EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
*hb1208*
HOUSE BILL 1208
J2, Q3 2lr0907
By: Delegate Kelly
Introduced and read first time: February 11, 2022
Assigned to: Health and Government Operations
A BILL ENTITLED
AN ACT concerning 1
Health Occupations – Health Care Workforce Expansion 2
FOR the purpose of establishing requirements on the State Board of Nursing related to the 3
expansion of the workforce in nursing–related fields; establishing a State income tax 4
credit for certain licensed practical nurses, nurse practitioners, and registered 5
nurses; establishing the Licensed Practical Nurse and Registered Nurse 6
Preceptorship Tax Credit Fund as a special, nonlapsing fund; requiring the 7
Maryland Department of Health to work with the Division of Workforce 8
Development and Adult Learning in the Maryland Department of Labor to convene 9
a stakeholder workgroup to study expanding the State apprenticeship programs to 10
the health care workforce; and generally relating to expansion of the health care 11
workforce in the State. 12
BY repealing and reenacting, with amendments, 13
Article – Health Occupations 14
Section 8–205, 8–312(c), and 8–6A–05(b) 15
Annotated Code of Maryland 16
(2021 Replacement Volume) 17
BY adding to 18
Article – Health Occupations 19
Section 8–205.2 and 8–514 20
Annotated Code of Maryland 21
(2021 Replacement Volume) 22
BY adding to 23
Article – Tax – General 24
Section 10–739.1 25
Annotated Code of Maryland 26
(2016 Replacement Volume and 2021 Supplement) 27
2 HOUSE BILL 1208
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 1
That the Laws of Maryland read as follows: 2
Article – Health Occupations 3
8–205. 4
(a) In addition to the powers and duties set forth elsewhere in this title, the Board 5
has the following powers and duties: 6
(1) To adopt rules and regulations to carry out the provisions of this title; 7
(2) To set standards for the practice of registered nursing, advanced 8
practice registered nursing, licensed practical nursing, certified nursing assistants, 9
certified medication technicians, electrology, direct–entry midwifery, and certified 10
midwifery; 11
(3) To adopt rules and regulations for the performance of delegated medical 12
functions that are recognized jointly by the State Board of Physicians and the State Board 13
of Nursing, under § 14–306(d) of this article; 14
(4) To adopt rules and regulations for the performance of additional 15
nursing acts that: 16
(i) May be performed under any condition authorized by the Board, 17
including emergencies; and 18
(ii) Require education and clinical experience; 19
(5) To adopt rules and regulations for registered nurses to perform 20
independent nursing functions that: 21
(i) Require formal education and clinical experience; and 22
(ii) May be performed under any condition authorized by the Board, 23
including emergencies; 24
(6) To adopt rules and regulations for licensed practical nurses to perform 25
additional acts in the practice of registered nursing that: 26
(i) Require formal education and clinical experience; 27
(ii) May be performed under any condition authorized by the Board, 28
including emergencies; and 29
(iii) Are recognized by the Nursing Board as proper for licensed 30
