Shown verbatim: the complete text as captured from the official PDF posted by the Maryland General Assembly, fetched 2026-09-25. Page and line markers are part of the official record; nothing is edited or removed. This is the chaptered version. The official bill page.
WES MOORE, Governor Ch. 235
Chapter 235
(Senate Bill 411)
AN ACT concerning
Hospitals – Clinical Staffing Committees and Plans – Establishment
(Safe Staffing Act of 2026)
FOR the purpose of requiring certain hospitals licensed in the State to comply with certain
staffing standards, to establish and maintain a clinical staffing committee, and to
implement a clinical staffing plan; requiring the chief nursing executive of each
hospital to produce a draft clinical staffing plan and submit it to the clinical staffing
committee of the hospital; requiring each clinical staffing committee to develop
finalize a clinical staffing plan; and generally relating to hospitals and clinical
staffing committees and plans.
BY adding to
Article – Health – General
Section 19–393 through 19–397 to be under the new part “Part XIII. Clinical Staffing
Committees and Plans”
Annotated Code of Maryland
(2023 Replacement Volume and 2025 Supplement)
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND,
That the Laws of Maryland read as follows:
Article – Health – General
19–391. RESERVED.
19–392. RESERVED.
PART XIII. CLINICAL STAFFING COMMITTEES AND PLANS.
19–393.
(A) IN THIS PART THE FOLLOWING WORDS HAVE THE MEANINGS
INDICATED.
(B) (1) “ANCILLARY MEMBER OF THE FRONTLINE TEAM” MEANS AN
INDIVIDUAL WHOSE PRIMARY DUTIES INCLUDE SUPPORTING INDIVIDUALS WHO
PROVIDE DIRECT PATIENT CARE.
(2) “ANCILLARY MEMBER OF THE FRONTLINE TEAM” INCLUDES:
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Ch. 235 2026 LAWS OF MARYLAND
(I) A DIETARY WORKER;
(II) A PATIENT CARE TECHNICIAN; AND
(III) ANY OTHER NONLICENSED STAFF ASSISTING WITH PATIENT
CARE.
(C) “CLINICAL STAFFING COMMITTEE” MEANS A COMMITTEE ESTABLISHED
BY A HOSPITAL IN ACCORDANCE WITH SUBSECTION (C) OF THIS SECTION §
19–394(C) OF THIS SUBTITLE.
(D) (C) “CLINICAL STAFFING PLAN” MEANS A PLAN DEVELOPED UNDER
SUBSECTION (D) OF THIS SECTION § 19–394(D) OF THIS SUBTITLE.
19–394.
(A) THIS PART DOES NOT APPLY TO STATE HOSPITALS.
(B) (1) EACH HOSPITAL LICENSED UNDER THIS TITLE SHALL COMPLY
WITH THE STAFFING STANDARDS OF:
(I) THE ACCREDITATION BODY THAT ACCREDITS THE
HOSPITAL; AND
(II) THE FEDERAL CENTERS FOR MEDICARE AND MEDICAID
SERVICES CONDITIONS OF PARTICIPATION.
(2) A CLINICAL STAFFING PLAN DEVELOPED UNDER THIS PART
SHALL COMPLY WITH THIS SUBSECTION.
(C) (1) EACH HOSPITAL LICENSED UNDER THIS TITLE SHALL ESTABLISH
AND MAINTAIN A CLINICAL STAFFING COMMITTEE THAT HAS EQUAL MEMBERSHIP
FROM MANAGEMENT AND EMPLOYEES:
(I) IF THE HOSPITAL HAS 150 OR FEWER LICENSED BEDS, HAS
3 MANAGERS AND 2 EMPLOYEES; OR
(II) IF THE HOSPITAL HAS 151 OR MORE LICENSED BEDS, HAS 5
MANAGERS AND 4 EMPLOYEES.
(2) EACH CLINICAL STAFFING COMMITTEE ESTABLISHED UNDER
THIS PART SHALL MAY INCLUDE AT LEAST ONE OF THE FOLLOWING INDIVIDUALS:
(I) A CERTIFIED NURSING ASSISTANT;
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WES MOORE, Governor Ch. 235
(II) A DIETARY AIDE;
(III) AN EMERGENCY ROOM A LICENSED NURSE;
(IV) AN ENVIRONMENTAL SERVICE WORKER;
(V) A MEDICAL RESIDENT, IF THE COMMITTEE IS IN A
TEACHING HOSPITAL;
(VI) A STAFF PHYSICIAN WHO IS NOT A HOSPITAL EMPLOYEE OR
ADMINISTRATOR; AND
(VII) A TECHNICIAN; OR
(VIII) AN EMPLOYEE WHOSE DUTIES INCLUDE PATIENT
ADVOCACY.
