Telehealth Procedures Manual

During the 2024 legislative session, the Maryland General Assembly passed House Bill (HB) 522 – Public Schools – Telehealth Appointments – State Guidelines, Policies, and Access (Md. Code, Education Article § 4-143). This statute is designed to improve student access to telehealth appointments for public middle and high school students across the State. The statute mandates that public schools allow students to participate in telehealth appointments during the school day.

Board of Education Policy 5140: “Student Participation in Telehealth Appointments”, adopted by the Board of Education in July 2025, established the specific requirements for Howard County Public School System (HCPSS) as follows:

• Designating a private space (not a closet or bathroom) with internet access for telehealth appointments,
• Ensuring student safety and privacy,
• Including a summary of the telehealth policy in the student handbook, and
• Ensuring that school staff, parents, and students are informed about the policy’s goals and requirements.

Telehealth appointments as referred to in Policy 5140 include both medical and behavioral health/ therapy appointments. These appointments are not the same as appointments occurring as part of HCPSS’ existing Telemedicine (School-Based Wellness, with HCPSS Health Services support) and School-Based Mental Health (SBMH) Services. The key difference is that Telemedicine and SBMH Services are provided by medical or mental health providers who have a relationship with HCPSS through a contract or memorandum of understanding (MOU). Policy 5140 refers to parent-initiated physical or behavioral health appointments provided by any health care practitioner selected by the parent. The parent’s selected provider is not required to have a contract or memorandum of understanding with HCPSS.

This manual outlines for students, parents, and employees the procedure and guidelines for supporting student participation in telehealth appointments in middle and high schools. The manual is intended to provide schools with specific steps for implementation of Policy 5140, and to provide schools, students, families, and community providers with information on each party’s role related to telehealth appointments.

Getting Started

Initial Steps for Schools

• The implementation of telehealth appointments in schools requires principals to:
• Determine a schedule for telehealth appointments:
• Middle and high schools will determine designated periods of time weekly when telehealth appointments are available.
• A school will offer up to five (5) appointment slots per week based on students’ needs, school schedules, and space availability.
• Appointments will be thirty (30) to forty-five (45) minutes, and will take place within a private location in the building.
• Plan a full-year calendar, indicating which dates the appointments are unavailable due to state testing or other school events.
• Once established, the schedule will be shared with families proactively to inform them of their telehealth access.
• Appointments must be scheduled with the Point of Contact (POC;see below for more details) at least one week in advance.
• Each middle and high school will establish a protocol for scheduling and canceling appointments.
• The telehealth appointment schedule will allow for transition time and/or align with a natural transition during the school day.
• School-based administrators will develop clear expectations and parameters for transitions to and from telehealth appointments during the school day.
• For example, if a telehealth appointment concludes when there is five (5) minutes or less remaining in a class period the student should wait until the bell rings to transition to their next class period.
• Parents are expected to remain in the building until their child successfully transitions back to their class.
• If transitions are challenging for a student, school staff will discuss with parents the feasibility and appropriateness of telehealth for students who are unable to transition independently.
• Telehealth appointments will be available to families at a maximum of one (1) per quarter, per child.
• School-based administrators, in collaboration with the designated POC, will monitor the scheduling of appointments to ensure equitable access.
• If parents have a question regarding scheduling their child’s telehealth appointment, they may contact the school-based administrator.
• Identify a location for telehealth appointments:
• The location cannot be a closet or bathroom.
• Must be quiet and private
• Free of others entering or exiting the room during appointments,
• Accessible to all students, including those with disabilities, and
• Incorporate elements that help create a calm and welcoming environment.
• Must include the following items:
• Internet access,
• Seating options,
• Flat surface to hold device (laptop, tablet), and
• A nearby electrical outlet to accommodate the placement of the device.
• Evaluating Fit
• The school will consider the following to determine the student’s fit for participation in telehealth appointments:
• the student’s health or behavioral health needs,
• the context and environment in which the student interacts (e.g. can the student independently navigate a telehealth appointment in the school environment),
• the student’s comfort using technology, and
• the nature and complexity of the service and/or intervention.
• The school will develop plans to address students’ reasons for telehealth, specifically students who may have chronic needs and/or disabilities.
• Appropriate HCPSS staff (e.g., Health Services, 504 Team, IEP Team) will participate in the plan development, and
• Reminder: Telehealth appointments may be scheduled one per quarter, per child.
• The school must offer the same access to telehealth appointments for all students regardless of disability status. This includes:
• ensuring that telehealth services support both the health and educational outcomes of students with special needs (e.g., Individualized Education Program (IEP) or Section 504 Plan),
• providing telehealth services to complement their accommodations or services, if appropriate, and
• Implementing the student’s IEP or Section 504 Plan to ensure students with disabilities have the same access to telehealth appointments.
• Identify a Point of Contact (POC):
• The Point of Contact (POC) is a staff person who is in the building five (5) days per week and based in the front office or student services office.
• The POC is responsible for:
• having knowledge of the telehealth procedures manual and confidentiality requirements
• receiving and responding to parent requests for telehealth appointments utilizing the designated schedule,
• providing the parent with consent form and release of records forms prior to the appointment,
• receiving the forms from the parent prior to the appointment,
• maintaining storage of forms and other telehealth records in the student record,
• directing students and families to the telehealth location on the day of the appointment,
• providing the student with a back-up chromebook and charger if needed,
• monitoring the start and end times of telehealth appointments to ensure that the student transitions back to class at the conclusion of the appointment, and
• tracking data for which students have attended appointments (one appointment per child per quarter).
• Inform school staff and parents of Policy 5140 Student Participation in Telehealth Appointments and the Telehealth Procedures Manual:
• For staff, the principal may share the following message via a staff email and/or announcement at a staff meeting:
• Starting with the 2025-2026 school year middle and high school students may participate in a telehealth appointment, medical or behavioral health, during the school day. The Telehealth Procedures Manual outlines the requirements for a telehealth appointment and can be found on the HCPSS website. Please contact a school-based administrator (may use staff members’ names) with any questions.
• For parents, the principal may share the following announcement via the school webpage, newsletter or student handbook:
• Starting with the 2025-2026 school year middle and high school students may participate in a telehealth appointment with a provider selected by the family, medical or behavioral health, during the school day. The Telehealth Procedures Manual outlines the requirements for a telehealth appointment and can be found on the HCPSS website. To schedule a telehealth appointment for your child please contact (Point of Contact’s name and contact information). If you have questions please contact (name of school-based administrator).

