SENATE BILL No. 2

 

 

January 16, 2013, Introduced by Senator JANSEN and referred to the Committee on Reforms, Restructuring and Reinventing.

 

 

 

      A bill to amend 1978 PA 368, entitled

 

"Public health code,"

 

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

 

16231, 16231a, 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, 333.16327, 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 added by

 

1990 PA 16, 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 added by 1993 PA 87,

 

section 16231 as amended by 2010 PA 382, section 16231a as added

 

by 1993 PA 79, 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, sections 17745 and 20201 as

 

amended by 2011 PA 210, section 17820 as amended by 2009 PA 55,

 

section 17822 as amended by 2005 PA 281, and section 18301 as

 

amended by 2008 PA 523, 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) "Designated nurse" means a certified nurse midwife or

 

17  certified nurse practitioner.

 

 1        (e) "Designated physician" means a physician qualified in 1

 

 2  of the physician specialty areas identified in section 2711.

 

 3        (f) "Designated professional" means a designated physician,

 

 4  designated nurse, or physician's assistant.

 

 5        (g) "Health resource shortage area" means a geographic area,

 

 6  population group, or health facility designated by the department

 

 7  under section 2717.

 

 8        (h) "Medicaid" means benefits under the program of medical

 

 9  assistance established under title XIX of the social security

 

10  act, 42 U.S.C. 1396 to 1396d, 1396f to 1396g, and 1396i to 1396s,

 

11  42 USC 1396-1 to 1396w-5, and administered by the department of

 

12  social human services under the social welfare act, Act No. 280

 

13  of the Public Acts of 1939, being sections 400.1 to 400.121 of

 

14  the Michigan Compiled Laws.1939 PA 280, MCL 400.1 to 400.119b.

 

15        (i) "Medical school" means an accredited program for the

 

16  training of individuals to become physicians.

 

17        (j) "Medicare" means benefits under the federal medicare

 

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

 

19  42 U.S.C. 1395 to 1395b, 1395b-2 to 1395i, 1395i-1a to 1395i-2,

 

20  1395j to 1395dd, 1395ff to 1395mm, and 1395oo to 1395ccc.42 USC

 

21  1395 to 1395kkk.

 

22        (k) "National health service corps" means the agency

 

23  established under section 331 of title III of the public health

 

24  service act, 42 U.S.C. 254d.42 USC 254d.

 

25        (l) "Nurse" means an individual licensed to engage in the

 

26  practice of nursing under part 172.

 

27        (m) "Nursing program" means an accredited program for the

 

 1  training of individuals to become nurses.

 

 2        (n) "Physician" means an individual licensed as a physician

 

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

 

 4        (o) "Physician's assistant" means an individual licensed as

 

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

 

 6        (p) "Physician's assistant program" means an accredited

 

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

 

 8  assistants.

 

 9        (q) "Service obligation" means the contractual obligation

 

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

 

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

 

12  site designated by the department.

 

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

 

14  shall be advised through the distribution of written educational

 

15  materials by the county clerk regarding prenatal care and the

 

16  transmission and prevention of venereal disease and HIV

 

17  infection. The written educational materials shall describe the

 

18  availability to the applicant of tests for both venereal disease

 

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

 

20  locations where HIV counseling and testing services funded by the

 

21  department are available. The written educational materials shall

 

22  be approved or prepared by the department.

 

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

 

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

 

25  application for a marriage license that includes a statement with

 

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

 

27  educational materials regarding the transmission and prevention

 

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

 

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

 

 3  to subsection (1).

 

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

 

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

 

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

 

 7  designee of the physician, the physician's assistant, the

 

 8  certified nurse midwife, or the certified nurse practitioner, or

 

 9  the clinical nurse specialist–certified or the local health

 

10  officer or designee of the local health officer administering the

 

11  test immediately shall inform both applicants of the test

 

12  results, and shall counsel both applicants regarding the modes of

 

13  HIV transmission, the potential for HIV transmission to a fetus,

 

14  and protective measures.

 

15        (4) As used in this section:

 

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

 

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

 

18  issued a specialty certification in the practice of nurse

 

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

 

20  as defined in section 17201.

 

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

 

22  licensed as a registered professional nurse under part 172 who

 

23  has been issued a specialty certification as a nurse practitioner

 

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

 

25  in section 17201.

 

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

 

27  defined in section 17201.

 

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

 

 2  physician under part 170 or an osteopathic physician under part

 

 3  175.

 

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

 

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

 

 6        Sec. 16125. (1) A licensing board shall be composed of a

 

 7  majority of members licensed in the health profession which that

 

 8  board licenses. The board shall include at least 1 public member.

 

 9  The director shall be an ex officio member without vote, but is

 

10  not a member for the purposes of section 5 of article 5 V of the

 

11  state constitution of 1963 or for determining a quorum. If a

 

12  licensed health profession subfield is created by under this

 

13  article, the board shall include at least 1 licensee from each

 

14  subfield.

 

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

 

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

 

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

 

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

 

19  provided in section 17221a, if a certified health profession

 

20  specialty field task force is created by under this article, 1

 

21  member of the board holding a license other than a health

 

22  profession subfield license shall also be appointed to the

 

23  specialty field task force.

 

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

 

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

 

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

 

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

 

 1  set forth in this part.

 

 2        (2) If a health profession specialty field task force is

 

 3  created for a health profession, that task force shall serve as

 

 4  the task force for all health profession specialty fields within

 

 5  the scope of practice of the health profession and shall function

 

 6  as set forth in this part. However, this subsection does not

 

 7  apply to the advanced practice registered nurse task force

 

 8  created in section 17221a.

 

 9        Sec. 16163. A Except as provided in section 17221a, a task

 

10  force shall recommend to the board as to:

 

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

 

12  experience required for practice in a health profession subfield

 

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

 

14  where appropriate, guidelines for approval of educational

 

15  programs for the health profession subfield or health profession

 

16  specialty field.

 

17        (b) Qualifications required of applicants for licensure in

 

18  health profession subfields or for registration in health

 

19  profession specialty fields.

 

20        (c) Evaluation of qualifications for initial and continuing

 

21  licensure of practitioners in health profession subfields or

 

22  health profession specialty fields. The evaluation may cover

 

23  assessment of educational credentials, work experience and

 

24  related training, and administration of tests and examinations.

