SB-1145, As Passed Senate, December 14, 2012

HOUSE SUBSTITUTE FOR

SENATE BILL NO. 1145

A bill to amend 1978 PA 368, entitled

"Public health code,"

by amending sections 17048 and 17548 (MCL 333.17048 and 333.17548),

sections 17048 and 17548 as amended by 2011 PA 210.

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

Sec. 17048. (1) Except as otherwise provided in this section

and section 17049(5), a physician who is a sole practitioner or who

practices in a group of physicians and treats patients on an

outpatient basis shall not supervise more than 4 physician's

assistants. If a physician described in this subsection supervises

physician's assistants at more than 1 practice site, the physician

shall not supervise more than 2 physician's assistants by a method

other than the physician's actual physical presence at the practice

site.

(2) A physician who is employed by, under contract or

subcontract to, or has privileges at a health facility or agency

licensed under article 17 or a state correctional facility may

supervise more than 4 physician's assistants at the health facility

or agency or state correctional facility.

(3) To the extent that a particular selected medical care

service requires extensive medical training, education, or ability

or poses serious risks to the health and safety of patients, the

board may prohibit or otherwise restrict the delegation of that

medical care service or may require higher levels of supervision.

(4) A physician shall not delegate ultimate responsibility for

the quality of medical care services, even if the medical care

services are provided by a physician's assistant.

(5) ~~The~~ Subject to section 17076(3) and (4), the board may

promulgate rules for the delegation by a supervising physician to a

physician's assistant of the function of prescription of drugs. The

rules may define the drugs or classes of drugs the prescription of

which shall not be delegated and other procedures and protocols

necessary to promote consistency with federal and state drug

control and enforcement laws. ~~When delegated prescription occurs,~~

~~both the physician's assistant's name and the supervising~~

~~physician's name shall be used, recorded, or otherwise indicated in~~

~~connection with each individual prescription.~~

(6) A supervising physician may delegate in writing to a

physician's assistant the ordering, receipt, and dispensing of

complimentary starter dose drugs including controlled substances

that are included in schedules 2 to 5 of part 72. When the

delegated ordering, receipt, or dispensing of complimentary starter

dose drugs occurs, both the physician's assistant's name and the

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

indicated in connection with each order, receipt, or dispensing.

When the delegated ordering, receipt, or dispensing of

complimentary starter dose drugs that are included in schedules 2

to 5 occurs, both the physician's assistant's and the supervising

physician's DEA registration numbers shall be used, recorded, or

otherwise indicated in connection with each order, receipt, or

dispensing. As used in this subsection, "complimentary starter

dose" means that term as defined in section 17745. It is the intent

of the legislature in enacting this subsection to allow a

pharmaceutical manufacturer or wholesale distributor, as those

terms are defined in part 177, to distribute complimentary starter

dose drugs to a physician's assistant, as described in this

subsection, in compliance with section 503(d) of the federal food,

drug, and cosmetic act, 21 USC 353.

(7) Beginning on July 19, 2010, if 1 or more individuals

licensed under part 170 to engage in the practice of medicine,

licensed under part 175 to engage in the practice of osteopathic

medicine and surgery, or licensed under part 180 to engage in the

practice of podiatric medicine and surgery, and 1 or more

physician's assistants organize a professional service corporation

~~pursuant to~~ under section 4 of ~~the professional service corporation~~

~~act,~~ former 1962 PA 192, ~~MCL 450.224,~~ a professional corporation

under section 284 of the business corporation act, 1972 PA 284, MCL

450.1284, or a professional limited liability company ~~pursuant to~~

under section 904 of the Michigan limited liability company act,

1993 PA 23, MCL 450.4904, the individuals who are the supervising

physicians of the physician's assistants shall be shareholders in

the same professional service corporation or professional

corporation or members in the same professional limited liability

company as the physician's assistants and shall meet all of the

applicable requirements of part 170, 175, or 180. If 1 or more

physician's assistants organized a professional service corporation

~~pursuant to~~ under section 4 of ~~the professional service corporation~~

~~act,~~ former 1962 PA 192, ~~MCL 450.224,~~ a professional corporation

under section 284 of the business corporation act, 1972 PA 284, MCL

450.1284, or a professional limited liability company ~~pursuant to~~

under section 904 of the Michigan limited liability company act,

1993 PA 23, MCL 450.4904, before July 19, 2010 that has only

physician's assistants as shareholders or members, the individuals

who are the supervising physicians of the physician's assistants

shall meet all of the applicable requirements of part 170, 175, or

180.

