state of michigan
100th Legislature
Regular session of 2020
Introduced by Senators
Johnson, Daley, Hollier, Geiss and Bayer
ENROLLED SENATE BILL No. 248
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 7333, 16226, 16322,
16501, 16511, 16513, 16521, 16525, 16529, 17744, and 17751 (MCL 333.7333,
333.16226, 333.16322, 333.16501, 333.16511, 333.16513, 333.16521, 333.16525,
333.16529, 333.17744, and 333.17751), section 7333 as amended by 2018 PA 34,
section 16226 as amended by 2018 PA 463, sections 16322, 16501, 16511, 16521,
16525, and 16529 as amended by 2019 PA 140, section 16513 as added by 2019 PA
140, section 17744 as added by 2012 PA 209, and section 17751 as amended by
2020 PA 4.
The People of the
State of Michigan enact:
(a) Lack of consistency in the doctor-patient
relationship.
(b) Frequency of prescriptions for the same
drug by 1 prescriber for larger numbers of patients.
(c) Quantities beyond those normally
prescribed for the same drug.
(d) Unusual dosages.
(e) Unusual geographic distances between
patient, pharmacist, and prescriber.
(2) Except as otherwise provided in this
section, a practitioner, in good faith, may dispense a controlled substance
included in schedule 2 that is a prescription drug as determined under section
503(b) of the federal food, drug, and cosmetic act, 21 USC 353, or section
17708, on receipt of either of the following:
(a) A prescription of a practitioner licensed
under section 7303 on a prescription form. More than 1 prescription for a
controlled substance included in schedule 2 may be included on a single
prescription form.
(b) A prescription that is electronically
transmitted under section 17754a.
(3) In an emergency situation, as described in
R 338.3165 of the Michigan Administrative Code, a controlled substance included
in schedule 2 may be dispensed on the oral prescription of a practitioner if
the prescribing practitioner promptly fills out a prescription form and
forwards the prescription form to the dispensing pharmacy within 7 days after
the oral prescription is issued. A prescription for a controlled substance
included in schedule 2 must not be filled more than 90 days after the date
on which the prescription was issued. A pharmacist, consistent with federal law
and regulations on the partial filling of a controlled substance included in
schedule 2, may partially fill in increments a prescription for a controlled
substance included in schedule 2.
(4) A practitioner, in good faith, may dispense
a controlled substance included in schedule 3, 4, or 5 that is a prescription
drug as determined under section 503(b) of the federal food, drug, and cosmetic
act, 21 USC 353, or section 17708, on receipt of any of the following:
(a) A prescription on a prescription form.
(b) An oral prescription of a practitioner.
(c) A prescription that is electronically
transmitted under section 17754a.
(5) A prescription for a controlled substance
included in schedule 3 or 4 must not be filled or refilled without specific
refill instructions noted by the prescriber. A prescription for a controlled
substance included in schedule 3 or 4 must not be filled or refilled later
than 6 months after the date of the prescription or be refilled more than 5 times,
unless renewed by the prescriber in accordance with rules promulgated by the
administrator.
(6) A controlled substance included in
schedule 5 must not be distributed or dispensed other than for a medical
purpose, or in any manner except in accordance with rules promulgated by the
administrator.
(7) If a prescription is required under this
section, the prescription must contain the quantity of the controlled substance
prescribed in both written and numerical terms. A prescription is in compliance
with this subsection if, in addition to containing the quantity of the
controlled substance prescribed in written terms, it contains preprinted
numbers representative of the quantity of the controlled substance prescribed
next to which is a box or line the prescriber may check.
(8) A prescribing practitioner shall not use a
prescription form for a purpose other than prescribing. A prescribing
practitioner shall not postdate a prescription form that contains a
prescription for a controlled substance. Until the date on which section 17754a
applies, a prescriber may transmit a prescription by facsimile of a printed
prescription form and by electronic transmission of a printed prescription
form, if not prohibited by federal law. If, with the patients consent, a
prescription is electronically transmitted under this subsection, it must be
transmitted directly to a pharmacy of the patients choice by the prescriber or
the prescribers authorized agent, and the data must not be altered, modified,
or extracted in the transmission process.
