HOUSE BILL NO. 4472

April 25, 2023, Introduced by Reps. Farhat and Mueller and referred to the Committee on Health Policy.

"Public health code,"

by amending sections 16221, 17001, 17047, 17049, 17201, 17211a, 17214, 17501, 17547, 17549, 18001, 18047, 18049, 20174, and 20201 (MCL 333.16221, 333.17001, 333.17047, 333.17049, 333.17201, 333.17211a, 333.17214, 333.17501, 333.17547, 333.17549, 333.18001, 333.18047, 333.18049, 333.20174, and 333.20201), section 16221 as amended by 2020 PA 232, section 17001 as amended by 2018 PA 624, sections 17047, 17547, 18047, and 20174 as added and sections 17049, 17549, and 18049 as amended by 2016 PA 379, sections 17201 and 20201 as amended and sections 17211a and 17214 as added by 2016 PA 499, section 17501 as amended by 2018 PA 524, and section 18001 as amended by 2018 PA 355, and by adding sections 17217 and 17217a.

the people of the state of michigan enact:

Sec. 16221. Subject to section 16221b, the department shall investigate any allegation that 1 or more of the grounds for disciplinary subcommittee action under this section exist, and may investigate activities related to the practice of a health profession by a licensee, a registrant, or an applicant for licensure or registration. The department may hold hearings, administer oaths, and order the taking of relevant testimony. After its investigation, the department shall provide a copy of the administrative complaint to the appropriate disciplinary subcommittee. The disciplinary subcommittee shall proceed under section 16226 if it finds that 1 or more of the following grounds exist:

(a) Except as otherwise specifically provided in this section, a violation of general duty, consisting of negligence or failure to exercise due care, including negligent delegation to or supervision of employees or other individuals, whether or not injury results, or any conduct, practice, or condition that impairs, or may impair, the ability to safely and skillfully engage in the practice of the health profession.

(b) Personal disqualifications, consisting of 1 or more of the following:

(i) Incompetence.

(ii) Subject to sections 16165 to 16170a, substance use disorder as defined in section 100d of the mental health code, 1974 PA 258, MCL 330.1100d.

(iii) Mental or physical inability reasonably related to and adversely affecting the licensee's or registrant's ability to practice in a safe and competent manner.

(iv) Declaration of mental incompetence by a court of competent jurisdiction.

(v) Conviction of a misdemeanor punishable by imprisonment for a maximum term of 2 years; conviction of a misdemeanor involving the illegal delivery, possession, or use of a controlled substance; or conviction of any felony other than a felony listed or described in another subparagraph of this subdivision. A certified copy of the court record is conclusive evidence of the conviction.

(vi) Lack of good moral character.

(vii) Conviction of a criminal offense under section 520e or 520g of the Michigan penal code, 1931 PA 328, MCL 750.520e and 750.520g. A certified copy of the court record is conclusive evidence of the conviction.

(viii) Conviction of a violation of section 492a of the Michigan penal code, 1931 PA 328, MCL 750.492a. A certified copy of the court record is conclusive evidence of the conviction.

(ix) Conviction of a misdemeanor or felony involving fraud in obtaining or attempting to obtain fees related to the practice of a health profession. A certified copy of the court record is conclusive evidence of the conviction.

(x) Final adverse administrative action by a licensure, registration, disciplinary, or certification board involving the holder of, or an applicant for, a license or registration regulated by another state or a territory of the United States, by the United States military, by the federal government, or by another country. A certified copy of the record of the board is conclusive evidence of the final action.

(xi) Conviction of a misdemeanor that is reasonably related to or that adversely affects the licensee's or registrant's ability to practice in a safe and competent manner. A certified copy of the court record is conclusive evidence of the conviction.

(xii) Conviction of a violation of section 430 of the Michigan penal code, 1931 PA 328, MCL 750.430. A certified copy of the court record is conclusive evidence of the conviction.

(xiii) Conviction of a criminal offense under section 83, 84, 316, 317, 321, 520b, 520c, 520d, or 520f of the Michigan penal code, 1931 PA 328, MCL 750.83, 750.84, 750.316, 750.317, 750.321, 750.520b, 750.520c, 750.520d, and 750.520f. A certified copy of the court record is conclusive evidence of the conviction.

(xiv) Conviction of a violation of section 136 or 136a of the Michigan penal code, 1931 PA 328, MCL 750.136 and 750.136a. A certified copy of the court record is conclusive evidence of the conviction.

(i) Fraud or deceit in obtaining or renewing a license or registration.

(ii) Permitting a license or registration to be used by an unauthorized person.

(iii) Practice outside the scope of a license.

(iv) Obtaining, possessing, or attempting to obtain or possess a controlled substance or a drug as defined in section 7105 without lawful authority; or selling, prescribing, giving away, or administering drugs for other than lawful diagnostic or therapeutic purposes.

(d) Except as otherwise specifically provided in this section, unethical business practices, consisting of 1 or more of the following:

(i) False or misleading advertising.

(ii) Dividing fees for referral of patients or accepting kickbacks on medical or surgical services, appliances, or medications purchased by or in behalf of patients.

(iii) Fraud or deceit in obtaining or attempting to obtain third party reimbursement.

(e) Except as otherwise specifically provided in this section, unprofessional conduct, consisting of 1 or more of the following:

(i) Misrepresentation to a consumer or patient or in obtaining or attempting to obtain third party reimbursement in the course of professional practice.

(ii) Betrayal of a professional confidence.

(iii) Promotion for personal gain of an unnecessary drug, device, treatment, procedure, or service.

(iv) Either of the following:

(A) A requirement by a licensee other than a physician or a registrant that an individual purchase or secure a drug, device, treatment, procedure, or service from another person, place, facility, or business in which the licensee or registrant has a financial interest.

(B) A referral by a physician for a designated health service that violates 42 USC 1395nn or a regulation promulgated under that section. For purposes of this subdivision, 42 USC 1395nn and the regulations promulgated under that section as they exist on June 3, 2002 are incorporated by reference. A disciplinary subcommittee shall apply 42 USC 1395nn and the regulations promulgated under that section regardless of the source of payment for the designated health service referred and rendered. If 42 USC 1395nn or a regulation promulgated under that section is revised after June 3, 2002, the department shall officially take notice of the revision. Within 30 days after taking notice of the revision, the department shall decide whether or not the revision pertains to referral by physicians for designated health services and continues to protect the public from inappropriate referrals by physicians. If the department decides that the revision does both of those things, the department may promulgate rules to incorporate the revision by reference. If the department does promulgate rules to incorporate the revision by reference, the department shall not make any changes to the revision. As used in this sub-subparagraph, "designated health service" means that term as defined in 42 USC 1395nn and the regulations promulgated under that section and "physician" means that term as defined in sections 17001 and 17501.

