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Frequently Asked Questions

    The prevalence of human trafficking has reached alarming levels in the United States. In an effort to address this widespread crisis, individuals licensed or registered by the Michigan Department of Licensing and Regulatory Affairs (Physician Associates, professional counselors, physicians, social workers, massage therapists, etc.) have a new continuing educational requirement which must be met when seeking initial or renewal of an individual's licensure or registration.

    Beginning with licsensure renewals on and after April 1, 2017, individuals must receive human trafficking training which includes the following criteria:

    • Understanding the types and venues of human trafficking in Michigan or the United States
    • Identifying victims of human trafficking in health care settings
    • Identifying the warning signs of human trafficking in health care settings for adults and minors
    • Identifying resources for reporting the suspected victims of human trafficking

    Training may be accomplished through any of the following methods:

    • Nationally recognized or state recognized health related organization
    • Training offered by, or in conjunction with, a state or federal agency
    • Educational programs approved by the board for initial licensure, or by a college or university; or
    • Reading an article related to the identification of victims of human trafficking that is published in a peer-reviewed journal, health care journal, or professional or scientific journal

    Approved training modalities include any of the following:

    • Teleconference or webinar
    • Online presentation
    • Live presentation
    • Printed or electronic media 

    Please note: No documents are to be sent to LARA. However, the Michigan Department of Licensing and Regulatory Affairs may randomly audit individuals and request documented proof of the completion of human trafficking training. If audited, the individual must provide acceptable proof of training, which includes ONE of the following:

    • A completion certificate issued by the training provider that includes the date, provider name, name of training, and individual's name.
    • A self-certification statement by an individual that includes the individual's name and either:
      • For training completed by a live presentation, online presentation, teleconference, or webinar, the self-certification must include the date, training provider name, and name of training; or
      • For training completed by print or electronic media, the self-certification must include the title of article, author, publication name of peer review journal, health care journal, or professional or scientific journal, and date, volume, and issue of publication, as applicable

    The human trafficking educational requirement applies to all license and registration renewals beginning with the first renewal cycle after this new rule became effective (April 2017) and for initial licenses and registrations issued five (5) or more years after the effective date of applicable rule.

    Q. Was a new practice law recently passed that changes the way PAs and physicians work together?
    A. Yes. Public Act 379 of 2016 was just signed into law which more clearly defines the relationship between a PA and a participating physician by creating a written Practice Agreement. The Practice Agreement requires each provider to consider education, training and experience in order to ensure the highest quality patient care. 


    Q. When does this new law go into effect?
    A. PA 379 will go into effect on March 22, 2017. A PA and their participating physician must have a new practice agreement in place by that date.


    Q. Does the new law remove the terms "supervision" and "delegation"?
    A. Yes. PAs in Michigan are no longer required to work under supervision or delegation of a physician according to the new law. PAs will now be required to work with a "participating physician" according to the terms in a "practice agreement."


    Q. Can a PA practice without a physician?
    A. No. The new law continues to support the PA and physician team. PAs will now be required to work with a "participating physician" according to the terms in a "practice agreement."


    Q. How is a "participating physician" defined by law?
    A. A "participating physician" means "a physician, a physician designated by a group of physicians under section 333.17049 to represent that group, or a physician designated by a health facility or agency under section 333.20174 to represent that health facility or agency."


    Q. What is a Practice Agreement?
    A. A Practice Agreement is a written agreement between a PA and a participating physician that is now required by law under Public Act 379. This agreement generally defines the communication and decision making process by which the PA and the participating physician provide medical care to their patients. The Practice Agreement may also place conditions on specific duties, procedures or drugs, if the parties of the agreement choose to do so. It is not intended to be a burdensome or lengthy document, but rather, provide a general understanding of each professional's knowledge and skills utilized in each unique practice setting.


    Q. What information is required within a Practice Agreement?
    A. The new law [Public Act 379] requires the following provisions to be addressed in a Practice Agreement:

    • A process between the physician associate 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 associate and participating physician based on their education, training and experience.
    • A protocol for designating an alternative physician for consultation in situations in which the participating physician is not available for consultation.
    • The signature of the physician associate and the participating physician.
    • A termination provision that allows the physician associate or participating physician to terminate the practice agreement by providing written notice at least 30 days before the date of termination.


    Q. Can credentialing documents qualify as a Practice Agreement?
    A. The document must contain, in some form, the information required by law (as outlined above) in order to qualify as a practice agreement.


    Q. How will PAs be able to prescribe medications without delegation from a physician?
    A. Physician Associates are now defined in PA 379 as independent "Prescribers" (within a practice agreement). This is an exclusive designation in law that, in addition to PAs, includes physicians, dentists, veterinarians, optometrists (limited to therapeutic pharmaceutical agents) and advance practice registered nurses (excluding schedule 2-5 which must be delegated by a physician according to Public Act 499 of 2016).


    Q. Does this mean that a PA must now obtain their own state Controlled Substance License (CSL)?
    A. Yes. A PA who intends to prescribe controlled substances must now purchase a State of Michigan Controlled Substance License (CSL) in addition to maintaining their DEA license. CSL applications are available now but will not be approved before March 22, 2017. Click here to apply now for the State of Michigan Controlled Substance License.


    Q. Are there any new limitations on the drugs a PA can prescribe?
    A. No. The new law does not place any additional limitations on drugs a PA can prescribe. Michigan law still prohibits PAs from prescribing medical marijuana and abortive drugs.


    Q. Are there any new limitations on a PA's scope of practice?
    A. No. The new law does not place any additional scope of practice limitations on PAs.


    Q. Does the new Practice Agreement need to be filed with the state or any other government entity?
    A. No. The Practice Agreement must be signed and dated by both the PA and the participating physician prior to a PA providing patient care. The Practice Agreement needs to be readily available for inspection if necessary.


    Q. What happens if the conditions of the Practice Agreement change?
    A. If the conditions of the Practice Agreement change, the updated Practice Agreement must be signed and dated by both the PA and participating physician.


