SB 34
Department of Legislative Services
Maryland General Assembly
2021 Session
FISCAL AND POLICY NOTE
Third Reader - Revised
Senate Bill 34 (Senator Lam)
Education, Health, and Environmental Affairs Health and Government Operations
State Board of Physicians - Genetic Counselors - Licensing
This bill requires individuals, on or after January 1, 2024, to be licensed to “practice genetic
counseling” by the State Board of Physicians (MBP) before they may practice genetic
counseling in the State. The bill also establishes a Genetic Counseling Advisory Committee
within MBP. MBP must adopt regulations for the licensure and practice of genetic
counseling. The bill takes effect January 1, 2022.
Fiscal Summary
State Effect: Special fund expenditures for MBP increase by $40,700 in FY 2022 to
establish the licensure program and staff the advisory committee. Future years reflect
annualization and, beginning in FY 2024, additional contractual services. Beginning in
FY 2024, special fund revenues increase from new licensing fee revenues (assumed to be
sufficient to cover estimated expenditures going forward) and any civil fines assessed
under the bill. General fund revenues may increase by a minimal amount from criminal
and civil penalties, beginning in FY 2024.
(in dollars) FY 2022 FY 2023 FY 2024 FY 2025 FY 2026
GF Revenue $0 $0 - - -
SF Revenue $0 $0 - - -
SF Expenditure $40,700 $68,100 $79,600 $91,600 $94,200
Net Effect ($40,700) ($68,100) ($79,600) ($91,600) ($94,200)
Note:() = decrease; GF = general funds; FF = federal funds; SF = special funds; - = indeterminate increase; (-) = indeterminate decrease
Local Effect: None.
Small Business Effect: Meaningful.
 Analysis
Bill Summary: “Practice genetic counseling” means (1) obtaining and evaluating the
medical histories of a patient and the patient’s family members for a genetic assessment;
(2) discussing the features, natural history, means of diagnosis, genetic and environmental
factors, and management of risk for genetic or medical conditions or diseases;
(3) identifying, ordering, and coordinating genetic laboratory tests and other diagnostic
studies, as appropriate, for purposes of a genetic assessment; (4) using medical histories
and the results of genetic laboratory tests and other diagnostic studies for a genetic
assessment; (5) explaining the clinical implications of genetic laboratory tests and other
diagnostic studies and the results of the tests and studies and communicating the risk factors
for genetic or medical conditions or diseases identified by a genetic assessment;
(6) evaluating the responses of a patient and the patient’s family members to the results of
a genetic assessment and providing counseling and anticipatory guidance for a genetic or
medical condition or disease; (7) identifying and using specified community resources for
a genetic or medical condition or disease; or (8) providing written documentation of
medical, genetic, and counseling information for a patient, a patient’s family members, or
appropriate health care professionals. “Practice genetic counseling” does not include
diagnosing or treating an illness, disease, or condition.
Exceptions to Licensure
The bill’s licensure requirement does not apply to an individual employed by the federal
government to practice genetic counseling while practicing within the scope of that
employment, an individual who resides in and holds an active license in another state while
consulting with a physician or genetic counselor licensed in the State about a particular
patient (subject to specified limitations), and students enrolled in an accredited genetic
counseling training program when practicing within the scope of the program.
Genetic Counselor License
An applicant for a license must be of good moral character, be at least 18 years old, be a
graduate of an education program approved by MBP, submit to MBP satisfactory evidence
of certification as a certified genetic counselor by an approved national certifying
organization, meet any additional requirements established by MBP, submit to a criminal
history records check, submit an application to MBP, and pay an application fee as set by
MBP. An applicant may meet the requirements for licensure without holding certification
from an approved national certifying organization if the applicant meets specified
qualifications, including working as a genetic counselor for at least 10 years prior to
January 1, 2024.
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The term of a genetic counselor license may not exceed three years. The bill specifies
licensing procedures for renewal and reinstatement, including continuing education
requirements.
Supervised Genetic Counselor License
MBP must issue a supervised genetic counselor license to an applicant who (1) has
graduated from a genetic counseling program accredited by the Accreditation Council for
Genetic Counselors; (2) met all qualifications for licensure with the exception of
certification; and (3) has applied for the first available national certifying examination
(subject to the exception that MBP may not issue a license to an applicant who has failed
the certification examination two or more times). As a condition of licensure, the
supervised genetic counselor must work under the supervision of a qualified supervisor
who meets specified requirements and has entered into a specified supervision contract
with the supervised genetic counselor.
The term of supervised genetic counselor license may not exceed one year and expires on
the earlier of (1) the issuance of a genetic counselor license; (2) the expiration date printed
on the supervised genetic counselor license; or (3) on notice of the second failure of the
supervised genetic counselor to pass the certification examination.
Requirement to Refer
If, while practicing genetic counseling, a licensed genetic counselor determines that a
patient requires a diagnosis or treatment, the genetic counselor must refer the patient to a
licensed physician or another appropriate health care practitioner.
Discipline
Subject to hearing provisions, an MBP disciplinary panel may deny a license to any
applicant, reprimand any licensee, place any licensee on probation, or suspend or revoke a
license, if the applicant or licensee violates any one of 29 enumerated disciplinary grounds.
The board may reinstate a revoked license under specified circumstances.
A disciplinary panel may also issue a cease and desist order for practicing (1) genetic
counseling without a license or with an unauthorized person or (2) supervising or aiding
an unauthorized person in the practice of genetic counseling.
