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*sb0411*
SENATE BILL 411
J1 6lr2317
CF HB 624
By: Senators Augustine, Hettleman, Kramer, and McCray
Introduced and read first time: January 29, 2026
Assigned to: Finance
Committee Report: Favorable with amendments
Senate action: Adopted
Read second time: March 23, 2026
CHAPTER ______
AN ACT concerning 1
Hospitals – Clinical Staffing Committees and Plans – Establishment 2
(Safe Staffing Act of 2026) 3
FOR the purpose of requiring certain hospitals licensed in the State to comply with certain 4
staffing standards, to establish and maintain a clinical staffing committee , and to 5
implement a clinical staffing plan; requiring the chief nursing executive of eac h 6
hospital to produce a draft clinical staffing plan and submit it to the clinical staffing 7
committee of the hospital; requiring each clinical staffing committee to develop 8
finalize a clinical staffing plan; and generally relating to hospitals and clinical 9
staffing committees and plans. 10
BY adding to 11
Article – Health – General 12
Section 19–393 through 19–397 to be under the new part “Part XIII. Clinical Staffing 13
Committees and Plans” 14
Annotated Code of Maryland 15
(2023 Replacement Volume and 2025 Supplement) 16
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 17
That the Laws of Maryland read as follows: 18
Article – Health – General 19
19–391. RESERVED. 20
2 SENATE BILL 411
19–392. RESERVED. 1
PART XIII. CLINICAL STAFFING COMMITTEES AND PLANS. 2
19–393. 3
(A) IN THIS PART THE FOLL OWING WORDS HAVE THE MEANINGS 4
INDICATED. 5
(B) (1) “ANCILLARY MEMBER OF T HE FRONTLINE TEAM ” MEANS AN 6
INDIVIDUAL WHOSE PRI MARY DUTIES INCLUDE SUPPORTING INDIVIDUA LS WHO 7
PROVIDE DIRECT PATIENT CARE. 8
(2) “ANCILLARY MEMBER OF THE FRONTLINE TEAM” INCLUDES: 9
(I) A DIETARY WORKER; 10
(II) A PATIENT CARE TECHNICIAN; AND 11
(III) ANY OTHER NONLICENSED STAFF ASSISTING WITH PATIENT 12
CARE. 13
(C) “CLINICAL STAFFING COMMITTEE” MEANS A COMMITTEE ESTABLISHED 14
BY A HOSPITAL IN ACC ORDANCE WITH SUBSECTION (C) OF THIS SECTION § 15
19–394(C) OF THIS SUBTITLE. 16
(D) (C) “CLINICAL STAFFING PLA N” MEANS A PLAN DEVELOP ED UNDER 17
SUBSECTION (D) OF THIS SECTION § 19–394(D) OF THIS SUBTITLE. 18
19–394. 19
(A) THIS PART DOES NOT APPLY TO STATE HOSPITALS. 20
(B) (1) EACH HOSPITAL LICENSE D UNDER THIS TITLE S HALL COMPLY 21
WITH THE STAFFING STANDARDS OF: 22
(I) THE ACCREDITATION BOD Y THAT ACCREDITS THE 23
HOSPITAL; AND 24
(II) THE FEDERAL CENTERS FOR MEDICARE AND MEDICAID 25
SERVICES CONDITIONS OF PARTICIPATION. 26
(2) A CLINICAL STAFFING PL AN DEVELOPED UNDER T HIS PART 27
SHALL COMPLY WITH THIS SUBSECTION. 28
SENATE BILL 411 3
(C) (1) EACH HOSPITAL LICENSED UNDER THIS TITLE SHALL ESTABLISH 1
AND MAINTAIN A CL INICAL STAFFING COMMITTEE THAT HAS EQUAL MEMBERSHIP 2
FROM MANAGEMENT AND EMPLOYEES: 3
(I) IF THE HOSPITAL HAS 150 OR FEWER LICENSED BEDS, HAS 4
3 MANAGERS AND 2 EMPLOYEES; OR 5
(II) IF THE HOSPITAL HAS 151 OR MORE LICENSED BEDS, HAS 5 6
MANAGERS AND 4 EMPLOYEES. 7
(2) EACH CLINICAL STAFFIN G COMMITTEE ESTABLIS HED UNDER 8
THIS PART SHALL MAY INCLUDE AT LEAST ONE OF THE FOLLOWING INDIVIDUALS: 9
(I) A CERTIFIED NURSING ASSISTANT; 10
(II) A DIETARY AIDE; 11
(III) AN EMERGENCY ROOM A LICENSED NURSE; 12
