EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
*sb0772*
SENATE BILL 772
J2 3lr1577
CF HB 717
By: Senator Lam
Introduced and read first time: February 6, 2023
Assigned to: Finance
A BILL ENTITLED
AN ACT concerning 1
State Board of Nursing – Peer Advisory Committees, Scopes of Practice, and 2
Licensure Requirements 3
FOR the purpose of authorizing the State Board of Nursing to appoint peer advisory 4
committees to provide advice related to midwifery; authorizing licensed nurses 5
certified as nurse–midwives and licensed certified midwives to personally prepare 6
and dispense a starter dosage of certain drugs under certain circumstances; 7
authorizing licensed nurses certified as nurse–midwives and licensed certified 8
midwives to delegate certain tasks to certified medication technicians and certified 9
nursing assistants under certain circumstances; altering the exceptions to the 10
certified midwifery licensure requirement and the qualifications required for a 11
license; requiring the Maryland Department of Health, in consultation with 12
stakeholders, to develop recommendations to expand access to birthing services in 13
birthing centers; and generally relating to health care practitioners licensed by the 14
State Board of Nursing. 15
BY repealing and reenacting, without amendments, 16
Article – Health Occupations 17
Section 8–6A–01(a) and 8–6D–01(a) 18
Annotated Code of Maryland 19
(2021 Replacement Volume and 2022 Supplement) 20
BY repealing and reenacting, with amendments, 21
Article – Health Occupations 22
Section 8–503(a), 8–508(a) and (b), 8–601, 8–6A–01(j) and (l), 8–6A–02, 8–6D–01(h), 23
8–6D–02, 8–6D–03, and 12–102(a), (c)(2)(iv) and (v), (e), (f), and (g) 24
Annotated Code of Maryland 25
(2021 Replacement Volume and 2022 Supplement) 26
BY adding to 27
Article – Health Occupations 28 2 SENATE BILL 772
Section 12–102(c)(2)(vi) 1
Annotated Code of Maryland 2
(2021 Replacement Volume and 2022 Supplement) 3
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 4
That the Laws of Maryland read as follows: 5
Article – Health Occupations 6
8–503. 7
(a) The Board may appoint peer advisory committees to provide the Board with 8
expert advice related to the practice of nursing by advance practice nurses AND THE 9
PRACTICE OF MIDWIFER Y BY LICENSED CERTIF IED MIDWIVES. 10
8–508. 11
(a) (1) In this section the following words have the meanings indicated. 12
(2) “MIDWIFE” MEANS A LICENSED NUR SE CERTIFIED AS A 13
NURSE–MIDWIFE OR A LICENSE D CERTIFIED MIDWIFE . 14
[(2)] (3) “Nurse practitioner” means a registered nurse who is: 15
(i) Certified as a nurse practitioner; and 16
(ii) Authorized to prescribe drugs under regulations adopted by the 17
Board. 18
[(3) “Starter dosage” means an amount of drug sufficient to begin therapy: 19
(i) Of short duration of 72 hours or less; or 20
(ii) Prior to obtaining a larger quantity of the drug to complete 21
therapy.] 22
(4) “Personally prepare and dispense” means that a nurse practitioner: 23
(i) Is physically present on the premises where the prescription is 24
filled; and 25
(ii) Performs a final check of the prescription before it is provided to 26
the patient. 27
(5) “STARTER DOSAGE ” MEANS AN AMOUNT OF D RUG SUFFICIENT TO 28
BEGIN THERAPY : 29 SENATE BILL 772 3
(I) OF SHORT DURATION OF 72 HOURS OR LESS ; OR 1
(II) PRIOR TO OBTAINING A LARGER QUANTITY OF T HE DRUG TO 2
COMPLETE THERAPY. 3
(b) A nurse practitioner OR MIDWIFE may personally prepare and dispense a 4
starter dosage of any drug the nurse practitioner OR MIDWIFE is authorized to prescribe 5
to a patient of the nurse practitioner OR MIDWIFE if: 6
(1) The starter dosage complies with the labeling requirements of § 12–505 7
of this article; 8
(2) No charge is made for the starter dosage; and 9
(3) The nurse practitioner OR MIDWIFE enters an appropriate record in 10
the patient’s medical record. 11
8–601. 12
In this subtitle: 13
(1) “Practice nurse midwifery” means the management and care of 14
essentially normal newborns and of essentially normal women antepartally, intrapartally 15
and postpartally. 16
(2) “Practice nurse midwifery” includes: 17
(i) Family planning and well woman reproductive care; 18
(ii) The prescribing of substances commonly used in the practice of 19
nurse midwifery; 20
