SENATE BILL No. 683

 

 

November 30, 2017, Introduced by Senator O'BRIEN and referred to the Committee on Health Policy.

 

 

      A bill to amend 1978 PA 368, entitled

 

"Public health code,"

 

by amending sections 16215, 16322, 16501, 16511, 16521, 16525,

 

and 16529 (MCL 333.16215, 333.16322, 333.16501, 333.16511,

 

333.16521, 333.16525, and 333.16529), section 16215 as amended by

 

2005 PA 211, sections 16322, 16501, 16525, and 16529 as added by

 

2006 PA 30, section 16511 as amended by 2006 PA 397, and section

 

16521 as amended by 2010 PA 79, and by adding sections 16513,

 

16515, and 16517.

 

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 

 1        Sec. 16215. (1) Subject to subsections (2) to (6), a

 

 2  licensee who holds a license other than a health profession

 

 3  subfield license may delegate to a licensed or unlicensed

 

 4  individual who is otherwise qualified by education, training, or

 


 1  experience the performance of selected acts, tasks, or functions

 

 2  where the acts, tasks, or functions fall within the scope of

 

 3  practice of the licensee's profession and will be performed under

 

 4  the licensee's supervision. A licensee shall not delegate an act,

 

 5  task, or function under this section if the act, task, or

 

 6  function, under standards of acceptable and prevailing practice,

 

 7  requires the level of education, skill, and judgment required of

 

 8  the licensee under this article.

 

 9        (2) Subject to subsection (1) and except as otherwise

 

10  provided in this subsection and subsections (3) and (4), a

 

11  licensee who is an allopathic physician or osteopathic physician

 

12  and surgeon shall delegate an act, task, or function that

 

13  involves the performance of a procedure that requires the use of

 

14  surgical instrumentation only to an individual who is licensed

 

15  under this article. A licensee who is an allopathic physician or

 

16  osteopathic physician and surgeon may delegate an act, task, or

 

17  function described in this subsection to an individual who is not

 

18  licensed under this article if the unlicensed individual is 1 or

 

19  more of the following and if the procedure is directly supervised

 

20  by a licensed allopathic physician or osteopathic physician and

 

21  surgeon who is physically present during the performance of the

 

22  procedure:

 

23        (a) A student enrolled in a school of medicine or

 

24  osteopathic medicine approved by the Michigan board of medicine

 

25  or the Michigan board of osteopathic medicine and surgery.

 

26        (b) A student enrolled in a physician's assistant training

 

27  program approved by the joint physician's assistant task force

 


 1  created under part 170.

 

 2        (3) Subject to subsection (1), a licensee who is an

 

 3  allopathic physician or osteopathic physician and surgeon may

 

 4  delegate an act, task, or function described in subsection (2) to

 

 5  an individual who is not licensed under this article and who is 1

 

 6  of the following:

 

 7        (a) Performing Until 12 months after the effective date of

 

 8  the rules promulgated under section 16525, performing

 

 9  acupuncture.

 

10        (b) Surgically removing only bone, skin, blood vessels,

 

11  cartilage, dura mater, ligaments, tendons, pericardial tissue, or

 

12  heart valves only from a deceased individual for transplantation,

 

13  implantation, infusion, injection, or other medical or scientific

 

14  purpose.

 

15        (4) Subject to subsection (1), a licensee who is an

 

16  allopathic physician or osteopathic physician and surgeon may

 

17  delegate an act, task, or function described in subsection (2) to

 

18  an individual who is not licensed under this article if the

 

19  procedure is directly supervised by a licensed allopathic

 

20  physician or osteopathic physician and surgeon who is physically

 

21  present during the performance of the procedure, the delegation

 

22  of such procedure is not prohibited or otherwise restricted by

 

23  the board or that health facility or agency, and the delegation

 

24  of that act, task, or function is specifically authorized by that

 

25  health facility or agency to be delegated and performed by either

 

26  of the following unlicensed individuals:

 

27        (a) A surgical technologist who meets the qualifications

 


 1  established by the health facility or agency with which he or she

 

 2  is employed or under contract. with.

 

 3        (b) A surgical first assistant who meets the qualifications

 

 4  established by the health facility or agency with which he or she

 

 5  is employed or under contract. with.

 

 6        (5) A board may promulgate rules to further prohibit or

 

 7  otherwise restrict delegation of specific acts, tasks, or

 

 8  functions to a licensed or unlicensed individual if the board

 

 9  determines that the delegation constitutes or may constitute a

 

10  danger to the health, safety, or welfare of the patient or

 

11  public.

