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Maryland House Bill HB757

Maryland 2024 Regular Session

Maryland House Bill HB757 Compare Versions

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1- WES MOORE, Governor Ch. 286
21
3-– 1 –
4-Chapter 286
5-(House Bill 757)
62
7-AN ACT concerning
3+EXPLANATION: CAPITALS INDICATE MATTER ADDED TO EXIS TING LAW.
4+ [Brackets] indicate matter deleted from existing law.
5+ Underlining indicates amendments to bill.
6+ Strike out indicates matter stricken from the bill by amendment or deleted from the law by
7+amendment.
8+ *hb0757*
89
9-State Board of Physicians – Supervised Medical Graduates and Cardiovascular
10-Invasive Specialists
11-(Bridge to Medical Residency Act)
10+HOUSE BILL 757
11+J2 EMERGENCY BILL 4lr2790
1212
13-FOR the purpose of authorizing a supervised medical graduate to provide delegated duties
14-under direct supervision in accordance with regulations adopted by the State Board
15-of Physicians; prohibiting an individual from practicing as a supervised medical
16-graduate for more than a certain period of time; repealing the termination of certain
17-provisions of law relating to delegation of duties by licensed physicians to
18-cardiovascular invasive specialists; and generally relating to the delegation of duties
19-by licensed physicians.
13+By: Delegate R. Lewis Delegates R. Lewis, Alston, Bagnall, Bhandari, Chisholm,
14+Cullison, Hill, Hutchinson, S. Johnson, Kaiser, Kerr, Kipke, Lopez,
15+Martinez, M. Morgan, Pena–Melnyk, Reilly, Rosenberg, Szeliga, Taveras,
16+White Holland, and Woods
17+Introduced and read first time: January 31, 2024
18+Assigned to: Health and Government Operations
19+Committee Report: Favorable with amendments
20+House action: Adopted
21+Read second time: February 26, 2024
2022
21-BY repealing and reenacting, with amendments,
22- Article – Health Occupations
23-Section 14–306
24- Annotated Code of Maryland
25- (2021 Replacement Volume and 2023 Supplement)
23+CHAPTER ______
2624
27-BY repealing and reenacting, with amendments,
28- Chapter 445 of the Acts of the General Assembly of 2019
29- Section 4
25+AN ACT concerning 1
3026
31- SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND,
32-That the Laws of Maryland read as follows:
27+State Board of Physicians – Supervised Medical Graduates and Cardiovascular 2
28+Invasive Specialists 3
29+(Bridge to Medical Residency Act) 4
3330
34-Article – Health Occupations
31+FOR the purpose of authorizing a supervised medical graduate to provide delegated duties 5
32+under direct supervision in accordance with regulations adopted by the State Board 6
33+of Physicians; prohibiting an individual from practicing as a supervised medical 7
34+graduate for more than a certain period of time; repealing the termination of certain 8
35+provisions of law relating to delegation of duties by licensed physicians to 9
36+cardiovascular invasive specialists; and generally relating to the delegation of duties 10
37+by licensed physicians. 11
3538
36-14–306.
39+BY repealing and reenacting, with amendments, 12
40+ Article – Health Occupations 13
41+Section 14–306 14
42+ Annotated Code of Maryland 15
43+ (2021 Replacement Volume and 2023 Supplement) 16
3744
38- (a) To the extent permitted by the rules, regulations, and orders of the Board, an
39-individual to whom duties are delegated by a licensed physician may perform those duties
40-without a license as provided in this section.
45+BY repealing and reenacting, with amendments, 17
46+ Chapter 445 of the Acts of the General Assembly of 2019 18
47+ Section 4 19
48+ 2 HOUSE BILL 757
4149
42- (b) The individuals to whom duties may be delegated under this section include
43-any individual authorized to practice any other health occupation regulated under this
44-article or § 13–516 of the Education Article.