 

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

 

26  for, licensees in health profession subfields or registrants in

 

27  health profession specialty fields.

 

 1        Sec. 16216. (1) The chair of each board or task force shall

 

 2  appoint 1 or more disciplinary subcommittees for that board or

 

 3  task force. A disciplinary subcommittee for a board or task force

 

 4  shall consist of 2 public members and 3 professional members from

 

 5  the board or task force. The chair of a board or task force shall

 

 6  not serve as a member of a disciplinary subcommittee. However,

 

 7  this subsection does not apply to the advanced practice

 

 8  registered nurse task force created in section 17221a.

 

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

 

10  finding a violation of this article or article 7 shall be by

 

11  requires a majority vote of the members appointed and serving on

 

12  the disciplinary subcommittee.

 

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

 

14  imposing a sanction under this article or article 7 or a final

 

15  decision of the disciplinary subcommittee other than a final

 

16  decision described in subsection (2) requires a majority vote of

 

17  the members appointed and serving on the disciplinary

 

18  subcommittee with an affirmative vote by at least 1 public

 

19  member.

 

20        (4) The chairperson of each disciplinary subcommittee shall

 

21  be a public member and shall be appointed by the chair of the

 

22  board or task force. However, this subsection does not apply to

 

23  the advanced practice registered nurse task force created in

 

24  section 17221a.

 

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

 

26  believes that a violation of this article or article 7 or a rule

 

27  promulgated under this article or article 7 exists may make an

 

 1  allegation of that fact to the department in writing.

 

 2        (2) If, upon after reviewing an application or an allegation

 

 3  or a licensee's file under section 16211(4), the department

 

 4  determines there is a reasonable basis to believe the existence

 

 5  of a violation of this article or article 7 or a rule promulgated

 

 6  under this article or article 7, the department, with the

 

 7  authorization of the chair of the appropriate board or task force

 

 8  or his or her designee, shall investigate. If the chair or his or

 

 9  her designee fails to grant or deny authorization within 7 days

 

10  after receipt of a request for authorization, the department

 

11  shall investigate.

 

12        (3) Upon the receipt of If the department receives

 

13  information reported pursuant to under section 16243(2) that

 

14  indicates 3 or more malpractice settlements, awards, or judgments

 

15  against a licensee in a period of 5 consecutive years or 1 or

 

16  more malpractice settlements, awards, or judgments against a

 

17  licensee totaling more than $200,000.00 in a period of 5

 

18  consecutive years, whether or not a judgment or award is stayed

 

19  pending appeal, the department shall investigate.

 

20        (4) At any time during an investigation or following the

 

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

 

22  conference pursuant to section 92 of the administrative

 

23  procedures act of 1969, MCL 24.292. The conference may include

 

24  the applicant, licensee, registrant, or individual, the

 

25  applicant's, licensee's, registrant's, or individual's attorney,

 

26  1 member of the department's staff, and any other individuals

 

27  approved by the department. One member of the appropriate board

 

 1  or task force who is not a member of the disciplinary

 

 2  subcommittee with jurisdiction over the matter, or a member of

 

 3  the task force if the disciplinary subcommittee with jurisdiction

 

 4  is the advanced practice registered nurse task force created in

 

 5  section 17221a, may attend the conference and provide such any

 

 6  assistance as that is needed. At the compliance conference, the

 

 7  department shall attempt to reach agreement. If an agreement is

 

 8  reached, the department shall submit a written statement

 

 9  outlining the terms of the agreement, or a stipulation and final

 

10  order, if applicable, or a request for dismissal to the

 

11  appropriate disciplinary subcommittee for approval. If the

 

12  agreement or stipulation and final order or request for dismissal

 

13  is rejected by the disciplinary subcommittee, or if no agreement

 

14  is reached, a hearing before a hearings examiner shall be

 

15  scheduled. A party shall not make a transcript of the compliance

 

16  conference. All records and documents of a compliance conference

 

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

 

18        (5) Within 90 days after an investigation is initiated under

 

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

 

20  following:

 

21        (a) Issue a formal complaint.

 

22        (b) Conduct a compliance conference under subsection (4).

 

23        (c) Issue a summary suspension.

 

24        (d) Issue a cease and desist order.

 

25        (e) Dismiss the complaint.

 

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

 

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

 

 1  subsection.

 

 2        (6) Unless the person submitting the allegation under

 

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

 

 4  keep the identity of a person submitting the allegation

 

 5  confidential until disciplinary proceedings under this part are

 

 6  initiated against the subject of the allegation and the person

 

 7  making the allegation is required to testify in the proceedings.

 

 8        (7) The department shall serve a complaint pursuant to under

 

 9  section 16192. The department shall include in the complaint a

 

10  notice that the applicant, licensee, registrant, or individual

 

11  who is the subject of the complaint has 30 days from the date of

 

12  receipt to respond in writing to the complaint.

 

13        (8) The department shall treat the failure of the applicant,

 

14  licensee, registrant, or individual to respond to the complaint

 

15  within the 30-day period set forth in subsection (7) as an

 

16  admission of the allegations contained in the complaint. The

 

17  department shall notify the appropriate disciplinary subcommittee

 

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

 

19  of the complaint to that disciplinary subcommittee. The

 

20  disciplinary subcommittee may then impose an appropriate sanction

 

21  under this article or article 7.

 

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

 

23  compliance conference held under section 16231(4), or if an

 

24  agreement is reached but is rejected by a disciplinary

 

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

 

26  department shall hold a hearing before a hearings examiner

 

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

 

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

 

 2  department shall not hold another compliance conference, but may

 

 3  continue to try and reach a new agreement. The hearings examiner

 

 4  shall conduct the hearing within 60 days after the compliance

 

 5  conference at which an agreement is not reached or after the

 

 6  agreement is rejected by the disciplinary subcommittee, unless a

 

 7  new agreement is reached and approved by the disciplinary

 

 8  subcommittee. One member of the appropriate board or task force

 

 9  who is not a member of the disciplinary subcommittee with

 

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

 

11  the disciplinary subcommittee with jurisdiction is the advanced

 

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

 

13  may attend the hearing and provide such any assistance as that is

 

14  needed.

 

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

 

16  grounds for disciplinary action under section 16221 or if the

 

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

 

18  article 7 or the rules promulgated under this article or article

 

19  7. The hearings examiner shall prepare recommended findings of

 

20  fact and conclusions of law for transmittal to the appropriate

 

21  disciplinary subcommittee. The hearings examiner shall not

 

22  recommend or impose penalties.

