1. A. Each local school system shall:

   1. (1) Provide in public schools an instructional program in comprehensive health education each year with sufficient frequency and duration to meet the requirements of the State Framework for all students in grades prekindergarten—8;
   2. (2) Offer in public schools a comprehensive health education program in grades 9—12 which enables students to meet graduation requirements and to select health education electives; and
   3. (3) Provide access to the curriculum for non-diploma-bound students.

2. B. Maryland Comprehensive Health Education Program.

   1. (1) The comprehensive instructional program shall help students adopt and maintain healthy behaviors and skills that contribute directly to a student’s ability to successfully practice behaviors that protect and promote health and avoid or reduce health risks.
   2. (2) The instructional program shall provide for the diversity of student needs, abilities, and interests at the elementary, middle, and high school learning years, and shall include the Maryland Health Education Standards with related indicators and objectives as set forth in §C(1)—(8) of this regulation.

3. C. Comprehensive Health Education Standards. All students will:

   1. (1) Use functional health information to support the health and well-being of self and others, including:

      1. (a) Mental and emotional health;
      2. (b) Substance use and misuse;
      3. (c) Family life and human sexuality;
      4. (d) Safety and violence prevention;
      5. (e) Nutrition; and
      6. (f) Disease prevention and control;
   2. (2) Analyze influences that affect the health and well-being of self and others;
   3. (3) Access valid and reliable resources to support the health and well-being of self and others;
   4. (4) Use interpersonal communication skills to support the health and well-being of self and others;
   5. (5) Use a decision-making process to support the health and well-being of self and others;
   6. (6) Use a goal-setting process to support the health and well-being of self and others;
   7. (7) Demonstrate practices and behaviors to support the health and well-being of self and others; and
   8. (8) Advocate to promote the health and well-being of self and others.

4. D. Special Requirements.

   1. (1) Substance Abuse Prevention.

      1. (a) Students shall complete instruction on drug addiction and prevention that includes instruction related to the heroin and opioid addiction and prevention and information relating to lethal effects of fentanyl.
      2. (b) This instruction is to be delivered, at a minimum, once in grade bands 3—5, 6—8, and 9—12 as a stand-alone program.
      3. (c) Instruction shall be delivered by teachers trained in the field of drug addiction and prevention education.

   2. (2) Family Life and Human Sexuality.

      1. (a) Maryland family life and human sexuality instruction shall represent all students regardless of ability, sexual orientation, gender identity, and gender expression.
      2. (b) Beginning no later than grade 7, teaching shall emphasize that refraining from sexual activity is the best method to avoid sexually transmitted infections, including HIV, and unintended pregnancy. To address the serious health risks of sexually transmitted infections, and the consequences of unintended pregnancy, family life and human sexuality education shall include medically accurate information about contraception and condoms.
      3. (c) The local school system shall establish a joint committee of educators and representatives of the community for the purpose of reviewing and commenting on instructional materials. If approval of instructional materials is necessary, it shall occur pursuant to local policy.
      4. (d) Direct teaching of the family life and human sexuality indicators and objectives must begin by grade 4.

      5. (e) Student Opt-Out.

         1. (i) The local school system shall establish policies, guidelines, and/or procedures for student opt-out regarding instruction related to family life and human sexuality objectives.
         2. (ii) For students opting out of family life and human sexuality instruction, each school shall establish a procedure for providing a student with appropriate alternative learning activities and/or assessments in health education.
         3. (iii) Each school shall make arrangements to permit students opting out of the objectives related to family life and human sexuality to receive instruction concerning menstruation.
         4. (iv) The local school system shall provide an opportunity for parents/guardians to view instructional materials to be used in the teaching of family life and human sexuality objectives.
      6. (f) The local school system shall provide age-appropriate instruction on the meaning of “consent” and respect for personal boundaries as part of the family life and human sexuality curriculum in every grade in which the curriculum is taught.
      7. (g) When teaching concepts and skills related to family life and human sexuality, in addition to general teacher preparation, teachers are required to have additional preparation in content and teaching methods of such depth and duration as to be appropriate for the material taught. The additional preparation may be provided by college courses, local in-service programs, and/or State workshops.

   3. (3) Safety and Violence Prevention.

      1. (a) High school students shall complete instruction in cardiopulmonary resuscitation that includes hands-only cardiopulmonary resuscitation and the use of an automated external defibrillator.
      2. (b) Students shall participate in age-appropriate instruction on the awareness and prevention of sexual abuse and assault. Teachers who are trained to provide instruction on the awareness and prevention of sexual abuse and assault shall deliver this instruction. This will include age-appropriate instruction on the meaning of “consent” and respect for personal boundaries.

   4. (4) Disease Prevention and Control.

      1. (a) Students will demonstrate the ability to apply prevention and treatment knowledge, skills, and strategies to reduce susceptibility and manage diseases, such as infections that are sexually transmitted, including HIV.
      2. (b) Students shall complete instruction in oral health that includes oral disease prevention and dental health promotion.
      3. (c) The local school system shall include age-appropriate lessons on diabetes and its treatment and prevention.

5. E. Curriculum Documents. Consistent with Education Article, §§2-205(h), 4-111.2, 7-205.2, 7-401, 7-410, 7-411, 7-411.1, 7-413, 7-439, and 7-445, Annotated Code of Maryland, each local school system shall provide age-appropriate, scientifically based, medically accurate, and data-driven comprehensive health education curriculum documents for the elementary and secondary schools under its jurisdiction that:

   1. (1) Include the standards set forth in §C of this regulation; and
   2. (2) Are aligned with the State Framework, as developed by the Maryland State Department of Education in collaboration with the local school systems.

6. F. The local school system shall develop guidelines and procedures for the selection of qualified health education teachers. Qualifications shall include:

   1. (1) Health Education licensure as set forth in COMAR 13A.12.02; and
   2. (2) Appropriate specialized training including skills-based health education, drug addiction and prevention education, family life and human sexuality, and awareness and prevention of sexual abuse and assault.
7. G. The local school system shall develop guidelines and procedures for the support of qualified teachers. Each local school system shall establish planned and continuous programs as required to adequately train its personnel (teachers, administrators, and supervisors) in order to update knowledge, instructional materials, and methodology in health education.
8. H. Student Participation. Each student shall have the opportunity to participate in the comprehensive health education program required by this chapter.

Authority: Education Article, §§2-205(c) and (h), 4-111.2, 7-205.2, 7-401, 7-410, 7-411, 7-411.1, 7-413, 7-439, and 7-445, Annotated Code of Maryland

Effective date: October 15, 1990 (17:20 Md. R. 2430)

Chapter revised effective May 13, 1991 (18:9 Md. R. 1009)

Regulation .01B amended effective September 12, 1994 (21:18 Md. R. 1510)

Regulation .02F amended effective September 12, 1994 (21:18 Md. R. 1510)

Regulations .01—.07 repealed and new Regulations .01—.02 adopted effective March 21, 2011 (38:6 Md. R. 396)

Regulation .01B, G amended effective August 1, 2016 (43:15 Md. R. 864)

Regulation .02 amended effective August 1, 2016 (43:15 Md. R. 864)

Regulations .01—.02 repealed and new Regulations .01—.02 adopted effective December 30, 2019 (46:26 Md. R. 1166)

Regulation .01 amended effective March 30, 2026 (53:6 Md. R. 291)