MD
Maryland House Bill HB717

Maryland 2023 Regular Session

Maryland House Bill HB717 Compare Versions

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1- WES MOORE, Governor Ch. 368
21
3-– 1 –
4-Chapter 368
5-(House Bill 717)
62
7-AN ACT concerning
3+EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
4+ [Brackets] indicate matter deleted from existing law.
5+ Underlining indicates amendments to bill.
6+ Strike out indicates matter stricken from the bill by amendment or deleted from the law by
7+amendment.
8+ *hb0717*
89
9-State Board of Nursing – Peer Advisory Committees, Scopes of Practice, and
10-Licensure Requirements
10+HOUSE BILL 717
11+J2 3lr1581
12+ CF SB 772
13+By: Delegate Bagnall Delegates Bagnall, Alston, Bhandari, Cullison, Guzzone,
14+Hill, S. Johnson, Kaiser, Kerr, R. Lewis, Lopez, Martinez, Pena–Melnyk,
15+Rosenberg, Taveras, White, and Woods
16+Introduced and read first time: February 7, 2023
17+Assigned to: Health and Government Operations
18+Committee Report: Favorable with amendments
19+House action: Adopted
20+Read second time: March 7, 2023
1121
12-FOR the purpose of authorizing the State Board of Nursing to appoint peer advisory
13-committees to provide advice related to midwifery; authorizing licensed nurses
14-certified as nurse–midwives and licensed certified midwives to personally prepare
15-and dispense a starter dosage of certain drugs under certain circumstances;
16-authorizing licensed nurses certified as nurse–midwives and licensed certified
17-midwives to delegate certain tasks to certified medication technicians and certified
18-nursing assistants under certain circumstances; altering the exceptions to the
19-certified midwifery licensure requirement and the qualifications required for a
20-license; requiring the Maryland Department of Health, in consultation with
21-stakeholders, to develop recommendations to expand access to birthing services in
22-birthing centers; and generally relating to health care practitioners licensed by the
23-State Board of Nursing.
22+CHAPTER ______
2423
25-BY repealing and reenacting, with amendments,
26- Article – Health Occupations
27-Section 8–503(a), 8–508(a) and (b), 8–601, 8–6A–01(j) and (l), 8–6A–02,
28-8–6D–01(h), 8–6D–02, 8–6D–03, and 12–102(a), (c)(2)(iv) and (v), (e), (f), and
29-(g)
30- Annotated Code of Maryland
31- (2021 Replacement Volume and 2022 Supplement)
24+AN ACT concerning 1
3225
33-BY repealing and reenacting, without amendments,
34- Article – Health Occupations
35- Section 8–6A–01(a) and 8–6D–01(a)
36- Annotated Code of Maryland
37- (2021 Replacement Volume and 2022 Supplement)
26+State Board of Nursing – Peer Advisory Committees, Scopes of Practice, and 2
27+Licensure Requirements 3
3828
39-BY adding to
40- Article – Health Occupations
41-Section 12–102(c)(2)(vi)
42- Annotated Code of Maryland
43- (2021 Replacement Volume and 2022 Supplement)
29+FOR the purpose of authorizing the State Board of Nursing to appoint peer advisory 4
30+committees to provide advice related to midwifery; authorizing licensed nurses 5
31+certified as nurse–midwives and licensed certified midwives to personally prepare 6
32+and dispense a starter dosage of certain drugs under certain circumstances; 7
33+authorizing licensed nurses certified as nurse–midwives and licensed certified 8
34+midwives to delegate certain tasks to certified medication technicians and certified 9
35+nursing assistants under certain circumstances; altering the exceptions to the 10
36+certified midwifery licensure requirement and the qualifications required for a 11
37+license; requiring the Maryland Department of Health, in consultation with 12
38+stakeholders, to develop recommendations to expand access to birthing services in 13
39+birthing centers; and generally relating to health care practitioners licensed by the 14
40+State Board of Nursing. 15
4441
45- SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND,
46-That the Laws of Maryland read as follows:
42+BY repealing and reenacting, with amendments, 16
43+ Article – Health Occupations 17
44+Section 8–503(a), 8–508(a) and (b), 8–601, 8–6A–01(j) and (l), 8–6A–02, 18
45+8–6D–01(h), 8–6D–02, 8–6D–03, and 12–102(a), (c)(2)(iv) and (v), (e), (f), and 19
46+(g) 20
47+ Annotated Code of Maryland 21
48+ (2021 Replacement Volume and 2022 Supplement) 22 2 HOUSE BILL 717
4749
48-Article – Health Occupations
49- Ch. 368 2023 LAWS OF MARYLAND
5050
51-– 2 –
52-8–503.
5351
54- (a) The Board may appoint peer advisory committees to provide the Board with
55-expert advice related to the practice of nursing by advance practice nurses AND THE
56-PRACTICE OF MIDWIFER Y BY LICENSED CERTIF IED MIDWIVES.
52+BY repealing and reenacting, without amendments, 1
53+ Article – Health Occupations 2
54+ Section 8–6A–01(a) and 8–6D–01(a) 3
55+ Annotated Code of Maryland 4
56+ (2021 Replacement Volume and 2022 Supplement) 5
5757
58-8–508.
