EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
*sb0999*
SENATE BILL 999
J2 4lr2458
SB 370/23 – FIN CF HB 1125
By: Senator Beidle
Introduced and read first time: February 2, 2024
Assigned to: Finance
A BILL ENTITLED
AN ACT concerning 1
Certified Nursing Assistants – Licensing Requirements and Administrative 2
Updates 3
FOR the purpose of exempting an individual who practices as a certain nursing assistant 4
for less than a certain number of months under federal regulations from the State’s 5
certification requirement; altering the designation of, and licensure requirements 6
for, certified nursing assistants and geriatric nursing assistants; requiring an 7
applicant for certification as a certified nursing assistant to complete a nursing 8
assistant competency evaluation; authorizing an approved acute care nursing 9
assistant training program to request a waiver of certain federal requirements; and 10
generally relating to the licensing of certified nursing assistants. 11
BY repealing and reenacting, with amendments, 12
Article – Health – General 13
Section 19–1410(b)(2)(vi), 19–1410.2, and 24–1901(e) 14
Annotated Code of Maryland 15
(2023 Replacement Volume) 16
BY repealing and reenacting, without amendments, 17
Article – Health – General 18
Section 24–1901(a) 19
Annotated Code of Maryland 20
(2023 Replacement Volume) 21
BY repealing and reenacting, with amendments, 22
Article – Health Occupations 23
Section 8–6A–01, 8–6A–02(b) and (c), 8–6A–05, 8–6A–07(b) and (c), 8–6A–08(c) and 24
(n), 8–6A–14, 8–701(c), and 8–703(a)(6) and (7) 25
Annotated Code of Maryland 26
(2021 Replacement Volume and 2023 Supplement) 27
2 SENATE BILL 999
BY repealing and reenacting, without amendments, 1
Article – Health Occupations 2
Section 8–6A–02(a) and 8–6A–07(a) 3
Annotated Code of Maryland 4
(2021 Replacement Volume and 2023 Supplement) 5
BY repealing 6
Article – Health Occupations 7
Section 8–703(a)(5) 8
Annotated Code of Maryland 9
(2021 Replacement Volume and 2023 Supplement) 10
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 11
That the Laws of Maryland read as follows: 12
Article – Health – General 13
19–1410. 14
(b) (2) Each nursing home shall establish a quality assurance committee and 15
shall include at least the following members: 16
(vi) A [geriatric] CERTIFIED nursing [assistant] ASSISTANT–I. 17
19–1410.2. 18
(a) In this section, “workplace safety” means the prevention of any physical 19
assault or threatening behavior against an employee in a nursing home. 20
(b) This section applies to nursing homes that are licensed for 45 beds or more. 21
(c) Each nursing home shall assign to an appropriate committee the task of: 22
(1) Conducting an annual assessment of workplace safety issues; and 23
(2) Making recommendations to the nursing home for reducing workplace 24
injuries. 25
(d) In conducting an annual assessment of workplace safety issues, the committee 26
assigned to conduct the assessment under subsection (c)(1) of this section shall consult with 27
[geriatric] CERTIFIED nursing assistants and other employees of the nursing home who 28
are involved in assisting residents with activities of daily living. 29
24–1901. 30
(a) In this subtitle the following words have the meanings indicated. 31
SENATE BILL 999 3
(e) “Nursing support staff” includes: 1
(1) A certified medication technician, as defined in [§ 8–6A–01(j)] § 2
8–6A–01 of the Health Occupations Article; 3
(2) A certified medicine aide, as defined in [§ 8–6A–01(k)] § 8–6A–01 of 4
the Health Occupations Article; AND 5
(3) A certified nursing assistant, as defined in [§ 8–6A–01(l)] § 8–6A–01 6
of the Health Occupations Article[; and 7
(4) A geriatric nursing assistant, as defined in § 8–6A–01(o) of the Health 8
Occupations Article]. 9
Article – Health Occupations 10
8–6A–01. 11
(a) In this subtitle the following words have the meanings indicated. 12
(b) “Applicant” means, unless the context requires otherwise: 13
