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

SENATE 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:

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

 2  to engage in practice as a physician's assistant under  either

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

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

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

4       (c) Temporary license........................     35.00

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

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

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

 8        (i) A medical school approved by the board.

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

10  the following requirements:

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

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

13  hospital owned by the federal government and directly operated by

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

15  than 4 postgraduate education residency programs approved by the

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

17  immediately preceding the date of an application for a limited

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

19  license under section 17031(2), provided that at least 1 of the

20  residency programs is in the specialty area of medical practice,

21  or in a specialty area that includes the subspecialty of medical

22  practice, in which the applicant for a limited license proposes

23  to practice or in which the applicant for a full license has

24  practiced for the hospital.

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

26  education during each of the 3 years immediately preceding the

 1  date of an application for a limited license under section

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

 3  17031(2). As used in this subparagraph, "medical education" means

 4  the education of physicians and candidates for degrees or

 5  licenses to become physicians, including, but not limited to,

 6  physician staff, residents, interns, and medical students.

 7        (b) "Electrodiagnostic studies" means the testing of

 8  neuromuscular functions utilizing nerve conduction tests and

 9  needle electromyography. It does not include the use of surface

10  electromyography.

11        (c) "Medical care services" means those services within the

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

13  those services that the board determines shall not be delegated

14  by a physician without endangering the health and safety of

15  patients as provided for in section 17048(3).

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

17  article to engage in the practice of medicine.

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

19  article to engage in the practice of podiatric medicine and

20  surgery.

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

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

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

24  condition, by attendance, advice, device, diagnostic test, or

25  other means, or offering, undertaking, attempting to do, or

26  holding oneself out as able to do, any of these acts.

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

 1  practice of medicine,  or osteopathic medicine and surgery, or

 2  podiatric medicine and surgery performed under the supervision of

 3  a physician or  physicians  podiatrist licensed under this  part

 4  or part 175  article.

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

 6  section 16109, except that it also includes the existence of a

 7  predetermined plan for emergency situations, including, but not

 8  limited to, the designation of a physician to supervise a

 9  physician's assistant in the absence of the primary supervising

10  physician.

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

12  sections  section 17025.  and 17525.

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

14  contains definitions and principles of construction applicable to

15  all articles in this code and part 161 contains definitions

16  applicable to this part.

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

18  profession subfield of the practice of medicine,  and

19  osteopathic medicine and surgery, and podiatric medicine and

20  surgery.

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

22  profession subfields licensed under this part.  and part 175.

23  The task force shall consist of the following  9  11 members, who

24  shall meet the requirements of part 161: 1 member each from the

25  board of medicine,  and the board of osteopathic medicine and

26  surgery, and the board of podiatric medicine and surgery holding

27  a license other than a health profession subfield license, 5

 1  physician's assistants, and  2  3 public members.

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

 3  member shall have practiced that profession for 2 years

 4  immediately before appointment is waived until October 1, 1980

 5  for members of the board licensed in a health profession subfield

 6  created by this part.

 7        Sec. 17066. The standards and decisions regarding the

 8  qualifications of physician's assistants shall be designed to

 9  determine that each physician's assistant has the necessary

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

11  with due regard to the complexity and risks attendant to

12  activities that may be delegated by a physician or podiatrist to

13  a physician's assistant.

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

15  or represent that he or she is qualified to undertake provision

16  of a medical care service that he or she knows or reasonably

17  should know to be outside his or her competence or is prohibited

18  by law.

19        (2) A physician's assistant shall not:

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

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

22  of the human eye, or both.

23        (b) Determine the spectacle or contact lens prescription

24  specifications required to treat refractive anomalies of the

25  human eye, or determine modification of spectacle or contact lens

26  prescription specifications, or both.

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

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

 2  care of medical diseases of the eye under the supervision of a

 3  physician.

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

 5  a podiatrist shall only perform those duties included within the

 6  scope of practice of that supervising podiatrist.

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

 8  supervising physician or supervising podiatrist. A communication

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

10  communication if made to the supervising physician or supervising

11  podiatrist is a privileged communication to the physician's

12  assistant and the supervising physician or supervising podiatrist

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

14  supervising physician or supervising podiatrist.

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

16  standards of acceptable and prevailing practice for the

17  supervising physician or supervising podiatrist.

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

19        (a) "Electrodiagnostic studies" means the testing of

20  neuromuscular functions utilizing nerve conduction tests and

21  needle electromyography. It does not include the use of surface

22  electromyography.

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

24  scope of practice of physicians licensed and approved by the

25  board, except those services that the board determines shall not

26  be delegated by a physician without endangering the health and

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

 1        (c) "Physician" means an individual licensed under this

 2  article to engage in the practice of osteopathic medicine and

 3  surgery.