(iii) The prescribing of controlled substances on Schedules II, III, IV, 21
and V commonly used in the practice of nurse midwifery; and 22
(iv) The dispensing of the substances prescribed in accordance with 23
the provisions of [subparagraphs] ITEMS (ii) and (iii) of this paragraph in the course of 24
treating a patient [at]: 25
1. [A] AT A medical facility or clinic that is operated on a 26
nonprofit basis; 27
2. [A] AT A health center that operates on a campus of an 28
institution of higher education; [or] 29
4 SENATE BILL 772
3. [A] AT A public health facility, a medical facility under 1
contract with a State or local health department, or a facility funded with public funds; OR 2
4. WITH A STARTER DOSAGE OF A DRUG AS AUTHORIZED 3
UNDER § 8–508 OF THIS TITLE. 4
8–6A–01. 5
(a) In this subtitle the following words have the meanings indicated. 6
(j) “Certified medication technician” means an individual who: 7
(1) Has completed a Board–approved medication technician training 8
program; [and] 9
(2) Is certified by the Board as a medication technician; AND 10
(3) PERFORMS MEDICATION T ECHNICIAN TASKS DELE GATED BY A 11
REGISTERED NURSE , LICENSED PRACTICAL N URSE, OR LICENSED CERTIFIED 12
MIDWIFE. 13
(l) “Certified nursing assistant”: 14
(1) Means an individual regardless of title who, FOR COMPENSATION , 15
routinely performs [nursing]: 16
(I) NURSING tasks delegated by a registered nurse or licensed 17
practical nurse [for compensation]; OR 18
(II) TECHNICAL TASKS DELEG ATED BY A LICENSED C ERTIFIED 19
MIDWIFE; and 20
(2) Does not include a certified dialysis technician or a certified medication 21
technician. 22
8–6A–02. 23
(a) Subject to subsection [(e)] (F) of this section and except as otherwise provided 24
in this subtitle, an individual shall be certified by the Board to practice as a nursing 25
assistant, dialysis technician, or medication technician before the individual may practice 26
as a nursing assistant, dialysis technician, or medication technician in the State. 27
(b) This subtitle does not apply to an individual who: 28
SENATE BILL 772 5
(1) Practices a health occupation that the individual is authorized to 1
practice under this article; 2
(2) Provides for the gratuitous care of friends, domestic partners, or family 3
members; 4
(3) Performs nursing assistant tasks while a nursing student enrolled in 5
an accredited nursing program and practicing under the direct supervision of qualified 6
faculty or preceptors; 7
(4) Performs nursing assistant tasks as a student while: 8
(i) Enrolled in a Board–approved nursing assistant training 9
program; and 10
(ii) Practicing under the direct supervision of qualified faculty or 11
preceptors; 12
(5) Performs medication technician tasks as a student while practicing 13
under the direct supervision of qualified faculty; 14
(6) Performs dialysis technician tasks as a student while under the direct 15
supervision of qualified faculty; or 16
(7) Works as a principal or school secretary, does not administe r 17
medication as a routine part of the position, and has completed training by the delegating 18
nurse for the occasion where the individual may need to administer medication in the 19
absence of the nurse or medication technician. 20
(c) Nothing in this section shall preclude a registered nurse or licensed practical 21
nurse from delegating a nursing or other technical task to an unlicensed individual 22
provided that acceptance of delegated nursing or other technical tasks does not become a 23
routine part of the unlicensed individual’s job duties. 24
(d) (1) Subject to regulations adopted by the Board under paragraph (2) of this 25
subsection, this section does not preclude an advanced practice registered nurse from 26
delegating a nursing or other technical task to an assistant if: 27
(i) The assistant performs only tasks that the assistant is trained to 28
perform; and 29
(ii) The delegating advanced practice registered nurse provides: 30
1. Instruction to the assistant on the delegated task; and 31
2. On–site supervision of the assistant performing the 32
delegated task. 33 6 SENATE BILL 772
(2) The Board shall adopt regulations to carry out this subsection, 1
including regulations that: 2
(i) Provide for the manner in which an advanced practice registered 3
