# COMAR Title 10 — Maryland Department of Health

## Subtitle 39 — Board of Nursing — Certificate Holders

### Chapter 02 — Nursing Assistant Training Programs

**Authority:** 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

**Administrative History:** Effective date: April 30, 2001 (28:8 Md. R. 761)

**Administrative History:** Regulation .02B amended effective July 2, 2018 (45:13 Md. R. 667)

**Administrative History:** Regulation .05A amended effective July 2, 2018 (45:13 Md. R. 667)

**Administrative History:** Regulation .07B amended effective November 7, 2005 (32:22 Md. R. 1756)

**Administrative 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)

#### Regulation .01 Definitions.

*COMAR 10.39.02.01*

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) “Certified Nursing Assistant (CNA)” has the meaning stated in COMAR 10.39.01.02B.

  (4) 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.

  (5) “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.

  (6) “Clinical facility” means a setting where clients are physically present and that provides facilities for supervised clinical training.

  (7) “Direct supervision” means that the registered nurse or licensed practical nurse is physically present while the student demonstrates patient care skills.

  (8) “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.

  (9) “Hybrid training program” means a nursing assistant training program that provides:

    (a) Didactic instruction through distance education;

    (b) On-site classroom laboratory training; and

    (c) Supervised clinical training.

  (10) “Licensed Practical Nurse (LPN)” means an individual who:

    (a) Is licensed by the Board to practice licensed practical nursing; or

    (b) Has a multistate licensure privilege to practice licensed practical nursing.

  (11) “Multistate licensure privilege” has the meaning set forth in COMAR 10.27.01.01B.

  (12) “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.

  (13) “Nursing assistant training program” means a course of training approved by the Board that meets the requirements under federal and State law.

  (14) “Program completion” means that the student:

    (a) Completed and demonstrated competency in the program objectives and performance indicators during the didactic, laboratory, and clinical portions of the training program; and

    (b) Passed the final written examination.

  (15) “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.

  (16) “Registered nurse (RN)” means an individual who:

    (a) Is licensed by the Board to practice registered nursing; or

    (b) Has a multistate licensure privilege to practice registered nursing.

  (17) “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.

  (18) “Traditional program” means a training program that provides on-site didactic instruction, classroom laboratory training, and supervised clinical training.

  (19) “Training program” means a nursing assistant training program or an acute care nursing assistant training program.

  (20) “Unencumbered” means without limitation or restriction on practice, such as revocation, suspension, or probation.

  (21) “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.

#### Regulation .02 Initial Approval and Ongoing Responsibilities.

*COMAR 10.39.02.02*

A. Approval Requirements.

  (1) All training programs shall be approved by:

    (a) The Board; and

    (b) 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.

  (2) 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.

  (3) The approval process shall be completed before the training program is offered.

B. 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:

  (1) Submit a complete application on the form required by the Board;

  (2) Demonstrate that the training program meets all of the applicable requirements in this chapter; and

  (3) Provide any additional information requested by the Board during the Board’s review of the application.

C. Board Action.

  (1) 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.

  (2) The Board shall:

    (a) Approve a training program that meets all of the applicable requirements of this chapter; or

    (b) Deny approval of a training program that does not meet all of the applicable requirements of this chapter.

D. Term. Board approval of a training program is valid for 2 years.

E. Ongoing Responsibilities.

  (1) A training program shall obtain approval from the Board before making any substantial changes to the program.

  (2) Substantial changes include:

    (a) Changes to faculty;

    (b) Significant changes to curriculum, including an increase or decrease in program hours; and

    (c) Removal or addition of clinical facilities or classroom locations.

  (3) 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.

F. Nursing Assistant Competency Evaluation Performance.

  (1) 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.

  (2) The Board shall annually review the performance of graduates from each training program on the nursing assistant competency evaluation.

