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Chapter 818
(House Bill 1125)
AN ACT concerning
Certified Nursing Assistants – Licensing Requirements and Administrative
Updates
FOR the purpose of exempting an individual who practices as a certain nursing assistant
for less than a certain number of months under federal regulations from the State’s
certification requirement; altering the designation of, and licensure requirements
for, certified nursing assistants and geriatric nursing assistants; requiring an
applicant for certification as a certified nursing assistant to complete a nursing
assistant competency evaluation; authorizing an approved acute care nursing
assistant training program to request a waiver of certain federal requirements; and
generally relating to the licensing of certified nursing assistants.
BY repealing and reenacting, with amendments,
Article – Health – General
Section 19–1410(b)(2)(vi), 19–1410.2, and 24–1901(e)
Annotated Code of Maryland
(2023 Replacement Volume)
BY repealing and reenacting, without amendments,
Article – Health – General
Section 24–1901(a)
Annotated Code of Maryland
(2023 Replacement Volume)
BY repealing and reenacting, with amendments,
Article – Health Occupations
Section 8–6A–01, 8–6A–02(b) and (c), 8–6A–05, 8–6A–07(b) and (c), 8–6A–08(c) and
(n), 8–6A–14, 8–701(c), and 8–703(a)(6) and (7)
Annotated Code of Maryland
(2021 Replacement Volume and 2023 Supplement)
BY repealing and reenacting, without amendments,
Article – Health Occupations
Section 8–6A–02(a) and 8–6A–07(a)
Annotated Code of Maryland
(2021 Replacement Volume and 2023 Supplement)
BY repealing
Article – Health Occupations
Section 8–703(a)(5)
Annotated Code of Maryland Ch. 818 2024 LAWS OF MARYLAND
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(2021 Replacement Volume and 2023 Supplement)
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND,
That the Laws of Maryland read as follows:
Article – Health – General
19–1410.
(b) (2) Each nursing home shall establish a quality assurance committee and
shall include at least the following members:
(vi) A [geriatric] CERTIFIED nursing [assistant] ASSISTANT–I.
19–1410.2.
(a) In this section, “workplace safety” means the prevention of any physical
assault or threatening behavior against an employee in a nursing home.
(b) This section applies to nursing homes that are licensed for 45 beds or more.
(c) Each nursing home shall assign to an appropriate committee the task of:
(1) Conducting an annual assessment of workplace safety issues; and
(2) Making recommendations to the nursing home for reducing workplace
injuries.
(d) In conducting an annual assessment of workplace safety issues, the committee
assigned to conduct the assessment under subsection (c)(1) of this section shall consult with
[geriatric] CERTIFIED nursing assistants and other employees of the nursing home who
are involved in assisting residents with activities of daily living.
24–1901.
(a) In this subtitle the following words have the meanings indicated.
(e) “Nursing support staff” includes:
(1) A certified medication technician, as defined in [§ 8–6A–01(j)] §
8–6A–01 of the Health Occupations Article;
(2) A certified medicine aide, as defined in [§ 8–6A–01(k)] § 8–6A–01 of
the Health Occupations Article; AND
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(3) A certified nursing assistant, as defined in [§ 8–6A–01(l)] § 8–6A–01
of the Health Occupations Article[; and
(4) A geriatric nursing assistant, as defined in § 8–6A–01(o) of the Health
Occupations Article].
Article – Health Occupations
8–6A–01.
(a) In this subtitle the following words have the meanings indicated.
(b) “Applicant” means, unless the context requires otherwise:
(1) An individual applying for an initial certificate by examination or
endorsement;
(2) A certificate holder applying for renewal of a certificate; or
(3) An individual applying for reinstatement of a certificate in accordance
with § 8–6A–10 of this subtitle.
(C) “APPROVED ACUTE CARE N URSING ASSISTANT TRA INING PROGRAM ”
MEANS A COURSE OF TR AINING THAT MEETS TH E ACUTE CARE NURSING ASSISTANT
CURRICULUM APPROVED BY THE BOARD.
[(c)] (D) (1) “Approved dialysis technician training program” means a course
of training approved by the Board that:
(i) Prepares the applicant for national certification;
(ii) Meets the requirements of 42 C.F.R. § 494.140(e)(3); and
(iii) Meets the requirements set by the Board in regulation.
(2) “Approved dialysis technician training program” includes the courses
required for national certification as:
(i) A Certified Clinical Hemodialysis Technician by the Nephrology
Nursing Certification Commission;
(ii) A Clinical Nephrology Technician by the National Nephrology
Certification Organization; or
(iii) A Certified Hemodialysis Technician by the Board of Nephrology
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[(d)] (E) “Approved medication technician training program” means a course of
training approved by the Board that meets the basic medication technician core curriculum
and the medication technician content training specific to the setting in which the
medication technician will work.
