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*sb0326*
SENATE BILL 326
J2 6lr2208
CF HB 377
By: Senators Lam and Carozza, Carozza, and Beidle
Introduced and read first time: January 22, 2026
Assigned to: Finance
Committee Report: Favorable with amendments
Senate action: Adopted
Read second time: March 1, 2026
CHAPTER ______
AN ACT concerning 1
Physician Assistants and Midwives – Parity With Other Health Care 2
Practitioners 3
(Physician Assistant Parity Act of 2026) 4
FOR the purpose of altering certain provisions of law to include physician assistants in the 5
health care practitioners who may take certain actions, including actions related to 6
the guardianship of disabled persons, admission of indi viduals to mental health 7
facilities, the Emergency and Allergy Treatment Program, and the Attendant Care 8
Program; altering the health care practitioners that may order that a pregnant 9
incarcerated individual be admitted to the infirmary; altering the healt h care 10
practitioners that health maintenance organizations must allow each member to 11
select from among those available to the health maintenance organization; requiring 12
the Maryland Department of Health to cover charges related to examinations by a 13
physician assistant for certain emergency evaluees; altering the membership and 14
duties of the Statewide Advisory Commission on Immunization; requiring the 15
Maryland H ealth Care Commission to review certain data and evaluate whether 16
there is a longer average length of stay for individuals who are the subject of an 17
application for involuntary admission who are brought during an overnight shift to 18
certain emergency depart ments; and generally relating to physician assistants , 19
certified nurse–midwives, and licensed certified midwives. 20
BY repealing and reenacting, with amendments, 21
Article – Correctional Services 22
Section 9–601.1(e)(1) 23
Annotated Code of Maryland 24
2 SENATE BILL 326
(2025 Replacement Volume) 1
BY repealing and reenacting, with amendments, 2
Article – Estates and Trusts 3
Section 13–705(c)(2) 4
Annotated Code of Maryland 5
(2022 Replacement Volume and 2025 Supplement) 6
BY repealing and reenacting, with amendments, 7
Article – Health – General 8
Section 5 –606, 10 –601(g) and (h), 10–610(c), 10–611(b), (c), and (e), 10–615(6), 9
10–616(a)(1) and (c), 10 –619, 10–620(f), 10 –622(b) and (d), 10 –623(a), 10
10–624(a)(1), 10 –628(a)(1), 13 –701, 13 –705, 13 –707(b)(1) and (c), 11
18–214(d)(11) and (12), 19–705.1(b)(1)(vi), and 19–2001(a)(4) 12
Annotated Code of Maryland 13
(2023 Replacement Volume and 2025 Supplement) 14
BY repealing and reenacting, without amendments, 15
Article – Health – General 16
Section 10–601(a), 10–620(a), 18–214(b), 19–705.1(a) and (b)(2), a nd 19–2001(a)(1) 17
and (b)(1) 18
Annotated Code of Maryland 19
(2023 Replacement Volume and 2025 Supplement) 20
BY adding to 21
Article – Health – General 22
Section 10–601(g) and 18–214(d)(12) 23
Annotated Code of Maryland 24
(2023 Replacement Volume and 2025 Supplement) 25
BY repealing and reenacting, with amendments, 26
Article – Human Services 27
Section 7–404(a) 28
Annotated Code of Maryland 29
(2019 Replacement Volume and 2025 Supplement) 30
BY repealing and reenacting, without amendments, 31
Article – State Personnel and Pensions 32
Section 9–504(a) 33
Annotated Code of Maryland 34
(2024 Replacement Volume and 2025 Supplement) 35
BY repealing and reenacting, with amendments, 36
Article – State Personnel and Pensions 37
Section 9–504(b) 38
Annotated Code of Maryland 39
(2024 Replacement Volume and 2025 Supplement) 40
SENATE BILL 326 3
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 1
That the Laws of Maryland read as follows: 2
Article – Correctional Services 3
9–601.1. 4
(e) (1) A pregnant incarcerated individual who is deemed to need infirmary 5
care shall be admitted to the infirmary on order of a primary care nurse practitioner , A 6
PHYSICIAN ASSISTANT , or AN obstetrician NURSE PRACTITIONER , CERTIFIED 7
NURSE–MIDWIFE, LICENSED CERTIFIED M IDWIFE, PHYSICIAN ASSISTANT , OR 8
PHYSICIAN. 9
Article – Estates and Trusts 10
13–705. 11
(c) (2) Notwithstanding the provisions of paragraph (1) of this subsection, a 12
