HOUSE BILL NO. 6167
November 26, 2024, Introduced by Rep. Brabec and referred to the Committee on Health Policy.
A bill to amend 1978 PA 368, entitled
"Public health code,"
by amending sections 7303, 17201, 17210, 17211a, and 17212 (MCL
333.7303, 333.17201, 333.17210, 333.17211a, and 333.17212), section
7303 as amended by 2013 PA 268, sections 17201 and 17212 as amended
and section 17211a as added by 2016 PA 499, and section 17210 as
amended by 2021 PA 53, and by adding section 17210a.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
EMR H00517'23
 2
1 Sec. 7303. (1) A Subject to subsection (9), a person who
2 manufactures, distributes, prescribes, or dispenses a controlled
3 substance in this state or who proposes to engage in the
4 manufacture, distribution, prescribing, or dispensing of a
5 controlled substance in this state shall obtain a license issued by
6 the administrator in accordance with the rules. A person who has
7 been issued a controlled substances license by the administrator
8 under this article and a license under article 15 shall renew the
9 controlled substances license concurrently with the renewal of the
10 license issued under article 15, and for an equal number of years.
11 (2) A person licensed by the administrator under this article
12 to manufacture, distribute, prescribe, dispense, or conduct
13 research with controlled substances may possess, manufacture,
14 distribute, prescribe, dispense, or conduct research with those
15 substances to the extent authorized by its license and in
16 conformity with the other provisions of this article.
17 (3) A license issued under this article to manufacture,
18 distribute, prescribe, or dispense pharmaceutical-grade cannabis
19 and the conduct of the licensee is subject to the additional
20 requirements of article 8.
21 (4) The following persons need not be licensed and may
22 lawfully possess controlled substances or prescription forms under
23 this article:
24 (a) An agent or employee of a licensed manufacturer,
25 distributor, prescriber, or dispenser of a controlled substance if
26 acting in the usual course of the agent's or employee's business or
27 employment.
28 (b) A common or contract carrier or warehouseman, or an
29 employee thereof, whose possession of a controlled substance or
EMR H00517'23
 3
1 prescription form is in the usual course of business or employment.
2 (c) An ultimate user or agent in possession of a controlled
3 substance or prescription form pursuant to a lawful order of a
4 practitioner or in lawful possession of a schedule 5 substance.
5 (5) The administrator may waive or include by rule the
6 requirement for licensure of certain manufacturers, distributors,
7 prescribers, or dispensers, if it finds the waiver or inclusion is
8 consistent with the public health and safety.
9 (6) A separate license is required at each principal place of
10 business or professional practice where the applicant manufactures,
11 distributes, prescribes, or dispenses controlled substances.
12 (7) As a requisite for licensure, the administrator may
13 inspect the establishment of a licensee or applicant for licensure
14 in accordance with the administrator's rule.
15 (8) A person licensed under this article to distribute
16 controlled substances shall report to the administrator on a
17 quarterly basis all schedule 2 controlled substances and those
18 controlled substances designated by the administrator pursuant to
19 this subsection that are sold to licensed practitioners and retail
20 pharmacies. The report shall must be in writing and shall must
21 include the name of each licensed practitioner and retail pharmacy
22 to whom the controlled substance was distributed. A report under
23 this subsection may be transmitted electronically, if the
24 transmission is ultimately reduced to writing. The administrator
25 shall designate by rule the controlled substances in schedules 3 to
26 5 to be reported under this subsection.
27 (9) The administrator may issue a controlled substances
28 license to an individual licensed as a registered professional
29 nurse under part 172 if the individual has been granted a specialty
EMR H00517'23
 4
1 certification as a nurse practitioner by the Michigan board of
2 nursing under section 17210.
3 Sec. 17201. (1) As used in this part:
4 (a) "Advanced practice registered nurse" or "a.p.r.n." means a
5 registered professional nurse who has been granted a specialty
6 certification under section 17210 in 1 of the following health
7 profession specialty fields:
8 (i) Nurse midwifery.
9 (ii) Nurse practitioner.
10 (iii) Clinical nurse specialist.
11 (b) "Physician" means a physician who is licensed under part
12 170 or part 175.
13 (c) "Practice Subject to sections 17210 and 17210a, "practice
14 of nursing" means the systematic application of substantial
15 specialized knowledge and skill, derived from the biological,
16 physical, and behavioral sciences, to the care, treatment, counsel,
17 and health teaching of individuals who are experiencing changes in
18 the normal health processes or who require assistance in the
19 maintenance of health and the prevention or management of illness,
20 injury, or disability.