[(e)] (F) “Approved nursing assistant training program” means a course of
training that [meets]:
(1) MEETS the [basic nursing assistant curriculum prescribed and]
REQUIREMENTS UNDER F EDERAL AND STATE LAW; AND
(2) IS approved by the Board.
[(f)] (G) “Board” means the State Board of Nursing.
[(g)] (H) “Certificate” means a certificate issued by the Board to practice as a
certified nursing assistant, a certified dialysis technician, or a certified medication
technician in the State.
[(h)] (I) “Certificate holder” means a certified nursing assistant, dialysis
technician, or medication technician who has:
(1) An active certificate;
(2) An inactive certificate;
(3) A temporary certificate;
(4) An expired temporary certificate;
(5) An expired certificate;
(6) A lapsed certificate;
(7) A suspended certificate; or
(8) A certificate subject to a reprimand, probation, or suspension.
[(i)] (J) “Certified dialysis technician” means an individual who:
(1) Has completed a Board–approved dialysis technician program; and
(2) Is certified by the Board as a dialysis technician.
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[(j)] (K) “Certified medication technician” means an individual who:
(1) Has completed a Board–approved medication technician training
program;
(2) Is certified by the Board as a medication technician; and
(3) Subject to regulations adopted by the Board, routinely performs:
(i) Nursing tasks related to the administration of medication,
delegated by a registered nurse, licensed practical nurse, or advanced practice nurse; or
(ii) Technical tasks related to the administration of medication
delegated by a licensed certified midwife.
[(k)] (L) “Certified medicine aide” means a certified nursing assistant who [has]:
(1) HAS completed a Board –approved course in medication
administration; AND
(2) IS CERTIFIED AS A MED ICINE AIDE BY THE BOARD.
[(l)] (M) (1) “Certified nursing assistant”[:
(1) Means] MEANS an individual regardless of title who, for compensation
and subject to regulations adopted by the Board, routinely performs:
(i) Nursing tasks delegated by a registered nurse, licensed practical
nurse, or advanced practice registered nurse; or
(ii) Technical tasks delegated by a licensed certified midwife[; and].
(2) [Does] “CERTIFIED NURSING ASS ISTANT” DOES not include a
certified dialysis technician or a certified medication technician.
(N) (1) “CERTIFIED NURSING ASS ISTANT–I” MEANS A CERT IFIED
NURSING ASSISTANT WH O MEETS THE REQUIREM ENTS SET BY THE BOARD AND
UNDER FEDERAL LAW TO PRACTICE IN ANY SETT ING.
(2) “CERTIFIED NURSING ASS ISTANT–I” INCLUDES:
(I) A CERTIFIED NURSING AS SISTANT WHO WAS CERT IFIED AS
A GERIATRIC NURSING ASSISTANT ON MAY 31, 2024 SEPTEMBER 30, 2025;
(II) A CERTIFIED MEDICINE A IDE; AND Ch. 818 2024 LAWS OF MARYLAND
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(III) A CERTIFIED NURSING AS SISTANT WHO IS APPRO VED
UNDER § 8–6A–05(C)(5) OF THIS SUBTITLE.
(O) “CERTIFIED NURSING ASS ISTANT–II” MEANS A CERTIFIED NU RSING
ASSISTANT:
(1) WHO, ON MAY 31, 2024 SEPTEMBER 30, 2025, WAS CERTIFIED AS
A NURSING ASSISTANT AND WAS NOT AUTHORIZ ED TO PRACTICE IN A NURSING
FACILITY OR SKILLED NURSING FACILITY ; AND
(2) WHOSE AUTHORITY TO PR ACTICE IN A NURSING FACILITY OR
SKILLED NURSING FACI LITY CONTINUES TO BE RESTRIC TED BECAUSE THE
CERTIFIED NURSING AS SISTANT HAS NOT BEEN APPROVED AS A CERTIF IED
NURSING ASSISTANT –I UNDER § 8–6A–05(C)(5) OF THIS SUBTITLE.
[(m)] (P) “Department” means the Maryland Department of Health.
[(n)] (Q) “Expired certificate” means a certificate that was not renewed before
the expiration date of the certificate as established under § 8–6A–08(a) of this title.
[(o) “Geriatric nursing assistant” means a certified nursing assistant who has
successfully completed the requirements for geriatric nursing assistant mandated under
federal law and the regulations of the Board.]
