HOUSE BILL No. 6407

 

 

September 27, 2018, Introduced by Rep. Kesto and referred to the Committee on Health Policy.

 

     A bill to amend 1978 PA 368, entitled

 

"Public health code,"

 

by amending sections 16215, 17201, and 17745a (MCL 333.16215,

 

333.17201, and 333.17745a), section 16215 as amended by 2005 PA

 

211, section 17201 as amended by 2016 PA 499, and section 17745a as

 

amended by 2016 PA 379.

 

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 

     Sec. 16215. (1) Subject to subsections (2) to (6), a licensee

 

who holds a license other than a health profession subfield license

 

may delegate to a licensed or unlicensed individual who is

 

otherwise qualified by education, training, or experience the

 

performance of selected acts, tasks, or functions where the acts,

 

tasks, or functions fall within the scope of practice of the

 

licensee's profession and, except as otherwise provided in section

 

17745a, will be performed under the licensee's supervision. A

 

licensee shall not delegate an act, task, or function under this

 

section if the act, task, or function, under standards of

 

acceptable and prevailing practice, requires the level of

 

education, skill, and judgment required of the licensee under this

 

article.

 

     (2) Subject to subsection (1) and except as otherwise provided

 

in this subsection and subsections (3) and (4), a licensee who is

 

an allopathic physician or osteopathic physician and surgeon shall

 

delegate an act, task, or function that involves the performance of

 

a procedure that requires the use of surgical instrumentation only

 

to an individual who is licensed under this article. A licensee who

 

is an allopathic physician or osteopathic physician and surgeon may

 

delegate an act, task, or function described in this subsection to

 

an individual who is not licensed under this article if the

 

unlicensed individual is 1 or more of the following and if the

 

procedure is directly supervised by a licensed allopathic physician

 

or osteopathic physician and surgeon who is physically present

 

during the performance of the procedure:

 

     (a) A student enrolled in a school of medicine or osteopathic

 

medicine approved by the Michigan board of medicine or the Michigan

 

board of osteopathic medicine and surgery.

 

     (b) A student enrolled in a physician's assistant training

 

program approved by the joint physician's assistant task force

 

created under part 170.

 

     (3) Subject to subsection (1), a licensee who is an allopathic

physician or osteopathic physician and surgeon may delegate an act,

 

task, or function described in subsection (2) to an individual who

 

is not licensed under this article and who is 1 of the following:

 

     (a) Performing acupuncture.

 

     (b) Surgically removing only bone, skin, blood vessels,

 

cartilage, dura mater, ligaments, tendons, pericardial tissue, or

 

heart valves only from a deceased individual for transplantation,

 

implantation, infusion, injection, or other medical or scientific

 

purpose.

 

     (4) Subject to subsection (1), a licensee who is an allopathic

 

physician or osteopathic physician and surgeon may delegate an act,

 

task, or function described in subsection (2) to an individual who

 

is not licensed under this article if the procedure is directly

 

supervised by a licensed allopathic physician or osteopathic

 

physician and surgeon who is physically present during the

 

performance of the procedure, the delegation of such procedure is

 

not prohibited or otherwise restricted by the board or that health

 

facility or agency, and the delegation of that act, task, or

 

function is specifically authorized by that health facility or

 

agency to be delegated and performed by either of the following

 

unlicensed individuals:

 

     (a) A surgical technologist who meets the qualifications

 

established by the health facility or agency with which he or she

 

is employed or under contract with.

 

     (b) A surgical first assistant who meets the qualifications

 

established by the health facility or agency with which he or she

 

is employed or under contract with.

     (5) A board may promulgate rules to further prohibit or

 

otherwise restrict delegation of specific acts, tasks, or functions

 

to a licensed or unlicensed individual if the board determines that

 

the delegation constitutes or may constitute a danger to the

 

health, safety, or welfare of the patient or public.

 

     (6) To promote safe and competent practice, a board may

 

promulgate rules to specify conditions under which, and categories

 

and types of licensed and unlicensed individuals for whom, closer

 

supervision may be required for acts, tasks, and functions

 

delegated under this section.

 

     (7) An individual who performs acts, tasks, or functions

 

delegated pursuant to this section does not violate the part that

 

regulates the scope of practice of that health profession.

 

     (8) The amendatory act that added this subsection does not

 

require new or additional third party reimbursement or mandated

 

worker's compensation benefits for services rendered by an

 

individual authorized to perform those services under subsection

 

(4).

 

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

 

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

 

registered professional nurse who has been granted a specialty

 

certification under section 17210 in 1 of the following health

 

profession specialty fields:

 

     (i) Nurse midwifery.

 

     (ii) Nurse practitioner.

 

     (iii) Clinical nurse specialist.

 

     (b) "Physician" means a physician who is licensed under part

170 or part 175.

 

     (c) "Practice of nursing" means the systematic application of

 

substantial specialized knowledge and skill, derived from the

 

biological, physical, and behavioral sciences, to the care,

 

treatment, counsel, and health teaching of individuals who are

 

experiencing changes in the normal health processes or who require

 

assistance in the maintenance of health and the prevention or

 

management of illness, injury, or disability.

 

     (d) "Practice of nursing as a licensed practical nurse" or

 

"l.p.n." means the practice of nursing based on less comprehensive

 

knowledge and skill than that required of a registered professional

 

nurse and that is performed under the supervision of a registered

 

professional nurse, physician, or dentist or is specifically

 

authorized to be performed under this article without supervision.

 

     (e) "Registered professional nurse" or "r.n." means an

 

individual who is licensed under this part to engage in the

 

practice of nursing which scope of practice includes the teaching,

 

direction, and supervision of less skilled personnel in the

 

performance of delegated nursing activities.

 

     (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. 17745a. (1) As used in this section:

 

     (a) "Medicaid" means the program of medical assistance

 

established under title XIX of the social security act, 42 USC 1396

 

to 1396w-5.

     (b) "Medicare" means the federal Medicare program established

 

under title XVIII of the social security act, 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 42 USC 254b. and 254c.

 

     (iii) A family planning program designated by the 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 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 42 USC 1395x that is certified to participate in

 

Medicaid and 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 a registered professional nurse licensed under part

 

172.

 

     (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 a registered professional

 

nurse or a licensed practical nurse licensed under part 172. If the

 

delivery is delegated to a licensed practical nurse under this

 

subdivision, the delivery may be performed by the licensed

 

practical nurse without supervision.

 

     (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.

 

     Enacting section 1. This amendatory act takes effect 90 days

 

after the date it is enacted into law.