(v) For a physician who makes referrals under 42 USC 1395nn or a regulation promulgated under that section, refusing to accept a reasonable proportion of patients eligible for Medicaid and refusing to accept payment from Medicaid or Medicare as payment in full for a treatment, procedure, or service for which the physician refers the individual and in which the physician has a financial interest. A physician who owns all or part of a facility in which he or she provides surgical services is not subject to this subparagraph if a referred surgical procedure he or she performs in the facility is not reimbursed at a minimum of the appropriate Medicaid or Medicare outpatient fee schedule, including the combined technical and professional components.

(vi) Any conduct by a health professional with a patient while he or she is acting within the health profession for which he or she is licensed or registered, including conduct initiated by a patient or to which the patient consents, that is sexual or may reasonably be interpreted as sexual, including, but not limited to, sexual intercourse, kissing in a sexual manner, or touching of a body part for any purpose other than appropriate examination, treatment, or comfort.

(vii) Offering to provide practice-related services, such as drugs, in exchange for sexual favors.

(viii) A violation of section 16655(4) by a dental therapist.

(f) Failure to notify under section 16222(3) or (4).

(g) Failure to report a change of name or mailing address as required in section 16192.

(h) A violation, or aiding or abetting in a violation, of this article or of a rule promulgated under this article.

(i) Failure to comply with a subpoena issued pursuant to this part, failure to respond to a complaint issued under this article, article 7, or article 8, failure to appear at a compliance conference or an administrative hearing, or failure to report under section 16222(1) or 16223.

(j) Failure to pay an installment of an assessment levied under the insurance code of 1956, 1956 PA 218, MCL 500.100 to 500.8302, within 60 days after notice by the appropriate board.

(k) A violation of section 17013 or 17513.

(l) Failure to meet 1 or more of the requirements for licensure or registration under section 16174.

(m) A violation of section 17015, 17015a, 17017, 17515, or 17517.

(n) A violation of section 17016 or 17516.

(o) Failure to comply with section 9206(3).

(p) A violation of section 5654 or 5655.

(q) A violation of section 16274.

(r) A violation of section 17020 or 17520.

(s) A violation of the medical records access act, 2004 PA 47, MCL 333.26261 to 333.26271.

(t) A violation of section 17764(2).

(u) Failure to comply with the terms of a practice agreement described in section 17047(2)(a) or (b), 17047(3)(a)(i) or (ii), 17217(2)(a)(i) or (ii), 17547(2)(a) or (b), or 17547(3)(a)(i) or (ii), 18047(2)(a) or (b), or 18047(3)(a)(i) or (ii).

(v) A violation of section 7303a(2).

(w) A violation of section 7303a(4) or (5).

(x) A violation of section 7303b.

(y) A violation of section 17754a.

(z) Beginning January 1, 2021, a A violation of section 24507 or 24509.

Sec. 17001. (1) As used in this part:

(a) "Academic institution" means either of the following:

(i) A medical school approved by the board.

(ii) A hospital licensed under article 17 that meets all of the following requirements:

(A) Was the sole sponsor or a co-sponsor, if each other co-sponsor is either a medical school approved by the board or a hospital owned by the federal government and directly operated by the United States Department of Veterans Affairs, of not less than 4 postgraduate education residency programs approved by the board under section 17031(1) for not less than the 3 years immediately preceding the date of an application for a limited license under section 16182(2)(c) or an application for a full license under section 17031(2), if at least 1 of the residency programs is in the specialty area of medical practice, or in a specialty area that includes the subspecialty of medical practice, in which the applicant for a limited license proposes to practice or in which the applicant for a full license has practiced for the hospital.

(B) Has spent not less than $2,000,000.00 for medical education during each of the 3 years immediately preceding the date of an application for a limited license under section 16182(2)(c) or an application for a full license under section 17031(2). As used in this sub-subparagraph, "medical education" means the education of physicians and candidates for degrees or licenses to become physicians, including, but not limited to, physician staff, residents, interns, and medical students.

(b) "Electrodiagnostic studies" means the testing of neuromuscular functions utilizing nerve conduction tests and needle electromyography. It does not include the use of surface electromyography.

(c) "Genetic counselor" means an individual who is licensed under this part to engage in the practice of genetic counseling.

(d) "Medical care services" means those services within the scope of practice of physicians who are licensed or authorized by the board, except those services that the board prohibits or otherwise restricts within a practice agreement or determines shall not be delegated by a physician because a delegation would endanger the health and safety of patients as provided for in section 17048(1).

(e) "Participating physician" means a physician , a physician designated by a group of physicians under described in section 17049. to represent that group, or a physician designated by a health facility or agency under section 20174 to represent that health facility or agency.

(f) "Physician" means an individual who is licensed or authorized under this article to engage in the practice of medicine.

(g) "Physician-led patient care team" means a multidisciplinary team consisting of at least 1 physician and at least 1 advanced practice registered nurse as that term is defined in section 17201 or physician's assistant that is led by 1 or more participating physicians and functions as a unit for the purposes of providing and delivering services.

(h) (g) "Podiatrist" means an individual who is licensed under this article to engage in the practice of podiatric medicine and surgery.

(i) (h) "Practice agreement" means an agreement described in section 17047.

(j) (i) "Practice of genetic counseling" means provision of any of the following services:

(i) Obtaining and evaluating individual, family, and medical histories to determine the genetic risk for genetic or medical conditions or diseases in a client, the client's descendants, or other family members of the client.

(ii) Discussing with a client the features, natural history, means of diagnosis, genetic and environmental factors, and management of the genetic risks of genetic or medical conditions or diseases.

(iii) Identifying and coordinating appropriate genetic laboratory tests and other diagnostic studies for genetic assessment of a client.

(iv) Integrating genetic laboratory test results and other diagnostic studies with personal and family medical history to assess and communicate a client's risk factors for genetic or medical conditions or diseases.

(v) Explaining to a client the clinical implications of genetic laboratory tests and other diagnostic studies and their results.

(vi) Evaluating the responses of a client and the client's family to a genetic or medical condition or disease or to the risk of recurrence of that condition or disease and providing client-centered counseling and anticipatory guidance.

(vii) Identifying and utilizing community resources that provide medical, educational, financial, and psychosocial support and advocacy to a client.

(viii) Providing written documentation of medical, genetic, and counseling information for families of and health care professionals of a client.

(k) (j) "Practice of medicine" means the diagnosis, treatment, prevention, cure, or relieving of a human disease, ailment, defect, complaint, or other physical or mental condition, by attendance, advice, device, diagnostic test, or other means, or offering, undertaking, attempting to do, or holding oneself out as able to do, any of these acts.

(l) (k) "Practice as a physician's assistant" means the practice of medicine with a participating physician under a practice agreement.

