SB-0683, As Passed Senate, June 12, 2018

 

 

 

 

 

 

 

 

 

 

 

SUBSTITUTE FOR

 

SENATE BILL NO. 683

 

 

 

 

 

 

 

 

 

 

 

      A bill to amend 1978 PA 368, entitled

 

"Public health code,"

 

by amending sections 16215, 16322, 16501, 16511, 16521, 16525,

 

and 16529 (MCL 333.16215, 333.16322, 333.16501, 333.16511,

 

333.16521, 333.16525, and 333.16529), section 16215 as amended by

 

2005 PA 211, sections 16322, 16501, 16525, and 16529 as added by

 

2006 PA 30, section 16511 as amended by 2006 PA 397, and section

 

16521 as amended by 2010 PA 79, and by adding sections 16513,

 

16515, and 16517.

 

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 

 1        Sec. 16215. (1) Subject to subsections (2) to (6), a

 

 2  licensee who holds a license other than a health profession

 

 3  subfield license may delegate to a licensed or unlicensed

 

 4  individual who is otherwise qualified by education, training, or

 


 1  experience the performance of selected acts, tasks, or functions

 

 2  where the acts, tasks, or functions fall within the scope of

 

 3  practice of the licensee's profession and will be performed under

 

 4  the licensee's supervision. A licensee shall not delegate an act,

 

 5  task, or function under this section if the act, task, or

 

 6  function, under standards of acceptable and prevailing practice,

 

 7  requires the level of education, skill, and judgment required of

 

 8  the licensee under this article.

 

 9        (2) Subject to subsection (1) and except as otherwise

 

10  provided in this subsection and subsections (3) and (4), a

 

11  licensee who is an allopathic physician or osteopathic physician

 

12  and surgeon shall delegate an act, task, or function that

 

13  involves the performance of a procedure that requires the use of

 

14  surgical instrumentation only to an individual who is licensed

 

15  under this article. A licensee who is an allopathic physician or

 

16  osteopathic physician and surgeon may delegate an act, task, or

 

17  function described in this subsection to an individual who is not

 

18  licensed under this article if the unlicensed individual is 1 or

 

19  more of the following and if the procedure is directly supervised

 

20  by a licensed allopathic physician or osteopathic physician and

 

21  surgeon who is physically present during the performance of the

 

22  procedure:

 

23        (a) A student enrolled in a school of medicine or

 

24  osteopathic medicine approved by the Michigan board of medicine

 

25  or the Michigan board of osteopathic medicine and surgery.

 

26        (b) A student enrolled in a physician's assistant training

 

27  program approved by the joint physician's assistant task force

 


 1  created under part 170.

 

 2        (3) Subject to subsection (1), a licensee who is an

 

 3  allopathic physician or osteopathic physician and surgeon may

 

 4  delegate an act, task, or function described in subsection (2) to

 

 5  an individual who is not licensed under this article and who is 1

 

 6  of the following:

 

 7        (a) Performing Until 12 months after the effective date of

 

 8  the rules promulgated under section 16525, performing

 

 9  acupuncture.

 

10        (b) Surgically removing only bone, skin, blood vessels,

 

11  cartilage, dura mater, ligaments, tendons, pericardial tissue, or

 

12  heart valves only from a deceased individual for transplantation,

 

13  implantation, infusion, injection, or other medical or scientific

 

14  purpose.

 

15        (4) Subject to subsection (1), a licensee who is an

 

16  allopathic physician or osteopathic physician and surgeon may

 

17  delegate an act, task, or function described in subsection (2) to

 

18  an individual who is not licensed under this article if the

 

19  procedure is directly supervised by a licensed allopathic

 

20  physician or osteopathic physician and surgeon who is physically

 

21  present during the performance of the procedure, the delegation

 

22  of such procedure is not prohibited or otherwise restricted by

 

23  the board or that health facility or agency, and the delegation

 

24  of that act, task, or function is specifically authorized by that

 

25  health facility or agency to be delegated and performed by either

 

26  of the following unlicensed individuals:

 

27        (a) A surgical technologist who meets the qualifications

 


 1  established by the health facility or agency with which he or she

 

 2  is employed or under contract. with.

 

 3        (b) A surgical first assistant who meets the qualifications

 

 4  established by the health facility or agency with which he or she

 

 5  is employed or under contract. with.

 

 6        (5) A board may promulgate rules to further prohibit or

 

 7  otherwise restrict delegation of specific acts, tasks, or

 

 8  functions to a licensed or unlicensed individual if the board

 

 9  determines that the delegation constitutes or may constitute a

 

10  danger to the health, safety, or welfare of the patient or

 

11  public.

