Telemedicine in Maryland: Laws, Rules and Regulations, and Policies

Posted by Michael Hsu on 6/20/20 10:49 AM
Michael Hsu

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Maryland enacted its private insurance parity law in October 2012 and has since made strides to increase accessibility to remote medical care in the state and expand the utilization of telemedicine and telehealth.

To understand the current state of telemedicine in Maryland better, let’s take a closer look at laws, rules, and regulations regarding remote medical care in the Free State.

Maryland Telemedicine Parity Law (SB 781, 2012)

After three readings and several amendments, Maryland legislators passed Senate Bill 781 in 2012, enforcing payment parity for services delivered through telemedicine. 

The Bill defines telemedicine as the delivery of healthcare services through the use of interactive audio, video, or other telecommunications and electronic technology, by a healthcare professional licensed in the State of Maryland and acting within their scope of practice. 

The initial legislation doesn’t highlight the difference between telemedicine and telehealth and encompasses both terms under “telemedicine.” 

SB 781 also explicitly states that the following forms of doctor-patient communication are not included under the term telemedicine:

  • Audio-only telephone consultations 
  • Electronic messages (email) 
  • Facsimile transmissions

The main goal of Senate Bill 781 was to define the circumstances under which health insurers and managed care organizations must provide coverage for telemedicine services. 

The law states that insurers, health service plans, and health maintenance organizations must provide coverage for healthcare services appropriately delivered through telemedicine. Entities subject to this section of SB 781 cannot deny coverage for telemedicine services based solely on the fact that said services weren’t provided in-person.

After the amendments, SB 781 highlighted the fact that reimbursement is required for diagnosis, consultation, and treatment of covered patients if healthcare services are appropriately delivered through telemedicine. The Bill doesn’t go into detail and fails to define “appropriate delivery,” but it implies that remote healthcare services that do not meet the standard of care applicable to an in-person setting shall not be reimbursed.

Although it technically enforced payment parity for telemedicine, SB 781 gave insurers quite a bit of leeway. Under the 2012 law, insurers could impose deductible, copayment, and coinsurance amounts on benefits for healthcare services delivered both in-person and through telemedicine. In addition, the law allowed insurers to impose an annual dollar maximum for telemedicine services. 

The first iteration of Maryland’s telemedicine parity law was brief and did not provide any legal guidelines regarding who can practice telemedicine in the state and under what conditions. 

Telemedicine and Telehealth in Maryland

In 2017, Maryland updated its Code Insurance to include the term “telehealth” and define circumstances under which insurers must cover telehealth services. The “update” did not introduce any new rules or regulations, and the wording is nearly identical to the SB 781, with the only notable difference being the use of the term “telehealth” instead of “telemedicine.” 

Maryland uses telemedicine and telehealth interchangeably. The same rules and regulations apply to providing examination, diagnosis, and treatment through telemedicine and consultations through telehealth, under state law. 

Although both providers and patients in Maryland have quickly embraced telemedicine, the fact remains that Maryland’s telemedicine law is incomprehensive. This prompted the Maryland Board of Physicians to hold a public hearing in 2018, in order to review proposed telehealth rules and comments submitted by the state’s telemedicine advocates, spearheaded by the Maryland Telehealth Alliance.

As a result, the Board replaced the term “physician” with “telehealth practitioner” and expanded telehealth modalities. After the Board’s revision, telehealth in Maryland also includes: 

  1. Store-and-forward technology
  2. Remote patient monitoring (RPM)
  3. Interpretive services

Store-and-forward — The technology is defined as “asynchronous transmission of digital images, documents, and videos electronically through secure means.” Reimbursement for store-and-forward technology remains a bit vague, given that the law states that it “may be reimbursed depending on the State budget and the extent permitted by federal law.” 

Remote patient monitoring — The Board defines remote patient monitoring as “the use of telehealth devices to collect medical and other forms of health data from patients” for the purpose of facilitating evaluation, recommendations, and treatment. The same reimbursement rules apply as with store-and-forward technology.

Interpretive service — These services are defined as “reading and analyzing images, tracings, or specimens through telehealth or giving interpretations based on visual, auditory, thermal, ultrasonic patterns or other patterns as may evolve with technology.”