Confidentiality and Informed Consent

Confidentiality

• HCPSS school-based employees supporting telehealth appointments will ensure confidentiality of students participating and their information are kept private.
• Students and their parent who participate in telehealth appointments in schools will be made aware of the limits of privacy. A few examples include:
• POC will be aware that the student is receiving services.
• A staff member or student may see the participating student enter or exit the room for a telehealth appointment.
• Private information may need to be disclosed in order for HCPSS school-based employees to facilitate a student’s participation in a telehealth appointment and ensure student safety.
• School-based employees will be made aware of the recommendations of the telehealth providers on an as-needed basis.
• Health Services employees may consider integrating telehealth into a student health plan to enhance access to care and improve health outcomes.
• Schools will ensure records from telehealth appointments, including schedule of appointments, consent forms, and HCPSS Release of Records Document, are confidential and will be maintained in the students’ cumulative record.
• HCPSS school-based employees will ensure that appropriate forms (e.g. HCPSS Release of Records) are sent to providers to facilitate care coordination.

Informed Consent

• Parents must sign HCPSS consent form for student participation in telehealth appointments at school.
• Parents should consider the need for telehealth versus missing instructional time to have their child’s needs met.
• Parents must agree to collaborate with HCPSS school-based employees to help ensure that students keep up with missed instruction.
• Make-up work per attendance policy
• Missed instruction due to a telehealth appointment will be made up in accordance with Policy 9010 Attendance. Missing class instruction due to a telehealth appointment would be considered a lawful absence for that portion of the day.
• The consent form will be included in the students’ cumulative record.

