# COMAR Title 10 — Maryland Department of Health

## Subtitle 41 — Board of Examiners for Audiologists, Hearing Aid Dispensers, Speech-Language Pathologists, and Music Therapists

### Chapter 06 — Telehealth Communication

**Authority:** Health Occupations Article, §§2-201 and 2-205, Annotated Code of Maryland

**Administrative History:** Effective date: October 20, 2008 (35:21 Md. R. 1824

**Administrative History:** Regulations .01—.05 repealed and new regulations .01—.06 adopted effective September 18, 2023 (50:18 Md. R. 796)

#### Regulation .01 Scope.

*COMAR 10.41.06.01*

A. This chapter governs the practice of audiology, hearing aid dispensing, speech-language pathology, and music therapy using telehealth as an adjunct to, or replacement for, in-person patient visits.

B. Nothing in this chapter restricts or limits reimbursement requirements pursuant to Health-General Article and Insurance Article, Annotated Code of Maryland.

#### Regulation .02 Definitions.

*COMAR 10.41.06.02*

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

B. Terms Defined.

  (1) “Asynchronous” means not occurring in real time.

  (2) “Board” means the State Board of Examiners for Audiologists, Hearing Aid Dispensers, Speech-Language Pathologists, and Music Therapists.

  (3) “In-person” means in the physical presence of the patient.

  (4) “Interpretive services” means reading and analyzing images, tracings, or specimens through telehealth or giving interpretations based on visual, auditory, thermal, or ultrasonic patterns or other patterns as may evolve with technology.

  (5) “Synchronous” means occurring in real time.

  (6) “Telehealth” has the meaning stated in Health Occupations Article, §1-1001, Annotated Code of Maryland.

  (7) “Telehealth practitioner” means:

    (a) A Maryland licensee of the Board of Examiners for Audiologists, Hearing Aid Dispensers, Speech-Language Pathologists, and Music Therapists performing telehealth services within their respective scope of practice; or

    (b) An audiologist or speech-language pathologist with a compact privilege in Maryland performing telehealth services within their respective scope of practice.

#### Regulation .03 Licensure.

*COMAR 10.41.06.03*

Subject to the provisions of Health Occupations Article, Title 2, Subtitle 3, Annotated Code of Maryland, a telehealth practitioner shall be licensed in Maryland  or hold a  compact privilege when providing telehealth services to a patient located in the State.

#### Regulation .04 Standards of Practice for Telehealth.

*COMAR 10.41.06.04*

A. Before performing telehealth services, a telehealth practitioner shall develop and follow a procedure to:

  (1) Verify the identification of the patient receiving telehealth services through use of:

    (a) A government issued photograph identification;

    (b) An insurance, Medicaid, or Medicare card; or

    (c) Documentation of the patient’s:

      (i) Date of birth; and

      (ii) Home address;

  (2) For an initial patient-telehealth practitioner encounter, disclose the telehealth practitioner’s:

    (a) Name;

    (b) Contact information;

    (c) Maryland license number and type or compact privilege number, if applicable; and

    (d) Medical specialty, if applicable;

  (3) Except for interpretive services, obtain oral or written consent from a patient or patient’s parent or guardian if State law requires the consent of a parent or guardian, including informing patients of the risks and benefits of the services to be provided;

  (4) Securely collect and transmit a patient’s medical health information, clinical data, clinical images, laboratory results, and self-reported medical health and clinical history, as necessary, and prevent access to data by unauthorized persons through encryption or other means;

  (5) Notify patients in the event of a data breach;

  (6) Ensure that the telehealth practitioner provides a secure and private communication modality that complies with federal and state privacy laws; and

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

B. Except when providing asynchronous telehealth services, a telehealth practitioner shall:

  (1) Obtain or confirm an alternative method of contacting the patient in case of a technological failure;

  (2) Confirm whether the patient is in Maryland and identify the specific practice setting in which the patient is located; and

  (3) Identify all individuals present at each location and confirm they are allowed to hear the patient’s health information.

C. A telehealth practitioner shall be held to the same standards of practice and documentation as those applicable for in-person health care settings.

D. The requirements set forth under §§A and B of this regulation may be delegated.

#### Regulation .05 Patient Evaluation.

*COMAR 10.41.06.05*

A. Except when providing asynchronous telehealth services or remote patient monitoring, a telehealth practitioner shall:

  (1) Perform a clinical patient evaluation adequate to establish a diagnosis and identify underlying conditions or contraindications to recommended treatment options before providing treatment or services through telehealth; and

  (2) If clinically appropriate for the patient, provide or refer a patient to:

    (a) In-person health care services; or

    (b) Another type of telehealth service.

B. If the evaluation is adequate to comply with §A of this regulation, a telehealth practitioner may use:

  (1) Telehealth devices;

  (2) Live synchronous audio-visual communication;

  (3) Other methods of performing a patient examination remotely; or

  (4) A patient evaluation performed by another licensed health care practitioner providing coverage.

C. A telehealth practitioner shall comply with all applicable laws and regulations governing referrals, testing, and evaluation of patients including, but not limited to, the requirements of:

  (1) COMAR 10.41.08; and

  (2) Health Occupations Article, §2-314.1, Annotated Code of Maryland.

D. A telehealth practitioner may not treat a patient based solely on an online questionnaire.

#### Regulation .06 Telehealth Practitioner Discipline.

*COMAR 10.41.06.06*

A. The Board shall use the same standards of evaluating and investigating a complaint about and in disciplining a licensee who practices telehealth as it would use for a licensee who does not use telehealth technology in the licensee’s practice.

B. The failure of a telehealth practitioner to comply with Regulations .04 and .05 of this chapter shall constitute unprofessional conduct and may be subject to disciplinary action by the Board.