EXPLANATION: CAPITALS INDICATE MATTER ADDE D TO EXISTING LAW .
[Brackets] indicate matter deleted from existing law.
*hb0717*
HOUSE BILL 717
J2 3lr1581
CF SB 772
By: Delegate Bagnall
Introduced and read first time: February 7, 2023
Assigned to: Health and Government Operations
A BILL ENTITLED
AN ACT concerning 1
State Board of Nursing – Peer Advisory Committees, Scopes of Practice, and 2
Licensure Requirements 3
FOR the purpose of authorizing the State Board of Nursing to appoint peer advisory 4
committees to provide advice related to midwifery; authorizing licensed nurses 5
certified as nurse–midwives and licensed certified midwives to personally prepare 6
and dispense a starter dosage of certain drugs under certain circumstances; 7
authorizing licensed nurses certified as nurse–midwives and licensed certified 8
midwives to delegate certain tasks to certified medication technicians and certified 9
nursing assistants under certain circumstances; altering the exceptions to the 10
certified midwifery licensure requirement and the qualifications required for a 11
license; requiring the Maryland Department of Health, in consultation with 12
stakeholders, to develop recommendations to expand access to birthing services in 13
birthing centers; and generally relating to health care practitioners licensed by the 14
State Board of Nursing. 15
BY repealing and reenacting, with amendments, 16
Article – Health Occupations 17
Section 8–503(a), 8–508(a) and (b), 8–601, 8–6A–01(j) and (l), 8–6A–02, 18
8–6D–01(h), 8–6D–02, 8–6D–03, and 12–102(a), (c)(2)(iv) and (v), (e), (f), and 19
(g) 20
Annotated Code of Maryland 21
(2021 Replacement Volume and 2022 Supplement) 22
BY repealing and reenacting, without amendments, 23
Article – Health Occupations 24
Section 8–6A–01(a) and 8–6D–01(a) 25
Annotated Code of Maryland 26
(2021 Replacement Volume and 2022 Supplement) 27
BY adding to 28 2 HOUSE BILL 717
Article – Health Occupations 1
Section 12–102(c)(2)(vi) 2
Annotated Code of Maryland 3
(2021 Replacement Volume and 2022 Supplement) 4
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 5
That the Laws of Maryland read as follows: 6
Article – Health Occupations 7
8–503. 8
(a) The Board may appoint peer advisory committees to provide the Board with 9
expert advice related to the practice of nursing by advance practice nurses AND THE 10
PRACTICE OF MIDWIFER Y BY LICENSED CERTIF IED MIDWIVES. 11
8–508. 12
(a) (1) In this section the following words have the meanings indicated. 13
(2) “MIDWIFE” MEANS A LICENSED NUR SE CERTIFIED AS A 14
NURSE–MIDWIFE OR A LICENSE D CERTIFIED MIDWIFE . 15
[(2)] (3) “Nurse practitioner” means a registered nurse who is: 16
(i) Certified as a nurse practitioner; and 17
(ii) Authorized to prescribe drugs under regulations adopted by the 18
Board. 19
[(3) “Starter dosage” means an amount of drug sufficient to begin therapy: 20
(i) Of short duration of 72 hours or less; or 21
(ii) Prior to obtaining a larger quantity of the drug to complete 22
therapy.] 23
(4) “Personally prepare and dispense” means that a nurse practitioner: 24
(i) Is physically present on the premises where the prescription is 25
filled; and 26
(ii) Performs a final check of the prescription before it is provided to 27
the patient. 28
HOUSE BILL 717 3
(5) “STARTER DOSAGE ” MEANS AN AMOUNT OF D RUG SUFFICIENT TO 1
BEGIN THERAPY : 2
(I) OF SHORT DURATION OF 72 HOURS OR LESS ; OR 3
(II) PRIOR TO OBTAINING A LARGER QUANTITY OF THE DRUG TO 4
COMPLETE THERAPY . 5
(b) A nurse practitioner OR MIDWIFE may personally prepare and dispense a 6
starter dosage of any drug the nurse practitioner OR MIDWIFE is authorized to prescribe 7
to a patient of the nurse practitioner OR MIDWIFE if: 8
(1) The starter dosage complies with the labeling requirements of § 12–505 9
of this article; 10
(2) No charge is made for the starter dosage; and 11
(3) The nurse practitioner OR MIDWIFE enters an appropriate record in 12
the patient’s medical record. 13
8–601. 14
In this subtitle: 15
(1) “Practice nurse midwifery” means the management and care of 16
essentially normal newborns and of essentially normal women antepartally, intrapartally 17
and postpartally. 18
(2) “Practice nurse midwifery” includes: 19
(i) Family planning and well woman reproductive care; 20
(ii) The prescribing of substances commonly used in the practice of 21
