April 14, 2015, Introduced by Rep. Pscholka and referred to the Committee on Appropriations.
A bill to amend 1978 PA 368, entitled
"Public health code,"
by amending sections 6237, 6238, 20104, 20106, 20145, 20155, 20161,
20501, 20521, and 20551 (MCL 333.6237, 333.6238, 333.20104,
333.20106, 333.20145, 333.20155, 333.20161, 333.20501, 333.20521,
and 333.20551), sections 6237 and 6238 as amended by 2012 PA 501,
section 20104 as amended by 2010 PA 381, section 20106 as amended
by 2014 PA 449, section 20145 as amended by 2004 PA 469, section
20155 as amended by 2012 PA 322, and section 20161 as amended by
2013 PA 137; and to repeal acts and parts of acts.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
1 Sec. 6237. The Until
October 1, 2019, the department shall
2 issue a license assess
a $500.00 fee for licenses on an annual
3 basis upon determining that the applicant has complied with this
1 part and rules promulgated under this part. A licensee shall
2 prominently display the license while it is in effect.
3 Sec. 6238. A standard license issued under this part is
4 effective for no longer than 1 year after the date of issuance. The
5 department may issue a provisional license to an applicant
6 temporarily unable to comply with this part or the rules
7 promulgated under this part. The department may renew or extend a
8 provisional license issued under this section for not more than 1
9 year. The department may issue a temporary, nonrenewable permit for
10 not more than 90 days if additional time is needed for the
11 department to properly investigate or for the applicant to
12 undertake remedial action.
13 Sec. 20104. (1) "Certification" means the issuance of a
14 document by the department to a health facility or agency attesting
15 to the fact that the health facility or agency meets both of the
16 following:
17 (a) It complies with applicable statutory and regulatory
18 requirements and standards.
19 (b) It is eligible to participate as a provider of care and
20 services in a specific federal or state health program.
21 (2) "Clinical laboratory" means a facility patronized
by, or
22 at the direction of, a physician, health officer, or other person
23 authorized by law to obtain information for the diagnosis,
24 prevention, or treatment of disease or the assessment of a medical
25 condition by the microbiological, serological, histological,
26 hematological, immunohematological, biophysical, cytological,
27 pathological, or biochemical examination of materials derived from
1 the human body, except as provided in section 20507.
2 (2) (3) "Consumer"
means a person who is not a provider of
3 health care as defined in section 1531(3) of title 15 of the public
4 health service act, 42 USC 300n.
5 (3) (4) "County
medical care facility" means a nursing care
6 facility, other than a hospital long-term care unit, which that
7 provides organized nursing care and medical treatment to 7 or more
8 unrelated individuals who are suffering or recovering from illness,
9 injury, or infirmity and which that is owned by a county or
10 counties.
11 (4) (5) "Direct
access" means access to a patient or resident
12 or to a patient's or resident's property, financial information,
13 medical records, treatment information, or any other identifying
14 information.
15 (5) (6) "Freestanding
surgical outpatient facility" means a
16 facility, other than the office of a physician, dentist,
17 podiatrist, or other private practice office, offering a surgical
18 procedure and related care that in the opinion of the attending
19 physician can be safely performed without requiring overnight
20 inpatient hospital care. It Freestanding surgical outpatient
21 facility does not include a surgical outpatient facility owned by
22 and operated as part of a hospital.
23 (6) (7) "Good
moral character" means that term as defined in
24 section 1 of 1974 PA 381, MCL 338.41.
25 Sec. 20106. (1) "Health facility or agency", except as
26 provided in section 20115, means:
27 (a) An ambulance operation, aircraft transport operation,
1 nontransport prehospital life support operation, or medical first
2 response service.
3 (b) A clinical laboratory.
4 (b) (c) A
county medical care facility.
5 (c) (d) A
freestanding surgical outpatient facility.
6 (d) (e) A
health maintenance organization.
7 (e) (f) A
home for the aged.
8 (f) (g) A
hospital.
9 (g) (h) A
nursing home.
10 (h) (i) A
hospice.
11 (i) (j) A
hospice residence.
12 (j) (k) A
facility or agency listed in subdivisions (a) to (h)
13 (g) located in a university, college, or other educational
14 institution.
15 (2) "Health maintenance organization" means that term as
16 defined in section 3501 of the insurance code of 1956, 1956 PA 218,
17 MCL 500.3501.
18 (3) "Home for the aged" means a supervised personal care
19 facility, other than a hotel, adult foster care facility, hospital,
20 nursing home, or county medical care facility that provides room,
21 board, and supervised personal care to 21 or more unrelated,
22 nontransient, individuals 60 years of age or older. Home for the
23 aged includes a supervised personal care facility for 20 or fewer
24 individuals 60 years of age or older if the facility is operated in
25 conjunction with and as a distinct part of a licensed nursing home.
26 Home for the aged does not include an area excluded from this
27 definition by section 17(3) of the continuing care community
1 disclosure act, 2014 PA 448, MCL 554.917.
2 (4) "Hospice" means a health care program that provides a
3 coordinated set of services rendered at home or in outpatient or
4 institutional settings for individuals suffering from a disease or
5 condition with a terminal prognosis.
6 (5) "Hospital" means a facility offering inpatient, overnight
7 care, and services for observation, diagnosis, and active treatment
8 of an individual with a medical, surgical, obstetric, chronic, or
9 rehabilitative condition requiring the daily direction or
10 supervision of a physician. Hospital does not include a mental
11 health hospital licensed or operated by the department of community
12 health or a hospital operated by the department of corrections.
13 (6) "Hospital long-term care unit" means a nursing care
14 facility, owned and operated by and as part of a hospital,
15 providing organized nursing care and medical treatment to 7 or more
16 unrelated individuals suffering or recovering from illness, injury,
17 or infirmity.
18 Sec. 20145. (1) Before contracting for and initiating a
19 construction project involving new construction, additions,
20 modernizations, or conversions of a health facility or agency with
21 a capital expenditure of $1,000,000.00 or more, a person shall
22 obtain a construction permit from the department. The department
23 shall not issue the permit under this subsection unless the
24 applicant holds a valid certificate of need if a certificate of
25 need is required for the project pursuant to under part
222.
26 (2) To protect the public health, safety, and welfare, the
27 department may promulgate rules to require construction permits for
1 projects other than those described in subsection (1) and the
2 submission of plans for other construction projects to expand or
3 change service areas and services provided.