petition for guardianship of a disabled person shall include signed and verified certificates 13
of competency from the following health care professionals who have examined or evaluated 14
the disabled person: 15
(i) Two licensed physicians; or 16
(ii) 1. One licensed physician; and 17
2. A. One licensed psychologist; 18
B. One licensed certified social worker–clinical; [or] 19
C. One nurse practitioner; OR 20
D. ONE LICENSED PHYSICIAN ASSISTANT. 21
Article – Health – General 22
5–606. 23
(a) (1) Prior to providing, withholding, or withdrawing treatment for which 24
authorization has been obtained or will be sought under this subtitle, the attending 25
physician and a sec ond physician [or a], nurse practitioner, OR PHYSICIAN ASSISTANT, 26
one of whom shall have examined the patient within 2 hours before making the 27
certification, shall certify in writing that the patient is incapable of making an informed 28
decision regarding th e treatment. The certification shall be based on a personal 29
examination of the patient. 30
4 SENATE BILL 326
(2) If a patient is unconscious, or unable to communicate by any means, the 1
certification of a second physician [or a], nurse practitioner, OR PHYSICIAN ASSISTANT is 2
not required under paragraph (1) of this subsection. 3
(3) When authorization is sought for treatment of a mental illness, the 4
second physician [or the ], nurse practitioner , OR PHYSICIAN ASSISTA NT may not be 5
otherwise currently involved in the treatment of the person assessed. 6
(4) The cost of an assessment to certify incapacity under this subsection 7
shall be considered for all purposes a cost of the patient’s treatment. 8
(b) A health care provider may not withhold or withdraw life –sustaining 9
procedures on the basis of an advance directive where no agent has been appointed or on 10
the basis of the authorization of a surrogate, unless: 11
(1) The patient’s attending physician and a second physician [or a], nurse 12
practitioner, OR PHYSICIAN ASSISTA NT have certified that the patient is in a terminal 13
condition or has an end–stage condition; or 14
(2) Two physicians, one of whom is a neurologist, neurosurgeon, or other 15
physician who has special expertise in the evaluation of cognitive functioning, certify that 16
the patient is in a persistent vegetative state. 17
10–601. 18
(a) In this subtitle the following words have the meanings indicated. 19
(G) “PHYSICIAN ASSISTANT ” MEANS AN INDIVIDUAL WHO IS LICENSED 20
UNDER TITLE 15 OF THE HEALTH OCCUPATIONS ARTICLE TO PRACTICE A S A 21
PHYSICIAN ASSISTANT. 22
[(g)] (H) “Psychiatric nurse practitioner” means an individual who is: 23
(1) Licensed as a registered nurse and certified as a nurse practitioner 24
under Title 8 of the Health Occupations Article; and 25
(2) Practicing in the State as a certified registered nurse 26
practitioner–psychiatric mental health. 27
[(h)] (I) “Psychologist” means an individual who is licensed under Title 18 of the 28
Health Occupations Article to practice psychology. 29
10–610. 30
(c) A facility may not admit an individual under this section unless: 31
SENATE BILL 326 5
(1) The individual has a mental disorder; 1
(2) The mental disorder is susceptible to care or treatment; 2
(3) The applicant understands the nature of a request for admission; and 3
(4) Assent to the admission has been given: 4
(i) By the admitting physician of the facility; or 5
(ii) For a child or adolescent unit of a State facility, by: 6
1. 1 physician and 1 psychologist; 7
2. 1 PHYSICIAN AND 1 PHYSICIAN ASSISTANT; 8
[2.] 3. 2 physicians; 9
[3.] 4. 1 physician and 1 psychiatric nurse practitioner; 10
[4.] 5. 1 physician and 1 licensed certified social worker–clinical; 11
or 12
[5.] 6. 1 physician and 1 licensed clinical professional counselor. 13
10–611. 14
(b) A disabled person may apply for voluntary admission of the disabled person 15
if: 16
(1) The disabled person submits a formal, written application that contains 17
the disabled person’s personal information and is on the form required b y the 18
Administration; and 19
(2) In accordance with subsections (c) through (e) of this section, either a 20
