Medication in a Maryland RSA: reminders, help and administration

Three rules frame every level:

• A certified caregiver where administration is needed. "An agency shall provide or refer a certified caregiver to a client who requires" administration of medication (COMAR 10.07.05.10E(2)). Certified care is work that, for pay, only someone certified by the Board of Nursing may do (a certified medication technician, certified medicine aide or certified nursing assistant), and includes nursing functions a registered nurse routinely delegates. (.02B(4))
• The written policy. "Administration of drugs" is one of the 23 policy items you index in the application (all 23 items), even if you give no medication help, in which case your policy says so (COMAR 10.07.05.08B(1)(c)(ii); application, Section B).
• The RN’s interval follows the medication level. 45 days, 3 months or 4 months, as above (.12E(2)). The RN’s wider role is on the registered nurse page.

OHCQ’s archived 2020 slides put it plainly: "Both waiver options never permit medication administration by Certified Nursing Assistants or unlicensed aides." (OHCQ slides, 2020). That is old guidance, but it matches the Board’s rule that only medication technicians and medicine aides may be delegated administration.

Neither is defined. COMAR 10.07.05’s definitions (.02B) do not define reminders, self-administration or what help with it includes. OHCQ’s trainer checklist says nursing assistants without medication management supervised by an RN must never administer medications, but may give reminders to clients who are self-administering (OHCQ trainer checklist).

Reminders and the RN’s interval. The 3-month interval applies "if the staff assists the client with self-administration of medications" and the 4-month interval when staff do neither (.12E(2)(b)-(c)). Which one a reminder falls under is on our list of questions for OHCQ. By our reading, treat reminders as help with self-administration until OHCQ answers: the consent form and 3-month visits cost little, and cover you either way.

What help can include. The rules leave the tasks to the agency and its RN. CareRulebook’s Policy 4.2 limits help to reminding the client, bringing the container, opening a container or organizer compartment the client cannot open, reading the label, steadying the client’s hand or holding a glass, and noting what the client said they took. The RN picks, for each client, which of those caregivers give. That list is our drafting for your RN to review, not rule text.

A client hiring help directly. The Board’s delegation rules do not restrict a cognitively capable adult from employing an unlicensed caregiver at home to help with routine treatments and self-administration of medication. An RSA is still bound by its own consent rules. (COMAR 10.27.11.01D)

What informed consent means. The rules define it as "the willing, uncoerced acceptance of medical intervention by a client or a client representative with legal authority to make health care decisions after adequate disclosure of the nature of the intervention, and its risks and benefits, as well as alternatives with their risks and benefits" (COMAR 10.07.05.02B(16)).

Where the rules are silent. They do not say whether "nonlicensed individual" includes certified nursing assistants, or whether a client under 18 can give this consent. By our reading, keep children’s medication with licensed or certified staff, or with the parent, until OHCQ answers. Both points are on our lists of questions for OHCQ and a Maryland lawyer.

COMAR 10.07.05.12F applies "If agency employees, independent contractors, or contractual employees administer medications". The agency shall (COMAR 10.07.05.12F):

1. "Provide for administration of drugs and treatments by licensed or certified staff consistent with Maryland law and the client’s plan of care, unless the client has executed an informed consent form under §D of this regulation";
2. "Provide for drugs and treatments to be administered only as ordered by the physician"; and
3. document in the client’s clinical record the medications administered or taken, medication errors, and adverse drug reactions with the corrective action.

The consent exception, our reading. The "unless" in item 1 points to the consent rules in .12D, which let a capable adult choose uncertified help with self-administration. By our reading it changes who may help a client who takes their own medication. It never allows a dose that was not ordered.

Orders and records. An agency may accept orders for care with an electronic signature, received by mail, hand delivery or fax, among other ways. (.14E) The clinical record lists medications administered or taken, with dosage, route of administration and frequency, and any history of sensitivities or allergic reactions. (.14A(6)-(7)) The rule says "physician"; whether a nurse practitioner’s or physician assistant’s order meets it is on our list of questions for OHCQ.

Medicaid. In Community First Choice, a worker who performs delegated nursing services and administers medication under the plan of service must be a certified medication technician, and also a CNA for other delegated nursing functions. (COMAR 10.09.84.06B)

A medication technician is "an individual who completes a 20-hour course in medication administration approved by the Board and is certified by the Board" (COMAR 10.27.11.02B(12)). A certified medicine aide is a certified nursing assistant who has completed a Board-approved course in medication administration and is certified by the Board as a medicine aide. (COMAR 10.07.05.02B(6)) Since April 2026 the Board’s CNA-I certificate includes certified medicine aides (COMAR 10.39.01.02B(6)).

OHCQ’s guidance. OHCQ’s outside trainer checklist says medication technicians give medication only from the original container, and lists their routes as oral, topical, ear, eyes, nose, suppositories, subcutaneous and finger sticks. It adds: "CMTs/CMAs may not calculate medication doses or fill pill boxes" (OHCQ trainer checklist). That is guidance for outside trainers, not rule text.

• Fill pill organizers. A medication technician may not "fill medication assistive devices such as mediplanners or time-dose medication containers with medication" (COMAR 10.39.04.10A(4)). By our reading, an aide with less authority than a technician should not fill one either.
• Calculate a dose or decide whether to give one. Calculation of any dose stays with the nurse (COMAR 10.27.11.05G), and a delegated task may not require nursing judgment except in an emergency (.03C).
• Give medication without certification. OHCQ says nursing assistants without RN-supervised medication management must never administer medications (OHCQ trainer checklist).
• Take a verbal order. Even a medication technician may not transcribe verbal orders (COMAR 10.39.04.10A(3)).

• Errors and reactions go in the record. Where staff administer, the clinical record shows medication errors and adverse drug reactions with the corrective action (COMAR 10.07.05.12F(3)).
• Changes reach the RN. Caregiver training covers identifying situations that need referral to a registered nurse, including significant changes in a client’s condition (.11C(2)), and changes in condition are documented and told in a timely manner to the client, representative and care team (.14C).
• Conduct that may be grounds for Board action. The agency reports it to the Board of Nursing and OHCQ immediately (.10F).