4 (3) If a construction project requires a construction permit
5 under subsection (1) or (2), but does not require a certificate of
6 need under part 222, the department shall require the applicant to
7 submit information considered necessary by the department to assure
8 that the capital expenditure for the project is not a covered
9 capital expenditure as defined in section 22203(9).
10 (4) If a construction project requires a construction permit
11 under subsection (1), but does not require a certificate of need
12 under part 222, the department shall require the applicant to
13 submit information on a 1-page sheet, along with the application
14 for a construction permit, consisting of all of the following:
15 (a) A short description of the reason for the project and the
16 funding source.
17 (b) A contact person for further information, including
18 address and phone number.
19 (c) The estimated resulting increase or decrease in annual
20 operating costs.
21 (d) The current governing board membership of the applicant.
22 (e) The entity, if any, that owns the applicant.
23 (5) The information filed under subsection (4) shall be made
24 publicly available by the department by the same methods used to
25 make information about certificate of need applications publicly
26 available.
27 (6) The review and approval of architectural plans and
1 narrative shall require that the proposed construction project is
2 designed and constructed in accord with applicable statutory and
3 other regulatory requirements. In performing a construction permit
4 review for a health facility or agency under this section, the
5 department shall, at a minimum, apply the standards contained in
6 the document entitled "Minimum Design Standards for Health Care
7 Facilities in Michigan" published by the department and dated March
8 1998. July 2007. The standards are incorporated by reference for
9 purposes of this subsection. The department may promulgate rules
10 that are more stringent than the standards if necessary to protect
11 the public health, safety, and welfare.
12 (7) The department shall promulgate rules to further prescribe
13 the scope of construction projects and other alterations subject to
14 review under this section.
15 (8) The department may waive the applicability of this section
16 to a construction project or alteration if the waiver will not
17 affect the public health, safety, and welfare.
18 (9) Upon request by the person initiating a construction
19 project, the department may review and issue a construction permit
20 to a construction project that is not subject to subsection (1) or
21 (2) if the department determines that the review will promote the
22 public health, safety, and welfare.
23 (10) The department shall assess a fee for each review
24 conducted under this section. The fee is .5% of the first
25 $1,000,000.00 of capital expenditure and .85% of any amount over
26 $1,000,000.00 of capital expenditure, up to a maximum of
27 $60,000.00.
1 (11) As used in this section, "capital expenditure" means that
2 term as defined in section 22203(2), except that it capital
3 expenditure does not include the cost of equipment that is not
4 fixed equipment.
5 Sec. 20155. (1) Except as otherwise provided in this section
6 and section 20155a, the department shall make annual triennial and
7 other visits to each health facility or agency licensed under this
8 article for the purposes of survey, evaluation, and consultation. A
9 visit made according to a complaint shall be unannounced. Except
10 for a county medical care facility, a home for the aged, a nursing
11 home, or a hospice residence, the department shall determine
12 whether the visits that are not made according to a complaint are
13 announced or unannounced. Beginning June 20, 2001, the The
14 department shall ensure that each newly hired nursing home
15 surveyor, as part of his or her basic training, is assigned full-
16 time to a licensed nursing home for at least 10 days within a 14-
17 day period to observe actual operations outside of the survey
18 process before the trainee begins oversight responsibilities.
19 (2) The state shall establish a process that ensures both of
20 the following:
21 (a) A newly hired nursing home surveyor shall not make
22 independent compliance decisions during his or her training period.
23 (b) A nursing home surveyor shall not be assigned as a member
24 of a survey team for a nursing home in which he or she received
25 training for 1 standard survey following the training received in
26 that nursing home.
27 (3) Beginning November 1, 2012, the The department
shall
1 perform a criminal history check on all nursing home surveyors in
2 the manner provided for in section 20173a.
3 (4) A member of a survey team shall not be employed by a
4 licensed nursing home or a nursing home management company doing
5 business in this state at the time of conducting a survey under
6 this section. The department shall not assign an individual to be a
7 member of a survey team for purposes of a survey, evaluation, or
8 consultation visit at a nursing home in which he or she was an
9 employee within the preceding 3 years.
10 (5) Representatives from all nursing home provider
11 organizations and the state long-term care ombudsman or his or her
12 designee shall be invited to participate in the planning process
13 for the joint provider and surveyor training sessions. The
14 department shall include at least 1 representative from nursing
15 home provider organizations that do not own or operate a nursing
16 home representing 30 or more nursing homes statewide in internal
17 surveyor group quality assurance training provided for the purpose
18 of general clarification and interpretation of existing or new
19 regulatory requirements and expectations.
20 (6) The department shall make available online the general
21 civil service position description related to the required
22 qualifications for individual surveyors. The department shall use
23 the required qualifications to hire, educate, develop, and evaluate
24 surveyors.
25 (7) The department shall ensure that each annual survey team
26 is composed of an interdisciplinary group of professionals, 1 of
27 whom must be a registered nurse. Other members may include social
1 workers, therapists, dietitians, pharmacists, administrators,
2 physicians, sanitarians, and others who may have the expertise
3 necessary to evaluate specific aspects of nursing home operation.
4 (8) Except as otherwise provided in this section and section
5 20155a, the department shall make at least a biennial triennial
6 visit to each licensed clinical laboratory, each nursing home ,
and
7 each hospice residence for
the purposes of survey, evaluation, and
8 consultation. The department shall semiannually provide for joint
9 training with nursing home surveyors and providers on at least 1 of
10 the 10 most frequently issued federal citations in this state
11 during the past calendar year. The department shall develop a
12 protocol for the review of citation patterns compared to regional
13 outcomes and standards and complaints regarding the nursing home
14 survey process. The review will be included in the report required
15 under subsection (20). Except as otherwise provided in this
16 subsection, beginning with his or her first full relicensure period
17 after June 20, 2000, each member of a department nursing home
18 survey team who is a health professional licensee under article 15
19 shall earn not less than 50% of his or her required continuing
20 education credits, if any, in geriatric care. If a member of a
21 nursing home survey team is a pharmacist licensed under article 15,
22 he or she shall earn not less than 30% of his or her required
23 continuing education credits in geriatric care.
