Bill Text: MI HB4207 | 2015-2016 | 98th Legislature | Introduced

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Bill Title: Health occupations; advanced practice registered nurses; establish licensure requirements, revise requirements for nurse midwives, nurse practitioners, and clinical nurse specialists, and provide other general amendments. Amends secs. 2701, 5119, 16125, 16161, 16163, 16216, 16231, 16231a, 16315, 16327, 17201, 17210, 17211, 17212, 17221, 17607, 17708, 17745, 17820, 17822, 18301 & 20201 of 1978 PA 368 (MCL 333.2701 et seq.) & adds secs. 17202, 17210a, 17211a, 17214 & 17221a.

Spectrum: Slight Partisan Bill (Republican 10-4)

Status: (Introduced - Dead) 2015-02-18 - Printed Bill Filed 02/18/2015 [HB4207 Detail]

Download: Michigan-2015-HB4207-Introduced.html

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HOUSE BILL No. 4207

 

February 17, 2015, Introduced by Reps. Yonker, Franz, Robinson, Dillon, Poleski, Goike, Howrylak, Johnson, Crawford, Outman, Hovey-Wright, Banks, Somerville and Pagel and referred to the Committee on Health Policy.

 

      A bill to amend 1978 PA 368, entitled

 

"Public health code,"

 

by amending sections 2701, 5119, 16125, 16161, 16163, 16216,

 

16231, 16231a, 16315, 16327, 17201, 17210, 17211, 17212, 17221,

 

17607, 17708, 17745, 17820, 17822, 18301, and 20201 (MCL

 

333.2701, 333.5119, 333.16125, 333.16161, 333.16163, 333.16216,

 

333.16231, 333.16231a, 333.16315, 333.16327, 333.17201,

 

333.17210, 333.17211, 333.17212, 333.17221, 333.17607, 333.17708,

 

333.17745, 333.17820, 333.17822, 333.18301, and 333.20201),

 

section 2701 as amended by 2014 PA 172, section 5119 as amended

 

by 2000 PA 209, sections 16125 and 16161 as amended by 1989 PA

 

202, section 16163 as amended by 2002 PA 643, section 16216 as

 

amended by 2014 PA 98, section 16231 as amended by 2014 PA 95,

 

sections 16231a and 16315 as amended by 2013 PA 268, section

 

16327 as amended by 2009 PA 216, sections 17211 and 17221 as

 

amended by 2006 PA 409, section 17212 as added by 1996 PA 355,

 

section 17607 as added by 2008 PA 524, section 17708 as amended

 

by 2012 PA 209, section 17745 as amended by 2014 PA 311, section

 

17820 as amended by 2014 PA 260, section 17822 as amended by 2005

 

PA 281, section 18301 as amended by 2008 PA 523, and section

 

20201 as amended by 2011 PA 210, and by adding sections 17202,

 

17210a, 17211a, 17214, and 17221a.

 

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 

 1        Sec. 2701. As used in this part:

 

 2        (a) "Board certified" means certified to practice in a

 

 3  particular medical speciality specialty by a national board

 

 4  recognized by the American board of medical specialties or the

 

 5  American osteopathic association.

 

 6        (b) "Certified nurse midwife" means an individual licensed

 

 7  as a registered professional nurse under part 172 who has been

 

 8  issued a specialty certification in the practice of nurse

 

 9  midwifery by the board of nursing under section 17210.that term

 

10  as defined in section 17201.

 

11        (c) "Certified nurse practitioner" means an individual

 

12  licensed as a registered professional nurse under part 172 who

 

13  has been issued a specialty certification as a nurse practitioner

 

14  by the board of nursing under section 17210.that term as defined

 

15  in section 17201.

 

16        (d) "Dental school" means an accredited program for the

 

17  training of individuals to become dentists.

 

18        (e) "Dentist" means an individual licensed to engage in the

 

 1  practice of dentistry under part 166.

 

 2        (f) "Designated nurse" means a certified nurse midwife or

 

 3  certified nurse practitioner.

 

 4        (g) "Designated physician" means a physician qualified in 1

 

 5  of the physician specialty areas identified in section 2711.

 

 6        (h) "Designated professional" means a designated physician,

 

 7  designated nurse, dentist, or physician's assistant.

 

 8        (i) "Health resource shortage area" means a geographic area,

 

 9  population group, or health facility designated by the department

 

10  under section 2717.

 

11        (j) "Medicaid" means benefits under the program of medical

 

12  assistance established under title XIX of the social security

 

13  act, 42 USC 1396 to 1396w-5, and administered by the department

 

14  of human services under the social welfare act, 1939 PA 280, MCL

 

15  400.1 to 400.119b.

 

16        (k) "Medical school" means an accredited program for the

 

17  training of individuals to become physicians.

 

18        (l) "Medicare" means benefits under the federal medicare

 

19  program established under title XVIII of the social security act,

 

20  42 USC 1395 to 1395kkk-1.1395lll.

 

21        (m) "National health service corps" means the agency

 

22  established under 42 USC 254d.

 

23        (n) "Nurse" means an individual licensed to engage in the

 

24  practice of nursing under part 172.

 

25        (o) "Nursing program" means an accredited program for the

 

26  training of individuals to become nurses.

 

27        (p) "Physician" means an individual licensed as a physician

 

 1  under part 170 or an osteopathic physician under part 175.

 

 2        (q) "Physician's assistant" means an individual licensed as

 

 3  a physician's assistant under part 170 or part 175.

 

 4        (r) "Physician's assistant program" means an accredited

 

 5  program for the training of individuals to become physician's

 

 6  assistants.

 

 7        (s) "Service obligation" means the contractual obligation

 

 8  undertaken by an individual under section 2705 or section 2707 to

 

 9  provide health care services for a determinable time period at a

 

10  site designated by the department.

 

11        Sec. 5119. (1) An individual applying for a marriage license

 

12  shall be advised through the distribution of written educational

 

13  materials by the county clerk regarding prenatal care and the

 

14  transmission and prevention of venereal disease and HIV

 

15  infection. The written educational materials shall describe the

 

16  availability to the applicant of tests for both venereal disease

 

17  and HIV infection. The information shall include a list of

 

18  locations where HIV counseling and testing services funded by the

 

19  department are available. The written educational materials shall

 

20  be approved or prepared by the department.

 

21        (2) A county clerk shall not issue a marriage license to an

 

22  applicant who fails to sign and file with the county clerk an

 

23  application for a marriage license that includes a statement with

 

24  a check-off box indicating that the applicant has received the

 

25  educational materials regarding the transmission and prevention

 

26  of both venereal disease and HIV infection and has been advised

 

27  of testing for both venereal disease and HIV infection, pursuant

 

 1  to subsection (1).

 

 2        (3) If either applicant for a marriage license undergoes a

 

 3  test for HIV or an antibody to HIV, and if the test results

 

 4  indicate that an applicant is HIV infected, the physician or a

 

 5  his or her designee, of the physician, the physician's assistant,

 

 6  the certified nurse midwife, or the certified nurse practitioner,

 

 7  or the clinical nurse specialist–certified or the local health

 

 8  officer or his or her designee of the local health officer

 

 9  administering the test immediately shall inform both applicants

 

10  of the test results, and shall counsel both applicants regarding

 

11  the modes of HIV transmission, the potential for HIV transmission

 

12  to a fetus, and protective measures.

 

13        (4) As used in this section:

 

14        (a) "Certified nurse midwife" means an individual licensed

 

15  as a registered professional nurse under part 172 who has been

 

16  issued a specialty certification in the practice of nurse

 

17  midwifery by the board of nursing under section 17210.that term

 

18  as defined in section 17201.

 

19        (b) "Certified nurse practitioner" means an individual

 

20  licensed as a registered professional nurse under part 172 who

 

21  has been issued a specialty certification as a nurse practitioner

 

22  by the board of nursing under section 17210.that term as defined

 

23  in section 17201.

 

24        (c) "Clinical nurse specialist-certified" means that term as

 

25  defined in section 17201.

 

26        (d) (c) "Physician" means an individual licensed as a

 

27  physician under part 170 or an osteopathic physician under part

 

 1  175.

 

 2        (e) (d) "Physician's assistant" means an individual licensed

 

 3  as a physician's assistant under part 170 or part 175.

 

 4        Sec. 16125. (1) A The majority of the members of a licensing

 

 5  board shall be composed of a majority of members licensed in the

 

 6  health profession which that the board licenses. The board shall

 

 7  include at least 1 public member. The director shall be is an ex

 

 8  officio member without vote, but is not a member for the purposes

 

 9  of section 5 of article 5 V of the state constitution of 1963 or

 

10  for determining a quorum. If a licensed health profession

 

11  subfield is created by under this article, the board shall

 

12  include at least 1 licensee from each subfield.

 

13        (2) If a health profession subfield task force is created by

 

14  under this article, 1 licensee from each subfield so appointed to

 

15  the board under subsection (1) shall also be appointed as a

 

16  member of the health profession subfield task force. If Except as

 

17  otherwise provided in section 17221a, if a certified health

 

18  profession specialty field task force is created by under this

 

19  article, 1 member of the board holding a license other than a

 

20  health profession subfield license shall also be appointed to the

 

21  specialty field task force.

 

22        Sec. 16161. (1) If a health profession subfield task force

 

23  is created for a health profession, that task force shall serve

 

24  as the task force for all health profession subfields within the

 

25  scope of practice of the health profession and shall function as

 

26  set forth in this part.

 

27        (2) If Except as otherwise provided in this subsection, if a

 

 1  health profession specialty field task force is created for a

 

 2  health profession, that task force shall serve as the task force

 

 3  for all health profession specialty fields within the scope of

 

 4  practice of the health profession and shall function as set forth

 

 5  in this part. This subsection does not apply to the advanced

 

 6  practice registered nurse task force created in section 17221a.

 

 7        Sec. 16163. A Except as otherwise provided in section

 

 8  17221a, a task force shall recommend to the board as to:

 

 9        (a) Determination of standards of education, training, and

 

10  experience required for practice in a health profession subfield

 

11  or for registration in a health profession specialty field, and,

 

12  where appropriate, guidelines for approval of educational

 

13  programs for the health profession subfield or health profession

 

14  specialty field.

 

15        (b) Qualifications required of applicants for licensure in

 

16  health profession subfields or for registration in health

 

17  profession specialty fields.

 

18        (c) Evaluation of qualifications for initial and continuing

 

19  licensure of practitioners in health profession subfields or

 

20  health profession specialty fields. The evaluation may cover

 

21  assessment of educational credentials, work experience and

 

22  related training, and administration of tests and examinations.

 

23        (d) Guidelines for utilization of, and standards of practice

 

24  for, licensees in health profession subfields or registrants in

 

25  health profession specialty fields.

 

26        Sec. 16216. (1) The Except as otherwise provided in this

 

27  subsection, the chair of each board or task force shall appoint 1

 

 1  or more disciplinary subcommittees for that board or task force.

 

 2  A disciplinary subcommittee for a board or task force shall must

 

 3  consist of 2 public members and 3 professional members from the

 

 4  board or task force. The chair of a board or task force shall not

 

 5  serve as a member of a disciplinary subcommittee.This subsection

 

 6  does not apply to the advanced practice registered nurse task

 

 7  force created in section 17221a.

 

 8        (2) A final decision of the a disciplinary subcommittee

 

 9  finding a violation of this article, article 7, or article 8

 

10  shall be by requires a majority vote of the members appointed and

 

11  serving on the disciplinary subcommittee.

