Maryland 2023 Regular Session

Maryland Senate Bill SB674 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1
2	2
3	3	EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
4	4	[Brackets] indicate matter deleted from existing law.
5	5	sb0674
6	6
7	7	SENATE BILL 674
8	8	J2 3lr1468
9	9	CF HB 722
10	10	By: Senators Carozza and Klausmeier
11	11	Introduced and read first time: February 6, 2023
12	12	Assigned to: Finance
13	13
14	14	A BILL ENTITLED
15	15
16	16	AN ACT concerning 1
17	17
18	18	Physician Assistants – Parity With Other Health Care Practitioners 2
19	19	(Physician Assistant Parity Act of 2023) 3
20	20
21	21	FOR the purpose of altering certain provisions of law to include physician assistants in the 4
22	22	health care practitioners who may take certain actions, including actions related to 5
23	23	the guardianship of disabled persons, admission of individuals to mental health 6
24	24	facilities, the Emergency and Allergy Treatment Program, the Attendant Care 7
25	25	Program, and petitions for extreme risk protective orders; requiring the Maryland 8
26	26	Department of Health to cover charges related to examinations by a physician 9
27	27	assistant for certain emergency evaluees; exempting physician assistants from the 10
28	28	Maryland Pharmacy Act; altering the membership and duties of the Statewide 11
29	29	Advisory Commission on Immunization; altering the membership of a certain 12
30	30	workgroup formed by the Maryland Health Care Commission; and generally relating 13
31	31	to physician assistants. 14
32	32
33	33	BY repealing and reenacting, with amendments, 15
34	34	Article – Correctional Services 16
35	35	Section 9–601.1(e)(1) 17
36	36	Annotated Code of Maryland 18
37	37	(2017 Replacement Volume and 2022 Supplement) 19
38	38
39	39	BY repealing and reenacting, with amendments, 20
40	40	Article – Estates and Trusts 21
41	41	Section 13–705(c)(2) 22
42	42	Annotated Code of Maryland 23
43	43	(2022 Replacement Volume and 2022 Supplement) 24
44	44
45	45	BY repealing and reenacting, with amendments, 25
46	46	Article – Health – General 26
47	47	Section 5–606, 10–601(g) and (h), 10–610(c), 10–611(b), (c), and (e), 10–615(6), 27
48	48	10–616(a)(1) and (c), 10–619, 10–620(f), 10–622(b) and (d), 10–623(a), 28 2 SENATE BILL 674
49	49
50	50
51	51	10–624(a)(1), 10–628(a)(1), 13–701, 13–705, 13–707(b)(1) and (c), 1
52	52	18–214(d)(11) and (12), 19–108.4, 19–705.1(b)(1)(vi) and (2), and 2
53	53	19–2001(a)(4) 3
54	54	Annotated Code of Maryland 4
55	55	(2019 Replacement Volume and 2022 Supplement) 5
56	56
57	57	BY repealing and reenacting, without amendments, 6
58	58	Article – Health – General 7
59	59	Section 10–601(a), 10–620(a), 18–214(b), 19–705.1(a), and 19–2001(a)(1) and (b)(1) 8
60	60	Annotated Code of Maryland 9
61	61	(2019 Replacement Volume and 2022 Supplement) 10
62	62
63	63	BY adding to 11
64	64	Article – Health – General 12
65	65	Section 10–601(g) and 18–214(d)(12) 13
66	66	Annotated Code of Maryland 14
67	67	(2019 Replacement Volume and 2022 Supplement) 15
68	68
69	69	BY repealing and reenacting, with amendments, 16
70	70	Article – Health Occupations 17
71	71	Section 4–308(k)(4)(vi) and (m)(1)(iii) and (5)(ii) and 12–102(d)(2), (e)(1)(i), (f)(1), and 18
72	72	(g) 19
73	73	Annotated Code of Maryland 20
74	74	(2021 Replacement Volume and 2022 Supplement) 21
75	75
76	76	BY repealing and reenacting, without amendments, 22
77	77	Article – Health Occupations 23
78	78	Section 4–308(m)(1)(i) 24
79	79	Annotated Code of Maryland 25
80	80	(2021 Replacement Volume and 2022 Supplement) 26
81	81
82	82	BY repealing and reenacting, with amendments, 27
83	83	Article – Human Services 28
84	84	Section 7–404(a) 29
85	85	Annotated Code of Maryland 30
86	86	(2019 Replacement Volume and 2022 Supplement) 31
87	87
88	88	BY repealing and reenacting, without amendments, 32
89	89	Article – Public Safety 33
90	90	Section 5–601(a) 34
91	91	Annotated Code of Maryland 35
92	92	(2022 Replacement Volume) 36
93	93
94	94	BY repealing and reenacting, with amendments, 37
95	95	Article – Public Safety 38
96	96	Section 5–601(e) 39
97	97	Annotated Code of Maryland 40 SENATE BILL 674 3
98	98
99	99
100	100	(2022 Replacement Volume) 1
101	101
102	102	BY repealing and reenacting, without amendments, 2
103	103	Article – State Personnel and Pensions 3
104	104	Section 9–504(a) 4
105	105	Annotated Code of Maryland 5
106	106	(2015 Replacement Volume and 2022 Supplement) 6
107	107
108	108	BY repealing and reenacting, with amendments, 7
109	109	Article – State Personnel and Pensions 8
110	110	Section 9–504(b) 9
111	111	Annotated Code of Maryland 10
112	112	(2015 Replacement Volume and 2022 Supplement) 11
113	113