(8) In addition to the requirements of section 17068 and

beginning on July 19, 2010, the department shall include on the

form used for renewal of licensure a space for a physician's

assistant to disclose whether he or she is a shareholder in a

professional service corporation ~~pursuant to~~ under section 4 of ~~the~~

~~professional service corporation act,~~ former 1962 PA 192, ~~MCL~~

~~450.224,~~ or a member in a professional limited liability company

~~pursuant to~~ under section 904 of the Michigan limited liability

company act, 1993 PA 23, MCL 450.4904, ~~which corporation or company~~

that was organized before July 19, 2010. A physician's assistant

who is a shareholder in a professional service corporation or a

member in a professional limited liability company described in

this subsection shall disclose all of the following in the form

used for renewal of licensure provided by the department:

(a) Whether any individuals licensed under part 170 to engage

in the practice of medicine, licensed under part 175 to engage in

the practice of osteopathic medicine and surgery, or licensed under

part 180 to engage in the practice of podiatric medicine and

surgery are shareholders in the professional service corporation or

members in the professional limited liability company.

(b) The name and license number of the individual licensed

under part 170 to engage in the practice of medicine, licensed

under part 175 to engage in the practice of osteopathic medicine

and surgery, or licensed under part 180 to engage in the practice

of podiatric medicine and surgery who supervises the physician's

assistant.

in the practice of medicine, licensed under part 175 to engage in

the practice of osteopathic medicine and surgery, or licensed under

part 180 to engage in the practice of podiatric medicine and

surgery disclosed in subdivision (b) is a shareholder in the same

professional service corporation or member in a professional

limited liability company as the physician's assistant.

Sec. 17548. (1) Except as otherwise provided in this

subsection and section 17549(5), a physician who is a sole

practitioner or who practices in a group of physicians and treats

patients on an outpatient basis shall not supervise more than 4

physician's assistants. If a physician described in this subsection

supervises physician's assistants at more than 1 practice site, the

physician shall not supervise more than 2 physician's assistants by

a method other than the physician's actual physical presence at the

practice site.

(2) A physician who is employed by or under contract or

subcontract to or has privileges at a health facility licensed

under article 17 or a state correctional facility may supervise

more than 4 physician's assistants at the health facility or agency

or state correctional facility.

(3) To the extent that a particular selected medical care

service requires extensive medical training, education, or ability

or pose serious risks to the health and safety of patients, the

board may prohibit or otherwise restrict the delegation of that

medical care service or may require higher levels of supervision.

(4) A physician shall not delegate ultimate responsibility for

the quality of medical care services, even if the medical care

services are provided by a physician's assistant.

(5) A physician's assistant may make calls or go on rounds

under the supervision of a physician in private homes, public

institutions, emergency vehicles, ambulatory care clinics,

hospitals, intermediate or extended care facilities, health

maintenance organizations, nursing homes, or other health care

facilities. Notwithstanding any law or rule to the contrary, a

physician's assistant may make calls or go on rounds as provided in

this subsection without restrictions on the time or frequency of

visits by the physician or the physician's assistant.

(6) ~~(5) The~~ Subject to subsections (7) and (8), the board may

promulgate rules for the delegation by a supervising physician to a

physician's assistant of the function of prescription of drugs. ~~The~~

Subject to subsections (7) and (8), the rules may define the drugs

or classes of drugs the prescription of which shall not be

delegated and other procedures and protocols necessary to promote

consistency with federal and state drug control and enforcement

laws. ~~When delegated prescription occurs, both the physician's~~

~~assistant's name and the supervising physician's name shall be~~

~~used, recorded, or otherwise indicated in connection with each~~

~~individual prescription.~~

(7) A physician's assistant may prescribe drugs as a delegated

act of a supervising physician in accordance with procedures and

protocol for the prescription established by rule of the

appropriate board. A physician's assistant may prescribe a drug,

including a controlled substance that is included in schedules 2 to

5 of part 72, as a delegated act of the supervising physician. When

delegated prescription occurs, both the physician's assistant's

name and the supervising physician's name shall be used, recorded,

or otherwise indicated in connection with each individual

prescription so that the individual who dispenses or administers

the prescription knows under whose delegated authority the

physician's assistant is prescribing. When delegated prescription

of drugs that are included in schedules 2 to 5 occurs, both the

physician's assistant's and the supervising physician's DEA

registration numbers shall be used, recorded, or otherwise

indicated in connection with each individual prescription.

(8) ~~(6)~~ A supervising physician may delegate in writing to a