#### Regulation .03 Administration.

*COMAR 10.39.02.03*

A. Equal Opportunity Statement. The training program provider shall have a statement of equal opportunity.

B. 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).

#### Regulation .04 Faculty.

*COMAR 10.39.02.04*

A. Faculty Requirements.

  (1) Each course instructor and program coordinator shall have:

    (a) An active, unencumbered license to practice as a Registered Nurse  or a multistate licensure privilege to practice as a Registered Nurse in the State;

    (b) A minimum of 2 years of nursing experience; and

    (c) Completed a course in teaching adults or have experience in teaching adults or supervising nursing assistants.

  (2) 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:

    (a) 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

    (b) Teaching a nursing assistant training program that complies with federal law.

B. Course Instructors.

  (1) 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.

  (2) The course instructor is responsible for:

    (a) Participating in the development and evaluation of the training program, including the acquisition of learning resources and instructional materials;

    (b) Implementing the training program and ensuring course objectives are met;

    (c) 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

    (d) Evaluating student performance during didactic, clinical, and laboratory training.

C. Program Coordinator.

  (1) Each training program shall have a program coordinator who:

    (a) Provides general supervision of the training of nursing assistants; and

    (b) Maintains responsibility for the overall operation of the program.

  (2) Except as provided in §C(3) of this regulation, the program coordinator may also be a course instructor.

  (3) In a facility-based program, the facility’s director of nursing may be the program coordinator but may not perform any actual training.

D. Supplemental Personnel.

  (1) Other health professional personnel may supplement the course instructor, including, but not limited to:

    (a) Registered nurses in accordance with §D(3) of this regulation;

    (b) Licensed practical nurses in accordance with §D(4) of this regulation;

    (c) Pharmacists;

    (d) Dietitians;

    (e) Social workers;

    (f) Sanitarians;

    (g) Fire safety experts;

    (h) Nursing home administrators;

    (i) Gerontologists;

    (j) Psychologists;

    (k) Physical and occupational therapists;

    (l) Activities specialists;

    (m) Speech/language/hearing therapists; and

    (n) Resident rights experts.

  (2) Supplemental personnel shall have at least 1 year of experience in their respective field.

  (3) A registered nurse functioning as supplemental personnel shall:

    (a) Hold a current, unencumbered license in the State or multistate licensure privilege as a registered nurse; and

    (b) Have had at least 1 year of direct client care experience as a registered nurse.

  (4) A licensed practical nurse functioning as supplemental personnel shall:

    (a) Hold a current, unencumbered license in the State or multistate licensure privilege as a practical nurse; and

    (b) Have had at least 1 year of direct client care experience as a licensed practical nurse.

  (5) Other supplemental personnel providing instruction shall provide instruction under the supervision of the course instructo.

#### Regulation .05 Facilities and Resources.

*COMAR 10.39.02.05*

A. General Facility Requirements. All classroom, laboratory, and clinical facilities used by a training program:

  (1) Shall be approved by the Board;

  (2) Shall be approved or accredited by the appropriate agency;

  (3) May not be on conditional or provisional approval status; and

  (4) May not meet any of the factors set forth in 42 CFR §483.151(b)(2)—(3).

B. Classroom and Laboratory Facilities. Classroom and laboratory facilities shall include:

  (1) Adequate space for privacy of faculty-student conferences; and

  (2) Space for equipment and instructional materials.

C. Resources.

  (1) All instructional learning resources and materials shall:

    (a) Be accessible and relevant to the role of the CNA;

    (b) Have a publication date not older than 5 years from the current year; and

    (c) Be written at an 8th grade level.

  (2) Laboratory Equipment.

    (a) Laboratory equipment, at a minimum, shall include materials to support the following classroom activities:

      (i) Infection control;

      (ii) Basic nursing skills;

      (iii) Personal care skills; and

      (iv) Basic restorative services;

    (b) The Board shall maintain on its website a list of the specific equipment required for laboratory facilities.

D. Clinical Facilities.

  (1) Clinical facilities shall:

    (a) Have a sufficient number and variety of clients to provide training experiences for all students to achieve the stated objectives;

    (b) Have a sufficient number of registered nurses and other nursing personnel to ensure safe and continuous care of clients; and

    (c) Conform with accepted standards of nursing care and practice.

  (2) There shall be a minimum of 1 course instructor for each 8 students in the clinical area.