21 (d) "Practice of nursing as a licensed practical nurse" or
22 "l.p.n." means the practice of nursing based on less comprehensive
23 knowledge and skill than that required of a registered professional
24 nurse and performed under the supervision of a registered
25 professional nurse, physician, or dentist.
26 (e) "Registered professional nurse" or "r.n." means an
27 individual who is licensed under this part to engage in the
28 practice of nursing which scope of practice includes the teaching,
29 direction, and supervision of less skilled personnel in the
EMR H00517'23
 5
1 performance of delegated nursing activities.
2 (2) In addition to the definitions in this part, article 1
3 contains general definitions and principles of construction
4 applicable to all articles in the code and part 161 contains
5 definitions applicable to this part.
6 Sec. 17210. (1) The Michigan Subject to this section and
7 section 17210a, the board of nursing may grant a specialty
8 certification to a registered professional nurse who has advanced
9 training beyond that required for initial licensure, who has
10 demonstrated competency through examination or other evaluative
11 processes, and who practices in 1 of the following health
12 profession specialty fields:
13 (a) Nurse midwifery.
14 (b) Nurse anesthetist.
15 (c) Nurse practitioner.
16 (d) Subject to subsection (2), clinical Clinical nurse
17 specialist.
18 (2) The Michigan board of nursing shall promulgate rules
19 establishing the qualifications for the training and competency of
20 the health profession specialty field of clinical nurse specialist.
21 The Michigan board of nursing shall not grant a specialty
22 certification as a clinical nurse specialist under subsection (1)
23 until after the effective date of the rules promulgated under this
24 subsection.
25 (3) All of the following apply to a registered professional
26 nurse who holds a specialty certification as a nurse anesthetist:
27 (a) In addition to performing duties within the scope of the
28 practice of nursing, his or her the individual's scope of practice
29 includes any of the following anesthesia and analgesia services if
EMR H00517'23
 6
1 the services are performed in accordance with the American
2 Association of Nurse Anesthetists Standards for Nurse Anesthesia
3 Practice:
4 (i) Development of a plan of care.
5 (ii) Performance of all patient assessments, procedures, and
6 monitoring to implement the plan of care or to address patient
7 emergencies that arise during implementation of the plan of care.
8 (iii) Selection, ordering, or prescribing and the administration
9 of anesthesia and analgesic agents, including pharmacological
10 agents that are prescription drugs as defined in section 17708 or
11 controlled substances. For purposes of this subparagraph, the
12 authority of a registered professional nurse who holds a specialty
13 certification as a nurse anesthetist to prescribe pharmacological
14 agents is limited to pharmacological agents for administration to
15 patients as described in subdivision (b), (c), or (d), and his or
16 her the individual's authority does not include any activity that
17 would permit a patient to self-administer, obtain, or receive
18 pharmacological agents, including prescription drugs or controlled
19 substances, outside of the facility in which the anesthetic or
20 analgesic service is performed or beyond the perioperative,
21 periobstetrical, or periprocedural period.
22 (b) If he or she the individual meets both of the following
23 requirements, he or she the individual may provide the anesthesia
24 and analgesia services described in subdivision (a) without
25 supervision:
26 (i) He or she The individual meets either of the following:
27 (A) He or she The individual has practiced in the health
28 profession specialty field of nurse anesthetist for 3 years or more
29 and has practiced in that health profession specialty field in a
EMR H00517'23
 7
1 health care facility for a minimum of 4,000 hours.
2 (B) He or she The individual has a doctor of nurse anesthesia
3 practice degree or doctor of nursing practice degree.
4 (ii) He or she The individual is collaboratively participating
5 in a patient-centered care team.
6 (c) He or she The individual may provide the anesthesia and
7 analgesia services described in subdivision (a) in a health care
8 facility if the health care facility has a policy in place under
9 subsection (4) allowing for the provision of the anesthesia and
10 analgesia services and ensuring that a qualified health care
11 professional is immediately available in person or through
12 telemedicine to address any urgent or emergent clinical concerns.
13 (d) The anesthesia and analgesia services described in
14 subdivision (a) may be performed for and during the perioperative,
15 periobstetrical, or periprocedural period.
16 (e) If he or she the individual is practicing pain management
17 in a freestanding pain clinic, he or she the individual must be
18 under the supervision of a physician.
19 (4) A health care facility may adopt policies relating to the
20 provision of anesthesia and analgesia services. If a health care
21 facility uses a registered professional nurse who holds a specialty
22 certification as a nurse anesthetist to perform the anesthesia and
23 analgesia services described in subsection (3) who is not employed
24 by the health care facility, the health care facility shall ensure
25 that the registered professional nurse or the person employing the
26 registered professional nurse maintains malpractice insurance.