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

 5  separate, complete, and independent school of medicine and

 6  surgery utilizing full methods of diagnosis and treatment in

 7  physical and mental health and disease, including the

 8  prescription and administration of drugs and biologicals,

 9  operative surgery, obstetrics, radiological and other

10  electromagnetic emissions, and placing special emphasis on the

11  interrelationship of the musculoskeletal system to other body

12  systems.

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

14  of medicine, osteopathic medicine and surgery, and podiatric

15  medicine and surgery performed under the supervision of a

16  physician or podiatrist licensed under this  part or part 170

17  article.

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

19  16109 except that it includes the existence of a predetermined

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

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

22  in the absence of the primary supervising physician.

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

24  sections  section 17025.  and 17525.

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

26  contains general definitions and principles of construction

27  applicable to all articles in the code and part 161 contains

 1  definitions applicable to this part.

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

 3  profession subfield of the practice of osteopathic medicine and

 4  surgery,  and the practice of medicine, and the practice of

 5  podiatric medicine and surgery.

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

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

 8  under this article to engage in the practice of podiatric

 9  medicine and surgery.

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

11  of medicine, osteopathic medicine and surgery, and podiatric

12  medicine and surgery under the supervision of a physician or

13  podiatrist licensed under this article.

14  (c)  (b) "Practice of podiatric medicine and surgery" means

15  the examination, diagnosis, and treatment of abnormal nails,

16  superficial excrescenses occurring on the human hands and feet,

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

18  troubles or the treatment medically, surgically, mechanically, or

19  by physiotherapy of ailments of human feet or ankles as they

20  affect the condition of the feet. It does not include amputation

21  of human feet, or the use or administration of anesthetics other

22  than local.

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

24  16109 except that it includes the existence of a predetermined

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

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

27  in the absence of the primary supervising podiatrist.

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

 2  section 17025.

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

 4  contains general definitions and principles of construction

 5  applicable to all articles in this code and part 161 contains

 6  definitions applicable to this part.

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

 8  profession subfield of the practice of podiatric medicine and

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

10  the practice of medicine.

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

12  podiatric medicine and surgery or practice as a physician's

13  assistant unless licensed or otherwise authorized by this

14  article.

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

16  surgery is created in the department and shall consist of the

17  following 9 voting members who shall meet the requirements of

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

19  public members.

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

21  have the powers and duties vested in the task force by sections

22  17060 to 17084.

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

24  section, a podiatrist who is a sole practitioner or who practices

25  in a group of podiatrists and treats patients on an outpatient

26  basis shall not supervise more than 4 physician's assistants.  If

27  a podiatrist described in this subsection supervises physician's

 1  assistants at more than 1 practice site, the podiatrist shall not

 2  supervise more than 2 physician's assistants by a method other

 3  than the podiatrist's actual physical presence at the practice

 4  site.

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

 6  subcontract to or has privileges at a health facility licensed

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

 8  at the health facility or agency.

 9        (3) The department may promulgate rules for the appropriate

10  delegation and utilization of a physician's assistant by a

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

12  otherwise restrict the delegation of certain podiatric services

13  or require higher levels of supervision if the board determines

14  that such services require extensive training, education, or

15  ability or pose serious risks to the health or safety of

16  patients.

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

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

19  supervises a physician's assistant is responsible for all of the

20  following:

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

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

23        (c) Monitoring the physician's assistant's practice and

24  provision of podiatric services.

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

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

27  assistant the performance of podiatric services for a patient who

 1  is under the case management responsibility of the podiatrist, if

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

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

 4  assistant in the performance of those duties included within his

 5  or her scope of practice.

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

 7  responsible for the clinical supervision of each physician's

 8  assistant to whom the physician delegates the performance of

 9  podiatric services under subsection (2).

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

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

12  office or in the health facility or agency in which the

13  podiatrist supervises the physician's assistant a permanent,

14  written record that includes the podiatrist's name and license

15  number and the name and license number of each physician's

16  assistant supervised by the podiatrist.

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

18  practitioners may designate 1 or more podiatrists in the group to

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

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

21  this article, the board may prohibit a podiatrist from

22  supervising 1 or more physician's assistants for any of the

23  grounds set forth in section 16221 or for failure to supervise a

24  physician's assistant in accordance with this part and rules

25  promulgated under this part.

26        Sec. 18054. The board shall make written recommendations on

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

 1  criteria for the valuation of physician's assistants training

 2  programs to the task force on physician's assistants.

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

 4  training to become a physician's assistant while performing

 5  duties assigned as part of the training.

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

 7  third party reimbursement or mandated worker's compensation

 8  benefits for services rendered by an individual authorized to

 9  practice as a physician's assistant under this part.

10        Enacting section 1. Section 17525 of the public health code,

11  1978 PA 368, MCL 333.17525, is repealed.

12        Enacting section 2. This amendatory act takes effect 6

13  months after it is enacted into law.