 

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

 

24  subject of the complaint or the department of attorney general

 

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

 

26  hearings examiner for good cause shown.

 

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

 

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

 

 2  be represented at the hearing by an assistant attorney general

 

 3  from the department of attorney general. The assistant attorney

 

 4  general shall not be the same individual assigned by the

 

 5  department of attorney general to provide legal counsel to the

 

 6  board or the special assistant attorney general described in

 

 7  section 16237.

 

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

 

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

 

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

 

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

 

12  the allegations contained in the complaint. The hearings examiner

 

13  shall notify the appropriate disciplinary subcommittee of the

 

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

 

15  complaint and any other relevant records to the disciplinary

 

16  subcommittee. The disciplinary subcommittee may then impose an

 

17  appropriate sanction under this article or article 7, or both.

 

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

 

19  seeking licensure to practice nursing as a registered nurse, a

 

20  licensed practical nurse, or a trained attendant under part 172

 

21  are as follows:

 

 

22

 

(a)

Application processing fee........... $ 24.00

23

 

(b)

License fee, per year................   30.00

24

 

(c)

Temporary license....................   10.00

25

 

(d)

Limited license, per year............   10.00

26

 

(e)

Specialty certification

27

 

 

for registered nurse:

1

 

(i)

Application processing fee...........   24.00

2

 

(ii)

Specialty certification, per year....   14.00

 

 

 3        (2) Fees for an individual who seeks or holds a license as

 

 4  an advanced practice registered nurse under part 172 are as

 

 5  follows:

 

 

6

 

(a)

Application processing fee..................... $ 24.00

7

 

(b)

License fee, per year..........................   40.00

 

 

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

 

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

 

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

 

11  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        (iii) In his or her practice, focuses on primary care services

 

20  for women throughout their lifespan, including comprehensive

 

21  maternity care that includes prenatal care, childbirth in diverse

 

22  settings, postpartum care, and newborn care; gynecological,

 

23  reproductive, and contraceptive care; physical exams; diagnosis

 

24  and treatment of common health problems with consultation or

 

25  referral as indicated; prescribing pharmacological and

 

 1  nonpharmacological interventions and treatments; and treatment of

 

 2  male partners for sexually transmitted infection and reproductive

 

 3  health.

 

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

 

 5  individual who meets all of the following:

 

 6        (i) Is a registered professional nurse.

 

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

 

 8  practitioner and meets the requirements of section 17210a

 

 9  applicable to that license.

 

10        (iii) In his or her practice, focuses on the performance of

 

11  comprehensive assessments; providing physical examinations and

 

12  other health assessments and screening activities; and

 

13  diagnosing, treating, and managing patients with acute and

 

14  chronic illnesses and diseases. Nursing care provided by a c.n.p.

 

15  includes ordering, performing, supervising, and interpreting

 

16  laboratory and imaging studies; prescribing pharmacological and

 

17  nonpharmacological interventions and treatments that are within

 

18  the c.n.p.'s specialty role and scope of practice; health

 

19  promotion; disease prevention; health education; and counseling

 

20  of patients and families with potential, acute, and chronic

 

21  health disorders.

 

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

 

23  means an individual who meets all of the following:

 

24        (i) Is a registered professional nurse.

 

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

 

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

 

27  applicable to that license.

 

 1        (iii) In his or her practice, focuses on continuous

 

 2  improvement of patient outcomes and nursing care with broad focus

 

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

 

 4  nursing practice, and organizational systems. The c.n.s.-c. is

 

 5  responsible and accountable for diagnosis, intervention and

 

 6  treatment of health or illness states, pharmacological and

 

 7  nonpharmacological disease management, health promotion, and

 

 8  prevention of illness and risk behavior among individuals,

 

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

 

10  patient outcomes; translates evidence into practice; and

 

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

 

12  acute and chronically ill patients and their families.

 

13        (e) "Mentorship agreement" means an agreement that meets the

 

14  requirements of section 17211a(1)(d).

 

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

 

16  any of the tasks, functions, or duties described in subdivision

 

17  (b)(iii), (c)(iii), or (d)(iii).

 

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. An advanced practice registered nurse shall do

 

14  all of the following:

 

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

 

16  which advanced practice registered nurses are educationally and

 

17  experientially prepared.

 

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

 

19  nursing and with the national accreditation standards of the

 

20  national professional nursing associations applicable to his or

 

21  her license.

 

22        (c) Consult with or refer patients to other health

 

23  professionals as appropriate.

 

24        (d) Supervise registered professional nurses, licensed

 

25  practical nurses, and other health professionals as appropriate.

 

26        Sec. 17210. The board of nursing may issue a specialty

 

27  certification to a registered professional nurse who has advanced

 

 1  training beyond that required for initial licensure and who has

 

 2  demonstrated competency through examination or other evaluative

 

 3  processes and who practices in 1 of the following health

 

 4  profession specialty fields: nurse midwifery, field of nurse

 

 5  anesthetist. , or nurse practitioner.

 

 6        Sec. 17210a. (1) The board shall issue a certified nurse

 

 7  midwife license under this article to a registered nurse who

 

 8  meets all of the following requirements:

 

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

 

10  doctoral level nursing education program that prepares the nurse

 

11  for the role of certified nurse midwife.

 

12        (b) Is certified by a nationally accredited certification

 

13  body as demonstrating role and population focused competencies

 

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

 

15  she meets the standards for that certification.

 

16        (c) Maintains continued competence by obtaining

 

17  recertification in the role and population described in

 

18  subdivision (b) through the national certification program, or

 

19  the board determines that he or she meets the standards for that

 

20  recertification.

 

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

 

22  she meets all of the following:

 

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

 

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

 

25  and also to provide indirect care.

 

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

 

27  registered professional nurses by demonstrating a greater depth

 

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

 

 2  complexity of skills and interventions, and greater role

 

 3  autonomy.

 

 4        (iii) Is educationally prepared to assume responsibility and

 

 5  accountability for health promotion or maintenance and the

 

 6  assessment, diagnosis, and management of patient problems,

 

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

 

 8  pharmacologic and nonpharmacologic interventions.

 

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

 

10  to perform as a licensee.

