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