nurse delegates a nursing or other technical task to an assistant; 4
(ii) Establish limitations on the authority of an advanced practice 5
registered nurse to delegate nursing or other technical tasks to an assistant; and 6
(iii) Otherwise clarify the scope of this subsection. 7
(E) (1) SUBJECT TO REGULATIONS A DOPTED BY THE BOARD UNDER 8
PARAGRAPH (2) OF THIS SUBSECTION , THIS SECTION DOES NO T PRECLUDE A 9
LICENSED CERTIFIED M IDWIFE FROM DELEGATI NG A TECHNICAL TASK TO AN 10
ASSISTANT IF: 11
(I) THE ASSISTANT PERFORM S ONLY TASKS THAT TH E 12
ASSISTANT IS TRAINED TO PERFORM ; AND 13
(II) THE DELEGATING LICENS ED CERTIFIED MIDWIFE 14
PROVIDES: 15
1. INSTRUCTION TO THE AS SISTANT ON THE DELEG ATED 16
TASK; AND 17
2. ON–SITE SUPERVISION OF THE ASSISTANT 18
PERFORMING THE DELEG ATED TASK. 19
(2) THE BOARD SHALL ADOPT REGULATIONS TO CARRY OUT THIS 20
SUBSECTION, INCLUDING REGULATION S THAT: 21
(I) PROVIDE FOR THE MANNE R IN WHICH A LICENSE D 22
CERTIFIED MIDWIFE DE LEGATES A TECHNICAL TASK TO AN ASSISTANT ; 23
(II) ESTABLISH LIMITATIONS ON THE AUTHORITY OF A 24
LICENSED CERTIFIED M IDWIFE TO DELEGATE TECHNICA L TASKS TO AN ASSIST ANT; 25
AND 26
(III) OTHERWISE CLARIFY THE SCOPE OF THIS SUBSEC TION. 27
[(e)] (F) An individual shall be certified by the Board to practice as a nursing 28
assistant and as a dialysis technician before the individual may practice as a dialysis 29
technician in a State–owned hospital or State–owned facility. 30 SENATE BILL 772 7
8–6D–01. 1
(a) In this subtitle the following words have the meanings indicated. 2
(h) (1) “Practice certified midwifery” means the management and care of 3
essentially normal newborns and of essentially normal women antepartally, intrapartally, 4
and postpartally. 5
(2) “Practice certified midwifery” includes: 6
(i) Family planning and well woman reproductive care; 7
(ii) The prescribing of substances commonly used in the practice of 8
midwifery; 9
(iii) The prescribing of Schedule II, Schedule III, Schedule IV, and 10
Schedule V controlled dangerous substances commonly used in the practice of midwifery; 11
and 12
(iv) The dispensing of the substances prescribed in accordance with 13
the provisions of items (ii) and (iii) of this paragraph in the course of treating a patient [at]: 14
1. [A] AT A medical facility or clinic that is operated on a 15
nonprofit basis; 16
2. [A] AT A health center that operates on a campus of an 17
institution of higher education; [or] 18
3. [A] AT A public health facility, a medical facility under 19
contract with a state or local health department, or a facility funded with public funds; OR 20
4. WITH A STARTER DOSAGE OF A DRUG AS AUTHORIZED 21
UNDER § 8–508 OF THIS TITLE. 22
8–6D–02. 23
(a) Except as otherwise provided in this subtitle, an individual shall be licensed 24
by the Board before the individual may practice certified midwifery in the State. 25
(b) This section does not apply to: 26
(1) An individual who assists at a birth in an emergency; 27
(2) An individual who is licensed as a health care practitioner whose scope 28
of practice allows the individual to practice certified midwifery; [or] 29 8 SENATE BILL 772
(3) A student who is practicing certified midwifery while engaged in an 1
approved clinical midwifery education experience under the supervision of a licensed 2
certified midwife or a licensed nurse certified as a nurse–midwife; OR 3
(4) AN INDIVIDUAL WHO HAS GRADUATED FROM AN APPROVE D 4
CLINICAL MIDWIFERY E DUCATION EXPERIENCE AND WHO IS: 5
(I) PRACTICING CERTIFIED MIDWIFERY UNDER THE 6
SUPERVISION OF A LIC ENSED CERTIFIED MIDW IFE OR A LICENSED NU RSE 7
CERTIFIED AS A NURSE –MIDWIFE; AND 8
(II) MEETS ANY OTHER REQUIREM ENTS SET BY THE BOARD. 9
8–6D–03. 10
(a) In addition to the certification and education requirements under subsection 11
(b) of this section, to qualify for a license, an applicant must: 12
(1) Be of good moral character; and 13
(2) Submit to a criminal history records check in accordance with § 8–303 14
of this title. 15
(b) An applicant must: 16
(1) Hold a current, valid certification as a certified midwife from AMCB; 17
(2) Have graduated from a graduate –level accredited program for 18
midwifery education approved by ACME; AND 19
(3) [Have completed coursework in health and sciences: 20