24 (9) The department shall make a biennial triennial visit to
25 each hospital health
facility and agency for survey and
evaluation
26 for the purpose of licensure. Subject to subsection (12), the
27 department may waive the biennial triennial visit required by
this
1 subsection if a hospital, health facility or agency, as
part of a
2 timely application for license renewal, requests a waiver and
3 submits both of the following and if all of the requirements of
4 subsection (11) are met:
5 (a) Evidence that it is currently fully accredited by a body
6 with expertise in hospital accreditation whose hospital
7 accreditations are the
health facility or agency type and the
8 accrediting organization is accepted by the United States
9 department of health and human services Department of Health and
10 Human Services for purposes of section 1865 of part C of title
11 XVIII of the social security act, 42 USC 1395bb.
12 (b) A copy of the most recent accreditation report, for
the
13 hospital or executive
summary, issued by a body described in
14 subdivision (a), and the hospital's health facility's or agency's
15 responses to the accreditation report is submitted to the
16 department within 30 days from license renewal. Submission of an
17 executive summary does not prevent or prohibit the department from
18 requesting the entire accreditation report if the department
19 considers it necessary.
20 (10) Except as provided in subsection (14), accreditation
21 information provided to the department under subsection (9) is
22 confidential, is not a public record, and is not subject to court
23 subpoena. The department shall use the accreditation information
24 only as provided in this section and shall return the accreditation
25 information to the hospital within a reasonable time properly
26 destroy the documentation after a decision on the waiver request is
27 made.
1 (11) The department shall grant a waiver under subsection (9)
2 if the accreditation report submitted under subsection (9)(b) is
3 less than 2 years old and there is no indication of substantial
4 noncompliance with licensure standards or of deficiencies that
5 represent a threat to public safety or patient care in the report,
6 in complaints involving the hospital, health facility or agency or
7 in any other information available to the department. If the
8 accreditation report is 2 or more years old, the department may do
9 1 of the following:
10 (a) Grant an extension of the hospital's health facility's or
11 agency's current license until the next accreditation survey is
12 completed by the body described in subsection (9)(a).
13 (b) Grant a waiver under subsection (9) based on the
14 accreditation report that is 2 or more years old, on condition that
15 the hospital health
facility or agency promptly submit the
next
16 accreditation report to the department.
17 (c) Deny the waiver request and conduct the visits required
18 under subsection (9). Denial of a waiver request by the department
19 is not subject to appeal.
20 (12) This section does not prohibit the department from citing
21 a violation of this part during a survey, conducting investigations
22 or inspections according to section 20156, or conducting surveys of
23 health facilities or agencies for the purpose of complaint
24 investigations or federal certification. This section does not
25 prohibit the bureau of fire services created in section 1b of the
26 fire prevention code, 1941 PA 207, MCL 29.1b, from conducting
27 annual surveys of hospitals, nursing homes, and county medical care
1 facilities.
2 (13) At the request of a health facility or agency, the
3 department may conduct a consultation engineering survey of a
4 health facility and provide professional advice and consultation
5 regarding health facility construction and design. A health
6 facility or agency may request a voluntary consultation survey
7 under this subsection at any time between licensure surveys. The
8 fees for a consultation engineering survey are the same as the fees
9 established for waivers under section 20161(10).20161(8).
10 (14) If the department determines that substantial
11 noncompliance with licensure standards exists or that deficiencies
12 that represent a threat to public safety or patient care exist
13 based on a review of an accreditation report submitted under
14 subsection (9)(b), the department shall prepare a written summary
15 of the substantial noncompliance or deficiencies and the hospital's
16 health facility's or agency's response to the department's
17 determination. The department's written summary and the hospital's
18 health facility's or agency's response are public documents.
19 (15) The department or a local health department shall conduct
20 investigations or inspections, other than inspections of financial
21 records, of a county medical care facility, home for the aged,
22 nursing home, or hospice residence without prior notice to the
23 health facility or agency. An employee of a state agency charged
24 with investigating or inspecting the health facility or agency or
25 an employee of a local health department who directly or indirectly
26 gives prior notice regarding an investigation or an inspection,
27 other than an inspection of the financial records, to the health
1 facility or agency or to an employee of the health facility or
2 agency, is guilty of a misdemeanor. Consultation visits that are
3 not for the purpose of annual or follow-up inspection or survey may
4 be announced.
5 (16) The department shall maintain a record indicating whether
6 a visit and inspection is announced or unannounced. Survey findings
7 gathered at each health facility or agency during each visit and
8 inspection, whether announced or unannounced, shall be taken into
9 account in licensure decisions.
10 (17) The department shall require periodic reports and a
11 health facility or agency shall give the department access to
12 books, records, and other documents maintained by a health facility
13 or agency to the extent necessary to carry out the purpose of this
14 article and the rules promulgated under this article. The
15 department shall not divulge or disclose the contents of the
16 patient's clinical records in a manner that identifies an
17 individual except under court order. The department may copy health
18 facility or agency records as required to document findings.
19 Surveyors shall use electronic resident information, whenever
20 available, as a source of survey-related data and shall request
21 facility assistance to access the system to maximize data export.
22 (18) The department may delegate survey, evaluation, or
23 consultation functions to another state agency or to a local health
24 department qualified to perform those functions. However, the The
25 department shall not delegate survey, evaluation, or consultation
26 functions to a local health department that owns or operates a
27 hospice or hospice residence licensed under this article. The
1 delegation shall be by cost reimbursement contract between the
2 department and the state agency or local health department. Survey,
3 evaluation, or consultation functions shall not be delegated to
4 nongovernmental agencies, except as provided in this section. The
5 department may accept voluntary inspections performed by an
6 accrediting body with expertise in clinical laboratory
7 accreditation under part 205 if the accrediting body utilizes forms
8 acceptable to the department, applies the same licensing standards
9 as applied to other clinical laboratories, and provides the same
10 information and data usually filed by the department's own
11 employees when engaged in similar inspections or surveys. The
12 voluntary inspection described in this subsection shall be agreed
13 upon by both the licensee and the department.
14 (19) If, upon investigation, the department or a state agency
15 determines that an individual licensed to practice a profession in
16 this state has violated the applicable licensure statute or the
17 rules promulgated under that statute, the department, state agency,
18 or local health department shall forward the evidence it has to the
19 appropriate licensing agency.
20 (20) The department may consolidate all information provided
21 for any report required under this section and section 20155a into
22 a single report. The department shall report to the appropriations
23 subcommittees, the senate and house of representatives standing
24 committees having jurisdiction over issues involving senior
25 citizens, and the fiscal agencies on March 1 of each year on the
26 initial and follow-up surveys conducted on all nursing homes in
27 this state. The report shall include all of the following
1 information:
2 (a) The number of surveys conducted.
