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.
*sb0059*
SENATE BILL 59
J1, J3, O4 4lr1355
(PRE–FILED)
By: Senator Ellis Senators Ellis, McCray, Beidle, Gile, Hayes, Klausmeier, Kramer,
Lam, Ready, and A. Washington
Requested: October 31, 2023
Introduced and read first time: January 10, 2024
Assigned to: Finance
Committee Report: Favorable with amendments
Senate action: Adopted
Read second time: March 2, 2024
CHAPTER ______
AN ACT concerning 1
Safe Sleep for Infants – Awareness and Certification 2
Hospitals – Care of Infants After Discharge 3
(Safe Sleep Act of 2024) 4
FOR the purpose of requiring the Maryland Department of Health to develop and 5
implement a public awareness campaign to promote education regarding safe sleep 6
for infants; establishing the Maryland Safe Sleep Certification Program and 7
requiring child care centers to be certified by the Program; requiring hospitals and 8
freestanding birthing centers to be certified by a certain safe sleep certification 9
program; and generally relating to safe sleep for infants a hospital to take certain 10
actions relating to the care of infants as soon as practicable before the hospital 11
discharges an infant after the birth of the infant, including providing oral and 12
written educational resources to the parent or legal guardian on how to provide a 13
safe sleep environment and providing a list of resources available for an infant’s 14
parent or legal guardian; requiring a hospital, on or before a certain date each year, 15
to establish a process for providing certain educational resources and confirming 16
receipt of the resources; requiring the Maryland Department of Health to develop a 17
list of resources available for an infant’s parent or legal guardian; and generally 18
relating to the care of infants after discharge from a hospital. 19
BY adding to 20
Article – Health – General 21 2 SENATE BILL 59
Section 13–5201 through 13–5203 to be under the new subtitle “Subtitle 52. Safe 1
Sleep Certification Program”; 19–310.4 and 19–3B–03.1; and 20–2401 to be 2
under the new subtitle “Subtitle 24. Safe Sleep for Infants Public Awareness” 3
19–308.10 4
Annotated Code of Maryland 5
(2023 Replacement Volume) 6
BY repealing and reenacting, without amendments, 7
Article – Education 8
Section 9.5–401(a) and (c) 9
Annotated Code of Maryland 10
(2022 Replacement Volume and 2023 Supplement) 11
BY adding to 12
Article – Education 13
Section 9.5–405(g) 14
Annotated Code of Maryland 15
(2022 Replacement Volume and 2023 Supplement) 16
BY repealing and reenacting, with amendments, 17
Article – Education 18
Section 9.5–418 19
Annotated Code of Maryland 20
(2022 Replacement Volume and 2023 Supplement) 21
BY repealing and reenacting, without amendments, 22
Article – Health – General 23
Section 19–301(a) and (f) and 19–3B–01(a) and (d) 24
Annotated Code of Maryland 25
(2023 Replacement Volume) 26
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 27
That the Laws of Maryland read as follows: 28
Article – Health – General 29
19–308.10. 30
(A) IN THIS SECTION, “SAFE SLEEP ENVIRONME NT” MEANS, AS DESCRIBED 31
IN THE MOST RECENT AMERICAN ACADEMY OF PEDIATRICS POLICY STA TEMENTS, 32
AN ENVIRONMENT IN WH ICH A NEWBORN MAY SL EEP THAT REDUCES THE RISK OF 33