practical nurses to perform; 31 HOUSE BILL 1208 3
(7) TO ADOPT RULES AND RE GULATIONS FOR CLINICAL EXTERN 1
CERTIFICATES AUTHORIZED UNDER § 8–514 OF THIS TITLE; 2
[(7)] (8) To keep a record of its proceedings; 3
[(8)] (9) To submit to the Governor, the Secretary, and, in accordance 4
with § 2–1257 of the State Government Article, the General Assembly, an annual report 5
that includes [the]: 6
(I) THE following data calculated on a fiscal year basis: 7
[(i)] 1. The number of initial and renewal licenses and certificates 8
issued; 9
[(ii)] 2. The number of positive and negative criminal history 10
records checks results received; 11
[(iii)] 3. The number of individuals denied initial or renewal 12
licensure or certification due to positive criminal history records checks results; 13
[(iv)] 4. The number of individuals denied licensure or certification 14
due to reasons other than a positive criminal history records check; 15
[(v)] 5. The number of new complaints received; 16
[(vi)] 6. The number of complaints carried over from year to year; 17
[(vii)] 7. The most common grounds for complaints; and 18
[(viii)] 8. The number and types of disciplinary actions taken by the 19
Board; AND 20
(II) BY ANALYZING INFORMAT ION GATHERED FROM RE NEWAL 21
APPLICATIONS SUBMITT ED UNDER § 8–312 OF THIS TITLE, AN EVALUATION OF THE 22
STATE’S NURSING WORKFORCE BY CERTIFICATION LEV EL, REGION, AND TYPE OF 23
WORKPLACE , INCLUDING HOSPITALS A ND HOME HEALTH WORKE RS; 24
[(9)] (10) To enforce the employment record requirements of this title; 25
[(10)] (11) To keep separate lists, which lists are open to reasonable public 26
inspection, of all: 27
(i) Registered nurses licensed under this title; 28
4 HOUSE BILL 1208
(ii) Licensed practical nurses licensed under this title; 1
(iii) Nurse midwives certified under this title; 2
(iv) Nurse practitioners certified under this title; 3
(v) Nurse anesthetists certified under this title; 4
(vi) Clinical nurse specialists certified under this title; 5
(vii) Certified medication technicians certified under this title; 6
(viii) Electrologists licensed under this title; 7
(ix) Direct–entry midwives licensed under this title; 8
(x) Certified midwives licensed under this title; and 9
(xi) Other licensees with a nursing specialty that is certified under 10
this title; 11
[(11)] (12) To collect any funds of the Board; 12
[(12)] (13) To report any alleged violation of this title to the State’s Attorney 13
of the county where the alleged violation occurred; 14
[(13)] (14) In accordance with the State budget, to incur any necessary 15
expense for prosecution of an alleged violation of this title; 16
[(14)] (15) On receipt of a written and signed complaint, including a referral 17
from the Commissioner of Labor and Industry, conduct an unannounced inspection of the 18
office of a nurse in independent practice, other than an office of a nurse in independent 19
practice in a hospital, related institution, freestanding medical facility, or a freestanding 20
birthing center, to determine compliance at that office with the Centers for Disease Control 21
and Prevention’s guidelines on universal precautions; 22
[(15)] (16) To maintain a nurse aide registry that complies with federal law; 23
