This chapter does not apply to an individual who: Other than a certified nursing assistant, practices a health occupation, that the individual is authorized to practice under the Health Occupations Article, Annotated Code of Maryland; Provides for the gratuitous care of friends, domestic partners, or family members; Performs nursing assistant tasks while a nursing student enrolled in an accredited nursing program if the individual either: Is practicing under the direct supervision of qualified faculty or preceptors; or Successfully completed the portion of the approved nursing education program that the Board determines meets the requirements of an approved nursing assistant training program as described in Regulation .05D of this chapter; Performs nursing assistant tasks: While a student enrolled in an approved nursing assistant training program or approved acute care nursing assistant training program; and While practicing under the direct supervision of qualified faculty or preceptors; Practices as a certified nursing assistant-I for less than 4 months in accordance with 42 CFR §483.35(d); Performs nursing tasks delegated by a registered nurse or licensed practical nurse so long as the delegated nursing tasks do not become a routine part of the individual's job duties; Performs nursing tasks delegated by an advanced practice registered nurse in accordance with Health Occupations Article, §8-6A-02(d), Annotated Code of Maryland; or Performs technical tasks delegated by a licensed certified midwife in accordance with Health Occupations Article, §8-6A-02(e), Annotated Code of Maryland. In this chapter, the following terms have the meanings indicated. Terms Defined. “Acute care nursing assistant training program” means a course of training that meets the acute care nursing assistant training program curriculum approved by the Board. “Board” means the Maryland Board of Nursing. “Central Repository” means the Maryland Criminal Justice Information System Central Repository of the Department of Public Safety and Correctional Services. “Certificate” means a certificate issued by the Board to practice as a certified nursing assistant in the State. Certified Nursing Assistant (CNA). “Certified nursing assistant (CNA)” means an individual, regardless of title, who, for compensation and subject to regulations adopted by the Board, routinely performs: Nursing tasks delegated by a registered nurse, licensed practical nurse, or advanced practice registered nurse; or Technical tasks delegated by a licensed certified midwife. “Certified nursing assistant (CNA)” does not include dialysis technician or medication technician. Certified Nursing Assistant-I (CNA-I). “Certified nursing assistant-I (CNA-I)” means a CNA who: Meets the requirements set by the Board and federal law; and May practice in any practice setting. “Certified nursing assistant-I (CNA-I)” includes a: CNA who was certified as a geriatric nursing assistant on March 31, 2026; Certified medicine aide; and CNA who is certified under Health Occupations Article, §8-6A-05(c)(5), Annotated Code of Maryland. “Certified nursing assistant-II (CNA-II)” means a CNA who: On March 31, 2026, was certified as a CNA but not certified as a geriatric nursing assistant; and May not practice in a nursing facility or skilled nursing facility. “Criminal history records check (CHRC)” means the performance of both a State criminal history records check by the Central Repository and a national criminal history records check performed by the Federal Bureau of Investigation (FBI). “Criminal history record information” means information provided by the criminal history records check regarding an applicant’s criminal arrests, charges, and convictions and other dispositions of criminal charges. “Good standing” means without an encumbrance that limits or restricts practice, such as revocation, suspension, or probation. “Nursing assistant competency evaluation” means an examination approved by the Board that: Determines the competency of the individual to practice as a CNA-I; and Meets the requirements under federal law. “Nursing assistant training program” means a course of training approved by the Board that meets the requirements under federal and State law. “Service member” has the meaning stated in State Government Article, §9-901, Annotated Code of Maryland. “Temporary nurse aide” means an individual who practiced as a geriatric nursing assistant without certification during the national Coronavirus Disease 2019 (COVID-19) Public Health Emergency, as declared on January 31, 2020, and periodically continued by the United States Secretary of Health and Human Services, pursuant to the waiver of the requirements of 42 CFR §483.35(d) issued by the Centers for Medicare and Medicaid Services on March 6, 2020. “Technical task” means a routine clinical act or task that does not require clinical judgment and is performed with the supervision as specified in COMAR 10.69.02. “Temporary nurse aide training” means an 8-hour online training and examination program offered by: The American Health Care Association; The National Center for Assisted Living; or Another comparable program approved by the Board. Fees are as follows: Initial certification fee — $20; Endorsement fee — $20; Renewal fee — $40; Verification of certification to another jurisdiction — $25; Returned check fee — $25; Duplicate certificate fee — $10. Fees are not refundable. An applicant shall submit: A completed application to the Board on the form that the Board requires; To a CHRC in accordance with Health Occupations Article, §8-303, Annotated Code of Maryland; Written evidence satisfactory to the Board that the applicant has submitted to a CHRC as required by §A(2) of this regulation by submitting: Two sets of fingerprints, as required by the Central Repository and the FBI; and All fees required by the Central Repository and the FBI; Any documentation requested from the applicant by the Board including, but not limited to, official certified or true test court documents and a signed, dated explanation written by the applicant, regarding the facts and circumstances, outcome, and current status of any criminal history record information received by the Board: Under §A(2) of this regulation; In an answer to a question on the Board’s application form; or From any other source; and Any additional documentation requested by the Board if the documentation received from the applicant under §A(4) of this regulation is incomplete or insufficient. If an application is not complete when initially submitted to the Board by the applicant, the applicant shall have no longer than 12 months from the date the application is received by the Board to complete the application and provide all information and documents required in §A of this regulation. If an applicant fails to provide to the Board a complete application and any additional documentation requested by the Board under §A of this regulation within 12 months from the date the application is received by the Board, then the application shall be considered abandoned and may be destroyed. Once an application is deemed abandoned under §C of this regulation, an individual seeking CNA certification shall submit a new application on the form required by the Board and meet all of the requirements for CNA certification and pay the required fees that are in effect at the time of re-application. Initial Certification. An applicant for initial nursing assistant certification shall have successfully: Completed: An approved nursing assistant training program; An approved acute care nursing assistant training program; A portion of an approved nursing education program that has been determined by the Board to meet the requirements of a nursing assistant training program set by the Board; or Service member training and education that has been determined by the Board to be substantially equivalent to a nursing assistant training program approved by the Board in accordance with Health Occupations Article, §1-702, Annotated Code of Maryland; and Passed a nursing assistant competency evaluation. Certification by Endorsement. An applicant for nursing assistant certification by endorsement shall: Hold a certificate to practice as a nursing assistant that: Was issued by another state or territory of the United States that has certification requirements that are essentially similar to those set forth in Health Occupations Article, §8-6A-05, Annotated Code of Maryland; and Is in good standing; and Have successfully completed a nursing assistant training program that meets the standards for an approved nursing assistant training program set by the Board. Any applicant for nursing assistant certification may not have: Committed any act or omission that would be grounds for discipline or denial of certification under Health Occupations Article, §8-6A-10, Annotated Code of Maryland; or A record of abuse, negligence, or misappropriation of a client's property or any disciplinary action taken or pending in any other state or territory of the United States against the certification of the CNA. Nursing Education Programs. To meet the requirements of a nursing assistant training program set by the Board, a portion of a nursing education program must include courses with content that primarily focuses on: Nursing fundamentals; Mental health; Health assessment; Nursing ethics; and The content listed under 42 CFR §483.152(b). If a portion of a nursing education program does not include courses with content that primarily focuses on the subject matters set forth in § D(1) of this regulation, the Board may review and approve other equivalent subject matters as meeting the requirements of a nursing assistant training program set by the Board. A CNA-II who seeks certification as a CNA-1 shall meet the qualifications set forth in §A of this regulation. Temporary Nurse Aides. A temporary nurse aide applying for certification as a CNA-1 shall be deemed to have completed a nursing assistant training program approved by the Board if the temporary nurse aide: Completed a temporary nurse aide training course; Completed a minimum of 100 hours of on-the-job training as a temporary nurse aide that: Met the requirements under 42 CFR §483.152(a) and 42 CFR §483.152(b)(2)—(7); and Was not provided in a facility described under 42 CFR §483.151(b)(2)—(3); and In addition to the minimum 100 hours of on-the-job training, worked as a temporary nurse aide competently for a minimum of 160 hours. A temporary nurse aide whose on-the-job training did not meet all of the requirements under 42 CFR 483.152(a) and 42 CFR 483.152(b)(2)—(7) may receive supplemental training in those requirements and be deemed to meet the requirement of §F(1)(b)(i) of this regulation. Initial Certification. An applicant for initial certification shall: Comply with all of the requirements under Regulation .04A of this chapter; Pay the required fee to the Board; and Submit to the Board one of the items in §A(2) of this regulation. Verification Requirements. For graduates of a nursing assistant or acute care nursing assistant training program, an application that has been signed by the program coordinator or faculty of the training program completed by the applicant; For service members, documentation demonstrating successful completion of service member training and education that has been determined by the Board to be substantially equivalent to a nursing assistant training program approved by the Board; For nursing students and graduates, an official transcript demonstrating successful completion of a portion of an approved nursing education program that the Board determines meets the requirements for a nursing assistant training program set by the Board; or For foreign-educated nursing graduates, a copy of an evaluation of the applicant’s transcript through a Board-approved vendor demonstrating successful completion of a portion of an approved nursing education program that meets the requirements for a nursing assistant training program set by the Board. A program coordinator or faculty of a nursing assistant or acute care nursing assistant training program: May sign an application before graduation; and Shall submit written verification, as required by the Board, of program completion to the Board after 5 business days of the applicant’s program completion. An applicant shall submit an application for initial certification after 24 months of the date of completion of an approved nursing assistant training program, an approved acute care nursing assistant training program, or portion of an approved nursing education program. If an applicant fails to meet §A(4) of this regulation, an applicant still seeking certification shall take or re-take an approved nursing assistant training program or approved acute care nursing assistant training program and comply with §A(4) of this regulation. Certification by Endorsement. An applicant for nursing assistant certification by endorsement shall: Comply with all of the requirements under Regulation .04A of this chapter; Pay the required fee to the Board; and Submit the following verifications directly to the Board from the appropriate authority: A certificate to practice as a nursing assistant in good standing from another state or territory with certification requirements that are essentially similar to the requirements in this State; and A certificate of completion from a nursing assistant training program in that state or territory that meets the standards for an approved nursing assistant training program set by the Board. Every applicant shall attest on the application whether the applicant has: Committed any act or omission that would be grounds for discipline or denial of certification; and A record of abuse, neglect, or misappropriation of a client’s property or any disciplinary action taken or pending in any state or territory of the United States against the certification of the applicant. A CNA-II who seeks certification as a CNA-I shall: Submit an application to the Board on the form required by the Board; and Comply with §§A(1)(c) and A(3)—(5) of this regulation. A temporary nurse aide applying for certification as a CNA-1 shall: Comply with §A of this regulation; and Ensure that the administrator, director of nursing, or human resources representative of the applicant’s employer submits to the Board an attestation, on the form required by the Board, that: Is completed by the: Applicant; Registered Nurse instructor or supervisor of the applicant during employment; and Administrator or director of nursing for the employer; and Verifies that the applicant satisfies the requirements of Regulation .05F of this chapter. An individual is eligible to sit for a nursing assistant competency evaluation if the individual: Meets the education requirements set forth in Regulation .05A(1) of this chapter; or Must retake a nursing assistant competency evaluation in order to renew or reinstate a certification in accordance with Regulation .10C(2)(a) of this chapter. Except for service members, an individual shall sit for a nursing assistant competency evaluation after 24 months of meeting the educational requirements set forth in Regulation .05A(1) of this chapter. An individual who fails to sit for a nursing assistant competency evaluation after 24 months of meeting the educational qualifications must re-take an approved nursing assistant training program or approved acute care nursing assistant training program in order to be eligible to sit for a nursing assistant