Scope. This regulation applies to an EMS operational program that seeks to facilitate telemedicine appointments between certain low-acuity patients and independent physicians that are not affiliated with a base station or system medical director, nor under the direct supervision of the EMS operational program or its medical director. This regulation does not limit the use or scope of medical direction offered through a base station in accordance with the Maryland Medical Protocols for Emergency Medical Services. Definition. In this regulation, “limited-scope medical direction” means the specific instruction of a licensed physician during a telemedicine encounter regarding the need for transport and the transport destination for a patient 18 years or older and determined to be Priority 3 or Priority 4 under the Maryland Medical Protocols for Emergency Medical Services. An EMS operational program may submit to MIEMSS a plan for the use of limited-scope medical direction through an entity that is not an approved EMS base station or system medical director. The plan shall: Describe the entity through which the limited-scope medical direction will be provided; Include the minimum standards that the EMS operational program will require of the entity that will supply and direct physicians in providing limited-scope medical direction authorized by this regulation; Contain a quality assurance/quality improvement plan that provides MIEMSS with access to any records produced and maintained by the EMS operational program and to any records and recordings of an encounter with the entity’s physicians who provide limited-scope medical direction; Include the manner by which the EMS operational program or other entity will inform a patient of any financial obligations of the patient associated with a telemedicine appointment provided under this regulation; Provide for a semi-annual report to MIEMSS that includes at a minimum: The number of patients evaluated or treated through telemedicine resulting in limited-scope medical direction; A record of the patients’ presenting chief complaints and any interventions provided; and A record of referrals for follow-up medical care; Provide a system for recording communications between an entity’s physician providing limited-scope medical direction and EMS personnel as well as a system for storing any such recordings for a minimum of 90 days; and Be consistent with the Emergency Medical System Plan approved by the EMS Board. To provide limited-scope medical direction through an EMS operational program’s plan, an individual shall at a minimum: Be licensed to practice medicine in the State of Maryland; Hold active board certification in: Emergency medicine; Emergency medical services; Family medicine; or Internal medicine; Be knowledgeable of EMS and the local treatment options for low-acuity patients; Certify to the EMSOP that the individual has not been subject to disciplinary action by any professional licensing body within the 5 years prior to providing limited-scope medical direction; and Meet the requirements of Regulation .03C of this chapter. MIEMSS may approve, modify, or deny a proposed plan of an EMS operational program to provide limited-scope medical direction. Subject to a MIEMSS-approved plan for use of limited-scope medical direction, an EMS operational program may allow an entity whose physicians meet the requirements of Regulation .03C of this chapter and §D of this regulation to provide limited-scope medical direction to EMS personnel affiliated with the EMS operational program. No later than June 30 of each year, each EMS operational program seeking to use or continue to use limited-scope medical direction shall submit to MIEMSS a list that identifies each physician by full name and Maryland license number who will provide limited-scope medical direction to the EMS personnel affiliated with the EMS operational program. An individual or entity may not provide or offer to provide limited-scope medical direction unless that individual or entity is doing so pursuant to an EMS operational program’s MIEMSS-approved plan. EMS Clinicians. An EMS clinician may not receive or attempt to receive limited-scope medical direction unless the EMS clinician is doing so pursuant to an EMS operational program’s MIEMSS-approved plan. This regulation does not affect an EMS clinician from receiving or attempting to receive medical direction that includes transport instructions from any base station in accordance with the Maryland Medical Protocols for Emergency Medical Services. MIEMSS may revoke the previously approved plan of an EMS operational program for the use of limited-scope medical direction if MIEMSS determines that the EMS operational program has violated the terms of its previously approved plan or any requirements of this regulation.