State Overview: Maryland

State law or statute prohibits or limits the use of prior authorization for buprenorphine containing products by either the state Medicaid plan or private insurance companies.

An insurer, nonprofit health service plan, or a health maintenance organization may not require prior authorization for a prescriptive drug when used for treatment of an opioid use disorder and that contains methadone, buprenorphine or naltrexone. Md. Insurance Code Ann. § 15-851

Maryland credentials three types of addiction counselors. A Certified Supervised Counselor–Alcohol and Drug requires an associate degree, completed relevant education courses and two years of supervised experience. A Certified Associate Counselor–Alcohol and Drug requires a bachelor's degree, completed relevant education courses and three years of experience. A Licensed Clinical Alcohol and Drug Counselor requires a graduate degree, completed relevant education courses and 100 hours of face-to-face supervision. Md. Code of Regs. §10.58.07 and Maryland Board of Professional Counselors and Therapists

A licensed professional counselor engages professionally in counseling and appraisal activities by providing services involving the application of counseling principles and methods in the diagnosis, prevention, treatment, and amelioration of psychological problems and emotional or mental conditions of individuals or groups. Md. Health Occupations Code §17-101(v)

The standards for the certification of peer recovery specialists, including experience, training, and supervision requirements, are developed and administered by a third-party certification provider.

Full independent practice and prescriptive authority.

A CNM may perform the following functions:

1. Independent management of clients appropriate to the skill and educational preparation of the CNM and the nurse midwife's clinical practice guidelines.
2. Consult or collaborate with a physician or other health care provider as needed.
3. Refer clients with complications beyond the scope of practice of the CNM to a licensed physician. Md. Code of Regs. §10.27.05.06

A certified midwife may prescribe substances commonly used in the practice of nurse midwifery and controlled substances on Schedules II-V. Md. Code of Regs. §10.27.05.11

Transition to independent practice and prescribing period required.

During the first 18 months, an NP must have a mentorship with a physician or NP who has full practice authority. This mentor shall be available for advice, consultation and collaboration as needed. Md. Code of Regs. §10.27.07.01

An NP may independently prescribe and dispense drugs, devices and Schedules II-V controlled substances. Md. Regs. Code §10-27.07.07

NPs are authorized to sign medical orders for life-sustaining treatment forms. Md. Code of Regs. §10.01.21

NPs are recognized in state policy as a primary care provider. A primary care provider is a nurse practitioner certified in any of the following areas of specialization: adult, pediatric, geriatric, OB/GYN, school nurse or family. Maryland Primary Care Program 

Physician relationship required for practice authority; full independent prescriptive authority.

An anesthesiologist, licensed physician or dentist must be physically available to the CRNA for consultation at all times during the administration of, and recovery from, anesthesia and all other aspects of the practice of nurse anesthesia. Md. Code Regs. §10.27.05.06

CRNAs may order and prescribe medications, including controlled substances, up to a 10-day supply of medicine in connection with the delivery of anesthesia services. Md. Code Ann., Health Occ. § 8-513

Optometrists may only perform procedures related to foreign body removal and the examination, evaluation, diagnosis and treatment of the human eye. Md. Health Occupations Code Ann. §11–101(2)(h)

Optometrists may only administer an epinephrine autoinjector for treatment of anaphylaxis. Md. Health Occupations Code Ann. §11–404(a)(3)

Optometrists may not prescribe controlled substances. Md. Health Occupations Code Ann. §11–404(a)(1)

A dental hygienist may practice under the general supervision of a licensed dentist, meaning the dentist must authorize the procedure but need not be present during the procedure's performance. Md. Code of Regs. §10.44.21.10

Statute does not identify dental therapists as an oral health provider.

Telehealth means the delivery of medically necessary services, including but not limited to dental services, to a patient through the use of technology-assisted communication. Md. Health Ann. Code §15-141.2

Pharmacists are authorized to order and administer certain vaccinations, including COVID-19 vaccines, to individuals in certain age groups if certain requirements are met. The federal PREP Act allows pharmacists to administer the COVID-19 vaccine through the duration of the public health emergency. Md. Health Occ. Code § 12-508 

A pharmacist may substitute a generically equivalent drug or device product, a therapeutically equivalent brand name drug or device product or an interchangeable biological product, of the same dosage form and strength, for any brand name the drug or device product originally prescribed. Md. Health Occupations Code §12–504

Pharmacists may prescribe and dispense contraceptive medications and self–administered contraceptive devices after completing a training program approved by the Board of Pharmacy for prescribing and dispensing contraceptives. The pharmacists must provide a self–screening risk assessment tool that a patient must use before a pharmacist may prescribe contraceptives. After dispensing the contraceptive, the pharmacist must refer the patient for any additional care to the patient's primary care practitioner or a reproductive health care practitioner. Md. Health Occupations Code §12–511

Maryland does not allow pharmacists to prescribe tobacco cessation aids.

Supervision with a physician required for practice and prescriptive authority. 

Physician assistants are required to have a collaboration agreement, rather than a delegation agreement, in order to practice. "Practice as a physician assistant" means the performance of medical acts that are authorized under a license issued by the board and authorized under the physician assistant's collaboration agreement. HB 806, to be reflected in Md. Health Occupations Code Ann. § 15-101(r) 

"Prescriptive authority" means the authority delegated by a primary or alternate supervising physician to of a physician assistant to prescribe and administer controlled dangerous substances, prescription drugs, medical devices, and the oral, written or electronic ordering of medications; and dispense. Md. Health Occupations Code Ann. § 15-101(s) 

Statue limits the number of PAs a physician may supervise.

A primary supervising physician may not delegate medical acts under a delegation agreement to more than four PAs at any one time, except in a hospital or in the following nonhospital settings:

1. A correctional facility.
2. A detention center.
3. A public health facility.

Md. Health Occupations Code Ann. § 15-302(h)

Maryland does not currently have any provisions related to chart review or co-chart signatures.

Statute allows adaptable proximity.

"Supervision" includes physician oversight of and acceptance of direct responsibility for the patient services and care rendered by a PA, including continuous availability to the PA in person, through written instructions, or by electronic means and by designation of one or more alternate supervising physicians. MD. HEALTH OCC. § 15-101(u)

Patient services that may be provided by a PA are outlined in law. A delegation agreement between the PA and the physician will include the medical acts delegated to the PA that are within the scope of practice of the supervising physician and appropriate to the PA's education, training and level of competence. Md. Code of Regs. §10.32.03.06