HOUSE BILL No. 5653

 

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.