Board of Nursing reports staffing, technology and fiscal fixes; proposes fee changes and Salesforce licensing system

The Maryland Department of Health and the Maryland Board of Nursing told the House Health and Government Operations Committee on the afternoon of the committee's briefing that they have made "substantial progress" on longstanding problems in licensing, investigations and customer service but that several key changes remain in progress.

For the record, the department's secretary, Laura Herrera Scott, said the department and the board's partnership "is really a path forward" for how the state manages health occupations boards. Chief of Staff Erin McMullen and Board of Nursing Executive Director Rhonda Scott outlined staffing hires, a proposed fee schedule, and plans to procure a new licensing platform built on the Salesforce platform.

Why it matters: Licensing delays and slow complaint investigations at the Board of Nursing previously disrupted the healthcare workforce in Maryland, the department and board told the committee. The board's finances were also strained; absent a time-limited general fund appropriation the board would have ended FY24 with a projected deficit near $6,000,000, the presentation said.

Major updates and current status

- Leadership and staffing: The board appointed Rhonda Scott as executive director in September 2023. The department and board report subsequent hiring in IT and operations, including a new director of operations and a new director of information technology to manage existing systems and the licensing replacement project. Erin McMullen said the volunteer board voted to extend the secretary's authority over the board's infrastructure and operations for an additional five years.

- Complaints and investigators: To address investigation backlogs the department approved 10 contractual non-nurse investigator positions, revised minimum qualifications and reclassified investigator roles. Board leadership reported active recruiting to fill four to five additional non-nurse investigator slots.

- Constituent services and phone access: The board said it has maintained zero overdue constituent inquiry cases to the MDH Office of Constituent Services since December 2023; at that time the backlog was about 197 overdue cases. The board added phone lines, hired licensing and certification staff, installed a new telephony queue with a callback option in October 2024, and uses QR codes and real-time responses to improve customer feedback.

- Fiscal condition and proposed fees: The board reported it began FY24 with a negative fund balance but closed the fiscal year with a $1,800,000 fund balance after general fund support. The board has not raised fees since 2007 and developed draft regulations proposing increases based on FY24 expenditures; those draft regulations were solicited in more than four stakeholder sessions with "hundreds" of comments and are expected to go to the Joint Committee on Administrative, Executive, and Legislative Review (AELR) and a public-comment period.

- Licensing system procurement: MDH described plans to procure a single, modern licensure system to replace the board's two-part process (front end intake and a separate back-end processing system). The department will leverage Salesforce as the platform chassis and issue solicitations for the vendor to build the architecture on that platform. The department said the State of Wisconsin shared code and architecture to accelerate implementation; other states named as using Salesforce for licensing include Wisconsin, Ohio, Oregon, New Mexico, Texas and D.C. Erin McMullen and the secretary used a consumer-facing analogy, saying applicants will be able to see application progress much like a commercial order tracker.

- Scope and limits: Officials repeatedly stated that the board is an independent, volunteer board but is working under departmental operational oversight per the temporary infrastructure authority and that any long-term changes to independence would require further action. The board also developed draft regulatory language that would create an alternative pathway for some endorsement applicants to meet Maryland licensure requirements by presenting additional educational credentials; that pathway is part of departmental legislation being prepared by the board.

Questions from committee members and follow-up items

Committee members pressed MDH and board staff about the procurement process for the licensing system, whether current vendors will be eligible to bid, and timeline considerations. Secretary Herrera Scott said the RFP for the build will be open to vendors; parts of the project leverage existing state enterprise vehicles and the department is coordinating with DGS and DoIT/DUIT. Delegate Kerr asked if the current vendor will have an opportunity to bid; the department said any vendor that can meet the requirements will be eligible.

Delegate Woods and others asked whether artificial intelligence will be used in the new system; department staff said it is too early to say but that the build will consider end-to-end efficiencies and avoid reintroducing manual, inefficient steps.

Noted operational problems still in progress

- Testing vendors for nursing assistants: The board said it voted to add a second testing vendor to address CNA testing backlogs; that second vendor is not yet online and procurement work is ongoing. The board is working with the existing vendor on a plan of action and pursuing a mass-testing event to reduce backlog.

- Technology and integration: The new licensing system will not immediately resolve every technology finding, but the department said the change will permit applicant document uploads, an integrated complaint-tracking database, automated dashboards, and better workforce reporting. MDH termed this an MITDP (major IT development project) coordinated with DoIT.

What the board and department asked of the committee

Officials asked for continued legislative and budget support for the licensing system procurement and for patience during implementation, while noting several near-term improvements already delivered.

Ending: The committee thanked MDH and board leaders for the work and asked for follow-up memos on the RFP process, the membership and timeline for the vendor selection, and the numeric detail the board will supply on proposed fee impacts.