58+BY adding to 6
59+ Article – Health Occupations 7
60+Section 12–102(c)(2)(vi) 8
61+ Annotated Code of Maryland 9
62+ (2021 Replacement Volume and 2022 Supplement) 10
5963
60- (a) (1) In this section the following words have the meanings indicated.
64+ SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 11
65+That the Laws of Maryland read as follows: 12
6166
62- (2) “MIDWIFE” MEANS A LICENSED REGISTERED NURSE CERTIFIED
63-AS A NURSE–MIDWIFE OR A LICENSE D CERTIFIED MIDWIFE .
67+Article – Health Occupations 13
6468
65- [(2)] (3) “Nurse practitioner” means a registered nurse who is:
69+8–503. 14
6670
67- (i) Certified as a nurse practitioner; and
71+ (a) The Board may appoint peer advisory committees to provide the Board with 15
72+expert advice related to the practice of nursing by advance practice nurses AND THE 16
73+PRACTICE OF MIDWIFER Y BY LICENSED CERTIF IED MIDWIVES. 17
6874
69- (ii) Authorized to prescribe drugs under regulations adopted by the
70-Board.
75+8–508. 18
7176
72- [(3) “Starter dosage” means an amount of drug sufficient to begin therapy:
77+ (a) (1) In this section the following words have the meanings indicated. 19
7378
74- (i) Of short duration of 72 hours or less; or
79+ (2) “MIDWIFE” MEANS A LICENSED REGISTERED NURSE CERTIFIED 20
80+AS A NURSE–MIDWIFE OR A LICENSE D CERTIFIED MIDWIFE . 21
7581
76- (ii) Prior to obtaining a larger quantity of the drug to complete
77-therapy.]
82+ [(2)] (3) “Nurse practitioner” means a registered nurse who is: 22
7883
79- (4) “Personally prepare and dispense” means that a nurse practitioner:
84+ (i) Certified as a nurse practitioner; and 23
8085
81- (i) Is physically present on the premises where the prescription is
82-filled; and
86+ (ii) Authorized to prescribe drugs under regulations adopted by the 24
87+Board. 25
8388
84- (ii) Performs a final check of the prescription before it is provided to
85-the patient.
89+ [(3) “Starter dosage” means an amount of drug sufficient to begin therapy: 26
8690
87- (5) “STARTER DOSAGE ” MEANS AN AMOUNT OF D RUG SUFFICIENT TO
88-BEGIN THERAPY :
91+ (i) Of short duration of 72 hours or less; or 27
8992
90- (I) OF SHORT DURATION OF 72 HOURS OR LESS ; OR
93+ (ii) Prior to obtaining a larger quantity of the drug to complete 28
94+therapy.] 29
9195
92- (II) PRIOR TO OBTAINING A LARGER QUANTITY OF T HE DRUG TO
93-COMPLETE THERAPY .
94- WES MOORE, Governor Ch. 368
96+ (4) “Personally prepare and dispense” means that a nurse practitioner: 30 HOUSE BILL 717 3
9597
96-– 3 –
97- (b) A nurse practitioner OR MIDWIFE may personally prepare and dispense a
98-starter dosage of any drug the nurse practitioner OR MIDWIFE is authorized to prescribe
99-to a patient of the nurse practitioner OR MIDWIFE if:
10098
101- (1) The starter dosage complies with the labeling requirements of § 12–505
102-of this article;
10399
104- (2) No charge is made for the starter dosage; and
100+ (i) Is physically present on the premises where the prescription is 1
101+filled; and 2
105102
106- (3) The nurse practitioner OR MIDWIFE enters an appropriate record in
107-the patient’s medical record.
103+ (ii) Performs a final check of the prescription before it is provided to 3
104+the patient. 4
108105
109-8–601.
106+ (5) “STARTER DOSAGE ” MEANS AN AMOUNT OF D RUG SUFFICIENT TO 5
107+BEGIN THERAPY : 6
110108
111- In this subtitle:
109+ (I) OF SHORT DURATION OF 72 HOURS OR LESS ; OR 7
112110
113- (1) “Practice nurse midwifery” means the managemen t and care of
114-essentially normal newborns and of essentially normal women antepartally, intrapartally
115-and postpartally.
