HB 1125
Department of Legislative Services
Maryland General Assembly
2024 Session
FISCAL AND POLICY NOTE
Third Reader - Revised
House Bill 1125
(Delegate Kerr, et al.)
Health and Government Operations
Finance
Certified Nursing Assistants - Licensing Requirements and Administrative
Updates
This bill alters the designation of and licensure requirements for a certified nursing assistant
(CNA), creating new designations of “certified nursing assistant-I” (CNA-I) and “certified
nursing assistant-II” (CNA-II). On or after October 1, 2025, a geriatric nursing assistant
(GNA) and any CNA that has passed a specified nursing assistant training program and
competency evaluation will be designated as a CNA-I. Those that do not meet these
requirements will be designated as a CNA-II. By June 1, 2025, the State Board of Nursing
(MBON) must (1) notify individuals with a nursing assistant certification of the bill’s
requirements and (2) update regulations to confirm with the bill in consultation with the
Office of Health Care Quality. The bill also alters exemptions from specified certification
requirements and makes clarifying and conforming changes. The bill generally takes
effect October 1, 2025; provisions relating to the requirement for MBON to notify
CNAs and update regulations take effect October 1, 2024.
Fiscal Summary
State Effect: MBON special fund expenditures increase by $209,900 in FY 2025 for staff
and one-time only licensing system updates. Future years reflect annualization and
elimination of one-time costs. Special fund revenues are not likely affected, as discussed
below.
(in dollars)
FY 2025
FY 2026
FY 2027
FY 2028
FY 2029
Revenues
$0
$0
$0
$0
$0
SF Expenditure
209,900
103,600
108,200
112,900
117,900
Net Effect
($209,900)
($103,600)
($108,200)
($112,900)
($117,900)
Note:() = decrease; GF = general funds; FF = federal funds; SF = special funds; - = indeterminate increase; (-) = indeterminate decrease
Local Effect: None.
Small Business Effect: Minimal.
HB 1125/ Page 2
Analysis
Bill Summary:
New Designation of Certified Nursing Assistant Credentials
The bill alters the designation of CNA credentials to include CNA-I and CNA-II. “CNA-I”
means a CNA who meets the requirements set by MBON and federal law to practice in any
setting. CNA-I includes (1) a CNA who was certified as a GNA on September 30, 2025;
(2) a certified medicine aide; and (3) a CNA-II certified as a CNA-I by MBON on or after
October 1, 2025, as specified.
“CNA-II” means a CNA (1) who, on September 30, 2025, was certified as a nursing
assistant and was not authorized to practice in a nursing facility or skilled nursing facility
and (2) whose authority to practice in a nursing facility or skilled nursing facility continues
to be restricted because the CNA has not been approved as a CNA-I.
The bill repeals the GNA credential and replaces it with CNA-I.
An individual who has met the requirements for a CNA credential by October 1, 2025,
must be certified as a CNA-I. Beginning October 1, 2025, a CNA-II may be certified as a
CNA-I by submitting an application to MBON and providing satisfactory evidence of
(1) successful completion of an approved nursing assistant training program and
(2) passing a “nursing assistant competency evaluation.” “Nursing assistant competency
evaluation” means an examination approved by MBON that (1) determines the competency
of the individual to practice as a CNA-I and (2) meets the requirements under federal law.
MBON, after consultation with relevant stakeholders, must adopt regulations establishing
qualifications for CNAs, including medicine aides.
Certified Nursing Assistant Applications
The bill clarifies the training requirements an applicant must meet when applying for a
nursing assistant certificate. An applicant must provide evidence of successful completion
of (1) an approved nursing assistant training program or approved acute care nursing
assistant training program; (2) an approved dialysis technician training program; (3) an
approved course in medication administration; or (4) a portion of an approved nursing
education program that meet the requirements of an approved nursing assistant training
program or medication course. The bill repeals the requirement that a certified
medicine aide submit an additional application to MBON.
HB 1125/ Page 3
An applicant for certification as a CNA must submit to MBON satisfactory evidence of
passing a nursing assistant competency evaluation. An applicant who has completed an
approved acute care nursing assistant training program must be deemed to have fulfilled
the classroom and clinical standards to sit for the nursing assistant competency evaluation.
Exemptions from Certification Requirements
The bill alters current exemptions from the requirement to be certified by MBON to
practice as a nursing assistant, dialysis technician, or medication technician. The bill adds
three new exemptions from the certification requirement for an individual who:
performs nursing assistant tasks as a student while enrolled in an acute care nursing
assistant training program;
performs nursing assistant tasks as a student while enrolled in an accredited nursing
program after the successful completion of the portion of the approved nursing
education program that MBON determines meets the requirements of an approved
nursing assistant training program or medication administration course; or
practices as a CNA-I for less than four months in accordance with federal
regulations.
The exemptions do not preclude a registered nurse (RN) or licensed practical nurse (LPN)
from delegating a nursing or other technical task to an unlicensed individual if acceptance
of delegated nursing or other technical tasks does not become a routine part of the
unlicensed individual’s job duties.
Certification Renewal Requirements
When renewing a CNA certificate, a certificate holder must provide satisfactory evidence
of completion of either (1) 16 hours of active certified nursing assistant practice within the
immediately preceding two-year period or (2) successful completion of an approved
nursing assistant training program or passing a nursing assistant competency evaluation.
MBON, after collaboration with relevant stakeholders, must adopt regulations to specify
the circumstances under which a nursing assistant, as a condition of renewal, must
complete an approved nursing assistant training program or pass a nursing assistant
competency examination.