 

12        (6) To promote safe and competent practice, a board may

 

13  promulgate rules to specify conditions under which, and

 

14  categories and types of licensed and unlicensed individuals for

 

15  whom, closer supervision may be required for acts, tasks, and

 

16  functions delegated under this section.

 

17        (7) An individual who performs acts, tasks, or functions

 

18  delegated pursuant to this section does not violate the part that

 

19  regulates the scope of practice of that health profession.

 

20        (8) The amendatory act that added this subsection does not

 

21  require new or additional third party reimbursement or mandated

 

22  worker's compensation benefits for services rendered by an

 

23  individual authorized to perform those services under subsection

 

24  (4).

 

25        Sec. 16322. Fees for a person registered or seeking

 

26  registration as an acupuncturist an individual who is licensed or

 

27  seeking licensure to engage in the practice of acupuncture under

 


 1  part 165 are as follows:

 

 

2

      (a) Application processing fee.................  $   75.00

3

      (b) Registration License fee, per year.........  $  200.00

4

      (c) Limited license, per year..................  $  200.00

5

      (d) Temporary license fee......................  $  200.00

 

 

 6        Sec. 16501. (1) As used in this part:

 

 7        (a) "Acupressure" means a form of manual therapy in which

 

 8  physical pressure is applied to various points on the body.

 

 9        (b) (a) "Acupuncture" means the insertion and manipulation

 

10  of needles through the surface of the human body. at specific

 

11  locations on the human body for the prevention or correction of

 

12  disease, injury, pain, or other condition.Acupuncture includes,

 

13  but is not limited to, laser acupuncture, electroacupuncture,

 

14  pricking therapy, dry needling, and intramuscular stimulation.

 

15        (c) (b) "Acupuncturist" means an individual who practices

 

16  acupuncture and is registered, or otherwise authorized, licensed

 

17  under this part to engage in the practice of acupuncture.

 

18        (d) "Cupping" means the placement of a specially designed

 

19  cup on the body to create suction.

 

20        (e) "Dermal friction" means the use of repeated, closely

 

21  timed, unidirectional press-stroking with a smooth-edged

 

22  instrument over a lubricated area of the body.

 

23        (f) "Dietary counseling" means the process of advising a

 

24  patient about healthy food choices and healthy eating habits in

 

25  accordance with East Asian medical theory.

 

26        (g) "Dry needling" means a rehabilitative procedure using


 

 1  filiform needles to penetrate the skin or underlying tissues by

 

 2  targeting only myofascial trigger points and muscular and

 

 3  connective tissues to affect change in body structures and

 

 4  functions for the evaluation and management of

 

 5  neuromusculoskeletal pain and movement impairment. Dry needling

 

 6  does not include the stimulation of auricular points or other

 

 7  acupuncture points.

 

 8        (h) "East Asian medicine techniques" includes, but is not

 

 9  limited to, acupuncture, manual therapy, moxibustion, heat

 

10  therapy, dietary counseling, therapeutic exercise, acupressure,

 

11  cupping, dermal friction, homeopathy, lifestyle coaching, and

 

12  treatment with herbal medicines.

 

13        (i) "Heat therapy" means the use of heat in therapy, such as

 

14  for pain relief and health.

 

15        (j) "Herbal medicine" means the internal and external use of

 

16  a plant or a plant extract, a mineral, or an animal product, that

 

17  is not a prescription drug as that term is defined in section

 

18  17708.

 

19        (k) "Homeopathy" means the use of a highly diluted natural

 

20  remedy from the plant, mineral, and animal domain.

 

21        (l) "Lifestyle coaching" means the process of advising a

 

22  patient about healthy lifestyle choices and habits in accordance

 

23  with East Asian medical theory.

 

24        (m) "Manual therapy" means the application of an accurately

 

25  determined and specifically directed manual force to the body.

 

26        (n) "Moxibustion" means burning the dried plant Artemisia

 

27  vulgaris on or very near the surface of the skin as a form of


 

 1  therapy.

 

 2        (o) "Practice of acupuncture", subject to subsection (2),

 

 3  means the use of traditional and contemporary east Asian medical

 

 4  theory to assess and diagnose a patient, to develop a plan to

 

 5  treat the patient, and to treat the patient through East Asian

 

 6  medicine techniques.

 

 7        (p) "Practice of massage therapy" means that term as defined

 

 8  in section 17951.

 

 9        (q) "Practice of medicine" means that term as defined in

 

10  section 17001.

 

11        (r) "Practice of osteopathic medicine and surgery" means

 

12  that term as defined in section 17501.

 

13        (s) "Practice of physical therapy" means that term as

 

14  defined in section 17801.