[(p)] (R) “Lapsed certificate” means a certificate that was not renewed because
a certificate holder failed to renew the certificate or otherwise did not meet the renewal
requirements of this subtitle.
(S) “NURSING ASSISTANT COM PETENCY EVALUATION ” MEANS AN
EXAMINATION APPROVED BY THE BOARD THAT:
(1) DETERMINES THE COMPET ENCY OF THE INDIVIDU AL TO
PRACTICE AS A CERTIF IED NURSING ASSISTAN T–I; AND
(2) MEETS THE REQUIREMENT S UNDER FEDERAL LAW .
8–6A–02.
(a) Subject to subsection (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.
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(b) This subtitle does not apply to an individual who:
(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) 1. Enrolled in a Board–approved nursing assistant training
program; and OR
2. ENROLLED IN AN ACUTE CARE NURSING ASSISTANT
TRAINING PROGRAM ; AND
(ii) Practicing under the direct supervision of qualified faculty or
preceptors] ENROLLED IN AN ACCRE DITED NURSING PROGRA M AFTER THE
SUCCESSFUL COMPLETIO N OF A PORTION OF AN APPROVED NURSING EDU CATION
PROGRAM THAT THE BOARD DETERMINES MEET S THE REQUIREMENTS O F AN
APPROVED NURSING ASS ISTANT TRAINING PROG RAM OR MEDICATION
ADMINISTRATION COURS E;
(5) PERFORMS NURSING ASSI STANT TASKS AS A STU DENT WHILE
ENROLLED IN AN ACCRE DITED NURSING PROGRA M AFTER THE SUCCESSF UL
COMPLETION OF THE PO RTION OF THE APPROVE D NURSING EDUCATION PROGRAM
THAT THE BOARD DETERMINES MEET S THE REQUIREMENTS O F AN APPROVED
NURSING ASSISTANT TR AINING PROGRAM OR ME DICATION ADMINISTRAT ION
COURSE;
(5) (6) Performs medication technician tasks as a student while
practicing under the direct supervision of qualified faculty;
(6) (7) Performs dialysis technician tasks as a student while under the
direct supervision of qualified faculty; [or]
(7) (8) 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; OR
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(8) (9) PRACTICES AS A CERTIF IED NURSING ASSISTAN T–I FOR
LESS THAN 4 MONTHS IN ACCORDANCE WITH 42 C.F.R. § 483.35(D).
(c) [Nothing in this section shall] THIS SECTION DOES NOT preclude a
registered nurse or licensed practical nurse from delegating a nursing or other technical
task to an unlicensed individual [provided that IF acceptance of delegated nursing or other
technical tasks does not become a routine part of the unlicensed individual’s job duties].
8–6A–05.
(a) The Board, IN COLLABORATION AFTER CONSULTATION WITH RELEVANT
STAKEHOLDERS , shall adopt regulations establishing:
(1) [Categories of certified nursing assistants, including geriatric nursing
assistants, home health aides, school health aides, individuals working in developmental
disabilities administration facilities, and medicine aides;
(2)] Qualifications for [each category of] certified nursing [assistant]
ASSISTANTS, INCLUDING CERTIFIED MEDICINE AIDES ;
[(3)] (2) Qualifications for certified dialysis technicians;
[(4)] (3) Qualifications for certified medication technicians;
[(5)] (4) Standards for qualification of applicants for certification,
including the applicant’s criminal history, work record, and prohibitions against behavior
which may be potentially harmful to patients; and
[(6)] (5) Standards for the online provision of didactic instruction in a
nursing assistant training program that meets the requirements established by the Board.
(b) (1) To qualify for certification as a nursing assistant, a [nursing assistant
in a specific category] CERTIFIED MEDICINE A IDE, a dialysis technician, or a medication
technician, an applicant shall meet the requirements set by the Board.
(2) Requirements set by the Board under paragraph (1) of this subsection
regarding qualifications for certification as a [geriatric nursing assistant] CERTIFIED
NURSING ASSISTANT –I shall include provisions to allow an individual who has been
practicing as a temporary nursing assistant, in accordance with the waiver of the
requirements of 42 C.F.R. § 483.35(d) issued by the Centers for Medicare and Medicaid
Services on March 6, 2020, to apply on–the–job experience as a nursing assistant toward
the total number of training hours required for certification as a [geriatric nursing
assistant] CERTIFIED NURSING ASS ISTANT–I.
