care provider, based on the clinical judgment of the health care provider, shall prescribe:

  (1) The lowest effective dose of an opioid; and

  (2) A quantity that is no greater than the quantity needed for the expected duration of pain severe enough to require an opioid that is a controlled dangerous substance unless the opioid is prescribed to treat:

    (i) A substance-related disorder;

    (ii) Pain associated with a cancer diagnosis;

    (iii) Pain experienced while the patient is receiving end-of-life, hospice, or palliative care services; or

    (iv) Chronic pain.

(c) The dosage, quantity, and duration of an opioid prescribed under subsection (b) of this section shall be based on an evidence-based clinical guideline for prescribing controlled dangerous substances that is appropriate for:

  (1) The health care service delivery setting for the patient;

  (2) The type of health care services required by the patient; and

  (3) The age and health status of the patient.

(d)

  (1) When a patient is prescribed an opioid under subsection (b) of this section, the patient shall be advised of the benefits and risks associated with the opioid.

  (2) When a patient is co-prescribed a benzodiazepine with an opioid that is prescribed under subsection (b) of this section, the patient shall be advised of the benefits and risks associated with the benzodiazepine and the co-prescription of the benzodiazepine.

(e) A violation of subsection (b) or (d) of this section is grounds for disciplinary action by the health occupations board that regulates the health care provider who commits the violation.

#### Section 1-225

(a) Subject to subsection (c) of this section, an applicant for the renewal of a license or certificate issued by a health occupations board under this article shall attest in the application that the applicant has completed an implicit bias and structural racism training program approved by the Cultural and Linguistic Health Care Professional Competency Program under Sec. 20-1306 of the Health - General Article.

(b) Each health occupations board may adopt regulations that allow an applicant seeking license renewal to receive continuing education credits for completing an implicit bias and structural racism training program.

(c) The requirement under subsection (a) of this section that an applicant attest to the completion of an implicit bias and structural racism training program shall apply only to an applicant's first license or certificate renewal after April 1, 2026.

#### Section 1-225.1

(a)

  (1) In this section, "local university" means a public or private institution of higher education in the State with a public health, law, or social work program.

  (2) "Local university" includes a program within an institution of higher education described in paragraph (1) of this subsection, such as the University of Maryland SAFE Center for Human Trafficking Survivors.

(b) Each health occupations board shall:

  (1) Allow an applicant seeking license or certificate renewal to receive continuing education credits for completing a human trafficking awareness training program described in subsection (c) of this section;

  (2) Conduct outreach to make individuals regulated by the board aware of human trafficking awareness training options, including by providing information in general board communications and on the board's website; and

  (3) Adopt regulations to carry out this section.

(c) A training program for which an applicant may receive continuing education credits under this section shall:

  (1) Be approved by the Department in collaboration with a local university and in consultation with the Maryland Human Trafficking Task Force and organizations that provide direct services to human trafficking survivors;

  (2) Be at least 1 hour in duration;

  (3) Be readily accessible and provided to an individual described under subsection (b) of this section free of charge; and

  (4) Include instruction on:

    (i) The definitions and forms of sex and labor trafficking under federal and State law;

    (ii) An understanding of the trauma-informed care model;

    (iii) The physical, behavioral, and emotional indicators of human trafficking, particularly those presenting in a health care setting;

    (iv) Appropriate screening protocols and documentation methods;

    (v) Mandatory reporting requirements under State law and established protocols for reporting suspected cases of human trafficking to the appropriate authorities, including the National Human Trafficking Hotline; and

    (vi) Available federal, State, and local resources and services for survivors of human trafficking.

#### Section 1-226

Each health occupations board authorized to issue a license or certificate under this article shall:

(1) Include on the form for an application for the license or certificate or a license or certificate renewal an option for the applicant to provide the applicant's race and ethnicity information; and

(2) Encourage an applicant to provide race and ethnicity information on the application.

#### Section 1-227

(a)

  (1) In this section the following words have the meanings indicated.

  (2) "Health care practitioner" means an individual who is licensed, certified, or otherwise authorized by law to provide health care services under this article.

  (3) "Legally protected health care" has the meaning stated in Sec. 2-312 of the State Personnel and Pensions Article.

(b) A health occupations board may not revoke, suspend, discipline, take an adverse action against, or refuse to issue or renew a license, certification, or other authorization to practice for any health care practitioner in whole or in part because of the provision or support of the provision of legally protected health care if the legally protected health care was provided in accordance with the standard of care as determined by the relevant health occupations board established under this article and in accordance with the laws of this State.

(c) A health occupations board may not revoke, suspend, discipline, take an adverse action against, or refuse to issue or renew a license, certification, or other authorization to practice for any health care practitioner if the health care practitioner is disciplined by a licensure board in another state in whole or in part because of the provision or support of the provision of legally protected health care if the legally protected health care was provided in accordance with the standard of care as determined by the relevant health occupations board established under this article and in accordance with the laws of this State.

#### Section 1-228

A health occupations board may not require as a condition for licensure, certification, or registration that an applicant:

(1) Provide proof that the applicant is lawfully present in the United States, as allowed under 8 U.S.C. Sec. 1621; or

(2) Have a Social Security number or Individual Taxpayer Identification Number.

#### Section 1-229

(a) This section applies only to a health occupations board that does not otherwise have statutory authority to issue licenses or certifications under this article by reciprocity.

(b) Subject to subsection (c) of this section, a health occupations board may adopt regulations to establish reciprocity for individuals who are licensed or certified in another state that offers similar reciprocity to individuals licensed or certified by the health occupations board under this article.

(c) Regulations adopted by a health occupations board under subsection (b) of this section shall require that an applicant:

  (1) Be licensed or certified in another state under requirements that the health occupations board determines are substantially equivalent to its licensing or certification requirements established under this article;

  (2) Be in good standing under the laws of the other state;

  (3) Submit an application to the health occupations board on a form that the board requires;

  (4) Pay to the health occupations board an application fee set by the board; and

  (5) Satisfy any other requirements established by statute or regulations adopted by the health occupations board.

#### Section 1-230

(a) If a health occupations board requires evidence of English proficiency as a condition for licensure, certification, or registration, the health occupations board may not require an applicant who holds a valid, unrestricted license, certification, or registration from another state that requires evidence of English proficiency for licensure, certification, or registration to provide additional evidence of English proficiency.

(b) Each health occupations board that requires evidence of English proficiency as a condition for licensure, certification, or registration shall prominently maintain on its website a statement that an applicant may not be required to provide additional evidence of English proficiency if the applicant holds a valid, unrestricted license, certification, or registration from another state that requires evidence of English proficiency for licensure, certification, or registration.

#### Section 1-231

(a) This section applies only to a licensee or certificate holder who evaluates and manages menopause and menopause-associated symptoms while acting within the scope of the license or certificate.