(IV) AN ENVIRONMENTAL SERVICE WORKER; 13
(V) A MEDICAL RESIDENT, IF THE COMMITTEE IS IN A 14
TEACHING HOSPITAL; 15
(VI) A STAFF PHYSICIAN WHO IS NOT A HOSPITAL EMPLOYEE OR 16
ADMINISTRATOR; AND 17
(VII) A TECHNICIAN; OR 18
(VIII) AN EMPLOYEE WHOSE DUT IES INCLUDE PATIENT 19
ADVOCACY. 20
(3) A CLINICAL STAFFING CO MMITTEE ESTABLISHED UNDER 21
PARAGRAPH (1) OF THIS SUBSECTION MAY INCLUDE A PATIENT ADVOCATE. 22
(C) (D) (1) THE CHIEF NURSE EXECU TIVE OF EACH HOSPITA L SHALL 23
PRODUCE A DRAFT CLIN ICAL STAFFING PLAN A ND SUBMIT IT TO THE CLI NICAL 24
STAFFING COMMITTEE OF THE HOSPITAL. 25
(2) EACH CLINICAL STAFFING COMMITTEE SHALL DEVELOP FINALIZE 26
A CLINICAL STAFFING PLAN THAT MEETS PATI ENT NEEDS USING THE PLAN 27
SUBMITTED UNDER PARAGRAPH (1) OF THIS SUBSECTION. 28
4 SENATE BILL 411
(D) (E) WHEN DEVELOPING FINALIZING A CLINICAL STAFFING PLAN, THE 1
CLINICAL STAFFING COMMITTEE SHALL CONSIDER: 2
(1) EXISTING STAFFING LEVELS; 3
(2) METHODS TO SECURE COVERAGE NEEDS AS NECESSARY; 4
(3) EXISTING GAPS IN STAFFING AND HOW TO ADDRESS THE GAPS; 5
(4) ANY AVAILABLE EVIDENCE–BASED STAFFING STANDARDS; AND 6
(5) A SCHEDULE FOR PERIODIC REVIEW OF THE STAFFING PLAN; 7
(6) APPROPRIATE SKILL MIX AND COMPETENCY OF STAFF; 8
(7) STANDARDS REQUIRED BY: 9
(I) THE CENTERS FOR MEDICARE AND MEDICAID SERVICES 10
CONDITIONS OF PARTICIPATION; AND 11
(II) THE ACCREDITATION BOD Y THAT ACCREDITS THE 12
HOSPITAL; 13
(8) THE AVERAGE NUMBER OF PATIENTS OF THE HOSP ITAL DURING 14
THE IMMEDIATELY PREC EDING YEAR AND RELEV ANT INFORMATION REGA RDING 15
PATIENT DISCHARGES, POTENTIAL ADMISSIONS, AND TRANSFERS; 16
(9) THE AVERAGE LEVEL OF ACUITY FOR PATIENTS OF THE HOSPITAL 17
DURING THE IMMEDIATELY PRECEDING YEAR AND THE CORRESPONDING LEVEL OF 18
NURSING CARE REQUIRED; AND 19
(10) AN ESTIMATE OF THE AP PROPRIATE COMBINATIO N OF SKILL , 20
EXPERIENCE LEVEL, AND SPECIALTY CERTIFICATION OR TRAINING OF STAFF THAT 21
IS REQUIRED TO ADEQUATELY PROVIDE CARE TO PATIENTS OF THE HOSPITAL. 22
(E) ON OR BEFORE JULY 1 EACH YEAR , EACH HOSPITAL , THROUGH THE 23
CLINICAL STAFFING CO MMITTEE, SHALL CONDUCT A REVI EW OF THE CLINICAL 24
STAFFING PLAN TO: 25
(1) EVALUATE THE EFFECTIV ENESS OF THE CLINICA L STAFFING 26
PLAN DURING THE IMMEDIATELY PRECEDING YEAR; 27
(2) UPDATE THE CLINICAL S TAFFING PLAN TO ENSU RE THAT THE 28
CLINICAL STAFFING PLAN CONTINUES TO BE APPROPRIATE AND EFFECTIVE; AND 29
SENATE BILL 411 5
(3) DEVELOP A PROCESS FOR RECEIVING, RESOLVING, AND 1
TRACKING COMPLAINTS RELATED TO THE CLINICAL STAFFING PLAN. 2
(F) IN DEVELOPING THE CLI NICAL STAFFING PLAN , THE CLINICAL 3
STAFFING COMMITTEE SHALL CONSIDER: 4
(1) THE AVERAGE NUMBER OF PATIENTS ON EACH UNIT ON EACH 5
SHIFT DURING THE IMMEDIATELY PRECEDING YEAR AND RELEVANT INFORMATION 6
REGARDING PATIENT DISCHARGES, POTENTIAL ADMISSIONS, AND TRANSFERS; 7
(2) THE AVERAGE LEVEL OF ACUITY FOR PATIENTS ON EACH UNIT ON 8
EACH SHIFT DURING TH E IMMEDIATELY PREC EDING YEAR AND THE 9
CORRESPONDING LEVEL OF NURSING CARE REQUIRED; AND 10
(3) AN ESTIMATE OF THE AP PROPRIATE COMBINATIO N OF SKILL , 11
EXPERIENCE LEVEL, AND SPECIALTY CERTIF ICATION OR TRAINING OF STAFF FOR 12
EACH UNIT ON EACH SHIFT THAT IS REQUIRED TO ADEQUATELY PROVIDE CARE. 13
19–395. 14
(A) ON OR BEFORE JANUARY JULY 1 EACH YEAR, BEGINNING IN 2028, EACH 15
HOSPITAL SHALL: 16
