This chapter: Applies to graduate and clinical professional counselors, graduate and clinical marriage and family therapists, graduate and clinical art therapists, graduate, clinical, and certified alcohol and drug counselors, and alcohol and drug trainees in Maryland; and Does not supersede the regulations set forth under: COMAR 10.58.07; COMAR 10.58.08; COMAR 10.58.12; and COMAR 10.58.17. In this subtitle, the following terms have the meanings indicated. Terms Defined. “Certificate” means a certificate issued by the Board to practice: Certified associate counseling — alcohol and drug (CAC—AD); Certified professional counseling (CPC); Certified professional counseling — alcohol and drug (CPC—AD); Certified professional counseling — marriage and family therapy (CPC—MFT); or Certified supervised counseling — alcohol and drug (CSC—AD). “Credit hour” means attendance in class for a minimum of 12 hours per semester or 18 hours per quarter, resulting in a grade which is earned, not audited, from an accredited educational institution approved by the Board. “License” means a license issued by the Board to practice: Clinical alcohol and drug counseling (LCADC); Clinical marriage and family therapy (LCMFT); Clinical professional counseling (LCPC); Clinical professional art therapy (LCPAT); Graduate alcohol and drug counseling (LGADC); Graduate marriage and family therapy counseling (LGMFT); [or] Graduate professional counseling (LGPC); or Graduate professional art therapy (LGPAT). Unless certified, licensed, or granted trainee status by the Board, an individual may not use: The title alcohol and drug trainee (ADT); or Any other: Title; Initials; Abbreviations; Representation; or Description as specified under Health Occupations Article, §§17-601—17-603, Annotated Code of Maryland. An individual who violates this regulation may be subject to sanctions pursuant to Health Occupations Article, §§17-513 and 17-604, Annotated Code of Maryland. In order to obtain a certificate or license, an applicant shall: Complete and return the Board-approved application; Except for out-of-state Marriage and Family Therapist applicants, submit an official transcript from an accredited educational institution awarding the highest degree attained in counseling or a related field; Pay all applicable fees set forth in COMAR 10.58.02; Provide at least three references from persons familiar with the work of the applicant; Submit to a criminal history background check in accordance with Health Occupations Article, §17-501.1, Annotated Code of Maryland; Be of good moral character; and Be at least 18 years old. Applications shall be acted upon as follows: Within 30 days after receipt of an application, the Board shall determine whether the application is complete; If the Board determines that the application is not complete, the Board shall send a notice of deficiency to the applicant; Upon receipt of the notice, the applicant shall correct the deficiency within 90 days, or other period specified in the notice; If the applicant fails to correct the deficiency within the required period, the application may lapse and the applicant shall be required to: Submit a new application; and Pay the nonrefundable fee set forth in COMAR 10.58.02; If the Board determines that an applicant is eligible to take the required examinations, the Board shall send a notice of approval to the applicant; Upon receipt of the approval notice, the applicant shall have 1 year from the date of the notice to take the examinations; and If the applicant fails to take the examinations within 1 year from the date of the approval notice, the requirements set forth under §B(4) of this regulation shall apply. An applicant who fails an examination for certification or licensure: May retake the exam if: It is within the time frame set by the applicable testing authority; or A waiver is approved by the Board to extend the testing deadline upon proof of exceptional circumstances; or Shall be required to: Submit a new application; and Pay the nonrefundable fee set forth in COMAR 10.58.02. The Board shall: Issue a certificate or license number to an applicant who has met the requirements as set forth under this subtitle; and Provide licensure, certification, or trainee status verification: On the Board's website; and From the Board's office. Renewal — Certified Professional Counselor. To renew as a certified professional counselor, the applicant shall: Complete a Board-approved renewal application; Pay the required application fee set forth in COMAR 10.58.02; and Attest to completion of continuing education activities as specified in COMAR 10.58.05.05 and .06. The Board may not: Renew the certification of any certified professional counselor who fails to complete all requirements for renewal before the expiration date of the current certification; or Reinstate the certification of a certified professional counselor who has failed to renew for any reason. Health Occupations Article, §§17-101, 17-205, 17-301, 17-304, 17-307, 17-308, and 17-509, Annotated Code of Maryland Effective date: July 10, 1989 (16:13 Md. R. 1422) Regulation .01 amended effective August 26, 1996 (23:17 Md. R. 1248); July 26, 1999 (26:15 Md. R. 1155) Regulation .02 amended effective August 26, 1996 (23:17 Md. R. 1248); September 22, 1997 (24:19 Md. R. 1340); July 26, 1999 (26:15 Md. R. 1155) Regulation .03 amended effective August 26, 1996 (23:17 Md. R. 1248); July 26, 1999 (26:15 Md. R. 1155) Regulation .05 amended effective August 26, 1996 (23:17 Md. R. 1248); July 26, 1999 (26:15 Md. R. 1155) Regulation .05 repealed and new Regulation .05 adopted effective September 22, 1997 (24:19 Md. R. 1340) Regulation .06 amended effective August 26, 1996 (23:17 Md. R. 1248); July 26, 1999 (26:15 Md. R. 1155) Regulation .08 amended effective July 26, 1999 (26:15 Md. R. 1155) Regulation .09 amended effective July 26, 1999 (26:15 Md. R. 1155) Regulation .09C adopted effective August 26, 1996 (23:17 Md. R. 1248) Regulations .10—.13 adopted effective July 26, 1999 (26:15 Md. R. 1155) Chapter revised as an emergency provision effective October 1, 2001 (28:22 Md. R. 1932); revised permanently effective January 21, 2002 (29:1 Md. R. 23) Regulation .02B amended as an emergency provision effective October 1, 2002 (29:25 Md. R. 1979); amended permanently effective March 3, 2003 (30:4 Md. R. 317) Regulation .02B amended effective November 23, 2006 (33:23 Md. R. 1796) Regulation .03 amended effective December 31, 2018 (45:26 Md. R. 1246) Regulation .09 adopted as an emergency provision effective October 1, 2002 (29:25 Md. R. 1979); adopted permanently effective March 3, 2003 (30:4 Md. R. 317) Regulation .10 adopted effective May 17, 2010 (37:10 Md. R. 723) Chapter revised effective June 28, 2021 (48:13 Md. R. 508) Regulation .04A amended effective November 14, 2025 (52:23 Md. R. 1140) A person shall pay a fee as set forth in Regulation .02, of this chapter, by certified check or money order. The Board shall provide a copy of this chapter: Along with any application form or renewal form; and To any other person upon request. The Board may not refund a fee. The following fees are established by the Board for items or services provided under this subtitle: Application processing fee: For certificate and trainee status ... $150; or For licensure ... $250; Subsequent application review fee ... $50; Preapplication credentials evaluation fee ... $50; Certification fee ... $100; Licensure fee ... $200; Certification and trainee renewal fee ... $200; Licensure renewal fee ... $275; Late renewal fee (in addition to §F or G of this regulation) ... $50; Certification and licensure verification ... $20; Duplicate or replacement certificate or license ... $15; Endorsement to another jurisdiction ... $10; Name or address change ... No fee; Inactive status (annual) ... $50; Reinstatement fee: For certificate ... $150; For license ... $200; 2-year sponsorship of continuing education programs: For organization ... $750; For individual ... $300; or For an individual workshop ... $150; Review for non-preapproved CEUs for individuals (per occurrence) ... $15; Drug and alcohol certification upgrade fee ... $25; Returned check fee ... $25; Failure to notify of change of address ... $25; Copy and scanning fee ... $2 per page; and Out-of-State application processing fee ... $250. Health Occupations Article, §§17-205, 17-206, and 17-310, Annotated Code of Maryland Effective date: July 10, 1989 (16:13 Md. R. 1422) Regulation .02 amended effective June 8, 1992 (19:11 Md. R. 1016); April 3, 2000 (27:6 Md. R. 642); September 28, 2015 (42:19 Md. R. 1228) Regulation .02E amended as an emergency provision effective September 16, 1992 (19:20 Md. R. 1812); amended permanently effective March 18, 1993 (19:21 Md. R. 1892) Regulation .02M, N amended effective January 2, 1994 (20:26 Md. R. 2028) Regulation .02A, D, E amended effective March 14, 1994 (21:5 Md. R. 404) This chapter applies to an individual certified or licensed by the Board of Professional Counselors and Therapists. In this chapter, the following terms have the meanings indicated. Terms Defined. “Board” means the State Board of Professional Counselors and Therapists. Client. “Client” means an individual, couple, family, group, business, agency, school, organization, or association to whom a counselor is rendering professional service. “Client” includes the term and concept of “patient”. “Counselor” means a counselor or therapist either certified or licensed by the Board. “Dual relationship” means a relationship in which a counselor is simultaneously involved in more than one type of relationship with a client. “Impaired counselor” means a counselor who cannot perform the counselor's job due to substance abuse, or psychological or physical illness. “Inappropriate sexual language” means: A sexualized harassing comment; An eroticized or sexually provocative comment not reasonably associated with a health care matter; or An inappropriate discussion of a sexually related matter. “Public statements” include, but are not limited to, communications or public announcements by a newspaper, magazine, book list, directory, television, radio, motion picture, advertisement, or any other electronic means. “Sexual behavior” means: A “sexual act” as defined in Criminal Law Article, §3-301, Annotated Code of Maryland; “Sexual contact” as defined in Criminal Law Article, §3-301, Annotated Code of Maryland; and “Vaginal intercourse” as defined in Criminal Law Article, §3-301, Annotated Code of Maryland. “Sexual exploitation” means a counselor taking advantage of an unequal relationship between a counselor and a client, student, or supervisee, and not permitting the autonomy of a client, student, or supervisee. “Sexual harassment” means a deliberate or repeated comment, advance, gesture, solicitation, request, or physical contact of a sexual nature. “Supervisee” means an individual to whom a counselor provides professional, educational, or administrative supervision or direction. “Therapeutic deception” means a representation by a counselor that sexual contact or sexual activity by or with a client is consistent with or part of a client's treatment. A counselor shall: Practice only within the boundaries of a counselor's competence, based on education, training, supervised experience, and professional credentials; When developing competence in a new service or technique, or both, engage in ongoing consultation with other counselors or relevant professionals and acquire appropriate additional education or training, or both, in the new area; and Maintain qualifications to practice counseling, including meeting the continuing education requirements established by the Board. An impaired counselor shall: Suspend, terminate, or limit professional activities if the counselor determines that he or she is unable to continue professional activities; or Seek competent professional assistance to determine whether to suspend, terminate, or limit the scope of professional or scientific activities if a counselor becomes or is made aware that personal problems interfere with providing or conducting counseling or therapy services. A counselor shall: Consult with other counselors or other relevant professionals regarding questions related to ethical obligations or professional practice; Take credit only for professional work actually performed; Notify the Board if the counselor's license, or certificate, or both, has been limited, restricted, suspended, revoked, or subject to disciplinary action by any other state, federal agency, or the District of Columbia; Disclose, to all involved, conflicts of interest regarding confidentiality requirements; Receive appropriate written authorization to provide counseling services for minors or other clients unable to give informed consent; Protect the interests of minors or other clients unable to give informed consent; Maintain accurate records; Provide supervision to supervisees as required under COMAR 10.58.01, 10.58.07, and 10.58.08; Make arrangements for another appropriate professional to act in the event of an absence of the counselor; Provide lawfully requested treatment reports or evaluations, or both, to a client, insurance carriers, courts systems, institutions, or other authorized persons; Be familiar with and adhere to this chapter; Report suspected violations of Health Occupations Article, Title 17, Annotated Code of Maryland, to the Board; Cooperate with investigations, proceedings, and other requirements of the Board; and Take reasonable precautions to protect clients from physical or psychological trauma. A counselor may not: Knowingly associate with, or permit the use of the professional counselor's name or firm name in a business venture by any person or firm which the professional counselor knows, or has reason to believe, is engaging in business or professional practices of a fraudulent or dishonest nature; Participate in dishonest, fraudulent, or deceitful activity in the capacity of a counselor; or Enter into relationships that could compromise a counselor's objectivity or create a conflict of interest. A counselor involved in research shall: Respect and protect the dignity, privacy, and welfare of research subjects; Comply with existing federal and State laws and regulations concerning treatment of research subjects; Take responsibility for the ethical treatment of research participants by others directly and reasonably related to the research; and Clearly indicate to prospective recipients treatment given as part of a research study and obtain written permission in advance of treatment. Client Welfare and Rights. A counselor shall: Inform clients of the purposes, goals, techniques, procedures, limitations, potential risks, and benefits of services to be performed; Explain to clients the implications of diagnosis, the intended use of tests and reports, fees, and billing arrangements; Document attempts to inform other professional persons concurrently providing mental health services to a client; Assist clients in making appropriate arrangements for the continuation of treatment due to interruptions including but not limited to vacations and extended illness; and Make appropriate referrals. A counselor may not: Place or participate in placing clients in positions that may result in damaging the interests and the welfare of clients, employees, employers, or the public; Condone or engage in discrimination based on age, color, culture, disability, ethnic group, gender, race, religion, sexual orientation, marital status, or socioeconomic status; Abandon or neglect clients in counseling; or Foster dependent counseling relationships. Dual Relationships. A counselor shall: Avoid dual relationships with clients; and Take appropriate measures, including but not limited to, informed consent, consultation, supervision, and documentation to ensure that judgment is not impaired and no exploitation occurs if a dual relationship cannot be avoided. A counselor may not: Exploit trust and dependency in relationships with supervisees, employees, research participants, students, or volunteers; or Accept as clients superiors or subordinates with whom a counselor has administrative, supervisory, or evaluative relationships. Multiple Clients. A counselor shall clarify the unit of treatment in a counselor's written records as: Individual; Couple; Family; Group; or Any combination of §C(1)(a)—(d) of this regulation. A counselor shall identify in the written records individuals present in sessions, but not a part of the unit of treatment. A counselor shall communicate limitations on confidentiality to all clients. Termination and Referral. Termination may occur if: Services are no longer requested by a client; Counseling no longer serves a client's needs or interests; A counselor is unable to competently and ethically perform duties; A client does not pay the fees charged; or Agency or institution limits do not allow further counseling services. A counselor may terminate a counseling relationship only after: Securing a client's agreement; or If a client does not agree to termination, offering an appropriate referral. A counselor shall explain to a client, before entering the counseling relationship, all financial arrangements related to professional services including the use of collection agencies or legal measures for nonpayment. Except as provided in §C of this regulation, a counselor may not accept goods or services instead of monetary payment. A counselor may accept goods or services instead of monetary payment only if: The relationship is not exploitative; The client requests it; A clear written contract is established; and The arrangements are an accepted practice among professionals in the community. A counselor may not accept or give anything of value for receiving or making a referral. Advertising. A counselor may place advertisements with directories, newspapers, periodicals, radio or television stations, or on the internet. In placing advertisements or making other types of public statements, a counselor shall identify a counselor's credentials in a manner that is accurate and not false, misleading, deceptive, or fraudulent. A counselor may not place advertisements or make public statements that: Contain false, fraudulent, misleading, deceptive, or unfair statements or information; Contain partial disclosures of relevant facts that misrepresent, mislead, or deceive; Contain information or facts intended or likely to create false or unjustified expectations of favorable results; Misrepresent, either directly or by implication, a counselor's professional qualifications such as education, experience, or areas of competence; Misrepresent, either directly or by implication, a counselor's affiliations or the purposes or characteristics of institutions or organizations with which a counselor is affiliated; Contain representations or implications that in reasonable probability can be expected to cause an ordinary prudent person to misunderstand or be deceived; or Contain representations that a counselor is willing to perform any procedure that is illegal under federal or State laws or regulations. If advertising on the internet, a counselor shall ensure that the advertisement contains the counselor's name, credentials, and certificate or license number. In advertising products, workshops, or training events, a counselor shall: Comply with this section; and Ensure that the information disclosed is adequate for consumers to make informed choices. A counselor holding a doctoral degree in a field other than counseling may not represent that doctoral degree as relating to status or practice as a counselor. Public Statements. A counselor shall: Correct others who misrepresent a counselor's professional qualifications or affiliations; Abstain from soliciting testimonial endorsements from current clients or other persons who, because of particular circumstances, are vulnerable to undue influence; Abstain from engaging in uninvited, in-person solicitation of business from actual or potential clients or others who, because of particular circumstances, are vulnerable to undue influence; and In the capacity of teacher, ensure that statements in course outlines are accurate and not misleading, false, or deceptive, including statements regarding subject matter to be covered, the basis for evaluating progress, and the nature of the course experience. A counselor may not: Use the counselor's place of employment or institutional affiliation to solicit or recruit clients, supervisees, or consultees for a counselor's private practice; Use counseling, teaching, training, or supervisory relationships: To promote a counselor's products or training events in a deceptive manner; or On persons who, because of circumstances, may be vulnerable; or Claim organizational membership in a manner that suggests specialized competence, training, or qualifications that a counselor does not have. Media Presentations. A counselor providing commentary or advice in a public lecture, presentation, demonstration, radio or television program, prerecorded electronic medium, printed article, mailed material, internet, or other medium, shall ensure that: Statements made are based on current and appropriate professional counseling literature and methodology; Recipients of the information are not mislead or encouraged to infer that a professional counseling relationship has been established; and Statements are in conformance with this chapter. A counselor shall: Maintain the privacy and confidentiality of a client and a client's records; Release mental health records or information about a client only with a client's consent, or as permitted by Health-General Article, Title 4, Subtitle 3, Annotated Code of Maryland; Release alcohol and substance abuse records or information about a client only with a client's consent, or as permitted by State and federal law; Dispose of records in accordance with Health-General Article, Title 4, Annotated Code of Maryland; Provide sufficient information to a client to allow a client to make an informed decision regarding treatment, including the following: The purpose and nature of an evaluation or treatment process; Additional options to the proposed treatment; Potential reactions to the proposed treatment; The estimated cost of treatment; The right of a client to withdraw from treatment at any time, including the possible risks that may be associated with withdrawal; and The right of a client to decline treatment, if part or all of the treatment is to be recorded for research or review by another person; Obtain full informed consent of a client participating in a human research program; and Protect a client's autonomy and dignity to decide whether to participate in a human research program. A counselor may not imply that a penalty may result if a client refuses to participate in a human research program. A counselor may not engage in sexual misconduct with a client or supervisee. Sexual misconduct includes but is not limited to: Inappropriate sexual language; Sexual exploitation; Sexual harassment; Sexual behavior; and Therapeutic deception. Concurrent Sexual Relationships. A counselor may not engage in either consensual or forced sexual behavior with: A client; A student or supervisee over whom the counselor exercises professional authority, or with whom the counselor maintains evaluative responsibility, supervision, or education, while the professional relationship continues to exist; or An individual with whom the client has a close personal relationship, including but not limited to a relative or significant individual in the client's life, if there is a risk of exploitation or potential harm to the client. Relationship with Former Clients. Except as set forth in §C(3) of this regulation, a counselor may not engage in sexual behavior with a former client. A counselor may not terminate professional services or a professional relationship with a client in order to enter into a nonprofessional, social, or sexual relationship with a client or an individual with whom a client has a close personal relationship. A counselor may enter into a relationship with an individual with whom a counselor's prior professional contact was brief, peripheral, consultative, or indirect, and did not constitute a therapeutic relationship. Prior Sexual Relationships. A counselor may not provide professional services to an individual with whom a counselor has previously engaged in sexual behavior. Sexual Harassment. A counselor may not sexually harass a: Client; Student; Supervisee; or Supervisor. If sexually harassed by a client, a counselor shall: Seek professional consultation with another licensed health care professional; Redefine the professional plan of action in writing in a client's record, documenting all action taken in a client's treatment plan; and Terminate the relationship with the client and assist in a referral to another health care provider. Therapeutic Deception. A counselor may not: Engage in sexual activity with a client or an individual in a close personal relationship with a client, on the pretense of therapeutic intent or benefit; Represent to a client or individual in close personal contact with a client that sexual contact or activity by or with a counselor is consistent with or part of a client's therapy; or Suggest, recommend, or encourage a client to engage in a sexually provocative act, including but not limited to: Sexual contact with a counselor; Genital stimulation by or of a client or counselor; Undressing, by or of a counselor in the presence of a client, or of a client in the presence of a counselor; and Discussion or disclosure of a sexually provocative or erotic nature, not necessitated by treatment or treatment protocol. A counselor engaging in nontraditional treatment modalities using physical contact with a client shall document in a client's record: An assessment of a client; A written rationale for the use of the physical contact treatment modality for a client; and A copy of the informed consent, signed and dated by the client and the counselor which addresses: The risks and benefits of the physical contact treatment modality; The objective or objectives and intended outcome or outcomes of the proposed treatment; Available alternative interventions; and A description of the physical contact which may be reasonably anticipated by a client in the course of the proposed treatment. A counselor may not engage in a treatment modality involving physical contact if the risk of psychological harm to a client, as a result of the physical contact, has been assessed by a counselor to outweigh the possible benefits of the treatment, independent of a client's wishes. A counselor who engages in sexual misconduct with a client or supervisee is subject to sanctions by the Board. A sanction constitutes the minimum disciplinary measure and does not preclude the Board from imposing additional penalties as it considers appropriate to an individual case. The Board shall advise professional associations of a reprimand, suspension, or revocation of a license or certificate on the grounds of sexual misconduct. A counselor may not prohibit a client from reporting sexual misconduct as a condition of settlement of a legal cause of action. A counselor who does not comply with this chapter shall be in violation of Health Occupations Article, §17-313, Annotated Code of Maryland, and subject to disciplinary actions. A lack of knowledge, or misunderstanding of an ethical responsibility, is not a defense against a charge of unethical conduct. Health Occupations Article, §§1-212 and 17-205, Annotated Code of Maryland Effective date: July 10, 1989 (16:13 Md. R. 1422) Chapter revised effective April 3, 2000 (27:6 Md. R. 642) Regulations .01—.06 repealed and new Regulations .01—.11 adopted effective October 1, 2001 (28:19 Md. R. 1685) These regulations apply to all formal hearings before the Board of Examiners of Professional Counselors. Written notice of a hearing shall be sent by the Board to all interested parties at least 30 days before the hearing. The notice shall state the: Date, time, and place of the hearing; and Issues or charges involved in the proceeding, provided, however, that if by reason of the nature of the proceeding, the issues cannot be stated in advance of the hearing, or if subsequent amendment of the issues is necessary, they shall be fully stated as soon as practicable. Service upon a party shall be by delivery of the charging document and copy of the complaint to the party in person. Instead of personal service, the Board may serve the charging document and a copy of the complaint by registered or certified mail, restricted delivery, return receipt requested. Each party appearing at a formal hearing shall have the right to appear in proper person, or by or with counsel. Discovery. Discovery on Request. By written request served on the other party and filed with the Board, a party may require another party to produce, within 15 days, the following: A list of witnesses to be called; Copies of documents intended to be produced at the hearing; or Both §A(1)(a) and (b) of this regulation. Mandatory Discovery. Each party shall provide to the other party not later than 15 days before the prehearing conference, if scheduled, or 45 days before the scheduled hearing date, whichever is earlier: The name and curriculum vitae of any expert witness who will testify at the hearing; and A detailed written report summarizing the expert's testimony, which includes the opinion offered and the factual basis and reasons underlying the opinion. If the Board finds that the report is not sufficiently specific, or otherwise fails to comply with the requirements of this section, the Board shall exclude from the hearing: The testimony of the expert; and Any report of the expert. The Board shall consider and decide arguments regarding the sufficiency of the report: At the prehearing conference, if scheduled; or Immediately before the scheduled hearing. If an expert adopts a sufficiently specific charging document as the expert's report, that adoption satisfies the requirements set forth in this section. Parties are not entitled to discovery of items other than as listed in §A(1) and (2) of this regulation. Both parties have a continuing duty to supplement their disclosures of witnesses and documents. Absent unforseen circumstances which would otherwise impose an extraordinary hardship on a party, witnesses or documents may not be added to the list: After the prehearing conference, if scheduled; or Later than 15 days before the hearing if no prehearing conference is scheduled. The prohibition against adding witnesses does not apply to witnesses or documents to be used for impeachment or rebuttal purposes. Prehearing Conferences. The Board may set prehearing conferences as it deems appropriate. Oaths and Subpoenas. The Board may administer oaths and compel the attendance of witnesses and the production of physical evidence before it from witnesses upon whom process is served anywhere within the State, as in civil cases in the circuit court of the county or of Baltimore City, by subpoena issued over the signature of the Chairman or Secretary and the seal of the Board. Upon a request by a party and statement under oath that the testimony or evidence is necessary to the party's defense, the Board shall issue a subpoena in the party's behalf. Motions filed by a party shall be accompanied by a memorandum of points and authorities, and shall be filed with the Board at least 10 working days before the hearing, and a copy served on the opposing party. Any response shall be filed with the Board at least 5 working days before the hearing and a copy shall be served on the opposing party. Board Majority. Each hearing shall be held before not less than a quorum of the Board unless the hearing authority is delegated pursuant to State Government Article, §10-207, Annotated Code of Maryland. A delegation of authority shall be subject to the provisions of State Government Article, §10-212. If hearing authority is not delegated, Board action shall be by a majority vote of those Board members then serving on the Board. Duties of Presiding Officer. The Chairman, or in the Chairman's absence a member designated by the Chairman, shall be the presiding officer, or if in a delegated hearing, an administrative law judge under State Government Article, §§9-1601—9-1610, Annotated Code of Maryland, shall be the presiding officer. The presiding officer shall: Have complete charge of the hearing; Permit the examination of witnesses; Admit evidence; Rule on the admissibility of evidence; and Adjourn or recess the hearing from time to time. The presiding officer may set reasonable time limits on arguments and presentation of evidence. The presiding officer shall be responsible for decorum in hearings and can suspend the proceedings as necessary to maintain decorum. Legal Advisor and Counsel for the Board. The Board may request the Office of the Attorney General to participate in any hearing to present the case on behalf of the Board. The member of the Office of the Attorney General presenting the case on behalf of the Board shall have all the following rights: The submission of evidence; Examination and cross-examination of witnesses; Presentation of summation and argument; and Filing of objections, exceptions, and motions. The Board may also request a representative of the Office of the Attorney General to act as legal advisor to the Board as to questions of evidence and law. Order of Procedure. The State shall present its case first. Then the respondent shall present his case. After this the State may present rebuttal. Examination of Witnesses and Introduction of Evidence. The rules of evidence in all hearings under these regulations shall be as set forth in State Government Article, §§10-208 and 10-209, Annotated Code of Maryland. Each party has the right to: Call witnesses and present evidence; Cross-examine witnesses called by the Board or other party; Present summation and argument and file objections, exceptions, and motions. If a party is represented by counsel, the submission of evidence, examination and cross-examination of witnesses, and filing of objections, exceptions, and motions shall be done and presented solely by counsel. Witnesses. The presiding officer, or any person designated by the presiding officer for the purpose, may examine any witness called to testify. The presiding officer may call as witness any person in attendance at the hearing. Any member of the Board may examine any witness called to testify. If an accused or complainant fails to appear at a hearing after due notice, the Board or its designee may reschedule the hearing, or may proceed upon the available investigation, report, documents, witnesses, and records. The Board shall prepare an official record which shall include all pleadings, testimony, exhibits, and other memoranda or material filed in the proceeding. A stenographic record of the proceedings shall be made at the expense of the Board. This record need not be transcribed, however, unless requested by a party, or by the Board. The cost of any typewritten transcripts of any proceedings, or part of them, shall be paid by the party requesting the transcript. Each decision and order rendered by the Board shall be in writing and shall be accompanied by findings of fact and conclusions of law. A copy of the decision and order and accompanying findings and conclusions shall be delivered or mailed promptly to each party or attorney of record. A party aggrieved by the