Clinical Nurse Specialist Cheat Sheet for Maryland
Requirements for Supervising Physician agreements in Maryland, plus a free agreement builder tailored to Maryland law.
Provider supervision requirements in Maryland
Updated 2026-09-03
Provided for educational and research purposes only — this is not legal advice. Laws and regulations change frequently, and this content may contain errors or omissions. Always confirm current requirements with a licensed attorney before relying on this for compliance decisions.
Maryland's APRN categories are not uniform: CRNPs and CNMs gained full practice authority in 2015 (after an 18-month new-graduate mentorship), CRNAs remain fully supervised with no prescriptive authority at all (Maryland is one of about 11 states granting CRNAs none), and only the psychiatric-mental-health population focus of CNS practice is independent. Maryland does not recognize PLLCs; professional entities use physician-only professional corporations, so multi-disciplinary ownership questions remain open.
Clinical Nurse Specialist
Independent practice requires: practicing within the psychiatric-mental-health population focus — the only CNS population focus Maryland has granted independent practice authority; this is a scope/specialty fact, not an hours/experience threshold
Maryland has granted full independent-practice authority only to psychiatric-mental-health CNSs; other CNS population foci must consult or collaborate with a licensed physician under COMAR 10.27.27's scope-of-practice language. Whether that collaboration must be under a written agreement, or is an as-needed relationship as with CNMs, is not spelled out.
Proximity
non-psychiatric population focus: Available remotely (no on-site requirement)
COMAR 10.27.27 requires consulting or collaborating with a licensed physician; no on-site or fixed-radius standard applies.psychiatric-mental-health population focus: No proximity requirement
No physician availability/proximity standard applies to the independent psychiatric-mental-health population focus.
Chart review
Not codified — left to the practice agreement
Prescriptive authority
Covered by practice agreement · controlled substances permitted
A CNS may prescribe any drug or durable medical equipment within their education, training, certification and population focus (recent COMAR update, per NACNS tracking); requires Maryland CDS and federal DEA registration. Schedule-level limits are not spelled out.Practice ownership (CPOM)
Licensee-only ownership required — As for NPs: physician-only professional corporations; PLLCs not recognized
Applies regardless of the psychiatric/non-psychiatric independence branch above — entity ownership is a separate legal question from clinical collaboration status.Supervision ratio
Not codified — left to the practice agreement
Meeting cadence
Not codified — left to the practice agreement
Written agreement
Required
Shown as required because most CNS population foci must consult or collaborate with a physician, while a CNS in the psychiatric-mental-health population focus practices independently (see the conditions above). Whether the collaboration for the non-independent branch is a formal written agreement or an as-needed relationship, as with CNMs, is not spelled out.$550–$850/mo
Estimated CNS supervision cost in Maryland
Available Supervising Physicians in Maryland
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