April 12, 2016, Introduced by Reps. Canfield, Bizon and Vaupel and referred to the Committee on Health Policy.
A bill to amend 1978 PA 368, entitled
"Public health code,"
by amending sections 7303a, 9701, 17001, 17021, 17048, 17049,
17050, 17060, 17074, 17076, 17078, 17501, 17521, 17548, 17549,
17550, 17708, 17745, 17745a, 17745b, 18001, 18021, 18048, 18049,
18050, and 20201 (MCL 333.7303a, 333.9701, 333.17001, 333.17021,
333.17048, 333.17049, 333.17050, 333.17060, 333.17074, 333.17076,
333.17078, 333.17501, 333.17521, 333.17548, 333.17549, 333.17550,
333.17708, 333.17745, 333.17745a, 333.17745b, 333.18001, 333.18021,
333.18048, 333.18049, 333.18050, and 333.20201), section 7303a as
added by 1993 PA 305, section 9701 as added by 2004 PA 250,
sections 17001, 17074, 17501, and 18001 as amended and section
18050 as added by 2006 PA 161, section 17021 as amended by 1993 PA
79, sections 17048 and 17548 as amended by 2012 PA 618, sections
17049, 17076, 17078, 17549, 18048, 18049, and 20201 as amended by
2011 PA 210, sections 17050 and 17550 as amended by 1990 PA 247,
section 17060 as amended by 2014 PA 343, section 17521 as amended
by 2006 PA 582, section 17708 as amended by 2016 PA 49, section
17745 as amended by 2014 PA 525, section 17745a as amended by 1999
PA 190, section 17745b as added by 1993 PA 306, and section 18021
as amended by 2006 PA 391, and by adding sections 17047, 17547,
18047, 18051, and 20174; and to repeal acts and parts of acts.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 7303a. (1) A prescriber who holds a controlled substances
license may administer or dispense a controlled substance listed in
schedules 2 to 5 without a separate controlled substances license
for those activities.
(2) Before prescribing or dispensing a controlled substance to
a patient, a licensed prescriber shall ask the patient about other
controlled substances the patient may be using. The prescriber
shall record the patient's response in the patient's medical or
clinical record.
(3) A licensed prescriber who dispenses controlled substances
shall maintain all of the following records separately from other
prescription records:
(a) All invoices and other acquisition records for each
controlled substance acquired by the prescriber for not less than 5
years after the date the prescriber acquires the controlled
substance.
(b) A log of all controlled substances dispensed by the
prescriber for not less than 5 years after the date the controlled
substance is dispensed.
(c) Records of all other dispositions of controlled substances
under the licensee's control for not less than 5 years after the
date of the disposition.
(4) The requirement under section 7303 for a license is waived
in the following circumstances:
(a) When a controlled substance listed in schedules 2 to 5 is
administered on the order of a licensed prescriber by an individual
who
is licensed under article 15 as a practical nurse , or a
registered
professional nurse. , or a physician's assistant.
(b) When methadone or a methadone congener is dispensed on the
order of a licensed prescriber in a methadone treatment program
licensed under article 6 or when a controlled substance listed in
schedules 2 to 5 is dispensed on the order of a licensed prescriber
in a hospice rendering emergency care services in a patient's home
as
described in section 17746 by a registered professional nurse or
a
physician's assistant licensed under
article 15.
Sec. 9701. As used in this part:
(a) "Committee" means the Michigan pharmacy and therapeutics
committee established by Executive Order No. 2001-8 and by section
9705.
(b) "Controlled substance" means that term as defined in
section 7104.
(c)
"Department" means the department of community health.
(c) (d)
"Drug" means that term as
defined in section 17703.
(d) (e)
"Initiative" means the
pharmaceutical best practices
initiative established by this part.
(e) (f)
"Medicaid" means the
program of medical assistance
established under title XIX of the social security act, 42 USC 1396
to
1396v.1396w-5.
(f) (g)
"Pharmacist" means an
individual licensed by this
state
to engage in the practice of pharmacy under article 15.that
term as defined in section 17707.
(g) (h)
"Physician" means an
individual licensed by this state
to
engage in the practice of medicine or osteopathic medicine and
surgery
under article 15.that term as
defined in sections 17001 and
17501.
(h) (i)
"Prescriber" means a
licensed dentist, a licensed
doctor
of medicine, a licensed doctor of osteopathic medicine and
surgery,
a licensed doctor of podiatric medicine and surgery, a
licensed
optometrist certified under part 174 to administer and
prescribe
therapeutic pharmaceutical agents, or another licensed
health
professional acting under the delegation and using,
recording,
or otherwise indicating the name of the delegating
licensed
doctor of medicine or licensed doctor of osteopathic
medicine
and surgery.that term as
defined in section 17708.
(i) (j)
"Prescription" means that
term as defined in section
17708.
(j) (k)
"Prescription drug" means
that term as defined in
section 17708.
(k) (l) "Type
II transfer" means that term as defined in
section 3 of the executive organization act of 1965, 1965 PA 380,
MCL 16.103.
Sec. 17001. (1) As used in this part:
(a) "Academic institution" means either of the following:
(i) A medical school approved by the board.
(ii) A hospital licensed under article 17 that meets all of
the following requirements:
(A) Was the sole sponsor or a co-sponsor, if each other co-
sponsor is either a medical school approved by the board or a
hospital owned by the federal government and directly operated by
the
United States department Department
of veterans' affairs,
Veterans Affairs, of not less than 4 postgraduate education
residency programs approved by the board under section 17031(1) for
not less than the 3 years immediately preceding the date of an
application for a limited license under section 16182(2)(c) or an
application
for a full license under section 17031(2), provided
that
if at least 1 of the residency programs is in the
specialty
area of medical practice, or in a specialty area that includes the
subspecialty of medical practice, in which the applicant for a
limited license proposes to practice or in which the applicant for
a full license has practiced for the hospital.
(B) Has spent not less than $2,000,000.00 for medical
education during each of the 3 years immediately preceding the date
of an application for a limited license under section 16182(2)(c)
or an application for a full license under section 17031(2). As
used
in this subparagraph, sub-subparagraph,
"medical education"
means the education of physicians and candidates for degrees or
licenses to become physicians, including, but not limited to,
physician staff, residents, interns, and medical students.
(b) "Electrodiagnostic studies" means the testing of
neuromuscular functions utilizing nerve conduction tests and needle
electromyography. It does not include the use of surface
electromyography.
(c) "Medical care services" means those services within the
scope of practice of physicians licensed by the board, except those
services that the board prohibits or otherwise restricts within a
practice agreement or determines shall not be delegated by a
physician without endangering the health and safety of patients as
provided
for in section 17048(3).17048(1).
(d) "Participating physician" means a physician, a physician
designated by a group of physicians under section 17049 to
represent that group, or a physician designated by a health
facility or agency under section 20174 to represent that health
facility or agency.
(e)
(d) "Physician" means an individual who is licensed
under
this article to engage in the practice of medicine.
(f) (e)
"Podiatrist" means an
individual who is licensed under
this article to engage in the practice of podiatric medicine and
surgery.
(g) "Practice agreement" means an agreement described in
section 17047.
(h)
(f) "Practice of medicine" means the
diagnosis, treatment,
prevention, cure, or relieving of a human disease, ailment, defect,
complaint, or other physical or mental condition, by attendance,
advice, device, diagnostic test, or other means, or offering,
undertaking, attempting to do, or holding oneself out as able to
do, any of these acts.
(i) (g)
"Practice as a physician's
assistant" means the
practice
of medicine , osteopathic medicine and surgery, or
podiatric
medicine and surgery performed under the supervision of a
with
a participating physician under a practice agreement. or
podiatrist
licensed under this article.
(h)
"Supervision" means that term as defined in section 16109,
except
that it also includes the existence of a predetermined plan
for
emergency situations, including, but not limited to, the
designation
of a physician to supervise a physician's assistant in
the
absence of the primary supervising physician.
(j) (i)
"Task force" means the
joint task force created in
section 17025.
(2) In addition to the definitions in this part, article 1
contains definitions and principles of construction applicable to
all articles in this code and part 161 contains definitions
applicable to this part.
Sec. 17021. (1) The Michigan board of medicine is created in
the
department and shall consist consists
of the following 19
voting members who shall meet the requirements of part 161: 10
physicians, 1 physician's assistant, and 8 public members.
(2)
The requirement of section 16135(d) 16135(1)(d) that a
board member shall have practiced that profession for 2 years
immediately before appointment is waived until September 30, 1980
for members of the board licensed in a health profession subfield
created
by under this part.