decision and order rendered may apply for rehearing within 10 days after service on the party of the decision and order. Action on an application shall lie in the discretion of the Board. Unless otherwise ordered, neither the rehearing nor the application for it shall stay the enforcement of the order, or excuse the person affected for failure to comply with its terms. The Board may consider facts not presented in the original hearing, including facts arising after the date of the original hearing, and may by new order abrogate, change, or modify its original order. A person whose certificate has been revoked or suspended by the Board, or a person placed on probation or reprimand under the regulations in this chapter, may appeal the Board's decision as provided by the law. Pursuant to State Government Article, §10- 226(c)(2), Annotated Code of Maryland, the Board may order the summary suspension of a license holder if the Board determines that there is substantial likelihood that a licensee or certificate holder poses a risk of harm to the public health, safety, or welfare. Notice of Intent to Summarily Suspend. Based on information gathered in an investigation or otherwise provided to the Board, the Board may vote to issue: A notice of intent to summarily suspend a license or certificate; or An order of summary suspension. If the Board votes to issue a notice of intent to summarily suspend a license or certificate or an order of summary suspension, the Board shall refer the matter to an administrative prosecutor for prosecution. A notice of intent to summarily suspend a license or certificate shall include: A proposed order of summary suspension which is unexecuted by the Board and includes: The statutory authority on which the action has been taken; Allegations of fact that the Board believes demonstrate a substantial likelihood that the licensee or certificate holder poses a risk of harm to the public health, safety, or welfare; and Notice to the respondent of the right to request a full hearing on the merits of the summary suspension if the Board executes the proposed order of summary suspension; and An order or summons to appear before the Board to show cause why the Board should not execute the order of summary suspension and which notifies the respondent of the consequences of failing to appear. Service. The Board shall serve a respondent with a notice of intent to summarily suspend a license or certificate not later than 5 days before a predeprivation show cause hearing is scheduled before the Board. Service of the notice of intent to summarily suspend shall be made: Personally upon the respondent; By certified mail to the address the respondent is required to maintain with the Board; or By other reasonable means to effect service. If the Board is unable to serve the notice of intent to summarily suspend a license or certificate upon the respondent as described in §B(4)(b) of this regulation, the Board may nevertheless proceed to prosecute the case. Predeprivation Opportunity to Be Heard. If the Board issues a notice of intent to summarily suspend a license or certificate, the respondent may request an opportunity to appear before the Board to show cause why the respondent’s license or certificate should not be suspended before the Board executes the order of summary suspension. Predeprivation Show Cause Hearing Before Board. The hearing shall be a nonevidentiary hearing to provide the parties with an opportunity for oral argument on the proposed summary suspension. The Board member presiding at the hearing shall determine all procedural issues and may impose reasonable time limits on each party’s oral argument. The presiding Board member shall make rulings reasonably necessary to facilitate the effective and efficient operation of the hearing. The respondent and the administrative prosecutor may not exceed 30 minutes each to present oral argument. The respondent shall proceed first and may reserve part of the allotted time for rebuttal. The Board member who presides over the hearing: May allow either the respondent or the administrative prosecutor to present documents or exhibits which are relevant and material to the proceedings and which are not duly repetitious, if the presiding Board member believes that such documents or exhibits are necessary for a fair hearing; and May not allow testimony by any witness unless agreed to by the parties and approved by the Board in advance of the hearing. A Board member may be recognized by the presiding member to ask questions of either party appearing before the Board. Summary Suspension Without Prior Notice or Hearing Opportunity. Extraordinary Circumstances. The Board may, after consultation with Board counsel, order the summary suspension of a license or certificate without first issuing a notice of intent to summarily suspend a license or certificate or providing a respondent with an opportunity for a predeprivation hearing if the Board determines that: The public health, safety, and welfare require the immediate suspension of the license; and Prior notice and an opportunity to be heard are not feasible. Time — Service and Hearing. An order of summary suspension under section §D(1) of this regulation shall be served upon the respondent within 48 hours after its execution. The respondent may request a show cause hearing before the Board within 30 days after the effective date of the summary suspension. The request shall be made within 10 days of the date of the notice of sumary suspension. If the respondent requests a hearing under §B(3)(a)(iii) of this regulation, that hearing shall: Be conducted before the Board as provided in §D(2)(b) of this regulation; and Provide the respondent with an opportunity to show cause why the Board should lift the summary suspension and reinstate the license or certificate. Burdens of Production and Persuasion. In a show cause proceeding under §C of this regulation, the respondent may present argument in opposition to the allegations presented in the order for summary suspension or which otherwise demonstrate that the public health, safety, or welfare is not at risk. The administrative prosecutor bears the burden of demonstrating by a preponderance of the evidence that the health, safety, or welfare of the public imperatively requires the Board to summarily suspend the respondent’s license or certificate. Disposition. If the Board issues a notice of intent to summarily suspend a license or certificate before summarily suspending a license or certificate, the Board may, after the show cause hearing, vote to: Order a summary suspension; Deny the summary suspension; Issue an order agreed upon by the parties; or Issue an interim order warranted by the circumstances of the case, including an order providing for a stay of the summary suspension subject to certain conditions. If the Board orders a summary suspension before a show cause hearing, the Board may, at the conclusion of the hearing, vote to: Affirm its order of summary suspension; Rescind its order of summary suspension; Issue an order agreed upon by the parties; or Issue an interim order warranted by the circumstances of the case, including an order providing for a stay of the summary suspension subject to certain conditions. An order for summary suspension or other order issued by the Board after the initiation of summary suspension proceedings are final orders of the Board and public records under State Government Article, §10–611, Annotated Code of Maryland. Postdeprivation Opportunity for Evidentiary Hearing. If the Board orders the summary suspension of a license or certificate under §C or D of this regulation, the respondent may request an evidentiary hearing before the Board, or if the Board delegates the matter to the Office of Administrative hearings, before an administrative law judge. The respondent may request an evidentiary hearing within 10 days after the Board issues the order of summary suspension. Unless otherwise agreed by the parties, a hearing shall be provided within 45 days after the respondent’s request. An evidentiary hearing may be consolidated with a hearing on charges issued by the Board that include the facts that form the basis for the summary suspension. An evidentiary hearing shall be conducted under the contested case provisions of State Government Article, Title 10, Subtitle 2, Annotated Code of Maryland. If the Board delegates the matter to the Office of Administrative Hearings, the administrative law judge shall issue a recommended decision to the Board with: Proposed or final findings of fact; Proposed or final conclusions of law; A proposed disposition; or Any combination of §G(6)(a), (b), or (c) of this regulation, pursuant to the Board’s delegation of the matter to the Office of Administrative Hearings. If the hearing is one combined with charges, the administrative law judge’s determination of the merits of the summary suspension shall be based only on the parts of the record available to the Board when the Board voted for summary suspension. The parties may file exemptions to the recommended decision, as provided in State Government Article, §10–216, Annotated Code of Maryland. An order issued by the Board after a post-deprivation evidentiary hearing is a final order of the Board and is a public record under State Government Article, §10–611, Annotated Code of Maryland. Health Occupations Article, §§17-205, 17-509, and 17-511; State Government Article, §§10-205, 10-206, 10-216, and 10-226(c)(2); Annotated Code of Maryland Effective date: April 2, 1990 (17:6 Md. R. 742) Regulation .01 amended effective March 20, 2000 (27:5 Md. R. 584) Regulation .04A amended effective March 20, 2000 (27:5 Md. R. 584) Regulation .10 adopted effective September 14, 2015 (42:18 Md. R. 1175) This chapter applies to all professional counselors and therapists who wish to renew or reinstate their licensure or certification in the State. In this chapter, the following terms have the meanings indicated. Terms Defined. “Accredited institution of higher education” means a college or university accredited by a national or regional accrediting body recognized by the Council on Post-Secondary Accreditation. “Activity” means any program, publication, course, institute, seminar, lecture, conference, workshop, symposium, or professional meeting that meets the criteria and objectives of continuing education. “Approved program” means an activity that has been reviewed and approved by the Board for Category A credit. “Authorized sponsor” means an organization or individual reviewed and authorized by the Board, or automatically eligible, to present Category A programs. “Board” means the State Board of Examiners of Professional Counselors and Therapists. “Committee” means the Advisory Committee for Continuing Education, appointed by the Board, consisting of at least one member of the Board. “Continuing education” means additional professional activities beyond that required for certification or licensure. “Continuing education unit (CEU)” means 60 minutes of activity that is approved by the Board to fulfill the continuing education requirements. “Course” means a series of meetings with defined content and systematic presentation with an instructor, as an expert, who imparts information to the participants. “Home study” means independent study that: Is not evaluated by a formal process documenting a minimum mastery of materials; and Does not issue a verification of program completion. “Renewal date” means the date upon which a certificate or license expires, as specified in the notice sent to the certified or licensed professional counselor by the Board in accordance with Health Occupations Article, §§17-309(b) and 17-3A-08(b), Annotated Code of Maryland. “Renewal period” means the 2-year period immediately before the renewal date. “Seminar” means a meeting or meetings of highly experienced participants or experts with an expert leader who conducts a discussion on a specific topic. “Symposium” means a presentation or presentations by two or more speakers with different views on a specific topic and with a discussant who summarizes the issues. “Workshop” means a meeting or meetings of general sessions and face-to-face groups with a leader, an expert in the defined content area, who imparts information to participants who have ample opportunity to interact. CEU Requirements. The certificate or license holder shall complete a minimum of 40 CEUs in each renewal period, as follows: At least 30 CEUs shall be in Category A activities and not more than 10 CEUs may be in Category B activities; or All 40 CEUs may be in Category A activities. CEUs that are in excess of requirements may not be carried over to the next renewal period. A certificate or license holder who has a renewal period of less than 2 years shall complete a minimum of 20 Category A CEUs for that renewal period. Proof of Completion. A license or certificate holder shall attest to completion of required CEUs at the time of renewal or reinstatement, on a form supplied by the Board. The license or certificate holder shall obtain the requisite documentation of CEU attendance and retain this documentation for the succeeding 4 years for possible inspection by the Board. Required Documentation of Category A and Category B Activities. The required documentation of Category A activities as defined in Regulations .04 and .05 of this chapter include: Certificates of participation; Transcripts; Reprints of publications; Proof of presentations; or Any other information necessary to verify compliance with the requirements of Regulations .04 and .05 of this chapter. The required documentation of Category B activities as defined in Regulations .04 and .06 of this chapter, include: Dates; Names of presenters; Outlines of presentations; Topics of meetings; or Any other information necessary to verify compliance with the requirements of Regulations .04 and .06 of this chapter. The license or certificate holder shall demonstrate that the CEU activity fell within the renewal period. To qualify for approval by the Board, continuing education activities shall employ didactic and experiential methods to meet one of the following objectives: Maintain professional competency; Increase professional skills and knowledge; Prepare for new roles or responsibilities in the practice of counseling or therapy; or Expand the science of counseling and therapy theory, method, or practice. The following activities are specifically excluded from continuing education credit and do not meet any required objective: Business meetings, professional committee meetings, and meetings concerned with the management of a professional practice; Presentations and publications intended for a lay audience; and Home study. The Board may approve the following activities for CEUs in Category A: Attending formally organized Category A programs as follows: The programs shall meet the following criteria: The program is offered by a sponsor approved by the Board to present Category A programs, The program is intended for a professional mental health audience, The program has a stated purpose and defined content area, Presenters are professionals qualified in the defined content area, The program's time period is clearly stated, Registration and attendance is recorded by the program's sponsor, Documentation of completion is provided, and Participants are required to complete an evaluation of the program; and The program may be formally organized and classified as a course, workshop, seminar, or symposium; Developing and presenting a Category A program which is credited as follows: Up to 3 hours of CEU credit may be claimed by the presenter for each hour of presentation of the program with a maximum of 20 CEUs; Up to 3 hours of CEU credit may be claimed for each hour of presentation, at a professional or scientific organization, of a professional or scientific paper prepared by the licensee or certificate holder, with a maximum of 6 CEUs per paper; and Each program may be credited only once in each renewal period; or Authoring, editing, or reviewing a juried publication with CEUs earned only in the year of publication, and only to the following extent: Author of a book—maximum of 40 CEUs; Author of a book chapter or journal article—maximum of 15 CEUs; Editor of a book—maximum of 30 CEUs; Editor of a scientific or professional journal recognized by the Board—maximum of 30 CEUs for each year of service; or Reviewer of a professional book, scientific journal, or professional journal recognized by the Board—maximum of 10 CEUs for each year of service. When a certificate holder or licensee, after meeting the education requirements for certification or licensure at the degree level at which the licensee or certificate holder became certified or licensed, completes for credit semester hours of qualifying graduate-level or undergraduate-level course work at an accredited institution of higher education, each semester hour is considered the equivalent of 15 hours of CEUs. The Board may approve the following activities for CEUs in Category B: Attendance at or presentation of informal courses, in-house colloquia, invited speaker sessions, in-house seminars, and case conferences which are specifically designed for training, teaching, or both; Attendance at or presentation of informal non-publicized programs offered at professional or scientific meetings of local, state, regional, national, and international professional or scientific organizations; or Individualized learning, such as receiving formal professional supervision (except administrative supervision), participation in peer case conference or peer supervision groups, and participation in distance learning programs with evidence of appropriateness, minimum mastery of materials, and completion. Programs that do not meet the criteria for Category A may be eligible for Category B if the programs meet the objectives of this chapter. Authorizing Sponsored Programs. The Board shall establish a committee to advise the Board on continuing education. The committee shall evaluate and the Board may authorize applicants to sponsor Category A programs. The committee may recommend Board approval of programs by authorized sponsors for Category A according to the objectives stated in Regulations .04A and .05 of this chapter. Criteria for Program Eligibility. The Board shall evaluate each continuing education program submitted on the basis of the following criteria: Relevance of the subject matter to increase or support the development of skill and competence in counseling or therapy; Objectives of specific information or skill to be learned; Program content, educational methods, materials, and facilities used, including the frequency and duration of sessions and the adequacy to implement objectives; and Sponsorship and leadership of programs, including: The qualifications of the sponsoring individual or organization, Program leaders if different from sponsors, and The contact person if different from those in §B(1)(d)(i) or (ii) of this regulation. A program sponsored by the American Counseling Association, the National Board for Certified Counselors, the American Association for Marriage and Family Therapy, the National Association of Alcohol and Drug Abuse Counselors, the International Certification and Reciprocity Consortium/Alcohol and Other Drug Abuse, Inc., any other national or international organization, or their regional or state affiliates is automatically approved by the Board for Category A, unless otherwise excluded. A program sponsored by an accredited institution of higher education and state departments of health is automatically approved by the Board for Category A, unless otherwise excluded. The following may be authorized to sponsor Category A programs upon application and approval by the Board: National, state, or local professional, scientific, or mental health organizations; Those individuals certified or licensed by the Board; and Other agencies, institutions, or organizations providing continuing education programs in the interest of carrying out the intent of Health Occupations Article, §§17-309 and 17-3A-08, Annotated Code of Maryland, and Regulations .04 and .05 of this chapter. Procedures for Pre-approval. An application, on a form provided by the Board, shall be made and fee submitted to the Board for authorization of programs of sponsoring agencies meeting the requirements of these regulations. The application shall be submitted to the committee at least 10 weeks before the scheduling of each continuing education program. Authorized sponsors shall state in the continuing education program description the following: “A certificate for (number of hours) CEUs of Category A will be awarded upon completion of this (type of program)”; “(Name of organization) has been approved by the Maryland State Board of Examiners as an authorized sponsor who may provide Category A CEUs for certified or licensed professional counselors, marriage and family therapists, and alcohol and drug counselors”; and “(Name of organization) maintains responsibility for the program”. Authorized sponsors shall maintain documentation of registration and attendance records, stated purpose, content and presentation, time and length of the activity, and participant evaluations for a 4-year period following the program that may be audited by the Board. Approved sponsors' programs shall be approved for a 2-year period except as otherwise provided in §D of this regulation. Certificate holders and licensees may request, upon payment of a fee, that the Board review programs that do not have pre-approval for awarding CEU units. Withdrawal of Approval. Authorization may be withdrawn when, in the judgment of the Board, the intent of Health Occupations Article, §§17-309 and 17-3A-08, Annotated Code of Maryland, and Regulations .04, .05, and .06 of this chapter are no longer served. Reporting Requirements. The certificate holder or licensee shall complete and submit a form attesting to satisfactory completion of the continuing education requirements for each renewal. The certificate holder or licensee who is audited shall provide full documentation of CEUs as set forth in Regulation .03D of this chapter on a completed form provided by the Board. The Board shall audit a percentage of certificate holders and licensees to be determined by the Board each renewal period. A certificate holder or licensee who fails to renew by the renewal date shall provide full documentation as set forth in Regulation .03D of this chapter on a completed form provided by the Board. Extension of Time to Meet CEU Requirements. A written request for an extension of time in which to complete CEU requirements shall be submitted by the certificate holder's or licensee's renewal date. The Board may grant an extension and renew a certificate or license if the Board determines that: Failure to fulfill the requirements is clearly a result of a significant illness, a procedural or technical difficulty, or other circumstances beyond the control of the certificate holder or licensee; and The certificate holder or licensee readily and appropriately attempted to fulfill the CEU requirements. The Board may deny the request for an extension, deny renewal of the certificate or license, or issue any other order the Board finds appropriate. CEUs which are acquired in order to fulfill the conditions of an extension may be credited only for the previous renewal period. Within 1 calendar year after the certificate or license renewal date, the Board may reinstate the certificate or license of a certificate holder or licensee otherwise entitled to reinstatement under Health Occupations Article, §§17-310(b) and 17-3A-09(b), Annotated Code of Maryland, whose certificate or license was not renewed due to failure to complete continuing education requirements for renewal if the certificate holder or licensee: Completed within that year the minimum of 40 CEUs required during the prior renewal period as set forth in Regulation .03A of this chapter; and Pays to the Board a reinstatement fee set by the Board. CEUs which are acquired in order to reinstate under §A(1) of this regulation may be credited only once and may not be credited for any future renewals. In accordance with Health Occupations Article, §§17-310 and 17-3A-09, Annotated Code of Maryland, a request to transfer a certificate or license to inactive status shall be granted on written request and payment of the fee set forth in COMAR 10.58.02. The procedure as shown in §A of this regulation may occur only if the certificate or license is still active at the time application for inactive status is made. A certificate holder or licensee on inactive status seeking to be reinstated to active status shall be required, as a condition of reinstatement, to submit proof of having completed: 40 Category A CEUs for 2 or less years of inactive status; or 80 Category A CEUs for 3 or more years of inactive status, at least 40 of which shall have been obtained within the 2-year period immediately preceding the application for reinstatement. Health Occupations Article, §17-205, Annotated Code of Maryland Effective date: May 13, 1991 (18:9 Md. R. 1009) Regulation .09 adopted effective August 3, 1992 (19:15 Md. R. 1391) Regulations .01—.09 repealed and new Regulations .01—.10 adopted effective September 4, 2000 (27:17 Md. R. 1621) Regulations .07B amended effective July 8, 2002 (29:13 Md. R. 992) This chapter governs the practice of counseling and therapy services in Maryland pursuant to Health Occupations Article, Title 17, Annotated Code of Maryland, using teletherapy as an adjunct to, or replacement for, in-person client visits. Nothing in this chapter changes, restricts, or limits reimbursement requirements pursuant to 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 Professional Counselors and Therapists. “Client” means the individual, couple, family, group, business, agency, school, organization, or association that the counselor or therapist provides, or has provided, with professional services. “Counselor or therapist” means an individual who is licensed or certified by the Board to practice: Certified associate alcohol and drug counseling; Certified professional counseling; Certified professional alcohol and drug counseling; Certified professional marriage and family therapy; Certified supervised alcohol and drug counseling; Clinical marriage and family therapy; Clinical professional alcohol and drug counseling; Clinical professional art therapy; Clinical professional counseling; Graduate alcohol and drug counseling; Graduate marriage and family therapy; Graduate professional art therapy; or Graduate professional counseling. “In-person” means within the physical presence of the client. “Synchronous” means occurring in real time. “Teletherapy” means telehealth as defined in Health Occupations Article, §1-901, Annotated Code of Maryland. “Teletherapy practitioner” means: A Maryland licensed individual authorized to provide counseling and therapy services pursuant to Health Occupations Article, Title 17, Annotated Code of Maryland, who performs teletherapy services within their respective scope of practice; or A professional counselor with a compact privilege in Maryland who performs telehealth services within their respective scope of practice. Subject to the provisions of Health Occupations Article, Title 17, Subtitles 3 and 4, Annotated Code of Maryland, in order to practice teletherapy a teletherapy practitioner shall be licensed in Maryland or hold a compact privilege in Maryland when providing teletherapy services to a client located in the State. Before providing teletherapy services, a teletherapy practitioner shall develop and follow a procedure to: Verify the identification of the client receiving teletherapy services through the use of: A government-issued photograph identification; An insurance, Medicaid, or Medicare card; or Documentation of the client’s: Date of birth; and Home address; For an initial client-teletherapy practitioner encounter, disclose the teletherapy practitioner’s: Name; Maryland license or certificate number and type or compact privilege number, if applicable; and Contact information; Obtain oral or written informed consent from a client or a client’s parent or guardian if State law requires the consent of a parent or guardian, including informing clients of potential risks and benefits of services to be performed; Securely collect and transmit a client’s clinical data and self-reported medical history, as necessary, and prevent access to data by unauthorized persons through encryption or other means; Notify clients in the event of a data breach; Ensure that the teletherapy practitioner provides a secure and private communication modality and 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 client’s location. Except when providing asynchronous teletherapy services, a teletherapy practitioner shall: Obtain or confirm an alternative method of contacting the client in case of a technological failure; Confirm whether the client is in Maryland and identify the client’s specific location; and Identify all individuals present at each location and confirm they are permitted to hear the client’s health information. A teletherapy practitioner shall be held to the same standards of practice and documentation as those applicable for in-person counseling and therapy sessions. A teletherapy practitioner shall: Perform a synchronous or asynchronous clinical client evaluation that is appropriate for the client and the condition with which the client presents before providing treatment or services through teletherapy; and If clinically appropriate for the client, provide or refer a client to: In-person treatment; or Another type of teletherapy service. A teletherapy practitioner may not treat a client based solely on an online questionnaire. The Board shall use the same standards in evaluating and investigating a complaint and disciplining an individual authorized to practice pursuant to Health Occupations Article, Title 17, Annotated Code of Maryland, who practices teletherapy as it would use for an individual authorized to practice pursuant to Health Occupations Article, Title 17, Annotated Code of Maryland, who does not use teletherapy technology in their counseling or therapy practice. The failure of a teletherapy practitioner to comply with this chapter shall constitute unprofessional conduct and may be subject to disciplinary action by the Board. Health-General Article, §15-141.2; Health Occupations Article, §§1-901—1-903 and 1-1001—1-1006; and Insurance Article; §15-139, Annotated Code of Maryland; Ch. 505, Acts of 2008 Effective date: Regulations .01—.03 adopted as an emergency provision effective December 14, 1998 (26:1 Md. R. 18); adopted permanently effective May 31, 1999 (26:11 Md. R. 855) Regulation .03 amended effective October 18, 1999 (26:21 Md. R. 1630) Regulations .01—.03, Licensure by Waiver, repealed and new Regulations .01—.06, Teletherapy, adopted effective June 17, 2019 (46:12 Md. R. 546) Regulation .01 amended effective September 18, 2023 (50:18 Md. R. 798) Regulation .02B amended effective September 18, 2023 (50:18 Md. R. 798) Regulation .03 amended effective September 18, 2023 (50:18 Md. R. 798) Regulation .04 amended effective September 18, 2023 (50:18 Md. R. 798) Regulation .05 amended effective September 18, 2023 (50:18 Md. R. 798) Regulation .06 amended effective September 18, 2023 (50:18 Md. R. 798) This chapter applies to alcohol and drug counselors and alcohol and drug trainees in Maryland. In this chapter, the following terms have the meanings indicated. Terms Defined. “Accredited educational institution” means a Board-approved college or university that is accredited by a national or regional accrediting body recognized by the Council on Post-Secondary Accreditation or through one of the following bodies recognized by the U.S. Department of Education: The Middle States Association of Colleges and Schools — the Commission on Higher Education; The New England Association of Schools and Colleges; The North Central Association of Schools and Colleges; The Northwest Association of Schools and of Colleges and Universities; The Southern Association of Colleges and Schools; or The Western Association of Colleges and Schools. “Appraisal” means: Selecting, administering, scoring, and interpreting instruments designed to assess an individual’s aptitudes, attitudes, abilities, achievements, interests, and personal characteristics; and Using nonstandardized methods and techniques for understanding human behavior in relation to coping with, adapting to, or changing life situations. “Approved alcohol and drug counselor supervisor” means a Board-approved: Licensed clinical alcohol and drug counselor; Health-care provider: Licensed under the Health Occupations Article, Annotated Code of Maryland; and With 3 years of documented experience in alcohol and drug counseling; Certified professional counselor-alcohol and drug; Certified associate counselor-alcohol and drug with 3 years of documented experience in alcohol and drug counseling; Licensed clinical professional counselor; Licensed clinical marriage and family therapist; or Licensed clinical professional art therapist. “Biopsychosocial evaluation” means a comprehensive assessment of the patient addressing the following areas: Physical health; Employment or financial support; Drug and alcohol use; Treatment history; Legal history; Familial and social relationships; Educational background; and Mental health. “Case management” means the provision of services which assist participants in gaining access to: The full range of substance abuse services; or Any additional needed medical, social, financial assistance, counseling, educational, housing services. “Clinical supervision” means that the supervisor: Controls the supervisees’ work, and provides face-to-face or immediately available supervision; Evaluates completed work for technical soundness, appropriateness, and conformity to policy and requirements; and Confirms that all diagnoses are clinically supported by appropriate criteria, as: Defined in the current editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Classification of Diseases and Related Health Problems (ICD); and Documented by signature and credentials. “Close supervision” means that the supervisor: Closely controls the supervisees’ work, and provides direct, face-to-face, or on-site supervision; Maintains control through review of case management and progress notes, treatment plan reviews, and other documentation as appropriate; Evaluates completed work for accuracy, detail, and adherence to instructions and established procedures; and Reviews and approves content for all diagnostic impressions and new treatment plans, as documented by signature and credentials. “Co-occurring disorders (CODs)” means the occurrence in any individual, simultaneously or sequentially, of two or more somatic or behavioral health disorders which may imply an interaction between the disorders that affect the course and prognosis of each diagnosis. “Diagnosis” means the identification of psychological problems, emotional, or mental disorders by a licensed clinician, using specified terms and criteria identified in the current editions of the: Diagnostic and Statistical Manual of Mental Disorders (DSM); or International Classification of Diseases and Related Health Problems (ICD). “Direct clinical counseling services” means the provision of face-to-face clinical professional counseling services to clients and their