Two Maryland licensing boards – the Board of Examiners of Psychologist and the Board of Professional Counselors and Therapists – issued a pair of proposed rules setting forth practice standards for mental health services delivered via telehealth technologies. The Boards previously did not have specific practice standards or rules unique to telehealth. Once finalized, psychologists, counselors, and therapists using telehealth in their services should read and apply these new requirements to their operations and service models.
The proposed rules closely mirror each other. Both apply to professionals delivering care to patients located in Maryland. Both allow a wide range of modalities, defining telehealth as the "use of interactive audio, video or other telecommunications or electronic media," but excluding an audio only telephone conversations, email, fax or text. Both rules prohibit treatment based solely upon an online questionnaire.
The Board of Professional Counselors and Therapists rule allows therapists to conduct the initial patient evaluation via telehealth. The Board of Psychology rule requires an in-person initial evaluation unless the psychologist or psychologist associate documents in the record the reason for not meeting in person. (The rule doesn't enumerate a list of acceptable or unacceptable reasons; it simply requires the reason to be documented.)
Professionals must confirm the identity of the client/patient, as well as the client's location and contact information. The professional must also identify contact information for emergency services at the client's location. Curiously, the rule issued by the Board of Professional Counselors and Therapists refers to the client's location as the "practice setting." While this could raise a suggestion that the client must be physically located in a clinical practice setting, it is more likely a drafting error because there is no mention of any originating site requirements in the rule.
Professionals must also identify everyone at the client's location and confirm those individuals are permitted to hear the client's health information. The use of the term "permitted" as opposed to "authorized or "legally authorized" and the absence of reference to any state or federal privacy law, suggests another person's presence is subject to the client's permission and not legal authority.
With regard to client consent to telehealth services, the Board of Psychology rule requires "written informed consent," whereas the Board of Professional Counselors and Therapists rule requires the client's "written and oral acknowledgement." Both rules state that the standard for services delivered via telehealth is the same as services delivered in-person.
The Boards are considering comments and Maryland providers are awaiting the final regulations. We will continue to monitor further developments including the passage of these final rules and any changes.
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