111+ (II) PRIOR TO OBTAINING A LARGER QUANTITY OF T HE DRUG TO 8
112+COMPLETE THERAPY . 9
116113
117- (2) “Practice nurse midwifery” includes:
114+ (b) A nurse practitioner OR MIDWIFE may personally prepare and dispense a 10
115+starter dosage of any drug the nurse practitioner OR MIDWIFE is authorized to prescribe 11
116+to a patient of the nurse practitioner OR MIDWIFE if: 12
118117
119- (i) Family planning and well woman reproductive care;
118+ (1) The starter dosage complies with the labeling requirements of § 12–505 13
119+of this article; 14
120120
121- (ii) The prescribing of substances commonly used in the practice of
122-nurse midwifery;
121+ (2) No charge is made for the starter dosage; and 15
123122
124- (iii) The prescribing of controlled substances on Schedules II, III, IV,
125-and V commonly used in the practice of nurse midwifery; and
123+ (3) The nurse practitioner OR MIDWIFE enters an appropriate record in 16
124+the patient’s medical record. 17
126125
127- (iv) The dispensing of the substances prescribed in accordance with
128-the provisions of [subparagraphs] ITEMS (ii) and (iii) of this paragraph in the course of
129-treating a patient [at]:
126+8–601. 18
130127
131- 1. [A] AT A medical facility or clinic that is operated on a
132-nonprofit basis;
128+ In this subtitle: 19
133129
134- 2. [A] AT A health center that operates on a campus of an
135-institution of higher education; [or]
130+ (1) “Practice nurse midwifery” means the management and care of 20
131+essentially normal newborns and of essentially normal women antepartally, intrapartally 21
132+and postpartally. 22
136133
137- 3. [A] AT A public health facility, a medical facility under
138-contract with a State or local health department, or a facility funded with public funds; OR
134+ (2) “Practice nurse midwifery” includes: 23
139135
140- 4. WITH A STARTER DOSAGE OF A DRUG AS AUTHORIZED
141-UNDER § 8–508 OF THIS TITLE. Ch. 368 2023 LAWS OF MARYLAND
136+ (i) Family planning and well woman reproductive care; 24
142137
143-– 4 –
138+ (ii) The prescribing of substances commonly used in the practice of 25
139+nurse midwifery; 26
144140
145-8–6A–01.
141+ (iii) The prescribing of controlled substances on Schedules II, III, IV, 27
142+and V commonly used in the practice of nurse midwifery; and 28
143+ 4 HOUSE BILL 717
146144
147- (a) In this subtitle the following words have the meanings indicated.
148145
149- (j) “Certified medication technician” means an individual who:
146+ (iv) The dispensing of the substances prescribed in accordance with 1
147+the provisions of [subparagraphs] ITEMS (ii) and (iii) of this paragraph in the course of 2
148+treating a patient [at]: 3
150149
151- (1) Has completed a Board–approved medication technician training
152-program; [and]
150+ 1. [A] AT A medical facility or clinic that is operated on a 4
151+nonprofit basis; 5
153152
154- (2) Is certified by the Board as a medication technician; AND
153+ 2. [A] AT A health center that operates on a campus of an 6
154+institution of higher education; [or] 7
155155
156- (3) PERFORMS MEDICATION T ECHNICIAN TASKS SUBJECT TO
157-REGULATIONS ADOPTED BY THE BOARD, ROUTINELY PERFORMS :
156+ 3. [A] AT A public health facility, a medical facility under 8
157+contract with a State or local health department, or a facility funded with public funds; OR 9
158158
159- (I) NURSING TASKS RELATED TO THE ADMINISTRATION OF
160-MEDICATION, DELEGATED BY A REGIS TERED NURSE , LICENSED PRACTICAL N URSE,
161-OR LICENSED CERTIFIED MIDWIFE ADVANCED PRACTICE NU RSE; OR
159+ 4. WITH A STARTER DOSAGE OF A DRUG AS AUTHORI ZED 10
160+UNDER § 8–508 OF THIS TITLE. 11
162161
163- (II) TECHNICAL TASKS RELAT ED TO THE ADMINISTRA TION OF
164-MEDICATION DELEGATED BY A LICENSED CERTIF IED MIDWIFE.
162+8–6A–01. 12
165163
166- (l) “Certified nursing assistant”:
164+ (a) In this subtitle the following words have the meanings indicated. 13
167165
168- (1) Means an individual regardless of title who, FOR COMPENSATION
169-AND SUBJECT TO REGUL ATIONS ADOPTED BY TH E BOARD, routinely performs
170-[nursing]:
166+ (j) “Certified medication technician” means an individual who: 14
171167
172- (I) NURSING tasks delegated by a registered nurse or, licensed
173-practical nurse, OR ADVANCED PRACTICE REGISTERED NURSE [for compensation]; OR
168+ (1) Has completed a Board–approved medication technician training 15
169+program; [and] 16
174170
175- (II) TECHNICAL TASKS DELEG ATED BY A LICENSED C ERTIFIED
176-MIDWIFE; and
171+ (2) Is certified by the Board as a medication technician; AND 17
177172
178- (2) Does not include a certified dialysis technician or a certified medication
179-technician.
173+ (3) PERFORMS MEDICATION T ECHNICIAN TASKS SUBJECT TO 18
174+REGULATIONS ADOPTED BY THE BOARD, ROUTINELY PERFORMS : 19
180175
181-8–6A–02.
176+ (I) NURSING TASKS RELATED TO THE ADMINISTRATIO N OF 20
177+MEDICATION, DELEGATED BY A REGIS TERED NURSE , LICENSED PRACTICAL N URSE, 21
178+OR LICENSED CERTIFIED MIDWIFE ADVANCED PRACTICE NU RSE; OR 22
182179
183- (a) Subject to subsection [(e)] (F) of this section and except as otherwise provided
184-in this subtitle, an individual shall be certified by the Board to practice as a nursing
185-assistant, dialysis technician, or medication technician before the individual may practice
186-as a nursing assistant, dialysis technician, or medication technician in the State.