competency evaluation. Re-testing. An individual who fails to obtain a passing score on the first examination may retake a nursing assistant competency evaluation three additional times. An individual shall wait at least 45 calendar days from the date of the prior evaluation before retaking a nursing assistant competency evaluation. An individual who fails to obtain a passing score after taking a nursing assistant competency evaluation four times must complete a new approved nursing assistant training program or approved acute care nursing assistant training program before retaking a nursing assistant competency evaluation. The Board may issue a temporary practice certificate to an applicant who: Has met the appropriate certification requirements to the satisfaction of the Board; Does not have a criminal record; and Has not been the subject of a health professional disciplinary action in this State or another jurisdiction. Unless the Board suspends or revokes a temporary practice certificate, the temporary practice certificate expires 90 calendar days after the date of issuance. A temporary practice certificate may be extended up to an additional 90 calendar days if the applicant is awaiting the completion of the criminal history records check. The Board may not issue a certificate to an applicant until the Board has: Received and reviewed the criminal history record information of the applicant; and Approved the application. Unless subject to discipline, the Board shall issue a certificate to each applicant who meets all the requirements of this chapter and Health Occupations Article, §§8-6A-05 and 8-6A-06, Annotated Code of Maryland. Expiration. Unless renewed for an additional two-year term, and except as otherwise provided in §A(2) of this regulation, a certificate expires in accordance with the following schedule: The certificate of a certificate holder with an odd-numbered birth year expires on the 28th day of the certificate holder’s birth month in an odd-numbered year; and The certificate of a certificate holder with an even-numbered birth year expires on the 28th day of the certificate holder’s birth month in an even-numbered year. A certificate shall not expire within 180 calendar days of the date of issuance. Renewal Notice. At least 3 months before a certificate expires, the Board shall send the certificate holder a renewal notice by either: First-class mail to the last known address of the certificate holder; or Electronic means to the last known electronic address of the certificate holder. The renewal notice shall provide: The date on which the certificate holder’s certificate is scheduled to expire; The date by which the Board must receive a renewal application in order for a certificate to remain active until the renewal application submitted by the certificate holder is processed by the Board, in accordance with State Government Article, §10-226(b), Annotated Code of Maryland; The amount of the renewal fee; and If the certificate holder is required to submit to a CHRC in accordance with §D of this regulation: Notice that the certificate holder must submit to a CHRC in order to renew the certificate; and Written instructions for how to complete a CHRC. It is the responsibility of the certificate holder to: Be aware of the expiration date of the certificate; and Renew the certificate before it expires. Failure of a certificate holder to receive the renewal notice sent by the Board does not relieve the certificate holder of the responsibility to renew a certificate before it expires. Renewal Requirements. The Board shall renew a certificate if the individual applying for renewal: Is otherwise entitled to be certified; Submits a complete application for renewal on the form required by the Board; Pays the renewal fee; Provides satisfactory evidence, as required by the Board, of16 hours of active employment, for compensation, as a nursing assistant within the 2-year period immediately preceding the date of expiration or meet the requirements under §C(2) of this regulation; and If required to submit to a CHRC in accordance with § D of this regulation, complies with the requirements of Regulation .04A of this chapter. If the individual applying for renewal does not have 16 hours of active employment as a nursing assistant within the 2-year period immediately preceding the date of expiration the individual shall: If a CNA-I, take and pass a nursing assistant competency evaluation; or If a CNA-II, complete a nursing assistant training program.. Schedule for CHRCs. CHRCs for renewal applicants shall be scheduled according to the certificate holder’s birth month as follows: In 2025 — all applicants with an August or September birth month; In 2026 — all applicants with a September or October birth month; In 2027 — all applicants with an October or November birth month; In 2028 — all applicants with a November or December birth month; In 2029 — all applicants with a December or January birth month; In 2030 — all applicants with a January or February birth month; In 2031 — all applicants with a February or March birth month; In 2032 — all applicants with a March or April birth month; In 2033 — all applicants with an April or May birth month; In 2034 — all applicants with a May or June birth month; In 2035 — all applicants with a June or July birth month; and In 2036 — all applicants with a July or August birth month. Grace Period. A certificate holder has a 30 calendar day grace period beyond the expiration date of the certificate to renew the certificate. The Board shall reinstate the certificate of a certificate holder who has failed to renew the certificate for any reason, if the certificate holder meets the renewal requirements in Health Occupations Article, §8-6A-08, Annotated Code of Maryland, and Regulation .10 of this chapter. An applicant for administrative reinstatement who has failed to renew the certificate for a period of 1 year or more shall submit to a CHRC before the certificate is reinstated. Health Occupations Article, §§8-205, 8-206, and 8-6A-01—8-6A-17, Annotated Code of Maryland; Ch. 486, Acts of 2012;Chs. 818 and 819, Acts of 2024; Ch. 416, Acts of 2025 Effective date: February 5, 2001 (28:2 Md. R. 100) Regulation .01B amended as an emergency provision effective January 2, 2007 (34:4 Md. R. 397); amended permanently effective May 7, 2007 (34:9 Md. R. 825) Regulations .02A, .06B, .09B amended as an emergency provision effective November 15, 2001 (28:24 Md. R. 2125); amended permanently effective February 18, 2002 (29:3 Md. R. 221) Regulation .02A amended effective February 2, 2004 (31:2 Md. R. 85); August 27, 2007 (34:17 Md. R. 1509) Regulation .03 amended effective April 24, 2006 (33:8 Md. R. 734) Regulation .04 amended as an emergency provision effective January 2, 2007 (34:4 Md. R. 397); amended permanently effective May 7, 2007 (34:9 Md. R. 825) Regulation .04D amended effective January 6, 2014 (40:26 Md. R. 2164) Regulation .06 amended as an emergency provision effective January 2, 2007 (34:4 Md. R. 397); amended permanently effective May 7, 2007 (34:9 Md. R. 825) Regulation .06 amended effective August 25, 2008 (35:17 Md. R. 1489); April 19, 2010 (37:8 Md. R. 617) Regulation .06H amended effective January 6, 2014 (40:26 Md. R. 2164) Regulation .06N amended effective June 13, 2011 (38:12 Md. R. 705) Regulation .07 amended effective April 19, 2010 (37:8 Md. R. 617) Regulation .08 repealed and Regulation .09 recodified to be Regulation .08 effective April 24, 2006 (33:8 Md. R. 734) Regulation .08 amended as an emergency provision effective January 2, 2007 (34:4 Md. R. 397); amended permanently effective May 7, 2007 (34:9 Md. R. 825) Regulation .08A, B amended effective April 7, 2008 (35:7 Md. R. 748) Regulation .08D amended effective March 22, 2010 (37:6 Md. R. 478) Regulation .10 repealed effective April 24, 2006 (33:8 Md. R. 734) Chapter revised effective February 13, 2017 (44:3 Md. R. 189) Regulation .01B amended effective July 2, 2018 (45:13 Md. R. 667) Regulation .01B amended as an emergency provision effective September 22, 2022 (49:22 Md. R. 975); emergency status expired effective March 30, 2023 Regulation .04D adopted as an emergency provision effective September 22, 2022 (49:22 Md. R. 975); emergency status expired effective March 30, 2023 Regulation .05 amended effective July 2, 2018 (45:13 Md. R. 667) Regulation .05 amended as an emergency provision effective September 22, 2022 (49:22 Md. R. 975); emergency status expired effective March 30, 2023 Regulation .07 amended effective July 2, 2018 (45:13 Md. R. 667) Regulation .08 amended effective July 2, 2018 (45:13 Md. R. 667) Regulation .09 amended effective July 2, 2018 (45:13 Md. R. 667) Regulation .09A amended as an emergency provision effective September 22, 2022 (49:22 Md. R. 975); emergency status expired effective March 30, 2023 Chapter revised as an emergency provision effective April 3, 2026 (53:9 Md. R. 411); amended permanently effective June 8, 2026 (53:11 Md. R. 484) In this chapter, the following terms have the meanings indicated. Terms Defined. “Acute care nursing assistant training program” means a course of training that meets the acute care nursing assistant training program curriculum approved by the Board. “Board” means the Maryland Board of Nursing. “Certified Nursing Assistant (CNA)” has the meaning stated in COMAR 10.39.01.02B. Certified Nursing Assistant-I (CNA-I). “Certified nursing assistant-I (CNA-I)” means a CNA who: Meets the requirements set by the Board and federal law; and May practice in any practice setting. “Certified nursing assistant-I (CNA-I)” includes a: CNA who was certified as a geriatric nursing assistant on March 31, 2026; Certified medicine aide; and CNA who is certified under Health Occupations Article, §8-6A-05(c)(5), Annotated Code of Maryland. “Classroom laboratory training” means instruction and demonstration, on an individual or a mannequin, of patient care skills by an instructor and return demonstration of competence in these skills by the student. “Clinical facility” means a setting where clients are physically present and that provides facilities for supervised clinical training. “Direct supervision” means that the registered nurse or licensed practical nurse is physically present while the student demonstrates patient care skills. “Distance education” means a formal education process in which the delivery of instruction occurs through the use of telecommunication technologies because the students and instructors are in different places. “Hybrid training program” means a nursing assistant training program that provides: Didactic instruction through distance education; On-site classroom laboratory training; and Supervised clinical training. “Licensed Practical Nurse (LPN)” means an individual who: Is licensed by the Board to practice licensed practical nursing; or Has a multistate licensure privilege to practice licensed practical nursing. “Multistate licensure privilege” has the meaning set forth in COMAR 10.27.01.01B. “Nursing assistant competency evaluation” means an examination approved by the Board that: Determines the competency of the individual to practice as a CNA-I; and Meets the requirements under federal law. “Nursing assistant training program” means a course of training approved by the Board that meets the requirements under federal and State law. “Program completion” means that the student: Completed and demonstrated competency in the program objectives and performance indicators during the didactic, laboratory, and clinical portions of the training program; and Passed the final written examination. “Program provider” means an individual, organization, facility, or educational institution that conducts a nursing assistant training program or an acute care nursing assistant training program. “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. “Supervised clinical training” means training in person at a clinical facility in which the student demonstrates knowledge and skills while performing tasks on a client under the supervision of an RN or an LPN. “Traditional program” means a training program that provides on-site didactic instruction, classroom laboratory training, and supervised clinical training. “Training program” means a nursing assistant training program or an acute care nursing assistant training program. “Unencumbered” means without limitation or restriction on practice, such as revocation, suspension, or probation. “Written agreement” means a contract between a program provider and a clinical facility outlining the terms required, by both the program and the facility, for supervised clinical training of students. Approval Requirements. All training programs shall be approved by: The Board; and The Maryland Higher Education Commission (MHEC) in accordance with Health Occupations Article, §8-6A-14(a), Annotated Code of Maryland and COMAR 13B.01.01.03. Public High School Training Programs. If the training program is offered by a public high school, the training program shall be approved by the State Board of Education. The approval process shall be completed before the training program is offered. Application. At least 120 days before the proposed start date of the training program, a program provider seeking initial approval of a training program shall: Submit a complete application on the form required by the Board; Demonstrate that the training program meets all of the applicable requirements in this chapter; and Provide any additional information requested by the Board during the Board’s review of the application. Board Action. Following receipt of a complete application, the Board’s professional staff may conduct a survey visit and submit a survey visit report to the Board. The Board shall: Approve a training program that meets all of the applicable requirements of this chapter; or Deny approval of a training program that does not meet all of the applicable requirements of this chapter. Term. Board approval of a training program is valid for 2 years. Ongoing Responsibilities. A training program shall obtain approval from the Board before making any substantial changes to the program. Substantial changes include: Changes to faculty; Significant changes to curriculum, including an increase or decrease in program hours; and Removal or addition of clinical facilities or classroom locations. A training program shall submit to the Board an annual report, on the form required by the Board, that includes statistics on enrollments, program completions, attrition rates, and nursing assistant competency evaluation results. Nursing Assistant Competency Evaluation Performance. A training program shall maintain an average pass rate of 90 percent of the average pass rate for all states using the applicable Board-approved vendors for the nursing assistant competency evaluation. The Board shall annually review the performance of graduates from each training program on the nursing assistant competency evaluation. Equal Opportunity Statement. The training program provider shall have a statement of equal opportunity. A training program offered by a nursing facility or skilled nursing facility shall not charge a fee for any portion of the program, including textbooks and other required course materials, in accordance with 42 CFR §483.152(c). Faculty Requirements. Each course instructor and program coordinator shall have: An active, unencumbered license to practice as a Registered Nurse or a multistate licensure privilege to practice as a Registered Nurse in the State; A minimum of 2 