Michigan Enacts Significant Changes to Physician Assistant Laws

Pursuant to Public Act 379 of 2016 (PA 379), the State of Michigan recently enacted legislation that significantly alters the legal landscape for physician assistants (PAs) in Michigan. Effective March 22, 2017, PAs are required to enter into a written practice agreement with a participating physician and comply with the terms of the practice agreement. Michigan healthcare providers thus must review agreements, policies and procedures related to PAs in light of this requirement and Michigan’s new legal framework for PAs.¹

Public Act 379 now defines “practice as a physician’s assistant” as the practice of medicine with a participating physician under a practice agreement.² A “participating physician” is defined as a physician, a physician designated by a group of physicians to represent that group, or a physician designated by a health facility or agency to represent that health facility or agency.³ With regard to group practices, a group of physicians practicing other than as sole practitioners may designate one or more physicians in the group to enter into the practice agreement. PAs cannot engage in the practice as a PA except under the terms of a practice agreement that meets the requirements under Michigan law.⁴ Michigan law provides that a practice agreement 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.

• (c) The signature of the physician’s assistant and the participating physician.

• (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 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.⁵

The practice agreement thus defines the relationship between the PA and participating physician and the framework for the PA and participating physician to provide care to patients. In order to comply with Michigan law, the practice agreement must consider the education, training and experience of the PA. The practice agreement may limit the actions of the PA or the medications or procedures that the PA is permitted to provide to patients. Under the new law, failure to comply with the terms of a practice agreement constitutes unprofessional conduct and subjects physicians and PAs to disciplinary actions including license denial, revocation, probation, suspension, limitation, reprimand, or fines.⁶

Public Act 379 eliminates Michigan’s strict ratio requirements that limited the number of PAs that may provide care under the supervision or delegation of each physician. Per the new law, the number of PAs in a practice agreement with a participating physician and the number of individuals to whom a physician has delegated the authority to perform acts, tasks, or functions, must comply with the terms of the practice agreement and the standard of care. Accordingly, Michigan law no longer imposes specific limitations on the number of PAs per participating physician.

Additionally, despite the requirement for the written agreement, the law provides greater autonomy to PAs. To the extent permitted by the practice agreement, a PA who is a party to a practice agreement may prescribe medications in accordance with the procedures and protocols for the prescription established by the State of Michigan.⁷ Pursuant to Public Act 379, licensed PAs are now defined as independent “prescribers” under Michigan law.⁸ Accordingly, Michigan has eliminated the waiver from Michigan controlled substance licensure requirements for PAs, and PAs are now required to obtain a Michigan Controlled Substance License in addition to maintaining the DEA license previously required by state law. To the extent permitted by the practice agreement, a physician’s assistant may prescribe medications, including a controlled substance that is included in schedules 2 to 5 of part 72, without the delegation of a physician.⁹ To the extent permitted by the practice agreement, PAs also may make calls or go on rounds in private homes, public institutions, and a wide range of health care facilities without restrictions on the time or frequency of visits by a physician or physician assistant.¹⁰ A physician is also not required to countersign orders written in the patient’s clinical record by a PA with whom the physician has a practice agreement.

Public Act 379 expands the role of PAs in Michigan by granting additional autonomy to PAs and eliminating the strict ratio requirements limiting the number of PAs that may be supervised by each physician. However, whether or not a PA’s role within a practice changes pursuant to the new laws, all Michigan healthcare providers must enter into written practice agreements with PAs and otherwise structure policies and procedures regarding PAs in compliance with Michigan’s new legal requirements.

¹ Note that whereas this article focuses on changes to Michigan legal requirements applicable to medical doctors (MDs) and physician assistants (PAs), parallel requirements exist applicable to doctors of osteopathic medicine (DOs), health facilities and agencies (e.g., nursing homes).

² MCL § 333.17001(i).

³ MCL § 333.17049.

⁴ MCL § 333.17047(1).

⁵ MCL § 333.17047(2).

⁶ MCL § 333.16221(u).

⁷ MCL § 333.17076(2).

⁸ MCL § 333.17708.

⁹ Id.

¹⁰ MCL § 333.17076(1).