 

12        (3) A final decision of the a disciplinary subcommittee

 

13  imposing a sanction under this article, article 7, or article 8

 

14  or a final decision of the a disciplinary subcommittee other than

 

15  a final decision described in subsection (2) requires a majority

 

16  vote of the members appointed to and serving on the disciplinary

 

17  subcommittee with an affirmative vote by at least 1 public

 

18  member.

 

19        (4) The Except as otherwise provided in this subsection, the

 

20  chair of a board or task force shall appoint a public member of

 

21  the disciplinary subcommittee as the chairperson of each that

 

22  disciplinary subcommittee. shall be a public member and shall be

 

23  appointed by the chair of the board or task force.The chair of a

 

24  board or task force shall not serve as a member of the

 

25  disciplinary subcommittee of that board or task force. This

 

26  subsection does not apply to the advanced practice registered

 

27  nurse task force created in section 17221a.

 

 1        (5) The department may review a final decision of the a

 

 2  disciplinary subcommittee within 30 days after the date of the

 

 3  disciplinary subcommittee's decision. If the department

 

 4  determines that the action taken by the a disciplinary

 

 5  subcommittee does not protect the health, safety, and welfare of

 

 6  the public, the department, with the approval of the board chair,

 

 7  may set aside the decision of the disciplinary subcommittee and

 

 8  issue a different final action. The final action of the

 

 9  department shall serve serves as the final action on the matter

 

10  and is subject to judicial review in the same manner as the final

 

11  decision of the disciplinary subcommittee.

 

12        (6) Beginning January 1, 2015, the department shall include

 

13  on its public licensing and registration website each final

 

14  decision where that imposes disciplinary action is taken against

 

15  a licensee or registrant, including the reason for and

 

16  description of that disciplinary action.

 

17        Sec. 16231. (1) A person or governmental entity that

 

18  believes that a violation of this article, article 7, or article

 

19  8 or a rule promulgated under this article, article 7, or article

 

20  8 exists may submit an allegation of that fact to the department

 

21  in writing.

 

22        (2) Subject to subsection (3), if the department determines

 

23  after reviewing an application or an allegation or a licensee's

 

24  or registrant's file under section 16211(4) that there is a

 

25  reasonable basis to believe that a violation of this article,

 

26  article 7, or article 8 or a rule promulgated under this article,

 

27  article 7, or article 8 exists, 1 of the following applies:

 

 1        (a) Unless subdivision (b) applies, subject to subsection

 

 2  (10), with the authorization of a panel of at least 3 board

 

 3  members that includes the chair and at least 2 other members of

 

 4  the appropriate board or task force designated by the chair, the

 

 5  department shall investigate the alleged violation. Subject to

 

 6  subsection (10), if the panel fails to grant or deny

 

 7  authorization within 7 days after the board or task force

 

 8  receives a request for authorization, the department shall

 

 9  investigate. If the department believes that immediate jeopardy

 

10  exists, the director or his or her designee shall authorize an

 

11  investigation and notify the board chair of that investigation

 

12  within 2 business days.

 

13        (b) If it reviews an allegation in writing under subsection

 

14  (1) that concerns a licensee or registrant whose record created

 

15  under section 16211 includes 1 substantiated allegation, or 2 or

 

16  more written investigated allegations, from 2 or more different

 

17  individuals or entities, received in the preceding 4 years, the

 

18  department shall investigate the alleged violation. Authorization

 

19  by a panel described in subdivision (a) is not required for an

 

20  investigation by the department under this subdivision.

 

21        (3) If a person or governmental entity submits a written

 

22  allegation under subsection (1) more than 4 years after the date

 

23  of the incident or activity that is the basis of the alleged

 

24  violation, the department may investigate the alleged violation

 

25  in the manner described in subsection (2)(a) or (b), as

 

26  applicable, but is not required to conduct an investigation under

 

27  subsection (2)(a) or (b).

 

 1        (4) If it receives information reported under section

 

 2  16243(2) that indicates 3 or more malpractice settlements,

 

 3  awards, or judgments against a licensee in a period of 5

 

 4  consecutive years or 1 or more malpractice settlements, awards,

 

 5  or judgments against a licensee totaling more than $200,000.00 in

 

 6  a period of 5 consecutive years, whether or not a judgment or

 

 7  award is stayed pending appeal, the department shall investigate.

 

 8        (5) At any time during an investigation or following the

 

 9  issuance of a complaint, the department may schedule a compliance

 

10  conference under section 92 of the administrative procedures act

 

11  of 1969, MCL 24.292. The conference may include the applicant,

 

12  licensee, registrant, or individual; , the applicant's,

 

13  licensee's, registrant's, or individual's attorney; , 1 member of

 

14  the department's staff; , and any other individuals approved by

 

15  the department. One member of the appropriate board or task force

 

16  who is not a member of the disciplinary subcommittee with

 

17  jurisdiction over the matter, or a member of the task force if

 

18  the disciplinary subcommittee with jurisdiction is the advanced

 

19  practice registered nurse task force created in section 17221a,

 

20  may attend the conference and provide any assistance that is

 

21  needed. At the compliance conference, the department shall

 

22  attempt to reach agreement. If an agreement is reached, the

 

23  department shall submit a written statement outlining the terms

 

24  of the agreement, or a stipulation and final order, if

 

25  applicable, or a request for dismissal to the appropriate

 

26  disciplinary subcommittee for approval. If the agreement or

 

27  stipulation and final order or request for dismissal is rejected

 

 1  by the disciplinary subcommittee, or if no agreement is reached,

 

 2  the department shall schedule a hearing before an administrative

 

 3  law judge. A party shall not make a transcript of the compliance

 

 4  conference. All records and documents of a compliance conference

 

 5  held before a complaint is issued are subject to section 16238.

 

 6        (6) Within 90 days after an investigation is initiated under

 

 7  subsection (2), (3), or (4), the department shall do 1 or more of

 

 8  the following:

 

 9        (a) Issue a formal complaint.

 

10        (b) Conduct a compliance conference under subsection (5).

 

11        (c) Issue a summary suspension.

 

12        (d) Issue a cease and desist order.

 

13        (e) Dismiss the allegation.

 

14        (f) Place in the complaint file not more than 1 written

 

15  extension of not more than 30 days to take action under this

 

16  subsection.

 

17        (7) Unless the person submitting an allegation under

 

18  subsection (1) otherwise agrees in writing, the department shall

 

19  keep the identity of a person that submitted the allegation

 

20  confidential until disciplinary proceedings under this part are

 

21  initiated against the subject of the allegation and the person

 

22  that made the allegation is required to testify in the

 

23  proceedings.

 

24        (8) The department shall serve a complaint under section

 

25  16192. The department shall include in the complaint a notice

 

26  that the applicant, licensee, registrant, or individual who is

 

27  the subject of the complaint has 30 days from the date of receipt

 

 1  to respond in writing to the complaint.

 

 2        (9) The department shall treat the failure of an applicant,

 

 3  licensee, registrant, or individual to respond to a complaint

 

 4  within the 30-day period set forth in subsection (8) as an

 

 5  admission of the allegations contained in the complaint. The

 

 6  department shall notify the appropriate disciplinary subcommittee

 

 7  of the individual's failure to respond and shall forward a copy

 

 8  of the complaint to that disciplinary subcommittee. The

 

 9  disciplinary subcommittee may then impose an appropriate sanction

 

10  under this article, article 7, or article 8.

 

11        (10) All of the following apply for purposes of subsection

 

12  (2)(a):

 

13        (a) If the chair of the board or task force has a conflict

 

14  of interest, he or she shall appoint another member of the board

 

15  or task force as his or her designee and shall not participate in

 

16  the panel's decision to grant or deny authorization to the

 

17  department to investigate an individual.

 

18        (b) A member of the board or task force shall not

 

19  participate in the panel's decision to grant or deny

 

20  authorization to the department to investigate an individual if

 

21  that member has a conflict of interest. If the chair of the board

 

22  or task force is notified that a member of the panel has a

 

23  conflict of interest, the chair shall remove him or her from the

 

24  panel and appoint another member of the board or task force to

 

25  serve on the panel.

 

26        (c) A member of the board or task force who participates in

 

27  or is requested to participate in the panel's decision to grant

 

 1  or deny authorization to the department to investigate an

 

 2  individual shall disclose to the department, to the chair of the

 

 3  board or task force, and to the other member of the panel a

 

 4  potential conflict of interest before those participants make

 

 5  that decision.

 

 6        (11) As used in subsection (10), "conflict of interest"

 

 7  means any of the following:

 

 8        (a) Has a personal or financial interest in the outcome of

 

 9  the investigation of or the imposition of disciplinary sanctions

 

10  on the licensee, registrant, or applicant for licensure or

 

11  registration.

 

12        (b) Had a past or has a present business or professional

 

13  relationship with the individual that the department is

 

14  investigating or requesting authorization to investigate.

 

15        (c) Has given expert testimony in a medical malpractice

 

16  action against or on behalf of the individual that the department

 

17  is seeking authorization to investigate.

 

18        (d) Any other interest or relationship designated as a

 

19  conflict of interest in a rule promulgated or order issued under

 

20  this act.

 

21        Sec. 16231a. (1) If an agreement is not reached at a

 

22  compliance conference held under section 16231(4), 16231(5), or

 

23  if an agreement is reached but is rejected by a disciplinary

 

24  subcommittee and the parties do not reach a new agreement, the

 

25  department shall hold a hearing before a hearings examiner

 

26  employed by or under contract to the department. If an agreement

 

27  is reached but is rejected by the disciplinary subcommittee, the

 

 1  department shall not hold another compliance conference, but may

 

 2  continue to try and to reach a new agreement. The hearings

 

 3  examiner shall conduct the hearing within 60 days after the

 

 4  compliance conference at which an agreement is not reached or

 

 5  after the agreement is rejected by the disciplinary subcommittee,

 

 6  unless a new agreement is reached and approved by the

 

 7  disciplinary subcommittee. One member of the appropriate board or

 

 8  task force who is not a member of the disciplinary subcommittee

 

 9  with jurisdiction over the matter, or a member of the task force

 

10  if the disciplinary subcommittee with jurisdiction is the

 

11  advanced practice registered nurse task force created in section

 

12  17221a, may attend the hearing and provide such any assistance as

 

13  that is needed.

 

14        (2) The hearings examiner shall determine if there are

 

15  grounds for disciplinary action under section 16221 or if the

 

16  applicant, licensee, or registrant has violated this article,

 

17  article 7, or article 8 or the rules promulgated under this

 

18  article, article 7, or article 8. The hearings examiner shall

 

19  prepare recommended findings of fact and conclusions of law for

 

20  transmittal to the appropriate disciplinary subcommittee. The

 

21  hearings examiner shall not recommend or impose penalties.

 

22        (3) The applicant, licensee, or registrant who is the

 

23  subject of the complaint or the department of attorney general

 

24  may request and be granted not more than 1 continuance by the

 

25  hearings examiner for good cause shown.

 

26        (4) The applicant, licensee, or registrant may be

 

27  represented at the hearing by legal counsel. The department shall

 

 1  be represented at the hearing by an assistant attorney general

 

 2  from the department of attorney general. The assistant attorney

 

 3  general shall not be the same individual assigned by the

 

 4  department of attorney general to provide legal counsel to the

 

 5  board or the special assistant attorney general described in

 

 6  section 16237.