(9) Notwithstanding subsections (1) to (6), a
class B dealer may acquire a limited permit only for the purpose of buying,
possessing, and administering a commercially prepared, premixed solution of
sodium pentobarbital to perform euthanasia on injured, sick, homeless, or
unwanted domestic pets and other animals, if the class B dealer does all of the
following:
(a) Applies to the administrator for a permit
in accordance with rules promulgated under this part. The application must
contain the name of the individual in charge of the day-to-day operations of
the class B dealers facilities and the name of the individual responsible for
designating employees who will be performing euthanasia on animals pursuant to
this act.
(b) Complies with the rules promulgated by the
administrator for the storage, handling, and use of a commercially prepared,
premixed solution of sodium pentobarbital to perform euthanasia on animals. The
class B dealer shall maintain a record of use and shall make the record
available for inspection by the department of licensing and regulatory affairs,
the department of agriculture and rural development, and the United States
Department of Agriculture.
(c) Subject to subdivision (d), certifies that
the class B dealer or an employee of the class B dealer has received, and can
document completion of, a minimum of 16 hours of training, including at least
12 hours of content training and at least 4 hours of practical training, in the
use of a commercially prepared, premixed solution of sodium pentobarbital and
an animal tranquilizer to perform euthanasia on animals from a training program
approved by the state veterinarian, in consultation with the Michigan board of
veterinary medicine, and given by a licensed veterinarian pursuant to rules
promulgated by the administrator. The training described in this subdivision
must comply with the American Veterinary Medical Associations guidelines for
the euthanasia of animals.
(d) Until December 31, 2021, ensures that the
class B dealer or an employee of the class B dealer who received, and can
document the completion of, the 8 hours of training required immediately before
May 22, 2018 only administers a commercially prepared, premixed solution of
sodium pentobarbital to perform euthanasia on the animals described in this
subsection. Beginning January 1, 2022, the individuals described in this
subdivision must have received, and be able to document the completion of, the
training described in subdivision (c) to administer a commercially prepared,
premixed solution of sodium pentobarbital or an animal tranquilizer to perform
euthanasia on the animals described in this subsection.
(e) Certifies that only an individual
described in subdivision (c) or (d) or an individual otherwise permitted to use
a controlled substance pursuant to this article will administer the
commercially prepared, premixed solution of sodium pentobarbital or an animal
tranquilizer according to written procedures established by the class B dealer.
(f) Beginning January 1, 2022, certifies that
the individual in charge of the day-to-day operations of the class B dealers
facilities has received, and can document the completion of, the training
described in subdivision (c).
(g) Complies with all state and federal laws,
rules, and regulations regarding the acquisition, use, and security of
controlled substances.
(10) Notwithstanding subsections (1) to (6),
an animal control shelter or animal protection shelter registered with the
department of agriculture and rural development pursuant to 1969 PA 287, MCL
287.331 to 287.340, may acquire a limited permit only for the purpose of
buying, possessing, and administering a commercially prepared, premixed
solution of sodium pentobarbital, or an animal tranquilizer, to use exclusively
as an adjunct in the process of performing euthanasia on injured, sick,
homeless, or unwanted domestic pets and other animals, if the animal control
shelter or animal protection shelter does all of the following:
(a) Applies to the administrator for a permit
in accordance with rules promulgated under this part. The application must
contain the name of the individual in charge of the day-to-day operations of
the animal control shelter or animal protection shelter and the name of the
individual responsible for designating employees who will be performing
euthanasia on animals pursuant to this act.
(b) Complies with the rules promulgated by the
administrator for the storage, handling, and use of a commercially prepared,
premixed solution of sodium pentobarbital or an animal tranquilizer to perform
euthanasia on animals. The animal control shelter or animal protection shelter
shall maintain a record of use and make the record available for inspection by
the department of licensing and regulatory affairs and the department of
agriculture and rural development.
(c) Subject to subdivision (d), certifies that
an employee of the animal control shelter or animal protection shelter has
received, and can document completion of, a minimum of 16 hours of training,
including at least 12 hours of content training and at least 4 hours of
practical training, in the use of a commercially prepared, premixed solution of
sodium pentobarbital and an animal tranquilizer to perform euthanasia on
animals from a training program approved by the state veterinarian, in
consultation with the Michigan board of veterinary medicine, and given by a
licensed veterinarian pursuant to rules promulgated by the administrator. The
training described in this subdivision must comply with the American Veterinary
Medical Associations guidelines for the euthanasia of animals.