(1) An individual applying for an initial certificate by examination or 14
endorsement; 15
(2) A certificate holder applying for renewal of a certificate; or 16
(3) An individual applying for reinstatement of a certificate in accordance 17
with § 8–6A–10 of this subtitle. 18
(C) “APPROVED ACUTE CARE N URSING ASSISTANT TRA INING PROGRAM ” 19
MEANS A COURSE OF TR AINING THAT MEETS TH E ACUTE CARE NURSING ASSISTANT 20
CURRICULUM APPROVED BY THE BOARD. 21
[(c)] (D) (1) “Approved dialysis technician training program” means a course 22
of training approved by the Board that: 23
(i) Prepares the applicant for national certification; 24
(ii) Meets the requirements of 42 C.F.R. § 494.140(e)(3); and 25
(iii) Meets the requirements set by the Board in regulation. 26
(2) “Approved dialysis technician training program” includes the courses 27
required for national certification as: 28
4 SENATE BILL 999
(i) A Certified Clinical Hemodialysis Technician by the Nephrology 1
Nursing Certification Commission; 2
(ii) A Clinical Nephrology Technician by the National Nephrology 3
Certification Organization; or 4
(iii) A Certified Hemodialysis Technician by the Board of Nephrology 5
Examiners Nursing Technology. 6
[(d)] (E) “Approved medication technician training program” means a course of 7
training approved by the Board that meets the basic medication technician core curriculum 8
and the medication technician content training specific to the setting in which the 9
medication technician will work. 10
[(e)] (F) “Approved nursing assistant training program” means a course of 11
training that [meets]: 12
(1) MEETS the [basic nursing assistant curriculum prescribed and] 13
REQUIREMENTS UNDER F EDERAL AND STATE LAW; AND 14
(2) IS approved by the Board. 15
[(f)] (G) “Board” means the State Board of Nursing. 16
[(g)] (H) “Certificate” means a certificate issued by the Board to practice as a 17
certified nursing assistant, a certified dialysis technician, or a certified medication 18
technician in the State. 19
[(h)] (I) “Certificate holder” means a certified nursing assistant, dialysis 20
technician, or medication technician who has: 21
(1) An active certificate; 22
(2) An inactive certificate; 23
(3) A temporary certificate; 24
(4) An expired temporary certificate; 25
(5) An expired certificate; 26
(6) A lapsed certificate; 27
(7) A suspended certificate; or 28
(8) A certificate subject to a reprimand, probation, or suspension. 29 SENATE BILL 999 5
[(i)] (J) “Certified dialysis technician” means an individual who: 1
(1) Has completed a Board–approved dialysis technician program; and 2
(2) Is certified by the Board as a dialysis technician. 3
[(j)] (K) “Certified medication technician” means an individual who: 4
(1) Has completed a Board–approved medication technician training 5
program; 6
(2) Is certified by the Board as a medication technician; and 7
(3) Subject to regulations adopted by the Board, routinely performs: 8
(i) Nursing tasks related to the administration of medication, 9
delegated by a registered nurse, licensed practical nurse, or advanced practice nurse; or 10
(ii) Technical tasks related to the administration of medication 11
delegated by a licensed certified midwife. 12
[(k)] (L) “Certified medicine aide” means a certified nursing assistant who [has]: 13
(1) HAS completed a Board –approved course in medication 14
administration; AND 15
(2) IS CERTIFIED AS A MED ICINE AIDE BY THE BOARD. 16
[(l)] (M) (1) “Certified nursing assistant”[: 17
(1) Means] MEANS an individual regardless of title who, for compensation 18
and subject to regulations adopted by the Board, routinely performs: 19
(i) Nursing tasks delegated by a registered nurse, licensed practical 20
nurse, or advanced practice registered nurse; or 21
(ii) Technical tasks delegated by a licensed certified midwife[; and]. 22
(2) [Does] “CERTIFIED NURSING ASS ISTANT” DOES not include a 23
certified dialysis technician or a certified medication technician. 24
