SENATE BILL NO. 880

April 24, 2020, Introduced by Senator MACGREGOR and referred to the Committee on Government Operations.

A bill to amend 1978 PA 368, entitled

"Public health code,"

by amending section 16101 (MCL 333.16101) and by adding sections 16113 and 17715.

the people of the state of michigan enact:

Sec. 16101. (1) For purposes of this article, the words and phrases defined in sections 16102 to 16109 16109a have the meanings ascribed to them in those sections unless the context clearly indicates a different meaning.

(2) In addition, article 1 contains general definitions and principles of construction applicable to all articles in this code.

Sec. 16113. (1) Notwithstanding any provision of this article or rule promulgated under this article to the contrary, all of the following apply in response to the state of emergency described in Executive Order Nos. 2020-30 and 2020-49:

(a) The provisions of this article that relate to scope of practice, supervision, and delegation are suspended, in whole or in part, as provided in this subdivision, to the extent necessary to allow a licensee or registrant to provide, within the designated health care facility at which the licensee or registrant is employed or under contract, a medical service that is necessary to support the facility's response to the COVID-19 pandemic and is appropriate to the licensee's or registrant's education, training, and experience, as determined by the facility in consultation with the facility's medical leadership. All of the following apply for purposes of this subdivision:

(i) A medical service may be provided under this subdivision without supervision from a physician licensed under part 170 or 175 and without a written practice agreement with the physician. An individual who provides a medical service under this subparagraph is not subject to criminal prosecution, civil liability, or administrative sanction for an act or omission related to the lack of physician supervision or the lack of a practice agreement.

(ii) The provisions of parts 170, 175, and 180, and any related provision of this article, that relate to scope of practice, supervision, and delegation are suspended to the extent necessary to allow a physician's assistant to provide a medical service appropriate to his or her education, training, and experience without a written practice agreement with a physician. An individual who provides a medical service under this subparagraph is not subject to criminal prosecution, civil liability, or administrative sanction for an act or omission related to the lack of a practice agreement.

(iii) The provisions of parts 170, 172, and 175, and any related provision of this article, that relate to scope of practice, supervision, and delegation are suspended to the extent necessary to allow an advanced practice registered nurse to provide a medical service appropriate to his or her education, training, and experience without physician supervision. An individual who provides a medical service under this subparagraph is not subject to criminal prosecution, civil liability, or administrative sanction for an act or omission related to the lack of physician supervision. As used in this subparagraph, "advanced practice registered nurse" means that term as defined in section 17201 and includes a nurse anesthetist.

(iv) The provisions of parts 170, 172, and 175, and any related provision of this article, that relate to scope of practice, supervision, and delegation are suspended to the extent necessary to allow a registered professional nurse and licensed practical nurse to order the collection of a throat or nasopharyngeal swab specimen from an individual suspected of being infected by COVID-19, for purposes of testing the individual.

(v) The provisions of part 172, and any related provision of this article, that relate to scope of practice, supervision, and delegation are suspended to the extent necessary to allow a licensed practical nurse to provide a medical service appropriate to his or her education, training, and experience without the supervision of a registered professional nurse. An individual who provides a medical service under this subparagraph is not subject to criminal prosecution, civil liability, or administrative sanction for an act or omission related to the lack of supervision by a registered professional nurse.

(vi) The provisions of part 177, and any related provision of this article, that relate to scope of practice, supervision, and delegation are suspended to the extent necessary to allow a pharmacist to provide care for routine health maintenance, a chronic disease state, or a similar condition, as appropriate to his or her education, training, and experience, without physician supervision. An individual who provides a service described in this subparagraph is not subject to criminal prosecution, civil liability, or administrative sanction for an act or omission related to the lack of supervision by a physician.

(b) A student who is enrolled in a program to become licensed or registered under this article may volunteer or work within a designated health facility in whatever role is necessary to support the facility's response to the COVID-19 pandemic and is appropriate to the student's education, training, and experience, as determined by the facility in consultation with the facility's medical leadership.

(c) A medical student, physical therapist, or emergency medical technician may volunteer or work within a designated health facility to assist in the operation of a ventilator or a related device under the supervision of a physician, respiratory therapist, or advanced practice registered nurse. Nothing in this subdivision precludes a medical student, physical therapist, or emergency medical technician from providing other services necessary to support the designated health facility's response to the COVID-19 pandemic and that are appropriate to his or her education, training, and experience, as determined by the facility in consultation with the facility's medical leadership.

(d) An individual who is licensed to practice a health care profession in another state and is in good standing in that state may practice in this state. An individual whose license has been suspended or revoked in another state or who is the subject of pending disciplinary action in another state is not in good standing for purposes of this subdivision. If the individual's license to practice in the other state contains restrictions or conditions, the restrictions or conditions apply to the individual's practice in this state. An individual who practices under this subdivision is not subject to criminal prosecution, civil liability, or administrative sanction for an act or omission related to the lack of licensure in this state.