4550
46- (c) The Board shall adopt rules and regulations to delineate the scope of this
47-section. Before it adopts any rule or regulation under this section, the Board shall invite
48-and consider proposals from any individual or health group that could be affected by the
49-rule or regulation. Ch. 286 2024 LAWS OF MARYLAND
51+ SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 1
52+That the Laws of Maryland read as follows: 2
5053
51-– 2 –
54+Article – Health Occupations 3
5255
53- (d) (1) If a duty that is to be delegated under this section is a part of the
54-practice of a health occupation that is regulated under this article by another board, any
55-rule or regulation concerning that duty shall be adopted jointly by the Board of Physicians
56-and the board that regulates the other health occupation.
56+14–306. 4
5757
58- (2) If the two boards cannot agree on a proposed rule or regulation, the
59-proposal shall be submitted to the Secretary for a final decision.
58+ (a) To the extent permitted by the rules, regulations, and orders of the Board, an 5
59+individual to whom duties are delegated by a licensed physician may perform those duties 6
60+without a license as provided in this section. 7
6061
61- (e) Except as otherwise provided in this section, an individual may perform
62-X–ray duties without a license only if the duties:
62+ (b) The individuals to whom duties may be delegated under this section include 8
63+any individual authorized to practice any other health occupation regulated under this 9
64+article or § 13–516 of the Education Article. 10
6365
64- (1) Do not include:
66+ (c) The Board shall adopt rules and regulations to delineate the scope of this 11
67+section. Before it adopts any rule or regulation under this section, the Board shall invite 12
68+and consider proposals from any individual or health group that could be affected by the 13
69+rule or regulation. 14
6570
66- (i) Computerized or noncomputerized tomography;
71+ (d) (1) If a duty that is to be delegated under this section is a part of the 15
72+practice of a health occupation that is regulated under this article by another board, any 16
73+rule or regulation concerning that duty shall be adopted jointly by the Board of Physicians 17
74+and the board that regulates the other health occupation. 18
6775
68- (ii) Fluoroscopy;
76+ (2) If the two boards cannot agree on a proposed rule or regulation, the 19
77+proposal shall be submitted to the Secretary for a final decision. 20
6978
70- (iii) Invasive radiology;
79+ (e) Except as otherwise provided in this section, an individual may perform 21
80+X–ray duties without a license only if the duties: 22
7181
72- (iv) Mammography;
82+ (1) Do not include: 23
7383
74- (v) Nuclear medicine;
84+ (i) Computerized or noncomputerized tomography; 24
7585
76- (vi) Radiation therapy; or
86+ (ii) Fluoroscopy; 25
7787
78- (vii) Xerography;
88+ (iii) Invasive radiology; 26
7989
80- (2) Are limited to X–ray procedures of the:
90+ (iv) Mammography; 27
8191
82- (i) Chest, anterior–posterior and lateral;
92+ (v) Nuclear medicine; 28
8393
84- (ii) Spine, anterior–posterior and lateral; or
94+ (vi) Radiation therapy; or 29
8595
86- (iii) Extremities, anterior–posterior and lateral, not including the
87-head; and
96+ (vii) Xerography; 30
97+ HOUSE BILL 757 3
8898
89- (3) Are performed:
9099
91- (i) By an individual who is not employed primarily to perform
92-X–ray duties;
100+ (2) Are limited to X–ray procedures of the: 1
93101
94- (ii) In the medical office of the physician who delegates the duties;
95-and
102+ (i) Chest, anterior–posterior and lateral; 2
96103
97- (iii) 1. By an individual who, before October 1, 2002, has: WES MOORE, Governor Ch. 286
104+ (ii) Spine, anterior–posterior and lateral; or 3
98105
99-– 3 –
106+ (iii) Extremities, anterior–posterior and lateral, not including the 4
107+head; and 5
100108
101- A. Taken a course consisting of at least 30 hours of training
102-in performing X–ray procedures approved by the Maryland Radiological Society in
103-consultation with the Maryland Society of Radiologic Technologists; and
109+ (3) Are performed: 6
104110
105- B. Successfully passed an examination based on that course
106-that has been approved by the Maryland Radiological Society in consultation with the
107-Maryland Society of Radiologic Technologists; or
111+ (i) By an individual who is not employed primarily to perform 7
112+X–ray duties; 8
108113
109- 2. By a licensed physician assistant who has completed a
110-course that includes anterior–posterior and lateral radiographic studies of extremities on
111-at least 20 separate patients under the direct supervision of the delegating physician or
112-radiologist using a mini C–arm or similar low–level radiation machine to perform
113-nonfluoroscopic X–ray procedures, if the duties:
114+ (ii) In the medical office of the physician who delegates the duties; 9
115+and 10
114116
115- A. Include only the X–ray procedures described in paragraph
116-(2)(iii) of this subsection; and
117+ (iii) 1. By an individual who, before October 1, 2002, has: 11
117118
118- B. Are performed pursuant to a Board–approved delegation
119-agreement that includes a request to perform advanced duties under § 15–302(c)(2) of this
120-article.