(3) A CLINICAL STAFFING COMMITTEE ESTABLISHED UNDER
PARAGRAPH (1) OF THIS SUBSECTION MAY INCLUDE A PATIENT ADVOCATE.
(C) (D) (1) THE CHIEF NURSE EXECUTIVE OF EACH HOSPITAL SHALL
PRODUCE A DRAFT CLINICAL STAFFING PLAN AND SUBMIT IT TO THE CLINICAL
STAFFING COMMITTEE OF THE HOSPITAL.
(2) EACH CLINICAL STAFFING COMMITTEE SHALL DEVELOP FINALIZE
A CLINICAL STAFFING PLAN THAT MEETS PATIENT NEEDS USING THE PLAN
SUBMITTED UNDER PARAGRAPH (1) OF THIS SUBSECTION.
(D) (E) WHEN DEVELOPING FINALIZING A CLINICAL STAFFING PLAN, THE
CLINICAL STAFFING COMMITTEE SHALL CONSIDER:
(1) EXISTING STAFFING LEVELS;
(2) METHODS TO SECURE COVERAGE NEEDS AS NECESSARY;
(3) EXISTING GAPS IN STAFFING AND HOW TO ADDRESS THE GAPS;
(4) ANY AVAILABLE EVIDENCE–BASED STAFFING STANDARDS; AND
(5) A SCHEDULE FOR PERIODIC REVIEW OF THE STAFFING PLAN;
(6) APPROPRIATE SKILL MIX AND COMPETENCY OF STAFF;
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Ch. 235 2026 LAWS OF MARYLAND
(7) STANDARDS REQUIRED BY:
(I) THE CENTERS FOR MEDICARE AND MEDICAID SERVICES
CONDITIONS OF PARTICIPATION; AND
(II) THE ACCREDITATION BODY THAT ACCREDITS THE
HOSPITAL;
(8) THE AVERAGE NUMBER OF PATIENTS OF THE HOSPITAL DURING
THE IMMEDIATELY PRECEDING YEAR AND RELEVANT INFORMATION REGARDING
PATIENT DISCHARGES, POTENTIAL ADMISSIONS, AND TRANSFERS;
(9) THE AVERAGE LEVEL OF ACUITY FOR PATIENTS OF THE HOSPITAL
DURING THE IMMEDIATELY PRECEDING YEAR AND THE CORRESPONDING LEVEL OF
NURSING CARE REQUIRED; AND
(10) AN ESTIMATE OF THE APPROPRIATE COMBINATION OF SKILL,
EXPERIENCE LEVEL, AND SPECIALTY CERTIFICATION OR TRAINING OF STAFF THAT
IS REQUIRED TO ADEQUATELY PROVIDE CARE TO PATIENTS OF THE HOSPITAL.
(E) ON OR BEFORE JULY 1 EACH YEAR, EACH HOSPITAL, THROUGH THE
CLINICAL STAFFING COMMITTEE, SHALL CONDUCT A REVIEW OF THE CLINICAL
STAFFING PLAN TO:
(1) EVALUATE THE EFFECTIVENESS OF THE CLINICAL STAFFING
PLAN DURING THE IMMEDIATELY PRECEDING YEAR;
(2) UPDATE THE CLINICAL STAFFING PLAN TO ENSURE THAT THE
CLINICAL STAFFING PLAN CONTINUES TO BE APPROPRIATE AND EFFECTIVE; AND
(3) DEVELOP A PROCESS FOR RECEIVING, RESOLVING, AND
TRACKING COMPLAINTS RELATED TO THE CLINICAL STAFFING PLAN.
(F) IN DEVELOPING THE CLINICAL STAFFING PLAN, THE CLINICAL
STAFFING COMMITTEE SHALL CONSIDER:
(1) THE AVERAGE NUMBER OF PATIENTS ON EACH UNIT ON EACH
SHIFT DURING THE IMMEDIATELY PRECEDING YEAR AND RELEVANT INFORMATION
REGARDING PATIENT DISCHARGES, POTENTIAL ADMISSIONS, AND TRANSFERS;
(2) THE AVERAGE LEVEL OF ACUITY FOR PATIENTS ON EACH UNIT ON
EACH SHIFT DURING THE IMMEDIATELY PRECEDING YEAR AND THE
CORRESPONDING LEVEL OF NURSING CARE REQUIRED; AND
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WES MOORE, Governor Ch. 235
(3) AN ESTIMATE OF THE APPROPRIATE COMBINATION OF SKILL,
EXPERIENCE LEVEL, AND SPECIALTY CERTIFICATION OR TRAINING OF STAFF FOR
EACH UNIT ON EACH SHIFT THAT IS REQUIRED TO ADEQUATELY PROVIDE CARE.