(d) Until December 31, 2021, ensures that an
employee of the animal control shelter or animal protection shelter who
received, and can document the completion of, the training required immediately
before May 22, 2018 only administers a commercially prepared solution of
xylazine hydrochloride or a commercially prepared, premixed solution of sodium
pentobarbital to perform euthanasia on the animals described in this subsection
in accordance with his or her training. Beginning January 1, 2022, the employee
described in this subdivision must have received, and be able to document the
completion of, the training described in subdivision (c) to administer a
commercially prepared, premixed solution of sodium pentobarbital or an animal
tranquilizer to perform euthanasia on the animals described in this subsection.
(e) Certifies that only an individual
described in subdivision (c) or (d) or an individual otherwise permitted to use
a controlled substance pursuant to this article will administer a commercially
prepared, premixed solution of sodium pentobarbital or an animal tranquilizer
according to written procedures established by the animal control shelter or
animal protection shelter.
(f) Beginning January 1, 2022, certifies that
the individual in charge of the day-to-day operations of the animal control
shelter or animal protection shelter has received, and can document the
completion of, the training described in subdivision (c).
(g)
Complies with all state and federal laws and regulations regarding the
acquisition, use, and security of controlled substances.
(11)
The application described in subsection (9) or (10) must include the names and
addresses of all individuals employed by the animal control shelter or animal
protection shelter or class B dealer who have been trained as described in
subsection (9)(c), (d), and (f) or (10)(c), (d), and (f) and the name of the
veterinarian who trained them. The list of names and addresses must be updated
every 6 months.
(12)
If an animal control shelter or animal protection shelter or class B dealer
issued a permit pursuant to subsection (9) or (10) does not have in its employ
an individual trained as described in subsection (9)(c) or (d) and (9)(f),
or (10)(c) or (d) and (10)(f), the animal control shelter or animal protection
shelter or class B dealer shall immediately notify the administrator and shall
cease to administer a commercially prepared, premixed solution of sodium
pentobarbital or an animal tranquilizer for the purposes described in
subsection (9) or (10) until the administrator is notified that 1 of the
following has occurred:
(a) An
individual trained as described in subsection (9)(c), (d), or (f) or (10)(c),
(d), or (f) has been hired by the animal control shelter or animal protection
shelter or class B dealer.
(b) An
individual employed by the animal control shelter or animal protection shelter
or class B dealer has been trained as described in subsection (9)(c) or (f) or
(10)(c) or (f).
(13) A
veterinarian, including a veterinarian who trains individuals as described in
subsection (9)(c), (d), or (f), or (10)(c), (d), or (f), is not civilly or
criminally liable for the use of a commercially prepared, premixed solution of
sodium pentobarbital or an animal tranquilizer by an animal control shelter or
animal protection shelter or a class B dealer, unless the veterinarian is
employed by or under contract with the animal control shelter or animal
protection shelter or class B dealer and the terms of the veterinarians employment
or the contract require the veterinarian to be responsible for the use or
administration of the commercially prepared, premixed solution of sodium
pentobarbital or animal tranquilizer.
(14) A
person shall not knowingly use or permit the use of a commercially prepared,
premixed solution of sodium pentobarbital or an animal tranquilizer in
violation of this section.
(15)
This section does not require that a veterinarian be employed by or under
contract with an animal control shelter or animal protection shelter or class B
dealer to obtain, possess, or administer a commercially prepared, premixed
solution of sodium pentobarbital or an animal tranquilizer pursuant to this
section.
(16)
Notwithstanding subsections (1) to (6), an animal control shelter registered
with the department of agriculture and rural development pursuant to 1969 PA
287, MCL 287.331 to 287.340, may acquire a limited permit only for the purpose
of buying, possessing, and administering an animal tranquilizer to sedate or
immobilize an animal running at large that is dangerous or difficult to
capture, if the animal control shelter does all of the following:
(a)
Applies to the administrator for a permit in accordance with the rules
promulgated under this part. The application must contain the name of the
individual in charge of the day-to-day operations of the animal control shelter
and the name of the individual responsible for designating employees who will
be administering an animal tranquilizer pursuant to this act.
(b)
Complies with the rules promulgated by the administrator for the storage,
handling, and use of an animal tranquilizer. The animal control shelter shall
maintain a record of use and shall make the record available for inspection by
the department of licensing and regulatory affairs and the department of
agriculture and rural development.
(c)
Subject to subdivision (d), certifies that an employee of the animal control
shelter has received, and can document completion of, both of the following in
the following order:
(i)
The training described in subsection (10)(c).