(m) (l) "Qualified supervisor" means an individual who is a genetic counselor and who holds a license under this part other than a temporary or limited license.

(n) (m) "Task force" means the joint task force created in section 17025.

(o) (n) "Temporary licensed genetic counselor" means a genetic counselor who has been issued a temporary license under this article.

(2) In addition to the definitions in this part, article 1 contains definitions and principles of construction applicable to all articles in this code and part 161 contains definitions applicable to this part.

Sec. 17047. (1) A physician's assistant shall not engage in the practice as a physician's assistant except under the terms of a practice agreement that meets the requirements of this section.subsection (2) or (3), as applicable.

(2) A practice agreement that is entered into, amended, extended, or renewed before January 1, 2024 must be between a physician's assistant and a participating physician and must include all of the following:

(a) A process between the physician's assistant and participating physician for communication, availability, and decision making when providing medical treatment to a patient. The process must utilize the knowledge and skills of the physician's assistant and participating physician based on their education, training, and experience.

(b) A protocol for designating an alternative physician for consultation in situations in which the participating physician is not available for consultation.

(d) A termination provision that allows the physician's assistant or participating physician to terminate the practice agreement by providing written notice at least 30 days before the date of termination.

(e) Subject to section 17048, the duties and responsibilities of the physician's assistant and participating physician. The practice agreement shall must not include as a duty or responsibility of the physician's assistant or participating physician an act, task, or function that the physician's assistant or participating physician is not qualified to perform by education, training, or experience and that is not within the scope of the license held by the physician's assistant or participating physician.

(f) A requirement that the participating physician verify the physician's assistant's credentials.

(3) If a practice agreement is entered into, amended, extended, or renewed on or after January 1, 2024, the practice agreement must be between a physician's assistant and a participating physician as members of a physician-led patient care team. The following apply to a practice agreement under this subsection:

(a) The practice agreement must include all of the following:

(i) A process between the physician's assistant and participating physician for communication, availability, and decision making when providing medical treatment to a patient. The process must utilize the knowledge and skills of the physician's assistant and participating physician based on their education, training, and experience.

(ii) A protocol for designating an alternative physician for consultation in situations in which the participating physician is not available for consultation.

(iii) The typewritten or printed names and signatures of the physician's assistant and participating physician.

(iv) A termination provision that allows the physician's assistant or participating physician to terminate the practice agreement by providing written notice at least 30 days before the date of termination.

(v) Subject to section 17048, the duties and responsibilities of the physician's assistant and participating physician. The practice agreement must not include as a duty or responsibility of the physician's assistant or participating physician an act, task, or function that the physician's assistant or participating physician is not qualified to perform by education, training, or experience and that is not within the scope of the license held by the physician's assistant or participating physician.

(vi) A requirement that the participating physician verify the physician's assistant's credentials.

(vii) A requirement for the periodic review of patient charts and medical records and guidelines for collaboration and consultation among the parties to the practice agreement.

(viii) A process for the periodic, joint evaluation of the services delivered to a patient and for physician input when necessary, including, but not limited to, in complex clinical cases, in patient emergencies, and for referrals.

(ix) An evaluation process for measuring the performance of the physician's assistant.

(b) The practice agreement may include procedures for periodic site visits by a participating physician if the participating physician practices at a location other than where the physician's assistant regularly practices. The participating physician shall determine the manner and frequency of a site visit under this subdivision.

(4) A physician's assistant shall maintain a copy of a practice agreement entered into under this section and provide it to the board and the department on request.

(5) During an initial encounter with a patient, a physician's assistant shall inform the patient of the respective health profession subfield of the physician's assistant and, on the request of the patient, provide the patient with the name of the participating physician with whom the physician's assistant is a party to a practice agreement and contact information for the participating physician.

(6) The name and contact information of a participating physician with whom a physician's assistant is a party to a practice agreement must be conspicuously posted where services are delivered by the physician's assistant and on the practice's website, if applicable, in a manner that ensures transparency for patients.

(7) (3) The following are subject to section 16221:

(a) The number of physician's assistants in a practice agreement with a participating physician. and the

(b) The number of individuals to whom a physician has delegated the authority to perform acts, tasks, or functions. are subject to section 16221.

Sec. 17049. (1) Subject to subsection (2), any of the following may enter into a practice agreement as a participating physician:

(a) A physician.

(b) One or more physicians in a group of physicians practicing other than as sole practitioners may designate 1 or more physicians in who are designated by the group to enter into a the practice agreement. under section 17047.

(c) One or more physicians designated by a health facility or agency under section 20174 to represent that health facility or agency.

(2) If a physician described in subsection (1) enters into a practice agreement under section 17047(3), the physician shall comply with all of the following:

(a) The physician shall regularly practice medicine in this state.

(b) The physician shall manage and lead the members of the physician-led patient care team with whom the physician is a party to the practice agreement.

(c) The physician shall be available at all times to collaborate and consult with each member of the physician-led patient care team with whom the physician is a party to the practice agreement.

(d) The physician shall ensure that any act, task, or function performed by a member of the physician-led patient care team with whom the physician is a party to a practice agreement is performed in a manner consistent with sound medical practice and for the protection of the health and safety of a patient.

(3) (2) Notwithstanding any law or rule to the contrary, a physician is not required to countersign orders written in a patient's clinical record by a physician's assistant with whom the physician has a practice agreement. Notwithstanding any law or rule to the contrary, a physician is not required to sign an official form that lists the physician's signature as the required signatory if that official form is signed by a physician's assistant with whom the physician has a practice agreement.

Sec. 17201. (1) As used in this part:

(a) "Advanced practice registered nurse" or "a.p.r.n." means a registered professional nurse who has been granted a specialty certification under section 17210 in 1 of the following health profession specialty fields:

(i) Nurse midwifery.

(ii) Nurse practitioner.

(iii) Clinical nurse specialist.

(b) "Physician" means a physician who is licensed under part 170 or part 175.

(d) "Physician- or podiatrist-led patient care team" means a multidisciplinary team consisting of at least 1 physician or podiatrist and at least 1 advanced practice registered nurse or physician's assistant that is led by 1 or more participating physicians or podiatrists and functions as a unit for the purposes of providing and delivering services.

(e) "Podiatrist" means that term as defined in section 18001.

(f) "Practice agreement" means the agreement described in section 17217.

(g) (c) "Practice of nursing" means the systematic application of substantial specialized knowledge and skill, derived from the biological, physical, and behavioral sciences, to the care, treatment, counsel, and health teaching of individuals who are experiencing changes in the normal health processes or who require assistance in the maintenance of health and the prevention or management of illness, injury, or disability.