(b) Each health occupations board that requires a licensee or certificate holder to complete continuing education as a condition of the renewal of the license or certificate shall grant at least 2 hours of continuing education credits for every 1 hour of continuing education on menopause and menopause-associated symptoms completed by the licensee or certificate holder.

(c)

  (1) The Department shall identify at least one training program for licensees and certificate holders regarding the evaluation and management of menopause and menopause-associated symptoms that may be used for the purposes of subsection (b) of this section.

  (2) In identifying a training program under paragraph (1) of this subsection, the Department shall consult with professional associations with expertise in menopause and menopause-associated symptoms, including the Menopause Society.

(d) A health occupations board subject to this section may adopt regulations to carry out this section, including regulations establishing the maximum number of continuing education credits that may be granted under this section.

#### Section 1-232

### Subtitle 3. Patient Referrals

#### Section 1-301

(a) In this subtitle the following words have the meanings indicated.

(b)

  (1) "Beneficial interest" means ownership, through equity, debt, or other means, of any financial interest.

  (2) "Beneficial interest" does not include ownership, through equity, debt, or other means, of securities, including shares or bonds, debentures, or other debt instruments:

    (i) In a corporation that is traded on a national exchange or over the counter on the national market system;

    (ii) That at the time of acquisition, were purchased at the same price and on the same terms generally available to the public;

    (iii) That are available to individuals who are not in a position to refer patients to the health care entity on the same terms that are offered to health care practitioners who may refer patients to the health care entity;

    (iv) That are unrelated to the past or expected volume of referrals from the health care practitioner to the health care entity; and

    (v) That are not marketed differently to health care practitioners that may make referrals than they are marketed to other individuals.

(c)

  (1) "Compensation arrangement" means any agreement or system involving any remuneration between a health care practitioner or the immediate family member of the health care practitioner and a health care entity.

  (2) "Compensation arrangement" does not include:

    (i) Compensation or shares under a faculty practice plan or a professional corporation affiliated with a teaching hospital and comprised of health care practitioners who are members of the faculty of a university;

    (ii) Amounts paid under a bona fide employment agreement between a health care entity and a health care practitioner or an immediate family member of the health care practitioner;

    (iii) An arrangement between a health care entity and a health care practitioner or the immediate family member of a health care practitioner for the provision of any services, as an independent contractor, if:

      (1) The arrangement is for identifiable services;

      (2) The amount of the remuneration under the arrangement is consistent with the fair market value of the service and is not determined in a manner that takes into account, directly or indirectly, the volume or value of any referrals by the referring health care practitioner; and

      (3) The compensation is provided in accordance with an agreement that would be commercially reasonable even if no referrals were made to the health care provider;

    (iv) Compensation for health care services pursuant to a referral from a health care practitioner and rendered by a health care entity, that employs or contracts with an immediate family member of the health care practitioner, in which the immediate family member's compensation is not based on the referral;

    (v) An arrangement for compensation which is provided by a health care entity to a health care practitioner or the immediate family member of the health care practitioner to induce the health care practitioner or the immediate family member of the health care practitioner to relocate to the geographic area served by the health care entity in order to be a member of the medical staff of a hospital, if:

      (1) The health care practitioner or the immediate family member of the health care practitioner is not required to refer patients to the health care entity;

      (2) The amount of the compensation under the arrangement is not determined in a manner that takes into account, directly or indirectly, the volume or value of any referrals by the referring health care practitioner; and

      (3) The health care entity needs the services of the practitioner to meet community health care needs and has had difficulty in recruiting a practitioner;

    (vi) Payments made for the rental or lease of office space if the payments are:

      (1) At fair market value; and

      (2) In accordance with an arm's length transaction;

    (vii) Payments made for the rental or lease of equipment if the payments are:

      (1) At fair market value; and

      (2) In accordance with an arm's length transaction; or

    (viii) Payments made for the sale of property or a health care practice if the payments are:

      (1) At fair market value;

      (2) In accordance with an arm's length transaction; and

      (3) Provided in accordance with an agreement that would be commercially reasonable even if no referrals were made.

(d) "Direct supervision" means a health care practitioner is present on the premises where the health care services or tests are provided and is available for consultation within the treatment area.

(e) "Faculty practice plan" means a tax-exempt organization established under Maryland law by or at the direction of a university to accommodate the professional practice of members of the faculty who are health care practitioners.

(f) "Group practice" means a group of two or more health care practitioners legally organized as a partnership, professional corporation, foundation, nonprofit corporation, faculty practice plan, or similar association:

  (1) In which each health care practitioner who is a member of the group provides substantially the full range of services which the practitioner routinely provides through the joint use of shared office space, facilities, equipment, and personnel;

  (2) For which substantially all of the services of the health care practitioners who are members of the group are provided through the group and are billed in the name of the group and amounts so received are treated as receipts of the group; and

  (3) In which the overhead expenses of and the income from the practice are distributed in accordance with methods previously determined on an annual basis by members of the group.

(g) "Health care entity" means a business entity that provides health care services for the:

  (1) Testing, diagnosis, or treatment of human disease or dysfunction; or

  (2) Dispensing of drugs, medical devices, medical appliances, or medical goods for the treatment of human disease or dysfunction.

(h) "Health care practitioner" means a person who is licensed, certified, or otherwise authorized under this article to provide health care services in the ordinary course of business or practice of a profession.

(i) "Health care service" means medical procedures, tests and services provided to a patient by or through a health care entity.

(j) "Immediate family member" means a health care practitioner's:

  (1) Spouse;

  (2) Child;

  (3) Child's spouse;

  (4) Parent;

  (5) Spouse's parent;

  (6) Sibling; or

  (7) Sibling's spouse.

(k)

  (1) "In-office ancillary services" means those basic health care services and tests routinely performed in the office of one or more health care practitioners.

  (2) Except for a radiologist group practice or an office consisting solely of one or more radiologists, "in-office ancillary services" does not include:

    (i) Magnetic resonance imaging services;

    (ii) Radiation therapy services; or

    (iii) Computer tomography scan services.

(l)

  (1) "Referral" means any referral of a patient for health care services.

  (2) "Referral" includes:

    (i) The forwarding of a patient by one health care practitioner to another health care practitioner or to a health care entity outside the health care practitioner's office or group practice; or

    (ii) The request or establishment by a health care practitioner of a plan of care for the provision of health care services outside the health care practitioner's office or group practice.

#### Section 1-302

(a) Except as provided in subsection (d) of this section, a health care practitioner may not refer a patient, or direct an employee of or person under contract with the health care practitioner to refer a patient to a health care entity:

  (1) In which the health care practitioner or the practitioner in combination with the practitioner's immediate family owns a beneficial interest;

  (2) In which the practitioner's immediate family owns a beneficial interest of 3 percent or greater; or

  (3) With which the health care practitioner, the practitioner's immediate family, or the practitioner in combination with the practitioner's immediate family has a compensation arrangement.

