PROPOSAL
Maryland Register
Issue Date: November 13, 2017
Volume 44• Issue 23 • Pages 1104—1105
Title 10
MARYLAND DEPARTMENT OF HEALTH
Subtitle 27 BOARD OF NURSING
10.27.01 Examination and Licensure
Authority: Health Occupations Article, §§8-205 and 8-312; Tax-General Article, §§10-738 and 10–739(b)(1); Annotated Code of Maryland; Chs. 385 and 386, Acts of 2016, and Chs. 234 and 235, Acts of 2017
Notice of Proposed Action
[17-278-P]
The Secretary of Health proposes to amend Regulation .02 under COMAR 10.27.01 Examination and Licensure. At this time, the Secretary is also withdrawing the proposed amendments to Regulation .02 under COMAR 10.27.01 Examination and Licensure which were proposed in 44:2 Md. R. 131—134 (January 20, 2017).
This action was considered and approved by the Board at its regular meeting held on July 26, 2017, notice of which was placed on the Board’s website on May 1 and June 1, 2017, pursuant to General Provisions Article, §3-302(c), Annotated Code of Maryland.
Statement of Purpose
The purpose of this action is to amend the Board’s fee schedule to add the Nurse Practitioner Preceptorship Tax Credit Fund assessment for each certified registered nurse practitioner who renews their certification. The fees collected will fund the Nurse Practitioner Preceptorship Tax Credit Fund established under S.B. 411/H.B. 1494, 2016 Legislative Session, and clarified by S.B. 436/H.B. 683, 2017 Legislative Session. Incidental to the amendment, clarifying and technical changes were made and the annual fee schedule is repealed because everyone regulated by the Board is now on a biennial renewal fee schedule. The clarifying changes do not add any new fees and are intended to make the fee schedule easier to interpret.
Comparison to Federal Standards
There is no corresponding federal standard to this proposed action.
Estimate of Economic Impact
I. Summary of Economic Impact. The Nurse Practitioner (CRNP) renewal will increase from $146 to $161 with the new added surcharge for the tax waiver credit. This is a small percentage of the renewal fee. The tax benefit exists for CRNPs and is not a substantial economic impact to CRNPs. Repeal of the annual fee has no effect on revenue. The biennial fee is double the annual fee.
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Revenue (R+/R-) |
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II. Types of Economic Impact. |
Expenditure
(E+/E-) |
Magnitude |
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A. On issuing agency: |
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(1) |
(R+) |
$45,000 |
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(2) |
(E+) |
$21,000—$57,000 Transferred to State Fund |
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B. On other State agencies: |
NONE |
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C. On local governments: |
NONE |
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Benefit (+)
Cost (-) |
Magnitude |
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D. On regulated industries or trade groups: |
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(1) Nurse Practitioner |
(-) |
$45,000 |
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(2) Nurse Practitioner or Licensed Physician |
(+) |
$21,000—$57,000 |
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E. On other industries or trade groups: |
NONE |
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F. Direct and indirect effects on public: |
(+) |
Indeterminable |
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III. Assumptions. (Identified by Impact Letter and Number from Section II.) |
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A(1). and D(1). Every nurse practitioner who renews an advanced practice certification must pay the $15 biennial assessment as required by Health Occupations Article, §8-026, Annotated Code of Maryland. There are approximately 3,000 nurse practitioners who renew their licenses every year. (3,000 x $15 = $45,000.) |
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A(2). and D(2). Based on the Health Resources and Service Administration (HRSA) database warehouse, as of 2015 Maryland had 32 primary care provider (PCP) HPSA across 16 jurisdictions, 46 MUA across 19 jurisdictions, 13 MUP across 7 jurisdictions. At an estimate of one preceptors per jurisdiction and at the minimum required rotation, the yearly allocated funds will be between $21,000 and $57,000. This money is placed into the Nurse Practitioner Preceptorship Tax Credit Fund and returned as a tax credit to those who apply for a credit certificate and are approved. |
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F. It is anticipated that the indirect effect will attract more physicians or NPs to precept student NPs in health care workforce shortage areas with a resultant increase in primary care providers. Research has shown that NPs often stay in the area where they do their clinical training. |
Economic Impact on Small Businesses
The proposed action has minimal or no economic impact on small businesses.
Impact on Individuals with Disabilities
The proposed action has no impact on individuals with disabilities.
