Lawmakers hear hours of testimony on HB 4399, a bill to remove mandatory collaborative agreements for nurse practitioners

At a House Health Policy Committee hearing, lawmakers heard more than a dozen witnesses for and against House Bill 4,399, the measure sponsored by Representative Preston that would make physician collaborative agreements for most advanced practice registered nurses (commonly called nurse practitioners or NPs) voluntary rather than required by law.

The debate centered on two competing claims: supporters, including AARP Michigan, community health centers and nursing associations, said removing the mandatory contracts would improve access to primary care—especially in rural and underserved areas—and reduce bureaucratic barriers; physician groups, radiologists and some emergency medicine specialists said the proposal risks patient safety by allowing providers with different training backgrounds to practice without the supervision they now have.

Supporters told the committee that the contracts can act as a works-stopping barrier when a physician revokes an agreement or when newly graduated NPs cannot find a collaborator. Cassie Thirfelder, manager of Advocacy for AARP Michigan, told the committee: "We support House Bill 4,399 because it will increase consumers' access to health care and reduce unnecessary health care costs." Tyra Evans, chief operating officer of Authority Health Detroit, said NP collaboration already happens in practice and that mandatory agreements sometimes function as "bureaucratic red tape" that limits clinics' ability to use NPs where physicians are not available.

Providers who serve populations with large mental‑health needs also argued for change. Michael Hunter, president of Team Wellness Center, said his organization relies on NPs because the psychiatry workforce is aging and openings for MDs and DOs often go unfilled: "We have gravitated more and more to the nurse practitioner model," he said, explaining that per‑physician limits on the number of collaborating NPs can constrain hiring and service delivery.

Opponents emphasized training, clinical hours, and quality-control concerns. Pamela Coffey, speaking for the Michigan College of Emergency Physicians, described physician training and warned that the bill could permit new NP graduates to practice independently without the clinical hours emergency physicians consider essential. "Under this bill, a new graduate with only a fraction of the clinical training of an EM doctor could be practicing by themselves in an emergency department with no supervision," Coffey said. Radiologists raised separate concerns about imaging and radiation safety; Leah Davis of the Michigan Radiological Society warned that language in the bill that permits ordering and interpreting imaging studies could expand practice in ways the society finds unsafe.

Several witnesses proposed amendments to address the concerns raised during testimony. Suggestions included a post‑graduate experience requirement before full independence, limiting independent practice to the specialty area in which the NP was trained, requiring supervision or enhanced oversight when NPs work outside their training, ensuring scope parity for physician assistants to prevent workforce destabilization, and preserving radiology interpretation and radiation‑safety oversight by board‑certified imaging physicians. Brian Gallagher of the Michigan Academy of Physician Associates and Sarah Scantambrillo, a physician associate practicing psychiatry, urged careful drafting to avoid unintended workforce incentives.

Representative Preston, the bill sponsor, told the committee he is open to changes: "My office is open," he said, inviting stakeholders to propose entry‑level collaborative requirements and other amendments that could increase provider capacity while addressing safety concerns.

No final committee vote on HB 4,399 was taken during the hearing; the session consisted of testimony and questions from committee members.

Ending: Committee members said they will continue to review the evidence and suggested amendments. Multiple witnesses supplied printed materials and offered to follow up with studies; Representative Preston indicated his office is available to receive substitution language and proposals aimed at balancing access and safety.