  (3) Written Agreements.

    (a) Except for facility-based programs, a training program shall have a written agreement with a clinical facility for student training experiences.

    (b) The written agreement developed in accordance with §D(3)(a) of this regulation shall:

      (i) Be developed jointly with the clinical facility and the training program;

      (ii) Be reviewed periodically by the clinical facility and the training program;

      (iii) Include a provision for adequate notice of termination;

      (iv) Specify the responsibility of the training program to the clinical facility and the responsibility of the clinical facility to the training program; and

      (v) Identify the functions and responsibilities of the parties involved.

#### Regulation .06 Curriculum.

*COMAR 10.39.02.06*

A. Program Hours.

  (1) A training program shall provide a minimum of 100 hours of instruction.

  (2) Of the 100 hours, a minimum of:

    (a) 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

    (b) 40 hours shall be devoted to supervised clinical training in a clinical facility.

  (3) 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.

B. Curriculum Content.

  (1) The curriculum for a training program shall include the subject matters and skills listed in 42 CFR §483.152(b).

  (2) The curriculum for an acute care nursing assistant training program shall include:

    (a) The subject matters listed in 42 CFR §483.152(b); and

    (b) All basic skills required of a nursing assistant in any acute care practice setting, including:

      (i) Caring for patients with acute and chronic medical conditions in a hospital facility;

      (ii) Observing and reporting changes in patient condition, including potential emergencies and safety issues, to the licensed nurse;

      (iii) Transport of specimens;

      (iv) Transport of medications;

      (v) Point of care testing;

      (vi) Specimen collecting;

      (vii) Equipment management;

      (viii) Time management in the acute care setting;

      (ix) De-escalation of assertive or aggressive patients and family members; and

      (x) Electronic documentation of care and basic computer skills.

  (3) The pre-clinical curriculum of a training program shall include the following topics:

    (a) Role of the CNA;

    (b) Infection control;

    (c) Safety and emergency procedures, including the Heimlich maneuver;

    (d) Communication and interpersonal skills;

    (e) Promoting clients’ independence; and

    (f) Legal and ethical considerations, including respecting clients’ rights.

  (4) A training program shall provide instruction in the pre-clinical curriculum before a student has any direct contact with a client.

C. 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.

D. Laboratory Instruction and Clinical Learning Experience.

  (1) 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.

  (2) 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.

#### Regulation .07 Evaluation.

*COMAR 10.39.02.07*

A. Each training program shall have an objective final written examination that measures achievement of the performance indicators.

B. To successfully complete the training program, each student shall:

  (1) Complete the required minimum hours provided in Regulation .06A of this chapter;

  (2) Demonstrate the ability to perform nursing functions with clients of any age and with various levels of physical, sensory, cognitive, and emotional ability;

  (3) Achieve a passing score of at least 75 percent on the written final examination; and

  (4) Demonstrate competence in meeting the objectives and performance indicators during didactic, laboratory, and clinical instruction.

C. The training program shall provide the following to students who complete the program:

  (1) A certificate of completion using the form required by the Board; and

  (2) Registration information for a nursing assistant competency evaluation.

D. A program coordinator or faculty of a training program:

  (1) May sign a student’s application for certification as a nursing assistant before graduation; and

  (2) 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.

#### Regulation .08 Renewal of Approval.

*COMAR 10.39.02.08*

A. Expiration. Unless renewed, Board approval of a training program expires 2 years from the last date of approval.

B. Renewal application. At least 120 days before the date of expiration of approval, a training program shall submit:

  (1) A complete application on the form required by the Board; and

  (2) All accompanying documentation required by the application or requested by the Board.

C. 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.

D. Board Action. The Board shall:

  (1) Renew approval of a training program for another 2-year term if the training program meets the applicable requirements of this chapter; or

  (2) 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.

E. Enrollment. A training program that fails to renew its approval:

  (1) Shall be listed on nonrenewed status in the Board’s records; and

  (2) May not enroll any new students to the program following the expiration of approval.

#### Regulation .09 Withdrawal of Approval.

*COMAR 10.39.02.09*

A. Notice of Deficiencies.

  (1) 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.