180+ (II) TECHNICAL TASKS RELAT ED TO THE ADMINISTRA TION OF 23
181+MEDICATION DELEGATED BY A LICENSED CERTIF IED MIDWIFE. 24
187182
188- (b) This subtitle does not apply to an individual who: WES MOORE, Governor Ch. 368
183+ (l) “Certified nursing assistant”: 25
189184
190-– 5 –
185+ (1) Means an individual regardless of title who, FOR COMPENSATION 26
186+AND SUBJECT TO REGUL ATIONS ADOPTED BY TH E BOARD, routinely performs 27
187+[nursing]: 28
191188
192- (1) Practices a health occupation that the individual is authorized to
193-practice under this article;
189+ (I) NURSING tasks delegated by a registered nurse or, licensed 29
190+practical nurse, OR ADVANCED PRACTICE REGISTERED NURSE [for compensation]; OR 30 HOUSE BILL 717 5
194191
195- (2) Provides for the gratuitous care of friends, domestic partners, or family
196-members;
197192
198- (3) Performs nursing assistant tasks while a nursing student enrolled in
199-an accredited nursing program and practicing under the direct supervision of qualified
200-faculty or preceptors;
201193
202- (4) Performs nursing assistant tasks as a student while:
194+ (II) TECHNICAL TASKS DELEG ATED BY A LICENSED C ERTIFIED 1
195+MIDWIFE; and 2
203196
204- (i) Enrolled in a Board–approved nursing assistant training
205-program; and
197+ (2) Does not include a certified dialysis technician or a certified medication 3
198+technician. 4
206199
207- (ii) Practicing under the direct supervision of qualified faculty or
208-preceptors;
200+8–6A–02. 5
209201
210- (5) Performs medication technician tasks as a student while practicing
211-under the direct supervision of qualified faculty;
202+ (a) Subject to subsection [(e)] (F) of this section and except as otherwise provided 6
203+in this subtitle, an individual shall be certified by the Board to practice as a nursing 7
204+assistant, dialysis technician, or medication technician before the individual may practice 8
205+as a nursing assistant, dialysis technician, or medication technician in the State. 9
212206
213- (6) Performs dialysis technician tasks as a student while under the direct
214-supervision of qualified faculty; or
207+ (b) This subtitle does not apply to an individual who: 10
215208
216- (7) Works as a principal or school secretary, does not administer
217-medication as a routine part of the position, and has completed training by the delegating
218-nurse for the occasion where the individual may need to administer medication in the
219-absence of the nurse or medication technician.
209+ (1) Practices a health occupation that the individual is authorized to 11
210+practice under this article; 12
220211
221- (c) Nothing in this section shall preclude a registered nurse or licensed practical
222-nurse from delegating a nursing or other technical task to an unlicensed individual
223-provided that acceptance of delegated nursing or other technical tasks does not become a
224-routine part of the unlicensed individual’s job duties.
212+ (2) Provides for the gratuitous care of friends, domestic partners, or family 13
213+members; 14
225214
226- (d) (1) Subject to regulations adopted by the Board under paragraph (2) of this
227-subsection, this section does not preclude an advanced practice registered nurse from
228-delegating a nursing or other technical task to an assistant if:
215+ (3) Performs nursing assistant tasks while a nursing student enrolled in 15
216+an accredited nursing program and practicing under the direct supervision of qualified 16
217+faculty or preceptors; 17
229218
230- (i) The assistant performs only tasks that the assistant is trained to
231-perform; and
219+ (4) Performs nursing assistant tasks as a student while: 18
232220
233- (ii) The delegating advanced practice registered nurse provides:
221+ (i) Enrolled in a Board–approved nursing assistant training 19
222+program; and 20
234223
235- 1. Instruction to the assistant on the delegated task; and
236- Ch. 368 2023 LAWS OF MARYLAND
224+ (ii) Practicing under the direct supervision of qualified faculty or 21
225+preceptors; 22
237226
238-– 6 –
239- 2. On–site supervision of the assistant performing the
240-delegated task.
227+ (5) Performs medication technician tasks as a student while practicing 23
228+under the direct supervision of qualified faculty; 24
241229
242- (2) The Board shall adopt regulations to carry out this subsection,
243-including regulations that:
230+ (6) Performs dialysis technician tasks as a student while under the direct 25
231+supervision of qualified faculty; or 26
244232
245- (i) Provide for the manner in which an advanced practice registered
246-nurse delegates a nursing or other technical task to an assistant;
233+ (7) Works as a principal or school secretary, does not administer 27
234+medication as a routine part of the position, and has completed training by the delegating 28
235+nurse for the occasion where the individual may need to administer medication in the 29
236+absence of the nurse or medication technician. 30
247237
248- (ii) Establish limitations on the authority of an advanced practice
249-registered nurse to delegate nursing or other technical tasks to an assistant; and
238+ (c) Nothing in this section shall preclude a registered nurse or licensed practical 31
239+nurse from delegating a nursing or other technical task to an unlicensed individual 32 6 HOUSE BILL 717
250240
251- (iii) Otherwise clarify the scope of this subsection.