 

11        (2) The board shall issue a certified nurse practitioner

 

12  license under this article to a registered nurse who meets all of

 

13  the following requirements:

 

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

 

15  doctoral level nursing education program that prepares the nurse

 

16  for the role of certified nurse practitioner.

 

17        (b) Is certified by a nationally accredited certification

 

18  body as demonstrating role and population focused competencies

 

19  for certified nurse practitioners, or the board determines that

 

20  he or she meets the standards for that certification.

 

21        (c) Maintains continued competence by obtaining

 

22  recertification in the role and population described in

 

23  subdivision (b) through the national certification program, or

 

24  the board determines that he or she meets the standards for that

 

25  recertification.

 

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

 

27  she meets all of the following:

 

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

 

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

 

 3  and also to provide indirect care.

 

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

 

 5  registered professional nurses by demonstrating a greater depth

 

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

 

 7  complexity of skills and interventions, and greater role

 

 8  autonomy.

 

 9        (iii) Is educationally prepared to assume responsibility and

 

10  accountability for health promotion or maintenance and the

 

11  assessment, diagnosis, and management of patient problems,

 

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

 

13  pharmacologic and nonpharmacologic interventions.

 

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

 

15  to perform as a licensee.

 

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

 

17  certified license under this article to a registered nurse who

 

18  meets all of the following requirements:

 

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

 

20  doctoral level nursing education program that prepares the nurse

 

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 described in

 

 1  subdivision (b) through the national certification program, or

 

 2  the board determines that he or she meets the standards for that

 

 3  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.

 

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

 

20  to perform as a licensee.

 

21        (4) The board shall issue an a.p.r.n. license to a

 

22  registered professional nurse who holds a specialty

 

23  certification, issued by the board, as a nurse midwife, nurse

 

24  practitioner, or clinical nurse specialist if he or she meets all

 

25  of the following:

 

26        (a) His or her license and specialty certification issued by

 

27  the board is current on the effective date of the amendatory act

 

 1  that added this section.

 

 2        (b) He or she submits an application for an a.p.r.n. license

 

 3  in the 2-year period beginning on the effective date of the

 

 4  amendatory act that added this section.

 

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

 

 6  the board is current on the date he or she submits the license

 

 7  application.

 

 8        (d) He or she provides proof satisfactory to the department

 

 9  that he or she has been employed as a clinical nurse specialist,

 

10  nurse practitioner, or nurse midwife for the 4-year period

 

11  immediately preceding the date he or she submits the license

 

12  application.

 

13        (e) On the date he or she submits the license application,

 

14  he or she meets any requirements for professional certification

 

15  established by the department in consultation with the board.

 

16        (5) The department shall renew an a.p.r.n. license under

 

17  this part concurrently with the registered professional nurse

 

18  license.

 

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

 

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

 

21  nurse, or the practice of advanced practice registered nursing

 

22  unless licensed or otherwise authorized by this article.

 

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

 

24  thereof of them, with or without qualifying words or phrases, are

 

25  restricted in use only to those persons authorized under this

 

26  part to use the terms and in a way prescribed in this part:

 

27  "registered professional nurse", "registered nurse", "r.n.",

 

 1  "licensed practical nurse", "l.p.n.", "nurse midwife", "certified

 

 2  nurse midwife", "c.n.m.", "nurse anesthetist", "nurse

 

 3  practitioner", "certified nurse practitioner", "c.n.p.",

 

 4  "clinical nurse specialist-certified", "c.n.s.-c.", "trained

 

 5  attendant", and "t.a.".

 

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

 

 7  practice registered nurse who meets all of the following may

 

 8  possess, prescribe, and administer nonscheduled prescription

 

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

 

10  part 72:

 

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

 

12  pathophysiology, and physical assessment courses and clinical

 

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

 

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

 

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

 

16        (b) Unless otherwise provided by rule, he or she has

 

17  completed the number of contact hours in pharmacology as part of

 

18  the requisite continuing education for a controlled substances

 

19  license under part 73, and for renewal of his or her license

 

20  under this part as determined by the board.

 

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

 

22  part 73.

 

23        (d) If he or she has held an a.p.r.n. license issued under

 

24  this part for a period of less than 2 years, he or she shall only

 

25  possess, prescribe, or administer those drugs and substances

 

26  under the terms of a mentorship agreement that meets all of the

 

27  following:

 

 1        (i) Is a written agreement between the advanced practice

 

 2  registered nurse and a physician who is licensed under part 170

 

 3  or 175 and holds a controlled substances license under part 73 or

 

 4  between the advanced practice registered nurse and another

 

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

 

 6  5 years of work experience in that licensed profession, and holds

 

 7  a controlled substances license under part 73.

 

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

 

 9  to the agreement.

 

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

 

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

 

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

 

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

 

14  before the date of the revocation.

 

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

 

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

 

17  or controlled substance only while engaged in the practice of

 

18  advanced practice registered nursing.

 

19        (f) All of the following apply to a prescription of a

 

20  controlled substance included in schedules 2 to 5 of part 72:

 

21        (i) Before prescribing the controlled substance, he or she

 

22  shall under section 7333a(2)(f) request that the department of

 

23  community health provide any data included in the electronic

 

24  monitoring system established under section 7333a(1) concerning

 

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

 

26  determine if prescribing or administering the controlled

 

27  substance to the intended individual is consistent with patient

 

 1  safety and that the controlled substance would not likely be

 

 2  subject to abuse by the individual.

 

 3        (ii) After prescribing the controlled substance, he or she

 

 4  shall provide any information about that prescription to the

 

 5  department of community health that a dispensing prescriber is

 

 6  required to report under section 7333a(1).

 

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

 

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

 

 9  this part for a period of less than 2 years may be a party to

 

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

 

11        (3) The department shall issue a controlled substances

 

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

 

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

 

14  nonscheduled prescription drugs and controlled substances

 

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

 

16  a limitation on a controlled substances license issued to an

 

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

 

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

 

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

 

20  require new or additional third-party reimbursement or mandated

 

21  worker's compensation benefits for services rendered by an

 

22  advanced practice registered nurse authorized to prescribe

 

23  nonscheduled prescription drugs and controlled substances

 

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

 

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

 

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

 

27  17745a, or 17745b, a supervising physician may delegate in

 

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

 

 2  and dispensing of complimentary starter dose drugs other than

 

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

 

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

 

 5  complimentary starter dose drugs described in this subsection

 

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

 

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

 

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

 

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

 

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

 

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

 

12  practice of advanced practice registered nursing may order,

 

13  receive, and dispense a complimentary starter dose of a

 

14  prescription drug or controlled substance described in section

 

15  17211a without delegation from a supervising physician. Only the

 

16  name of the advanced practice registered nurse shall be used,

 

17  recorded, or otherwise indicated in connection with an order,

 

18  receipt, or dispensing of a complimentary starter dose of a

 

19  prescription drug or controlled substance under this subsection.

