1. A. In this chapter, the following terms have the meanings indicated.

2. B. Terms Defined.

   1. (1) “Assistant” means an individual:

      1. (a) To whom only routine technical tasks are delegated by a licensed certified midwife;
      2. (b) Who is trained; and
      3. (c) Who is not licensed, certified, registered, or otherwise authorized by law by the Board, or any other State health occupations board, to practice any health occupation in the State.
   2. (2) “Asynchronous telehealth interaction” has the meaning stated in Health Occupations Article, §1-1001(b), Annotated Code of Maryland.
   3. (3) “Board” means the Maryland Board of Nursing.
   4. (4) “Delegating Licensed Certified Midwife (LCM)” means a licensed certified midwife who directs an assistant to perform technical tasks.

   5. (5) “Direct supervision” means oversight exercised by a delegating licensed certified midwife who is:

      1. (a) Personally treating the client; and
      2. (b) In the physical presence of the client and the assistant.
   6. (6) “Licensed Certified Midwife (LCM)” means an individual who has been issued a license by the Board to practice certified midwifery in accordance with COMAR 10.69.01.

   7. (7) Mechanical Act.

      1. (a) “Mechanical act” means an act which does not require professional judgment, medical or pharmaceutical training, or discretion.

      2. (b) “Mechanical act” does not include:

         1. (i) Selecting a drug;
         2. (ii) Labeling;
         3. (iii) Measuring or calculating dosages;
         4. (iv) Substituting one drug for another, including substituting a generic or brand drug for the prescribed drug;
         5. (v) Substituting one dosage form of a drug for another;
         6. (vi) Altering the route of administration; or
         7. (vii) Counseling client.

   8. (8) “On-site supervision” means oversight exercised by a delegating licensed certified midwife who is:

      1. (a) Present at the same site as the assistant and the client; and
      2. (b) Able to be immediately available in person during the assistant’s performance of a delegated act; or
      3. (c) In the context of a synchronous telehealth interaction, able to be immediately available via secure telecommunications technology to the telehealth visit during the assistant’s performance of a delegated act; or
      4. (d) In the context of an asynchronous telehealth interaction, is able to review the assistant’s work and interact with the assistant before communication with the client.
   9. (9) “Site” means any facility or location, including those defined in Health-General Article, §§19-114 and 19-3B-01(b), Annotated Code of Maryland, used for the delivery of health services.
   10. (10) “Synchronous telehealth interaction” has the meaning stated in Health Occupations Article, §1-1001(d), Annotated Code of Maryland.
   11. (11) “Technical task” means a routine clinical act or task that does not require clinical or midwifery judgment and is performed with supervision as specified within this chapter.
   12. (12) “Trained” means possessing the knowledge, skills, and abilities, as determined by the delegating licensed certified midwife, to perform delegated technical tasks.

Authority: Health Occupations Article, §§ 8-101, 8-205, 8-208, 8-508, 8-601, 8-6A-02, 8-6D-01 through 8-6D-15, 8-701, 8-708, and 8-710, Annotated Code of Maryland

Effective date: February 22, 2026 (52:17 Md. R. 875)