significant others that include, but are not limited to the following: Individual counseling; Group counseling; Family counseling; Couples counseling; Evaluation; Intake or Assessment; Diagnosis; Treatment planning with a client; and Crisis management or intervention. “Direct supervision” means supervision provided by a supervisor who is present on the premises where services are provided, and is available for consultation within the treatment area. Face-to-Face. “Face-to-face” means in the physical presence of an individual or using video conferencing which allows individuals to hear and see each other in synchronous points of time. “Face-to-face” does not include: Telephone supervision; or Internet communication that does not involve synchronous video conferencing, such as instant messaging services and social networking sites. “Health and human services counseling field” means a specific degree program with a counseling emphasis, including but not limited to the following areas: Addictions counseling, including: Alcohol and drug counseling; Substance abuse counseling; or Chemical dependence counseling; Counseling practiced under Health Occupations Article, Title 17, Annotated Code of Maryland, including: Professional counseling; Marriage and family therapy; or Art therapy; Practice areas of other mental health care providers, including, but not limited to: Psychiatry; Psychology; Social work; or Psychiatric nursing; Other academic concentrations in the health and human services field, including, but not limited to: Human services; Behavioral health or behavioral sciences; Rehabilitation counseling; Counselor education; Counseling psychology; or Human development. “Immediately available supervision” means supervision provided by a supervisor who is instantly available: In person; By telephone or other electronic means; or By designation of one or more supervisors in the absence of the supervisor of record. “Indirect clinical counseling services” means all case management and professional development activities related to the provision of clinical professional counseling services to a client that include but are not limited to the following: Referral; Intake or assessment by telephone or other means when client is not face-to-face; Receiving individual and group supervision on-site or at a university; Consultation with other professionals; Treatment planning with other professionals; Case staffing; Staff meetings; Related trainings and seminars; Record keeping; Report writing; Case note taking; Providing clinical training; Telephone triage; Case management; Program development; and Other clinical professional counselor administrative duties as required by the setting in which the clinical hours are accrued. “Licensed graduate alcohol and drug counselor” means an individual approved by the Board to practice graduate alcohol and drug counseling under the supervision of an approved alcohol and drug counselor supervisor while fulfilling the supervised clinical experience for licensure under: Health Occupations Article, §17-302(e), Annotated Code of Maryland; and Regulation .04 of this chapter. “Moderate supervision” means that the supervisor: Controls the supervisee’s work and provides face-to-face or immediately available supervision; Ensures that completed work and methods used are technically accurate and in compliance with instructions or established procedures; Provides more intense review for difficult assignments, if the supervisee has not previously performed similar assignments; and Reviews and approves content for all diagnostic impressions and new treatment plans, as documented by signature and credentials. Ongoing Process of Supervision. “Ongoing process of supervision” means that the supervisor is available to provide support for the supervisee’s day-to-day practice of alcohol and drug counseling, throughout the course of the supervisee’s scheduled work hours; “Ongoing process of supervision” includes close, moderate, or clinical supervision of an individual or a group. “On-site supervision” means supervision provided by a supervisor who is: Physically present in the facility where patient or client services are rendered; and Able to respond in person without delay. Participating in the development of diagnostic impressions. “Participating in the development of diagnostic impressions” means gathering information to support a diagnosis through: Screening and assessment activities; Observations of signs and symptoms; Reports of behaviors; Collateral information acquired with the appropriate release; and The identification of specific disorders to be ruled out by the diagnosing clinician. “Participating in the development of diagnostic impressions” does not include diagnosis. “Practice clinical alcohol and drug counseling” means to engage professionally and for compensation in alcohol and drug counseling and appraisal activities by providing services for individuals, couples, families and groups involving: The application of counseling principles; and Methods in the diagnosis, prevention, treatment, and amelioration of psychological problems, emotional conditions, or mental conditions. “Psychotherapy” means providing clinical services which involve: The professional application of psychotherapy and counseling theories and methods, including but not limited to psychodynamic, cognitive, behavioral, humanistic, systems theories, or trauma informed care to assist the client in: Improving functioning; Obtaining symptom relief; Preventing psychosocial dysfunction; Changing personality; or Maintaining improved functioning; and Situations in which the principal discourse involves, but is not limited to: Diagnosis of psychopathology based on standard diagnostic criteria; Psychotherapeutic treatment of mental disorders, emotional disorders, and adjustment reactions utilizing clinically appropriate treatment modalities; Childhood trauma and abuse; Identifying and changing self-defeating patterns of behaving, thinking, feeling, believing, or interacting with others in systems; Developmental issues; Personality development; or Problems related to disorders of thinking, emotional suffering, addictions, behavior, or interpersonal dysfunctions. “Relative” means an individual connected to another by: Blood; Marriage; Guardianship; or Domestic partnership. “SBIRT” means Screening, Brief Intervention, and Referral to Treatment, including the following practices: Screening which quickly assesses the severity of substance use and identifies the appropriate level of treatment; Brief intervention which focuses on increasing insight and awareness regarding substance use and motivation toward behavioral change; and Referral to treatment which provides individuals identified as needing more extensive treatment with access to specialty care. “Scope of competence” means that area within which the individual is proficient to practice based on: Education; Training; Supervised clinical experience; and Professional credentials. “Substance use disorders (SUDs)” means any problematic pattern of substance use leading to clinically significant impairment or distress, which is diagnosed using specified terms and criteria identified in the current editions of the: Diagnostic and Statistical Manual of Mental Disorders (DSM); or International Classification of Diseases and Related Health Problems (ICD). “Supervised clinical experience in alcohol and drug counseling” means alcohol and drug counseling services provided under the close or moderate supervision of an approved licensed or certified alcohol and drug counselor supervisor. “Supervisee” means any of the following who obtains the supervised clinical experience required by Health Occupations Article, §17-302, Annotated Code of Maryland: A licensed graduate alcohol and drug counselor; A certified associate counselor-alcohol and drug; A certified supervised counselor-alcohol and drug; or An alcohol and drug trainee. Supervision. “Supervision” means a formalized professional relationship between a supervisor and supervisee that involves: Directing, guiding, monitoring, instructing, and evaluating the supervisee’s alcohol and drug counseling practice throughout an ongoing process of supervision; and Utilizes close, moderate, or clinical levels of supervision. “Supervision” includes an acceptance of direct responsibility for the patient services rendered by the supervisee, including continuous availability to the supervisee: In person; Through written instructions; By telephone or other electronic means; or By designation of one or more supervisors in the absence of the supervisor of record as defined in Regulations .13—.16 of this chapter. “Trauma informed care” means including in treatment an approach that: Engages people with histories of physical, sexual, emotional, or mental trauma in a manner that recognizes the: Presence of a trauma history; Consequences of the trauma; and Neurological, biological, psychological, and social effects of trauma for the affected individual; and Addresses the vulnerabilities or triggers for these individuals while minimizing any harm. “Under the supervision of an approved alcohol and drug counselor supervisor” means: Engaging in an ongoing process that includes direct, on-site, face-to-face individual or group meetings focused on quality of delivery of alcohol and drug counseling services; Monitoring the performance of a: Licensed graduate alcohol and drug counselor Certified associate counselor-alcohol and drug; Certified supervised counselor-alcohol and drug; or Alcohol and drug trainee; Providing documented and direct consultation, guidance, and instruction with respect to clinical skill and competency; and Improving counseling skills for a minimum of: 1 documented hour for each 40-hour work week; or Not less than 2 documented hours per month for less than a 40-hour work week. “Written contract for supervision” means a Board-approved agreement between the supervisee and approved alcohol and drug supervisor that is initiated before beginning supervision and that details the scope of supervision and includes at a minimum the following: Name and credentials of the supervisor and the supervisee; Primary purpose, goals, and objectives of the supervision process; Details of provisions, including frequency, format, and case or chart review; Methods of documentation; Duties and responsibilities of the supervisor and the supervisee; Procedural considerations in the case of the supervisor’s absence; and Information regarding the supervisor’s scope of competence. In order to obtain a certificate or license or to be eligible for trainee status, an applicant shall: Complete and return the Board-approved application; Submit an official transcript from an accredited educational institution indicating the: Completion of the highest degree attained; and Course work required for: Licensure; Certification; or Trainee status; Pay all applicable fees set forth in COMAR 10.58.02; Submit to a criminal history background check in accordance with Health Occupations Article, §17-501.1, Annotated Code of Maryland; Be of good moral character; and Be at least 18 years old. Applications shall be acted upon as follows: Within 30 days after receipt of an application, the Board shall determine whether the application is complete; If the Board determines that the application is not complete, the Board shall send a notice of deficiency to the applicant; Upon receipt of the notice, the applicant shall correct the deficiency within 90 days, or other period specified in the notice; If the applicant fails to correct the deficiency within the required period, the application may lapse and the applicant shall be required to: Submit a new application; and Pay the nonrefundable fee set forth in COMAR 10.58.02; If the Board determines that an applicant is eligible to take the required examinations, the Board shall send a notice of approval to the applicant; Upon receipt of the approval notice, the applicant shall have 1 year from the date of the notice to take the examinations; and If the applicant fails to take the examinations within 1 year from the date of the approval notice, the requirements set forth under §B(4) of this regulation shall apply. Scope of Practice. The scope of practice for a licensed graduate alcohol and drug counselor includes the following activities to be performed under the clinical supervision of an approved alcohol and drug counselor supervisor: Clinical evaluation, including screening, assessment, and diagnosis for mental health disorders; Treatment planning for mental health disorders, including initial, ongoing, continuity of care, discharge, and planning for relapse prevention; Referral; Service coordination and case management; Counseling, therapy, and trauma informed care with individuals, couples, families and groups; Client, family, and community education; Documentation; and Professional and ethical responsibilities. Licensure. To qualify for licensure as a graduate alcohol and drug counselor, an applicant shall have: Completed one of the following from an accredited educational institution: A master’s degree in a health and human services counseling field with: A minimum of 60 graduate semester credit hours; or 90 graduate quarter credit hours; A doctoral degree in a health and human services counseling field with: A minimum of 90 graduate semester credit hours; or 135 graduate quarter credit hours; or A master’s degree and have completed a program of studies determined by the Board to be substantially equivalent in subject matter with a minimum of 60 credit hours in counseling, including the required alcohol and drug course work for the license, as specified in §B(2) and (4) of this regulation; Completed a minimum of 39 semester credit hours or 65 quarter credit hours in alcohol and drug counselor training from an accredited educational institution including: 3 semester credit hours or 5 quarter credit hours of course work in each of the following course content areas: Pharmacology; Group counseling; Individual counseling; Addictions treatment delivery; Ethics that include alcohol and drug counseling issues; and Abnormal psychology; and Any three of the following 3 semester credit hours or 5 quarter credit hours of course work in each of the following course content areas: Human development; Theories of counseling; Treatment of co-occurring disorders; Topics in substance-related and addictive disorders; or Family counseling; Completed one of the following: An internship in alcohol and drug counseling that totals 6 semester credit hours or 10 quarter credit hours; or A minimum of 1,000 hours of alcohol and drug counseling work completed as a certified associate counselor-alcohol and drug, a certified supervised counselor-alcohol and drug, or an alcohol and drug trainee under and verified by an approved alcohol and drug counselor supervisor; Completed a minimum of 3 graduate semester credit hours or 5 quarter credit hours in each of the following course content areas: Diagnosis and psychopathology; and Psychotherapy and treatment of mental and emotional disorders; Achieved a passing score on: A national alcohol and drug counselor examination approved by the Board; An examination of: Health Occupations Article, Title 17, Annotated Code of Maryland; and COMAR 10.58; Met all of the requirements set forth under Regulation .03 of this chapter; and Complied with: Health Occupations Article, Title 17, Annotated Code of Maryland; and The code of ethics as set forth in COMAR 10.58.03. Licensed graduate alcohol and drug counselors shall have available for inspection a professional disclosure statement, as described in Health Occupations Article, §17-507, Annotated Code of Maryland, that: Clearly states that the counseling services are provided under supervision; and Provides the name, title, and credentials of the supervisor of record, including the supervisor’s address and contact information. Reexamination. An applicant who fails an examination for licensure: May retake the exam if: It is within the time frame set by the applicable testing authority; or A waiver is approved by the Board to extend the testing deadline upon proof of exceptional circumstances; or Shall be required to: Submit a new application; and Pay the nonrefundable fee set forth in COMAR 10.58.02. The Board shall act upon applications as set forth under Regulation .03B of this chapter. A licensed graduate alcohol and drug counselor may not: Practice independently; or Provide supervision. Expiration and Extension. The graduate alcohol and drug counselor license expires 2 years after the date issued. If the graduate alcohol and drug counselor licensee is unable to accumulate the required clinical hours for licensure as a clinical alcohol and drug counselor in 2 years, the graduate alcohol and drug counselor may apply on a Board-approved form for a 2-year extension before the current license as a graduate alcohol and drug counselor expires, up to a maximum of 6 years, except as provided in §G(4) of this regulation. For the graduate alcohol and drug counselor who has been granted a 2-year extension, CEUs are not required for the first 2-year extension. Subsequent extensions approved by the Board shall be subject to the continuing education requirements in COMAR 10.58.05. A graduate alcohol and drug counselor shall submit a written request for an extension beyond the 6-year maximum, which the Board may grant in certain circumstances. Reinstatement. Within 5 calendar years after the license renewal date, the Board may reinstate the license of a licensed graduate alcohol and drug counselor otherwise entitled to reinstatement under Health Occupations Article, §17-505(b), Annotated Code of Maryland, whose license was not renewed for any reason, if the licensee: Completes the required CEUs as set forth under COMAR 10.58.05; Meets the current licensure requirements; and Pays the reinstatement fee as set forth under COMAR 10.58.02. CEUs which are acquired in order to reinstate under COMAR 10.58.05.05 and .06 may be credited only once and may not be credited for any future renewals. For any licensed graduate alcohol and drug counselor whose license has expired more than 5 calendar years before the request for reinstatement, a new application for licensure shall be completed and the current licensure requirements shall be met. An individual who fails to reinstate licensure is not authorized to and may not practice clinical alcohol and drug counseling. Inactive Status. In accordance with Health Occupations Article, §17-505, Annotated Code of Maryland, a request to transfer a license to inactive status shall be granted upon receipt of the: Completed Board-approved application; and Payment of all applicable fees set forth in COMAR 10.58.02. An individual may apply for inactive status only if the individual’s license is still active at the time application for inactive status is made. An individual on inactive status is not authorized to practice graduate alcohol and drug counseling. Within 5 calendar years after being placed on inactive status, an individual on inactive status seeking to be reinstated to active status shall be required, as a condition of reinstatement, to submit proof of having completed the CEU requirements as set forth under COMAR 10.58.05. If an individual on inactive status seeks to be reinstated beyond the required 5-year period and the conditions set forth under §I(4) of this regulation, the individual shall be required to: Submit a new application; Meet the current licensure requirements; and Pay the nonrefundable fee set forth in COMAR 10.58.02. Scope of Practice. The scope of practice of a licensed clinical alcohol and drug counselor includes the following activities: Clinical evaluation, including screening, assessment, and diagnosis for mental health disorders; Treatment planning for mental health and substance use disorders, including initial, ongoing, continuity of care, discharge, and planning for relapse prevention; Referral; Service coordination and case management; Counseling, therapy, and trauma-informed care with individuals, couples, families, and groups; Client, family, and community education; Documentation; Professional and ethical responsibilities; and Supervisory responsibilities for all categories of licensed and certified alcohol and drug counselors or trainees. Licensure. To qualify for licensure as a clinical alcohol and drug counselor, the applicant shall have: Completed one of the following from an accredited educational institution: A master’s degree in a health and human services counseling field with: A minimum of 60 graduate semester credit hours; or 90 quarter credit hours; A doctoral degree in a health and human services counseling field with: A minimum of 90 graduate semester credit hours; or 135 graduate quarter credit hours; or A master’s degree and have completed a program of studies determined by the Board to be substantially equivalent in subject matter with a minimum of 60 credit hours in counseling, including the required alcohol and drug course work for the license, as specified in §B(2) and (4) of this regulation; Completed a minimum of 39 semester credit hours or 65 quarter credit hours in alcohol and drug counselor training from an accredited educational institution with at least 3 semester credit hours or 5 quarter credit hours of course work in each of the following course content areas: Pharmacology; Group counseling; Individual counseling; Addictions treatment delivery; Ethics that include alcohol and drug counseling issues; Human development; Abnormal psychology; Theories of counseling; Treatment of co-occurring disorders; Topics in substance-related and addictive disorders; and Family counseling; Completed one of the following: An internship in alcohol and drug counseling that totals 6 semester credit hours or 10 quarter credit hours; or A minimum of 1,000 hours of alcohol and drug counseling work completed as a licensed graduate alcohol and drug counselor, a certified associate counselor-alcohol and drug, a certified supervised counselor-alcohol and drug, or an alcohol and drug trainee under and verified by an approved alcohol and drug counselor supervisor; Completed a minimum of 3 graduate semester credit hours or 5 quarter credit hours in each of the following content areas: Diagnosis and psychopathology; and Psychotherapy and treatment of mental and emotional disorders; Completed a minimum of 2 years and 2,000 hours of supervised clinical experience in alcohol and drug counseling: Obtained after the awarding of a master’s or doctoral degree; As a supervisee, as defined under Regulation .02B of this chapter, under an approved alcohol and drug counselor supervisor; and Of which a minimum of 1,500 hours shall be direct clinical counseling services, including 100 hours of clinical supervision, of which: A minimum of 50 hours shall be individual face-to-face clinical supervision; and A maximum of 50 hours may be face-to-face group clinical supervision; Achieved a passing score on: A national alcohol and drug counselor examination approved by the Board; and An examination of: Health Occupations Article, Title 17, Annotated Code of Maryland; and COMAR 10.58; Met all of the requirements set forth under Regulation .03 of this chapter; and Complied with: Health Occupations Article, Title 17, Annotated Code of Maryland; and The code of ethics as set forth in COMAR 10.58.03. Renewal. To renew clinical alcohol and drug counselor licensure, the applicant, before the current license expiration, shall: Complete a Board-approved renewal application; Pay all applicable fees set forth in COMAR 10.58.02; and Attest to completion of continuing education activities as specified in COMAR 10.58.05.05 and .06. A licensed clinical alcohol and drug counselor shall comply with the renewal requirements as provided in Health Occupations Article, §17–504, Annotated Code of Maryland. An individual who fails to renew licensure is not authorized to and may not practice clinical alcohol and drug counseling. Reinstatement. The Board may reinstate the license of a licensed clinical alcohol and drug counselor as set forth under Regulation .04H of this chapter. Inactive Status. A licensed clinical alcohol and drug counselor may request inactive status as set forth under Regulation .04I of this chapter. The scope of practice for a certified professional counselor-alcohol and drug consists of the following activities: Biopsychosocial evaluation, including screening, assessment, and participating in the development of diagnostic impressions for SUDs and CODs; Treatment planning for SUDs and CODs, including initial, ongoing, continuity of care, discharge, and planning for relapse prevention; Referral; Service coordination and case management in the areas of SUDs and CODs; Counseling, therapy, and trauma-informed care with individuals, families, and groups in the areas of SUDs and CODs; Client, family, and community education; Documentation; Professional and ethical responsibilities; and Supervisory responsibilities for all categories of certified alcohol and drug counselors or trainees in the certification track. Renewal. To renew certified professional counselor-alcohol and drug certification, the applicant, before the current certificate expiration, shall: Complete an application on a form approved by the Board; Pay the required application fee set forth in COMAR 10.58.02; and Attest to completion of continuing education activities as specified in COMAR 10.58.05.05 and .06. The Board may not renew the certification of any certified professional counselor-alcohol and drug who fails to complete all requirements for renewal before the expiration date of the current certification. The Board may not reinstate the certification of a certified professional counselor-alcohol and drug who has failed to renew for any reason. Scope of Practice. The scope of practice of a certified associate counselor-alcohol and drug consists of the following activities, performed in accordance with §B of this regulation: Biopsychosocial evaluation, including participating in the development of diagnostic impressions for SUDs or Screening, Brief Intervention, and Referral to Treatment (SBIRT); Treatment planning for SUDs and CODs, including initial, ongoing, continuity of care, discharge, and planning for relapse prevention; Referral; Service coordination and case management for SUDs and CODs; Counseling, therapy, and trauma informed care, with individuals, couples, families, and groups; Client, family, and community education; Documentation; and Complying with: Professional and ethical responsibilities; and Supervisory responsibilities for a certified associate counselor-alcohol and drug, certified supervised counselor-alcohol and drug, or a trainee seeking certification, provided that the certified associate counselor-alcohol and drug has been approved as a supervisor by the Board. A certified associate counselor-alcohol and drug: Shall provide alcohol and drug counseling: As an employee of an agency or facility that is certified or licensed by the State; and Under the moderate supervision of an approved alcohol and drug counselor supervisor as specified in Health Occupations Article, §17–403, Annotated Code of Maryland; May provide supervision with approval by the Board; and May not practice independently. To qualify for certification as a certified associate counselor-alcohol and drug (CAC-AD) an applicant shall have: At a minimum: A bachelor’s degree from an accredited educational institution in a health and human services counseling field; or A bachelor’s degree and have completed a program of studies determined by the Board to be substantially equivalent in subject matter with a minimum of 45 credit hours in counseling, including the required alcohol and drug course work for the level of certification sought, as specified in §C(2) of this regulation; Completed a minimum of 33 semester credit hours or 50 quarter credit hours in alcohol and drug counselor training from an accredited educational institution including: 3 semester credit hours or 5 quarter credit hours of course work in each of the following course content areas: Pharmacology; Group counseling; Individual counseling; Addictions treatment delivery; Ethics that includes alcohol and drug counseling issues; and Abnormal psychology; and Any three of the following 3 semester credit hours or 5 quarter credit hours of course work in each of the following course content areas: Human development; Theories of counseling; Treatment of co-occurring disorders; Topics in substance-related and addictive disorders; and Family counseling; Completed one of the following: An internship in alcohol and drug counseling that totals 6 semester credit hours or 10 quarter credit hours; or A minimum of 1,000 hours of alcohol and drug counseling work completed as a certified associate counselor-alcohol and drug, a certified supervised counselor-alcohol and drug, or an alcohol and drug trainee under and verified by an approved alcohol and drug counselor supervisor; Completed not less than 1 year with a minimum of 1,000 hours of clinically supervised experience in alcohol and drug counseling completed as a certified supervised counselor-alcohol and drug or an alcohol and drug trainee under and verified by an approved alcohol and drug counselor supervisor; Achieved a passing score on: A national alcohol and drug counselor examination as approved by the Board; and An examination of: Health Occupations Article, Title 17, Annotated Code of Maryland; and This subtitle; Met all of the requirements set forth under Regulation .03 of this chapter; and Complied with: Health Occupations Article, Title 17, Annotated Code of Maryland; and The code of ethics as set forth in COMAR 10.58.03. Certified associate counselors-alcohol and drug shall have available for inspection a professional disclosure statement, as described in Health Occupations Article, §17-507, Annotated Code of Maryland, that: Clearly states that the counseling services are provided under supervision; and Provides the name, title, and credentials of the supervisor of record, including the supervisor’s address and contact information. Reexamination. An applicant who fails an examination for certification: May retake the exam if: It is within the time frame set by the applicable testing authority; or A waiver is approved by the Board to extend the testing deadline upon proof of exceptional circumstances; or Shall be required to submit a new application and pay the nonrefundable fee set forth in COMAR 10.58.02. The Board shall act upon applications as set forth under Regulation .03B of this chapter. Renewal. To renew the certification of a certified associate counselor-alcohol and drug, the applicant, before the current certificate expiration, shall: Complete a Board-approved renewal application; Pay all applicable fees set forth in COMAR 10.58.02; and Attest to completion of continuing education activities as specified in COMAR 10.58.05.05 and .06. The Board may not renew the certification of any certified associate counselor — alcohol and drug who fails to complete all requirements for renewal before the expiration date of the current certification. An individual who fails to renew certification is not authorized to and may not practice alcohol and drug counseling. Reinstatement. Within 5 calendar years after the certificate renewal date, the Board may reinstate the certificate of a certified associate counselor-alcohol and drug otherwise entitled to reinstatement under Health Occupations Article, §17-505(b), Annotated Code of Maryland, whose certificate was not renewed for any reason, if the certificate holder: Completes the required CEUs as set forth under COMAR 10.58.05; Meets the current certification requirements; and Pays the reinstatement fee as set forth under COMAR 10.58.02. CEUs which are acquired in order to reinstate under COMAR 10.58.05.05 and .06 may be credited only once and may not be credited for any future renewals. For any certified associate counselor-alcohol and drug whose certificate has expired more than 5 calendar years before the request for reinstatement, a new application for certification shall be completed and the current certification requirements shall be met. Inactive Status. In accordance with Health Occupations Article, §17-505, Annotated Code of Maryland, a request to transfer a certificate to inactive status shall be granted upon receipt of the: Completed Board-approved application; and Payment of all applicable fees set forth in COMAR 10.58.02. An individual may apply for inactive status only if the individual’s certificate is active at the time application for inactive status is made. An individual on inactive status is not authorized to practice alcohol and drug counseling. Within 5 calendar years after being placed on inactive status, an individual on inactive status seeking to be reinstated to active status shall be required, as a condition of reinstatement, to submit proof of having completed the CEU requirements as set forth under COMAR 10.58.05. If an individual on inactive status seeks to be reinstated beyond the required 5-year period and conditions set forth under §I(4) of this regulation, the individual shall be required to: Submit a new application; Meet the current certification requirements; and Pay the nonrefundable fee set forth in COMAR 10.58.02. Scope of Practice. The scope of practice for a certified supervised counselor-alcohol and drug consists of the following activities, performed in accordance with §B of this regulation: Participating in the development of diagnostic impressions for SUDs and CODs, as: Confirmed by an approved alcohol and drug counselor supervisor; and Documented by signature and credentials; Biopsychosocial evaluation, as permitted by the Board-approved supervisor; Screening, Brief Intervention, and Referral to Treatment (SBIRT); Treatment planning for SUDs and CODs, including initial, ongoing, continuity of care, discharge, and planning for relapse prevention, as confirmed by: An approved alcohol and drug counselor supervisor; and Documentation by signature and credentials; Referral; Participating in service coordination, case coordination, and case management for SUDs and CODs; Counseling of individuals and groups for SUDs; Client, family, and community education for SUDs; Documentation; and Complying with the professional and ethical responsibilities set forth in COMAR 10.58.03. A certified supervised counselor-alcohol and drug: Shall practice under the close supervision of an approved alcohol and drug counselor supervisor; Shall provide alcohol and drug counseling as an employee of an agency or facility that is certified or licensed by the State; and May not: Provide supervision; or Practice independently. To qualify for certification as a supervised counselor-alcohol and drug, an applicant shall have: At a minimum: An associate’s degree from an accredited educational institution in a health and human services counseling field; or An associate’s degree and have completed a program of studies determined by the Board to be substantially equivalent in subject matter with a minimum of 30 credit hours in counseling, including the required alcohol and drug course work for the level of certification sought, as specified in §C of this regulation; Completed a minimum of 24 semester credit hours or 37 quarter credit hours in alcohol and drug counselor training from an accredited educational institution including: 3 semester credit hours or 5 quarter credit hours of course work in each