(ii)
A minimum of 16 hours of training, including at least 12 hours of content
training and at least 4 hours of practical training, in the use of animal
tranquilizers to sedate or immobilize the animals described in this subsection
from a training program approved by the state veterinarian, in consultation
with the Michigan board of veterinary medicine, and given by a licensed
veterinarian pursuant to rules promulgated by the administrator.
(d)
Until December 31, 2021, ensures that an employee of the animal control shelter
who received, and can document the completion of, the training required
immediately before May 22, 2018 only administers a commercially prepared
solution of xylazine hydrochloride to sedate or immobilize the animals
described in this subsection. Beginning January 1, 2022, the employee described
in this subdivision must have received, and be able to document the completion
of, the training described in subdivision (c) to administer an animal tranquilizer
to perform euthanasia on the animals described in this subsection.
(e)
Certifies that only an individual described in subdivision (c) or (d) or an
individual otherwise permitted to use a controlled substance pursuant to this
article will administer an animal tranquilizer according to written procedures
established by the animal control shelter.
(f) Beginning January 1, 2022, certifies that
the individual in charge of the day-to-day operations of the animal control
shelter has received, and can document the completion of, the training
described in subdivision (c).
(g) Complies with all state and federal laws,
rules, and regulations regarding the acquisition, use, and security of
controlled substances.
(17) The application described in subsection
(16) must include the names and business addresses of all individuals employed
by the animal control shelter who have been trained as described in subsection
(16)(c), (d), and (f) and must include documented proof of the training. The
list of names and business addresses must be updated every 6 months.
(18) If an animal control shelter issued a
permit pursuant to subsection (16) does not have in its employ an individual
trained as described in subsection (16)(c) or (d) and (16)(f), the animal
control shelter shall immediately notify the administrator and shall cease to
administer an animal tranquilizer for the purposes described in subsection (16)
until the administrator is notified that 1 of the following has occurred:
(a) An individual trained as described in subsection
(16)(c), (d), or (f) has been hired by the animal control shelter.
(b) An individual employed by the animal
control shelter has been trained as described in subsection (16)(c) or (f).
(19) A veterinarian, including a veterinarian
who trains individuals as described in subsection (16)(c), (d), or (f), is
not civilly or criminally liable for the use of an animal tranquilizer by an
animal control shelter unless the veterinarian is employed by or under contract
with the animal control shelter and the terms of the veterinarians employment
or the contract require the veterinarian to be responsible for the use or
administration of an animal tranquilizer.
(20) As used in this section:
(a) Animal tranquilizer means a commercially
prepared solution of xylazine hydrochloride, a commercially prepared solution
of ketamine, or a commercially prepared compound containing tiletamine and
zolazepam.
(b) Class B dealer means a class B dealer
licensed by the United States Department of Agriculture pursuant to the animal
welfare act, 7 USC 2131 to 2160 and the department of agriculture and rural
development pursuant to 1969 PA 224, MCL 287.381 to 287.395.
Sec.
16226. (1) After finding the existence of 1 or more of the grounds for
disciplinary subcommittee action listed in section 16221, a disciplinary
subcommittee shall impose 1 or more of the following sanctions for each
violation:
Violations
of Section 16221 Sanctions
Subdivision
(a), (b)(i), (b)(ii), (b)(iii), (b)(iv), Probation, limitation, denial, suspension, revocation,
(b)(v), (b)(vi), (b)(vii), (b)(ix), (b)(x), (b)(xi), permanent revocation, restitution, or
fine.
or (b)(xii)
Subdivision
(b)(viii) Revocation,
permanent revocation, or denial.
Subdivision
(b)(xiii) Permanent
revocation for a violation described in
subsection (5);
otherwise, probation, limitation, denial,
suspension,
revocation, restitution, or fine.
Subdivision
(b)(xiv) Permanent
revocation.
Subdivision
(c)(i) Denial,
revocation, suspension, probation, limitation,
or
fine.
Subdivision
(c)(ii) Denial,
suspension, revocation, restitution, or fine.
Subdivision
(c)(iii) Probation,
denial, suspension, revocation, restitution,
or
fine.
Subdivision
(c)(iv) or (d)(iii) Fine, probation,
denial, suspension, revocation,
permanent
revocation, or restitution.
Subdivision
(d)(i) or (d)(ii) Reprimand,
fine, probation, denial, or restitution.
Subdivision
(e)(i), (e)(iii), (e)(iv), (e)(v), (h), or (s) Reprimand, fine, probation,
limitation, suspension,
revocation,
permanent revocation, denial, or restitution.