physician and a psychologist, two physicians, [or] a physician and a psychiatric nurse 21
practitioner, OR A PHYSICIAN AND A PHYSICIAN ASSISTANT certify that: 22
(i) The disabled person has the capacity to execute an application 23
for voluntary admission; and 24
(ii) The disabled person understands both the criteria for voluntary 25
admission set forth under this section and the procedure for requesting discharge from the 26
facility. 27
6 SENATE BILL 326
(c) (1) A certificate for voluntary admission of a disabled person under 1
subsection (b) of this section shall: 2
(i) Be based on the personal examination of the physician, 3
psychologist, [or] psychiatric nurse practitioner, OR PHYSICIAN ASSISTANT who signs the 4
certificate; and 5
(ii) Be in the form that the Secretary of Health adopts, by rule or 6
regulation. 7
(2) The rules and regulations shall require the form to include an opinion 8
that: 9
(i) The disabled person has a mental disorder; 10
(ii) The mental disorder is susceptible to care or treatment; 11
(iii) The disabled person understands the nature of the request for 12
admission; and 13
(iv) The disabled person is able to give continuous assent to retention 14
by the facility. 15
(e) A certificate may not be used for an admission if the physician, psychologist, 16
[or] psychiatric nurse practitioner, OR PHYSICIAN ASSISTANT who signed the certificate: 17
(1) Has a financial interest, through ownership or compensation, in a 18
proprietary facility and admission to that proprietary facility is sought for the disabled 19
person whose status is being certified; or 20
(2) Is related, by blood or marriage, to the disabled person or the guardian 21
of the person of the disabled person. 22
10–615. 23
Each application for involuntary admission to a facility or Veterans’ Administration 24
hospital under this part shall: 25
(6) Be accompanied by the certificates of: 26
(i) 1 physician and 1 psychologist; 27
(ii) 2 physicians; 28
(III) 1 PHYSICIAN AND 1 PHYSICIAN ASSISTANT; 29
[(iii)] (IV) 1 physician and 1 psychiatric nurse practitioner; 30
SENATE BILL 326 7
[(iv)] (V) 1 physician and 1 licensed certified social worker–clinical; 1
or 2
[(v)] (VI) 1 physician and 1 licensed clinical professional counselor ; 3
and 4
10–616. 5
(a) (1) A certificate for involuntary admission of an individual under this part 6
shall: 7
(i) Be based on the personal examination of the physician, 8
psychologist, psychiatric nurse practitioner, PHYSICIAN ASSISTANT , licensed certified 9
social worker–clinical, or licensed clinical professional counselor who signs the certificate; 10
and 11
(ii) Be in the form that the Secretary adopts, by rule or regulation. 12
(c) A certificate may not be used for an admission if the physician, psychologist, 13
psychiatric nurse practitioner, PHYSICIAN ASSISTANT , licensed certified social 14
worker–clinical, or licensed clinical professional counselor who signed the certificate: 15
(1) Has a financial interest, through ownership or compensation, in a 16
proprietary facility and admission to that proprietary facility is sought for the individual 17
whose status is being certified; or 18
(2) Is related, by blood or marriage, to the individual or to the applicant. 19
10–619. 20
Within 12 hours of notification by a physician, licensed psychologist, psychiatric 21
nurse practitioner, PHYSICIAN ASSISTANT, licensed certified social worker –clinical, or 22
licensed clinical professional counselor who has certifie d an individual under this part, a 23
facility operated by the Maryland Department of Health shall receive and evaluate the 24
individual certified for involuntary admission if: 25
(1) The individual’s involuntary admission is not limited by § 10 –617 of 26
this subtitle; 27
(2) An application for admission has been completed; 28
(3) A certifying physician, psychologist, psychiatric nurse practitioner, 29
PHYSICIAN ASSISTANT , licensed certified social worker –clinical, or licensed clinical 30
professional counselor is unabl e to place the individual in a facility not operated by the 31
Department; and 32
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(4) The Department is unable to provide for the placement of the person 1