(3)
The Except as otherwise
provided in this article, the
board of medicine shall not have the powers and duties vested in
the task force by sections 17060 to 17084.
Sec. 17047. (1) A physician's assistant shall not engage in
the practice as a physician's assistant except under the terms of a
practice agreement that meets the requirements of this section.
(2) A practice agreement must include all of the following:
(a) A process between the physician's assistant and
participating physician for communication, availability, and
decision making when providing medical treatment to a patient. The
process must utilize the knowledge and skills of the physician's
assistant and participating physician based on their education,
training, and experience.
(b) A protocol for designating an alternative physician for
consultation in situations in which the participating physician is
not available for consultation.
(c) The signature of the physician's assistant and the
participating physician.
(d) A termination provision that allows the physician's
assistant or participating physician to terminate the practice
agreement by providing written notice at least 30 days before the
date of termination.
(e) Subject to section 17048, the duties and responsibilities
of the physician's assistant and participating physician. The
practice agreement shall not include as a duty or responsibility of
the physician's assistant or participating physician an act, task,
or function that the physician's assistant or participating
physician is not qualified to perform by education, training, or
experience and that is not within the scope of the license held by
the physician's assistant or participating physician.
(f) A requirement that the participating physician verify the
physician's assistant's credentials.
(3) The board, in consultation with the Michigan board of
osteopathic medicine and surgery and the Michigan board of
podiatric medicine and surgery, shall consider whether to limit the
number of physician's assistants for each participating physician
in a practice agreement and may promulgate rules establishing the
appropriate maximum ratio of physician's assistants to
participating physicians in a practice agreement.
Sec. 17048. (1) Except as otherwise provided in
this section
and
section 17049(5), a physician who is a sole practitioner or who
practices
in a group of physicians and treats patients on an
outpatient
basis shall not supervise more than 4 physician's
assistants.
If a physician described in this subsection supervises
physician's
assistants at more than 1 practice site, the physician
shall
not supervise more than 2 physician's assistants by a method
other
than the physician's actual physical presence at the practice
site.
(2)
A physician who is employed by, under contract or
subcontract
to, or has privileges at a health facility or agency
licensed
under article 17 or a state correctional facility may
supervise
more than 4 physician's assistants at the health facility
or
agency or state correctional facility.
(1) (3)
To Except for a medical care
service within a practice
agreement, to the extent that a particular selected medical care
service requires extensive medical training, education, or ability
or poses serious risks to the health and safety of patients, the
board may prohibit or otherwise restrict the delegation of that
medical care service or may require higher levels of supervision.
To the extent that a particular medical care service requires
extensive training, education, or ability or poses serious risks to
the health or safety of patients, the board may prohibit or
otherwise restrict that medical care service within a practice
agreement.
(4)
A physician shall not delegate ultimate responsibility for
the
quality of medical care services, even if the medical care
services
are provided by a physician's assistant.
(2) (5)
Subject to For purposes of section 17076(3) and (4),
17076(2)
and (3), the board may promulgate rules
for the delegation
by
a supervising physician to concerning
the prescribing of drugs
by
a physician's assistant. of
the function of prescription of
drugs.
The Subject to section 17076,
the rules may define the drugs
or
classes of drugs the prescription of which shall not be
delegated
that a physician's assistant
may not prescribe and other
procedures and protocols necessary to promote consistency with
federal and state drug control and enforcement laws.
(6)
A supervising physician may delegate in writing to a
physician's
assistant the ordering, receipt, and dispensing of
complimentary
starter dose drugs including controlled substances
that
are included in schedules 2 to 5 of part 72. When the
delegated
ordering, receipt, or dispensing of complimentary starter
dose
drugs occurs, both the physician's assistant's name and the
supervising
physician's name shall be used, recorded, or otherwise
indicated
in connection with each order, receipt, or dispensing.
When
the delegated ordering, receipt, or dispensing of
complimentary
starter dose drugs that are included in schedules 2
to
5 occurs, both the physician's assistant's and the supervising
physician's
DEA registration numbers shall be used, recorded, or
otherwise
indicated in connection with each order, receipt, or
dispensing.
As used in this subsection, "complimentary starter
dose"
means that term as defined in section 17745. It is the intent
of
the legislature in enacting this subsection to allow a
pharmaceutical
manufacturer or wholesale distributor, as those
terms
are defined in part 177, to distribute complimentary starter
dose
drugs to a physician's assistant, as described in this
subsection,
in compliance with section 503(d) of the federal food,
drug,
and cosmetic act, 21 USC 353.
(3) (7)
Beginning on July 19, 2010, if 1 or
more individuals
licensed under part 170 to engage in the practice of medicine,
licensed under part 175 to engage in the practice of osteopathic
medicine and surgery, or licensed under part 180 to engage in the
practice of podiatric medicine and surgery, and 1 or more
physician's assistants organize a professional service corporation
under section 4 of former 1962 PA 192, a professional corporation
under section 284 of the business corporation act, 1972 PA 284, MCL
450.1284, or a professional limited liability company under section
904 of the Michigan limited liability company act, 1993 PA 23, MCL
450.4904,
the individuals physicians
who are the supervising
physicians
of parties to a practice
agreement with the physician's
assistants shall be shareholders in the same professional service
corporation or professional corporation or members in the same
professional limited liability company as the physician's
assistants and shall meet all of the applicable requirements of
part 170, 175, or 180. If 1 or more physician's assistants
organized a professional service corporation under section 4 of
former 1962 PA 192, a professional corporation under section 284 of
the business corporation act, 1972 PA 284, MCL 450.1284, or a
professional limited liability company under section 904 of the
Michigan limited liability company act, 1993 PA 23, MCL 450.4904,
before July 19, 2010 that has only physician's assistants as
shareholders
or members, the individuals physicians
who are the
supervising
physicians of parties to a
practice agreement with the
physician's assistants shall meet all of the applicable
requirements of part 170, 175, or 180.
(4) (8)
In addition to the requirements of
section 17068 and
beginning on July 19, 2010, the department shall include on the
form used for renewal of licensure a space for a physician's
assistant to disclose whether he or she is a shareholder in a
professional service corporation under section 4 of former 1962 PA
192, or a member in a professional limited liability company under
section 904 of the Michigan limited liability company act, 1993 PA
23, MCL 450.4904, that was organized before July 19, 2010. A
physician's assistant who is a shareholder in a professional
service corporation or a member in a professional limited liability
company described in this subsection shall disclose all of the
following in the form used for renewal of licensure provided by the
department:
(a) Whether any individuals licensed under part 170 to engage
in the practice of medicine, licensed under part 175 to engage in
the practice of osteopathic medicine and surgery, or licensed under
part 180 to engage in the practice of podiatric medicine and
surgery are shareholders in the professional service corporation or
members in the professional limited liability company.
(b) The name and license number of the individual licensed
under part 170 to engage in the practice of medicine, licensed
under part 175 to engage in the practice of osteopathic medicine
and surgery, or licensed under part 180 to engage in the practice
of
podiatric medicine and surgery who supervises is a party to a
practice agreement with the physician's assistant.
(c) Whether the individual licensed under part 170 to engage
in the practice of medicine, licensed under part 175 to engage in
the practice of osteopathic medicine and surgery, or licensed under
part 180 to engage in the practice of podiatric medicine and
surgery disclosed in subdivision (b) is a shareholder in the same
professional service corporation or member in a professional
limited liability company as the physician's assistant.
Sec.
17049. (1) In addition to the other requirements of this
section
and subject to subsection (5), a physician who supervises a
physician's
assistant is responsible for all of the following:
(a)
Verification of the physician's assistant's credentials.
(b)
Evaluation of the physician's assistant's performance.
(c)
Monitoring the physician's assistant's practice and
provision
of medical care services.
(2)
Subject to section 16215 or 17048, as applicable, a
physician
who supervises a physician's assistant may delegate to
the
physician's assistant the performance of medical care services
for
a patient who is under the case management responsibility of
the
physician, if the delegation is consistent with the physician's
assistant's
training.
(3)
A physician who supervises a physician's assistant is
responsible
for the clinical supervision of each physician's
assistant
to whom the physician delegates the performance of
medical
care service under subsection (2).
(4)
Subject to subsection (5), a physician who supervises a
physician's
assistant shall keep on file in the physician's office
or
in the health facility or agency or correctional facility in
which
the physician supervises the physician's assistant a
permanent,
written record that includes the physician's name and
license
number and the name and license number of each physician's
assistant
supervised by the physician.
(1) (5)
A group of physicians practicing
other than as sole
practitioners may designate 1 or more physicians in the group to
fulfill
the requirements of subsections (1) and (4).enter into a
practice agreement under section 17047.
