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SENATE BILL No. 550

September 12, 2017, Introduced by Senators KOWALL, WARREN and SHIRKEY and referred to the Committee on Michigan Competitiveness.

A bill to amend 1978 PA 368, entitled

"Public health code,"

by amending sections 17210 and 17708 (MCL 333.17210 and 333.17708),

section 17210 as amended by 2017 PA 22 and section 17708 as amended

by 2016 PA 499.

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

Sec. 17210. (1) The Michigan board of nursing may grant a

specialty certification to a registered professional nurse who has

advanced training beyond that required for initial licensure, who

has demonstrated competency through examination or other evaluative

processes, and who practices in 1 of the following health

profession specialty fields:

(a) Nurse midwifery.

(b) Nurse anesthetist.

(d) Subject to subsection (2), clinical nurse specialist.

(2) The Michigan board of nursing shall promulgate rules

establishing the qualifications for the training and competency of

the health profession specialty field of clinical nurse specialist.

The Michigan board of nursing shall not grant a specialty

certification as a clinical nurse specialist under subsection (1)

until after the effective date of the rules promulgated under this

subsection.

(3) All of the following apply to a registered professional

nurse who holds a specialty certification as a nurse anesthetist:

(a) In addition to performing duties within the scope of the

practice of nursing, his or her scope of practice includes any of

the following anesthesia and analgesia services:

(i) Development of a plan of care.

(ii) Performance of all patient assessments, procedures, and

monitoring to implement the plan of care or to address patient

emergencies that arise during implementation of the plan of care.

(iii) Selection, ordering, or prescribing and the

administration of anesthesia and analgesic agents, including

pharmacological agents that are prescription drugs as defined in

section 17708 or controlled substances. For purposes of this

subparagraph, the authority of a registered professional nurse who

holds a specialty certification as a nurse anesthetist to prescribe

pharmacological agents is limited to pharmacological agents for

administration to patients as described in subdivision (b), (c), or

(d), and his or her authority does not include any activity that

would permit a patient to obtain or receive pharmacological agents,

including prescription drugs or controlled substances, outside of

the facility in which the anesthetic or analgesic services are

performed.

(b) He or she may provide the anesthesia and analgesia

services described in subdivision (a) without supervision and as

the sole and independent anesthesia provider while he or she is

collaboratively participating in a patient-centered care team. As

used in this subdivision:

(i) "Health care professional" means an individual who is

licensed or registered to perform a health profession under this

article.

(ii) "Patient-centered care team" means a group of health care

professionals, including, but not limited to, a physician or

podiatrist, who directly or indirectly care for a patient by each

contributing his or her specialized knowledge, skill, and

experience to the care of the patient.

anesthesia and analgesia services described in subdivision (a) in

any of the following:

(i) A hospital inpatient or outpatient facility.

(ii) A freestanding surgical outpatient facility.

(iii) An office of an allopathic physician, an osteopathic

physician and surgeon, or a podiatrist.

(iv) Any other office or facility in which diagnostic imaging,

endoscopy, or cystoscopy services are provided to a patient.

(d) The anesthesia and analgesia services described in

subdivision (a) may be performed for operative, obstetrical,

interventional, or diagnostic purposes, but only during 1 or more

of the following:

(i) The preoperative, intraoperative, and postoperative

period.

(ii) The obstetrical service period.

(iii) The pre-, intra-, and post-interventional service

period.

(iv) The pre-, intra-, and post-diagnostic service period.

(e) The anesthesia and analgesia services described in

subdivision (a) do not include chronic pain management services.

However, he or she may perform chronic pain management services

under delegation pursuant to section 16215.

(f) He or she may provide the anesthesia and analgesia

services described in subdivision (a) in a mobile or freestanding

imaging facility only under delegation pursuant to section 16215,

unless the mobile or freestanding imaging facility is located

adjacent to or on the same property as a facility or office

described in subdivision (c).

(4) A health care facility may adopt policies relating to the

provision of anesthesia and analgesia services. As used in this

subsection, "health care facility" means a facility or office

described in subsection (3)(c).

(5) Subsection (3) does not require new or additional third

party reimbursement or mandated worker's compensation benefits for

anesthesia and analgesia services provided under that subsection by

a registered professional nurse who holds a specialty certification

as a nurse anesthetist 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 any of the following:

(a) A licensed dentist. , a

(b) A licensed doctor of medicine. , a

(d) A licensed doctor of podiatric medicine and surgery. , a

(e) A licensed physician's assistant. , a

(f) A licensed optometrist certified under part 174 to

administer and prescribe therapeutic pharmaceutical agents. , an

(g) An advanced practice registered nurse as that term is

defined in section 17201 who meets the requirements of section

17211a. , a

(h) A licensed veterinarian. , or another

(i) A registered professional nurse who holds a specialty

certification as a nurse anesthetist under section 17210 when he or

she is engaging in the practice of nursing and providing the

anesthesia and analgesia services described in section 17210(3).

For purposes of this subdivision, the authority of a registered

professional nurse who holds a specialty certification as a nurse

anesthetist under section 17210 to prescribe pharmacological agents

is limited to pharmacological agents for administration to patients

as described in section 17210(3)(b), (c), or (d).

(j) Any other 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 is considered

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 is considered for the purposes of

this definition the original prescription. For purposes of this

part, prescription also includes a standing order issued under

section 17744e. Subject to section 17751(2) and (5), prescription

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

a controlled substance 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 who is 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".

only be dispensed pursuant to a prescription.

(5) Subsection (2)(i) does not require new or additional third

party reimbursement or mandated worker's compensation benefits for

anesthesia and analgesia services provided under section 17210(3)

by a registered professional nurse who holds a specialty

certification as a nurse anesthetist under section 17210.

Enacting section 1. This amendatory act takes effect 90 days

after the date it is enacted into law.