years of nursing experience; and Completed a course in teaching adults or have experience in teaching adults or supervising nursing assistants. Long-Term Care Facility Experience Requirements. Either the program coordinator or all course instructors shall have at least 1 year of experience in the provision of long-term care facility services, which may include: Providing direct client care or supervisory oversight in a long-term care facility or unit, including in a geriatrics department, chronic care hospital, or other long-term care setting; and Teaching a nursing assistant training program that complies with federal law. Course Instructors. Course instructors in training programs in public secondary schools in the State shall also meet the requirements set forth in COMAR 13A.12.02.02. The course instructor is responsible for: Participating in the development and evaluation of the training program, including the acquisition of learning resources and instructional materials; Implementing the training program and ensuring course objectives are met; Supervising classroom, laboratory, and clinical learning experiences, including direct supervision of a student the first time a student performs a patient care skill during a clinical learning experience and until the student demonstrates proficiency in that skill; and Evaluating student performance during didactic, clinical, and laboratory training. Program Coordinator. Each training program shall have a program coordinator who: Provides general supervision of the training of nursing assistants; and Maintains responsibility for the overall operation of the program. Except as provided in §C(3) of this regulation, the program coordinator may also be a course instructor. In a facility-based program, the facility’s director of nursing may be the program coordinator but may not perform any actual training. Supplemental Personnel. Other health professional personnel may supplement the course instructor, including, but not limited to: Registered nurses in accordance with §D(3) of this regulation; Licensed practical nurses in accordance with §D(4) of this regulation; Pharmacists; Dietitians; Social workers; Sanitarians; Fire safety experts; Nursing home administrators; Gerontologists; Psychologists; Physical and occupational therapists; Activities specialists; Speech/language/hearing therapists; and Resident rights experts. Supplemental personnel shall have at least 1 year of experience in their respective field. A registered nurse functioning as supplemental personnel shall: Hold a current, unencumbered license in the State or multistate licensure privilege as a registered nurse; and Have had at least 1 year of direct client care experience as a registered nurse. A licensed practical nurse functioning as supplemental personnel shall: Hold a current, unencumbered license in the State or multistate licensure privilege as a practical nurse; and Have had at least 1 year of direct client care experience as a licensed practical nurse. Other supplemental personnel providing instruction shall provide instruction under the supervision of the course instructo. General Facility Requirements. All classroom, laboratory, and clinical facilities used by a training program: Shall be approved by the Board; Shall be approved or accredited by the appropriate agency; May not be on conditional or provisional approval status; and May not meet any of the factors set forth in 42 CFR §483.151(b)(2)—(3). Classroom and Laboratory Facilities. Classroom and laboratory facilities shall include: Adequate space for privacy of faculty-student conferences; and Space for equipment and instructional materials. Resources. All instructional learning resources and materials shall: Be accessible and relevant to the role of the CNA; Have a publication date not older than 5 years from the current year; and Be written at an 8th grade level. Laboratory Equipment. Laboratory equipment, at a minimum, shall include materials to support the following classroom activities: Infection control; Basic nursing skills; Personal care skills; and Basic restorative services; The Board shall maintain on its website a list of the specific equipment required for laboratory facilities. Clinical Facilities. Clinical facilities shall: Have a sufficient number and variety of clients to provide training experiences for all students to achieve the stated objectives; Have a sufficient number of registered nurses and other nursing personnel to ensure safe and continuous care of clients; and Conform with accepted standards of nursing care and practice. There shall be a minimum of 1 course instructor for each 8 students in the clinical area. Written Agreements. Except for facility-based programs, a training program shall have a written agreement with a clinical facility for student training experiences. The written agreement developed in accordance with §D(3)(a) of this regulation shall: Be developed jointly with the clinical facility and the training program; Be reviewed periodically by the clinical facility and the training program; Include a provision for adequate notice of termination; Specify the responsibility of the training program to the clinical facility and the responsibility of the clinical facility to the training program; and Identify the functions and responsibilities of the parties involved. Program Hours. A training program shall provide a minimum of 100 hours of instruction. Of the 100 hours, a minimum of: 60 hours shall be devoted to didactic instruction and classroom laboratory training, with at least 16 hours of in-person laboratory training in the pre-clinical curriculum listed in §B(3) of this regulation; and 40 hours shall be devoted to supervised clinical training in a clinical facility. A training program shall have at least 16 of the 40 hours of supervised clinical training in the provision of long-term care facility services or caring for the elderly or chronically ill of any age, which shall be performed under direct supervision. Curriculum Content. The curriculum for a training program shall include the subject matters and skills listed in 42 CFR §483.152(b). The curriculum for an acute care nursing assistant training program shall include: The subject matters listed in 42 CFR §483.152(b); and All basic skills required of a nursing assistant in any acute care practice setting, including: Caring for patients with acute and chronic medical conditions in a hospital facility; Observing and reporting changes in patient condition, including potential emergencies and safety issues, to the licensed nurse; Transport of specimens; Transport of medications; Point of care testing; Specimen collecting; Equipment management; Time management in the acute care setting; De-escalation of assertive or aggressive patients and family members; and Electronic documentation of care and basic computer skills. The pre-clinical curriculum of a training program shall include the following topics: Role of the CNA; Infection control; Safety and emergency procedures, including the Heimlich maneuver; Communication and interpersonal skills; Promoting clients’ independence; and Legal and ethical considerations, including respecting clients’ rights. A training program shall provide instruction in the pre-clinical curriculum before a student has any direct contact with a client. Each training program shall identify the unit objectives and performance indicators for each of the areas in §B of this regulation in its training criteria. Laboratory Instruction and Clinical Learning Experience. Each training program shall provide laboratory instruction in and require students to demonstrate clinical competence in performing skills consistent with the subjects under §B of this regulation. A training program shall ensure that students may not perform any services during their clinical learning experience for which they have not trained and been found proficient by the course instructor. Each training program shall have an objective final written examination that measures achievement of the performance indicators. To successfully complete the training program, each student shall: Complete the required minimum hours provided in Regulation .06A of this chapter; Demonstrate the ability to perform nursing functions with clients of any age and with various levels of physical, sensory, cognitive, and emotional ability; Achieve a passing score of at least 75 percent on the written final examination; and Demonstrate competence in meeting the objectives and performance indicators during didactic, laboratory, and clinical instruction. The training program shall provide the following to students who complete the program: A certificate of completion using the form required by the Board; and Registration information for a nursing assistant competency evaluation. A program coordinator or faculty of a training program: May sign a student’s application for certification as a nursing assistant before graduation; and Shall submit to the Board written verification, as required by the Board, of each student’s program completion within 5 business days of program completion. Expiration. Unless renewed, Board approval of a training program expires 2 years from the last date of approval. Renewal application. At least 120 days before the date of expiration of approval, a training program shall submit: A complete application on the form required by the Board; and All accompanying documentation required by the application or requested by the Board. Survey Visit. Following receipt of a renewal application from a training program, the Board’s professional staff shall conduct an announced or unannounced on-site survey visit and submit a survey visit report to the Board. Board Action. The Board shall: Renew approval of a training program for another 2-year term if the training program meets the applicable requirements of this chapter; or Initiate withdrawal of approval proceedings in accordance with Regulation .09 of this chapter if the training program fails to meet the applicable requirements of this chapter. Enrollment. A training program that fails to renew its approval: Shall be listed on nonrenewed status in the Board’s records; and May not enroll any new students to the program following the expiration of approval. Notice of Deficiencies. If the Board determines that there is a basis for withdrawal of approval under §C of this regulation, the Board shall issue a written notice of deficiencies to the training program. The notice of deficiencies shall notify the training program of the: Requirements with which the program has not complied; Reasons for the Board’s determination; and Requirement to submit a written plan of correction in accordance with §B of this regulation. Written Plan of Correction. A training program shall submit a written plan of correction after 30 calendar days of the date of the notice of deficiencies unless granted an extension by the Board for good cause. The written plan of correction shall: Address all deficiencies noted by the Board; and Include dates of completion for correcting the deficiencies. The Board shall review the plan of correction and may approve or modify the dates of completion for correcting deficiencies. The training program shall correct the deficiencies within the time frame approved by the Board. Grounds for Withdrawal. The Board may withdraw approval of a training program that: Fails to comply with any of the applicable requirements of this chapter; Fails to correct deficiencies within the time frame approved by the Board; Enrolls new students after expiration of approval; or Has a graduate pass rate of less than 90 percent of the pass rate for all states using the applicable Board-approved vendors for a nursing assistant competency evaluation. Procedure for Withdrawal. Before withdrawing approval of a training program under §C of this regulation, the Board shall: Notify the program of its intent to withdraw approval; and Give the program an opportunity to request an evidentiary hearing before the Board. The notice of intent to withdraw approval and hearing shall comply with the Administrative Procedure Act. Mandatory Withdrawal. Notwithstanding any other section of this regulation, the Board shall withdraw approval of a training program upon receipt of notice from the Office of Healthcare Quality that the facility is prohibited from holding a training program pursuant 42 CFR §483.151(f)(1) or 42 CFR §483.151(f)(3). Reinstatement. A training program whose approval was withdrawn may apply for reinstatement of approval by submitting a reinstatement application demonstrating that the program meets all of the applicable requirements of this chapter. When a training program provider considers closing a program, the training program provider shall: Notify the Board in writing of: The intended closing date; and The arrangements for custody and safeguarding of student and graduate records; and Continue the program until the committed class schedule of currently enrolled students is completed. Custody of Student Records. If the training program provider is a facility or educational institution that will continue to function, the facility or educational institution shall assume responsibility for the student and graduate records of the closed training program. Except as provided in §B(1) of this regulation, a training program provider that is required to obtain approval from the Maryland Higher Education Commission (MHEC) shall file student and graduate records, or legible copies of those records, with MHEC in accordance with Education Article, §11-401, Annotated Code of Maryland. A training program provider that is not required to obtain MHEC approval shall reach a mutual agreement with the Board about the disposition of student records. Scope. This regulation applies to hybrid nursing assistant training programs. Approval. The Board shall approve a hybrid training program that meets all of the requirements of this regulation. Prerequisite Qualifications. A program seeking initial approval as a hybrid training program shall: Comply with the requirements set forth in Regulation .02 of this chapter; Be approved by the Board as a traditional training program for at least 2 years before the program applies for initial approval as a hybrid training program; and Comply with all requirements set forth under this chapter and be in good standing with the Board at the time that the program applies for initial approval as a hybrid training program. Application and Approval Requirements. A training program seeking initial approval as a hybrid training program shall apply for approval on a form required by the Board. To be eligible for Board approval, a hybrid training program shall: Host sessions no longer than 4 hours per session; Specify the technology platform to be used for each content area of the curriculum; Conduct lab and clinical training: In person with a course instructor who meets the requirements under Regulation .04 of this chapter; and No later than 2 weeks after the completion of didactic instruction; Require test sessions to be conducted in person; Have a policy, which is provided to the Board as a part of the application, for: Admissions, including determining whether a student has sufficient access to a computer and learning resources; Orienting students to online modules; Providing troubleshooting assistance for enrolled students; and In the case of technology failure, an alternative method of instruction and notification to the Board of the technology failure