(2) (6)
Notwithstanding any law or rule to
the contrary, a
physician is not required to countersign orders written in a
patient's
clinical record by a physician's assistant to whom the
physician
has delegated the performance of medical care services
for
a patient. with whom the
physician has a practice agreement.
Notwithstanding any law or rule to the contrary, a physician is not
required to sign an official form that lists the physician's
signature as the required signatory if that official form is signed
by
a physician's assistant to whom the physician has delegated the
performance
of medical care services.with
whom the physician has a
practice agreement.
Sec. 17050. In addition to its other powers and duties under
this article, the board may prohibit a physician or a physician's
assistant
from supervising 1 or more
physician's assistants
entering into a practice agreement for any of the grounds set forth
in
section 16221. or for failure to supervise a physician's
assistant
in accordance with this part and rules promulgated under
this
part.
Sec. 17060. The task force shall:
(a) Promulgate rules necessary for the implementation of its
powers and duties and may perform the acts and make the
determinations necessary for the proper implementations of those
powers and duties.
(b) Promulgate rules to establish the requirements for the
education, training, or experience of physician's assistants for
licensure
in this state. The requirements shall must take into
account nationally recognized standards for education, training,
and experience and the desired utilization of physician's
assistants.
By 2 years after the effective date of the amendatory
act
that added this sentence, January
14, 2017, the rules must
include training standards for identifying victims of human
trafficking. The training standards for identifying victims of
human
trafficking shall must apply for a physician's assistant
license or registration renewal beginning with the first renewal
cycle after the rules are promulgated and for an initial license or
registration issued 5 or more years after the rules are
promulgated.
(c)
Develop and make public guidelines on the appropriate
delegation
of functions to and supervision of physician's
assistants
according to the level of education, training, or
experience
of physician's assistants. The guidelines are not
binding,
but shall serve to explain how the task force's training
criteria
coincides with the board's expectation for delegation to
and
supervision of physician's assistants by physicians.
(c) (d)
Direct the department to issue
licenses to applicants
who meet the requirements of this part and the rules promulgated
under this part for practice and use of the title of physician's
assistant.
(d) (e)
Promulgate rules to establish
criteria for the
evaluation of programs for the education and training of
physician's assistants for the purpose of determining whether
graduates of the programs have the knowledge and skills requisite
for practice and use of the title physician's assistant in this
state as defined by this part and the rules promulgated under this
part.
The criteria established shall must
be substantially
consistent with nationally recognized standards for the education
and training of physician's assistants. Until the criteria are
established, the criteria developed by the advisory commission on
physician's assistants shall remain in effect. The task force shall
consider and may use where appropriate the criteria established by
professional associations, education accrediting bodies, or
governmental agencies. In establishing criteria for the evaluation
of education and training programs, the task force may seek the
advice of the boards and the department of education.
(f)
Make written recommendations to the boards concerning the
rules
to be developed for approval by the boards of physicians to
supervise
physician's assistants, including recommendations for
appropriate
utilization of physician's assistants by level of
preparation
where appropriate.
(e) (g)
File an annual report with the
department and the
boards containing matters prescribed by the department and boards.
Sec. 17074. (1) A physician's assistant shall not undertake or
represent that he or she is qualified to undertake provision of a
medical care service that he or she knows or reasonably should know
to be outside his or her competence or is prohibited by law.
(2) A physician's assistant shall not:
(a) Perform acts, tasks, or functions to determine the
refractive state of a human eye or to treat refractive anomalies of
the human eye, or both.
(b) Determine the spectacle or contact lens prescription
specifications required to treat refractive anomalies of the human
eye, or determine modification of spectacle or contact lens
prescription specifications, or both.
(3) A physician's assistant may perform routine visual
screening or testing, postoperative care, or assistance in the care
of
medical diseases of the eye under the supervision of a
physician.a practice agreement.
(4)
A physician's assistant acting under the supervision of a
podiatrist
shall only perform those duties included within the
scope
of practice of that supervising podiatrist.
Sec.
17076. (1) Except in an emergency situation, a
physician's
assistant shall provide medical care services only
under
the supervision of a physician or properly designated
alternative
physician, and only if those medical care services are
within
the scope of practice of the supervising physician and are
delegated
by the supervising physician.
(1) (2)
A physician's assistant may make
calls or go on rounds
under
the supervision of a physician in
private homes, public
institutions, emergency vehicles, ambulatory care clinics,
hospitals, intermediate or extended care facilities, health
maintenance organizations, nursing homes, or other health care
facilities in accordance with a practice agreement. Notwithstanding
any law or rule to the contrary, a physician's assistant may make
calls or go on rounds as provided in this subsection without
restrictions
on the time or frequency of visits by the a physician
or the physician's assistant.
(2) (3)
A physician's assistant who is a party to a practice
agreement
may prescribe drugs as a delegated
act of a supervising
physician
a drug in accordance with procedures and protocol
protocols for the prescription established by rule of the
appropriate board. A physician's assistant may prescribe a drug,
including a controlled substance that is included in schedules 2 to
5
of part 72. , as a delegated act of the supervising physician.
When
delegated prescription occurs, both If a physician's assistant
prescribes a drug under this subsection, the physician's
assistant's
name and the supervising physician's name shall be
used,
recorded, or otherwise indicated in connection with each
individual
that prescription. so that the individual who dispenses
or
administers the prescription knows under whose delegated
authority
the physician's assistant is prescribing. When delegated
prescription
of drugs If a physician's
assistant prescribes a drug
under
this subsection that are is included
in schedules 2 to 5,
occurs,
both the physician's assistant's and
the supervising
physician's
DEA registration numbers number shall
be used,
recorded,
or otherwise indicated in connection with each that
individual
prescription.
(3) (4)
A physician's assistant may order,
receive, and
dispense complimentary starter dose drugs, including controlled
substances
that are included in schedules 2 to 5 of part 72. , as a
delegated
act of a supervising physician. When the delegated
ordering,
receipt, or dispensing of If
a physician's assistant
orders,
receives, or dispenses a complimentary
starter dose drugs
occurs,
both drug under this
subsection, the physician's
assistant's
name and the supervising physician's name shall be
used,
recorded, or otherwise indicated in connection with each that
order,
receipt, or dispensing. so that the individual who processes
the
order or delivers the complimentary starter dose drugs or to
whom
the complimentary starter dose drugs are dispensed knows under
whose
delegated authority the physician's assistant is ordering,
receiving,
or dispensing. When the delegated ordering, receipt, or
dispensing
of If a physician's assistant
orders, receives, or
dispenses
a complimentary starter dose drugs drug under this
subsection
that are is included
in schedules 2 to 5, occurs, both
the
physician's assistant's and the supervising physician's DEA
registration
numbers number shall be used, recorded, or otherwise
indicated
in connection with each that
order, receipt, or
dispensing. As used in this subsection, "complimentary starter
dose" means that term as defined in section 17745. It is the intent
of the legislature in enacting this subsection to allow a
pharmaceutical manufacturer or wholesale distributor, as those
terms are defined in part 177, to distribute complimentary starter
dose drugs to a physician's assistant, as described in this
subsection, in compliance with section 503(d) of the federal food,
drug, and cosmetic act, 21 USC 353.
Sec.
17078. (1) A physician's assistant is the agent of his or
her
supervising physician under this part or part 175 or
supervising
podiatrist under part 180. A communication made to a
physician's
assistant that would be a privileged communication if
made
to the supervising physician under this part or part 175 or
supervising
podiatrist under part 180 is a privileged communication
to
the physician's assistant and the supervising physician or
supervising
podiatrist to the same extent as if the communication
were
made to the supervising physician or supervising podiatrist.
(2)
A physician's assistant shall
conform to minimal standards
of
acceptable and prevailing practice for the supervising physician
under
this part, or part 175, or supervising
podiatrist under part
180, as applicable.
Sec. 17501. (1) As used in this part:
(a) "Electrodiagnostic studies" means the testing of
neuromuscular functions utilizing nerve conduction tests and needle
electromyography. It does not include the use of surface
electromyography.
(b) "Medical care services" means those services within the
scope of practice of physicians licensed and approved by the board,
except those services that the board prohibits or otherwise
restricts within a practice agreement or determines shall not be
delegated by a physician without endangering the health and safety
of
patients as provided for in section 17548(3).17548(1).
(c) "Participating physician" means a physician, a physician
designated by a group of physicians under section 17549 to
represent that group, or a physician designated by a health
facility or agency under section 20174 to represent that health
facility or agency.
(d)
(c) "Physician" means an individual who is licensed
under
this article to engage in the practice of osteopathic medicine and
surgery.