19–395.
(A) ON OR BEFORE JANUARY JULY 1 EACH YEAR, BEGINNING IN 2028, EACH
HOSPITAL SHALL:
(1) IMPLEMENT THE CLINICAL STAFFING PLAN ADOPTED FINALIZED
UNDER § 19–394 OF THIS SUBTITLE; AND
(2) ASSIGN PERSONNEL TO EACH PATIENT CARE UNIT IN
ACCORDANCE WITH THE CLINICAL STAFFING PLAN.
(B) A REGISTERED NURSE, A LICENSED PRACTICAL NURSE, AN ANCILLARY
MEMBER OF THE FRONTLINE TEAM, OR AN APPLICABLE EXCLUSIVE
REPRESENTATIVE MAY SUBMIT A COMPLAINT TO THE CLINICAL STAFFING
COMMITTEE REGARDING ANY VARIATION WHERE PERSONNEL ASSIGNMENT IN A
PATIENT CARE UNIT IS NOT IN ACCORDANCE WITH THE ADOPTED CLINICAL
STAFFING PLAN.
(C) THE CLINICAL STAFFING COMMITTEE SHALL DETERMINE, BY A
MAJORITY VOTE, WHETHER A COMPLAINT HAS BEEN ADEQUATELY RESOLVED.
19–396.
(A) SUBJECT TO SUBSECTION (B) OF THIS SECTION, ON OR BEFORE
JANUARY 1 EACH YEAR, EACH EACH HOSPITAL SHALL:
(1) POST IN A PUBLICLY ACCESSIBLE AND CONSPICUOUS AREA ON
EACH PATIENT UNIT THE CLINICAL STAFFING PLAN FOR THE UNIT AND THE ACTUAL
DAILY STAFFING FOR EACH SHIFT ON THE UNIT; AND
(2) ENSURE THAT A COPY OF THE CLINICAL STAFFING PLAN IS
AVAILABLE, ON REQUEST, ON EACH PATIENT UNIT PROVIDE THE CLINICAL
STAFFING PLAN TO STAFF ON REQUEST.
(B) IF A CLINICAL STAFFING PLAN FOR A UNIT IS AMENDED AFTER IT IS
IMPLEMENTED, THE HOSPITAL SHALL POST OR PROVIDE THE AMENDED CLINICAL
STAFFING PLAN FOR THE UNIT IN THE MANNER REQUIRED UNDER SUBSECTION (A)
OF THIS SECTION IN A TIMELY MANNER.
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Ch. 235 2026 LAWS OF MARYLAND
19–397.
(A) ON OR BEFORE JULY 1 EACH YEAR, BEGINNING IN 2030, EACH
HOSPITAL LICENSED UNDER THIS TITLE SHALL SUBMIT A REPORT TO THE
MARYLAND HEALTH CARE COMMISSION SUMMARIZING HOW THE HOSPITAL’S
CLINICAL STAFFING COMMITTEE HAS ADDRESSED SAFE HOSPITAL STAFFING
THROUGH THE HOSPITAL’S CLINICAL STAFFING PLAN DURING THE IMMEDIATELY
PRECEDING YEAR.
(B) THE MARYLAND HEALTH CARE COMMISSION SHALL:
(1) COMPILE THE REPORTS SUBMITTED UNDER SUBSECTION (A) OF
THIS SECTION; AND
(2) MAKE THE COMPILED REPORT PUBLICLY AVAILABLE BY
PUBLISHING THE COMPILATION ON THE MAIN PAGE OF ITS WEBSITE.
THIS PART MAY NOT BE CONSTRUED TO REQUIRE A HOSPITAL TO TAKE
ACTIONS THAT ARE INCONSISTENT WITH THE CENTERS FOR MEDICARE AND
MEDICAID SERVICES CONDITIONS OF PARTICIPATION OR THE ACCREDITATION
STANDARDS OF THE ACCREDITATION BODY THAT ACCREDITS THE HOSPITAL.
SECTION 2. AND BE IT FURTHER ENACTED, That each hospital shall establish
a clinical staffing committee as required under § 19–394 of the Health – General Article,
as enacted by Section 1 of this Act, on or before January July 1, 2027.
SECTION 3. AND BE IT FURTHER ENACTED, That each clinical staffing
committee hospital shall develop implement a clinical staffing plan as required under §
19–394 of the Health – General Article, as enacted by Section 1 of this Act, on or before
July 1, 2027 2028.
SECTION 4. AND BE IT FURTHER ENACTED, That this Act shall take effect
October 1, 2026.
Approved by the Governor, April 28, 2026.
–6–Every fact on this page links to its source, starting with the official bill record.