# COMAR Title 10 — Maryland Department of Health

## Subtitle 39 — Board of Nursing — Certificate Holders

### Chapter 03 — Certified Medicine Aides

**Authority:** 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

**Administrative History:** Effective date: February 5, 2001 (28:2 Md. R. 100)

**Administrative History:** 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)

**Administrative History:** Regulations .01 — .04 repealed and new Regulations .01 — .06 adopted as an emergency provision effective January 19, 2005 (32:3 Md.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)

**Administrative History:** 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)

**Administrative History:** 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)

**Administrative History:** Regulation .02C amended effective August 25, 2008 (35:17 Md. R. 1489)

**Administrative History:** Regulation .03B amended effective April 15, 2013 (40:7 Md. R. 612)

#### Regulation .01 Definitions.

*COMAR 10.39.03.01*

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

  (1) “Board” means the Maryland Board of Nursing.

  (2) “Certificate” means a certificate issued by the Board to practice as a nursing assistant in this State.

  (3) “Certified medicine aide (CMA)” means an individual certified in good standing as an active CNA who:

    (a) Satisfies the requirements of COMAR 10.39.03.02; and

    (b) Is further certified by the Board to accept delegation of administration of certain medications.

  (4) 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.

  (5) 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 pursuant to § 8-6A-05(c)(5) of the Health Occupations Article, Annotated Code of Maryland.

  (6) “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.

  (7) “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.

  (8) “Licensed practical nurse (LPN)” has the meaning stated in Health Occupations Article, §8-101, Annotated Code of Maryland.

  (9) “Registered nurse (RN)” has the meaning stated in Health Occupations Article, §8-101, Annotated Code of Maryland.

#### Regulation .02 Certification and Qualification.

*COMAR 10.39.03.02*

A. An applicant for certification as a CMA shall provide evidence satisfactory to the Board of meeting the following requirements:

  (1) Current certification by the Board as an active CNA-1 in good standing;

  (2) Current employment and work experience as required by the Board in a setting acceptable to the Board, including:

    (a) 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

    (b) 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

  (3) Successful completion as evidenced by a certificate of completion from a Board-approved CMA training program.

B. 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.

C. 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:

  (1) Successfully complete a Board-approved 8-hour medicine aide continuing education program as required by Regulation .03B of this chapter; and

  (2) 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.

#### Regulation .03 Medicine Aide Course Requirements.

*COMAR 10.39.03.03*

A. Medicine Aide Course Curriculum. The Board shall approve a CMA program that:

  (1) Requires a candidate for admission to the program have current employment and work experience as set forth in Regulation .02A(2) of this chapter;

  (2) Requires before admission that a candidate have a positive recommendation from the director of nursing in the facility where the candidate is employed;

  (3) 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;

  (4) Includes instruction in both theory and clinical regarding all approved routes of medication administration and the scope of responsibility of the CMA; and

  (5) Includes each of the following subjects:

    (a) Responsibilities and limitations of the CMA;

    (b) Drug standards, references, and resources;

    (c) Legislation concerning drug utilization;

    (d) Characteristics of the elderly client or client with multiple handicaps;

    (e) Sources and purposes of drugs;

    (f) Dosage forms and methods of administration;

    (g) Drug life;

    (h) The medication order;

    (i) The pharmacy label;

    (j) The administration of nonparenteral medications;

    (k) Procedures and techniques for administering drugs;

    (l) Drug classification, related health problems, and patient care responsibilities;

    (m) Drug solutions and measurements; and

    (n) Monitoring side effects of drugs and drug interactions.

B. 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:

  (1) A 3-hour core content that includes:

    (a) Current State regulations related to the role of the medicine aide;

    (b) Uses, actions, and possible interactions of and related precautions for current medications used in the care of the geriatric patient;

    (c) New care procedures; and

    (d) Resources available to the medicine aide which clarify and expand the knowledge of the medicine aide; and

  (2) 3 hours on at least three of the following topics:

    (a) Documentation;

    (b) Nutrition;

    (c) The physiological system of the geriatric patient;

    (d) De-institutionalization of the intellectually disabled or psychiatric patient; or

    (e) Other aspects of pharmacology; and

  (3) 2 hours of assessment testing administered at the completion of the continuing education course.

#### Regulation .04 Scope of Responsibility.

*COMAR 10.39.03.04*

A. The CMA may be delegated medication administration by the RN or LPN under the following conditions:

  (1) The licensed nursing supervision requirements in Regulation .05 of this chapter have been met;

  (2) The CMA is assigned to administer medication;

  (3) There is a written medication order;

  (4) 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:

    (a) Monitor the therapeutic effects of the medication;

    (b) Observe and report untoward effects of the medication;

    (c) Report observed changes in client behavior and clinical status; and

    (d) Withhold administration of the medication if necessary.

B. The CMA may perform the following RN or LPN delegated nursing functions:

  (1) Prepare, administer, and chart medications administered:

    (a) Orally;

    (b) By nebulizer, metered dose inhalant, and, in the case of oxygen, by nasal cannula or mask;

    (c) Topically, excluding wound or decubitus site care;

    (d) By suppository; and

    (e) By eye, ear, and nose drops;

  (2) Prepare, administer, and chart:

    (a) Nonlegend PRN medications; and

    (b) Controlled schedule drugs after the RN or LPN:

      (i) Makes a bedside assessment of the patient;

      (ii) Documents the assessment; and

      (iii) Gives permission to the CMA to administer that medication; and

  (3) When the licensed nurse delegating medication administration provides access to the controlled schedule drug cabinet, sign for and administer controlled schedule drugs.

#### Regulation .05 Supervision.

*COMAR 10.39.03.05*

The CMA may administer medications when:

A. 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

B. 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:

  (1) Chronic;

  (2) Stable;

  (3) Uncomplicated; and

  (4) Permitting placement in the community.

#### Regulation .06 Unlawful Delegation.

*COMAR 10.39.03.06*

The RN or LPN may not delegate the following duties to the CMA:

A. Transcription of original physician orders to medication and treatment administration records, charts, or Kardexes;

B. Charge level responsibilities, including receiving instructions for or being assigned to such responsibilities;

C. 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.;

D. Administration of medication by way of the following routes:

  (1) Injection;

  (2) Intravenous route; and

  (3) By way of a tube inserted in a cavity of the body, including nasogastric or gastrostomy tube feeding;

E. Client teaching;

F. Acceptance of verbal or telephone orders; and

G. Responsibility for maintaining possession of the keys or access code to the locked container for controlled schedule drugs.