of the following course content areas: Pharmacology; Addictions treatment delivery; and Ethics that includes alcohol and drug counseling issues; and Any three of the following 3 semester credit hours or 5 quarter credit hours of course work in each of the following course content areas: Human development; Theories of counseling; Treatment of co-occurring disorders; Family counseling; Individual counseling; Group counseling; Abnormal psychology; and Topics in substance-related and addictive disorders; Completed one of the following: An internship in alcohol and drug counseling that totals 6 semester credit hours or 10 quarter credit hours; or A minimum of 1,000 hours of alcohol and drug counseling work completed as an alcohol and drug trainee under and verified by an approved alcohol and drug counselor supervisor; Achieved a passing score on: A national alcohol and drug counselor examination as approved by the Board; and An examination of: Health Occupations Article, Title 17, Annotated Code of Maryland; and This subtitle; Met all of the requirements set forth under Regulation .03 of this chapter; and Complied with: Health Occupations Article, Title 17, Annotated Code of Maryland; and The code of ethics as set forth in COMAR 10.58.03. Certified supervised counselors-alcohol and drug shall have available for inspection a professional disclosure statement, as described in Health Occupations Article, §17-507, Annotated Code of Maryland, that: Clearly states that the counseling services are provided under supervision; and Provides the name, title, and credentials of the supervisor of record, including the supervisor’s address and contact information. Reexamination. An applicant who fails an examination for certification: May retake the exam if: It is within the time frame set by the applicable testing authority; or A waiver is approved by the Board to extend the testing deadline upon proof of exceptional circumstances; or Shall be required to: Submit a new application; and Pay the nonrefundable fee set forth in COMAR 10.58.02. The Board shall act upon applications as set forth under Regulation .03B of this chapter. Renewal. The Board may renew the certificate of a certified supervised counselor-alcohol and drug as set forth under Regulation .07G in this chapter. Reinstatement. The Board may reinstate the certificate of a certified supervised counselor-alcohol and drug as set forth under Regulation .07H in this chapter. Inactive Status. A certified supervised counselor-alcohol and drug may request inactive status as set forth under Regulation .07I of this chapter. Scope of Practice. The scope of practice of an alcohol and drug trainee shall be limited to the following activities under an approved alcohol and drug counselor supervisor: Biopsychosocial evaluation, including screening, assessment, and diagnostic impressions for SUDs and CODs; Treatment planning for SUDs and CODs, including initial, ongoing, continuity of care, discharge, and planning for relapse prevention; Referral; Service coordination and case management in the areas of SUDs and CODs; Counseling, therapy, and trauma informed care with individuals, couples, families and groups in the areas of SUDs and CODs; Client, family, group, and community education; Documentation; and Compliance with professional and ethical responsibilities. A trainee may not perform supervision. Qualifications. To qualify as an alcohol and drug trainee, an applicant shall meet one of the following requirements: Hold an associate’s degree or higher from an accredited educational institution: In a health and human services counseling field; or Hold an associate’s degree and a completed program of studies determined by the Board to be substantially equivalent in subject matter, which includes 1 semester credit hour or 2 quarter credit hours in the ethics of alcohol and drug counseling; or Have completed 15 semester credit hours or 25 quarter credit hours from among the topic areas specified in Regulation .05B of this chapter including: 15 continuing education units (CEUs) in the ethics of alcohol and drug counseling; or 1 semester credit hour or 2 quarter credit hours in the ethics of alcohol and drug counseling from an accredited educational institution. An alcohol and drug trainee shall: Practice under the supervision of a Board-approved alcohol and drug supervisor as specified under §§E—H of this regulation; and Have available for inspection a professional disclosure statement, as described in Health Occupations Article, §17-507, Annotated Code of Maryland, that: Clearly states that the counseling services are provided under supervision; and Provides the name, title, and credentials of the supervisor of record, including the supervisor’s address and contact information. A trainee holding a master’s degree shall: Practice under the clinical supervision of an approved alcohol and drug counselor supervisor as defined under Regulation .02B of this chapter; Provide alcohol and drug counseling as an employee of an agency or facility that is certified or licensed by the State; and Provide documentation satisfactory to the Board every 2 years of progress towards the fulfillment of the experiential and course of study requirements under Health Occupations Article, §17-302, Annotated Code of Maryland. A trainee holding a bachelor’s degree shall: Practice under the moderate supervision of an approved alcohol and drug counselor supervisor; Provide alcohol and drug counseling as an employee of an agency or facility that is certified or licensed by the State; and Provide documentation satisfactory to the Board every 2 years of progress towards the fulfillment of the experiential and course of study requirements under Health Occupations Article, §17-403 or 17-404, Annotated Code of Maryland. A trainee holding an associate’s degree shall: Practice under the close supervision of an approved alcohol and drug counselor supervisor; Provide alcohol and drug counseling as an employee of an agency or facility that is certified or licensed by the State; and Provide documentation satisfactory to the Board every 2 years of progress towards the fulfillment of the experiential and course of study requirements under Health Occupations Article, §17-403 or 17-404, Annotated Code of Maryland. A trainee holding a high school diploma shall meet all guidelines set forth under §G of this regulation. Application Process. To qualify for alcohol and drug trainee status, an applicant shall: Complete and return the Board-approved application that includes: Information and supporting documentation regarding the applicant’s current educational level at the start of the trainee period; and An attestation specifying the certification or licensure level being sought at the end of the trainee period; Meet all of the requirements set forth under Regulation .03 of this chapter; Provide the name and credentials of the applicant’s prospective supervisor before beginning practice; and Comply with: Health Occupations Article, Title 17, Annotated Code of Maryland; and The code of ethics as set forth in COMAR 10.58.03. The trainee shall notify the Board in writing within 30 days of any changes in employment and supervision. An individual licensed as a clinical mental healthcare provider under the Health Occupations Article, Title 17, Annotated Code of Maryland, may not apply as a trainee. Trainee Practice of Alcohol and Drug Counseling. An individual may practice alcohol and drug counseling as a trainee for a maximum of 6 years. After fulfilling the experiential and course of study requirements under Regulations .04, .05, .07, or .08 of this chapter, the alcohol and drug trainee may be eligible to apply for: Licensed clinical alcohol and drug counselor (LCADC); Licensed graduate alcohol and drug counselor (LGADC); Certified associate counselor-alcohol and drug (CAC—AD); or Certified supervised counselor-alcohol and drug (CSC—AD). Renewal. The Board shall issue a letter to the individual authorizing the individual to practice alcohol and drug counseling as a trainee for 2 years, renewable in 2-year increments up to a total of 6 years. In each 2-year renewal application, before the expiration of the current trainee period, the trainee shall: Document progress made during the current 2-year period towards the stated educational and supervised clinical experience required for the licensure or certification sought at the end of the trainee period, including: A verification from the approved alcohol and drug supervisor documenting the number of hours of supervised clinical experience obtained during the 2-year period; and A copy of an official transcript from an educational institution approved by the Board documenting progress made in completing the required education; Submit a completed Board-approved trainee renewal application; Pay the required renewal fee set forth in COMAR 10.58.02; and Provide documentation, satisfactory to the Board, every 2 years of the applicant’s progress towards fulfilling the experiential and course of study requirements under Health Occupations Article, §17-403 or 17-404, Annotated Code of Maryland. The Board may deny renewal if the applicant fails to document sufficient progress as determined by the Board. A trainee who fails to renew their trainee status is not authorized to practice alcohol and drug counseling. An applicant licensed as a clinical alcohol and drug counselor or its equivalent, as established by the Board, in another state, territory, or jurisdiction is eligible for licensure if the applicant: Provides: A completed Board-approved application; Documentation or transcripts confirming completion of one of the following from an accredited educational institution: A master’s or doctoral degree in a health and human services counseling field; or A master’s degree and confirmation of the completion of a program of studies determined by the Board to be substantially equivalent in subject matter with a minimum of 60 credit hours in counseling, including the required alcohol and drug course work for the license, as specified in Regulation .04B of this chapter; A copy of a current license from each state, territory, or jurisdiction in which the applicant has been licensed, registered, or otherwise authorized to practice alcohol and drug counseling; Documentation, satisfactory to the Board, that the applicant is currently licensed in good standing to practice alcohol and drug counseling in another state, territory, or jurisdiction; and Verification that the applicant has: No history of disciplinary action, past or pending, in a state, territory, or jurisdiction in which the applicant holds a license to practice clinical alcohol and drug counseling; and Not committed any act or omission that would be grounds for discipline or denial of licensure under Health Occupations Article, §17-509, Annotated Code of Maryland; Pays the application fee set forth in the COMAR 10.58.02; Has achieved a passing score on: A national alcohol and drug counselor examination approved by the Board; and An examination of: Health Occupations Article, Title 17, Annotated Code of Maryland; and This subtitle; Meets all of the requirements set forth under Regulation .03 of this chapter; and Complies with: Health Occupations Article, Title 17, Annotated Code of Maryland; and The code of ethics as set forth in COMAR 10.58.03. Waiver of Examination. The Board may waive any examination requirements for an applicant who satisfies the Board that the applicant: Obtained licensure in a state or country that grants a similar endorsement to license holders of this State; Became licensed in another state or country after passing an examination approved by the Board; and Meets the qualifications otherwise required by Health Occupations Article, Title 17, Annotated Code of Maryland, and this chapter. Educational Requirements. The educational requirements for licensure in this State as a clinical alcohol and drug counselor shall be met: As established in Regulation .05 of this chapter; or By providing documentation of the substitute educational and experience requirements outlined in §§D and E of this regulation. Waiver of Course Requirements. The Board may waive one or more course requirements specified in Regulation .04B of this chapter, except for documentation or transcripts showing completion of: 3 graduate semester credit hours or 5 graduate quarter credit hours covering the following primary topics or content areas: Psychotherapy and treatment of mental and emotional disorders, as described in Regulation .02B of this chapter; Diagnosis and psychopathology; and Professional, legal, and ethical responsibilities; and 3 undergraduate semester credit hours or 5 undergraduate quarter credit hours in: The ethics of alcohol and drug counseling; and Pharmacology. Equivalent Experience Requirements. The applicant shall provide documentation, satisfactory to the Board, of one of the following for an applicant with: A master’s degree consisting of: A minimum of 60 graduate credit hours; and Not less than 3 years, with a minimum of 2,000 hours, of supervised clinical experience in alcohol and drug counseling, 2 years of which shall be completed after the award of the master’s degree; A master’s degree consisting of: Less than 60 graduate credit hours; and Not less than 3 years of experience practicing as a clinical alcohol and drug counselor, with a minimum of 2,000 hours of clinical alcohol and drug counseling experience; or A doctoral degree consisting of: Not less than 2 years practicing as a clinical alcohol and drug counselor; or A minimum of 2,000 hours of clinical alcohol and drug counseling experience. The applicant shall provide verification, on a Board-approved form, from employers, supervisors, or colleagues that the applicant has practiced clinical alcohol and drug counseling for the length of time stated in §E(1) of this regulation. An applicant certified as a certified associate counselor-alcohol and drug or its equivalent, as established by the Board, in another state, territory, or jurisdiction is eligible for certification if the applicant: Provides: A completed Board-approved application; Documentation or transcripts confirming completion of one of the following from an accredited educational institution: A bachelor’s degree in a health and human services counseling field; or A bachelor’s degree and confirmation of the completion of a program of studies determined by the Board to be substantially equivalent in subject matter with a minimum of 45 credit hours in counseling, including the required alcohol and drug course work for the certificate, as specified in Regulations .07 and .08 of this chapter; A copy of a current certification from each state, territory, or jurisdiction, in which the applicant has been certified or otherwise authorized to practice alcohol and drug counseling; Documentation, satisfactory to the Board, that the applicant is currently certified in good standing to practice alcohol and drug counseling in another state, territory, or jurisdiction; and Verification that the applicant has: No history of disciplinary action, past or pending, in a state, territory, or jurisdiction in which the applicant holds a certificate to practice alcohol and drug counseling; and Not committed any act or omission that would be grounds for discipline or denial of certification under Health Occupations Article, §17-509, Annotated Code of Maryland; Pays the application fee set forth in the COMAR 10.58.02; Has achieved a passing score on: A national alcohol and drug counselor examination approved by the Board; and An examination of: Health Occupations Article, Title 17, Annotated Code of Maryland; and This subtitle; Meets all of the requirements set forth under Regulation .03 of this chapter; and Complies with: Health Occupations Article, Title 17, Annotated Code of Maryland; and The code of ethics as set forth in COMAR 10.58.03. Waiver of Examination. The Board may waive any examination requirements for an applicant who satisfies the Board that the applicant: Obtained certification in a state or country that grants a similar endorsement to certificate holders of this State; Became certified in another state or country after passing an examination approved by the Board; Meets the qualifications otherwise required by Health Occupations Article, Title 17, Annotated Code of Maryland, and this chapter. Educational Requirements. The educational requirements for certification in this State as a certified associate counselor-alcohol and drug shall be met: As established in Regulation .07 of this chapter; or By providing documentation of the substitute educational and experience requirements outlined in §§D and E of this regulation. Waiver of Course Requirements. The Board may waive one or more course requirements specified in Regulations .04B and .05B of this chapter, except for documentation showing completion of: 12 continuing education units (CEUs) in the ethics of alcohol and drug counseling; or 1 semester credit hour or 2 quarter credit hours in the ethics of alcohol and drug counseling. Equivalent Experience Requirements. The applicant shall provide: Documentation, satisfactory to the Board, of not less than 2 years of supervised clinical experience in alcohol and drug counseling with a minimum of 2,000 hours experience; and Verification, on a Board-approved form, from employers, supervisors, or colleagues that the applicant has practiced alcohol and drug counseling for the length of time stated in §E(1) of this regulation. An applicant certified as a certified supervised counselor-alcohol and drug or its equivalent, as established by the Board, in another state, territory, or jurisdiction is eligible for certification if the applicant: Provides: A completed Board-approved application; Documentation or transcripts confirming completion of one of the following from an accredited educational institution: An associate’s degree in a health and human services counseling field; or An associate’s degree and confirmation of the completion of a program of studies determined by the Board to be substantially equivalent in subject matter with a minimum of 30 credit hours in counseling, including the required alcohol and drug course work for the certificate, as specified in Regulations .07 and .08 of this chapter; A copy of a current certification from each state, territory, or jurisdiction in which the applicant has been certified or otherwise authorized to practice alcohol and drug counseling; Documentation, satisfactory to the Board, that the applicant is currently certified in good standing to practice alcohol and drug counseling in another state, territory, or jurisdiction; Verification that the applicant has: No history of disciplinary action, past or pending, in a state, territory, or jurisdiction in which the applicant holds a certificate to practice alcohol and drug counseling; and Not committed any act or omission that would be grounds for discipline or denial of certification under Health Occupations Article, §17-509, Annotated Code of Maryland; Pays the application fee set forth in the COMAR 10.58.02; Has achieved a passing score on: A national alcohol and drug counselor examination approved by the Board; and An examination of: Health Occupations Article, Title 17, Annotated Code of Maryland; and This subtitle; Meets all of the requirements set forth under Regulation .03 of this chapter; and Complies with: Health Occupations Article, Title 17, Annotated Code of Maryland; and The code of ethics as set forth in COMAR 10.58.03. Waiver of Examination. The Board may waive any examination requirements for an applicant as set forth under Regulation .11B of this chapter. Educational Requirements. The educational requirements for certification in this State as a certified supervised counselor-alcohol and drug shall be met: As established in Regulation .08 of this chapter; or By providing documentation of the substitute educational and experience requirements outlined in §§D and E of this regulation. Waiver of Course Requirements. The Board may waive one or more course requirements specified in Regulations .07C and .08C of this chapter, except for documentation from an accredited educational institution showing completion of: 12 continuing education units (CEUs) in the ethics of alcohol and drug counseling; or 1 semester credit hour or 2 quarter credit hours in the ethics of alcohol and drug counseling. Equivalent Experience Requirements. The applicant shall provide: Documentation, satisfactory to the Board, of not less than 2 years of supervised clinical experience in alcohol and drug counseling with a minimum of 2,000 hours experience; and Verification, on a Board-approved form, from employers, supervisors, or colleagues that the applicant has practiced alcohol and drug counseling for the length of time stated in §E(1) of this regulation. Except as otherwise specified in this chapter, this chapter does not apply to personnel or management practices associated with contractual relationships or employment. A supervisor shall: Supervise only in those areas within the supervisor’s competence, as determined by: Education; Training; and Experience; Provide supervision appropriate to the particular level of licensure or certification being applied for or maintained; Provide supervision in the general content areas established in Health Occupations Article, §§17-302, 17-403, 17-404, and 17-406, Annotated Code of Maryland; and Ensure that a supervisee has read and is knowledgeable about: Health Occupations Article, Title 17, Annotated Code of Maryland; and This subtitle, with special emphasis on the code of ethics chapter, COMAR 10.58.03. In addition to the requirements of §B of this regulation, the supervisor shall specifically instruct and provide guidance relating to: The supervisee’s scope of practice of: Clinical alcohol and drug counseling under Health Occupations Article, §17-101(s), Annotated Code of Maryland; or Alcohol and drug counseling under Health Occupations Article, §17-101(p), Annotated Code of Maryland; Activities specified under Regulations .04A, .07A, .08A, and .09A, of this chapter; Appropriate billing practices, if applicable to the practice site, including: Financial record keeping and disclosure; and Establishment and disclosure to clients of: Fees for services; Payment arrangements; Payment plans; Financial services; and Terms and conditions of service; Professional and ethical responsibilities, including a working knowledge of the Board’s code of ethics, as set forth in COMAR 10.58.03; The provision of services involving the application of counseling principles and methods in the diagnosis, prevention, treatment, and amelioration of psychological problems, emotional conditions, or mental conditions of individuals or groups, as required by Health Occupations Article, §17-308, Annotated Code of Maryland; and Appropriate maintenance and destruction of clinical and financial records. The following supervisees shall practice alcohol and drug counseling under the supervision of an approved alcohol and drug counselor supervisor as defined under Regulation .02B of this chapter: A licensed graduate alcohol and drug counselor; A certified associate counselor-alcohol and drug; A certified supervised counselor-alcohol and drug; or An alcohol and drug trainee. An individual providing supervision shall be Board-approved and: Licensed by the Board as a clinical alcohol and drug counselor; Licensed by the Board as: A clinical professional counselor; A clinical marriage and family therapist; or A clinical professional art therapist; A licensed mental health care provider as defined in Regulation .02B of this chapter; Certified by the Board as a certified professional counselor-alcohol and drug; or Certified by the Board as a certified associate counselor-alcohol and drug for at least 2 years. Experience, Education, and Training. A supervisor licensed or certified by the Board, or any Board-approved mental health care provider licensed under Health Occupations Article, Annotated Code of Maryland, with 3 years of documented experience in alcohol and drug counseling, including 3,000 hours of direct client contact, shall complete any of the following options: For a certified professional counselor-alcohol and drug or a certified associate counselor-alcohol and drug, at least 3 semester credit hours or 5 quarter credit hours of undergraduate or graduate-level academic course work that includes counseling supervision; For a licensed clinical alcohol and drug counselor or other board-approved mental health care provider, at least 3 semester credit hours or 5 quarter credit hours of graduate-level academic course work that includes counseling supervision; A Board-approved continuing education program in counseling supervision that includes a minimum of 18 CEUs with a sponsor approved by the Board to provide Category A CEUs as defined under COMAR 10.58.05.05; or Hold the: National Association of Alcohol and Drug Abuse Counselors Approved Clinical Supervisor credential; or International Certification and Reciprocity Consortium Clinical Supervisor credential. Supervision training required by §B(1) of this regulation may be obtained in a graduate or undergraduate course as provided in §B(1)(a) or (b) of this regulation, or continuing education as listed in §B(1)(c) of this regulation, and may include, but is not limited to, training in: The role and responsibilities of the supervisor; The needs of the supervisee, the supervisor, and the agency setting while: The role of the supervisor as gatekeeper to the profession; Methods for building effective and appropriate relationships with clients; Methods for group supervision; and Models and modalities for practice intervention. Pre-Supervision Responsibilities of a Supervisor. In addition to meeting the requirements of this regulation, the supervisor shall: File with the Board the approved alcohol and drug supervisor application form; Provide each supervisee with a copy of the Board’s authorization of approved alcohol and drug supervisor status; Have a license or certification that is in good standing; and Be an approved alcohol and drug supervisor as defined under Regulation .02B of this chapter. A supervisor shall: Agree to and sign a written contract for supervision before initiating supervision; Ensure that the supervisee is practicing within the scope of the supervisee’s credentialing; Determine the skill level at which the supervisee may practice; Focus on primary data from the supervisee’s practice; Maintain documentation for at least 7 years of supervisory sessions, including: Dates; Duration; and Focus of the supervisory sessions; Ensure that a supervisee has read and is knowledgeable about: Health Occupations Article, Title 17, Annotated Code of Maryland; and This subtitle, with special emphasis on the code of ethics chapter, COMAR 10.58.03; Within a reasonable period of time before termination of supervision, provide the supervisee and employer with a written notice of termination to avoid or minimize any harmful effect on the supervisee’s clients or patients; Be responsible for the professional practices of supervisees; Provide: For emergency supervision of and direction to a supervisee by a Board-approved alcohol and drug supervisor; A written evaluation of progress to the supervisee on a regular basis or as needed; and A copy of the documentation required by §E of this regulation on request by the: Supervisee; or Board or its authorized agent; and Comply with a Board audit of a supervisor’s compliance with regard to the supervisory requirements and responsibilities. A supervisee shall: Verify that the supervisor has been approved by the Board; Agree to and sign a Board-approved contract before initiating supervision; Attend and participate in supervision as agreed to in the supervision contract; Prepare for supervision using case materials related to the supervisee’s alcohol and drug counseling practice; Maintain documentation of supervisory sessions for at least 7 years, to be available for verification to the Board or its authorized agent, including: Dates; Duration; and Focus of the supervision; and Follow all terms of the written contract for supervision. A supervisee may not engage in the practice of alcohol and drug counseling independently. A supervisee shall provide each client with a copy of the supervisee’s professional disclosure statement, as required by Health Occupations Article, §17-507, Annotated Code of Maryland, stating: That the supervisee’s alcohol and drug counseling services are provided under supervision; and The name of the supervisor, including the supervisor’s address and contact information. A supervisee shall obtain from each client a signed informed consent for treatment form which indicates that the client: Is aware that counseling services are being provided under supervision; and Consents to the recording of counseling sessions, and the sharing of client information, acknowledging that all of these materials may be shared with: The approved alcohol and drug supervisor of record; or The instructor supervising an education-related practicum. Health Occupations Article, §§17-101, 17-102, 17-205, 17-301, 17-302, 17-305, 17-308, 17-309, 17-401(b), 17-403—17-407, and 17-501—17-509, Annotated Code of Maryland Effective date: Regulations .01—.06 adopted as an emergency provision effective October 1, 2001 (28:22 Md. R. 1932); adopted permanently effective January 21, 2002 (29:1 Md. R. 23) Regulation .02B amended as an emergency provision effective October 1, 2002 (29:25 Md. R. 1979); amended permanently effective March 3, 2003 (30:4 Md. R. 317) Regulation .02B amended effective November 23, 2006 (33:23 Md. R. 1796) Regulations .07 and .08 adopted as an emergency provision effective October 1, 2001 (28:22 Md. R. 1932); amended as an emergency provision effective March 30, 2002 (29:7 Md. R. 617); adopted permanently effective June 24, 2002 (29:12 Md. R. 929) Regulation .07 amended as an emergency provision effective August 15, 2002 (29:18 Md. R. 1439); amended permanently effective November 25, 2002 (29:23 Md. R. 1811) Regulations .09—.12 adopted as an emergency provision effective October 1, 2001 (28:22 Md. R. 1932); adopted permanently effective January 21, 2002 (29:1 Md. R. 23) Regulation .12 amended effective November 23, 2006 (33:23 Md. R. 1796) Regulation .13 adopted as an emergency provision effective October 1, 2002 (29:25 Md. R. 1979); adopted permanently effective March 3, 2003 (30:4 Md. R. 317) Regulation .14 adopted effective May 17, 2010 (37:10 Md. R. 723) Regulation .15 adopted effective May 17, 2010 (37:10 Md. R. 723) Regulation .16 adopted effective May 17, 2010 (37:10 Md. R. 723) Regulation .17 adopted effective May 17, 2010 (37:10 Md. R. 723) Chapter revised effective July 22, 2013 (40:14 Md. R. 1176) Regulation .03A, D amended effective November 9, 2015 (42:22 Md. R. 1379) Regulation .04 amended effective November 9, 2015 (42:22 Md. R. 1379) Regulation .05 amended effective November 9, 2015 (42:22 Md. R. 1379) Regulation .06 amended effective November 9, 2015 (42:22 Md. R. 1379) Regulation .07 amended effective November 9, 2015 (42:22 Md. R. 1379) Chapter revised effective December 31, 2018 (45:26 Md. R. 1247) Chapter revised effective June 28, 2021 (48:13 Md. R. 508) This chapter: Establishes the requirements for an individual to practice clinical marriage and family therapy; Establishes standards of supervision and the responsibilities of supervisors and supervisees in the practice of clinical marriage and family therapy; Applies to licensees who: Practice clinical marriage and family therapy; or Provide supervision for licensed graduate marriage and family therapists; and Applies to licensed graduate marriage and family therapists who are in the process of obtaining the supervised clinical experience required by Health Occupations Article, §17-303, Annotated Code of Maryland. In this chapter, the following terms have the meanings indicated. Terms Defined. “Accredited educational institution” means a Board-approved college or university that is accredited by a national or regional accrediting body recognized by the Council on Post-Secondary Accreditation or through one of the following bodies recognized by the U.S. Department of Education: The Middle States Association of Colleges and Schools — the Commission on Higher Education; The New England Association of Schools and Colleges; The North Central Association of Schools and Colleges; The Northwest Association of Schools and of Colleges and Universities; The Southern Association of Colleges and Schools; and The Western Association of Colleges and Schools. “Appraisal” means: Selecting, administering, scoring, and interpreting instruments designed to assess an individual's aptitudes, attitudes, abilities, achievements, interests, and personal characteristics; and Using nonstandardized methods and techniques for understanding human behavior in relation to coping with, adapting to, or changing life situations. “Board-approved marriage and family therapy supervisor” means: An American Association for Marriage and Family Therapy approved and Board-approved: Supervisor; Supervisor in training; or Supervisor candidate; A licensed clinical marriage and family therapist who: Meets the requirements for licensure under this chapter; and Has been approved by the Board; A licensed clinical professional counselor, licensed clinical marriage and family therapist, licensed clinical professional art therapist, or licensed clinical alcohol and drug counselor who meets the requirements for licensure under Health Occupations Article, Title 17, Annotated Code of Maryland, and has been approved by the Board; or An individual who is authorized by law to practice a health occupation which includes the diagnosis, prevention, treatment, and amelioration of psychological problems and emotional or mental conditions of individuals or groups, and has been approved by the Board. “Client contact hour” means at least 45 minutes of direct session time with a client present. “Clinical supervision hour” means at least 45 minutes of direct supervision time with the supervisee present. “Direct clinical marriage and family therapy services” means the provision of face-to-face clinical marriage and family therapy services to clients and their significant others that includes, but is not limited, to the following: Individual counseling; Group counseling; Family counseling; Couples counseling; Evaluation; Intake or assessment; Diagnosis; Treatment planning with a client; and Crisis management or intervention. Face-to-Face. “Face-to-face” means in the physical presence of an individual or using video conferencing which allows individuals to hear and see each other in synchronous points of time. “Face-to-face” does not include: Telephone communication; or Internet communication that does not involve synchronous video conferencing, such as instant messaging services and social networking sites. “Indirect clinical marriage and family therapy services” means all case management and professional development activities related to the provision of clinical marriage and family therapy services to a client that include, but are not limited to, the following: Referral; Intake or assessment by telephone or other means when the client is not face-to-face; Receiving individual and group supervision at site or at the university; Consultation with other professionals; Treatment planning with other professionals; Case staffing; Staff meetings; Related trainings and seminars; Record keeping; Report