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<chapter num="10" heading="Telepsychology" title_num="10" subtitle_num="36">
  <regulation prefix="Regulation" num=".01" heading="Scope.">
    <text>This chapter applies to all psychologists and psychology associates in Maryland who engage in the practice of psychology using telepsychology.</text>
  </regulation>
  <regulation prefix="Regulation" num=".02" heading="Definitions.">
    <paragraph num="A.">
      <text>In this chapter, the following terms have the meanings indicated.</text>
    </paragraph>
    <paragraph num="B.">
      <text>Terms Defined.</text>
      <paragraph num="(1)">
        <text>“Board” means the Maryland Board of Examiners of Psychologists.</text>
      </paragraph>
      <paragraph num="(2)">
        <text>“Client” means the individual, couple, family, group, business, agency, school, organization, or association that the psychologist or psychology associate provides, or has provided, with professional services.</text>
      </paragraph>
      <paragraph num="(3)">
        <text>“Psychologist” means an individual who is licensed by the Board to practice psychology.</text>
      </paragraph>
      <paragraph num="(4)">
        <text>“Psychology associate” means an individual who is registered by the Board to practice psychology under the supervision of a licensed psychologist.</text>
      </paragraph>
      <paragraph num="(5)">
        <text>Telepsychology.</text>
        <paragraph num="(a)">
          <text>“Telepsychology” means the use of interactive audio, video, or other telecommunications or electronic media by a psychologist or psychology associate who engages in the practice of psychology at a location other than the location of the client.</text>
        </paragraph>
        <paragraph num="(b)">
          <text>“Telepsychology” does not include:</text>
          <paragraph num="(i)">
            <text>An audio-only telephone conversation between a psychologist or psychology associate and a client;</text>
          </paragraph>
          <paragraph num="(ii)">
            <text>An electronic mail message between a psychologist or psychology associate and a client;</text>
          </paragraph>
          <paragraph num="(iii)">
            <text>A facsimile transmission between a psychologist or psychology associate and a client; or</text>
          </paragraph>
          <paragraph num="(iv)">
            <text>A text message or other type of message sent between a psychologist or psychology associate and a client by a short message service or multimedia messaging service.</text>
          </paragraph>
        </paragraph>
      </paragraph>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".03" heading="Licensure.">
    <text>An individual shall be licensed with the Board as a psychologist or registered with the Board as a psychology associate in order to engage in the practice of psychology using telepsychology in Maryland if one or both of the following occurs:</text>
    <paragraph num="A.">
      <text>The individual practicing telepsychology is physically located in Maryland: or</text>
    </paragraph>
    <paragraph num="B.">
      <text>The client is in Maryland.</text>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".04" heading="Standards of Practice for Telepsychology.">
    <paragraph num="A.">
      <text>Before providing telepsychology services, a psychologist or psychology associate shall develop and follow a procedure to:</text>
      <paragraph num="(1)">
        <text>Verify the identification of the client receiving telepsychology services;</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Obtain informed consent specific to telepsychology services using appropriate language understandable to the client;</text>
      </paragraph>
      <paragraph num="(3)">
        <text>Prevent access to data by unauthorized persons through encryption, or other means;</text>
      </paragraph>
      <paragraph num="(4)">
        <text>Notify clients in the event of a data breach;</text>
      </paragraph>
      <paragraph num="(5)">
        <text>Ensure that the telepsychology practitioner provides a secure and private telepsychology connection and complies with federal and state privacy laws;</text>
      </paragraph>
      <paragraph num="(6)">
        <text>Establish safety protocols to be used in the case of an emergency, including contact information for emergency services at the client’s location; and</text>
      </paragraph>
      <paragraph num="(7)">
        <text>Ensure that any psychological testing instruments used are designed, validated, or appropriate for use via telepsychology.</text>
      </paragraph>
    </paragraph>
    <paragraph num="B.">
      <text>A psychologist or psychology associate shall:</text>
      <paragraph num="(1)">
        <text>Obtain or confirm an alternative method of contacting the client in case of a technological failure;</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Determine whether the client is in Maryland and identify the client’s specific location;</text>
      </paragraph>
      <paragraph num="(3)">
        <text>For an initial telepsychology interaction only, disclose the psychologist’s or psychology associate’s name, location, license number, and contact information;</text>
      </paragraph>
      <paragraph num="(4)">
        <text>Identify all individuals present at each location and confirm they are permitted to hear the client’s health information; and</text>
      </paragraph>
      <paragraph num="(5)">
        <text>Be held to the same standards of practice and documentation as those applicable for in-person sessions.</text>
      </paragraph>
    </paragraph>
    <paragraph num="C.">
      <text>A psychologist or psychology associate may not treat a client based solely on an online questionnaire.</text>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".05" heading="Evaluation for Telepsychology Services.">
    <paragraph num="A.">
      <text>Before engaging in the practice of psychology using telepsychology, a psychologist or psychology associate shall evaluate the client to determine that delivery of telepsychology is appropriate considering at least the following factors:</text>
      <paragraph num="(1)">
        <text>The client’s:</text>
        <paragraph num="(a)">
          <text>Diagnosis;</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Symptoms;</text>
        </paragraph>
        <paragraph num="(c)">
          <text>Medical and psychological history; and</text>
        </paragraph>
        <paragraph num="(d)">
          <text>Preference for receiving services via telepsychology; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(2)">
        <text>The nature of the services to be provided, including anticipated:</text>
        <paragraph num="(a)">
          <text>Benefits;</text>
        </paragraph>
        <paragraph num="(b)">
          <text>Risks; and</text>
        </paragraph>
        <paragraph num="(c)">
          <text>Constraints resulting from their delivery via telepsychology.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="B.">
      <text>The client evaluation set forth in §A of this regulation shall take place at an initial in-person session, unless the psychologist or psychology associate documents in the record the reason for not meeting in person.</text>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".06" heading="Discipline.">
    <paragraph num="A.">
      <text>The Board shall use the same standards in evaluating and investigating a complaint and disciplining a psychologist or psychology associate who practices telepsychology as it would use for a psychologist or psychology associate who does not use telepsychology technology in the licensee’s practice.</text>
    </paragraph>
    <paragraph num="B.">
      <text>The failure of a psychologist or psychology associate to comply with this chapter shall constitute unprofessional conduct and may be subject to disciplinary action by the Board.</text>
    </paragraph>
  </regulation>
  <annotations>
    <annotation type="Authority">Health Occupations Article, §§1-901—1-903, Annotated Code of Maryland</annotation>
    <annotation type="History" subtype="Administrative History">Effective date: May 20, 2019 (46:10 Md. R. 489)</annotation>
  </annotations>
</chapter>