(h) (d) "Practice of nursing as a licensed practical nurse" or "l.p.n." means the practice of nursing based on less comprehensive knowledge and skill than that required of a registered professional nurse and performed under the supervision of a registered professional nurse, physician, or dentist.

(i) (e) "Registered professional nurse" or "r.n." means an individual who is licensed under this part to engage in the practice of nursing which scope of practice includes the teaching, direction, and supervision of less skilled personnel in the performance of delegated nursing activities.

(2) 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. 17211a. (1) An advanced practice registered nurse may prescribe any of the following:

(a) A nonscheduled prescription drug.

(b) Subject to subsection (2) and except as otherwise provided in subsection (3), a controlled substance included in schedules 2 to 5 of part 72, as a delegated act of a physician.

(2) If an advanced practice registered nurse prescribes a controlled substance under subsection (1)(b), both the advanced practice registered nurse's name and the physician's name shall must be used, recorded, or otherwise indicated in connection with that prescription. If an advanced practice registered nurse prescribes a controlled substance under subsection (1)(b), both the advanced practice registered nurse's and the physician's DEA registration numbers shall must be used, recorded, or otherwise indicated in connection with that prescription.

(3) Beginning January 1, 2024, an advanced practice registered nurse shall not prescribe a controlled substance under subsection (1)(b) unless the advanced practice registered nurse is authorized to prescribe that controlled substance in a practice agreement.

(4) (3) The amendatory act that added this This section does not require new or additional third-party reimbursement or mandated worker's compensation benefits for services rendered by an advanced practice registered nurse who is authorized to prescribe nonscheduled prescription drugs and controlled substances included in schedules 2 to 5 of part 72 under this section.

Sec. 17214. (1) An Except as otherwise provided in subsection (2), an advanced practice registered nurse may make calls or go on rounds in private homes, public institutions, emergency vehicles, ambulatory care clinics, hospitals, intermediate or extended care facilities, health maintenance organizations, nursing homes, or other health care facilities.

(2) Beginning January 1, 2024, an advanced practice registered nurse may make calls or go on rounds in private homes, public institutions, emergency vehicles, ambulatory care clinics, hospitals, intermediate or extended care facilities, health maintenance organizations, nursing homes, or other health care facilities, only in accordance with a practice agreement.

(3) Notwithstanding any law or rule to the contrary, an advanced practice registered nurse may make calls or go on rounds as provided in this section without restrictions on the time or frequency of visits by a physician or the advanced practice registered nurse.

Sec. 17217. (1) Beginning January 1, 2024, except as otherwise provided in subsection (6), an advanced practice registered nurse shall not practice in his or her respective health profession specialty field except under the terms of a practice agreement with a participating physician or podiatrist as members of a physician- or podiatrist-led patient care team.

(2) Subject to rules promulgated under subsection (7), the following apply to a practice agreement:

(a) The practice agreement must include all of the following:

(i) A process between the advanced practice registered nurse and participating physician or podiatrist for communication, availability, and decision making when providing medical treatment to a patient. The process must utilize the knowledge and skills of the advanced practice registered nurse and participating physician or podiatrist based on their education, training, and experience.

(ii) A protocol for designating an alternative physician or podiatrist, as applicable, for consultation in situations in which the participating physician or podiatrist is not available for consultation.

(iii) The typewritten or printed names and signatures of the advanced practice registered nurse and participating physician or podiatrist.

(iv) A termination provision that allows the advanced practice registered nurse and participating physician or podiatrist to terminate the practice agreement by providing written notice at least 30 days before the date of termination.

(v) The duties and responsibilities of the advanced practice registered nurse and participating physician or podiatrist. The practice agreement must not include as a duty or responsibility of the advanced practice registered nurse and participating physician or podiatrist an act, task, or function that the advanced practice registered nurse and participating physician or podiatrist are not qualified to perform by education, training, or experience and that is not within the scope of the license held by the participating physician or podiatrist.

(vi) A requirement that the participating physician or podiatrist verify the advanced practice registered nurse's credentials.

(vii) A requirement for the periodic review of patient charts and medical records and guidelines for collaboration and consultation among the parties to the practice agreement.

(viii) A process for the periodic, joint evaluation of the services delivered to a patient and for physician or podiatrist input, as applicable, when necessary, including, but not limited to, in complex clinical cases, in patient emergencies, and for referrals.

(ix) An evaluation process for measuring the performance of the advanced practice registered nurse.

(x) A description of the controlled substances that the advanced practice registered nurse is or is not authorized to prescribe under section 17211a. A practice agreement must not limit or prohibit the ordering, receipt, and dispensing of complimentary starter dose drugs, including controlled substances, by an advanced practice registered nurse as otherwise permitted under section 17212.

(xi) Any other requirement required by the department by rule.

(b) The practice agreement may include the following:

(i) Procedures for periodic site visits by a participating physician or podiatrist if the participating physician or podiatrist practices at a location other than where the advanced practice registered nurse regularly practices. The participating physician or podiatrist shall determine the manner and frequency of a site visit under this subparagraph.

(ii) A requirement that the advanced practice registered nurse maintain malpractice insurance.

(3) An advanced practice registered nurse shall maintain a copy of a practice agreement entered into under this section and provide it to the board and the department on request.

(4) During an initial encounter with a patient, an advanced practice registered nurse shall inform the patient of the respective health profession specialty field of the advanced practice registered nurse and, on the request of the patient, provide the patient with the name of the participating physician or podiatrist with whom the advanced practice registered nurse is a party to a practice agreement and contact information for the participating physician or podiatrist.

(5) The name and contact information of a participating physician or podiatrist with whom an advanced practice registered nurse is a party to a practice agreement must be conspicuously posted where services are delivered by the advanced practice registered nurse and on the practice's website, if applicable, in a manner that ensures transparency for patients.

(6) If a participating physician or podiatrist who is a party to a practice agreement with an advance practice registered nurse is unable to serve and the advanced practice registered nurse is unable to enter into a new practice agreement, the advanced practice registered nurse may continue to practice in his or her respective health profession specialty field for a period not to exceed 60 days. Before continuing to practice under this subsection, the advanced practice registered nurse shall notify the board, in a form and manner required by the department, that the participating physician or podiatrist is unable to serve. The 60-day period described in this subsection begins on the date that the board receives the notice required under this subsection. The board may extend the 60-day period described in this subsection for 1 additional 60-day period if the advanced practice registered nurse provides evidence to the satisfaction of the board that he or she is attempting to enter into a new practice agreement. An advanced practice registered nurse who continues to practice under this subsection shall ensure that he or she has access to appropriate physician or podiatrist input for complex clinical cases, patient emergencies, and referrals and shall not prescribe a controlled substance unless he or she is authorized to prescribe that controlled substance pursuant to the terms of the practice agreement with the participating physician or podiatrist described in this subsection. As used in this subsection, "is unable to serve" means dies, becomes disabled, retires, relocates and the relocation prevents him or her from being able to serve as the participating physician or podiatrist, or surrenders his or her license to or has his or her license suspended, revoked, or permanently revoked by the Michigan board of medicine, Michigan board of osteopathic medicine and surgery, or Michigan board of podiatric medicine and surgery, as applicable.