3 (b) The number requiring follow-up surveys.
4 (c) The average number of citations per nursing home for the
5 most recent calendar year.
6 (d) The number of night and weekend complaints filed.
7 (e) The number of night and weekend responses to complaints
8 conducted by the department.
9 (f) The average length of time for the department to respond
10 to a complaint filed against a nursing home.
11 (g) The number and percentage of citations disputed through
12 informal dispute resolution and independent informal dispute
13 resolution.
14 (h) The number and percentage of citations overturned or
15 modified, or both.
16 (i) The review of citation patterns developed under subsection
17 (8).
18 (j) Implementation of the clinical process guidelines and the
19 impact of the guidelines on resident care.
20 (k) Information regarding the progress made on implementing
21 the administrative and electronic support structure to efficiently
22 coordinate all nursing home licensing and certification functions.
23 (l) The number of annual standard surveys of nursing homes
24 that were conducted during a period of open survey or enforcement
25 cycle.
26 (m) The number of abbreviated complaint surveys that were not
27 conducted on consecutive surveyor workdays.
1 (n) The percent of all form CMS-2567 reports of findings that
2 were released to the nursing home within the 10-working-day
3 requirement.
4 (o) The percent of provider notifications of acceptance or
5 rejection of a plan of correction that were released to the nursing
6 home within the 10-working-day requirement.
7 (p) The percent of first revisits that were completed within
8 60 days from the date of survey completion.
9 (q) The percent of second revisits that were completed within
10 85 days from the date of survey completion.
11 (r) The percent of letters of compliance notification to the
12 nursing home that were released within 10 working days of the date
13 of the completion of the revisit.
14 (s) A summary of the discussions from the meetings required in
15 subsection (24).
16 (t) The number of nursing homes that participated in a
17 recognized quality improvement program as described under section
18 20155a(3).
19 (21) The department shall report March 1 of each year to the
20 standing committees on appropriations and the standing committees
21 having jurisdiction over issues involving senior citizens in the
22 senate and the house of representatives on all of the following:
23 (a) The percentage of nursing home citations that are appealed
24 through the informal dispute resolution process.
25 (b) The number and percentage of nursing home citations that
26 are appealed and supported, amended, or deleted through the
27 informal dispute resolution process.
1 (c) A summary of the quality assurance review of the amended
2 citations and related survey retraining efforts to improve
3 consistency among surveyors and across the survey administrative
4 unit that occurred in the year being reported.
5 (22) Subject to subsection (23), a clarification work group
6 comprised of the department in consultation with a nursing home
7 resident or a member of a nursing home resident's family, nursing
8 home provider groups, the American medical directors association,
9 Medical Directors Association, the state long-term care ombudsman,
10 and the federal centers for medicare and medicaid services Centers
11 for Medicare and Medicaid Services shall clarify the following
12 terms as those terms are used in title XVIII and title XIX and
13 applied by the department to provide more consistent regulation of
14 nursing homes in this state:
15 (a) Immediate jeopardy.
16 (b) Harm.
17 (c) Potential harm.
18 (d) Avoidable.
19 (e) Unavoidable.
20 (23) All of the following clarifications developed under
21 subsection (22) apply for purposes of subsection (22):
22 (a) Specifically, the term "immediate jeopardy" means a
23 situation in which immediate corrective action is necessary because
24 the nursing home's noncompliance with 1 or more requirements of
25 participation has caused or is likely to cause serious injury,
26 harm, impairment, or death to a resident receiving care in a
27 nursing home.
1 (b) The likelihood of immediate jeopardy is reasonably higher
2 if there is evidence of a flagrant failure by the nursing home to
3 comply with a clinical process guideline adopted under subsection
4 (25) than if the nursing home has substantially and continuously
5 complied with those guidelines. If federal regulations and
6 guidelines are not clear, and if the clinical process guidelines
7 have been recognized, a process failure giving rise to an immediate
8 jeopardy may involve an egregious widespread or repeated process
9 failure and the absence of reasonable efforts to detect and prevent
10 the process failure.
11 (c) In determining whether or not there is immediate jeopardy,
12 the survey agency should consider at least all of the following:
13 (i) Whether the nursing home could reasonably have been
14 expected to know about the deficient practice and to stop it, but
15 did not stop the deficient practice.
16 (ii) Whether the nursing home could reasonably have been
17 expected to identify the deficient practice and to correct it, but
18 did not correct the deficient practice.
19 (iii) Whether the nursing home could reasonably have been
20 expected to anticipate that serious injury, serious harm,
21 impairment, or death might result from continuing the deficient
22 practice, but did not so anticipate.
23 (iv) Whether the nursing home could reasonably have been
24 expected to know that a widely accepted high-risk practice is or
25 could be problematic, but did not know.
26 (v) Whether the nursing home could reasonably have been
27 expected to detect the process problem in a more timely fashion,
1 but did not so detect.
2 (d) The existence of 1 or more of the factors described in
3 subdivision (c), and especially the existence of 3 or more of those
4 factors simultaneously, may lead to a conclusion that the situation
5 is one in which the nursing home's practice makes adverse events
6 likely to occur if immediate intervention is not undertaken, and
7 therefore constitutes immediate jeopardy. If none of the factors
8 described in subdivision (c) is present, the situation may involve
9 harm or potential harm that is not immediate jeopardy.
10 (e) Specifically, "actual harm" means a negative outcome to a
11 resident that has compromised the resident's ability to maintain or
12 reach, or both, his or her highest practicable physical, mental,
13 and psychosocial well-being as defined by an accurate and
14 comprehensive resident assessment, plan of care, and provision of
15 services. Harm does not include a deficient practice that only may
16 cause or has caused limited consequences to the resident.
17 (f) For purposes of subdivision (e), in determining whether a
18 negative outcome is of limited consequence, if the "state
19 operations manual" or "the guidance to surveyors" published by the
20 federal centers for medicare and medicaid services Centers for
21 Medicare and Medicaid Services does not provide specific guidance,
22 the department may consider whether most people in similar
23 circumstances would feel that the damage was of such short duration
24 or impact as to be inconsequential or trivial. In such a case, the
25 consequence of a negative outcome may be considered more limited if
26 it occurs in the context of overall procedural consistency with an
27 accepted clinical process guideline adopted under subsection (25),
1 as compared to a substantial inconsistency with or variance from
2 the guideline.