114	114	SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 12
115	115	That the Laws of Maryland read as follows: 13
116	116
117	117	Article – Correctional Services 14
118	118
119	119	9–601.1. 15
120	120
121	121	(e) (1) A pregnant inmate who is deemed to need infirmary care shall be 16
122	122	admitted to the infirmary on order of a primary care nurse practitioner, A PHYSICIAN 17
123	123	ASSISTANT, or AN obstetrician. 18
124	124
125	125	Article – Estates and Trusts 19
126	126
127	127	13–705. 20
128	128
129	129	(c) (2) Notwithstanding the provisions of paragraph (1) of this subsection, a 21
130	130	petition for guardianship of a disabled person shall include signed and verified certificates 22
131	131	of competency from the following health care professionals who have examined or evaluated 23
132	132	the disabled person: 24
133	133
134	134	(i) Two licensed physicians; or 25
135	135
136	136	(ii) 1. One licensed physician; and 26
137	137
138	138	2. A. One licensed psychologist; 27
139	139
140	140	B. One licensed certified social worker–clinical; [or] 28
141	141
142	142	C. One nurse practitioner; OR 29
143	143
144	144	D. ONE LICENSED PHYSICIAN ASSISTANT . 30
145	145	4 SENATE BILL 674
146	146
147	147
148	148	Article – Health – General 1
149	149
150	150	5–606. 2
151	151
152	152	(a) (1) Prior to providing, withholding, or withdrawing treatment for which 3
153	153	authorization has been obtained or will be sought under this subtitle, the attending 4
154	154	physician and a second physician [or a], nurse practitioner, OR PHYSICIAN ASSISTA NT, 5
155	155	one of whom shall have examined the patient within 2 hours before making the 6
156	156	certification, shall certify in writing that the patient is incapable of making an informed 7
157	157	decision regarding the treatment. The certification shall be based on a personal 8
158	158	examination of the patient. 9
159	159
160	160	(2) If a patient is unconscious, or unable to communicate by any means, the 10
161	161	certification of a second physician [or a], nurse practitioner, OR PHYSICIAN ASSISTA NT is 11
162	162	not required under paragraph (1) of this subsection. 12
163	163
164	164	(3) When authorization is sought for treatment of a mental illness, the 13
165	165	second physician [or the], nurse practitioner, OR PHYSICIAN ASSISTA NT may not be 14
166	166	otherwise currently involved in the treatment of the person assessed. 15
167	167
168	168	(4) The cost of an assessment to certify incapacity under this subsection 16
169	169	shall be considered for all purposes a cost of the patient’s treatment. 17
170	170
171	171	(b) A health care provider may not withhold or withdraw life –sustaining 18
172	172	procedures on the basis of an advance directive where no agent has been appointed or on 19
173	173	the basis of the authorization of a surrogate, unless: 20
174	174
175	175	(1) The patient’s attending physician and a second physician [or a], nurse 21
176	176	practitioner, OR PHYSICIAN ASSISTA NT have certified that the patient is in a terminal 22
177	177	condition or has an end–stage condition; or 23
178	178
179	179	(2) Two physicians, one of whom is a neurologist, neurosurgeon, or other 24
180	180	physician who has special expertise in the evaluation of cognitive functioning, certify that 25
181	181	the patient is in a persistent vegetative state. 26
182	182
183	183	10–601. 27
184	184
185	185	(a) In this subtitle the following words have the meanings indicated. 28
186	186
187	187	(G) “PHYSICIAN ASSISTANT ” MEANS AN INDIVIDUAL WHO IS LICENSED 29
188	188	UNDER TITLE 15 OF THE HEALTH OCCUPATIONS ARTICLE TO PRACTICE A S A 30
189	189	PHYSICIAN ASSI STANT. 31
190	190
191	191	[(g)] (H) “Psychiatric nurse practitioner” means an individual who is: 32
192	192	SENATE BILL 674 5
193	193
194	194
195	195	(1) Licensed as a registered nurse and certified as a nurse practitioner 1
196	196	under Title 8 of the Health Occupations Article; and 2
197	197
198	198	(2) Practicing in the State as a certified r egistered nurse 3
199	199	practitioner–psychiatric mental health. 4
200	200
201	201	[(h)] (I) “Psychologist” means an individual who is licensed under Title 18 of the 5
202	202	Health Occupations Article to practice psychology. 6
203	203
204	204	10–610. 7
205	205
206	206	(c) A facility may not admit an individual under this section unless: 8
207	207
208	208	(1) The individual has a mental disorder; 9
209	209
210	210	(2) The mental disorder is susceptible to care or treatment; 10
211	211
212	212	(3) The applicant understands the nature of a request for admission; and 11
213	213
214	214	(4) Assent to the admission has been given: 12
215	215
216	216	(i) By the admitting physician of the facility; or 13
217	217