writing; Case notes; Providing clinical training; Telephone triage; Case management; Program development; and Other clinical marriage and family therapy administrative duties as required by the setting in which the clinical hours are accrued. “Licensed clinical marriage and family therapist” means an individual approved by the Board to practice clinical marriage and family therapy. “Licensed graduate marriage and family therapist” means an individual approved by the Board to practice graduate marriage and family therapy under the supervision of a Board-approved marriage and family therapy supervisor while fulfilling the supervised clinical experience for licensure under Health Occupations Article, §§17-303 and 17-309, Annotated Code of Maryland, and Regulation .04B of this chapter. “Licensed mental health care provider” means a: Licensed clinical marriage and family therapist; or Licensed clinical professional counselor, licensed clinical alcohol and drug counselor, licensed clinical professional art therapist, licensed certified social worker-clinical, psychiatrist, psychologist, or psychiatric nurse practitioner who is authorized by law to practice a health occupation that includes the diagnosis, prevention, treatment, and amelioration of psychological problems and emotional or mental conditions of individuals or groups. “Marriage and family therapy field” means a specific degree program with a marriage and family therapy emphasis, including, but not limited to, the following areas: Marriage and family therapy, including: Marriage and family counseling; Couple and family therapy; Couple and family counseling; Family and systems therapy; Family therapy; or Family counseling; Counseling practice under Health Occupations Article, Title 17, Annotated Code of Maryland; or Practice areas of other mental health providers, including: Psychiatry; Psychology; Social Work; Psychiatric nursing; or Any other program of study approved by the Board. “Practice clinical marriage and family therapy” means: To engage professionally and for compensation in marriage and family therapy and appraisal activities by providing services involving the application of therapy principles and methods in the diagnosis, crisis management, prevention, treatment, and amelioration of psychological problems, emotional conditions, or mental conditions of individuals or groups, including couples and families; and The use of instruments that require specialized psychological training for administration and interpretation as described in Health Occupations Article, §17-310, Annotated Code of Maryland. “Practice graduate marriage and family therapy” means to practice marriage and family therapy: Under the supervision of a Board-approved marriage and family therapy supervisor; and While fulfilling the requirements for supervised experience under: Health Occupations Article, §17-303, Annotated Code of Maryland; and Regulation .04 of this chapter. “Psychotherapy” means providing clinical services that involve: The professional application of psychotherapy and counseling theories and methods, including, but not limited to, psychodynamic, cognitive, behavioral, humanistic, systems theories, or trauma informed care to assist the client in: Improving functioning; Obtaining symptom relief; Preventing psychosocial dysfunction; Changing personality; or Maintaining improved functioning; and Situations in which the principal discourse involves, but is not limited to: Diagnosis of psychopathology based on standard diagnostic criteria; Psychotherapeutic treatment of mental disorders, emotional disorders, and adjustment reactions utilizing clinically appropriate treatment modalities; Childhood trauma and abuse; Identifying and changing self-defeating patterns of behaving, thinking, feeling, believing, or interacting with others in systems; Developmental issues; Personality development; or Problems related to disorders of thinking, emotional suffering, addictions, behavior, or interpersonal dysfunctions. “Related field” means a profession using counseling whose academic requirements include degree programs from an accredited college or university that has curricula in areas such as expressive therapy, gerontology, human services, marriage and family therapy, mental health, pastoral counseling, psychology, psychotherapy, social work, and other areas approved by the Board. “Relative” means an individual connected to another by: Blood; Marriage; Guardianship; or Domestic partnership. “Scope of competence” means that area within which the individual is proficient to practice, based on education, training, supervised experience, and professional credentials. “Substantially equivalent” means: A degree in a program of studies determined by the Board to have: Substantial marriage and family therapy emphasis in the subject matter; and The extent of training required for the specified level of licensure; and The applicant meets the relevant qualifications stated in Health Occupations Article, §17–303, Annotated Code of Maryland. “Supervised clinical experience in marriage and family therapy” means the provision of marriage and family therapy services conducted under the supervision of a Board-approved marriage and family therapy supervisor. “Supervisee” means a licensed graduate marriage and family therapist obtaining the supervised experience required by Health Occupations Article, §17-303, Annotated Code of Maryland. “Supervision” means a formalized professional relationship between a supervisor and supervisee in which the supervisor directs, guides, monitors, instructs, and evaluates the supervisee’s clinical marriage and family therapy practice while promoting development of the supervisee’s knowledge, skills, and abilities to provide clinical marriage and family therapy services in an ethical and competent manner and includes an acceptance of direct responsibility for the client services rendered by the supervisee. Supervision Training. “Supervision training” means a course or program designed to provide information regarding the supervision process utilized by licensed clinical marriage and family therapists in a variety of settings. “Supervision training” includes training obtained through: Graduate-level course work; Continuing education units (CEUs); or Other training hours approved by the Board. “Under the supervision of a Board-approved marriage and family therapy supervisor” means engaging in an ongoing process of receiving direction from a Board-approved supervisor that includes: Monitoring the performance of a supervisee; and Providing documented and direct consultation, guidance, and instruction with respect to clinical skill and competency. “Written contract for supervision” means an agreement between the supervisee and Board-approved supervisor that is initiated before beginning supervision and that details the scope of supervision and includes at a minimum the following: Name and credentials of the supervisor and the supervisee; Primary purpose, goals, and objectives of the supervision process; Details of provisions, including frequency, format, and case or chart review; Methods of documentation; Duties and responsibilities of the supervisor and the supervisee; Procedural considerations in the case of the supervisor’s absence; and Information regarding the supervisor’s scope of competence. In order to obtain a license, an applicant shall: Complete and return the Board-approved application; Submit an official transcript from an accredited educational institution awarding the highest degree attained in clinical marriage and family therapy or a related field; Pay all applicable fees set forth in COMAR 10.58.02; Submit to a criminal history background check in accordance with Health Occupations Article, §17-501.1, Annotated Code of Maryland; Be of good moral character; and Be at least 18 years old. Applications shall be acted upon as follows: Within 30 days after receipt of an application, the Board shall determine whether the application is complete; If the Board determines that the application is not complete, the Board shall send a notice of deficiency to the applicant; Upon receipt of the notice, the applicant shall correct the deficiency within 90 days, or other period specified in the notice; If the applicant fails to correct the deficiency within the required period, the application may lapse and the applicant shall be required to: Submit a new application; and Pay the nonrefundable fee set forth in COMAR 10.58.02; If the Board determines that an applicant is eligible to take the required examinations, the Board shall send a notice of approval to the applicant; Upon receipt of the approval notice, the applicant shall have 1 year from the date of the notice to take the examinations; and If the applicant fails to take the examinations within 1 year from the date of the approval notice, the requirements set forth under §B(4) of this regulation shall apply. To qualify for licensure as a graduate marriage and family therapist, an applicant shall have: One of the following from an accredited educational institution approved by the Board: For an applicant holding a master’s degree in marriage and family therapy, or a substantially equivalent program, completed a minimum of 60 semester credit hours or 90 graduate quarter credit hours; or For an applicant holding a doctoral degree in marriage and family therapy, or a substantially equivalent program, completed a minimum of 90 graduate semester credit hours or 135 graduate quarter credit hours; Completed a minimum of 45 graduate semester credit hours or 68 graduate quarter credit hours as required by Regulation .05B of this chapter; Of the graduate credit hours required by §A(1) and (2) of this regulation, completed a minimum of 45 credit hours in each of the following areas: A supervised clinical internship or practicum that includes at least 60 hours completed under the supervision of a Board-approved supervisor and 300 hours of direct client contact with couples, families, and individuals, at least 100 hours of which are relational therapy; Normal and abnormal personality development which includes individual development across the life span and the family life cycle; Psychopathology with emphasis on standard diagnostic manuals, as well as family systems models; Diagnosis and treatment of mental and emotional disorders in family systems; A comprehensive survey of the extant major models of family therapy; At least two courses which focus on a minimum of three marriage and family therapy models; A comprehensive survey of the extant, major models of couples therapy; An intensive study of at least three different models of couples therapy: One course covering gender and ethnicity as they relate to marriage and family theory and practice, or two separate courses with one focusing on gender issues and the other one on ethnicity as they relate to marriage and family therapy; Sexual issues in marriage and family therapy, including: Sexual normality; Sexual dysfunction; Sexual orientation; and Sexual identity; and Ethical, legal, and professional issues in marriage and family therapy; Met all of the requirements set forth under Regulation .03 of this chapter; Achieved a passing score on: A national certification exam approved by the Board; and An examination of: Health Occupations Article, Title 17, Annotated Code of Maryland; and This subtitle; and Complied with: Health Occupations Article, Title 17, Annotated Code of Maryland; and The code of ethics as set forth in COMAR 10.58.03. An applicant who fails an examination for licensure: May retake the exam if: It is within the time frame set by the applicable testing authority; or A waiver is approved by the Board to extend the testing deadline upon proof of exceptional circumstances; or Shall be required to: Submit a new application; and Pay the nonrefundable fee set forth in COMAR 10.58.02. The Board shall act upon applications as set forth under Regulation .03B of this chapter. A licensed graduate marriage and family therapist shall practice clinical marriage and family therapy under the supervision of a Board-approved marriage and family therapy supervisor. A licensed graduate marriage and family therapist may not: Practice independent of supervision; or Provide supervision. Expiration and Extension. The graduate marriage and family therapist license expires 2 years after the date issued. If a licensed graduate marriage and family therapist is unable to accumulate the required clinical hours for licensure as a clinical marriage and family therapist within 2 years, the licensed graduate marriage and family therapist may apply on a Board-approved form for a 2-year extension before the current license expires, up to a maximum of 6 years, except as provided in §F(4) of this regulation. For a licensed graduate marriage and family therapist who has been granted a 2-year extension, CEUs are not required for the first 2-year extension. Subsequent extensions approved by the Board shall be subject to the continuing education requirements in COMAR 10.58.05. If a licensed graduate marriage and family therapist notifies the Board in writing, the Board may grant, in certain circumstances, a license extension beyond the 6-year maximum as set forth in §F(2) of this regulation. Reinstatement. Within 5 calendar years after the license renewal date, the Board may reinstate the license of a licensed graduate marriage and family therapist otherwise entitled to reinstatement under Health Occupations Article, §17-505(b), Annotated Code of Maryland, whose license was not renewed for any reason, if the licensee: Completes within that 5-year period the minimum of 20 CEUs required for each year; and Pays the reinstatement fee set by the Board in COMAR 10.58.02. CEUs which are acquired in order to reinstate under COMAR 10.58.05.05 and .06 may be credited only once and may not be credited for any future renewals. For any licensed graduate marriage and family therapist whose license has expired more than 5 calendar years before the request for reinstatement, a new application for licensure shall be completed and the current licensure requirements shall be met. An individual who fails to reinstate licensure is not authorized to and may not practice graduate marriage and family therapy. To qualify for licensure as a clinical marriage and family therapist, an applicant shall have: A graduate marriage and family therapist license or other credential approved by the Board; Completed the course work requirements set forth under Regulation .04B of this chapter; Completed a minimum of 2 years and 2,000 hours of clinical experience in marriage and family therapy, of which: A minimum of the 1,000 hours shall be direct clinical therapy services; A maximum of 1,000 hours may consist of indirect clinical therapy services; A minimum of 2,000 hours of supervised clinical experience as a licensed graduate marriage and family therapist shall be completed after the awarding of the master's degree under a Board-approved supervisor; At least 80 percent of the requisite direct and indirect hours included as supervised clinical experience hours shall be completed under the supervision of a Board-approved marriage and family therapy supervisor who is a licensed clinical marriage and family therapist; and No more than 20 percent of the requisite direct and indirect hours included as supervised clinical experience hours shall be completed under the supervision of a Board-approved marriage and family therapy supervisor, as defined in Regulation .02B of this chapter, who is one of the following, provided the supervisor can document a minimum of 5 years’ experience delivering marriage and family therapy services: A licensed clinical alcohol and drug counselor; A licensed clinical professional counselor; A licensed clinical professional art therapist: or Another licensed mental health care provider as defined under Regulation .02B of this chapter and approved by the Board; and 100 hours of face-to-face clinical supervision hours shall be completed within 2 years of the awarding of the master’s degree, including: A minimum of 50 hours shall be individual face-to-face clinical supervision; and A maximum of 50 hours may be face-to-face group clinical supervision; Achieved a passing score on: A national certification exam approved by the Board; and An examination of: Health Occupations Article, Title 17, Annotated Code of Maryland; and This subtitle; Met all of the requirements set forth under Regulation .03 of this chapter; and Complied with: Health Occupations Article, Title 17, Annotated Code of Maryland; and The code of ethics as set forth in COMAR 10.58.03. An applicant who fails an examination for licensure: May retake the exam if: It is within the time frame set by the applicable testing authority; or A waiver is approved by the Board to extend the testing deadline upon proof of exceptional circumstances; or Shall be required to: Submit a new application; and Pay the nonrefundable fee set forth in COMAR 10.58.02. The Board shall act upon applications as set forth under Regulation .03B of this chapter. The Board may include hours of clinical supervised experience obtained in another jurisdiction toward the total 2,000 required hours of supervised experience required for the licensed clinical marriage and family therapist, if the clinical experience hours: Were obtained in accordance with the rules and regulations of that jurisdiction; and Included the course work requirements set forth under Regulation .06D of this chapter. Renewal. To renew a clinical marriage and family therapist license, the applicant shall: Submit a completed Board-approved application; Pay the required application fee set forth in COMAR 10.58.02; and Attest to completion of continuing education activities as specified in COMAR 10.58.05.05 and .06. A licensed clinical marriage and family therapist shall comply with the renewal requirements as provided in Health Occupations Article, §17–504, Annotated Code of Maryland. An individual who fails to renew licensure: Is not authorized to and may not practice clinical marriage and family therapy; and May be subject to sanctions pursuant to Health Occupations Article, §§17-513 and 17-604, Annotated Code of Maryland. Reinstatement. Within 5 calendar years after the license renewal date, the Board may reinstate the license of a licensed clinical marriage and family therapist otherwise entitled to reinstatement under Health Occupations Article, §17-505(b), Annotated Code of Maryland, whose license was not renewed for any reason, if the licensee: Completes within that 5-year period the minimum of 20 CEUs required for each year; and Pays the reinstatement fee set by the Board in COMAR 10.58.02. CEUs which are acquired in order to reinstate under COMAR 10.58.05.05 and.06 may be credited only once and may not be credited for any future renewals. For any licensed clinical marriage and family therapist whose license has expired more than 5 calendar years before the request for reinstatement, a new application for licensure shall be completed and the current licensure requirements shall be met. An individual who fails to reinstate licensure is not authorized to and may not practice clinical marriage and family therapy. Inactive Status. In accordance with Health Occupations Article, §17-505, Annotated Code of Maryland, a request to transfer a license to inactive status shall be granted upon receipt of the: Completed Board-approved application; and Payment of the required, nonrefundable, annual fee set forth in COMAR 10.58.02. An individual may apply for inactive status only if the individual’s license is still active at the time application for inactive status is made. An individual on inactive status is not authorized to and may not practice clinical marriage and family therapy. Within 5 calendar years after being placed on inactive status, an individual seeking to be reinstated to active status shall be required, as a condition of reinstatement, to submit proof of having completed 20 CEUs for each year of inactive status, at least 40 of which shall have been obtained within the 2-year period immediately preceding the application for reinstatement. If an individual on inactive status seeks to be reinstated beyond the required 5-year period and conditions set forth under §G(4) of this regulation, the individual shall be required to: Submit a new application; and Pay the nonrefundable fee set forth in COMAR 10.58.02. An applicant licensed as a clinical marriage and family therapist or its equivalent, as established by the Board, in another state, territory, or jurisdiction is eligible for licensure if the applicant: Provides: A completed Board-approved application; A copy of a current license from each state, territory, or jurisdiction in which the applicant has been licensed, registered, or otherwise authorized to practice clinical marriage and family therapy; Documentation, satisfactory to the Board, that the applicant is currently licensed in good standing to practice clinical marriage and family therapy in another state, territory, or jurisdiction; and Verification that the applicant has: No history of disciplinary action, past or pending, in a state, territory, or jurisdiction in which the applicant holds a license to practice clinical marriage and family therapy; and Not committed any act or omission that would be grounds for discipline or denial of licensure under Health Occupations Article, §17-509, Annotated Code of Maryland; Pays the application fee set forth in COMAR 10.58.02; Has achieved a passing score on an examination of: Health Occupations Article, Title 17, Annotated Code of Maryland; and This subtitle; Submits to a criminal history background check in accordance with Health Occupations Article, §17-501.1, Annotated Code of Maryland; Is of good moral character; and Complies with: Health Occupations Article, Title 17, Annotated Code of Maryland; and The code of ethics as set forth in COMAR 10.58.03. Waiver of Examination. The Board shall waive the requirements for an applicant: To pass a national certification examination; and Who meets the qualifications otherwise required by Health Occupations Article, Title 17, Annotated Code of Maryland, and this chapter. Except as otherwise specified in this chapter, this chapter does not apply to personnel or management practices associated with contractual relationships or employment. A supervisor shall: Supervise only in those areas within the supervisor’s competence, as determined by: Education; Training; and Experience; Provide supervision appropriate to the particular level of licensure being applied for or maintained; Provide supervision in the general content areas established in Health Occupations Article, §17-303, Annotated Code of Maryland; and Ensure that a supervisee has read and is knowledgeable about: Health Occupations Article, Title 17, Annotated Code of Maryland: and This subtitle, with special emphasis on the code of ethics under COMAR 10.58.03. In addition to the requirements of §B of this regulation, the supervisor shall specifically instruct and provide guidance relating to the supervisee’s scope of practice of clinical marriage and family therapy under Health Occupations Article, §17-101, Annotated Code of Maryland. The supervisor shall also instruct and provide guidance to supervisees in: Appropriate billing practices if applicable to the practice site, including: Financial record keeping and disclosure; and Establishment and disclosure to clients of: Fees for services; Payment arrangements; Payment plans; Financial services; and Terms and conditions of service; Providing services involving the application of therapy principles and methods in the diagnosis, prevention, treatment, and amelioration of psychological problems, emotional conditions, or mental conditions of individuals, families, couples, or groups, as stated in Health Occupations Article, §17-308, Annotated Code of Maryland; and Appropriate maintenance and destruction of clinical and financial records. The following individuals may not provide clinical supervision for a licensed graduate marriage and family therapy supervisee: A relative; A licensed graduate marriage and family therapist, licensed graduate alcohol and drug counselor, a certified alcohol and drug counselor, licensed graduate professional counselor, licensed graduate professional art therapist, or any other graduate-level health care provider licensed under Health Occupations Article, Annotated Code of Maryland; or An individual with whom there could be a conflict of interest, including, but not limited to, an employee supervising their own employer or a student supervising their own teacher. Licensure. An individual providing supervision shall be: Licensed by the Board as a clinical: Marriage and family therapist; Professional counselor; Alcohol and drug counselor; or Professional art therapist; or A licensed mental health care provider as defined in Regulation .02B of this chapter and approved by the Board. Education, Training, or Supervision Experience. A Board-approved supervisor, or any licensed mental health care provider as defined in Regulation .02B of this chapter who is approved by the Board and has completed 3 years of documented experience in clinical marriage and family therapy shall complete at least one of the following education and training experiences: 2 years of documented experience providing clinical supervision for marriage and family therapists working with families from a systemic perspective and conceptualizing family cases using a recognized family theoretical model; At least 3 graduate semester credit hours or 5 quarter credit hours of academic course work in clinical supervision; A graduate-level course in marriage and family therapy supervision; The American Association for Marriage and Family Therapy Approved Supervisor designation; or The American Association for Marriage and Family Therapy Supervisor in Training or Supervisor Candidate designation. In addition to the requirements of §B(1) of this regulation, a supervisor shall complete at least 6 semester credit hours or 10 quarter credit hours of graduate-level academic training in Theories of Couples and Family Therapy. Supervision training required by this section may be obtained in a graduate course as listed in §B(1) of this regulation and may include, but not be limited to: The role and responsibilities of the supervisor; The needs of the supervisee, supervisor, and the agency setting while maintaining a clear ethical perspective, including: The maintenance of appropriate boundaries; and Making clinically appropriate diagnoses; The role of the supervisor as gatekeeper to the profession; Methods for building effective and appropriate relationships with clients; Models for group supervision; and Models and modalities for practice intervention. Pre-Supervision Responsibilities of a Supervisor. In addition to meeting the requirements of this regulation, before beginning supervision, the Board-approved supervisor shall: File the completed Board-approved supervisor application form; Provide the supervisee with a copy of the Board’s licensed clinical marriage and family therapy approved supervisor letter; and Have an active license that is without restrictions or conditions due to disciplinary action for the 2 years preceding an application for licensed clinical marriage and family therapy Board-approved supervisor status. A supervisor may be an: Agency-designated supervisor; or Independent supervisor in private practice. A supervisor shall: Agree to and sign a written contract for supervision before initiating supervision; Ensure that the supervisee is practicing within the scope of the supervisee’s license; Determine the skill level at which the supervisee may practice; Focus on primary data from the supervisee’s practice; Maintain documentation, for at least 7 years, of supervisory sessions, including: Dates; Duration; and Focus of the supervisory sessions; Ensure that a supervisee has read and is knowledgeable about: Health Occupations Article, Title 17, Annotated Code of Maryland; and This subtitle with special emphasis on the code of ethics under COMAR 10.58.03; Within a reasonable period of time before termination of supervision, provide the supervisee and employer with a written notice of termination to avoid or minimize any harmful effect on the supervisee’s clients or patients; Be responsible for the clinical marriage and family therapy practices of supervisees; Provide: For emergency supervision and direction to a supervisee by a Board-approved supervisor; A written evaluation of progress to the supervisee on a regular basis or as needed; and A copy of the documentation required by §E of this regulation on request by the: Supervisee; or Board or its authorized agent; and Comply with a Board audit of a Board-approved supervisor’s compliance with regard to the supervisory requirements and responsibilities. A supervisee shall: Verify that the supervisee's supervisor has been approved by the Board; Agree to and sign a written contract for supervision before initiating supervision; Attend and participate in supervision as agreed to in the supervision contract; Prepare for supervision using case materials related to the supervisee’s clinical marriage and family therapy practice; Maintain documentation of supervisory sessions for at least 7 years, to be available for verification to the Board or its authorized agent, including: Dates; Duration; and Focus of the supervision; and Follow all terms of the written contract for supervision. A supervisee may not engage in the practice of clinical marriage and family therapy independent of supervision. A supervisee shall provide the client with a copy of a professional disclosure statement as required under Health Occupations Article, §17-507, Annotated Code of Maryland, that: Clearly states the marriage and family therapy services are provided under clinical supervision; and Provides the name of the supervisor with address and contact information. A supervisee shall obtain a signed informed consent for treatment form from the client which indicates that the client: Is aware that marriage and family therapy services are being provided under clinical supervision; and Consents to the recording of therapy sessions and the sharing of client information and, acknowledges that all these materials may be shared with: The Board-approved supervisor of record; or The instructor supervising an education-related practicum. Health Occupations Article, §§17-101, 17-205, 17-301, 17-303, 17-306, 17-308, 17-309, 17-507, and 17-509, Annotated Code of Maryland Effective date: Regulations .01—.05 adopted as an emergency provision effective October 1, 2001 (28:22 Md. R. 1932); adopted permanently effective January 21, 2002 (29:1 Md. R. 24) Regulation .02B amended as an emergency provision effective October 1, 2002 (29:25 Md. R. 1979); amended permanently effective March 3, 2003 (30:4 Md. R. 317) Regulation .06 adopted as an emergency provision effective October 1, 2002 (29:25 Md. R. 1979); adopted permanently effective March 3, 2003 (30:4 Md. R. 317) Regulation .07 adopted effective June 6, 2005 (32:11 Md. R. 983) Regulation .07 repealed and new Regulation .07 adopted effective May 17, 2010 (37:10 Md. R. 723) Chapter revised effective April 28, 2014 (41:8 Md. R. 473) Chapter revised effective April 4, 2022 (49:7 Md. R. 467) Regulation .06 amended effective November 24, 2025 (52:23 Md. R. 1140) This chapter establishes standards for the imposition of disciplinary sanctions and monetary penalties for violations of the Maryland Professional Counselors and Therapists Act, Health Occupations Article, §17-509, Annotated Code of Maryland by any: Licensed clinical professional counselor; Licensed graduate professional counselor; Licensed clinical alcohol and drug counselor; Licensed graduate alcohol and drug counselor; Licensed clinical marriage and family therapist; Licensed graduate marriage and family therapist; Licensed clinical art therapist; Licensed graduate art therapist; Certified professional counselor; Certified professional counselor-alcohol and drug; Certified professional counselor-marriage and family therapist; Certified associate counselor-alcohol and drug; or Certified supervised counselor-alcohol and drug. In this chapter, the following terms have the meanings indicated. Terms Defined. “Act” means the Maryland Professional Counselors and Therapists Act. “Board” means the State Board of Professional Counselors and Therapists. “License” means one of eight types of licenses issued by the Board to practice as follows: Clinical professional counseling (LCPC); Clinical marriage and family therapy (LCMFT); Clinical alcohol and drug counseling (LCADC); Clinical professional art therapy (LCPAT); Graduate professional counseling (LGPC); Graduate marriage and family therapy (LGMFT); Graduate alcohol and drug counseling (LGADC); or Graduate professional art therapy (LGPAT). “Licensee” means: A clinical or graduate professional counselor; A clinical or graduate marriage and family therapist; A clinical or graduate alcohol and drug counselor; or A clinical or graduate professional art therapist who is licensed by the Board to practice clinical counseling, clinical marriage and family therapy, clinical alcohol and drug counseling or clinical professional art therapy. “Certificate” means a certificate issued by the Board to practice as a: Certified professional counselor (CPC); Certified professional counselor-alcohol and drug (CPC-AD); Certified professional counselor-marriage and family therapy (CPC-MFT); Certified associate counselor-alcohol and drug (CAC-AD); or Certified supervised counselor-alcohol and drug (CSC-AD). “Certificate holder” means a: Certified professional counselor; Certified alcohol and drug counselor; Certified supervised alcohol and drug counselor; Certified associate alcohol and drug counselor; or Certified professional counselor-marriage and family therapist. “Penalty” means a monetary penalty or fine. “Sanction” means a formal disciplinary action such as a reprimand, probation, suspension or revocation. If, after a hearing or an opportunity for a hearing under Health Occupations Article, §17-511, Annotated Code of Maryland, the Board finds that there are grounds for discipline under Health Occupations Article, §17-509, Annotated Code of Maryland, the Board may place any licensee or certificate holder on probation, reprimand any licensee or certificate holder, or suspend or revoke a license or certificate. In addition to placing the licensee or certificate holder on probation, reprimanding the licensee or certificate holder, or suspending or revoking the license or certificate, the Board may impose a penalty as set forth in this chapter. General Application of Sanctioning Guidelines. Except as provided in Regulation .05 of this chapter, for violations of the Act listed in the sanctioning guidelines, the Board shall impose a sanction not less severe than the minimum listed in the sanctioning guidelines or more severe than the maximum listed in the guidelines for each offense. Ranking of Sanctions. For the purposes of this regulation, the severity of sanctions is ranked as follows, from the least severe to the most severe: Reprimand; Probation; Suspension; and Revocation. A stayed suspension in which the stay is conditioned on the completion of certain requirements is ranked as probation. A stayed suspension not meeting the criteria of §B(2) of this regulation is ranked as a reprimand. A penalty listed in the sanctioning