 

 7        (5) Unless a continuance has been is granted under

 

 8  subsection (3), failure of an applicant, licensee, or registrant

 

 9  to appear or be represented at a scheduled hearing shall be

 

10  treated by the hearings examiner as a default and an admission of

 

11  the allegations contained in the complaint. The hearings examiner

 

12  shall notify the appropriate disciplinary subcommittee of the

 

13  individual's failure to appear and forward a copy of the

 

14  complaint and any other relevant records to the disciplinary

 

15  subcommittee. The disciplinary subcommittee may then impose an

 

16  appropriate sanction under any combination of this article,

 

17  article 7, or article 8.

 

18        Sec. 16315. (1) The health professions regulatory fund is

 

19  established in the state treasury. Except as otherwise provided

 

20  in this section, the state treasurer shall credit the fees

 

21  collected under sections 16319 to 16349 to the health professions

 

22  regulatory fund. The department shall expend money in the health

 

23  professions regulatory fund, shall be expended upon

 

24  appropriation, only as provided in subsection (5).(3).

 

25        (2) The state treasurer shall direct the investment of the

 

26  health professions regulatory fund. Interest The state treasurer

 

27  shall credit to the health professions regulatory fund interest

 

 1  and earnings from health professions regulatory fund

 

 2  investment shall be credited to the health professions regulatory

 

 3  fund.

 

 4        (3) The unencumbered balance investments. Money in the

 

 5  health professions regulatory fund at the close of the fiscal

 

 6  year shall must remain in the health professions regulatory fund

 

 7  and shall does not revert to the general fund.

 

 8        (4) The health professions regulatory fund state treasurer

 

 9  may receive gifts and devises and other money as provided by law

 

10  for deposit into the health professions regulatory fund. The

 

11  department is the administrator of the health professions

 

12  regulatory fund for auditing purposes.

 

13        (3) (5) The department shall use expend money from the

 

14  health professions regulatory fund, upon appropriation, to carry

 

15  out its powers and duties under this article, article 7, and

 

16  article 8, including, but not limited to, reimbursing the

 

17  department of attorney general for the reasonable cost of

 

18  services provided to the department under this article, article

 

19  7, and article 8.

 

20        (4) (6) The nurse professional fund is established in the

 

21  state treasury. Of the money that is attributable to per-year

 

22  license fees collected under section 16327, the state treasurer

 

23  shall credit $8.00 of each individual annual license fee

 

24  collected to the nurse professional fund. The department shall

 

25  expend money in from the nurse professional fund, shall be

 

26  expended upon appropriation, only as provided in subsection

 

27  (9).(6).

 

 1        (5) (7) The state treasurer shall direct the investment of

 

 2  the nurse professional fund, and shall credit to the fund

 

 3  interest and earnings from the investment to the nurse

 

 4  professional fund investments. The nurse professional fund state

 

 5  treasurer may receive gifts and devises and other money as

 

 6  provided by law for deposit into the nurse professional fund. The

 

 7  department is the administrator of the nurse professional fund

 

 8  for auditing purposes.

 

 9        (8) The unencumbered balance Money in the nurse professional

 

10  fund at the close of the fiscal year shall must remain in the

 

11  nurse professional fund and shall does not revert to the general

 

12  fund.

 

13        (6) (9) The department of community health shall use expend

 

14  money from the nurse professional fund, each fiscal year upon

 

15  appropriation, only as follows:

 

16        (a) To promote safe patient care in all nursing practice

 

17  environments.

 

18        (b) To advance the safe practice of the nursing profession.

 

19        (c) To assure a continuous supply of high-quality direct

 

20  care nurses, nursing faculty, and nursing education programs.

 

21        (d) To operate a nursing scholarship program.

 

22        (7) (10) The pain management education and controlled

 

23  substances electronic monitoring and antidiversion fund is

 

24  established in the state treasury.

 

25        (11) The state treasurer shall direct the investment of the

 

26  pain management education and controlled substances electronic

 

27  monitoring and antidiversion fund. Interest The state treasurer

 

 1  shall credit to the pain management education and controlled

 

 2  substances electronic monitoring and antidiversion fund interest

 

 3  and earnings from investment of the pain management education and

 

 4  controlled substances electronic monitoring and antidiversion

 

 5  fund shall be credited to the pain management education and

 

 6  controlled substances electronic monitoring and antidiversion

 

 7  fund investments. The state treasurer is the administrator of the

 

 8  pain management education and controlled substances electronic

 

 9  monitoring and antidiversion fund for auditing purposes.

 

10        (8) (12) The unencumbered balance Money in the pain

 

11  management education and controlled substances electronic

 

12  monitoring and antidiversion fund at the close of the fiscal year

 

13  shall must remain in the pain management education and controlled

 

14  substances electronic monitoring and antidiversion fund and shall

 

15  does not revert to the general fund. The pain management

 

16  education and controlled substances electronic monitoring and

 

17  antidiversion fund state treasurer may receive gifts and devises

 

18  and other money as provided by law for deposit into the pain

 

19  management education and controlled substances electronic

 

20  monitoring and antidiversion fund. Twenty dollars of the From

 

21  each license fee received by the department under section 16319,

 

22  the department shall be deposited deposit $20.00 with the state

 

23  treasurer to the credit of the pain management education and

 

24  controlled substances electronic monitoring and antidiversion

 

25  fund. The department shall use expend money from the pain

 

26  management education and controlled substances electronic

 

27  monitoring and antidiversion fund, upon appropriation, only in

 

 1  connection with programs relating to pain management education

 

 2  for health professionals, preventing the diversion of controlled

 

 3  substances, and development and maintenance of the electronic

 

 4  monitoring system for controlled substances data required by

 

 5  section 7333a.

 

 6        (9) The a.p.r.n. health resource shortage area fund is

 

 7  established in the state treasury. Of the money that is

 

 8  attributable to per-year license fees collected under section

 

 9  16327(2), the state treasurer shall credit $10.00 of each

 

10  individual annual license fee collected to the a.p.r.n. health

 

11  resource shortage area fund. The department shall expend money

 

12  from the a.p.r.n. health resource shortage area fund, upon

 

13  appropriation, only as provided in subsection (11).

 

14        (10) The state treasurer shall direct the investment of the

 

15  a.p.r.n. health resource shortage area fund, and shall credit to

 

16  the fund interest and earnings from fund investments. The state

 

17  treasurer may receive gifts and devises and other money as

 

18  provided by law for deposit into the a.p.r.n. health resource

 

19  shortage area fund. The department is the administrator of the

 

20  a.p.r.n. health resource shortage area fund for auditing

 

21  purposes. Money in the a.p.r.n. health resource shortage area

 

22  fund at the close of the fiscal year must remain in the a.p.r.n.

 

23  health resource shortage area fund and does not revert to the

 

24  general fund.

 

25        (11) The department, at the discretion of and under the

 

26  direction of the Michigan board of nursing, shall expend money

 

27  from the a.p.r.n. health resource shortage area fund, upon

 

 1  appropriation, to provide grants to advanced practice registered

 

 2  nurses who, after the effective date of the amendatory act that

 

 3  added this subsection, begin employment to engage in the practice

 

 4  of advanced practice registered nursing in a health resource

 

 5  shortage area designated by the department under section 2717. As

 

 6  used in this subsection, "advanced practice registered nurse" and

 

 7  "practice of advanced practice registered nursing" mean those

 

 8  terms as defined in section 17201.

 

 9        Sec. 16327. (1) Fees for a person an individual licensed or

 

10  seeking licensure to practice nursing as a registered

 

11  professional nurse, a licensed practical nurse, or a trained

 

12  attendant under part 172 are as follows:

 

 

13        (a)    Application processing fee........... $ 24.00

14        (b)    License fee, per year................   30.00

15        (c)    Temporary license....................   10.00

16        (d)    Limited license, per year............   10.00

17        (e)    Specialty certification

18               for registered nurse:

19        (i)    Application processing fee...........   24.00

20        (ii)    Specialty certification, per year....   14.00

 

 

21        (2) Subject to subsection (3), fees for an individual who

 

22  seeks or holds a license as an advanced practice registered nurse

 

23  under part 172 are as follows:

 

 

24        (a)    Application processing fee........... $ 32.00

25        (b)    License fee, per year................   65.00

 

 

 1        (3) The department and the advanced practice registered

 

 2  nurse task force created in section 17221a shall review the fees

 

 3  under subsection (2) every 2 years, and the department may, by

 

 4  rule and with the consent of the task force, adjust the fees to

 

 5  reflect the actual costs and expenses of the department in

 

 6  issuing advanced practice registered nurse licenses and

 

 7  administering that licensing program.

 

 8        Sec. 17201. (1) As used in this part:

 

 9        (a) "Advanced practice registered nurse" or "a.p.r.n." means

 

10  an individual who is licensed under this part as a certified

 

11  nurse midwife, certified nurse practitioner, or clinical nurse

 

12  specialist-certified.

 

13        (b) "Certified nurse midwife" or "c.n.m." means an

 

14  individual who meets all of the following:

 

15        (i) Is a registered professional nurse.

 

16        (ii) Is also licensed under this part as a certified nurse

 

17  midwife and meets the requirements of section 17210a applicable

 

18  to that license.

 

19        (c) "Certified nurse practitioner" or "c.n.p." means an

 

20  individual who meets all of the following:

 

21        (i) Is a registered professional nurse.

 

22        (ii) Is also licensed under this part as a certified nurse

 

23  practitioner and meets the requirements of section 17210a

 

24  applicable to that license.

 

25        (d) "Clinical nurse specialist-certified" or "c.n.s.-c."

 

26  means an individual who meets all of the following:

 

27        (i) Is a registered professional nurse.

 

 1        (ii) Is also licensed under this part as a clinical nurse

 

 2  specialist-certified and meets the requirements of section 17210a

 

 3  applicable to that license.

 

 4        (e) "Mentorship agreement" means a written agreement that

 

 5  meets all of the following:

 

 6        (i) Is between an advanced practice registered nurse and a

 

 7  physician who is licensed under part 170 or 175 and, if

 

 8  applicable, holds a controlled substances license under part 73,

 

 9  or between the advanced practice registered nurse and another

 

10  a.p.r.n. who holds the same license under this part, has at least

 

11  5 years of work experience in that licensed profession, and, if

 

12  applicable, holds a controlled substances license under part 73,

 

13  and concerns engaging in the practice of advanced practice

 

14  registered nursing and, if applicable, the possession,

 

15  prescription, and administration of nonscheduled prescription

 

16  drugs and controlled substances included in schedules 2 to 5 of

 

17  part 72 by the advanced practice registered nurse.

 

18        (ii) Includes the responsibilities and duties of each party

 

19  to the agreement.

 

20        (iii) Is for a term of 1 year and may be renewed by the

 

21  parties for 1 or more additional 1-year periods.

 

22        (iv) Is revocable by either party to the agreement, by

 

23  providing written notice to the other party at least 30 days

 

24  before the date of the revocation.

 

25        (v) Is signed by each of the parties to the agreement.

 

26        (f) "Practice of advanced practice registered nursing" means

 

27  doing any of the following tasks, functions, or duties, as

 

 1  applicable:

 

 2        (i) In his or her practice as a certified nurse midwife,

 

 3  within the parameters of his or her education, training, and

 

 4  national certification, focusing on health care services for

 

 5  women throughout their lifespan, including comprehensive

 

 6  maternity care that includes prenatal care, childbirth in diverse

 

 7  settings, postpartum care, and care of newborns who are 28 days

 

 8  old or younger; gynecological, reproductive, and contraceptive

 

 9  care; physical exams; diagnosis and treatment of common health

 

10  problems with consultation or referral as indicated; prescribing

 

11  pharmacological and nonpharmacological interventions and

 

12  treatments; and treatment of male partners for sexually

 

13  transmitted infection and reproductive health.