218	218	(ii) For a child or adolescent unit of a State facility, by: 14
219	219
220	220	1. 1 physician and 1 psychologist; 15
221	221
222	222	2. 1 PHYSICIAN AND 1 PHYSICIAN ASSISTANT ; 16
223	223
224	224	[2.] 3. 2 physicians; 17
225	225
226	226	[3.] 4. 1 physician and 1 psychiatric nurse practitioner; 18
227	227
228	228	[4.] 5. 1 physician and 1 licensed certified social worker–clinical; 19
229	229	or 20
230	230
231	231	[5.] 6. 1 physician and 1 licensed clinical professional counselor. 21
232	232
233	233	10–611. 22
234	234
235	235	(b) A disabled person may apply for voluntary admission of the disabled person 23
236	236	if: 24
237	237
238	238	(1) The disabled person submits a formal, written application that contains 25
239	239	the disabled person’s personal information and is on the form required by the 26
240	240	Administration; and 27 6 SENATE BILL 674
241	241
242	242
243	243
244	244	(2) In accordance with subsections (c) through (e) of this section, either a 1
245	245	physician and a psychologist, two physicians, [or] a physician and a psychiatric nurse 2
246	246	practitioner, OR A PHYSICIAN AND A PHYSICIAN ASSISTANT certify that: 3
247	247
248	248	(i) The disabled person has the capacity to execute an application 4
249	249	for voluntary admission; and 5
250	250
251	251	(ii) The disabled person understands both the criteria for voluntary 6
252	252	admission set forth under this section and the procedure for requesting discharge from the 7
253	253	facility. 8
254	254
255	255	(c) (1) A certificate for voluntary admission of a disabled person under 9
256	256	subsection (b) of this section shall: 10
257	257
258	258	(i) Be based on the personal examination of the physician, 11
259	259	psychologist, [or] psychiatric nurse practitioner, OR PHYSICIAN ASSISTA NT who signs the 12
260	260	certificate; and 13
261	261
262	262	(ii) Be in the form that the Secretary of Health adopts, by rule or 14
263	263	regulation. 15
264	264
265	265	(2) The rules and regulations shall require the form to include an opinion 16
266	266	that: 17
267	267
268	268	(i) The disabled person has a mental disorder; 18
269	269
270	270	(ii) The mental disorder is susceptible to care or treatment; 19
271	271
272	272	(iii) The disabled person understands the nature of the request for 20
273	273	admission; and 21
274	274
275	275	(iv) The disabled person is able to give continuous assent to retention 22
276	276	by the facility. 23
277	277
278	278	(e) A certificate may not be used for an admission if the physician, psychologist, 24
279	279	[or] psychiatric nurse practitioner, OR PHYSICIAN ASSISTA NT who signed the certificate: 25
280	280
281	281	(1) Has a financial interest, through ownership or compensation, in a 26
282	282	proprietary facility and admission to that proprietary facility is sought for the disabled 27
283	283	person whose status is being certified; or 28
284	284
285	285	(2) Is related, by blood or marriage, to the disabled person or the guardian 29
286	286	of the person of the disabled person. 30
287	287
288	288	10–615. 31
289	289	SENATE BILL 674 7
290	290
291	291
292	292	Each application for involuntary admission to a facility or Veterans’ Administration 1
293	293	hospital under this part shall: 2
294	294
295	295	(6) Be accompanied by the certificates of: 3
296	296
297	297	(i) 1 physician and 1 psychologist; 4
298	298
299	299	(ii) 2 physicians; 5
300	300
301	301	(III) 1 PHYSICIAN AND 1 PHYSICIAN ASSISTANT; 6
302	302
303	303	[(iii)] (IV) 1 physician and 1 psychiatric nurse practitioner; 7
304	304
305	305	[(iv)] (V) 1 physician and 1 licensed certified social worker–clinical; 8
306	306	or 9
307	307
308	308	[(v)] (VI) 1 physician and 1 licensed clinical professional counselor; 10
309	309	and 11
310	310
311	311	10–616. 12
312	312
313	313	(a) (1) A certificate for involuntary admission of an individual under this part 13
314	314	shall: 14
315	315
316	316	(i) Be based on the personal examination of the physician, 15
317	317	psychologist, psychiatric nurse practitioner, PHYSICIAN ASSISTANT , licensed certified 16
318	318	social worker–clinical, or licensed clinical professional counselor who signs the certificate; 17
319	319	and 18
320	320
321	321	(ii) Be in the form that the Secretary adopts, by rule or regulation. 19
322	322
323	323	(c) A certificate may not be used for an admission if the physician, psychologist, 20
324	324	psychiatric nurse practitioner, PHYSICIAN ASSISTANT , licensed certified social 21
325	325	worker–clinical, or licensed clinical professional counselor who signed the certificate: 22
326	326
327	327	(1) Has a financial interest, through ownership or compensation, in a 23
