EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
*hb0407*
HOUSE BILL 407
J1, J2 EMERGENCY BILL 2lr0153
CF 2lr0152
By: The Speaker (By Request – Administration) and Delegates Anderton, Boteler,
Buckel, Chisholm, Ghrist, Griffith, Hartman, Hornberger, Howard, Jacobs,
Kipke, Kittleman, Krebs, Long, Mangione, McComas, McKay, Metzgar,
Morgan, Munoz, Novotny, Otto, Parrott, Reilly, Saab, Shoemaker, Szeliga,
Thiam, and Wivell
Introduced and read first time: January 19, 2022
Assigned to: Health and Government Operations
A BILL ENTITLED
AN ACT concerning 1
Health Occupations – Health Care Staffing Shortage Emergency – Declaration 2
and Licensing and Practice Requirements 3
(Health Care Heroes Act of 2022) 4
FOR the purpose of authorizing the Secretary of Health to declare a health care staffing 5
shortage emergency in the State; requiring each health occupations board to 6
establish processes for the issuance of initial licenses, temporary licenses, and 7
temporary practice letters on an expedited basis during a health care staffing 8
shortage emergency; providing that certain health care practitioners qualify for 9
initial or temporary health occupation licenses or temporary practice letters or to be 10
practicing a certain health occupation at a health care facility without a license or 11
temporary practice letter under certain circumstances; and generally relating to a 12
health care staffing shortage emergency and health occupational licensing and 13
practice. 14
BY adding to 15
Article – Health – General 16
Section 2–109 17
Annotated Code of Maryland 18
(2019 Replacement Volume and 2021 Supplement) 19
BY adding to 20
Article – Health Occupations 21
Section 1–227 22
Annotated Code of Maryland 23
(2021 Replacement Volume) 24
2 HOUSE BILL 407
SECTION 1. BE IT ENACTED BY THE GEN ERAL ASSEMBLY OF MARYLAND, 1
That the Laws of Maryland read as follows: 2
Article – Health – General 3
2–109. 4
(A) IN THIS SECTION, “HEALTH CARE FACILITY ” MEANS: 5
(1) A HOSPITAL AS DEFINED IN § 19–301 OF THIS ARTICLE; 6
(2) A HEALTH MAINTENANCE O RGANIZATION AS DEFIN ED IN § 7
19–701(G) OF THIS ARTICLE; 8
(3) A FREESTANDING AMBULAT ORY CARE FACILITY AS DEFINED IN § 9
19–3B–01 OF THIS ARTICLE; 10
(4) AN ASSISTED LIVING FA CILITY AS DEFINED IN § 19–1801 OF THIS 11
ARTICLE; 12
(5) A LABORATORY AS DEFINED IN § 17–201 OF THIS ARTICLE; 13
(6) A HOME HEALTH AGENCY A S DEFINED IN § 19–401 OF THIS 14
ARTICLE; 15
(7) A RESIDENTIAL TREATMEN T CENTER AS DEFINED IN § 19–301 OF 16
THIS ARTICLE; 17
(8) A COMPREHENSIVE REHABI LITATION FACILITY AS DEFINED IN § 18