(b) A health care entity or a referring health care practitioner may not present or cause to be presented to any individual, third party payor, or other person a claim, bill, or other demand for payment for health care services provided as a result of a referral prohibited by this subtitle.

(c) Subsection (a) of this section applies to any arrangement or scheme, including a cross-referral arrangement, which the health care practitioner knows or should know has a principal purpose of assuring indirect referrals that would be in violation of subsection (a) of this section if made directly.

(d) The provisions of this section do not apply to:

  (1) A health care practitioner when treating a member of a health maintenance organization as defined in Sec. 19-701 of the Health - General Article if the health care practitioner does not have a beneficial interest in the health care entity;

  (2) A health care practitioner who refers a patient to another health care practitioner in the same group practice as the referring health care practitioner;

  (3) A health care practitioner with a beneficial interest in a health care entity who refers a patient to that health care entity for health care services or tests, if the services or tests are personally performed by or under the direct supervision of the referring health care practitioner;

  (4) A health care practitioner who refers in-office ancillary services or tests that are:

    (i) Personally furnished by:

      (1) The referring health care practitioner;

      (2) A health care practitioner in the same group practice as the referring health care practitioner; or

      (3) An individual who is employed and personally supervised by the qualified referring health care practitioner or a health care practitioner in the same group practice as the referring health care practitioner;

    (ii) Provided in the same building where the referring health care practitioner or a health care practitioner in the same group practice as the referring health care practitioner furnishes services; and

    (iii) Billed by:

      (1) The health care practitioner performing or supervising the services; or

      (2) A group practice of which the health care practitioner performing or supervising the services is a member;

  (5) A health care practitioner who has a beneficial interest in a health care entity if, in accordance with regulations adopted by the Secretary:

    (i) The Secretary determines that the health care practitioner's beneficial interest is essential to finance and to provide the health care entity; and

    (ii) The Secretary, in conjunction with the Maryland Health Care Commission, determines that the health care entity is needed to ensure appropriate access for the community to the services provided at the health care entity;

  (6) A health care practitioner employed or affiliated with a hospital, who refers a patient to a health care entity that is owned or controlled by a hospital or under common ownership or control with a hospital if the health care practitioner does not have a direct beneficial interest in the health care entity;

  (7) A health care practitioner or member of a single specialty group practice, including any person employed or affiliated with a hospital, who has a beneficial interest in a health care entity that is owned or controlled by a hospital or under common ownership or control with a hospital if:

    (i) The health care practitioner or other member of that single specialty group practice provides the health care services to a patient pursuant to a referral or in accordance with a consultation requested by another health care practitioner who does not have a beneficial interest in the health care entity; or

    (ii) The health care practitioner or other member of that single specialty group practice referring a patient to the facility, service, or entity personally performs or supervises the health care service or procedure;

  (8) A health care practitioner with a beneficial interest in, or compensation arrangement with, a hospital or related institution as defined in Sec. 19-301 of the Health - General Article or a facility, service, or other entity that is owned or controlled by a hospital or related institution or under common ownership or control with a hospital or related institution if:

    (i) The beneficial interest was held or the compensation arrangement was in existence on January 1, 1993; and

    (ii) Thereafter the beneficial interest or compensation arrangement of the health care practitioner does not increase;

  (9) A health care practitioner when treating an enrollee of a provider-sponsored organization as defined in Sec. 19-7A-01 of the Health - General Article if the health care practitioner is referring enrollees to an affiliated health care provider of the provider-sponsored organization;

  (10) A health care practitioner who refers a patient to a dialysis facility, if the patient has been diagnosed with end stage renal disease as defined in the Medicare regulations pursuant to the Social Security Act;

  (11) A health care practitioner who refers a patient to a hospital in which the health care practitioner has a beneficial interest if:

    (i) The health care practitioner is authorized to perform services at the hospital; and

    (ii) The ownership or investment interest is in the hospital itself and not solely in a subdivision of the hospital; or

  (12) Subject to subsection (f) of this section, a health care practitioner who has a compensation arrangement with a health care entity, if the compensation arrangement is funded by or paid under:

    (i) A Medicare shared savings program accountable care organization authorized under 42 U.S.C. Sec. 1395jjj;

    (ii) As authorized under 42 U.S.C. Sec. 1315a:

      (1) An advance payment accountable care organization model;

      (2) A pioneer accountable care organization model; or

      (3) A next generation accountable care organization model;

    (iii) An alternative payment model approved by the federal Centers for Medicare and Medicaid Services;

    (iv) Another model approved by the federal Centers for Medicare and Medicaid Services that may be applied to health care services provided to both Medicare beneficiaries and individuals who are not Medicare beneficiaries; or

    (v) A value-based arrangement that meets the requirements of 42 C.F.R. Sec. 411.357(aa)(1) through (3).

(e) A health care practitioner exempted from the provisions of this section in accordance with subsection (d) of this section shall be subject to the disclosure provisions of Sec. 1-303 of this subtitle.

(f) If the Maryland Insurance Commissioner issues an order under Sec. 15-143 of the Insurance Article that a compensation arrangement funded by or paid under a payment model listed in subsection (d)(12) of this section violates the Insurance Article or a regulation adopted under the Insurance Article, the exemption provided under subsection (d)(12) of this section for a health care practitioner who has the compensation arrangement with a health care entity is null and void.

(g) Subsection (d)(12) of this section may not be construed to:

  (1) Permit an individual or entity to engage in the insurance business, as defined in Sec. 1-101 of the Insurance Article, without obtaining a certificate of authority from the Maryland Insurance Commissioner and satisfying all other applicable requirements of the Insurance Article;

  (2)

    (i) Impose additional obligations on a carrier providing incentive-based compensation to a health care practitioner under Sec. 15-113 of the Insurance Article; or

    (ii) Require the disclosure of information regarding the incentive-based compensation, except as required under Sec. 15-113 of the Insurance Article;

  (3) Authorize a health care entity to knowingly make a direct or indirect payment to a health care practitioner as an inducement to reduce or limit medically necessary services to individuals who are under the direct care of the health care practitioner;

  (4) Permit an arrangement that violates:

    (i) Sec. 14-404(a)(15) of this article; or

    (ii) Sec. 8-508, Sec. 8-511, Sec. 8-512, Sec. 8-516, or Sec. 8-517 of the Criminal Law Article;

  (5) Narrow, expand, or otherwise modify:

    (i) Any definition in Sec. 1-301 of this subtitle, including the definition of "in-office ancillary services"; or

    (ii) Any exception in subsection (d)(4) of this section including the exception for referrals for in-office ancillary services or tests; or

  (6) Require a compensation arrangement to comply with the provisions of subsection (d)(12) of this section if the compensation arrangement is exempt under any other provision of subsection (d) of this section.

