HB-5400, As Passed House, November 29, 2016
SUBSTITUTE FOR
HOUSE BILL NO. 5400
A bill to amend 1978 PA 368, entitled
"Public health code,"
by amending sections 2701, 2705, 5119, 16327, 17201, 17210, 17211,
17212, 17221, 17607, 17708, 17745, 17820, 17822, and 20201 (MCL
333.2701, 333.2705, 333.5119, 333.16327, 333.17201, 333.17210,
333.17211, 333.17212, 333.17221, 333.17607, 333.17708, 333.17745,
333.17820, 333.17822, and 333.20201), sections 2701 and 2705 as
amended by 2014 PA 172, section 5119 as amended by 2016 PA 66,
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
2016 PA 49, section 17745 as amended by 2014 PA 525, section 17820
as amended by 2014 PA 260, section 17822 as amended by 2005 PA 281,
and section 20201 as amended by 2011 PA 210, and by adding sections
17211a and 17214.
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 Board of medical
specialties
5 Medical Specialties or the
American osteopathic
6 association.Osteopathic
Association.
7 (b) "Certified nurse midwife" means an individual who is
8 licensed as a registered professional nurse under part 172 who has
9 been issued granted
a specialty certification in the
practice of
10 nurse midwifery by the Michigan board of nursing under section
11 17210.
12 (c) "Certified nurse practitioner" means an individual who is
13 licensed as a registered professional nurse under part 172 who has
14 been issued granted
a specialty certification as a nurse
15 practitioner by the Michigan board of nursing under section 17210.
16 (d) "Clinical nurse specialist-certified" means an individual
17 who is licensed as a registered professional nurse under part 172
18 who has been granted a specialty certification as a clinical nurse
19 specialist by the Michigan board of nursing under section 17210.
20 (e) (d) "Dental
school" means an accredited program for the
21 training of individuals to become dentists.
22 (f) (e) "Dentist"
means an individual who is licensed to
23 engage in the practice of dentistry under part 166.
24 (g) (f) "Designated
nurse" means a certified nurse midwife, or
25 certified nurse practitioner, or clinical nurse specialist-
1 certified.
2 (h) (g) "Designated
physician" means a physician qualified in
3 1 of the physician specialty areas identified in section 2711.
4 (i) (h) "Designated
professional" means a designated
5 physician, designated nurse, dentist, or physician's assistant.
6 (j) (i) "Health
resource shortage area" means a geographic
7 area, population group, or health facility designated by the
8 department under section 2717.
9 (k) (j) "Medicaid"
means benefits under the program of medical
10 assistance established under title XIX of the social security act,
11 42 USC 1396 to 1396w-5, and administered by the department of
12 health and human services under the social welfare act, 1939 PA
13 280, MCL 400.1 to 400.119b.
14 (l) (k)
"Medical school" means an
accredited program for the
15 training of individuals to become physicians.
16 (m) (l) "Medicare" means benefits under the
federal medicare
17 Medicare program established under title XVIII of the social
18 security act, 42 USC 1395 to 1395kkk-1.1395lll.
19 (n) (m) "National
health service corps" Health
Service Corps"
20 means the agency established under 42 USC 254d.
21 (o) (n) "Nurse"
means an individual who is licensed to engage
22 in the practice of nursing under part 172.
23 (p) (o) "Nursing
program" means an accredited program for the
24 training of individuals to become nurses.
25 (q) (p) "Physician"
means an individual who is licensed as a
26 physician under part 170 or an osteopathic physician under part
27 175.
1 (r) (q) "Physician's
assistant" means an individual who
is
2 licensed as a physician's assistant under part 170 or part 175.
3 (s) (r) "Physician's
assistant program" means an accredited
4 program for the training of individuals to become physician's
5 assistants.
6 (t) (s) "Service
obligation" means the contractual obligation
7 undertaken by an individual under section 2705 or section 2707 to
8 provide health care services for a determinable time period at a
9 site designated by the department.
10 Sec. 2705. (1) The department shall administer an essential
11 health provider repayment program for designated professionals who
12 have incurred a debt or expenses as a result of a loan taken to
13 attend a medical school, dental school, nursing program for the
14 training of certified nurse midwives, or certified nurse
15 practitioners, or clinical nurse specialists-certified, or
16 physician's assistant program or as a result of providing services
17 in a health resource shortage area. The department may each year
18 repay all or part of a designated professional's debt or expenses,
19 but the amount repaid in any 1 year shall not exceed the amount
20 described in subsection (3). The department shall repay a debt or
21 expenses only for a designated professional who has entered into a
22 written contract with the department that requires the designated
23 professional to engage in the full-time practice of health care
24 services in a health resource shortage area to which he or she is
25 assigned by the department for a period equal in years to the
26 number of years for which the department has agreed in the contract
27 to make a debt or expense repayment, or for a period of 2 years,
1 whichever is greater.
2 (2) A debt or expense repayment on behalf of a designated
3 professional under subsection (1) for fulfilling a service
4 obligation for a particular year shall must be
paid in a lump sum
5 at the completion of the service obligation for that year. A
6 designated professional who does not fulfill a service obligation
7 for a particular year forfeits his or her right to the debt or
8 expense repayment or any part of it for that year and the
9 department may treat an agreement for further debt or expense
10 repayment in a subsequent year as void. In its sole discretion, the
11 department may make a debt or expense repayment prior to before or
12 during each year of service if there are extenuating circumstances.