(N) (1) “CERTIFIED NURSING ASS ISTANT–I” MEANS A CERTIFIED 25
NURSING ASSISTANT WH O MEETS THE REQUIREM ENTS SET BY THE BOARD AND 26
UNDER FEDERAL LAW TO PRACTICE IN ANY SETT ING. 27
6 SENATE BILL 999
(2) “CERTIFIED NURSING ASS ISTANT–I” INCLUDES: 1
(I) A CERTIFIED NURSING AS SISTANT WHO WAS CERT IFIED AS 2
A GERIATRIC NURSING ASSISTANT ON MAY 31, 2024; 3
(II) A CERTIFIED MEDICINE A IDE; AND 4
(III) A CERTIFIED NURSING AS SISTANT WHO IS APPRO VED 5
UNDER § 8–6A–05(C)(5) OF THIS SUBTITLE. 6
(O) “CERTIFIED NURSING ASS ISTANT–II” MEANS A CERTIFIED NU RSING 7
ASSISTANT: 8
(1) WHO, ON MAY 31, 2024, WAS CERTIFIED AS A N URSING ASSISTANT 9
AND WAS NOT AUTHORIZ ED TO PRACTICE IN A NURSING FACILITY OR SKILLED 10
NURSING FAC ILITY; AND 11
(2) WHOSE AUTHORITY TO PR ACTICE IN A NURSING FACILITY OR 12
SKILLED NURSING FACI LITY CONTINUES TO BE RESTRICTED BECAUSE T HE 13
CERTIFIED NURSING AS SISTANT HAS NOT BEEN APPROVED AS A CERTIF IED 14
NURSING ASSISTANT –I UNDER § 8–6A–05(C)(5) OF THIS SUBTITLE. 15
[(m)] (P) “Department” means the Maryland Department of Health. 16
[(n)] (Q) “Expired certificate” means a certificate that was not renewed before 17
the expiration date of the certificate as established under § 8–6A–08(a) of this title. 18
[(o) “Geriatric nursing assistant” means a certified nursing assistant who has 19
successfully completed the requirements for geriatric nursing assistant mandated under 20
federal law and the regulations of the Board.] 21
[(p)] (R) “Lapsed certificate” means a certificate that was not renewed because 22
a certificate holder failed to renew the certificate or otherwise did not meet the renewal 23
requirements of this subtitle. 24
(S) “NURSING ASSISTANT COM PETENCY EVALUATION ” MEANS AN 25
EXAMINATION APPROVED BY THE BOARD THAT: 26
(1) DETERMINES THE COMPETENCY OF THE INDIVIDUAL TO 27
PRACTICE AS A CERTIF IED NURSING ASSISTAN T–I; AND 28
(2) MEETS THE REQUIREMENT S UNDER FEDERAL LAW . 29
8–6A–02. 30 SENATE BILL 999 7
(a) Subject to subsection (f) of this section and except as otherwise provided in 1
this subtitle, an individual shall be certified by the Board to practice as a nursing assistant, 2
dialysis technician, or medication technician before the individual may practice as a 3
nursing assistant, dialysis technician, or medication technician in the State. 4
(b) This subtitle does not apply to an individual who: 5
(1) Practices a health occupation that the individual is authorized to 6
practice under this article; 7
(2) Provides for the gratuitous care of friends, domestic partners, or family 8
members; 9
(3) Performs nursing assistant tasks while a nursing student enrolled in 10
an accredited nursing program and practicing under the direct supervision of qualified 11
faculty or preceptors; 12
(4) Performs nursing assistant tasks as a student while[: 13
(i) Enrolled in a Board–approved nursing assistant training 14
program; and 15
(ii) Practicing under the direct supervision of qualified faculty or 16
preceptors] ENROLLED IN AN ACCRE DITED NURSING PROGRA M AFTER THE 17
SUCCESSFUL COMPLETIO N OF A PORTION OF AN APPROVED NURSING EDU CATION 18
PROGRAM THAT THE BOARD DETERMINES MEET S THE REQUIREMENTS O F AN 19
APPROVED NURSING ASS ISTANT TRAINING PROG RAM OR MEDICATION 20
ADMINISTRATION COURS E; 21
(5) Performs medication technician tasks as a student while practicing 22
under the direct supervision of qualified faculty; 23
(6) Performs dialysis technician tasks as a student while under the direct 24
supervision of qualified faculty; [or] 25
(7) Works as a principal or school secretary, does not administer 26
medication as a routine part of the position, and has completed training by the delegating 27
nurse for the occasion where the individual may need to administer medication in the 28
absence of the nurse or medication technician; OR 29
(8) PRACTICES AS A CERTIF IED NURSING ASSISTAN T–I FOR LESS 30
THAN 4 MONTHS IN ACCORD ANCE WITH 42 C.F.R. § 483.35(D). 31
(c) [Nothing in this section shall] THIS SECTION DOES NOT preclude a 32