#### Section 1-303

(a) Except as provided in subsection (c) of this section and Title 12 of this article, a health care practitioner making a lawful referral shall disclose the existence of the beneficial interest in accordance with provisions of this section.

(b) Prior to referring a patient to a health care entity in which the practitioner, the practitioner's immediate family, or the practitioner in combination with the practitioner's immediate family owns a beneficial interest, the health care practitioner shall:

  (1) Except if an oral referral is made by telephone, provide the patient with a written statement that:

    (i) Discloses the existence of the ownership of the beneficial interest or compensation arrangement;

    (ii) States that the patient may choose to obtain the health care service from another health care entity; and

    (iii) Requires the patient to acknowledge in writing receipt of the statement;

  (2) Except if an oral referral is made by telephone, insert in the medical record of the patient a copy of the written acknowledgement;

  (3) Place on permanent display a written notice that is in a typeface that is large enough to be easily legible to the average person from a distance of 8 feet and that is in a location that is plainly visible to the patients of the health care practitioner disclosing all of the health care entities:

    (i) In which the practitioner, the practitioner's immediate family, or the practitioner in combination with the practitioner's immediate family owns a beneficial interest; and

    (ii) To which the practitioner refers patients; and

  (4) Documents in the medical record of the patient that:

    (i) A valid medical need exists for the referral; and

    (ii) The practitioner has disclosed the existence of the beneficial interest to the patient.

(c) The provisions of this section do not apply to:

  (1) A health care practitioner when treating a member of a health maintenance organization as defined in Sec. 19-701 of the Health - General Article and the health care practitioner does not have a beneficial interest in the health care entity; or

  (2) A health care practitioner who refers a patient:

    (i) To another health care practitioner in the same group practice as the referring health care practitioner;

    (ii) For in-office ancillary services; or

    (iii) For health care services provided through or by a health care entity owned or controlled by a hospital.

(d) A health care practitioner who fails to comply with any provision of this section is guilty of a misdemeanor and on conviction is subject to a fine not exceeding $5,000.

#### Section 1-304

(a) A health care practitioner shall disclose the name of a referring health care practitioner on each request for payment or bill submitted to a third party payor, including nonprofit health plans and fiscal intermediaries and carriers, that may be responsible for payment, in whole or in part, of the charges for a health care service, if the health care practitioner knows or has reason to believe:

  (1) There has been a referral by a health care practitioner; and

  (2) The referring health care practitioner has a beneficial interest in or compensation arrangement with the health care entity that is prohibited under Sec. 1-302 of this subtitle.

(b) A health care practitioner who knows or should have known of the practitioner's failure to comply with the provisions of this section shall be subject to disciplinary action by the appropriate licensing board.

#### Section 1-305

(a) If a referring health care practitioner, a health care entity, or other person furnishing health care services collects any amount of money that was billed in violation of Sec. 1-302(b) of this subtitle and the referring health care practitioner, health care entity, or other person knew or should have known of the violation, the referring health care practitioner, health care entity, or other person is jointly and severally liable to the payor for any amounts collected.

(b) If a claim, bill, or other demand or request for payment for health care services is denied under Sec. 19-712.4 of the Health - General Article or Sec. 15-110 of the Insurance Article, the referring health care practitioner, health care entity, or other person furnishing the health care services may not submit a claim, bill, or other demand or request for payment to the person who received the health care services.

#### Section 1-306

(a)

  (1) In this section the following words have the meanings indicated.

  (2) "Anatomic pathology services" means:

    (i) Histopathology or surgical pathology;

    (ii) Cytopathology;

    (iii) Hematology;

    (iv) Subcellular pathology and molecular pathology; or

    (v) Blood-banking services performed by pathologists.

  (3) "Clinical laboratory" means a facility that provides anatomic pathology services.

  (4)

    (i) "Cytopathology" means the microscopic examination of cells from fluids, aspirates, washings, brushings, or smears.

    (ii) "Cytopathology" includes the microscopic examination of cells in a Pap test examination performed by a physician or under the direct supervision of a physician.

  (5) "Hematology" means:

    (i) The microscopic evaluation of bone marrow aspirates and biopsies performed by a physician or under the direct supervision of a physician; or

    (ii) Review of a peripheral blood smear if a physician or technologist requests that a pathologist review a blood smear.

  (6) "Histopathology or surgical pathology" means gross and microscopic examination of organ tissue performed by a physician or under the direct supervision of a physician.

  (7)

    (i) "Referring laboratory" means a clinical laboratory that sends a specimen to another clinical laboratory for histologic processing or anatomic pathology consultation.

    (ii) "Referring laboratory" does not include a laboratory of a physician's office or a group practice that collects a specimen and orders, but does not perform, anatomic pathology services for patients.

(b) Nothing in this section may be construed to:

  (1) Mandate the assignment of benefits for anatomic pathology services; or

  (2) Prohibit a health care practitioner who performs or supervises anatomic pathology services and is a member of a group practice, as defined under Sec. 1-301 of this subtitle, from reassigning the right to bill for anatomic pathology services to the group practice if the billing complies with the requirements of subsection (c) of this section.

(c) A clinical laboratory, a physician, or a group practice located in this State or in another state that provides anatomic pathology services for a patient in this State shall present, or cause to be presented, a claim, bill, or demand for payment for the services to:

  (1) Subject to the limitations of Sec. 19-710(p) of the Health - General Article, the patient directly unless otherwise prohibited by law;

  (2) A responsible insurer or other third-party payor;

  (3) A hospital, public health clinic, or nonprofit health clinic ordering the services;

  (4) A referring laboratory;

  (5) On behalf of the patient, a governmental agency or its public or private agent, agency, or organization; or

  (6) A health care practitioner who orders but does not supervise or perform an anatomic pathology service on a Pap test specimen, provided the health care practitioner is in compliance with subsection (e)(2) of this section.

(d) Except as provided in subsection (e) of this section, a health care practitioner licensed under this article may not directly or indirectly charge, bill, or otherwise solicit payment for anatomic pathology services unless the services are performed:

  (1) By the health care practitioner or under the direct supervision of the health care practitioner; and

  (2) In accordance with the provisions for the preparation of biological products by service in the federal Public Health Service Act.