119+ A. Taken a course consisting of at least 30 hours of training 12
120+in performing X–ray procedures approved by the Maryland Radiological Society in 13
121+consultation with the Maryland Society of Radiologic Technologists; and 14
121122
122- (f) (1) In accordance with regulations adopted by the Board, a licensed
123-physician may delegate duties to a registered cardiovascular invasive specialist assisting
124-in the physician’s performance of fluoroscopy if:
123+ B. Successfully passed an examination based on that course 15
124+that has been approved by the Maryland Radiological Society in consultation with the 16
125+Maryland Society of Radiologic Technologists; or 17
125126
126- (i) The delegated duties are limited to a cardiac catheterization
127-procedure performed in a hospital cardiac catheterization laboratory;
127+ 2. By a licensed physician assistant who has completed a 18
128+course that includes anterior–posterior and lateral radiographic studies of extremities on 19
129+at least 20 separate patients under the direct supervision of the delegating physician or 20
130+radiologist using a mini C–arm or similar low–level radiation machine to perform 21
131+nonfluoroscopic X–ray procedures, if the duties: 22
128132
129- (ii) The physician is physically present and personally directs each
130-act performed by the registered cardiovascular invasive specialist;
133+ A. Include only the X–ray procedures described in paragraph 23
134+(2)(iii) of this subsection; and 24
131135
132- (iii) The registered cardiovascular invasive specialist has completed
133-the training and education and has the experience required by regulations adopted by the
134-Board; and
136+ B. Are performed pursuant to a Board–approved delegation 25
137+agreement that includes a request to perform advanced duties under § 15–302(c)(2) of this 26
138+article. 27
135139
136- (iv) The hospital in which the cardiac catheterization laboratory is
137-located has verified and documented that the registered cardiovascular invasive specialist
138-has completed the training and education and has the experience required by regulations
139-adopted by the Board.
140+ (f) (1) In accordance with regulations adopted by the Board, a licensed 28
141+physician may delegate duties to a registered cardiovascular invasive specialist assisting 29
142+in the physician’s performance of fluoroscopy if: 30
140143
141- (2) The hospital in which the cardiac catheterization laboratory is located
142-and the physician delegating duties to a registered cardiovascular invasive specialist under
143-this subsection are responsible for ensuring that all requirements of this subsection are
144-met for each procedure.
145- Ch. 286 2024 LAWS OF MARYLAND
144+ (i) The delegated duties are limited to a cardiac catheterization 31
145+procedure performed in a hospital cardiac catheterization laboratory; 32
146+ 4 HOUSE BILL 757
146147
147-– 4 –
148- (3) A disciplinary panel may impose a civil penalty of up to $5,000 for each
149-instance of a hospital’s failure to comply with the requirements of this subsection.
150148
151- (G) (1) (I) IN THIS SUBSECTION TH E FOLLOWING WORDS HA VE THE
152-MEANINGS INDICATED .