 

15        (t) "Registered acupuncturist" means an individual who is

 

16  registered or otherwise authorized under this part before the

 

17  effective date of the amendatory act that added section 16513.

 

18        (u) "Systematic acupuncture education" means a course of

 

19  education that covers the foundation of acupuncture science and

 

20  theory, channel and point location, needling techniques,

 

21  approaches to diagnosis and therapy, and patient management.

 

22        (v) "Therapeutic exercise" means a range of physical

 

23  activities that help restore and build physical strength,

 

24  endurance, flexibility, balance, and stability.

 

25        (2) For purposes of this part, practice of acupuncture does

 

26  not include the practice of medicine, the practice of osteopathic

 

27  medicine and surgery, the practice of physical therapy, or the


 

 1  practice of massage therapy.

 

 2        (3) (2) In addition to the definitions in this part, article

 

 3  1 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. 16511. (1) Except as otherwise provided under

 

 7  subsection (2), after in this part, beginning on the effective

 

 8  date of rules are promulgated under section 16145, 16525, an

 

 9  individual shall not use the words, titles, or letters

 

10  "acupuncturist", "certified acupuncturist", or "registered

 

11  acupuncturist", "licensed acupuncturist", "L.Ac.", or a

 

12  combination thereof, with or without qualifying words or phrases,

 

13  similar word or initial that indicates that the individual is an

 

14  acupuncturist, unless he or she is registered authorized under

 

15  this part to use the terms and in a way prescribed in this part.

 

16        (2) Neither of the following is subject to the provisions of

 

17  this part:

 

18        (a) A physician who is licensed under part 170 or 175.

 

19        (b) An individual who is certified by the national

 

20  acupuncture detoxification association.

 

21        Sec. 16513. (1) Beginning on the effective date of rules

 

22  promulgated under section 16525, an individual shall not engage

 

23  in the practice of acupuncture unless he or she is licensed under

 

24  this part or is otherwise authorized under this article. For a

 

25  period not to exceed 12 months from the effective date of the

 

26  rules promulgated under section 16525, a registered acupuncturist

 

27  may, without a license under this part, continue to use the


 

 1  titles "acupuncturist", "registered acupuncturist", or "certified

 

 2  acupuncturist" and engage in the practice of acupuncture.

 

 3        (2) In addition to the exemptions from licensure under

 

 4  section 16171, this part does not apply to any of the following:

 

 5        (a) Except as otherwise provided in subdivision (e), an

 

 6  individual licensed, registered, or otherwise authorized under

 

 7  any other part or act who is performing activities that are

 

 8  considered to be within the practice of acupuncture if those

 

 9  activities are within the individual's scope of practice and if

 

10  the individual does not use the words, titles, or letters

 

11  protected under section 16511.

 

12        (b) A physician who is licensed under part 170 or part 175

 

13  if the physician has completed a total of not less than 300 hours

 

14  of systematic acupuncture education that include not less than

 

15  100 hours of live lectures, demonstrations, and supervised

 

16  clinical training specific to acupuncture.

 

17        (c) An individual who meets all of the following

 

18  requirements:

 

19        (i) He or she meets the requirements for a certificate of

 

20  training as an acupuncture detoxification specialist issued by

 

21  the National Acupuncture Detoxification Association or an

 

22  organization that the board determines is a successor

 

23  organization.

 

24        (ii) He or she only uses the auricular protocol for substance

 

25  use disorder prevention and treatment developed by the National

 

26  Acupuncture Detoxification Association or an organization that

 

27  the board determines is a successor organization.


 

 1        (iii) He or she is under the supervision of an acupuncturist

 

 2  or a physician licensed under part 170 or part 175 when using the

 

 3  protocol described in subparagraph (ii).

 

 4        (iv) He or she does not use the words, titles, or letters

 

 5  protected under section 16511.

 

 6        (d) An individual performing acupressure, cupping, dermal

 

 7  friction, dietary counseling, heat therapy, herbal medicine,

 

 8  homeopathy, lifestyle coaching, manual therapy, or therapeutic

 

 9  exercise, while he or she is engaged in the scope of practice of

 

10  a profession with established standards and ethics if the

 

11  services described in this subdivision are not designated as or

 

12  implied to be the practice of acupuncture and the individual does

 

13  not use the titles, words, or letters protected under section

 

14  16511.

 

15        (e) Dry needling by an individual licensed, registered, or

 

16  otherwise authorized under any other part if dry needling is

 

17  within the individual's scope of practice.

 

18        Sec. 16515. (1) Except as otherwise provided in subsection

 

19  (2), the department shall issue a license to an applicant who

 

20  meets the requirements of section 16174 and the requirements for

 

21  licensure established in rules promulgated under section 16525.