registered nurse or licensed practical nurse from delegating a nursing or other technical 33 8 SENATE BILL 999
task to an unlicensed individual [provided that acceptance of delegated nursing or other 1
technical tasks does not become a routine part of the unlicensed individual’s job duties]. 2
8–6A–05. 3
(a) The Board, IN COLLABORATION WIT H RELEVANT STAKEHOLD ERS, shall 4
adopt regulations establishing: 5
(1) [Categories of certified nursing assistants, including geriatric nursing 6
assistants, home health aides, school health aides, individuals working in developmental 7
disabilities administration facilities, and medicine aides; 8
(2)] Qualifications for [each category of] certified nursing [assistant] 9
ASSISTANTS, INCLUDING CERTIFIED MEDICINE AIDES ; 10
[(3)] (2) Qualifications for certified dialysis technicians; 11
[(4)] (3) Qualifications for certified medication technicians; 12
[(5)] (4) Standards for qualification of applicants for certification, 13
including the applicant’s criminal history, work record, and prohibitions against behavior 14
which may be potentially harmful to patients; and 15
[(6)] (5) Standards for the online provision of didactic instruction in a 16
nursing assistant training program that meets the requirements established by the Board. 17
(b) (1) To qualify for certification as a nursing assistant, a [nursing assistant 18
in a specific category] CERTIFIED MEDICINE A IDE, a dialysis technician, or a medication 19
technician, an applicant shall meet the requirements set by the Board. 20
(2) Requirements set by the Board under paragraph (1) of this subsection 21
regarding qualifications for certification as a [geriatric nursing assistant] CERTIFIED 22
NURSING ASSISTANT –I shall include provisions to allow an individual who has been 23
practicing as a temporary nursing assistant, in accordance with the waiver of the 24
requirements of 42 C.F.R. § 483.35(d) issued by the Centers for Medicare and Medicaid 25
Services on March 6, 2020, to apply on–the–job experience as a nursing assistant toward 26
the total number of training hours required for certification as a [geriatric nursing 27
assistant] CERTIFIED NURSING AS SISTANT–I. 28
(c) (1) An applicant for a certificate shall: 29
(i) Submit an application to the Board on the form that the Board 30
requires; 31
(ii) Provide evidence, as required by the Board, of successful 32
completion of: 33 SENATE BILL 999 9
1. An approved nursing assistant training program OR 1
APPROVED ACUTE CARE NURSING ASSISTANT TR AINING PROGRAM ; 2
2. An approved dialysis technician training program; 3
3. An approved course in medication administration; or 4
4. A portion of an approved nursing education program that 5
the Board determines meets the requirements of [a] AN APPROVED nursing assistant 6
training program or medication administration course; 7
(iii) Pay to the Board an application fee set by the Board; 8
(iv) Be of good moral character; 9
(v) Be at least 16 years old to apply for certification as a nursing 10
assistant; 11
(vi) Be at least 18 years old to apply for certification as a dialysis 12
technician; and 13
(vii) Be at least 18 years old to apply for certification as a medication 14
technician. 15
(2) Subject to paragraph (1) of this subsection, an applicant for certification 16
as a certified nursing assistant or dialysis technician shall submit to the Board: 17
(i) A criminal history records check in accordance with § 8–303 of 18
this title and § 8–6A–08(k) of this subtitle; and 19
(ii) On the form required by the Board, written, verified evidence 20
that the requirement of item (i) of this paragraph is being met or has been met. 21
[(3) An applicant for certification as a certified medicine aide, in addition to 22
the requirements under paragraph (1) of this subsection, shall submit an additional 23
application to that effect to the Board on the form that the Board requires.] 24
(3) (I) AN APPLICANT FOR CERT IFICATION AS A CERTI FIED 25
