State Overview: Michigan

Prior authorization requirements are up to the discretion of the state Medicaid program or insurance company.

Michigan credentials two types of addiction counselors. A Certified Alcohol and Drug Counselor requires a high school diploma, at minimum, 270 hours of relevant education courses and 6,000 hours of experience. A higher-level degree can substitute the number of hours (i.e. a person with a bachelor's degree needs 4,000 hours). A Certified Advanced Alcohol and Drug Counselors requires a master's degree, 180 hours of relevant education courses and 2,000 hours of experience. Mich. Admin. Code R §325.1301 – 1399 and Michigan Certification Board for Addiction Professionals

A licensed professional counselors may provide services to individuals, groups, families, organizations, or the general public including psychotherapy, psychoeducational counseling, counseling techniques and diagnosing the problem. This includes the application of basic counseling and psychotherapy skills and theories in the counseling process for the purposes of establishing and maintaining the counseling relationship; diagnosing the problem; formulating a preventative, treatment, or rehabilitative plan; and facilitating appropriate interventions. Mich. Comp. Laws §333.18101

The standards for the certification of peer recovery mentors, including experience, training, and supervision requirements, are developed and administered by a third-party, non-profit certification provider.

Physician relationship required in order to prescribe.

An NM may prescribe nonscheduled drugs without the delegation of a physician. The NP may prescribe Schedules II-V controlled substances if delegated by a physician. Mich. Comp. Laws §333.17211a

Physician relationship required for Medicaid reimbursement.

The practice of nursing includes 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. Michigan statute does not explicitly require collaboration with a physician but a collaborative agreement is required in order to be reimbursed by the state Medicaid program. Mich. Comp. Laws §333.17201

An NP may prescribe nonscheduled drugs without the delegation of a physician. The NP may prescribe Schedules II-V controlled substances if delegated by a physician. Mich. Comp. Laws §333.17211a

NPs are authorized to sign physician orders for scope of treatment forms.

NPs are not explicitly recognized in state policy as primary care providers.

Full independent practice authority; no prescriptive authority.

Michigan opted out of the CRNA federal supervision requirement in 2022.

CRNAs may provide anesthesia and analgesia services without supervision and as the sole and independent anesthesia provider while they are collaboratively participating in a patient-centered care team. Mich. Comp. Laws §333.17210

CRNAs are authorized to select, order, prescribe and administer anesthesia and prescription drugs and controlled substances specifically for use in their practice as anesthesia providers. The authority to prescribe pharmacological agents for CRNAs is confined to those agents to be administered directly to patients in a clinical setting; prescriptive authority does not extend to allowing patients to self-administer, obtain or receive these pharmacological agents outside of the immediate clinical context of anesthetic or analgesic service. Mich. Comp. Laws §333.17210

Optometrists may only examine, diagnose and treat conditions of the visual system. Mich. Comp. Laws §333.17401(1)

Optometrists may not administer medication through injection. Mich. Comp. Laws §333.17401(1)(h)

Optometrists may prescribe Schedule III-V controlled substances and also Schedule II hydrocodone or hydrocodone combination medications. Mich. Comp. Laws §333.17401(1)

A dental hygienist may practice in a public or nonprofit entity or school or nursing home that administers a program of dental care to a dentally underserved population. They must have continuous availability of direct communication with a dentist and may provide the full scope of dental hygiene services allowed under general supervision. Mich. Comp. Laws §333.16625

Dental therapists may practice in Michigan under the supervision of a dentist in a variety of settings including, but not limited to, correctional facilities, school-based health centers and federally qualified health centers. Mich. Comp. Laws §333.16655

Michigan does not explicitly allow for the practice of teledentistry.

Michigan has not enacted legislation allowing pharmacists to administer the COVID-19 vaccine. However, the federal PREP Act allowed pharmacists to administer the COVID-19 vaccine through the duration of the public health emergency.

Michigan does not allow pharmacists to modify prescriptions.

Michigan allows pharmacists to prescribe hormonal contraceptives.

The Michigan Licensing and Regulatory Affairs division clarified that under Michigan Public Code (Mich. Comp. Laws §333.17707(3)) as long as listed requirements are met, licensed physicians may choose to delegate to licensed pharmacists the authority to prescribe self-administered, hormonal contraceptives, as pharmacists are "otherwise qualified by education, training or experience" to carry out that function.

Requirements include:

• Only MDs and DOs licensed in Michigan may delegate.
• Those who are delegated authority must be pharmacists licensed in Michigan with a PharmD degree.
• Only the authority to prescribe self-administered, hormonal contraceptives may be delegated.
• A pharmacist must complete training regarding prescribing self-administered, hormonal contraceptives.
• This delegation requires "adequate supervision by the delegating licensee." This must include all the following (as provided in Mich. Comp. Laws §333.16109(2)):
  • Continuous availability of direct communication in person or by radio, telephone, or telecommunication between the MD/DO and the pharmacist.
  • The MD/DO being available on a regularly scheduled basis to review the pharmacist's records and practice, to consult with the pharmacist, and to further educate the pharmacist in the performance of the delegated functions.
  • The MD/DO providing predetermined procedures and drug protocol.
• All prescriptions issued by a pharmacist must indicate the name of the delegating MD/DO.
• The scope of the delegation, including predetermined procedures and drug protocol, should be memorialized in a written delegation agreement. A sample agreement template is available on LARA's website.

Delegation of Limited Prescriptive Authority to Licensed Pharmacists

Michigan does not allow pharmacists to prescribe tobacco cessation aids.

Collaboration allowed with a physician for practice and prescriptive authority.

A PA 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. Mich. Comp. Laws §333.17047

A PA who is a party to a practice agreement may prescribe a drug in accordance with procedures and protocols for the prescription established by rule of the department in consultation with the appropriate board. A PA may prescribe a drug, including a controlled substance that is included in schedules II to V. Mich. Comp. Laws §333.17076(2),(3)

Statute does not limit the number of PAs a physician may supervise.

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 are subject to section 16221. [Duties and violations] Mich. Comp. Laws §333.17047(3)

Chart co-signatures may be determined at the practice level.

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. […] Mich. Comp. Laws §333.17049(2)

Statute allows adaptable proximity.

A practice agreement must specify a process between the PA 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 PA 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. Mich. Comp. Laws §333.17047

A PA may provide medical services under the supervision of a physician and only if the medical services are within the scope of practice of the supervising physician and delegated by the supervising physician. Mich. Comp. Laws §333.17076