 

22        (2) On or before the expiration of 12 months after the

 

23  effective date of the rules promulgated under section 16525, the

 

24  department shall issue a license to an applicant who meets the

 

25  requirements of section 16174 and 1 of the following:

 

26        (a) He or she is a registered acupuncturist.

 

27        (b) He or she demonstrates to the satisfaction of the board


 

 1  that he or she has the education, training, and experience

 

 2  appropriate to the practice of acupuncture as established in

 

 3  rules promulgated under section 16525. In determining whether an

 

 4  applicant has met the requirements for licensure under this

 

 5  subdivision, the board shall consider patient records, billing

 

 6  records, education records, training records, or any other

 

 7  evidence submitted to the board that it considers credible. An

 

 8  applicant shall ensure that any document provided to the board

 

 9  for purposes of this subdivision ensures the confidentiality of a

 

10  patient's identity.

 

11        Sec. 16517. (1) Notwithstanding the requirements of part

 

12  161, the board shall promulgate rules requiring a licensee

 

13  seeking renewal of a license to furnish the board with

 

14  satisfactory evidence that during the license cycle immediately

 

15  preceding the application for renewal the licensee has attended

 

16  continuing education courses or programs approved by the board in

 

17  subjects related to the practice of acupuncture and designed to

 

18  further educate licensees. An individual is considered to have

 

19  completed the continuing education requirements described in this

 

20  subsection if the board determines that the individual has met

 

21  the continuing education standards of the National Certification

 

22  Commission for Acupuncture and Oriental Medicine or equivalent

 

23  standards as determined by the board.

 

24        (2) As required under section 16204, the board shall

 

25  promulgate rules requiring each applicant for license renewal to

 

26  complete as part of the educational courses or programs required

 

27  under subsection (1) an appropriate number of hours or courses in


 

 1  pain and symptom management.

 

 2        Sec. 16521. (1) The Michigan board of acupuncture is created

 

 3  in the department and shall consist consists of the following 13

 

 4  voting members, who each of whom must meet the requirements of

 

 5  part 161:

 

 6        (a) Until June 30, 2010, 4 acupuncturists. Beginning July 1,

 

 7  2010, 7 Seven acupuncturists. The members appointed under this

 

 8  subdivision shall must meet the requirements of section 16135.

 

 9        (b) Three physicians licensed under part 170 or 175, at

 

10  least 1 of whom has met the requirement in section 16513(2)(b).

 

11        (c) Until June 30, 2010, 2 public members. Beginning July 1,

 

12  2010, 3 Three public members.

 

13        (2) The terms of office of individual members of the board

 

14  created under this part, except those appointed to fill

 

15  vacancies, expire 4 years after appointment on June 30 of the

 

16  year in which the term expires pursuant to section 16122.

 

17        Sec. 16525. (1) The By 12 months after the effective date of

 

18  the amendatory act that amended this section, the department, in

 

19  consultation with the board, shall promulgate rules setting forth

 

20  the minimum standards for registration as an acupuncturist. The

 

21  department, in consultation with the board, may adopt by

 

22  reference the professional standards issued by a certified

 

23  program that is recognized by the national commission for

 

24  certifying agencies or by a nationally recognized trade

 

25  association.that establish the minimum standards for licensure as

 

26  an acupuncturist and implement the licensure program for the

 

27  practice of acupuncture. In promulgating rules for purposes of


 

 1  section 16515(1), the department, in consultation with the board,

 

 2  may adopt by reference the professional standards issued by a

 

 3  certified program that is recognized by the National Commission

 

 4  for Certifying Agencies. In promulgating rules for purposes of

 

 5  section 16515(2), the department, in consultation with the board,

 

 6  shall consider the following:

 

 7        (a) Whether, in the 3 years immediately preceding the

 

 8  application, an applicant has used acupuncture to treat an

 

 9  average of 30 patients per year, has averaged 250 patient visits

 

10  per year, and has used acupuncture to treat patients with general

 

11  health conditions.

 

12        (b) Whether an applicant has completed systematic

 

13  acupuncture education that includes live lectures,

 

14  demonstrations, and supervised clinical training specific to

 

15  acupuncture.

 

16        (2) The department, in consultation with the board, shall

 

17  not promulgate rules under this section that diminish competition

 

18  or exceed the minimum level of regulation necessary to protect

 

19  the public.

 

20        Sec. 16529. This part does not require new or additional

 

21  third party reimbursement or mandated worker's compensation

 

22  benefits for services by an individual registered licensed as an

 

23  acupuncturist under this part.

 

24        Enacting section 1. This amendatory act takes effect 90 days

 

25  after the date it is enacted into law.