(7) The department, in consultation with the board, the Michigan board of medicine, the Michigan board of osteopathic medicine and surgery, and the Michigan board of podiatric medicine and surgery, shall promulgate rules to implement this section, including, but not limited to, rules specifying all of the following:

(a) What collaboration and communication must include for purposes of a practice agreement. The rules must allow for collaboration and consultation to occur through the use of electronic media to link an advanced practice registered nurse with a participating physician or podiatrist in different locations. The electronic media must be a health insurance portability and accountability act of 1996, Public Law 104-191, compliant, secure interactive audio or video, or both, telecommunications system, or use store and forward online messaging.

(b) A process for the periodic review of and revisions to a practice agreement.

(c) A process for allowing the advanced practice registered nurse to practice during the transition from 1 practice agreement to another if the practice agreement is terminated or if the participating physician or podiatrist is unable to serve under subsection (6).

(d) Whether and to what extent there should be a limit on the number of advanced practice registered nurses with whom a participating physician or podiatrist may be a party to a practice agreement.

Sec. 17217a. (1) Any of the following may enter into a practice agreement as a participating physician or podiatrist:

(a) A physician.

(b) One or more physicians in a group of physicians practicing other than as sole practitioners who are designated by the group to enter into the practice agreement.

(c) One or more physicians designated by a health facility or agency under section 20174 to represent that health facility or agency.

(d) A podiatrist.

(e) One or more podiatrists in a group of podiatrists practicing other than as sole practitioners who are designated by the group to enter into the practice agreement.

(2) If a physician or podiatrist described in subsection (1) enters into a practice agreement, the physician or podiatrist shall comply with all of the following:

(a) The physician or podiatrist shall regularly practice medicine, osteopathic medicine and surgery, or podiatric medicine and surgery, in this state.

(b) The physician or podiatrist shall manage and lead the members of the physician- or podiatrist-led patient care team with whom the physician or podiatrist is a party to the practice agreement.

(c) The physician or podiatrist shall be available at all times to collaborate and consult with each member of the physician- or podiatrist-led patient care team with whom the physician or podiatrist is a party to the practice agreement.

(d) The physician or podiatrist shall ensure that any act, task, or function performed by a member of the physician- or podiatrist-led patient care team with whom the physician or podiatrist is a party to the practice agreement is performed in a manner consistent with sound medical practice and for the protection of the health and safety of a patient.

Sec. 17501. (1) As used in this part:

(a) "Electrodiagnostic studies" means the testing of neuromuscular functions utilizing nerve conduction tests and needle electromyography. It does not include the use of surface electromyography.

(b) "Medical care services" means those services within the scope of practice of physicians who are licensed or authorized by the board, except those services that the board prohibits or otherwise restricts within a practice agreement or determines shall not be delegated by a physician without endangering the health and safety of patients as provided for in section 17548(1).

(c) "Participating physician" means a physician , a physician designated by a group of physicians under described in section 17549. to represent that group, or a physician designated by a health facility or agency under section 20174 to represent that health facility or agency.

(d) "Physician" means an individual who is licensed or authorized under this article to engage in the practice of osteopathic medicine and surgery.

(e) "Physician-led patient care team" means a multidisciplinary team consisting of at least 1 physician and at least 1 advanced practice registered nurse as that term is defined in section 17201 or physician's assistant that is led by 1 or more participating physicians and functions as a unit for the purposes of providing and delivering services.

(f) (e) "Practice agreement" means an agreement described in section 17547.

(g) (f) "Practice of osteopathic medicine and surgery" means a separate, complete, and independent school of medicine and surgery utilizing full methods of diagnosis and treatment in physical and mental health and disease, including the prescription and administration of drugs and biologicals, operative surgery, obstetrics, radiological and other electromagnetic emissions, and placing special emphasis on the interrelationship of the musculoskeletal system to other body systems.

(h) (g) "Practice as a physician's assistant" means the practice of osteopathic medicine and surgery with a participating physician under a practice agreement.

(i) (h) "Task force" means the joint task force created in section 17025.

Sec. 17547. (1) A physician's assistant shall not engage in the practice as a physician's assistant except under the terms of a practice agreement that meets the requirements of this section.subsection (2) or (3), as applicable:

(b) A protocol for designating an alternative physician for consultation in situations in which the participating physician is not available for consultation.

(e) Subject to section 17548, the duties and responsibilities of the physician's assistant and participating physician. The practice agreement shall must not include as a duty or responsibility of the physician's assistant or participating physician an act, task, or function that the physician's assistant or participating physician is not qualified to perform by education, training, or experience and that is not within the scope of the license held by the physician's assistant or participating physician.

(f) A requirement that the participating physician verify the physician's assistant's credentials.

(a) The practice agreement must include all of the following:

(ii) A protocol for designating an alternative physician for consultation in situations in which the participating physician is not available for consultation.

(iii) The typewritten or printed names and signatures of the physician's assistant and participating physician.

(v) Subject to section 17548, the duties and responsibilities of the physician's assistant and participating physician. The practice agreement must not include as a duty or responsibility of the physician's assistant or participating physician an act, task, or function that the physician's assistant or participating physician is not qualified to perform by education, training, or experience and that is not within the scope of the license held by the physician's assistant or participating physician.

(vi) A requirement that the participating physician verify the physician's assistant's credentials.

(vii) A requirement for the periodic review of patient charts and medical records and guidelines for collaboration and consultation among the parties to the practice agreement.

(ix) An evaluation process for measuring the performance of the physician's assistant.

(4) A physician's assistant shall maintain a copy of a practice agreement entered into under this section and provide it to the board and the department on request.

(7) (3) The following are subject to section 16221:

(a) The number of physician's assistants in a practice agreement with a participating physician. and the

(b) The number of individuals to whom a physician has delegated the authority to perform acts, tasks, or functions. are subject to section 16221.

Sec. 17549. (1) Subject to subsection (2), any of the following may enter into a practice agreement as a participating physician:

(a) A physician.

(c) One or more physicians designated by a health facility or agency under section 20174 to represent that health facility or agency.

(2) If a physician described in subsection (1) enters into a practice agreement under section 17547(3), the physician shall comply with all of the following:

(a) The physician shall regularly practice osteopathic medicine and surgery in this state.

(b) The physician shall manage and lead the members of the physician-led patient care team with whom the physician is a party to the practice agreement.