Nursing Assistant Training Programs
The bill alters the definition of “approved nursing assistant training program” to mean a
course of training that (1) meets the requirements under federal and State law and (2) is
HB 1125/ Page 4
approved by MBON. “Approved acute care nursing assistant training program” means a
course of training that meets the acute care nursing curriculum approved by MBON.
The curriculum content for an approved nursing assistant training program must include,
among other things, content that meets all specified federal requirements and all basic skills
required of a nursing assistant regardless of the setting of the practice.
Nursing assistant training program requirements may not be interpreted to impose
additional requirements for a CNA-I beyond those required under federal law. A nursing
assistant training program may continue to operate during the approval process.
Nursing Support Staff
The bill alters the definition of “nursing support staff” to remove GNAs from the list of
professionals who are eligible to receive funds from the Maryland Loan Assistance
Repayment Program for Nurses and Nursing Support Staff to repay their educational loans.
This change in the bill is only technical in nature. An individual currently certified as a
GNA should still be able to qualify for repayment assistance from the program as a CNA.
Current law specifies that nursing support staff includes certified medication technicians,
certified medicine aides, CNAs, and GNAs.
Current Law: Under current law, an individual must be certified by MBON to practice
as a nursing assistant in the State. A CNA routinely performs nursing tasks delegated by
an RN or an LPN. CNAs can obtain additional certification as a GNA, home health aide,
certified medicine aide, or dialysis technician.
Geriatric Nursing Assistants
A GNA means a CNA who has successfully completed the requirements for a GNA
mandated under federal law and MBON regulations. MBON must grant an applicant for
certification as a GNA the status of GNA on their CNA certificate if the applicant is
(1) certified as a CNA; (2) has successfully completed a CNA/GNA training program
approved by MBON; and (3) has passed the GNA competency examination.
Nurse Aid Competency Training Programs
Federal regulations set requirements for nurse aid competency evaluations
(42 CFR § 483.154). States must review and approve nurse aide training and competency
evaluation programs (42 CFR § 483.151) and establish and maintain a registry of nurse
aids (42 CFR § 483.156). MBON, in conjunction with the Maryland Higher Education
Commission, must approve each nursing assistant training program prior to its
implementation and provide periodic survey of all programs in the State.
HB 1125/ Page 5
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 RN; (5) meet specified requirements for
instructors; and (6) contain specified competency evaluation procedures.
State Fiscal Effect: The bill requires MBON, by June 1, 2025, to adopt regulations to
implement the bill’s requirements and notify individuals with a nursing assistant
certification of the bill’s requirements. All GNAs and any CNA that has passed a nursing
assistant training program that satisfies federal and State requirements, and a nursing
assistant competency evaluation must be designated as a CNA-I by October 1, 2025. All
other CNAs not authorized to practice in a nursing facility or skilled nursing facility must
be designated as a CNA-II. Also beginning October 1, 2025, MBON must accept
applications from any CNA-II who has successfully completed an approved nursing
assistant training program and passed a nursing assistant competency evaluation and
applies for a CNA-I credential. MBON must also approve specified nursing assistant
training programs and ensure each training program complies with State and federal law.
Although MBON currently approves nursing assistant training programs, MBON advises
that existing staff cannot absorb the bill’s requirements.
Therefore, MBON special fund expenditures increase by $209,901 in fiscal 2025, which
accounts for a 90-day start up delay from the bill’s October 1, 2024 effective date. This
estimate reflects the cost of hiring one nurse program administrator to provide guidance to
approved nursing assistant training programs and review program compliance with
specified federal standards. It includes a salary, fringe benefits, one-time start-up costs, and
ongoing operating expenses. MBON advises that one-time costs of approximately
$150,000 in fiscal 2025 only are necessary to update the board’s licensing software system
to reflect the bill’s changes to CNA certification requirements and designations.
FY 2025
FY 2026
Position
1.0
-
Salary and Fringe Benefits
$52,915
$102,503
Licensing System Update
150,000
-
Operating Expenses
6,986
1,091
Total FY 2025 State Expenditures
$209,901
$103,594
Future year expenditures reflect a full salary with annual increases and employee turnover
as well as annual increases in ongoing operating expenses.
This analysis assumes that individuals currently certified by MBON will not be required to
pay additional certification fees for redesignation as a CNA-I or CNA-II.
HB 1125/ Page 6
Additional Comments: MBON has previously advised that Maryland is the only state
with both CNA and GNA certifications. Nationally, CNAs have the flexibility to work in
a hospital, long-term residential facilities, nursing homes, rehabilitation centers, adult day
care centers, and clinical facility settings. In Maryland, CNAs are only authorized to
practice in acute-care settings. MBON noted that GNAs must meet additional requirements
to be eligible for certification and are authorized to practice in all acute-care and long-term
care settings (including nursing homes).
Additional Information
Recent Prior Introductions: Similar legislation has been introduced within the last
three years. See SB 370 of 2023 and SB 82 of 2022.
Designated Cross File: SB 999 (Senator Beidle) - Finance.
Information Source(s): Maryland Department of Health; Department of Legislative
Services
Fiscal Note History:
First Reader - March 1, 2024
Third Reader - March 22, 2024
Revised - Amendment(s) - March 22, 2024
km/jc
Analysis by: Amberly E. Holcomb
Direct Inquiries to:
(410) 946-5510
(301) 970-5510