    Q. Does the Practice Agreement need to be updated annually?
    A. No. The agreement only needs to be updated if the conditions of the Practice Agreement change (see above).


    Q. Are there any restrictions in the number of PAs that can enter into a practice agreement with a participating physician?
    A. The new law [Public Act 379] removes the previous PA/physician ratios in law and creates new language that triggers disciplinary action by the Board of Medicine, Board of Osteopathic Medicine or the Podiatric Board of Medicine if the number of PAs per physician exceeds a reasonable standard-of-practice threshold.


    Q. Does the new law impact liability or reimbursement for PAs?
    A. There are no predicted changes to liability or reimbursement as a result of the new law. This FAQ will be updated if we expect any impact on liability or reimbursement for PAs.

    Q. Can a new graduate who has a temporary license still practice as a PA if they failed the board certification exam (PANCE)?
    A. No. MCL 333.17072 states "...the temporary license shall be valid for a period determined by the task force, but not to exceed 18 months, or until the results of a required examination are made available, whichever is sooner."

    • If the results of the "required examination" prove to be a failing score, the temporary license will be revoked.  The graduate can, of course, re-take the exam, but in the interim, cannot work as a licensed PA and will have to reapply for a PA license.
    • According to the Michigan Licensing Division, an employed graduate who is in a situation where they failed the exam, have no license and are waiting for the next exam, can have a supervising physician assess their competency and delegate supervised tasks that fit their competency level.  This does not take into account any liability risks and the graduate will not be allowed to use the title "physician assistant" until fully licensed. 


    Q. Can a retired PA with a lapsed license volunteer for patient care?
    A. No. Section MCL 333.17011 states that "an individual shall not engage in the practice of medicine or practice as a physician's assistant unless licensed..."  It is also not recommended that a former licensed PA volunteer as a lesser trained individual who doesn't practice medicine.  The Department of Community Health strongly discourages this practice, pointing out that in a malpractice case, the prosecution will try to prove that the "ex-PA" stepped out of the lesser role and used their past PA knowledge in violation of the law.

    Q. Does a PA need to be certified to practice?
    A. No. According to Michigan Law and Administrative Rules, an "applicant for a new license shall have passed the certifying examination conducted and scored by the National Commission on Certification of Physician Assistants." (MCL 333.17064). For re-licensure, a PA must "establish that he or she passed either the certifying or re-certifying examination...with the 6-year period immediately preceding the date of the application." (R338.6308).


    Q. Are PAs able to prescribe durable medical equipment (DME)?
    A. Yes. There are no restrictions in Michigan law regarding DMEs. However, there are some federal requirements that must be adhered to:

    • The Centers for Medicare & Medicaid Services (CMS) published a requirement that certain items of durable medical equipment can only be ordered after the physician, physician assistant, nurse practitioner, or clinical nurse specialist has had a face-to-face encounter with the patient to assess, evaluate and/or treat the patient for the medical condition that supports the need for the DME product. This requirement applies to the following medically necessary item categories:
    • Trans-cutaneous electrical nerve stimulation units
    • Roll-about chair
    • Oxygen and respiratory equipment
    • Hospital beds and accessories
    • Traction-cervical
    • Any item of DME in the durable medical equipment, prosthetics, orthotics, and Supplies Fee Schedule with a price ceiling at or greater than $1,000.
    • The full list of 167 applicable DME items can be found by clicking here.


    Q. Are PAs allowed to order an outpatient video fluoroscopy swallow study?
    A. Yes. PAs can order this test as an outpatient. There are no restrictions in Michigan law preventing an order for a PA for outpatient video fluoroscopy swallow study.

    Q. Can a PA order restraints and/or seclusion?
    A. Yes. Two entities regulate this issue: the federal Centers for Medicare and Medicaid Services (CMS) and the state of Michigan's laws regarding restraints and seclusion. Generally speaking, the answer is "yes" in emergency situations and as defined for the following applications and venues:

    • Federal Law: The CMS has previously issued (1/8/07) final regulations that clarify when a PA may order patient restraint or seclusion as a physician-delegated responsibility, only if such delegation is allowed by state law and hospital policy. This final rule states: "The use of restraint or seclusion must be in accordance with the order of the physician or other licensed independent practitioner (LIP) who is responsible for the care of the patient and specified under (federal law) Section 482.12(c) and authorized to order restraint or seclusion by hospital policy in accordance with state law."
    • State Law: The laws in Michigan regarding restraints and seclusion are found in the Public Health Code and the Mental Health Code.
      • The Mental Health Code (sections 330.1740-1742) stipulates that a physician shall be contacted. It provides that a resident (in a mental health facility) may be temporarily restrained for a maximum of 30 minutes without an order or authorization in an emergency. Immediately after imposition of the temporary restraint, however, a physician shall be contacted. If, after being contacted, the physician does not order or authorize the restraint, the restraint shall be removed.
      • Also, a resident may be restrained prior to examination pursuant to an authorization by a physician. An authorized restraint may continue only until a physician can personally examine the resident. Seclusion may be temporarily employed using the same criteria.
      • The Public Health Code (section 333.20201) says that a patient or resident (in a hospital) is entitled to be free from physical and chemical restraints, except those restraints authorized in writing by the attending physician. These restraints may only be applied for a specified and limited time. In an emergency situation where restraints are needed to protect the patient or resident from injury to self or others, the restraint may only be applied by a qualified professional (in this case a PA). The circumstances surrounding this action must be documented in writing and promptly reported to the attending physician. In case of a chemical restraint, a physician shall be consulted within 24 hours after the commencement of the chemical restraint.
      • Child Care Organizations laws also allow a Licensed Practitioner (PA who has been "trained in the use of personal restraint and seclusion and knowledgeable of the risks inherent in the implementation of personal restraint and seclusion" to utilize these measures.


    Q. Can a PA perform x-rays, ultrasound and other imaging procedures?
    A. Yes. As with most specialties, these procedures can be performed by a PA only if the PA has the necessary clinical scope of practice (radiology) training.

    There are a number of training programs and certification processes for physicians and ATCs that can be accessed by PAs. The ability for a PA to practice within their scope of practice allows the PA to take courses offered by other professional disciplines and apply their acquired knowledge and techniques to the PA's practice.