(c) The physician shall be available at all times to collaborate and consult with each member of the physician-led patient care team with whom the physician is a party to the practice agreement.

(d) The physician shall ensure that any act, task, or function performed by a member of the physician-led patient care team with whom the physician is a party to the practice agreement is performed in a manner consistent with sound medical practice and for the protection of the health and safety of a patient.

Sec. 18001. (1) As used in this part:

(a) "Medical care services" means those services within the scope of practice of podiatric physicians licensed by the board, except those services that the board prohibits or otherwise restricts within a practice agreement or determines shall not be delegated by a podiatric physician without endangering the health and safety of patients as provided for in section 18048.

(b) "Participating podiatrist" means a podiatric physician or a podiatric physician designated by a group of podiatric physicians under described in section 18049. to represent that group.

(c) "Podiatric physician" or "podiatrist" means an individual who is licensed under this article to engage in the practice of podiatric medicine and podiatric surgery.

(d) "Podiatrist-led patient care team" means a multidisciplinary team consisting of at least 1 podiatrist and at least 1 advanced practice registered nurse as that term is defined in section 17201 or physician's assistant that is led by 1 or more participating podiatrists and functions as a unit for the purposes of providing and delivering services.

(e) (d) "Practice agreement" means an agreement described in section 18047.

(f) (e) "Practice as a physician's assistant" means the practice of podiatric medicine and podiatric surgery with a participating podiatric physician podiatrist under a practice agreement.

(g) (f) Except as otherwise provided in subdivision (g), (h), "practice of podiatric medicine and podiatric surgery" or "practice of podiatric medicine and surgery" means any of the following:

(i) The evaluation, diagnosis, management, and prevention of conditions of the lower extremities, including local manifestations of systemic disease in the human foot and ankle, by attending to and advising patients and through the use of devices, diagnostic tests, drugs and biologicals, surgical procedures, or other means. The evaluation, diagnosis, management, and prevention of conditions of the lower extremities may include osseous and soft tissue procedures that address the pathology of the foot, ankle, and the contiguous attachments below the tibial tuberosity.

(ii) The treatment of ulcerations below the tibial tuberosity and of human nail diseases, callosities, and verruca.

(h) (g) "Practice of podiatric medicine and podiatric surgery" does not include amputations proximal to the tibiotalar joint, proximal osseous procedures that do not involve the tibiotalar joint, or the administration of intravenous sedation or general anesthesia.

(i) (h) "Task force" means the joint task force created in section 17025.

(2) In addition to the definitions in this part, article 1 contains general definitions and principles of construction applicable to all articles in this code and part 161 contains definitions applicable to this part.

Sec. 18047. (1) A physician's assistant shall not engage in the practice as a physician's assistant except under the terms of a practice agreement that meets the requirements of this section.subsection (2) or (3), as applicable.

(2) A practice agreement that is entered into, amended, extended, or renewed before January 1, 2024 must be between a physician's assistant and a participating podiatrist and must include all of the following:

(a) A process between the physician's assistant and participating podiatrist for communication, availability, and decision making when providing medical treatment to a patient. The process must utilize the knowledge and skills of the physician's assistant and participating podiatrist based on their education, training, and experience.

(b) A protocol for designating an alternative podiatrist for consultation in situations in which the participating podiatrist is not available for consultation.

(d) A termination provision that allows the physician's assistant or participating podiatrist to terminate the practice agreement by providing written notice at least 30 days before the date of termination.

(e) Subject to section 18048, the duties and responsibilities of the physician's assistant and participating podiatrist. The practice agreement shall must not include as a duty or responsibility of the physician's assistant or participating podiatrist an act, task, or function that the physician's assistant or participating podiatrist is not qualified to perform by education, training, or experience and that is not within the scope of the license held by the physician's assistant or participating podiatrist.

(f) A requirement that the participating podiatrist verify the physician's assistant's credentials.

(3) If a practice agreement is entered into, amended, extended, or renewed on or after January 1, 2024, the practice agreement must be between a physician's assistant and at least 1 participating podiatrist as members of a podiatrist-led patient care team. The following apply to a practice agreement under this subsection:

(a) The practice agreement must include all of the following:

(i) A process between the physician's assistant and participating podiatrist for communication, availability, and decision making when providing medical treatment to a patient. The process must utilize the knowledge and skills of the physician's assistant and participating podiatrist based on their education, training, and experience.

(ii) A protocol for designating an alternative podiatrist for consultation in situations in which the participating podiatrist is not available for consultation.

(iii) The typewritten or printed names and signatures of the physician's assistant and participating podiatrist.

(iv) A termination provision that allows the physician's assistant or participating podiatrist to terminate the practice agreement by providing written notice at least 30 days before the date of termination.

(v) Subject to section 18048, the duties and responsibilities of the physician's assistant and participating podiatrist. The practice agreement must not include as a duty or responsibility of the physician's assistant or participating podiatrist an act, task, or function that the physician's assistant or participating podiatrist is not qualified to perform by education, training, or experience and that is not within the scope of the license held by the physician's assistant or participating podiatrist.

(vi) A requirement that the participating podiatrist verify the physician's assistant's credentials.

(vii) A requirement for the periodic review of patient charts and medical records and guidelines for collaboration and consultation among the parties to the practice agreement.

(viii) A process for the periodic, joint evaluation of the services delivered to a patient and for podiatrist input when necessary, including, but not limited to, in complex clinical cases, in patient emergencies, and for referrals.

(ix) An evaluation process for measuring the performance of the physician's assistant.

(b) The practice agreement may include procedures for periodic site visits by a participating podiatrist if the participating podiatrist practices at a location other than where the physician's assistant regularly practices. The participating podiatrist shall determine the manner and frequency of a site visit under this subdivision.

(4) A physician's assistant shall maintain a copy of a practice agreement entered into under this section and provide it to the board and the department on request.

(5) During an initial encounter with a patient, a physician's assistant shall inform the patient of the respective health profession subfield of the physician's assistant and, on the request of the patient, provide the patient with the name of the participating podiatrist with whom the physician's assistant is a party to a practice agreement and contact information for the participating podiatrist.

(6) The name and contact information of a participating podiatrist with whom a physician's assistant is a party to a practice agreement must be conspicuously posted where services are delivered by the physician's assistant and on the practice's website, if applicable, in a manner that ensures transparency for patients.

(7) (3) The following are subject to section 16221:

(a) The number of physician's assistants in a practice agreement with a participating podiatrist. and the

(b) The number of individuals to whom a podiatrist has delegated the authority to perform acts, tasks, or functions. are subject to section 16221.

Sec. 18049. (1) Subject to subsection (2), any of the following may enter into a practice agreement as a participating podiatrist:

(a) A podiatrist.