and the use of the alternative method of instruction; Have sufficient mechanisms for: Requiring the use of a personal identification number that confirms the identity of the students and instructor; Ensuring that all students have demonstrated competency on all virtual education content; Tracking and auditing active student participation in online instruction; Confirming student identity during and after completion of online modules and live sessions; and Safeguarding appropriate security measures; Provide the Board with access rights to the program to verify program compliance and monitor distance learning sessions; and Provide the Board with statistics about the performance of students in the program, including: Student exam pass rates; The rate at which students repeat each module of the program; and Any other information requested by the Board regarding student participation in and Reapproval. An approved hybrid training program shall apply for renewal of approval in accordance with Regulation .08 of this chapter. Withdrawal of Approval. The Board may withdraw approval of a hybrid training program in accordance with Regulation .09 of this chapter. Health Occupations Article, §§8-205, 8-6A-05(a)(6), and 8-6A-14, Annotated Code of Maryland; Chs. 818 and 819, Acts of 2024; Ch. 416, Acts of 2025 Effective date: April 30, 2001 (28:8 Md. R. 761) Regulation .02B amended effective July 2, 2018 (45:13 Md. R. 667) Regulation .05A amended effective July 2, 2018 (45:13 Md. R. 667) Regulation .07B amended effective November 7, 2005 (32:22 Md. R. 1756) Chapter revised as an emergency provision effective April 3, 2026 (53:9 Md. R. 411); amended permanently effective June 8, 2026 (53:11 Md. R. 484) In this chapter, the following terms have the meanings indicated. Terms Defined. “Board” means the Maryland Board of Nursing. “Certificate” means a certificate issued by the Board to practice as a nursing assistant in this State. “Certified medicine aide (CMA)” means an individual certified in good standing as an active CNA who: Satisfies the requirements of COMAR 10.39.03.02; and Is further certified by the Board to accept delegation of administration of certain medications. Certified Nursing Assistant (CNA). “Certified nursing assistant (CNA)” means an individual, regardless of title, who, for compensation and subject to regulations adopted by the Board, routinely performs: Nursing tasks delegated by a registered nurse, licensed practical nurse, or advanced practice registered nurse; or Technical tasks delegated by a licensed certified midwife. “Certified nursing assistant (CNA)” does not include dialysis technician or medication technician. Certified Nursing Assistant-I (CNA-I). “Certified nursing assistant-I (CNA-I)” means a CNA who: Meets the requirements set by the Board and federal law; and May practice in any practice setting. “Certified nursing assistant-I (CNA-I)” includes a: CNA who was certified as a geriatric nursing assistant on March 31, 2026; Certified medicine aide; and CNA who is certified pursuant to § 8-6A-05(c)(5) of the Health Occupations Article, Annotated Code of Maryland. “Certified nursing assistant-II (CNA-II)” means a CNA who: On March 31, 2026, was certified as a CNA but not certified as a geriatric nursing assistant; and May not practice in a nursing facility or skilled nursing facility. “Controlled schedule drugs” means drugs listed as Schedule I, II, III, IV, or V controlled dangerous substances under Criminal Law Article, §§5-402 — 5-406, Annotated Code of Maryland. “Licensed practical nurse (LPN)” has the meaning stated in Health Occupations Article, §8-101, Annotated Code of Maryland. “Registered nurse (RN)” has the meaning stated in Health Occupations Article, §8-101, Annotated Code of Maryland. An applicant for certification as a CMA shall provide evidence satisfactory to the Board of meeting the following requirements: Current certification by the Board as an active CNA-1 in good standing; Current employment and work experience as required by the Board in a setting acceptable to the Board, including: Current employment and 2 years of full-time experience as a CNA-1 in a facility licensed under 42 CFR Part 483 et seq.; or Current employment and 1 year of full-time experience as a CNA-I in a facility licensed in Maryland under COMAR 10.07.02; and Successful completion as evidenced by a certificate of completion from a Board-approved CMA training program. The community college shall submit verification of successful completion of the CMA training program to the Board within 5 business days after completion of the program in a manner prescribed by the Board. Before renewal of certification as a CMA, and subject to the requirements in Health Occupations Article, §8-6A-08, Annotated Code of Maryland, and COMAR 10.39.01.09, the applicant shall: Successfully complete a Board-approved 8-hour medicine aide continuing education program as required by Regulation .03B of this chapter; and Provide satisfactory evidence of completion of 100 hours of practice as a certified medicine aide in the 2-year period preceding the date of renewal. Medicine Aide Course Curriculum. The Board shall approve a CMA program that: Requires a candidate for admission to the program have current employment and work experience as set forth in Regulation .02A(2) of this chapter; Requires before admission that a candidate have a positive recommendation from the director of nursing in the facility where the candidate is employed; Is at least 60 hours in length with a minimum of 30 clock hours devoted to theoretical instruction and a minimum of 30 clock hours of supervised clinical training experience in a facility licensed under COMAR 10.07.02; Includes instruction in both theory and clinical regarding all approved routes of medication administration and the scope of responsibility of the CMA; and Includes each of the following subjects: Responsibilities and limitations of the CMA; Drug standards, references, and resources; Legislation concerning drug utilization; Characteristics of the elderly client or client with multiple handicaps; Sources and purposes of drugs; Dosage forms and methods of administration; Drug life; The medication order; The pharmacy label; The administration of nonparenteral medications; Procedures and techniques for administering drugs; Drug classification, related health problems, and patient care responsibilities; Drug solutions and measurements; and Monitoring side effects of drugs and drug interactions. Medicine Aide Continuing Education Curriculum. Continuing education courses required for continued listing as a CMA as required in Regulation .02C of this chapter shall contain: A 3-hour core content that includes: Current State regulations related to the role of the medicine aide; Uses, actions, and possible interactions of and related precautions for current medications used in the care of the geriatric patient; New care procedures; and Resources available to the medicine aide which clarify and expand the knowledge of the medicine aide; and 3 hours on at least three of the following topics: Documentation; Nutrition; The physiological system of the geriatric patient; De-institutionalization of the intellectually disabled or psychiatric patient; or Other aspects of pharmacology; and 2 hours of assessment testing administered at the completion of the continuing education course. The CMA may be delegated medication administration by the RN or LPN under the following conditions: The licensed nursing supervision requirements in Regulation .05 of this chapter have been met; The CMA is assigned to administer medication; There is a written medication order; The CMA is physically present on a continuing basis in the unit of care to accomplish the following as instructed and directed by the RN or LPN: Monitor the therapeutic effects of the medication; Observe and report untoward effects of the medication; Report observed changes in client behavior and clinical status; and Withhold administration of the medication if necessary. The CMA may perform the following RN or LPN delegated nursing functions: Prepare, administer, and chart medications administered: Orally; By nebulizer, metered dose inhalant, and, in the case of oxygen, by nasal cannula or mask; Topically, excluding wound or decubitus site care; By suppository; and By eye, ear, and nose drops; Prepare, administer, and chart: Nonlegend PRN medications; and Controlled schedule drugs after the RN or LPN: Makes a bedside assessment of the patient; Documents the assessment; and Gives permission to the CMA to administer that medication; and When the licensed nurse delegating medication administration provides access to the controlled schedule drug cabinet, sign for and administer controlled schedule drugs. The CMA may administer medications when: In a setting licensed under COMAR 10.07.02, the licensed nurse is physically present and immediately available on the unit of care in which the client resides to provide direct supervision of any client who receives medication administered by the CMA; and In a setting licensed under 42 CFR Part 483 et seq., the licensed nurse is on-site and physically available to the CMA and the CMA administers medications only to clients whose clinical status is: Chronic; Stable; Uncomplicated; and Permitting placement in the community. The RN or LPN may not delegate the following duties to the CMA: Transcription of original physician orders to medication and treatment administration records, charts, or Kardexes; Charge level responsibilities, including receiving instructions for or being assigned to such responsibilities; Administration of medication to clients whose clinical status is acutely unstable, complex, or medically fragile in a setting licensed under 42 CFR Part 483 et seq.; Administration of medication by way of the following routes: Injection; Intravenous route; and By way of a tube inserted in a cavity of the body, including nasogastric or gastrostomy tube feeding; Client teaching; Acceptance of verbal or telephone orders; and Responsibility for maintaining possession of the keys or access code to the locked container for controlled schedule drugs. Health Occupations Article, §§8-205(a) and (c) and 8-6A-01 — 8-6A-16, Annotated Code of MarylandChs. 818 and 819, Acts of 2024; Ch. 416, Acts of 2025 Effective date: February 5, 2001 (28:2 Md. R. 100) Regulation .02 amended as an emergency provision effective October 30, 2001 (28:23 Md. R. 2052); amended permanently effective February 18, 2002 (29:3 Md. R. 221) Regulations .01 — .04 repealed and new Regulations .01 — .06 adopted as an emergency provision effective January 19, 2005 (32:3 Md. R. 287); adopted permanently effective March 14, 2005 (32:5 Md. R. 580) Regulation .01B amended as an emergency provision effective April 3, 2026 (53:9 Md. R. 411); amended permanently effective June 8, 2026 (53:11 Md. R. 484) Regulation .02A, C amended as an emergency provision effective April 3, 2026 (53:9 Md. R. 411); amended permanently effective June 8, 2026 (53:11 Md. R. 484) Regulation .02C amended effective August 25, 2008 (35:17 Md. R. 1489) Regulation .03B amended effective April 15, 2013 (40:7 Md. R. 612) This chapter does not apply to an individual who is: Practicing a health occupation, other than as medication technician, that the individual is authorized to perform under Health Occupations Article, Annotated Code of Maryland; A student enrolled in an approved nursing education program while practicing registered nursing or licensed practical nursing in that program; Providing gratuitous care of friends or family members; Performing medication technician tasks while a student practicing under the direct supervision of qualified faculty in a Board-approved medication technician training program; or Working as a school principal or school secretary, does not administer medication as a routine part of the position, and, after completing training by the school's delegating nurse, administers medication due to the absence of the nurse or medication technician. In this chapter, the following terms have the meanings indicated. Terms Defined. “Board” means the Maryland Board of Nursing. “Certificate” means a certificate issued by the Board to practice as a certified medication technician in this State. Certified Nursing Assistant (CNA). “Certified nursing assistant (CNA)” means an individual, regardless of title, who: Routinely performs delegated nursing tasks which were delegated by a registered nurse (RN) or licensed practice nurse (LPN) for compensation; and Is certified under COMAR 10.39.01. “Certified nursing assistant (CNA)” does not include: A medication technician; or An individual who merely provides assistance with activities of daily living unless the client's needs are such that adverse health consequences are predictable. “Clinical refresher course” means a course of study approved by the Board to maintain the medication technician's knowledge and skill to administer medication. “Licensed practical nurse (LPN)” means an individual who: Is licensed by the Board to practice licensed practical nursing; or Has a multistate licensure privilege to practice licensed practical nursing. “Medication technician (MT)” means an individual who: Has successfully completed a Board-approved MT training program; Meets any other qualifications set by the Board; and Is certified by the Board as a MT. “Medication technician training program” means a course of training approved by the Board that meets the basic MT core curriculum and content training specific to the setting in which the MT will work. “Multistate licensure privilege” has the meaning set forth in COMAR 10.27.01.01B. “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. Fees are as follows: Initial certification fee . . . $20; Renewal fee . . . $30; Returned check fee . . . $25; and Duplicate certification fee . . . $10. Fees are not refundable. An applicant for MT certification shall: Be 18 years old or older; and Submit to the Board: An application to the Board on the form required by the Board and signed by the RN that taught the applicant's medication technician training program; and The required fee; and Be of good moral character. An applicant for MT certification may not have: Committed any act or omission that would be grounds for discipline or denial of certification under this subtitle; or A record of abuse, negligence, misappropriation of a resident's property, or any disciplinary action taken or pending in any state or territory of the United States against any certificate or license issued to the applicant. An applicant for MT certification from any other state, territory, or country shall meet all requirements of this chapter. An applicant who reports a positive criminal history on any application shall provide: Any documentation requested from the applicant by the Board including, but not limited to, official certified or true test court documents and a signed, dated explanation written by the applicant, regarding the facts and circumstances, outcome, and current status of any criminal history record information received by the Board: In an answer to a question on the Board’s application form; or From any other source; and Any additional documentation requested by the Board if the documentation received from the applicant under §D(1) of this section is incomplete or insufficient. If an application is not complete when initially submitted to the Board by the applicant, the applicant shall have no longer than 12 months from the date the