 

14        (ii) In his or her practice as a certified nurse

 

15  practitioner, within the parameters of his or her education,

 

16  training, and national certification, focusing on the performance

 

17  of comprehensive assessments; providing physical examinations and

 

18  other health assessments and screening activities; and

 

19  diagnosing, treating, and managing patients with acute and

 

20  chronic illnesses and diseases. The tasks, functions, or duties

 

21  performed by a c.n.p. include ordering, performing, supervising,

 

22  and interpreting laboratory and imaging studies; prescribing

 

23  pharmacological and nonpharmacological interventions and

 

24  treatments that are within the c.n.p.'s specialty role and scope

 

25  of practice; health promotion; disease prevention; health

 

26  education; and counseling of patients and families with

 

27  potential, acute, and chronic health disorders.

 

 1        (iii) In his or her practice as a clinical nurse specialist-

 

 2  certified, within the parameters of his or her education,

 

 3  training, and national certification, focusing on continuous

 

 4  improvement of patient outcomes and nursing care with broad focus

 

 5  across the areas of direct patient care, patient education,

 

 6  nursing education, nursing practice, and organizational systems.

 

 7  The tasks, functions, or duties performed by a c.n.s.-c. include

 

 8  being responsible and accountable for diagnosis, intervention,

 

 9  and treatment of health or illness states, and disease

 

10  management, including the use and prescription of pharmacological

 

11  and nonpharmacological intervention and treatment within his or

 

12  her specialty and scope of practice; health promotion; and

 

13  prevention of illness and risk behavior among individuals,

 

14  families, groups, and communities. The c.n.s.-c. evaluates

 

15  patient outcomes; translates evidence into practice; and

 

16  develops, plans, coordinates, and directs programs of care for

 

17  acute and chronically ill patients and their families.

 

18        (g) (a) "Practice of nursing" means the systematic

 

19  application of substantial specialized knowledge and skill,

 

20  derived from the biological, physical, and behavioral sciences,

 

21  to the care, treatment, counsel, and health teaching of

 

22  individuals who are experiencing changes in the normal health

 

23  processes or who require assistance in the maintenance of health

 

24  and the prevention or management of illness, injury, or

 

25  disability.

 

26        (h) (b) "Practice of nursing as a licensed practical nurse"

 

27  or "l.p.n." means the practice of nursing based on less

 

 1  comprehensive knowledge and skill than that required of a

 

 2  registered professional nurse and performed under the supervision

 

 3  of a registered professional nurse, physician, or dentist.

 

 4        (i) (c) "Registered professional nurse" or "r.n." means an

 

 5  individual licensed under this article part to engage in the

 

 6  practice of nursing, which scope of practice includes the

 

 7  teaching, direction, and supervision of less skilled personnel in

 

 8  the performance of delegated nursing activities.

 

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

 

10  contains general definitions and principles of construction

 

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

 

12  definitions applicable to this part.

 

13        Sec. 17202. (1) To engage in the practice of advanced

 

14  practice registered nursing, an a.p.r.n. shall meet any of the

 

15  following:

 

16        (a) For at least 4 years, he or she has held a national

 

17  certification as a nurse midwife, nurse practitioner, or clinical

 

18  nurse specialist-certified; a specialty certification in the

 

19  practice of nurse midwifery or nurse practitioner under section

 

20  17210 before the effective date of the amendatory act that added

 

21  section 17210a; or an advanced practice registered nurse license

 

22  issued under this part and he or she provides written

 

23  documentation of that certification or licensure to the board.

 

24        (b) If he or she does not meet any of the 4-year

 

25  certification or licensure requirements described in subdivision

 

26  (a), he or she has engaged in the practice of advanced practice

 

27  registered nursing and, if applicable, possessed, prescribed, or

 

 1  administered nonscheduled prescription drugs and controlled

 

 2  substances included in schedules 2 to 5 of part 72 within the

 

 3  parameters of his or her education, training, and national

 

 4  certification under the terms of 1 or more mentorship agreements

 

 5  for a total period of 4 years.

 

 6        (c) If he or she does not meet any of the 4-year

 

 7  certification or licensure requirements described in subdivision

 

 8  (a) or the 4-year mentorship agreement requirement described in

 

 9  subdivision (b), he or she only engages in the practice of

 

10  advanced practice registered nursing and, if applicable,

 

11  possesses, prescribes, or administers nonscheduled prescription

 

12  drugs and controlled substances included in schedules 2 to 5 of

 

13  part 72 within the parameters of his or her education, training,

 

14  and national certification under the terms of a mentorship

 

15  agreement and in collaboration with a physician or, if

 

16  applicable, a dispensing prescriber.

 

17        (2) An advanced practice registered nurse shall do all of

 

18  the following:

 

19        (a) Provide those functions common to the population for

 

20  which advanced practice registered nurses are educationally and

 

21  experientially prepared.

 

22        (b) Comply with the standards established by the board of

 

23  nursing and with the national accreditation standards of the

 

24  national professional nursing associations applicable to his or

 

25  her license.

 

26        (c) Consult with other health professionals, as appropriate,

 

27  or refer a patient to other health professionals if the patient's

 

 1  care is outside of the parameters of his or her education,

 

 2  training, or national certification.

 

 3        (d) Supervise registered professional nurses, licensed

 

 4  practical nurses, and other health professionals as appropriate.

 

 5        (3) As a condition of licensure under this part, an a.p.r.n.

 

 6  shall not own or organize a for-profit entity for the purpose of

 

 7  providing services as an advanced practice registered nurse

 

 8  directly to the general public after the effective date of the

 

 9  amendatory act that added this section. An a.p.r.n. who owns or

 

10  organizes a for-profit entity for the purpose of providing

 

11  services as an advanced practice registered nurse directly to the

 

12  general public after the effective date of the amendatory act

 

13  that added this section is in violation of a general duty of this

 

14  article as provided in section 16221(a).

 

15        (4) In addition to the requirements of sections 17210a and

 

16  17213, the department shall include on a form used for a new or

 

17  renewal license a space for an a.p.r.n. to certify that he or she

 

18  did not own or organize a for-profit entity for the purpose of

 

19  providing services as an advanced practice registered nurse

 

20  directly to the general public after the effective date of the

 

21  amendatory act that added this subsection.

 

22        (5) As used in this section:

 

23        (a) "Corporation" means a corporation, other than a

 

24  professional corporation, formed under the business corporation

 

25  act, 1972 PA 284, MCL 450.1101 to 450.2098.

 

26        (b) "For-profit entity" means a for-profit corporation, a

 

27  for-profit limited liability company, a for-profit professional

 

 1  limited liability company, or a for-profit professional

 

 2  corporation.

 

 3        (c) "Limited liability company" means an entity, other than

 

 4  a professional limited liability company, that is an

 

 5  unincorporated membership organization formed under the Michigan

 

 6  limited liability company act, 1993 PA 23, MCL 450.4101 to

 

 7  450.5200.

 

 8        (d) "Professional corporation" means a professional

 

 9  corporation incorporated under the business corporation act, 1972

 

10  PA 284, MCL 450.1101 to 450.2098, that is subject to chapter 2a

 

11  of the business corporation act, 1972 PA 284, MCL 450.1281 to

 

12  450.1289.

 

13        (e) "Professional limited liability company" means a

 

14  professional limited liability company organized under the

 

15  Michigan limited liability company act, 1993 PA 23, MCL 450.4101

 

16  to 450.5200, that is subject to article 9 of the Michigan limited

 

17  liability company act, 1993 PA 23, MCL 450.4901 to 450.4910.

 

18        Sec. 17210. The board of nursing department may issue a

 

19  specialty certification to a registered professional nurse who

 

20  has advanced training beyond that required for initial licensure

 

21  and who has demonstrated competency through examination or other

 

22  evaluative processes and who practices in 1 of the following a

 

23  health profession specialty fields: field as follows:

 

24        (a) Before the effective date of the amendatory act that

 

25  added section 17210a, nurse midwifery, nurse anesthetist, or

 

26  nurse practitioner.

 

27        (b) On and after the effective date of the amendatory act

 

 1  that added section 17210a, nurse anesthetist.

 

 2        Sec. 17210a. (1) The department shall issue a certified

 

 3  nurse midwife license under this article to a registered

 

 4  professional nurse who meets all of the following requirements:

 

 5        (a) Has completed an accredited graduate, postgraduate, or

 

 6  doctoral level nursing education program that prepares the r.n.

 

 7  for the role of certified nurse midwife.

 

 8        (b) Is certified by a nationally accredited certification

 

 9  body as demonstrating role and population-focused competencies

 

10  for certified nurse midwives, or the board determines that he or

 

11  she meets the standards for that certification.

 

12        (c) Maintains continued competence by obtaining

 

13  recertification in the role and population-focused competencies

 

14  described in subdivision (b) through the national certification

 

15  program, or the board determines that he or she meets the

 

16  standards for that recertification.

 

17        (d) Demonstrates to the satisfaction of the board that he or

 

18  she meets all of the following:

 

19        (i) Has acquired advanced clinical knowledge and skills that

 

20  primarily prepare him or her to provide direct care to patients,

 

21  and also to provide indirect care.

 

22        (ii) His or her practice builds on the competencies of

 

23  registered professional nurses by demonstrating a greater depth

 

24  and breadth of knowledge, a greater synthesis of data, increased

 

25  complexity of skills and interventions, and greater role

 

26  autonomy.

 

27        (iii) Is educationally prepared to assume responsibility and

 

 1  accountability for health promotion or maintenance and the

 

 2  assessment, diagnosis, and management of patient problems,

 

 3  including, but not limited to, the use and prescription of

 

 4  pharmacologic and nonpharmacologic interventions within the

 

 5  parameters of his or her education, training, and national

 

 6  certification.

 

 7        (iv) Has clinical experience of sufficient depth and breadth

 

 8  to perform as a licensee.

 

 9        (2) The department shall issue a certified nurse

 

10  practitioner license under this article to a registered

 

11  professional nurse who meets all of the following requirements:

 

12        (a) Has completed an accredited graduate, postgraduate, or

 

13  doctoral level nursing education program that prepares the r.n.

 

14  for the role of certified nurse practitioner.

 

15        (b) Is certified by a nationally accredited certification

 

16  body as demonstrating role and population-focused competencies

 

17  for certified nurse practitioners, or the board determines that

 

18  he or she meets the standards for that certification.

 

19        (c) Maintains continued competence by obtaining

 

20  recertification in the role and population-focused competencies

 

21  described in subdivision (b) through the national certification

 

22  program, or the board determines that he or she meets the

 

23  standards for that recertification.

 

24        (d) Demonstrates to the satisfaction of the board that he or

 

25  she meets all of the following:

 

26        (i) Has acquired advanced clinical knowledge and skills that

 

27  primarily prepare him or her to provide direct care to patients,

 

 1  and also to provide indirect care.

 

 2        (ii) His or her practice builds on the competencies of

 

 3  registered professional nurses by demonstrating a greater depth

 

 4  and breadth of knowledge, a greater synthesis of data, increased

 

 5  complexity of skills and interventions, and greater role

 

 6  autonomy.

 

 7        (iii) Is educationally prepared to assume responsibility and

 

 8  accountability for health promotion or maintenance and the

 

 9  assessment, diagnosis, and management of patient problems,

 

10  including, but not limited to, the use and prescription of

 

11  pharmacologic and nonpharmacologic interventions within the

 

12  parameters of his or her education, training, and national

 

13  certification.

 

14        (iv) Has clinical experience of sufficient depth and breadth

 

15  to perform as a licensee.