3 (g) For purposes of subdivision (e), if the publications
4 described in subdivision (f) do not provide specific guidance, the
5 department may consider the degree of a nursing home's adherence to
6 a clinical process guideline adopted under subsection (25) in
7 considering whether the degree of compromise and future risk to the
8 resident constitutes actual harm. The risk of significant
9 compromise to the resident may be considered greater in the context
10 of substantial deviation from the guidelines than in the case of
11 overall adherence.
12 (h) To improve consistency and to avoid disputes over
13 avoidable and unavoidable negative outcomes, nursing homes and
14 survey agencies must have a common understanding of accepted
15 process guidelines and of the circumstances under which it can
16 reasonably be said that certain actions or inactions will lead to
17 avoidable negative outcomes. If the "state operations manual" or
18 "the guidance to surveyors" published by the federal centers
for
19 medicare and medicaid services Centers for Medicare and Medicaid
20 Services is not specific, a nursing home's overall documentation of
21 adherence to a clinical process guideline with a process indicator
22 adopted under subsection (25) is relevant information in
23 considering whether a negative outcome was avoidable or unavoidable
24 and may be considered in the application of that term.
25 (24) The department shall conduct a quarterly meeting and
26 invite appropriate stakeholders. Appropriate stakeholders shall
27 include at least 1 representative from each nursing home provider
1 organization that does not own or operate a nursing home
2 representing 30 or more nursing homes statewide, the state long-
3 term care ombudsman or his or her designee, and any other clinical
4 experts. Individuals who participate in these quarterly meetings,
5 in conjunction with the department, may designate advisory
6 workgroups to develop recommendations on the discussion topics that
7 should include, at a minimum, all of the following:
8 (a) Opportunities for enhanced promotion of nursing home
9 performance, including, but not limited to, programs that encourage
10 and reward providers that strive for excellence.
11 (b) Seeking quality improvement to the survey and enforcement
12 process, including clarifications to process-related policies and
13 protocols that include, but are not limited to, all of the
14 following:
15 (i) Improving the surveyors' quality and preparedness.
16 (ii) Enhanced communication between regulators, surveyors,
17 providers, and consumers.
18 (iii) Ensuring fair enforcement and dispute resolution by
19 identifying methods or strategies that may resolve identified
20 problems or concerns.
21 (c) Promoting transparency across provider and surveyor
22 communities, including, but not limited to, all of the following:
23 (i) Applying regulations in a consistent manner and evaluating
24 changes that have been implemented to resolve identified problems
25 and concerns.
26 (ii) Providing consumers with information regarding changes in
27 policy and interpretation.
1 (iii) Identifying positive and negative trends and factors
2 contributing to those trends in the areas of resident care,
3 deficient practices, and enforcement.
4 (d) Clinical process guidelines.
5 (25) Subject to subsection (27), the department shall develop
6 and adopt clinical process guidelines. The department shall
7 establish and adopt clinical process guidelines and compliance
8 protocols with outcome measures for all of the following areas and
9 for other topics where the department determines that clarification
10 will benefit providers and consumers of long-term care:
11 (a) Bed rails.
12 (b) Adverse drug effects.
13 (c) Falls.
14 (d) Pressure sores.
15 (e) Nutrition and hydration including, but not limited to,
16 heat-related stress.
17 (f) Pain management.
18 (g) Depression and depression pharmacotherapy.
19 (h) Heart failure.
20 (i) Urinary incontinence.
21 (j) Dementia.
22 (k) Osteoporosis.
23 (l) Altered mental states.
24 (m) Physical and chemical restraints.
25 (n) Culture-change principles, person-centered caring, and
26 self-directed care.
27 (26) The department shall biennially review and update all
1 clinical process guidelines as needed and shall continue to develop
2 and implement clinical process guidelines for topics that have not
3 been developed from the list in subsection (25) and other topics
4 identified as a result of the meetings required in subsection (24).
5 The department shall consider recommendations from an advisory
6 workgroup created under subsection (24) on clinical process
7 guidelines. The department shall include training on new and
8 revised clinical process guidelines in the joint provider and
9 surveyor training sessions as those clinical process guidelines are
10 developed and revised.
11 (27) Beginning November 1, 2012, representatives
12 Representatives from each nursing home provider organization that
13 does not own or operate a nursing home representing 30 or more
14 nursing homes statewide and the state long-term care ombudsman or
15 his or her designee shall be permanent members of any clinical
16 advisory workgroup created under subsection (24). The department
17 shall issue survey certification memorandums to providers to
18 announce or clarify changes in the interpretation of regulations.
19 (28) The department shall maintain the process by which the
20 director of the division of nursing home monitoring or his or her
21 designee or the director of the division of operations or his or
22 her designee reviews and authorizes the issuance of a citation for
23 immediate jeopardy or substandard quality of care before the
24 statement of deficiencies is made final. The review shall be to
25 assure that the applicable concepts, clinical process guidelines,
26 and other tools contained in subsections (25) to (27) are being
27 used consistently, accurately, and effectively. As used in this
1 subsection, "immediate jeopardy" and "substandard quality of care"
2 mean those terms as defined by the federal centers for medicare and
3 medicaid services.Centers
for Medicare and Medicaid Services.
4 (29) Upon availability of funds, the department shall give
5 grants, awards, or other recognition to nursing homes to encourage
6 the rapid implementation or maintenance of the clinical process
7 guidelines adopted under subsection (25).
8 (30) The department shall instruct and train the surveyors in
9 the clinical process guidelines adopted under subsection (25) in
10 citing deficiencies.
11 (31) A nursing home shall post the nursing home's survey
12 report in a conspicuous place within the nursing home for public
13 review.
14 (32) Nothing in this amendatory act shall be construed to
15 limit section limits the requirements of related state and federal
16 law.
17 (33) As used in this section:
18 (a) "Consecutive days" means calendar days, but does not
19 include Saturday, Sunday, or state- or federally-recognized
20 holidays.
21 (b) "Form CMS-2567" means the federal centers for
medicare and
22 medicaid services' Centers
for Medicare and Medicaid Services' form
23 for the statement of deficiencies and plan of correction or a
24 successor form serving the same purpose.
25 (c) "Title XVIII" means title XVIII of the social security
26 act, 42 USC 1395 to 1395kkk.