application is received by the Board to complete the application and provide all information and documents required under §D of this regulation. If an applicant fails to provide to the Board a complete application and any additional documentation requested by the Board under §D of this regulation within 12 months from the date the application is received by the Board, then the application shall be considered abandoned and may be destroyed. Once an application is deemed abandoned under §F of this regulation, an individual seeking MT certification must submit a new application and meet all of the requirements for MT certification and pay the required fees that are in effect at the time of re-application. The Board shall renew the certificate of each certificate holder who meets the requirements of this chapter. The certificate holder shall renew the certificate every 2 years by birth month. At least 3 months before a certificate expires, the Board shall send the certificate holder a renewal notice by: First-class mail to the last known address of the certificate holder; or Electronic means to the last known electronic address of the certificate holder. An individual applying for renewal of certification shall provide evidence of: Satisfactory completion of a Board-approved clinical refresher course; and Completion of 100 hours of practice as a certified medicine technician within the 2-year period preceding the date of renewal. A Board-approved MT training program shall meet the requirements stated in this regulation and in Regulation .09 of this chapter. The MT training program: Shall utilize the Board-approved uniform curriculum, including the math and English proficiency examinations, to teach the MT training program; Shall contain 20 hours of curriculum content, including 4 hours of content addressing common disease processes and high-risk medications specific to the client population of the practice setting in which the enrolled student will practice upon certification; May not have classes exceeding 6 classroom clock hours at one time; Shall have at least one instructor per 15 students; and Shall submit verification of the applicant's successful completion of the MT course on a form required by the Board within 5 business days. Each faculty member for an MT training program shall be an RN who: Is licensed by the Board to practice registered nursing or has a multistate licensure privilege to practice registered nursing; and Has completed a course of instruction approved by the Board designed to instruct the RN on how to teach the MT training program for the specific practice setting in which the enrolled students are to work. Each certificate holder shall notify the Board in writing of any change in name or address within 30 days of the change. The Board may impose a fine of $25 for failure to notify the Board of a change in name or address. The certificate expires every 2 years on the 28th day of the certificate holder's birth month. The Board may impose a civil fine, not to exceed $50, on a medication technician who: Fails to renew a certificate within 30 days after the expiration date; and Practices as an MT during the period of expiration. Administration of medication is a licensed nursing function. As such, the nurse retains full responsibility when delegating this nursing function. In community-based practice settings, the MT: May perform delegated medication administration functions as set forth in COMAR 10.27.11.05G(3) and 10.07.14; and Shall be supervised by the RN as specified in COMAR 10.27.09, 10.27.11, and 10.07.14. The MT may perform the delegated nursing function of medication administration as permitted under COMAR 10.27.11.05H(3), which includes the administration of: Medication by metered dose inhalant or nebulizer, and oxygen by nasal cannula or mask; Medication by gastrostomy tube or rectal tube if the nurse has calculated the dosage; Oral medication, including: Measuring as prescribed an amount of liquid medication where the nurse has calculated the dose; and Administering a fraction of a tablet if the nurse has cut the tablet; Medication by subcutaneous injection after the nurse has calculated the dose; Medication administered by topical route as specified in COMAR 10.27.11.05H(3)(e) and (h); Medication administered by suppository route; and Medication drops administered by routes involving eye, ear, or nose. The MT may not: Calculate any medication dose; Administer medications by: Injection, except as specified in Regulation .09C(4) of this chapter; Way of a tube inserted in a cavity of the body, except as specified in Regulation .09C(2) of this chapter; or Intravenous route; Transcribe verbal orders; Fill medication assistive devices such as mediplanners or time-dose medication containers with medication; Package or repackage medications that are prescribed, ordered, over-the-counter, or herbal; Perform certified nursing assistant duties unless certified as a nursing assistant by the Board or otherwise authorized by Health Occupations Article, Title 8, Annotated Code of Maryland; Provide medication administration teaching; or Delegate medication administration. An individual who is not certified as an MT under this chapter may not: Represent by title of “certified medication technician” or “MT”, by description of services, methods, or procedures or otherwise, that the individual is authorized to practice as a certified medication technician; Use the words or terms “medication technician”, “MT”, “CMT”, or any other abbreviation, title, symbol, sign, card, device, or other representation, with the intent to represent that the person practices as a certified medication technician; or Practice, attempt to practice, or offer to practice as a certified medication technician. Health Occupations Article, §§8-205(a) and 8-6A-01—8-6A-16, Annotated Code of Maryland Effective date: April 24, 2006 (33:8 Md. R. 734) Regulation .02B amended effective July 2, 2018 (45:13 Md. R. 667) Regulation .04 amended effective February 13, 2017 (44:3 Md. R. 189) Regulation .04A amended effective July 2, 2018 (45:13 Md. R. 667) Regulation .05 amended effective July 2, 2018 (45:13 Md. R. 667) Regulation .05D amended effective August 25, 2008 (35:17 Md. R. 1489) Regulation .06C amended effective July 2, 2018 (45:13 Md. R. 667) Regulation .09C amended effective March 12, 2007 (34:5 Md. R. 561) This chapter is not applicable to and does not restrict or limit: Other health care practitioners who are authorized to perform these duties under their respective acts; The provision of gratuitous care by self, family, or friends; A nurse from delegating a nursing task to an unlicensed individual if acceptance of delegated nursing tasks does not become a routine part of the unlicensed individual’s job duties; or A cognitively capable adult from employing an unlicensed caregiver in the adult’s home to assist the adult in treatments of a routine nature and in self-administration of medication. In this chapter, the following terms have the meanings indicated. Terms Defined. “Assessment” means a comprehensive, dynamic process by which the registered nurse collects and analyzes data through interaction with: The client; The family; Significant others; and Other health care providers. “Certified nursing assistant (CNA)” means an individual certified by the Board to practice as a nursing assistant. “Delegate” means the nurse: Authorizes the CNA to act on behalf of the nurse; Authorizes the CNA to augment and supplement the care the nurse provides; and Retains the accountability and responsibility for the delegated act. “Health care team” means a group of individuals that includes licensed health care providers, CNAs, and unlicensed personnel working in collaboration with the client, family, and friends to achieve identified outcomes. “Health status data” means and includes, but is not limited to: Biophysical status to measure: Height; Weight; and Vital signs; Cultural, religious, and socioeconomic background; and Activities of daily living. “Nurse” means a licensed registered nurse (RN) or a licensed practical nurse (LPN). “Nursing plan of care” means an established set of goals, priorities, and methods designed to solve, prevent, and manage a client’s identified problems. “Outcome” means a measurable, expected, client-focused goal which is observable by the client’s behavior or status. Responsibility. A CNA: Works under the delegated authority from a nurse to perform a nursing function; Assists the nurse in collecting data for a nursing assessment; and Is under the supervision of a nurse. In a team relationship with a registered nurse, and under the instruction, direction, and supervision of a nurse, the CNA shall: Collect and record routine health data identified by the nurse on assigned clients; Orally report the health status data as required by the nurse; Identify when the client’s condition or behavior has changed from one day to another or from one part of the assigned shift to another and report any change to the nurse; Provide feedback to the nurse regarding the nurse-directed plan of care which is being implemented; Provide feedback to the nurse about the client’s expressed wishes concerning the plan of care; Provide assistance with activities of daily living as delegated by the nurse; Perform interventions as delegated by a registered nurse; Record routine data and care provided on appropriate documents; Identify the need for assistance and request assistance when the CNA: Is unsure about a client’s condition; Does not know how to do an activity; Is aware that client circumstances have changed; Is working in a new practice or work setting; or Is working with a new client in an unfamiliar situation; Report the client’s response and the client’s progress to the nurse: At designated times; and When client circumstances have changed; Make suggestions or recommendations on how the nursing plan of care can be modified based on observations of the client’s performance and statements; and Demonstrate competency in safely performing CNA functions, which include, but are not limited to: Participation in quality of care activities; Performance self-appraisal; Continued learning; Collaboration; Completion of delegated assignments; and Refusing or accepting an assignment based on one’s knowledge or experience. Confidentiality. The CNA shall: Adhere to local, State, and federal guidelines and regulations regarding client confidentiality and privacy rights; and Direct all client requests for information to a nurse. Advocacy. The CNA shall: Advocate for the client by reporting to the nurse statements expressed by the client or family regarding: Any request for information; Concerns about care; and Client needs; and Collaborate with other health care team members by reporting information and data regarding the client in a timely, truthful, and complete manner. Teaching. The CNA shall: Reinforce the nurse’s health teaching: In accordance with the: Facility; Employer; or Agency policy; and At the direction of the registered nurse’s written instruction; Report the client’s response to the teaching; and Report any request by the client for additional information. Accountability. The CNA shall: Comply with all policies and procedures of the: Facility; Employer; and Agency; Comply with all local, State, and federal guidelines and regulations governing nursing assistant practice; Perform competently all activities as assigned or delegated; Report to the nurse; Provide the client with a safe therapeutic environment; Recognize the CNA’s individual limits of knowledge and experience; As needed, request assistance, direction, and supervision from the nurse; Recognize the CNA’s responsibility and accountability to perform functions safely and competently; Comply with the CNA code of ethics in accordance with COMAR 10.39.07; Report all errors, omissions, or incidents which may have occurred during the CNA’s own practice or the practice of others; and Follow the basic principle of nursing practice: “First, do no harm to the client”. Health Occupations Article, §§8-205(a)(1) and (2) and 8-6A-05(a)(1), Annotated Code of Maryland Effective date: November 15, 2010 (37:23 Md. R. 1611) This chapter does not apply to an individual who: Practices a health occupation, other than certified dialysis technician, that the individual is authorized to practice in accordance with Health Occupations Article, Annotated Code of Maryland; Provides for the gratuitous care of friends, domestic partners, or family members; Performs dialysis technician tasks as a student while under the direct supervision of qualified faculty; Performs nursing tasks delegated by a registered nurse or licensed practical nurse so long as the delegated nursing tasks do not become a routine part of the unlicensed or uncertified individual’s job duties; and Is an unlicensed caregiver hired by a cognitively capable adult to assist the individual at their home in treatments of a routine nature and in self-administration of medication. In this chapter, the following terms have the meanings indicated. Terms Defined. “Accountability” means being answerable for actions of self or others. “Board” means the Maryland Board of Nursing. “Central Repository” means the Maryland Criminal Justice Information System Central Repository of the Department of Public Safety and Correctional Services. “Certificate” means a certificate issued by the Board to practice as a certified dialysis technician in this State. Certified Dialysis Technician (CDT). “Certified dialysis technician” means an individual who is certified by the Board to practice as a dialysis technician. “Certified dialysis technician” does not include a: Medication technician; or Certified nursing assistant. “Certified nursing assistant (CNA)” means an individual certified by the Board as a nursing assistant in accordance with COMAR 10.39.01. “Clinical facility” means a setting where patients are present and that provides facilities for supervised clinical training. “Criminal history records check (CHRC)” means the performance of both a State criminal history records check by the Central Repository and a national criminal history records check performed by the Federal Bureau of Investigation. “Criminal history record information” means information provided by the criminal history records check regarding an applicant’s criminal arrests, charges, convictions, and other dispositions of criminal charges. “Delegation” means the act of authorizing a certified dialysis technician to perform acts of registered nursing or licensed practical nursing. “Direct supervision” means the individual is on site, physically present, accessible in the immediate patient care area, and available to intervene if necessary. “Evaluation” means the review and analysis of the extent to which the assessment, nursing diagnosis, planning, and implementation phases of the nursing process were effective in resolving the patient’s identified problems. “Family” means related family members, foster parents, domestic partners, and legal guardians. “Good standing” means without an encumbrance that limits or restricts practice, such as revocation, suspension, or probation. “Licensed practical nurse (LPN)” means an individual who: Is licensed by the Board to practice licensed practical nursing; or Has a multistate licensure privilege to practice licensed practical nursing. Licensed Practitioner. “Licensed practitioner” means an individual licensed in the healthcare field. “Licensed practitioner” includes RNs, LPNs, advanced