[(16)] (17) To appoint standing and ad hoc committees from among Board 24
members as necessary; and 25
[(17)] (18) To delegate to the executive director of the Board the authority 26
to discharge Board duties deemed appropriate and necessary by the Board and to hold the 27
executive director accountable to the Board. 28
(b) With regard to any list kept by the Board under subsection [(a)(10)] (A)(11) 29 HOUSE BILL 1208 5
of this section, upon written request from an individual licensee the Board shall delete that 1
individual’s name from any licensee list purchased from the Board. 2
(c) (1) The Board is the only unit of the Department that is responsible for 3
adopting rules and regulations to determine: 4
(i) Individuals to whom any act of the practice of registered nursing 5
and licensed practical nursing may be delegated; and 6
(ii) The acts that may be delegated safely. 7
(2) The Department shall retain its authority to require training for 8
nonlicensed patient care personnel under § 19–308.1 of the Health – General Article. 9
8–205.2. 10
THE BOARD SHALL: 11
(1) CREATE AND IMPLEMENT A MARK ETING PLAN TO ATTRAC T 12
INDIVIDUALS TO SEEK LICENSURE AND CERTIF ICATION UNDER THIS T ITLE; AND 13
(2) CREATE AND MAINTAIN ON ITS PUBLICLY ACCESSIBLE WEBSITE A 14
SINGLE LOCATION THAT HAS INFORMATION FOR INDIVIDUALS SEEKING LICENSURE 15
OR CERTIFICATION UND ER THIS TITLE ON: 16
(I) PATHWAYS TO LICENSURE OR CERTIFI CATION; 17
(II) FUNDING AND FINANCING OPTION S TO PAY FOR REQUIRE D 18
EDUCATION AND TRAINING; AND 19
(III) ACCREDITED SCHOOLS AND TRAINING PROGRAMS . 20
8–312. 21
(c) Before a license expires, the licensee periodically may renew it for an 22
additional term, if the licensee: 23
(1) Otherwise is entitled to be licensed; 24
(2) Pays to the Board: 25
(i) A renewal fee set by the Board; or 26
(ii) A renewal fee that is set by the Board if the licensee certifies to 27
the Board that the licensee provides professional services only as a volunteer; and 28
6 HOUSE BILL 1208
(3) Submits to the Board by paper application or electronic means: 1
(i) A renewal application on the form that the Board requires THAT 2
INCLUDES WORKFORCE DATA INFORMATION NECESSARY FOR THE REPORT 3
REQUIRED UNDER § 8–205(A) OF THIS TITLE; and 4
(ii) Satisfactory evidence of completion of: 5
1. 1,000 hours of active nursing practice within the 5–year 6
period immediately preceding the date of renewal; 7
2. A course of instruction, commonly known as a refresher 8
course, approved by the Board; 9
3. A preceptorship program provided by an employer and 10
approved by the Board; or 11
4. A minimum number of continuing education units as 12
required by regulations adopted by the Board. 13
8–514. 14
(A) IN THIS SECTION , “CLINICAL EXTERN ” MEANS A STUDENT AT A N 15
ACCREDITED SCHOOL OF NURSING APPROVED BY THE BOARD WHO HAS BEEN 16
CERTIFIED BY THE BOARD TO AUGMENT TH E HEALTH SERVICES WO RKFORCE. 17
(B) THE BOARD SHALL ISSUE A CLINICAL EXTERN CERTIFICATE TO A 18
NURSING STUDENT WHO: 19
(1) SUBMITS TO THE BOARD: 20
(I) AN APPLICATION ON THE FORM REQUIRED BY THE BOARD; 21
AND 22
(II) A SUPERVISOR AGREEMENT SIGNED BY THE APPLIC ANT’S 23
PROPOSED LICENSEE SU PERVISOR; 24