    Q. Can a PA pronounce death?
    A. Yes. A PA is allowed to pronounce a person's death as part of their medical diagnosis and scope of practice.


    Q. Can a PA sign a death certificate?
    A. No. Only a physician is allowed under state law (MCL 333.2843) to sign a death certificate.


    Q. Can a PA treat conditions related to the eye?
    A. Conditions apply. Michigan Law (MCL 17074) prohibits PAs from performing "acts, tasks, or functions to determine the refractive state of the human eye or to treat refractive anomalies of the human eye, or both."  

    It also does not allow PAs to "determine the spectacle or contact lens prescription specifications to treat refractive anomalies of the human eye, or determine modification of spectacle or contact lens prescription specifications, or both." 

    Beyond these prohibitive services that protect the scope of practice of optometrists and opticians, MCL 333.17074(3) permits PAs to "perform routine visual screening or testing, postoperative care, or assistance in the care of medical disease of the eye under a practice agreement."


    Q. Can a PA perform anesthesia or conscious sedation?
    A. Yes. Anesthesia and Endoscopic Procedures deserve some special attention. It is generally accepted that anesthesia is a very complex procedure that requires specific training in that field. For this reason, many PAs opt to augment their training as a physician assistant by becoming Anesthesia Assistants. Conscious sedation, on the other hand, is well within the scope of practice of a PA and utilized in procedures such as colonoscopies and interventional radiology procedures.


    Q. Can a PA perform a colonoscopy or flexible sigmoidoscopy?
    A. No. Currently, Michigan Rule 325.3802 specifies that endoscopic procedures performed in a surgical outpatient facility are defined as "surgery" and can only be performed by a "physician."  Some would argue that the term "physician" includes physician assistants by virtue of delegation; however, others argue that the law clearly specified that a physician could only perform this task. There is no similar provision relating to this practice in a hospital, which would not prevent these procedures from taking place in a hospital setting.


    Q. Is there any general statement in law about a PA's scope of practice?
    A. Yes. According to Michigan law (MCL 333.17074), "a physician's assistant shall not undertake or represent that he or she is qualified to undertake provision of medical care services that he or she knows or reasonably should know to be outside his or her competence or is prohibited by law."


    Q. Can a PA perform physical therapy?
    A. No. The term "physical therapy" is protected by law. According to MCL 333.17820, "A person shall not engage in the practice of physical therapy unless licensed.." A physician assistant may perform other physical medicine procedures, like osteopathic manipulation (under the supervision of an osteopathic physician), etc., as long as it is not deemed "physical therapy."


    Q. Can a PA make patient referrals to physical therapy?
    A. Yes. Up until recently, a PA was not allowed to refer patients to a physical therapist, but the law was changed in 2005 to allow these referrals.


    Q. Can a PA order an MRI?
    A. Yes. PAs are able to write for all studies including MRIs without a physician signature. The issue has arisen that third party payers are interested in tracking the utilization of MRIs, and the institutions that perform them need a physician's name to assign the ordered study to. It does not require a physician's signature.


    Q. Can a PA perform osteopathic manipulative therapy?
    A. Yes. A PA can perform osteopathic manipulative therapy (OMT) if the PA was taught or received training for this therapy and is supervised by a DO who is able to perform OMT themselves; under our delegatory laws, PAs would be able to perform OMT and bill for this service, if it is covered by the patient's insurance.


    Q. What procedures require a first assistant?
    A. No procedures require a PA as first assistant. PAs first assisting at surgery are reimbursed by Medicare at 85% of the first-assisting fee paid to a physician (16%), or 13.6%. PAs cannot act as primary surgeons, but they are eligible for reimbursement for first assisting in any procedure where a physician would receive such a reimbursement. PAs are also covered when performing minor surgical procedures.

    • PAs should bill for their services at the full physician fee schedule, using the (-AS) modifier. The use of the PA's NPI number and the surgical assistant billing modifier (-AS) will indicate to the Medicare carrier to implement the appropriate discount. See Medicare Claims Processing Manual, Chapter 12, Section 110.3. Some MACs are asking for both the 80 and AS modifiers. 
    • Medicare maintains a list of approximately 1,900 Current Procedure Terminology (CPT) codes for which a first assistant at surgery will not be reimbursed. For these codes, Medicare determined that a first assistant is not needed and will not pay for the services of any medical professional acting as a first assistant. Note: this list applies to all providers who first assist - physicians, PAs, and NPs. If a physician deems that a first assistant is medically needed, and Medicare agrees, Medicare may grant an exception and reimburse for that service. The op note must reflect the medical necessity and contribution of the first assistant. There is allowance for the discretion of the surgeon to determine necessity. Document necessity with phrases such as "the skills of [name of PA] were necessary for the successful completion of the case, due to the complexity of the case, a first assistant was deemed necessary, due to the patient's morbid obesity with a BMI greater than 40 and resultant complexity of the case, the assistance of the PA was essential."


    Q. Can a PA prescribe physical therapy, speech therapy, occupational therapy, etc.
    A. Yes. There are no restrictions in Michigan law limiting this.
    Practice Agreements

    Q. What is a Practice Agreement?
    A.     A Practice Agreement is a written contractual agreement between a PA and a physician. Public Act 379 of 2016, which was passed into law in December 2016, removed the "supervision" and "delegation" requirements in favor of a written Practice Agreement between a PA and a "participating physician." A PA and his or her participating physician will be required to have a Practice Agreement in place by March 22, 2017.

    • The specific information required to be included in a Practice Agreement is defined by Public Act 379. In general, it includes a process for communication, availability and decision-making between the PA and participating physician, as well as the duties and responsibilities, and any restrictions or limitations, of the PA and participating physician. The law allows for some flexibility and there will likely be variations among Practice Agreements depending on the specific practice arrangement and practice setting. MAPA has prepared FAQs specifically addressing Practice Agreements and other key components of PA 379 of 2016, including a sample Practice Agreement template.