 

20        (3) (2) It is the intent of the legislature in enacting this

 

21  section to allow a pharmaceutical manufacturer or wholesale

 

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

 

23  distribute complimentary starter dose drugs to a an advanced

 

24  practice registered nurse described in subsection (2), or to any

 

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

 

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

 

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

 

 1        Sec. 17214. (1) In addition to the requirements of section

 

 2  16205, the board by rule may require a licensee seeking renewal

 

 3  of a license under this part to furnish the board with

 

 4  satisfactory evidence that, during the 2 years immediately

 

 5  preceding the date of his or her application for renewal, the

 

 6  licensee completed continuing education or competency courses or

 

 7  activities approved by the board.

 

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

 

 9  section 16205 that require continuing education or competency

 

10  courses or activities, the board shall promulgate rules under

 

11  section 16204 that require each applicant for license renewal to

 

12  complete as part of those continuing education or competency

 

13  courses or activities an appropriate number of hours or courses

 

14  in pain and symptom management.

 

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

 

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

 

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

 

18  the following 23 29 voting members who shall meet the

 

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

 

20  certified nurse midwife, 1 midwives, 2 nurse anesthetist

 

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

 

22  clinical nurse specialists-certified, 3 licensed practical

 

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

 

24  professional nurse members shall be engaged in nursing education,

 

25  1 of whom shall be in less than a baccalaureate program, 1 in a

 

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

 

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

 

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

 

 2  registered professional nurse members shall be engaged in nursing

 

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

 

 4  baccalaureate degree in nursing from an accredited college. Three

 

 5  of the registered professional nurse members shall be engaged in

 

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

 

 7  a nonbaccalaureate registered nurse. The 3 licensed practical

 

 8  nurse members shall have graduated from a state approved program

 

 9  for the preparation of individuals to practice as licensed

 

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

 

11  the nurse practitioner Each of the certified nurse midwives,

 

12  certified nurse practitioners, and clinical nurse specialists-

 

13  certified appointed to the board shall each have a specialty

 

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

 

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

 

16  anesthetists shall have a specialty certificate issued by the

 

17  department in that specialty field under section 17210.

 

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

 

19  created under this part, except those appointed to fill

 

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

 

21  year in which the term expires.

 

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

 

23  force is created. Subject to subsection (2), the task force shall

 

24  consist of the following 11 members, who shall be members of the

 

25  board and shall meet the requirements of part 161:

 

26        (a) One registered professional nurse.

 

27        (b) Two certified nurse midwives.

 

 1        (c) Two certified nurse practitioners.

 

 2        (d) Two clinical nurse specialists-certified.

 

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

 

 4        (f) Two public members.

 

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

 

 6  the following:

 

 7        (a) Develop and make public guidelines on the appropriate

 

 8  scope of practice of an a.p.r.n. according to his or her

 

 9  education, training, and experience. Guidelines developed under

 

10  this subdivision are nonbinding and advisory and shall only

 

11  express the task force's criteria for determining whether an

 

12  a.p.r.n. is practicing within his or her scope of practice.

 

13        (b) Serve as the disciplinary subcommittee under section

 

14  16216 for advanced practice registered nurses and nurse

 

15  anesthetists certified under section 17210.

 

16        (c) Make written recommendations to the board on

 

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

 

18  a.p.r.n. licenses.

 

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

 

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

 

21  department concerning any matters prescribed by the task force

 

22  and board.

 

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

 

24  practice of speech-language pathology unless licensed under this

 

25  part.

 

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

 

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

 

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

 

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

 

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

 

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

 

 5  practice of medicine or osteopathic medicine and surgery if signs

 

 6  or symptoms identified during the practice of speech-language

 

 7  pathology cause the speech-language pathologist to suspect that

 

 8  the patient has an underlying medical condition.

 

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

 

10  therapy, and procedures related to swallowing disorders and

 

11  medically related communication disorders only on patients who

 

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

 

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

 

14  advanced practice registered nurse licensed under part 172

 

15  engaged in the practice of advanced practice registered nursing.

 

16        (4) Limited diagnostic testing, such as endoscopic

 

17  videolaryngostroboscopy, shall only be performed by a licensee in

 

18  collaboration with or under the supervision of a person licensed

 

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

 

20        (5) A licensee shall follow procedures in which

 

21  collaboration among the licensee and a person licensed in the

 

22  practice of medicine or osteopathic medicine and surgery and

 

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

 

24  best interests of the patient.

 

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

 

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

 

27  part or act from performing activities that are considered

 

 1  speech-language pathology services if those activities are within

 

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

 

 3  use the titles protected under section 17603.

 

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

 

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

 

 6  accredited speech-language pathology educational program approved

 

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

 

 8  students and provide speech-language pathology services only

 

 9  while under the supervision of a licensed speech-language

 

10  pathologist.

 

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

 

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

 

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

 

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

 

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

 

16  pharmacy.

 

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

 

18  of medicine, a licensed doctor of osteopathic medicine and

 

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

 

20  licensed optometrist certified under part 174 to administer and

 

21  prescribe therapeutic pharmaceutical agents, a licensed advanced

 

22  practice registered nurse who meets the requirements of section

 

23  17211a engaged in the practice of advanced practice registered

 

24  nursing, a licensed veterinarian, or another licensed health

 

25  professional acting under the delegation and using, recording, or

 

26  otherwise indicating the name of the delegating licensed doctor

 

27  of medicine or licensed doctor of osteopathic medicine and

 

 1  surgery.

 

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

 

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

 

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

 

 5  transmitted by facsimile; or transmitted electronically or by

 

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

 

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

 

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

 

 9  that record constitutes the original prescription. In a health

 

10  facility or agency licensed under article 17 or other medical

 

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

 

12  constitutes for the purposes of this definition the original

 

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

 

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

 

15  including a controlled substance as defined in section 7104

 

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

 

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

 

18  and transmitted by facsimile; or transmitted electronically or by

 

19  other means of communication by a physician prescriber or dentist

 

20  prescriber licensed to practice dentistry, medicine, or

 

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

 

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

 

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

 

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

 

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

 

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

 

27  be dispensed pursuant to a prescription.