 

12        (6) To promote safe and competent practice, a board may

 

13  promulgate rules to specify conditions under which, and

 

14  categories and types of licensed and unlicensed individuals for

 

15  whom, closer supervision may be required for acts, tasks, and

 

16  functions delegated under this section.

 

17        (7) An individual who performs acts, tasks, or functions

 

18  delegated pursuant to this section does not violate the part that

 

19  regulates the scope of practice of that health profession.

 

20        (8) The amendatory act that added this subsection does not

 

21  require new or additional third party reimbursement or mandated

 

22  worker's compensation benefits for services rendered by an

 

23  individual authorized to perform those services under subsection

 

24  (4).

 

25        Sec. 16322. Fees for a person registered or seeking

 

26  registration as an acupuncturist an individual who is licensed or

 

27  seeking licensure to engage in the practice of acupuncture under

 


 1  part 165 are as follows:

 

 

2

      (a) Application processing fee.................  $   75.00

3

      (b) Registration License fee, per year.........  $  200.00

4

      (c) Limited license, per year..................  $  200.00

5

      (d) Temporary license fee......................  $  200.00

 

 

 6        Sec. 16501. (1) As used in this part:

 

 7        (a) "Acupressure" means a form of manual therapy in which

 

 8  physical pressure is applied to various points on the body.

 

 9        (b) (a) "Acupuncture" means the insertion and manipulation

 

10  of needles through the surface of the human body. at specific

 

11  locations on the human body for the prevention or correction of

 

12  disease, injury, pain, or other condition.Acupuncture includes,

 

13  but is not limited to, laser acupuncture, electroacupuncture,

 

14  pricking therapy, dry needling, and intramuscular stimulation.

 

15        (c) (b) "Acupuncturist" means an individual who practices

 

16  acupuncture and is registered, or otherwise authorized, licensed

 

17  under this part to engage in the practice of acupuncture.

 

18        (d) "Cupping" means the placement of a specially designed

 

19  cup on the body to create suction.

 

20        (e) "Dermal friction" means the use of repeated, closely

 

21  timed, unidirectional press-stroking with a smooth-edged

 

22  instrument over a lubricated area of the body.

 

23        (f) "Dietary counseling" means the process of advising a

 

24  patient about healthy food choices and healthy eating habits in

 

25  accordance with East Asian medical theory.

 

26        (g) "Dry needling" means a rehabilitative procedure using


 

 1  filiform needles to penetrate the skin or underlying tissues by

 

 2  targeting only myofascial trigger points and muscular and

 

 3  connective tissues to affect change in body structures and

 

 4  functions for the evaluation and management of

 

 5  neuromusculoskeletal pain and movement impairment. Dry needling

 

 6  does not include the stimulation of auricular points or other

 

 7  acupuncture points.

 

 8        (h) "East Asian medicine techniques" includes, but is not

 

 9  limited to, acupuncture, manual therapy, moxibustion, heat

 

10  therapy, dietary counseling, therapeutic exercise, acupressure,

 

11  cupping, dermal friction, homeopathy, lifestyle coaching, and

 

12  treatment with herbal medicines.

 

13        (i) "Heat therapy" means the use of heat in therapy, such as

 

14  for pain relief and health.

 

15        (j) "Herbal medicine" means the internal and external use of

 

16  a plant or a plant extract, a mineral, or an animal product, that

 

17  is not a prescription drug as that term is defined in section

 

18  17708.

 

19        (k) "Homeopathy" means the use of a highly diluted natural

 

20  remedy from the plant, mineral, and animal domain.

 

21        (l) "Lifestyle coaching" means the process of advising a

 

22  patient about healthy lifestyle choices and habits in accordance

 

23  with East Asian medical theory.

 

24        (m) "Manual therapy" means the application of an accurately

 

25  determined and specifically directed manual force to the body,

 

26  excluding a high-velocity, low-amplitude thrust to the spine.

 

27        (n) "Moxibustion" means burning the dried plant Artemisia


 

 1  vulgaris on or very near the surface of the skin as a form of

 

 2  therapy.

 

 3        (o) "Practice of acupuncture", subject to subsection (2),

 

 4  means the use of traditional and contemporary east Asian medical

 

 5  theory to assess and diagnose a patient, to develop a plan to

 

 6  treat the patient, and to treat the patient through East Asian

 

 7  medicine techniques.

 

 8        (p) "Practice of chiropractic" means that term as defined in

 

 9  section 16401.

 

10        (q) "Practice of massage therapy" means that term as defined

 

11  in section 17951.

 

12        (r) "Practice of medicine" means that term as defined in

 

13  section 17001.

 

14        (s) "Practice of osteopathic medicine and surgery" means

 

15  that term as defined in section 17501.