(e) A licensee or registrant is not required to complete any of the following as a condition of licensure, registration, or renewal of the license or registration:

(i) An examination, to the extent that the examination's administration has been canceled while the emergency declaration is in effect.

(ii) Fingerprinting, to the extent that, in the judgment of the director, locations to have fingerprints taken are substantially unavailable on account of closures arising from the COVID-19 pandemic.

(iii) Continuing education while the emergency declaration is in effect.

(f) The department may recognize hours worked responding to the COVID-19 pandemic as hours toward continuing education courses or programs required for licensure.

(g) The department shall waive any requirement under this article or a rule promulgated under this article for a licensee or registrant to hold a certificate in basic life support, advanced cardiac life support, or first aid, if the certificate expires or is due to expire while the emergency declaration is in effect.

(2) As used in this section:

(a) "COVID-19" means coronavirus disease 2019.

(b) "Designated health care facility" or "facility" means 1 or more of the following:

(i) A health facility or agency as that term is defined in section 20106.

(ii) A state-owned surgical center.

(iii) A state-operated outpatient facility.

(iv) A state-operated veterans facility.

(v) An entity used as surge capacity for any of the entities described in this subdivision.

Sec. 17715. (1) Notwithstanding any provision of this article or rule promulgated under this article to the contrary, all of the following apply in response to the state of emergency described in Executive Order Nos. 2020-25 and 2020-30:

(a) A pharmacist may dispense an emergency refill of up to a 60-day supply of a prescription drug other than a controlled substance for a resident of this state if, in the pharmacist's professional judgment, a failure to refill the prescription might interrupt the patient's ongoing care and have a significant adverse effect on the patient's well-being. All of the following apply for purposes of this subdivision:

(i) The pharmacist shall inform the patient that the prescription was dispensed under this subdivision.

(ii) The pharmacist shall inform the prescriber, in writing and within a reasonable period of time, of any refills that the pharmacist dispensed under this subdivision.

(iii) Before refilling a prescription under this subdivision, the pharmacist shall make a reasonable effort to communicate with the prescriber regarding refilling the prescription and make a record of the efforts made, including the reason for refilling a prescription under this subdivision.

(iv) A prescriber is not subject to criminal prosecution, civil liability, or administrative sanction as a result of a pharmacist refilling a prescription under this subdivision.

(b) A pharmacist may temporarily operate a pharmacy in a location that is not designated on a pharmacy license. However, the pharmacy described in this subdivision may not prepare sterile drug products beyond low-risk preparations, as defined by USP standards, for immediate inpatient administration.

(c) A pharmacist may dispense and administer a drug as needed to treat an individual with COVID-19 pursuant to protocols established by the federal Centers for Disease Control and Prevention or the National Institute of Health, or as determined by the chief medical executive in the office of chief medical executive created within the department of health and human services or the chief medical executive's designee.

(d) A pharmacist may substitute a therapeutically equivalent drug for a drug that is the subject of a critical shortage. A pharmacist substituting a drug under this subdivision shall inform the patient of the substitution and notify the prescriber of the substitution within a reasonable period of time. A prescriber is not subject to criminal prosecution, civil liability, or administrative sanction as a result of a pharmacist's substitution under this subdivision.

(e) A preceptor may supervise a student pharmacist remotely to fulfill eligibility requirements for licensure and to avoid a delay in graduation.

(f) A pharmacist may oversee a pharmacy technician and other pharmacy staff remotely through the use of a real-time, continuous audiovisual camera system that is capable of allowing the pharmacist to visually identify the markings on tablets and capsules. The pharmacist must have access to all relevant patient information to accomplish remote oversight and must be available at all times during the oversight to provide real-time patient consultation. A pharmacy technician shall not perform sterile or nonsterile compounding without a pharmacist on the premises.

(g) An out-of-state pharmacy that is in good standing is considered licensed to do business in this state. An out-of-state pharmacy shall not deliver controlled substances into this state and shall comply with this part and the rules promulgated by this part, except that an out-of-state pharmacy is not required to designate a pharmacist in charge for the out-of-state pharmacy. To provide sterile compounding services to a patient in this state, an out-of-state pharmacy shall hold a current accreditation from a national organization approved by the board.

(h) A manufacturer or wholesale distributor that is licensed in another state is considered to be licensed to do business in this state. A manufacturer or wholesale distributor that holds a license in good standing in another state may temporarily distribute a controlled substance in this state to a hospital or to a manufacturer or wholesale distributor that is licensed under this part. An out-of-state license described in this subdivision is not considered to be in good standing for purposes of this subdivision if it has been suspended or revoked or is the subject of pending disciplinary action in another state. If an out-of-state license described in this subdivision contains restrictions or conditions, those restrictions or conditions apply in this state for purposes of this subdivision.

(2) As used in this section:

(a) "COVID-19" means coronavirus disease 2019.

(b) "Out-of-state pharmacy" means a facility or part of a facility that is located outside of this state and that is licensed in another state to dispense prescription drugs or prepare prescription drugs for delivery or distribution.