WES MOORE, Governor Ch. 368
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Chapter 368
(House Bill 717)
AN ACT concerning
State Board of Nursing – Peer Advisory Committees, Scopes of Practice, and
Licensure Requirements
FOR the purpose of authorizing the State Board of Nursing to appoint peer advisory
committees to provide advice related to midwifery; authorizing licensed nurses
certified as nurse–midwives and licensed certified midwives to personally prepare
and dispense a starter dosage of certain drugs under certain circumstances;
authorizing licensed nurses certified as nurse–midwives and licensed certified
midwives to delegate certain tasks to certified medication technicians and certified
nursing assistants under certain circumstances; altering the exceptions to the
certified midwifery licensure requirement and the qualifications required for a
license; requiring the Maryland Department of Health, in consultation with
stakeholders, to develop recommendations to expand access to birthing services in
birthing centers; and generally relating to health care practitioners licensed by the
State Board of Nursing.
BY repealing and reenacting, with amendments,
Article – Health Occupations
Section 8–503(a), 8–508(a) and (b), 8–601, 8–6A–01(j) and (l), 8–6A–02,
8–6D–01(h), 8–6D–02, 8–6D–03, and 12–102(a), (c)(2)(iv) and (v), (e), (f), and
(g)
Annotated Code of Maryland
(2021 Replacement Volume and 2022 Supplement)
BY repealing and reenacting, without amendments,
Article – Health Occupations
Section 8–6A–01(a) and 8–6D–01(a)
Annotated Code of Maryland
(2021 Replacement Volume and 2022 Supplement)
BY adding to
Article – Health Occupations
Section 12–102(c)(2)(vi)
Annotated Code of Maryland
(2021 Replacement Volume and 2022 Supplement)
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND,
That the Laws of Maryland read as follows:
Article – Health Occupations
Ch. 368 2023 LAWS OF MARYLAND
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8–503.
(a) The Board may appoint peer advisory committees to provide the Board with
expert advice related to the practice of nursing by advance practice nurses AND THE
PRACTICE OF MIDWIFER Y BY LICENSED CERTIF IED MIDWIVES.
8–508.
(a) (1) In this section the following words have the meanings indicated.
(2) “MIDWIFE” MEANS A LICENSED REGISTERED NURSE CERTIFIED
AS A NURSE–MIDWIFE OR A LICENSE D CERTIFIED MIDWIFE .
[(2)] (3) “Nurse practitioner” means a registered nurse who is:
(i) Certified as a nurse practitioner; and
(ii) Authorized to prescribe drugs under regulations adopted by the
Board.
[(3) “Starter dosage” means an amount of drug sufficient to begin therapy:
(i) Of short duration of 72 hours or less; or
(ii) Prior to obtaining a larger quantity of the drug to complete
therapy.]
(4) “Personally prepare and dispense” means that a nurse practitioner:
(i) Is physically present on the premises where the prescription is
filled; and
(ii) Performs a final check of the prescription before it is provided to
the patient.
(5) “STARTER DOSAGE ” MEANS AN AMOUNT OF D RUG SUFFICIENT TO
BEGIN THERAPY :
(I) OF SHORT DURATION OF 72 HOURS OR LESS ; OR
(II) PRIOR TO OBTAINING A LARGER QUANTITY OF T HE DRUG TO
COMPLETE THERAPY .
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(b) A nurse practitioner OR MIDWIFE may personally prepare and dispense a
starter dosage of any drug the nurse practitioner OR MIDWIFE is authorized to prescribe
to a patient of the nurse practitioner OR MIDWIFE if:
(1) The starter dosage complies with the labeling requirements of § 12–505
of this article;
(2) No charge is made for the starter dosage; and
(3) The nurse practitioner OR MIDWIFE enters an appropriate record in
the patient’s medical record.
8–601.
In this subtitle:
(1) “Practice nurse midwifery” means the managemen t and care of
essentially normal newborns and of essentially normal women antepartally, intrapartally
and postpartally.