(e) This section does not prohibit:

  (1) A referring laboratory from billing for anatomic pathology services or histologic processing if the referring laboratory must send a specimen to another clinical laboratory for histologic processing or anatomic pathology consultation; and

  (2) A health care practitioner who takes a Pap test specimen from a patient and who orders but does not supervise or perform an anatomic pathology service on the specimen, from billing a patient or payor for the service, provided the health care practitioner complies with:

    (i) The disclosure requirements of Sec. 14-404(a)(16) of this article; and

    (ii) The ethics policies of the American Medical Association that relate to referring physician billing for laboratory services.

(f) A patient, insurer, third-party payor, hospital, public health clinic, or nonprofit health clinic is not required to reimburse a health care practitioner who violates the provisions of this section.

#### Section 1-307

(a) A health care practitioner who fails to comply with the provisions of this  subtitle shall be subject to disciplinary action by the appropriate regulatory board.

(b) The appropriate regulatory board may investigate a  claim under this subtitle in accordance with the investigative  authority granted under this article.

### Subtitle 4. Medical Review Committees

#### Section 1-401

(a)

  (1) In this section the following words have the meanings indicated.

  (2)

    (i) "Alternative health care system" means a system of health care delivery other than a hospital or related institution.

    (ii) "Alternative health care system" includes:

      (1) A health maintenance organization;

      (2) A preferred provider organization;

      (3) An independent practice association;

      (4) A community health center that is a nonprofit, freestanding ambulatory health care provider governed by a voluntary board of directors and that provides primary health care services to the medically indigent;

      (5) A freestanding ambulatory care facility as that term is defined in Sec. 19-3B-01 of the Health - General Article; or

      (6) Any other health care delivery system that utilizes a medical review committee.

  (3) "Medical review committee" means a committee or board that:

    (i) Is within one of the categories described in subsection (b) of this section; and

    (ii) Performs functions that include at least one of the functions listed in subsection (c) of this section.

  (4)

    (i) "Provider of health care" means any person who is licensed by law to provide health care to individuals.

    (ii) "Provider of health care" does not include any nursing institution that is conducted by and for those who rely on treatment by spiritual means through prayer alone in accordance with the tenets and practices of a recognized church or religious denomination.

  (5) "The Maryland Health Care Commission" means the State agency described in Sec. 19-103 of the Health - General Article.

  (6) "The Maryland Institute for Emergency Medical Services Systems" means the State agency described in Sec. 13-503 of the Education Article.

(b) For purposes of this section, a medical review committee is:

  (1) A regulatory board or agency established by State or federal law to license, certify, or discipline any provider of health care;

  (2) A committee of the Maryland State Medical Society or any of its component societies or a committee of any other professional society or association composed of providers of health care;

  (3) A committee appointed by or established in the Department or a local health department for review purposes;

  (4) A committee appointed by or established in the Maryland Institute for Emergency Medical Services Systems;

  (5) A committee of the medical staff or other committee, including any risk management, credentialing, or utilization review committee established in accordance with Sec. 19-319 of the Health - General Article, of a hospital, related institution, or alternative health care system, if the governing board of the hospital, related institution, or alternative health care system forms and approves the committee or approves the written bylaws under which the committee operates;

  (6) A committee or individual designated by the holder of a pharmacy permit, as defined in Sec. 12-101 of this article, that performs the functions listed in subsection (c) of this section, as part of a pharmacy's ongoing quality assurance program;

  (7) Any person, including a professional standard review organization, who contracts with an agency of this State or of the federal government to perform any of the functions listed in subsection (c) of this section;

  (8) Any person who contracts with a provider of health care to perform any of those functions listed in subsection (c) of this section that are limited to the review of services provided by the provider of health care;

  (9) An organization, established by the Maryland Hospital Association, Inc. and the Maryland State Medical Society, that contracts with a hospital, related institution, or alternative delivery system to:

    (i) Assist in performing the functions listed in subsection (c) of this section; or

    (ii) Assist a hospital in meeting the requirements of Sec. 19-319(e) of the Health - General Article;

  (10) A committee appointed by or established in an accredited health occupations school;

  (11) An organization described under Sec. 14-501 of this article that contracts with a hospital, related institution, or health maintenance organization to:

    (i) Assist in performing the functions listed in subsection (c) of this section; or

    (ii) Assist a health maintenance organization in meeting the requirements of Title 19, Subtitle 7 of the Health - General Article, the National Committee for Quality Assurance (NCQA), or any other applicable credentialing law or regulation;

  (12) An accrediting organization as defined in Sec. 14-501 of this article;

  (13) A Mortality and Quality Review Committee established under Sec. 5-802 of the Health - General Article or a Morbidity, Mortality, and Quality Review Committee established under Sec. 18-107 of the Health - General Article;

  (14) A center designated by the Maryland Health Care Commission as the Maryland Patient Safety Center that performs the functions listed in subsection (c)(1) of this section; or

  (15) The Maryland Health Care Commission or its staff, when performing the functions listed in subsection (c) of this section, provided that the data or medical information under review is furnished to the Maryland Health Care Commission by another medical review committee.

(c) For purposes of this section, a medical review committee:

  (1) Evaluates and seeks to improve the quality of health care provided by providers of health care;

  (2) Evaluates the need for and the level of performance of health care provided by providers of health care;

  (3) Evaluates the qualifications, competence, and performance of providers of health care; or

  (4) Evaluates and acts on matters that relate to the discipline of any provider of health care.

(d)

  (1) Except as otherwise provided in this section, the proceedings, records, and files of a medical review committee are not discoverable and are not admissible in evidence in any civil action.

  (2) The proceedings, records, and files of a medical review committee are confidential and are not discoverable and are not admissible in evidence in any civil action arising out of matters that are being reviewed and evaluated by the medical review committee if requested by the following:

    (i) The Maryland Department of Health to ensure compliance with the provisions of Sec. 19-319 of the Health - General Article;

    (ii) A health maintenance organization to ensure compliance with the provisions of Title 19, Subtitle 7 of the Health - General Article and applicable regulations;

    (iii) A health maintenance organization to ensure compliance with the National Committee for Quality Assurance (NCQA) credentialing requirements; or

    (iv) An accrediting organization to ensure compliance with accreditation requirements or the procedures and policies of the accrediting organization.

  (3) If the proceedings, records, and files of a medical review committee are requested by any person from any of the entities in paragraph (2) of this subsection:

    (i) The person shall give the medical review committee notice by certified mail of the nature of the request and the medical review committee shall be granted a protective order preventing the release of its proceedings, records, and files; and

    (ii) The entities listed in paragraph (2) of this subsection may not release any of the proceedings, records, and files of the medical review committee.

(e) Subsection (d)(1) of this section does not apply to:

  (1) A civil action brought by a party to the proceedings of the medical review committee who claims to be aggrieved by the decision of the medical review committee; or

  (2) Any record or document that is considered by the medical review committee and that otherwise would be subject to discovery and introduction into evidence in a civil trial.