 

16        (t) "Practice of physical therapy" means that term as

 

17  defined in section 17801.

 

18        (u) "Registered acupuncturist" means an individual who is

 

19  registered or otherwise authorized under this part before the

 

20  effective date of the amendatory act that added section 16513.

 

21        (v) "Systematic acupuncture education" means a course of

 

22  education that covers the foundation of acupuncture science and

 

23  theory, channel and point location, needling techniques,

 

24  approaches to diagnosis and therapy, and patient management.

 

25        (w) "Therapeutic exercise" means a range of physical

 

26  activities that help restore and build physical strength,

 

27  endurance, flexibility, balance, and stability.


 

 1        (2) For purposes of this part, practice of acupuncture does

 

 2  not include the practice of medicine, the practice of osteopathic

 

 3  medicine and surgery, the practice of physical therapy, the

 

 4  practice of occupational therapy, the practice of podiatric

 

 5  medicine and surgery, the practice of nursing, the practice of

 

 6  dentistry, the practice of massage therapy, or the practice of

 

 7  chiropractic.

 

 8        (3) (2) In addition to the definitions in this part, article

 

 9  1 contains general definitions and principles of construction

 

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

 

11  definitions applicable to this part.

 

12        Sec. 16511. (1) Except as otherwise provided under

 

13  subsection (2), after in this part, beginning on the effective

 

14  date of rules are promulgated under section 16145, 16525, an

 

15  individual shall not use the words, titles, or letters

 

16  "acupuncturist", "certified acupuncturist", or "registered

 

17  acupuncturist", "licensed acupuncturist", "L.Ac.", or a

 

18  combination thereof, with or without qualifying words or phrases,

 

19  similar word or initial that indicates that the individual is an

 

20  acupuncturist, unless he or she is registered authorized under

 

21  this part to use the terms and in a way prescribed in this part.

 

22        (2) Neither of the following is subject to the provisions of

 

23  this part:

 

24        (a) A physician who is licensed under part 170 or 175.

 

25        (b) An individual who is certified by the national

 

26  acupuncture detoxification association.

 

27        Sec. 16513. (1) Beginning on the effective date of rules


 

 1  promulgated under section 16525, an individual shall not engage

 

 2  in the practice of acupuncture unless he or she is licensed under

 

 3  this part or is otherwise authorized under this article. For a

 

 4  period not to exceed 12 months from the effective date of the

 

 5  rules promulgated under section 16525, a registered acupuncturist

 

 6  may, without a license under this part, continue to use the

 

 7  titles "acupuncturist", "registered acupuncturist", or "certified

 

 8  acupuncturist" and engage in the practice of acupuncture.

 

 9        (2) In addition to the exemptions from licensure under

 

10  section 16171, this part does not apply to any of the following:

 

11        (a) Except as otherwise provided in subdivision (e), an

 

12  individual licensed, registered, or otherwise authorized under

 

13  any other part or act who is performing activities that are

 

14  considered to be within the practice of acupuncture if those

 

15  activities are within the individual's scope of practice and if

 

16  the individual does not use the words, titles, or letters

 

17  protected under section 16511.

 

18        (b) A physician who is licensed under part 170 or part 175

 

19  if the physician has completed a total of not less than 300 hours

 

20  of systematic acupuncture education that include not less than

 

21  100 hours of live lectures, demonstrations, and supervised

 

22  clinical training specific to acupuncture.

 

23        (c) An individual who meets all of the following

 

24  requirements:

 

25        (i) He or she meets the requirements for a certificate of

 

26  training as an acupuncture detoxification specialist issued by

 

27  the National Acupuncture Detoxification Association or an


 

 1  organization that the board determines is a successor

 

 2  organization.

 

 3        (ii) He or she only uses the auricular protocol for substance

 

 4  use disorder prevention and treatment developed by the National

 

 5  Acupuncture Detoxification Association or an organization that

 

 6  the board determines is a successor organization.

 

 7        (iii) He or she is under the supervision of an acupuncturist

 

 8  or a physician licensed under part 170 or part 175 when using the

 

 9  protocol described in subparagraph (ii).

 

10        (iv) He or she does not use the words, titles, or letters

 

11  protected under section 16511.

 

12        (d) An individual performing acupressure, cupping, dermal

 

13  friction, dietary counseling, heat therapy, herbal medicine,

 

14  homeopathy, lifestyle coaching, manual therapy, or therapeutic

 

15  exercise, while engaged in the practice of a profession with

 

16  established standards and ethics and as long as those services

 

17  are not designated as or implied to be the practice of

 

18  acupuncture and the individual does not use the titles, words, or

 

19  letters protected under section 16511.