NURSING ASSISTANT SH ALL SUBMIT TO THE BOARD SATISFACTORY EV IDENCE OF 26
PASSING A NURSING AS SISTANT COMPETENCY E VALUATION. 27
(II) AN APPLICANT WHO HAS COMPLETED AN APPROVE D ACUTE 28
CARE NURSING ASSISTA NT TRAINING PROGRAM SHALL BE DEEMED TO H AVE 29
FULFILLED THE CLASSR OOM AND CLINICAL STA NDARDS TO SIT FOR TH E NURSING 30
ASSISTANT COMPETENCY EVALUATION. 31 10 SENATE BILL 999
(4) An applicant for a certificate may not: 1
(i) Have committed any act or omission that would be grounds for 2
discipline or denial of certification under this subtitle; and 3
(ii) Have a record of abuse, negligence, misappropriation of a 4
resident’s property, or any disciplinary action taken or pending in any other state or 5
territory of the United States against the certification of the nursing assistant or 6
medication technician in the state or territory. 7
(5) BEGINNING JUNE 1, 2024, A CERTIFIED NURSING ASSISTANT–II 8
MAY BE CERTIFIED AS A CERTIFIED NURSING ASSISTANT–I BY: 9
(I) SUBMITTING AN APPLICA TION TO THE BOARD ON THE 10
FORM THAT THE BOARD REQUIRES ; AND 11
(II) PROVIDING SATISFACTOR Y EVIDENCE OF: 12
1. SUCCESSFUL COMPLETION OF AN APPROVED 13
NURSING ASSI STANT TRAINING PROGR AM; AND 14
2. PASSING A NURSING ASS ISTANT COMPETENCY 15
EVALUATION. 16
8–6A–07. 17
(a) Subject to subsection (f) of this section, the Board shall certify any applicant 18
who meets the requirements of this subtitle. 19
(b) (1) The Board shall: 20
(i) Issue each new certified nursing assistant, dialysis technician, or 21
medication technician a certificate number and [registration] certificate that indicates the 22
initial certificate was issued by the Board; and 23
(ii) Electronically record each certificate in the Board’s database and 24
on the Board’s website. 25
(2) Each certificate shall include: 26
(i) Any expiration date; 27
(ii) The type of certificate; and 28
(iii) Any specific category of nursing assistant. 29 SENATE BILL 999 11
(c) An individual who has met the requirements for a certified nursing assistant 1
ON OR AFTER JUNE 1, 2024, shall be certified with the title of “certified nursing 2
[assistant”] ASSISTANT–I”. 3
8–6A–08. 4
(c) Before a certificate expires, a CERTIFIED nursing assistant periodically may 5
renew it for an additional term, if the certificate holder: 6
(1) Otherwise is entitled to be certified; 7
(2) Submits to the Board a renewal application on the form that the Board 8
requires; 9
(3) Pays to the Board a renewal fee set by the Board; and 10
(4) Provides satisfactory evidence of [completion of]: 11
(i) COMPLETION OF 16 hours of active CERTIFIED nursing 12
assistant practice within the 2–year period immediately preceding the date of expiration; 13
or 14
(ii) If the CERTIFIED nursing assistant did not complete 16 hours of 15
active practice as required under item (i) of this item, [an approved nursing assistant 16
training program or an approved nursing assistant refresher training program] as required 17
in regulations adopted by the Board in accordance with subsection (m) of this section: 18
1. SUCCESSFUL COMPLETION OF AN APPROVED 19
NURSING ASSISTANT TR AINING PROGRAM ; OR 20
2. PASSING A NURSING ASS ISTANT COMPETENCY 21
EVALUATION . 22
(n) (1) The Board, IN CONSULTATION WITH RELEVANT STAKEHOLDER S, 23
shall adopt regulations to specify[: 24
(i) The] THE circumstances under which a nursing assistant, as a 25
condition of renewal, is required to complete [either] an approved nursing assistant 26
training program or [an approved nursing assistant refresher training program; and 27
(ii) The number of didactic instruction hours and clinical training 28
hours the nursing assistant training program or nursing assistant refresher training 29
program must have to be approved] PASS A NURSING ASSIS TANT COMPETENCY 30
EXAMINATION . 31 12 SENATE BILL 999
(2) Regulations adopted under paragraph (1) of this subsection must be 1
consistent with federal law. 2
8–6A–14. 3