    Employment Contracts

    Q. I received an employment contract from my new employer, what do I do now?
    A.     More and more physician assistant positions in both hospitals and medical groups involve employment contracts. First and foremost, it is important to understand the terms to which you are agreeing. It is generally recommended to have an attorney review the employment agreement before signing it. In many cases, the employer likely had an attorney draft the agreement on their behalf. The contract will dictate the terms of the employment relationship including your responsibilities as well as the benefits your employer has agreed to provide. It is important to carefully review the contract terms to identify any restrictions that may be placed on your ability to practice after you leave the position, such as a non-compete clause, as well as any obligations you are agreeing to, such as indemnification or obtaining professional liability “tail” coverage. It is also important to identify any other details (e.g., specific hours, weekend or call coverage, practice locations, benefits, future buy-in or partnership opportunities, etc.) that may have been discussed with the employer during the interview process but that have not been included in the written agreement. Setting forth the terms you discussed ensures that both parties are on the same page and protects you if memories fade in the future.

    • In light of the recent passage of Public Act 379 of 2016, which removed the "supervision" and "delegation" requirements in favor of a written Practice Agreement, PAs are also advised to review a proposed employment agreement to make sure the terms of employment do not conflict with the terms of the Practice Agreement.
    • It may be possible to negotiate with the employer to remove or narrow overly-restrictive terms or add additional details to clarify the terms of employment. Often drafting proposed changes can open the door for discussions with the employer. It is important to take the time to review and negotiate changes up front before signing the agreement; once the contract is signed it is legally binding and the employer is under no obligation to renegotiate.
    • It is also important if the employment agreement references other documents, such as an employee handbook, that you obtain a copy of the documents to review prior to signing the agreement. 


    Q. What are some of the key terms I should look for in an employment contract?

    A. While each individual contract is different, some contract terms in particular can have a long-term impact on your  practice and should be looked at with scrutiny. These terms include, but are not limited to:

    • Non-compete clauses/restrictive covenants
    • Termination provisions (for cause & without cause)
    • Professional liability insurance
    • Indemnification provisions

    While the hope is that these terms never come into play, it is important to view them from a “worst-case scenario” perspective to see how they would function in practice. For example, if the contract includes a non-compete clause that prohibits you from practicing within a 15-mile radius of the hospital or medical office for a one-year period, it is important to understand how this would affect your ability to find another position when considering where you live, if you own a home, and the impact of relocating a spouse or children. It may be possible to discuss narrowing or removing overly-restrictive terms with your prospective employer prior to signing the employment agreement.


    Professional Liability Insurance Coverage

    Q. Should a Physician Assistant carry his or her own professional liability insurance?
    A.     This is an important decision which should be made after speaking with an individual who specializes in professional liability coverage. From a legal perspective, the first (and most important step) is to determine if you have malpractice coverage from your employer. Whether the employer provides professional liability insurance should be included in the employment agreement. It is important to understand at the outset of a new position whether professional liability insurance is provided as a benefit.

    From there, you can assess whether you are comfortable with the amount of coverage your employer is offering. If you are not, you can always purchase a supplemental insurance policy to add to the existing policy. It is important to note that not all professional liability insurance covers licensing investigations and you may want to talk to your insurance agent about obtaining coverage for this type of matter, even if you have adequate professional liability limits. Depending on the nature of the allegations, attorney’s fees to defend a licensing matter can be considerable.  


    Q. What is "tail" coverage?
    A.     The need for “tail” coverage arises in connection with a “claims made” professional liability insurance policy. It is important to first determine whether you are covered under a “claims made” or “occurrence” policy. If you have an “occurrence” policy, tail coverage is not necessary. 

    • A “claims made” policy protects you from medical malpractice claims made during the period for which the policy is in effect. The policy only covers claims for events that both occurred and were reported to the insurer during the policy period. So if your “claims made” professional liability insurance is provided by your employer and you leave that job (and are therefore taken off of their insurance policy), you would no longer have coverage for a malpractice claim that occurred during your employment but was reported after you left the job unless you have “tail” coverage. Tail coverage is an extended reporting endorsement which provides that the insurer will cover claims reported in the future (after you have left the position) but which are related to events that occurred during the policy period (while you were employed and covered under your employer’s group policy).
    • Who is responsible for providing tail coverage after employment ends is an important term in the employment relationship and is one that should typically be addressed in the employment contract. If the employment agreement obligates you to obtain tail coverage, it may be advisable to try to negotiate on this issue as the out-of-pocket cost of obtaining tail coverage can be significant.  

    Entity Formation

    Q. Can I form a professional corporation (PC) or professional limited liability company (PLLC) in Michigan?
    A. Yes, in Michigan, physician assistants can form a professional corporation, professional service corporation or professional limited liability company with one or more physicians or podiatrists provided that the participating physicians who are parties to the Practice Agreements with the physician assistants are shareholders or members in the same entity. More specifically, if the entity (PC or PLLC) is formed after July 19, 2010, then it must include the participating physician as a shareholder or member and may not be made up solely of physician assistants. Those entities formed prior to July 19, 2010 and consisting of only a single physician assistant or group of physician assistants are permitted under Michigan law, though the participating physicians under the PAs' Practice Agreements are still required to meet all of the requirements of the Public Health Code, part 170 (Medicine, 175 (Osteopathic Medicine and Surgery), or 180 (Podiatric Medicine and Surgery).  


    Licensing Actions

    Q. Do I need to hire counsel if I have been notified by the state that I have an allegation or complaint filed against me?
    A.     In most situations, it is recommended that you hire an attorney if an interview is requested during the investigation phase. In many cases, a licensing investigation may be initiated after an allegation or complaint is filed with the Bureau of Professional Licensing by a former patient or a colleague. An investigation may also occur after an adverse action is taken against a physician assistant’s clinical privileges (e.g., suspension or revocation) by a healthcare facility, as the facility will likely be required to make a report to the state. State law also requires an investigation to be initiated if the department receives notice of 3 or more malpractice settlements, awards or judgments against a licensee in a 5 year period or one or more settlements, awards or judgements against a licensee totaling more than $200,000.00 in a five year period. 