252241
253- (E) (1) SUBJECT TO REGULATION S ADOPTED BY THE BOARD UNDER
254-PARAGRAPH (2) OF THIS SUBSECTION , THIS SECTION DOES NO T PRECLUDE A
255-LICENSED CERTIFIED M IDWIFE FROM DELEGATI NG A TECHNICAL TASK TO AN
256-ASSISTANT IF:
242+provided that acceptance of delegated nursing or other technical tasks does not become a 1
243+routine part of the unlicensed individual’s job duties. 2
257244
258- (I) THE ASSISTANT PERFORMS ONL Y TASKS THAT THE
259-ASSISTANT IS TRAINED TO PERFORM ; AND
245+ (d) (1) Subject to regulations adopted by the Board under paragraph (2) of this 3
246+subsection, this section does not preclude an advanced practice registered nurse from 4
247+delegating a nursing or other technical task to an assistant if: 5
260248
261- (II) THE DELEGATING LICENS ED CERTIFIED MIDWIFE
262-PROVIDES:
249+ (i) The assistant performs only tasks that the assistant is trained to 6
250+perform; and 7
263251
264- 1. INSTRUCTION TO THE AS SISTANT ON THE DELEG ATED
265-TASK; AND
252+ (ii) The delegating advanced practice registered nurse provides: 8
266253
267- 2. ON–SITE SUPERVISION OF THE ASSISTANT
268-PERFORMING THE DELEGATED TASK .
254+ 1. Instruction to the assistant on the delegated task; and 9
269255
270- (2) THE BOARD SHALL ADOPT REG ULATIONS TO CARRY OU T THIS
271-SUBSECTION, INCLUDING REGULATION S THAT:
256+ 2. On–site supervision of the assistant performing the 10
257+delegated task. 11
272258
273- (I) PROVIDE FOR THE MANNE R IN WHICH A LICENSE D
274-CERTIFIED MIDWIFE DE LEGATES A TECHNICAL TASK TO AN ASSISTANT ;
259+ (2) The Board shall adopt regulations to carry out this subsection, 12
260+including regulations that: 13
275261
276- (II) ESTABLISH LIMIT ATIONS ON THE AUTHOR ITY OF A
277-LICENSED CERTIFIED M IDWIFE TO DELEGATE T ECHNICAL TASKS TO AN ASSISTANT;
278-AND
262+ (i) Provide for the manner in which an advanced practice registered 14
263+nurse delegates a nursing or other technical task to an assistant; 15
279264
280- (III) OTHERWISE CLARIFY THE SCOPE OF THIS SUBSEC TION.
281- WES MOORE, Governor Ch. 368
265+ (ii) Establish limitations on the authority of an advanced practice 16
266+registered nurse to delegate nursing or other technical tasks to an assistant; and 17
282267
283-– 7 –
284- [(e)] (F) An individual shall be certified by the Board to practice as a nursing
285-assistant and as a dialysis technician before the individual may practice as a dialysis
286-technician in a State–owned hospital or State–owned facility.
268+ (iii) Otherwise clarify the scope of this subsection. 18
287269
288-8–6D–01.
270+ (E) (1) SUBJECT TO REGULATION S ADOPTED BY THE BOARD UNDER 19
271+PARAGRAPH (2) OF THIS SUBSECTION , THIS SECTION DOES NO T PRECLUDE A 20
272+LICENSED CERTIFIED M IDWIFE FROM DELEGATI NG A TECHNICAL TASK TO AN 21
273+ASSISTANT IF: 22
289274
290- (a) In this subtitle the following words have the meanings indicated.
275+ (I) THE ASSISTANT PERFORM S ONLY TASKS THAT TH E 23
276+ASSISTANT IS TRAINED TO PERFORM ; AND 24
291277
292- (h) (1) “Practice certified midwifery” means the management and care of
293-essentially normal newborns and of essentially normal women antepartally, intrapartally,
294-and postpartally.
278+ (II) THE DELEGATING LICE NSED CERTIFIED MIDWI FE 25
279+PROVIDES: 26
295280
296- (2) “Practice certified midwifery” includes:
281+ 1. INSTRUCTION TO THE AS SISTANT ON THE DELEG ATED 27
282+TASK; AND 28
297283
298- (i) Family planning and well woman reproductive care;
284+ 2. ON–SITE SUPERVISION OF THE ASSISTANT 29
285+PERFORMING THE DELEG ATED TASK. 30
286+ HOUSE BILL 717 7
299287
300- (ii) The prescribing of substances commonly used in the practice of
301-midwifery;
302288
303- (iii) The prescribing of Schedule II, Schedule III, Schedule IV, and
304-Schedule V controlled dangerous substances commonly used in the practice of midwifery;
305-and
289+ (2) THE BOARD SHALL ADOPT REG ULATIONS TO CARRY OU T THIS 1
290+SUBSECTION, INCLUDING RE GULATIONS THAT : 2
306291
307- (iv) The dispensing of the substances prescribed in accordance with
308-the provisions of items (ii) and (iii) of this paragraph in the course of treating a patient [at]:
292+ (I) PROVIDE FOR THE MANNE R IN WHICH A LICENSE D 3
293+CERTIFIED MIDWIFE DE LEGATES A TECHNICAL TASK TO AN ASSISTANT ; 4
309294
310- 1. [A] AT A medical facility or clinic that is operated on a
311-nonprofit basis;
295+ (II) ESTABLISH LIMITATIONS ON THE AUTHORITY OF A 5
296+LICENSED CERTIFIED M IDWIFE TO DELEGATE T ECHNICAL TASKS TO AN ASSISTANT; 6
297+AND 7
312298
313- 2. [A] AT A health center that operates on a campus of an
314-institution of higher education; [or]
299+ (III) OTHERWISE CLARIFY THE SCOPE OF THIS SUBSEC TION. 8
315300
316- 3. [A] AT A public health facility, a medical facility under
317-contract with a state or local health department, or a facility funded with public funds; OR
301+ [(e)] (F) An individual shall be certified by the Board to practice as a nursing 9
302+assistant and as a dialysis technician before the individual may practice as a dialysis 10
303+technician in a State–owned hospital or State–owned facility. 11
318304
319- 4. WITH A STARTER DOSAGE OF A DRUG AS AUTHORI ZED
320-UNDER § 8–508 OF THIS TITLE.