328	328	proprietary facility and admission to that proprietary facility is sought for the individual 24
329	329	whose status is being certified; or 25
330	330
331	331	(2) Is related, by blood or marriage, to the individual or to the applicant. 26
332	332
333	333	10–619. 27
334	334
335	335	Within 12 hours of notification by a physician, licensed psychologist, psychiatric 28
336	336	nurse practitioner, PHYSICIAN ASSISTANT , licensed certified social worker–clinical, or 29
337	337	licensed clinical professional counselor who has certified an individual under this part, a 30 8 SENATE BILL 674
338	338
339	339
340	340	facility operated by the Maryland Department of Health shall receive and evaluate the 1
341	341	individual certified for involuntary admission if: 2
342	342
343	343	(1) The individual’s involuntary admission is not limited by § 10–617 of 3
344	344	this subtitle; 4
345	345
346	346	(2) An application for admission has been completed; 5
347	347
348	348	(3) A certifying physician, psychologist, psychiatric nurse practitioner, 6
349	349	PHYSICIAN ASSISTANT , licensed certified social worker–clinical, or licensed clinical 7
350	350	professional counselor is unable to place the individual in a facility not operated by the 8
351	351	Department; and 9
352	352
353	353	(4) The Department is unable to provide for the placement of the person 10
354	354	other than in a facility operated by the Department. 11
355	355
356	356	10–620. 12
357	357
358	358	(a) In Part IV of this subtitle the following words have the meanings indicated. 13
359	359
360	360	(f) (1) “Mental disorder” means the behavioral or other symptoms that 14
361	361	indicate: 15
362	362
363	363	(i) To a lay petitioner who is submitting an emergency petition, a 16
364	364	clear disturbance in the mental functioning of another individual; and 17
365	365
366	366	(ii) To the following health professionals doing an examination, at 18
367	367	least one mental disorder that is described in the version of the American Psychiatric 19
368	368	Association’s “Diagnostic and Statistical Manual – Mental Disorders” that is current at the 20
369	369	time of the examination: 21
370	370
371	371	1. Physician; 22
372	372
373	373	2. Psychologist; 23
374	374
375	375	3. Clinical social worker; 24
376	376
377	377	4. Licensed clinical professional counselor; 25
378	378
379	379	5. Clinical nurse specialist in psychiatric and mental health 26
380	380	nursing (APRN/PMH); 27
381	381
382	382	6. Psychiatric nurse practitioner (CRNP–PMH); 28
383	383
384	384	7. PHYSICIAN ASSISTANT ; or 29
385	385
386	386	[7.] 8. Licensed clinical marriage and family therapist. 30 SENATE BILL 674 9
387	387
388	388
389	389
390	390	(2) “Mental disorder” does not include intellectual disability. 1
391	391
392	392	10–622. 2
393	393
394	394	(b) (1) The petition for emergency evaluation of an individual may be made by: 3
395	395
396	396	(i) A physician, psychologist, PHYSICIAN ASSISTANT , clinical 4
397	397	social worker, licensed clinical professional counselor, clinical nurse specialist in 5
398	398	psychiatric and mental health nursing, psychiatric nurse practitioner, licensed clinical 6
399	399	marriage and family therapist, or health officer or designee of a health officer who has 7
400	400	examined the individual; 8
401	401
402	402	(ii) A peace officer who personally has observed the individual or the 9
403	403	individual’s behavior; or 10
404	404
405	405	(iii) Any other interested person. 11
406	406
407	407	(2) An individual who makes a petition for emergency evaluation under 12
408	408	paragraph (1)(i) or (ii) of this subsection may base the petition on: 13
409	409
410	410	(i) The examination or observation; or 14
411	411
412	412	(ii) Other information obtained that is pertinent to the factors giving 15
413	413	rise to the petition. 16
414	414
415	415	(d) (1) A petitioner who is a physician, psychologist, PHYSICIAN ASSISTANT , 17
416	416	clinical social worker, licensed clinical professional counselor, clinical nurse specialist in 18
417	417	psychiatric and mental health nursing, psychiatric nurse practitioner, licensed clinical 19
418	418	marriage and family therapist, health officer, or designee of a health officer shall give the 20
419	419	petition to a peace officer. 21
420	420
421	421	(2) The peace officer shall explain to the petitioner: 22
422	422
423	423	(i) The serious nature of the petition; and 23
424	424
425	425	(ii) The meaning and content of the petition. 24
426	426
427	427	10–623. 25
428	428
429	429	(a) If the petitioner under Part IV of this subtitle is not a physician, psychologist, 26
430	430	PHYSICIAN ASSISTANT , clinical social worker, licensed clinical professional counselor, 27