 

16        (3) The department shall issue a clinical nurse specialist-

 

17  certified license under this article to a registered professional

 

18  nurse who meets all of the following requirements:

 

19        (a) Has completed an accredited graduate, postgraduate, or

 

20  doctoral level nursing education program that prepares the r.n.

 

21  for the role of clinical nurse specialist-certified.

 

22        (b) Is certified by a nationally accredited certification

 

23  body as demonstrating role and population-focused competencies

 

24  for clinical nurse specialist-certifieds, or the board determines

 

25  that he or she meets the standards for that certification.

 

26        (c) Maintains continued competence by obtaining

 

27  recertification in the role and population-focused competencies

 

 1  described in subdivision (b) through the national certification

 

 2  program, or the board determines that he or she meets the

 

 3  standards for that recertification.

 

 4        (d) Demonstrates to the satisfaction of the board that he or

 

 5  she meets all of the following:

 

 6        (i) Has acquired advanced clinical knowledge and skills that

 

 7  primarily prepare him or her to provide direct care to patients,

 

 8  and also to provide indirect care.

 

 9        (ii) His or her practice builds on the competencies of

 

10  registered professional nurses by demonstrating a greater depth

 

11  and breadth of knowledge, a greater synthesis of data, increased

 

12  complexity of skills and interventions, and greater role

 

13  autonomy.

 

14        (iii) Is educationally prepared to assume responsibility and

 

15  accountability for health promotion or maintenance and the

 

16  assessment, diagnosis, and management of patient problems,

 

17  including, but not limited to, the use and prescription of

 

18  pharmacologic and nonpharmacologic interventions within the

 

19  parameters of his or her education, training, and national

 

20  certification.

 

21        (iv) Has clinical experience of sufficient depth and breadth

 

22  to perform as a licensee.

 

23        (4) The department shall issue an a.p.r.n. license to a

 

24  registered professional nurse who holds a specialty certification

 

25  issued by the department under section 17210(a) as a nurse

 

26  midwife or nurse practitioner, who submits a license application,

 

27  and who meets all of the following:

 

 1        (a) His or her registered professional nurse license and

 

 2  specialty certification issued by the department under section

 

 3  17210(a) is current on the effective date of the amendatory act

 

 4  that added this section.

 

 5        (b) He or she submits the license application in the 2-year

 

 6  period beginning on the effective date of the amendatory act that

 

 7  added this section.

 

 8        (c) His or her license and specialty certification issued by

 

 9  the department under section 17210(a) is current on the date he

 

10  or she submits the license application.

 

11        (d) On the date he or she submits the license application,

 

12  he or she meets any requirements for professional certification

 

13  established by the department in consultation with the board.

 

14        (5) The department shall issue a license as a clinical nurse

 

15  specialist-certified to a registered professional nurse who

 

16  submits a license application and meets all of the following:

 

17        (a) His or her registered professional nurse license is

 

18  current on the effective date of the amendatory act that added

 

19  this section and on the date he or she submits the license

 

20  application.

 

21        (b) He or she submits the license application in the 2-year

 

22  period beginning on the effective date of the amendatory act that

 

23  added this section.

 

24        (c) On the effective date of the amendatory act that added

 

25  this section and on the date he or she submits the license

 

26  application, he or she holds a current certification by a

 

27  nationally accredited certification body.

 

 1        (d) On the date he or she submits the license application,

 

 2  he or she meets any requirements for professional certification

 

 3  established by the department in consultation with the board.

 

 4        (6) The department shall renew an a.p.r.n. license under

 

 5  this part concurrently with the registered professional nurse

 

 6  license.

 

 7        Sec. 17211. (1) A person shall not engage in the practice of

 

 8  nursing, or the practice of nursing as a licensed practical

 

 9  nurse, or the practice of advanced practice registered nursing

 

10  unless licensed or otherwise authorized by this article.

 

11        (2) The following words, titles, or letters, or a

 

12  combination thereof, of the words, titles, or letters, with or

 

13  without qualifying words or phrases, are restricted in use only

 

14  to those persons authorized under this part to use the terms and

 

15  in a way prescribed in this part: "registered professional

 

16  nurse", "registered nurse", "r.n.", "licensed practical nurse",

 

17  "l.p.n.", "nurse midwife", "certified nurse midwife", "c.n.m.",

 

18  "nurse anesthetist", "nurse practitioner", "certified nurse

 

19  practitioner", "c.n.p.", "clinical nurse specialist-certified",

 

20  "c.n.s.-c.", "trained attendant", and "t.a.".

 

21        (3) In an action for malpractice or licensure removal, if an

 

22  a.p.r.n. practices as an a.p.r.n. without the supervision of a

 

23  physician, the a.p.r.n. will be held to the higher standard of

 

24  acceptable professional practice or care in the community for a

 

25  physician as if a physician had acted or failed to take the

 

26  action that the a.p.r.n. was alleged to have acted or failed to

 

27  act.

 

 1        Sec. 17211a. (1) Subject to section 17202, an advanced

 

 2  practice registered nurse who meets all of the following may

 

 3  possess, prescribe, and administer nonscheduled prescription

 

 4  drugs and controlled substances included in schedules 2 to 5 of

 

 5  part 72 within the parameters of his or her education, training,

 

 6  and national certification:

 

 7        (a) He or she has completed graduate level pharmacology,

 

 8  pathophysiology, and physical assessment courses and clinical

 

 9  practicum in the role of a certified nurse midwife, certified

 

10  nurse practitioner, or clinical nurse specialist-certified, as

 

11  applicable to his or her a.p.r.n. license.

 

12        (b) He or she has completed the number of contact hours in

 

13  pharmacology as part of the requisite continuing education for a

 

14  controlled substances license under part 73, and for renewal of

 

15  his or her license under this part as determined by the board.

 

16        (c) He or she holds a controlled substances license under

 

17  part 73.

 

18        (d) He or she meets the mentorship agreement requirements of

 

19  section 17202(1)(b) or (c) to possess, prescribe, or administer

 

20  those drugs or substances.

 

21        (e) He or she possesses, prescribes, or administers the drug

 

22  or controlled substance only while engaged in the practice of

 

23  advanced practice registered nursing within the parameters of his

 

24  or her education, training, and national certification.

 

25        (f) As required under section 7333a(2)(f), before

 

26  prescribing a controlled substance included in schedules 2 to 5

 

27  of part 72, he or she requests that the department of community

 

 1  health provide any data included in the electronic monitoring

 

 2  system established under section 7333a(1) concerning that

 

 3  controlled substance. He or she shall consider that data to

 

 4  determine if prescribing or administering the controlled

 

 5  substance to the intended individual is consistent with patient

 

 6  safety and that the controlled substance would not likely be

 

 7  subject to abuse by the individual.

 

 8        (2) For purposes of subsection (1), an advanced practice

 

 9  registered nurse who has held an a.p.r.n. license issued under

 

10  this part for a period of less than 4 years may be a party to

 

11  more than 1 mentorship agreement described in subsection (1)(d).

 

12        (3) The department shall issue a controlled substances

 

13  license under part 73 to an a.p.r.n. who applies and is qualified

 

14  under subsection (1) to possess, prescribe, and administer

 

15  nonscheduled prescription drugs and controlled substances

 

16  included in schedules 2 to 5 of part 72. The department may place

 

17  a limitation on a controlled substances license issued to an

 

18  individual described in subsection (1)(d) to reflect the terms of

 

19  any mentorship agreement to which he or she is a party.

 

20        (4) The amendatory act that added this section does not

 

21  require new or additional third-party reimbursement or mandated

 

22  worker's compensation benefits for services rendered by an

 

23  advanced practice registered nurse authorized to prescribe

 

24  nonscheduled prescription drugs and controlled substances

 

25  included in schedules 2 to 5 of part 72 under this section.

 

26        Sec. 17212. (1) In Subject to subsection (2), in addition to

 

27  acts, tasks, and functions delegated under section 16215, 17745,

 

 1  17745a, or 17745b, a supervising physician may delegate in

 

 2  writing to a registered professional nurse the ordering, receipt,

 

 3  and dispensing of complimentary starter dose drugs other than

 

 4  controlled substances as defined by in article 7 or federal law.

 

 5  When the If a delegated ordering, receipt, or dispensing of

 

 6  complimentary starter dose drugs described in this subsection

 

 7  occurs, both the registered professional nurse's name and the

 

 8  supervising physician's name shall be used, recorded, or

 

 9  otherwise indicated in connection with each order, receipt, or

 

10  dispensing. As used in this subsection, "complimentary starter

 

11  dose" means that term as defined in section 17745.

 

12        (2) An advanced practice registered nurse engaged in the

 

13  practice of advanced practice registered nursing within the

 

14  parameters of his or her education, training, and national

 

15  certification may order, receive, and dispense a complimentary

 

16  starter dose of a prescription drug or controlled substance

 

17  described in section 17211a without delegation from a supervising

 

18  physician. Only the name of the advanced practice registered

 

19  nurse shall be used, recorded, or otherwise indicated in

 

20  connection with an order, receipt, or dispensing of a

 

21  complimentary starter dose of a prescription drug or controlled

 

22  substance under this subsection.

 

23        (3) (2) It is the intent of the legislature in enacting this

 

24  section to allow a pharmaceutical manufacturer or wholesale

 

25  distributor, as those terms are defined in part 177, to

 

26  distribute complimentary starter dose drugs to a an advanced

 

27  practice registered nurse described in subsection (2), or to a

 

 1  registered professional nurse , as described in subsection (1),

 

 2  in compliance with section 503(d) of the federal food, drug, and

 

 3  cosmetic act, chapter 675, 52 Stat. 1051, 21 U.S.C. USC 353.

 

 4        Sec. 17214. (1) In addition to the requirements of any rules

 

 5  promulgated under section 16205, the board by rule may require a

 

 6  licensee seeking renewal of a license under this part to furnish

 

 7  the board with satisfactory evidence that, during the 2 years

 

 8  immediately preceding the date of his or her application for

 

 9  renewal, the licensee completed continuing education or

 

10  competency courses or activities approved by the board.

 

11        (2) If the board promulgates rules under subsection (1) or

 

12  section 16205 that require continuing education or competency

 

13  courses or activities, the board shall promulgate rules under

 

14  section 16204 that require each applicant for license renewal to

 

15  complete as part of those continuing education or competency

 

16  courses or activities an appropriate number of hours or courses

 

17  in pain and symptom management.

 

18        Sec. 17221. (1) The Michigan board of nursing is created in

 

19  the department and, beginning 60 days after the effective date of

 

20  the amendatory act that added section 17221a, shall consist of

 

21  the following 23 29 voting members who shall meet the

 

22  requirements of part 161: 9 registered professional nurses, 1 2

 

23  certified nurse midwife, 1 midwives, 2 nurse anesthetist

 

24  anesthetists, 1 2 certified nurse practitioner, practitioners, 2

 

25  clinical nurse specialists-certified, 3 licensed practical

 

26  nurses, and 8 9 public members. Three of the registered

 

27  professional nurse members shall be engaged in nursing education,

 

 1  1 of whom shall be in less than a baccalaureate program, 1 in a

 

 2  baccalaureate or higher program, and 1 in a licensed practical

 

 3  nurse program, and each of whom shall have a master's degree from

 

 4  an accredited college with a major in nursing. Three of the

 

 5  registered professional nurse members shall be engaged in nursing

 

 6  practice or nursing administration, each of whom shall have a

 

 7  baccalaureate degree in nursing from an accredited college. Three

 

 8  of the registered professional nurse members shall be engaged in

 

 9  nursing practice or nursing administration, each of whom shall be

 

10  a nonbaccalaureate registered nurse. The 3 licensed practical

 

11  nurse members shall have graduated from a state approved program

 

12  for the preparation of individuals to practice as licensed

 

13  practical nurses. The nurse midwife, the nurse anesthetist, and

 

14  the nurse practitioner Each of the certified nurse midwives,

 

15  certified nurse practitioners, and clinical nurse specialists-

 

16  certified appointed to the board shall each have a specialty

 

17  certification an a.p.r.n. license issued by the department in his

 

18  or her respective specialty field role and each of the nurse

 

19  anesthetists shall have a specialty certificate issued by the

 

20  department in that specialty field under section 17210.