practice registered nurses, physicians, physician’s assistants, physical therapists, and respiratory therapists. Model of Nursing Practice. “Model of nursing practice” means the policies, procedures, and practice guidelines: Established by the facility, which are consistent with this chapter regarding delegation of nursing functions and regulations governing the facility; and That provide direction to nursing staff on the delivery of care to the patient population which the facility serves. “Model of nursing practice” may not supersede a delegating nurse’s prudent judgment regarding: Delegation of a nursing function to a dialysis technician; or A particular delegated nursing function to that individual or individuals. “Multistate licensure privilege” has the meaning set forth in COMAR 10.27.01.01B. “National certification” means certification as a: Certified Clinical Hemodialysis Technician issued by the Nephrology Nursing Certification Commission; Clinical Nephrology Technician issued by the National Nephrology Certification Organization; or Certified Hemodialysis Technician issued by the Board of Nephrology Examiners Nursing Technology. “Nurse” means a registered nurse or licensed practical nurse. “Patient” means the recipient of nursing care. “Practice as a certified dialysis technician” means to provide, under the supervision of a registered nurse or licensed practical nurse, direct care to patients undergoing renal dialysis treatments. “Program completion” means that the student: Completed and demonstrated competency in the program objectives and performance indicators during the didactic, laboratory, and clinical portions of the training program; and Passed the final written examination. “Qualified faculty” means an instructor or instructors as described in Regulation .10A of this chapter. “Readily available” means: The delegating nurse is physically present on the unit; and The nurse may transfer responsibility for the nursing supervision and delegation to another nurse who then becomes the nurse delegating the nursing functions. “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. “Routine care” means those activities necessary on a daily basis for the patient to gain or maintain a level of functioning. “Structured setting” means a dialysis facility, hospital, nursing home, long-term care facility, ambulatory care setting, or any other acute care, chronic care, or correctional facility that has a location in which dialysis care is provided. “Supervised clinical training” means training in person in a clinical facility during which the student demonstrates knowledge and skills while performing tasks on a patient under the direct supervision of an RN. “Supervision” means the process of critical watching, directing, and evaluating another's performance. “Unlicensed individual” means an individual who is not licensed or certified to provide nursing care in accordance with Health Occupations Article, Title 8, Annotated Code of Maryland. “Written agreement” means a contract between a training program and a clinical facility outlining the terms required, by both the program and the facility, for supervised clinical training of students. An applicant shall submit: A completed application to the Board on the form required by the Board; To a CHRC in accordance with Health Occupations Article, §8-303, Annotated Code of Maryland; Written evidence satisfactory to the Board that the applicant has submitted to a CHRC as required by §A(2) of this regulation by submitting: Two sets of fingerprints, as required by the Central Repository and the Federal Bureau of Investigation; and All fees required by the Central Repository and the Federal Bureau of Investigation; Any documentation requested from the applicant by the Board including, but not limited to, official certified or true test court documents and a signed, dated explanation written by the applicant, regarding the facts and circumstances, outcome, and current status of any criminal history record information received by the Board: Under §A(2) of this regulation; In an answer to a question on the Board's application form; or From any other source; and Any additional documentation requested by the Board if the documentation received from the applicant under §A(4) of this regulation is incomplete or insufficient. If an application is not complete when initially submitted to the Board by the applicant, the applicant shall have no longer than 12 months from the date the application is received by the Board to complete the application and provide all information and documents required in §A of this regulation. If an applicant fails to provide to the Board a complete application and any additional documentation requested by the Board under §A of this regulation within 12 months from the date the application is received by the Board, then the application shall be considered abandoned and may be destroyed. Once an application is deemed abandoned under §C of this regulation, an individual seeking certification as a dialysis technician shall submit a new application on the form required by the Board and meet all the requirements for certification as a dialysis technician and pay the required fees that are in effect at the time of re-application. Initial certification. Except as provided in §D of this regulation, an applicant for initial certification as a dialysis technician shall have successfully completed a dialysis technician training program approved by the Board. Certification by Endorsement. An applicant for certification as a dialysis technician by endorsement shall: Hold a certificate to practice as a dialysis technician that: Was issued by another state or territory of the United States that has certification requirements that are essentially similar to those set forth in Health Occupations Article, §8-6A-05, Annotated Code of Maryland; and Is in good standing; and Have successfully completed a dialysis technician training program that meets the standards for an approved dialysis technician training program set by the Board. A certified dialysis technician shall obtain national dialysis technician certification within 18 months of the date of hire as a certified dialysis technician. An individual certified as a certified nursing assistant with the status of dialysis technician (CNA-DT) shall be deemed to meet the requirements for initial certification as a dialysis technician under §A of this regulation. Initial Certification. Except as otherwise provided in this chapter, an applicant for initial certification as a dialysis technician shall: Comply with all of the requirements under Regulation .03 of this chapter; Pay the required fee to the Board; and Submit to the Board an application that has been signed by the administrator or faculty of the approved dialysis technician training program completed by the applicant. An applicant shall submit an application for initial certification within 24 months of the date of completion of an approved dialysis technician training program. If an applicant fails to comply with §A(2) of this regulation, an applicant still seeking certification shall re-take an approved dialysis technician training program and comply with §A(1) of this regulation. Certification by Endorsement. An applicant for certification as a dialysis technician by endorsement shall: Comply with all of the requirements under Regulation .03 of this chapter; Pay the required fee to the Board; and Submit the following verifications directly to the Board from the appropriate authority: A certificate to practice as a dialysis technician in good standing from another state or territory with certification requirements that are essentially similar to the requirements in this State; and A certificate of completion from a dialysis technician training program in that state or territory that meets the standards for an approved dialysis technician training program set by the Board. The Board may issue a temporary practice certificate to an applicant who: Has met the appropriate certification requirements to the satisfaction of the Board; Does not have a criminal record; and Has not been the subject of a health professional disciplinary action in this State or another jurisdiction. Unless the Board suspends or revokes a temporary practice certificate, the temporary practice certificate expires 90 days after the date of issuance. A temporary practice certificate may be extended up to an additional 90 days if the applicant is awaiting the completion of the criminal history records check. The Board may not issue a certificate to an applicant until the Board has: Received and reviewed the criminal history record information of the applicant; and Approved the application. Unless an applicant is subject to discipline, the Board shall issue a dialysis technician certificate to each applicant who meets all the requirements of this chapter and Health Occupations Article, §§8-6A-05 and 8-6A-06, Annotated Code of Maryland. CNA-DT Certificates. On or after the effective date of this regulation, the Board shall issue an initial dialysis technician certificate to all individuals then-certified as a CNA-DT. The status of an initial dialysis technician certificate issued pursuant to §C(1) of this regulation shall be the same as the status of the individual’s CNA-DT certificate. Expiration. Unless renewed for an additional 2-year term, and except as otherwise provided in this regulation, a certificate expires in accordance with the following schedule: The certificate of a certificate holder with an odd-numbered birth year expires on the 28th day of the certificate holder’s birth month in an odd-numbered year; and The certificate of a certificate holder with an even-numbered birth year expires on the 28th day of the certificate holder’s birth month in an even-numbered year. Unless an initial certificate is issued pursuant to Regulation .07C of this chapter, an initial dialysis technician certificate shall not expire within 180 days of the date of issuance. Certificate Holder Responsibility. It is the responsibility of the certificate holder to: Be aware of the expiration date of the certificate; and Renew the certificate before it expires. Failure of a certificate holder to receive the renewal notice sent by the Board does not relieve the certificate holder of the responsibility to renew a certificate before it expires. Renewal Requirements. The Board shall renew a certificate if the certificate holder: Is otherwise entitled to be certified; Submits a complete application for renewal on the form required by the Board; Pays the renewal fee to the Board; Provides satisfactory evidence, as required by the Board, of: 16 hours of active practice as a dialysis technician, for monetary compensation, in the last 24 months immediately preceding the date of expiration; Completion of 3 hours of continuing education approved by the Board in the 24 months immediately preceding the date of expiration; and Except as provided in §D(3) of this regulation, an active national certification; and If required to submit to a CHRC in accordance with §G of this regulation, complies with the requirements of Regulation .03A of this chapter. If a renewal applicant cannot meet the requirements of §D(1)(d)(i)—(ii) of this regulation, the applicant shall re-take a Board-approved dialysis technician training program. If a renewal applicant is not yet eligible for a national certification before the first renewal, the applicant: May renew the certificate; and Shall submit evidence of an active national certification at the next renewal. National Certification. A dialysis technician shall not practice on an expired national certification. The dialysis technician shall submit a record of a renewed national certification to the Board if the national certification expires before renewal. Continuing Education Courses. The Board may review and approve continuing education courses that provide didactic instruction in the principles and applications of dialysis. The Board shall approve a course, seminar, or speaker session as a continuing education course if it is: Relevant to the practice of a dialysis technician; and Offered by a: College or university approved by the Maryland Higher Education Commission; State or national professional dialysis association; Board-approved certified dialysis technician program; or Health department or hospital. Course Review Requests. If a course does not meet the requirements under §F(2) of this regulation, a certified dialysis technician may request that the Board approve the course by submitting, in writing, at least 2 months before the course registration date, the following information on an application provided by the Board: Title, location, and date of the course; Course sponsors; Course objectives and contents; Hours of study; Name, qualifications, and curriculum vitae of each presenter; and The specific information that relates to the continuing education course. The Board shall notify the applicant of the Board's decision. A certified dialysis technician shall submit a course to the Board for reapproval if there is a change of subject matter, length, or presenter of a previously approved course. Criminal History Records Checks. CHRCs for renewal applicants shall be scheduled according to the certificate holder’s birth month as follows: In 2025 — all applicants with an August or September birth month; In 2026 — all applicants with a September or October birth month; In 2027 — all applicants with an October or November birth month; In 2028 — all applicants with a November or December birth month; In 2029 — all applicants with a December or January birth month; In 2030 — all applicants with a January or February birth month; In 2031 — all applicants with a February or March birth month; In 2032 — all applicants with a March or April birth month; In 2033 — all applicants with an April or May birth month; In 2034 — all applicants with a May or June birth month; In 2035 — all applicants with a June or July birth month; and In 2036 — all applicants with a July or August birth month. Approval. Before a training program is offered, the dialysis technician training program shall be approved by the Board. Board approval of a dialysis technician training program is valid for 2 years. Procedure for Initial Approval. At least 90 days before the proposed start date of the program, a program provider seeking initial approval of a dialysis technician training program shall: Submit to the Board a complete application on the form required by the Board; Demonstrate that the training program meets all the requirements of this regulation; and Provide any additional information requested by the Board during the Board’s review of the application. Board Action. Following receipt of a complete application, the Board’s professional staff may conduct a survey visit and submit a survey visit report to the Board. The Board shall: Approve a training program that meets all the requirements of this regulation; or Deny approval of a training program that does not meet all the requirements of this regulation. Ongoing Responsibilities. Board Approval of Substantial Program Changes. An approved dialysis technician training program shall obtain approval from the Board before making any substantial changes to the program. Substantial program changes include: Changes to faculty; Significant changes to curriculum, including an increase or decrease in program hours and changes to the modality of teaching; and Removal or addition of clinical