Bill Summary – FastDemocracy

HOUSE BILL NO. 5295
 November 02, 2023, Introduced by Reps. Bezotte, Wozniak, BeGole and Bruck and referred to
   the Committee on Health Policy.
      A bill to amend 1978 PA 368, entitled
"Public health code,"
by amending sections 7303a, 16325, 16331, 17001, 17011, 17501, and
(MCL 333.7303a, 333.16325, 333.16331, 333.17001, 333.17011,
17501, and 333.17511), section 7303a as amended by 2019 PA 43,
sections 16325 and 16331 as added by 1993 PA 80, section 17001 as
amended by 2018 PA 624, sections 17011 and 17511 as amended by 2006
PA 398, and section 17501 as amended by 2018 PA 524, and by adding
sections 16325a, 17034, 17034a, 17034b, 17534, 17534a, and 17534b.
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                  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) Except as otherwise provided in rules promulgated under
  section 16204e and for a patient who is under the care of a
  hospice, beginning March 31, 2019 or, if rules are promulgated
  under section 16204e before March 31, 2019, on the date on which
  rules are promulgated under section 16204e, a licensed prescriber
 shall not prescribe a controlled substance listed in schedules 2 to
 5 unless the prescriber is in a bona fide prescriber-patient
 relationship with the patient for whom the controlled substance is
 being prescribed. Except as otherwise provided in this subsection,
 if a licensed prescriber prescribes a controlled substance under
 this subsection, the prescriber shall provide follow-up care to the
 patient to monitor the efficacy of the use of the controlled
 substance as a treatment of the patient's medical condition. If the
 licensed prescriber is unable to provide follow-up care, he or she
 the licensed prescriber shall refer the patient to the patient's
 primary care provider for follow-up care or, if the patient does
 not have a primary care provider, he or she the licensed prescriber
 shall refer the patient to another licensed prescriber who is
 geographically accessible to the patient for follow-up care.
       (3) 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.
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        (4) Beginning June 1, 2018, before prescribing or dispensing
  to a patient a controlled substance in a quantity that exceeds a 3-
  day supply, a licensed prescriber shall obtain and review a report
  concerning that patient from the electronic system for monitoring
  schedule 2, 3, 4, and 5 controlled substances established under
  section 7333a. This subsection does not apply under any of the
  following circumstances:
        (a) If the dispensing occurs in a hospital or freestanding
  surgical outpatient facility licensed under article 17 and the
 controlled substance is administered to the patient in that
 hospital or facility.
       (b) If the patient is an animal as that term is defined in
 section 18802, the dispensing occurs in a veterinary hospital or
 clinic and the controlled substance is administered to the patient
 in that hospital or clinic.
       (c) If the controlled substance is prescribed by a licensed
 prescriber who is a veterinarian and the controlled substance will
 be dispensed by a pharmacist.
       (d) If the patient is under the care of a hospice and the
 report described in this subsection was obtained and reviewed at
 the time the patient was admitted to the hospice.
       (5) Beginning June 1, 2018, before prescribing or dispensing a
 controlled substance to a patient, a licensed prescriber shall
 register with the electronic system for monitoring schedule 2, 3,
 4, and 5 controlled substances established under section 7333a.
       (6) 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
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  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.
       (7) 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 certified anesthesiologist
 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
 licensed under article 15.
       Sec. 16325. Fees for a person an individual licensed or
 seeking licensure to engage in the practice of medicine under part
 170 are as follows:
       (a) Application processing fee..................... $ 50.00
       (b) License fee, per year..........................   90.00
       (c) Temporary license fee..........................   25.00
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        (d) Limited license fee, per year..................     30.00
        Sec. 16325a. Fees for an individual licensed or seeking
  licensure to engage in practice as a certified anesthesiologist
  assistant under part 170 or part 175 are as follows:
        (a) Application processing fee..................      $ 75.00
        (b) License fee, per year.......................        60.00
        (c) Educational limited license.................        25.00
        Sec. 16331. Fees for a person an individual licensed or
  seeking licensure to engage in the practice of osteopathic medicine
 and surgery under part 175 are as follows:
       (a) Application processing fee....................... $ 50.00
       (b) License fee, per year............................     90.00
       (c) Temporary license fee............................     25.00
       (d) Limited license fee, per year....................     30.00
       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 of 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), if at least 1 of the residency programs is in the
 specialty area of medical practice, or in a specialty area that
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  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 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) "Anesthesiologist" means a physician who has successfully
 completed a training program in anesthesiology accredited by the
 Accreditation Council for Graduate Medical Education, the American
 Osteopathic Association, or an equivalent organization as
 determined by the board.
       (c) "Certified anesthesiologist assistant" means an individual
 who is licensed under this article to engage in practice as a
 certified anesthesiologist assistant.
       (d) (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.
       (e) (c) "Genetic counselor" means an individual who is
 licensed under this part article to engage in the practice of
 genetic counseling.
