Nothing in this chapter shall be applicable to or restrict or limit a registered nurse from performing those functions which constitute the practice of registered nursing as defined by law. The following terms have the meanings indicated. Terms Defined. “Advanced practice registered nurse (APRN)” means a registered nurse who is certified by the Board as: A certified nurse midwife (CNM); A certified registered nurse anesthetist (CRNA); A certified nurse practitioner (CRNP); or A clinical nurse specialist (CNS). “Board” means the Maryland Board of Nursing. “Certification” means the permission to practice as a PMH/APRN granted by the Board to a registered nurse who has: Met all the specified requirements of a national certifying body recognized by the Board; and Complied with the requirements of this chapter. “Mental health diagnosis” means the identification of a potential or an actual alteration in an individual's mental health status. “Multistate licensure privilege” has the meaning set forth in COMAR 10.27.01.01B. “Nurse psychotherapist” means a registered nurse, certified under this chapter, who utilizes psychotherapy in a formally structured, contractual relationship between the nurse therapist and a client. “Psychiatric mental health/ advanced practice registered nurse (PMH/APRN)” means an advanced practice registered nurse who: Is certified by the Board as a clinical nurse specialist in the practice of psychiatric mental health; and Autonomously and independently engages in activities authorized by this chapter. “Psychobiological interventions” means interventions which integrate physiological and psychological dimensions of care and include a range of therapies from diet/nutrition regulation, hypnosis, and relaxation techniques to the use of pharmacologic agents. “Registered nurse (RN)” means an individual who: Is licensed by the Board to practice registered nursing; or Has a multistate licensure privilege to practice registered nursing. An applicant for certification to practice as a PMH/APRN in independent practice shall: Hold a current Maryland license in good standing to practice registered nursing or a multistate licensure privilege to practice registered nursing; Have graduated from a Board-approved graduate level education program for clinical nurse specialists in psychiatric mental health nursing at the Masters’ level or higher that is accredited by a national accrediting body recognized by the Board; Hold current national certification as a clinical nurse specialist in psychiatric or mental health nursing issued by the American Nurses Credentialing Center (ANCC) or any other national certifying body recognized by the Board; Submit to the Board a completed application for certification as a clinical nurse specialist, PMH/APRN; Comply with all the requirements set forth in COMAR 10.27.01.04; Demonstrate written and oral competency in the English language; and Pay all fees. A registered nurse who meets the qualifications to sit for a national certifying examination acceptable to the Board or who has taken that examination and is waiting for the results, may practice in this State as a PMH/APRN graduate if the: Practice is under the supervision of a Maryland certified PMH/APRN who shall be readily available to the PMH/APRN graduate; Supervising PMH/APRN agrees in a written supervision agreement on a form to be prescribed by the Board to provide the supervision; and PMH/APRN graduate: Completes the application for Maryland certification as a as a clinical nurse specialist in psychiatric mental health; and Pays the certification application fee established by the Board in COMAR 10.27.01. A PMH/APRN graduate who has entered into a supervision agreement shall immediately notify the Board and the supervising PMH/APRN of the results of the national certifying examination. A PMH/APRN graduate may not continue to practice under supervision for more than 24 months from the filing of all documents required under §A of this regulation or after the denial of certification, whichever occurs first. The PMH/APRN may perform independently, autonomously, and in a variety of settings, the following functions: Establish a mental health diagnosis; Evaluate and manage psychobiological intervention; Provide individual therapy; Provide group therapy; Provide family therapy; Provide any therapy which purpose is to: Effect change in the client in an attempt to alleviate emotional disturbances, Reverse or change maladaptive behavior, and Facilitate personality growth and development; Provide consultation to health care providers and others to: Influence the plans of care for clients, Enhance the abilities of others to provide behavioral, psychiatric, and mental health care, and Effect change in systems; Provide behavioral rehabilitation care; and Utilize advanced practice skills to independently provide: Case management including psychiatric rehabilitation and home care, and Health teaching, health promotion, health prevention, and aid to the client in developing healthy patterns of living. Advanced practice skills shall be utilized in the collection of relevant data to comprehensively assess the client's mental health. Assessment data shall be analyzed in determining diagnosis. A plan of care shall be developed and implemented that outlines treatment to attain expected outcomes. Individual, group, and family psychotherapy, child psychotherapy, behavioral care, case management, and other therapeutic treatments shall be utilized to assist clients in fostering mental health, preventing mental illness and disability, and improving or regaining previous health status and functional abilities. Advanced knowledge of psychobiological interventions shall be utilized and clinical skills applied to maximize the client's health and prevent further disability. The use of psycholobiological interventions in this chapter does not authorize the prescription of medications. The client's progress in attaining the expected outcome shall be evaluated. Strategies and interventions shall be utilized to promote and maintain health and prevent mental illness. Decisions and actions on behalf of clients shall be determined in an ethical manner. Certification as a PMH/APRN expires at the same time as the license to practice registered nursing. Before a PMH/APRN’s certification expires, the PMH/APRN may renew the certification biennially if the PMH/APRN: Is otherwise entitled to be certified; Submits to the Board: Documentation of a current national certification as a PMH/APRN from a national certifying body recognized by the Board; and A completed renewal application on a form that the Board requires; and Pays all fees. PMH/APRN renewal applicants who are authorized to practice registered nursing in this State under a multistate licensure privilege shall be periodically required to submit to a criminal history check in accordance with the schedule and requirements set forth in COMAR 10.27.01.13J.—N. The PMH/APRN shall ensure that the Board has a record of the renewed national certification if the national certification expires before the registered nurse license renewal date. Certification as a PMH/APRN shall be deemed to have lapsed if the Board does not have a record of a current active national certification. Practicing on an expired national certification is prohibited and subject to discipline under Health Occupations Article, §8-316(a), Annotated Code of Maryland. The Board shall maintain an up-to-date list of all PMH/APRNs certified in this State and include on the license an indication that the licensee is a PMH/APRN. Unless authorized to practice under this chapter, an individual may not use the words “advanced practice registered nurse/psychiatric mental health”, “nurse psychotherapist”, “psychiatric mental health/advanced practice registered nurse”, or any other words, letters, or symbols with the intent to represent that the individual is a psychiatric-mental health/advanced practice registered nurse. An individual certified under this chapter is subject to the disciplinary sanctions set forth in Health Occupations Article, Title 8, Annotated Code of Maryland. An individual may not practice as a PMH/APRN or nurse psychotherapist in this State unless the individual is certified under this chapter. Health Occupations Article, §8-205, Annotated Code of Maryland Effective date: June 25, 1990 (17:12 Md. R. 1494) Regulation .07C adopted effective August 1, 1994 (21:15 Md. R. 1306) Chapter revised effective June 26, 2000 (27:12 Md. R. 1140) Regulation .02B amended effective July 2, 2018 (45:13 Md. R. 667) Regulation .03 amended effective July 2, 2018 (45:13 Md. R. 667) Regulation .03B, C amended effective October 17, 2011 (38:21 Md. R. 1279) Regulation .04 amended effective July 2, 2018 (45:13 Md. R. 667) Regulation .05 amended effective July 2, 2018 (45:13 Md. R. 667) Regulation .07 amended effective July 2, 2018 (45:13 Md. R. 667) Regulation .08A, C amended effective July 2, 2018 (45:13 Md. R. 667)