13 In its sole discretion, the department may pay a pro rata amount of
14 an agreed debt or expense repayment to a designated professional or
15 his or her estate if 1 of the following occurs prior to before the
16 completion of the designated professional's service obligation:
17 (a) The designated professional dies.
18 (b) The designated professional is unable, by reason of
19 permanent disability, to render the service.
20 (c) Other circumstances prevail that are considered by the
21 department to constitute a compelling reason to consider the
22 service obligation fulfilled.
23 (3) In any year of a debt or expense repayment program, the
24 maximum amount of a debt or expense repayment is $40,000.00 per
25 year. The maximum amount of debt or expense repayment the
26 department may pay on behalf of a designated professional is
27 $200,000.00, paid over a period of 4 years or more. The written
1 contract described in subsection (1) must include the amount the
2 department shall pay on behalf of a designated professional and the
3 amount payable for each year of service. shall be included in the
4 written contract under subsection (1).
5 (4) The department may accept funds from any source for the
6 operation of the essential health provider repayment program, and
7 the department shall distribute those funds in a manner consistent
8 with this section.
9 (5) The department shall give the essential health provider
10 repayment program created by this section priority over the other
11 programs created under this part.
12 Sec. 5119. (1) An individual who is applying for a marriage
13 license shall be advised through the distribution of written
14 educational materials by the county clerk regarding prenatal care
15 and the transmission and prevention of sexually transmitted
16 infection and HIV infection. The written educational materials
17 shall must describe the availability to the applicant of tests
for
18 both sexually transmitted infection and HIV infection. The
19 information shall must
include a list of locations where HIV
20 counseling and testing services funded by the department are
21 available. The department shall approve or prepare the written
22 educational materials. shall be approved or prepared by the
23 department.
24 (2) A county clerk shall not issue a marriage license to an
25 applicant who fails to sign and file with the county clerk an
26 application for a marriage license that includes a statement with a
27 check-off box indicating that the applicant has received the
1 educational materials regarding the transmission and prevention of
2 both sexually transmitted infection and HIV infection and has been
3 advised of testing for both sexually transmitted infection and HIV
4 infection, pursuant to under
subsection (1).
5 (3) If either applicant for a marriage license undergoes a
6 test for HIV or an antibody to HIV, and if the test results
7 indicate that an applicant is HIV infected, the physician or a his
8 or her designee, of
the physician, the physician's assistant, the
9 certified nurse midwife, the certified nurse practitioner, the
10 clinical nurse specialist-certified, or the local health officer or
11 a his or her designee of the local health officer administering
the
12 test immediately shall inform both applicants of the test results
13 and shall counsel both applicants regarding the modes of HIV
14 transmission, the potential for HIV transmission to a fetus, and
15 protective measures.
16 (4) As used in this section:
17 (a) "Certified nurse midwife" means an individual who is
18 licensed as a registered professional nurse under part 172 who has
19 been issued granted
a specialty certification in the
practice of
20 nurse midwifery by the Michigan board of nursing under section
21 17210.
22 (b) "Certified nurse practitioner" means an individual who is
23 licensed as a registered professional nurse under part 172 who has
24 been issued granted
a specialty certification as a nurse
25 practitioner by the Michigan board of nursing under section 17210.
26 (c) "Clinical nurse specialist-certified" means an individual
27 who is licensed as a registered professional nurse under part 172
1 who has been granted a specialty certification as a clinical nurse
2 specialist by the Michigan board of nursing under section 17210.
3 (d) (c) "Physician"
means an individual who is licensed as a
4 physician under part 170 or an osteopathic physician under part
5 175.
6 (e) (d) "Physician's
assistant" means an individual who
is
7 licensed as a physician's assistant under part 170 or part 175.
8 Sec. 16327. Fees for a
person an individual who is licensed or
9 seeking licensure to practice nursing as a registered professional
10 nurse, a licensed practical nurse, or a trained attendant under
11 part 172 are as follows:
|
12 |
(a) |
Application
processing fee........... $ |
|
|
13 |
(b) |
License
fee, per year................ |
|
|
14 |
(c) |
Temporary license.................... 10.00 |
|
|
15 |
(d) |
Limited license, per year............ 10.00 |
|
|
16 |
(e) |
Specialty certification for |
|
|
17 |
registered nurse: |
||
|
18 |
(i) |
Application processing fee........... 24.00 |
|
|
19 |
(ii) |
Specialty certification, per year.... 14.00 |
20 Sec. 17201. (1) As used in this part:
21 (a) "Advanced practice registered nurse" or "a.p.r.n." means a
22 registered professional nurse who has been granted a specialty
23 certification under section 17210 in 1 of the following health
24 profession specialty fields:
25 (i) Nurse midwifery.
26 (ii) Nurse practitioner.
1 (iii) Clinical nurse specialist.
2 (b) "Physician" means a physician who is licensed under part
3 170 or part 175.
4 (c) (a) "Practice of nursing" means the systematic
application
5 of substantial specialized knowledge and skill, derived from the
6 biological, physical, and behavioral sciences, to the care,
7 treatment, counsel, and health teaching of individuals who are
8 experiencing changes in the normal health processes or who require
9 assistance in the maintenance of health and the prevention or
10 management of illness, injury, or disability.
11 (d) (b) "Practice
of nursing as a licensed practical nurse" or
12 "l.p.n." means the practice of nursing based on less comprehensive
13 knowledge and skill than that required of a registered professional
14 nurse and performed under the supervision of a registered
15 professional nurse, physician, or dentist.
