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Maryland’s Secretary of Health adopted new regulations that lay out standards for the nonclinical practice of teletherapy by certified registered nurse practitioners/psychiatric mental health (CRNP/PMHs) and psychiatric mental health/advanced practice registered nurses (PMH/APRNs).  

Defining Teletherapy

In Maryland, Teletherapy means “the delivery of behavioral health services by a CRNP/PMH or a PMH/APRN at a location other than the location of the client through the use of synchronous interactive audio, video, audio-visual, or other telecommunications or electronic technology.” The regulations specifically carve out audio-only telephone conversations, email, and fax. Interestingly, there were modifications to the proposed rule that changed the definition of “synchronous” to simply require simultaneous or “quick enough” for the practitioner to “interact” with the patient. This and the language allowing for other telecommunications technology (beyond interactive audio and video) is part of a trend of broader definitions of telemedicine, which are meant to accommodate for advances in technology and its use in service delivery.  


Licensure and Board certification is required before a registered nurse can provide teletherapy services if (1) the patient or client is physically located in Maryland or (2) the CRNP/PMH or PMH/APRN is physically located in Maryland. A practitioner seeking to provide teletherapy service must be certified by the Maryland Board of Nursing as a CRNP/PMH or PMH/APRN and permitted by Maryland or multistate licensure to practice in Maryland. 

Practice Standards

The final regulations contain requirements related to the delivery of teletherapy that a CRNP/PMH or PMH/APRN must follow, including:

  • Establishing a client-therapist relationship;

  • Performing a mental status assessment;

  • Establishing a diagnosis;

  • Developing a treatment plan; and

  • Obtaining informed consent from the client to provide teletherapy.

  • Developing procedures to: 

    • Verify the identity of the client receiving teletherapy services;

    • Ensure that all medical records are protected from unauthorized access through encryption or other means;

    • Ensure that the CRNP/PMH or PMH/APRN provides a secure and private teletherapy connection and complies with federal and state privacy laws;

    • Notify a client in the event of a data breach in accordance with the Health Insurance Portability and Accountability Act (HIPAA) and the Maryland Confidentiality of Medical Records Act; and

    • Establish safety protocols to be used in the case of an emergency.

  • At the outset of each teletherapy session, the CRNP/PMH or PMH/APRN must:

    • Identify all individuals present at each location and confirm that they are permitted to hear or access personal health information;

    • Obtain or confirm an alternative method of contacting the client in case of a technological failure; and

    • Determine whether the client is in Maryland.


The regulations prohibit the use of online questionnaire to form the basis of a medication prescription, and each CRNP/PMH or PMH/APRN should be aware of federal rules regarding teleprescribing before writing prescriptions for clients seen via teletherapy. 

If you’re interested in providing telemedicine, teletherapy, or telebehavioral health, contact us to learn more about how to start your own practice or deliver services via telemedicine in your current practice!