# COMAR Title 10 — Maryland Department of Health

## Subtitle 65 — Board of Massage Therapy Examiners

### Chapter 10 — Telehealth

**Authority:** Health Occupations Article, §§1-1001—1-1006 and 6-206, Annotated Code of Maryland

**Administrative History:** Effective date: September 18, 2023 (50:18 Md. R. 799)

#### Regulation .01 Scope.

*COMAR 10.65.10.01*

A. This chapter governs the practice of massage therapy using telehealth as an adjunct to, or replacement for, in-person client visits.

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

#### Regulation .02 Definitions.

*COMAR 10.65.10.02*

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

B. Terms Defined.

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

  (2) “Board” means the Maryland Board of Massage Therapy Examiners.

  (3) Health Care Services.

    (a) “Health care services” means to provide client instruction through telehealth using:

      (i) Techniques that include, but are not limited to, stretching, movement, breathing, and self-massage; and

      (ii) Applications, such as nonlegend topicals and hot and cold packs or pads.

    (b) “Health care services” does not include:

      (i) Mental health counseling; or

      (ii) Nutritional counseling.

  (4) “In-person” means within the physical presence of the client.

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

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

  (7) “Telehealth practitioner” means a Maryland licensed massage therapist or a registered massage practitioner performing telehealth services within their respective scope of practice as defined under Health Occupations Article, §6-101, Annotated Code of Maryland.

#### Regulation .03 Licensure and Registration.

*COMAR 10.65.10.03*

Subject to the provisions of Health Occupations Article, Title 6, Annotated Code of Maryland, a telehealth practitioner shall be licensed or registered in Maryland when providing telehealth services to a client located in the State.

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

*COMAR 10.65.10.04*

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

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

    (a) A government-issued photograph identification;

    (b) Documentation of the client’s:

      (i) Date of birth; and

      (ii) Home address; or

    (c) Except for registered massage therapists, an insurance, Medicaid, or Medicare card;

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

    (a) Name;

    (b) Maryland license or registration number; and

    (c) Contact information;

  (3) Obtain oral or written consent from a client or client’s parent or guardian if State law requires the consent of a parent or guardian, including informing clients of the risks, benefits, and side effects of the recommended health care services;

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

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

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

  (7) Establish safety protocols to be used in the case of an emergency, including contact information for emergency services at the client’s location.

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

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

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

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

C. A telehealth practitioner shall be held to the same standards of practice and documentation as those applicable for in-person massage therapy practice appointments.

#### Regulation .05 Client Evaluation.

*COMAR 10.65.10.05*

A. A telehealth practitioner shall:

  (1) Perform a synchronous or asynchronous clinical client evaluation that is appropriate for the client and the condition with which the client presents before providing health care services through telehealth; and

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

    (a) In-person treatment; or

    (b) Another type of telehealth service.

B. A telehealth practitioner may not treat a client based solely on an online questionnaire.

#### Regulation .06 Telehealth Practitioner Discipline.

*COMAR 10.65.10.06*

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

B. 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