(f)

  (1) A person shall have the immunity from liability described under Sec. 5-637 of the Courts and Judicial Proceedings Article for any action as a member of the medical review committee or for giving information to, participating in, or contributing to the function of the medical review committee.

  (2) A contribution to the function of a medical review committee includes any statement by any person, regardless of whether it is a direct communication with the medical review committee, that is made within the context of the person's employment or is made to a person with a professional interest in the functions of a medical review committee and is intended to lead to redress of a matter within the scope of a medical review committee's functions.

(g) Notwithstanding this section, Sec.Sec. 14-410 and 14-412 of this article apply to:

  (1) The Board of Physicians; and

  (2) Any other entity, to the extent that it is acting in an investigatory capacity for the Board of Physicians.

#### Section 1-402

(a) In accordance with the Health Care Quality Improvement Act of 1986, the State elects not to be governed by the provisions of the Act that provide limitations on damages for suits brought under State law against medical review bodies and to physicians participating in professional peer review activities.

(b) For suits brought under State law, the State shall be governed by this subtitle.

### Subtitle 5. Health Care Worker Whistleblower Protection Act

#### Section 1-501

(a) In this subtitle the following words have the meanings indicated.

(b) "Board" means any board established under this article.

(c)

  (1) "Employee" means any individual licensed or certified by a board under this article who performs services for and under the control and direction of an employer for wages or other remuneration.

  (2) "Employee" does not include a State employee.

(d) "Supervisor" means any individual within an employer's organization who has the authority to direct and control the work performance of an employee, or who has managerial authority to take corrective action regarding the violation of a law, rule, or regulation of which the employee complains.

#### Section 1-502

Subject to Sec. 1-503 of this subtitle, an employer may not take or refuse to take any personnel action as reprisal against an employee because the employee:

(1) Discloses or threatens to disclose to a supervisor or board an activity, policy, or practice of the employer that is in violation of a law, rule, or regulation;

(2) Provides information to or testifies before any public body conducting an investigation, hearing, or inquiry into any violation of a law, rule, or regulation by the employer; or

(3) Objects to or refuses to participate in any activity, policy, or practice in violation of a law, rule, or regulation.

#### Section 1-503

The protection provided against a violation of Sec. 1-502 of this subtitle shall only apply if:

(1) The employee has a reasonable, good faith belief that the employer has, or still is, engaged in an activity, policy, or practice that is in violation of a law, rule, or regulation;

(2) The employer's activity, policy, or practice that is the subject of the employee's disclosure poses a substantial and specific danger to the public health or safety; and

(3) Before reporting to the board:

  (i) The employee has reported the activity, policy, or practice to a supervisor or administrator of the employer in writing and afforded the employer a reasonable opportunity to correct the activity, policy, or practice; or

  (ii) If the employer has a corporate compliance plan specifying who to notify of an alleged violation of a rule, law, or regulation, the employee has followed the plan.

#### Section 1-504

(a) Any employee who is subject to a personnel action in violation of Sec. 1-502 of this subtitle may institute a civil action in the county where:

  (1) The alleged violation occurred;

  (2) The employee resides; or

  (3) The employer maintains its principal offices in the State.

(b) The action shall be brought within 1 year after the alleged violation of Sec. 1-502 of this subtitle occurred, or within 1 year after the employee first became aware of the alleged violation of Sec. 1-502 of this subtitle.

#### Section 1-505

In any action brought under this subtitle, a court may:

(1) Issue an injunction to restrain continued violation of this subtitle;

(2) Reinstate the employee to the same, or an equivalent position held before the violation of Sec. 1-502 of this subtitle;

(3) Remove any adverse personnel record entries based on or related to the violation of Sec. 1-502 of this subtitle;

(4) Reinstate full fringe benefits and seniority rights;

(5) Require compensation for lost wages, benefits, and other remuneration; and

(6) Assess reasonable attorney's fees and other litigation expenses against:

  (i) The employer, if the employee prevails; or

  (ii) The employee, if the court determines that the action was brought by the employee in bad faith and without basis in law or fact.

#### Section 1-506

In any action brought under this subtitle, it is a defense that the personnel action was based on grounds other than the employee's exercise of any rights protected under this subtitle.

### Subtitle 6. General Clarification of the Disciplinary Process

#### Section 1-601

In this subtitle, "health occupations board" means a board authorized to issue a license or certificate under this article.

#### Section 1-602

(a) After consultation with the Secretary and to the extent permitted by existing administrative and fiscal resources, each health occupations board shall establish a disciplinary subcommittee.

(b) To the extent deemed practicable by each board, a disciplinary subcommittee shall:

  (1) Be responsible for the investigation of complaints;

  (2) Determine whether the health occupations board should bring charges against a licensee or certificate holder; and

  (3) Participate in preadjudication case resolution conferences resulting from the charges.

#### Section 1-603

(a) Except as provided in subsection (b) of this section, a health occupations board may not bring charges against a licensee or certificate holder based solely on events contained in a complaint the board receives more than 6 years after:

  (1) The day the complainant actually discovered the facts that form the basis of the complaint; or

  (2) The day when a reasonable person exercising due diligence should have discovered the facts that form the basis of the complaint.

(b) This section does not apply to a complaint based on:

  (1) Criminal convictions or sexual misconduct or other similar boundary violations;

  (2) Reciprocal discipline matters;

  (3) Ongoing substance abuse;

  (4) Fraudulent concealment of material information; or

  (5) Acts that occur while a patient is a minor.

#### Section 1-604

(a) If a statute authorizes a health occupations board to use a system of peer review in standard of care cases and the peer reviewer or peer reviewers determine that there has been a violation of a standard of care, the board shall provide the licensee or certificate holder under investigation:

  (1) An opportunity to review the final peer review report; and

  (2) At least 10 business days after the report was sent to the licensee or certificate holder to provide the board with a written response.

(b) If a health occupations board receives a written response to a final peer review report, the board shall consider both the report and response before taking any action.

(c)

  (1) Except as provided in paragraph (2) of this subsection, health occupations boards and disciplinary panels may not reprimand a licensee or certificate holder, place a licensee or certificate holder on probation, or suspend or revoke the license of a licensee or the certificate of a certificate holder solely on the basis of the licensee's or certificate holder's use of a diagnostic evaluation or treatment of a patient that is integrative, complementary, alternative, or nonconventional, including in the treatment of Lyme disease or tick-borne illnesses.

  (2) This subsection may not be construed to release a licensee or certificate holder from the duty to exercise a professional standard of care when evaluating and treating a patient's medical condition.

#### Section 1-605

(a) As an alternative to a formal hearing, each health occupations board may establish a program for licensees or certificate holders who commit a single standard of care violation.

(b) A program established under this section shall provide training, mentoring, or other forms of remediation as determined by the health occupations board.

