Legislative Analysis
Phone: (517) 373-8080
MEDICATION AIDE REGISTRATION AND PERMITS
http://www.house.mi.gov/hfa
House Bill 4885 as enacted Analysis available at
Public Act 273 of 2023 http://www.legislature.mi.gov
Sponsor: Rep. Donavan McKinney
House Bill 4923 as enacted
Public Act 274 of 2023
Sponsor: Rep. Joseph A. Aragona
1st House Committee: Health Policy
2nd House Committee: Regulatory Reform
Senate Committee: Health Policy
Complete to 1-10-24
SUMMARY:
House Bills 4885 and 4923 amend the Public Health Code to allow for the training and
registration of medication aides, with conditions running parallel to those adopted in 2017 that
govern the training and registration of nurse aides (often referred to as certified nurse aides, or
CNAs). 1 A medication aide is a nurse aide who is additionally registered to practice as a
medication aide. House Bill 4885 addresses substantive provisions, and House Bill 4923 adds
or amends definitions for terms used in those provisions. The bills take effect March 7, 2024.
Medication aides (also called medication technicians or medication assistive persons, among
other titles) are recognized in several other states and constitute another tier of care between
nurse aides and nurses. A 2015 list by the American Nurses Association reports 36 states
allowing medication aides, while a more recent media report puts the number at 38. 2
The bills require the Department of Licensing and Regulatory Affairs (LARA) to administer a
medication aide training and registration program in Michigan under Part 219 (Nurse Aide
Training and Registration Program).
Medication aide means a nurse aide who holds a registration to engage in practice as
a medication aide. A health professional licensed under the code, a registered dietitian,
or someone who volunteers to provide nursing or nursing-related services without pay
is not considered a medication aide.
Practice as a medication aide means administering regularly scheduled medications
to residents of a nursing home or skilled nursing facility while under the supervision
of a registered professional nurse or licensed practical nurse. Practice as a medication
1
House Fiscal Agency analysis of 2017 PA 172: http://www.legislature.mi.gov/documents/2017-
2018/billanalysis/House/pdf/2017-HLA-0286-34DD3392.pdf
Also see https://www.michigan.gov/lara/bureau-list/bchs/nurse-aide-registry
2
https://www.nursingworld.org/~4af4e6/globalassets/docs/ana/ethics/state-chart-medication-aide-status-09-15.pdf
https://skillednursingnews.com/2023/04/creative-staffing-nursing-homes-push-to-allow-cnas-to-administer-
medication-citing-labor-benefits-savings/
House Fiscal Agency Page 1 of 4
 aide is not the practice of nursing as defined in the code and does not include the
administration of controlled substances or injectable medications, the initial
administration of medications, or the administration of as-needed medications
including medications administered as the need arises.
Nurse aide means an individual who holds a registration to engage in practice as a
nurse aide (providing nursing or nursing-related services to a patient or resident) under
Part 219. A health professional licensed under Article 15, a registered dietitian, or
someone who volunteers to provide nursing or nursing-related services without pay is
not considered a nurse aide, and practice as a nurse aide is not the practice of nursing
as defined in the code.
Registration and permits
Under the bills, LARA can grant registration as a medication aide, a permit for a medication
aide trainer, or a permit for a medication aide training program to an applicant who submits
an application according to LARA’s requirements and pays the fee described below. The
following also apply:
• A medication aide applicant must demonstrate to LARA that they hold a current nurse
aide registration, have worked as a nurse aide in a nursing home or skilled nursing
facility for at least 2,000 hours during the two-year period immediately preceding
application, and have successfully completed a medication aide training program and
a LARA-approved competency examination. The applicant also must meet the
requirements in rules to be promulgated under the bills.
• A medication aide trainer applicant must be a registered professional nurse licensed
under the code and meet requirements in the new rules.
• A medication aide training program applicant must meet requirements in the new
rules and demonstrate that the program’s curriculum is consistent with other
medication aide training programs as provided by rules. A medication aide training
program must incorporate the Medication Assistant-Certified (MA-C) Model
Curriculum adopted by the National Council of State Boards of Nursing (NCSBN). 3
Medication aide trainer means an individual who holds a permit to provide training to
a medication aide candidate enrolled in a medication aide training program.
Medication aide training program means an instructional program offered by a person
with a permit that prepares a nurse aide to engage in practice as a medication aide and
is provided at a qualified educational institution.
A person cannot engage in the above activities without obtaining a registration or permit to do
so. A registration or permit cannot be transferred. A registration or permit is effective for up to
two years after the date it is granted.
Registration for an applicant from another state
LARA can grant medication aide registration to an applicant from another state who
demonstrates that they have successfully completed a training program from Indiana, Ohio, or
Wisconsin and passes a competency examination approved by LARA.