SLEEP–RELATED INFANT DEATH S, INCLUDING THROUGH : 34
(1) THE USE OF SUPINE POS ITIONING; 35
(2) THE USE OF A FIRM, FLAT SLEEP SURFACE ; 36 SENATE BILL 59 3
(3) THE USE OF ROOM SHARI NG WITHOUT BED SHARI NG; 1
(4) THE AVOIDANCE OF SOFT BEDDING AND OVERHEAT ING; AND 2
(5) THE AVOIDANCE OF EXPO SURE TO SMOKE . 3
(B) (1) AS SOON AS PRACTICABL E BEFORE A HOSPITAL DISCHARGES AN 4
INFANT AFTER THE BIRTH OF THE INFANT , THE HOSPITAL SHALL P ROVIDE ORAL 5
AND WRITTEN EDUCATIO NAL RESOURCES TO THE PARENT OR LEGAL GUAR DIAN ON 6
HOW TO PROVIDE A SAF E SLEEP ENVIRONMENT . 7
(2) THE ORAL AND WRITTEN EDUCATIONAL RESOURCE S REQUIRED 8
UNDER PARAGRAPH (1) OF THIS SUBSECTION M AY BE SUPPLEMENTED B Y AN 9
EDUCATIONAL VIDEO. 10
(C) (1) AS SOON AS PRACTICABL E BEFORE DISCHARGING AN INFAN T 11
AFTER THE BIRTH OF T HE INFANT, A HOSPITAL SHALL : 12
(I) ASK THE INFANT ’S PARENT OR LEGAL GU ARDIAN TO 13
DESCRIBE THE SLEEP ENVIRONMENT THAT THE PARENT OR LEGAL GUAR DIAN WILL 14
PROVIDE AT HOME ; 15
(II) INFORM THE PARENT OR LEGAL GUARDIAN OF TH E 16
IMPORTANCE OF ENSURI NG THAT THE INFANT H AS A SAFE SLEEP ENVI RONMENT 17
AND THE RISKS OF SUF FOCATION AND SUDDEN INFANT DEATH IN UNSA FE SLEEP 18
ENVIRONMENTS ; AND 19
(III) DOCUMENT THAT THE EDU CATIONAL RESOURCES 20
DESCRIBED UNDER SUBSECTION (B) OF THIS SECTION AND THE INFORMATION 21
DESCRIBED UNDER ITEM (II) OF THIS PARAGRAPH WE RE PROVIDED TO THE P ARENT 22
OR LEGAL GUARDIAN . 23
(2) THE HOSPITAL SHALL PROVIDE A LIST OF RE SOURCES AVAILABLE 24
FOR THE PARENT OR LE GAL GUARDIAN TO OBTA IN THE ITEMS NECESSA RY TO 25
PROVIDE A SAFE SLEEP ENVIRONMENT FOR THE INFANT. 26
(D) ON OR BEFORE JANUARY 1, 2025, EACH HOSPITAL SHALL ESTABLISH A 27
PROCESS FOR: 28
(1) PROVIDING EACH PARENT OR LEGAL GUAR DIAN WITH: 29
(I) ORAL AND WRITTEN EDUC ATIONAL RESOURCES AS 30
REQUIRED UNDER SUBSE CTION (B) OF THIS SECTION; AND 31 4 SENATE BILL 59
(II) THE INFORMATION DESCR IBED UNDER SUBSECTIO N 1
(C)(1)(II) OF THIS SECTION; 2
(2) A PARENT OR LEGAL GUAR DIAN TO CONFIR M THE RECEIPT OF 3
THE EDUCATIONAL RESO URCES PROVIDED UNDER SUBSECTION (B) OF THIS 4
SECTION; AND 5
(3) MAINTAINING RECORDS O F CONFIRMATIONS MADE UNDER ITEM 6
(2) OF THIS SUBSECTION . 7
(E) (1) ON OR BEFORE JANUARY 1, 2025, THE DEPARTMENT , IN 8
CONSULTATION WITH LOCAL HEALTH OFFICER S, SHALL DEVELOP FOR 9
DISTRIBUTION TO BIRT HING PARENTS AND LEG AL GUARDIANS A LIST OF 10
RESOURCES AVAILABLE BY COUNTY TO OBTAIN THE ITEMS NECESSARY TO PROVIDE 11
A SAFE SLEEP ENVIRON MENT FOR AN INFANT . 12
(2) EACH LOCAL HEALTH DEP ARTMENT SHALL PROVIDE AN UPDATED 13
LIST OF RESOURCES TO THE DEPARTMENT EACH YEAR TO ASSIST THE DEPARTMENT 14
IN DEVELOPING THE LI ST OF RESOURCES REQU IRED UNDER PARAGRAPH (1) OF 15
THIS SUBSECTION . 16
SUBTITLE 24. SAFE SLEEP FOR INFANTS PUBLIC AWARENESS. 17
20–2401. 18
(A) THE DEPARTMENT SHALL DEVE LOP AND IMPLEMENT A PUBLIC 19
AWARENESS CAMPAIGN T O PROMOTE EDUCATION REGARDING SAFE SLEEP FOR 20
INFANTS. 21
(B) TO IMPLEMENT THE PUBL IC AWARENESS CAMPAIG N, THE 22
DEPARTMENT SHALL : 23
(1) REACH OUT TO THE GENE RAL PUBLIC AND SPECI FIC 24
POPULATIONS DETERMIN ED TO BE AT HIGH RIS K FOR SUDDEN UNEXPEC TED INFANT 25
DEATH OR SUDDEN INFANT DEATH SYNDROME AND MOST IN NEED OF EDUCATION 26