(i) Before commencing a midwifery program described in item (2) of 21
this subsection; or 22
(ii) As part of a midwifery program described in item (2) of this 23
subsection; and 24
(4)] Have passed the AMCB examination. 25
12–102. 26
(a) (1) In this section the following terms have the meanings indicated. 27
SENATE BILL 772 9
(2) “In the public interest” means the dispensing of drugs or devices by a 1
licensed dentist, physician, NURSE OR MIDWIFE, or podiatrist to a patient when a 2
pharmacy is not conveniently available to the patient. 3
(3) “NURSE OR MIDWIFE ” MEANS AN INDIVIDUAL LICENSED OR 4
CERTIFIED BY THE BOARD OF NURSING UNDER TITLE 8 OF THIS ARTICLE. 5
[(3)] (4) “Personally preparing and dispensing” means that the licensed 6
dentist, physician, NURSE OR MIDWIFE, or podiatrist: 7
(i) Is physically present on the premises where the prescription is 8
filled; and 9
(ii) Performs a final check of the prescription before it is provided to 10
the patient. 11
(c) (2) This title does not prohibit: 12
(iv) A licensed physician who complies with the requirements of item 13
(ii) of this paragraph from personally preparing and dispensing a prescription written by: 14
1. A physician assistant in accordance with a delegation 15
agreement that complies with Title 15, Subtitle 3 of this article; or 16
2. A nurse practitioner who is authorized to practice under 17
Title 8, Subtitle 3 of this article and is working with the physician in the same office setting; 18
[or] 19
(v) A hospital–based clinic from dispensing prescriptions to its 20
patients; OR 21
(VI) AN INDIVIDUAL LICENSE D OR CERTIFIED UNDER TITLE 8 22
OF THIS ARTICLE FROM PERSONALLY PREPARING AND DISPENSING A DRU G OR 23
DEVICE AS AUTHORIZED UNDER TITLE 8 OF THIS ARTICLE . 24
(e) (1) This title does not prohibit: 25
(i) A dentist, physician, NURSE OR MIDWIFE, or podiatrist from 26
administering a prescription drug or device in the course of treating a patient; 27
(ii) A licensed dental hygienist from administering medication under 28
§ 4–206.4 of this article; or 29
(iii) A nurse anesthetist from administering medication under § 30
8–513 of this article. 31
10 SENATE BILL 772
(2) For the purposes of paragraph (1)(i) of this subsection, “administering” 1
means the direct introduction of a single dosage of a drug or device at a given time, whether 2
by injection or other means, and whether in liquid, tablet, capsule, or other form. 3
(f) (1) This title does not prohibit a dentist, physician, NURSE OR MIDWIFE, 4
or podiatrist from personally dispensing a starter dosage of a prescription drug or device to 5
a patient of the dentist, physician, NURSE OR MIDWIFE, or podiatrist, provided that: 6
(i) The starter dosage complies with the labeling requirements of § 7
12–505 of this title; 8
(ii) No charge is made for the starter dosage; and 9
(iii) The dentist, physician, NURSE OR MIDWIFE, or podiatrist enters 10
an appropriate record on the patient’s chart. 11
(2) For the purposes of paragraph (1) of this subsection, “starter dosage” 12
means an amount of drug or device sufficient to begin therapy: 13
(i) Of short duration of 72 hours or less; or 14
(ii) Prior to obtaining a larger quantity of the drug or device to 15
complete the therapy. 16
(g) This title does not prohibit a dentist, physician, NURSE OR MIDWIFE, or 17
podiatrist from dispensing a prescription drug or device in the course of treating a patient: 18
(1) At a medical facility or clinic that is operated on a nonprofit basis; 19
(2) At a health center that operates on a campus of an institution of higher 20
education; or 21
(3) At a public health facility, a medical facility under contract with a State 22
or local health department, or a facility funded with public funds. 23
SECTION 2. AND BE IT FURTHER ENACTED, That, on or before December 1, 24
2023, the Maryland Department of Health, in consultation with relevant stakeholders, 25
shall develop recommendations to expand access to birthing services in birthing centers in 26
the State and report its findings to the Senate Finance Committee and the House Health 27
and Government Operations Committee, in accordance with § 2 –1257 of the State 28
Government Article. 29
SECTION 3. AND BE IT FURTHER ENACTED, That this Act shall take effect 30
October 1, 2023. 31