 

21        (2) The terms of office of individual members of the board

 

22  created under this part, except those appointed to fill

 

23  vacancies, expire 4 years after appointment on June 30 of the

 

24  year in which the term expires.

 

25        Sec. 17221a. (1) The advanced practice registered nurse task

 

26  force is created. The task force shall consist of the following

 

27  13 members, who shall be members of the board and shall meet the

 

 1  requirements of part 161:

 

 2        (a) One registered professional nurse.

 

 3        (b) Two certified nurse midwives.

 

 4        (c) Two certified nurse practitioners.

 

 5        (d) Two clinical nurse specialists-certified.

 

 6        (e) Two nurse anesthetists certified under section 17210.

 

 7        (f) Two public members.

 

 8        (g) Two physician members.

 

 9        (2) The task force created in subsection (1) shall do all of

 

10  the following:

 

11        (a) In consultation with the department, develop and make

 

12  public guidelines on the appropriate scope of practice of an

 

13  a.p.r.n. according to his or her education, training, and

 

14  experience. Guidelines developed under this subdivision are

 

15  nonbinding and advisory and shall only express the task force's

 

16  criteria for determining whether an a.p.r.n. is practicing within

 

17  his or her scope of practice.

 

18        (b) In consultation with the department, serve as the

 

19  disciplinary subcommittee, in lieu of a disciplinary subcommittee

 

20  appointed under section 16216(1), for advanced practice

 

21  registered nurses and nurse anesthetists certified under section

 

22  17210.

 

23        (c) Make written recommendations to the board on

 

24  reinstatement of a.p.r.n. licenses and notices of intent to deny

 

25  a.p.r.n. licenses.

 

26        (d) In addition to or as part of the report required under

 

27  section 16143(2), file an annual report with the board and the

 

 1  department concerning any matters prescribed by the task force

 

 2  and board.

 

 3        Sec. 17607. (1) An individual shall not engage in the

 

 4  practice of speech-language pathology unless licensed under this

 

 5  part.

 

 6        (2) A licensee shall not perform an act, task, or function

 

 7  within the practice of speech-language pathology unless he or she

 

 8  is trained to perform the act, task, or function and the

 

 9  performance of that act, task, or function is consistent with the

 

10  rules promulgated under section 17610(3). A speech-language

 

11  pathologist shall refer a patient to a person licensed in the

 

12  practice of medicine or osteopathic medicine and surgery if signs

 

13  or symptoms identified during the practice of speech-language

 

14  pathology cause the speech-language pathologist to suspect that

 

15  the patient has an underlying medical condition.

 

16        (3) A licensee shall perform assessment, treatment or

 

17  therapy, and procedures related to swallowing disorders and

 

18  medically related communication disorders only on patients who

 

19  have been referred to him or her by a person licensed in the

 

20  practice of medicine or osteopathic medicine and surgery or by an

 

21  advanced practice registered nurse who is licensed under part 172

 

22  and engaged in the practice of advanced practice registered

 

23  nursing.

 

24        (4) Limited diagnostic testing, such as endoscopic

 

25  videolaryngostroboscopy, shall only be performed by a licensee in

 

26  collaboration with or under the supervision of a person licensed

 

27  in the practice of medicine or osteopathic medicine and surgery.

 

 1        (5) A licensee shall follow procedures in which

 

 2  collaboration among the licensee and a person licensed in the

 

 3  practice of medicine or osteopathic medicine and surgery and

 

 4  other licensed health care professionals is regarded to be in the

 

 5  best interests of the patient.

 

 6        (6) Subsection (1) does not prevent any of the following:

 

 7        (a) An individual licensed or registered under any other

 

 8  part or act from performing activities that are considered

 

 9  speech-language pathology services if those activities are within

 

10  the individual's scope of practice and if the individual does not

 

11  use the titles protected under section 17603.

 

12        (b) The practice of speech-language pathology that is an

 

13  integral part of a program of study by students enrolled in an

 

14  accredited speech-language pathology educational program approved

 

15  by the board, provided that those individuals are identified as

 

16  students and provide speech-language pathology services only

 

17  while under the supervision of a licensed speech-language

 

18  pathologist.

 

19        (c) Self-care by a patient or uncompensated care by a friend

 

20  or family member who does not represent or hold himself or

 

21  herself out to be a licensed speech-language pathologist.

 

22        Sec. 17708. (1) "Preceptor" means a pharmacist approved by

 

23  the board to direct the training of an intern in an approved

 

24  pharmacy.

 

25        (2) "Prescriber" means a licensed dentist, a licensed doctor

 

26  of medicine, a licensed doctor of osteopathic medicine and

 

27  surgery, a licensed doctor of podiatric medicine and surgery, a

 

 1  licensed optometrist certified under part 174 to administer and

 

 2  prescribe therapeutic pharmaceutical agents, a licensed advanced

 

 3  practice registered nurse who meets the requirements of section

 

 4  17211a and is engaged in the practice of advanced practice

 

 5  registered nursing, a licensed veterinarian, or another licensed

 

 6  health professional acting under the delegation and using,

 

 7  recording, or otherwise indicating the name of the delegating

 

 8  licensed doctor of medicine or licensed doctor of osteopathic

 

 9  medicine and surgery.

 

10        (3) "Prescription" means an order by a prescriber to fill,

 

11  compound, or dispense a drug or device written and signed;

 

12  written or created in an electronic format, signed, and

 

13  transmitted by facsimile; or transmitted electronically or by

 

14  other means of communication. An order transmitted in other than

 

15  written or hard-copy form shall be electronically recorded,

 

16  printed, or written and immediately dated by the pharmacist, and

 

17  that record constitutes the original prescription. In a health

 

18  facility or agency licensed under article 17 or other medical

 

19  institution, an order for a drug or device in the patient's chart

 

20  constitutes for the purposes of this definition the original

 

21  prescription. Subject to section 17751(2) and (5), prescription

 

22  includes, but is not limited to, an order for a drug, not

 

23  including a controlled substance as defined in section 7104

 

24  except under circumstances described in section 17763(e), written

 

25  and signed; written or created in an electronic format, signed,

 

26  and transmitted by facsimile; or transmitted electronically or by

 

27  other means of communication by a physician prescriber or dentist

 

 1  prescriber licensed to practice dentistry, medicine, or

 

 2  osteopathic medicine and surgery in a state other than Michigan.

 

 3        (4) "Prescription drug" means 1 or more of the following:

 

 4        (a) A drug dispensed pursuant to a prescription.

 

 5        (b) A drug bearing the federal legend "CAUTION: federal law

 

 6  prohibits dispensing without prescription" or "Rx only".

 

 7        (c) A drug designated by the board as a drug that may only

 

 8  be dispensed pursuant to a prescription.

 

 9        Sec. 17745. (1) Except as otherwise provided in this

 

10  subsection, a prescriber, except an advanced practice registered

 

11  nurse, who wishes to dispense prescription drugs shall obtain

 

12  from the board a drug control license for each location in which

 

13  the storage and dispensing of prescription drugs occur. A drug

 

14  control license is not necessary if the dispensing occurs in the

 

15  emergency department, emergency room, or trauma center of a

 

16  hospital licensed under article 17 or if the dispensing involves

 

17  only the issuance of complimentary starter dose drugs.

 

18        (2) Except as otherwise authorized for expedited partner

 

19  therapy in section 5110 or as provided in section 17744a or

 

20  17744b, a dispensing prescriber, except an advanced practice

 

21  registered nurse, shall dispense prescription drugs only to his

 

22  or her own patients.

 

23        (3) A dispensing prescriber shall include in a patient's

 

24  chart or clinical record a complete record, including

 

25  prescription drug names, dosages, and quantities, of all

 

26  prescription drugs dispensed directly by the dispensing

 

27  prescriber or indirectly under his or her delegatory authority.

 

 1  If prescription drugs are dispensed under the prescriber's

 

 2  delegatory authority, the delegatee who dispenses the

 

 3  prescription drugs shall initial the patient's chart, clinical

 

 4  record, or log of prescription drugs dispensed. In a patient's

 

 5  chart or clinical record, a dispensing prescriber shall

 

 6  distinguish between prescription drugs dispensed to the patient,

 

 7  prescription drugs prescribed for the patient, prescription drugs

 

 8  dispensed or prescribed for expedited partner therapy as

 

 9  authorized in section 5110, and prescription drugs dispensed or

 

10  prescribed as authorized under section 17744a or 17744b. A

 

11  dispensing prescriber shall retain information required under

 

12  this subsection for not less than 5 years after the information

 

13  is entered in the patient's chart or clinical record.

 

14        (4) A dispensing prescriber shall store prescription drugs

 

15  under conditions that will maintain their stability, integrity,

 

16  and effectiveness and will assure that the prescription drugs are

 

17  free of contamination, deterioration, and adulteration.

 

18        (5) A dispensing prescriber shall store prescription drugs

 

19  in a substantially constructed, securely lockable cabinet. Access

 

20  to the cabinet shall be limited to individuals authorized to

 

21  dispense prescription drugs in compliance with this part and

 

22  article 7.

 

23        (6) Unless otherwise requested by a patient, a dispensing

 

24  prescriber shall dispense a prescription drug in a safety closure

 

25  container that complies with the poison prevention packaging act

 

26  of 1970, 15 USC 1471 to 1477.

 

27        (7) A dispensing prescriber shall dispense a drug in a

 

 1  container that bears a label containing all of the following

 

 2  information:

 

 3        (a) The name and address of the location from which the

 

 4  prescription drug is dispensed.

 

 5        (b) Except as otherwise authorized under section 5110,

 

 6  17744a, or 17744b, the patient's name and record number.

 

 7        (c) The date the prescription drug was dispensed.

 

 8        (d) The prescriber's name or, if dispensed under the

 

 9  prescriber's delegatory authority, the name of the delegatee.

 

10        (e) The directions for use.

 

11        (f) The name and strength of the prescription drug.

 

12        (g) The quantity dispensed.

 

13        (h) The expiration date of the prescription drug or the

 

14  statement required under section 17756.

 

15        (8) A dispensing prescriber who dispenses a complimentary

 

16  starter dose drug to a patient, or an advanced practice

 

17  registered nurse, while engaged in the practice of advanced

 

18  practice registered nursing, who meets the requirements of

 

19  section 17212 and who possesses, prescribes, or administers a

 

20  complimentary starter dose drug to a patient, shall give the

 

21  patient at least all of the following information required in

 

22  this subsection, either by dispensing the complimentary starter

 

23  dose drug to the patient in a container that bears a label

 

24  containing the required information or by giving the patient a

 

25  written document that may include, but is not limited to, a

 

26  preprinted insert that comes with the complimentary starter dose

 

27  drug , and that contains all of the following required

 

 1  information. The information required to be given to the patient

 

 2  under this subsection includes all of the following:

 

 3        (a) The name and strength of the complimentary starter dose

 

 4  drug.

