SB 13
Department of Legislative Services
Maryland General Assembly
2021 Session
FISCAL AND POLICY NOTE
Third Reader
Senate Bill 13 (Senator Eckardt)
Education, Health, and Environmental Affairs Health and Government Operations
Certified Nursing Assistants – Certificate Renewal – Training Program
Requirements
This bill authorizes a certified nursing assistant (CNA) to renew a certificate if the
certificate holder did not complete 16 hours of required active practice within the two-year
period preceding renewal by instead providing satisfactory evidence of completion of an
approved nursing assistant refresher training program. The State Board of Nursing (BON)
must adopt regulations to specify (1) the circumstances under which a nursing assistant is
required to complete an approved nursing assistant training program or refresher training
program and (2) the number of didactic instruction hours and clinical training hours the
nursing assistant training program or refresher training program must have to be approved.
Regulations must be consistent with federal law.
Fiscal Summary
State Effect: BON special fund expenditures increase by $44,500 beginning in FY 2022
for staff to oversee and approve nursing assistant refresher programs. Revenues are not
affected.
(in dollars) FY 2022 FY 2023 FY 2024 FY 2025 FY 2026
Revenues $0 $0 $0 $0 $0
SF Expenditure 44,500 50,500 51,900 53,800 55,800
Net Effect ($44,500) ($50,500) ($51,900) ($53,800) ($55,800)
Note:() = decrease; GF = general funds; FF = federal funds; SF = special funds; - = indeterminate increase; (-) = indeterminate decrease
Local Effect: None.
Small Business Effect: None.
Analysis
Current Law: In general, an individual must be certified by BON to practice as a nursing
assistant in the State; a CNA routinely performs nursing tasks delegated by a registered
nurse or licensed practical nurse. CNAs can obtain additional certification as a geriatric
nursing assistant, home health aide, certified medicine aide, or a dialysis technician.
To apply for a nursing assistant certificate, an individual must (1) submit an application;
(2) provide evidence of successful completion of an approved nursing assistant training
program or a portion of an approved nursing education program that meet the requirements
of a nursing assistant training program; (3) pay an application fee; (4) be of good moral
character; (5) be at least 16 years old; and (6) submit a criminal history records check.
Under Maryland regulations (COMAR 10.39.01.07), a nursing assistant certificate must be
renewed every two years. A CNA may renew their certificate for an additional term, if the
certificate holder:
is otherwise entitled to be certified;
submits a renewal application;
pays a renewal fee; and
provides satisfactory evidence of completion of (1) 16 hours of active nursing
assistant practice within the two-year period immediately preceding the renewal; or
(2) an approved nursing assistant training program.
BON must renew the certificate of each nursing assistant who meets renewal requirements.
Nursing Assistant Training Programs
Under Maryland regulations (COMAR 10.39.02), nursing assistant training programs are
generally approved by BON. Training programs must provide a minimum of 60 hours of
didactic instruction and classroom laboratory practice and 40 hours of clinical training in a
clinical facility. Each training program must have an objective final examination that
measures achievements of specified performance indicators. BON compiles a list of
approved nursing assistant training programs on its website. BON does not currently
provide oversight to nursing assistant refresher programs.
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Federal Training Program Requirements
Under federal regulations (42 CFR § 483.152), a nurse aid training and competency
evaluation program must, at minimum (1) consist of no less than 75 hours of training;
(2) include specified subjects; (3) include at least 16 hours of supervised practical training;
(4) ensure students do not perform services they are not trained for and remain under the
general supervision of a licensed nurse or registered nurse; (5) meet specified requirements
for instructors; and (6) contain specified competency evaluation procedures.
State Expenditures: BON special fund expenditures increase by $44,518 in fiscal 2022,
which accounts for the bill’s October 1, 2021 effective date. This estimate reflects the cost
of hiring one part-time nursing program consultant to review nursing assistant refresher
program curriculum, process applications for program approval, and conduct site visits of
programs. It includes a salary, fringe benefits, one-time start-up costs, and ongoing
operating expenses.
Position 0.5
Salary and Fringe Benefits $39,182
Operating Expenses 5,336
Total FY 2022 State Expenditures $44,518
Future year expenditures reflect a full salary with annual increases and employee turnover
and ongoing operating expenses.
Additional Information
Prior Introductions: None.
Designated Cross File: HB 1193 (Delegate Adams) - Health and Government Operations.
Information Source(s): Maryland Department of Health; Department of Legislative
Services
Fiscal Note History: First Reader - January 22, 2021
rh/jc Third Reader - February 11, 2021
Analysis by: Amberly Holcomb Direct Inquiries to:
(410) 946-5510
(301) 970-5510
SB 13/ Page 3