Maryland State Telehealth Laws and Reimbursement Policies

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Information Provided ByCenter for Connected Health Policy

© Public Health Institute/ Center for
Connected Health Policy 2019:http://cchpca.org

MD Medical Assistance Program

Maryland
Medicaid Program: MD Medical Assistance Program

Program Administrator: MD Dept. of Social Services

Regional Telehealth Resource Center

Mid-Atlantic Telehealth Resource Center
PO Box 800711

Charlottesville, VA 22908-0711
(434) 906-4960 / (855) MATRC4U
www.matrc.org

STATE LAW/REGULATIONS MEDICAID PROGRAM

Definition of telemedicine/telehealth

“Telehealth means the use of telecommunications and No reference found.

information technologies for the exchange of information
from one site to another, for the provision of health care
to an individual from a provider through hardwire or
Internet connection.”

Source: MD Health Occupations Annotated Sec. 2-101 (2012).

Telemedicine means, as it relates to the delivery of

health care services, the use of interactive audio, video,
or other telecommunications or electronic technology:
1. By a health care provider to deliver a health care service that is within the scope of practice of the health care provider at a site other than the site at which the patient is located; and
2. That enables the patient to see and interact with the health care provider at the time the health care service is provided to the patient.

Source: Health General Code 15-105.2.

Telehealth means, as it relates to the delivery of health

care services, the use of interactive audio, video or other
telecommunications or electronic technology by a
licensed health care provider to deliver a health care
service within the scope of practice of the health care
provider at a location other than the location of the
patient. Telehealth does not include audio only

telephone between a health care provider and a patient;
an electronic mail message between a health care
provider and a patient; or a facsimile transmission
between a healthcare provider and patient.

Source: MD Insurance Code 15-139.

“Telemedicine means the practice of medicine from a

distance in which intervention and treatment decisions
and recommendations are based on clinical data,
documents, and information transmitted through

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STATE LAW/REGULATIONS MEDICAID PROGRAM

telecommunications systems.”
Source: Code of Maryland Admin. Regs. Sec. 10.32.05.02
“Telehealth means the delivery of medically necessary
services to a patient at an originating site by distant site
provider, through the use of technology-assisted
communication.”
“Telemedicine means the delivery of medically
necessary somatic services to a patient at an originating
site by a distant site provider, through the use of
technology-assisted communication.”
Source: Code of Maryland Admin. Regs. Sec. 10.09.49.02.
Perinatal and Neonatal Referral Center Standards:
“Telemedicine” means the use of interactive audio,
video, or other telecommunications or electronic
technology by a licensed health care provider to deliver
a health care service within the scope of practice of the
health care provider at a site other than the site at which
the patient is located, in compliance with COMAR
10.32.05.and including at least two forms of
communication.
Source: MD COMAR Sec. 30.08.12.

Live Video Reimbursement

Maryland law requires private insurers to provide Maryland Medicaid provides a telehealth program that
coverage for telehealth services, which includes live employs a “hub-and-spoke” model. Applies to fee for
video. service and managed care.
(See “Private Payers” section). Communication must be in real time, and the participant
Source: MD Insurance Code Annotated Sec. 15-139 (2012). must be at an originating site with a telepresenter.

Maryland law requires the state Medicaid program to Covered Services – Somatic and behavioral health
services: Providers must contact the participant’s
provide coverage for live video telemedicine services
healthchoice MCO or Beacon Health Option with
(subject to terms and conditions of contract), the same
questions regarding prior authorization requirements for
as it does for private payers.
telehealth services.

Primary care providers are required to qualify as eligible Eligible distant site provider:
telemedicine providers.
Nurse midwife

The Department may require providers to submit a Nurse practitioner
Psychiatric nurse practitioner
registration form to include information required for the
Physician; or
processing of telemedicine claims.
Outpatient mental health center

Source: House Bill 1217 – 2016. Telehealth providers must complete an online
The Department shall grant approval to allow originating
registration.
and consulting site providers to receive State and
federal funds for providing telemedicine services if the Source: MD Medicaid Telehealth Program. Telehealth Provider
telemedicine provider meets certain requirements. Manual. Updated May 3, 2016. Accessed Oct. 2017.
Telemedicine providers must be part of a private Reimbursement for telemedicine is required by Maryland
Medical Assistance if the health care service is

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STATE LAW/REGULATIONS MEDICAID PROGRAM

practice, hospital or other health care system. medically necessary and provided:
For the treatment of cardiovascular disease or
Must be an agreement between a medical stroke;
assistance-approved originating site provider In an emergency department setting; and
and consulting provider. When an appropriate specialist is not available.
Source: Health General Code 15-105.2. Source: MD Insurance Code Sec. 15-105.2

The Department of Health and Mental Hygiene must Managed Care
adopt regulations related to the scope of benefits for
MCOs shall provide coverage for medically necessary
telehealth services.
telemedicine services.

