HOUSE BILL No. 4207 January 30, 1997, Introduced by Reps. Schroer, Anthony, LaForge and Brater and referred to the Committee on Health Policy. A bill to amend 1978 PA 368, entitled "Public health code," by amending sections 21707 and 21715 (MCL 333.21707 and 333.21715) and by adding sections 21714 and 21720c. THE PEOPLE OF THE STATE OF MICHIGAN ENACT: 1 Sec. 21707. (1)TheSUBJECT TO SECTION 21714, THE course 2 of medical treatment provided to a patient in a nursing home 3 shall be prescribed by the patient's physician. 4 (2) This part does not: 5 (a) Authorize the supervision, regulation, or control of the 6 practice of any method of healing. 7 (b) Authorize the medical supervision, regulation, or con- 8 trol of the remedial care or nonmedical nursing care of patients 9 in a nursing home operated for the adherents of a bona fide 10 church or religious denomination who rely upon treatment by 00929'97 CPD 2 1 prayer or spiritual means only in accordance with the creed or 2 tenets of that church or denomination. The residents, patients, 3 personnel, or employees, other than food handlers, of the NURSING 4 home are not required to submit to a medical or physical 5 examination. However, the nursing home shall be inspected and 6 licensed under laws pertaining to fire, safety, sanitation, and 7 building construction. 8 SEC. 21714. (1) IF A PATIENT IN A LICENSED HOSPITAL IS 9 UNDER THE CARE OF A PHYSICIAN AT THE TIME THE PATIENT APPLIES FOR 10 ADMISSION TO A NURSING HOME OR HOSPITAL LONG-TERM CARE UNIT, AND 11 IF THE PHYSICIAN WILL CONTINUE TO DIRECT THE CARE OF THE PATIENT 12 AT THE NURSING HOME OR HOSPITAL LONG-TERM CARE UNIT, THE NURSING 13 HOME OR HOSPITAL LONG-TERM CARE UNIT SHALL REQUIRE THE PATIENT TO 14 BE EXAMINED BY THE PHYSICIAN WITHIN 1 MONTH BEFORE THE PATIENT IS 15 ADMITTED TO THE NURSING HOME OR HOSPITAL LONG-TERM CARE UNIT. 16 THE NURSING HOME OR HOSPITAL LONG-TERM CARE UNIT SHALL ALSO 17 REQUIRE THE PATIENT TO SUBMIT A COPY OF THE EXAMINATION AT THE 18 TIME OF THE PATIENT'S ADMISSION. IF THE PATIENT HAS AN ACUTE 19 ILLNESS SUBSEQUENT TO THE INITIAL EXAMINATION REQUIRED UNDER THIS 20 SUBSECTION, BUT BEFORE ADMISSION TO THE NURSING HOME OR HOSPITAL 21 LONG-TERM CARE UNIT, THE NURSING HOME OR HOSPITAL LONG-TERM CARE 22 UNIT SHALL REQUIRE THE PATIENT TO BE REEXAMINED BY THE PHYSICIAN 23 WITHIN 1 WEEK BEFORE ADMISSION TO THE NURSING HOME OR HOSPITAL 24 LONG-TERM CARE UNIT. A PHYSICIAN'S ASSISTANT OR CERTIFIED NURSE 25 PRACTITIONER MAY PERFORM THE INITIAL EXAMINATION REQUIRED UNDER 26 THIS SUBSECTION UNDER THE SUPERVISION OF THE PHYSICIAN. 