Who Can Practice Telemedicine and Telehealth in Maryland?

Maryland law does not limit the eligibility of healthcare providers who can offer remote healthcare services to patients in the state. 

Any healthcare professional licensed to practice medicine in Maryland can practice telemedicine and telehealth, provided they act within their scope of practice and deliver services that meet the standards of care applicable to an in-person setting.

Establishing a Valid Doctor-Patient Relationship

Healthcare providers in Maryland can establish a valid doctor-patient relationship through telemedicine. The relationship must be established through interactive, live, two-way video communication.

Patient Consent

Prior to engaging in telemedicine and telehealth, Maryland providers must obtain and document patient consent. The consent doesn’t have to be written — it can also be oral and digital in nature, so long as the provider includes it in the patient’s medical record. 

One exception to this rule is an emergency situation, during which Maryland providers may offer telemedicine and telehealth services to patients in the state without having to obtain their explicit consent. 

Online Prescriptions

Until recently, Maryland law didn’t provide any legal guidelines regarding the issuance of prescriptions as a result of telemedicine or telehealth visits. We believe this was a huge oversight by Maryland’s legislators, which they somewhat remedied in January 2020 by updating the Standard Related to Telehealth. 

The update forbids providers from issuing medication and treatment to patients based solely on an online questionnaire. Given that telemedicine under Maryland law does not include phone and email consultations or facsimile transmission, it’s safe to assume that online prescriptions require examination and diagnosis performed through live, two-way video communication with the patient.

The Standard Related to Telehealth also states that telehealth practitioners may not prescribe opioids through telehealth. An exception to this rule is telehealth services provided to patients in healthcare facilities who have immediate access to in-person medical care. 

Documenting Telemedicine Encounters

Under Maryland state and federal law, providers must document all telemedicine encounters. 

This can be quite tedious and time-consuming if you’re using a telemedicine solution that doesn’t integrate with your electronic health record. You would have to manually enter all the relevant medical data after each telemedicine or telehealth visit. This way, your doctors and medical staff would be wasting valuable time on administrative tasks rather than spending that time treating patients.

When creating Curogram, we wanted to streamline telemedicine as much as possible. That’s why we’ve made sure that our platform integrates with over 700 EHRs. Curogram eliminates redundant administrative tasks, allowing you to admit more patients daily, ultimately helping you increase the revenue of your practice.

Curogram EHR integrations

eClinicalWorks

Athena

Epic

Cerner

DrChrono

NextGen

Practice Fusion

CareCloud

Kareo

OfficeAlly

See More Integrations Here

Cross-State Medical License

The State of Maryland has passed legislation to join the Interstate Medical Licensure Compact, allowing providers licensed in other states to provide telemedicine and telehealth services to patients in Maryland.

The state’s Medicaid program also allows healthcare professionals from adjoining states — Delaware, Pennsylvania, Virginia, and West Virginia — to provide remote medical care to Maryland Medicaid participants if they have an agreement with an eligible originating site in Maryland.

Maryland Medicaid

The Maryland Medicaid program issued a Telehealth Program Manual in 2015, implementing detailed guidelines for telehealth providers offering remote healthcare services to the program’s participants. 

Maryland’s Medicaid employs a standard “hub-and-spoke” model. “Hub” refers to a distant site or, put simply, the location of the provider who is offering remote healthcare services. “Spoke” is the originating site, or rather the location of the patient receiving those services.

One thing to note regarding Maryland Medicaid’s view of telehealth is that the program also defines a “telepresenter” as a medical professional located at an originating site who facilitates telehealth communication and arranges the necessary equipment. 

The inclusion of this definition means that a patient’s home is not an eligible originating site. A Medicaid participant receiving remote healthcare services must be located at one of the eligible medical facilities, where in-person medical care is immediately available to them.