REGARDING SAFE SLEEP FOR INFANTS; 27
(2) DISSEMINATE PLAIN –LANGUAGE MESSAGING T HROUGH VARIOUS 28
MEDIA AND MODES OF C OMMUNICATION; 29
(3) COLLABORATE WITH THE DEPARTMENT OF HUMAN SERVICES TO 30
PROMOTE BEST PRACTIC ES AND EDUCATION FOR PARENTS, GUARDIANS, AND 31
OTHER CAREGIVERS OF INFANTS; 32 SENATE BILL 59 5
(4) PLACE EDUCATIONAL MAT ERIALS IN RELEVANT H EALTH CARE 1
FACILITIES, INCLUDING LABOR AND DELIVERY UNITS IN HO SPITALS AND BIRTHING 2
CENTERS; AND 3
(5) PARTNER WITH LOCAL HE ALTH DEPARTMENTS , HEALTH CARE 4
PROVIDERS, INSTITUTIONS OF HIGH ER EDUCATION , NONPROFIT ORGANIZATI ONS, 5
AND OTHER RELEVANT E NTITIES. 6
SECTION 2. AND BE IT FURTHER ENACTED, That the Laws of Maryland read 7
as follows: 8
Article – Education 9
9.5–401. 10
(a) In this subtitle the following words have the meanings indicated. 11
(c) (1) “Child care center” means an agency, institution, or establishment that, 12
for part or all of a day, or on a 24–hour basis on a regular schedule, and at least twice a 13
week, offers or provides child care to children who do not have the same parentage except 14
as otherwise provided for in law or regulation. 15
(2) “Child care center” shall include a nonpublic nursery school in which 16
an instructional program is offered or provided for children who are under the age of 5 17
years. 18
(3) “Child care center” does not include: 19
(i) A nonpublic kindergarten in which an instructional program is 20
offered or provided for children who are at least 5 years old; 21
(ii) A nonpublic elementary school in which an instructional 22
program is offered or provided for children who are in grades 1 through 8; 23
(iii) A child care home, a child care institution, or other child care 24
facility that offers or provides a residential placement for a child and is established, 25
licensed, or registered under this title, Title 9 of the Human Services Article, or Title 10 of 26
the Health – General Article; or 27
(iv) A family child care home or large family child care home that is 28
required to be registered or is registered under this title. 29
9.5–405. 30
6 SENATE BILL 59
(G) (1) A CHILD CARE CENTER SH ALL BE CERTIFIED BY THE MARYLAND 1
SAFE SLEEP CERTIFICATION PROGRAM. 2
(2) A CHILD CARE CENTER CE RTIFIED BY THE MARYLAND SAFE 3
SLEEP CERTIFICATION PROGRAM SHALL SUBMIT PROOF OF THE CERTIFI CATION TO 4
THE PROGRAM AND THE DEPARTMENT . 5
9.5–418. 6
(a) Except as provided in subsection (b) of this section and subject to the 7
provisions of subsection (d) of this section, a person who violates any provision of this 8
subtitle or any rule or regulation adopted under this subtitle is subject to a civil penalty 9
imposed in a civil action not exceeding $1,000 for each violation. 10
(b) A person who violates § 9.5–405(a), [or] (e), OR (G) or § 9.5–416 of this subtitle 11
and is served a civil citation under that section is subject to a civil penalty as follows: 12
(1) $250 for the first violation; 13
(2) $500 for the second violation; and 14
(3) $1,000 for the third and each subsequent violation. 15
(c) Each day a violation occurs is a separate violation under this section. 16
(d) The total amount of civil penalties imposed in an action under this section 17
may not exceed $5,000. 18