00929'97 3 1 (2) IF A PATIENT IS NOT UNDER THE CARE OF A PHYSICIAN WHO 2 WILL CONTINUE TO DIRECT THE CARE OF THE PATIENT AT THE TIME THE 3 PATIENT APPLIES FOR ADMISSION TO A NURSING HOME OR HOSPITAL 4 LONG-TERM CARE UNIT, THE NURSING HOME OR HOSPITAL LONG-TERM CARE 5 UNIT SHALL REQUIRE THE PATIENT TO BE EXAMINED BY A PHYSICIAN 6 WITHIN 7 DAYS BEFORE OR 14 DAYS AFTER ADMISSION TO THE NURSING 7 HOME OR HOSPITAL LONG-TERM CARE UNIT. 8 (3) A NURSING HOME OR HOSPITAL LONG-TERM CARE UNIT SHALL NOT 9 ADMIT A PATIENT UNLESS THERE ARE ORDERS PRESCRIBED BY A PHYSICIAN 10 FOR THE PATIENT'S IMMEDIATE CARE IN THE NURSING HOME OR HOSPITAL 11 LONG-TERM CARE UNIT. 12 (4) THE DIRECTOR OF NURSING IMMEDIATELY SHALL ENTER STANDING 13 AND OTHER TREATMENT ORDERS PRESCRIBED BY A PHYSICIAN FOR THE CARE 14 OF A PATIENT IN A NURSING HOME IN THE PATIENT'S PERMANENT MEDICAL 15 RECORD AND SHALL SIGN THE ENTRY, UNLESS THE ORDERS HAVE ALREADY 16 BEEN ENTERED AND SIGNED BY THE PRESCRIBING PHYSICIAN OR PURSUANT 17 TO SUBSECTION (5). IF THE DIRECTOR OF NURSING MAKES AND SIGNS AN 18 ENTRY UNDER THIS SUBSECTION, THE PHYSICIAN WHO PRESCRIBED THE 19 STANDING OR OTHER TREATMENT ORDERS SHALL COUNTERSIGN THE ORDERS 20 WITHIN 1 MONTH AFTER THE DATE THE STANDING OR OTHER TREATMENT 21 ORDERS ARE ENTERED INTO THE PATIENT'S PERMANENT MEDICAL RECORD BY 22 THE DIRECTOR OF NURSING. 23 (5) IF STANDING OR OTHER TREATMENT ORDERS FOR THE CARE OF A 24 PATIENT IN A NURSING HOME ARE ENTERED INTO THE PATIENT'S MEDICAL 25 RECORD BY A PHYSICIAN'S ASSISTANT OR A CERTIFIED NURSE PRACTI- 26 TIONER, THE SUPERVISING PHYSICIAN SHALL COUNTERSIGN THE ORDERS 27 WITHIN 1 MONTH AFTER THE ENTRY. 00929'97 4 1 Sec. 21715. (1)ASUBJECT TO SECTION 21720C, A nursing 2 home shall provide: (a) A program of planned and continuing3nursing care under the charge of a registered nurse in a skilled4facility and a licensed practical nurse with a registered nurse5consultant in an intermediate care facility. This subdivision6shall expire December 31, 1979. (b) AA program of planned and 7 continuing medical care under the charge of 1 OR MORE 8 physicians. 9 (2) Nursing care and medical care shall consist of services 10 given to individuals who are subject to prolonged suffering from 11 illness or injury or who are recovering from illness or injury. 12 The services shall be within the ability of the NURSING home to 13 provide and shall include the functions of medical caresuch as14 INCLUDING, BUT NOT LIMITED TO, diagnosis and treatment of an ill- 15 ness; nursing care via assessment, planning, and implementation; 16 evaluation of a patient's health care needs; and the carrying out 17 of required treatment prescribed by a physician. 18 SEC. 21720C. (1) THE DEPARTMENT SHALL NOT LICENSE A NURSING 19 HOME OR RENEW A NURSING HOME LICENSE UNDER THIS PART UNLESS THE 20 NURSING HOME HAS DESIGNATED A PHYSICIAN TO SERVE AS MEDICAL 21 DIRECTOR OF THE NURSING HOME. 22 (2) A MEDICAL DIRECTOR DESIGNATED UNDER SUBSECTION (1) IS 23 RESPONSIBLE FOR ALL OF THE FOLLOWING: 24 (A) IMPLEMENTATION OF RESIDENT CARE POLICIES. 25 (B) COORDINATION OF MEDICAL CARE IN THE NURSING HOME. 26 (C) THE OVERALL QUALITY OF MEDICAL SERVICES IN THE NURSING 27 HOME. 00929'97