27 (d) "Title XIX" means title XIX of the social security act, 42
1 USC 1396 to 1396w-5.
2 Sec. 20161. (1) The department shall assess fees and other
3 assessments for health facility and agency licenses and
4 certificates of need on an annual basis as provided in this
5 article. Except Until
October 1, 2019, except as otherwise
provided
6 in this article, fees and assessments shall be paid as provided in
7 the following schedule:
8 (a) Freestanding surgical
9 outpatient facilities................$238.00 $500.00 per
facility
10 license.
11 (b) Hospitals...................$8.28 $500.00 per facility
12 license and $10.00 per
13 licensed bed.
14 (c) Nursing homes, county
15 medical care facilities, and
16 hospital long-term care units........$2.20 $500.00 per facility
17 license and $5.00 per
18 licensed bed.
19 (d) Homes for the aged..........$6.27 per licensed bed.
20 (e) Clinical laboratories.......$475.00 per laboratory.
21 (e) Hospice agencies............$500.00 per agency license.
22 (f) Hospice residences..........$200.00 $500.00 per
facility
23 survey; license and
$20.00
$5.00
24 per licensed bed.
25 (g) Subject to subsection
26 (13), (11), quality assurance assessment
27 for nursing homes and hospital
1 long-term care units.................an amount resulting
2 in not more than 6%
3 of total industry
4 revenues.
5 (h) Subject to subsection
6 (14), (12), quality assurance assessment
7 for hospitals........................at a fixed or variable
8 rate that generates
9 funds not more than the
10 maximum allowable under
11 the federal matching
12 requirements, after
13 consideration for the
14 amounts in subsection
15 (14)(a) (12)(a) and
(i).
16 (i) Initial licensure
17 application fee for subdivisions
18 (a), (b), (c), (e), and (f)..........$2,000.00 per initial
19 license.
20 (2) If a hospital requests the department to conduct a
21 certification survey for purposes of title XVIII or title XIX of
22 the social security act, the hospital shall pay a license fee
23 surcharge of $23.00 per bed. As used in this subsection, "title
24 XVIII" and "title XIX" mean those terms as defined in section
25 20155.
26 (3) All of the following apply to the assessment under this
27 section for certificates of need:
1 (a) The base fee for a certificate of need is $3,000.00 for
2 each application. For a project requiring a projected capital
3 expenditure of more than $500,000.00 but less than $4,000,000.00,
4 an additional fee of $5,000.00 is added to the base fee. For a
5 project requiring a projected capital expenditure of $4,000,000.00
6 or more but less than $10,000,000.00, an additional fee of
7 $8,000.00 is added to the base fee. For a project requiring a
8 projected capital expenditure of $10,000,000.00 or more, an
9 additional fee of $12,000.00 is added to the base fee.
10 (b) In addition to the fees under subdivision (a), the
11 applicant shall pay $3,000.00 for any designated complex project
12 including a project scheduled for comparative review or for a
13 consolidated licensed health facility application for acquisition
14 or replacement.
15 (c) If required by the department, the applicant shall pay
16 $1,000.00 for a certificate of need application that receives
17 expedited processing at the request of the applicant.
18 (d) The department shall charge a fee of $500.00 to review any
19 letter of intent requesting or resulting in a waiver from
20 certificate of need review and any amendment request to an approved
21 certificate of need.
22 (e) A health facility or agency that offers certificate of
23 need covered clinical services shall pay $100.00 for each
24 certificate of need approved covered clinical service as part of
25 the certificate of need annual survey at the time of submission of
26 the survey data.
27 (f) The department of community health shall use the fees
1 collected under this subsection only to fund the certificate of
2 need program. Funds remaining in the certificate of need program at
3 the end of the fiscal year shall not lapse to the general fund but
4 shall remain available to fund the certificate of need program in
5 subsequent years.
6 (4) If licensure is for more than 1 year, the fees described
7 in subsection (1) are multiplied by the number of years for which
8 the license is issued, and the total amount of the fees shall be
9 collected in the year in which the license is issued.A license
10 issued under this part is effective for no longer than 1 year after
11 the date of issuance.
12 (5) Fees described in this section are payable to the
13 department at the time an application for a license, permit, or
14 certificate is submitted. If an application for a license, permit,
15 or certificate is denied or if a license, permit, or certificate is
16 revoked before its expiration date, the department shall not refund
17 fees paid to the department.
18 (6) The fee for a provisional license or temporary permit is
19 the same as for a license. A license may be issued at the
20 expiration date of a temporary permit without an additional fee for
21 the balance of the period for which the fee was paid if the
22 requirements for licensure are met.
23 (7) The department may charge a fee to recover the cost of
24 purchase or production and distribution of proficiency evaluation
25 samples that are supplied to clinical laboratories under section
26 20521(3).
27 (8) In addition to the fees imposed under subsection (1), a
1 clinical laboratory shall submit a fee of $25.00 to the department
2 for each reissuance during the licensure period of the clinical
3 laboratory's license.
4 (7) (9) The
cost of licensure activities shall be supported by
5 license fees.
6 (8) (10) The
application fee for a waiver under section 21564
7 is $200.00 plus $40.00 per hour for the professional services and
8 travel expenses directly related to processing the application. The
9 travel expenses shall be calculated in accordance with the state
10 standardized travel regulations of the department of technology,
11 management, and budget in effect at the time of the travel.
12 (9) (11) An
applicant for licensure or renewal of licensure
13 under part 209 shall pay the applicable fees set forth in part 209.
14 (10) (12) Except
as otherwise provided in this section, the
15 fees and assessments collected under this section shall be
16 deposited in the state treasury, to the credit of the general fund.
17 The department may use the unreserved fund balance in fees and
18 assessments for the criminal history check program required under
19 this article.
20 (11) (13) The
quality assurance assessment collected under
21 subsection (1)(g) and all federal matching funds attributed to that
22 assessment shall be used only for the following purposes and under
23 the following specific circumstances:
24 (a) The quality assurance assessment and all federal matching
25 funds attributed to that assessment shall be used to finance
26 medicaid Medicaid nursing home reimbursement payments. Only
27 licensed nursing homes and hospital long-term care units that are
1 assessed the quality assurance assessment and participate in the
2 medicaid Medicaid program are eligible for increased per diem
3 medicaid Medicaid reimbursement rates under this subdivision. A
4 nursing home or long-term care unit that is assessed the quality
5 assurance assessment and that does not pay the assessment required
6 under subsection (1)(g) in accordance with subdivision (c)(i) or in
7 accordance with a written payment agreement with the state shall
8 not receive the increased per diem medicaid Medicaid reimbursement
9 rates under this subdivision until all of its outstanding quality
10 assurance assessments and any penalties assessed pursuant to under
11 subdivision (f) have been paid in full. Nothing in this This
12 subdivision shall be construed to does not authorize or
require the
13 department to overspend tax revenue in violation of the management
14 and budget act, 1984 PA 431, MCL 18.1101 to 18.1594.
