HOUSE BILL NO. 4472
April 25, 2023, Introduced by Reps. Farhat and Mueller and referred to the Committee on Health
Policy.
A bill to amend 1978 PA 368, entitled
"Public health code,"
by amending sections 16221, 17001, 17047, 17049, 17201, 17211a,
17214, 17501, 17547, 17549, 18001, 18047, 18049, 20174, and 20201
(MCL 333.16221, 333.17001, 333.17047, 333.17049, 333.17201,
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333.17211a, 333.17214, 333.17501, 333.17547, 333.17549, 333.18001,
333.18047, 333.18049, 333.20174, and 333.20201), section 16221 as
amended by 2020 PA 232, section 17001 as amended by 2018 PA 624,
sections 17047, 17547, 18047, and 20174 as added and sections
17049, 17549, and 18049 as amended by 2016 PA 379, sections 17201
and 20201 as amended and sections 17211a and 17214 as added by 2016
PA 499, section 17501 as amended by 2018 PA 524, and section 18001
as amended by 2018 PA 355, and by adding sections 17217 and 17217a.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
1 Sec. 16221. Subject to section 16221b, the department shall
2 investigate any allegation that 1 or more of the grounds for
3 disciplinary subcommittee action under this section exist, and may
4 investigate activities related to the practice of a health
5 profession by a licensee, a registrant, or an applicant for
6 licensure or registration. The department may hold hearings,
7 administer oaths, and order the taking of relevant testimony. After
8 its investigation, the department shall provide a copy of the
9 administrative complaint to the appropriate disciplinary
10 subcommittee. The disciplinary subcommittee shall proceed under
11 section 16226 if it finds that 1 or more of the following grounds
12 exist:
13 (a) Except as otherwise specifically provided in this section,
14 a violation of general duty, consisting of negligence or failure to
15 exercise due care, including negligent delegation to or supervision
16 of employees or other individuals, whether or not injury results,
17 or any conduct, practice, or condition that impairs, or may impair,
18 the ability to safely and skillfully engage in the practice of the
19 health profession.
20 (b) Personal disqualifications, consisting of 1 or more of the
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1 following:
2 (i) Incompetence.
3 (ii) Subject to sections 16165 to 16170a, substance use
4 disorder as defined in section 100d of the mental health code, 1974
5 PA 258, MCL 330.1100d.
6 (iii) Mental or physical inability reasonably related to and
7 adversely affecting the licensee's or registrant's ability to
8 practice in a safe and competent manner.
9 (iv) Declaration of mental incompetence by a court of competent
10 jurisdiction.
11 (v) Conviction of a misdemeanor punishable by imprisonment for
12 a maximum term of 2 years; conviction of a misdemeanor involving
13 the illegal delivery, possession, or use of a controlled substance;
14 or conviction of any felony other than a felony listed or described
15 in another subparagraph of this subdivision. A certified copy of
16 the court record is conclusive evidence of the conviction.
17 (vi) Lack of good moral character.
18 (vii) Conviction of a criminal offense under section 520e or
19 520g of the Michigan penal code, 1931 PA 328, MCL 750.520e and
20 750.520g. A certified copy of the court record is conclusive
21 evidence of the conviction.
22 (viii) Conviction of a violation of section 492a of the Michigan
23 penal code, 1931 PA 328, MCL 750.492a. A certified copy of the
24 court record is conclusive evidence of the conviction.
25 (ix) Conviction of a misdemeanor or felony involving fraud in
26 obtaining or attempting to obtain fees related to the practice of a
27 health profession. A certified copy of the court record is
28 conclusive evidence of the conviction.
29 (x) Final adverse administrative action by a licensure,
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1 registration, disciplinary, or certification board involving the
2 holder of, or an applicant for, a license or registration regulated
3 by another state or a territory of the United States, by the United
4 States military, by the federal government, or by another country.
5 A certified copy of the record of the board is conclusive evidence
6 of the final action.
7 (xi) Conviction of a misdemeanor that is reasonably related to
8 or that adversely affects the licensee's or registrant's ability to
9 practice in a safe and competent manner. A certified copy of the
10 court record is conclusive evidence of the conviction.
11 (xii) Conviction of a violation of section 430 of the Michigan
12 penal code, 1931 PA 328, MCL 750.430. A certified copy of the court
13 record is conclusive evidence of the conviction.
14 (xiii) Conviction of a criminal offense under section 83, 84,
15 316, 317, 321, 520b, 520c, 520d, or 520f of the Michigan penal
16 code, 1931 PA 328, MCL 750.83, 750.84, 750.316, 750.317, 750.321,
17 750.520b, 750.520c, 750.520d, and 750.520f. A certified copy of the
18 court record is conclusive evidence of the conviction.
