SB 278
Department of Legislative Services
Maryland General Assembly
2021 Session
FISCAL AND POLICY NOTE
Third Reader
Senate Bill 278 (Senator Kagan)
Education, Health, and Environmental Affairs Health and Government Operations and
Ways and Means
State Department of Education and Maryland Department of Health - Maryland
School-Based Health Center Standards - Telehealth
This emergency bill requires the Maryland State Department of Education (MSDE) and
the Maryland Department of Health (MDH) to authorize a health care practitioner at a
school-based health center (SBHC) to provide services through telehealth consistent with
specified provisions of the Health Occupations Article. The bill prohibits MSDE and MDH
from (1) requiring an approved SBHC to submit an application or seek approval to provide
telehealth services or (2) establishing requirements for SBHCs to provide telehealth that
are inconsistent with specified current law. By July 1, 2021, MSDE and MDH must revise
the Maryland SBHC standards to reflect the bill.
Fiscal Summary
State Effect: MSDE and MDH can revise SBHC standards using existing budgeted
resources. Revenues are not affected.
Local Effect: The bill’s impact on local jurisdictions that sponsor a SBHC is primarily
operational as the bill eliminates the required application and approval process for offering
telehealth. Revenues are not affected.
Small Business Effect: Potential minimal.
Analysis
Current Law: SBHCs are health centers located in a school or on a school campus that
provide on-site comprehensive preventive and primary health services. Services may also
include behavioral health, oral health, ancillary, and supportive services.
Under Maryland School-Based Health Center Standards, all SBHCs must meet minimum
requirements. In order to provide telehealth services, SBHCs must submit an application
and receive approval from MSDE, including meeting the requirements of MSDE’s
telehealth checklist prior to rendering telehealth services.
SBHCs must adhere to federal Medicaid regulations governing clinics. Generally,
Medicaid may not reimburse SBHCs (or any freestanding clinics) if neither the practitioner
nor patient is physically located within the clinic. However, due to COVID-19, the federal
Centers for Medicare and Medicaid Services approved additional flexibilities for the
duration of the federal government’s declared public health emergency that permit SBHCs
to receive reimbursement for services rendered if both the practitioner and the patient are
in their homes.
Chapters 15 and 16 of 2020 authorize a health care practitioner to establish a
practitioner-patient relationship through either a synchronous telehealth interaction or an
asynchronous telehealth interaction, if the health care practitioner (1) verifies the identity
of the patient receiving health care services through telehealth; (2) discloses to the patient
the health care practitioner’s name, contact information, and the type of health occupation
license held by the health care practitioner; and (3) obtains oral or written consent from the
patient (or the patient’s parent or guardian if required).
A health care practitioner must perform a clinical evaluation (which can be through a
synchronous or an asynchronous telehealth interaction) that is appropriate for the patient
and the condition with which the patient presents before providing treatment or issuing a
prescription through telehealth.
The Acts prohibited regulations adopted by a health occupations board from establishing a
separate standard of care for telehealth and specified that such regulations must allow for
the establishment of a practitioner-patient relationship through a synchronous or an
asynchronous telehealth interaction provided by a health care practitioner who is
complying with the health care practitioner’s standard of care.
Additional Comments: According to the Maryland Assembly on School-Based Health
Care, only some of the more than 80 SBHCs are currently approved to provide telehealth
services, while those not approved have generally shut down during the COVID-19
pandemic. Under the bill, additional SBHCs could begin offering telehealth services
without having to seek approval or complete the telehealth checklist.
SB 278/ Page 2
 Additional Information
Prior Introductions: None.
Designated Cross File: HB 34 (Delegate Rosenberg) - Health and Government
Operations and Ways and Means.
Information Source(s): Maryland Assembly on School-Based Health Care; Maryland
Association of County Health Officers; Maryland State Department of Education;
Maryland Department of Health; Baltimore City Public Schools; Montgomery County
Public Schools; Prince George’s County Public Schools; Department of Legislative
Services
Fiscal Note History: First Reader - January 19, 2021
rh/jc Third Reader - February 25, 2021
Analysis by: Michael E. Sousane Direct Inquiries to:
(410) 946-5510
(301) 970-5510
SB 278/ Page 3