other than in a facility operated by the Department. 2
10–620. 3
(a) In Part IV of this subtitle the following words have the meanings indicated. 4
(f) (1) “Mental disorder” means the behavioral or other symptoms that 5
indicate: 6
(i) To a lay petitioner who is submitting an emergency petition, a 7
clear disturbance in the mental functioning of another individual; and 8
(ii) To the following health professionals doing an examination, at 9
least one mental disorder that is described in the version of the American Psychiatric 10
Association’s “Diagnostic and Statistical Manual – Mental Disorders” that is current at the 11
time of the examination: 12
1. Physician; 13
2. Psychologist; 14
3. Clinical social worker; 15
4. Licensed clinical professional counselor; 16
5. Clinical nurse specialist in psychiatric and mental health 17
nursing (APRN/PMH); 18
6. Psychiatric nurse practitioner (CRNP–PMH); 19
7. PHYSICIAN ASSISTANT; or 20
[7.] 8. Licensed clinical marriage and family therapist. 21
(2) “Mental disorder” does not include intellectual disability. 22
10–622. 23
(b) (1) The petition for emergency evaluation of an individual may be made by: 24
(i) A physician, psychologist, PHYSICIAN ASSISTANT , clinical 25
social worker, licensed clinical professional counselor, clinical nurse specialist in 26
psychiatric and mental health nursing, psychiatric nurse practit ioner, licensed clinical 27
marriage and family therapist, or health officer or designee of a health officer who has 28
examined the individual; 29
SENATE BILL 326 9
(ii) A peace officer who personally has observed the individual or the 1
individual’s behavior; or 2
(iii) Any other interested person. 3
(2) An individual who makes a petition for emergency evaluation under 4
paragraph (1)(i) or (ii) of this subsection may base the petition on: 5
(i) The examination or observation; or 6
(ii) Other information obtained that is pertinent to the factors giving 7
rise to the petition. 8
(d) (1) A petitioner who is a physician, psychologist, PHYSICIAN ASSISTANT, 9
clinical social worker, licensed clinical professional counselor, clinical nurse specialist in 10
psychiatric and mental health nursing, psychiatric nurse practitioner, licensed clinical 11
marriage and family therapist, health officer, or designee of a health officer shall give the 12
petition to a peace officer. 13
(2) The peace officer shall explain to the petitioner: 14
(i) The serious nature of the petition; and 15
(ii) The meaning and content of the petition. 16
10–623. 17
(a) If the petitioner under Part IV of this subtitle is not a physician, psychologist, 18
PHYSICIAN ASSISTANT , clinical social worker, licensed clinical professional counselor, 19
clinical nurse specialist in psychiatric and mental health nursing, psychiatric nurse 20
practitioner, licensed clinical marriage and family therapist, health officer or designee of a 21
health officer, or peace officer, the petitioner shall present t he petition to the court for 22
immediate review. 23
10–624. 24
(a) (1) A peace officer shall take an emergency evaluee to the nearest 25
emergency facility if the peace officer has a petition under Part IV of this subtitle that: 26
(i) Has been endorsed by a court within the last 5 days; or 27
(ii) Is signed and submitted by a physician, psychologist, 28
PHYSICIAN ASSISTANT , clinical social worker, licensed clinical professional counselor, 29
clinical nurse specialist in psychiatric and mental health nursing, psychiatric nurse 30
practitioner, licensed clinical marriage and family therapist, health officer or designee of a 31
health officer, or peace officer. 32
10 SENATE BILL 326
10–628. 1
(a) (1) If an emergency evaluee cannot pay or does not have insurance that 2
covers the charges for emergency services, an initial consultant examination by a physician, 3
PHYSICIAN ASSISTANT, or nurse practitioner, and transportation to an emergency facility 4
and, for an involuntary admission of the emergency evaluee, to the admitting facility, the 5
Department shall pay the appropriate party the actual cost or a reasonable rate for this 6
service, whichever is lower, except that hospitals shall be paid at rates approved by the 7
