This chapter governs the practice of chiropractic using telehealth as an adjunct to, or replacement for, in-person patient visits. Nothing in the chapter restricts or limits reimbursement requirements pursuant to the Health-General Article and Insurance Article, Annotated Code of Maryland. In this chapter, the following terms have the meanings indicated. Terms Defined. “Asynchronous” means not occurring in real time. “Board” means the Maryland Board of Chiropractic Examiners. “In-person” means within the physical presence of the patient. “Synchronous” means occurring in real time. “Telehealth” has the meaning stated in Health Occupations Article, §1-1001, Annotated Code of Maryland. “Telehealth practitioner” means a Maryland licensed chiropractor performing telehealth services within their respective scope of practice. Subject to the provisions of Health Occupations Article, Title 3, Annotated Code of Maryland, a telehealth practitioner shall be licensed in Maryland when providing telehealth services to a patient located in the State. Before performing telehealth services, a telehealth practitioner shall develop and follow a procedure to: Verify the identification of the patient receiving telehealth services through use of: A government-issued photograph identification; An insurance, Medicaid, or Medicare card; or Documentation of the patient’s: Date of birth; and Home address; For an initial patient-telehealth practitioner encounter, disclose the telehealth practitioner’s: Name; Maryland license number; and Contact information; 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, benefits, and side effects of the recommended treatment plan; 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; Notify patients in the event of a data breach; Ensure that the telehealth practitioner provides a secure and private communication modality that complies with federal and state privacy laws; and Establish safety protocols to be used in the case of an emergency, including contact information for emergency services at the patient’s location. Except when providing asynchronous telehealth services, a telehealth practitioner shall: Obtain or confirm an alternative method of contacting the patient in case of a technological failure; Confirm whether the patient is in Maryland and identify the specific practice setting in which the patient is located; and Identify all individuals present at each location and confirm they are allowed to hear the patient’s health information. A telehealth practitioner shall be held to the same standards of practice and documentation as those applicable for in-person chiropractic practice appointments. A telehealth practitioner shall: Perform a synchronous or asynchronous clinical patient evaluation that is appropriate for the patient and the condition with which the patient presents before providing a treatment plan through telehealth; and If clinically appropriate for the patient, provide or refer a patient to: In-person treatment; or Another type of telehealth service. A telehealth practitioner may not treat a patient based solely on an online questionnaire. The Board shall use the same standards of evaluating and investigating a complaint about and in disciplining a telehealth practitioner who practices telehealth as it would use for a licensee who does not use telehealth technology in the licensee’s practice. The failure of a telehealth practitioner to comply with this chapter shall constitute unprofessional conduct and may be subject to disciplinary action by the Board. Health Occupations Article, §§1-1001—1-1006 and 3-205,, Annotated Code of Maryland Effective date: September 18, 2023 (50:18 Md. R. 797)