Source: House Bill 1217 – 2016. Source: Code of Maryland Admin. Regs. Sec. 10.09.67.31.

Mental Health Eligible Services:
Diagnostic interview;
Individual therapy
Family therapy
Outpatient evaluation and management
Outpatient office consultation
Initial inpatient consultation
Emergency department services
Source: Code of Maryland Admin. Regs. Sec. 10.09.49.05.
Eligible Distant Site Providers:
Nurse midwife
Nurse practitioner
Psychiatric nurse practitioner
Physician
Community-based substance use disorder
provider
Opioid treatment program
Outpatient mental health center
Providers must apply to participate in the telehealth
program and be approved. They also must have a
written contingency plan when telemedicine is
unavailable.
Source: Code of Maryland Admin. Regs. Sec. 10.09.49.07.
The Department may not reimburse telemedicine
services by an originating and distant site provider
located in different facilities in the same hospital
campus.
Source: Code of Maryland Admin. Regs. Sec. 10.09.49.11.
The Department’s contractor who operates the Maryland
Public Behavioral Health System must reimburse for
specialty mental health services when authorized by
COMAR 10.09.49.
Source: Code of Maryland Admin. Regs. Sec. 10.09.49.06.

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STATE LAW/REGULATIONS MEDICAID PROGRAM

Store and Forward Reimbursement

No reimbursement based upon definition of “telehealth” Maryland Medicaid does not cover store and forward.
which describes telemedicine as “interactive”. Source: MD Medicaid Telehealth Program. Telehealth Provider

Source: MD Insurance Code Annotated Sec. 15-139 (2012). Manual. Updated May 3, 2016. (Accessed Oct. 2017).
The department may provide reimbursement for MD Medicaid does not cover store and forward.
services delivered through store and forward However, dermatology, ophthalmology and radiology are
technology. excluded from definition of store and forward. They do
reimburse for these services according to COMAR
Source: Health General Code 15-105.2. 10.09.02.07.
Source: Code of Maryland Admin. Regs. Sec. 10.09.49.10.

Remote Patient Monitoring Reimbursement

The department may provide reimbursement for No reimbursement for home health monitoring services.
services delivered through remote patient monitoring
technology. Source: MD Medicaid Telehealth Program. Telehealth Provider
Manual. Updated May 3, 2016. (Accessed Oct. 2017)
Source: Health General Code 15-105.2. & Code of Maryland Admin. Regs. Sec. 10.09.49.11.

Email/Phone/FAX

No reimbursement for email. No reimbursement for email.
No reimbursement for telephone. No reimbursement for telephone.
No reimbursement for FAX. No reimbursement for FAX.
Source: MD Insurance Code Annotated Sec. 15-139 (2012) & No reimbursement for email, phone or telephone
Health General Code 15-105.2. conversations between providers.
Telehealth also does not include a telephone Source: MD Medicaid Telehealth Program. Telehealth Provider
conversation, email or fax between providers without Manual. Updated May 3, 2016. (Accessed Oct. 2017)
interaction between the distant site provider and patient. & Code of Maryland Admin. Regs. Sec. 10.09.49.11.
Source: Code of Maryland Admin. Regs. Sec. 10.09.49.11.

Online Prescribing

A physician-patient relationship can be established No reference found.
through real time auditory communications or real-time
visual and auditory communications.
Source: Code of Maryland Admin. Regs. Sec. 10.32.05.02

Consent

Telehealth providers must inform patients and The originating site must obtain consent
consultants of the following: Source: MD Medicaid Telehealth Program. Telehealth Provider

The inability to have direct, physical contact with Manual. Updated May 3, 2016. Accessed Oct. 2017.
the patient is a primary difference between Consent is required unless there is an emergency.
telehealth and direct in-person service delivery;

The knowledge, experiences, and qualifications Code of Maryland Admin. Regs. Sec. 10.09.49.06.
of the consultant providing data and information

to the provider of the telehealth services need
not be completely known to and understood by
the provider;

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STATE LAW/REGULATIONS MEDICAID PROGRAM

The quality of transmitted data may affect the

quality of services provided by the provider;

That changes in the environment and test

conditions could be impossible to make during
delivery of telehealth services;

Telehealth services may not be provided by

correspondence only.

Source: Code of MD Reg., 10.41.06.04 (2012).

Except when providing interpretive services, the

physician must obtain and document patient consent.