19–1201 OF THIS ARTICLE; 19
(9) A FORENSIC LABORATORY AS DEFINED IN § 17–2A–01 OF THIS 20
ARTICLE; 21
(10) A SUBSTANCE–RELATED DISORDER PRO GRAM AS DEFINED IN § 22
7.5–101 OF THIS ARTICLE; 23
(11) A MENTAL HEALTH PROGRA M AS DEFINED IN § 7.5–101 OF THIS 24
ARTICLE; 25
(12) A NURSING HOME AS DEFI NED IN § 19–401 OF THIS ARTICLE; 26
(13) A PHARMACY; OR 27
HOUSE BILL 407 3
(14) ANY OTHER FACILITY AS DETERMINED BY THE SECRETARY. 1
(B) IF THE SECRETARY FINDS THAT AN EMERGENCY HAS DEV ELOPED 2
REGARDING THE ABILIT Y OF HEALTH CARE FAC ILITIES IN THE STATE TO 3
APPROPRIATELY RESPON D TO THE CLINICAL NE EDS OF PATIENTS BECA USE OF 4
INSUFFICIENT STAFF A ND THAT THE STAFFING SHORTAGE ENDANGERS T HE PUBLIC 5
HEALTH IN THE STATE, THE SECRETARY MAY DECLARE A HEALTH CARE STAFFI NG 6
SHORTAGE EMERGENCY . 7
(C) THE SECRETARY SHALL ESTABLISH THE CRITERIA FOR DET ERMINING 8
THE EMERGENCY CONDIT IONS THAT WOULD REQU IRE THE DECLARATION OF A 9
HEALTH CARE STAFFING SHORTAGE EMERGENCY . 10
(D) THE CRITERIA ESTABLIS HED UNDER SUBSECTION (C) OF THIS SECTION 11
SHALL INCLUDE CONSID ERATION OF THE FOLLOWING FACTOR S: 12
(1) STAFFED BED OCCUPANCY RATE; 13
(2) STAFF VACANCY RATE FO R THE SPECIFIC CATEG ORY OF HEALTH 14
CARE PRACTITIONER IN CLUDED IN THE STAFFI NG SHORTAGE ; 15
(3) AVERAGE EMERGENCY DEP ARTMENT WAIT TIMES ; 16
(4) DURATION OF VACANCY R ATE FOR THE SPECIFIC CATEG ORY OF 17
HEALTH CARE PRACTITI ONER INCLUDED IN THE STAFFING SHORTAGE ; 18
(5) AVERAGE STAFF VACANCY RATE FOR THE IMMEDIA TELY 19
PRECEDING 12 MONTHS FOR THE SPECI FIC CATEGORY OF HEAL TH CARE 20
PRACTITIONER INCLUDE D IN THE STAFFING SH ORTAGE; AND 21
(6) ANY OTHER FACTOR DETE RMINED RELEVANT BY T HE 22
SECRETARY. 23
(E) ON THE DECLARATION OF A HEALTH CARE STAFFI NG SHORTAGE 24
EMERGENCY , THE SECRETARY MAY DIRECT THE HEALTH OCCUPATIO NS BOARDS 25
THAT REGULATE THE CA TEGORIES OF HEALTH C ARE PRACTITIONERS IN CLUDED IN 26
THE IDENTIFIED STAFF ING SHORTAGE TO IMPL EMENT THE EXPEDITED LICENSING 27
PROCESSES UNDER § 1–227 OF THE HEALTH OCCUPATIONS ARTICLE. 28
(F) A DECLARED HEALTH CARE STAFFING SHORTAGE EM ERGENCY MAY NOT 29
EXCEED 180 DAYS. 30
4 HOUSE BILL 407
(G) THE SECRETARY SHALL ADOPT REGULATIONS TO CARRY OUT THIS 1
SECTION. 2
Article – Health Occupations 3
1–227. 4
(A) (1) IN THIS SECTION THE F OLLOWING WORDS HAVE THE MEANINGS 5
INDICATED. 6
(2) “HEALTH OCCUPATION LIC ENSE” MEANS A LICENSE OR 7
CERTIFICATE ISSUED B Y A HEALTH OCCUPATIO NS BOARD TO PRACTICE A HEALTH 8
OCCUPATION IN THE STATE. 9
