CNS · Maryland
Supervision Agreement for Clinical Nurse Specialists in Maryland
Yes, a written supervising-physician agreement is required. Maryland does not name a specific instrument.
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 per COMAR 10.27.27's scope-of-practice language — whether that collaboration must be under a written agreement (vs. an as-needed relationship like CNM's) was not confirmed in this pass.
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.
What the supervision must look like
The rules the physician relationship has to follow. Each fact comes from the statute or board rule listed under sources.
Proximity
non-psychiatric population focus: Available remotely (no on-site requirement)
COMAR 10.27.27 requires consulting/collaborating with a licensed physician; no on-site or fixed-radius standard was confirmed in this pass.
psychiatric-mental-health population focus: No proximity requirement
No physician availability/proximity standard applies to the independent psychiatric-mental-health population focus.
Supervision ratio
Not codified — no cap on file
Chart review
Not codified — left to the agreement
Meeting cadence
Not codified — left to the agreement
Prescriptive authority
Covered by the 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; exact schedule-level limits not independently confirmed in this pass.
Written agreement
Required
Coded as required by default because most CNS population foci must consult/collaborate with a physician, but a CNS in the psychiatric-mental-health population focus practices independently — see conditions above. Whether the non-independent branch's 'collaboration' is a formal written agreement or an as-needed relationship (as with CNM) was not confirmed in this pass.
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — Same open item as the general `np` entry.
Applies regardless of the psychiatric/non-psychiatric independence branch above — entity ownership is a separate legal question from clinical collaboration status.
Legal sources for these rules (2)
What a supervising physician costs here
Typical monthly cost in Maryland
$500 – $600
Estimate for one Clinical Nurse Specialist. This state's proximity rules add a small premium.
About Maryland's rules
Maryland's APRN categories are NOT uniform: CRNPs/CNMs gained full practice authority in 2015 (after an 18-month new-graduate mentorship), but CRNAs remain fully supervised with NO prescriptive authority at all (Maryland is one of ~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 PC ownership questions are open items below.
Other clinicians in Maryland: see the state overview.