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Implicit Bias Training - Requirements for License Renewal

posted: June 09, 2021

On June 1, the Department of Licensing and Regulatory Affairs (LARA) announced new requirements for over 400,000 health care professionals licensed in Michigan.  Licensees who have email addresses listed with the Bureau of Health Professions/LARA should have received an email outlining the new requirement.  That message is copied below.  Licensees renewing in 2021 will not be impacted.  Those renewing in 2022 will need 2 hours of implicit bias training.  APTA Michigan is developing course content to meet this new requirement and we hope to offer both sessions at our conferences along with live webinars. 

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Dear Licensee –

The Bureau of Professional Licensing (BPL) within the Department of Licensing and Regulatory Affairs (LARA) would like to inform you that the Public Health Code – General Rules have been revised which will require implicit bias training for your profession, effective June 1, 2022.

The new training requirements are the product of numerous workgroup meetings over the past year and represent feedback from 86 organizations including our health professional boards, insurance providers, health systems, health care associations, legislators, state agencies, higher education, and community and advocacy groups. The requirements apply to both new applicants as well as those renewing their existing licenses or registrations.

Below are the changes in the rules that pertain to the new training requirements:

  • The term “implicit bias” is defined as:

(A)n attitude or internalized stereotype that affects an individual’s perception, action, or decision making in an unconscious manner and often contributes to unequal treatment of people based on race, ethnicity, nationality, gender, gender identity, sexual orientation, religion, socioeconomic status, age, disability, or other characteristic. (R 338.7001 (c) )

  • Specifically, the new rule (R 338.7004) requires the following:

Rule 4. (1) Beginning 1 year after promulgation of this rule, an applicant for licensure or registration under article 15 of the code, MCL 333.16101 to 333.18838, except those seeking to be licensed under part 188 of the code, MCL 333.18801 to 333.18838, shall have completed a minimum of 2 hours of implicit bias training within the 5 years immediately preceding issuance of the license or registration.

(2) Beginning 1 year after promulgation of this rule and for every renewal cycle thereafter, in addition to completing any continuing education required for renewal, an applicant for license or registration renewal under article 15 of the code, MCL 333.16101 to 333.18838, except those licensed under part 188 of the code, MCL 333.18801 to 333.18838, shall have completed a minimum of 1 hour of implicit bias training for each year of the applicant’s license or registration cycle.

(3) The implicit bias training must be related to reducing barriers and disparities in access to and delivery of health care services and meet all of the following requirements:

(a) Training content must include, but is not limited to, 1 or more of the following topics:

(i) Information on implicit bias, equitable access to health care, serving a diverse population, diversity and inclusion initiatives, and cultural sensitivity.
(ii) Strategies to remedy the negative impact of implicit bias by recognizing and understanding how it impacts perception, judgment, and actions that may result in inequitable decision making, failure to effectively communicate, and result in barriers and disparities in the access to and delivery of health care services.
(iii) The historical basis and present consequences of implicit biases based on an individual’s characteristics.
(iv) Discussion of current research on implicit bias in the access to and delivery of health care services.

(b) Training must include strategies to reduce disparities in access to and delivery of health care services and the administration of pre- and post-test implicit bias assessments.

(c) Acceptable sponsors of this training include any of the following:

(i) Training offered by a nationally-recognized or state-recognized health-related organization.
(ii) Training offered by, or in conjunction with, a state or federal agency.
(iii) Training obtained in an educational program that has been approved by any board created under article 15 of the code, MCL 333.16101 to 333.18838, except under part 188 of the code, MCL 333.18801 to 333.18838, for initial licensure or registration or for the accumulation of continuing education credits.
(iv) Training offered by an accredited college or university.
(v) An organization specializing in diversity, equity, and inclusion issues.

(d) Acceptable modalities of training include any of the following:

(i) A teleconference or webinar that permits live synchronous interaction.
(ii) A live presentation.
(iii) Interactive online instruction.

(4) Submission of an application for licensure, registration, or renewal constitutes an applicant’s certificate of compliance with the requirements of this rule. A licensee or registrant shall retain documentation of meeting the requirements of this rule for a period of 6 years from the date of applying for licensure, registration, or renewal. The department may select and audit a sample of a licensees or registrants and request documentation of proof of compliance with this rule. If audited by the department, a licensee or registrant shall provide the proof of completion of training, including either of the following:

(a) A completion certificate issued by the training program that includes the date of the training, the program sponsor’s name, the title of the program, and licensee’s or registrant’s name.