(3) “INACTIVE LICENSEE ” MEANS A LICENSEE WHO HOLDS A HEALTH 10
OCCUPATION LICENSE I SSUED BY A HEALTH OC CUPATIONS BOARD THAT HAS BEEN 11
PLACED ON INACTIVE S TATUS WITHIN THE PAS T 8 YEARS. 12
(4) “NURSING GRADUATE ” MEANS AN IND IVIDUAL WHO HAS 13
SATISFACTORILY COMPL ETED ALL THE REQUIRE MENTS FOR A DIPLOMA OR DEGREE 14
FROM: 15
(I) A REGISTERED NURSING E DUCATION PROGRAM APP ROVED 16
BY THE STATE BOARD OF NURSING; OR 17
(II) AN OUT–OF–STATE NURSING EDUCAT ION PROGRAM 18
DETERMINED TO BE EQU IVALENT TO A PROGRAM UNDER ITEM (I) OF THIS 19
PARAGRAPH BY THE STATE BOARD OF NURSING. 20
(5) “RETIRED HEALTH CARE P RACTITIONER” MEANS AN INDIVIDUAL 21
WHO HELD A VALID HEA LTH OCCUPATION LICEN SE ISSUED BY A HEALT H 22
OCCUPATIONS BOARD WI THIN THE PAST 8 YEARS THAT IS NOT ACTIVE AND HAS NOT 23
BEEN PLACED ON INACT IVE STATUS. 24
(6) “TEMPORARY HEALTH OCCU PATION LICENSE ” AND “TEMPORARY 25
PRACTICE LETTER ” MEANS A HEALTH OCCUP ATION LICENSE OR PRA CTICE LETTER 26
ISSUED BY A HEALTH O CCUPATIONS BOARD AUT HORIZING THE HOLDER TO 27
PRACTICE A SPECIFIED HEALT H OCCUPATION IN THE STATE FOR A TEMPORARY 28
PERIOD OF TIME. 29
(B) EACH HEALTH OCCUPATIO NS BOARD SHALL ESTAB LISH PROCESSES 30
FOR THE ISSUANCE OF AN INITIAL HEALTH OC CUPATION LICENSE , A TEMPORARY 31
HEALTH OCCUPATION LI CENSE, AND A TEMPORARY PRA CTICE LETTER ON AN 32
EXPEDITED BASIS DURI NG A HEALTH CARE STA FFING SHORTAGE EMERG ENCY 33 HOUSE BILL 407 5
DECLARED BY THE SECRETARY UNDER § 2–109 OF THE HEALTH – GENERAL 1
ARTICLE. 2
(C) THE FOLLOWING INDIVID UALS QUALIFY FOR A H EALTH OCCUPATION 3
LICENSE ISSUED ON AN EXPEDITED BASI S UNDER SUBSECTION (B) OF THIS SECTION 4
DURING A HEALTH CARE STAFFING SHORTAGE EM ERGENCY: 5
(1) AN APPLICANT FOR AN I NITIAL HEALTH OCCUPA TION LICENSE; 6
(2) AN INDIVIDUAL WHO HOL DS A VALID, UNEXPIRED HEALTH 7
OCCUPATION LICENSE I SSUED IN ANOTHER STA TE; 8
(3) AN INACTIVE LICENSEE ; 9
(4) A RETIRED HEALTH CARE PRACTITIONER ; AND 10
(5) A NURSING GRADUATE . 11
(D) (1) TO APPLY FOR AN INITI AL HEALTH OCCUPATION LICENSE, A 12
TEMPORARY HEALTH OCC UPATION LICENSE , OR A TEMPORARY PRACT ICE LETTER 13
UNDER SUBSECTION (B) OF THIS SECTION, AN APPLICANT SHALL S UBMIT TO THE 14
APPROPRIATE HEALTH O CCUPATIONS BOARD : 15
(I) AN APPLICATION; 16
(II) ANY DOCUMENTATION REQ UIRED BY THE BOARD ; 17
(III) IF A CRIMINAL HISTORY RECORDS CHECK IS REQ UIRED BY 18
THE BOARD FOR LICENS URE, PROOF OF APP LICATION FOR A CRIMI NAL HISTORY 19
RECORDS CHECK ; 20
(IV) ANY APPLICATION FEE ; AND 21
(V) ANY OTHER INFORMATION REQUIRED BY THE BOAR D. 22