305+8–6D–01. 12
321306
322-8–6D–02.
307+ (a) In this subtitle the following words have the meanings indicated. 13
323308
324- (a) Except as otherwise provided in this subtitle, an individual shall be licensed
325-by the Board before the individual may practice certified midwifery in the State.
309+ (h) (1) “Practice certified midwifery” means the management and care of 14
310+essentially normal newborns and of essentially normal women antepartally, intrapartally, 15
311+and postpartally. 16
326312
327- (b) This section does not apply to:
313+ (2) “Practice certified midwifery” includes: 17
328314
329- (1) An individual who assists at a birth in an emergency; Ch. 368 2023 LAWS OF MARYLAND
315+ (i) Family planning and well woman reproductive care; 18
330316
331-– 8 –
317+ (ii) The prescribing of substances commonly used in the practice of 19
318+midwifery; 20
332319
333- (2) An individual who is licensed as a health care practitioner whose scope
334-of practice allows the individual to practice certified midwifery; [or]
320+ (iii) The prescribing of Schedule II, Schedule III, Schedule IV, and 21
321+Schedule V controlled dangerous substances commonly used in the practice of midwifery; 22
322+and 23
335323
336- (3) A student who is practicing certified midwifery while engaged in an
337-approved clinical midwifery education experience under the supervision of a licensed
338-certified midwife or a licensed nurse certified as a nurse–midwife; OR
324+ (iv) The dispensing of the substances prescribed in accordance with 24
325+the provisions of items (ii) and (iii) of this paragraph in the course of treating a patient [at]: 25
339326
340- (4) AN INDIVIDUAL WHO HAS GRADUATED FROM AN APPROVED
341-CLINICAL A GRADUATE LEVEL ACC REDITED PROGRAM FOR MIDWIFERY EDUCATION
342-EXPERIENCE APPROVED BY ACME, AND WHO IS:
327+ 1. [A] AT A medical facility or clinic that is operated on a 26
328+nonprofit basis; 27
343329
344- (I) PRACTICING CERTIFIED MIDWIFERY UNDER THE
345-SUPERVISION OF A LIC ENSED CERTIFIED MIDW IFE OR A LICENSED NU RSE
346-CERTIFIED AS A NURSE –MIDWIFE; AND
330+ 2. [A] AT A health center that operates on a campus of an 28
331+institution of higher education; [or] 29
347332
348- (II) MEETS ANY OTHER REQUI REMENTS SET BY THE BOARD.
333+ 3. [A] AT A public health facility, a medical facility under 30
334+contract with a state or local health department, or a facility funded with public funds; OR 31 8 HOUSE BILL 717
349335
350-8–6D–03.
351336
352- (a) In addition to the certification and education requirements under subsection
353-(b) of this section, to qualify for a license, an applicant must:
354337
355- (1) Be of good moral character; and
338+ 4. WITH A STARTER DOSAGE OF A DRUG AS AUTHORI ZED 1
339+UNDER § 8–508 OF THIS TITLE. 2
356340
357- (2) Submit to a criminal history records check in accordance with § 8–303
358-of this title.
341+8–6D–02. 3
359342
360- (b) An applicant must:
343+ (a) Except as otherwise provided in this subtitle, an individual shall be licensed 4
344+by the Board before the individual may practice certified midwifery in the State. 5
361345
362- (1) Hold a current, valid certification as a certified midwife from AMCB;
346+ (b) This section does not apply to: 6
363347
364- (2) Have graduated from a graduate –level accredited program for
365-midwifery education approved by ACME; AND
348+ (1) An individual who assists at a birth in an emergency; 7
366349
367- (3) [Have completed coursework in health and sciences:
350+ (2) An individual who is licensed as a health care practitioner whose scope 8
351+of practice allows the individual to practice certified midwifery; [or] 9
368352
369- (i) Before commencing a midwifery program described in item (2) of
370-this subsection; or
353+ (3) A student who is practicing certified midwifery while engaged in an 10
354+approved clinical midwifery education experience under the supervision of a licensed 11
355+certified midwife or a licensed nurse certified as a nurse–midwife; OR 12
371356
372- (ii) As part of a midwifery program described in item (2) of this
373-subsection; and
357+ (4) AN INDIVIDUAL WHO HAS GRADUATED FROM AN APPROVED 13
358+CLINICAL A GRADUATE LEVEL ACC REDITED PROGRAM FOR MIDWIFERY EDUCATION 14
359+EXPERIENCE APPROVED BY ACME, AND WHO IS: 15
374360
375- (4)] Have passed the AMCB examination.