Source: Code of Maryland Admin. Regs. Sec. 10.32.05.06

Location

Eligible originating sites (admin code):

College or university student health or counseling office;

Community-based substance use disorder provider;

Elementary, middle, high, or technical school with a supported nursing, counseling or medical office;

Local health department;

FQHC;

Hospital, including the emergency department;

Nursing facility;

The office of a physician, psychiatric nurse practitioner, nurse practitioner, or nurse midwife;

An opioid treatment program; Outpatient mental health center;

Renal dialysis center; or Residential crisis services site.

When patient is in a hospital emergency department, the professional fee for the distant site provider would be covered if the distant site provider is not the physician of record or the attending physician and the initial telehealth consultation is distinct from the care provided by the physician of record or the attending physician.

Distant site provider must be located within the State, the District of Columbia, or a contiguous state.

Source: Code of Maryland Admin. Regs. Sec. 10.09.49.07.

Eligible originating sites:

College or university student health or counseling office

Community-based substance use disorder provider

Elementary, middle, high or technical school with a supported nursing, counseling or medical office

Local health department

FQHC

Hospital, including emergency department

Nursing facility

Private office

Opioid treatment program

Outpatient mental health center

Renal dialysis center; or

Residential services site

Source: MD Medicaid Telehealth Program. Telehealth Provider Manual. Updated May 3, 2016. Accessed Oct. 2017.

Cross-State Licensing

MD has exceptions to its MD-only licensed physicians No reference found.
for physicians practicing in the adjoining states of
Delaware, Virginia, West Virginia, and Pennsylvania.

Source: MD Health Occupations Code Annotated Sec. 14-302

(2012).

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STATE LAW/REGULATIONS MEDICAID PROGRAM

A physician providing services through telemedicine

must have a Maryland license if they are located in
Maryland, or if the patient is in Maryland.

Source: COMAR 10.32.05.03

Private Payers

Recently Amended Statute (Now Effective) No reference found.

Requires coverage of telehealth services under a health
insurance policy or contract for health care services
appropriately delivered through telehealth..
A health insurer can undertake utilization review,
including preauthorization to determine the
appropriateness of any health care service whether
delivered in person or through telehealth if the
appropriateness is determined in the same manner.
Healthcare services appropriately delivered through
telehealth shall include counseling and substance use
disorders.
Source: MD Insurance Code Annotated Sec. 15-139 (2012).

Site/Transmission Fee

Originating sites are eligible for a transmission fee. Fee Originating sites may bill for a transmission fee.
set in COMAR 10.09.07D; or by the Health Services
Cost Review Commission for sites located in regulated Source: MD Medicaid Telehealth Program. Telehealth Provider
space. Manual. Updated May 3, 2016. Accessed Oct. 2017.
Services delivered must be clinically appropriate, as
determined by the provider’s licensure or credentialing
board.
Transmission fees paid to the originating site may be
used to pay for: Line or per minute usage charges or
both; and any additional programmatic, administrative,
clinical or contingency support at the originating site.
Code of Maryland Admin. Regs. Sec. 10.09.49.11.

Miscellaneous

Providers of health care services delivered through Technology requirements for providers:
telemedicine must use video and audio transmission A camera with specific resolution, focus, and
with less than a 300 millisecond delay. Other minimum zoom capabilities
technology requirements apply. Have display monitor sufficient in size
Source: Code of Maryland Admin. Regs. Sec. 10.09.49.08. Bandwidth speed and image resolution sufficient
to provide quality video
Providers may not store at originating or distant site Audio equipment that ensures clear
communication
video images or audio portion of telemedicine services
Creates audio transmission with less than 300
for future use.
millisecond delay
Source: Code of Maryland Admin. Regs. Sec. 10.09.49.09.

Must ensure HIPAA compliance.

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STATE LAW/REGULATIONS MEDICAID PROGRAM

Telehealth can be used to meet network adequacy
Provider manual outlines various telehealth provider
standards.
Source: MD House Bill 1318 – 2016. scenarios.

Source: MD Medicaid Telehealth Program. Telehealth Provider
On or before Oct. 1, 2016, the Department of Health and Manual. Updated May 3, 2016. Accessed Oct. 2017.
Mental Hygiene, in consultation with the Maryland
Health Care Commission must submit a report to the
Senate Finance Committee and House Health and
Government Operations Committee assessing
telehealth policies of select Medicaid programs in other
states, including reimbursement for telehealth services
provided in a home setting and detailed planned
enhancements to the Maryland Medicaid telehealth
program.

Source: MD House Bill 886 – 2016.

Comments: The Maryland Health Care Commission has a Telemedicine Task Force to study the use of

telehealth throughout the State.

Professional Telehealth-Specific Regulations

Teletherapy (Source: SB 1106 – 2017, Health Occupations Code, Subtitle 9)

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