EXPLANATION: CAPITALS INDICATE MATTER ADDED TO EXIS TING 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.
*hb0757*
HOUSE BILL 757
J2 EMERGENCY BILL 4lr2790
By: Delegate R. Lewis Delegates R. Lewis, Alston, Bagnall, Bhandari, Chisholm,
Cullison, Hill, Hutchinson, S. Johnson, Kaiser, Kerr, Kipke, Lopez,
Martinez, M. Morgan, Pena–Melnyk, Reilly, Rosenberg, Szeliga, Taveras,
White Holland, and Woods
Introduced and read first time: January 31, 2024
Assigned to: Health and Government Operations
Committee Report: Favorable with amendments
House action: Adopted
Read second time: February 26, 2024
CHAPTER ______
AN ACT concerning 1
State Board of Physicians – Supervised Medical Graduates and Cardiovascular 2
Invasive Specialists 3
(Bridge to Medical Residency Act) 4
FOR the purpose of authorizing a supervised medical graduate to provide delegated duties 5
under direct supervision in accordance with regulations adopted by the State Board 6
of Physicians; prohibiting an individual from practicing as a supervised medical 7
graduate for more than a certain period of time; repealing the termination of certain 8
provisions of law relating to delegation of duties by licensed physicians to 9
cardiovascular invasive specialists; and generally relating to the delegation of duties 10
by licensed physicians. 11
BY repealing and reenacting, with amendments, 12
Article – Health Occupations 13
Section 14–306 14
Annotated Code of Maryland 15
(2021 Replacement Volume and 2023 Supplement) 16
BY repealing and reenacting, with amendments, 17
Chapter 445 of the Acts of the General Assembly of 2019 18
Section 4 19
2 HOUSE BILL 757
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 1
That the Laws of Maryland read as follows: 2
Article – Health Occupations 3
14–306. 4
(a) To the extent permitted by the rules, regulations, and orders of the Board, an 5
individual to whom duties are delegated by a licensed physician may perform those duties 6
without a license as provided in this section. 7
(b) The individuals to whom duties may be delegated under this section include 8
any individual authorized to practice any other health occupation regulated under this 9
article or § 13–516 of the Education Article. 10
(c) The Board shall adopt rules and regulations to delineate the scope of this 11
section. Before it adopts any rule or regulation under this section, the Board shall invite 12
and consider proposals from any individual or health group that could be affected by the 13
rule or regulation. 14
(d) (1) If a duty that is to be delegated under this section is a part of the 15
practice of a health occupation that is regulated under this article by another board, any 16
rule or regulation concerning that duty shall be adopted jointly by the Board of Physicians 17
and the board that regulates the other health occupation. 18
(2) If the two boards cannot agree on a proposed rule or regulation, the 19
proposal shall be submitted to the Secretary for a final decision. 20
(e) Except as otherwise provided in this section, an individual may perform 21
X–ray duties without a license only if the duties: 22
(1) Do not include: 23
(i) Computerized or noncomputerized tomography; 24
(ii) Fluoroscopy; 25
(iii) Invasive radiology; 26
(iv) Mammography; 27
(v) Nuclear medicine; 28
(vi) Radiation therapy; or 29
(vii) Xerography; 30
HOUSE BILL 757 3
(2) Are limited to X–ray procedures of the: 1
(i) Chest, anterior–posterior and lateral; 2
(ii) Spine, anterior–posterior and lateral; or 3
(iii) Extremities, anterior–posterior and lateral, not including the 4
head; and 5
(3) Are performed: 6
(i) By an individual who is not employed primarily to perform 7
X–ray duties; 8
(ii) In the medical office of the physician who delegates the duties; 9
and 10
(iii) 1. By an individual who, before October 1, 2002, has: 11
A. Taken a course consisting of at least 30 hours of training 12
in performing X–ray procedures approved by the Maryland Radiological Society in 13
consultation with the Maryland Society of Radiologic Technologists; and 14
B. Successfully passed an examination based on that course 15
that has been approved by the Maryland Radiological Society in consultation with the 16
Maryland Society of Radiologic Technologists; or 17
2. By a licensed physician assistant who has completed a 18