  (2) The notice of deficiencies shall notify the training program of the:

    (a) Requirements with which the program has not complied;

    (b) Reasons for the Board’s determination; and

    (c) Requirement to submit a written plan of correction in accordance with §B of this regulation.

B. Written Plan of Correction.

  (1) 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.

  (2) The written plan of correction shall:

    (a) Address all deficiencies noted by the Board; and

    (b) Include dates of completion for correcting the deficiencies.

  (3) The Board shall review the plan of correction and may approve or modify the dates of completion for correcting deficiencies.

  (4) The training program shall correct the deficiencies within the time frame approved by the Board.

C. Grounds for Withdrawal. The Board may withdraw approval of a training program that:

  (1) Fails to comply with any of the applicable requirements of this chapter;

  (2) Fails to correct deficiencies within the time frame approved by the Board;

  (3) Enrolls new students after expiration of approval; or

  (4) 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.

D. Procedure for Withdrawal.

  (1) Before withdrawing approval of a training program under §C of this regulation, the Board shall:

    (a) Notify the program of its intent to withdraw approval; and

    (b) Give the program an opportunity to request an evidentiary hearing before the Board.

  (2) The notice of intent to withdraw approval and hearing shall comply with the Administrative Procedure Act.

E. 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).

F. 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.

#### Regulation .10 Voluntary Closure.

*COMAR 10.39.02.10*

A. When a training program provider considers closing a program, the training program provider shall:

  (1) Notify the Board in writing of:

    (a) The intended closing date; and

    (b) The arrangements for custody and safeguarding of student and graduate records; and

  (2) Continue the program until the committed class schedule of currently enrolled students is completed.

B. Custody of Student Records.

  (1) 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.

  (2) 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.

  (3) 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.

#### Regulation .11 Hybrid Nursing Assistant Training Programs.

*COMAR 10.39.02.11*

A. Scope. This regulation applies to hybrid nursing assistant training programs.

B. Approval. The Board shall approve a hybrid training program that meets all of the requirements of this regulation.

C. Prerequisite Qualifications. A program seeking initial approval as a hybrid training program shall:

  (1) Comply with the requirements set forth in Regulation .02 of this chapter;

  (2) 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

  (3) 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.

D. Application and Approval Requirements.

  (1) A training program seeking initial approval as a hybrid training program shall apply for approval on a form required by the Board.

  (2) To be eligible for Board approval, a hybrid training program shall:

    (a) Host sessions no longer than 4 hours per session;

    (b) Specify the technology platform to be used for each content area of the curriculum;

    (c) Conduct lab and clinical training:

      (i) In person with a course instructor who meets the requirements under Regulation .04 of this chapter; and

      (ii) No later than 2 weeks after the completion of didactic instruction;

    (d) Require test sessions to be conducted in person;

    (e) Have a policy, which is provided to the Board as a part of the application, for:

      (i) Admissions, including determining whether a student has sufficient access to a computer and learning resources;

      (ii) Orienting students to online modules;

      (iii) Providing troubleshooting assistance for enrolled students; and

      (iv) 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;

    (f) Have sufficient mechanisms for:

      (i) Requiring the use of a personal identification number that confirms the identity of the students and instructor;

      (ii) Ensuring that all students have demonstrated competency on all virtual education content;

      (iii) Tracking and auditing active student participation in online instruction;

      (iv) Confirming student identity during and after completion of online modules and live sessions; and

      (v) Safeguarding appropriate security measures;

    (g) Provide the Board with access rights to the program to verify program compliance and monitor distance learning sessions; and

    (h) Provide the Board with statistics about the performance of students in the program, including:

      (i) Student exam pass rates;

      (ii) The rate at which students repeat each module of the program; and

      (iii) Any other information requested by the Board regarding student participation in and

E. Reapproval. An approved hybrid training program shall apply for renewal of approval in accordance with Regulation .08 of this chapter.

F. Withdrawal of Approval. The Board may withdraw approval of a hybrid training program in accordance with Regulation .09 of this chapter.