facilities or classroom locations. An approved training program shall submit to the Board an annual report, on the form required by the Board, that includes: Statistics on enrollments; Program completions; and Attrition rates. The Board may make survey visits from time to time, without prior notice, to all approved dialysis technician training programs. Renewal of Approval. Expiration. Unless renewed, Board approval of a training program expires 2 years from the last date of approval. Renewal application. At least 90 days before the date of expiration of approval, an approved training program applying for renewal shall submit: A complete application on the form required by the Board; and All accompanying documentation required by the application or requested by the Board. Survey visit. Following receipt of a renewal application, the Board’s professional staff may conduct an announced or unannounced on-site survey visit and submit a survey visit report to the Board. Board Action. The Board shall: Renew approval of a training program for another 2-year term if the training program meets the requirements of this regulation; or Initiate withdrawal proceedings in accordance with §E of this regulation if the training program fails to meet the requirements of this regulation. Enrollment. A training program that fails to renew its approval: Shall be listed on nonrenewed status in the Board’s records; and May not enroll any new students to the program following the expiration of approval. Withdrawal of Approval. Notice of Deficiencies. If the Board determines that there is a basis for withdrawal of approval under §E(3) of this regulation, the Board shall issue a written notice of deficiencies to the training program. The notice of deficiencies shall notify the training program of the: Requirements with which the program has not complied; Reasons for the Board’s determination; and Requirement to submit a written plan of correction in accordance with §E(2) of this regulation. Plan of Correction. A training program shall submit a written plan of correction within 30 days of the date of the notice of deficiencies unless granted an extension by the Board for good cause. The written plan of correction shall: Address all deficiencies noted by the Board; and Include dates of completion for correcting the deficiencies. The Board shall review the plan of correction and may approve or modify the dates of completion for correcting deficiencies. The training program shall correct the deficiencies within the time frame approved by the Board. Grounds for withdrawal. The Board may withdraw approval of a training program that: Fails to comply with any of the requirements of this regulation; Fails to correct deficiencies within the time frame approved by the Board; or Enrolls new students after expiration of approval. Procedure for Withdrawal. Before withdrawing approval of a training program, the Board shall: Notify the program of its intent to withdraw approval; and Give the program an opportunity to request an evidentiary hearing before the Board. The notice of intent to withdraw approval and hearing shall comply with State Government Article, Title 10, Subtitle 2, Annotated Code of Maryland. Reinstatement. A dialysis technician training program whose approval was withdrawn may apply for reinstatement of approval by submitting a reinstatement application demonstrating that the program meets all of the requirements of this regulation. Faculty. The training program shall be administered by a registered nurse approved by the Board who meets the following qualifications: An active license to practice as a registered nurse in good standing in the State or a multistate licensure privilege to practice registered nursing in the State; A minimum of 2 years of experience practicing as a registered nurse, of which at least 1 year was in the care of renal patients; and Education or experience in adult education in the form of: Experience as a staff development instructor for a minimum of 1 year; Completion of at least 6 credit hours of an adult education program at a college or university; or Completion of an adult education course approved by the Board. The registered nurse who is responsible for administering the training program may utilize other licensed practitioners to assist in conducting classroom and clinical portions of the program in accordance with the professional’s educational background and applicable scope of practice. CDT Assistance. A certified dialysis technician may assist in aspects of supervised clinical training in a clinical facility, under the direct supervision of the registered nurse. A certified dialysis technician assisting in aspects of the training program shall: Hold a Certified Dialysis Technician certificate from the Board; Possess a current national certification; and Have at least 2 years' experience in hemodialysis services. The course instructor is responsible for: Participating in development and evaluation of the training program, including the acquisition of learning resources and instructional materials; Implementing the approved training program; Supervising classroom laboratory experiences; Evaluating student performance during didactic and laboratory training; and Providing direct supervision and clinical evaluation of each student at the clinical facility. Facilities and Resources. Classroom, laboratory, and clinical facilities shall be approved by the Board. All instructional learning resources and materials shall: Be accessible and relevant to the role of a dialysis technician; Be written at a level appropriate for a dialysis technician; and Have a publication date not older than 5 years from the current year. Clinical Facilities. Clinical facilities shall: Have a sufficient number and variety of patients to provide training experiences for all students to achieve the stated course objectives; Have a sufficient number of RNs and other nursing personnel to ensure safe and continuous care of patients; and Conform with accepted standards of nursing care and practice. There shall be a minimum of one course instructor for each eight students in the clinical area. Except for facility-based programs, the training program shall have a written agreement with a clinical facility that shall: Be developed jointly with the clinical facility and the training program; Be reviewed periodically by the clinical facility and the training program; Include a provision for adequate notice of termination; Specify the responsibility of the training program to the clinical facility and the responsibility of the clinical facility to the training program; and Identify the functions and responsibilities of the parties involved. Curriculum. A dialysis technician training program shall provide a minimum of 220 hours of instruction, of which a minimum of: 80 hours shall be devoted to didactic instruction and classroom laboratory training; and 140 hours shall be devoted to supervised clinical training in a clinical facility. A dialysis training program shall include curriculum content that ensures sufficient preparation for national certification and for safe and effective practice as a dialysis technician. Didactic instruction shall include the following content: Content required under 42 CFR §494.140E(3); A review of the relevant laws and regulations regarding the practice of a dialysis technician and appropriate program policies; Data collection; Environment; Renal anatomy and physiology; Infection control and universal precautions; Basic chemistry of body fluids and electrolytes; Manifestations of renal failure; Blood work and laboratory values related to dialysis; Principles of dialysis; Pharmacology of the drugs commonly used during dialysis; Medication administration techniques specific to the drugs used in dialysis, including lidocaine, heparin, and normal saline; Management of the complications of dialysis and renal failure; The role of the dialysis technician in a dialysis setting including, but not limited to, legal and ethical considerations and concepts of delegation; Water treatment relevant to dialysis; Principles of patient education related to renal failure; Principles of and requirements for documentation; Communication and teamwork skills, including: Observing, recording, and reporting; Interpersonal skills; and Listening; Operation of dialysis delivery systems that includes the machines, dialysate, and dialyzer; Principles of safe effective dialysis care; Principles related to the nutritional considerations for patients receiving dialysis; Psychosocial aspects of renal disease; Principles of dialyzer reprocessing; Principles for initiating, monitoring, and discontinuing dialysis; Principles related to the adequacy of dialysis; and Establishing and maintaining professional boundaries with a patient. Clinical instruction shall: Provide the student with the opportunity to practice the cognitive, psychomotor, and affective skills required for the safe performance of dialysis care by the dialysis technician; Meet the learning needs of each student; Meet the established program objectives or outcomes; and Be provided concurrently with the related classroom theory instruction. Each training program shall identify the unit objectives and performance indicators for each of the areas in §C(3) of this regulation in its training criteria. A training program shall provide at least 16 hours of didactic and classroom laboratory training before a trainee’s direct assignment to patient care. This instruction shall include the following topics: The role of the dialysis technician; Infection control; Safety and environment; Data collection; Treatments; and Laboratory procedures. Evaluation. Each training program shall have an objective final written examination that measures achievement of the performance indicators. To successfully complete the program, each student shall: Complete the required minimum hours provided in §C(1) of this regulation; Achieve a passing score of at least 75 percent on the written final examination; and Demonstrate competence in meeting the objectives and performance indicators during didactic, laboratory, and clinical instruction. The training program shall provide a certificate of completion, using the form required by the Board, to students upon program completion. An administrator or faculty of a training program: May sign a student’s application for certification as a dialysis technician before graduation; and Shall submit to the Board written verification, as required by the Board, of each student’s program completion within 5 business days of program completion. Medication Administration. A certified dialysis technician shall administer only the following medications: Intradermal lidocaine or another single therapeutically equivalent local anesthetic for the purpose of initiating dialysis treatment; Intravenous heparin or other single therapeutically equivalent anti-coagulant for the purpose of initiating and maintaining dialysis treatment; Intravenous normal saline; and Oxygen, when the administration of the oxygen has been delegated to the certified dialysis technician by a registered nurse. When administering the medications set forth in §A(1) of this regulation, the certified dialysis technician shall: Ensure that the right dose of the right medication is given to the right individual through the right route of administration at the right time; Accurately and timely document the administration of the medication and notify a physician or licensed nurse of the patient’s response to the medication as appropriate; Consult with an appropriate licensed practitioner when the certified dialysis technician believes or has reason to believe that a prescribed medication is inaccurate, not properly authorized, harmful or potentially harmful to a patient, or contraindicated by other documented information; and Take any other action needed to ensure the safety of the patient. A certified dialysis technician shall administer the medications authorized under §A(1) of this regulation only if the task has been delegated to the dialysis technician by a registered nurse or licensed practical nurse in accordance with Regulations .11—.13 of this chapter. The certified dialysis technician shall be under the direct supervision of a registered nurse or licensed practical nurse when administering medications. Practice Standards. A certified dialysis technician shall provide dialysis care only when the performance of the care is delegated to the certified dialysis technician by a registered nurse or licensed practical nurse. A certified dialysis technician shall demonstrate competence and accountability in all areas of dialysis care in which the technician is engaged, including, but not limited to, the following: Consistent performance of all aspects of dialysis care according to acceptable standards; and Appropriate recognition, referral, consultation, or intervention when a complication arises in conjunction with dialysis or when a change in patient status occurs. A certified dialysis technician shall timely: Implement the prescribed dialysis care order for a patient unless the technician believes or should have reason to believe that the prescribed order is inaccurate, not properly authorized, not current or valid, harmful or potentially harmful to the patient, or contraindicated by other documented information; and Clarify any prescribed dialysis care order for a patient when the technician believes or should have reason to believe that the order is inaccurate, not properly authorized, not current or valid, harmful or potentially harmful to the patient, or contraindicated by other documented information. When clarifying the prescribed dialysis care order, the certified dialysis technician shall timely: Consult with an appropriate licensed practitioner; Notify the delegating nurse when the technician believes that it would not be appropriate to follow the prescribed dialysis care order; Document: That the delegating nurse was notified; The outcome of the consultation with the delegating nurse; and The treatment plan for the patient; and Take any other action needed to ensure the safety of the patient. A dialysis technician shall timely report to and consult as necessary with other members of the dialysis care team, including, but not limited to, the licensed nurse or physician when a patient refuses to follow the prescribed dialysis care order. A dialysis technician shall comply with the code of ethics for certificate holders set forth in COMAR 10.39.07. A dialysis technician shall do the following to promote patient safety: Display the applicable CDT title or initials at all times when providing dialysis care; Completely, accurately, and timely document and report all patient data obtained while providing dialysis care and the patient’s response to the care; Completely, accurately, and timely document and report to the appropriate practitioner all errors in or deviations from the prescribed dialysis care regimen; Not falsify any patient record or any other documents prepared in the course of or in conjunction with the provision of dialysis care. This includes, but is not limited to, case management documents or reports, time records or reports, and other documents related to billing for dialysis services; and Implement measures to provide a safe environment for the patient. A dialysis technician shall only work in a structured setting. The nurse may delegate the responsibility to perform a dialysis-related nursing task to a certified dialysis