16 (e) (c) "Registered
professional nurse" or "r.n." means an
17 individual who is licensed under this article part to
engage in the
18 practice of nursing which scope of practice includes the teaching,
19 direction, and supervision of less skilled personnel in the
20 performance of delegated nursing activities.
21 (2) In addition to the definitions in this part, article 1
22 contains general definitions and principles of construction
23 applicable to all articles in the code and part 161 contains
24 definitions applicable to this part.
25 Sec. 17210. The Michigan
board of nursing may issue grant a
26 specialty certification to a registered professional nurse who has
27 advanced training beyond that required for initial licensure, and
1 who has demonstrated competency through examination or other
2 evaluative processes, and who practices in 1 of the following
3 health profession specialty fields: nurse
4 (a) Nurse midwifery. ,
nurse anesthetist, or nurse
5 practitioner.
6 (b) Nurse anesthetist.
7 (c) Nurse practitioner.
8 (d) Clinical nurse specialist.
9 Sec. 17211. (1) A
person An individual shall not engage in the
10 practice of nursing or the practice of nursing as a licensed
11 practical nurse unless he or she is licensed or is otherwise
12 authorized by this article.
13 (2) The following words, titles, or letters or a combination
14 thereof, of the
words, titles, or letters, with or
without
15 qualifying words or phrases, are restricted in use only to those
16 persons authorized under this part to use the terms and in a way
17 prescribed in this part: "registered professional nurse",
18 "registered nurse", "r.n.", "licensed practical nurse", "l.p.n.",
19 "nurse midwife", "certified nurse midwife", "c.n.m.", "advanced
20 practice registered nurse", "a.p.r.n.", "nurse anesthetist", "nurse
21 practitioner", "trained attendant", and
"t.a."."n.p.",
"certified
22 nurse practitioner", "c.n.p.", "clinical nurse specialist",
23 "c.n.s.", "clinical nurse specialist-certified", and "c.n.s.-c.".
24 Sec. 17211a. (1) An advanced practice registered nurse may
25 prescribe any of the following:
26 (a) A nonscheduled prescription drug.
27 (b) Subject to subsection (2), a controlled substance included
1 in schedules 2 to 5 of part 72, as a delegated act of a physician.
2 (2) If an advanced practice registered nurse prescribes a
3 controlled substance under subsection (1)(b), both the advanced
4 practice registered nurse's name and the physician's name shall be
5 used, recorded, or otherwise indicated in connection with that
6 prescription. If an advanced practice registered nurse prescribes a
7 controlled substance under subsection (1)(b), both the advanced
8 practice registered nurse's and the physician's DEA registration
9 numbers shall be used, recorded, or otherwise indicated in
10 connection with that prescription.
11 (3) The amendatory act that added this section does not
12 require new or additional third-party reimbursement or mandated
13 worker's compensation benefits for services rendered by an advanced
14 practice registered nurse who is authorized to prescribe
15 nonscheduled prescription drugs and controlled substances included
16 in schedules 2 to 5 of part 72 under this section.
17 Sec. 17212. (1) In Subject to subsections (2) and (3), in
18 addition to acts, tasks, and functions delegated under section
19 16215, 17211a(1)(b), 17745, 17745a, or 17745b, a supervising
20 physician may delegate in writing to a registered professional
21 nurse the ordering, receipt, and dispensing of complimentary
22 starter dose drugs other than controlled substances as defined by
23 in article 7 or federal law.
When the If a delegated ordering,
24 receipt, or dispensing of complimentary starter dose drugs
25 described in this subsection occurs, both the registered
26 professional nurse's name and the supervising physician's name
27 shall be used, recorded, or otherwise indicated in connection with
1 each order, receipt, or dispensing. As used in this subsection,
2 "complimentary starter dose" means that term as defined in
section
3 17745.
4 (2) Subject to subsection (3), an advanced practice registered
5 nurse may order, receive, and dispense a complimentary starter dose
6 drug without delegation from a physician. Only the name of the
7 advanced practice registered nurse shall be used, recorded, or
8 otherwise indicated in connection with an order, receipt, or
9 dispensing of a complimentary starter dose drug under this
10 subsection.
11 (3) An advanced practice registered nurse may order, receive,
12 and dispense complimentary starter doses of controlled substances
13 included in schedules 2 to 5 of part 72 as a delegated act of a
14 physician. If a delegated ordering, receipt, or dispensing of
15 complimentary starter dose drugs described in this subsection
16 occurs, the advanced practice registered nurse's name and the
17 delegating physician's name shall be used, recorded, or otherwise
18 indicated in connection with each order, receipt, or dispensing and
19 both the advanced practice registered nurse's and the delegating
20 physician's DEA registration number shall be used, recorded, or
21 otherwise indicated in connection with each order, receipt, or
22 dispensing.
23 (4) (2) It is the intent of the legislature in enacting this
24 section to allow a pharmaceutical manufacturer or wholesale
25 distributor, as those terms are defined in part 177, to distribute
26 complimentary starter dose drugs to an advanced practice registered
27 nurse described in subsections (2) and (3), or to a registered
1 professional nurse , as described
in subsection (1), in compliance
2 with section 503(d) of the federal food, drug, and cosmetic act,
3 chapter 675, 52 Stat. 1051, 21
U.S.C. USC 353.
4 (5) As used in this section, "complimentary starter dose"
5 means that term as defined in section 17745.
6 Sec. 17214. An advanced practice registered nurse may make
7 calls or go on rounds in private homes, public institutions,
8 emergency vehicles, ambulatory care clinics, hospitals,
9 intermediate or extended care facilities, health maintenance
10 organizations, nursing homes, or other health care facilities.