guidelines may be imposed in addition to but not as a substitute for a sanction. The addition of a penalty does not change the ranking of the severity of the sanction. The Board may impose more than one sanction provided that the most severe sanction neither exceeds the maximum nor is less than the minimum sanction permitted in the chart. Any sanction may be accompanied by conditions reasonably related to the offense or to the rehabilitation of the offender. The inclusion of conditions does not change the ranking of the sanction. If a licensee or certificate holder is found in violation of more than one ground for discipline as enumerated in this chapter, the sanction with the highest severity ranking shall be used to determine which ground will be used in developing a sanction and the Board may impose concurrent sanctions based on other grounds violated. Notwithstanding the guidelines set forth in this chapter, in order to resolve a pending disciplinary action, the Board and licensee or certificate holder may agree to a surrender of license or certificate or to a consent order with terms, sanction, and penalty agreed to by the Board and the licensee or certificate holder. If the Board imposes a sanction that departs from the sanctioning guidelines set forth in this chapter, the Board shall state its reasons for doing so in its final decision and order. Depending on the facts and circumstances of each case, and to the extent that the facts and circumstances apply, the Board may consider mitigating and aggravating factors in determining whether the sanction in a particular case should fall outside the range of sanctions established by the guidelines. Nothing in this regulation requires the Board or an Administrative Law Judge to make findings of fact with respect to any of these factors. A departure from the guidelines set forth in this chapter is not a ground for any hearing or appeal of a Board action. The existence of one or more of these factors does not impose on the Board or an Administrative Law Judge any requirement to articulate its reasoning for not exercising its discretion to impose a sanction outside of the range of sanctions set forth in this chapter. The absence of a prior disciplinary record; The offender self-reported the violation to the Board; The offender’s full and voluntary admissions of misconduct to the Board and cooperation during Board proceedings; The offender implemented remedial measures to correct or mitigate the harm arising from the misconduct; The offender made timely good-faith efforts to make restitution or to rectify the consequences of the misconduct; The offender has been rehabilitated or exhibits rehabilitative potential; The absence of premeditation to commit the misconduct; The absence of potential harm to patients or the public or other adverse impact; or The offender’s conduct was an isolated incident and is not likely to recur. Mitigating factors may include, but are not limited to, the following: The absence of a prior disciplinary record; The offender self-reported the violation to the Board; The offender’s full and voluntary admissions of misconduct to the Board and cooperation during Board proceedings; The offender implemented remedial measures to correct or mitigate the harm arising from the misconduct; The offender made timely good-faith efforts to make restitution or to rectify the consequences of the misconduct; The offender has been rehabilitated or exhibits rehabilitative potential; The absence of premeditation to commit the misconduct; The absence of potential harm to patients or the public or other adverse impact; or The offender’s conduct was an isolated incident and is not likely to recur. Aggravating factors may include, but are not limited to, the following: The offender has a previous criminal or administrative disciplinary history; The violation was committed deliberately or with gross negligence or recklessness; The violation had the potential for, or caused, serious patient or public harm; The violation was part of a pattern of detrimental conduct; The offender was motivated to perform the violation for financial gain; The vulnerability of the clients; The offender lacked insight into the wrongfulness of the conduct; The offender committed the violation under the guise of treatment; The offender attempted to hide the error or misconduct from patients or others; The offender did not cooperate with the investigation; or Previous attempts at rehabilitation of the offender were unsuccessful. Subject to the provisions of Regulations .04 and .05 of this chapter, the Board may impose sanctions and penalties for violations of the Act and regulations according to the guidelines set forth in the following chart: Range of Sanctions. A licensee or certificate holder shall pay to the Board a penalty imposed under this chapter as of the date the Board's order is issued, unless the Board's order specifies otherwise. Filing an appeal under State Government Article, §10-222, Annotated Code of Maryland, or Health Occupations Article, §17-512, Annotated Code of Maryland, does not automatically stay payment of a penalty imposed by the Board under this chapter. If a licensee or certificate holder fails to pay, in whole or in part, a penalty imposed by the Board under this chapter, the Board may not restore, reinstate, or renew a license until the penalty has been paid in full. In its discretion, the Board may refer all cases of delinquent payment to the Central Collection Unit of the Department of Budget and Management to institute and maintain proceedings to ensure prompt payment. The Board shall pay all monies collected under this chapter into the State's General Fund. Health Occupations Article, §§1-606, 17-313.1, and 17-509—17-511, Annotated Code of Maryland Effective date: November 7, 2005 (32:22 Md. R. 1757) Chapter revised effective November 11, 2013 (40:22 Md. R. 1877) The Board may find that a compelling public purpose warrants disclosure of information in a certification, licensing, or investigative file, regardless of whether there has been a request for the information, and may disclose the information under the following circumstances: The information concerns possible criminal activity and is disclosed to a federal, state, or local law enforcement or prosecutorial official or authority; The information concerns a possible violation of law and is disclosed to a federal, state, or local authority that has jurisdiction over the individual whose conduct may be a violation and the information disclosed is limited to information relevant to the possible violation by that individual; or The information concerns conduct by an individual which the Board reasonably believes may pose a risk to the public health, safety, or welfare and is disclosed to a law enforcement authority, administrative official, or agency that regulates the individual, or to a hospital or other health care facility where the individual has privileges. This chapter does not prevent or limit the ability of the Board to disclose general licensing information as provided in General Provisions Article, §4-333, Annotated Code of Maryland, or any information which the Board may otherwise disclose by law. General Provisions Article, §4-333; Health Occupations Article, §17-205; Annotated Code of Maryland Effective date: December 24, 2001 (28:25 Md. R. 2192) This chapter applies to licensees who practice clinical professional counseling, clinical marriage and family therapy, and clinical alcohol and drug counseling in this State. This chapter establishes standards for engaging in advanced assessment activities using instruments that require specialized psychological training for administration and interpretation. In this chapter, the following terms have the meanings indicated. Terms Defined. “Advanced assessment” means to use instruments that require specialized psychological training for administration and interpretation. Face-to-Face Supervision. “Face-to-face supervision” means in the physical presence of the individuals involved in the supervisory relationship during supervision. “Face-to-face supervision” does not include: Telephone supervision; or Video conferencing. Internet communication. “Supervisor who is proficient in the use of advanced assessment tests” means a licensed mental health professional approved by the Board, who: Under Health Occupations Article, §§17-302, 17-303, and 17-304, Annotated Code of Maryland: Is qualified to practice clinical alcohol and drug counseling, clinical marriage and family therapy, or clinical professional counseling; Has completed the courses and supervised experience required by Health Occupations Article, §17-310(1) and (2), Annotated Code of Maryland; Has passed the National Counselors Examination (NCE) or another examination, as determined by the Board, that includes a comparable number of items assessing knowledge of advanced assessment procedures; and Has 2 years experience practicing as a licensed clinical professional counselor, a licensed clinical marriage and family therapist, or a licensed clinical alcohol and drug counselor; or Has 2 years of documented, professional experience in psychological testing or advanced assessment, as approved by the Board, using the modalities, principles, and procedures of advanced assessment, including, but not limited to: Teaching; Counseling; Clinical practice; and Research modalities. License. To engage in advanced assessment activities under this chapter, a licensee shall hold an active license in this State as a: Licensed clinical professional counselor; Licensed clinical marriage and family therapist; Licensed clinical alcohol and drug counselor; or Licensed clinical professional art therapist. Education and Training. A licensee may engage in advanced assessment activities as defined in this chapter if the licensee has obtained a doctoral or master’s degree in counseling or a related field that includes a minimum of nine graduate courses of at least 3 semester hours or 5 quarter credit hours in each of the following courses listed in §B(2)—(10) of this regulation. Psychopathology. Studies in this area shall include, but are not limited to, the scientific study of mental disorders and principles of abnormal psychology. Biological Bases of Behavior. Studies in this area shall include, but are not limited to, the biological, physiological, and neurological aspects of behavioral and mental disorders. Research Methods. Studies in this area shall include, but are not limited to, research methods for and principles of performing qualitative and quantitative research in the social sciences. Advanced Statistics. Studies in this area shall include, but are not limited to, the following: Parametric and nonparametric statistics; Multivariate statistical methods, correlation, regression, factor analysis, and discriminate analysis; and Use of computers for data management and analysis. Tests and Measures. Studies in this area shall include, but are not limited to, the following: Test construction; Evaluation and documentation; Fairness in testing; and Testing applications. Intellectual Assessment. Studies in this area shall include, but are not limited to, the construction, standardization, administration, scoring, and interpretation of intelligence tests. Personality Assessment. Studies in this area shall include, but are not limited to, the construction, standardization, scoring, and interpretation of personality tests. Ethics. Studies in this area shall include, but are not limited to the ethical, legal, and professional standards related to assessment and the practice of professional counseling or therapy. Practicum in Advanced Assessment. Studies in this area shall include, but are not limited to the following: Practice with clients in the use of advanced assessment tests; Practice in the scoring, interpretation, and reporting of results; and Practice in the integration of advanced assessment results with other sources of client information. Supervision. In order to engage in advanced assessment activities as defined in this chapter, a licensee shall also complete 500 hours of supervised, direct, client-related, advanced assessment testing that is fulfilled in not less than 2 years and after the award of the master’s degree, of which a minimum of 100 hours shall include face-to-face supervision by a supervisor who is proficient in the use of advanced assessment tests. Examination. In addition to meeting the requirements in §§A—C of this regulation, the licensee shall pass the National Counselors Examination (NCE) or another examination, as determined by the Board, that includes a comparable number of items assessing knowledge of advanced assessment procedures. Complaint. In the event the Board receives a complaint regarding a licensee’s engagement in the practice of advanced assessment or the use of instruments that require specialized psychological training for administration and interpretation, a licensee shall demonstrate compliance with the education, supervision, and examination requirements set forth in this chapter. Health Occupations Article, §17-310, Annotated Code of Maryland Effective date: November 15, 2010 (37:23 Md. R. 1611) Regulation .03A amended effective December 31, 2018 (45:26 Md. R. 1246) This chapter: Establishes the requirements for an individual to practice clinical professional counseling; Establishes standards of supervision and the responsibilities of supervisors and supervisees in the practice of clinical professional counseling; Applies to licensees who: Practice clinical professional counseling; and Provide supervision for licensed graduate professional counseling; and Applies to licensed graduate professional counselors who are in the process of obtaining the supervised clinical experience required by Health Occupations Article, §17-304.1, Annotated Code of Maryland. In this chapter, the following terms have the meanings indicated. Terms Defined. “Accredited educational institution” means a Board-approved college or university accredited by a national or regional accrediting body recognized by the Council on Post-Secondary Accreditation or through one of the following bodies recognized by the U.S. Department of Education: The Middle States Association of Colleges and Schools — the Commission on Higher Education; The New England Association of Schools and Colleges; The North Central Association of Schools and Colleges; The Northwest Association of Schools and of Colleges and Universities; The Southern Association of Colleges and Schools; or The Western Association of Colleges and Schools. “Appraisal” means: Selecting, administering, scoring, and interpreting instruments designed to assess an individual's aptitudes, attitudes, abilities, achievements, interests, and personal characteristics; and Using nonstandardized methods and techniques for understanding human behavior in relation to coping with, adapting to, or changing life situations. “Board-approved supervisor” means: A licensed clinical professional counselor, licensed clinical marriage and family therapist, licensed clinical professional art therapist, or licensed clinical alcohol and drug counselor who meets the requirements for licensure under this chapter, and has been approved by the Board; or An individual who is authorized by law to practice a health occupation, which includes the diagnosis, prevention, treatment, and amelioration of psychological problems and emotional or mental conditions of individuals or groups, and has been approved by the Board. “Client contact hour” means at least 45 minutes of direct session time with a client present. “Clinical supervision hour” means at least 45 minutes of direct supervision time with the supervisee present. “Direct clinical counseling services” means the provision of face-to-face clinical professional counseling services to clients and their significant others that includes, but is not limited to the following: Individual counseling; Group counseling; Family counseling; Couples counseling; Evaluation; Intake or Assessment; Diagnosis; Treatment planning with a client; and Crisis management or intervention. Face-to-Face. “Face-to-face” means in the physical presence of an individual or using video conferencing which allows individuals to hear and see each other in synchronous points of time. “Face-to-face” does not include: Telephone communication; or Internet communication that does not involve synchronous video conferencing, such as instant messaging services and social networking sites. “Indirect clinical counseling services” means all case management and professional development activities related to the provision of clinical professional counseling services to a client that include, but are not limited to, the following: Referral; Intake or assessment by telephone or other means when client is not face-to-face; Receiving individual and group supervision at site or at the university; Consultation with other professionals; Treatment planning with other professionals; Case staffing; Staff meetings; Related trainings and seminars; Record keeping; Report writing; Case note taking; Providing clinical training; Telephone triage; Case management; Program development; and Other clinical professional counselor administrative duties as required by the setting in which the clinical hours are accrued. “Licensed clinical professional counselor” means an individual approved by the Board to practice clinical professional counseling. “Licensed graduate professional counselor” means an individual approved by the Board to practice graduate professional counseling: Under the supervision of a Board-approved supervisor; and While fulfilling the supervised clinical experience for licensure under: Health Occupations Article, §17-304, Annotated Code of Maryland; and Regulation .04 of this chapter. “Practice clinical professional counseling” means: To engage professionally and for compensation in clinical professional counseling and appraisal activities by providing services involving the application of clinical professional counseling principles and methods in the diagnosis, crisis management, prevention, treatment, and amelioration of psychological problems, and emotional or mental conditions of individuals or groups; and The use of instruments that require specialized psychological training for administration and interpretation as described in Health Occupations Article, §17-310, Annotated Code of Maryland. “Practice graduate professional counseling” means to practice clinical professional counseling: Under the supervision of a Board-approved supervisor; and While fulfilling the requirements for supervised experience under: Health Occupations Article, §17-304, Annotated Code of Maryland; and Regulation .04 of this chapter. “Psychotherapy” means providing clinical services which involve: The professional application of psychotherapy and counseling theories and methods, including but not limited to psychodynamic, cognitive, behavioral, humanistic, systems theories, or trauma informed care to assist the client in: Improving functioning; Obtaining symptom relief; Preventing psychosocial dysfunction; Changing personality; or Maintaining improved functioning; and Situations in which the principal discourse involves, but is not limited to: Diagnosis of psychopathology based on standard diagnostic criteria; Psychotherapeutic treatment of mental disorders, emotional disorders, and adjustment reactions utilizing clinically appropriate treatment modalities; Childhood trauma and abuse; Identifying and changing self-defeating patterns of behaving, thinking, feeling, believing, or interacting with others in systems; Developmental issues; Personality development; or Problems related to disorders of thinking, emotional suffering, addictions, behavior, or interpersonal dysfunctions. “Related field” means a profession using counseling whose academic requirements include degree programs from an accredited college or university that has curricula in areas such as expressive therapy, gerontology, human services, marriage and family therapy, mental health, pastoral counseling, psychology, psychotherapy, social work, and other areas approved by the Board. “Relative” means an individual connected to another by: Blood; Marriage; Guardianship; or Domestic partnership. “Supervised clinical experience in clinical professional counseling” means counseling services conducted under the supervision of a Board-approved supervisor. “Supervisee” means a licensed graduate professional counselor obtaining the supervised experience required by Health Occupations Article, §17-304, Annotated Code of Maryland. “Supervision” means a formalized professional relationship between a supervisor and supervisee in which the supervisor directs, guides, monitors, instructs, and evaluates the supervisee’s clinical professional counseling practice while promoting development of the supervisee’s knowledge, skills, and abilities to provide clinical professional counseling services in an ethical and competent manner and includes an acceptance of direct responsibility for the client services rendered by the supervisee. Supervision Training. “Supervision training” means a course or program designed to provide information regarding the clinical supervision process utilized by licensed clinical professional counselors in a variety of settings. “Supervision training” includes training obtained through: Graduate-level course work; Continuing education units (CEUs); or Other training hours approved by the Board. “Under the supervision of a Board-approved supervisor” means engaging in an ongoing process of receiving direction from a Board-approved supervisor that includes: Monitoring the performance of a supervisee; and Documented and direct consultation, guidance, and instruction with respect to clinical skill and competency. “Written contract for supervision” means a Board-approved agreement between the supervisee and approved supervisor that is initiated before beginning supervision and that details the scope of supervision and includes at a minimum the following: Name and credentials of the supervisor and the supervisee; Primary purpose, goals, and objectives of the supervision process; Details of provisions, including frequency, format, and case or chart review; Methods of documentation; Duties and responsibilities of the supervisor and the supervisee; Procedural considerations in the case of the supervisor’s absence; and Information regarding the supervisor’s scope of competence. In order to obtain a license, an applicant shall: Complete and return the Board-approved application; Submit an official transcript from an accredited educational institution awarding the highest degree attained in a clinical professional counseling or related field; Pay all applicable fees set forth in COMAR 10.58.02; Submit to a criminal history background check in accordance with Health Occupations Article, §17-501.1, Annotated Code of Maryland; Be of good moral character; and Be at least 18 years old. Applications shall be acted upon as follows: Within 30 days after receipt of an application, the Board shall determine whether the application is complete; If the Board determines that the application is not complete, the Board shall send a notice of deficiency to the applicant; Upon receipt of the notice, the applicant shall correct the deficiency within 90 days, or other period specified in the notice; If the applicant fails to correct the deficiency within the required period, the application may lapse and the applicant shall be required to: Submit a new application; and Pay the nonrefundable fee set forth in COMAR 10.58.02; If the Board determines that an applicant is eligible to take the required examinations, the Board shall send a notice of approval to the applicant; Upon receipt of the approval notice, the applicant shall have 1 year from the date of the notice to take the examinations; and If the applicant fails to take the examinations within 1 year from the date of the approval notice, the requirements set forth under §B(4) of this regulation shall apply. To qualify for licensure as a graduate professional counselor, an applicant shall have: Completed one of the following from an accredited educational institution: A master's degree in a clinical professional counseling or related field with: A minimum of 60 graduate semester credit hours, or, if the master’s program provides less than 60 graduate semester credit hours, requirements may be met by completing additional graduate courses as approved by the Board; or 90 graduate quarter credit hours; or A doctoral degree in a clinical professional counseling or related field with: A minimum of 90 graduate semester credit hours; or 135 graduate quarter credit hours; Completed a minimum of 3 semester credit hours or the equivalent quarter credit hours of course work in each of the following course content areas: Human growth and personality development; Social and cultural foundations of counseling; Counseling theory; Counseling techniques; Group dynamics, processing, and counseling; Lifestyle and career development; Appraisal; Research and evaluation; Professional, legal, and ethical responsibilities; Marriage and family therapy; Supervised field experience that includes a: Supervised clinical internship, externship, field experience, or practicum placement; and Minimum of 125 direct clinical counseling service hours; Alcohol and drug counseling; Psychopathology; and Diagnosis and treatment of mental and emotional disorders; Achieved a passing score on: A national certification exam approved by the Board; and An examination of: Health Occupations Article, Title 17, Annotated Code of Maryland; and This subtitle; Met all of the requirements set forth under Regulation .03 of this chapter; and Complied with: Health Occupations Article, Title 17, Annotated Code of Maryland; and The code of ethics as set forth in COMAR 10.58.03. An applicant who fails an examination for licensure: May retake the exam if: It is within the time frame set by the applicable testing authority; or A waiver is approved by the Board to extend the testing deadline upon proof of exceptional circumstances; or Shall be required to: Submit a new application; and Pay the nonrefundable fee set forth in COMAR 10.58.02. The Board shall act upon applications as set forth under Regulation .03B of this chapter. A licensed graduate professional counselor shall practice clinical professional counseling under the supervision of a Board-approved supervisor. A licensed graduate professional counselor may not: Practice independent of supervision; or Provide supervision. Expiration and Extension. The graduate professional counselor license expires 2 years after the date issued. If the graduate professional counselor licensee is unable to accumulate the required clinical hours for licensure as a clinical professional counselor in 2 years, the graduate professional counselor may apply on a Board-approved form for a 2-year extension before the current license expiration, up to a maximum of 6 years, except as provided in §F(4) of this regulation. For a graduate professional counselor who has been granted a 2-year extension, CEUs are not required for the first 2-year extension. Subsequent extensions approved by the Board shall be subject to the continuing education requirements in COMAR 10.58.05. A graduate professional counselor shall submit a written request for an extension beyond the 6-year maximum, which the Board may grant in certain circumstances. Reinstatement. Within 5 calendar years after the license renewal date, the Board may reinstate the license of a licensed graduate professional counselor otherwise entitled to reinstatement under Health Occupations Article, §17-505(b), Annotated Code of Maryland, whose license was not renewed for any reason, if the licensee: Completes within that 5-year period the minimum of 20 CEUs required for each year; and Pays the reinstatement fee set by the Board in COMAR 10.58.02. CEUs which are acquired in order to reinstate under COMAR 10.58.05.05 and.06 may be credited only once and may not be credited for any future renewals. For any licensed graduate professional counselor whose license has expired more than 5 calendar years before the request for reinstatement, a new application for licensure shall be completed and the current licensure requirements shall be met. An individual who fails to reinstate licensure is not authorized to and may not practice graduate professional counseling. To qualify for licensure as a clinical professional counselor the applicant shall have: A graduate professional counselor license or other credential approved by the Board; For an applicant holding a master’s degree, completed a minimum of 3 years and 3,000 hours of experience in clinical professional counseling, of which: A minimum of the 1,500 hours shall be direct clinical counseling services; A maximum of 1,500 hours may consist of indirect clinical counseling services; A minimum of 2,000 hours of supervised clinical experience as a licensed graduate professional counselor shall be completed after the awarding of the master's degree under a Board-approved supervisor; A maximum of 1,000 hours of supervised clinical experience may be acquired as supervised field experience as defined under Regulation .04A(2)(k) of this chapter; At least half of the requisite direct and indirect hours included as supervised clinical experience hours shall be completed under the supervision of a Board-approved supervisor who is a licensed clinical professional counselor; No more than half of the requisite direct and indirect hours included as supervised clinical experience hours shall be completed under a Board-approved supervisor as defined in Regulation .02Bof this chapter; and 100 hours of face-to-face clinical supervision hours shall be completed within 2 years of the awarding of the master’s degree, of which: A minimum of 50 hours shall be individual face-to-face clinical supervision; and A maximum of 50 hours may be face-to-face group clinical supervision; For an applicant holding a doctoral degree, completed a minimum of 2,000 hours of experience in clinical professional counseling, of which: A minimum of 1,000 hours shall be face-to-face direct clinical counseling services and a maximum of 1,000 hours may consist of indirect clinical counseling services; 1,000 hours shall be acquired after the doctoral degree has been awarded; A maximum of 1,000 hours of clinical experience may be acquired before the awarding of the doctoral degree; At least half of the requisite direct and indirect hours included as supervised clinical experience hours shall be completed under the supervision of a Board-approved supervisor who is a licensed clinical professional counselor; No more than half of the requisite direct and indirect hours included as supervised clinical experience hours shall be completed under a Board-approved supervisor as defined in Regulation .02Bof this chapter; and 50 hours of face-to-face clinical supervision hours shall be completed within 1 year of the awarding of the doctoral degree, including: 25 hours shall be individual face-to-face clinical supervision; and A maximum of 25 hours may be face-to-face group clinical supervision; Completed the required course work set forth under Regulation .04A(2) of this chapter; Achieved a passing score on: A national certification exam approved by the Board; and An examination of: Health Occupations Article, Title 17, Annotated Code of Maryland; and This subtitle; Met all of the requirements set forth under Regulation .03 of this chapter; and Complied with: Health Occupations Article, Title 17, Annotated Code of Maryland; and The code of ethics as set forth in COMAR 10.58.03. An applicant who fails an examination for licensure: May retake the exam if: It is within the time frame set by the applicable testing authority; or A waiver is approved by the Board to extend the testing deadline upon proof of exceptional circumstances; or Shall be required to: Submit a new application; and Pay the nonrefundable fee set forth in COMAR 10.58.02. The Board shall act upon applications as set forth under Regulation .03B of this chapter. The Board may include hours of clinical supervised experience obtained in another jurisdiction toward the total 3,000 required hours of supervised experience required for the licensed clinical professional counselor, if the clinical experience hours: Were obtained in accordance with the rules and regulations of that jurisdiction; and Included the course work requirements set forth under Regulation .06D of this chapter. Renewal. To renew a clinical professional counselor license, the applicant shall: Submit a completed Board-approved application; Pay the required application fee set forth in COMAR 10.58.02; and Attest to completion of continuing education activities as specified in COMAR 10.58.05.05 and .06. A licensed clinical professional counselor shall comply with the renewal requirements as provided in Health Occupations Article, §17–504, Annotated Code of Maryland. An individual who fails to renew licensure is not authorized to and may not practice clinical professional counseling. Reinstatement. Within 5 calendar years after the license renewal date, the Board may reinstate the license of a licensed clinical professional counselor otherwise entitled to reinstatement under Health Occupations Article, §17-505(b), Annotated Code of Maryland, whose license was not renewed for any reason, if the licensee: Completes within that 5-year period the minimum of 20 CEUs required for each year; and Pays the reinstatement fee set by the Board in COMAR 10.58.02. CEUs which are acquired in order to reinstate under COMAR 10.58.05.05 and .06 may be credited only once and may not be credited for any future renewals. For any licensed clinical professional counselor whose license has expired more than 5 calendar years before the request for reinstatement, a new application for licensure shall be completed and the current licensure requirements shall be met. An individual who fails to reinstate licensure is not authorized to and may not practice clinical professional counseling. Inactive Status. In accordance with Health Occupations Article, §17-505, Annotated Code of Maryland, a request to transfer a license to inactive status shall be granted upon receipt of the: Completed Board-approved application; and Payment of the required, nonrefundable, annual fee set forth in COMAR 10.58.02. An individual may apply for inactive status only if the individual’s license is still active at the time application for inactive status is made. An individual on inactive status is not authorized to and may not practice clinical professional counseling. Within 5 calendar years after being placed on inactive status, an individual seeking to be reinstated to active status shall be required, as a condition of reinstatement, to submit proof of having completed 20 CEUs for each year of inactive status, at least 40 of which shall have been obtained within the 2-year period immediately preceding the application for reinstatement. If an individual on inactive status seeks to be reinstated beyond the required 5-year period and conditions set forth under §G(4) of this regulation, the individual shall be required to: Submit a new application; and Pay the nonrefundable fee set forth in COMAR 10.58.02. An applicant licensed as a clinical professional counselor or its equivalent, as established by the Board, in another state, territory, or jurisdiction is eligible for