nurse midwifery; 22
(iii) The prescribing of controlled substances on Schedules II, III, IV, 23
and V commonly used in the practice of nurse midwifery; and 24
(iv) The dispensing of the substances prescribed in accordance with 25
the provisions of [subparagraphs] ITEMS (ii) and (iii) of this paragraph in the course of 26
treating a patient [at]: 27
1. [A] AT A medical facility or clinic that is operated on a 28
nonprofit basis; 29
4 HOUSE BILL 717
2. [A] AT A health center that operates on a campus of an 1
institution of higher education; [or] 2
3. [A] AT A public health facility, a medical facility under 3
contract with a State or local health department, or a facility funded with public funds; OR 4
4. WITH A STARTER DOSAGE OF A DRUG AS AUTHORI ZED 5
UNDER § 8–508 OF THIS TITLE. 6
8–6A–01. 7
(a) In this subtitle the following words have the meanings indicated. 8
(j) “Certified medication technician” means an individual who: 9
(1) Has completed a Board–approved medication technician training 10
program; [and] 11
(2) Is certified by the Board as a medication technician; AND 12
(3) PERFORMS MEDICATION T ECHNICIAN TASKS DELE GATED BY A 13
REGISTERED NURSE , LICENSED PRACTICAL N URSE, OR LICENSED CERTIFIE D 14
MIDWIFE. 15
(l) “Certified nursing assistant”: 16
(1) Means an individual regardless of title who, FOR COMPENSATION , 17
routinely performs [nursing]: 18
(I) NURSING tasks delegated by a registered nurse or licensed 19
practical nurse [for compensation]; OR 20
(II) TECHNICAL TASKS DELEG ATED BY A LICENSED C ERTIFIED 21
MIDWIFE; and 22
(2) Does not include a certified dialysis technician or a certified medication 23
technician. 24
8–6A–02. 25
(a) Subject to subsection [(e)] (F) of this section and except as otherwise provided 26
in this subtitle, an individual shall be certified by the Board to practice as a nursing 27
assistant, dialysis technician, or medication technician before the individual may practice 28
as a nursing assistant, dialysis technician, or medication technician in the State. 29
HOUSE BILL 717 5
(b) This subtitle does not apply to an individual who: 1
(1) Practices a health occupation that the individual is authorized to 2
practice under this article; 3
(2) Provides for the gratuitous care of friends, domestic partners, or family 4
members; 5
(3) Performs nursing assistant tasks while a nursing student enrolled in 6
an accredited nursing program and practicing under the direct supervision of qualified 7
faculty or preceptors; 8
(4) Performs nursing assistant tasks as a student while: 9
(i) Enrolled in a Board–approved nursing assistant training 10
program; and 11
(ii) Practicing under the direct supervision of qualified faculty or 12
preceptors; 13
(5) Performs medication technician tasks as a student while practicing 14
under the direct supervision of qualified faculty; 15
(6) Performs dialysis technician tasks as a student while under the direct 16
supervision of qualified faculty; or 17
(7) Works as a principal or school secretary, does not administer 18
medication as a routine part of the position, and has completed training by the delegating 19
nurse for the occasion where the individual may need to administer medication in the 20
absence of the nurse or medication technician. 21
(c) Nothing in this section shall preclude a registered nurse or licensed practical 22
nurse from delegating a nursing or other technical task to an unlicensed individual 23
provided that acceptance of delegated nursing or other technical tasks does not become a 24
routine part of the unlicensed individual’s job duties. 25
(d) (1) Subject to regulations adopted by the Board under paragraph (2) of this 26
subsection, this section does not preclude an advanced practice registered nurse from 27
delegating a nursing or other technical task to an assistant if: 28
(i) The assistant performs only tasks that the assistant is trained to 29
perform; and 30
(ii) The delegating advanced practice registered nurse provides: 31
1. Instruction to the assistant on the delegated task; and 32
6 HOUSE BILL 717
2. On–site supervision of the assistant performing the 1
delegated task. 2
(2) The Board shall adopt regulations to carry out this subsection, 3
including regulations that: 4
(i) Provide for the manner in which an advanced practice registered 5