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(c) (1) An applicant for a certificate shall:
(i) Submit an application to the Board on the form that the Board
requires;
(ii) Provide evidence, as required by the Board, of successful
completion of:
1. An approved nursing assistant training program OR
APPROVED ACUTE CARE NURSING ASSISTANT TR AINING PROGRAM ;
2. An approved dialysis technician training program;
3. An approved course in medication administration; or
4. A portion of an approved nursing education program that
the Board determines meets the requirements of [a] AN APPROVED nursing assistant
training program or medication administration course;
(iii) Pay to the Board an application fee set by the Board;
(iv) Be of good moral character;
(v) Be at least 16 years old to apply for certification as a nursing
assistant;
(vi) Be at least 18 years old to apply for certification as a dialysis
technician; and
(vii) Be at least 18 years old to apply for certification as a medication
technician.
(2) Subject to paragraph (1) of this subsection, an applicant for certification
as a certified nursing assistant or dialysis technician shall submit to the Board:
(i) A criminal history records check in accordance with § 8–303 of
this title and § 8–6A–08(k) of this subtitle; and
(ii) On the form required by the Board, written, verified evidence
that the requirement of item (i) of this paragraph is being met or has been met.
[(3) An applicant for certification as a certified medicine aide, in addition to
the requirements under paragraph (1) of this subsection, shall submit an additional
application to that effect to the Board on the form that the Board requires.]
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(3) (I) AN APPLICANT FOR CERT IFICATION AS A CERTI FIED
NURSING ASSISTANT SHALL SUBMIT TO THE BOARD SATISFACTORY EV IDENCE OF
PASSING A NURSING AS SISTANT COMPETENCY E VALUATION.
(II) AN APPLICANT WHO HAS COMPLETED AN APPROVE D ACUTE
CARE NURSING ASSISTA NT TRAINING PROGRAM SHALL BE DEEMED TO H AVE
FULFILLED THE CL ASSROOM AND CLINICAL STANDARDS TO SIT FOR THE NURSING
ASSISTANT COMPETENCY EVALUATION.
(4) An applicant for a certificate may not:
(i) Have committed any act or omission that would be grounds for
discipline or denial of certification under this subtitle; and
(ii) Have a record of abuse, negligence, misappropriation of a
resident’s property, or any disciplinary action taken or pending in any other state or
territory of the United States against the certification of the nursing assistant or
medication technician in the state or territory.
(5) BEGINNING JUNE 1, 2024 OCTOBER 1, 2025, A CERTIFIED
NURSING ASSISTANT –II MAY BE CERTIFIED AS A CERTIFIED NURSING ASSISTANT–I
BY:
(I) SUBMITTING AN APPLICA TION TO THE BOARD ON THE
FORM THAT THE BOARD REQUIRES ; AND
(II) PROVIDING SATISFACTOR Y EVIDENCE OF:
1. SUCCESSFUL COMPLETION OF AN APPROVED
NURSING ASSISTANT TR AINING PROGRAM ; AND
2. PASSING A NURSING ASS ISTANT COMPETENCY
EVALUATION.
8–6A–07.
(a) Subject to subsection (f) of this section, the Board shall certify any applicant
who meets the requirements of this subtitle.
(b) (1) The Board shall:
(i) Issue each new certified nursing assistant, dialysis technician, or
medication technician a certificate number and [registration] certificate that indicates the
initial certificate was issued by the Board; and
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(ii) Electronically record each certificate in the Board’s database and
on the Board’s website.
(2) Each certificate AVAILABLE THROUGH TH E BOARD’S WEBSITE shall
include:
(i) Any expiration date;
(ii) The type of certificate; and
(iii) Any specific category of nursing assistant.
(c) An individual who has met the requirements for a certified nursing assistant
ON OR AFTER JUNE 1, 2024 OCTOBER 1, 2025, shall be certified with the title of
“certified nursing [assistant”] ASSISTANT–I”.
8–6A–08.
(c) Before a certificate expires, a CERTIFIED nursing assistant periodically may
renew it for an additional term, if the certificate holder:
(1) Otherwise is entitled to be certified;
(2) Submits to the Board a renewal application on the form that the Board
requires;
(3) Pays to the Board a renewal fee set by the Board; and
(4) Provides satisfactory evidence of [completion of]:
(i) COMPLETION OF 16 hours of active CERTIFIED nursing
assistant practice within the 2–year period immediately preceding the date of expiration;
or
(ii) If the CERTIFIED nursing assistant did not complete 16 hours of
active practice as required under item (i) of this item, [an approved nursing assistant
training program or an approved nursing assistant refresher training program] as required
in regulations adopted by the Board in accordance with subsection (m) of this section:
1. SUCCESSFUL COMPLETION OF AN APPROVED
NURSING ASSISTANT TR AINING PROGRAM ; OR
2. PASSING A NURSING ASS ISTANT COMPETENCY
EVALUATION .