licensure if the applicant: Provides: A completed Board-approved application; An official transcript from the educational institution which awarded the master’s or doctoral degree; A copy of a current license from each state, territory, or jurisdiction in which the applicant has been licensed, registered, or otherwise authorized to practice clinical professional counseling; Documentation, satisfactory to the Board, that the applicant is currently licensed in good standing to practice clinical professional counseling in another state, territory, or jurisdiction; and Verification that the applicant has: No history of disciplinary action, past or pending, in a state, territory, or jurisdiction in which the applicant holds a license to practice clinical professional counseling; and Not committed any act or omission that would be grounds for discipline or denial of licensure under Health Occupations Article, §17-509, Annotated Code of Maryland; Pays the application fee set forth in the COMAR 10.58.02; Has achieved a passing score on: A national certification examination approved by the Board; and An examination of: Health Occupations Article, Title 17, Annotated Code of Maryland; and COMAR 10.58; Submits to a criminal history background check in accordance with Health Occupations Article, §17-501.1, Annotated Code of Maryland; Meets the educational requirements for licensure in this State as a clinical professional counselor: As established in Regulation .05 of this chapter; or By providing documentation of the substitute educational and experience requirements outlined in §§B—E of this regulation; Is of good moral character; and Complies with: Health Occupations Article, Title 17, Annotated Code of Maryland; and The code of ethics as set forth in COMAR 10.58.03. Waiver of Examination. The Board may waive any examination requirements for an applicant who satisfies the Board that the applicant: Obtained licensure in a state or country that grants a similar endorsement to licensees of this State; Became licensed in another state or country after passing an examination approved by the Board; and Meets the qualifications otherwise required by Health Occupations Article, Title 17, Annotated Code of Maryland, and this chapter. Equivalent Educational Requirements. The applicant shall provide documentation or transcripts confirming completion of a master's or doctoral degree in a professional counseling field from an accredited educational institution. Waiver of Course Requirements. The Board may waive one or more course requirements specified in Regulation .04 of this chapter, except for documentation showing completion of a minimum of 3 graduate semester credit hours or the equivalent graduate quarter hours covering each of the following primary topics or content areas: Diagnosis and psychopathology; Psychotherapy and treatment of mental and emotional disorders, as described in Regulation .02Bof this chapter; and Professional, legal, and ethical responsibilities. Equivalent Experience Requirements. The Board may waive the clinical experience requirements specified in Regulation .04 of this chapter as follows: The applicant shall provide documentation, satisfactory to the Board, of one of the following for an applicant with: A master's degree consisting of: A minimum of 60 graduate credit hours; and Not less than 3 years, with a minimum of 3,000 hours, of supervised clinical experience in clinical professional counseling, 2 years of which shall be completed after the award of the master's degree; A master's degree consisting of: Less than 60 graduate credit hours; and Not less than 3 years’ experience practicing as a licensed clinical professional counselor, with a minimum of 3,000 hours of clinical professional counseling experience; or A doctoral degree consisting of: Not less than 2 years practicing as a clinical professional counselor; or A minimum of 2,000 hours of clinical professional counseling experience; and The applicant shall provide verification, on a Board-approved form, from employers, supervisors, or colleagues that the applicant has practiced clinical professional counseling for the length of time stated in §E(1) of this regulation. Except as otherwise specified in this chapter, this chapter does not apply to personnel or management practices associated with contractual relationships or employment. A supervisor shall: Supervise only in those areas within the supervisor’s competence as determined by education, training, and experience; Provide supervision appropriate to the particular level of licensure being applied for or maintained; Provide supervision in the general content areas established in Health Occupations Article, §17-304, Annotated Code of Maryland; and Ensure that a supervisee has read and is knowledgeable about: Health Occupations Article, Title 17, Annotated Code of Maryland; and This subtitle, with special emphasis on the code of ethics under COMAR 10.58.03. In addition to the requirements of §B of this regulation, the supervisor shall specifically instruct and provide guidance: Relating to the supervisee’s scope of practice of clinical professional counseling under Health Occupations Article, §17-101, Annotated Code of Maryland; For services involving the application of therapy principles and methods in the diagnosis, prevention, treatment, and amelioration of psychological problems, emotional conditions, or mental conditions of individuals, families, couples or groups, as stated in Health Occupations Article, §17-308, Annotated Code of Maryland; and To supervisees in appropriate billing practices, if applicable to the practice site, including: Record keeping; Disclosure of fees and financial arrangements; and Appropriate maintenance and destruction of clinical and financial records. The following individuals may not provide clinical supervision for a licensed graduate professional counselor supervisee: A relative; or An individual with whom there could be a conflict of interest, including, but not limited to: An employee supervising their own employer; or A student supervising their own teacher. Licensure. An individual providing supervision shall be approved by the Board and licensed by the Board as a: Clinical professional counselor; Clinical professional art therapist; Clinical alcohol and drug counselor; Clinical marriage and family therapist; or Mental health care provider as defined in Regulation .02B of this chapter. Experience, Education, and Training. A Board-approved supervisor shall have completed 2 years of active clinical practice experience: In clinical professional counseling, marriage and family therapy, professional art therapy, or alcohol and drug counseling; As a clinical professional counselor, marriage and family therapist, professional art therapist, or alcohol and drug counselor licensed or certified in another state, territory or jurisdiction that has requirements that are equivalent to or exceed the requirements of Health Occupations Article, §§17-302—17-304.1, Annotated Code of Maryland; or As another licensed mental health care provider as defined in Regulation .02Bof this chapter. A Board-approved supervisor shall have completed one of the following education and training experiences: At least 3 graduate semester credit hours or the equivalent quarter credit hours of academic course work in clinical supervision; A Board-approved continuing education program that includes a minimum of 18 continuing education units (CEUs) in: Clinical professional counseling supervision; or Another behavioral health profession that is authorized to diagnose and treat mental and emotional disorders; The National Board of Certified Counselors (NBCC) Approved Clinical Supervisor (ACS) credential; or Supervision training as defined in Regulation .02Bof this chapter. Supervision training required by this section may be obtained in a graduate course or a continuing education program as required under §B(2)(b) of this regulation that may include, but is not limited to: The role and responsibilities of the supervisor; The needs of the supervisee, supervisor, and the agency setting while maintaining a clear ethical perspective, including: The maintenance of appropriate boundaries; and Making clinically appropriate diagnoses; The role of the supervisor as gatekeeper to the profession; Methods for building effective and appropriate relationships with clients; Models for group supervision; and Models and modalities for practice intervention. Pre-Supervision Responsibilities of a Supervisor. In addition to meeting the requirements of this regulation, the Board-approved supervisor shall: File the completed Board-approved supervisor application form; Provide the supervisee with a copy of the Board’s licensed clinical professional counselor supervisor letter; and Have an active license that is without restrictions or conditions due to disciplinary action for the 2 years preceding an application for Board-approved supervisor status. A supervisor may be: An agency-designated supervisor; or An independent supervisor in private practice. A supervisor shall: Agree to and sign a written contract for supervision before initiating supervision; Ensure that the supervisee is practicing within the scope of the supervisee’s license; Determine the skill level at which the supervisee may practice; Focus on primary data from the supervisee’s practice; Maintain documentation of supervisory sessions for at least 7 years, including: Dates; Duration; and Focus of the supervisory sessions; Ensure that a supervisee has read and is knowledgeable about: Health Occupations Article, Title 17, Annotated Code of Maryland; and This subtitle with special emphasis on the code of ethics under COMAR 10.58.03; Within a reasonable period of time before the conclusion of supervision, provide the supervisee and employer with a notice of termination to avoid or minimize any harmful effect on the supervisee’s clients or patients; Be responsible for the clinical professional practices of supervisees; Provide: For emergency supervision of and direction to a supervisee by a Board-approved supervisor; A written evaluation of progress to the supervisee on a regular basis or as needed; and A copy of the documentation required by §E of this regulation on request by the: Supervisee; or Board or its authorized agent; and Comply with a Board audit of a Board-approved supervisor’s compliance with regard to the supervisory requirements and responsibilities. A supervisee shall: Verify that the supervisor has been approved by the Board; Agree to and sign a Board-approved contract before initiating supervision; Attend and participate in supervision as agreed to in the supervision contract; Prepare for supervision using case materials related to the supervisee’s clinical professional counseling practice; Maintain documentation of supervisory sessions for at least 7 years, to be available for verification to the Board or its authorized agent, including: Dates; Duration; and Focus of the supervision; and Follow all terms of the written contract for supervision. A supervisee may not engage in the practice of clinical professional counseling independent of supervision. A supervisee shall give the client a copy of a professional disclosure statement as described in Health Occupations Article, §17-507, Annotated Code of Maryland, that: Clearly states the counseling services are provided under clinical supervision; and Provides the name of the supervisor with address and contact information. A supervisee shall obtain from the client a signed: Release of information; and Informed consent for treatment which indicates that the client: Is aware that counseling services are being provided under clinical supervision; Consents to the recording of counseling sessions with the knowledge that the recording may only be shared with the supervisor; and Consents to the sharing of client information between the licensed graduate professional counselor and the named clinical supervisor. Health Occupations Article, §§17-101 17-205, 17-301, 17-304, 17-307, and 17-509, Annotated Code of Maryland Effective date: August 22, 2011 (38:17 Md. R. 1013) Regulations .01—.08 under Supervision Requirements repealed and new Regulations .01—.10 under Licensed Clinical Professional Counselors — Requirements for Licensure adopted effective June 28, 2021 (48:13 Md. R. 508) Effective date: November 11, 2013 (40:22 Md. R. 1877) Regulations .01—.08 repealed effective June 28, 2021 (48:13 Md. R. 508) Effective date: November 11, 2013 (40:22 Md. R. 1878) Regulation .04 amended effective November 9, 2015 (42:22 Md. R. 1379) Regulations .01—.08 repealed effective June 28, 2021 (48:13 Md. R. 508) Effective date: April 28, 2014 (41:8 Md. R. 473) Regulation .03 amended effective December 8, 2016 (43:24 Md. R. 1351) Regulation .04B amended effective December 8, 2016 (43:24 Md. R. 1351) Chapter repealed effective April 4, 2022 (49:7 Md. R. 467) This chapter governs the practice of behavior analysis. In this chapter, the following terms have the meanings indicated. Terms Defined. “Asynchronous” means not occurring in real time. “Board” means the Board of Professional Counselors and Therapists. “Board-certified assistant behavior analyst” means an individual who: Is credentialed by the Behavior Analyst Certification Board or a successor organization; and Practices under the supervision of a licensed behavior analyst in accordance with the Behavior Analyst Certification Board's description of the role and functions of a board-certified assistant behavior analyst and supervision requirements. “Board-certified behavior analyst” means an individual credentialed by the Behavior Analyst Certification Board or a successor organization. “Committee” means the Behavior Analyst Advisory Committee. “In-person” means within the physical presence of the individual receiving behavior analyst services or the individual’s caregiver. “License” means a license issued by the Board to practice behavior analysis. “Licensed behavior analyst” means a behavior analyst licensed by the Board to practice behavior analysis. “Paraprofessional” means an individual who: Practices behavior analysis under the supervision of a licensed behavior analyst in accordance with requirements set by the Behavior Analyst Certification Board; and Is not a board-certified assistant behavior analyst; and May be a registered behavior technician. Practice Behavior Analysis. “Practice behavior analysis” means to design, implement, and evaluate systematic instructional and environmental modifications to produce socially significant improvements in human behavior. “Practice behavior analysis” includes: The empirical identification of functional relations between behavior and environmental factors, also known as functional assessment and analysis; and Interventions based on scientific research and the direct observation and measurement of behavior and environment. “Practice behavior analysis” does not include: Psychological testing; Diagnosis of a mental or physical disorder; Neuropsychology; Psychotherapy; Cognitive therapy; Sex therapy; Psychoanalysis or hypnotherapy; or Counseling. “Registered behavior technician” means an individual who: Is credentialed as a registered behavior technician by the Behavior Analyst Certification Board or a successor organization; and Practices behavior analysis under the close, ongoing supervision of a licensed behavior analyst in accordance with requirements set by the Behavior Analyst Certification Board. “Supervisee” means an individual who implements behavior analytic assessment or intervention procedures under the supervision of a licensed behavior analyst. Supervisees include, but are not limited to: Board-Certified Assistant Behavior Analysts; Paraprofessionals; Matriculated undergraduate or graduate students engaging in behavior analytic activities to fulfill requirements for coursework, practica, internships, theses, dissertations, graduate assistantships, or independent study; and Non-students who are completing the supervised experiential training eligibility requirement for certification by the Behavior Analyst Certification Board. “Supervision” means: The ongoing monitoring of implementation quality, the frequency of which should be based on the supervisee’s Training; Competence; and Experience; The nature of the assessment or intervention procedures delegated to the supervisee; and Meeting the minimum supervision requirements of the Behavior Analyst Certification Board. “Supervisor” means a licensed behavior analyst who: Provides supervision to a supervisee; and Meets the minimum supervision requirements of the Behavior Analyst Certification Board. “Synchronous” means occurring in real time. “Telehealth” has the meaning stated in Health Occupations Article, §1-1001, Annotated Code of Maryland. “Telehealth practitioner” means an individual authorized to provide telehealth services in Maryland pursuant to Health Occupations Article, Title 17, Subtitle 6A, Annotated Code of Maryland, who performs telehealth services within their respective scope of practice. The Board shall appoint members of the committee as follows: On or before December 31, 2014, four behavior analysts who: Are credentialed by the Behavior Analyst Certification Board as board-certified behavior analysts or designated as board-certified behavior analysts-doctoral; and Have a minimum of 5 years of clinical experience; and On or after January 1, 2015, four licensed behavior analysts who: Are credentialed by the Behavior Analyst Certification Board; and Have a minimum of 5 years of clinical experience; and One consumer member who: Is a member of the general public; Is receiving or has received applied behavior analysis services, or has a child who is receiving or has received applied behavior analysis services; and May not: Be or ever have been a behavior analyst or in training to become a behavior analyst; Have a household member who is a behavior analyst or in training to become a behavior analyst; Participate or ever have participated in a commercial or professional field related to behavior analysis; Have a household member who participates in a commercial or professional field related to behavior analysis; and Have had within 2 years before appointment a substantial financial interest in a person regulated by the Board. Terms. The term of a member is 4 years. The terms of members are staggered. At the end of a term, a member continues to serve until a successor is appointed and qualifies. An individual may be reappointed for a second 4-year term, but the individual may not serve more than two consecutive 4-year terms. Vacancy. If a vacancy occurs, the Board shall appoint a new member to serve. The successor member shall only serve for the remainder of the term, unless reappointed. Officers. From among its members, the Committee shall elect a Chair and a Vice Chair, annually. Quorum. A majority of the members then serving on the Committee is a quorum. Business may not be conducted at a Committee meeting unless there is a quorum. The Committee shall: Develop and make recommendations to the Board in the following areas: Regulations governing the practice of behavior analysis; Code of ethics requirements for the practice of behavior analysis; Requirements for licensure as a behavior analyst, including: Criteria for educational and clinical training of licensed behavior analysts; and Criteria for a professional competency examination and testing of applicants for licensure to practice behavior analysis; and Continuing education requirements for license renewal; Investigate allegations of violations of this chapter and these regulations and make recommendations to the Board regarding disposition of such allegations; Report to the Board as required; and Keep a record of its proceedings. To qualify for licensure as a licensed behavior analyst, an individual shall: Be of good moral character; Be at least 18 years of age; Have a current certification as a board-certified behavior analyst or board-certified behavior analyst - doctoral verified by the Board with the Behavior Analyst Certification Board or its successor organization; Have received a master’s degree or higher from a behavior analysis educational course sequence that is approved by the Behavior Analyst Certification Board or a successor organization; and Demonstrate oral and written competency in English as required by the Board. The Board shall waive the educational requirements in §A(4) of this regulation if an individual was certified by the Behavior Analyst Certification Board on or before December 31, 2014 and is in good standing. To apply for a license, an individual shall submit: A completed application form to the Board on a form that the Board requires and that is provided by the Committee; To a criminal history records check in accordance with Health Occupations Article, §17–501.1, Annotated Code of Maryland; and The following documentation: An official transcript, demonstrating that the applicant has met the minimum degree requirement of the Behavior Analyst Certification Board, or its successor, at the time of certification; and A copy of the applicant’s Behavior Analyst Certification Board certificate, demonstrating that the applicant is currently certified in good standing as a board-certified behavior analyst by the Behavior Analyst Certification Board, or its successor. An individual who has been licensed by the Board as a behavior analyst may renew the license every 2 years on the date specified by the Board by: Completing a renewal application on a form supplied by the Board; Submitting evidence of a current certification with the Behavior Analyst Certification Board; Having current certification verified with the Behavior Analyst Certification Board; Submitting to a criminal history records check in accordance with Health Occupations Article, §17–501.1, Annotated Code of Maryland; and Submitting satisfactory evidence of compliance with any continuing education requirements established by the Board under Health Occupations Article, §17–6A–15(d), Annotated Code of Maryland. A licensed behavior analyst who has not renewed his or her license or whose license has not been placed on inactive status by the Board may not practice behavior analysis. A licensed behavior analyst shall complete continuing education units in accordance with the requirements of the Behavior Analyst Certification Board or its successor organization. A licensed behavior analyst shall document completion of continuing education requirements and retain this documentation for the succeeding 4 years for possible inspection by the Board. The Board shall place a license on inactive status if the licensed behavior analyst submits to the Board a completed application on a form required by the Board and provided by the Committee. A licensed behavior analyst whose license is inactive may not practice behavior analysis until the license has been reactivated in accordance with Regulation .09 of this chapter. A licensed behavior analyst whose license is inactive shall renew the inactive status every year before it expires by completing the form required by the Board and provided by the Committee. A license on inactive status may be reactivated by the Board by: Complying with the requirements for renewal that exist at the time the license changes from inactive to active status; Meeting any continuing education requirements established by the Board; and Verifying active and current certification with the Behavior Analyst Certification Board. The Board may reject an application for reactivation if the licensed behavior analyst is found to have violated any provision of Health Occupations Article, Title 17, Subtitle 6A, Annotated Code of Maryland or this chapter. The Board shall reinstate the license of a behavior analyst who has not been put on inactive status and who has failed to renew the license for any reason if the behavior analyst: Meets the requirements set forth in Regulation .09 of this chapter; and Applies to the Board for reinstatement of the license within 5 years after the license expires. The Board may not reinstate the license of a behavior analyst who fails to apply for reinstatement of the license within 5 years after the license expires. Notwithstanding the provisions of §B of this regulation, a behavior analyst may become licensed by meeting the current requirements for obtaining a new license under this chapter. Except where there is a consultative agreement, the licensed behavior analyst is ultimately responsible for the design and implementation of behavior analytic services that are in the best interest of the client, under the licensed behavior analyst’s supervision. Behavior analysis involves the design, implementation, and evaluation of systematic instructional and environmental modifications to produce socially significant improvements in human behavior. The responsibilities of a licensed behavior analyst are as follows: Objective measurement and description of specific levels of client behavior at baseline and throughout treatment; An emphasis on understanding the current function or functions and future importance of behaviors targeted for treatment; Efforts to design, establish, and manage treatment environments in order to minimize problem behaviors and maximize progress on treatment targets; Use of a carefully constructed, individualized, and detailed behavior analytic treatment plan that: Utilizes reinforcement and other scientifically validated behavior analytic procedures as opposed to procedures that lack scientific evidence of effectiveness; Is designed to establish small units of behavior and build toward larger, clinically important changes in behavior that result in improved client health and functioning; Includes ongoing, frequent, direct observation and objective measurement of treatment targets and analysis of the resulting data in order to adjust treatment procedures to maximize client progress; and Is implemented repeatedly, frequently, and consistently across multiple environments by the licensed behavior analysts’ supervisees, and the client’s caregivers who are trained and supervised by the licensed behavior analyst to implement specified components of the treatment plan; and Determination and supervision of tasks to be performed by a supervisee based on the supervisee’s training, experience, and competence, in accordance with the responsibilities for supervision described in Regulation .13 of this chapter. The provision of behavior analytic services may take one of three forms: A tiered-service delivery model; A direct service model; or A consultative model. Unless a consultation agreement described in §E of this regulation exists, a licensed behavior analyst shall be ultimately responsible for the design and implementation of behavior analytic services that are in the best interest of the client, under the licensed behavior analyst’s supervision. Tiered Service Delivery Model. A licensed behavior analyst may utilize the services of supervisees to deliver behavior analysis services to clients, provided the licensed behavior analyst does so in accordance with this regulation and requirements set by the Behavior Analyst Certification Board. Under a tiered delivery service model: A licensed behavior analyst and a supervisee shall comply with the supervision responsibilities specified in Regulation .13 of this chapter and requirements set by the Behavior Analyst Certification Board; A licensed behavior analyst shall be responsible for all aspects of clinical direction, supervision, and case management, including activities of supervisees; A supervisee shall deliver assessment and treatment protocols as directed by and under the close and ongoing supervision of a licensed behavior analyst; and The licensed behavior analyst may delegate responsibilities to supervisees only if, in the judgment of the licensed behavior analyst: The task or procedures can be properly and safely performed by the supervisee; Delegation does not jeopardize the health or safety of the client; and The delegation is in accordance with the current supervision requirements of the Behavior Analyst Certification Board or successor organization. Direct Delivery Service Model. Under a direct service delivery model, a licensed behavior analyst shall be responsible for all aspects of case management and implementation of assessment and treatment protocols. Consultation Agreement. Under a consultation agreement, a licensed behavior analyst: Shall enter into a contract with the individual or entity for whom the licensed behavior analyst will be consulting that defines: The frequency of the consultation; The location of the consultation; and The expectations of both parties to the contract; Shall act principally in the best interest of the individual or entity for which the licensed behavior analyst will be consulting, with appropriate consent, subject to other relevant considerations, including applicable law and contractual obligations; When indicated and professionally appropriate, shall cooperate with other professionals in a manner that is consistent with the philosophical assumptions and principles of behavior analysis, to effectively and appropriately serve their clients; and May be held responsible for the treatment of a client for whom a behavior analytic treatment plan was recommended. Licensure. Subject to the provisions of Health Occupations Article, Title 17, Subtitle 6A, Annotated Code of Maryland, in order to practice telehealth a telehealth practitioner shall be licensed in Maryland when providing telehealth services to a client located in the State. Standards of Practice. Before providing telehealth services, a telehealth practitioner shall develop and follow a procedure to: Verify the identification of the client through the use of: A government-issued photograph identification; An insurance, Medicaid, or Medicare card; or Documentation of the client’s date of birth and home address; For an initial client-telehealth practitioner encounter, disclose the telehealth practitioner’s: Name; Maryland license number; and Contact information; Obtain oral or written informed consent from a client or a client’s parent or guardian if State law requires the consent of a parent or guardian, including informing clients of potential risks and benefits of telehealth services to be performed; Securely collect and transmit a client’s clinical data and self-reported medical history, as necessary, and prevent access to data by unauthorized persons through encryption or other means; Notify clients in the event of a data breach; Ensure that the telehealth practitioner provides a secure and private communication modality and 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 client’s location. Except when providing asynchronous telehealth services, a telehealth practitioner shall: Obtain or confirm an alternative method of contacting the client in case of a technological failure; Confirm whether the client is in Maryland and identify the client’s specific location; and Identify all individuals present at each location and confirm they are permitted to hear the client’s health information. A telehealth practitioner shall be held to the same standards of practice and documentation as those applicable for in-person sessions. Client Evaluation. A telehealth practitioner shall: Perform a synchronous or asynchronous client evaluation that is appropriate for the client and the condition with which the client presents before providing services through telehealth; and If clinically appropriate for the client, provide or refer a client to: In-person treatment; or Another type of telehealth service. A telehealth practitioner may not treat a client based solely on an online questionnaire. Telehealth Practitioner Discipline. The Board shall use the same standards in evaluating and investigating a complaint and disciplining a telehealth practitioner who practices telehealth as it would use for a telehealth practitioner who does not use telehealth technology. 