11 Notwithstanding any law or rule to the contrary, an advanced
12 practice registered nurse may make calls or go on rounds as
13 provided in this section without restrictions on the time or
14 frequency of visits by a physician or the advanced practice
15 registered nurse.
16 Sec. 17221. (1) The Michigan board of nursing is created in
17 the department. and
18 (2) Except as otherwise provided in subsection (3), the
19 Michigan board of nursing shall
consist of the following 23 24
20 voting members who shall meet the requirements of part 161: 9
21 registered professional nurses, 1 nurse midwife, 1 nurse
22 anesthetist, 1 nurse practitioner, 1 clinical nurse specialist, 3
23 licensed practical nurses, and 8 public members. Three of the
24 registered professional nurse members shall be engaged in nursing
25 education, 1 of whom shall be in less than a baccalaureate program,
26 1 in a baccalaureate or higher program and 1 in a licensed
27 practical nurse program and each of whom shall have a master's
1 degree from an accredited college with a major in nursing. Three of
2 the registered professional nurse members shall be engaged in
3 nursing practice or nursing administration, each of whom shall have
4 a 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 a
7 nonbaccalaureate registered nurse. The 3 licensed practical nurse
8 members shall have graduated from a state approved program for the
9 preparation of individuals to practice as licensed practical
10 nurses. The nurse midwife, the nurse anesthetist, and the nurse
11 practitioner, and the clinical nurse specialist shall each have a
12 specialty certification issued granted by the department
Michigan
13 board of nursing in his or her respective specialty field.
14 (3) All of the following apply to the members of the board
15 described in subsection (2):
16 (a) The individual who is a registered professional nurse who
17 is certified by a national organization as a clinical nurse
18 specialist shall continue as a member of the board under subsection
19 (2) for the remainder of his or her respective term. When the term
20 of the registered professional nurse described in this subdivision
21 expires, subject to section 16121, the governor shall appoint a
22 registered professional nurse who has been granted a specialty
23 certification as a clinical nurse specialist by the Michigan board
24 of nursing.
25 (b) The 8 public members on the board shall continue in office
26 for the remainder of their respective terms. Until the term of
27 office of 1 of those public members expires, the board shall
1 continue with 24 members. When the term of office of 1 or more of
2 the 8 public members first expires, the governor shall not appoint
3 1 public member, to reduce the total number of public members to 7
4 and the total number of board members to 23.
5 (4) (2) The terms of office of individual members of the
board
6 created under this part, except those appointed to fill vacancies,
7 expire 4 years after appointment on June 30 of the year in which
8 the term expires.
9 Sec. 17607. (1) An individual shall not engage in the practice
10 of speech-language pathology unless licensed under this part.
11 (2) A licensee shall not perform an act, task, or function
12 within the practice of speech-language pathology unless he or she
13 is trained to perform the act, task, or function and the
14 performance of that act, task, or function is consistent with the
15 rules promulgated under section 17610(3). A speech-language
16 pathologist shall refer a patient to a person an individual
17 licensed in the practice of medicine or osteopathic medicine and
18 surgery if signs or symptoms identified during the practice of
19 speech-language pathology cause the speech-language pathologist to
20 suspect that the patient has an underlying medical condition.
21 (3) A licensee shall perform assessment, treatment or therapy,
22 and procedures related to swallowing disorders and medically
23 related communication disorders only on patients who have been
24 referred to him or her by a person an individual licensed in the
25 practice of medicine or osteopathic medicine and surgery or by an
26 advanced practice registered nurse as that term is defined in
27 section 17201.
1 (4) Limited A
licensee shall only perform diagnostic
testing,
2 such as endoscopic videolaryngostroboscopy, shall only be performed
3 by a licensee in
collaboration with or under the supervision of a
4 person an individual licensed in the practice of medicine or
5 osteopathic medicine and surgery.
6 (5) A licensee shall follow procedures in which collaboration
7 among the licensee and a person an individual licensed in
the
8 practice of medicine or osteopathic medicine and surgery and other
9 licensed health care professionals is regarded to be in the best
10 interests of the patient.
11 (6) Subsection (1) does not prevent any of the following:
12 (a) An individual licensed or registered under any other part
13 or act from performing activities that are considered speech-
14 language pathology services if those activities are within the
15 individual's scope of practice and if the individual does not use
16 the titles protected under section 17603.
17 (b) The practice of speech-language pathology that is an
18 integral part of a program of study by students enrolled in an
19 accredited speech-language pathology educational program approved
20 by the board, provided that if those individuals are
identified as
21 students and provide speech-language pathology services only while
22 under the supervision of a licensed speech-language pathologist.
23 (c) Self-care by a patient or uncompensated care by a friend
24 or family member who does not represent or hold himself or herself
25 out to be a licensed speech-language pathologist.
26 Sec. 17708. (1) "Preceptor" means a pharmacist approved by the
27 board to direct the training of an intern in an approved pharmacy.
1 (2) "Prescriber" means a licensed dentist, a licensed doctor
2 of medicine, a licensed doctor of osteopathic medicine and surgery,
3 a licensed doctor of podiatric medicine and surgery, a licensed
4 optometrist certified under part 174 to administer and prescribe
5 therapeutic pharmaceutical agents, an advanced practice registered
6 nurse as that term is defined in section 17201 who meets the
7 requirements of section 17211a, a licensed veterinarian, or another
8 licensed health professional acting under the delegation and using,
9 recording, or otherwise indicating the name of the delegating
10 licensed doctor of medicine or licensed doctor of osteopathic
11 medicine and surgery.