 

20        (e) Dry needling by an individual licensed, registered, or

 

21  otherwise authorized under any other part if dry needling is

 

22  within the individual's scope of practice.

 

23        Sec. 16515. (1) Except as otherwise provided in subsection

 

24  (2), the department shall issue a license to an applicant who

 

25  meets the requirements of section 16174 and the requirements for

 

26  licensure established in rules promulgated under section 16525.

 

27        (2) On or before the expiration of 12 months after the


 

 1  effective date of the rules promulgated under section 16525, the

 

 2  department shall issue a license to an applicant who meets the

 

 3  requirements of section 16174 and 1 of the following:

 

 4        (a) He or she is a registered acupuncturist.

 

 5        (b) He or she has the education, training, and experience

 

 6  appropriate to the practice of acupuncture as established in

 

 7  rules promulgated under section 16525. In determining whether an

 

 8  applicant has met the requirements for licensure under this

 

 9  subdivision, the department, in consultation with the board,

 

10  shall promulgate rules establishing criteria for considering

 

11  patient records, billing records, education records, training

 

12  records, or other evidence of the applicant's education,

 

13  training, and experience that is submitted to the department. An

 

14  applicant shall ensure that any document that is submitted to the

 

15  department under this subdivision ensures the confidentiality of

 

16  a patient's identity.

 

17        Sec. 16517. (1) Notwithstanding the requirements of part

 

18  161, the department, in consultation with the board, shall

 

19  promulgate rules requiring a licensee seeking renewal of a

 

20  license to furnish the department with satisfactory evidence that

 

21  during the license cycle immediately preceding the application

 

22  for renewal the licensee has attended continuing education

 

23  courses or programs approved by the board in subjects related to

 

24  the practice of acupuncture and designed to further educate

 

25  licensees. An individual is considered to have completed the

 

26  continuing education requirements described in this subsection if

 

27  the department determines that the individual has met the


 

 1  continuing education standards of the National Certification

 

 2  Commission for Acupuncture and Oriental Medicine or equivalent

 

 3  standards as determined by the board.

 

 4        (2) As required under section 16204, the department, in

 

 5  consultation with the board, shall promulgate rules requiring

 

 6  each applicant for license renewal to complete as part of the

 

 7  educational courses or programs required under subsection (1) an

 

 8  appropriate number of hours or courses in pain and symptom

 

 9  management.

 

10        Sec. 16521. (1) The Michigan board of acupuncture is created

 

11  in the department and shall consist consists of the following 13

 

12  voting members, who each of whom must meet the requirements of

 

13  part 161:

 

14        (a) Until June 30, 2010, 4 acupuncturists. Beginning July 1,

 

15  2010, 7 Seven acupuncturists. The members appointed under this

 

16  subdivision shall must meet the requirements of section 16135.

 

17        (b) Three physicians licensed under part 170 or 175, at

 

18  least 1 of whom has met the requirement in section 16513(2)(b).

 

19        (c) Until June 30, 2010, 2 public members. Beginning July 1,

 

20  2010, 3 Three public members.

 

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 pursuant to section 16122.

 

25        Sec. 16525. (1) The Within 12 months after the effective

 

26  date of the amendatory act that amended this section, the

 

27  department, in consultation with the board, shall promulgate


 

 1  rules setting forth the minimum standards for registration as an

 

 2  acupuncturist. The department, in consultation with the board,

 

 3  may adopt by reference the professional standards issued by a

 

 4  certified program that is recognized by the national commission

 

 5  for certifying agencies or by a nationally recognized trade

 

 6  association.that establish the minimum standards for licensure as

 

 7  an acupuncturist and implement the licensure program for the

 

 8  practice of acupuncture. In promulgating rules for purposes of

 

 9  section 16515(1), the department, in consultation with the board,

 

10  may adopt by reference the professional standards issued by a

 

11  certified program that is recognized by the National Commission

 

12  for Certifying Agencies. In promulgating rules for purposes of

 

13  section 16515(2), the department, in consultation with the board,

 

14  shall consider whether an applicant has completed systematic

 

15  acupuncture education that includes live lectures,

 

16  demonstrations, and supervised clinical training specific to

 

17  acupuncture.

 

18        (2) The department, in consultation with the board, shall

 

19  not promulgate rules under this section that diminish competition

 

20  or exceed the minimum level of regulation necessary to protect

 

21  the public.

 

22        Sec. 16529. This part does not require new or additional

 

23  third party reimbursement or mandated worker's compensation

 

24  benefits for services by an individual registered licensed as an

 

25  acupuncturist under this part.

 

26        Enacting section 1. This amendatory act takes effect 90 days

 

27  after the date it is enacted into law.