431	431	clinical nurse specialist in psychiatric and mental health nursing, psychiatric nurse 28
432	432	practitioner, licensed clinical marriage and family therapist, health officer or designee of a 29
433	433	health officer, or peace officer, the petitioner shall present the petition to the court for 30
434	434	immediate review. 31
435	435	10 SENATE BILL 674
436	436
437	437
438	438	10–624. 1
439	439
440	440	(a) (1) A peace officer shall take an emergency evaluee to the nearest 2
441	441	emergency facility if the peace officer has a petition under Part IV of this subtitle that: 3
442	442
443	443	(i) Has been endorsed by a court within the last 5 days; or 4
444	444
445	445	(ii) Is signed and submitted by a physician, psychologist, 5
446	446	PHYSICIAN ASSISTANT , clinical social worker, licensed clinical professional counselor, 6
447	447	clinical nurse specialist in psychiatric and mental health nursing, psychiatric nurse 7
448	448	practitioner, licensed clinical marriage and family therapist, health officer or designee of a 8
449	449	health officer, or peace officer. 9
450	450
451	451	10–628. 10
452	452
453	453	(a) (1) If an emergency evaluee cannot pay or does not have insurance that 11
454	454	covers the charges for emergency services, an initial consultant examination by a physician, 12
455	455	PHYSICIAN ASSISTANT , or nurse practitioner, and transportation to an emergency facility 13
456	456	and, for an involuntary admission of the emergency evaluee, to the admitting facility, the 14
457	457	Department shall pay the appropriate party the actual cost or a reasonable rate for this 15
458	458	service, whichever is lower, except that hospitals shall be paid at rates approved by the 16
459	459	Health Services Cost Review Commission. 17
460	460
461	461	13–701. 18
462	462
463	463	The Emergency and Allergy Treatment Program is a program in the Department for 19
464	464	the purpose of providing a means of authorizing certain individuals to administer 20
465	465	life–saving treatment to individuals who have severe adverse reactions to allergens or 21
466	466	insect stings when physician, PHYSICIAN ASSISTANT , registered nurse practitioner, or 22
467	467	emergency medical services are not immediately available in a youth camp. 23
468	468
469	469	13–705. 24
470	470
471	471	(a) (1) A registered nurse practitioner, PHYSICIAN ASSISTANT , or a physician 25
472	472	licensed to practice [medicine] in the State may prescribe auto–injectable epinephrine in 26
473	473	the name of a certificate holder. 27
474	474
475	475	(2) A registered nurse practitioner, a pharmacist [licensed to practice 28
476	476	pharmacy in the State], A PHYSICIAN ASSISTAN T, or a physician LICENSED TO 29
477	477	PRACTICE IN THE STATE may dispense auto–injectable epinephrine under a prescription 30
478	478	issued to a certificate holder. 31
479	479
480	480	(b) A certificate holder may: 32
481	481
482	482	(1) On presentment of a certificate, receive from any registered nurse 33
483	483	practitioner, PHYSICIAN ASSISTANT , or any physician licensed to practice [medicine] in 34 SENATE BILL 674 11
484	484
485	485
486	486	the State a prescription for auto–injectable epinephrine and the necessary paraphernalia 1
487	487	for the administration of auto–injectable epinephrine; and 2
488	488
489	489	(2) Possess and store prescribed auto–injectable epinephrine and the 3
490	490	necessary paraphernalia for the administration of auto–injectable epinephrine. 4
491	491
492	492	(c) In an emergency situation when registered nurse practitioner, physician, 5
493	493	PHYSICIAN ASSISTANT , or emergency medical services are not immediately available, a 6
494	494	certificate holder or agent may administer auto–injectable epinephrine to an individual 7
495	495	who is experiencing or believed in good faith by the certificate holder or agent to be 8
496	496	experiencing anaphylaxis. 9
497	497
498	498	13–707. 10
499	499
500	500	(b) (1) A cause of action may not arise against any physician OR PHYSICIAN 11
501	501	ASSISTANT for any act or omission when the physician OR PHYSICIAN ASSISTA NT in good 12
502	502	faith prescribes or dispenses auto–injectable epinephrine and the necessary paraphernalia 13
503	503	for the administration of auto–injectable epinephrine to a person certified by the 14
504	504	Department under this subtitle. 15
505	505
506	506	(c) This section does not affect, and may not be construed as affecting, any 16
507	507	immunities from civil liability or defenses established by any other provision of the Code or 17
508	508	by common law to which a volunteer, registered nurse practitioner, physician, PHYSICIAN 18
509	509	ASSISTANT, or pharmacist may be entitled. 19
510	510
511	511	18–214. 20