(e) "Practice agreement" means an agreement described in
section 17547.
(f)
(d) "Practice of osteopathic medicine and
surgery" means a
separate, complete, and independent school of medicine and surgery
utilizing full methods of diagnosis and treatment in physical and
mental health and disease, including the prescription and
administration of drugs and biologicals, operative surgery,
obstetrics, radiological and other electromagnetic emissions, and
placing special emphasis on the interrelationship of the
musculoskeletal system to other body systems.
(g) (e)
"Practice as a physician's
assistant" means the
practice
of medicine, osteopathic medicine and surgery ,
and
podiatric
medicine and surgery performed under the supervision of
with
a participating physician or
podiatrist licensed under this
article.under a practice agreement.
(f)
"Supervision" has the meaning ascribed to it in section
16109
except that it includes the existence of a predetermined plan
for
emergency situations, including, but not limited to, the
designation
of a physician to supervise a physician's assistant in
the
absence of the primary supervising physician.
(h) (g)
"Task force" means the
joint task force created in
section 17025.
(2) In addition to the definitions in this part, article 1
contains general definitions and principles of construction
applicable to all articles in the code and part 161 contains
definitions applicable to this part.
Sec. 17521. (1) The Michigan board of osteopathic medicine and
surgery
is created in the department and shall consist consists of
the following 11 voting members who shall meet the requirements of
part 161: 7 physicians, 1 physician's assistant, and 3 public
members.
(2)
The requirement of section 16135(d) 16135(1)(d) that a
board member shall have practiced that profession for 2 years
immediately before appointment is waived until September 30, 1980
for members of the board who are licensed in a health profession
subfield
created by under this part. The
(3) Except as otherwise provided in this article, the Michigan
board of osteopathic medicine and surgery does not have the powers
and duties vested in the task force by sections 17060 to 17084.
Sec. 17547. (1) A physician's assistant shall not engage in
the practice as a physician's assistant except under the terms of a
practice agreement that meets the requirements of this section.
(2) A practice agreement must include all of the following:
(a) A process between the physician's assistant and
participating physician for communication, availability, and
decision making when providing medical treatment to a patient. The
process must utilize the knowledge and skills of the physician's
assistant and participating physician based on their education,
training, and experience.
(b) A protocol for designating an alternative physician for
consultation in situations in which the participating physician is
not available for consultation.
(c) The signatures of the physician's assistant and the
participating physician.
(d) A termination provision that allows the physician's
assistant or participating physician to terminate the practice
agreement by providing written notice at least 30 days before the
date of termination.
(e) Subject to section 17548, the duties and responsibilities
of the physician's assistant and participating physician. The
practice agreement shall not include as a duty or responsibility of
the physician's assistant or participating physician an act, task,
or function that the physician's assistant or participating
physician is not qualified to perform by education, training, or
experience and that is not within the scope of the license held by
the physician's assistant or participating physician.
(f) A requirement that the participating physician verify the
physician's assistant's credentials.
(3) The board, in consultation with the Michigan board of
medicine and the Michigan board of podiatric medicine and surgery,
shall consider whether to limit the number of physician's
assistants for each participating physician in a practice agreement
and may promulgate rules establishing the maximum ratio of
physician's assistants to participating physicians in a practice
agreement.
Sec. 17548. (1) Except as otherwise provided in
this
subsection
and section 17549(5), a physician who is a sole
practitioner
or who practices in a group of physicians and treats
patients
on an outpatient basis shall not supervise more than 4
physician's
assistants. If a physician described in this subsection
supervises
physician's assistants at more than 1 practice site, the
physician
shall not supervise more than 2 physician's assistants by
a
method other than the physician's actual physical presence at the
practice
site.
(2)
A physician who is employed by or under contract or
subcontract
to or has privileges at a health facility licensed
under
article 17 or a state correctional facility may supervise
more
than 4 physician's assistants at the health facility or agency
or
state correctional facility.
(1) (3)
To Except for a medical care
service within a practice
agreement, to the extent that a particular selected medical care
service requires extensive medical training, education, or ability
or pose serious risks to the health and safety of patients, the
board may prohibit or otherwise restrict the delegation of that
medical care service or may require higher levels of supervision.
To the extent that a particular medical care service requires
extensive training, education, or ability or poses serious risks to
the health or safety of patients, the board may prohibit or
otherwise restrict that medical care service within a practice
agreement.
(4)
A physician shall not delegate ultimate responsibility for
the
quality of medical care services, even if the medical care
services
are provided by a physician's assistant.
(2) (5)
A physician's assistant may make
calls or go on rounds
under
the supervision of a physician in
private homes, public
institutions, emergency vehicles, ambulatory care clinics,
hospitals, intermediate or extended care facilities, health
maintenance organizations, nursing homes, or other health care
facilities in accordance with a practice agreement. Notwithstanding
any law or rule to the contrary, a physician's assistant may make
calls or go on rounds as provided in this subsection without
restrictions
on the time or frequency of visits by the a physician
or the physician's assistant.
(3) (6)
Subject to subsections (7) and (8), For purposes of
subsection
(4), the board may promulgate rules for
the delegation
by
a supervising physician to concerning
the prescribing of drugs
by
a physician's assistant. of
the function of prescription of
drugs.
Subject to subsections (7) and
(8), subsection (4), the
rules
may define the drugs or classes of drugs the prescription of
which
shall not be delegated that a
physician's assistant may not
prescribe and other procedures and protocols necessary to promote
consistency with federal and state drug control and enforcement
laws.
(4) (7)
A physician's assistant who is a party to a practice
agreement
may prescribe drugs as a delegated
act of a supervising
physician
a drug in accordance with procedures and protocol
protocols for the prescription established by rule of the
appropriate board. A physician's assistant may prescribe a drug,
including a controlled substance that is included in schedules 2 to
5
of part 72. , as a delegated act of the supervising physician.
When
delegated prescription occurs, both If a physician's assistant
prescribes a drug under this subsection, the physician's
assistant's
name and the supervising physician's name shall be
used,
recorded, or otherwise indicated in connection with each
individual
that prescription. so that the individual who dispenses
or
administers the prescription knows under whose delegated
authority
the physician's assistant is prescribing. When delegated
prescription
of drugs If a physician's
assistant prescribes a drug
under
this subsection that are is included
in schedules 2 to 5,
occurs,
both the physician's assistant's and
the supervising
physician's
DEA registration numbers number shall
be used,
recorded,
or otherwise indicated in connection with each individual
that prescription.
(5) (8)
A supervising physician may
delegate in writing to a
physician's
assistant the ordering, receipt, and dispensing of may
order, receive, and dispense complimentary starter dose drugs
including controlled substances that are included in schedules 2 to
5
of part 72. When the delegated ordering, receipt, or dispensing
of
If a physician's assistant
orders, receives, or dispenses a
complimentary
starter dose drugs occurs, both drug
under this
subsection,
the physician's assistant's name and
the supervising
physician's
name shall be used, recorded, or
otherwise indicated in
connection
with each that order, receipt, or dispensing. When the
delegated
ordering, receipt, or dispensing of If a physician's
assistant orders, receives, or dispenses a complimentary starter
dose
drugs drug under this
subsection that are is included
in
schedules
2 to 5, occurs, both the physician's assistant's and
the
supervising
physician's DEA registration numbers
number shall be
used,
recorded, or otherwise indicated in connection with each that
order, receipt, or dispensing. As used in this subsection,
"complimentary starter dose" means that term as defined in section
17745. It is the intent of the legislature in enacting this
subsection to allow a pharmaceutical manufacturer or wholesale
distributor, as those terms are defined in part 177, to distribute
complimentary starter dose drugs to a physician's assistant, as
described in this subsection, in compliance with section 503(d) of
the federal food, drug, and cosmetic act, 21 USC 353.
Sec.
17549. (1) In addition to the other requirements of this
section
and subject to subsection (5), a physician who supervises a
physician's
assistant is responsible for all of the following:
(a)
Verification of the physician's assistant's credentials.
(b)
Evaluation of the physician's assistant's performance.
(c)
Monitoring the physician's assistant's practice and
provision
of medical care services.
(2)
Subject to section 16215 or 17548, as applicable, a
physician
who supervises a physician's assistant may delegate to
the
physician's assistant the performance of medical care services
for
a patient who is under the case management responsibility of
the
physician, if the delegation is consistent with the physician's
assistant's
training.
(3)
A physician who supervises a physician's assistant is
responsible
for the clinical supervision of each physician's
assistant
to whom the physician delegates the performance of
medical
care service under subsection (2).