Subdivision
(e)(ii) or (i) Reprimand,
probation, suspension, revocation,
permanent
revocation, restitution, denial, or fine.
Subdivision
(e)(vi), (e)(vii), or (e)(viii) Probation, suspension,
revocation, limitation, denial,
restitution,
or fine.
Subdivision
(f) Reprimand,
denial, limitation, probation, or fine.
Subdivision
(g) Reprimand
or fine.
Subdivision
(j) Suspension
or fine.
Subdivision
(k), (p), or (r) Reprimand,
probation, suspension, revocation,
permanent
revocation, or fine.
Subdivision
(l) Reprimand,
denial, or limitation.
Subdivision
(m) or (o) Denial,
revocation, restitution, probation, suspension,
limitation,
reprimand, or fine.
Subdivision
(n) Revocation
or denial.
Subdivision
(q) Revocation.
Subdivision
(t) Revocation,
permanent revocation, fine, or restitution.
Subdivision
(u) Denial,
revocation, probation, suspension, limitation,
reprimand,
or fine.
Subdivision
(v) or (x) Probation,
limitation, denial, fine, suspension,
revocation,
or permanent revocation.
Subdivision
(w) Denial,
fine, reprimand, probation, limitation,
suspension,
revocation, or permanent revocation.
Subdivision
(y) Subject
to subsection (7), fine.
(2)
Determination of sanctions for violations under this section shall be made by a
disciplinary subcommittee. If, during judicial review, the court of appeals
determines that a final decision or order of a disciplinary subcommittee
prejudices substantial rights of the petitioner for 1 or more of the grounds
listed in section 106 of the administrative procedures act of 1969, MCL 24.306,
and holds that the final decision or order is unlawful and is to be set aside,
the court shall state on the record the reasons for the holding and may remand
the case to the disciplinary subcommittee for further consideration.
(3) A
disciplinary subcommittee may impose a fine in an amount that does not exceed
$250,000.00 for a violation of section 16221(a) or (b). A disciplinary
subcommittee shall impose a fine of at least $25,000.00 if the violation of
section 16221(a) or (b) results in the death of 1 or more patients.
(4) A
disciplinary subcommittee may require a licensee or registrant or an applicant
for licensure or registration who has violated this article, article 7, or
article 8 or a rule promulgated under this article, article 7, or article 8 to
satisfactorily complete an educational program, a training program, or a
treatment program, a mental, physical, or professional competence examination,
or a combination of those programs and examinations.
(5) A
disciplinary subcommittee shall impose the sanction of permanent revocation for
a violation of section 16221(b)(xiii) if the violation occurred
while the licensee or registrant was acting within the health profession for
which he or she was licensed or registered.
(6)
Except as otherwise provided in subsection (5) and this subsection, a
disciplinary subcommittee shall not impose the sanction of permanent revocation
under this section without a finding that the licensee or registrant engaged in
a pattern of intentional acts of fraud or deceit resulting in personal
financial gain to the licensee or registrant and harm to the health of patients
under the licensees or registrants care. This subsection does not apply if a
disciplinary subcommittee finds that a licensee or registrant has violated
section 16221(b)(xiv).
(7) A
disciplinary subcommittee shall impose a fine of not more than $250.00 for each
violation of section 16221(y).
Sec. 16322. (1) Until the effective date of the rules promulgated under section
16525 regarding licensure, fees for an individual who is registered or seeking
registration as an acupuncturist under part 165 are as follows:
(a) Application processing fee................................................................................................................... $ 75.00
(b) Registration fee, per year.................................................................................................................... $ 200.00
(2)
Beginning on the effective date of the rules promulgated under section 16525
regarding licensure, fees for an individual who
is licensed or seeking licensure to engage in the practice of acupuncture under
part 165 are as follows:
(a)
Application processing fee................................................................................................................... $
75.00
(b)
License fee, per year............................................................................................................................. $ 200.00
(c) Limited license, per year...................................................................................................................... $ 200.00
(d) Temporary license fee.......................................................................................................................... $ 200.00
Sec. 16501. (1) As used in this part:
(a) Acupressure means a form of manual therapy in which
physical pressure is applied to various points on the body.
(b) Acupuncture means the insertion and manipulation of
needles through the surface of the human body. Acupuncture includes, but is not
limited to, laser acupuncture, electroacupuncture, pricking therapy, dry
needling, and intramuscular stimulation.
