Chapter 01. Certified Nursing Assistants
Regulation .01 Exceptions.LinkCopy Citation
This chapter does not apply to an individual who:
A.
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;
B.
Provides for the gratuitous care of friends, domestic partners, or family members;
C.
Performs nursing assistant tasks while a nursing student enrolled in an accredited nursing program if the individual either:
(1)
Is practicing under the direct supervision of qualified faculty or preceptors; or
(2)
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;
D.
Performs nursing assistant tasks:
(1)
While a student enrolled in an approved nursing assistant training program or approved acute care nursing assistant training program; and
(2)
While practicing under the direct supervision of qualified faculty or preceptors;
E.
Practices as a certified nursing assistant-I for less than 4 months in accordance with 42 CFR §483.35(d);
F.
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;
G.
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
H.
Performs technical tasks delegated by a licensed certified midwife in accordance with Health Occupations Article, §8-6A-02(e), Annotated Code of Maryland.
History:
Regulation .02 Definitions.LinkCopy Citation
A.
In this chapter, the following terms have the meanings indicated.
B.
Terms Defined.
(1)
“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.
(2)
“Board” means the Maryland Board of Nursing.
(3)
“Central Repository” means the Maryland Criminal Justice Information System Central Repository of the Department of Public Safety and Correctional Services.
(4)
“Certificate” means a certificate issued by the Board to practice as a certified nursing assistant in the State.
(5)
Certified Nursing Assistant (CNA).
(a)
“Certified nursing assistant (CNA)” means an individual, regardless of title, who, for compensation and subject to regulations adopted by the Board, routinely performs:
(i)
Nursing tasks delegated by a registered nurse, licensed practical nurse, or advanced practice registered nurse; or
(ii)
Technical tasks delegated by a licensed certified midwife.
(b)
“Certified nursing assistant (CNA)” does not include dialysis technician or medication technician.
(6)
Certified Nursing Assistant-I (CNA-I).
(a)
“Certified nursing assistant-I (CNA-I)” means a CNA who:
(i)
Meets the requirements set by the Board and federal law; and
(ii)
May practice in any practice setting.
(b)
“Certified nursing assistant-I (CNA-I)” includes a:
(i)
CNA who was certified as a geriatric nursing assistant on March 31, 2026;
(ii)
Certified medicine aide; and
(iii)
CNA who is certified under Health Occupations Article, §8-6A-05(c)(5), Annotated Code of Maryland.
(7)
“Certified nursing assistant-II (CNA-II)” means a CNA who:
(a)
On March 31, 2026, was certified as a CNA but not certified as a geriatric nursing assistant; and
(b)
May not practice in a nursing facility or skilled nursing facility.
(8)
“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).
(9)
“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.
(10)
“Good standing” means without an encumbrance that limits or restricts practice, such as revocation, suspension, or probation.
(11)
“Nursing assistant competency evaluation” means an examination approved by the Board that:
(a)
Determines the competency of the individual to practice as a CNA-I; and
(b)
Meets the requirements under federal law.
(12)
“Nursing assistant training program” means a course of training approved by the Board that meets the requirements under federal and State law.
(13)
“Service member” has the meaning stated in State Government Article, §9-901, Annotated Code of Maryland.
(14)
“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.
(15)
“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.
(16)
“Temporary nurse aide training” means an 8-hour online training and examination program offered by:
(a)
The American Health Care Association;
(b)
The National Center for Assisted Living; or
(c)
Another comparable program approved by the Board.
History:
Regulation .03 Fees.LinkCopy Citation
A.
Fees are as follows:
(1)
Initial certification fee — $20;
(2)
Endorsement fee — $20;
(3)
Renewal fee — $40;
(4)
Verification of certification to another jurisdiction — $25;
(5)
Returned check fee — $25;
(6)
Duplicate certificate fee — $10.
B.
Fees are not refundable.
History:
Regulation .04 General Provisions for Applications.LinkCopy Citation
A.
An applicant shall submit:
(1)
A completed application to the Board on the form that the Board requires;
(2)
To a CHRC in accordance with Health Occupations Article, §8-303, Annotated Code of Maryland;
(3)
Written evidence satisfactory to the Board that the applicant has submitted to a CHRC as required by §A(2) of this regulation by submitting:
(a)
Two sets of fingerprints, as required by the Central Repository and the FBI; and
(b)
All fees required by the Central Repository and the FBI;
(4)
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:
(a)
Under §A(2) of this regulation;
(b)
In an answer to a question on the Board’s application form; or
(c)
From any other source; and
(5)
Any additional documentation requested by the Board if the documentation received from the applicant under §A(4) of this regulation is incomplete or insufficient.
B.
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.
C.
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.
D.
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.
History:
Regulation .05 Qualifications for Certification.LinkCopy Citation
A.