(4)
Subject to subsection (5), a physician who supervises a
physician's
assistant shall keep on file in the physician's office
or
in the health facility or agency or state correctional facility
in
which the physician supervises the physician's assistant a
permanent,
written record that includes the physician's name and
license
number and the name and license number of each physician's
assistant
supervised by the physician.
(1) (5)
A group of physicians practicing
other than as sole
practitioners may designate 1 or more physicians in the group to
fulfill
the requirements of subsections (1) and (4).enter into a
practice agreement under section 17547.
(2) (6)
Notwithstanding any law or rule to
the contrary, a
physician is not required to countersign orders written in a
patient's
clinical record by a physician's assistant to whom the
physician
has delegated the performance of medical care services
for
a patient. with whom the
physician has a practice agreement.
Notwithstanding any law or rule to the contrary, a physician is not
required to sign an official form that lists the physician's
signature as the required signatory if that official form is signed
by
a physician's assistant to whom the physician has delegated the
performance
of medical care services.with
whom the physician has a
practice agreement.
Sec. 17550. In addition to its other powers and duties under
this
article, the board may prohibit a physician from supervising 1
or
more physician's assistants or
a physician's assistant from
entering into a practice agreement for any of the grounds set forth
in
section 16221. or for failure to supervise a physician's
assistant
in accordance with this part and rules promulgated under
this
part.
Sec. 17708. (1) "Preceptor" means a pharmacist approved by the
board to direct the training of an intern in an approved pharmacy.
(2) "Prescriber" means a licensed dentist, a licensed doctor
of medicine, a licensed doctor of osteopathic medicine and surgery,
a licensed doctor of podiatric medicine and surgery, a licensed
physician's assistant, a licensed optometrist certified under part
174 to administer and prescribe therapeutic pharmaceutical agents,
a licensed veterinarian, or another licensed health professional
acting under the delegation and using, recording, or otherwise
indicating the name of the delegating licensed doctor of medicine
or licensed doctor of osteopathic medicine and surgery.
(3) "Prescription" means an order by a prescriber to fill,
compound, or dispense a drug or device written and signed; written
or created in an electronic format, signed, and transmitted by
facsimile; or transmitted electronically or by other means of
communication. An order transmitted in other than written or hard-
copy form must be electronically recorded, printed, or written and
immediately dated by the pharmacist, and that record constitutes
the original prescription. In a health facility or agency licensed
under article 17 or other medical institution, an order for a drug
or device in the patient's chart constitutes for the purposes of
this definition the original prescription. Subject to section
17751(2) and (5), prescription includes, but is not limited to, an
order for a drug, not including a controlled substance as defined
in section 7104 except under circumstances described in section
17763(e), written and signed; written or created in an electronic
format, signed, and transmitted by facsimile; or transmitted
electronically or by other means of communication by a physician
prescriber, dentist prescriber, or veterinarian prescriber licensed
to practice dentistry, medicine, osteopathic medicine and surgery,
or veterinary medicine in another state.
(4) "Prescription drug" means a drug to which 1 or more of the
following apply:
(a) The drug is dispensed pursuant to a prescription.
(b) The drug bears the federal legend "CAUTION: federal law
prohibits dispensing without prescription" or "Rx only".
(c) The drug is designated by the board as a drug that may
only be dispensed pursuant to a prescription.
Sec. 17745. (1) Except as otherwise provided in this
subsection, a prescriber who wishes to dispense prescription drugs
shall obtain from the board a drug control license for each
location in which the storage and dispensing of prescription drugs
occur. A drug control license is not necessary if the dispensing
occurs in the emergency department, emergency room, or trauma
center of a hospital licensed under article 17 or if the dispensing
involves only the issuance of complimentary starter dose drugs.
(2) Except as otherwise authorized for expedited partner
therapy in section 5110 or as provided in section 17744a or 17744b,
a dispensing prescriber shall dispense prescription drugs only to
his or her own patients.
(3) A dispensing prescriber shall include in a patient's chart
or clinical record a complete record, including prescription drug
names, dosages, and quantities, of all prescription drugs dispensed
directly by the dispensing prescriber or indirectly under his or
her delegatory authority. If prescription drugs are dispensed under
the prescriber's delegatory authority, the delegatee who dispenses
the prescription drugs shall initial the patient's chart, clinical
record, or log of prescription drugs dispensed. In a patient's
chart or clinical record, a dispensing prescriber shall distinguish
between prescription drugs dispensed to the patient, prescription
drugs prescribed for the patient, prescription drugs dispensed or
prescribed for expedited partner therapy as authorized in section
5110, and prescription drugs dispensed or prescribed as authorized
under section 17744a or 17744b. A dispensing prescriber shall
retain information required under this subsection for not less than
5 years after the information is entered in the patient's chart or
clinical record.
(4) A dispensing prescriber shall store prescription drugs
under conditions that will maintain their stability, integrity, and
effectiveness
and will assure ensure that the prescription drugs
are free of contamination, deterioration, and adulteration.
(5) A dispensing prescriber shall store prescription drugs in
a substantially constructed, securely lockable cabinet. Access to
the
cabinet shall must be limited to individuals authorized to
dispense prescription drugs in compliance with this part and
article 7.
(6) Unless otherwise requested by a patient, a dispensing
prescriber shall dispense a prescription drug in a safety closure
container that complies with the poison prevention packaging act of
1970, 15 USC 1471 to 1477.
(7) A dispensing prescriber shall dispense a drug in a
container that bears a label containing all of the following
information:
(a) The name and address of the location from which the
prescription drug is dispensed.
(b) Except as otherwise authorized under section 5110, 17744a,
or 17744b, the patient's name and record number.
(c) The date the prescription drug was dispensed.
(d) The prescriber's name or, if dispensed under the
prescriber's delegatory authority, the name of the delegatee.
(e) The directions for use.
(f) The name and strength of the prescription drug.
(g) The quantity dispensed.
(h) The expiration date of the prescription drug or the
statement required under section 17756.
(8) A dispensing prescriber who dispenses a complimentary
starter dose drug to a patient shall give the patient the
information required in this subsection, by dispensing the
complimentary starter dose drug to the patient in a container that
bears a label containing the required information or by giving the
patient a written document that may include, but is not limited to,
a preprinted insert that comes with the complimentary starter dose
drug and that contains the required information. The information
required to be given to the patient under this subsection includes
all of the following:
(a) The name and strength of the complimentary starter dose
drug.
(b) Directions for the patient's use of the complimentary
starter dose drug.
(c) The expiration date of the complimentary starter dose drug
or the statement required under section 17756.
(9) The information required under subsection (8) is in
addition to, and does not supersede or modify, other state or
federal law regulating the labeling of prescription drugs.
(10) In addition to meeting the requirements of this part, a
dispensing prescriber who dispenses controlled substances shall
comply with section 7303a.
(11) The board may periodically inspect locations from which
prescription drugs are dispensed.
(12) The act, task, or function of dispensing prescription
drugs shall be delegated only as provided in this part and sections
16215,
17048, 17076, 17212, and 17548.
(13) A supervising physician may delegate in writing to a
pharmacist practicing in a hospital pharmacy within a hospital
licensed under article 17 the receipt of complimentary starter dose
drugs other than controlled substances as defined by article 7 or
federal law. When the delegated receipt of complimentary starter
dose drugs occurs, both the pharmacist's name and the supervising
physician's name shall be used, recorded, or otherwise indicated in
connection with each receipt. A pharmacist described in this
subsection may dispense a prescription for complimentary starter
dose drugs written or transmitted by facsimile, electronic
transmission, or other means of communication by a prescriber.
(14) As used in this section, "complimentary starter dose"
means a prescription drug packaged, dispensed, and distributed in
accordance with state and federal law that is provided to a
dispensing prescriber free of charge by a manufacturer or
distributor and dispensed free of charge by the dispensing
prescriber to his or her patients.
Sec. 17745a. (1) As used in this section:
(a) "Medicaid" means the program of medical assistance
established
under title XIX of the social security act, chapter
531,
49 Stat. 620, 42 U.S.C. 1396 to 1396f, 1396g-1 to 1396r-6, and
1396r-8
to 1396v.42 USC 1396 to
1396w-5.
(b)
"Medicare" means the federal medicare Medicare program
established
under title XVIII of the social security act, chapter
531,
49 Stat. 620, 42 U.S.C. 1395 to 1395b, 1395b-2, 1395b-6 to
1395b-7,
1395c to 1395i, 1395i-2 to 1395i-5, 1395j to 1395t, 1395u
to
1395w, 1395w-2 to 1395w-4, 1395w-21 to 1395w-28, 1395x to
1395yy,
and 1395bbb to 1395ggg.42 USC
1395 to 1395lll.