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(n) (1) The Board, IN AFTER CONSULTATION WITH RE LEVANT
STAKEHOLDERS , shall adopt regulations to specify[:
(i) The] THE circumstances under which a nursing assistant, as a
condition of renewal, is required to complete [either] an approved nursing assistant
training program or [an approved nursing assistant refresher training program; and
(ii) The number of didactic instruction hours and clinical training
hours the nursing assistant training program or nursing assistant refresher training
program must have to be approved] PASS A NURSING ASSIS TANT COMPETEN CY
EXAMINATION .
(2) Regulations adopted under paragraph (1) of this subsection must be
consistent with federal law.
8–6A–14.
(a) The Board, in conjunction with the Maryland Higher Education Commission,
shall approve each nursing assistant training program prior to its implementation and
provide periodic survey of all programs in the State.
(b) The Board in conjunction with the Department, Maryland Higher Education
Commission, and the affected industry shall develop regulations for nursing assistant
training programs.
(c) The curriculum content for an approved nursing assistant training program
shall include:
(1) Content [consistent with State licensing requirements in the Health –
General Article and] THAT MEETS all federal requirements SET FORTH IN 42 C.F.R. §
483.152; AND
(2) All basic skills required of a nursing assistant regardless of the setting
of the practice[; and
(3) Any skills required for certification in a specific category].
(d) Any additional clinical practice skills specific to a setting of practice shall be
taught in that setting as a part of the employment training process in that setting.
(e) The Board may make survey visits from time to time, without prior notice, to
all certified nursing assistant training programs.
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[(f) The provisions of this section may not be interpreted to impose additional
requirements for geriatric nursing assistants A CERTIFIED NURSING ASSISTANT–I
beyond those required under federal law.
(g) (1) The Board shall approve the use of a nursing assistant training site by
a nursing assistant training program within 45 days after the nursing assistant training
program applies for approval if the nursing assistant training program had previously been
approved to use the training site by the Board.]
(2) A NURSING ASSISTANT TR AINING PROGRAM UNDER PARAGRAPH
(1) OF THIS SUBSECTION M AY CONTINUE TO OPERA TE DURING THE APPROV AL
PROCESS.
(F) AN APPROVED ACUTE CAR E NURSING ASSISTANT TRAINING PROGRAM
MAY REQUEST A WAIVER OF THE FEDERAL REQUI REMENT UNDER 42 C.F.R. §
483.152(C)(5) THAT INSTRUCTORS HAV E A MINIMUM OF 1 YEAR OF EXPERIENCE I N
THE PROVISION OF LON G–TERM CARE FACILITY S ERVICES.
8–701.
(c) [(1)] Except as otherwise provided in this title, an individual may not
practice, attempt to practice, or offer to practice as a certified nursing assistant unless
certified by the Board as a certified nursing assistant.
[(2) Except as otherwise provided in this title, an individual may not
practice, attempt to practice, or offer to practice as a certified nursing assistant in a specific
category unless certified by the Board as a certified nursing assistant in that category.]
8–703.
(a) [(5) Unless authorized to provide patient care in a specific category of
certified nursing assistant, an individual may not represent to the public by title, by
description of services, methods, or procedures, or otherwise, that the individual is
authorized to provide care as a certified nursing assistant in a specific category in this
State.]
[(6)] (5) Unless authorized to administer medication as a medication
technician under this title, an individual may not represent to the public by title, by
description of services, methods, or procedures, or otherwise, that the individual is
authorized to administer medication as a certified medication technician in this State.
[(7)] (6) Unless authorized to administer medication as a medicine aide
under this title, an individual may not represent to the public by title, by description of
services, methods, or procedures, or otherwise, that the individual is authorized to
administer medication as a certified medicine aide in this State. Ch. 818 2024 LAWS OF MARYLAND
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SECTION 2. AND BE IT FURTHER ENACTED, That, on or before October 1, 2024
June 1, 2025, the State Board of Nursing shall:
(1) notify individuals who possess a nursing assistant certification of the
licensing requirements established under Section 1 of this Act; and
(2) in consultation with the Office of Health Care Quality, update
regulations to conform with Section 1 of this Act.
SECTION 3. AND BE IT FURTHER ENACTED, That Section 1 of this Act shall take
effect June October 1, 2024 2025.
SECTION 4. AND BE IT FURTHER ENACTED, That, except as provided in Section
3 of this Act, this Act shall take effect October 1, 2024.
Approved by the Governor, May 16, 2024.