(1) IMPLEMENT THE CLINICAL STAFFING PLAN ADOPTED FINALIZED 17
UNDER § 19–394 OF THIS SUBTITLE; AND 18
(2) ASSIGN PERSONNEL TO E ACH PATIENT CARE UNI T IN 19
ACCORDANCE WITH THE CLINICAL STAFFING PLAN. 20
(B) A REGISTERED NURSE, A LICENSED PRACTICAL NURSE, AN ANCILLARY 21
MEMBER OF THE FRONTL INE TEAM , OR AN APPLICABLE EXC LUSIVE 22
REPRESENTATIVE MAY S UBMIT A COMPLAINT TO THE CLINICAL STAFFIN G 23
COMMITTEE REGARDING ANY VARIATION WHERE PE RSONNEL ASSIGNMENT I N A 24
PATIENT CARE UNIT IS NOT IN ACCORDANCE WI TH THE ADOPTED CLINI CAL 25
STAFFING PLAN. 26
(C) THE CLINICAL STAFFING COMMITTEE SHALL DETE RMINE, BY A 27
MAJORITY VOTE, WHETHER A COMPLAINT HAS BEEN ADEQUATELY RESOLVED. 28
19–396. 29
(A) SUBJECT TO SUBSECTION (B) OF THIS SECTION , ON OR BEFORE 30
JANUARY 1 EACH YEAR, EACH EACH HOSPITAL SHALL: 31
6 SENATE BILL 411
(1) POST IN A PUBLICLY AC CESSIBLE AND CONSPIC UOUS AREA ON 1
EACH PATIENT UNIT THE CLINICAL STAFFING PLAN FOR THE UNIT AND THE ACTUAL 2
DAILY STAFFING FOR EACH SHIFT ON THE UNIT; AND 3
(2) ENSURE THAT A COPY OF THE CLINICAL STAFFIN G PLAN IS 4
AVAILABLE, ON REQUEST , ON EACH PATIENT UNIT PROVIDE THE CLINICAL 5
STAFFING PLAN TO STAFF ON REQUEST. 6
(B) IF A CLINICAL STAFFIN G PLAN FOR A UNIT IS AMENDED AFTER IT IS 7
IMPLEMENTED, THE HOSPITAL SHALL P OST OR PROVIDE THE A MENDED CLINICAL 8
STAFFING PLAN FOR THE UNIT IN THE MANNER REQUIRED UNDER SUBSECTION (A) 9
OF THIS SECTION IN A TIMELY MANNER. 10
19–397. 11
(A) ON OR BEFORE JULY 1 EACH YEAR , BEGINNING IN 2030, EACH 12
HOSPITAL LICENSED UN DER THIS TITLE SHALL SUBMIT A REPORT TO T HE 13
MARYLAND HEALTH CARE COMMISSION SUMMARIZIN G HOW THE HOSPITAL ’S 14
CLINICAL STAFFING CO MMITTEE HAS ADDRESSE D SAFE HOSPITAL STAF FING 15
THROUGH THE HOSPITAL ’S CLINICAL STAFFING PLAN DURING THE IMME DIATELY 16
PRECEDING YEAR. 17
(B) THE MARYLAND HEALTH CARE COMMISSION SHALL: 18
(1) COMPILE THE REPORTS S UBMITTED UNDER SUBSECTION (A) OF 19
THIS SECTION; AND 20
(2) MAKE THE COMPILED REP ORT PUBLICLY AVAILAB LE BY 21
PUBLISHING THE COMPILATION ON THE MAIN PAGE OF ITS WEBSITE. 22
THIS PART MAY NOT BE CONSTRUED TO REQUIRE A HOSPITAL TO TAKE 23
ACTIONS THAT ARE INC ONSISTENT WITH THE CENTERS FOR MEDICARE AND 24
MEDICAID SERVICES CONDITIONS OF PARTIC IPATION OR THE ACCRE DITATION 25
STANDARDS OF THE ACCREDITATION BODY THAT ACCREDITS THE HOSPITAL. 26
SECTION 2. AND BE IT FURTHER ENACTED, That each hospital shall establish 27
a clinical staffing committee as required under § 19 –394 of the Hea lth – General Article, 28
as enacted by Section 1 of this Act, on or before January July 1, 2027. 29
SECTION 3. AND BE IT FURTHER ENACTED, That each clinical staffing 30
committee hospital shall develop implement a clinical staffing plan as required under § 31
19–394 of the Health – General Article, as enacted by Section 1 of this Act, on or before 32
July 1, 2027 2028. 33
SENATE BILL 411 7
SECTION 4. AND BE IT FURTHER ENACTED, That this Act shall take effect 1
October 1, 2026. 2
Approved:
________________________________________________________________________________
Governor.
________________________________________________________________________________
President of the Senate.
________________________________________________________________________________
Speaker of the House of Delegates.