 

 5        (b) Directions for the patient's use of the complimentary

 

 6  starter dose drug.

 

 7        (c) The expiration date of the complimentary starter dose

 

 8  drug or the statement required under section 17756.

 

 9        (9) The information required under subsection (8) is in

 

10  addition to, and does not supersede or modify, other state or

 

11  federal law regulating the labeling of prescription drugs.

 

12        (10) In addition to meeting the requirements of this part, a

 

13  dispensing prescriber who dispenses controlled substances shall

 

14  comply with section 7303a.

 

15        (11) The board may periodically inspect locations from which

 

16  prescription drugs are dispensed.

 

17        (12) The act, task, or function of dispensing prescription

 

18  drugs shall be delegated only as provided in this part and

 

19  sections 16215, 17048, 17076, 17212, and 17548.

 

20        (13) A supervising physician may delegate in writing to a

 

21  pharmacist practicing in a hospital pharmacy within a hospital

 

22  licensed under article 17 the receipt of complimentary starter

 

23  dose drugs other than controlled substances as defined by article

 

24  7 or federal law. When the delegated receipt of complimentary

 

25  starter dose drugs occurs, both the pharmacist's name and the

 

26  supervising physician's name shall be used, recorded, or

 

27  otherwise indicated in connection with each receipt. A pharmacist

 

 1  described in this subsection may dispense a prescription for

 

 2  complimentary starter dose drugs written or transmitted by

 

 3  facsimile, electronic transmission, or other means of

 

 4  communication by a prescriber.

 

 5        (14) As used in this section, "complimentary starter dose"

 

 6  means a prescription drug packaged, dispensed, and distributed in

 

 7  accordance with state and federal law that is provided to a

 

 8  dispensing prescriber free of charge by a manufacturer or

 

 9  distributor and dispensed free of charge by the dispensing

 

10  prescriber to his or her patients.

 

11        Sec. 17820. (1) An individual shall not engage in the

 

12  practice of physical therapy or practice as a physical therapist

 

13  assistant unless licensed or otherwise authorized under this

 

14  part. Except as otherwise provided in this subsection, a physical

 

15  therapist or physical therapist assistant shall engage in the

 

16  treatment of a patient only upon the prescription of if that

 

17  treatment is prescribed by a health care professional who holds a

 

18  license issued under part 166, 170, 175, or 180, an a.p.r.n.

 

19  license issued under part 172, while engaged in the practice of

 

20  advanced practice registered nursing, or the an equivalent

 

21  license issued by another state. A physical therapist or a

 

22  physical therapist assistant may engage in the treatment of a

 

23  patient without the prescription of a health care professional

 

24  who holds a license issued under part 166, 170, 175, or 180, an

 

25  a.p.r.n. license issued under part 172, or the an equivalent

 

26  license issued by another state, under either of the following

 

27  circumstances:

 

 1        (a) For 21 days or 10 treatments, whichever first occurs.

 

 2  However, a physical therapist shall determine that the patient's

 

 3  condition requires physical therapy before delegating physical

 

 4  therapy interventions to a physical therapist assistant.

 

 5        (b) The patient is seeking physical therapy services for the

 

 6  purpose of preventing injury or promoting fitness.

 

 7        (2) The following words, titles, or letters or a combination

 

 8  of words, titles, or letters, with or without qualifying words or

 

 9  phrases, are restricted in use only to those persons authorized

 

10  under this part to use the terms and in a way prescribed in this

 

11  part: "physical therapy", "physical therapist", "doctor of

 

12  physiotherapy", "doctor of physical therapy", "physiotherapist",

 

13  "physiotherapy", "registered physical therapist", "licensed

 

14  physical therapist", "physical therapy technician", "physical

 

15  therapist assistant", "physical therapy assistant",

 

16  "physiotherapist assistant", "physiotherapy assistant", "p.t.

 

17  assistant", "p.t.", "r.p.t.", "l.p.t.", "c.p.t.", "d.p.t.",

 

18  "m.p.t.", "p.t.a.", "registered p.t.a.", "licensed p.t.a.",

 

19  "certified p.t.a.", "c.p.t.a.", "l.p.t.a.", "r.p.t.a.", and

 

20  "p.t.t.".

 

21        Sec. 17822. This part does not prohibit a hospital, as a

 

22  condition of employment or the granting of staff privileges, from

 

23  requiring that a physical therapist to perform activities within

 

24  his or her scope of practice in the hospital only upon the

 

25  prescription of an individual holding if that treatment is

 

26  prescribed by an individual who holds a license issued under part

 

27  166, 170, 175, or 180; or the an a.p.r.n. license issued under

 

 1  part 172, while engaged in the practice of advanced practice

 

 2  registered nursing; or an equivalent license issued by another

 

 3  state.

 

 4        Sec. 18301. (1) As used in this part:

 

 5        (a) "Occupational therapy assistant" means an individual who

 

 6  is licensed under this article to engage in practice as an

 

 7  occupational therapy assistant.

 

 8        (b) "Occupational therapist" means an individual who is

 

 9  licensed under this article to engage in the practice of

 

10  occupational therapy.

 

11        (c) "Occupational therapy services" means those services

 

12  provided to promote health and wellness, prevent disability,

 

13  preserve functional capabilities, prevent barriers, and enable or

 

14  improve performance in everyday activities, including, but not

 

15  limited to, the following:

 

16        (i) Establishment, remediation, or restoration of a skill or

 

17  ability that is impaired or not yet developed.

 

18        (ii) Compensation, modification, or adaptation of a person,

 

19  activity, or environment.

 

20        (iii) Evaluation of factors that affect activities of daily

 

21  living, instrumental activities of daily living, and other

 

22  activities relating to education, work, play, leisure, and social

 

23  participation. Those factors include, but are not limited to,

 

24  body functions, body structure, habits, routines, role

 

25  performance, behavior patterns, sensory motor skills, cognitive

 

26  skills, communication and interaction skills, and cultural,

 

27  physical, psychosocial, spiritual, developmental, environmental,

 

 1  and socioeconomic contexts and activities that affect

 

 2  performance.

 

 3        (iv) Interventions and procedures, including, but not limited

 

 4  to, any of the following:

 

 5        (A) Task analysis and therapeutic use of occupations,

 

 6  exercises, and activities.

 

 7        (B) Training in self-care, self-management, home management,

 

 8  and community or work reintegration.

 

 9        (C) Development remediation, or compensation of client

 

10  factors such as body functions and body structure.

 

11        (D) Education and training.

 

12        (E) Care coordination, case management, transition, and

 

13  consultative services.

 

14        (F) Modification of environments and adaptation processes

 

15  such as the application of ergonomic and safety principles.

 

16        (G) Assessment, design, fabrication, application, fitting,

 

17  and training in rehabilitative and assistive technology, adaptive

 

18  devices, and low temperature orthotic devices, and training in

 

19  the use of prosthetic devices. For the purposes of this sub-

 

20  subparagraph, the design and fabrication of low temperature

 

21  orthotic devices does not include permanent orthotics.

 

22        (H) Assessment, recommendation, and training in techniques

 

23  to enhance safety, functional mobility, and community mobility

 

24  such as wheelchair management and mobility.

 

25        (I) Management of feeding, eating, and swallowing.

 

26        (J) Application of physical agent modalities and use of a

 

27  range of specific therapeutic procedures, including, but not

 

 1  limited to, techniques to enhance sensory-motor, perceptual, and

 

 2  cognitive processing, manual therapy techniques, and adjunctive

 

 3  and preparatory activities.

 

 4        (K) Providing vision therapy services or low vision

 

 5  rehabilitation services, if those services are provided pursuant

 

 6  to a referral or prescription from, or under the supervision or

 

 7  comanagement of, a physician licensed under part 170 or 175 or an

 

 8  optometrist licensed under part 174 or pursuant to a referral or

 

 9  prescription from an advanced practice registered nurse, licensed

 

10  under part 172, while engaged in the practice of advanced

 

11  practice registered nursing.

 

12        (d) "Practice as an occupational therapy assistant" means

 

13  the practice of occupational therapy under the supervision of an

 

14  occupational therapist licensed under this article.

 

15        (e) "Practice of occupational therapy" means the therapeutic

 

16  use of everyday life occupations and occupational therapy

 

17  services to aid individuals or groups to participate in

 

18  meaningful roles and situations in the home, school, workplace,

 

19  community, and other settings, to promote health and wellness

 

20  through research and practice, and to serve those individuals or

 

21  groups who have or are at risk for developing an illness, injury,

 

22  disease, disorder, condition, impairment, disability, activity

 

23  limitation, or participation restriction. The practice of

 

24  occupational therapy addresses the physical, cognitive,

 

25  psychosocial, sensory, and other aspects of performance in a

 

26  variety of contexts to support engagement in everyday life

 

27  activities that affect a person's health, well-being, and quality

 

 1  of life throughout his or her life span. The practice of

 

 2  occupational therapy does not include any of the following:

 

 3        (i) The practice of medicine or osteopathic medicine and

 

 4  surgery or medical diagnosis or treatment.

 

 5        (ii) The practice of physical therapy.

 

 6        (iii) The practice of optometry.

 

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

 

 8  contains general definitions and principles of construction

 

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

 

10  definitions applicable to this part.

 

11        Sec. 20201. (1) A health facility or agency that provides

 

12  services directly to patients or residents and is licensed under

 

13  this article shall adopt a policy describing the rights and

 

14  responsibilities of patients or residents admitted to the health

 

15  facility or agency. Except for a licensed health maintenance

 

16  organization, which shall comply with chapter 35 of the insurance

 

17  code of 1956, 1956 PA 218, MCL 500.3501 to 500.3580, the policy

 

18  shall be posted at a public place in the health facility or

 

19  agency and shall be provided to each member of the health

 

20  facility or agency staff. Patients or residents shall be treated

 

21  in accordance with the policy.

 

22        (2) The policy describing the rights and responsibilities of

 

23  patients or residents required under subsection (1) shall

 

24  include, as a minimum, all of the following:

 

25        (a) A patient or resident shall not be denied appropriate

 

26  care on the basis of race, religion, color, national origin, sex,

 

27  age, disability, marital status, sexual preference, or source of

 

 1  payment.

 

 2        (b) An individual who is or has been a patient or resident

 

 3  is entitled to inspect, or receive for a reasonable fee, a copy

 

 4  of his or her medical record upon request in accordance with the

 

 5  medical records access act, 2004 PA 47, MCL 333.26261 to

 

 6  333.26271. Except as otherwise permitted or required under the

 

 7  health insurance portability and accountability act of 1996,

 

 8  Public Law 104-191, or regulations promulgated under that act, 45

 

 9  CFR parts 160 and 164, a third party shall not be given a copy of

 

10  the patient's or resident's medical record without prior

 

11  authorization of the patient or resident.

 

12        (c) A patient or resident is entitled to confidential

 

13  treatment of personal and medical records, and may refuse their

 

14  release to a person outside the health facility or agency except

 

15  as required because of a transfer to another health care

 

16  facility, as required by law or third party payment contract, or

 

17  as permitted or required under the health insurance portability

 

18  and accountability act of 1996, Public Law 104-191, or

 

19  regulations promulgated under that act, 45 CFR parts 160 and 164.

 

20        (d) A patient or resident is entitled to privacy, to the

 

21  extent feasible, in treatment and in caring for personal needs

 

22  with consideration, respect, and full recognition of his or her

 

23  dignity and individuality.