course that includes anterior–posterior and lateral radiographic studies of extremities on 19
at least 20 separate patients under the direct supervision of the delegating physician or 20
radiologist using a mini C–arm or similar low–level radiation machine to perform 21
nonfluoroscopic X–ray procedures, if the duties: 22
A. Include only the X–ray procedures described in paragraph 23
(2)(iii) of this subsection; and 24
B. Are performed pursuant to a Board–approved delegation 25
agreement that includes a request to perform advanced duties under § 15–302(c)(2) of this 26
article. 27
(f) (1) In accordance with regulations adopted by the Board, a licensed 28
physician may delegate duties to a registered cardiovascular invasive specialist assisting 29
in the physician’s performance of fluoroscopy if: 30
(i) The delegated duties are limited to a cardiac catheterization 31
procedure performed in a hospital cardiac catheterization laboratory; 32
4 HOUSE BILL 757
(ii) The physician is physically present and personally directs each 1
act performed by the registered cardiovascular invasive specialist; 2
(iii) The registered cardiovascular invasive specialist has completed 3
the training and education and has the experience required by regulations adopted by the 4
Board; and 5
(iv) The hospital in which the cardiac catheterization laboratory is 6
located has verified and documented that the registered cardiovascular invasive specialist 7
has completed the training and education and has the experience required by regulations 8
adopted by the Board. 9
(2) The hospital in which the cardiac catheterization laboratory is located 10
and the physician delegating duties to a registered cardiovascular invasive specialist under 11
this subsection are responsible for ensuring that all requirements of this subsection are 12
met for each procedure. 13
(3) A disciplinary panel may impose a civil penalty of up to $5,000 for each 14
instance of a hospital’s failure to comply with the requirements of this subsection. 15
(G) (1) (I) IN THIS SUBSECT ION THE FOLLOWING WO RDS HAVE THE 16
MEANINGS INDICATED . 17
(II) “DIRECT SUPERVISION ” MEANS OVERSIGHT EXER CISED BY 18
A DELEGATING PHYSICI AN WHO IS: 19
1. PERSONALLY TREATING T HE PATIENT; AND 20
2. IN THE PRESENCE OF SAME MEDICAL OFFICE AS THE 21
PATIENT AND THE SUPERVISED MEDIC AL GRADUATE ; AND 22
3. IMMEDIATELY AVAILABLE TO PROVIDE ASSISTANC E 23
AND GUIDANCE TO THE SUPERVISED MEDICAL G RADUATE FOR THE DURA TION OF 24
THE COMPLETION OF A DELEGATED DUTY . 25
(III) “SUPERVISED MEDICAL GR ADUATE” MEANS AN INDIVIDUAL 26
WHO: 27
1. HAS A DEGREE OF: 28
A. DOCTOR OF MEDICINE FROM A M EDICAL SCHOOL 29
THAT IS ACCREDITED B Y AN ACCREDITING ORG ANIZATION THAT THE BOARD 30
RECOGNIZES IN ITS RE GULATIONS; OR 31
HOUSE BILL 757 5
B. DOCTOR OF OSTEOPATHY FROM A SCHOOL OF 1
OSTEOPATHY IN THE UNITED STATES, ITS TERRITORIES OR P OSSESSIONS, PUERTO 2
RICO, OR CANADA THAT HAS STAND ARDS FOR GRADUATION EQUIVALENT TO THOSE 3
ESTABLISHED BY THE AMERICAN OSTEOPATHIC ASSOCIATION; AND 4
2. HAS PASSED PARTS 1 AND 2 OF THE UNITED STATES 5
MEDICAL LICENSING EXAMINATION. 6
(2) IN SUBJECT TO PARAGRAPH (3) OF THIS SUBSECTION A ND IN 7
ACCORDANCE WITH REGU LATIONS ADOPTED BY T HE BOARD, A SUPERVISED 8
MEDICAL GRADUATE MAY PERFORM DELEGATED DU TIES UNDER DIRECT 9
SUPERVISION. 10
(3) AN INDIVIDUAL MAY NOT PRACTICE AS A SUPERV ISED MEDICAL 11
GRADUATE FOR A PERIO D OF MORE THAN 2 YEARS. 12
(4) FOR THE PURPOSES OF T HIS SUBSECTION , A DELEGATING 13
PHYSICIAN IS NOT REQ UIRED TO BE IN THE P RESENCE OF A PATIENT AND A 14
SUPERVISED MEDICAL G RADUATE DURING THE C OMPLETION OF A DELEG ATED 15
DUTY. 16
Chapter 445 of the Acts of 2019 17
SECTION 4. AND BE IT FURTHER ENACTED, That this Act shall take effect 18
October 1, 2019. [It shall remain effective for a period of 5 years and, at the end of 19
September 30, 2024, this Act, with no further action required by the General Assembly, 20
shall be abrogated and of no further force and effect.] 21
SECTION 2. AND BE IT FURTHER ENACTED, That this Act is an emergency 22
measure, is necessary for the immediate preservation of the public health or safety, has 23
been passed by a yea and nay vote supported by three–fifths of all the members elected to 24
each of the two Houses of the General Assembly, and shall take effect from the date it is 25
enacted. 26