Initial Certification. An applicant for initial nursing assistant certification shall have successfully:
(1)
Completed:
(a)
An approved nursing assistant training program;
(b)
An approved acute care nursing assistant training program;
(c)
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
(d)
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
(2)
Passed a nursing assistant competency evaluation.
B.
Certification by Endorsement. An applicant for nursing assistant certification by endorsement shall:
(1)
Hold a certificate to practice as a nursing assistant that:
(a)
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
(b)
Is in good standing; and
(2)
Have successfully completed a nursing assistant training program that meets the standards for an approved nursing assistant training program set by the Board.
C.
Any applicant for nursing assistant certification may not have:
(1)
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
(2)
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.
D.
Nursing Education Programs.
(1)
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:
(a)
Nursing fundamentals;
(b)
Mental health;
(c)
Health assessment;
(d)
Nursing ethics; and
(e)
The content listed under 42 CFR §483.152(b).
(2)
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.
E.
A CNA-II who seeks certification as a CNA-1 shall meet the qualifications set forth in §A of this regulation.
F.
Temporary Nurse Aides.
(1)
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:
(a)
Completed a temporary nurse aide training course;
(b)
Completed a minimum of 100 hours of on-the-job training as a temporary nurse aide that:
(i)
Met the requirements under 42 CFR §483.152(a) and 42 CFR §483.152(b)(2)—(7); and
(ii)
Was not provided in a facility described under 42 CFR §483.151(b)(2)—(3); and
(c)
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.
(2)
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.
History:
Regulation .06 Application for Certification.LinkCopy Citation
A.
Initial Certification.
(1)
An applicant for initial certification shall:
(a)
Comply with all of the requirements under Regulation .04A of this chapter;
(b)
Pay the required fee to the Board; and
(c)
Submit to the Board one of the items in §A(2) of this regulation.
(2)
Verification Requirements.
(a)
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;
(b)
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;
(c)
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
(d)
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.
(3)
A program coordinator or faculty of a nursing assistant or acute care nursing assistant training program:
(a)
May sign an application before graduation; and
(b)
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.
(4)
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.
(5)
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.
B.
Certification by Endorsement. An applicant for nursing assistant certification by endorsement shall:
(1)
Comply with all of the requirements under Regulation .04A of this chapter;
(2)
Pay the required fee to the Board; and
(3)
Submit the following verifications directly to the Board from the appropriate authority:
(a)
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
(b)
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.
C.
Every applicant shall attest on the application whether the applicant has:
(1)
Committed any act or omission that would be grounds for discipline or denial of certification; and
(2)
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.
D.
A CNA-II who seeks certification as a CNA-I shall:
(1)
Submit an application to the Board on the form required by the Board; and
(2)
Comply with §§A(1)(c) and A(3)—(5) of this regulation.
E.
A temporary nurse aide applying for certification as a CNA-1 shall:
(1)
Comply with §A of this regulation; and
(2)
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:
(a)
Is completed by the:
(i)
Applicant;
(ii)
Registered Nurse instructor or supervisor of the applicant during employment; and
(iii)
Administrator or director of nursing for the employer; and
(b)
Verifies that the applicant satisfies the requirements of Regulation .05F of this chapter.
History:
Regulation .07 Nursing Assistant Competency Evaluation.LinkCopy Citation
A.
An individual is eligible to sit for a nursing assistant competency evaluation if the individual:
(1)
Meets the education requirements set forth in Regulation .05A(1) of this chapter; or
(2)
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.
B.
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.
C.
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.
D.
Re-testing.
(1)
An individual who fails to obtain a passing score on the first examination may retake a nursing assistant competency evaluation three additional times.
(2)
An individual shall wait at least 45 calendar days from the date of the prior evaluation before retaking a nursing assistant competency evaluation.
(3)
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.
History:
Regulation .08 Temporary Practice Certificate.LinkCopy Citation
A.
The Board may issue a temporary practice certificate to an applicant who:
(1)
Has met the appropriate certification requirements to the satisfaction of the Board;
(2)
Does not have a criminal record; and
(3)
Has not been the subject of a health professional disciplinary action in this State or another jurisdiction.
B.
Unless the Board suspends or revokes a temporary practice certificate, the temporary practice certificate expires 90 calendar days after the date of issuance.
C.
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.
History:
Regulation .09 Issuance of Certification.LinkCopy Citation
A.
The Board may not issue a certificate to an applicant until the Board has:
(1)
Received and reviewed the criminal history record information of the applicant; and
(2)
Approved the application.
B.
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.
History:
Regulation .10 Expiration and Renewal.LinkCopy Citation
A.
Expiration.
(1)
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:
(a)
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
(b)
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.
(2)
A certificate shall not expire within 180 calendar days of the date of issuance.
B.
Renewal Notice.
(1)
At least 3 months before a certificate expires, the Board shall send the certificate holder a renewal notice by either:
(a)
First-class mail to the last known address of the certificate holder; or
(b)
Electronic means to the last known electronic address of the certificate holder.