 

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

 

 2  subsection, a prescriber, except an advanced practice registered

 

 3  nurse, who wishes to dispense prescription drugs shall obtain

 

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

 

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

 

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

 

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

 

 8  hospital licensed under article 17 or if the dispensing involves

 

 9  only the issuance of complimentary starter dose drugs.

 

10        (2) A dispensing prescriber, except an advanced practice

 

11  registered nurse, shall dispense prescription drugs only to his

 

12  or her own patients.

 

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

 

14  chart or clinical record a complete record, including

 

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

 

16  prescription drugs dispensed directly by the dispensing

 

17  prescriber or indirectly under his or her delegatory authority.

 

18  If prescription drugs are dispensed under the prescriber's

 

19  delegatory authority, the delegatee who dispenses the

 

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

 

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

 

22  chart or clinical record, a dispensing prescriber shall

 

23  distinguish between prescription drugs dispensed to the patient

 

24  and prescription drugs prescribed for the patient. A dispensing

 

25  prescriber shall retain information required under this

 

26  subsection for not less than 5 years after the information is

 

27  entered in the patient's chart or clinical record.

 

 1        (4) A dispensing prescriber shall store prescription drugs

 

 2  under conditions that will maintain their stability, integrity,

 

 3  and effectiveness and will assure that the prescription drugs are

 

 4  free of contamination, deterioration, and adulteration.

 

 5        (5) A dispensing prescriber shall store prescription drugs

 

 6  in a substantially constructed, securely lockable cabinet. Access

 

 7  to the cabinet shall be limited to individuals authorized to

 

 8  dispense prescription drugs in compliance with this part and

 

 9  article 7.

 

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

 

11  prescriber shall dispense a prescription drug in a safety closure

 

12  container that complies with the poison prevention packaging act

 

13  of 1970, 15 USC 1471 to 1477.

 

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

 

15  container that bears a label containing all of the following

 

16  information:

 

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

 

18  prescription drug is dispensed.

 

19        (b) The patient's name and record number.

 

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

 

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

 

22  prescriber's delegatory authority, shall list the name of the

 

23  delegatee.

 

24        (e) The directions for use.

 

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

 

26        (g) The quantity dispensed.

 

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

 

 1  statement required under section 17756.

 

 2        (8) A dispensing prescriber who dispenses, or an advanced

 

 3  practice registered nurse, while engaged in the practice of

 

 4  advanced practice registered nursing, who meets the requirements

 

 5  of section 17212 and who possesses, prescribes, or administers, a

 

 6  complimentary starter dose drug to a patient shall give the

 

 7  patient at least all of the following information, either by

 

 8  dispensing the complimentary starter dose drug to the patient in

 

 9  a container that bears a label containing the information or by

 

10  giving the patient a written document which may include, but is

 

11  not limited to, a preprinted insert that comes with the

 

12  complimentary starter dose drug, that contains the information:

 

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

 

14  drug.

 

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

 

16  starter dose drug.

 

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

 

18  drug or the statement required under section 17756.

 

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

 

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

 

21  federal law regulating the labeling of prescription drugs.

 

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

 

23  dispensing prescriber who dispenses controlled substances shall

 

24  comply with section 7303a.

 

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

 

26  prescription drugs are dispensed.

 

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

 

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

 

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

 

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

 

 4  pharmacist practicing in a hospital pharmacy within a hospital

 

 5  licensed under article 17 the receipt of complimentary starter

 

 6  dose drugs other than controlled substances as defined by article

 

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

 

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

 

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

 

10  otherwise indicated in connection with each receipt. A pharmacist

 

11  described in this subsection may dispense a prescription for

 

12  complimentary starter dose drugs written or transmitted by

 

13  facsimile, electronic transmission, or other means of

 

14  communication by a prescriber.

 

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

 

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

 

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

 

18  dispensing prescriber free of charge by a manufacturer or

 

19  distributor and dispensed free of charge by the dispensing

 

20  prescriber to his or her patients.

 

21        Sec. 17820. (1) A person shall not engage in the practice of

 

22  physical therapy or practice as a physical therapist assistant

 

23  unless licensed or otherwise authorized under this part. A person

 

24  shall engage in the actual treatment of an individual only upon

 

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

 

 5  thereof, with or without qualifying words or phrases, are

 

 6  restricted in use only to those persons authorized under this

 

 7  part to use the terms and in a way prescribed in this part:

 

 8  "physical therapy", "physical therapist", "physiotherapist",

 

 9  "physiotherapy", "registered physical therapist", "licensed

 

10  physical therapist", "physical therapy technician", "physical

 

11  therapist assistant", "physical therapy assistant",

 

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

 

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

 

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

 

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

 

16  "p.t.t.".

 

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

 

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

 

19  requiring that a physical therapist to perform activities within

 

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

 

21  prescription of an individual holding if that treatment is

 

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

 

23  166, 170, 175, or 180, or the an a.p.r.n. license issued under

 

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

 

25  registered nursing, or an equivalent license issued by another

 

26  state.

 

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

 

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

 

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

 

 3  occupational therapy assistant.

 

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

 

 5  licensed under this article to engage in the practice of

 

 6  occupational therapy.

 

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

 

 8  provided to promote health and wellness, prevent disability,

 

 9  preserve functional capabilities, prevent barriers, and enable or

 

10  improve performance in everyday activities, including, but not

 

11  limited to, the following:

 

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

 

13  ability that is impaired or not yet developed.

 

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

 

15  activity, or environment.

 

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

 

17  living, instrumental activities of daily living, and other

 

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

 

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

 

20  body functions, body structure, habits, routines, role

 

21  performance, behavior patterns, sensory motor skills, cognitive

 

22  skills, communication and interaction skills, and cultural,

 

23  physical, psychosocial, spiritual, developmental, environmental,

 

24  and socioeconomic contexts and activities that affect

 

25  performance.

 

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

 

27  to, any of the following:

 

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

 

 2  exercises, and activities.

 

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

 

 4  and community or work reintegration.