nurse delegates a nursing or other technical task to an assistant; 6
(ii) Establish limitations on the authority of an advanced practice 7
registered nurse to delegate nursing or other technical tasks to an assistant; and 8
(iii) Otherwise clarify the scope of this subsection. 9
(E) (1) SUBJECT TO REGULATION S ADOPTED BY THE BOARD UNDER 10
PARAGRAPH (2) OF THIS SUBSECTION , THIS SECTION DOES NO T PRECLUDE A 11
LICENSED CERTIFIED M IDWIFE FROM DELEGATI NG A TECHNICAL TASK TO AN 12
ASSISTANT IF: 13
(I) THE ASSISTANT PERFORMS ONLY T ASKS THAT THE 14
ASSISTANT IS TRAINED TO PERFORM ; AND 15
(II) THE DELEGATING LICENS ED CERTIFIED MIDWIFE 16
PROVIDES: 17
1. INSTRUCTION TO THE AS SISTANT ON THE DELEG ATED 18
TASK; AND 19
2. ON–SITE SUPERVISION OF THE ASSISTANT 20
PERFORMING THE DELEGATED TASK . 21
(2) THE BOARD SHALL ADOPT REG ULATIONS TO CARRY OU T THIS 22
SUBSECTION, INCLUDING REGULATION S THAT: 23
(I) PROVIDE FOR THE MANNE R IN WHICH A LICENSE D 24
CERTIFIED MIDWIFE DE LEGATES A TECHNICAL TASK TO AN ASSISTANT ; 25
(II) ESTABLISH LIMITATIO NS ON THE AUTHORITY OF A 26
LICENSED CERTIFIED M IDWIFE TO DELEGATE T ECHNICAL TASKS TO AN ASSISTANT; 27
AND 28
(III) OTHERWISE CLARIFY THE SCOPE OF THIS SUBSEC TION. 29
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[(e)] (F) An individual shall be certified by the Board to practice as a nursing 1
assistant and as a dialysis technician before the individual may practice as a dialysis 2
technician in a State–owned hospital or State–owned facility. 3
8–6D–01. 4
(a) In this subtitle the following words have the meanings indicated. 5
(h) (1) “Practice certified midwifery” means the management and care of 6
essentially normal newborns and of essentially normal women antepartally, intrapartally, 7
and postpartally. 8
(2) “Practice certified midwifery” includes: 9
(i) Family planning and well woman reproductive care; 10
(ii) The prescribing of substances commonly used in the practice of 11
midwifery; 12
(iii) The prescribing of Schedule II, Schedule III, Schedule IV, and 13
Schedule V controlled dangerous substances commonly used in the practice of midwifery; 14
and 15
(iv) The dispensing of the substances prescribed in accordance with 16
the provisions of items (ii) and (iii) of this paragraph in the course of treating a patient [at]: 17
1. [A] AT A medical facility or clinic that is operated on a 18
nonprofit basis; 19
2. [A] AT A health center that operates on a campus of an 20
institution of higher education; [or] 21
3. [A] AT A public health facility, a medical facility under 22
contract with a state or local health department, or a facility funded with public funds; OR 23
4. WITH A STARTER DOSAGE OF A DRUG AS AUTHORI ZED 24
UNDER § 8–508 OF THIS TITLE. 25
8–6D–02. 26
(a) Except as otherwise provided in this subtitle, an individual shall be licensed 27
by the Board before the individual may practice certified midwifery in the State. 28
(b) This section does not apply to: 29
(1) An individual who assists at a birth in an emergency; 30 8 HOUSE BILL 717
(2) An individual who is licensed as a health care practitioner whose scope 1
of practice allows the individual to practice certified midwifery; [or] 2
(3) A student who is practicing certified midwifery while engaged in an 3
approved clinical midwifery education experience under the supervision of a licensed 4
certified midwife or a licensed nurse certified as a nurse–midwife; OR 5
(4) AN INDIVIDUAL WHO HAS GRADUATED FROM AN APPROVE D 6
CLINICAL MIDWIFERY E DUCATION EXPERIENCE AND WHO IS: 7
(I) PRACTICING CERTIFIED MIDWIFERY UNDER THE 8
SUPERVISION OF A LIC ENSED CERTIFIED MIDW IFE OR A LICENSED NU RSE 9
CERTIFIED AS A NURSE –MIDWIFE; AND 10
(II) MEETS ANY OTHER REQUI REMENTS SET BY THE BOARD. 11
8–6D–03. 12
(a) In addition to the certification and education requirements under subsection 13
(b) of this section, to qualify for a license, an applicant must: 14
(1) Be of good moral character; and 15
(2) Submit to a criminal history records check in accordance with § 8–303 16
of this title. 17
(b) An applicant must: 18
(1) Hold a current, valid certification as a certified midwife from AMCB; 19
(2) Have graduated from a graduate –level accredited program for 20
midwifery education approved by ACME; AND 21
(3) [Have completed coursework in health and sciences: 22