(2)
The renewal notice shall provide:
(a)
The date on which the certificate holder’s certificate is scheduled to expire;
(b)
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;
(c)
The amount of the renewal fee; and
(d)
If the certificate holder is required to submit to a CHRC in accordance with §D of this regulation:
(i)
Notice that the certificate holder must submit to a CHRC in order to renew the certificate; and
(ii)
Written instructions for how to complete a CHRC.
(3)
It is the responsibility of the certificate holder to:
(a)
Be aware of the expiration date of the certificate; and
(b)
Renew the certificate before it expires.
(4)
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.
C.
Renewal Requirements.
(1)
The Board shall renew a certificate if the individual applying for renewal:
(a)
Is otherwise entitled to be certified;
(b)
Submits a complete application for renewal on the form required by the Board;
(c)
Pays the renewal fee;
(d)
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
(e)
If required to submit to a CHRC in accordance with § D of this regulation, complies with the requirements of Regulation .04A of this chapter.
(2)
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:
(a)
If a CNA-I, take and pass a nursing assistant competency evaluation; or
(b)
If a CNA-II, complete a nursing assistant training program..
D.
Schedule for CHRCs. CHRCs for renewal applicants shall be scheduled according to the certificate holder’s birth month as follows:
(1)
In 2025 — all applicants with an August or September birth month;
(2)
In 2026 — all applicants with a September or October birth month;
(3)
In 2027 — all applicants with an October or November birth month;
(4)
In 2028 — all applicants with a November or December birth month;
(5)
In 2029 — all applicants with a December or January birth month;
(6)
In 2030 — all applicants with a January or February birth month;
(7)
In 2031 — all applicants with a February or March birth month;
(8)
In 2032 — all applicants with a March or April birth month;
(9)
In 2033 — all applicants with an April or May birth month;
(10)
In 2034 — all applicants with a May or June birth month;
(11)
In 2035 — all applicants with a June or July birth month; and
(12)
In 2036 — all applicants with a July or August birth month.
E.
Grace Period. A certificate holder has a 30 calendar day grace period beyond the expiration date of the certificate to renew the certificate.
History:
Regulation .11 Administrative Reinstatement.LinkCopy Citation
A.
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.
B.
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.
History:
Chapter annotations
Authority: 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
Chs. 818 and 819, Acts of 2024; Ch. 416, Acts of 2025
History: Effective date: February 5, 2001 (28:2 Md. R. 100)
History: 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)
History: 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)
History: Regulation .02A amended effective February 2, 2004 (31:2 Md. R. 85); August 27, 2007 (34:17 Md. R. 1509)
History: Regulation .03 amended effective April 24, 2006 (33:8 Md. R. 734)
History: 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)
History: Regulation .04D amended effective January 6, 2014 (40:26 Md. R. 2164)
History: 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)
History: Regulation .06 amended effective August 25, 2008 (35:17 Md. R. 1489); April 19, 2010 (37:8 Md. R. 617)
History: Regulation .06H amended effective January 6, 2014 (40:26 Md. R. 2164)
History: Regulation .06N amended effective June 13, 2011 (38:12 Md. R. 705)
History: Regulation .07 amended effective April 19, 2010 (37:8 Md. R. 617)
History: Regulation .08 repealed and Regulation .09 recodified to be Regulation .08 effective April 24, 2006 (33:8 Md. R. 734)
History: 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)
History: Regulation .08A, B amended effective April 7, 2008 (35:7 Md. R. 748)
History: Regulation .08D amended effective March 22, 2010 (37:6 Md. R. 478)
History: Regulation .10 repealed effective April 24, 2006 (33:8 Md. R. 734)
History: Chapter revised effective February 13, 2017 (44:3 Md. R. 189)
History: Regulation .01B amended effective July 2, 2018 (45:13 Md. R. 667)
History: Regulation .01B amended as an emergency provision effective September 22, 2022 (49:22 Md. R. 975); emergency status expired effective March 30, 2023
History: Regulation .04D adopted as an emergency provision effective September 22, 2022 (49:22 Md. R. 975); emergency status expired effective March 30, 2023
History: Regulation .05 amended effective July 2, 2018 (45:13 Md. R. 667)
History: Regulation .05 amended as an emergency provision effective September 22, 2022 (49:22 Md. R. 975); emergency status expired effective March 30, 2023
History: Regulation .07 amended effective July 2, 2018 (45:13 Md. R. 667)
History: Regulation .08 amended effective July 2, 2018 (45:13 Md. R. 667)
History: Regulation .09 amended effective July 2, 2018 (45:13 Md. R. 667)
History: Regulation .09A amended as an emergency provision effective September 22, 2022 (49:22 Md. R. 975); emergency status expired effective March 30, 2023
History: 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)