Required Reporting
Hospitals, related institutions, alternative health systems, and employers must report
specified information regarding genetic counselors to MBP for any reasons that may be
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grounds for disciplinary action. The entity must submit any required report within 10 days
of the action that is the subject of the report. A disciplinary panel may impose a civil penalty
of up to $1,000 for failure to make a required report; any collected penalties are remitted
to the general fund.
Licensee Profiles
MBP must create and maintain a public individual profile on each genetic counselor
licensee that includes specified information, including information relating to charges filed
and any final disciplinary action taken against a licensee. MBP must forward a written copy
of the profile to a person on request.
Genetic Counseling Advisory Committee
The advisory committee must develop and recommend to MBP regulations to carry out the
licensure and regulation of genetic counselors, a code of ethics for the practice of genetic
counseling, continuing education requirements for license renewal, criteria for individuals
who are licensed to practice genetic counseling in another state or territory to become
licensed in Maryland, and on request, standards of care for the practice of genetic
counseling. The advisory committee must also evaluate the credentials of applicants and
recommend licensure of applicants who fulfill the requirements for a license to practice
genetic counseling and submit an annual report to MBP.
Penalties
A person who violates the bill’s prohibitions against practicing genetic counseling without
a license; misrepresentation as a licensed genetic counselor; or providing, attempting to
provide, or representing that the person provides genetic counseling services if not
authorized is guilty of a misdemeanor and on conviction subject to a maximum penalty of
one year imprisonment and/or a $1,000 fine. A person who violates these provisions is also
subject to a maximum civil fine of $5,000 to be levied by a disciplinary panel; fines are
payable to the MBP Fund.
Program Evaluation and Termination
The Maryland Genetic Counseling Act is subject to the evaluation and reestablishment
provisions of the Maryland Program Evaluation Act and terminates July 1, 2031.
Current Law: The mission of MBP is to assure quality health care in Maryland through
the efficient licensure and effective discipline of health providers under its jurisdiction by
protecting and educating clients/customers and stakeholders and enforcing the Maryland
Medical Practice Act. The board has regulatory authority over physicians, physician
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assistants, radiographers, radiation therapists, nuclear medicine technologists, radiologist
assistants, respiratory care practitioners, polysomnographic technologists, athletic trainers,
perfusionists, and naturopathic doctors.
State Fiscal Effect: Special fund expenditures for MBP increase by $40,703 in
fiscal 2022, which accounts for the bill’s January 1, 2022 effective date. This estimate
reflects the cost to hire one full-time, grade 15 licensure analyst to develop regulations,
recruit members for and staff the advisory committee, and establish a licensing program
for genetic counselors. It includes a salary, fringe benefits, one-time start-up costs, and
ongoing operating expenses.
Position 1
Salary and Fringe Benefits $35,285
Operating Expenses 5,418
Total FY 2022 State Expenditures $40,703
Once licensure of genetic counselors is in place (on or after January 1, 2024), MBP
special fund expenditures increase by an additional $19,000 annually for contractual
services related to investigating compliance, performing peer reviews, providing
rehabilitation services to licensed genetic counselors, and litigation expenses for any
disciplinary actions against licensed genetic counselors (or unlicensed genetic counselors
in violation of the licensure requirement).
This analysis assumes that available fund balance is used to cover costs for fiscal 2022 and
2023 related to establishing the licensure program. As MBP is special funded, it must set
reasonable fees for the issuance and renewal of licenses and other services it provides to
genetic counselors. Licensure fees must be set so as to approximate the cost of maintaining
the licensure program.
No special fund revenues are anticipated in fiscal 2022 or 2023, as MBP needs time to
implement the new licensure program before accepting applications; moreover, licensure
is not required until January 1, 2024. Accordingly, this analysis assumes license fees are
collected beginning in fiscal 2024, at which time the license fee will be set to cover the
cost of the licensure program going forward.
Based on provider information from the National Society of Genetic Counselors, there are
approximately 70 genetic counselors in Maryland. Based on the estimated expenditures
discussed above, and assuming that MBP licenses genetic counselors on a biennial basis
as with other licensees under the board, initial biennial license fees may be as much as
$2,500. The license fee must be sufficient to cover expenditures for a two-year period.
Actual license fees and revenues depend on the number of genetic counselors that seek
licensure under the bill, as well as the actual costs incurred by MBP. To the extent that
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costs related to establishing licensure (assumed to be paid by fund balance) must also be
covered by the license fee, the initial license fee must be set much higher.
Small Business Effect: Genetic counselors must be licensed under the bill in order to
practice in Maryland; accordingly, they must pay license fees and are subject to
disciplinary actions.
Additional Comments: Certification in genetic counseling is offered by the American
Board of Genetic Counseling through an examination administered twice per year.
Certification, while not required everywhere, demonstrates that the individual has met the
standards necessary to provide competent genetic counseling.
Additional Information
Prior Introductions: SB 763 of 2020, a similar bill, passed the Senate as amended and
was referred to the House Health and Government Operations Committee, but no further
action was taken. Its cross file, HB 1040, received a hearing in the House Health and
Government Operations Committee, but no further action was taken.
Designated Cross File: HB 299 (Delegate Carr) - Health and Government Operations.
Information Source(s): National Society of Genetic Counselors; Judiciary
(Administrative Office of the Courts); Maryland Department of Health; Office of
Administrative Hearings; Department of Legislative Services
Fiscal Note History: First Reader - January 20, 2021
rh/jc Third Reader - March 9, 2021
Revised - Amendment(s) - March 9, 2021
Analysis by: Amber R. Gundlach Direct Inquiries to:
(410) 946-5510
(301) 970-5510
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Statutes affected:
Text - Third - State Board of Physicians - Genetic Counselors - Licensing: 2-024 Health Occupations