(b) A self-attestation by the licensee or registrant that includes the date of the training, the program sponsor’s name, the title of the program, and licensee’s or registrant’s name.

Please send any questions you may have about these revised rules to BPLHelp@michigan.gov .

Thank you,

Debra Gagliardi, Director
Bureau of Professional Licensing
Department of Licensing and Regulatory Affairs


LARA is an equal opportunity employer/program.

Auxiliary aids, services and other reasonable accommodations are available upon request to individuals with disabilities.

BUREAU OF PROFESSIONAL LICENSING
P.O. BOX 30670· LANSING, MICHIGAN 48909
www.michigan.gov/bpl

For more information about LARA, please visit www.michigan.gov/lara

Follow us on Twitter www.twitter.com/michiganLARA

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Public Health Code Amended to Allow Nurse Practitioners to Prescribe Physical Therapy - Effective April 9, 2017

posted: April 24, 2017

The Physical Therapy Section of the Public Health Code has been amended to allow Advanced Practice Registered Nurses to prescribe physical therapy:

 

PUBLIC HEALTH CODE (EXCERPT)
Act 368 of 1978

***** 333.17820.amended THIS AMENDED SECTION IS EFFECTIVE APRIL 9, 2017 *****



333.17820.amended Practice of physical therapy or physical therapist assistant; license or authorization required; engaging in treatment with or without prescription of certain license holders; use of words, titles, or letters.

Sec. 17820.

(1) An individual shall not engage in the practice of physical therapy or practice as a physical therapist assistant unless licensed or otherwise authorized under this part. Except as otherwise provided in this subsection, a physical therapist or physical therapist assistant shall engage in the treatment of a patient if that treatment is prescribed by a health care professional who is an advanced practice registered nurse as that term is defined in section 17201, or who holds a license issued under part 166, 170, 175, or 180, or an equivalent license issued by another state. A physical therapist or a physical therapist assistant may engage in the treatment of a patient without the prescription of a health care professional who is an advanced practice registered nurse as that term is defined in section 17201, or who holds a license issued under part 166, 170, 175, or 180, or an equivalent license issued by another state, under either of the following circumstances:

(a) For 21 days or 10 treatments, whichever first occurs. However, a physical therapist shall determine that the patient's condition requires physical therapy before delegating physical therapy interventions to a physical therapist assistant.

(b) The patient is seeking physical therapy services for the purpose of preventing injury or promoting fitness.

 

 

(2) The following words, titles, or letters or a combination of words, titles, or letters, with or without qualifying words or phrases, are restricted in use only to those persons authorized under this part to use the terms and in a way prescribed in this part: "physical therapy", "physical therapist", "doctor of physiotherapy", "doctor of physical therapy", "physiotherapist", "physiotherapy", "registered physical therapist", "licensed physical therapist", "physical therapy technician", "physical therapist assistant", "physical therapy assistant", "physiotherapist assistant", "physiotherapy assistant", "p.t. assistant", "p.t.", "r.p.t.", "l.p.t.", "c.p.t.", "d.p.t.", "m.p.t.", "p.t.a.", "registered p.t.a.", "licensed p.t.a.", "certified p.t.a.", "c.p.t.a.", "l.p.t.a.", "r.p.t.a.", and "p.t.t.".

Section 17201:

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.

PUBLIC HEALTH CODE (EXCERPT)
Act 368 of 1978

***** 333.17820.amended THIS AMENDED SECTION IS EFFECTIVE APRIL 9, 2017 *****

 


333.17820.amended Practice of physical therapy or physical therapist assistant; license or authorization required; engaging in treatment with or without prescription of certain license holders; use of words, titles, or letters.

 

Sec. 17820.

(1) An individual shall not engage in the practice of physical therapy or practice as a physical therapist assistant unless licensed or otherwise authorized under this part. Except as otherwise provided in this subsection, a physical therapist or physical therapist assistant shall engage in the treatment of a patient if that treatment is prescribed by a health care professional who is an advanced practice registered nurse as that term is defined in section 17201, or who holds a license issued under part 166, 170, 175, or 180, or an equivalent license issued by another state. A physical therapist or a physical therapist assistant may engage in the treatment of a patient without the prescription of a health care professional who is an advanced practice registered nurse as that term is defined in section 17201, or who holds a license issued under part 166, 170, 175, or 180, or an equivalent license issued by another state, under either of the following circumstances:

(a) For 21 days or 10 treatments, whichever first occurs. However, a physical therapist shall determine that the patient's condition requires physical therapy before delegating physical therapy interventions to a physical therapist assistant.