376- WES MOORE, Governor Ch. 368
361+ (I) PRACTICING CERTIFIED MIDWIFERY UNDER THE 16
362+SUPERVISION OF A LIC ENSED CERTIFIED MIDW IFE OR A LICENSED NU RSE 17
363+CERTIFIED AS A NURSE –MIDWIFE; AND 18
377364
378-– 9 –
379-12–102.
365+ (II) MEETS ANY OTHER REQUI REMENTS SET BY THE BOARD. 19
380366
381- (a) (1) In this section the following terms have the meanings indicated.
367+8–6D–03. 20
382368
383- (2) “In the public interest” means the dispensing of drugs or devices by a
384-licensed dentist, physician, NURSE OR MIDWIFE , or podiatrist to a patient when a
385-pharmacy is not conveniently available to the patient.
369+ (a) In addition to the certification and education requirements under subsection 21
370+(b) of this section, to qualify for a license, an applicant must: 22
386371
387- (3) “NURSE OR MIDWIFE ” MEANS AN INDIVIDUAL LICENSED OR
388-CERTIFIED BY THE BOARD OF NURSING UNDER TITLE 8 OF THIS ARTICLE.
372+ (1) Be of good moral character; and 23
389373
390- [(3)] (4) “Personally preparing and dispensing” means that the licensed
391-dentist, physician, NURSE OR MIDWIFE , or podiatrist:
374+ (2) Submit to a criminal history records check in accordance with § 8–303 24
375+of this title. 25
392376
393- (i) Is physically present on the premises where the prescription is
394-filled; and
377+ (b) An applicant must: 26
395378
396- (ii) Performs a final check of the prescription before it is provided to
397-the patient.
379+ (1) Hold a current, valid certification as a certified midwife from AMCB; 27
398380
399- (c) (2) This title does not prohibit:
381+ (2) Have graduated from a graduate –level accredited program for 28
382+midwifery education approved by ACME; AND 29 HOUSE BILL 717 9
400383
401- (iv) A licensed physician who complies with the requirements of item
402-(ii) of this paragraph from personally preparing and dispensing a prescription written by:
403384
404- 1. A physician assistant in accordance with a delegation
405-agreement that complies with Title 15, Subtitle 3 of this article; or
406385
407- 2. A nurse practitioner who is authorized to practice under
408-Title 8, Subtitle 3 of this article and is working with the physician in the same office setting;
409-[or]
386+ (3) [Have completed coursework in health and sciences: 1
410387
411- (v) A hospital–based clinic from dispensing prescriptions to its
412-patients; OR
388+ (i) Before commencing a midwifery program described in item (2) of 2
389+this subsection; or 3
413390
414- (VI) AN INDIVIDUAL LICENSED OR CERT IFIED UNDER TITLE 8
415-OF THIS ARTICLE FROM PERSONALLY PREPARING AND DISPENSING A DRU G OR
416-DEVICE AS AUTHORIZED UNDER TITLE 8 OF THIS ARTICLE .
391+ (ii) As part of a midwifery program described in item (2) of this 4
392+subsection; and 5
417393
418- (e) (1) This title does not prohibit:
394+ (4)] Have passed the AMCB examination. 6
419395
420- (i) A dentist, physician, NURSE OR MIDWIFE , or podiatrist from
421-administering a prescription drug or device in the course of treating a patient;
396+12–102. 7
422397
423- (ii) A licensed dental hygienist from administering medication under
424-§ 4–206.4 of this article; or Ch. 368 2023 LAWS OF MARYLAND
398+ (a) (1) In this section the following terms have the meanings indicated. 8
425399
426-– 10 –
400+ (2) “In the public interest” means the dispensing of drugs or devices by a 9
401+licensed dentist, physician, NURSE OR MIDWIFE , or podiatrist to a patient when a 10
402+pharmacy is not conveniently available to the patient. 11
427403
428- (iii) A nurse anesthetist from administering medication under §
429-8–513 of this article.
404+ (3) “NURSE OR MIDWIFE ” MEANS AN INDIVIDUAL LICENSED OR 12
405+CERTIFIED BY THE BOARD OF NURSING UNDER TITLE 8 OF THIS ARTICLE. 13
430406
431- (2) For the purposes of paragraph (1)(i) of this subsection, “administering”
432-means the direct introduction of a single dosage of a drug or device at a given time, whether
433-by injection or other means, and whether in liquid, tablet, capsule, or other form.
407+ [(3)] (4) “Personally preparing and dispensing” means that the licensed 14
408+dentist, physician, NURSE OR MIDWIFE , or podiatrist: 15
434409
435- (f) (1) This title does not prohibit a dentist, physician, NURSE OR MIDWIFE ,
436-or podiatrist from personally dispensing a starter dosage of a prescription drug or device to
437-a patient of the dentist, physician, NURSE OR MIDWIFE, or podiatrist, provided that:
410+ (i) Is physically present on the premises where the prescription is 16
411+filled; and 17
438412
439- (i) The starter dosage complies with the labeling requirements of §
440-12–505 of this title;
413+ (ii) Performs a final check of the prescription before it is provided to 18
414+the patient. 19
441415
442- (ii) No charge is made for the starter dosage; and
416+ (c) (2) This title does not prohibit: 20
443417
444- (iii) The dentist, physician, NURSE OR MIDWIFE , or podiatrist enters
445-an appropriate record on the patient’s chart.