(2) HAS MET THE EDUCATION AL CRITERIA ESTABLIS HED BY THE 25
BOARD; AND 26
(3) MEETS ANY OTHER CRITE RIA ESTABLISHED BY T HE BOARD FOR 27
CERTIFICATION AS A C LINICAL EXTERN . 28
(C) A CLINICAL EXTERN MAY : 29
HOUSE BILL 1208 7
(1) PRACTICE AT A HOSPITAL OR AUXILIARY TREATMENT SITE 1
APPROVED BY THE BOARD; 2
(2) PERFORM HEALTH CARE S ERVICES APPROVED BY THE BOARD 3
ONLY UNDER THE DIRECT SUP ERVISION OF THE LICENSEE SUPERVISOR APPROVED 4
BY THE BOARD; AND 5
(3) PROVIDE HEALTH CARE S ERVICES IN ACCORDANC E WITH THE 6
CLINICAL EXTERN ’S TRAINING AND TO TH E EXTENT OF THE CLIN ICAL EXTERN’S 7
COMPETENCY AS DETERM INED BY THE CLINICAL EXTERN ’S LICENSEE SUPERVISOR . 8
(D) THE BOARD SHALL ADOPT REG ULATIONS NECESSARY T O CARRY OU T 9
THIS SECTION. 10
8–6A–05. 11
(b) (1) To qualify for certification as a nursing assistant, a nursing assistant 12
in a specific category, or a medication technician, an applicant shall meet the requirements 13
set by the Board. 14
(2) REQUIREMENTS SET BY T HE BOARD UNDER PARAGRAPH (1) OF 15
THIS SUBSECTION REGARDING QUALIFICATIONS FOR C ERTIFICATION AS A NU RSING 16
ASSISTANT SHALL INCL UDE PROVISIONS TO ALLOW AN INDIVIDUAL WHO HAS BEEN 17
PRACTICING AS A NURS ING ASSISTANT WITHOU T CERTIFICATION BY T HE BOARD TO 18
APPLY ON–THE–JOB EXPERIENCE AS A NURSING ASSISTANT TO WARD THE TOTAL 19
NUMBER OF TRAINING H OURS REQUIRED FOR CE RTIFICATION. 20
SECTION 2. AND BE IT FURTHER ENACTED, That the Laws of Maryland read 21
as follows: 22
Article – Tax – General 23
10–739.1. 24
(A) (1) IN THIS SECTION THE F OLLOWING WORDS HAVE THE MEANINGS 25
INDICATED. 26
(2) “DEPARTMENT ” MEANS THE MARYLAND DEPARTMENT OF 27
HEALTH. 28
(3) “LICENSED PRACTICAL NU RSE” HAS THE MEANING STAT ED IN § 29
8–101 OF THE HEALTH OCCUPATIONS ARTICLE. 30
(4) “NURSE PRACTITIONER ” HAS THE MEANING STAT ED IN § 8–101 31 8 HOUSE BILL 1208
OF THE HEALTH OCCUPATIONS ARTICLE. 1
(5) “PRECEPTORSHIP PROGRAM ” MEANS AN ORGANIZED S YSTEM OF 2
CLINICAL EXPERIENCE THAT, FOR THE PURPOSE OF A TTAINING SPECIFIED 3
LEARNING OBJECTIVES , PAIRS A LICENSED PRACTICAL NURSE OR REGISTERED 4
NURSE STUDENT ENROLLED IN A NURSING EDUCATION PROGRAM THAT IS 5
RECOGNIZED BY THE STATE BOARD OF NURSING WITH A LICENSED PRACTICAL 6
NURSE, NURSE PRACTITIONER , OR REGISTERED NURSE WHO MEETS THE 7
QUALIFICATIONS AS A PRECEPTOR . 8
(6) “REGISTERED NURSE” HAS THE MEANING STAT ED IN § 8–101 OF 9
THE HEALTH OCCUPATIONS ARTICLE. 10
(B) (1) SUBJECT TO THE LIMITA TIONS OF THIS SECTIO N, A LICENSED 11
PRACTICAL NURSE , NURSE PRACTITIONER , OR REGISTERED NURSE MAY CLAIM A 12
CREDIT AGAINST THE STATE INCOME TAX IN T HE AMOUNT STATED ON THE TAX 13
CREDIT CERTIFICATE I SSUED UNDER SUBSECTI ON (C) OF THIS SECTION FOR THE 14
TAXABLE YEAR IN WHIC H THE LICENSED PRACTICAL N URSE, NURSE PRACTITIONER , 15
OR REGISTERED NURSE SERVED WITHOUT COMPE NSATION AS A PRECEPT OR IN A 16
PRECEPTORSHIP PROGR AM APPROVED BY THE STATE BOARD OF NURSING AND 17
WORKED: 18
(I) A MINIMUM OF THREE R OTATIONS, EACH CONSISTING OF A T 19
LEAST 100 HOURS OF COMMUNITY –BASED CLINICAL TRAIN ING; AND 20
(II) IN AN AREA OF THE STATE IDENTIFIED AS H AVING A 21
HEALTH CARE WORKFORC E SHORTAGE BY THE DEPARTMENT , IN CONSULTATION 22
WITH THE GOVERNOR’S WORKFORCE DEVELOPMENT BOARD. 23