(c) "Public health program" means 1 of the following:
(i) A local health department.
(ii) A migrant health center or a community health center as
defined
under sections 329 and 330 of subpart I of part C of title
III
of the public health service act, 42
U.S.C. USC 254b and 254c.
(iii) A family planning program designated by the family
independence
agency department of health
and human services as a
provider type 23 under the social welfare act, 1939 PA 280, MCL
400.1
to 400.119b, and verified by the department of community
health.health and human services.
(iv) A methadone treatment program licensed under article 6.
(v) A rural health clinic.
(vi) A hospice rendering emergency care services in a
patient's home as described in section 17746.
(d) "Rural health clinic" means a rural health clinic as
defined
in section 1861 of part C of title XVIII of the social
security
act, 42 U.S.C. USC 1395x , that is certified to
participate
in medicaid Medicaid and medicare.Medicare.
(2) Except as otherwise provided in subsections (3) and (4),
in a public health program without an on-site pharmacy, a
dispensing prescriber may delegate the dispensing of prescription
drugs
only to the following individuals:
(a)
A a registered professional nurse licensed under part
172.
(b)
A physician's assistant licensed under part 170 or part
175,
if the delegating dispensing prescriber is responsible for the
clinical
supervision of the physician's assistant.
(3) In a public health program without an on-site pharmacy, a
dispensing prescriber may delegate the delivery of prescription
drugs consisting only of prelabeled, prepackaged oral
contraceptives under the following circumstances:
(a) The delivery is delegated to an appropriately trained
individual.
(b) The delivery is performed pursuant to specific, written
protocols.
(4) In a methadone treatment program licensed under article 6
without an on-site pharmacy, a dispensing prescriber may delegate
the delivery of a prescription drug consisting only of 1 or more
single doses of methadone, up to the maximum number of single doses
allowed by law, to a registered client of the methadone treatment
program, if all of the following requirements are met:
(a)
The delivery is delegated to 1 of the following
individuals:
(i) A a
registered professional nurse or a
licensed practical
nurse licensed under part 172.
(ii) A physician's assistant licensed under part 170 or
part
175,
but only if the delegating dispensing prescriber is
responsible
for the clinical supervision of the physician's
assistant.
(b) The delivery is performed pursuant to specific, written
protocols.
(c) The prescription drug described in this subsection is
labeled in accordance with section 17745.
Sec. 17745b. (1) Subject to subsection (3), in an industrial
clinic or other prescriber practice location without an on-site
pharmacy, a dispensing prescriber may delegate the dispensing of
prescription
drugs only to the following individuals:
(a)
A a registered professional nurse licensed under part
172.
(b)
A physician's assistant licensed under part 170 or part
175,
if the dispensing prescriber is responsible for the clinical
supervision
of the physician's assistant.
(2) In an industrial clinic or other prescriber practice
location without an on-site pharmacy, if a dispensing prescriber
does not delegate the dispensing of a prescription drug, the
dispensing prescriber shall do both of the following:
(a) Be physically present at the time the prescription drug is
dispensed.
(b) Immediately before the prescription drug is dispensed,
perform a final inspection of the type of prescription drug,
labeling, dosage, and amount of the prescription drug dispensed.
(3) A dispensing prescriber who delegates the dispensing of a
prescription drug to a patient in an industrial clinic or other
prescriber practice location without an on-site pharmacy shall not
delegate the dispensing of more than a 72-hour supply of the
prescription drug.
(4) Before dispensing a prescription drug to a patient in an
industrial clinic or other prescriber practice location without an
on-site pharmacy, a dispensing prescriber who intends to charge for
dispensing the drug shall give a written prescription to the
patient and shall instruct the patient that he or she may elect to
have the prescription filled by the dispensing prescriber or the
patient's pharmacy of choice.
(5) If a dispensing prescriber intends to charge for
dispensing a prescription drug to a patient in an industrial clinic
or other prescriber practice location without an on-site pharmacy,
the dispensing prescriber shall inform the patient of that fact
before dispensing the prescription drug to the patient. The
dispensing prescriber also shall list the charge for dispensing the
prescription drug as a separate item on the patient's bill.
(6) This section does not apply to public health programs as
defined in section 17745a.
Sec. 18001. (1) As used in this part:
(a) "Medical care services" means those services within the
scope of practice of podiatrists licensed by the board, except
those services that the board prohibits or otherwise restricts
within a practice agreement or determines shall not be delegated by
a podiatrist without endangering the health and safety of patients
as provided for in section 18048.
(b) "Participating podiatrist" means a podiatrist or a
podiatrist designated by a group of podiatrists under section 18049
to represent that group.
(c)
(a) "Podiatrist" means a physician and surgeon
licensed
under this article to engage in the practice of podiatric medicine
and surgery.
(d) "Practice agreement" means an agreement described in
section 18047.
(e)
(b) "Practice as a physician's assistant"
means the
practice
of medicine, osteopathic medicine and surgery, and
podiatric
medicine and surgery under the supervision of a physician
or
podiatrist licensed under this article.with a participating
podiatrist under a practice agreement.
(f) (c)
"Practice of podiatric
medicine and surgery" means the
examination, diagnosis, and treatment of abnormal nails,
superficial excrescenses occurring on the human hands and feet,
including corns, warts, callosities, and bunions, and arch troubles
or the treatment medically, surgically, mechanically, or by
physiotherapy of ailments of human feet or ankles as they affect
the condition of the feet. It does not include amputation of human
feet, or the use or administration of anesthetics other than local.
(d)
"Supervision" means that term as defined under section
16109
except that it includes the existence of a predetermined plan
for
emergency situations including, but not limited to, the
designation
of a podiatrist to supervise a physician's assistant in
the
absence of the primary supervising podiatrist.
(g) (e)
"Task force" means the
joint task force created in
section 17025.
(2) In addition to the definitions in this part, article 1
contains general definitions and principles of construction
applicable to all articles in this code and part 161 contains
definitions applicable to this part.
Sec. 18021. (1) The Michigan board of podiatric medicine and
surgery
is created in the department and shall consist consists of
the following 9 voting members who shall meet the requirements of
part 161: 5 podiatrists, 1 physician's assistant, and 3 public
members.
(2)
The Except as otherwise
provided in this article, the
board of podiatric medicine and surgery does not have the powers
and duties vested in the task force by sections 17060 to 17084.
(3) The terms of office of individual members of the board
created under this section, except those appointed to fill
vacancies, expire 4 years after appointment on June 30 of the year
in which the term expires.
Sec. 18047. (1) A physician's assistant shall not engage in
the practice as a physician's assistant except under the terms of a
practice agreement that meets the requirements of this section.
(2) A practice agreement must include all of the following:
(a) A process between the physician's assistant and
participating podiatrist for communication, availability, and
decision making when providing medical treatment to a patient. The
process must utilize the knowledge and skills of the physician's
assistant and participating podiatrist based on their education,
training, and experience.
(b) A protocol for designating an alternative physician for
consultation in situations in which the participating podiatrist is
not available for consultation.
(c) The signature of the physician's assistant and the
participating podiatrist.
(d) A termination provision that allows the physician's
assistant or participating podiatrist to terminate the practice
agreement by providing written notice at least 30 days before the
date of termination.
(e) Subject to section 18048, the duties and responsibilities
of the physician's assistant and participating podiatrist. The
practice agreement shall not include as a duty or responsibility of
the physician's assistant or participating podiatrist an act, task,
or function that the physician's assistant or participating
podiatrist is not qualified to perform by education, training, or
experience and that is not within the scope of the license held by
the physician's assistant or participating podiatrist.
(f) A requirement that the participating podiatrist verify the
physician's assistant's credentials.
(3) The board, in consultation with the Michigan board of
medicine and the Michigan board of osteopathic medicine and
surgery, shall consider whether to limit the number of physician's
assistants for each participating physician in a practice agreement
and may promulgate rules establishing the maximum ratio of
physician's assistants to participating podiatrists in a practice
agreement.
Sec.
18048. (1) Except as otherwise provided in this section
and
section 18049(5), a podiatrist who is a sole practitioner or
who
practices in a group of podiatrists and treats patients on an
outpatient
basis shall not supervise more than 4 physician's
assistants.
If a podiatrist described in this subsection supervises
physician's
assistants at more than 1 practice site, the podiatrist
shall
not supervise more than 2 physician's assistants by a method
other
than the podiatrist's actual physical presence at the
practice
site.
(2)
A podiatrist who is employed by or under contract or
subcontract
to or has privileges at a health facility licensed
under
article 17 may supervise more than 4 physician's assistants
at
the health facility or agency.