(c) Acupuncturist means an individual who is licensed under
this part to engage in the practice of acupuncture.
(d) Cupping means the placement of a specially designed cup
on the body to create suction.
(e) Dermal friction means the use of repeated, closely
timed, unidirectional press-stroking with a smooth-edged instrument over a
lubricated area of the body.
(f) Dietary counseling means the process of advising a
patient about healthy food choices and healthy eating habits in accordance with
East Asian medical theory.
(g) Dry needling means a rehabilitative procedure using
filiform needles to penetrate the skin or underlying tissues by targeting only
myofascial trigger points and muscular and connective tissues to affect change
in body structures and functions for the evaluation and management of
neuromusculoskeletal pain and movement impairment. Dry needling does not
include the stimulation of auricular points or other acupuncture points.
(h) East Asian medicine techniques includes, but is not
limited to, acupuncture, manual therapy, moxibustion, heat therapy, dietary
counseling, therapeutic exercise, acupressure, cupping, dermal friction,
homeopathy, lifestyle coaching, and treatment with herbal medicines.
(i) Heat therapy means the use of heat in therapy, such as
for pain relief and health.
(j) Herbal medicine means the internal and external use of
a plant or a plant extract, a mineral, or an animal product, that is not a
prescription drug as that term is defined in section 17708.
(k) Homeopathy means the use of a highly diluted natural
remedy from the plant, mineral, and animal domain.
(l) Lifestyle coaching
means the process of advising a patient about healthy lifestyle choices and
habits in accordance with East Asian medical theory.
(m) Manual therapy means
the application of an accurately determined and specifically directed manual
force to the body, excluding a high-velocity, low-amplitude thrust to the
spine.
(n) Moxibustion means
burning the dried plant Artemisia
vulgaris on or very near the surface of the skin as a form of therapy.
(o) Practice of
acupuncture, subject to subsection (2), means the use of traditional and
contemporary East Asian medical theory to assess and diagnose a patient, to
develop a plan to treat the patient, and to treat the patient through East
Asian medicine techniques.
(p) Practice of
chiropractic means that term as defined in section 16401.
(q) Practice of massage
therapy means that term as defined in section 17951.
(r) Practice of medicine
means that term as defined in section 17001.
(s) Practice of
osteopathic medicine and surgery means that term as defined in section 17501.
(t) Practice of physical
therapy means that term as defined in section 17801.
(u) Registered
acupuncturist means an individual who is registered or otherwise authorized
under this part before the effective date of the rules
promulgated under section 16525 regarding licensure.
(v) Systematic
acupuncture education means a course of education that covers the foundation
of acupuncture science and theory, channel and point location, needling
techniques, approaches to diagnosis and therapy, and patient management.
(w) Therapeutic exercise
means a range of physical activities that help restore and build physical
strength, endurance, flexibility, balance, and stability.
(2) For purposes of this
part, practice of acupuncture does not include the practice of medicine, the
practice of osteopathic medicine and surgery, the practice of physical therapy,
the practice of occupational therapy, the practice of podiatric medicine and
podiatric surgery, the practice of nursing, the practice of dentistry, the
practice of massage therapy, or the practice of chiropractic.
(3) In addition to the
definitions in this part, article 1 contains general definitions and principles
of construction applicable to all articles in the code and part 161 contains
definitions applicable to this part.
Sec. 16511. (1) Except as
otherwise provided in this part, beginning on the effective date of rules
promulgated under section 16525 regarding licensure, an individual shall not
use the words, titles, or letters acupuncturist, certified acupuncturist, registered
acupuncturist, licensed acupuncturist, L.Ac., or a similar word or initial
that indicates that the individual is an acupuncturist, unless he or she is
authorized under this part to use the terms and in a way prescribed in this
part. However, for a period not to exceed 36 months from the effective
date of the rules promulgated under section 16525 regarding licensure, a
registered acupuncturist may, without a license under this part, continue to
use the titles acupuncturist, registered acupuncturist, or certified
acupuncturist and engage in the practice of acupuncture.
(2)
Until the effective date of the rules promulgated under section 16525 regarding
licensure, an individual shall not use the words, titles, or letters acupuncturist,
certified acupuncturist, or registered acupuncturist, or a combination of
the words, titles, or letters, with or without qualifying words or phrases,
unless he or she is registered under this part.