149+ (ii) The physician is physically present and personally directs each 1
150+act performed by the registered cardiovascular invasive specialist; 2
153151
154- (II) “DIRECT SUPERVISION ” MEANS OVERSIGHT EXER CISED BY
155-A DELEGATING PHYSICIAN WHO IS :
152+ (iii) The registered cardiovascular invasive specialist has completed 3
153+the training and education and has the experience required by regulations adopted by the 4
154+Board; and 5
156155
157- 1. PERSONALLY TREATING T HE PATIENT; AND
156+ (iv) The hospital in which the cardiac catheterization laboratory is 6
157+located has verified and documented that the registered cardiovascular invasive specialist 7
158+has completed the training and education and has the experience required by regulations 8
159+adopted by the Board. 9
158160
159- 2. IN THE PRESENCE OF SAME MEDICAL OFFICE AS THE
160-PATIENT AND THE SUPE RVISED MEDICAL GRADU ATE; AND
161+ (2) The hospital in which the cardiac catheterization laboratory is located 10
162+and the physician delegating duties to a registered cardiovascular invasive specialist under 11
163+this subsection are responsible for ensuring that all requirements of this subsection are 12
164+met for each procedure. 13
161165
162- 3. IMMEDIATELY AVAILABLE TO PROVIDE ASSISTANC E
163-AND GUIDANCE TO THE SUPERVISED MEDICAL GRADUATE FOR THE DUR ATION OF
164-THE COMPLETION OF A DELEGATED DUTY .
166+ (3) A disciplinary panel may impose a civil penalty of up to $5,000 for each 14
167+instance of a hospital’s failure to comply with the requirements of this subsection. 15
165168
166- (III) “SUPERVISED MEDICAL GR ADUATE” MEANS AN INDIVIDUAL
167-WHO:
169+ (G) (1) (I) IN THIS SUBSECT ION THE FOLLOWING WO RDS HAVE THE 16
170+MEANINGS INDICATED . 17
168171
169- 1. HAS A DEGREE OF:
172+ (II) “DIRECT SUPERVISION ” MEANS OVERSIGHT EXER CISED BY 18
173+A DELEGATING PHYSICI AN WHO IS: 19
170174
171- A. DOCTOR OF MEDICINE FROM A M EDICAL SCHOOL
172-THAT IS ACCREDITED B Y AN ACCREDITING ORG ANIZATION THAT THE BOARD
173-RECOGNIZES IN ITS RE GULATIONS; OR
175+ 1. PERSONALLY TREATING T HE PATIENT; AND 20
174176
175- B. DOCTOR OF OSTEOPATHY FROM A SCHOOL OF
176-OSTEOPATHY IN THE UNITED STATES, ITS TERRITORIES OR P OSSESSIONS, PUERTO
177-RICO, OR CANADA THAT HAS STAND ARDS FOR GRADUATION EQUIVALENT TO THOSE
178-ESTABLISHED BY THE AMERICAN OSTEOPATHIC ASSOCIATION; AND
177+ 2. IN THE PRESENCE OF SAME MEDICAL OFFICE AS THE 21
178+PATIENT AND THE SUPERVISED MEDIC AL GRADUATE ; AND 22
179179
180- 2. HAS PASSED PARTS 1 AND 2 OF THE UNITED STATES
181-MEDICAL LICENSING EXAMINATION.
180+ 3. IMMEDIATELY AVAILABLE TO PROVIDE ASSISTANC E 23
181+AND GUIDANCE TO THE SUPERVISED MEDICAL G RADUATE FOR THE DURA TION OF 24
182+THE COMPLETION OF A DELEGATED DUTY . 25
182183
183- (2) IN SUBJECT TO PARAGRAPH (3) OF THIS SUBSECTION A ND IN
184-ACCORDANCE WITH REGU LATIONS ADOPTED BY T HE BOARD, A SUPERVISED
185-MEDICAL G RADUATE MAY PERFORM DELEGATED DUTIES UND ER DIRECT
186-SUPERVISION.
184+ (III) “SUPERVISED MEDICAL GR ADUATE” MEANS AN INDIVIDUAL 26
185+WHO: 27
187186
188- (3) AN INDIVIDUAL MAY NOT PRACTICE AS A SUPERV ISED MEDICAL
189-GRADUATE FOR A PERIO D OF MORE THAN 2 YEARS.