 

 5        (C) Development remediation, or compensation of client

 

 6  factors such as body functions and body structure.

 

 7        (D) Education and training.

 

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

 

 9  consultative services.

 

10        (F) Modification of environments and adaptation processes

 

11  such as the application of ergonomic and safety principles.

 

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

 

13  and training in rehabilitative and assistive technology, adaptive

 

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

 

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

 

16  subparagraph, the design and fabrication of low temperature

 

17  orthotic devices does not include permanent orthotics.

 

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

 

19  to enhance safety, functional mobility, and community mobility

 

20  such as wheelchair management and mobility.

 

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

 

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

 

23  range of specific therapeutic procedures, including, but not

 

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

 

25  cognitive processing, manual therapy techniques, and adjunctive

 

26  and preparatory activities.

 

27        (K) Providing vision therapy services or low vision

 

 1  rehabilitation services, if those services are provided pursuant

 

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

 

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

 

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

 

 5  prescription from an advanced practice registered nurse, licensed

 

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

 

 7  practice registered nursing.

 

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

 

 9  the practice of occupational therapy under the supervision of an

 

10  occupational therapist licensed under this article.

 

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

 

12  use of everyday life occupations and occupational therapy

 

13  services to aid individuals or groups to participate in

 

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

 

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

 

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

 

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

 

18  disease, disorder, condition, impairment, disability, activity

 

19  limitation, or participation restriction. The practice of

 

20  occupational therapy addresses the physical, cognitive,

 

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

 

22  variety of contexts to support engagement in everyday life

 

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

 

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

 

25  occupational therapy does not include any of the following:

 

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

 

27  surgery or medical diagnosis or treatment.

 

 1        (ii) The practice of physical therapy.

 

 2        (iii) The practice of optometry.

 

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

 

 4  contains general definitions and principles of construction

 

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

 

 6  definitions applicable to this part.

 

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

 

 8  services directly to patients or residents and is licensed under

 

 9  this article shall adopt a policy describing the rights and

 

10  responsibilities of patients or residents admitted to the health

 

11  facility or agency. Except for a licensed health maintenance

 

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

 

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

 

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

 

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

 

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

 

17  in accordance with the policy.

 

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

 

19  patients or residents required under subsection (1) shall

 

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

 

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

 

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

 

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

 

24  payment.

 

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

 

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

 

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

 

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

 

 2  333.26271. Except as otherwise permitted or required under the

 

 3  health insurance portability and accountability act of 1996,

 

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

 

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

 

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

 

 7  authorization of the patient or resident.

 

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

 

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

 

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

 

11  as required because of a transfer to another health care

 

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

 

13  as permitted or required under the health insurance portability

 

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

 

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

 

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

 

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

 

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

 

19  dignity and individuality.

 

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

 

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

 

22  individual within the health facility or agency, information

 

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

 

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

 

25  can understand, unless medically contraindicated as documented in

 

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

 

27  assistant to whom the physician has delegated the performance of

 

 1  medical care services.

 

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

 

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

 

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

 

 5  facility or agency or its staff from providing appropriate care

 

 6  according to ethical and professional standards, the relationship

 

 7  with the patient or resident may be terminated upon reasonable

 

 8  notice.

 

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

 

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

 

11  may present grievances or recommend changes in policies and

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

19  resident complaints.

 

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

 

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

 

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

 

23  experimental procedure without jeopardizing his or her continuing

 

24  care.

 

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

 

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

 

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

 

 1  financial assistance available through the health facility or

 

 2  agency.

 

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

 

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

 

 5  entitled to receive information concerning his or her continuing

 

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

 

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

 

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

 

 9  private communications and consultations with his or her

 

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

 

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

 

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

 

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

 

14  health facility or agency, unless medically contraindicated as

 

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

 

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

 

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

 

18  civil and religious liberties, including the right to independent

 

19  personal decisions and the right to knowledge of available

 

20  choices, shall not be infringed and the health facility or agency

 

21  shall encourage and assist in the fullest possible exercise of

 

22  these rights. A patient or resident may meet with, and

 

23  participate in, the activities of social, religious, and

 

24  community groups at his or her discretion, unless medically

 

25  contraindicated as documented in the medical record by the

 

26  attending physician or a physician's assistant to whom the

 

27  physician has delegated the performance of medical care services.

 

 1        (l) A patient or resident is entitled to be free from mental

 

 2  and physical abuse and from physical and chemical restraints,

 

 3  except those restraints authorized in writing by the attending

 

 4  physician, by an advanced practice registered nurse engaged in

 

 5  the practice of advanced practice registered nursing, or by a

 

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

 

 7  performance of medical care services, for a specified and limited

 

 8  time or as are necessitated by an emergency to protect the

 

 9  patient or resident from injury to self or others, in which case

 

10  the restraint may only be applied by a qualified professional who

 

11  shall set forth in writing the circumstances requiring the use of

 

12  restraints and who shall promptly report the action to the

 

13  attending physician, or physician's assistant, or advanced

 

14  practice registered nurse who authorized the restraint. In case

 

15  of a chemical restraint, a physician shall be consulted within 24

 

16  hours after the commencement of the chemical restraint.

 

17        (m) A patient or resident is entitled to be free from

 

18  performing services for the health facility or agency that are

 

19  not included for therapeutic purposes in the plan of care.

 

20        (n) A patient or resident is entitled to information about

 

21  the health facility or agency rules and regulations affecting

 

22  patient or resident care and conduct.

 

23        (o) A patient or resident is entitled to adequate and

 

24  appropriate pain and symptom management as a basic and essential

 

25  element of his or her medical treatment.

 

26        (3) The following additional requirements for the policy

 

27  described in subsection (2) apply to licensees under parts 213

 

 1  and 217:

 

 2        (a) The policy shall be provided to each nursing home

 

 3  patient or home for the aged resident upon admission, and the

 

 4  staff of the facility shall be trained and involved in the

 

 5  implementation of the policy.