15 (b) Except as otherwise provided under subdivision (c),
16 beginning October 1, 2005, the quality assurance assessment is
17 based on the total number of patient days of care each nursing home
18 and hospital long-term care unit provided to nonmedicare non-
19 Medicare patients within the immediately preceding year and shall
20 be assessed at a uniform rate on October 1, 2005 and subsequently
21 on October 1 of each following year, and is payable on a quarterly
22 basis, the first payment due 90 days after the date the assessment
23 is assessed.
24 (c) Within 30 days after September 30, 2005, the department
25 shall submit an application to the federal centers for medicare and
26 medicaid services Centers
for Medicare and Medicaid Services to
27 request a waiver pursuant according to 42 CFR
433.68(e) to
1 implement this subdivision as follows:
2 (i) If the waiver is approved, the quality assurance
3 assessment rate for a nursing home or hospital long-term care unit
4 with less than 40 licensed beds or with the maximum number, or more
5 than the maximum number, of licensed beds necessary to secure
6 federal approval of the application is $2.00 per nonmedicare non-
7 Medicare patient day of care provided within the immediately
8 preceding year or a rate as otherwise altered on the application
9 for the waiver to obtain federal approval. If the waiver is
10 approved, for all other nursing homes and long-term care units the
11 quality assurance assessment rate is to be calculated by dividing
12 the total statewide maximum allowable assessment permitted under
13 subsection (1)(g) less the total amount to be paid by the nursing
14 homes and long-term care units with less than 40 or with the
15 maximum number, or more than the maximum number, of licensed beds
16 necessary to secure federal approval of the application by the
17 total number of nonmedicare non-Medicare patient days of
care
18 provided within the immediately preceding year by those nursing
19 homes and long-term care units with more than 39, but less than the
20 maximum number of licensed beds necessary to secure federal
21 approval. The quality assurance assessment, as provided under this
22 subparagraph, shall be assessed in the first quarter after federal
23 approval of the waiver and shall be subsequently assessed on
24 October 1 of each following year, and is payable on a quarterly
25 basis, the first payment due 90 days after the date the assessment
26 is assessed.
27 (ii) If the waiver is approved, continuing care retirement
1 centers are exempt from the quality assurance assessment if the
2 continuing care retirement center requires each center resident to
3 provide an initial life interest payment of $150,000.00, on
4 average, per resident to ensure payment for that resident's
5 residency and services and the continuing care retirement center
6 utilizes all of the initial life interest payment before the
7 resident becomes eligible for medical assistance under the state's
8 medicaid Medicaid plan. As used in this subparagraph, "continuing
9 care retirement center" means a nursing care facility that provides
10 independent living services, assisted living services, and nursing
11 care and medical treatment services, in a campus-like setting that
12 has shared facilities or common areas, or both.
13 (d) Beginning May 10, 2002, the department of community health
14 shall increase the per diem nursing home medicaid Medicaid
15 reimbursement rates for the balance of that year. For each
16 subsequent year in which the quality assurance assessment is
17 assessed and collected, the department of community health shall
18 maintain the medicaid Medicaid
nursing home reimbursement payment
19 increase financed by the quality assurance assessment.
20 (e) The department of community health shall implement
this
21 section in a manner that complies with federal requirements
22 necessary to assure ensure
that the quality assurance assessment
23 qualifies for federal matching funds.
24 (f) If a nursing home or a hospital long-term care unit fails
25 to pay the assessment required by subsection (1)(g), the department
26 of community health may
assess the nursing home or hospital long-
27 term care unit a penalty of 5% of the assessment for each month
1 that the assessment and penalty are not paid up to a maximum of 50%
2 of the assessment. The department of community health may also
3 refer for collection to the department of treasury past due amounts
4 consistent with section 13 of 1941 PA 122, MCL 205.13.
5 (g) The medicaid Medicaid
nursing home quality assurance
6 assessment fund is established in the state treasury. The
7 department of community health shall deposit the revenue raised
8 through the quality assurance assessment with the state treasurer
9 for deposit in the medicaid Medicaid nursing home
quality assurance
10 assessment fund.
11 (h) The department of community health shall not implement
12 this subsection in a manner that conflicts with 42 USC 1396b(w).
13 (i) The quality assurance assessment collected under
14 subsection (1)(g) shall be prorated on a quarterly basis for any
15 licensed beds added to or subtracted from a nursing home or
16 hospital long-term care unit since the immediately preceding July
17 1. Any adjustments in payments are due on the next quarterly
18 installment due date.
19 (j) In each fiscal year governed by this subsection, medicaid
20 Medicaid reimbursement rates shall not be reduced below the
21 medicaid Medicaid reimbursement rates in effect on April 1, 2002 as
22 a direct result of the quality assurance assessment collected under
23 subsection (1)(g).
24 (k) The state retention amount of the quality assurance
25 assessment collected pursuant to under subsection (1)(g)
shall be
26 equal to 13.2% of the federal funds generated by the nursing homes
27 and hospital long-term care units quality assurance assessment,
1 including the state retention amount. The state retention amount
2 shall be appropriated each fiscal year to the department of
3 community health to support
medicaid Medicaid expenditures for
4 long-term care services. These funds shall offset an identical
5 amount of general fund/general purpose revenue originally
6 appropriated for that purpose.
7 (l) Beginning October 1, 2015,
2019, the department shall no
8 longer assess or collect the quality assurance assessment or apply
9 for federal matching funds. The quality assurance assessment
10 collected under subsection (1)(g) shall no longer be assessed or
11 collected after September 30, 2011, in the event that the quality
12 assurance assessment is not eligible for federal matching funds.
13 Any portion of the quality assurance assessment collected from a
14 nursing home or hospital long-term care unit that is not eligible
15 for federal matching funds shall be returned to the nursing home or
16 hospital long-term care unit.
17 (12) (14) The
quality assurance dedication is an earmarked
18 assessment collected under subsection (1)(h). That assessment and
19 all federal matching funds attributed to that assessment shall be
20 used only for the following purpose and under the following
21 specific circumstances:
22 (a) To maintain the increased medicaid Medicaid reimbursement
23 rate increases as provided for in subdivision (c).