(2) “Practice nurse midwifery” includes:
(i) Family planning and well woman reproductive care;
(ii) The prescribing of substances commonly used in the practice of
nurse midwifery;
(iii) The prescribing of controlled substances on Schedules II, III, IV,
and V commonly used in the practice of nurse midwifery; and
(iv) The dispensing of the substances prescribed in accordance with
the provisions of [subparagraphs] ITEMS (ii) and (iii) of this paragraph in the course of
treating a patient [at]:
1. [A] AT A medical facility or clinic that is operated on a
nonprofit basis;
2. [A] AT A health center that operates on a campus of an
institution of higher education; [or]
3. [A] AT A public health facility, a medical facility under
contract with a State or local health department, or a facility funded with public funds; OR
4. WITH A STARTER DOSAGE OF A DRUG AS AUTHORIZED
UNDER § 8–508 OF THIS TITLE. Ch. 368 2023 LAWS OF MARYLAND
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8–6A–01.
(a) In this subtitle the following words have the meanings indicated.
(j) “Certified medication technician” means an individual who:
(1) Has completed a Board–approved medication technician training
program; [and]
(2) Is certified by the Board as a medication technician; AND
(3) PERFORMS MEDICATION T ECHNICIAN TASKS SUBJECT TO
REGULATIONS ADOPTED BY THE BOARD, ROUTINELY PERFORMS :
(I) NURSING TASKS RELATED TO THE ADMINISTRATION OF
MEDICATION, DELEGATED BY A REGIS TERED NURSE , LICENSED PRACTICAL N URSE,
OR LICENSED CERTIFIED MIDWIFE ADVANCED PRACTICE NU RSE; OR
(II) TECHNICAL TASKS RELAT ED TO THE ADMINISTRA TION OF
MEDICATION DELEGATED BY A LICENSED CERTIF IED MIDWIFE.
(l) “Certified nursing assistant”:
(1) Means an individual regardless of title who, FOR COMPENSATION
AND SUBJECT TO REGUL ATIONS ADOPTED BY TH E BOARD, routinely performs
[nursing]:
(I) NURSING tasks delegated by a registered nurse or, licensed
practical nurse, OR ADVANCED PRACTICE REGISTERED NURSE [for compensation]; OR
(II) TECHNICAL TASKS DELEG ATED BY A LICENSED C ERTIFIED
MIDWIFE; and
(2) Does not include a certified dialysis technician or a certified medication
technician.
8–6A–02.
(a) Subject to subsection [(e)] (F) of this section and except as otherwise provided
in this subtitle, an individual shall be certified by the Board to practice as a nursing
assistant, dialysis technician, or medication technician before the individual may practice
as a nursing assistant, dialysis technician, or medication technician in the State.
(b) This subtitle does not apply to an individual who: WES MOORE, Governor Ch. 368
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(1) Practices a health occupation that the individual is authorized to
practice under this article;
(2) Provides for the gratuitous care of friends, domestic partners, or family
members;
(3) Performs nursing assistant tasks while a nursing student enrolled in
an accredited nursing program and practicing under the direct supervision of qualified
faculty or preceptors;
(4) Performs nursing assistant tasks as a student while:
(i) Enrolled in a Board–approved nursing assistant training
program; and
(ii) Practicing under the direct supervision of qualified faculty or
preceptors;
(5) Performs medication technician tasks as a student while practicing
under the direct supervision of qualified faculty;
(6) Performs dialysis technician tasks as a student while under the direct
supervision of qualified faculty; or
(7) Works as a principal or school secretary, does not administer
medication as a routine part of the position, and has completed training by the delegating
nurse for the occasion where the individual may need to administer medication in the
absence of the nurse or medication technician.
(c) Nothing in this section shall preclude a registered nurse or licensed practical
nurse from delegating a nursing or other technical task to an unlicensed individual
provided that acceptance of delegated nursing or other technical tasks does not become a
routine part of the unlicensed individual’s job duties.
(d) (1) Subject to regulations adopted by the Board under paragraph (2) of this
subsection, this section does not preclude an advanced practice registered nurse from
delegating a nursing or other technical task to an assistant if:
(i) The assistant performs only tasks that the assistant is trained to
perform; and
(ii) The delegating advanced practice registered nurse provides:
1. Instruction to the assistant on the delegated task; and
Ch. 368 2023 LAWS OF MARYLAND
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2. On–site supervision of the assistant performing the
delegated task.
(2) The Board shall adopt regulations to carry out this subsection,
including regulations that:
(i) Provide for the manner in which an advanced practice registered
nurse delegates a nursing or other technical task to an assistant;
(ii) Establish limitations on the authority of an advanced practice
registered nurse to delegate nursing or other technical tasks to an assistant; and
(iii) Otherwise clarify the scope of this subsection.