(2) (I) THE TOTAL AMOUNT OF T HE CREDIT ALLOWED UN DER THIS 24
SECTION FOR ANY TAXA BLE YEAR MAY NOT EXC EED THE STATE INCOME TAX 25
IMPOSED FOR THAT TAX ABLE YEAR. 26
(II) ANY UNUSED AMOUNT OF THE CREDIT FOR ANY TAXAB LE 27
YEAR MAY NOT BE CARR IED OVER TO ANY OTHE R TAXABLE YEAR . 28
(C) (1) ON APPLICATION BY A LICENSED PRACTICAL N URSE, NURSE 29
PRACTITIONER , OR REGISTERED NURSE , THE DEPARTMENT SHALL ISSU E A CREDIT 30
CERTIFICATE IN THE A MOUNT OF $1,000 FOR EACH STUDENT ROT ATION OF THE 31
MINIMUM NUMBER OF HO URS REQUIRED UNDER S UBSECTION (B)(1)(I) OF THIS 32
SECTION FOR WHICH TH E LICENSED PRACTICAL N URSE, NURSE PRACTITIONER , OR 33
REGISTERED NURSE SERVED AS A PRECEPTO R WITHOUT COMPENSATI ON. 34
HOUSE BILL 1208 9
(2) THE APPLICATION SHALL CONTAIN: 1
(I) THE NAME OF THE APPLICANT; 2
(II) INFORMATION IDENTIFY ING THE PRECEPTORSHI P IN 3
WHICH THE APPLICANT PARTICIPATED ; 4
(III) THE NUMBER AND NAMES OF THE STUDENTS FOR WHOM 5
THE INDIVIDUAL SERVE D AS A PRECEPTOR WIT HOUT COMPENSATION ; AND 6
(IV) ANY OTHER INFORMATIO N THAT THE DEPARTMENT 7
REQUIRES. 8
(3) FOR ANY TAXABLE YEAR , THE AMOUNT OF TAX CR EDIT STATED IN 9
THE TAX CREDIT CERTI FICATE MAY NOT EXCEE D $10,000. 10
(4) THE DEPARTMENT SHALL : 11
(I) APPROVE ALL APPLICAT IONS THAT QUALIFY FOR A T AX 12
CREDIT CERTIFICATE U NDER THIS SUBSECTION ON A FIRST–COME, FIRST–SERVED 13
BASIS; AND 14
(II) NOTIFY A TAXPAYER WI THIN 45 DAYS OF RECEIPT OF T HE 15
TAXPAYER’S APPLICATION OF ITS APPROVAL OR DENIAL . 16
(5) (I) FOR EACH TAXABLE YEAR , THE TOTAL AMOUNT OF TAX 17
CREDIT CERTIFICATES THAT MAY BE ISSUED B Y THE DEPARTMENT UNDER THIS 18
SECTION MAY NOT EXCE ED THE LESSER OF : 19
1. THE TOTAL FUNDS IN T HE LICENSED PRACTICAL 20
NURSE AND REGISTERED NURSE PRECEPTORSHIP TAX CREDIT FUND FOR THAT 21
YEAR; OR 22
2. $100,000. 23
(II) IF THE AGGREGATE AMOU NT OF TAX CREDIT CER TIFICATES 24
ISSUED UNDER THIS SE CTION DURING A TAXAB LE YEAR TOTAL S LESS THAN THE 25
AMOUNT AUTHORIZED UN DER THIS PARAGRAPH , ANY EXCESS AMOUNT MA Y BE 26
ISSUED UNDER TAX CRE DIT CERTIFICATES IN THE NEXT TAX ABLE YEAR. 27
(D) (1) IN THIS SECTION , “FUND” MEANS THE LICENSED PRACTICAL 28
NURSE AND REGISTERED NURSE PRECEPTORSHIP TAX CREDIT FUND 29
ESTABLISHED UNDER PA RAGRAPH (2) OF THIS SUBSECTION . 30 10 HOUSE BILL 1208
(2) THERE IS A LICENSED PRACTICAL NURSE AND REGISTERED 1
NURSE PRECEPTOR SHIP TAX CREDIT FUND. 2
(3) THE DEPARTMENT SHALL ADMI NISTER THE FUND. 3
(4) THE PURPOSE OF THE FUND IS TO OFFSET THE COSTS OF THE TAX 4
CREDIT AVAILABLE UND ER THIS SECTION. 5
(5) THE FUND IS A SPECIAL , NONLAPSING FUND THAT IS NOT 6
SUBJECT TO § 7–302 OF THE STATE FINANCE AND PROCUREMENT ARTICLE. 7
(6) THE STATE TREASURER SHALL HOLD THE FUND SEPARATELY , 8
AND THE COMPTROLLER SHALL ACC OUNT FOR THE FUND. 9
(7) THE FUND CONSISTS OF : 10
(I) FEDERAL FUNDING PROV IDED UNDER: 11
1. THE FEDERAL CORONAVIRUS AID, RELIEF, AND 12
ECONOMIC SECURITY ACT; 13
2. THE FEDERAL CONSOLIDATED APPROPRIATIONS 14
ACT, 2021; OR 15
3. ANY OTHER FEDERAL COVID–19 PANDEMIC RELIEF 16
FUNDING; 17
(II) MONEY APPROPRIATED I N THE STATE BUDGET TO THE 18
FUND; AND 19
(III) ANY OTHER MONEY FROM ANY OTHER SOURCE ACC EPTED 20
FOR THE BENEFIT OF T HE FUND. 21
(8) THE MONEY IN THE FUND SHALL BE INVESTE D AND REINVESTED 22
