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.
(c) Nurse practitioner.
(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.
(c) Subject to subdivision (f), he or she may provide the
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
(c)
A licensed doctor of osteopathic
medicine and surgery. , 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".
(c) The drug is designated by the board as a drug that may
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.