February 8, 2006, Introduced by Reps. Taub, Marleau, Stahl, Vander Veen, Elsenheimer, Newell, Nofs, Hildenbrand, Stakoe, Sheen, Stewart, Hune, Moore, Pastor, Brandenburg, LaJoy, Drolet, Huizenga, Garfield, Shaffer, Amos, Gaffney and Acciavatti and referred to the Committee on Health Policy.
A bill to amend 1978 PA 368, entitled
"Public health code,"
by amending sections 2701, 5119, 16337, 17001, 17008, 17025, 17066,
17074, 17078, 17501, 17745a, 17745b, 18001, 18011, and 18021 (MCL
333.2701, 333.5119, 333.16337, 333.17001, 333.17008, 333.17025,
333.17066, 333.17074, 333.17078, 333.17501, 333.17745a, 333.17745b,
333.18001, 333.18011, and 333.18021), section 2701 as added by 1990
PA 16, section 5119 as amended by 2000 PA 209, 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, section 17745a as
amended by 1999 PA 190, section 17745b as added by 1993 PA 306, and
section 18021 as amended by 1993 PA 79, and by adding sections
18048, 18049, 18050, 18054, and 18056; and to repeal acts and parts
of acts.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 2701. As used in this part:
(a) "Board certified" means certified to practice in a
particular
medical speciality specialty by a national
board
recognized by the American board of medical specialties or the
American osteopathic association.
(b) "Certified nurse midwife" means an individual licensed as
a registered professional nurse under part 172 who has been issued
a specialty certification in the practice of nurse midwifery by the
board of nursing under section 17210.
(c) "Certified nurse practitioner" means an individual
licensed as a registered professional nurse under part 172 who has
been issued a specialty certification as a nurse practitioner by
the board of nursing under section 17210.
(d) "Designated nurse" means a certified nurse midwife or
certified nurse practitioner.
(e) "Designated physician" means a physician qualified in 1 of
the physician specialty areas identified in section 2711.
(f) "Designated professional" means a designated physician,
designated nurse, or physician's assistant.
(g) "Health resource shortage area" means a geographic area,
population group, or health facility designated by the department
under section 2717.
(h) "Medicaid" means benefits under the program of medical
assistance established under title XIX of the social security act,
42
U.S.C. 1396 to 1396d, 1396f to 1396g, and 1396i to 1396s 42 USC
1396
to 1396v, and administered by the
department of social human
services
under the social welfare act, Act No. 280 of the Public
Acts
of 1939, being sections 400.1 to 400.121 of the Michigan
Compiled
Laws 1939 PA 280, MCL 400.1
to 400.119b.
(i) "Medical school" means an accredited program for the
training of individuals to become physicians.
(j) "Medicare" means benefits under the federal medicare
program established under title XVIII of the social security act,
42
U.S.C. 1395 to 1395b, 1395b-2 to 1395i, 1395i-1a to 1395i-2,
1395j
to 1395dd, 1395ff to 1395mm, and 1395oo to 1395ccc 42 USC
1395 to 1395hhh.
(k) "National health service corps" means the agency
established under section 331 of title III of the public health
service
act, 42 U.S.C. USC
254d.
(l) "Nurse" means an individual licensed to engage in the
practice of nursing under part 172.
(m) "Nursing program" means an accredited program for the
training of individuals to become nurses.
(n) "Physician" means an individual licensed as a physician
under part 170 or an osteopathic physician under part 175.
(o) "Physician's assistant" means an individual licensed as a
physician's
assistant under part 170. or part 175.
(p) "Physician's assistant program" means an accredited
program for the training of individuals to become physician's
assistants.
(q) "Service obligation" means the contractual obligation
undertaken by an individual under section 2705 or section 2707 to
provide health care services for a determinable time period at a
site designated by the department.
Sec. 5119. (1) An individual applying for a marriage license
shall be advised through the distribution of written educational
materials by the county clerk regarding prenatal care and the
transmission and prevention of venereal disease and HIV infection.
The written educational materials shall describe the availability
to the applicant of tests for both venereal disease and HIV
infection. The information shall include a list of locations where
HIV counseling and testing services funded by the department are
available. The written educational materials shall be approved or
prepared by the department.
(2) A county clerk shall not issue a marriage license to an
applicant who fails to sign and file with the county clerk an
application for a marriage license that includes a statement with a
check-off box indicating that the applicant has received the
educational materials regarding the transmission and prevention of
both venereal disease and HIV infection and has been advised of
testing for both venereal disease and HIV infection, pursuant to
subsection (1).
(3) If either applicant for a marriage license undergoes a
test for HIV or an antibody to HIV, and if the test results
indicate that an applicant is HIV infected, the physician or a
designee of the physician, the physician's assistant, the certified
nurse midwife, or the certified nurse practitioner or the local
health officer or designee of the local health officer
administering the test immediately shall inform both applicants of
the test results, and shall counsel both applicants regarding the
modes of HIV transmission, the potential for HIV transmission to a
fetus, and protective measures.
(4) As used in this section:
(a) "Certified nurse midwife" means an individual licensed as
a registered professional nurse under part 172 who has been issued
a specialty certification in the practice of nurse midwifery by the
board of nursing under section 17210.
(b) "Certified nurse practitioner" means an individual
licensed as a registered professional nurse under part 172 who has
been issued a specialty certification as a nurse practitioner by
the board of nursing under section 17210.
(c) "Physician" means an individual licensed as a physician
under part 170 or an osteopathic physician under part 175.