(c) A health occupations board may refer a licensee to the program.

#### Section 1-606

(a) Each health occupations board shall adopt specific sanctioning guidelines, including:

  (1) A range of sanctions that is based on historical data or a normative process for each type of violation; and

  (2) A list of mitigating and aggravating circumstances that may be used to decide if a sanction falls within or outside the established range of sanctions.

(b) Sanctioning guidelines adopted under this section shall:

  (1) Conform to a general framework or incorporate a common set of elements; and

  (2) Be used as a guide for sanctioning licensees and certificate holders in formal and informal proceedings.

(c)

  (1) To the extent a health occupations board departs from the sanctioning guidelines adopted under this section, the board shall state its reasons.

  (2) A departure from the guidelines alone is not grounds for any hearing or appeal of any board action.

#### Section 1-607

Each health occupations board shall post on the board's Web site each final, public order for a disciplinary sanction issued to a licensee or certificate holder.

#### Section 1-608

The Secretary shall monitor the timeliness of complaint resolution for each health occupations board.

#### Section 1-609

(a) Each health occupations board shall collaborate with the Office of the Attorney General to make guidelines available to the public concerning the separate roles for assistant attorneys general as counsel and prosecutor for the board.

(b) Noncompliance with the guidelines made available under this section may not be used as grounds for any hearing or appeal of any board action.

### Subtitle 7. Service Members, Veterans, and Military Spouses -- Licensing

#### Section 1-701

(a) In this subtitle the following words have the meanings indicated.

(b) "Active service member" has the meaning stated in Sec. 9-901 of the State Government Article.

(c)

  (1) "Eligible spouse" means the spouse of an active service member or eligible veteran.

  (2) "Eligible spouse" includes a surviving spouse of:

    (i) An eligible veteran; or

    (ii) An active service member who died before the date on which the application for a license, certificate, or registration is submitted.

(d) "Eligible veteran" means a veteran who was discharged from active duty before the date on which the application for a license, certificate, or registration is submitted.

(e) "Health occupations board" means a board authorized to issue a license, certificate, or registration under this article.

#### Section 1-702

(a) In calculating an individual's years of practice in a health occupation, each health occupations board shall give credit to the individual for all relevant experience as an active service member.

(b) Each health occupations board shall credit any training and education provided by the uniformed services and completed by an active service member toward any training or education requirements for licensure, certification, or registration if the training or education is determined by the health occupations board to be:

  (1) Substantially equivalent to the training or education required by the health occupations board; and

  (2) Not otherwise contrary to any other licensing requirement.

#### Section 1-703

A health occupations board may allow a licensee or certificate holder who is a member of one of the uniformed services deployed outside the United States or its territories to:

(1) Renew the license or certificate after the expiration of the renewal period without payment of a penalty or reinstatement fee if the late renewal is a direct result of the deployment; and

(2) Complete any continuing education or continuing competency requirements or criminal history records check required for renewal within a reasonable time after renewing the license or certificate.

#### Section 1-704

(a)

  (1) Each health occupations board shall develop a procedure by which an individual who applies for a license, certificate, or registration can notify the board that the individual is an active service member, eligible veteran, or eligible spouse.

  (2) A health occupations board may satisfy the requirement of paragraph (1) of this subsection by including a check-off box on a license, certificate, or registration application form.

(b) For each applicant who is an active service member, eligible veteran, or eligible spouse, a health occupations board shall assign to the applicant an advisor to assist the individual with the application process.

(c)

  (1) Each health occupations board shall expedite the process for the licensure, certification, or registration of an active service member, eligible veteran, or eligible spouse.

  (2) If an active service member, eligible veteran, or eligible spouse meets the requirements for licensure, certification, or registration, a health occupations board shall issue the license, certificate, or registration within 15 business days after receiving a completed application.

(d) If a health occupations board determines that an active service member, eligible veteran, or eligible spouse does not meet the education, training, or experience requirements for licensure, certification, or registration, a representative of the board shall assist the active service member, eligible veteran, or eligible spouse in identifying:

  (1) Programs that offer relevant education or training; or

  (2) Ways of obtaining needed experience.

(e) An individual authorized to practice in the State under Sec. 10-14B-03 of the State Government Article may not be required to apply for expedited licensure under this section to practice in the State.

#### Section 1-705

Each health occupations board shall publish prominently on its website information on:

(1) The expedited licensing process available to active service members, eligible veterans, and eligible spouses under Sec. 1-704 of this subtitle; and

(2) Any assistance and services related to licensure, certification, or registration provided by the board to active service members, eligible veterans, and eligible spouses.

#### Section 1-706

Each health occupations board may adopt regulations to carry out this subtitle. 

#### Section 1-707

(a) Each health occupations board may establish a process to include a notation indicating veteran status on a license, certificate, registration, or public profile.

(b) If a health occupations board establishes the process described in subsection (a) of this section, an application for a license, certificate, or registration shall allow an applicant to:

  (1) Present a certification of veteran status obtained from the Department of Veterans and Military Families in accordance with Sec. 9-905 of the State Government Article, a DD Form 214, or other documentation acceptable to the health occupations board certifying veteran status; and

  (2) Indicate that the applicant consents to:

    (i) Having a notation on the applicant's license, certificate, registration, or public profile indicating that the applicant is a veteran; and

    (ii) Being contacted by appropriate Executive Branch agencies regarding the applicant's eligibility for State or federal veterans benefits.

(c) If an applicant presents the required documentation and consents in accordance with subsection (b) of this section, a health occupations board shall:

  (1) Include on the applicant's license, certification, registration, or public profile a notation indicating that the applicant is a veteran; and

  (2) In accordance with Sec.Sec. 4-304 through 4-325 of the General Provisions Article and any other applicable law, and on request from an Executive Branch agency, electronically transmit to the Executive Branch agency appropriate information about the applicant.

(d) Each health occupations board may adopt regulations to carry out the provisions of this section.

### Subtitle 8. Continuing Education in Health Care Disparities, Cultural and Linguistic Competency, and Health Literacy

#### Section 1-801

(a) In this subtitle the following words have the meanings indicated.

(b) "Applicant" means an individual who applies for licensure to practice as a health care professional.

(c) "Board" means:

  (1) The State Board of Examiners for Audiologists, Hearing Aid Dispensers, and Speech-Language Pathologists;

  (2) The State Board of Dental Examiners;

  (3) The State Board of Nursing;

  (4) The State Board of Examiners in Optometry;

  (5) The State Board of Pharmacy;

  (6) The State Board of Physicians;

  (7) The State Board of Podiatric Medical Examiners;

  (8) The State Board of Professional Counselors and Therapists;

  (9) The State Board of Examiners of Psychologists; and

  (10) The State Board of Social Work Examiners.

