This chapter establishes standards for the provision of dry needling as an intervention performed by occupational therapists who are certified hand therapists (CHTs). In this chapter, the following terms have the meanings indicated. Terms Defined. “Board” means the Maryland Board of Occupational Therapy Practice. “Dry needling” means a physical agent modality as defined in COMAR 10.46.06.03, also known as intramuscular manual therapy, that: Involves the insertion of one or more solid needles, a mechanical device, into the muscle and related tissues to effect change in muscle and related tissues of the hand, wrist, elbow, and shoulder; Requires ongoing evaluation, assessment, and re-evaluation of the impairments; Is only utilized in parts of the body with neuromuscular or musculoskeletal links to the impairments; and Is not performed for: The purposes of acupuncture and East Asian medicine as defined in Health Occupations Article, §1A-101, Annotated Code of Maryland; or Any purpose outside the scope of occupational therapy In order to perform dry needling, an occupational therapist shall be a certified hand therapist in good standing, in addition to having completed at least 52 total hours of further instruction, which includes: A total of at least 27 hours of instruction in the following dry-needling-specific course content areas: Theory and application of dry needling to the hand, wrist, elbow, and shoulder; Dry needling technique to the hand, wrist, elbow, and shoulder; Dry needling indications and contraindications; Infection control, the Occupational Safety and Health Administration’s Bloodborne Pathogen Protocol, and safe handling of needles; Emergency preparedness and response procedures related to complications associated with dry needling; and Appropriate documentation of dry needling; and At least 25 hours of practical, hands-on instruction in the application and technique of dry needling, under the supervision of a licensed health care practitioner competent in dry needling procedures who has: Completed the requisite course work under §A(1) of this regulation; and Practiced dry needling for at least 5 years. The instruction required under §A(1) of this regulation shall be provided by a continuing education course approved by the Board. All instruction required under this regulation shall include an assessment of competency. The instruction required under §A(1) of this regulation shall be offered: In person at a face-to-face session; or In real time through electronic means that allow for simultaneous interaction between the instructor and the participants. An occupational therapist may not fulfill any portion of the practical, hands-on instruction required under §A(2) of this regulation with online or distance learning. An occupational therapist shall have practiced occupational therapy for at least 2 years, in addition to having been certified as a hand therapist, before performing dry needling in the State. Registration. An occupational therapist shall be registered with the Board as having the appropriate education and training required by this regulation to be approved to practice dry needling. In order to be registered to practice dry needling, an occupational therapist shall submit a completed application on a form supplied by the Board with proof of the hand therapist certification. In order to continue to practice dry needling, an approved occupational therapist shall submit proof of their certified hand therapy recertification. An occupational therapist who practices dry needling without the education and training required by this regulation shall be subject to discipline pursuant to COMAR 10.46.07. An occupational therapist shall: Fully explain dry needling to the patient in advance of treatment; and Obtain written informed consent specific to dry needling that shall be included in the patient’s medical record. An occupational therapist shall perform dry needling to the hand, wrist, elbow, and shoulder in a manner consistent with standards set forth in the Maryland Occupational Safety and Health Act, Labor and Employment Article, Title 5, Annotated Code of Maryland. An occupational therapist shall document the provision of dry needling services in accordance with the documentation requirements set forth under COMAR 10.46.01.03. An occupational therapist who practices dry needling in a manner inconsistent with the standards of practice enumerated in this regulation shall be subject to discipline pursuant to COMAR 10.46.07. Dry needling is not within the scope of practice of limited occupational therapy and shall only be performed by a licensed occupational therapist with a hand therapy certification. Health Occupations Article, §§10-101 and 10-205, Annotated Code of Maryland Effective date: September 16, 2024 (51:18 Md. R. 810)