    It is important to note that an investigation may not necessarily result in a complaint being filed against the health professional. As outlined in greater detail below, after the investigation of an allegation is complete, a recommendation is made to either: (1) close the file; (2) refer for expert review; or (3) draft an administrative complaint against the individual. For this reason, it is important to put your best foot forward during the investigation stage if an interview is requested. During the investigative interviews you will not likely be permitted to have other individuals accompany you to meetings with the investigator – other than an attorney. For this reason, it can be prudent to have an attorney present to help memorialize the statements made during the interview and advocate on your behalf with regard to the statements made during the interview if the matter ultimately proceeds beyond the investigation stage. 


    Q. Under what circumstances could a licensing allegation be filed against me?
    A.     The Public Health Code has a lengthy list of grounds for which a disciplinary action can be filed against a licensee. Allegations may include (but are not limited to): 

    • Incompetence (failure to comply with minimal standards of care)
    • Negligence involving an alleged failure to provide appropriate clinical care
    • Substance abuse
    • Mental or physical inability
    • Conviction of certain criminal offenses
    • Adverse actions taken by another state’s licensing board
    • False or misleading advertising
    • Lack of good moral character
    • Fraud or deceit in obtaining or renewing one’s license
    • Practice outside the scope of one’s license
    • Unprofessional conduct (misrepresentation to obtain reimbursement, betrayal of professional confidence)
    • Violation of the Medical Record Access Act
    • Failure to timely report a change of name or mailing address
    • Failure to comply with the terms of a Practice Agreement.


    Q. What is the process that I would go through if there is an allegation filed against me?
    A.     The filing of an allegation starts the process for disciplinary action with the Bureau of Professional Licensing and then typically proceeds through the following steps:

    • Allegation: After an allegation is filed, the department conducts a review to determine if there is a reasonable basis to believe a violation occurred. If it’s believed a violation may have occurred, the department may authorize an investigation. If the allegation involves impairment due to substance abuse or mental health disorders, the department may refer the matter to the Health Professional Recovery Program (HPRP)
    • Investigation: If an investigation is authorized, the investigation staff may seek to interview –
      • The individual filing the allegation (e.g., former patient, colleague)
      • You (the PA licensee)
      • Other individuals, such as co-workers or your employer, who may be able to provide information regarding the allegation
      • The licensing investigator may also obtain authorizations from the patient to request medical records from the healthcare providers involved.  It is generally helpful to consult with an attorney during this early phase of the allegation and investigation process, ideally before participating in an interview
    • Review: Following the investigation, the case is reviewed and a recommendation is made to -
      • Close the file because the allegation was not substantiated (you may or may not be notified if this is the case)
      • Refer for expert review by a health professional with similar education, experience and training to determine if minimum standards for the profession were met; or
      • Transfer for drafting of an administrative complaint against the PA licensee.
    • Administrative Complaint: If the department believes there is evidence of a Public Health Code violation, a formal administrative complaint outlining the alleged violations will be filed. The PA licensee has 30 days to file a written response. It is important that a response is filed timely as the failure to do so will result in the alleged facts being considered true and the case being referred to the disciplinary subcommittee for sanctions to be imposed. Note regarding summary suspension: If the State of Michigan believes there is an imminent threat to the public’s health, safety or welfare, the State, with the support of the chair of the PA board, may issue a summary suspension of the PA’s license. If a summary suspension is issued, the PA cannot practice until the matter is resolved.
    • Compliance Conference: After the response to the administrative complaint is filed, the PA licensee has the option of participating in a compliance conference or proceeding directly to an administrative hearing. The compliance conference is an opportunity to discuss the case with a department analyst and possibly a PA board member or attorney general in an effort to try to reach an agreeable settlement. If a proposed settlement is reached, it is sent to the disciplinary subcommittee of the PA board for review and approval. The disciplinary subcommittee may approve the settlement or reject it and propose a counter-offer. If a resolution is not reached through this process, the case proceeds to an administrative hearing.  
    • Administrative Hearing: An administrative hearing is similar to a court proceeding where an administrative law judge (ALJ) serves as both the judge and jury. Both sides may present evidence and call witnesses to testify. The department is typically represented by an assistant attorney general and the PA licensee has the right to be represented by an attorney. After the hearing, the ALJ will issue a decision outlining the findings of fact, conclusions of law, and whether a violation of the Public Health Code was proven. The parties then have an opportunity to file objections to the ALJ’s decision. This proposed decision is presented to the disciplinary subcommittee for review at its next scheduled meeting. The disciplinary subcommittee may:
      • Accept the ALJ’s decision and issue sanctions if the violations were proven
      • Dismiss the administrative complaint if the State of Michigan was unable to sufficiently prove the allegations; or
      • Reverse the ALJ’s decision and render its own findings of fact and conclusions of law if it disagrees with the ALJ’s findings

    Q. What type of sanctions can be imposed if the board concludes I violated the Public Health Code?
    A.     Sanctions are a public record. The information is available on the department’s website and is subject to a Freedom of Information request.

    • Depending on the type of violation, the potential sanctions include:
    • Probation
    • Limitation on your PA license
    • Denial of license
    • Monetary fine
    • Reprimand
    • Community service
    • Revocation of license
    • Suspension of license, and/or
    • Restitution.

    Q. How do I sign up to be a Medicare provider?
    A.     A PA may obtain an National Provider Identifier (NPI) and enroll with Medicare if eligibility requirements are met.

    • NPI: The NPI is a unique 10-digit identification number for covered healthcare providers mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPPA). The NPI replaced the Medicare PIN, the Medicare UPIN and many private insurance company provider identifiers. The NPI is required for billing Medicare; many private payers require its usage too.

      Apply for an NPI online here. If you change employers or change your address or change your name, you should update your NPI at the above link. For questions about the NPI application or update process, contact the NPI Enumerator at 1-800-465-3203 or 1-800-692-2326 (TTY).
    • Medicare Enrollment Process: Complete, review, and submit an electronic enrollment application via the internet-based Provider, Enrollment, Chain and Ownership System (PECOS). You will need your NPI in order to complete the process. If you do not know your NPI, it is easily accessed from the NPI registry.