12 (3) "Prescription" means an order by a prescriber to fill,
13 compound, or dispense a drug or device written and signed; written
14 or created in an electronic format, signed, and transmitted by
15 facsimile; or transmitted electronically or by other means of
16 communication. An order transmitted in other than written or hard-
17 copy form must be electronically recorded, printed, or written and
18 immediately dated by the pharmacist, and that record constitutes
19 the original prescription. In a health facility or agency licensed
20 under article 17 or other medical institution, an order for a drug
21 or device in the patient's chart constitutes for the purposes of
22 this definition the original prescription. Subject to section
23 17751(2) and (5), prescription includes, but is not limited to, an
24 order for a drug, not including a controlled substance as defined
25 in section 7104 except
under circumstances described in section
26 17763(e), written and signed; written or created in an electronic
27 format, signed, and transmitted by facsimile; or transmitted
1 electronically or by other means of communication by a physician
2 prescriber, dentist prescriber, or veterinarian prescriber licensed
3 to practice dentistry, medicine, osteopathic medicine and surgery,
4 or veterinary medicine in another state.
5 (4) "Prescription drug" means a drug to which 1 or more of the
6 following apply:
7 (a) The drug is dispensed pursuant to a prescription.
8 (b) The drug bears the federal legend "CAUTION: federal law
9 prohibits dispensing without prescription" or "Rx only".
10 (c) The drug is designated by the board as a drug that may
11 only be dispensed pursuant to a prescription.
12 Sec. 17745. (1) Except as otherwise provided in this
13 subsection, a prescriber who wishes to dispense prescription drugs
14 shall obtain from the board a drug control license for each
15 location in which the storage and dispensing of prescription drugs
16 occur. A drug control license is not necessary if the dispensing
17 occurs in the emergency department, emergency room, or trauma
18 center of a hospital licensed under article 17 or if the dispensing
19 involves only the issuance of complimentary starter dose drugs.
20 (2) Except as otherwise authorized for expedited partner
21 therapy in section 5110 or as provided in section 17744a or 17744b,
22 a dispensing prescriber shall dispense prescription drugs only to
23 his or her own patients.
24 (3) A dispensing prescriber shall include in a patient's chart
25 or clinical record a complete record, including prescription drug
26 names, dosages, and quantities, of all prescription drugs dispensed
27 directly by the dispensing prescriber or indirectly under his or
1 her delegatory authority. If prescription drugs are dispensed under
2 the prescriber's delegatory authority, the delegatee who dispenses
3 the prescription drugs shall initial the patient's chart, clinical
4 record, or log of prescription drugs dispensed. In a patient's
5 chart or clinical record, a dispensing prescriber shall distinguish
6 between prescription drugs dispensed to the patient, prescription
7 drugs prescribed for the patient, prescription drugs dispensed or
8 prescribed for expedited partner therapy as authorized in section
9 5110, and prescription drugs dispensed or prescribed as authorized
10 under section 17744a or 17744b. A dispensing prescriber shall
11 retain information required under this subsection for not less than
12 5 years after the information is entered in the patient's chart or
13 clinical record.
14 (4) A dispensing prescriber shall store prescription drugs
15 under conditions that will maintain their stability, integrity, and
16 effectiveness and will assure ensure that the prescription
drugs
17 are free of contamination, deterioration, and adulteration.
18 (5) A dispensing prescriber shall store prescription drugs in
19 a substantially constructed, securely lockable cabinet. Access to
20 the cabinet shall must
be limited to individuals authorized to
21 dispense prescription drugs in compliance with this part and
22 article 7.
23 (6) Unless otherwise requested by a patient, a dispensing
24 prescriber shall dispense a prescription drug in a safety closure
25 container that complies with the poison prevention packaging act of
26 1970, 15 USC 1471 to 1477.
27 (7) A dispensing prescriber shall dispense a drug in a
1 container that bears a label containing all of the following
2 information:
3 (a) The name and address of the location from which the
4 prescription drug is dispensed.
5 (b) Except as otherwise authorized under section 5110, 17744a,
6 or 17744b, the patient's name and record number.
7 (c) The date the prescription drug was dispensed.
8 (d) The prescriber's name or, if dispensed under the
9 prescriber's delegatory authority, the name of the delegatee.
10 (e) The directions for use.
11 (f) The name and strength of the prescription drug.
12 (g) The quantity dispensed.
13 (h) The expiration date of the prescription drug or the
14 statement required under section 17756.
15 (8) A dispensing prescriber who dispenses a complimentary
16 starter dose drug to a patient, or an advanced practice registered
17 nurse as that term is defined in section 17201 who dispenses a
18 complimentary starter dose drug to a patient under section 17212,
19 shall give the patient the information required in this subsection,
20 by dispensing the complimentary starter dose drug to the patient in
21 a container that bears a label containing the required information
22 or by giving the patient a written document that may include, but
23 is not limited to, a preprinted insert that comes with the
24 complimentary starter dose drug and that contains the required
25 information. The information required to be given to the patient
26 under this subsection includes all of the following:
27 (a) The name and strength of the complimentary starter dose
1 drug.
2 (b) Directions for the patient's use of the complimentary
3 starter dose drug.
4 (c) The expiration date of the complimentary starter dose drug
5 or the statement required under section 17756.
6 (9) The information required under subsection (8) is in
7 addition to, and does not supersede or modify, other state or
8 federal law regulating the labeling of prescription drugs.