(a) The Board, in conjunction with the Maryland Higher Education Commission, 4
shall approve each nursing assistant training program prior to its implementation and 5
provide periodic survey of all programs in the State. 6
(b) The Board in conjunction with the Department, Maryland Higher Education 7
Commission, and the affected industry shall develop regulations for nursing assistant 8
training programs. 9
(c) The curriculum content for an approved nursing assistant training program 10
shall include: 11
(1) Content [consistent with State licensing requirements in the Health – 12
General Article and] THAT MEETS all federal requirements SET FORTH IN 42 C.F.R. § 13
483.152; AND 14
(2) All basic skills required of a nursing assistant regardless of the setting 15
of the practice[; and 16
(3) Any skills required for certification in a specific category]. 17
(d) Any additional clinical practice skills specific to a setting of practice shall be 18
taught in that setting as a part of the employment training process in that setting. 19
(e) The Board may make survey visits from time to time, without prior notice, to 20
all certified nursing assistant training programs. 21
[(f) The provisions of this section may not be interpreted to impose additional 22
requirements for geriatric nursing assistants beyond those required under federal law. 23
(g) The Board shall approve the use of a nursing assistant training site by a 24
nursing assistant training program within 45 days after the nursing assistant training 25
program applies for approval if the nursing assistant training program had previously been 26
approved to use the training site by the Board.] 27
(F) AN APPROVED ACUTE CAR E NURSING ASSISTANT TRAINING PROGRAM 28
MAY REQUEST A WAIVER OF THE FEDERAL REQUI REMENT UNDER 42 C.F.R. § 29
483.152(C)(5) THAT INSTRUCTORS HAV E A MINIMUM OF 1 YEAR OF EXPERIENCE I N 30
THE PROVISION OF LON G–TERM CARE FACILITY S ERVICES. 31
8–701. 32 SENATE BILL 999 13
(c) [(1)] Except as otherwise provided in this title, an individual may not 1
practice, attempt to practice, or offer to practice as a certified nursing assistant unless 2
certified by the Board as a certified nursing assistant. 3
[(2) Except as otherwise provided in this title, an individual may not 4
practice, attempt to practice, or offer to practice as a certified nursing assistant in a specific 5
category unless certified by the Board as a certified nursing assistant in that category.] 6
8–703. 7
(a) [(5) Unless authorized to provide patient care in a specific category of 8
certified nursing assistant, an individual may not represent to the public by title, by 9
description of services, methods, or procedures, or otherwise, that the individual is 10
authorized to provide care as a certified nursing assistant in a specific category in this 11
State.] 12
[(6)] (5) Unless authorized to administer medication as a medication 13
technician under this title, an individual may not represent to the public by title, by 14
description of services, methods, or procedures, or otherwise, that the individual is 15
authorized to administer medication as a certified medication technician in this State. 16
[(7)] (6) Unless authorized to administer medication as a medicine aide 17
under this title, an individual may not represent to the public by title, by description of 18
services, methods, or procedures, or otherwise, that the individual is authorized to 19
administer medication as a certified medicine aide in this State. 20
SECTION 2. AND BE IT FURTHER ENACTED, That, on or before October 1, 2024, 21
the State Board of Nursing shall: 22
(1) notify individuals who possess a nursing assistant certification of the 23
licensing requirements established under Section 1 of this Act; and 24
(2) in consultation with the Office of Health Care Quality, update 25
regulations to conform with Section 1 of this Act. 26
SECTION 3. AND BE IT FURTHER ENACTED, That this Act shall take effect June 27
1, 2024. 28