      Internet-based PECOS will walk you through the application process and supply you with a two-page Certification Statement for each enrollment application you submit. PECOS web screenshot step-by-step instructions are available from the website.  

      Mail the original signed Certification Statement from internet-based PECOS and supporting documents to your Medicare contractor within seven days of your electronic submission. The effective date of filing an enrollment application is the date the Medicare contractor receives the signed and dated (blue ink recommended) Certification Statement. NOTE: A Medicare contractor will not process an internet enrollment application without the signed and dated Certification Statement.


    Q. How many PAs are practicing in Michigan?
    A.     As of 2024, there are approximately 8,000 licensed PAs in Michigan.


    Q. How many accredited PA programs are in Michigan?
    A.     There are 11 PA programs in Michigan


    Q. Where can PAs prescribe?
    A.     All 50 states, the District of Columbia, Guam, and the Commonwealth of the Northern Mariana Islands have enacted laws that authorize PA prescribing.


    Q. How long does it take to become a PA?
    A. Physician Associate educational programs usually take at least 2 years to complete for full-time students. Most programs are at schools of allied health, academic health centers, medical schools, or 4 year colleges; a few are at community colleges, are part of the military, or are at hospitals. Many accredited PA programs have clinical teaching affiliations with medical schools.

    PA education includes classroom and laboratory instruction in subjects like biochemistry, pathology, human anatomy, physiology, clinical pharmacology, clinical medicine, physical diagnosis, and medical ethics. PA programs also include supervised clinical training (rotations) in several areas, including family medicine, internal medicine, surgery, prenatal care and gynecology, geriatrics, emergency medicine, and pediatrics. Sometimes, PA students serve in one or more of these areas under the supervision of a physician who is seeking to hire a PA. The rotation may lead to permanent employment in one of the areas where the student works. (Information from US Dept of Labor)


    Q. Is being a PA a stepping stone to becoming a physician?
    A.     While being a PA would be great preparation for medical school, it is rather excessive to plan ahead of time to do both. There are some PAs who have gone further in their education to become physicians but it is not a common occurrence. PAs don't generally see themselves as wannabe-doctors, they don't take pride in their work because of what it buys them, and they don't view their field as a stepping stone to something else. Most of them would rather be a PA than a physician (just ask a few).


    Q. Which is the proper term - Physician Assistant or Physician's Assistant?
    A.     Physician Assistant or PA is the proper term, but the Michigan Health Code (state law) identifies PAs as "Physician's Assistants" and it is this spelling, with the apostrophe, that must be used on licenses and other official documents. This name was placed in the statutes in the 1970s when PAs were first defined in law and has not been updated since that time. Unfortunately, the laws regulating the physician assistant profession are not confined to a separate, single section of law but rather scattered throughout the Health Code. For the Michigan legislature to enact a name change (remove the apostrophe), the entirety of the Health Code would have to be opened up to accommodate that change, which our legislators are loath to do since it would also open up the Code to other professions seeking controversial scope-of-practice changes. MAPA has, for years, wanted to remove the apostrophe in the statute, but has not yet proceeded with the change for these reasons. It's possible that an opportunity may present itself in the near future and you can be assured that MAPA will take advantage of that opportunity to make those changes in the law.

    Q. Are all PAs defined as licensed prescribers in Michigan Law?
    A. Yes. PAs are defined as licensed prescribers. Each PAs prescriptive authority can be modified according to the terms of the Practice Agreement if agreed to by the PA and the Participating Physician.


    Q. Are all PAs required to register with MAPS and receive a Controlled Substance License before prescribing medication?
    A.     No. Only PAs prescribing controlled substances are required to register with MAPS and receive a Controlled Substance License (CSL); prior to prescribing a controlled substance. According to the Code, “before prescribing or dispensing a controlled substance to a patient, a licensed prescriber shall register with MAPS.”


    Q. Are PAs required to register with MAPS prior to prescribing and/or dispensing a controlled substance? Even if they don’t prescribe opioids?
    A. Yes. According to the Code, “before prescribing or dispensing a controlled substance to a patient, a licensed prescriber shall register with MAPS.”


    Q. How do I register with MAPS?
    A.     Register with MAPS Here: https://michigan.pmpaware.net/login


    Q. Are PAs delegated and supervised by physicians the authority to prescribe controlled substances?
    A. No. Each PAs prescriptive authority can be modified according to the terms of the Practice Agreement if agreed to by the PA and the Participating Physician. Advanced Practice Registered Nurses (APRNs) must be delegated the authority to prescribe controlled substances by Physicians.


    Q. Can PAs, APRNs and Physicians delegate and supervise the acts, tasks or functions related to prescribing controlled substances?
    A. No. Only physicians can delegate and supervise the prescribing of controlled substances. Physicians do not delegate and supervise other physicians. APRNs may delegate and supervise Nursing acts, tasks or functions. PAs are licensed as a subfield of Medicine therefor PAs do not delegate or supervise medical acts, tasks or functions. PAs do not require delegation for the prescribing of controlled substances. Each PA’s prescriptive authority may be modified by the terms of a Practice agreement as agreed to by the PA and Participating Physician.

    • NOTE: Issuing a “standing order” is not considered delegating or providing supervision as defined in the Code.


    Q. How is Delegation defined in the Code?
    A.     Delegation requires supervision via established protocols and implies shared liability. All prescribers should measure these responsibilities and risks when considering delegating and therefor supervising any acts, tasks or functions. According to the Michigan Health & Hospital Association:

    • “Section 16215 of the Code permits a licensee, other than a subfield licensee, to delegate to another individual who is qualified by education, training or experience, the performance of a task that is within the scope of the delegator’s license and is performed under the delegator’s “supervision” as defined in the Code. In other words, Section 16215 requires that all delegated tasks be performed under “supervision,” which the Code defines as the presence of all of the following conditions:
    • The continuous availability of direct communication in person or by radio, telephone, or telecommunication between the supervised individual and a licensed health professional.
    • The availability of a licensed health professional on a regularly scheduled basis to review the practice of the supervised individual, to provide consultation to the supervised individual, to review records, and to further educate the supervised individual in the performance of the individual's functions.
    • The provision by the licensed supervising health professional of predetermined procedures and drug protocol.“
    • Further, it is considered professional misconduct subject to adverse licensure action to be involved in negligent delegation to and supervision of another practitioner.