(b) One or more podiatrists in a group of podiatrists practicing other than as sole practitioners may designate 1 or more podiatrists in who are designated by the group to enter into a the practice agreement. under section 18047.

(2) If a podiatrist described in subsection (1) enters into a practice agreement under section 18047(3), the podiatrist shall comply with all of the following:

(a) The podiatrist shall regularly practice podiatric medicine and podiatric surgery in this state.

(b) The podiatrist shall manage and lead the members of the podiatrist-led patient care team with whom the podiatrist is a party to the practice agreement.

(c) The podiatrist shall be available at all times to collaborate and consult with each member of the podiatrist-led patient care team with whom the podiatrist is a party to the practice agreement.

(d) The podiatrist shall ensure that any act, task, or function performed by a member of the podiatrist-led patient care team with whom the podiatrist is a party to the practice agreement is performed in a manner consistent with sound medical practice and for the protection of the health and safety of a patient.

(3) (2) Notwithstanding any law or rule to the contrary, a podiatrist is not required to countersign orders written in a patient's clinical record by a physician's assistant with whom the podiatrist has a practice agreement. Notwithstanding any law or rule to the contrary, a podiatrist is not required to sign an official form that lists the podiatrist's signature as the required signatory if that official form is signed by a physician's assistant with whom the podiatrist has a practice agreement.

Sec. 20174. A health facility or agency may designate 1 or more physicians, with the physician's knowledge and consent, to enter into a practice agreement under section 17047, 17217, or 17547.

Sec. 20201. (1) A health facility or agency that provides services directly to patients or residents and is licensed under this article shall adopt a policy describing the rights and responsibilities of patients or residents admitted to the health facility or agency. Except for a licensed health maintenance organization that is subject to chapter 35 of the insurance code of 1956, 1956 PA 218, MCL 500.3501 to 500.3573, the health facility or agency shall post the policy at a public place in the health facility or agency and shall provide the policy to each member of the health facility or agency staff. Patients or residents shall must be treated in accordance with the policy.

(2) The policy describing the rights and responsibilities of patients or residents required under subsection (1) shall must include, as a minimum, all of the following:

(a) A patient or resident shall not be denied appropriate care on the basis of race, religion, color, national origin, sex, age, disability, marital status, sexual preference, or source of payment.

(b) An individual who is or has been a patient or resident is entitled to inspect, or receive for a reasonable fee, a copy of his or her medical record upon request in accordance with the medical records access act, 2004 PA 47, MCL 333.26261 to 333.26271. Except as otherwise permitted or required under the health insurance portability and accountability act of 1996, Public Law 104-191, or regulations promulgated under that act, 45 CFR parts 160 and 164, a third party shall not be given a copy of the patient's or resident's medical record without prior authorization of the patient or resident.

(c) A patient or resident is entitled to confidential treatment of personal and medical records, and may refuse their release to a person outside the health facility or agency except as required because of a transfer to another health care facility, as required by law or third party payment contract, or as permitted or required under the health insurance portability and accountability act of 1996, Public Law 104-191, or regulations promulgated under that act, 45 CFR parts 160 and 164.

(d) A patient or resident is entitled to privacy, to the extent feasible, in treatment and in caring for personal needs with consideration, respect, and full recognition of his or her dignity and individuality.

(e) A patient or resident is entitled to receive adequate and appropriate care, and to receive, from the appropriate individual within the health facility or agency, information about his or her medical condition, proposed course of treatment, and prospects for recovery, in terms that the patient or resident can understand, unless medically contraindicated as documented in the medical record by the 1 of the following:

(i) The attending physician. , a

(ii) A physician's assistant with whom the physician has a practice agreement. , or

(iii) Through December 31, 2023, an advanced practice registered nurse.

(iv) Beginning January 1, 2024, an advanced practice registered nurse with whom the physician has a practice agreement.

(f) A patient or resident is entitled to refuse treatment to the extent provided by law and to be informed of the consequences of that refusal. If a refusal of treatment prevents a health facility or agency or its staff from providing appropriate care according to ethical and professional standards, the relationship with the patient or resident may be terminated upon reasonable notice.

(g) A patient or resident is entitled to exercise his or her rights as a patient or resident and as a citizen, and to this end may present grievances or recommend changes in policies and services on behalf of himself or herself or others to the health facility or agency staff, to governmental officials, or to another person of his or her choice within or outside the health facility or agency, free from restraint, interference, coercion, discrimination, or reprisal. A patient or resident is entitled to information about the health facility's or agency's policies and procedures for initiation, review, and resolution of patient or resident complaints.

(h) A patient or resident is entitled to information concerning an experimental procedure proposed as a part of his or her care and has the right to refuse to participate in the experimental procedure without jeopardizing his or her continuing care.

(i) A patient or resident is entitled to receive and examine an explanation of his or her bill regardless of the source of payment and to receive, upon request, information relating to financial assistance available through the health facility or agency.

(j) A patient or resident is entitled to know who is responsible for and who is providing his or her direct care, to receive information concerning his or her continuing health needs and alternatives for meeting those needs, and to be involved in his or her discharge planning, if appropriate.

(k) A patient or resident is entitled to associate and have private communications and consultations with his or her physician, or a physician's assistant with whom the physician has a practice agreement, with his or her advanced practice registered nurse, with an individual described in subdivision (e)(ii), (iii), or (iv), with his or her attorney, or with any other individual of his or her choice and to send and receive personal mail unopened on the same day it is received at the health facility or agency, unless medically contraindicated as documented in the medical record by the attending physician, a physician's assistant with whom the physician has a practice agreement, or an advanced practice registered nurse. an individual described in subdivision (e)(i), (ii), (iii), or (iv). A patient's or resident's civil and religious liberties, including the right to independent personal decisions and the right to knowledge of available choices, shall not be infringed and the health facility or agency shall encourage and assist in the fullest possible exercise of these rights. A patient or resident may meet with, and participate in, the activities of social, religious, and community groups at his or her discretion, unless medically contraindicated as documented in the medical record by the attending physician, a physician's assistant with whom the physician has a practice agreement, or an advanced practice registered nurse.an individual described in subdivision (e)(i), (ii), (iii), or (iv).

(l) A patient or resident is entitled to be free from mental and physical abuse and from physical and chemical restraints, except those restraints authorized in writing by the attending physician, by a physician's assistant with whom the physician has a practice agreement, or by an advanced practice registered nurse, an individual described in subdivision (e)(i), (ii), (iii), or (iv), for a specified and limited time or as are necessitated by an emergency to protect the patient or resident from injury to self or others, in which case the restraint may only be applied by a qualified professional who shall set forth in writing the circumstances requiring the use of restraints and who shall promptly report the action to the attending physician, physician's assistant, or advanced practice registered nurse individual described in subdivision (e)(i), (ii), (iii), or (iv), who authorized the restraint. In case of a chemical restraint, the physician, or the advanced practice registered nurse who authorized the restraint, shall must be consulted within 24 hours after the commencement of the chemical restraint.