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. A licensee shall: Comply with the Behavior Analyst Certification Board requirements regarding supervision of supervisees; and Use appropriate clinical judgment in determining when and how often to conduct supervision. Supervision Process. The supervision shall occur for the duration of clinical service provision (e.g., beginning with assessment and through case closure). Supervision activities may involve direct contact with the client or activities related to case management, at the discretion of the licensed behavior analyst providing the supervision and as in accordance with the requirements set by the Behavior Analyst Certification Board. The licensed behavior analyst shall be ultimately responsible and accountable for the design and implementation of behavior analytic services that are in the best interest of the client and outcomes under her or his clinical supervision. Unless a consultation agreement exists, a licensed behavior analyst shall be ultimately responsible for the design and implementation of behavior analytic services that are in the best interest of the client, under the licensed behavior analyst’s supervision. Delegation shall only be made if, in the judgment of the licensed behavior analyst: The task or procedures can be properly and safely performed by an appropriately trained supervisee; and The delegation does not jeopardize the health or safety of the client. Supervision activities by the licensed behavior analyst may include, but not be limited to: Direct training of supervisees in implementation of behavior analytic assessment or intervention procedures; Conducting real-time, live, and person-to-person observation of the supervisee implementing behavior analytic assessment and intervention procedures with clients in natural environments or training others to implement them, with feedback from the supervisor; Conducting one-to-one real-time, live, and person-to-person interactions between supervisor and supervisee to review and discuss: Assessment and treatment plans and procedures; Client assessment and progress data and reports; Published research; Ethical and professional standards and guidelines; Professional development needs and opportunities; and Relevant laws, regulations, and policies; or Conducting real-time, live, and person-to-person interactions between a supervisor and a group of supervisees to review and discuss: Assessment and treatment plans and procedures; Client assessment and progress data and reports; Published research; Ethical and professional standards and guidelines; Professional development needs and opportunities; and Relevant laws, regulations, and policies. The frequency and nature of supervision interactions are determined by the individualized assessment or treatment plans of the clients served by the licensed behavior analyst and the supervisees. A licensed behavior analyst shall comply with the current professional disciplinary and ethical code established by the Behavior Analyst Certification Board or its successor organization. Familiarity with revisions to the Behavior Analyst Certification Board’s professional disciplinary and ethical code is the responsibility of the licensed behavior analyst. Subject to the hearing provisions of Health Occupations Article, §17–6A–21, Annotated Code of Maryland, the Board may deny a license to any applicant, reprimand any licensed behavior analyst, place any licensed behavior analyst on probation, or suspend or revoke a license if the applicant or licensed behavior analyst: Fraudulently or deceptively obtains or attempts to obtain a license for the applicant or licensed behavior analyst or for another; Fraudulently or deceptively uses a license; Is convicted of or pleads guilty or nolo contendere to a felony or a crime involving moral turpitude, whether or not any appeal or other proceeding is pending to have the conviction or plea set aside; Aids or abets an unauthorized person in practicing behavior analysis or representing oneself to be a behavior analyst; Practices behavior analysis fraudulently or deceitfully; Violates the code of ethics adopted by the Board under Health Occupations Article, §17–6A–03, Annotated Code of Maryland; Willfully fails to file or record any report as required under law, willfully impedes or obstructs the filing or recording of the report, or induces another to fail to file or record the report; Submits a false statement to collect a fee; Willfully makes or files a false report or record in the practice of behavior analysis; Is disciplined by a licensing or disciplinary authority of any state or country or convicted or disciplined by a court of any state or country or disciplined by any branch of the United States uniformed services or the United States Veterans Administration for an act that would be grounds for disciplinary action under the Board’s disciplinary statutes; Violates any provision of: Health Occupations Article, Title 17, Subtitle 6A, Annotated Code of Maryland; or This chapter; Uses or promotes or causes the use of any misleading, deceiving, or untruthful advertising matter, promotional literature, or testimonial; Is professionally, physically, or mentally incompetent; Promotes the sale of devices, appliances, or goods to a patient so as to exploit the patient for financial gain; Behaves immorally in the practice of behavior analysis; Commits an act of unprofessional conduct in the practice of behavior analysis; Refuses, withholds from, denies, or discriminates against an individual with regard to the provision of professional services for which the licensed behavior analyst is licensed and qualified to render because the individual is HIV positive; Fails to cooperate with a lawful investigation conducted by the Board; Commits an act that is inconsistent with generally accepted professional standards in the practice of behavior analysis; Fails to submit to a criminal history records check in accordance with Health Occupations Article, §17–501.1, Annotated Code of Maryland; Habitually is intoxicated; Provides professional services while under the influence of alcohol or while using any narcotic or controlled dangerous substance, as defined in Criminal Law Article, §5–101, Annotated Code of Maryland, or other drug that is in excess of therapeutic amounts or without valid medical indication; or Knowingly fails to report suspected child abuse in violation of Family Law Article, §5–704, Annotated Code of Maryland. Complaints alleging prohibited conduct shall be referred to the Committee to be investigated and reported to the Board according to the Board’s procedures. A hearing on charges issued under Regulation .15 of this chapter or Health Occupations Article, §17–6A–19, Annotated Code of Maryland, shall be held in accordance with the hearing provisions of Health Occupations Article, §§17–511 and 17–6A–21, Annotated Code of Maryland. The Committee shall follow the hearing procedures in accordance with the hearing provisions of Health Occupations Article, §§17–511 and 17–6A–21, Annotated Code of Maryland. Appeals from a final Board decision shall be taken in accordance with Health Occupations Article, §17–6A–22, Annotated Code of Maryland. An individual who violates any provision of Health Occupations Article, Title 17, Subtitle 6A, Annotated Code of Maryland, is guilty of a misdemeanor and on conviction is subject to a fine not exceeding $10,000, or imprisonment not exceeding 1 year, or both. The Board may impose a civil fine of not more than $50,000 on an individual who violates any provision of Health Occupations Article, §17–6A–27, Annotated Code of Maryland. The Board shall deposit a penalty collected under §B of this regulation into the State General Fund. If, after a hearing or an opportunity for a hearing under Health Occupations Article, §17–511, Annotated Code of Maryland, the Board finds that there are grounds for discipline under Health Occupations Article, §17–6A–19, Annotated Code of Maryland, the Board may place any licensee or certificate holder on probation, reprimand any licensee or certificate holder, or suspend or revoke a license or certificate. In addition to placing the licensee or certificate holder on probation, reprimanding the licensee or certificate holder, or suspending or revoking the license or certificate, the Board may impose a penalty as set forth in this regulation. General Application of Sanctioning Guidelines. Except as provided in §J of this regulation, for violations of the Maryland Behavior Analysts Act listed in the sanctioning guidelines, the Board shall impose a sanction not less severe than the minimum listed in the sanctioning guidelines or more severe than the maximum listed in the guidelines for each offense. Ranking of Sanctions. For the purposes of this regulation, the severity of sanctions is ranked as follows, from the least severe to the most severe: Reprimand; Probation; Suspension; and Revocation. A stayed suspension in which the stay is conditioned on the completion of certain requirements is ranked as probation. A stayed suspension not meeting the criteria of §D(2) of this regulation is ranked as a reprimand. A penalty listed in the sanctioning guidelines may be imposed in addition to but not as a substitute for a sanction. The addition of a penalty does not change the ranking of the severity of the sanction. The Board may impose more than one sanction provided that the most severe sanction neither exceeds the maximum nor is less than the minimum sanction permitted. Any sanction may be accompanied by conditions reasonably related to the offense or to the rehabilitation of the offender. The inclusion of conditions does not change the ranking of the sanction. If a licensee is found in violation of more than one ground for discipline as enumerated in this regulation, the sanction with the highest severity ranking shall be used to determine which ground will be used in developing a sanction and the Board may impose concurrent sanctions based on other grounds violated. Notwithstanding the guidelines set forth in this regulation, in order to resolve a pending disciplinary action, the Board and licensee may agree to a surrender of license or to a consent order with terms, sanction, and penalty agreed to by the Board and the licensee. If the Board imposes a sanction that departs from the sanctioning guidelines set forth in this regulation, the Board shall state its reasons for doing so in its final decision and order. Aggravating and Mitigating Factors. Depending on the facts and circumstances of each case, and to the extent that the facts and circumstances apply, the Board may consider mitigating and aggravating factors in determining whether the sanction in a particular case should fall outside the range of sanctions established by the guidelines. Nothing in this regulation requires the Board or an Administrative Law Judge to make findings of fact with respect to any of these factors. A departure from the guidelines set forth in this chapter is not a ground for any hearing or appeal of a Board action. The existence of one or more of these factors does not impose on the Board or an Administrative Law Judge any requirement to articulate its reasoning for not exercising its discretion to impose a sanction outside of the range of sanctions set forth in this chapter: The absence of a prior disciplinary record; The offender self-reported the violation to the Board; The offender’s full and voluntary admissions of misconduct to the Board and cooperation during Board proceedings; The offender implemented remedial measures to correct or mitigate the harm arising from the misconduct; The offender made timely good-faith efforts to make restitution or to rectify the consequences of the misconduct; The offender has been rehabilitated or exhibits rehabilitative potential; The absence of premeditation to commit the misconduct; The absence of potential harm to patients or the public or other adverse impact; or The offender’s conduct was an isolated incident and is not likely to recur. Aggravating factors may include, but are not limited to, the following: The offender has a previous criminal or administrative disciplinary history; The violation was committed deliberately or with gross negligence or recklessness; The violation had the potential for, or caused, serious patient or public harm; The violation was part of a pattern of detrimental conduct; The offender was motivated to perform the violation for financial gain; The vulnerability of the clients; The offender lacked insight into the wrongfulness of the conduct; The offender committed the violation under the guise of treatment; The offender attempted to hide the error or misconduct from patients or others; The offender did not cooperate with the investigation; or Previous attempts at rehabilitation of the offender were unsuccessful. Payment of a Penalty. A licensee shall pay to the Board a penalty imposed under this chapter as of the date the Board's order is issued, unless the Board's order specifies otherwise. Filing an appeal under State Government Article, §10-222, Annotated Code of Maryland, or Health Occupations Article, §17-512, Annotated Code of Maryland, does not automatically stay payment of a penalty imposed by the Board under this regulation. If a licensee fails to pay, in whole or in part, a penalty imposed by the Board under this regulation, the Board may not restore, reinstate, or renew a license until the penalty has been paid in full. In its discretion, the Board may refer all cases of delinquent payment to the Central Collection Unit of the Department of Budget and Management to institute and maintain proceedings to ensure prompt payment. The Board shall pay all monies collected under this regulation into the State's General Fund. Health Occupations Article, §1-606, 1-1001—1-1006, and Title 17, Subtitle 6A, Annotated Code of Maryland Effective date: May 22, 2017 (44:10 Md. R. 473) Regulation .02B amended effective September 18, 2023 (50:18 Md. R. 799) New Regulation .13 adopted effective September 18, 2023 (50:18 Md. R. 799) Regulations .13—18 recodified to be Regulations .14—.19 effective September 18, 2023 (50:18 Md. R. 799) This chapter: Establishes the requirements for an individual to practice professional art therapy; Establishes standards of supervision and the responsibilities of supervisors and supervisees in the practice of clinical professional art therapy; Applies to licensees who: Practice clinical professional art therapy; and Provide supervision for licensed graduate professional art therapists; Applies to licensed graduate professional art therapists who are in the process of obtaining the supervised clinical experience required by Health Occupations Article, §17-304.1, Annotated Code of Maryland; and Does not apply to personnel or management practices associated with contractual relationships or employment. On or after December 31, 2018, an approved art therapy supervisor shall follow the requirements set forth in Regulations .06—.08 of this chapter. In this chapter, the following terms have the meanings indicated. Terms Defined. “Accredited educational institution” means a college or university that is: Accredited through a recognized body endorsed by the U.S. Department of Education; and Approved by the Board. “Applicant” means an individual applying for licensure as a clinical or graduate professional art therapist. “Approved art therapy supervisor” means: An Art Therapy Credentials Board Certified Supervisor; An Art Therapy Credentials Board Registered Art Therapist or Board Certified Art Therapist; A licensed clinical professional art therapist; or Another mental health care provider approved by the Board and licensed under the Health Occupations Article, Title 17, Annotated Code of Maryland. “Equivalent” means a degree in a program of studies determined by the Board to have: Substantial art therapy emphasis in the subject matter; and The extent of training required for the specified level of licensure. Face-to-Face. “Face-to-face” means in the physical presence of the individuals involved in the supervisory relationship during either individual or group supervision or using video conferencing which allows individuals to hear and see each other in actual points of time. “Face-to-face” does not include: Telephone supervision; or Internet communication that does not involve actual or real time video conferencing, such as instant messaging services, emails, texting, and social networking sites. “Group supervision” means the provision of face-to-face supervision to more than one individual at a time. “Licensed graduate professional art therapist” means an individual approved by the Board to practice graduate professional art therapy under the supervision of an approved supervisor while fulfilling the supervised clinical experience for licensure under: Health Occupations Article, §§17-304.1 and 17-309, Annotated Code of Maryland; and Regulation .04 of this chapter. “Licensed mental health care provider” means: A licensed clinical professional art therapist; Another mental health care provider approved by the Board and licensed under Health Occupations Article, Title 17, Annotated Code of Maryland; or A licensed mental health care provider from a state, territory, or jurisdiction that authorizes the application of equivalent art therapy principles and methods as set forth in Health Occupations Article, §17-308, Annotated Code of Maryland. “Practice” means to engage professionally and for compensation in art therapy and appraisal activities by providing services for individuals, couples, families and groups involving: The application of therapy principles; and Methods in the diagnosis, prevention, treatment, and amelioration of psychological problems, emotional conditions, or mental conditions. “Relative” means: Spouse, or domestic partner; Parent, stepparent or legal guardian; Sibling or stepsibling; Child, stepchild, foster child, or ward; Mother-in-law or father-in-law; Son-in-law or daughter-in-law; Grandparent or grandchild; Aunt or uncle; or Cousin. “Supervised clinical experience in professional art therapy” means therapy services conducted under the supervision of an approved art therapy supervisor that includes: Monitoring the performance of a supervisee; and Providing, with respect to clinical skill and competencies: Documented and direct consultation; Guidance; and Instruction. “Supervision training” means a course or program designed to provide information regarding the supervision process utilized by: Licensed clinical professional art therapists; or Licensed mental health providers. To qualify for licensure as a clinical professional art therapist, an applicant shall have: Completed one of the following from an accredited educational institution: A master’s degree in an art therapy program approved by the Board with: A minimum of 60 graduate semester credit hours; or 90 graduate quarter credit hours; A doctoral degree in an art therapy program approved by the Board with: A minimum of 90 graduate semester credit hours; or 135 graduate quarter credit hours; or A graduate level degree which: Includes the coursework listed in §A(2) of this regulation; and Is approved by the Board; Completed a minimum of 3 graduate semester credit hours in each of the following course content areas: Human growth and personality development; Social and cultural foundations of counseling; Theories of art therapy; Art therapy techniques: Group dynamics, processing, and counseling; Lifestyle and career development; Appraisal; Research and evaluation; Professional, legal, and ethical responsibilities; Marriage and family therapy; Supervised field experience that includes: A supervised clinical internship, externship, field experience, or practicum placement; and Direct client contact in art therapy with a minimum of 125 hours of face-to-face client therapy; Alcohol and drug counseling; Psychopathology; and Diagnosis and treatment of mental and emotional disorders; For a master’s level applicant, completed supervised clinical experience in professional art therapy obtained under the supervision of an approved art therapy supervisor of not less than 3 years with a minimum of 3,000 hours, of which: 1,500 hours shall be face-to-face client contact hours, including 100 face-to-face clinical supervision hours obtained after the awarding of a master’s degree, of which: At least 50 hours shall be face-to-face individual clinical supervision; and 50 hours may be face-to-face group clinical supervision; A maximum of 1 year and 1,000 hours of clinical experience may be acquired before the awarding of the master's degree; and Not less than 2 years and 2,000 hours shall be acquired after the master's degree has been awarded; For a doctoral level applicant, completed supervised clinical experience in professional art therapy obtained under the supervision of an approved art therapy supervisor of not less than 2 years with a minimum of 2,000 hours, of which: 1,000 hours shall be face-to-face client contact hours, including 50 face-to-face clinical supervision hours obtained after the awarding of a doctoral degree, of which: At least 25 hours shall be face-to-face individual clinical supervision; and 25 hours may be face-to-face group clinical supervision; A maximum of 1 year and 1,000 hours of clinical experience may be acquired before the awarding of the doctoral degree; and Not less than 1 year and 1,000 hours shall be acquired after the doctoral degree has been awarded; Achieved a passing score on: A national certification exam approved by the Board; and An examination of: Health Occupations Article, Title 17, Annotated Code of Maryland; and COMAR 10.58; Submitted a completed Board-approved application; Provided an official transcript from the educational institution which awarded the master’s or doctoral degree; Paid all applicable fees set forth in COMAR 10.58.02; Submitted to a criminal background check; Good moral character; and Complied with: Health Occupations Article, Title 17, Annotated Code of Maryland; and The code of ethics as set forth in COMAR 10.58.03. An applicant who fails an examination for licensure may retake the exam. The Board shall act upon applications within a 6-month period as follows: Within 90 days after receipt of an application, the Board shall determine whether the application is complete; If the Board determines that the application is not complete, the Board or the Board’s designee shall send a notice of deficiency to the applicant; Upon receipt of a notice, the applicant shall correct the deficiency within 90 days, or another period specified in the notice; and If the applicant fails to correct the deficiency within the required period, the application shall lapse and the applicant shall be required to: Submit a new application; and Pay the required non-refundable fee set forth in COMAR 10.58.02. Renewal. To renew a clinical professional art therapist license, the applicant shall: Submit a completed Board-approved application; Pay the required application fee set forth in COMAR 10.58.02; and Attest to completion of continuing education activities as specified in COMAR 10.58.05.05 and .06. A licensed clinical professional art therapist shall comply with the renewal requirements as provided in Health Occupations Article, §17–504, Annotated Code of Maryland. An individual who fails to renew licensure is not authorized to and may not practice clinical professional art therapy. Reinstatement. Within 5 calendar years after the certificate renewal date, the Board may reinstate the license of a licensed clinical professional art therapist otherwise entitled to reinstatement under Health Occupations Article, §17-505(b), Annotated Code of Maryland, whose license was not renewed for any reason, if the licensee: Completes within that 5-year period the minimum of 20 CEUs required for each year; and Pays the reinstatement fee set by the Board in COMAR 10.58.02. CEUs which are acquired in order to reinstate under COMAR 10.58.05.05 and.06 may be credited only once and may not be credited for any future renewals. For any licensed clinical professional art therapist whose license has expired more than 5 calendar years before the request for reinstatement, a new application for licensure shall be completed and the current licensure requirements shall be met. An individual who fails to reinstate licensure is not authorized to and may not practice clinical professional art therapy. Inactive Status. In accordance with Health Occupations Article, §17-505, Annotated Code of Maryland, a request to transfer a license to inactive status shall be granted upon receipt of the: Completed Board-approved application; and Payment of the required, non-refundable, annual fee set forth in COMAR 10.58.02. An individual may apply for inactive status only if the individual’s license is still active at the time application for inactive status is made. An individual on inactive status is not authorized to and may not practice clinical professional art therapy. An individual on inactive status seeking to be reinstated to active status shall be required, as a condition of reinstatement, to submit proof of having completed 20 CEU’s for each year of inactive status, at least 40 of which shall have been obtained within the 2-year period immediately preceding the application for reinstatement. To qualify for licensure as a graduate professional art therapist, an applicant shall have: Completed one of the following from an accredited educational institution approved by the Board: A master’s degree in an art therapy program approved by the Board with: A minimum of 60 graduate semester credit hours; or 90 graduate quarter credit hours; A doctoral degree in an art therapy program approved by the Board with: A minimum of 90 graduate semester credit hours; or 135 graduate quarter credit hours; or A graduate level degree which: Includes the coursework listed in §A(2) of this regulation; and Is approved by the Board; Completed the graduate coursework required as set forth in Regulation .03A(2) of this chapter; Achieved a passing score on: A national certification exam approved by the Board; and An examination of: Health Occupations Article, Title 17, Annotated Code of Maryland; and COMAR 10.58; Submitted a completed Board-approved application; Provided an official transcript from the educational institution which awarded the master’s or doctoral degree; Paid all applicable fees set forth in COMAR 10.58.02; Submitted to a criminal background check; Good moral character; and Complied with: Health Occupations Article, Title 17, Annotated Code of Maryland; and The code of ethics as set forth in COMAR 10.58.03. An applicant who fails an examination for licensure may retake the exam. Composition of Supervised Clinical Experience. A licensed graduate professional art therapist shall complete at least half of the requisite supervised clinical experience in professional art therapy hours under the supervision of a licensed clinical professional art therapist who has been approved by the Board to provide art therapy supervision. A licensed graduate professional art therapist may complete the remainder of the supervised clinical experience in professional art therapy hours under the supervision of an approved art therapy supervisor as defined in Regulation .02 of this chapter. The Board shall act upon applications within a 6-month period as follows: Within 90 days after receipt of an application, the Board shall determine whether the application is complete; If the Board determines that the application is not complete, the Board or the Board’s designee shall send a notice of deficiency to the applicant; Upon receipt of a notice, the applicant shall correct the deficiency within 90 days, or other period specified in the notice; and If the applicant fails to correct the deficiency within the required period, the application shall lapse and the applicant shall be required to: Submit a new application; and Pay the required non-refundable fee set forth in COMAR 10.58.02. Expiration, Renewal, and Extension. The graduate professional art therapist license expires 2 years after the date issued. If a licensed graduate professional art therapist is unable to accumulate the required clinical hours of supervision for licensure within 2 years, the licensee may apply for a 2-year extension before the license expires, up to a maximum of 6 years. A licensed graduate professional art therapist who has applied for and received an extension as set forth in §D(2) of this regulation, shall comply with the renewal requirements as provided in Health Occupations Article, §17–504, Annotated Code of Maryland. If a licensed graduate professional art therapist notifies the Board in writing, the Board may consider a license extension beyond the 6-year maximum set forth in §D(2) of this regulation. An applicant licensed as an art therapist or its equivalent, as established by the Board, in another state, territory, or jurisdiction is eligible for licensure if the applicant: Provides: A completed Board-approved application; Verification that the applicant has: A copy of a current license from each state, territory, or jurisdiction in which the applicant has been licensed, registered, or otherwise authorized to practice art therapy; Documentation, satisfactory to the Board, that the applicant is currently licensed in good standing to practice art therapy in another state, territory, or jurisdiction; No history of disciplinary action, past or pending, in a state, territory, or jurisdiction in which the applicant holds a license to practice art therapy; and Not committed any act or omission that would be grounds for discipline or denial of licensure under Health Occupations Article, §17-509, Annotated Code of Maryland; An official transcript from the educational institution which awarded the master’s or doctoral degree; Verification from employers, supervisors, or colleagues after the awarding of the graduate degree, that the applicant has practiced clinical professional art therapy for: Not less than 2 years; and A minimum of 2,000 hours; and For an applicant with a master’s degree consisting of less than 60 graduate semester credit hours: Documentation, satisfactory to the Board, of not less than 2 years and minimum of 2,000 hours after the awarding of the graduate degree; and Documentation showing completion of a minimum of 3 graduate semester credit hours covering each of the following primary topics or content areas: Diagnosis and treatment of mental and emotional disorders; Appraisal; Professional, legal, and ethical responsibilities; and Current certification from a national accrediting body approved by the Board; Pays all applicable fees set forth in COMAR 10.58.02; Achieves a passing score on: A national certification exam approved by the Board; and An examination of: Health Occupations Article, Title 17, Annotated Code of Maryland; and COMAR 10.58; Submits to a criminal background check; Is of good moral character; and Complies with: Health Occupations Article, Title 17, Annotated Code of Maryland; and The code of ethics as set forth in COMAR 10.58.03. A supervisor shall: Supervise only in those areas within the supervisor’s competence as determined by education, training, and experience; Provide supervision appropriate to the particular level of licensure being applied for or maintained; Provide supervision in the general content areas established in Health Occupations Article, §17-304.1, Annotated Code of Maryland; and Ensure that a supervisee has read and is knowledgeable about: Health Occupations Article, Title 17, Annotated Code of Maryland; and COMAR 10.58, with special emphasis on the Code of Ethics, COMAR 10.58.03. In addition to the requirements of §A of this regulation, the supervisor shall specifically instruct and provide guidance: Relating to the supervisee’s scope of practice of clinical professional art therapy under Health Occupations Article, §17-101, Annotated Code of Maryland; To supervisees in appropriate billing practices if applicable to the practice site including: Providing services involving the application of therapy principles and methods in the diagnosis, prevention, treatment, and amelioration of psychological problems, emotional conditions, or mental conditions of individuals, families, couples or groups, as stated in Health Occupations Article, §17-308, Annotated Code of Maryland; Record keeping; Disclosure of fees and financial arrangements; and Appropriate maintenance and destruction of clinical and financial records. The following individuals may not provide clinical supervision for a licensed graduate professional art therapy supervisee: A relative; A licensed graduate professional art therapist; A licensed graduate alcohol and drug counselor; A licensed graduate professional counselor; A licensed graduate marriage and family therapist; A certified alcohol and drug counselor; An individual with whom there could be a conflict of interest, including, but not limited to: An employee supervising their own employer; or A student supervising their own teacher; or Any other graduate level health care provider licensed under Health Occupations Article, Title 17, Annotated Code of Maryland. Licensure. An individual providing supervision shall be approved by the Board and licensed by the Board as a Clinical professional art therapist; Clinical professional counselor; Clinical alcohol and drug counselor; Clinical marriage and family therapist; or Mental health care provider as defined in Regulation .02B of this chapter. Supervision Experience, Education and Training. A supervisor or any mental health care provider, licensed by the Board under Health Occupations Article, Title 17, Annotated Code of Maryland, who is approved by the Board and has completed 3 years of documented experience in clinical counseling or psychotherapy, shall complete by December 31, 2019: 2 years of documented experience providing art therapy supervision; At least 3 graduate semester credit hours or 5 quarter credit hours of academic coursework in art therapy supervision; At least 3 graduate semester credit hours or 5 quarter credit hours of academic coursework in counseling supervision; or A Board-approved continuing education program that includes a minimum of 18 continuing education units (CEUs) with a trainer or trainers in: Counseling; Art therapy; or Psychotherapy supervision. A licensed individual who applied for and was granted Board-approved supervisor status before December 31, 2019 based on 2 years of documented experience providing art therapy supervision, may continue to provide art therapy supervision after that date. After December 31, 2019, an applicant for Board-approved supervisor status shall have: 3 years documented experience in professional art therapy as approved by the Board; and Completed the requirements of §A or B of this regulation. Supervision training required by this section may be obtained in a graduate course that may include, but is not limited to: The role and responsibilities of the supervisor; The needs of the supervisee, supervisor, and the agency setting while maintaining a clear ethical perspective, including: The maintenance of appropriate boundaries; and Making clinically appropriate diagnoses; The role of the supervisor as gatekeeper to the profession; Methods for building effective and appropriate relationships with clients; Models for group supervision; and Models and modalities for practice intervention. Pre-Supervision Responsibilities of a Supervisor. In addition to meeting the requirements of this regulation, the supervisor shall: File the completed Board-approved licensed professional art therapy supervisor application form; Provide the supervisee with a copy of the Board’s licensed clinical professional art therapy supervisor letter; and Have an active license that is without restrictions or conditions due to disciplinary action for the 2 years preceding an application for licensed clinical professional art therapy-approved supervisor status. A supervisor shall: Agree to and sign a Board-approved contract before initiating supervision; Ensure that the supervisee is practicing within the scope of the supervisee’s license; Determine the skill level at which the supervisee may practice; Focus on primary data from the supervisee’s practice; Maintain documentation of supervisory sessions for at least 7 years, including: Dates; Duration; and Focus of the supervisory sessions; Ensure that a supervisee has read and is knowledgeable about: Health Occupations Article, Title 17, Annotated Code of Maryland; and COMAR 10.58 with special emphasis on the Code of Ethics, COMAR 10.58.03; Within a reasonable period of time before the conclusion of supervision, provide the supervisee and employer with a notice of termination to avoid or minimize any harmful effect on the supervisee’s clients or patients; Be responsible for the clinical professional practices of supervisees; Provide: For emergency supervision and direction to a supervisee by a Board-approved supervisor; A written evaluation of progress to the supervisee on a regular basis or as needed; and A copy of the documentation required by §E of this regulation on request by the: Supervisee; or Board or its authorized agent; and Comply with a Board audit of a supervisor’s compliance with regard to the supervisory requirements and responsibilities. A supervisee shall: Verify that the supervisor has been approved by the Board; Agree to and sign a Board-approved contract before initiating supervision; Attend and participate in supervision as agreed to in the supervision contract; Prepare for supervision using case materials related to the supervisee’s clinical professional art therapy practice; and Maintain documentation of supervisory sessions for at least 7 years, to be available for verification to the Board or its authorized agent, including: Dates; Duration; and Focus of the supervision. A supervisee may not engage in the practice of clinical professional art therapy independent of supervision. A supervisee shall give the client a copy of a professional disclosure statement as described in Health Occupations Article, §17-507, Annotated Code of Maryland, that: Clearly states the art therapy services are provided under clinical supervision; and Provides the name of the supervisor with address and contact information. A supervisee shall obtain from the client a signed: Release of information; and Informed consent for treatment which indicates that the client: Is aware that art therapy services are being provided under clinical supervision; Consents to the recording of art therapy sessions with the knowledge that the recording may only be shared with the supervisor; and Consents to the sharing of client information between the licensed graduate professional art therapist and the named clinical supervisor. Health Occupations Article, §§17-101, 17-205, 17-301, 17-304.1, 17-304.2, 17-307, 17-307.1, 17-309,17-501.1, 17-502—17-505, 17-507, and 17-509, Annotated Code of Maryland Effective date: December 31, 2018 (45:26 Md. R. 1246)