512	512
513	513	(b) There is a Statewide Advisory Commission on Immunizations. 21
514	514
515	515	(d) The following members are subject to term limits: 22
516	516
517	517	(11) One physician member of the American College of Physicians – Internal 23
518	518	Medicine Society of Maryland; [and] 24
519	519
520	520	(12) ONE PHYSICIAN ASSISTA NT MEMBER OF THE MARYLAND 25
521	521	ACADEMY OF PHYSICIAN ASSISTANTS; AND 26
522	522
523	523	[(12)] (13) Up to three additional members selected by the Secretary. 27
524	524
525	525	19–108.4. 28
526	526
527	527	(a) In this section, “primary care” means health care provided in the following 29
528	528	fields’ outpatient settings: 30
529	529
530	530	(1) Family medicine; 31
531	531	12 SENATE BILL 674
532	532
533	533
534	534	(2) General pediatrics; 1
535	535
536	536	(3) Primary care internal medicine; 2
537	537
538	538	(4) Primary care obstetrics and gynecology; 3
539	539
540	540	(5) Primary care nurse practitioner services; [and] 4
541	541
542	542	(6) PRIMARY CARE PHYSICIA N ASSISTANT SERVICES ; AND 5
543	543
544	544	[(6)] (7) Primary care midwifery. 6
545	545
546	546	(b) On or before December 1 each year, beginning in 2024, the Commission shall 7
547	547	provide a report to the Governor and, in accordance with § 2–1257 of the State Government 8
548	548	Article, the General Assembly that includes: 9
549	549
550	550	(1) An analysis of primary care investment over the immediately preceding 10
551	551	year, including data stratified by zip code and county, in relation to total health care 11
552	552	spending over the previous year; 12
553	553
554	554	(2) Ways to improve the quality of and access to primary care services, with 13
555	555	special attention to increasing health care equity, reducing health care disparities, and 14
556	556	avoiding increased costs to patients and the health care system; and 15
557	557
558	558	(3) Any findings and recommendations of the Commission. 16
559	559
560	560	(c) (1) The Commission shall form a workgroup to develop the report required 17
561	561	under subsection (b) of this section, including by interpreting the results of the required 18
562	562	analysis and making the recommendations. 19
563	563
564	564	(2) The workgroup required under this subsection shall include 20
565	565	representatives of: 21
566	566
567	567	(i) The Maryland Primary Care Program; 22
568	568
569	569	(ii) The Health Services Review Commission; 23
570	570
571	571	(iii) The Maryland Insurance Administration; 24
572	572
573	573	(iv) The Health Care Financing Division of the Maryland 25
574	574	Department of Health; 26
575	575
576	576	(v) The primary care community, including from the Maryland 27
577	577	Academy of Family Physicians, the Maryland Chapter of the America n Academy of 28
578	578	Pediatrics, the Maryland Section of the American College of Obstetricians and 29
579	579	Gynecologists, the Maryland Nurses Association, THE MARYLAND ACADEMY OF 30 SENATE BILL 674 13
580	580
581	581
582	582	PHYSICIAN ASSISTANTS, the Maryland Affiliate – American College of Nurse Midwives, 1
583	583	the Maryland Community Health System, and the MidAtlantic Association of Community 2
584	584	Health Centers; 3
585	585
586	586	(vi) Payors of primary care services, including carriers and managed 4
587	587	care organizations; 5
588	588
589	589	(vii) Health services researchers with expertise in primary care; and 6
590	590
591	591	(viii) Other interested stakeholders. 7
592	592
593	593	19–705.1. 8
594	594
595	595	(a) The Secretary shall adopt regulations that set out reasonable standards of 9
596	596	quality of care that a health maintenance organization shall provide to its members. 10
597	597
598	598	(b) (1) The standards of quality of care shall include: 11
599	599
600	600	(vi) A requirement that each member shall have an opportunity to 12
601	601	select a primary physician, A PHYSICIAN ASSISTANT , or a certified nurse practitioner from 13
602	602	among those available to the health maintenance organization; and 14
603	603
604	604	(2) This subsection may not be construed to require that a health 15
605	605	maintenance organization include certified nurse practitioners OR PHYSICIAN 16
606	606	ASSISTANTS on the health maintenance organization’s provider panel as primary care 17
607	607	providers. 18
608	608
609	609	19–2001. 19
610	610
611	611	(a) (1) In this subtitle the following words have the meanings indicated. 20
612	612
613	613	(4) (i) Except as provided in subparagraph (ii) of this paragraph, 21
614	614	“health care practitioner” means any individual licensed or certified under the Health 22
615	615	Occupations Article who: 23
616	616