(d) "Physician's assistant" means an individual licensed as a
physician's
assistant under part 170. or part 175.
Sec. 16337. Fees for a person licensed or seeking licensure
under part 170 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
(c) Temporary license............................. 35.00
(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.
(c) "Medical care services" means those services within the
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).
(c) "Physician" means an individual licensed under this
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. 17745a. (1) As used in this section:
(a) "Medicaid" means the program of medical assistance
established
under title XIX of the social security act, chapter
531,
49 Stat. 620, 42 U.S.C. 1396 to 1396f, 1396g-1 to 1396r-6, and
1396r-8
42 USC 1396 to 1396v.
(b) "Medicare" means the federal medicare program established
under
title XVIII of the social security act,
chapter 531, 49
Stat.
620, 42 U.S.C. 1395 to 1395b, 1395b-2, 1395b-6 to 1395b-7,
1395c
to 1395i, 1395i-2 to 1395i-5, 1395j to 1395t, 1395u to 1395w,
1395w-2
to 1395w-4, 1395w-21 to 1395w-28, 1395x to 1395yy, and
1395bbb
to 1395ggg 42 USC 1395 to
1395hhh.
(c) "Public health program" means 1 of the following:
(i) A local health department.
(ii) A migrant health center or a community health center as
defined under sections 329 and 330 of subpart I of part C of title
III
of the public health service act, 42
U.S.C. USC
254b and
254c.
(iii) A family planning program designated by the family
independence
agency department of human
services as a provider
type 23 under the social welfare act, 1939 PA 280, MCL 400.1 to
400.119b, and verified by the department of community health.
(iv) A methadone treatment program licensed under article 6.
(v) A rural health clinic.
(vi) A hospice rendering emergency care services in a patient's
home as described in section 17746.
(d) "Rural health clinic" means a rural health clinic as
defined in section 1861 of part C of title XVIII of the social
security
act, 42 U.S.C. USC 1395x, that is certified to
participate in medicaid and medicare.
(2) Except as otherwise provided in subsections (3) and (4),
in a public health program without an on-site pharmacy, a
dispensing prescriber may delegate the dispensing of prescription
drugs only to the following individuals:
(a) A registered professional nurse licensed under part 172.
(b)
A physician's assistant licensed under part 170, or part
175,
if the delegating dispensing prescriber is
responsible for
the clinical supervision of the physician's assistant.
(3) In a public health program without an on-site pharmacy, a
dispensing prescriber may delegate the delivery of prescription
drugs consisting only of prelabeled, prepackaged oral
contraceptives under the following circumstances:
(a) The delivery is delegated to an appropriately trained
individual.
(b) The delivery is performed pursuant to specific, written
protocols.
(4) In a methadone treatment program licensed under article 6
without an on-site pharmacy, a dispensing prescriber may delegate
the delivery of a prescription drug consisting only of 1 or more
single doses of methadone, up to the maximum number of single doses
allowed by law, to a registered client of the methadone treatment
program, if all of the following requirements are met:
(a) The delivery is delegated to 1 of the following
individuals:
(i) A registered professional nurse or a licensed practical
nurse licensed under part 172.
(ii) A physician's assistant licensed under part 170, or
part
175,
but only if the delegating dispensing prescriber is
responsible for the clinical supervision of the physician's
assistant.
(b) The delivery is performed pursuant to specific, written
protocols.
(c) The prescription drug described in this subsection is
labeled in accordance with section 17745.
Sec. 17745b. (1) Subject to subsection (3), in an industrial
clinic or other prescriber practice location without an on-site
pharmacy, a dispensing prescriber may delegate the dispensing of
prescription drugs only to the following individuals:
(a) A registered professional nurse licensed under part 172.
(b)
A physician's assistant licensed under part 170, or part
175,
if the dispensing prescriber is responsible for the
clinical
supervision of the physician's assistant.
(2) In an industrial clinic or other prescriber practice
location without an on-site pharmacy, if a dispensing prescriber
does not delegate the dispensing of a prescription drug, the
dispensing prescriber shall do both of the following:
(a) Be physically present at the time the prescription drug is
dispensed.
(b) Immediately before the prescription drug is dispensed,
perform a final inspection of the type of prescription drug,
labeling, dosage, and amount of the prescription drug dispensed.
(3) A dispensing prescriber who delegates the dispensing of a
prescription drug to a patient in an industrial clinic or other
prescriber practice location without an on-site pharmacy shall not
delegate the dispensing of more than a 72-hour supply of the
prescription drug.
(4) Before dispensing a prescription drug to a patient in an
industrial clinic or other prescriber practice location without an
on-site pharmacy, a dispensing prescriber who intends to charge for
dispensing the drug shall give a written prescription to the
patient and shall instruct the patient that he or she may elect to
have the prescription filled by the dispensing prescriber or the
patient's pharmacy of choice.
(5) If a dispensing prescriber intends to charge for
dispensing a prescription drug to a patient in an industrial clinic
or other prescriber practice location without an on-site pharmacy,
the dispensing prescriber shall inform the patient of that fact
before dispensing the prescription drug to the patient. The
dispensing prescriber also shall list the charge for dispensing the
prescription drug as a separate item on the patient's bill.
(6) This section does not apply to public health programs as
defined in section 17745a.
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.
(c) (b)
"Practice of podiatric medicine and
surgery" means
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. 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 and 4 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.
(c) Monitoring the physician's assistant's practice and
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.
Enacting section 1. Sections 17508 and 17525 of the public
health code, 1978 PA 368, MCL 333.17508 and 333.17525, are
repealed.