418+ (iv) A licensed physician who complies with the requirements of item 21
419+(ii) of this paragraph from personally preparing and dispensing a prescription written by: 22
446420
447- (2) For the purposes of paragraph (1) of this subsection, “starter dosage”
448-means an amount of drug or device sufficient to begin therapy:
421+ 1. A physician assistant in accordance with a delegation 23
422+agreement that complies with Title 15, Subtitle 3 of this article; or 24
449423
450- (i) Of short duration of 72 hours or less; or
424+ 2. A nurse practitioner who is authorized to practice under 25
425+Title 8, Subtitle 3 of this article and is working with the physician in the same office setting; 26
426+[or] 27
451427
452- (ii) Prior to obtaining a larger quantity of the drug or device to
453-complete the therapy.
428+ (v) A hospital–based clinic from dispensing prescriptions to its 28
429+patients; OR 29
430+ 10 HOUSE BILL 717
454431
455- (g) This title does not prohibit a dentist, physician, NURSE OR MIDWIFE , or
456-podiatrist from dispensing a prescription drug or device in the course of treating a patient:
457432
458- (1) At a medical facility or clinic that is operated on a nonprofit basis;
433+ (VI) AN INDIVIDUAL LICENSE D OR CERTIFIED UNDER TITLE 8 1
434+OF THIS ARTICLE FROM PERSONALLY PREPARING AND DISPENSING A DRU G OR 2
435+DEVICE AS AUTHORIZED UNDER TITLE 8 OF THIS ARTICLE. 3
459436
460- (2) At a health center that operates on a campus of an institution of higher
461-education; or
437+ (e) (1) This title does not prohibit: 4
462438
463- (3) At a public health facility, a medical facility under contract with a State
464-or local health department, or a facility funded with public funds.
439+ (i) A dentist, physician, NURSE OR MIDWIFE , or podiatrist from 5
440+administering a prescription drug or device in the course of treating a patient; 6
465441
466- SECTION 2. AND BE IT FURTHER ENACTED, That, on or before December 1,
467-2023, the Maryland Department of Health, in consultation with relevant stakeholders,
468-shall develop recommendations to expand access to birthing services in birthing centers in
469-the State and report its findings to the Senate Finance Committee and the House Health
470-and Government Operations Committee, in accordance with § 2 –1257 of the State
471-Government Article.
472- WES MOORE, Governor Ch. 368
442+ (ii) A licensed dental hygienist from administering medication under 7
443+§ 4–206.4 of this article; or 8
473444
474-– 11 –
475- SECTION 3. AND BE IT FURTHER ENACTED, That this Act shall take effect
476-October 1, 2023.
445+ (iii) A nurse anesthetist from administering medication under § 9
446+8–513 of this article. 10
477447
478-Approved by the Governor, May 3, 2023.
448+ (2) For the purposes of paragraph (1)(i) of this subsection, “administering” 11
449+means the direct introduction of a single dosage of a drug or device at a given time, whether 12
450+by injection or other means, and whether in liquid, tablet, capsule, or other form. 13
451+
452+ (f) (1) This title does not prohibit a dentist, physician, NURSE OR MIDWIFE , 14
453+or podiatrist from personally dispensing a starter dosage of a prescription drug or device to 15
454+a patient of the dentist, physician, NURSE OR MIDWIFE , or podiatrist, provided that: 16
455+
456+ (i) The starter dosage complies with the labeling requirements of § 17
457+12–505 of this title; 18
458+
459+ (ii) No charge is made for the starter dosage; and 19
460+
461+ (iii) The dentist, physician, NURSE OR MIDWIFE , or podiatrist enters 20
462+an appropriate record on the patient’s chart. 21
463+
464+ (2) For the purposes of paragraph (1) of this subsection, “starter dosage” 22
465+means an amount of drug or device sufficient to begin therapy: 23
466+
467+ (i) Of short duration of 72 hours or less; or 24
468+
469+ (ii) Prior to obtaining a larger quantity of the drug or device to 25
470+complete the therapy. 26
471+
472+ (g) This title does not prohibit a dentist, physician, NURSE OR MIDWIFE , or 27
473+podiatrist from dispensing a prescription drug or device in the course of treating a patient: 28
474+
475+ (1) At a medical facility or clinic that is operated on a nonprofit basis; 29
476+
477+ (2) At a health center that operates on a campus of an institution of higher 30
478+education; or 31 HOUSE BILL 717 11
479+
480+
481+
482+ (3) At a public health facility, a medical facility under contract with a State 1
483+or local health department, or a facility funded with public funds. 2
484+
485+ SECTION 2. AND BE IT FURTHER ENACTED, That, on or before December 1, 3
486+2023, the Maryland Department of Health, in consultation with relevant stakeholders, 4
487+shall develop recommendations to expand access to birthing services in birthing centers in 5
488+the State and report its findings to the Senate Finance Committee and the House Health 6
489+and Government Operations Committee, in accordance with § 2–1257 of the State 7
490+Government Article. 8
491+
492+ SECTION 3. AND BE IT FURTHER ENACTED, That this Act shall take effect 9
493+October 1, 2023. 10
494+
495+
496+
497+
498+Approved:
499+________________________________________________________________________________
500+ Governor.
501+________________________________________________________________________________
502+ Speaker of the House of Delegates.
503+________________________________________________________________________________
504+ President of the Senate.