(d) "Health care professional" means:

  (1) An individual licensed by the State Board of Examiners for Audiologists, Hearing Aid Dispensers, and Speech-Language Pathologists;

  (2) A dentist licensed by the State Board of Dental Examiners;

  (3) A registered nurse or licensed practical nurse licensed by the State Board of Nursing;

  (4) An optometrist licensed by the State Board of Examiners in Optometry;

  (5) A pharmacist licensed by the State Board of Pharmacy;

  (6) A physician licensed by the State Board of Physicians;

  (7) A podiatrist licensed by the State Board of Podiatric Medical Examiners;

  (8) An individual licensed by the State Board of Professional Counselors and Therapists;

  (9) A psychologist licensed by the State Board of Examiners of Psychologists; and

  (10) An associate social worker, a graduate social worker, a certified social worker, or a certified social worker-clinical licensed by the State Board of Social Work Examiners.

#### Section 1-802

(a)

  (1) The Office of Minority Health and Health Disparities shall provide to each board a list of recommended courses in cultural and linguistic competency, health disparities, and health literacy.

  (2) The Department, in consultation with the Department of Veterans and Military Families, shall provide to each board a list of recommended courses in uniformed services culture.

(b) Each board shall:

  (1) Post the list of recommended courses provided to the board under subsection (a) of this section prominently on the board's website;

  (2) Provide information about the recommended courses to health care professionals at the time of renewal of licensure; and

  (3) Advertise the availability of the recommended courses in newsletters and any other media published by the board.

### Subtitle 9. Teletherapy

#### Section 1-901

(a) In this subtitle the following words have the meanings indicated.

(b) "Health care practitioner" means an individual who:

  (1) Provides  behavioral health services to a patient in the State; and

  (2) Is licensed in the State by:

    (i) The State Board of Nursing;

    (ii) The State Board of Physicians;

    (iii) The State Board of Professional Counselors and Therapists;

    (iv) The State Board of Examiners of Psychologists; or

    (v) The State Board of Social Work Examiners.

(c) "Teletherapy" means telehealth, as defined in Sec. 15-139 of the Insurance Article, used to deliver behavioral health services.

#### Section 1-902

A health care practitioner may use teletherapy if:

(1) The health care practitioner complies with  any regulations adopted under this subtitle; and

(2) The health care practitioner:

  (i) Establishes a patient-practitioner relationship with the patient for whom teletherapy is being used;

  (ii) Provides for the privacy of communications made through teletherapy; and

  (iii) Addresses, to the extent practicable, the need to maintain the safety and well-being of patients for whom teletherapy is being used.

#### Section 1-903

Each health occupations board listed in Sec. 1-901(b)(2) of this subtitle shall adopt regulations to carry out this subtitle that, to the extent practicable, are uniform and nonclinical.

### Subtitle 10. Telehealth

#### Section 1-1001

(a) In this subtitle the following words have the meanings indicated.

(b) "Asynchronous telehealth interaction" means an exchange of information between a patient and a health care practitioner that does not occur in real time, including the secure collection and transmission of a patient's medical information, clinical data, clinical images, laboratory results, and self-reported medical history.

(c) "Health care practitioner" means an individual who is licensed, certified, or otherwise authorized by law to provide health care services under this article.

(d) "Synchronous telehealth interaction" means an exchange of information between a patient and a health care practitioner that occurs in real time.

(e)

  (1) "Telehealth" means a mode of delivering health care services through the use of telecommunications technologies by a health care practitioner to a patient at a different physical location than the health care practitioner.

  (2) "Telehealth" includes synchronous and asynchronous interactions.

  (3) "Telehealth" does not include the provision of health care services solely through audio-only calls, e-mail messages, or facsimile transmissions.

#### Section 1-1002

A health care practitioner may establish a practitioner-patient relationship through either a synchronous telehealth interaction or an asynchronous telehealth interaction, if the health care practitioner:

(1) Verifies the identity of the patient receiving health care services through telehealth;

(2) Discloses to the patient the health care practitioner's name, contact information, and the type of health occupation license held by the health care practitioner; and

(3) Obtains oral or written consent from the patient or from the patient's parent or guardian if State law requires the consent of a parent or guardian.

#### Section 1-1003

(a) A health care practitioner providing telehealth services shall:

  (1) Be held to the same standards of practice that are applicable to in-person health care settings; and

  (2) If clinically appropriate for the patient, provide or refer a patient to in-person health care services or another type of telehealth service.

(b)

  (1) A health care practitioner shall perform a clinical evaluation that is appropriate for the patient and the condition with which the patient presents before providing treatment or issuing a prescription through telehealth.

  (2) A health care practitioner may use a synchronous telehealth interaction or an asynchronous telehealth interaction to perform the clinical evaluation required under paragraph (1) of this subsection.

(c)

  (1) A health care practitioner may not prescribe an opiate described in the list of Schedule II substances under Sec. 5-403 of the Criminal Law Article for the treatment of pain through telehealth, unless:

    (i) The individual receiving the prescription is a patient in a health care facility, as defined in Sec. 19-114 of the Health - General Article;

    (ii) The Governor has declared a state of emergency due to a catastrophic health emergency; or

    (iii) There is an established bona fide practitioner-patient relationship in which the health care practitioner has ongoing responsibility for the assessment, care, and treatment of the patient and the health care practitioner, or another health care practitioner in the same group practice, previously conducted an in-person assessment of the patient.

  (2) Subject to paragraph (1) of this subsection, a health care practitioner who through telehealth prescribes a controlled dangerous substance, as defined in Sec. 5-101 of the Criminal Law Article, is subject to any applicable regulation, limitation, and prohibition in federal and State law relating to the prescription of controlled dangerous substances.

#### Section 1-1004

(a) A health care practitioner shall document in a patient's medical record the health care services provided through telehealth to the patient according to the same documentation standards used for in-person health care services.

(b) All laws regarding the confidentiality of health information and a patient's right to the patient's health information apply to telehealth interactions in the same manner as the laws apply to in-person health care interactions.

#### Section 1-1005

A health care practitioner providing health care services through telehealth must be licensed, certified, or otherwise authorized by law to provide health care services in the State if the health care services are being provided to a patient located in the State.

#### Section 1-1006

(a) A health occupations board may adopt regulations to implement this subtitle.

(b) Regulations adopted by a health occupations board under subsection (a) of this section:

  (1) May not establish a separate standard of care for telehealth; and

  (2) Shall allow for the establishment of a practitioner-patient relationship through a synchronous telehealth interaction or an asynchronous telehealth interaction provided by a health care practitioner who is complying with the health care practitioner's standard of care.

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Md. Code Ann., Health Occ. (as displayed at mgaleg.maryland.gov, October 16, 2026)