Opportunity for Public Comment
Comments may be sent to Michele Phinney, Director, Office of Regulation and Policy Coordination, Maryland Department of Health, 201 West Preston Street, Room 512, Baltimore, MD 21201, or call 410-767-6499 (TTY 800-735-2258), or email to mdh.regs@maryland.gov, or fax to 410-767-6483. Comments will be accepted through December 13, 2017. A public hearing has not been scheduled.
.02 Fees.
A. (text unchanged)
B. [Examination] Licensure by examination fees are as follows:
(1) (text unchanged)
(2) [Practical] Licensed practical nurse licensure — $100; and
(3) An examination fee for registered nurse and licensed practical nurse licensure shall be paid by the candidate directly to the testing service.
C. [Endorsement] Licensure by endorsement fees are as follows:
(1) [Endorsement for registered] Registered nurse licensure — $100; and
(2) [Endorsement for] Licensed practical nurse licensure — $100[; and].
[(3)] D. Temporary registered nurse or licensed practical nurse licensure fee — $40.
[D. Annual Renewal Fees.
(1) Annual renewal fees shall apply only to registered or licensed practical nurses who are required to renew annually on or before December 31, 2013, in accordance with Regulation .12A(1) and (2) of this chapter.
(2) Annual renewal fees are as follows:
(a) Annual renewal for a registered or licensed practical nurse — $55;
(b) Registered nurse and licensed practical nurse volunteer license — $20;
(c) Inactive license renewal for registered or licensed practical nurse — $20; and
(d) Advanced practice certification renewal fees are in addition to the registered nurse renewal fee:
(i) Renewal of each registered nurse certification in advanced practice — $5; and
(ii) Certificate renewal for forensic nurse examiner or workers’ compensation medical case manager — $5.]
E. Advanced practice registered nurse certification fees are as follows:
(1) Initial advanced practice certification — $50; and
(2) Each additional initial advanced practice certification — $25.
F. Specialty nursing practice certification fees are as follows:
(1) Initial forensic nurse examiner certification — $25; and
(2) Initial workers’ compensation medical case manager certification — $25.
[E.] G. Biennial renewal fees are as follows:
(1) Renewal [for] of a registered nurse license — $110;
(2) Renewal [for] of a licensed practical nurse license — $110;
(3) [Registered] Renewal of a registered nurse [and] or licensed practical nurse volunteer license — $40;
(4) [Inactive license renewal for] Renewal of an inactive license for a registered nurse or licensed practical nurse — $40; [and]
(5) [Advanced Practice] Renewal of each advanced practice registered nurse certification [renewal fees are] is in addition to the registered nurse license renewal fee and [are:
(a) Renewal of each registered nurse certification in Advanced Practice] is — $10; and
[(b)] (6) [Certificate renewal for specialty areas] Renewal of certification for specialty nursing practices regulated by the Board is in addition to the registered nurse license renewal fee and is as follows:
[(i)] (a) Forensic nurse examiner certification — $10; and
[(ii)] (b) Workers’ compensation medical case manager certification — $10.
[F. Other fees are as follows:
(1) Verification of licensure — $25;
(2) Copies of transcripts or duplicate test scores — $25;
(3) Duplicate registration certificate of initial licensure — $15;
(4) Returned check fee — $25; and
(5) Certification fees:
(a) Initial certification for advanced practice certification — $50
(b) Certification for a registered nurses in each additional advanced practice category — $25; and
(c) Initial certification for registered nurses in specialty areas:
(i) Forensic Nurse Examiner — $25; and
(ii) Workers’ compensation medical case manager — $25.]
[G.] H. Health Care Practitioner User Fee.
(1)—(2) (text unchanged)
(3) The amount of the assessed health care practitioner user fee shall be double the amount of the annual health care practitioner user fee for [anyone applying for a 2-year license term] biennial licensure.
(4) (text unchanged)
I. Nurse Practitioner Preceptorship Tax Credit Fund.
(1) This fee applies only to nurse practitioners.
(2) The Board shall assess a separate $15 fee for the renewal of a nurse practitioner, regardless of the number of certifications held by the nurse practitioner.
(3) The Board shall:
(a) Account for the fees collected under this section; and
(b) Transfer the fee to the Nurse Practitioner Preceptorship Tax Credit Fund.
J. Other fees are as follows:
(1) Verification of licensure — $25;
(2) Copies of transcripts or duplicate test scores — $25;
(3) Duplicate certificate of initial licensure — $15; and
(4) Returned check fee — $25.
DENNIS SCHRADER
Secretary of Health
