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HB-5653, As Passed House, May 16, 2006

SUBSTITUTE FOR

HOUSE BILL NO. 5653

A bill to amend 1978 PA 368, entitled

"Public health code,"

by amending sections 16337, 17001, 17008, 17025, 17066, 17074,

17078, 17501, 17508, 18001, 18011, and 18021 (MCL 333.16337,

333.17001, 333.17008, 333.17025, 333.17066, 333.17074, 333.17078,

333.17501, 333.17508, 333.18001, 333.18011, and 333.18021), section

16337 as added by 1993 PA 79, sections 17001 and 17501 as amended

by 2005 PA 264, section 17025 as amended by 1980 PA 146, sections

17066, 17074, and 17078 as amended by 1990 PA 247, and section

18021 as amended by 1993 PA 79, and by adding sections 18008,

18048, 18049, 18050, 18054, 18056, and 18058; and to repeal acts

and parts of acts.

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

Sec. 16337. Fees for a person licensed or seeking licensure to

engage in practice as a physician's assistant under ~~either~~ part

170, or part 175, or part 180 are as follows:

(a) Application processing fee.................... $ 30.00

(b) License fee, per year......................... 50.00

(d) Limited license, per year..................... 25.00

Sec. 17001. (1) As used in this part:

(a) "Academic institution" means either of the following:

(i) A medical school approved by the board.

(ii) A hospital licensed under article 17 that meets all of the

following requirements:

(A) Was the sole sponsor or a co-sponsor, if each other co-

sponsor is either a medical school approved by the board or a

hospital owned by the federal government and directly operated by

the United States department of veterans' affairs, of not less than

4 postgraduate education residency programs approved by the board

under section 17031(1) for not less than the 3 years immediately

preceding the date of an application for a limited license under

section 16182(2)(c) or an application for a full license under

section 17031(2), provided that at least 1 of the residency

programs is in the specialty area of medical practice, or in a

specialty area that includes the subspecialty of medical practice,

in which the applicant for a limited license proposes to practice

or in which the applicant for a full license has practiced for the

hospital.

(B) Has spent not less than $2,000,000.00 for medical

education during each of the 3 years immediately preceding the date

of an application for a limited license under section 16182(2)(c)

or an application for a full license under section 17031(2). As

used in this subparagraph, "medical education" means the education

of physicians and candidates for degrees or licenses to become

physicians, including, but not limited to, physician staff,

residents, interns, and medical students.

(b) "Electrodiagnostic studies" means the testing of

neuromuscular functions utilizing nerve conduction tests and needle

electromyography. It does not include the use of surface

electromyography.

scope of practice of physicians licensed by the board, except those

services that the board determines shall not be delegated by a

physician without endangering the health and safety of patients as

provided for in section 17048(3).

(d) "Physician" means an individual licensed under this

article to engage in the practice of medicine.

(e) "Podiatrist" means an individual licensed under this

article to engage in the practice of podiatric medicine and

surgery.

(f) ~~(e)~~ "Practice of medicine" means the diagnosis,

treatment, prevention, cure, or relieving of a human disease,

ailment, defect, complaint, or other physical or mental condition,

by attendance, advice, device, diagnostic test, or other means, or

offering, undertaking, attempting to do, or holding oneself out as

able to do, any of these acts.

(g) ~~(f)~~ "Practice as a physician's assistant" means the

practice of medicine, or osteopathic medicine and surgery, or

podiatric medicine and surgery performed under the supervision of a

physician or ~~physicians~~ podiatrist licensed under this ~~part or~~

~~part 175~~ article.

(h) ~~(g)~~ "Supervision" means that term as defined in section

16109, except that it also includes the existence of a

predetermined plan for emergency situations, including, but not

limited to, the designation of a physician to supervise a

physician's assistant in the absence of the primary supervising

physician.

(i) ~~(h)~~ "Task force" means the joint task force created in

~~sections~~ section 17025. ~~and 17525.~~

(2) In addition to the definitions in this part, article 1

contains definitions and principles of construction applicable to

all articles in this code and part 161 contains definitions

applicable to this part.

Sec. 17008. Practice as a physician's assistant is a health

profession subfield of the practice of medicine, ~~and~~ osteopathic

medicine and surgery, and podiatric medicine and surgery.

