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