617	617	1. Is a licensed practical nurse, registered nurse, or certified 24
618	618	nursing assistant; or 25
619	619
620	620	2. Practices in an allied health care field, as defined by the 26
621	621	Office in regulation. 27
622	622
623	623	(ii) “Health care practitioner” does not include: 28
624	624
625	625	1. An acupuncturist; 29
626	626
627	627	2. A dentist; 30
628	628	14 SENATE BILL 674
629	629
630	630
631	631	3. A nurse anesthetist; 1
632	632
633	633	4. A nurse midwife; 2
634	634
635	635	5. A nurse practitioner; 3
636	636
637	637	6. A pharmacist; 4
638	638
639	639	7. A physician; [or] 5
640	640
641	641	8. A PHYSICIAN ASSISTANT ; OR 6
642	642
643	643	[8.] 9. A podiatrist. 7
644	644
645	645	(b) (1) A health care staff agency shall be licensed by the Office before 8
646	646	referring health care practitioners to a health care facility to render temporary health care 9
647	647	services at a health care facility in this State. 10
648	648
649	649	Article – Health Occupations 11
650	650
651	651	4–308. 12
652	652
653	653	(k) (4) A facility in which a dental hygienist is authorized to practice under the 13
654	654	general supervision of a licensed dentist in accordance with this subsection shall ensure 14
655	655	that: 15
656	656
657	657	(vi) A dental hygienist consults with the supervising dentist or the 16
658	658	patient’s dentist and the treating physician, registered nurse practitioner, certified nurse 17
659	659	midwife, LICENSED P HYSICIAN ASSISTANT , or licensed certified midwife before 18
660	660	proceeding with treatment if there is a change in the patient’s medical condition; 19
661	661
662	662	(m) (1) (i) In this subsection the following words have the meanings 20
663	663	indicated. 21
664	664
665	665	(iii) “Clinical office” means an office of a licensed physician, 22
666	666	LICENSED PHYSICIAN A SSISTANT, CERTIFIED registered nurse practitioner, certified 23
667	667	nurse midwife, or licensed certified midwife who provides prenatal, postpartum, or primary 24
668	668	care and in which the supervising dentist and dental hygienist communicate with the 25
669	669	licensed physician, LICENSED PHYSICIAN A SSISTANT, certified registered nurse 26
670	670	practitioner, certified nurse midwife, or licensed certified midwife in providing dental 27
671	671	hygiene services to a patient. 28
672	672
673	673	(5) A dental hygienist practicing under the general supervision of a 29
674	674	licensed dentist in a facility and performing an authorized dental hygiene service for a 30
675	675	patient’s initial appointment shall: 31
676	676	SENATE BILL 674 15
677	677
678	678
679	679	(ii) Consult with the supervising dentist and the treating physician, 1
680	680	LICENSED PHYSICIAN A SSISTANT, CERTIFIED registered nurse practitioner, certified 2
681	681	nurse midwife, or licensed certified midwife before proceeding with treatment if there is a 3
682	682	change in or concerns about a patient’s medical condition; 4
683	683
684	684	12–102. 5
685	685
686	686	(d) This title does not prohibit: 6
687	687
688	688	(2) A licensed dentist, licensed physician, LICENSED PHYSICIAN 7
689	689	ASSISTANT, or licensed podiatrist from personally dispensing a drug or device sample to a 8
690	690	patient of the licensed dentist, licensed physician, LICENSED PHYSICIAN A SSISTANT, or 9
691	691	licensed podiatrist if: 10
692	692
693	693	(i) The sample complies with the labeling requirements of § 12–505 11
694	694	of this title; 12
695	695
696	696	(ii) No charge is made for the sample; and 13
697	697
698	698	(iii) The authorized prescriber enters an appropriate record in the 14
699	699	patient’s chart. 15
700	700
701	701	(e) (1) This title does not prohibit: 16
702	702
703	703	(i) A dentist, physician, LICENSED PHYSICIAN A SSISTANT, or 17
704	704	podiatrist from administering a prescription drug or device in the course of treating a 18
705	705	patient; 19
706	706
707	707	(f) (1) This title does not prohibit a dentist, physician, LICENSED PHYSICIAN 20
708	708	ASSISTANT, or podiatrist from personally dispensing a starter dosage of a prescription drug 21
709	709	or device to a patient of the dentist, physician, LICENSED PHYSICIAN A SSISTANT, or 22
710	710	podiatrist, provided that: 23
711	711
712	712	(i) The starter dosage complies with the labeling requirements of § 24
713	713	12–505 of this title; 25
714	714
715	715	(ii) No charge is made for the starter dosage; and 26
716	716
717	717	(iii) The dentist, physician, LICENSED PHYS ICIAN ASSISTANT, or 27
718	718	podiatrist enters an appropriate record on the patient’s chart. 28
719	719
720	720	(g) This title does not prohibit a dentist, physician, LICENSED PHYSICIAN 29
721	721	ASSISTANT, or podiatrist from dispensing a prescription drug or device in the course of 30