 

24        (e) A patient or resident is entitled to receive adequate

 

25  and appropriate care, and to receive, from the appropriate

 

26  individual within the health facility or agency, information

 

27  about his or her medical condition, proposed course of treatment,

 

 1  and prospects for recovery, in terms that the patient or resident

 

 2  can understand, unless medically contraindicated as documented in

 

 3  the medical record by the attending physician or a physician's

 

 4  assistant to whom the physician has delegated the performance of

 

 5  medical care services.

 

 6        (f) A patient or resident is entitled to refuse treatment to

 

 7  the extent provided by law and to be informed of the consequences

 

 8  of that refusal. If a refusal of treatment prevents a health

 

 9  facility or agency or its staff from providing appropriate care

 

10  according to ethical and professional standards, the relationship

 

11  with the patient or resident may be terminated upon reasonable

 

12  notice.

 

13        (g) A patient or resident is entitled to exercise his or her

 

14  rights as a patient or resident and as a citizen, and to this end

 

15  may present grievances or recommend changes in policies and

 

16  services on behalf of himself or herself or others to the health

 

17  facility or agency staff, to governmental officials, or to

 

18  another person of his or her choice within or outside the health

 

19  facility or agency, free from restraint, interference, coercion,

 

20  discrimination, or reprisal. A patient or resident is entitled to

 

21  information about the health facility's or agency's policies and

 

22  procedures for initiation, review, and resolution of patient or

 

23  resident complaints.

 

24        (h) A patient or resident is entitled to information

 

25  concerning an experimental procedure proposed as a part of his or

 

26  her care and has the right to refuse to participate in the

 

27  experimental procedure without jeopardizing his or her continuing

 

 1  care.

 

 2        (i) A patient or resident is entitled to receive and examine

 

 3  an explanation of his or her bill regardless of the source of

 

 4  payment and to receive, upon request, information relating to

 

 5  financial assistance available through the health facility or

 

 6  agency.

 

 7        (j) A patient or resident is entitled to know who is

 

 8  responsible for and who is providing his or her direct care, is

 

 9  entitled to receive information concerning his or her continuing

 

10  health needs and alternatives for meeting those needs, and to be

 

11  involved in his or her discharge planning, if appropriate.

 

12        (k) A patient or resident is entitled to associate and have

 

13  private communications and consultations with his or her

 

14  physician or a physician's assistant to whom the physician has

 

15  delegated the performance of medical care services, attorney, or

 

16  any other person of his or her choice and to send and receive

 

17  personal mail unopened on the same day it is received at the

 

18  health facility or agency, unless medically contraindicated as

 

19  documented in the medical record by the attending physician or a

 

20  physician's assistant to whom the physician has delegated the

 

21  performance of medical care services. A patient's or resident's

 

22  civil and religious liberties, including the right to independent

 

23  personal decisions and the right to knowledge of available

 

24  choices, shall not be infringed and the health facility or agency

 

25  shall encourage and assist in the fullest possible exercise of

 

26  these rights. A patient or resident may meet with, and

 

27  participate in, the activities of social, religious, and

 

 1  community groups at his or her discretion, unless medically

 

 2  contraindicated as documented in the medical record by the

 

 3  attending physician or a physician's assistant to whom the

 

 4  physician has delegated the performance of medical care services.

 

 5        (l) A patient or resident is entitled to be free from mental

 

 6  and physical abuse and from physical and chemical restraints,

 

 7  except those restraints authorized in writing by the attending

 

 8  physician, by an advanced practice registered nurse engaged in

 

 9  the practice of advanced practice registered nursing, or by a

 

10  physician's assistant to whom the physician has delegated the

 

11  performance of medical care services, for a specified and limited

 

12  time or as are necessitated by an emergency to protect the

 

13  patient or resident from injury to self or others, in which case

 

14  the restraint may only be applied by a qualified professional who

 

15  shall set forth in writing the circumstances requiring the use of

 

16  restraints and who shall promptly report the action to the

 

17  attending physician, or physician's assistant, or advanced

 

18  practice registered nurse who authorized the restraint. In case

 

19  of a chemical restraint, a physician shall be consulted within 24

 

20  hours after the commencement of the chemical restraint.

 

21        (m) A patient or resident is entitled to be free from

 

22  performing services for the health facility or agency that are

 

23  not included for therapeutic purposes in the plan of care.

 

24        (n) A patient or resident is entitled to information about

 

25  the health facility or agency rules and regulations affecting

 

26  patient or resident care and conduct.

 

27        (o) A patient or resident is entitled to adequate and

 

 1  appropriate pain and symptom management as a basic and essential

 

 2  element of his or her medical treatment.

 

 3        (3) The following additional requirements for the policy

 

 4  described in subsection (2) apply to licensees under parts 213

 

 5  and 217:

 

 6        (a) The policy shall be provided to each nursing home

 

 7  patient or home for the aged resident upon admission, and the

 

 8  staff of the facility shall be trained and involved in the

 

 9  implementation of the policy.

 

10        (b) Each nursing home patient may associate and communicate

 

11  privately with persons of his or her choice. Reasonable, regular

 

12  visiting hours, which shall be not less than 8 hours per day, and

 

13  which shall take into consideration the special circumstances of

 

14  each visitor, shall be established for patients to receive

 

15  visitors. A patient may be visited by the patient's attorney or

 

16  by representatives of the departments named in section 20156,

 

17  during other than established visiting hours. Reasonable privacy

 

18  shall be afforded for visitation of a patient who shares a room

 

19  with another patient. Each patient shall have reasonable access

 

20  to a telephone. A married nursing home patient or home for the

 

21  aged resident is entitled to meet privately with his or her

 

22  spouse in a room that assures privacy. If both spouses are

 

23  residents in the same facility, they are entitled to share a room

 

24  unless medically contraindicated and documented in the medical

 

25  record by the attending physician or a physician's assistant to

 

26  whom the physician has delegated the performance of medical care

 

27  services.

 

 1        (c) A nursing home patient or home for the aged resident is

 

 2  entitled to retain and use personal clothing and possessions as

 

 3  space permits, unless to do so would infringe upon the rights of

 

 4  other patients or residents, or unless medically contraindicated

 

 5  as documented in the medical record by the attending physician or

 

 6  a physician's assistant to whom the physician has delegated the

 

 7  performance of medical care services. Each nursing home patient

 

 8  or home for the aged resident shall be provided with reasonable

 

 9  space. At the request of a patient, a nursing home shall provide

 

10  for the safekeeping of personal effects, funds, and other

 

11  property of a patient in accordance with section 21767, except

 

12  that a nursing home is not required to provide for the

 

13  safekeeping of a property that would impose an unreasonable

 

14  burden on the nursing home.

 

15        (d) A nursing home patient or home for the aged resident is

 

16  entitled to the opportunity to participate in the planning of his

 

17  or her medical treatment. The attending physician or a

 

18  physician's assistant to whom the physician has delegated the

 

19  performance of medical care services shall fully inform the

 

20  nursing home patient of the patient's medical condition unless

 

21  medically contraindicated as documented in the medical record by

 

22  a physician or a physician's assistant to whom the physician has

 

23  delegated the performance of medical care services. Each nursing

 

24  home patient shall be afforded the opportunity to discharge

 

25  himself or herself from the nursing home.

 

26        (e) A home for the aged resident may be transferred or

 

27  discharged only for medical reasons, for his or her welfare or

 

 1  that of other residents, or for nonpayment of his or her stay,

 

 2  except as provided by title XVIII or title XIX. A nursing home

 

 3  patient may be transferred or discharged only as provided in

 

 4  sections 21773 to 21777. A nursing home patient or home for the

 

 5  aged resident is entitled to be given reasonable advance notice

 

 6  to ensure orderly transfer or discharge. Those actions shall be

 

 7  documented in the medical record.

 

 8        (f) A nursing home patient or home for the aged resident is

 

 9  entitled to be fully informed before or at the time of admission

 

10  and during stay of services available in the facility, and of the

 

11  related charges including any charges for services not covered

 

12  under title XVIII, or not covered by the facility's basic per

 

13  diem rate. The statement of services provided by the facility

 

14  shall be in writing and shall include those required to be

 

15  offered on an as-needed basis.

 

16        (g) A nursing home patient or home for the aged resident is

 

17  entitled to manage his or her own financial affairs, or to have

 

18  at least a quarterly accounting of personal financial

 

19  transactions undertaken in his or her behalf by the facility

 

20  during a period of time the patient or resident has delegated

 

21  those responsibilities to the facility. In addition, a patient or

 

22  resident is entitled to receive each month from the facility an

 

23  itemized statement setting forth the services paid for by or on

 

24  behalf of the patient and the services rendered by the facility.

 

25  The admission of a patient to a nursing home does not confer on

 

26  the nursing home or its owner, administrator, employees, or

 

27  representatives the authority to manage, use, or dispose of a

 

 1  patient's property.

 

 2        (h) A nursing home patient or a person authorized by the

 

 3  patient in writing may inspect and copy the patient's personal

 

 4  and medical records. The records shall be made available for

 

 5  inspection and copying by the nursing home within a reasonable

 

 6  time, not exceeding 1 week, after the receipt of a written

 

 7  request.

 

 8        (i) If a nursing home patient desires treatment by a

 

 9  licensed member of the healing arts, the treatment shall be made

 

10  available unless it is medically contraindicated, and the medical

 

11  contraindication is justified in the patient's medical record by

 

12  the attending physician or a physician's assistant to whom the

 

13  physician has delegated the performance of medical care services.

 

14        (j) A nursing home patient has the right to have his or her

 

15  parents, if a minor, or his or her spouse, next of kin, or

 

16  patient's representative, if an adult, stay at the facility 24

 

17  hours a day if the patient is considered terminally ill by the

 

18  physician responsible for the patient's care or a physician's

 

19  assistant to whom the physician has delegated the performance of

 

20  medical care services.

 

21        (k) Each nursing home patient shall be provided with meals

 

22  that meet the recommended dietary allowances for that patient's

 

23  age and sex and that may be modified according to special dietary

 

24  needs or ability to chew.

 

25        (l) Each nursing home patient has the right to receive

 

26  representatives of approved organizations as provided in section

 

27  21763.

 

 1        (4) A nursing home, its owner, administrator, employee, or

 

 2  representative shall not discharge, harass, or retaliate or

 

 3  discriminate against a patient because the patient has exercised

 

 4  a right protected under this section.

 

 5        (5) In the case of a nursing home patient, the rights

 

 6  enumerated in subsection (2)(c), (g), and (k) and subsection

 

 7  (3)(d), (g), and (h) may be exercised by the patient's

 

 8  representative.

 

 9        (6) A nursing home patient or home for the aged resident is

 

10  entitled to be fully informed, as evidenced by the patient's or

 

11  resident's written acknowledgment, before or at the time of

 

12  admission and during stay, of the policy required by this

 

13  section. The policy shall provide that if a patient or resident

 

14  is adjudicated incompetent and not restored to legal capacity,

 

15  the rights and responsibilities set forth in this section shall

 

16  be exercised by a person designated by the patient or resident.

 

17  The health facility or agency shall provide proper forms for the

 

18  patient or resident to provide for the designation of this person

 

19  at the time of admission.

 

20        (7) This section does not prohibit a health facility or

 

21  agency from establishing and recognizing additional patients'

 

22  rights.

 

23        (8) As used in this section:

 

24        (a) "Patient's representative" means that term as defined in

 

25  section 21703.

 

26        (b) "Title XVIII" means title XVIII of the social security

 

27  act, 42 USC 1395 to 1395kkk-1.1395lll.

 

 1        (c) "Title XIX" means title XIX of the social security act,

 

 2  42 USC 1396 to 1396w-5.