       (f) (d) "Medical care services" means those services within
 the scope of practice of physicians who are licensed or authorized
 by the board, except those services that the board prohibits or
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  otherwise restricts within a practice agreement or determines shall
  not be delegated by a physician because a delegation would endanger
  the health and safety of patients as provided for in section
  17048(1).
        (g) (e) "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.
       (h) (f) "Physician" means an individual who is licensed or
 authorized under this article to engage in the practice of
 medicine.
       (i) (g) "Podiatrist" means an individual who is licensed under
 this article to engage in the practice of podiatric medicine and
 surgery.
       (j) (h) "Practice agreement" means an agreement described in
 section 17047.
       (k) "Practice as a certified anesthesiologist assistant" means
 providing assistance to an anesthesiologist engaged in the practice
 of anesthesiology by performing any of the functions described in
 section 17034a under the supervision of the anesthesiologist.
       (l) "Practice as a physician's assistant" means the practice of
 medicine with a participating physician under a practice agreement.
       (m) "Practice of anesthesiology" means engaging in the
 practice of medicine as an anesthesiologist.
       (n) (i) "Practice of genetic counseling" means provision of
 any of the following services:
       (i) Obtaining and evaluating individual, family, and medical
 histories to determine the genetic risk for genetic or medical
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  conditions or diseases in a client, the client's descendants, or
  other family members of the client.
        (ii) Discussing with a client the features, natural history,
  means of diagnosis, genetic and environmental factors, and
  management of the genetic risks of genetic or medical conditions or
  diseases.
        (iii) Identifying and coordinating appropriate genetic
  laboratory tests and other diagnostic studies for genetic
  assessment of a client.
       (iv) Integrating genetic laboratory test results and other
 diagnostic studies with personal and family medical history to
 assess and communicate a client's risk factors for genetic or
 medical conditions or diseases.
       (v) Explaining to a client the clinical implications of
 genetic laboratory tests and other diagnostic studies and their
 results.
       (vi) Evaluating the responses of a client and the client's
 family to a genetic or medical condition or disease or to the risk
 of recurrence of that condition or disease and providing client-
 centered counseling and anticipatory guidance.
       (vii) Identifying and utilizing community resources that
 provide medical, educational, financial, and psychosocial support
 and advocacy to a client.
       (viii) Providing written documentation of medical, genetic, and
 counseling information for families of and health care
 professionals of a client.
       (o) (j) "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,
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  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.
        (k) "Practice as a physician's assistant" means the practice
  of medicine with a participating physician under a practice
  agreement.
        (p) (l) "Qualified supervisor" means an individual who is a
  genetic counselor and who holds a license under this part other
  than a temporary or limited license.
       (q) "Supervision" means that term as defined in section 16109,
 except that for subdivision (k) and sections 17034a to 17034b it
 also includes the existence of a predetermined plan for emergency
 situations, including, but not limited to, the designation of an
 anesthesiologist to supervise a certified anesthesiologist
 assistant in the absence of the primary supervising
 anesthesiologist.
       (r) (m) "Task force" means the joint task force created in
 section 17025.
       (s) (n) "Temporary licensed genetic counselor" means a genetic
 counselor who has been issued a temporary license under this
 article.
       (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. 17011. (1) An individual shall not engage in the practice
 of medicine or practice as a physician's assistant unless licensed
 or otherwise authorized by this article. An individual shall not
 engage in teaching or research that requires the practice of
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  medicine unless the individual is licensed or otherwise authorized
  by this article.
        (2) Notwithstanding section 16145 or rules promulgated under
  that section, the board may grant a license to an individual who
  meets the requirements of section 16186 or 17031(2) after reviewing
  the applicant's record of practice, experience, and credentials and
  determining that the applicant is competent to practice medicine.
        (3) For individuals applying for licensure under section
  16186, the board shall not impose requirements on graduates of
 medical schools located outside the United States or Canada that
 exceed the requirements imposed on graduates of medical schools
 located in the United States or Canada.
       (4) Notwithstanding section 16145 or rules promulgated under
 that section, the board may grant a license in accordance with
 section 16186 after determining that each of the following
 conditions is satisfied:
       (a) The applicant has disclosed that a sanction is in force
 against him or her the applicant as described in section
 16174(2)(b) and considering the reasons for the sanction and the
 applicant's record of practice, experience, credentials, and
 competence to engage in the practice of medicine, that sanction
 should not prevent the applicant from being granted a license in
 this state.
       (b) The sanction imposed by the other state is not permanent.
       (c) The sanction imposed by the other state was not the result
 of a patient safety violation.
       (d) If the applicant was required by the state that imposed
 the sanction to participate in and complete a probationary period
 or treatment plan as a condition of the continuation of his or her
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  the applicant's licensure, the applicant did not complete the
  probationary period or treatment plan because the applicant ceased