9 (10) In addition to meeting the requirements of this part, a
10 dispensing prescriber who dispenses controlled substances shall
11 comply with section 7303a.
12 (11) The board may periodically inspect locations from which
13 prescription drugs are dispensed.
14 (12) The act, task, or function of dispensing prescription
15 drugs shall be delegated only as provided in this part and sections
16 16215, 17048, 17076, 17211a, 17212, and 17548.
17 (13) A supervising physician may delegate in writing to a
18 pharmacist practicing in a hospital pharmacy within a hospital
19 licensed under article 17 the receipt of complimentary starter dose
20 drugs other than controlled substances as defined by article 7 or
21 federal law. When the delegated receipt of complimentary starter
22 dose drugs occurs, both the pharmacist's name and the supervising
23 physician's name shall be used, recorded, or otherwise indicated in
24 connection with each receipt. A pharmacist described in this
25 subsection may dispense a prescription for complimentary starter
26 dose drugs written or transmitted by facsimile, electronic
27 transmission, or other means of communication by a prescriber.
1 (14) As used in this section, "complimentary starter dose"
2 means a prescription drug packaged, dispensed, and distributed in
3 accordance with state and federal law that is provided to a
4 dispensing prescriber free of charge by a manufacturer or
5 distributor and dispensed free of charge by the dispensing
6 prescriber to his or her patients.
7 Sec. 17820. (1) An individual shall not engage in the practice
8 of physical therapy or practice as a physical therapist assistant
9 unless licensed or otherwise authorized under this part. Except as
10 otherwise provided in this subsection, a physical therapist or
11 physical therapist assistant shall engage in the treatment of a
12 patient only upon the prescription of if that treatment is
13 prescribed by a health care professional who is an advanced
14 practice registered nurse as that term is defined in section 17201,
15 or who holds a license issued under part 166, 170, 175, or 180, or
16 the an equivalent license issued by another state. A
physical
17 therapist or a physical therapist assistant may engage in the
18 treatment of a patient without the prescription of a health care
19 professional who is an advanced practice registered nurse as that
20 term is defined in section 17201, or who holds a license issued
21 under part 166, 170, 175, or 180, or the an equivalent
license
22 issued by another state, under either of the following
23 circumstances:
24 (a) For 21 days or 10 treatments, whichever first occurs.
25 However, a physical therapist shall determine that the patient's
26 condition requires physical therapy before delegating physical
27 therapy interventions to a physical therapist assistant.
1 (b) The patient is seeking physical therapy services for the
2 purpose of preventing injury or promoting fitness.
3 (2) The following words, titles, or letters or a combination
4 of words, titles, or letters, with or without qualifying words or
5 phrases, are restricted in use only to those persons authorized
6 under this part to use the terms and in a way prescribed in this
7 part: "physical therapy", "physical therapist", "doctor of
8 physiotherapy", "doctor of physical therapy", "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 if
that treatment is prescribed by an
individual
22 holding who is an
advanced practice registered nurse as that term
23 is defined in section 17201, or who holds a license issued under
24 part 166, 170, 175, or 180,
or the an equivalent
license issued by
25 another state.
26 Sec. 20201. (1) A health facility or agency that provides
27 services directly to patients or residents and is licensed under
1 this article shall adopt a policy describing the rights and
2 responsibilities of patients or residents admitted to the health
3 facility or agency. Except for a licensed health maintenance
4 organization, which shall comply with chapter 35 of the insurance
5 code of 1956, 1956 PA 218, MCL 500.3501 to 500.3580, 500.3573, the
6 health facility or agency shall post the policy shall be posted at
7 a public place in the health facility or agency and shall be
8 provided provide the
policy to each member of the health
facility
9 or agency staff. Patients or residents shall be treated in
10 accordance with the policy.
11 (2) The policy describing the rights and responsibilities of
12 patients or residents required under subsection (1) shall include,
13 as a minimum, all of the following:
14 (a) A patient or resident shall not be denied appropriate care
15 on the basis of race, religion, color, national origin, sex, age,
16 disability, marital status, sexual preference, or source of
17 payment.
18 (b) An individual who is or has been a patient or resident is
19 entitled to inspect, or receive for a reasonable fee, a copy of his
20 or her medical record upon request in accordance with the medical
21 records access act, 2004 PA 47, MCL 333.26261 to 333.26271. Except
22 as otherwise permitted or required under the health insurance
23 portability and accountability act of 1996, Public Law 104-191, or
24 regulations promulgated under that act, 45 CFR parts 160 and 164, a
25 third party shall not be given a copy of the patient's or
26 resident's medical record without prior authorization of the
27 patient or resident.
1 (c) A patient or resident is entitled to confidential
2 treatment of personal and medical records, and may refuse their
3 release to a person outside the health facility or agency except as
4 required because of a transfer to another health care facility, as
5 required by law or third party payment contract, or as permitted or
6 required under the health insurance portability and accountability
7 act of 1996, Public Law 104-191, or regulations promulgated under
8 that act, 45 CFR parts 160 and 164.
9 (d) A patient or resident is entitled to privacy, to the
10 extent feasible, in treatment and in caring for personal needs with
11 consideration, respect, and full recognition of his or her dignity
12 and individuality.
13 (e) A patient or resident is entitled to receive adequate and
14 appropriate care, and to receive, from the appropriate individual
15 within the health facility or agency, information about his or her
16 medical condition, proposed course of treatment, and prospects for
17 recovery, in terms that the patient or resident can understand,
18 unless medically contraindicated as documented in the medical
19 record by the attending physician, or a physician's
assistant to
20 whom the physician has delegated the performance of medical care
21 services, or an advanced practice registered nurse.