(3)
The department may promulgate rules for the appropriate
delegation
and utilization of a physician's assistant by a
podiatrist,
including, but not limited to, rules to prohibit or
otherwise
restrict the delegation of certain podiatric services or
require
higher levels of supervision if the board determines that
these
services require Except for a
medical care service within a
practice agreement, to the extent that a particular selected
medical care service requires extensive training, education, or
ability
or pose poses serious risks to the health or safety of
patients, the board may prohibit or otherwise restrict the
delegation of that medical care service or may require higher
levels of supervision. To the extent that a particular medical care
service requires extensive training, education, or ability or poses
serious risks to the health or safety of patients, the board may
prohibit or otherwise restrict that medical care service within a
practice agreement.
Sec.
18049. (1) In addition to the other requirements of this
section
and subject to subsection (5), a podiatrist who supervises
a
physician's assistant is responsible for all of the following:
(a)
Verification of the physician's assistant's credentials.
(b)
Evaluation of the physician's assistant's performance.
(c)
Monitoring the physician's assistant's practice and
provision
of podiatric services.
(2)
Subject to section 16215 or 18048, as applicable, a
podiatrist
who supervises a physician's assistant may only delegate
to
the physician's assistant the performance of podiatric services
for
a patient who is under the case management responsibility of
the
podiatrist, if the delegation is consistent with the
physician's
assistant's training. A podiatrist shall only supervise
a
physician's assistant in the performance of those duties included
within
his or her scope of practice.
(3)
A podiatrist who supervises a physician's assistant is
responsible
for the clinical supervision of each physician's
assistant
to whom the physician delegates the performance of
podiatric
services under subsection (2).
(4)
Subject to subsection (5), a podiatrist who supervises a
physician's
assistant shall keep on file in the physician's office
or
in the health facility or agency in which the podiatrist
supervises
the physician's assistant a permanent, written record
that
includes the podiatrist's name and license number and the name
and
license number of each physician's assistant supervised by the
podiatrist.
(1) (5)
A group of podiatrists practicing
other than as sole
practitioners may designate 1 or more podiatrists in the group to
fulfill
the requirements of subsections (1) and (4).enter into a
practice agreement under section 18047.
(2) Notwithstanding any law or rule to the contrary, a
podiatrist is not required to countersign orders written in a
patient's clinical record by a physician's assistant with whom the
podiatrist has a practice agreement. Notwithstanding any law or
rule to the contrary, a podiatrist is not required to sign an
official form that lists the podiatrist's signature as the required
signatory if that official form is signed by a physician's
assistant with whom the podiatrist has a practice agreement.
Sec. 18050. (1) In addition to its other powers and duties
under
this article, the board may prohibit a podiatrist from
supervising
1 or more physician's assistants or
a physician's
assistant from entering into a practice agreement for any of the
grounds
set forth in section 16221. or for failure to supervise a
physician's
assistant in accordance with this part and rules
promulgated
under this part.
(2) For purposes of section 18051, the board may promulgate
rules concerning the prescribing of drugs by a physician's
assistant. Subject to section 18051, the rules may define the drugs
or classes of drugs that a physician's assistant may not prescribe
and other procedures and protocols necessary to promote consistency
with federal and state drug control and enforcement laws.
Sec. 18051. (1) A physician's assistant may make calls or go
on rounds in private homes, public institutions, emergency
vehicles, ambulatory care clinics, hospitals, intermediate or
extended care facilities, health maintenance organizations, nursing
homes, or other health care facilities in accordance with a
practice agreement. Notwithstanding any law or rule to the
contrary, a physician's assistant may make calls or go on rounds as
provided in this subsection without restrictions on the time or
frequency of visits by a podiatrist or the physician's assistant.
(2) A physician's assistant who is a party to a practice
agreement may prescribe a drug in accordance with procedures and
protocols for the prescription established by rule of the
appropriate board. A physician's assistant may prescribe a drug,
including a controlled substance that is included in schedules 2 to
5 of part 72. If a physician's assistant prescribes a drug under
this subsection, the physician's assistant's name shall be used,
recorded, or otherwise indicated in connection with that
prescription. If a physician's assistant prescribes a drug under
this subsection that is included in schedules 2 to 5, the
physician's assistant's DEA registration number shall be used,
recorded, or otherwise indicated in connection with that
prescription.
(3) A physician's assistant may order, receive, and dispense
complimentary starter dose drugs, including controlled substances
that are included in schedules 2 to 5 of part 72. If a physician's
assistant orders, receives, or dispenses a complimentary starter
dose drug under this subsection, the physician's name shall be
used, recorded, or otherwise indicated in connection with that
order, receipt, or dispensing. If a physician's assistant orders,
receives, or dispenses a complimentary starter dose drug under this
subsection that is included in schedules 2 to 5, the physician's
assistant's DEA registration number shall be used, recorded, or
otherwise indicated in connection with that order, receipt, or
dispensing. As used in this subsection, "complimentary starter
dose" means that term as defined in section 17745. It is the intent
of the legislature in enacting this subsection to allow a
pharmaceutical manufacturer or wholesale distributor, as those
terms are defined in part 177, to distribute complimentary starter
dose drugs to a physician's assistant, as described in this
subsection, in compliance with section 503(d) of the federal food,
drug, and cosmetic act, 21 USC 353.
Sec. 20174. A health facility or agency may designate 1 or
more physicians to enter into a practice agreement under section
17047 or 17547.
Sec. 20201. (1) A health facility or agency that provides
services directly to patients or residents and is licensed under
this article shall adopt a policy describing the rights and
responsibilities of patients or residents admitted to the health
facility or agency. Except for a licensed health maintenance
organization ,
which shall comply with that
is subject to chapter
35 of the insurance code of 1956, 1956 PA 218, MCL 500.3501 to
500.3580,
the health facility or agency
shall post the policy shall
be
posted at a public place in the
health facility or agency and
shall
be provided provide the
policy to each member of the health
facility or agency staff. Patients or residents shall be treated in
accordance with the policy.
(2) The policy describing the rights and responsibilities of
patients or residents required under subsection (1) shall include,
as a minimum, all of the following:
(a) A patient or resident shall not be denied appropriate care
on the basis of race, religion, color, national origin, sex, age,
disability, marital status, sexual preference, or source of
payment.
(b) An individual who is or has been a patient or resident is
entitled to inspect, or receive for a reasonable fee, a copy of his
or her medical record upon request in accordance with the medical
records access act, 2004 PA 47, MCL 333.26261 to 333.26271. Except
as otherwise permitted or required under the health insurance
portability and accountability act of 1996, Public Law 104-191, or
regulations promulgated under that act, 45 CFR parts 160 and 164, a
third party shall not be given a copy of the patient's or
resident's medical record without prior authorization of the
patient or resident.
(c) A patient or resident is entitled to confidential
treatment of personal and medical records, and may refuse their
release to a person outside the health facility or agency except as
required because of a transfer to another health care facility, as
required by law or third party payment contract, or as permitted or
required under the health insurance portability and accountability
act of 1996, Public Law 104-191, or regulations promulgated under
that act, 45 CFR parts 160 and 164.
(d) A patient or resident is entitled to privacy, to the
extent feasible, in treatment and in caring for personal needs with
consideration, respect, and full recognition of his or her dignity
and individuality.
(e) A patient or resident is entitled to receive adequate and
appropriate care, and to receive, from the appropriate individual
within the health facility or agency, information about his or her
medical condition, proposed course of treatment, and prospects for
recovery, in terms that the patient or resident can understand,
unless medically contraindicated as documented in the medical
record
by the attending physician or a physician's assistant to
whom
the physician has delegated the performance of medical care
services.with whom the physician has a practice
agreement.
(f) A patient or resident is entitled to refuse treatment to
the extent provided by law and to be informed of the consequences
of that refusal. If a refusal of treatment prevents a health
facility or agency or its staff from providing appropriate care
according to ethical and professional standards, the relationship
with the patient or resident may be terminated upon reasonable
notice.
(g) A patient or resident is entitled to exercise his or her
rights as a patient or resident and as a citizen, and to this end
may present grievances or recommend changes in policies and
services on behalf of himself or herself or others to the health
facility or agency staff, to governmental officials, or to another
person of his or her choice within or outside the health facility
or agency, free from restraint, interference, coercion,
discrimination, or reprisal. A patient or resident is entitled to
information about the health facility's or agency's policies and
procedures for initiation, review, and resolution of patient or
resident complaints.
(h) A patient or resident is entitled to information
concerning an experimental procedure proposed as a part of his or
her care and has the right to refuse to participate in the
experimental procedure without jeopardizing his or her continuing
care.