27 (5) Subsection (3) does not require new or additional third
28 party reimbursement or mandated worker's compensation benefits for
29 anesthesia and analgesia services provided under that subsection by
EMR H00517'23
 8
1 a registered professional nurse who holds a specialty certification
2 as a nurse anesthetist under this part.
3 (6) As used in this section:
4 (a) "Collaboratively participating" means practicing and
5 communicating with health care professionals involved in the
6 patient-centered care team to optimize the overall care delivered
7 to the patient.
8 (b) "Health care facility" means any of the following:
9 (i) A hospital inpatient or outpatient facility.
10 (ii) A freestanding surgical outpatient facility.
11 (iii) An office of a physician, podiatrist, or dentist.
12 (iv) Any other office or facility in which diagnostic or
13 therapeutic procedures are provided to a patient, including, but
14 not limited to, imaging, endoscopy, or cystoscopy services.
15 (c) "Health care professional" means an individual who is
16 licensed or registered to perform a health profession under this
17 article.
18 (d) "Patient-centered care team" means a group of health care
19 professionals, which must include, but is not limited to, a
20 qualified health care professional, who directly or indirectly care
21 for a patient by each contributing his or her the professional's
22 specialized knowledge, skill, and experience to the care of the
23 patient.
24 (e) "Qualified health care professional" means any of the
25 following health care professionals who has completed the necessary
26 education, training, and experience in anesthesia care or
27 pharmacology, or has experience with procedures requiring
28 anesthesia:
29 (i) A physician.
EMR H00517'23
 9
1 (ii) A dentist licensed under part 166.
2 (iii) A podiatric physician licensed under part 180.
3 Sec. 17210a. (1) The board may grant a specialty certification
4 as a nurse practitioner under section 17210 to a registered
5 professional nurse who meets all of the following requirements:
6 (a) Has completed a graduate, postgraduate, or doctoral level
7 nursing education program that the board determines prepares the
8 registered professional nurse for the health profession specialty
9 field of nurse practitioner.
10 (b) Has completed a graduate level course in pharmacology,
11 pathophysiology, and physical assessment, or their equivalent as
12 determined by the board, and has completed a clinical practicum
13 applicable to the health profession specialty field of nurse
14 practitioner.
15 (c) Holds a certification from a nationally accredited
16 certification body approved by the board.
17 (d) Meets any other requirement established by the board by
18 rule.
19 (2) All of the following apply to a registered professional
20 nurse who holds a specialty certification as a nurse practitioner:
21 (a) In addition to performing duties within the practice of
22 nursing, the individual's scope of practice includes all of the
23 following:
24 (i) Performing comprehensive assessments, providing physical
25 examinations and other health assessments, and providing screening
26 activities.
27 (ii) Diagnosing, treating, and managing patients with acute and
28 chronic illnesses and diseases.
29 (iii) Ordering, performing, supervising, and interpreting
EMR H00517'23
 10
1 laboratory and imaging studies.
2 (iv) Prescribing pharmacological and nonpharmacological
3 interventions and treatments that are within the registered
4 professional nurse's specialty role.
5 (v) Engaging in health promotion and disease prevention.
6 (vi) Providing health education.
7 (vii) Counseling patients and families with potential, acute,
8 and chronic health disorders.
9 (b) The individual shall do all of the following:
10 (i) Provide only the functions common to the population for
11 which a registered professional nurse who holds a specialty
12 certification as a nurse practitioner is educationally and
13 experientially prepared.
14 (ii) Comply with the standards established by the board and
15 with the national accreditation standards of the national
16 professional nursing associations applicable to the individual's
17 specialty certification.
18 (iii) Consult with other health professionals and refer a
19 patient to other health professionals, as appropriate.
20 (c) The individual may supervise registered professional
21 nurses, licensed practical nurses, and other health professionals,
22 as appropriate.
23 Sec. 17211a. (1) An advanced practice registered nurse may
24 prescribe any of the following:
25 (a) A nonscheduled prescription drug.
26 (b) Subject to subsection (2), Except as otherwise provided in
27 subsection (2), a controlled substance included in schedules 2 to 5
28 of part 72, as a delegated act of a physician.
29 (2) If an advanced practice registered nurse prescribes a
EMR H00517'23
 11
1 controlled substance under subsection (1)(b), this subdivision,
2 both the advanced practice registered nurse's name and the
3 physician's name shall must be used, recorded, or otherwise
4 indicated in connection with that prescription, . If an advanced
5 practice registered nurse prescribes a controlled substance under
6 subsection (