(3)
Until the effective date of the rules promulgated under section 16525 regarding
licensure, neither of the following is subject to this part:
(a) A
physician who is licensed under part 170 or part 175.
(b) An
individual who is certified by the National Acupuncture Detoxification
Association.
Sec. 16513. (1) Beginning on the effective date of rules
promulgated under section 16525 regarding licensure, an individual shall not
engage in the practice of acupuncture unless he or she is licensed under this
part or is otherwise authorized under this article.
(2) In addition to the exemptions from licensure under
section 16171, beginning on the effective date of the rules
promulgated under section 16525 regarding licensure, this part does not apply to any of the following:
(a) Except as otherwise provided in subdivision (e), an individual
licensed, registered, or otherwise authorized under any other part or act who
is performing activities that are considered to be within the practice of
acupuncture if those activities are within the individuals scope of practice
and the individual does not use the words, titles, or letters protected under
section 16511.
(b) A physician who is licensed under part 170 or part 175 if
the physician has completed a total of not less than 300 hours of systematic
acupuncture education that include not less than 100 hours of live lectures,
demonstrations, and supervised clinical training specific to acupuncture.
(c) An individual who meets all of the following
requirements:
(i) He or she meets the
requirements for a certificate of training as an acupuncture detoxification
specialist issued by the National Acupuncture Detoxification Association or an
organization that the board determines is a successor organization.
(ii) He or she only uses the auricular protocol for substance use disorder
prevention and treatment developed by the National Acupuncture Detoxification
Association or an organization that the board determines is a successor
organization.
(iii) When using the protocol described in subparagraph (ii), he or she is under the supervision of an acupuncturist or a physician
licensed under part 170 or part 175.
(iv) He or she does not use the words, titles, or letters protected under
section 16511.
(d) An individual
performing acupressure, cupping, dermal friction, dietary counseling, heat
therapy, herbal medicine, homeopathy, lifestyle coaching, manual therapy, or
therapeutic exercise, while engaged in the practice of a profession with
established standards and ethics and as long as those services are not
designated as or implied to be the practice of acupuncture and the individual
does not use the titles, words, or letters protected under section 16511.
(e) Dry needling by an
individual licensed, registered, or otherwise authorized under any other part
if dry needling is within the individuals scope of practice.
Sec. 16521. (1) The Michigan
board of acupuncture is created in the department and consists of the following
13 voting members, each of whom must meet the requirements of part 161:
(a) Seven acupuncturists or, until 36 months after
the effective date of the rules promulgated under section 16525, 7
registered acupuncturists. The members appointed
under this subdivision must meet the requirements of section 16135.
(b) Three physicians licensed under part 170 or 175, at least
1 of whom has met the requirement in section 16513(2)(b).
(c) Three public members.
(2) The terms of office of individual members of the board
created under this part, except those appointed to fill vacancies, expire on
June 30 of the year in which the term expires pursuant to section 16122.
Sec. 16525. (1) By
March 4, 2021, the department, in consultation with the board, shall promulgate rules
that establish the minimum standards for licensure as an acupuncturist and
implement the licensure program for the practice of acupuncture. In
promulgating rules for purposes of section 16515(1), the department, in
consultation with the board, may adopt by reference the professional standards
issued by a certified program that is recognized by the National Commission for
Certifying Agencies. In promulgating rules for purposes of section 16515(2)(b),
the department, in consultation with the board, shall consider whether an
applicant has completed systematic acupuncture education that includes live
lectures, demonstrations, and supervised clinical training specific to
acupuncture.
(2)
The rules in effect on March 3, 2020 regarding the registration of
acupuncturists remain in effect until the effective date of the rules
promulgated under subsection (1).
Sec. 16529. This part does
not require new or additional third party reimbursement or mandated workers
compensation benefits for services by an individual registered
or licensed as an acupuncturist under this part.
Sec.
17744. (1) A prescriber may designate an agent to act on behalf of or at the
discretion of that prescriber. A designation of an agent by a prescriber under
this section is not required to be in writing to be a valid designation. If a
designation of an agent by a prescriber under this section is contained in a
written document, the prescriber or the agent may transmit that document to a
pharmacy that will dispense a prescription issued by that prescriber.
(2)
Only a prescriber acting within the scope of his or her practice may issue a
prescription. An agent may prepare and transmit a prescription that has been
signed by the prescriber, including a signature that meets the requirements of
section 17754 or 17754a. The prescriber issuing a prescription and the
pharmacist dispensing a drug or device under a prescription is responsible for
all of the requirements of state and federal law, rules, and regulations
regarding the issuance of prescriptions and dispensing of drugs or devices
under prescriptions.