(E) (1) SUBJECT TO REGULATION S ADOPTED BY THE BOARD UNDER
PARAGRAPH (2) OF THIS SUBSECTION , THIS SECTION DOES NO T PRECLUDE A
LICENSED CERTIFIED M IDWIFE FROM DELEGATI NG A TECHNICAL TASK TO AN
ASSISTANT IF:
(I) THE ASSISTANT PERFORMS ONL Y TASKS THAT THE
ASSISTANT IS TRAINED TO PERFORM ; AND
(II) THE DELEGATING LICENS ED CERTIFIED MIDWIFE
PROVIDES:
1. INSTRUCTION TO THE AS SISTANT ON THE DELEG ATED
TASK; AND
2. ON–SITE SUPERVISION OF THE ASSISTANT
PERFORMING THE DELEGATED TASK .
(2) THE BOARD SHALL ADOPT REG ULATIONS TO CARRY OU T THIS
SUBSECTION, INCLUDING REGULATION S THAT:
(I) PROVIDE FOR THE MANNE R IN WHICH A LICENSE D
CERTIFIED MIDWIFE DE LEGATES A TECHNICAL TASK TO AN ASSISTANT ;
(II) ESTABLISH LIMIT ATIONS ON THE AUTHOR ITY OF A
LICENSED CERTIFIED M IDWIFE TO DELEGATE T ECHNICAL TASKS TO AN ASSISTANT;
AND
(III) OTHERWISE CLARIFY THE SCOPE OF THIS SUBSEC TION.
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[(e)] (F) An individual shall be certified by the Board to practice as a nursing
assistant and as a dialysis technician before the individual may practice as a dialysis
technician in a State–owned hospital or State–owned facility.
8–6D–01.
(a) In this subtitle the following words have the meanings indicated.
(h) (1) “Practice certified midwifery” means the management and care of
essentially normal newborns and of essentially normal women antepartally, intrapartally,
and postpartally.
(2) “Practice certified midwifery” includes:
(i) Family planning and well woman reproductive care;
(ii) The prescribing of substances commonly used in the practice of
midwifery;
(iii) The prescribing of Schedule II, Schedule III, Schedule IV, and
Schedule V controlled dangerous substances commonly used in the practice of midwifery;
and
(iv) The dispensing of the substances prescribed in accordance with
the provisions of items (ii) and (iii) of this paragraph in the course of treating a patient [at]:
1. [A] AT A medical facility or clinic that is operated on a
nonprofit basis;
2. [A] AT A health center that operates on a campus of an
institution of higher education; [or]
3. [A] AT A public health facility, a medical facility under
contract with a state or local health department, or a facility funded with public funds; OR
4. WITH A STARTER DOSAGE OF A DRUG AS AUTHORI ZED
UNDER § 8–508 OF THIS TITLE.
8–6D–02.
(a) Except as otherwise provided in this subtitle, an individual shall be licensed
by the Board before the individual may practice certified midwifery in the State.
(b) This section does not apply to:
(1) An individual who assists at a birth in an emergency; Ch. 368 2023 LAWS OF MARYLAND
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(2) An individual who is licensed as a health care practitioner whose scope
of practice allows the individual to practice certified midwifery; [or]
(3) A student who is practicing certified midwifery while engaged in an
approved clinical midwifery education experience under the supervision of a licensed
certified midwife or a licensed nurse certified as a nurse–midwife; OR
(4) AN INDIVIDUAL WHO HAS GRADUATED FROM AN APPROVED
CLINICAL A GRADUATE LEVEL ACC REDITED PROGRAM FOR MIDWIFERY EDUCATION
EXPERIENCE APPROVED BY ACME, AND WHO IS:
(I) PRACTICING CERTIFIED MIDWIFERY UNDER THE
SUPERVISION OF A LIC ENSED CERTIFIED MIDW IFE OR A LICENSED NU RSE
CERTIFIED AS A NURSE –MIDWIFE; AND
(II) MEETS ANY OTHER REQUI REMENTS SET BY THE BOARD.
8–6D–03.
(a) In addition to the certification and education requirements under subsection
(b) of this section, to qualify for a license, an applicant must:
(1) Be of good moral character; and
(2) Submit to a criminal history records check in accordance with § 8–303
of this title.