technician. The delegating nurse retains the accountability for the dialysis-related nursing task. A dialysis-related nursing task delegated by the nurse shall be: Within the area of responsibility of the nurse delegating the act; Such that, in the judgment of the nurse, it can be properly and safely performed by the certified dialysis technician without jeopardizing patient welfare; and A task that a reasonable and prudent nurse would find is within the scope of sound nursing judgment. A dialysis-related nursing task delegated by the nurse may not require the certified dialysis technician to exercise nursing judgment or intervention except in an emergency situation. When delegating a dialysis-related nursing task to a certified dialysis technician, the nurse shall: Make an assessment of the patient's nursing care needs related to the delegated task; Either instruct the certified dialysis technician in the delegated task or verify the certified dialysis technician's competency to perform the nursing task; Supervise the performance of the delegated nursing task in accordance with Regulation .13 of this chapter; Be accountable and responsible for the delegated task; Evaluate the performance of the delegated nursing task; and Be responsible for ensuring accurate documentation of outcomes on the medical record. The nurse shall be the primary decision maker when delegating a dialysis-related nursing task to a certified dialysis technician. Nursing judgment shall be exercised within the context of the employer’s model of nursing practice which includes a mechanism for: Identifying those individuals to whom nursing tasks may be delegated; Reevaluation of the competency of those to whom nursing tasks may be delegated; Recognizing that the final decision regarding delegation is within the scope of the nurse's professional judgment; Determining the competency of the nurse to delegate; and Determining to whom nursing tasks may be delegated, which includes input by nurses employed in the structured setting. Except as provided in §B(2) of this regulation, the nurse shall determine the required degree of supervision after an evaluation of appropriate factors including, but not limited to, the: Stability of the condition of the patient; Training of the individual to whom the nursing task is being delegated; Nature of the nursing task being delegated; Orientation of the certified dialysis technician to the specific patient environment; Ability of the certified dialysis technician to perform the delegated nursing task in a safe and competent manner; and Reevaluation of the patient's health status. The delegating nurse shall: Be readily available when delegating a nursing task to a certified dialysis technician; and Provide direct supervision of the certified dialysis technician when the certified dialysis technician is administering medications. The following nursing functions require nursing knowledge, judgment, and skill and may not be delegated: The nursing assessment including, but not limited to, the admission, shift, transfer, or discharge assessment; Development of the nursing diagnosis; The establishment of the nursing care goal; Development of the nursing care plan; Evaluation of the patient's progress, or lack of progress, toward goal achievement; and Any nursing task which requires nursing knowledge, judgment, and skill. The nurse may delegate treatments of a routine nature if: The licensed nursing staff of the specific dialysis setting has identified the function as being routinely performed; The specific treatments are performed at a high frequency necessary to retain competency; The treatment has an inherently low risk to the patient, as determined by weighing the following factors: Type of equipment utilized to perform the function; Nurse staffing ratio that allows for close supervision; Basic educational preparation of the certified dialysis technician performing the delegated function; and Knowledge and skill set of the nurse delegating and supervising the delegated function; and There is a quality assurance mechanism in place to ensure the function is performed safely and patient outcomes meet accepted professional nursing standards, including, but not limited to: An ongoing formalized documented performance appraisal mechanism designed to ensure that the certified dialysis technician’s revalidation of continued competency is a component of the quality assurance mechanism; and Patient outcomes meeting accepted professional standards, as reflected by: Infection rates; Rates of adverse events; Error rates; and Patient satisfaction surveys. The nurse may delegate the obtaining of specific information to a certified dialysis technician. When implementing the interdisciplinary plan of care, the nurse may delegate a nursing task to a certified dialysis technician when the delegation of that task does not jeopardize the patient's welfare. Administration of medication is a nursing function. As such, the nurse retains full responsibility for medication administration. The following activities related to medication administration may not be delegated except as provided in Regulation .11A(1) of this chapter: Calculation of any medication dose; Administration of medications by injection route; Administration of medications by way of a tube inserted in a cavity of the body; and Administration of medication by intravenous route. Delegation of Medication Administration. The administration of medication may be delegated to certified dialysis technicians only in structured settings. A nurse may delegate the administration of only the medications set forth in Regulation .11A(1) of this chapter to a certified dialysis technician. The registered nurse shall be accountable and responsible for the development and initiation of the health teaching plan and for health counseling of the patient. The nurse shall be accountable and responsible for facilitating and promoting: Patient education; and Participation of the patient and significant others in implementation of health goals. Certified dialysis technicians given instruction and direction by the nurse may supplement the health teaching by providing standardized information to the patient. The certified dialysis technician is responsible and accountable for reporting information to the nurse regarding the patient's: Request for information; and Response to teaching provided by the nurse or reinforcement provided by the certified dialysis technician. Health Occupations Article, §§ 8-205, 8-303, 8-6A-01 through 8-6A-10, 8-6A-12, 8-6A-14.1, 8-6A-15, 8-701, 8-703, 8-705, and 8-706, Annotated Code of Maryland Effective date: August 4, 2025 (52:15 Md. R. 812) Regulation .08D, F amended effective April 27, 2026 (53:8 Md. R. 356) Regulation .08G adopted effective April 27, 2026 (53:8 Md. R. 356) Regulation .10C, D amended effective April 27, 2026 (53:8 Md. R. 356) In this chapter, the following terms have the meanings indicated. Terms Defined. Abandonment. “Abandonment” means: Termination by a certificate holder of a client assignment that was accepted by the certificate holder, without reasonable notification to the immediate supervisor to allow for the continuation of the client's care; Refusal by a certificate holder of an assignment, mandatory overtime, or both in the event of a natural disaster or a federal, State, county, or city declaration of an emergency; or Failure of a certificate holder to report for assigned duty or leaving a client unattended at the end of the assigned shift if the certificate holder is the sole provider of care for a private duty or hospice assignment and does not provide prior notification to the nursing supervisor, the cognitively capable adult client, or the client's designated representative. “Abandonment” does not include the declining by a certificate holder of employer-stipulated mandatory overtime. “Accepting an assignment” means a certificate holder has arrived on duty and assumed responsibility for client care. “Board” means the Board of Nursing. “Certificate holder” means an individual who is certified by the Board as a certified nursing assistant in any category, a certified dialysis technician, or a medication technician. “Client” means a patient, resident, or recipient of care. “Electronic devices” means, but is not limited to, any of the following: Telephones with recording and picture-taking ability; Digital cameras or any other device that can record pictures and data; Facsimile machines, photocopiers, and scanners for copying; and Recording devices. “Social media” means any form of electronic communication, including, but not limited to, communication by use of websites for social networking and blogging through which users create online communities to share information, ideas, personal messages, and other content such as videos. A certificate holder shall: Respect the human dignity and uniqueness of a client and provide services unrestricted by consideration of social or economic status, religious affiliation, personal attributes, or the nature of health problems; Safeguard a client's right to privacy by maintaining confidentiality of information; Promptly report a breach of confidentiality or privacy; Act to safeguard a client and the public if health care and safety are affected by the incompetent, unethical, or illegal practice of any individual; Assume responsibility and accountability for the individual certificate holder's judgments and actions; Maintain practice competence; Inform the Board of unethical conduct by another certificate holder; Demonstrate honesty and integrity in the performance of tasks, functions, and activities; and Perform nursing tasks, functions, and activities based on a certificate holder's education and training, and at the direction of the supervising nurse. A certificate holder may not, when acting in the capacity or identity of a certificate holder: Abandon a client or assignment after assuming care for the client or accepting the assignment; Knowingly participate in or condone dishonesty, fraud, deceit, or misrepresentation; Engage or participate in an action that violates or diminishes the civil or legal rights of a client; Assume duties and responsibilities without adequate preparation or maintaining competency; or Practice if unfit to perform procedures because of physical or mental impairment including, but not limited to, the effects of prescription drugs. A certificate holder may not engage in the following behaviors that dishonor the practice, whether or not acting in the capacity or identity of a certificate holder, including, but not limited to: Verbal abuse, including use of racial or ethnic slurs, directed toward a coworker, employer, Board staff member, client, or client’s family member; Physically abusing, threatening, or intimidating a coworker, employer, Board staff member, client, or client’s family member; Deceiving, defrauding, or stealing from a coworker, employer, client, or client's family member; Diverting any medication or providing false or misleading information to an authorized prescriber or a pharmacist to obtain or attempt to obtain any medication; Knowingly employing another individual to practice or engage in or attempt to practice or engage in an occupation or profession licensed under this title if the employee is not licensed to do so under Health Occupations Article, Title 8, Annotated Code of Maryland; Obtaining or copying any part of a client's health record; Using, possessing, supplying, administering, or attempting to use, possess, supply, or administer prescription drugs or controlled dangerous substances without valid medical indication; Reporting for employment under the influence of alcohol or a controlled dangerous substance or submitting a pre-employment sample that is positive for alcohol or a controlled dangerous substance without having provided evidence of valid prescriptions for all controlled dangerous substances in the sample; Reporting for employment under the influence of an illicit drug or submitting a pre-employment sample that is positive for an illicit drug; Using the power, influence, or knowledge obtained during the certificate holder’s relationship with the client for the certificate holder’s personal gratification or benefit; Performing acts beyond the scope of practice for which the individual is certified, unless acting in accordance with COMAR 10.27.11; Engaging in unprofessional or immoral conduct; Misrepresenting or concealing a material fact in obtaining a certificate, renewing a certificate, or reinstating a certificate; Committing an act of moral turpitude, dishonesty, or corruption when the act directly or indirectly affects the health, welfare, or safety of the citizens of this State, and, if the act constitutes a crime, conviction thereof in a criminal proceeding is not a condition precedent to disciplinary action; or Arranging or permitting another certificate holder or unlicensed person to replace the certificate holder or utilize the certificate holder's certificate to provide care to a client. A certificate holder may not engage in sexual misconduct including, but not limited to: Sexual behavior with a client during the performance of a procedure or service for the client, regardless of the setting in which the service is rendered; Sexual behavior with a client under any pretext of therapeutic intent or benefit; Solicitation of a sexual relationship, whether consensual or nonconsensual, with a client; Sexual advances toward, or requesting sexual favors from, a coworker, student, employer, client, or client’s family member; Discussion of sexual matters while caring for a client; Taking photographs of a client for a sexual purpose or personal gratification; Sexual harassment of a coworker, student, employer, client, or client's family member; Sexual contact with an incompetent or unconscious client; Intentionally exposing any of the certificate holder's sexual body parts; and Intentionally exposing any of the client's sexual body parts for a nontherapeutic purpose. Electronic devices, including but not limited to telephones, may not be used to record medical records and take pictures or videos of clients without written client authorization. A certificate holder: May not make use of electronic devices and social media to transmit or place any client information online; and Shall adhere to the following principles for the use of social media: Every certificate holder has an obligation to understand the nature, benefits, and consequences of the use of electronic devices and participating in social media networking; Certificate holders are bound to observe ethically prescribed client-certificate holder boundaries online as in any other setting; Client information shall be maintained in separate encrypted and secure files on personal computers and online; A certificate holder has an obligation to report any content that could harm a client’s privacy rights; and The standards of professionalism are the same when using electronic devices and social media as in any other circumstance. Violation of this chapter may result in the Board taking disciplinary action against a certificate holder pursuant to Health Occupations Article, §8-6A-10, Annotated Code of Maryland. Health Occupations Article, §§8-205 and 8-6A-01, Annotated Code of Maryland Effective date: April 7, 2008 (35:7 Md. R. 749) Regulation .01B amended effective December 11, 2014 (41:24 Md. R. 1428); August 4, 2025 (52:15 Md. R. 812) Regulation .02 amended effective December 11, 2014 (41:24 Md. R. 1428)