22 (f) A patient or resident is entitled to refuse treatment to
23 the extent provided by law and to be informed of the consequences
24 of that refusal. If a refusal of treatment prevents a health
25 facility or agency or its staff from providing appropriate care
26 according to ethical and professional standards, the relationship
27 with the patient or resident may be terminated upon reasonable
1 notice.
2 (g) A patient or resident is entitled to exercise his or her
3 rights as a patient or resident and as a citizen, and to this end
4 may present grievances or recommend changes in policies and
5 services on behalf of himself or herself or others to the health
6 facility or agency staff, to governmental officials, or to another
7 person of his or her choice within or outside the health facility
8 or agency, free from restraint, interference, coercion,
9 discrimination, or reprisal. A patient or resident is entitled to
10 information about the health facility's or agency's policies and
11 procedures for initiation, review, and resolution of patient or
12 resident complaints.
13 (h) A patient or resident is entitled to information
14 concerning an experimental procedure proposed as a part of his or
15 her care and has the right to refuse to participate in the
16 experimental procedure without jeopardizing his or her continuing
17 care.
18 (i) A patient or resident is entitled to receive and examine
19 an explanation of his or her bill regardless of the source of
20 payment and to receive, upon request, information relating to
21 financial assistance available through the health facility or
22 agency.
23 (j) A patient or resident is entitled to know who is
24 responsible for and who is providing his or her direct care, is
25 entitled to receive information concerning his or her continuing
26 health needs and alternatives for meeting those needs, and to be
27 involved in his or her discharge planning, if appropriate.
1 (k) A patient or resident is entitled to associate and have
2 private communications and consultations with his or her physician
3 or a physician's assistant to whom the physician has delegated the
4 performance of medical care services, with his or her advanced
5 practice registered nurse, with his or her attorney, or with any
6 other person individual
of his or her choice and to send and
7 receive personal mail unopened on the same day it is received at
8 the health facility or agency, unless medically contraindicated as
9 documented in the medical record by the attending physician, or
a
10 physician's assistant to whom the physician has delegated the
11 performance of medical care services, or an advanced practice
12 registered nurse. A patient's or resident's civil and religious
13 liberties, including the right to independent personal decisions
14 and the right to knowledge of available choices, shall not be
15 infringed and the health facility or agency shall encourage and
16 assist in the fullest possible exercise of these rights. A patient
17 or resident may meet with, and participate in, the activities of
18 social, religious, and community groups at his or her discretion,
19 unless medically contraindicated as documented in the medical
20 record by the attending physician, or a physician's
assistant to
21 whom the physician has delegated the performance of medical care
22 services, or an advanced practice registered nurse.
23 (l) A patient or resident is entitled to be free from mental
24 and physical abuse and from physical and chemical restraints,
25 except those restraints authorized in writing by the attending
26 physician, or by
a physician's assistant to whom the
physician has
27 delegated the performance of medical care services, or by an
1 advanced practice registered nurse, for a specified and limited
2 time or as are necessitated by an emergency to protect the patient
3 or resident from injury to self or others, in which case the
4 restraint may only be applied by a qualified professional who shall
5 set forth in writing the circumstances requiring the use of
6 restraints and who shall promptly report the action to the
7 attending physician, or physician's assistant, or advanced practice
8 registered nurse who authorized the restraint. In case of a
9 chemical restraint, a the
physician, or the advanced practice
10 registered nurse who authorized the restraint, shall be consulted
11 within 24 hours after the commencement of the chemical restraint.
12 (m) A patient or resident is entitled to be free from
13 performing services for the health facility or agency that are not
14 included for therapeutic purposes in the plan of care.
15 (n) A patient or resident is entitled to information about the
16 health facility or agency rules and regulations affecting patient
17 or resident care and conduct.
18 (o) A patient or resident is entitled to adequate and
19 appropriate pain and symptom management as a basic and essential
20 element of his or her medical treatment.
21 (3) The following additional requirements for the policy
22 described in subsection (2) apply to licensees under parts 213 and
23 217:
24 (a) The policy shall be provided to each nursing home patient
25 or home for the aged resident upon admission, and the staff of the
26 facility shall be trained and involved in the implementation of the
27 policy.
1 (b) Each nursing home patient may associate and communicate
2 privately with persons of his or her choice. Reasonable, regular
3 visiting hours, which shall be not less than 8 hours per day, and
4 which shall take into consideration the special circumstances of
5 each visitor, shall be established for patients to receive
6 visitors. A patient may be visited by the patient's attorney or by
7 representatives of the departments named in section 20156, during
8 other than established visiting hours. Reasonable privacy shall be
9 afforded for visitation of a patient who shares a room with another
10 patient. Each patient shall have reasonable access to a telephone.
11 A married nursing home patient or home for the aged resident is
12 entitled to meet privately with his or her spouse in a room that
13 assures ensures privacy. If both spouses are residents in the same
14 facility, they are entitled to share a room unless medically
15 contraindicated and documented in the medical record by the
16 attending physician, or a physician's assistant to whom the
17 physician has delegated the performance of medical care services,
18 or an advanced practice registered nurse.
