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)