19 (xiv) Conviction of a violation of section 136 or 136a of the
20 Michigan penal code, 1931 PA 328, MCL 750.136 and 750.136a. A
21 certified copy of the court record is conclusive evidence of the
22 conviction.
23 (c) Prohibited acts, consisting of 1 or more of the following:
24 (i) Fraud or deceit in obtaining or renewing a license or
25 registration.
26 (ii) Permitting a license or registration to be used by an
27 unauthorized person.
28 (iii) Practice outside the scope of a license.
29 (iv) Obtaining, possessing, or attempting to obtain or possess
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1 a controlled substance or a drug as defined in section 7105 without
2 lawful authority; or selling, prescribing, giving away, or
3 administering drugs for other than lawful diagnostic or therapeutic
4 purposes.
5 (d) Except as otherwise specifically provided in this section,
6 unethical business practices, consisting of 1 or more of the
7 following:
8 (i) False or misleading advertising.
9 (ii) Dividing fees for referral of patients or accepting
10 kickbacks on medical or surgical services, appliances, or
11 medications purchased by or in behalf of patients.
12 (iii) Fraud or deceit in obtaining or attempting to obtain third
13 party reimbursement.
14 (e) Except as otherwise specifically provided in this section,
15 unprofessional conduct, consisting of 1 or more of the following:
16 (i) Misrepresentation to a consumer or patient or in obtaining
17 or attempting to obtain third party reimbursement in the course of
18 professional practice.
19 (ii) Betrayal of a professional confidence.
20 (iii) Promotion for personal gain of an unnecessary drug,
21 device, treatment, procedure, or service.
22 (iv) Either of the following:
23 (A) A requirement by a licensee other than a physician or a
24 registrant that an individual purchase or secure a drug, device,
25 treatment, procedure, or service from another person, place,
26 facility, or business in which the licensee or registrant has a
27 financial interest.
28 (B) A referral by a physician for a designated health service
29 that violates 42 USC 1395nn or a regulation promulgated under that
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1 section. For purposes of this subdivision, 42 USC 1395nn and the
2 regulations promulgated under that section as they exist on June 3,
3 2002 are incorporated by reference. A disciplinary subcommittee
4 shall apply 42 USC 1395nn and the regulations promulgated under
5 that section regardless of the source of payment for the designated
6 health service referred and rendered. If 42 USC 1395nn or a
7 regulation promulgated under that section is revised after June 3,
8 2002, the department shall officially take notice of the revision.
9 Within 30 days after taking notice of the revision, the department
10 shall decide whether or not the revision pertains to referral by
11 physicians for designated health services and continues to protect
12 the public from inappropriate referrals by physicians. If the
13 department decides that the revision does both of those things, the
14 department may promulgate rules to incorporate the revision by
15 reference. If the department does promulgate rules to incorporate
16 the revision by reference, the department shall not make any
17 changes to the revision. As used in this sub-subparagraph,
18 "designated health service" means that term as defined in 42 USC
19 1395nn and the regulations promulgated under that section and
20 "physician" means that term as defined in sections 17001 and 17501.
21 (v) For a physician who makes referrals under 42 USC 1395nn or
22 a regulation promulgated under that section, refusing to accept a
23 reasonable proportion of patients eligible for Medicaid and
24 refusing to accept payment from Medicaid or Medicare as payment in
25 full for a treatment, procedure, or service for which the physician
26 refers the individual and in which the physician has a financial
27 interest. A physician who owns all or part of a facility in which
28 he or she provides surgical services is not subject to this
29 subparagraph if a referred surgical procedure he or she performs in
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1 the facility is not reimbursed at a minimum of the appropriate
2 Medicaid or Medicare outpatient fee schedule, including the
3 combined technical and professional components.
4 (vi) Any conduct by a health professional with a patient while
5 he or she is acting within the health profession for which he or
6 she is licensed or registered, including conduct initiated by a
7 patient or to which the patient consents, that is sexual or may
8 reasonably be interpreted as sexual, including, but not limited to,
9 sexual intercourse, kissing in a sexual manner, or touching of a
10 body part for any purpose other than appropriate examination,
11 treatment, or comfort.
12 (vii) Offering to provide practice-related services, such as
13 drugs, in exchange for sexual favors.
14 (viii) A violation of section 16655(4) by a dental therapist.
15 (f) Failure to notify under section 16222(3) or (4).
16 (g) Failure to report a change of name or mailing address as
17 required in section 16192.
18 (h) A violation, or aiding or abetting in a violation, of this
19 article or of a rule promulgated under this article.
20 (i) Failure to comply with a subpoena issued pursuant to this
21 part, failure to respond to a complaint issued under this article,
22 article 7, or article 8, failure to appear at a compliance
23 conference or an administrative hearing, or failure to report under
24 section 16222(1) or 16223.
25 (j) Failure to pay an installment of an assessment levied
26 under the insurance code of 1956, 1956 PA 218, MCL 500.100 to
27 500.8302, within 60 days after notice by the appropriate board.