19 (c) A nursing home patient or home for the aged resident is
20 entitled to retain and use personal clothing and possessions as
21 space permits, unless to do so would infringe upon the rights of
22 other patients or residents, or unless medically contraindicated as
23 documented in the medical record by the attending physician, or
a
24 physician's assistant to whom the physician has delegated the
25 performance of medical care services, or an advanced practice
26 registered nurse. Each nursing home patient or home for the aged
27 resident shall be provided with reasonable space. At the request of
1 a patient, a nursing home shall provide for the safekeeping of
2 personal effects, funds, money, and other property of
a patient in
3 accordance with section 21767, except that a nursing home is not
4 required to provide for the safekeeping of a property that would
5 impose an unreasonable burden on the nursing home.
6 (d) A nursing home patient or home for the aged resident is
7 entitled to the opportunity to participate in the planning of his
8 or her medical treatment. The attending physician, or
a physician's
9 assistant to whom the physician has delegated the performance of
10 medical care services, or an advanced practice registered nurse,
11 shall fully inform the nursing home patient of the patient's
12 medical condition unless medically contraindicated as documented in
13 the medical record by a physician, or a physician's
assistant to
14 whom the physician has delegated the performance of medical care
15 services, or an advanced practice registered nurse. Each nursing
16 home patient shall be afforded the opportunity to discharge himself
17 or herself from the nursing home.
18 (e) A home for the aged resident may be transferred or
19 discharged only for medical reasons, for his or her welfare or that
20 of other residents, or for nonpayment of his or her stay, except as
21 provided by title XVIII or title XIX. A nursing home patient may be
22 transferred or discharged only as provided in sections 21773 to
23 21777. A nursing home patient or home for the aged resident is
24 entitled to be given reasonable advance notice to ensure orderly
25 transfer or discharge. Those actions shall be documented in the
26 medical record.
27 (f) A nursing home patient or home for the aged resident is
1 entitled to be fully informed before or at the time of admission
2 and during stay of services available in the facility, and of the
3 related charges including any charges for services not covered
4 under title XVIII, or not covered by the facility's basic per diem
5 rate. The statement of services provided by the facility shall be
6 in writing and shall include those required to be offered on an as-
7 needed basis.
8 (g) A nursing home patient or home for the aged resident is
9 entitled to manage his or her own financial affairs, or to have at
10 least a quarterly accounting of personal financial transactions
11 undertaken in his or her behalf by the facility during a period of
12 time the patient or resident has delegated those responsibilities
13 to the facility. In addition, a patient or resident is entitled to
14 receive each month from the facility an itemized statement setting
15 forth the services paid for by or on behalf of the patient and the
16 services rendered by the facility. The admission of a patient to a
17 nursing home does not confer on the nursing home or its owner,
18 administrator, employees, or representatives the authority to
19 manage, use, or dispose of a patient's property.
20 (h) A nursing home patient or a person authorized by the
21 patient in writing may inspect and copy the patient's personal and
22 medical records. The records shall be made available for inspection
23 and copying by the nursing home within a reasonable time, not
24 exceeding 1 week, after the receipt of a written request.
25 (i) If a nursing home patient desires treatment by a licensed
26 member of the healing arts, the treatment shall be made available
27 unless it is medically contraindicated, and the medical
1 contraindication is justified in the patient's medical record by
2 the attending physician, or a physician's assistant to whom the
3 physician has delegated the performance of medical care services,
4 or an advanced practice registered nurse.
5 (j) A nursing home patient has the right to have his or her
6 parents, if a minor, or his or her spouse, next of kin, or
7 patient's representative, if an adult, stay at the facility 24
8 hours a day if the patient is considered terminally ill by the
9 physician responsible for the patient's care, or
a physician's
10 assistant to whom the physician has delegated the performance of
11 medical care services, or an advanced practice registered nurse.
12 (k) Each nursing home patient shall be provided with meals
13 that meet the recommended dietary allowances for that patient's age
14 and sex and that may be modified according to special dietary needs
15 or ability to chew.
16 (l) Each nursing home patient has the right to receive
17 representatives of approved organizations as provided in section
18 21763.
19 (4) A nursing home, its owner, administrator, employee, or
20 representative shall not discharge, harass, or retaliate or
21 discriminate against a patient because the patient has exercised a
22 right protected under this section.
23 (5) In the case of a nursing home patient, the rights
24 enumerated in subsection (2)(c), (g), and (k) and subsection
25 (3)(d), (g), and (h) may be exercised by the patient's
26 representative.
27 (6) A nursing home patient or home for the aged resident is
1 entitled to be fully informed, as evidenced by the patient's or
2 resident's written acknowledgment, before or at the time of
3 admission and during stay, of the policy required by this section.
4 The policy shall provide that if a patient or resident is
5 adjudicated incompetent and not restored to legal capacity, the
6 rights and responsibilities set forth in this section shall be
7 exercised by a person designated by the patient or resident. The
8 health facility or agency shall provide proper forms for the
9 patient or resident to provide for the designation of this person
10 at the time of admission.
11 (7) This section does not prohibit a health facility or agency
12 from establishing and recognizing additional patients' rights.
13 (8) As used in this section:
14 (a) "Advanced practice registered nurse" means that term as
15 defined in section 17201.
16 (b) (a) "Patient's
representative" means that term as defined
17 in section 21703.
18 (c) (b) "Title
XVIII" means title XVIII of the social security
19 act, 42 USC 1395 to 1395kkk-1.1395lll.
20 (d) (c) "Title
XIX" means title XIX of the social security
21 act, 42 USC 1396 to 1396w-5.
22 Enacting section 1. This amendatory act takes effect 90 days
23 after the date it is enacted into law.