(i) Before commencing a midwifery program described in item (2) of 23
this subsection; or 24
(ii) As part of a midwifery program described in item (2) of this 25
subsection; and 26
(4)] Have passed the AMCB examination. 27
12–102. 28
HOUSE BILL 717 9
(a) (1) In this section the following terms have the meanings indicated. 1
(2) “In the public interest” means the dispensing of drugs or devices by a 2
licensed dentist, physician, NURSE OR MIDWIFE, or podiatrist to a patient when a 3
pharmacy is not conveniently available to the patient. 4
(3) “NURSE OR MIDWIFE ” MEANS AN INDIVIDUAL LICENSED OR 5
CERTIFIED BY THE BOARD OF NURSING UNDER TITLE 8 OF THIS ARTICLE. 6
[(3)] (4) “Personally preparing and dispensing” means that the licensed 7
dentist, physician, NURSE OR MIDWIFE, or podiatrist: 8
(i) Is physically present on the premises where the prescription is 9
filled; and 10
(ii) Performs a final check of the prescription before it is provided to 11
the patient. 12
(c) (2) This title does not prohibit: 13
(iv) A licensed physician who complies with the requirements of item 14
(ii) of this paragraph from personally preparing and dispensing a prescription written by: 15
1. A physician assistant in accordance with a delegation 16
agreement that complies with Title 15, Subtitle 3 of this article; or 17
2. A nurse practitioner who is authorized to practice under 18
Title 8, Subtitle 3 of this article and is working with the physician in the same office setting; 19
[or] 20
(v) A hospital–based clinic from dispensing prescriptions to its 21
patients; OR 22
(VI) AN INDIVIDUAL LICENSE D OR CERTIFIED UNDER TITLE 8 23
OF THIS ARTICLE FROM PERSONALLY PREPARING AND DISPENSING A DRU G OR 24
DEVICE AS AUTHORIZED UNDER TITLE 8 OF THIS ARTICLE . 25
(e) (1) This title does not prohibit: 26
(i) A dentist, physician, NURSE OR MIDWIFE, or podiatrist from 27
administering a prescription drug or device in the course of treating a patient; 28
(ii) A licensed dental hygienist from administering medication under 29
§ 4–206.4 of this article; or 30
10 HOUSE BILL 717
(iii) A nurse anesthetist from administering medication under § 1
8–513 of this article. 2
(2) For the purposes of paragraph (1)(i) of this subsection, “administering” 3
means the direct introduction of a single dosage of a drug or device at a given time, whether 4
by injection or other means, and whether in liquid, tablet, capsule, or other form. 5
(f) (1) This title does not prohibit a dentist, physician, NURSE OR MIDWIFE, 6
or podiatrist from personally dispensing a starter dosage of a prescription drug or device to 7
a patient of the dentist, physician, NURSE OR MIDWIFE, or podiatrist, provided that: 8
(i) The starter dosage complies with the labeling requirements of § 9
12–505 of this title; 10
(ii) No charge is made for the starter dosage; and 11
(iii) The dentist, physician, NURSE OR MIDWIFE, or podiatrist enters 12
an appropriate record on the patient’s chart. 13
(2) For the purposes of paragraph (1) of this subsection, “starter dosage” 14
means an amount of drug or device sufficient to begin therapy: 15
(i) Of short duration of 72 hours or less; or 16
(ii) Prior to obtaining a larger quantity of the drug or device to 17
complete the therapy. 18
(g) This title does not prohibit a dentist, physician, NURSE OR MIDWIFE, or 19
podiatrist from dispensing a prescription drug or device in the course of treating a patient: 20
(1) At a medical facility or clinic that is operated on a nonprofit basis; 21
(2) At a health center that operates on a campus of an institution of higher 22
education; or 23
(3) At a public health facility, a medical facility under contract with a State 24
or local health department, or a facility funded with public funds. 25
SECTION 2. AND BE IT FURTHER ENACTED, That, on or before December 1, 26
2023, the Maryland Department of Health, in consultation with relevant stakeholders, 27
shall develop recommendations to expand access to birthing services in birthing centers in 28
the State and report its findings to the Senate Finance Committee and the House Health 29
and Government Operations Committee, in accordance with § 2–1257 of the State 30
Government Article. 31
SECTION 3. AND BE IT FURTHER ENACTED, That this Act shall take effect 32
October 1, 2023. 33 HOUSE BILL 717 11