Eligible Originating Sites

Maryland Medicaid provides an exclusive list of originating sites eligible for reimbursement. These sites include:

  • Hospitals, including emergency departments
  • Nursing facilities
  • Private offices of physicians, psychiatric nurse practitioners, nurse practitioners, or nurse-midwives
  • Federally Qualified Health Centers (FQHCs)
  • Outpatient Mental Health Centers (OMHCs)
  • Local health departments
  • College or university student health or counseling offices
  • Elementary, middle, high, or technical schools with supported nursing, counseling, or medical offices
  • Community-based substance use disorder providers
  • Opioid treatment programs
  • Renal dialysis centers
  • Residential crisis services sites

Eligible Providers

Maryland Medicaid also provides a list of eligible distant sites.

Providers enrolled in the state’s Medicaid program eligible for telehealth reimbursement include:

  • Physicians
  • Physician assistants
  • Nurse practitioners
  • Psychiatric nurse practitioners
  • Nurse-midwives
  • Medical professionals working at Outpatient Medical Health Centers

Prior to providing telehealth services to Maryland Medicaid program participants, providers must complete online registration. This applies to both originating and distant sites. 

Covered Services

According to Medicaid’s Telehealth Program Manual, Maryland's Medicaid covers somatic and behavioral health services delivered through telehealth. All services rendered via telehealth are subject to the same program restrictions, preauthorizations, limitations, and coverage that applies to in-person medical care.

Somatic services — Before offering somatic services via telehealth, providers must contact the participant's HealthChoice MCO and inquire about authorization requirements for telehealth services.

Behavioral services — Providers must first contact Beacon Health Options with questions regarding prior authorization of telehealth services.

Technical Requirements

In order to comply with the standards of care applicable to in-person settings, Medicaid prescribes the minimum technical requirements every provider must meet before engaging in a telehealth encounter with the program’s participants.

Minimal technical requirements are:

  1. A camera that can be manually or remotely adjusted to provide multiple views of the patient. It must also include capabilities to zoom, focus, and alter resolution, according to the consultation requirements. 
  2. A sufficient size display monitor that can accommodate for diagnostic needs in the rendered telehealth service.
  3. Bandwidth speed and image resolution that provides the necessary minimum quality to meet a minimum of 15 frames per second.
  4. Audio equipment that enables clear communication and includes noise cancellation 
  5. Technology that creates audio transmission with a 300-millisecond delay, at most.

Five Tips for Practicing Telemedicine and Telehealth in Maryland

Laws, policies, rules, and regulations regarding the practice of telemedicine and telehealth in Maryland come from various different sources — Senate Bills, the state's Medical Boards, and Maryland Medicaid.

Reading through half a dozen different Bills and manuals to see what policies apply to your practice can be quite consuming and frustrating, given the often vague wording of some policies. 

That’s why we’ve compiled a list of ten tips that will help you get started with telemedicine and telehealth in the State of Maryland.

Tip #1 — Understanding the Revised Definition

The revisions implemented by the Maryland Board of Physicians replaced the term “telemedicine” with “telehealth,” as well as the term “physician” with “telehealth practitioner.” 

The revisions highlight that telehealth services might require face-to-face contact by a healthcare professional at an originating site when they are delivered to a Medicaid program participant.

Changing the term “physician” to “telehealth practitioner” helps expand the usage of telehealth services, by enabling non-physician medical professionals to render such services to patients in Maryland. 

The rules set forth by the Board also include other modalities, such as store-and-forward technology, remote patient monitoring, and interpretive services, into telehealth practice, which are reimbursable under special conditions.  

Tip #2 — Complying with the Standard of Care

Maryland law states that healthcare professionals providing telehealth services will be held to the same standard of care applicable to in-person settings. 

The law doesn’t explicitly state that you must refuse patients if you determine that treatment for their medical condition wouldn’t meet the standards when delivered via telehealth. In these cases, you should still advise the patients to seek in-person medical care. Otherwise, you may be subject to disciplinary measures by the state’s Medical Board.

Tip #3 — Meeting the Requirements before Rendering Telehealth Services

There are several conditions that must be met before you can admit patients remotely in the State of Maryland. 