Health Services Cost Review Commission. 8
13–701. 9
The Emergency and Allergy Treatment Program is a program in the Department for 10
the purpose of providing a means of authorizing certain individuals to administer 11
life–saving treatment to individuals who have severe adverse reactions to allergens or 12
insect stings when physician, PHYSICIAN ASSISTANT, registered nurse practitioner, or 13
emergency medical services are not immediately available in a youth camp. 14
13–705. 15
(a) (1) A registered nurse practitioner, PHYSICIAN ASSISTANT, or a physician 16
licensed to practice [medicine] in the State may prescribe emergency use epinephrine in 17
the name of a certificate holder. 18
(2) A registered nurse practitioner, a pharmacist [licensed to practice 19
pharmacy in the State ], A PHYSICIAN ASSISTAN T, or a physician LICENSED TO 20
PRACTICE IN THE STATE may dispense emergency use epinephrine under a prescription 21
issued to a certificate holder. 22
(b) A certificate holder may: 23
(1) On presentment of a certificate, receive from any registered nurse 24
practitioner, PHYSICIAN ASSISTANT, or any physician licensed to practi ce [medicine] in 25
the State a prescription for emergency use epinephrine and the necessary paraphernalia 26
for the administration of emergency use epinephrine; and 27
(2) Possess and store prescribed emergency use epinephrine and the 28
necessary paraphernalia for the administration of emergency use epinephrine. 29
(c) In an emergency situation when registered nurse practitioner, physician, 30
PHYSICIAN ASSISTANT, or emergency medical services are not immediately available, a 31
certificate holder or agent may administer emergency use epinephrine to an individual who 32
is experiencing or believed in good faith by the certificate holder or agent to be experiencing 33
anaphylaxis. 34
SENATE BILL 326 11
13–707. 1
(b) (1) A cause of action may not arise against any physician OR PHYSICIAN 2
ASSISTANT for any act or omission when the physician OR PHYSICIAN ASSISTANT in good 3
faith prescribes or dispenses emergency use epinephrine and the necessary paraphernalia 4
for the administration of emergency use epinephrine to a person certified by the 5
Department under this subtitle. 6
(c) This section does not affect, and may not be construed as affecting, any 7
immunities from civil liability or defenses established by any other provision of the Code or 8
by common law to which a volunteer, registered nurse practitioner, physician, PHYSICIAN 9
ASSISTANT, or pharmacist may be entitled. 10
18–214. 11
(b) There is a Statewide Advisory Commission on Immunizations. 12
(d) The following members are subject to term limits: 13
(11) One physician member of the American College of Physicians – Internal 14
Medicine Society of Maryland; [and] 15
(12) ONE PHYSICIAN ASSISTA NT MEMBER OF THE MARYLAND 16
ACADEMY OF PHYSICIAN ASSISTANTS; AND 17
[(12)] (13) Up to three additional members selected by the Secretary. 18
19–705.1. 19
(a) The Secretary shall adopt regulations that set out reasonable standards of 20
quality of care that a health maintenance organization shall provide to its members. 21
(b) (1) The standards of quality of care shall include: 22
(vi) A requirement that each member shall have an opportunity to 23
select a primary physician, A PHYSICIAN ASSISTANT, A CERTIFIED NURSE–MIDWIFE, A 24
LICENSED CERTIFIED M IDWIFE, or a certified nurse practitioner from among those 25
available to the health maintenance organization; and 26
(2) This subsection may not be construed to require that a health 27
maintenance organization include certified nurse practitioners on the health maintenance 28
organization’s provider panel as primary care providers. 29
19–2001. 30
(a) (1) In this subtitle the following words have the meanings indicated. 31
12 SENATE BILL 326
(4) (i) Except as provided in subparagraph (ii) of this paragraph, 1
“health care practitioner” means any individual licensed or certified under the Health 2
Occupations Article who: 3
1. Is a licensed practical nurse, registered nurse, or certified 4
nursing assistant; or 5
2. Practices in an allied health care field, as defined by the 6