Initial Steps and Information for Parent

• The parent must be present at the school and monitor their child for the duration of any telehealth appointment.
• The parent is required to:
• Sign a consent form for their child to participate in telehealth appointments, and
• Provide permission (by signing a “Release of Records” Form) for HCPSS school-based employees to communicate with telehealth provider to facilitate coordination of care
• The parents should consider the need for telehealth vs missed instructional time:
• Parents provide a statement to school staff to help determine if telehealth is a good fit for their child
• Parents must agree to collaborate with HCPSS school-based employees to help ensure that students keep up with missed instruction.
• The parent contacts the POC to learn of available telehealth appointment slots.
• The parent schedules the appointment with the telehealth provider.
• The parent reviews the Telehealth Procedures Manual.

Before the Session

Preparations by the School

• Arrange for student to be called down to space used for telehealth appointment
• Have a pass prepared for the student to share at the beginning of the day.
• The student should arrive five (5) minutes prior to the scheduled appointment time to set up technology in the telehealth appointment room.
• Ask the parent to arrive ten (10) minutes prior to scheduled appointment time.
• When the parent arrives, direct the student and parent to the telehealth appointment room.
• POC makes sure the parent and the student have their device for appointment, if not set up a school chromebook.
• Student and parent set up technology in the telehealth appointment room
• Make certain there is a place available for the parent to wait if not attending the appointment.

Preparations by the Parent

• Confirm the telehealth appointment with the provider one day in advance.
• Ensure link for telehealth appointment has been sent to the parent.
• Ensure Release of Records form is signed by provider and given to the POC prior to the telehealth appointment.
• Bring a device for the telehealth appointment.
• Parents may provide a personal device upon arrival for the telehealth appointment. In the event that the parent does not have a personal device, the student should utilize their HCPSS-issued Chromebook.
• It is recommended that the parent also bring a charger for the device to the telehealth appointment.
• If the parent does not have their own device, inform the POC upon arrival to ensure that either student has their chromebook or a school chromebook will be provided.

Preparations by the Provider

• Secure the parent’s cell phone number and confirm the parent has the virtual link for the appointment.
• Sign the Release of Records Form and give the parent a copy.
• Ensure the parent has your contact information for technical difficulties.
• Confirm the provider has a way to communicate with the parent and/or school if an emergency occurs.

During the Session

Parent

• Parent must be present, physically in the school building.
• The parent will remain at the school and monitor their child for the duration of the telehealth appointment.
• The parent is permitted to be in the room with the child or sitting outside the room (for mental health appointments) where the child is meeting with the provider.
• The parent is responsible for ensuring student safety during the telehealth appointment.
• HCPSS school-based employees will provide resources (e.g. hotline numbers, referral to Grassroots Crisis Intervention Center) as needed, in the event of a crisis during the telehealth appointment.
• Action steps if an emergency arises:
• If a medical emergency arises, the parent will contact the POC for assistance from the school health room.
• If a mental health emergency arises, the parent will contact the POC for assistance from student services, who will provide resources.
• Technical Issues:
• Parent will contact the provider to reconnect to the telehealth appointment.

Student

• Students will comply with established policies regarding the use of computers, tablets, or other devices equipped with high-resolution cameras and microphones for clear communication. (Policy 8080 Responsible Use of Technology, Digital Tools, and Social Media).
• If parent is waiting outside of the telehealth appointment room, student will inform parent
• when they experience technical issues.
• if the provider requests to speak with the parent.
• when the appointment is concluded.

After the Session

School

• Student Services staff will provide resources (e.g., hotline numbers, referral to Grassroots Crisis Intervention Center) as needed, following the telehealth appointment.
• The POC will provide the student with a pass to return to class.
• School-based employees will be made aware of the recommendations of the telehealth providers on an as-needed basis.
• Health Services employees may consider integrating telehealth into a student health plan to enhance access to care and improve health outcomes.

Parent

• The parent will inform POC if there is a need for resources; POC will contact a member of the Student Services staff in the building.
• Support your child in complying with completion of make-up work per Policy 9010- Attendance.
• Policy 9010 states that missing class instruction due to a telehealth appointment would be considered a lawful absence for that portion of the day.

Student

• The student will return to class after the telehealth appointment is completed.
• The student will complete make-up work per Policy 9010- Attendance.
• Policy 9010 states that missing class instruction due to a telehealth appointment would be considered a lawful absence for that portion of the day.

Resources

• Board of Education Policy 5140: ”Student Participation inTelehealth Apointments”
• Informed Consent for Student Participation in Telehealth Services
• Release of Records Form