(m) A patient or resident is entitled to be free from performing services for the health facility or agency that are not included for therapeutic purposes in the plan of care.

(n) A patient or resident is entitled to information about the health facility or agency rules and regulations affecting patient or resident care and conduct.

(o) A patient or resident is entitled to adequate and appropriate pain and symptom management as a basic and essential element of his or her medical treatment.

(3) The following additional requirements for the policy described in subsection (2) apply to licensees under parts 213 and 217:

(a) The policy shall must be provided to each nursing home patient or home for the aged resident upon admission, and the staff of the facility shall must be trained and involved in the implementation of the policy.

(b) Each nursing home patient may associate and communicate privately with persons of his or her choice. Reasonable, regular visiting hours, which shall must be not less than 8 hours per day, and which shall must take into consideration the special circumstances of each visitor, shall must be established for patients to receive visitors. A patient may be visited by the patient's attorney or by representatives of the departments named in section 20156, during other than established visiting hours. Reasonable privacy shall must be afforded for visitation of a patient who shares a room with another patient. Each patient shall have reasonable access to a telephone. A married nursing home patient or home for the aged resident is entitled to meet privately with his or her spouse in a room that ensures privacy. If both spouses are residents in the same facility, they are entitled to share a room unless medically contraindicated and documented in the medical record by the attending physician, a physician's assistant with whom the physician has a practice agreement, or an advanced practice registered nurse.an individual described in subsection (2)(e)(i), (ii), (iii), or (iv).

(c) A nursing home patient or home for the aged resident is entitled to retain and use personal clothing and possessions as space permits, unless to do so would infringe upon the rights of other patients or residents, or unless medically contraindicated as documented in the medical record by the attending physician, a physician's assistant with whom the physician has a practice agreement, or an advanced practice registered nurse. an individual described in subsection (2)(e)(i), (ii), (iii), or (iv). Each nursing home patient or home for the aged resident shall must be provided with reasonable space. At the request of a patient, a nursing home shall provide for the safekeeping of personal effects, money, and other property of a patient in accordance with section 21767, except that a nursing home is not required to provide for the safekeeping of a property that would impose an unreasonable burden on the nursing home.

(d) A nursing home patient or home for the aged resident is entitled to the opportunity to participate in the planning of his or her medical treatment. The attending physician, a physician's assistant with whom the physician has a practice agreement, or an advanced practice registered nurse, An individual described in subsection (2)(e)(i), (ii), (iii), or (iv) shall fully inform the nursing home patient of the patient's medical condition unless medically contraindicated as documented in the medical record by a physician, a physician's assistant with whom the physician has a practice agreement, or an advanced practice registered nurse. an individual described in subsection (2)(e)(i), (ii), (iii), or (iv). Each nursing home patient shall must be afforded the opportunity to discharge himself or herself from the nursing home.

(e) A home for the aged resident may be transferred or discharged only for medical reasons, for his or her welfare or that of other residents, or for nonpayment of his or her stay, except as provided by title XVIII or title XIX. A nursing home patient may be transferred or discharged only as provided in sections 21773 to 21777. A nursing home patient or home for the aged resident is entitled to be given reasonable advance notice to ensure orderly transfer or discharge. Those actions shall must be documented in the medical record.

(f) A nursing home patient or home for the aged resident is entitled to be fully informed before or at the time of admission and during stay of services available in the facility, and of the related charges including any charges for services not covered under title XVIII, or not covered by the facility's basic per diem rate. The statement of services provided by the facility shall must be in writing and shall must include those required to be offered on an as-needed basis.

(g) A nursing home patient or home for the aged resident is entitled to manage his or her own financial affairs, or to have at least a quarterly accounting of personal financial transactions undertaken in his or her behalf by the facility during a period of time the patient or resident has delegated those responsibilities to the facility. In addition, a patient or resident is entitled to receive each month from the facility an itemized statement setting forth the services paid for by or on behalf of the patient and the services rendered by the facility. The admission of a patient to a nursing home does not confer on the nursing home or its owner, administrator, employees, or representatives the authority to manage, use, or dispose of a patient's property.

(h) A nursing home patient or a person authorized by the patient in writing may inspect and copy the patient's personal and medical records. The records shall must be made available for inspection and copying by the nursing home within a reasonable time, not exceeding 1 week, after the receipt of a written request.

(i) If a nursing home patient desires treatment by a licensed member of the healing arts, the treatment shall must be made available unless it is medically contraindicated, and the medical contraindication is justified in the patient's medical record by the attending physician, a physician's assistant with whom the physician has a practice agreement, or an advanced practice registered nurse.an individual described in subsection (2)(e)(i), (ii), (iii), or (iv).

(j) A nursing home patient has the right to have his or her parents, if a minor, or his or her spouse, next of kin, or patient's representative, if an adult, stay at the facility 24 hours a day if the patient is considered terminally ill by the physician responsible for the patient's care , a physician's assistant with whom the physician has a practice agreement, or an advanced practice registered nurse.or an individual described in subsection (2)(e)(ii), (iii), or (iv).

(k) Each nursing home patient shall must be provided with meals that meet the recommended dietary allowances for that patient's age and sex and that may be modified according to special dietary needs or ability to chew.

(l) Each nursing home patient has the right to receive representatives of approved organizations as provided in section 21763.

(4) A nursing home, its owner, administrator, employee, or representative shall not discharge, harass, or retaliate or discriminate against a patient because the patient has exercised a right protected under this section.

(5) In the case of a nursing home patient, the rights enumerated in subsection (2)(c), (g), and (k) and subsection (3)(d), (g), and (h) may be exercised by the patient's representative.

(6) A nursing home patient or home for the aged resident is entitled to be fully informed, as evidenced by the patient's or resident's written acknowledgment, before or at the time of admission and during stay, of the policy required by this section. The policy shall must provide that if a patient or resident is adjudicated incompetent and not restored to legal capacity, a person designated by the patient or resident shall exercise the rights and responsibilities set forth in this section. shall be exercised by a person designated by the patient or resident. The health facility or agency shall provide proper forms for the patient or resident to provide for the designation of this person at the time of admission.

(7) This section does not prohibit a health facility or agency from establishing and recognizing additional patients' rights.

(8) As used in this section:

(a) "Advanced practice registered nurse" means that term as defined in section 17201.

(b) "Patient's representative" means that term as defined in section 21703.

(d) "Title XVIII" means title XVIII of the social security act, 42 USC 1395 to 1395lll.

(e) "Title XIX" means title XIX of the social security act, 42 USC 1396 to 1396w-5.1396w-6.