(b) An applicant must:
(1) Hold a current, valid certification as a certified midwife from AMCB;
(2) Have graduated from a graduate –level accredited program for
midwifery education approved by ACME; AND
(3) [Have completed coursework in health and sciences:
(i) Before commencing a midwifery program described in item (2) of
this subsection; or
(ii) As part of a midwifery program described in item (2) of this
subsection; and
(4)] Have passed the AMCB examination.
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12–102.
(a) (1) In this section the following terms have the meanings indicated.
(2) “In the public interest” means the dispensing of drugs or devices by a
licensed dentist, physician, NURSE OR MIDWIFE , or podiatrist to a patient when a
pharmacy is not conveniently available to the patient.
(3) “NURSE OR MIDWIFE ” MEANS AN INDIVIDUAL LICENSED OR
CERTIFIED BY THE BOARD OF NURSING UNDER TITLE 8 OF THIS ARTICLE.
[(3)] (4) “Personally preparing and dispensing” means that the licensed
dentist, physician, NURSE OR MIDWIFE , or podiatrist:
(i) Is physically present on the premises where the prescription is
filled; and
(ii) Performs a final check of the prescription before it is provided to
the patient.
(c) (2) This title does not prohibit:
(iv) A licensed physician who complies with the requirements of item
(ii) of this paragraph from personally preparing and dispensing a prescription written by:
1. A physician assistant in accordance with a delegation
agreement that complies with Title 15, Subtitle 3 of this article; or
2. A nurse practitioner who is authorized to practice under
Title 8, Subtitle 3 of this article and is working with the physician in the same office setting;
[or]
(v) A hospital–based clinic from dispensing prescriptions to its
patients; OR
(VI) AN INDIVIDUAL LICENSED OR CERT IFIED UNDER TITLE 8
OF THIS ARTICLE FROM PERSONALLY PREPARING AND DISPENSING A DRU G OR
DEVICE AS AUTHORIZED UNDER TITLE 8 OF THIS ARTICLE .
(e) (1) This title does not prohibit:
(i) A dentist, physician, NURSE OR MIDWIFE , or podiatrist from
administering a prescription drug or device in the course of treating a patient;
(ii) A licensed dental hygienist from administering medication under
§ 4–206.4 of this article; or Ch. 368 2023 LAWS OF MARYLAND
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(iii) A nurse anesthetist from administering medication under §
8–513 of this article.
(2) For the purposes of paragraph (1)(i) of this subsection, “administering”
means the direct introduction of a single dosage of a drug or device at a given time, whether
by injection or other means, and whether in liquid, tablet, capsule, or other form.
(f) (1) This title does not prohibit a dentist, physician, NURSE OR MIDWIFE ,
or podiatrist from personally dispensing a starter dosage of a prescription drug or device to
a patient of the dentist, physician, NURSE OR MIDWIFE, or podiatrist, provided that:
(i) The starter dosage complies with the labeling requirements of §
12–505 of this title;
(ii) No charge is made for the starter dosage; and
(iii) The dentist, physician, NURSE OR MIDWIFE , or podiatrist enters
an appropriate record on the patient’s chart.
(2) For the purposes of paragraph (1) of this subsection, “starter dosage”
means an amount of drug or device sufficient to begin therapy:
(i) Of short duration of 72 hours or less; or
(ii) Prior to obtaining a larger quantity of the drug or device to
complete the therapy.
(g) This title does not prohibit a dentist, physician, NURSE OR MIDWIFE , or
podiatrist from dispensing a prescription drug or device in the course of treating a patient:
(1) At a medical facility or clinic that is operated on a nonprofit basis;
(2) At a health center that operates on a campus of an institution of higher
education; or
(3) At a public health facility, a medical facility under contract with a State
or local health department, or a facility funded with public funds.
SECTION 2. AND BE IT FURTHER ENACTED, That, on or before December 1,
2023, the Maryland Department of Health, in consultation with relevant stakeholders,
shall develop recommendations to expand access to birthing services in birthing centers in
the State and report its findings to the Senate Finance Committee and the House Health
and Government Operations Committee, in accordance with § 2 –1257 of the State
Government Article.
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SECTION 3. AND BE IT FURTHER ENACTED, That this Act shall take effect
October 1, 2023.
Approved by the Governor, May 3, 2023.