28 (k) A violation of section 17013 or 17513.
29 (l) Failure to meet 1 or more of the requirements for licensure
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1 or registration under section 16174.
2 (m) A violation of section 17015, 17015a, 17017, 17515, or
3 17517.
4 (n) A violation of section 17016 or 17516.
5 (o) Failure to comply with section 9206(3).
6 (p) A violation of section 5654 or 5655.
7 (q) A violation of section 16274.
8 (r) A violation of section 17020 or 17520.
9 (s) A violation of the medical records access act, 2004 PA 47,
10 MCL 333.26261 to 333.26271.
11 (t) A violation of section 17764(2).
12 (u) Failure to comply with the terms of a practice agreement
13 described in section 17047(2)(a) or (b), 17047(3)(a)(i) or (ii),
14 17217(2)(a)(i) or (ii), 17547(2)(a) or (b), or 17547(3)(a)(i) or (ii),
15 18047(2)(a) or (b), or 18047(3)(a)(i) or (ii).
16 (v) A violation of section 7303a(2).
17 (w) A violation of section 7303a(4) or (5).
18 (x) A violation of section 7303b.
19 (y) A violation of section 17754a.
20 (z) Beginning January 1, 2021, a A violation of section 24507
21 or 24509.
22 Sec. 17001. (1) As used in this part:
23 (a) "Academic institution" means either of the following:
24 (i) A medical school approved by the board.
25 (ii) A hospital licensed under article 17 that meets all of the
26 following requirements:
27 (A) Was the sole sponsor or a co-sponsor, if each other co-
28 sponsor is either a medical school approved by the board or a
29 hospital owned by the federal government and directly operated by
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1 the United States Department of Veterans Affairs, of not less than
2 4 postgraduate education residency programs approved by the board
3 under section 17031(1) for not less than the 3 years immediately
4 preceding the date of an application for a limited license under
5 section 16182(2)(c) or an application for a full license under
6 section 17031(2), if at least 1 of the residency programs is in the
7 specialty area of medical practice, or in a specialty area that
8 includes the subspecialty of medical practice, in which the
9 applicant for a limited license proposes to practice or in which
10 the applicant for a full license has practiced for the hospital.
11 (B) Has spent not less than $2,000,000.00 for medical
12 education during each of the 3 years immediately preceding the date
13 of an application for a limited license under section 16182(2)(c)
14 or an application for a full license under section 17031(2). As
15 used in this sub-subparagraph, "medical education" means the
16 education of physicians and candidates for degrees or licenses to
17 become physicians, including, but not limited to, physician staff,
18 residents, interns, and medical students.
19 (b) "Electrodiagnostic studies" means the testing of
20 neuromuscular functions utilizing nerve conduction tests and needle
21 electromyography. It does not include the use of surface
22 electromyography.
23 (c) "Genetic counselor" means an individual who is licensed
24 under this part to engage in the practice of genetic counseling.
25 (d) "Medical care services" means those services within the
26 scope of practice of physicians who are licensed or authorized by
27 the board, except those services that the board prohibits or
28 otherwise restricts within a practice agreement or determines shall
29 not be delegated by a physician because a delegation would endanger
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1 the health and safety of patients as provided for in section
2 17048(1).
3 (e) "Participating physician" means a physician , a physician
4 designated by a group of physicians under described in section
5 17049. to represent that group, or a physician designated by a
6 health facility or agency under section 20174 to represent that
7 health facility or agency.
8 (f) "Physician" means an individual who is licensed or
9 authorized under this article to engage in the practice of
10 medicine.
11 (g) "Physician-led patient care team" means a
12 multidisciplinary team consisting of at least 1 physician and at
13 least 1 advanced practice registered nurse as that term is defined
14 in section 17201 or physician's assistant that is led by 1 or more
15 participating physicians and functions as a unit for the purposes
16 of providing and delivering services.
17 (h) (g) "Podiatrist" means an individual who is licensed under
18 this article to engage in the practice of podiatric medicine and
19 surgery.
20 (i) (h) "Practice agreement" means an agreement described in
21 section 17047.
22 (j) (i) "Practice of genetic counseling" means provision of
23 any of the following services:
24 (i) Obtaining and evaluating individual, family, and medical
25 histories to determine the genetic risk for genetic or medical
26 conditions or diseases in a client, the client's descendants, or
27 other family members of the client.
28 (ii) Discussing with a client the features, natural history,
29 means of diagnosis, genetic and environmental factors, and
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1 management of the genetic risks of genetic or medical conditions or
2 diseases.
3 (iii) Identifying and coordinating appropriate genetic
4 laboratory tests and other diagnostic studies for genetic
5 assessment of a client.
6 (iv) Integrating genetic laboratory test results and other
7 diagnostic studies with personal and family medical history to
8