(2) EXCEPT AS PROVIDED IN PARAGRAPH (3) OF THIS SUBSECTION , A 23
HEALTH OCCUPATIONS B OARD SHALL PROCESS A ND ISSUE A LICE NSE OR 24
TEMPORARY PRACTICE L ETTER TO AN APPLICAN T WHO MEETS THE REQU IREMENTS 25
OF THIS SUBSECTION U SING THE EXPEDITED P ROCESS ESTABLISHED U NDER 26
SUBSECTION (B) OF THIS SECTION. 27
(3) A HEALTH OCCUPATIONS B OARD MAY NOT ISSUE A LICENSE OR 28
TEMPORARY PRACTICE L ETTER UNDER THIS SECTI ON IF THE ISSUANCE O F THE 29 6 HOUSE BILL 407
LICENSE OR TEMPORARY PRACTICE LETTER WOUL D POSE A RISK TO PUB LIC 1
HEALTH, WELFARE, OR SAFETY. 2
(E) (1) A TEMPORARY HEALTH OCC UPATION LICENSE OR T EMPORARY 3
PRACTICE LETTER ISSU ED UNDER THIS SECTIO N AUTHORIZES THE HEALTH CARE 4
PRACTITIONER TO PRAC TICE THE SPECIFIED H EALTH OCCUPATION FOR A LIMITED 5
PERIOD OF TIME , AS DETERMINED BY THE HEALTH OCCUPATIONS B OARD AND 6
SUBJECT TO THE DURAT ION OF THE HEALTH CA RE STAFFING SHORTAGE 7
EMERGENCY . 8
(2) A HEALTH OCCUPATION LI CENSE ISSUED UNDER THIS SE CTION 9
AUTHORIZES THE LICEN SEE TO PRACTICE THE SPECIFIED HEALTH OCC UPATION 10
FOR A LIMITED PERIOD OF TIME, AS DETERMINED BY THE HEALTH OCCUPATIONS 11
BOARD, WHILE THE LICENSEE C OMPLETES ADDITIONAL REQUIREMENTS FOR 12
LICENSURE IN THE STATE, IF REQUIRED. 13
(F) (1) DURING A HEALTH CARE STAFFING SHORTAGE EM ERGENCY, A 14
HEALTH CARE PRACTITI ONER MAY PRACTICE TH E SPECIFIED HEALTH O CCUPATION 15
THAT IS INCLUDED IN THE STAFFING SHORTAG E IN A HEALTH CARE F ACILITY IN THE 16
STATE WITHOUT FIRST O BTAINING A LICENSE OR PRACTICE LETTER F ROM THE 17
RELEVANT HEALTH OCCU PATIONS BOARD ONLY I N ACCORDANCE WITH TH E 18
REQUIREMENTS OF THIS SUBSECTION. 19
(2) A HEALTH CARE PRACTITI ONER WHO HOLDS A VAL ID, UNEXPIRED 20
HEALTH OCCUPATION LI CENSE ISSUED IN ANOT HER STATE MAY PRACTI CE THE 21
SPECIFIED HEALTH OCCU PATION IN A HEALTH C ARE FACILITY UNDER P ARAGRAPH 22
(1) OF THIS SUBSECTION I F: 23
(I) DOING SO IS NECESSARY TO ALLOW THE HEALTH CARE 24
FACILITY TO MEET REQ UIRED STAFFING RATIO S OR OTHERWISE ENSUR E THE 25
CONTINUED AND SAFE D ELIVERY OF HEALTH CA RE SERVICES TO PATIE NTS IN THE 26
FACILITY; 27
(II) THE HEALTH CARE PRACT ITIONER REASONABLY B ELIEVES 28
A TEMPORARY HEALTH OCCU PATION LICENSE OR TE MPORARY PRACTICE LET TER 29
COULD NOT BE OBTAINE D IN SUFFICIENT TIME TO MEET THE IMMINENT NEEDS OF 30
THE HEALTH CARE FACI LITY; AND 31
(III) THE HEALTH CARE PRACT ITIONER SUBMITS AN 32
APPLICATION FOR A TE MPORARY HEALTH OCCUP ATION LICENSE OR TEMP ORARY 33
PRACTICE LETTER WITH IN 10 DAYS OF THE DAY THE HEALTH CARE PRACTITI ONER 34
BEGINS WORKING AT A HEALTH CARE FACILITY . 35