3
MA-C model curriculum, adopted by NCSBN in 2007: https://www.ncsbn.org/07_Final_MAC.pdf
House Fiscal Agency HBs 4885 and 4923 as enacted Page 2 of 4
 Renewal of registration and permits
A registration or permit can be renewed if the applicant pays the required fees, submits an
application, and demonstrates that they have met the requirements for renewal according to the
new rules (including any continuing education requirements).
Medication aide fees
The bills provide for the following fees to be assessed biennially, both upon initial application
and subsequent renewals:
Type of Fee Fee Amount
Medication aide $160
Medication aide trainer $200
Medication aide training program $500 per site
In addition, an applicant for registration must pay a medication aide competency examination
fee of $175 per examination. All fees are payable to LARA or LARA’s contractor at the time
of application or renewal. Fees will not be refunded for an application that is denied or a permit
or registration that is revoked before expiration.
Nurse Aide and Medication Aide Registration Fund
The bills rename the current Nurse Aide Registration Fund in the state treasury as the Nurse
Aide and Medication Aide Registration Fund, and the above fees will be credited to the fund.
LARA can expend money from the fund, upon appropriation, only to implement the
registration and training programs for nurse aides and medication aides.
Rules
The bills provide that, in addition to the rule-making authority already provided in Part 219 for
nurse aides, LARA can establish the following requirements that also or exclusively relate to
medication aides, medication aide trainers, and medication aide training programs:
• Requirements for enforcing Part 219.
• Eligibility, competency, and examination requirements for registration.
• Requirements for registration renewal.
• Requirements for surveying a medication aide training program.
• Requirements for investigating allegations against, and taking action against, a
medication aide in a nursing home or skilled nursing facility where a medication aide
engages in the practice of a medication aide.
• Requirements for investigating allegations against, and taking action against, a
medication aide trainer or medication aide training program.
Nurse aide fees
Finally, the bills increase the biennial fees for registration or renewal to practice as a nurse aide
from $20 to $40, and for a permit or its renewal to conduct training or instruction of a nurse
aide candidate from $40 to $60. The bill also raise the nurse aid competency examination fee
from $125 to $175 per examination.
HB 4885: MCL 333.21907 et seq.
HB 4923: MCL 333.21903 and 333.21905
House Fiscal Agency HBs 4885 and 4923 as enacted Page 3 of 4
BRIEF DISCUSSION:
According to committee testimony, the bills are meant to address the staffing shortages being
faced by nursing home facilities. Supporters argued that creating a career ladder for CNAs will
encourage them to stay in the field and also help to attract new workers. They also argued that
creating a position dedicated to delivering medication will free up time for nurses in the
facilities and help to reduce errors.
The bills together are substantively identical to House Bill 4316 (S-2) of the 2020-21 legislative
session, except that HB 4316 provided for the medication aide training and permit provisions
to end after December 31, 2026.
FISCAL IMPACT:
House Bills 4885 and 4923 will have an indeterminate net fiscal impact on LARA. Under the
bills, LARA will be required to administer a medication aide training and permit program,
which will largely mirror the existing regulatory structure for nurse aides. House Bill 4885 will
provide for the regulation of medication aides, medication aide trainers, and medication aide
training programs. The bill establishes biennial fees for registrations and permits in each of
these categories of $160, $200, and $500, respectively. Medication aides will also be liable for
a $175 competency examination fee. Revenues from these fees—in addition to existing
revenues from nurse aide regulation—will be deposited into the Nurse Aide and Medication
Aide Registration Fund, which will be the amended name of the current Nurse Aide
Registration Fund. The amount of revenue will depend on application volumes related to the
regulation of medication aides, which is currently indeterminate. LARA would have expanded
responsibilities related to licensing and investigations of, and enforcement actions against,
medication aides. The department projects that increased staffing will be necessary to fulfill
these responsibilities, although is unclear whether revenues under the bill will be sufficient to
offset the department’s increased regulatory costs.
House Bill 4885 also increases existing fees associated with nurse aide registrations and
permits. Given the current populations (as of October 2023) of nurse aides and nurse aide
trainers (45,829 and 537, respectively), the revised fee amounts would be expected to generate
an additional $925,000 during the two-year licensing cycle. The bill also revises the fee amount
associated with a nurse aide competency examination, increasing the fee from $125 to $175.
The revenue impact from this increase will depend on the number of competency examinations
administered.
Legislative Analyst: Alex Stegbauer
Fiscal Analyst: Marcus Coffin
■ This analysis was prepared by nonpartisan House Fiscal Agency staff for use by House members in their
deliberations and does not constitute an official statement of legislative intent.
House Fiscal Agency HBs 4885 and 4923 as enacted Page 4 of 4


Statutes affected:
House Introduced Bill: 333.21903, 333.21905
As Passed by the House: 333.21903, 333.21905
As Passed by the Senate: 333.21903, 333.21905
House Concurred Bill: 333.21903, 333.21905
Public Act: 333.21903, 333.21905
House Enrolled Bill: 333.21903, 333.21905