(3) A
prescriber or his or her agent may transmit to a pharmacy a prescription that
is contained within a patients chart in a health facility or agency licensed
under article 17 or other medical institution. A prescription that is contained
within a patients chart in a health facility or agency licensed under article
17 or other medical institution and that is created in an electronic format may
contain more than 6 prescriptions and may contain prescriptions for schedule 3
through 5 controlled substances and noncontrolled substances on the same form.
Sec. 17751. (1) A pharmacist shall not dispense a drug
requiring a prescription under the federal act or a law of this state except
under authority of an original prescription or an equivalent record of an
original prescription approved by the board. A pharmacist described in section
17742b(2) may dispense a drug pursuant to an original prescription received at
a remote pharmacy if the pharmacist receives, reviews, and verifies an exact
digital image of the prescription received at the remote pharmacy before the
drug is dispensed at the remote pharmacy.
(2) Subject to subsections (1) and (5), a pharmacist may
dispense a prescription 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 in another state, but not including a prescription
for a controlled substance except under circumstances described in section 17763(e),
only if the pharmacist in the exercise of his or her professional judgment
determines all of the following:
(a) Except as otherwise authorized under section 5110,
17744a, or 17744b, if the prescriber is a physician or dentist, that the
prescription was issued pursuant to an existing physician-patient or
dentist-patient relationship.
(b) That the prescription is authentic.
(c) That the prescribed drug is appropriate and necessary for
the treatment of an acute, chronic, or recurrent condition.
(3) A pharmacist or a prescriber shall dispense a
prescription only if the prescription falls within the scope of practice of the
prescriber.
(4) A pharmacist shall not knowingly dispense a prescription
after the death of the prescriber or patient.
(5) A pharmacist shall not dispense a drug or device under a
prescription transmitted by facsimile or created in electronic format and
printed out for use by the patient unless the document is manually signed by
the prescriber. This subsection does not apply to any of the following:
(a) A prescription that is transmitted by a computer to a
facsimile machine if that prescription complies with section 17754 or
17754a.
(b) A prescription that is
received by a remote pharmacy and made available to a pharmacist described in
section 17742b(2) for review and verification in the manner required under
subsection (1).
(6) After consultation with
and agreement from the prescriber, a pharmacist may add or change a patients
address, a dosage form, a drug strength, a drug quantity, a direction for use,
or an issue date with regard to a prescription. A pharmacist shall note the
details of the consultation and agreement required under this subsection on the
prescription or, if the drug is dispensed at a remote pharmacy, on the digital
image of the prescription described in subsection (1), and shall maintain that
documentation with the prescription as required in section 17752. A
pharmacist shall not change the patients name, controlled substance prescribed
unless authorized to dispense a lower cost generically equivalent drug product
under section 17755, or the prescribers signature with regard to a
prescription.
(7) A prescription that is
contained within a patients chart in a health facility or agency licensed
under article 17 or other medical institution and that is transmitted to a
pharmacy under section 17744 is the original prescription. If all other
requirements of this part are met, a pharmacist shall dispense a drug or device
under a prescription described in this subsection. A pharmacist may dispense a
drug or device under a prescription described in this subsection even if the
prescription does not contain the quantity ordered. If a prescription described
in this subsection does not contain the quantity ordered, the pharmacist shall
consult with the prescriber to determine an agreed-upon quantity. The
pharmacist shall record the quantity dispensed on the prescription and shall
maintain that documentation with the prescription as required in section 17752.
(8) If, after consulting with
a patient, a pharmacist determines in the exercise of his or her professional
judgment that dispensing additional quantities of a prescription drug is
appropriate for the patient, the pharmacist may dispense, at one time,
additional quantities of the prescription drug up to the total number of dosage
units authorized by the prescriber on the original prescription for the patient
and any refills of the prescription. Except for a controlled substance included
in schedule 5 that does not contain an opioid, this subsection does not apply to
a prescription for a controlled substance.
Enacting section 1. This amendatory act does not take effect unless all
of the following bills of the 100th Legislature are enacted into law:
(a) Senate Bill No. 254.
(b) House Bill No. 4217.
Secretary of the Senate
Clerk of the House of Representatives
Approved___________________________________________
____________________________________________________
Governor