190- WES MOORE, Governor Ch. 286
187+ 1. HAS A DEGREE OF: 28
191188
192-– 5 –
193- (4) FOR THE PURPOSES OF T HIS SUBSECTION , A DELEGATING
194-PHYSICIAN IS NOT REQ UIRED TO BE IN THE PRESENCE O F A PATIENT AND A
195-SUPERVISED MEDICAL G RADUATE DURING THE C OMPLETION OF A DELEG ATED
196-DUTY.
189+ A. DOCTOR OF MEDICINE FROM A M EDICAL SCHOOL 29
190+THAT IS ACCREDITED B Y AN ACCREDITING ORG ANIZATION THAT THE BOARD 30
191+RECOGNIZES IN ITS RE GULATIONS; OR 31
192+ HOUSE BILL 757 5
197193
198-Chapter 445 of the Acts of 2019
199194
200- SECTION 4. AND BE IT FURTHER ENACTED, That this Act shall take effect
201-October 1, 2019. [It shall remain effective for a period of 5 years and, at the end of
202-September 30, 2024, this Act, with no further action required by the General Assembly,
203-shall be abrogated and of no further force and effect.]
195+ B. DOCTOR OF OSTEOPATHY FROM A SCHOOL OF 1
196+OSTEOPATHY IN THE UNITED STATES, ITS TERRITORIES OR P OSSESSIONS, PUERTO 2
197+RICO, OR CANADA THAT HAS STAND ARDS FOR GRADUATION EQUIVALENT TO THOSE 3
198+ESTABLISHED BY THE AMERICAN OSTEOPATHIC ASSOCIATION; AND 4
204199
205- SECTION 2. AND BE IT FURTHER ENACTED, That this Act is an emergency
206-measure, is necessary for the immediate preservation of the public health or safety, has
207-been passed by a yea and nay vote supported by three–fifths of all the members elected to
208-each of the two Houses of the General Assembly, and shall take effect from the date it is
209-enacted.
200+ 2. HAS PASSED PARTS 1 AND 2 OF THE UNITED STATES 5
201+MEDICAL LICENSING EXAMINATION. 6
210202
211-Approved by the Governor, April 25, 2024.
203+ (2) IN SUBJECT TO PARAGRAPH (3) OF THIS SUBSECTION A ND IN 7
204+ACCORDANCE WITH REGU LATIONS ADOPTED BY T HE BOARD, A SUPERVISED 8
205+MEDICAL GRADUATE MAY PERFORM DELEGATED DU TIES UNDER DIRECT 9
206+SUPERVISION. 10
207+
208+ (3) AN INDIVIDUAL MAY NOT PRACTICE AS A SUPERV ISED MEDICAL 11
209+GRADUATE FOR A PERIO D OF MORE THAN 2 YEARS. 12
210+
211+ (4) FOR THE PURPOSES OF T HIS SUBSECTION , A DELEGATING 13
212+PHYSICIAN IS NOT REQ UIRED TO BE IN THE P RESENCE OF A PATIENT AND A 14
213+SUPERVISED MEDICAL G RADUATE DURING THE C OMPLETION OF A DELEG ATED 15
214+DUTY. 16
215+
216+Chapter 445 of the Acts of 2019 17
217+
218+ SECTION 4. AND BE IT FURTHER ENACTED, That this Act shall take effect 18
219+October 1, 2019. [It shall remain effective for a period of 5 years and, at the end of 19
220+September 30, 2024, this Act, with no further action required by the General Assembly, 20
221+shall be abrogated and of no further force and effect.] 21
222+
223+ SECTION 2. AND BE IT FURTHER ENACTED, That this Act is an emergency 22
224+measure, is necessary for the immediate preservation of the public health or safety, has 23
225+been passed by a yea and nay vote supported by three–fifths of all the members elected to 24
226+each of the two Houses of the General Assembly, and shall take effect from the date it is 25
227+enacted. 26
228+
229+
230+