722	722	treating a patient: 31
723	723
724	724	(1) At a medical facility or clinic that is operated on a nonprofit basis; 32 16 SENATE BILL 674
725	725
726	726
727	727
728	728	(2) At a health center that operates on a campus of an institution of higher 1
729	729	education; or 2
730	730
731	731	(3) At a public health facility, a medical facility under contract with a State 3
732	732	or local health department, or a facility funded with public funds. 4
733	733
734	734	Article – Human Services 5
735	735
736	736	7–404. 6
737	737
738	738	(a) (1) The Department shall ensure that at any given time at least 50% of the 7
739	739	eligible individuals receiving financial assistance under the Program are: 8
740	740
741	741	(i) gainfully employed; 9
742	742
743	743	(ii) actively seeking employment; or 10
744	744
745	745	(iii) attending an institution of postsecondary or higher education, as 11
746	746	defined in § 10–101 of the Education Article. 12
747	747
748	748	(2) The remainder of the eligible individuals receiving financial assistance 13
749	749	under the Program shall be individuals who: 14
750	750
751	751	(i) reside in a nursing facility or similar institution licensed to 15
752	752	provide chronic or intermediate care and who will be deinstitutionalized as a result of the 16
753	753	Program; or 17
754	754
755	755	(ii) are certified by an attending physician, PHYSICIAN ASSISTANT , 18
756	756	or certified nurse practitioner as being at risk of placement in a nursing facility or similar 19
757	757	institution licensed to provide chronic or intermediate care if attendant care services are 20
758	758	not received in the community. 21
759	759
760	760	Article – Public Safety 22
761	761
762	762	5–601. 23
763	763
764	764	(a) In this subtitle the following words have the meanings indicated. 24
765	765
766	766	(e) (1) “Petitioner” means an individual who files a petition for an extreme risk 25
767	767	protective order under this subtitle. 26
768	768
769	769	(2) “Petitioner” includes: 27
770	770
771	771	(i) a physician, PHYSICIAN ASSISTANT , psychologist, clinical social 28
772	772	worker, licensed clinical professional counselor, clinical nurse specialist in psychiatric and 29 SENATE BILL 674 17
773	773
774	774
775	775	mental health nursing, psychiatric nurse practitioner, licensed clinical marriage or family 1
776	776	therapist, or health officer or designee of a health officer who has examined the individual; 2
777	777
778	778	(ii) a law enforcement officer; 3
779	779
780	780	(iii) the spouse of the respondent; 4
781	781
782	782	(iv) a cohabitant of the respondent; 5
783	783
784	784	(v) a person related to the respondent by blood, marriage, or 6
785	785	adoption; 7
786	786
787	787	(vi) an individual who has a child in common with the respondent; 8
788	788
789	789	(vii) a current dating or intimate partner of the respondent; and 9
790	790
791	791	(viii) a current or former legal guardian of the respondent. 10
792	792
793	793	Article – State Personnel and Pensions 11
794	794
795	795	9–504. 12
796	796
797	797	(a) An employee who uses sick leave for 5 or more consecutive workdays for 13
798	798	personal illness or disability or the illness or disability of a member of the employee’s 14
799	799	immediate family may not receive payment under this subtitle unless the employee gives 15
800	800	the employee’s immediate supervisor an original certificate of illness or disability. 16
801	801
802	802	(b) The certificate required under subsection (a) of this section shall be signed by 17
803	803	one of the following: 18
804	804
805	805	(1) a medical doctor who is authorized to practice medicine or surgery by 19
806	806	the state in which the doctor practices; 20
807	807
808	808	(2) if authorized to practice in a state and performing within the scope of 21
809	809	that authority: 22
810	810
811	811	(i) a chiropractor; 23
812	812
813	813	(ii) a clinical psychologist; 24
814	814
815	815	(iii) a dentist; 25
816	816
817	817	(iv) a licensed certified social worker – clinical; 26
818	818
819	819	(v) a nurse midwife; 27
820	820
821	821	(vi) a nurse practitioner; 28 18 SENATE BILL 674
822	822
823	823
824	824
825	825	(vii) an oral surgeon; 1
826	826
827	827	(viii) an optometrist; 2
828	828
829	829	(ix) a physical therapist; [or] 3
830	830
831	831	(X) A PHYSICIAN ASSI STANT; OR 4
832	832
833	833	[(x)] (XI) a podiatrist; 5
834	834
835	835	(3) an accredited Christian Science practitioner; or 6
836	836
837	837	(4) a health care provider as defined by the federal Family Medical Leave 7
838	838	Act. 8
839	839
840	840	SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect 9
841	841	October 1, 2023. 10