This chapter applies to all certified registered nurse practitioners/psychiatric mental health (CRNP/PMH) and psychiatric mental health/advanced practice registered nurses (PMH/APRN) in Maryland, with a specialty certification in psychiatric mental health, who will be providing behavioral health services using teletherapy. In this chapter, the following terms have the meanings indicated. Terms Defined. “Certified registered nurse practitioner/psychiatric mental health (CRNP/PMH)” means a certified registered nurse practitioner who: Is certified by the Board as a certified registered nurse practitioner in the practice of psychiatric mental health; and Autonomously and independently engages in activities authorized by this chapter and in accordance with COMAR 10.27.07. “Psychiatric mental health/advanced practice registered nurse (PMH/APRN)” means an advanced practice registered nurse who: Is certified by the Board as a clinical nurse specialist in the practice of psychiatric mental health; and Autonomously and independently engages in activities authorized by this chapter and in accordance with COMAR 10.27.12. “Synchronous” means simultaneous or quick enough to allow two or more individuals to interact. Teletherapy. “Teletherapy” means the delivery of behavioral health services by a CRNP/PMH or a PMH/APRN at a location other than the location of the client through the use of synchronous interactive audio, video, audio-visual, or other telecommunications or electronic technology. “Teletherapy” does not include: An audio-only telephone conversation between the CRNP/PMH or PMH/APRN and a client; An electronic mail message between a CRNP/PMH or PMH/ APRN and a client; or A facsimile transmission between a CRNP/PMH or PMH/APRN and a client. An individual shall be licensed as a registered nurse in Maryland, or have an active multistate licensure privilege to practice as a registered nurse in Maryland, and be certified by the Board as a CRNP/PMH or PMH/APRN in order to provide teletherapy services in Maryland if either the client or the CRNP/PMH or PMH/APRN is physically located in Maryland. In order to provide teletherapy services to a client, a CRNP/PMH or PMH/APRN shall have: Established a client-therapist relationship; Performed a mental status assessment; Established a diagnosis; Developed a treatment plan; and Obtained an informed consent from the client to provide teletherapy. Before providing teletherapy services, the CRNP/PMH or PMH/APRN shall develop a procedure to: Verify the identity of the client receiving teletherapy services; Ensure that all medical records are protected from unauthorized access through encryption or other means; Ensure that the CRNP/PMH or PMH/APRN provides a secure and private teletherapy connection and complies with federal and state privacy laws; Notify a client in the event of a data breach in accordance with the Health Insurance Portability and Accountability Act (HIPAA) and the Maryland Confidentiality of Medical Records Act; and Establish safety protocols to be used in the case of an emergency. At the outset of each teletherapy session, the CRNP/PMH or PMH/APRN shall: Identify all individuals present at each location and confirm that they are permitted to hear or access personal health information; Obtain or confirm an alternative method of contacting the client in case of a technological failure; and Determine whether the client is in Maryland. A CRNP/PMH or PMH/APRN providing teletherapy services shall be held to the same standards of practice and documentation as those applicable in in-person health care settings. A CRNP/PMH or PMH/APRN may not treat a patient or prescribe medication based solely on an online questionnaire. The Board shall use the same standards in evaluating and investigating a complaint and disciplining a CRNP/PMH or PMH/APRN who provides teletherapy as it would use for a CRNP/PMH or PMH/APRN who is not. A CRNP/PMH or PMH/APRN who provides teletherapy services and fails to comply with this chapter may be subject to discipline under Health Occupations Article, §8-316, Annotated Code of Maryland. Health Occupations Article, §§1-901, 1-902, and 8-205(a)(2)—(5), Annotated Code of Maryland Effective date: July 29, 2019 (46:15 Md. R. 655)