24 (b) The quality assurance assessment shall be assessed on all
25 net patient revenue, before deduction of expenses, less medicare
26 Medicare net revenue, as reported in the most recently available
27 medicare Medicare cost report and is payable on a quarterly basis,
1 the first payment due 90 days after the date the assessment is
2 assessed. As used in this subdivision, "medicare "Medicare net
3 revenue" includes medicare Medicare payments and
amounts collected
4 for coinsurance and deductibles.
5 (c) Beginning October 1, 2002, the department of community
6 health shall increase the
hospital medicaid Medicaid
reimbursement
7 rates for the balance of that year. For each subsequent year in
8 which the quality assurance assessment is assessed and collected,
9 the department of community health shall maintain the hospital
10 medicaid Medicaid reimbursement rate increase financed by the
11 quality assurance assessments.
12 (d) The department of community health shall implement
this
13 section in a manner that complies with federal requirements
14 necessary to assure ensure
that the quality assurance assessment
15 qualifies for federal matching funds.
16 (e) If a hospital fails to pay the assessment required by
17 subsection (1)(h), the department of community health may assess
18 the hospital a penalty of 5% of the assessment for each month that
19 the assessment and penalty are not paid up to a maximum of 50% of
20 the assessment. The department of community health may also
refer
21 for collection to the department of treasury past due amounts
22 consistent with section 13 of 1941 PA 122, MCL 205.13.
23 (f) The hospital quality assurance assessment fund is
24 established in the state treasury. The department of community
25 health shall deposit the
revenue raised through the quality
26 assurance assessment with the state treasurer for deposit in the
27 hospital quality assurance assessment fund.
1 (g) In each fiscal year governed by this subsection, the
2 quality assurance assessment shall only be collected and expended
3 if medicaid Medicaid
hospital inpatient DRG and outpatient
4 reimbursement rates and disproportionate share hospital and
5 graduate medical education payments are not below the level of
6 rates and payments in effect on April 1, 2002 as a direct result of
7 the quality assurance assessment collected under subsection (1)(h),
8 except as provided in subdivision (h).
9 (h) The quality assurance assessment collected under
10 subsection (1)(h) shall no longer be assessed or collected after
11 September 30, 2011 in the event that the quality assurance
12 assessment is not eligible for federal matching funds. Any portion
13 of the quality assurance assessment collected from a hospital that
14 is not eligible for federal matching funds shall be returned to the
15 hospital.
16 (i) The state retention amount of the quality assurance
17 assessment collected pursuant to under subsection (1)(h)
shall be
18 equal to 13.2% of the federal funds generated by the hospital
19 quality assurance assessment, including the state retention amount.
20 The state retention percentage shall be applied proportionately to
21 each hospital quality assurance assessment program to determine the
22 retention amount for each program. The state retention amount shall
23 be appropriated each fiscal year to the department of community
24 health to support medicaid
Medicaid expenditures for hospital
25 services and therapy. These funds shall offset an identical amount
26 of general fund/general purpose revenue originally appropriated for
27 that purpose.
1 (13) (15) The
quality assurance assessment provided for under
2 this section is a tax that is levied on a health facility or
3 agency.
4 (14) (16) As
used in this section, "medicaid" "Medicaid" means
5 that term as defined in section 22207.
6 Sec. 20501. (1) As used in this part, :
"laboratory" means
a
7 facility for the biological, microbiological, serological,
8 chemical, immunohematological, hematological, biophysical,
9 cytological, pathological, or other examination of materials
10 derived from the human body for the purpose of providing
11 information for the diagnosis, prevention, or treatment of any
12 disease or impairment of, or the assessment of the health of, human
13 beings.
14 (a) "Laboratory director" means the individual
responsible for
15 administration of the technical and scientific operation of a
16 clinical laboratory, including the supervision of procedures and
17 reporting of findings.
18 (b) "Owner" means a person who owns and controls a
clinical
19 laboratory.
20 (2) In addition, article 1 contains general definitions and
21 principles of construction applicable to all articles in this code.
22 and part 201 contains definitions applicable to this part.
23 Sec. 20521. (1) The owner, laboratory director, and governing
24 body of a clinical laboratory are responsible for the operation of
25 the clinical laboratory.
26 (2) The laboratory director is responsible for the making and
27 keeping of an accurate record for each specimen examined and
1 procedure followed.
2 (3) A clinical laboratory shall analyze test samples submitted
3 by the department and report to the department on the results of
4 the analyses, except that proficiency evaluation programs of
5 recognized professional organizations may be acceptable to the
6 department in lieu thereof. The analyses and reports may be
7 considered by the department in taking action under section 20165
8 or 20525. Only a
physician, dentist, or other person authorized by
9 law can order a laboratory test that has been classified by the
10 Food and Drug Administration as moderate or high complexity. A
11 laboratory test that is classified by the Food and Drug
12 Administration as waived does not require an order.
13 Sec. 20551. (1) A laboratory or other place where live
14 bacteria, fungi, mycoplasma, parasites, viruses, or other
15 microorganisms of a pathogenic nature are handled, cultivated,
16 sold, given away, or shipped from or to or where recombinant
17 deoxyribonucleic acid research is done shall be registered with the
18 department, and a registration number shall be issued to each place
19 registered. An application for a registration number shall be made
20 by the person in charge of the laboratory or other place where the
21 pathogens are handled or where recombinant deoxyribonucleic acid
22 research is done. The registration number is valid for 1 year and
23 may be renewed upon application to the department.
24 (2) A clinical laboratory licensed in microbiology under
25 sections 20501 to 20525 is registered for purposes of this section
26 and section 20552, and its license number shall be used as its
27 registration number.
1 (2) (3) As
used in sections 20551 this
section and section
2 20552, "handled", "cultivated", or "shipped" does not include the
3 collection of specimens, the initial inoculation of specimens into
4 transport media or culture media, or the shipment to registered
5 laboratories, but does include any additional work performed on
6 cultivated pathogenic microorganisms or any recombinant
7 deoxyribonucleic acid research is done.
8 Enacting section 1. Sections 20511, 20515, and 20525 of the
9 public health code, 1978 PA 368, MCL 333.20511, 333.20515, and
10 333.20525, are repealed.
11 Enacting section 2. This amendatory act takes effect 90 days
12 after the date it is enacted into law.