 

 6        (b) Each nursing home patient may associate and communicate

 

 7  privately with persons of his or her choice. Reasonable, regular

 

 8  visiting hours, which shall be not less than 8 hours per day, and

 

 9  which shall take into consideration the special circumstances of

 

10  each visitor, shall be established for patients to receive

 

11  visitors. A patient may be visited by the patient's attorney or

 

12  by representatives of the departments named in section 20156,

 

13  during other than established visiting hours. Reasonable privacy

 

14  shall be afforded for visitation of a patient who shares a room

 

15  with another patient. Each patient shall have reasonable access

 

16  to a telephone. A married nursing home patient or home for the

 

17  aged resident is entitled to meet privately with his or her

 

18  spouse in a room that assures privacy. If both spouses are

 

19  residents in the same facility, they are entitled to share a room

 

20  unless medically contraindicated and documented in the medical

 

21  record by the attending physician or a physician's assistant to

 

22  whom the physician has delegated the performance of medical care

 

23  services.

 

24        (c) A nursing home patient or home for the aged resident is

 

25  entitled to retain and use personal clothing and possessions as

 

26  space permits, unless to do so would infringe upon the rights of

 

27  other patients or residents, or unless medically contraindicated

 

 1  as documented in the medical record by the attending physician or

 

 2  a physician's assistant to whom the physician has delegated the

 

 3  performance of medical care services. Each nursing home patient

 

 4  or home for the aged resident shall be provided with reasonable

 

 5  space. At the request of a patient, a nursing home shall provide

 

 6  for the safekeeping of personal effects, funds, and other

 

 7  property of a patient in accordance with section 21767, except

 

 8  that a nursing home is not required to provide for the

 

 9  safekeeping of a property that would impose an unreasonable

 

10  burden on the nursing home.

 

11        (d) A nursing home patient or home for the aged resident is

 

12  entitled to the opportunity to participate in the planning of his

 

13  or her medical treatment. The attending physician or a

 

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

 

15  performance of medical care services shall fully inform the

 

16  nursing home patient of the patient's medical condition unless

 

17  medically contraindicated as documented in the medical record by

 

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

 

19  delegated the performance of medical care services. Each nursing

 

20  home patient shall be afforded the opportunity to discharge

 

21  himself or herself from the nursing home.

 

22        (e) A home for the aged resident may be transferred or

 

23  discharged only for medical reasons, for his or her welfare or

 

24  that of other residents, or for nonpayment of his or her stay,

 

25  except as provided by title XVIII or title XIX. A nursing home

 

26  patient may be transferred or discharged only as provided in

 

27  sections 21773 to 21777. A nursing home patient or home for the

 

 1  aged resident is entitled to be given reasonable advance notice

 

 2  to ensure orderly transfer or discharge. Those actions shall be

 

 3  documented in the medical record.

 

 4        (f) A nursing home patient or home for the aged resident is

 

 5  entitled to be fully informed before or at the time of admission

 

 6  and during stay of services available in the facility, and of the

 

 7  related charges including any charges for services not covered

 

 8  under title XVIII, or not covered by the facility's basic per

 

 9  diem rate. The statement of services provided by the facility

 

10  shall be in writing and shall include those required to be

 

11  offered on an as-needed basis.

 

12        (g) A nursing home patient or home for the aged resident is

 

13  entitled to manage his or her own financial affairs, or to have

 

14  at least a quarterly accounting of personal financial

 

15  transactions undertaken in his or her behalf by the facility

 

16  during a period of time the patient or resident has delegated

 

17  those responsibilities to the facility. In addition, a patient or

 

18  resident is entitled to receive each month from the facility an

 

19  itemized statement setting forth the services paid for by or on

 

20  behalf of the patient and the services rendered by the facility.

 

21  The admission of a patient to a nursing home does not confer on

 

22  the nursing home or its owner, administrator, employees, or

 

23  representatives the authority to manage, use, or dispose of a

 

24  patient's property.

 

25        (h) A nursing home patient or a person authorized by the

 

26  patient in writing may inspect and copy the patient's personal

 

27  and medical records. The records shall be made available for

 

 1  inspection and copying by the nursing home within a reasonable

 

 2  time, not exceeding 1 week, after the receipt of a written

 

 3  request.

 

 4        (i) If a nursing home patient desires treatment by a

 

 5  licensed member of the healing arts, the treatment shall be made

 

 6  available unless it is medically contraindicated, and the medical

 

 7  contraindication is justified in the patient's medical record by

 

 8  the attending physician or a physician's assistant to whom the

 

 9  physician has delegated the performance of medical care services.

 

10        (j) A nursing home patient has the right to have his or her

 

11  parents, if a minor, or his or her spouse, next of kin, or

 

12  patient's representative, if an adult, stay at the facility 24

 

13  hours a day if the patient is considered terminally ill by the

 

14  physician responsible for the patient's care or a physician's

 

15  assistant to whom the physician has delegated the performance of

 

16  medical care services.

 

17        (k) Each nursing home patient shall be provided with meals

 

18  that meet the recommended dietary allowances for that patient's

 

19  age and sex and that may be modified according to special dietary

 

20  needs or ability to chew.

 

21        (l) Each nursing home patient has the right to receive

 

22  representatives of approved organizations as provided in section

 

23  21763.

 

24        (4) A nursing home, its owner, administrator, employee, or

 

25  representative shall not discharge, harass, or retaliate or

 

26  discriminate against a patient because the patient has exercised

 

27  a right protected under this section.

 

 1        (5) In the case of a nursing home patient, the rights

 

 2  enumerated in subsection (2)(c), (g), and (k) and subsection

 

 3  (3)(d), (g), and (h) may be exercised by the patient's

 

 4  representative.

 

 5        (6) A nursing home patient or home for the aged resident is

 

 6  entitled to be fully informed, as evidenced by the patient's or

 

 7  resident's written acknowledgment, before or at the time of

 

 8  admission and during stay, of the policy required by this

 

 9  section. The policy shall provide that if a patient or resident

 

10  is adjudicated incompetent and not restored to legal capacity,

 

11  the rights and responsibilities set forth in this section shall

 

12  be exercised by a person designated by the patient or resident.

 

13  The health facility or agency shall provide proper forms for the

 

14  patient or resident to provide for the designation of this person

 

15  at the time of admission.

 

16        (7) This section does not prohibit a health facility or

 

17  agency from establishing and recognizing additional patients'

 

18  rights.

 

19        (8) As used in this section:

 

20        (a) "Patient's representative" means that term as defined in

 

21  section 21703.

 

22        (b) "Title XVIII" means title XVIII of the social security

 

23  act, 42 USC 1395 to 1395kkk-1.

 

24        (c) "Title XIX" means title XIX of the social security act,

 

25  42 USC 1396 to 1396w-5.