    Q. Can APRNs delegate acts, tasks or functions related to prescribing controlled substances?
    A. No. According to a memo from the Michigan Health & Hospital Association:

    • “It is not at all clear that an advanced practice registered nurse (APRN) who is prescribing controlled substances as a delegated act may “sub-delegate” or “redelegate” tasks associated with controlled substance prescribing, including establishing a bona fide prescriber-patient relationship. The Code permits an APRN to prescribe controlled substances only pursuant to delegation from a physician. Prescribing controlled substances is not within the legal scope of the APRN’s license.
    • Given the requirement in Section 16215 that a delegated task must be within the scope of the delegator’s license, it is not clear that it would be appropriate for an APRN to “redelegate” or “sub-delegate” any aspect of prescribing controlled substances, including establishing a bona fide prescriber-patient relationship, to another practitioner. Thus, an APRN wishing to establish a bona fide prescriber-patient relationship with a patient could not use the delegation/supervision provisions of the Code to permit another licensee to complete the tasks related to prescribing controlled substances, including the tasks needed to establish a bona fide prescriber-patient relationship. This same would be true for on-call situations involving an APRN.”


    Q. Can a PA delegate their access to the MAPS system?
    A. Yes. The MAPS system allows all prescribers to assign licensed or unlicensed professionals delegated access to the MAPS system. This is not considered “delegation” as defined in the Code. Delegate MAPS users may access patient MAPS reports.

    However, every prescriber is required to personally review the patients MAPS report before prescribing a controlled substance for more than a 3-day supply.


    Q. Are all prescribers required to personally review the MAPS report before prescribing or refilling a controlled substance?
    A.     Yes, EXCEPT if it is only a 3-day supply.

    • Before prescribing or dispensing to a patient a controlled substance in a quantity that exceeds a 3-day supply, a licensed prescriber shall obtain and review a MAPS report concerning that patient. The requirement does not apply in any of the following circumstances:
    • If the dispensing occurs in a hospital or a freestanding surgical outpatient facility and the controlled substance is administered to the patient in the hospital or facility.
    • If the patient is an animal, the dispensing occurs in a veterinary hospital or clinic, and the controlled substance is administered to the animal in that hospital or clinic.
    • If the controlled substance is prescribed by a licensed prescriber who is a veterinarian and the controlled substance will be dispensed by a pharmacist.


    Q. Are prescribers required to educate patients on the risks of opioids and when is it required?
    A. Yes. Before an opioid is prescribed to a patient, a prescriber shall provide the following information:

    • The dangers of opioid addiction.
    • How to properly dispose of an expired, unused, or unwanted controlled substance.
    • That the delivery of a controlled substance is a felony under Michigan Law.
    • If the patient is pregnant or is a female of reproductive age, the short and long-term effects of exposing a fetus to an opioid, including but not limited to neonatal abstinence syndrome.
    • After providing the information described above, the prescriber shall obtain the signature of the patient or the patient's representative on a form approved by the department.
    • The signed form shall be kept in the patient's medical record.
    • The requirement does not apply if the controlled substance is prescribed for inpatient use.


    Q. Where can I find the required form acknowledging the patient has received the required opioid risk education?
    A.     The Michigan Department of Health and Human Services has combined the acknowledgement of opioid risk education form for adults and minors into a single form titled the “Opioid Start Talking” form. The form can be accessed here. 


    Q. Are the acknowledgement of opioid risk education form requirements different for a minor vs. an adult?
    A. Yes. When prescribing an opioid to an adult, the “Opioid Start Talking” form must be signed by the patient and may be signed by a prescriber or any other licensed health professional. 

    When prescribing to a minor, the “Opioid Start Talking” form must be signed by the prescriber.


    Q. How often does the “start talking” form need to be signed?
    A.     According to the Department of Licensing and Regulatory Affairs (LARA):

    • Practitioners should provide patients with the required opioid information prior to issuing the first prescription, in a course of treatment, for a controlled substance that is an opioid. Continuation of the established previous therapy does not require a new form.
    • This requirement applies to both minors and adult patients who are being prescribed an opioid beginning June 1, 2018. If a minor or adult patient is currently receiving any opioid prior to June 1, 2018 this form would not need to be completed for that specific prescription, as the requirements do not apply retroactively.
    • If a practitioner has a patient on an opioid on or after June 1, 2018, and the patient needs a refill of the same prescription the form would not need to be completed again. If the prescriber starts to treat the patient with a new opioid the form would need to be signed and saved in the patient file.
    • When changing the dosage of the same opioid prescription, in a course of treatment, the form would not need to be signed and saved in the patient file.


    Q. Does the Opioid Start Talking form need to be completed for an inpatient administration of an opioid drug?
    A. No. According to the Department of Licensing and Regulatory Affairs (LARA):

    • For inpatient as well as outpatient surgical procedures, the form does not have to be completed given that the opioid is being administered while the patient is at the facility. For example, administration of the opioid for inpatient stay within, but not limited to, a hospital, freestanding surgical outpatient facility, skilled nursing facility, hospice, homes for aged, etc.


    Q. How is a bona fide prescriber-patient relationship defined for the purpose of prescribing a controlled substance?
    A. LARA is working with the licensing boards, health care providers and stakeholders to address this new law through administrative rules prior to the new effective date of March 31, 2019. If so, the requirement for prescribers to establish a “bona fide” relationship will take effect when the rules are enacted.