HOUSE BILL 407 7
(3) AN INACTIVE LICENSEE OR A RETIRED HEALTH CARE 1
PRACTITIONER MAY PRA CTICE A SPECIFIED HE ALTH OCCUPATION IN A HEALTH 2
CARE FACILITY UNDER PARAGRAPH (1) OF THIS SUBSECTION I F: 3
(I) QUALIFIED SUPERVISORY PERSONNEL AT THE HEA LTH 4
CARE FACILITY REASON ABLY CONCLUDE THAT T HE INACTIVE LICENSEE OR 5
RETIRED HEALTH CARE PRACTITIONER CAN COM PETENTLY PRACTICE TH E HEALTH 6
OCCUPATION; 7
(II) DOING SO IS NECESSARY TO ALLOW THE HEALTH CARE 8
FACILITY TO MEET REQ UIRED STAFFING RATIO S OR OTHERWISE ENSUR E THE 9
CONTINUED AND SAFE D ELIVERY OF HEALTH CA RE SERVICES TO PATIE NTS IN THE 10
FACILITY; 11
(III) THE HEALTH CARE PRACT ITIONER REASONAB LY BELIEVES 12
THE INACTIVE LICENSE COULD NOT BE REACTIV ATED OR A TEMPORARY HEALTH 13
OCCUPATION LICENSE O R TEMPORARY PRACTICE LETTER COULD NOT BE OBTAINED 14
IN SUFFICIENT TIME T O MEET THE IMMINENT NEEDS OF THE HEALTH CARE 15
FACILITY; AND 16
(IV) THE INACTIVE LICEN SEE OR RETIRED HEALT H CARE 17
PRACTITIONER SUBMITS AN APPLICATION TO TH E HEALTH OCCUPATIONS BOARD 18
WITHIN 10 DAYS OF THE DAY THE HEALTH CARE PRACTITI ONER BEGINS WORKING 19
AT A HEALTH CARE FAC ILITY: 20
1. TO REACTIVATE AN INAC TIVE LICENSE; OR 21
2. FOR A TEMP ORARY HEALTH OCCUPAT ION LICENSE 22
OR TEMPORARY PRACTIC E LETTER. 23
(4) A NURSING GRADUATE MAY PRACTICE REGISTERED NURSING, AS 24
DEFINED IN § 8–101(O) OF THIS ARTICLE , IN A HEALTH CARE FAC ILITY UNDER 25
PARAGRAPH (1) OF THIS SUBSECTION I F: 26
(I) DOING SO IS NECESSARY TO ALLOW THE HEALTH CARE 27
FACILITY TO MEET REQ UIRED STAFFING RATIO S OR OTHERWISE ENSUR E THE 28
CONTINUED AND SAFE D ELIVERY OF HEALTH CA RE SERVICES TO PATIE NTS IN THE 29
FACILITY; 30
(II) QUALIFIED SUPERVISORY PERSONNEL AT THE HEA LTH 31
CARE FACILITY: 32
8 HOUSE BILL 407
1. REASONABLY CONCLUDE T HAT THE NURSING 1
GRADUATE CAN COMPETE NTLY PRACTICE REGIST ERED NURSING ; AND 2
2. ACTIVELY SUPERVISE TH E NURSING GRADUATE 3
WHILE PRACTICING REG ISTERED NURSING AT T HE HEALTH CARE FACIL ITY; AND 4
(III) THE NURSING GRAD UATE SUBMITS AN APPL ICATION TO 5
THE STATE BOARD OF NURSING WITHIN 10 DAYS OF THE DAY THE NURSING 6
GRADUATE BEGINS WORK ING AT THE HEALTH CA RE FACILITY. 7
SECTION 2. AND BE IT FURTHER ENACTED, That this Act is an emergency 8
measure, is necessary for the immediate preservation of the public health or safety, has 9
been passed by a yea and nay vote supported by three–fifths of all the members elected to 10
each of the two Houses of the General Assembly, and shall take effect from the date it is 11
enacted. 12