Office in regulation. 7
(ii) “Health care practitioner” does not include: 8
1. An acupuncturist; 9
2. A dentist; 10
3. A nurse anesthetist; 11
4. A nurse midwife; 12
5. A nurse practitioner; 13
6. A pharmacist; 14
7. A physician; [or] 15
8. A PHYSICIAN ASSISTANT; OR 16
[8.] 9. A podiatrist. 17
(b) (1) A health care staff agency shall be licensed by the Office before 18
referring health care practitioners to a health care facility to render temporary health care 19
services at a health care facility in this State. 20
Article – Human Services 21
7–404. 22
(a) (1) The Department shall ensure that at any given time at least 50% of the 23
eligible individuals receiving financial assistance under the Program are: 24
(i) gainfully employed; 25
(ii) actively seeking employment; or 26
SENATE BILL 326 13
(iii) attending an institution of postsecondary or higher education, as 1
defined in § 10–101 of the Education Article. 2
(2) The remainder of the eligible individuals receiving financial assistance 3
under the Program shall be individuals who: 4
(i) reside in a nursing facility or similar institution licensed to 5
provide chronic or intermediate care and who will be deinstitutionalized as a result of the 6
Program; or 7
(ii) are certified by an attending physician, PHYSICIAN ASSISTANT, 8
or certified nurse practitioner as being at risk of placement in a nursing facility or similar 9
institution licensed to provide chronic or intermediate care if attendant care services are 10
not received in the community. 11
Article – State Personnel and Pensions 12
9–504. 13
(a) An employee who uses sick leave for 5 or more consecutive workdays for 14
personal il lness or disability or the illness or disability of a member of the employee’s 15
immediate family may not receive payment under this subtitle unless the employee gives 16
the employee’s immediate supervisor an original certificate of illness or disability. 17
(b) The certificate required under subsection (a) of this section shall be signed by 18
one of the following: 19
(1) a medical doctor who is authorized to practice medicine or surgery by 20
the state in which the doctor practices; 21
(2) if authorized to practic e in a state and performing within the scope of 22
that authority: 23
(i) a chiropractor; 24
(ii) a clinical psychologist; 25
(iii) a dentist; 26
(iv) a licensed certified social worker – clinical; 27
(v) a nurse midwife; 28
(vi) a nurse practitioner; 29
(vii) an oral surgeon; 30
14 SENATE BILL 326
(viii) an optometrist; 1
(ix) a physical therapist; 2
(X) A PHYSICIAN ASSISTANT; 3
[(x)] (XI) a podiatrist; or 4
[(xi)] (XII) a licensed professional counselor – clinical; 5
(3) an accredited Christian Science practitioner; or 6
(4) a health care provider as defined by the federal Family Medical Leave 7
Act. 8
SECTION 2. AND BE IT FURTHER ENACTED, That: 9
(a) The Maryland Health Care Commission shall: 10
(1) review data on the average length of stay in emergency departments for 11
individuals who are the subject of an application for involuntary admission under Title 10, 12
Subtitle 6, Part III of the Health – General Article; and 13
(2) evaluate whether there is a longer average length of stay for individuals 14
who are brought during an overnight shift to emergency departments that lack a sufficient 15
number of clinicians with authority to certify an application for involuntary admission 16
under § 10–615 of the Health – General Article, but are staffed with physician assistants. 17
(b) On or before November 1, 2026, the Maryland Health Care Commission shall 18
report its findings and recommendations to the Senate Finance Committee and the House 19
Health Committee, in accordance with § 2–1257 of the State Government Article. 20
SECTION 2. 3. AND BE IT FURTHER ENACTED, That this Act shall take effect 21
October 1, 2026. 22
Approved:
________________________________________________________________________________
Governor.
________________________________________________________________________________
President of the Senate.
________________________________________________________________________________
Speaker of the House of Delegates.