The requirements for telehealth in Maryland include:

  1. Confirming that the patient resides in Maryland and determining their physical location (originating site)
  2. Verifying the patient’s identity
  3. Disclosing the provider’s credentials to the patient for the initial telehealth visit, including the provider’s name, title, medical specialty, and location
  4. Identifying every individual present at the practitioner’s location (distant site)
  5. Confirming that no persons unauthorized to hear or share patient’s medical information are present at the originating site
  6. Informing the patient of the time telehealth visit will take place and discussing the potential confidentiality risk associated with delivering remote healthcare services
  7. Having a contingency procedure for re-establishing communication with the patient if the appointment is terminated due to technical difficulties on either side

Tip #4 — Performing Telehealth Examinations

A telehealth provider must perform a detailed evaluation of the patient, sufficient for establishing a diagnosis, and identify underlying conditions and contraindications to recommended treatment options before prescribing any medications or providing treatment. 

To do so, a telehealth practitioner may rely on physical examination provided by a telepresenter or other licensed healthcare practitioner, or on telehealth devices and live two-way, audio-video communication to perform an examination remotely.

Tip #5 — Issuing Online Prescriptions

Maryland law allows telehealth practitioners to prescribe medication as a result of a telehealth visit, provided that the medical professional performed an adequate examination of the patient. This means that telehealth practitioners cannot prescribe medication as a result of a phone or email consultation, or based solely on an internet questionnaire. 

There are a few limitations to this rule. Telehealth practitioners may not prescribe opioids through telehealth, except when opioids are used to treat opioid use disorder or the patient is in the presence of a licensed healthcare professional.

Have a Successful Telehealth Start in Maryland with Curogram

If you’re looking for a telehealth solution that would enable you to start offering remote healthcare services to patients in Maryland in compliance with the state’s laws, rules, and policies — Curogram is the perfect option. 

Curogram is a fully HIPAA compliant telemedicine platform, designed specifically for healthcare professionals, that allows you to set up your virtual practice in less than 48 hours! 

It comes with all the built-in safeguards and capabilities necessary to meet the established standards of care, meaning you won’t have to concern yourself with technical details or consult a medical lawyer. 

We designed Curogram in a way that mimics your in-person workflows and made it easy to use for both patients and providers. You can manage your virtual clinic, share PHI, discuss work-related topics, and admit patients online from a single, web-based dashboard. The patients will receive a link in an SMS that they can click to join your virtual waiting rooms and attend scheduled appointments. 

Here are a few reasons why you’ll love Curogram

Full EHR integration

Curogram integrates with over 700 EHRs and automatically updates your electronic health record following each telehealth visit. Our platform eliminates redundant, manual administrative tasks, allowing you to dedicate more time to your patients.

A two-way messaging platform and automated appointment reminders

Curogram assigns a local number to your practice, allowing you to send automated appointment reminders to your patients. They can respond to the text if they want to reschedule or inquire about your telehealth service, then simply click the link to join the online appointment. 

Automated patient intake forms

Curogram automatically sends electronic patient intake forms a few days ahead of the appointment. This means doctors don’t have to spend 15 minutes per appointment onboarding the patients, allowing them to admit more patients daily.

Easy and secure internal communication and file sharing

Curogram includes a messaging platform your medical staff can use to discuss work-related topics and share PHI in a secure environment.

Replicates in-person workflows

Curogram enables you to set up multiple virtual clinics, each with their own virtual waiting room. Our waiting room management tools facilitate patient check-in and check-out and replicate the in-person workflows your medical staff is used to.

If you want to learn more about Curogram and see all of its amazing features in action — click here and start your free 14-day trial!

Telemedicine by State

Don’t see your state? We just haven’t written about it yet! Stay tuned on our blog or check out our article on telemedicine reimbursement by state.

Telemedicine by State in the US

Alabama

Indiana

Nebraska

South Carolina

Alaska

Iowa

Nevada

South Dakota

Arizona

Kansas

New Hampshire

Tennessee

Arkansas

Kentucky

New Jersey

Texas

California

Louisiana

New Mexico

Utah

Colorado

Maine

New York

Vermont

Connecticut

Maryland

North Carolina

Virginia

Delaware

Massachusetts 

North Dakota

Washington

Florida

Michigan

Ohio

West Virginia

Georgia

Minnesota

Oklahoma

Wisconsin

Hawaii

Mississippi

Oregon

Wyoming

Idaho

Missouri

Pennsylvania

 

Illinois

Montana

Rhode Island

 

Topics: telemedicine

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