(b) The patient is seeking physical therapy services for the purpose of preventing injury or promoting fitness.

(2) The following words, titles, or letters or a combination of words, titles, or letters, with or without qualifying words or phrases, are restricted in use only to those persons authorized under this part to use the terms and in a way prescribed in this part: "physical therapy", "physical therapist", "doctor of physiotherapy", "doctor of physical therapy", "physiotherapist", "physiotherapy", "registered physical therapist", "licensed physical therapist", "physical therapy technician", "physical therapist assistant", "physical therapy assistant", "physiotherapist assistant", "physiotherapy assistant", "p.t. assistant", "p.t.", "r.p.t.", "l.p.t.", "c.p.t.", "d.p.t.", "m.p.t.", "p.t.a.", "registered p.t.a.", "licensed p.t.a.", "certified p.t.a.", "c.p.t.a.", "l.p.t.a.", "r.p.t.a.", and "p.t.t.".

 

 


Practice Resources

The practice of physical therapy is governed by various sets of laws, regulations, policies, and guidelines. It is important for physical therapists and physical therapist assistants to be familiar with them and to understand when each is applicable to a given practice setting and/or specific patient. They include:

State Law. The practice of physical therapy is legally regulated at the state level. In Michigan, the Public Health Code is state law. The Administrative Rules written by the Michigan Board of Physical Therapy provide details and interpretation of legislative intent, and are as binding as state law. Compliance with both is required for all settings and patients at all times. Violations of state law can result in sanctions against your license.

Michigan Public Health Code General Provisions:
http://www.legislature.mi.gov/(S(mythcqvglmcecop44qzzz3vd))/mileg.aspx?page=getObject&objectName=mcl-368-1978-15-161

Michigan Public Health Code Part 178, Physical Therapy: http://www.legislature.mi.gov/(S(s1hvtjgnvvp2pive3db5cuzd))/mileg.aspx?page=getObject&objectName=mcl-368-1978-15-178

Michigan Board of Physical Therapy Administrative Rules: https://aptami.org/pdfs/General Rules Dec2019.pdf

Information on filing a complaint against another licensee:
http://www.michigan.gov/lara/0,4601,7-154-35299_63294_27647---,00.html

Third Party Payer Regulations/Contracts. Billing a third party payer for care provided to one of its beneficiaries explicitly attests to your compliance with all of the third party payer's regulations. The penalty for inappropriately billing for services is insurance fraud. Some consider this the most challenging aspect of practice given the wide variety of payer regulations and contracts. Below are links to key regulations for Medicare and Medicaid. Be sure to be familiar with all private payer contracts to whom you bill for services.

Medicare Benefit Policy Manual (See especially Chapter 15, Sections 220 and 230, as well as other Chapters relevant to your specific setting)
http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS012673.html

Michigan Medicaid Provider Manual (see especially Outpatient Therapy Section 5.2 as well as therapy sections for other settings)
http://www.mdch.state.mi.us/dch-medicaid/manuals/medicaidprovidermanual.pdf

Reporting Medicare Fraud and Abuse:
http://www.medicare.gov/forms-help-and-resources/report-fraud-and-abuse/report-fraud/reporting-fraud.html

Reporting Michigan Medicaid Fraud and Abuse:
http://www.michigan.gov/ag/0,4534,7-164-18156_18152-47192--,00.html

Professional Practice Standards. The American Physical Therapy Association (APTA) is the exclusive professional association that supports the profession of physical therapy. It sets forth policies and positions regarding best practice and helps establish the prevailing practice standards. Although adherence to all APTA policies and positions is not required, it is strongly advised. In the event of a complaint or lawsuit filed against you, APTA policies and positions will be used to judge your actions by the Michigan Board of Physical Therapy and in a court of law through expert witness testimony.

American Physical Therapy Association Polices and Positions:
http://www.apta.org/Policies/
*See especially those related to "Practice" (http://www.apta.org/Policies/Practice/)

Facility Policies. Each practice setting/facility has policies and procedures for the provision of care to patients. As with professional practice standards, facility polices are not legally binding. However, if there is a malpractice claim against you, your deviation from any established policies or procedures will be used to judge your actions.

Your Personal Scope of Competence. Although this is addressed in the General Provisions of the Michigan Public Health Code and is therefore a legal requirement, it bears repeating: No matter what your license allows you as a PT/PTA to perform legally, you should not perform any aspect of physical therapy practice that you personally are not trained or competent to perform.

     

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