(i) A patient or resident is entitled to receive and examine
an explanation of his or her bill regardless of the source of
payment and to receive, upon request, information relating to
financial assistance available through the health facility or
agency.
(j) A patient or resident is entitled to know who is
responsible
for and who is providing his or her direct care, is
entitled
to receive information concerning
his or her continuing
health needs and alternatives for meeting those needs, and to be
involved in his or her discharge planning, if appropriate.
(k) A patient or resident is entitled to associate and have
private communications and consultations with his or her physician
or
a physician's assistant to whom the physician has delegated the
performance
of medical care services, with
whom the physician has a
practice agreement, with his or her attorney, or with any other
person
individual of his or her choice and to send and receive
personal mail unopened on the same day it is received at the health
facility or agency, unless medically contraindicated as documented
in the medical record by the attending physician or a physician's
assistant
to whom the physician has delegated the performance of
medical
care services. with whom the
physician has a practice
agreement. A patient's or resident's civil and religious liberties,
including the right to independent personal decisions and the right
to knowledge of available choices, shall not be infringed and the
health facility or agency shall encourage and assist in the fullest
possible exercise of these rights. A patient or resident may meet
with, and participate in, the activities of social, religious, and
community groups at his or her discretion, unless medically
contraindicated as documented in the medical record by the
attending
physician or a physician's assistant to whom the
physician
has delegated the performance of medical care
services.with whom the physician has a practice
agreement.
(l) A patient or resident is entitled to be free from mental
and physical abuse and from physical and chemical restraints,
except those restraints authorized in writing by the attending
physician
or a physician's assistant to whom the physician has
delegated
the performance of medical care services with whom the
physician has a practice agreement for a specified and limited time
or as are necessitated by an emergency to protect the patient or
resident from injury to self or others, in which case the restraint
may only be applied by a qualified professional who shall set forth
in writing the circumstances requiring the use of restraints and
who shall promptly report the action to the attending physician or
physician's assistant. In case of a chemical restraint, a physician
shall be consulted within 24 hours after the commencement of the
chemical restraint.
(m) A patient or resident is entitled to be free from
performing services for the health facility or agency that are not
included for therapeutic purposes in the plan of care.
(n) A patient or resident is entitled to information about the
health facility or agency rules and regulations affecting patient
or resident care and conduct.
(o) A patient or resident is entitled to adequate and
appropriate pain and symptom management as a basic and essential
element of his or her medical treatment.
(3) The following additional requirements for the policy
described in subsection (2) apply to licensees under parts 213 and
217:
(a) The policy shall be provided to each nursing home patient
or home for the aged resident upon admission, and the staff of the
facility shall be trained and involved in the implementation of the
policy.
(b) Each nursing home patient may associate and communicate
privately with persons of his or her choice. Reasonable, regular
visiting hours, which shall be not less than 8 hours per day, and
which shall take into consideration the special circumstances of
each visitor, shall be established for patients to receive
visitors. A patient may be visited by the patient's attorney or by
representatives of the departments named in section 20156, during
other than established visiting hours. Reasonable privacy shall be
afforded for visitation of a patient who shares a room with another
patient. Each patient shall have reasonable access to a telephone.
A married nursing home patient or home for the aged resident is
entitled to meet privately with his or her spouse in a room that
assures privacy. If both spouses are residents in the same
facility, they are entitled to share a room unless medically
contraindicated and documented in the medical record by the
attending
physician or a physician's assistant to whom the
physician
has delegated the performance of medical care
services.with whom the physician has a practice
agreement.
(c) A nursing home patient or home for the aged resident is
entitled to retain and use personal clothing and possessions as
space permits, unless to do so would infringe upon the rights of
other patients or residents, or unless medically contraindicated as
documented in the medical record by the attending physician or a
physician's
assistant to whom the physician has delegated the
performance
of medical care services. with
whom the physician has a
practice agreement. Each nursing home patient or home for the aged
resident shall be provided with reasonable space. At the request of
a patient, a nursing home shall provide for the safekeeping of
personal
effects, funds, money, and other property of a patient in
accordance with section 21767, except that a nursing home is not
required to provide for the safekeeping of a property that would
impose an unreasonable burden on the nursing home.
(d) A nursing home patient or home for the aged resident is
entitled to the opportunity to participate in the planning of his
or her medical treatment. The attending physician or a physician's
assistant
to whom the physician has delegated the performance of
medical
care services with whom the
physician has a practice
agreement shall fully inform the nursing home patient of the
patient's medical condition unless medically contraindicated as
documented in the medical record by a physician or a physician's
assistant
to whom the physician has delegated the performance of
medical
care services. with whom the
physician has a practice
agreement. Each nursing home patient shall be afforded the
opportunity to discharge himself or herself from the nursing home.
(e) A home for the aged resident may be transferred or
discharged only for medical reasons, for his or her welfare or that
of other residents, or for nonpayment of his or her stay, except as
provided by title XVIII or title XIX. A nursing home patient may be
transferred or discharged only as provided in sections 21773 to
21777. A nursing home patient or home for the aged resident is
entitled to be given reasonable advance notice to ensure orderly
transfer or discharge. Those actions shall be documented in the
medical record.
(f) A nursing home patient or home for the aged resident is
entitled to be fully informed before or at the time of admission
and during stay of services available in the facility, and of the
related charges including any charges for services not covered
under title XVIII, or not covered by the facility's basic per diem
rate. The statement of services provided by the facility shall be
in writing and shall include those required to be offered on an as-
needed basis.
(g) A nursing home patient or home for the aged resident is
entitled to manage his or her own financial affairs, or to have at
least a quarterly accounting of personal financial transactions
undertaken in his or her behalf by the facility during a period of
time the patient or resident has delegated those responsibilities
to the facility. In addition, a patient or resident is entitled to
receive each month from the facility an itemized statement setting
forth the services paid for by or on behalf of the patient and the
services rendered by the facility. The admission of a patient to a
nursing home does not confer on the nursing home or its owner,
administrator, employees, or representatives the authority to
manage, use, or dispose of a patient's property.
(h) A nursing home patient or a person authorized by the
patient in writing may inspect and copy the patient's personal and
medical records. The records shall be made available for inspection
and copying by the nursing home within a reasonable time, not
exceeding 1 week, after the receipt of a written request.
(i) If a nursing home patient desires treatment by a licensed
member of the healing arts, the treatment shall be made available
unless it is medically contraindicated, and the medical
contraindication is justified in the patient's medical record by
the
attending physician or a physician's assistant to whom the
physician
has delegated the performance of medical care
services.with whom the physician has a practice
agreement.
(j) A nursing home patient has the right to have his or her
parents, if a minor, or his or her spouse, next of kin, or
patient's representative, if an adult, stay at the facility 24
hours a day if the patient is considered terminally ill by the
physician responsible for the patient's care or a physician's
assistant
to whom the physician has delegated the performance of
medical
care services.with whom the
physician has a practice
agreement.
(k) Each nursing home patient shall be provided with meals
that meet the recommended dietary allowances for that patient's age
and sex and that may be modified according to special dietary needs
or ability to chew.
(l) Each nursing home patient has the right to receive
representatives of approved organizations as provided in section
21763.
(4) A nursing home, its owner, administrator, employee, or
representative shall not discharge, harass, or retaliate or
discriminate against a patient because the patient has exercised a
right protected under this section.
(5) In the case of a nursing home patient, the rights
enumerated in subsection (2)(c), (g), and (k) and subsection
(3)(d), (g), and (h) may be exercised by the patient's
representative.
(6) A nursing home patient or home for the aged resident is
entitled to be fully informed, as evidenced by the patient's or
resident's written acknowledgment, before or at the time of
admission and during stay, of the policy required by this section.
The policy shall provide that if a patient or resident is
adjudicated incompetent and not restored to legal capacity, the
rights and responsibilities set forth in this section shall be
exercised by a person designated by the patient or resident. The
health facility or agency shall provide proper forms for the
patient or resident to provide for the designation of this person
at the time of admission.
(7) This section does not prohibit a health facility or agency
from establishing and recognizing additional patients' rights.
(8) As used in this section:
(a) "Patient's representative" means that term as defined in
section 21703.
(b) "Practice agreement" means an agreement described in
section 17047, 17547, or 18047.
(c)
(b) "Title XVIII" means title XVIII of the
social security
act,
42 USC 1395 to 1395kkk-1.1395lll.
(d) (c)
"Title XIX" means title
XIX of the social security
act, 42 USC 1396 to 1396w-5.
Enacting section 1. Section 17066 of the public health code,
1978 PA 368, MCL 333.17066, is repealed.
Enacting section 2. This amendatory act takes effect 90 days
after the date it is enacted into law.