BY THE STATE TREASURER, AND INTEREST AND EAR NINGS SHALL BE CREDI TED TO 23
THE GENERAL FUND OF THE STATE. 24
(9) (I) EXCEPT AS OTHERWISE PR OVIDED IN THIS PARAG RAPH, 25
MONEY CREDITED OR AP PROPRIATED TO THE FUND SHALL REMAIN IN THE FUND. 26
(II) 1. WITHIN 15 DAYS AFTER THE END O F EACH CALENDAR 27
QUARTER, THE DEPARTMENT SHALL NOTI FY THE COMPTROLLER AS TO EAC H 28 HOUSE BILL 1208 11
CREDIT CERTIFICATE ISSUED DURING THE QU ARTER. 1
2. ON NOTIFICATION THAT A CREDIT CERTIFICATE HAS 2
BEEN ISSUED BY THE DEPARTMENT , THE COMPTROLLER SHALL TRA NSFER AN 3
AMOUNT EQUAL TO THE CREDIT AMOUNT STATED IN THE TAX CREDIT CE RTIFICATE 4
FROM THE FUND TO THE GENERAL FUND OF THE STATE. 5
(E) ON OR BEFORE JANUARY 31 EACH TAXABLE YEAR , THE DEPARTMENT 6
SHALL: 7
(1) REPORT TO THE COMPTROLLER ON THE TA X CREDIT 8
CERTIFICATES ISSUED UNDER THIS SECTION D URING THE PRIOR TAXA BLE YEAR; 9
AND 10
(2) REPORT TO THE GENERAL ASSEMBLY, IN ACCORDANCE WITH § 11
2–1257 OF THE STATE GOVERNMENT ARTICLE, ON THE UTILIZATION O F THE 12
CREDIT ESTABLISHED U NDER THIS SECTION . 13
(F) THE DEPARTMENT , IN CONSULTATION WITH THE GOVERNOR’S 14
WORKFORCE DEVELOPMENT BOARD, SHALL ADOP T REGULATIONS TO CAR RY OUT 15
THE PROVISIONS OF TH IS SECTION, INCLUDING THE CRITER IA AND PROCEDURES 16
FOR APPLICATION FOR , APPROVAL OF , AND MONITORING ELIGI BILITY FOR THE TAX 17
CREDIT AUTHORIZED UN DER THIS SECTION . 18
SECTION 3. AND BE IT FURTHER ENACTED, That : 19
(a) The Maryland Department of Health shall work with the Division of 20
Workforce Development and Adult Learning in the Maryland Department of Labor to 21
convene a stakeholder workgroup to: 22
(1) study expanding the State apprenticeship programs to the health care 23
workforce; and 24
(2) make recommendations on: 25
(i) health care fields that could be best served by introducing a 26
health care apprenticeship program, including health–related fields that do not require 27
licensure or certification under the Health Occupations Article; 28
(ii) options to provide incentives to experienced health care 29
practitioners to work with health care apprentices; 30
(iii) safeguards needed to ensure the safety of the public when 31
receiving health care services from health care apprentices; and 32
12 HOUSE BILL 1208
(iv) funding needed to support a health care apprenticeship program. 1
(b) On or before December 1, 2022, the Maryland Department of Health shall 2
report the findings and recommendations of the workgroup to the Senate Education, 3
Health, and Environmental Affairs Committee and the House Health and Government 4
Operations Committee, in accordance with § 2–1257 of the State Government Article. 5
SECTION 4. AND BE IT FURTHER ENACTED, That the State Board of Nursing 6
shall adopt the regulations required under § 8–6A–05(b)(2) of the Health Occupations 7
Article, as enacted under Section 1 of this Act, on or before December 31, 2022. 8
SECTION 5. AND BE IT FURTH ER ENACTED, That this Act shall take effect June 9
1, 2022. Section 2 of this Act shall remain effective for a period of 3 years and, at the end of 10
May 31, 2025, Section 2 of this Act, with no further action required by the General 11
Assembly, shall be abrogated and of no further force and effect. 12