Act No. 161

Public Acts of 2006

Approved by the Governor

May 25, 2006

Filed with the Secretary of State

May 26, 2006

EFFECTIVE DATE: November 26, 2006

STATE OF MICHIGAN

93RD LEGISLATURE

REGULAR SESSION OF 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

ENROLLED HOUSE BILL No. 5653

AN ACT to amend 1978 PA 368, entitled "An act to protect and promote the public health; to codify, revise, consolidate, classify, and add to the laws relating to public health; to provide for the prevention and control of diseases and disabilities; to provide for the classification, administration, regulation, financing, and maintenance of personal, environmental, and other health services and activities; to create or continue, and prescribe the powers and duties of, departments, boards, commissions, councils, committees, task forces, and other agencies; to prescribe the powers and duties of governmental entities and officials; to regulate occupations, facilities, and agencies affecting the public health; to regulate health maintenance organizations and certain third party administrators and insurers; to provide for the imposition of a regulatory fee; to provide for the levy of taxes against certain health facilities or agencies; to promote the efficient and economical delivery of health care services, to provide for the appropriate utilization of health care facilities and services, and to provide for the closure of hospitals or consolidation of hospitals or services; to provide for the collection and use of data and information; to provide for the transfer of property; to provide certain immunity from liability; to regulate and prohibit the sale and offering for sale of drug paraphernalia under certain circumstances; to provide for the implementation of federal law; to provide for penalties and remedies; to provide for sanctions for violations of this act and local ordinances; to provide for an appropriation and supplements; to repeal certain acts and parts of acts; to repeal certain parts of this act; and to repeal certain parts of this act on specific dates," 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 part170, 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 section17031(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) "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) "Practice as a physician's assistant" means the practice of medicine, osteopathic medicine and surgery, or podiatric medicine and surgery performed under the supervision of a physician or podiatrist licensed under this article.

(h) "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) "Task force" means the joint task force created in section 17025.

(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, 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. The task force shall consist of the following 11 members, who shall meet the requirements of part 161: 1 member each from the board of medicine, 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 3 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 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 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 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, 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.

(c) "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. 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 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.

(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.

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.

Enacting section 1. Section 17525 of the public health code, 1978 PA 368, MCL 333.17525, is repealed.

Enacting section 2. This amendatory act takes effect 6 months after it is enacted into law.

This act is ordered to take immediate effect.

Clerk of the House of Representatives

Secretary of the Senate

Approved

Governor