Article – Health – General 19
SUBTITLE 52. SAFE SLEEP CERTIFICATION PROGRAM. 20
13–5201. 21
(A) IN THIS SUBTITLE THE FOLLOWING WORDS HAVE THE MEANINGS 22
INDICATED. 23
(B) “CHILD CARE CENTER ” HAS THE MEANING STAT ED IN § 9.5–401 OF THE 24
EDUCATION ARTICLE. 25
(C) “PROGRAM” MEANS THE MARYLAND SAFE SLEEP CERTIFICATION 26
PROGRAM. 27
(D) “SAFE SLEEP BEST PRACT ICES” MEANS BEST PRACTICES FOR KEEPING 28
AN INFANT SAFE AND H EALTHY WHILE THE INF ANT IS SLEEPING, THOUGHT TO BE 29
SLEEPING, OR IN A SLEEPING ARE A. 30 SENATE BILL 59 7
13–5202. 1
(A) THERE IS A MARYLAND SAFE SLEEP CERTIFICATION PROGRAM WITHIN 2
THE DEPARTMENT . 3
(B) THE DEPARTMENT SHALL ADMI NISTER THE PROGRAM. 4
(C) (1) THE PROGRAM, IN COLLABORATION WIT H CRIBS FOR KIDS, 5
SHALL ESTABLISH CERT IFICATION STANDARDS FOR CHILD CARE CENTE RS THAT 6
ARE IN ACCORDANCE WI TH SAFE SLEEP BEST P RACTICES. 7
(2) THE PROGRAM SHALL : 8
(I) CERTIFY A CHILD CARE CENTER THAT DEMONSTR ATES 9
COMPLIANCE WITH THE CERTIFICATION STANDA RDS ESTABLISHED BY T HE 10
PROGRAM UNDER PARAGRA PH (1) OF THIS SUBSECTION ; AND 11
(II) RETAIN A COPY OF EACH CERTIFICATION . 12
(D) THE PROGRAM SHALL EVALUAT E CHILD CARE CENTERS FOR 13
COMPLIANCE WITH SAFE SLEEP BEST PRACTICES . 14
(E) THE PROGRAM SHALL PROVIDE RESOURCES TO HELP CH ILD CARE 15
CENTERS ADOPT AND MA INTAIN SAFE SLEEP BE ST PRACTICES. 16
13–5203. 17
THE DEPARTMENT SHALL ADOP T REGULATIONS TO CAR RY OUT THIS 18
SUBTITLE. 19
19–301. 20
(a) In this subtitle the following words have the meanings indicated. 21
(f) “Hospital” means an institution that: 22
(1) Has a group of at least 5 physicians who are organized as a medical 23
staff for the institution; 24
(2) Maintains facilities to provide, under the supervision of the medical 25
staff, diagnostic and treatment services for 2 or more unrelated individuals; and 26
(3) Admits or retains the individuals for overnight care. 27
8 SENATE BILL 59
19–310.4. 1
(A) A HOSPITAL SHALL BE CE RTIFIED BY THE CRIBS FOR KIDS’ NATIONAL 2
SAFE SLEEP HOSPITAL CERTIFICATION PROGRAM AT LEAST AT THE BRON ZE 3
LEVEL. 4
(B) A HOSPITAL CERTIFIED B Y THE CRIBS FOR KIDS’ NATIONAL SAFE 5
SLEEP HOSPITAL CERTIFICATION PROGRAM SHALL SUBMIT PROOF O F THE 6
CERTIFICATION TO THE SECRETARY. 7
19–3B–01. 8
(a) In this subtitle the following words have the meanings indicated. 9
(d) (1) “Freestanding birthing center” means a facility that provides nurse 10
midwife services under Title 8, Subtitle 6 of the Health Occupations Article. 11
(2) “Freestanding birthing center” does not include: 12
(i) A hospital regulated under Subtitle 2 of this title; or 13
(ii) The private residence of the mother. 14
19–3B–03.1. 15
(A) A FREESTANDING BIRTHIN G CENTER SHALL BE CE RTIFIED BY THE 16
CRIBS FOR KIDS’ NATIONAL SAFE SLEEP HOSPITAL CERTIFICATION PROGRAM AT 17
LEAST AT THE BRONZE LEVEL. 18
(B) A FREESTANDING BIRTHIN G CENTER CERTIFIED B Y THE CRIBS FOR 19
KIDS’ NATIONAL SAFE SLEEP HOSPITAL CERTIFICATION PROGRAM SHALL SUBMIT 20
PROOF OF THE CERTIFI CATION TO THE SECRETARY. 21
SECTION 3. AND BE IT FURTHER ENACTED, That Section 2 of this Act shall take 22
effect October 1, 2025. 23
SECTION 4. 2. AND BE IT FURTHER ENACTED, That , except as provided in 24
Section 3 of this Act, this Act shall take effect October 1, 2024. 25