Bill Text: MI HB4359 | 2021-2022 | 101st Legislature | Chaptered
Bill Title: Health occupations: nurses; scope of practice of registered professional nurse holding a specialty certification as a nurse anesthetist; modify. Amends secs. 17210 & 17708 of 1978 PA 368 (MCL 333.17210 & 333.17708)
Spectrum: Slight Partisan Bill (Republican 15-6)
Status: (Passed) 2021-07-14 - Assigned Pa 53'21 With Immediate Effect [HB4359 Detail]
Download: Michigan-2021-HB4359-Chaptered.html
Act No. 53
Public Acts of 2021
Approved by the Governor
July 13, 2021
Filed with the Secretary of State
July 13, 2021
EFFECTIVE DATE: October 11, 2021
state of michigan
101st Legislature
Regular session of 2021
Introduced by Reps. Whiteford, Roth, Borton, Allor, Markkanen, Steven Johnson, Wozniak, Brann, Meerman, Thanedar, Sneller, Cherry, Brabec, Cambensy, Rabhi, Paquette, Farrington, Bellino, Martin, O’Malley and Calley
ENROLLED HOUSE BILL No. 4359
AN ACT to amend 1978 PA 368, entitled “An act to protect and promote the public health; to codify, revise, consolidate, classify, and add to the laws relating to public health; to provide for the prevention and control of diseases and disabilities; to provide for the classification, administration, regulation, financing, and maintenance of personal, environmental, and other health services and activities; to create or continue, and prescribe the powers and duties of, departments, boards, commissions, councils, committees, task forces, and other agencies; to prescribe the powers and duties of governmental entities and officials; to regulate occupations, facilities, and agencies affecting the public health; to regulate health maintenance organizations and certain third party administrators and insurers; to provide for the imposition of a regulatory fee; to provide for the levy of taxes against certain health facilities or agencies; to promote the efficient and economical delivery of health care services, to provide for the appropriate utilization of health care facilities and services, and to provide for the closure of hospitals or consolidation of hospitals or services; to provide for the collection and use of data and information; to provide for the transfer of property; to provide certain immunity from liability; to regulate and prohibit the sale and offering for sale of drug paraphernalia under certain circumstances; to provide for the implementation of federal law; to provide for penalties and remedies; to provide for sanctions for violations of this act and local ordinances; to provide for an appropriation and supplements; to repeal certain acts and parts of acts; to repeal certain parts of this act; and to repeal certain parts of this act on specific dates,” 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 2020 PA 4.
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.
(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 if the services are performed in accordance with the American Association of Nurse Anesthetists Standards for Nurse Anesthesia Practice:
(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 self-administer, obtain, or receive pharmacological agents, including prescription drugs or controlled substances, outside of the facility in which the anesthetic or analgesic service is performed or beyond the perioperative, periobstetrical, or periprocedural period.
(b) If he or she meets both of the following requirements, he or she may provide the anesthesia and analgesia services described in subdivision (a) without supervision:
(i) He or she meets either of the following:
(B) He or she has a doctor of nurse anesthesia practice degree or doctor of nursing practice degree.
(ii) He or she is collaboratively participating in a patient-centered care team.
(c) He or she may provide the anesthesia and analgesia services described in subdivision (a) in a health care facility if the health care facility has a policy in place under subsection (4) allowing for the provision of the anesthesia and analgesia services and ensuring that a qualified health care professional is immediately available in person or through telemedicine to address any urgent or emergent clinical concerns.
(d) The anesthesia and analgesia services described in subdivision (a) may be performed for and during the perioperative, periobstetrical, or periprocedural period.
(e) If he or she is practicing pain management in a freestanding pain clinic, he or she must be under the supervision of a physician.
(4) A health care facility may adopt policies relating to the provision of anesthesia and analgesia services. If a health care facility uses a registered professional nurse who holds a specialty certification as a nurse anesthetist to perform the anesthesia and analgesia services described in subsection (3) who is not employed by the health care facility, the health care facility shall ensure that the registered professional nurse or the person employing the registered professional nurse maintains malpractice insurance.
(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.
(6) As used in this section:
(a) “Collaboratively participating” means practicing and communicating with health care professionals involved in the patient-centered care team to optimize the overall care delivered to the patient.
(b) “Health care facility” means any of the following:
(i) A hospital inpatient or outpatient facility.
(ii) A freestanding surgical outpatient facility.
(iii) An office of a physician, podiatrist, or dentist.
(iv) Any other office or facility in which diagnostic or therapeutic procedures are provided to a patient, including, but not limited to, imaging, endoscopy, or cystoscopy services.
(c) “Health care professional” means an individual who is licensed or registered to perform a health profession under this article.
(d) “Patient-centered care team” means a group of health care professionals, which must include, but is not limited to, a qualified health care professional, 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.
(e) “Qualified health care professional” means any of the following health care professionals who has completed the necessary education, training, and experience in anesthesia care or pharmacology, or has experience with procedures requiring anesthesia:
(i) A physician.
(ii) A dentist licensed under part 166.
(iii) A podiatric physician licensed under part 180.
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 any of the following:
(a) A licensed dentist.
(b) A licensed doctor of medicine.
(c) A licensed doctor of osteopathic medicine and surgery.
(d) A licensed doctor of podiatric medicine and surgery.
(e) A licensed physician’s assistant.
(f) A licensed optometrist certified under part 174 to administer and prescribe therapeutic pharmaceutical agents.
(g) An advanced practice registered nurse as that term is defined in section 17201 who meets the requirements of section 17211a.
(h) A licensed veterinarian.
(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) Subject to subsection (5), “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) For purposes of this part, prescription drug also includes a drug dispensed pursuant to section 17744f.
(6) “Remote pharmacy” means a pharmacy described in sections 17742a and 17742b.
(7) 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.
This act
is ordered to take immediate effect.
Clerk of the House of Representatives
Secretary of the Senate
Approved___________________________________________
____________________________________________________
Governor
