Maryland NPs practice and prescribe without any collaborative agreement, but a first-time applicant never certified by any board of nursing must identify a mentor on the certification application who will consult and collaborate with the new NP — as needed, not supervise — for 18 months.
Maryland is the lightest-touch transition on this list — light enough that AANP counts it full practice. There has been no collaborative agreement since October 1, 2015. What remains is a named mentor for a first-time NP: 18 months of consult-and-collaborate, as needed — not supervision, no sign-offs. The clock starts when the Board receives the certification application, and full unencumbered status arrives automatically when it runs out.
The transition
18-month mentorship (consult-and-collaborate) for never-before-certified NPs; no collaborative agreement since 2015
The moment it ends
Initial certification — the 18-month mentorship clock starts on the date the Board receives the certification application, and full unencumbered status arrives automatically when it runs out; no later filing or re-adjudication
The timeline
Oct. 1, 2015 (Full Practice Authority Act, SB 723/HB 999, Chs. 385/386 of 2015; mentor rule now codified at §8-302.1)
Since Oct. 1, 2015, a brand-new Maryland NP's only tether is a named mentor for 18 months of as-needed consultation — and the mentor need not be a physician; an experienced nurse practitioner qualifies.
Md. Code, Health Occ. §8-302.1
Scope and carve-outs
The grant and the strings, at equal weight
Full scope from certification: independent diagnosis, treatment, and prescribing, including Schedule II–V controlled substances, with no physician sign-off. The only transition-period tether is the named mentor relationship; NPs previously certified by Maryland or any other board of nursing are exempt entirely.
The watch
Pending in Maryland
Statutes move, boards write rules, sunsets arrive. This watch is checked against primary sources on a standing cadence — last verified 11 August 2026 — and every item links the source it was read from.
Nothing pending in Maryland that we can pin to a primary source. Quiet is a finding too — it means the ground your practice stands on is not moving this season.
Superbills for the patient who wants to claim out-of-network benefits.
The Fee Schedule — the one Gale document that states the fee.
Your practice page, in the public directory compiled from the NPPES registry.
Your credentials in one place — every license, DEA registration, board certification and plan enrollment you already hold, with reminders at 90, 60 and 30 days before one expires. Gale checks your NPI against the national registry and marks what it checked. It does not file applications; a credentialing service can.
Referrals from colleagues through your own link, acknowledged and booked in one place, and a view of which referral sources send you patients and which have gone quiet.
Practice notes on your public page, and your own notes on Gale’s health articles in the content library — credited to you, and nothing is public until you publish it.
An activity and access log that records who opened, changed or exported a patient’s chart, and when.
Connect Claude to set up your services, rates and hours by talking to it. It cannot open a patient record, move money or sign anything.
Opening with the founding cohort
Concierge memberships — a monthly plan your practice sells on its own terms. Not sellable yet: enrollment fails closed behind a legal switch until counsel clears it. No countdown — when it clears, it clears.
The loop tracker — every referral, lab, and question a visible loop with an owner, a state, and a promised window. Closing one requires an outcome note; nothing silently expires.
The guided founding sequence — practice setup walked step by step with the first cohort: entity, posted prices, the practice page, the first visit.
Currents — the regulatory watch for your state and the latest evidence for your specialty, dated, sourced, and re-verified on a standing cadence. Quiet weeks say so.
Built, on sample data for now
Insurance billing — a billing console, coding you review and attest, and every claim followed from draft to paid. Today a claim is checked by Gale’s own test system: nothing reaches a payer and no money moves.
Outreach — check-ins for patients who have drifted, drafted overnight for you to approve. Approving sends nothing yet; patient contact stays off until it opens.
Your panel, sorted so the patients who are due or slipping out of care come first — a sort order, not a prediction — with show rates and between-visit activity counted beside it.
Practice health — whether notes get signed and Good Faith Estimates go out on time.
Guidance monitoring — the between-visit guidance a patient chooses to share with you, with anything off track listed first. It fills as patients share.
Workbooks — your charts, claims, referral pipeline, compliance records and clinician roster as tables you can edit. New accounts start on a sample practice.
A desktop bridge and scheduled agents, for work that runs while you are away. A scheduled agent can never send a message, move money or sign anything.
The economics
During the transition, someone signs — and the signature is a cost line, in money or in kind. Independence retires it. What Gale adds is built to stay just as legible.
Gale’s side of the ledger is deliberately short. The software is free, and Gale earns one flat all-in fee on a transaction — charged only when your practice is actually paid, never as a subscription, never with per-feature line items, never a spread on your rate. The number itself lives in exactly one document, on purpose, so it can never quietly say two different things in two places: the Fee Schedule states it.
The playbook
The deepest state cluster we have built is California’s — eight guides on the 103/104 ladder, cited to the statute and the board’s own filings. They are California’s rules, not Maryland’s; the same treatment is coming state by state. Until then, they show the depth of homework to expect from us.
No. The 18-month mentor requirement applies only to applicants never certified by any board of nursing. An NP previously certified by Maryland or any other state is exempt entirely.
No. An experienced nurse practitioner qualifies as the mentor — and the relationship is consult-and-collaborate as needed, with full independent diagnosis, treatment, and prescribing (Schedule II–V included) from certification.
Where to start
Your page may already exist
Gale publishes a public directory compiled from the NPPES registry. Find your listing, claim it, and see how you rank for your own name — that page is the front door your independent practice will be found through.