Sec. 17025. (1) A joint task force is created for the health

profession subfields licensed under this part. ~~and part 175.~~ The

task force shall consist of the following 9 10 members, who shall

meet the requirements of part 161: 1 member each from the board of

medicine, ~~and~~ the board of osteopathic medicine and surgery, and

the board of podiatric medicine and surgery holding a license other

than a health profession subfield license, 5 physician's

assistants, and 2 public members.

(2) The requirement of section 16135(d) that a task force

member shall have practiced that profession for 2 years immediately

before appointment is waived until October 1, 1980 for members of

the board licensed in a health profession subfield created by this

part.

Sec. 17066. The standards and decisions regarding the

qualifications of physician's assistants shall be designed to

determine that each physician's assistant has the necessary

knowledge and skill to perform in a safe and competent manner with

due regard to the complexity and risks attendant to activities that

may be delegated by a physician or podiatrist to a physician's

assistant.

Sec. 17074. (1) A physician's assistant shall not undertake or

represent that he or she is qualified to undertake provision of a

medical care service that he or she knows or reasonably should know

to be outside his or her competence or is prohibited by law.

(2) A physician's assistant shall not:

(a) Perform acts, tasks, or functions to determine the

refractive state of a human eye or to treat refractive anomalies of

the human eye, or both.

(b) Determine the spectacle or contact lens prescription

specifications required to treat refractive anomalies of the human

eye, or determine modification of spectacle or contact lens

prescription specifications, or both.

(3) A physician's assistant may perform routine visual

screening or testing, postoperative care, or assistance in the care

of medical diseases of the eye under the supervision of a

physician.

(4) A physician's assistant acting under the supervision of a

podiatrist shall only perform those duties included within the

scope of practice of that supervising podiatrist.

Sec. 17078. (1) A physician's assistant is the agent of the

supervising physician or supervising podiatrist. A communication

made to a physician's assistant that would be a privileged

communication if made to the supervising physician or supervising

podiatrist is a privileged communication to the physician's

assistant and the supervising physician or supervising podiatrist

to the same extent as if the communication were made to the

supervising physician or supervising podiatrist.

(2) A physician's assistant shall conform to minimal standards

of acceptable and prevailing practice for the supervising physician

or supervising podiatrist.

Sec. 17501. (1) As used in this part:

(a) "Electrodiagnostic studies" means the testing of

neuromuscular functions utilizing nerve conduction tests and needle

electromyography. It does not include the use of surface

electromyography.

(b) "Medical care services" means those services within the

scope of practice of physicians licensed and approved by the board,

except those services that the board determines shall not be

delegated by a physician without endangering the health and safety

of patients as provided for in section 17548(3).

article to engage in the practice of osteopathic medicine and

surgery.

(d) "Practice of osteopathic medicine and surgery" means a

separate, complete, and independent school of medicine and surgery

utilizing full methods of diagnosis and treatment in physical and

mental health and disease, including the prescription and

administration of drugs and biologicals, operative surgery,

obstetrics, radiological and other electromagnetic emissions, and

placing special emphasis on the interrelationship of the

musculoskeletal system to other body systems.

(e) "Practice as a physician's assistant" means the practice

of medicine, osteopathic medicine and surgery, and podiatric

medicine and surgery performed under the supervision of a physician

or podiatrist licensed under this ~~part or part 170~~ article.

(f) "Supervision" has the meaning ascribed to it in section

16109 except that it includes the existence of a predetermined plan

for emergency situations, including, but not limited to, the

designation of a physician to supervise a physician's assistant in

the absence of the primary supervising physician.

(g) "Task force" means the joint task force created in

~~sections~~ section 17025. ~~and 17525.~~

(2) In addition to the definitions in this part, article 1

contains general definitions and principles of construction

applicable to all articles in the code and part 161 contains

definitions applicable to this part.

Sec. 17508. Practice as a physician's assistant is a health

profession subfield of the practice of osteopathic medicine and

surgery, ~~and~~ the practice of medicine, and the practice of

podiatric medicine and surgery.

Sec. 18001. (1) As used in this part:

(a) "Podiatrist" means a physician and surgeon licensed under

this article to engage in the practice of podiatric medicine and

surgery.