    Here is the draft rule defining bona fide relationship requirements approved by the Michigan Board of Pharmacy on June 13th, 2018:

    • Notwithstanding Section 7303a of the Act, MCL 333.7303a and sub-rule (1) of this Rule, and pursuant to Section 16204e, MCL 333.16204e, a prescriber shall be deemed to have a bona fide prescriber-patient relationship under one or more of the following circumstances:
    • The prescriber has reviewed the patient’s relevant medical or clinical records, medical history and any change in medical condition, is acting on behalf of a prescriber described in sub-rule (2) who is not available, and provides documentation in the patient’s medical record in accordance with medically accepted standards of care.
    • The prescriber is following or modifying the orders of a prescriber who has an established bona fide prescriber-patient relationship described in sub-rule (2) with a hospital in-patient, hospice patient, or nursing care facility resident and provides documentation in the patient’s medical record in accordance with medically accepted standards of care.
    • The prescriber is prescribing for a patient for whom the tasks listed in sub-rule (2)(a) and (2)(b) have been performed by an individual licensed under article 15 as authorized by law and documentation is provided in the patient’s medical record in accordance with medically accepted standards of care.
    • The prescriber is treating a patient in an emergency medical situation. For the purposes of this subdivision, "emergency medical situation" means a situation that, in the prescriber’s good faith professional judgment, creates an immediate threat of serious risk to life or health of the patient for whom the controlled substance prescription is being prescribed.
    • The prescriber is prescribing or ordering a schedule 2 to 5 controlled substance for a patient being admitted to a nursing care facility, the tasks identified in sub-rule (2)(a) and (2)(b) are completed in accordance with R 325.20602, and documentation is provided in the patient’s medical record in accordance with medically accepted standards of care.


    Q. Are there limits on how much pain medication can be prescribed?
    A.     Yes. According to the Department of Licensing and Regulatory Affairs (LARA):

    • Starting on July 1, 2018, if a licensed prescriber is treating a patient for acute pain, the prescriber shall not prescribe more than a 7-day supply of an opioid within a 7-day period.
    • Public Act 251 of 2017 defines acute pain as pain that is the normal, predicted physiological response to a noxious chemical or mechanical stimulus and is typically associated with invasive procedures, trauma, and disease, and usually lasts for a limited amount of time.
    • This law does not apply to chronic pain.


    Q. How is an opioid defined?
    A.     “Opioid drugs” are defined in Michigan Administrative Code Rule 418.10109(i) as “opiate analgesics, narcotic analgesics, or any other Schedule C (II-III) controlled substance as identified in United States Code Controlled Substances Act of 1970, 21. U.S.C. §812. Opioid analgesics are the class of drugs, such as morphine, codeine, and methadone, that have the primary indication for the relief of pain.


    Q. Can PAs dispense controlled substances?
    A. Yes. According to the Michigan Public Health Code, Section 7303a(1), “A prescriber who holds a controlled substances license may administer or dispense a controlled substance listed in schedules 2 to 5 without a separate controlled substances license for those activities.” PAs are licensed prescribers who may hold a controlled substance license (CSL) in the State of Michigan.


    Q. Are there any restrictions for PAs ordering and administering controlled substances?
    A. No. PAs can order and administer a Schedule II through V drug. Medications ordered for immediate administration are handled as any other order such as non-scheduled medications. Ordering schedule drug medications in the hospital or psychiatric setting does not require DEA registration, but a state Controlled Substance License is required.


    Q. Can a PA prescribe controlled substances?
    A. Yes. PAs are now defined in Public Act 379 of 2016 as independent prescribers (within a practice agreement). This is an exclusive designation in law that, in addition to PAs, includes physicians, dentists, veterinarians, optometrists (limited to therapeutic pharmaceutical agents) and advance practice registered nurses (excluding schedule II - V which must be delegated by a physician, according to Public Act 499 of 2016).

    Specific prescribing exclusions for PAs, however, may be detailed within the practice agreement between the PA and their participating physician.


    Q. Are there any restrictions for PAs prescribing Schedule II drugs?
    A. No. See suboxone/buprenorphine and medical marijuana questions below.


    Q. Does this mean that a PA must now obtain their own state Controlled Substance License (CSL) and DEA license?
    A. Yes. A PA who intends to prescribe controlled substances must now purchase a State of Michigan Controlled Substance License (CSL) in addition to maintaining their DEA registration. Click on the links below to apply now for the State of Michigan CSL and a DEA registration.


    Q. When do I need to renew my CSL?
    A.     A state CSL expires after one, two, or three years depending upon your application parameters (see CSL application form).


    Q. Can I submit the renewal application for my CSL before submitting the renewal for my professional license?
    A. No. The professional license must be renewed first. If the Department receives the controlled substance renewal but not the professional license renewal, neither license will be renewed.


    Q. Do I have to renew my CSL if I am not currently living in Michigan and my professional license is active? Can I renew my CSL later if I move back to Michigan?
    A.     You do not have to renew your CSL unless you are currently prescribing controlled substances in Michigan under your practice agreement. You can get your CSL reinstated at a later time as long as your professional license is active in Michigan. You would do this by submitting a CSL application to the Department. You can download the most current application here.


    Q. Is a CSL transferable to other locations?
    A. Yes. If you prescribe controlled substances at more than one location, you only need one controlled substance license.


    Q. When do I need to renew my DEA registration? Is a DEA registration transferable to other locations?
    A.     The DEA registration is renewable every three years and is transferable by a PA going from one practice to another.


    Q. If a PA suspects that a new patient is "shopping around" for controlled substances, can a PA find out what prescriptions that patient has filled?
    A. Yes. Michigan has a prescription/pharmacy database where most pharmacies report prescriptions that are filled. PAs are allowed to access the Michigan Automated Prescription System (MAPS) online, but a PA must first email the systems administrator to set up the account.


    Q. Can PAs prescribe Suboxone (buprenorphine)?
    A. As of January 2023, PAs in Michigan can prescribe buprenorphine, the generic version of Suboxone, without a Buprenorphine Waiver (X-Waiver) to treat patients for opioid use disorder (OUD). However, PAs must have an active DEA license and include their DEA registration number on all prescriptions.


    Q. Can PAs prescribe medical marijuana?
    A. No. PAs were not included in Michigan law as prescribers for this drug.