(b) "Practice as a physician's assistant" means the practice

of medicine, osteopathic medicine and surgery, and podiatric

medicine and surgery under the supervision of a physician or

podiatrist licensed under this article.

the examination, diagnosis, and treatment of abnormal nails,

superficial excrescenses occurring on the human hands and feet,

including corns, warts, callosities, and bunions, and arch troubles

or the treatment medically, surgically, mechanically, or by

physiotherapy of ailments of human feet or ankles as they affect

the condition of the feet. It does not include amputation of human

feet, or the use or administration of anesthetics other than local.

(d) "Supervision" means that term as defined under section

16109 except that it includes the existence of a predetermined plan

for emergency situations including, but not limited to, the

designation of a podiatrist to supervise a physician's assistant in

the absence of the primary supervising podiatrist.

(e) "Task force" means the joint task force created in section

17025.

(2) In addition to the definitions in this part, article 1

contains general definitions and principles of construction

applicable to all articles in this code and part 161 contains

definitions applicable to this part.

Sec. 18008. Practice as a physician's assistant is a health

profession subfield of the practice of podiatric medicine and

surgery, the practice of osteopathic medicine and surgery, and the

practice of medicine.

Sec. 18011. A person shall not engage in the practice of

podiatric medicine and surgery or practice as a physician's

assistant unless licensed or otherwise authorized by this article.

Sec. 18021. (1) The Michigan board of podiatric medicine and

surgery is created in the department and shall consist of the

following 9 voting members who shall meet the requirements of part

161: 5 podiatrists, 1 physician's assistant, and 4 3 public

members.

(2) The board of podiatric medicine and surgery does not have

the powers and duties vested in the task force by sections 17060 to

17084.

Sec. 18048. (1) Except as otherwise provided in this section,

a podiatrist who is a sole practitioner or who practices in a group

of podiatrists and treats patients on an outpatient basis shall not

supervise more than 4 physician's assistants. If a podiatrist

described in this subsection supervises physician's assistants at

more than 1 practice site, the podiatrist shall not supervise more

than 2 physician's assistants by a method other than the

podiatrist's actual physical presence at the practice site.

(2) A podiatrist who is employed by or under contract or

subcontract to or has privileges at a health facility licensed

under article 17 may supervise more than 4 physician's assistants

at the health facility or agency.

(3) The department may promulgate rules for the appropriate

delegation and utilization of a physician's assistant by a

podiatrist, including, but not limited to, rules to prohibit or

otherwise restrict the delegation of certain podiatric services or

require higher levels of supervision if the board determines that

such services require extensive training, education, or ability or

pose serious risks to the health or safety of patients.

Sec. 18049. (1) In addition to the other requirements of this

section and subject to subsection (5), a podiatrist who supervises

a physician's assistant is responsible for all of the following:

(a) Verification of the physician's assistant's credentials.

(b) Evaluation of the physician's assistant's performance.

provision of podiatric services.

(2) Subject to section 18048, a podiatrist who supervises a

physician's assistant may only delegate to the physician's

assistant the performance of podiatric services for a patient who

is under the case management responsibility of the podiatrist, if

the delegation is consistent with the physician's assistant's

training. A podiatrist shall only supervise a physician's assistant

in the performance of those duties included within his or her scope

of practice.

(3) A podiatrist who supervises a physician's assistant is

responsible for the clinical supervision of each physician's

assistant to whom the physician delegates the performance of

podiatric services under subsection (2).

(4) Subject to subsection (5), a podiatrist who supervises a

physician's assistant shall keep on file in the physician's office

or in the health facility or agency in which the podiatrist

supervises the physician's assistant a permanent, written record

that includes the podiatrist's name and license number and the name

and license number of each physician's assistant supervised by the

podiatrist.

(5) A group of podiatrists practicing other than as sole

practitioners may designate 1 or more podiatrists in the group to

fulfill the requirements of subsections (1) and (4).

Sec. 18050. In addition to its other powers and duties under

this article, the board may prohibit a podiatrist from supervising

1 or more physician's assistants for any of the grounds set forth

in section 16221 or for failure to supervise a physician's

assistant in accordance with this part and rules promulgated under

this part.

Sec. 18054. The board shall make written recommendations on

criteria for the approval of physician's assistants and on criteria

for the valuation of physician's assistants training programs to

the task force on physician's assistants.

Sec. 18056. This part does not apply to a student in training

to become a physician's assistant while performing duties assigned

as part of the training.

Sec. 18058. This part does not require new or additional third

party reimbursement or mandated worker's compensation benefits for

services rendered by an individual authorized to practice as a

physician's assistant under this part.