House committee hears competing testimony on bill to let nurse practitioners practice independently

Lansing — The House Health Policy Committee resumed testimony on House Bill 43 99, a broad proposal that would remove certain physician delegation and supervision requirements for nurse practitioners and allow independent practice in many settings.

Supporters — including university clinic leaders, community health centers and primary care associations — said ending mandatory collaborative contracts would improve access to care, reduce administrative costs and make it easier to hire clinicians to serve underserved and rural areas. "The best solution for our clinic and others like ours is to retire these contracts entirely," said Anne Sheehan, assistant dean for faculty practice at Michigan State University's College of Nursing, describing a nurse‑run family medicine clinic whose new‑patient wait dropped from 45 days to eight days after opening. Sheehan told the committee physician contract fees in her system add roughly $35,000 a year in costs that could otherwise support additional clinician hours.

Lisa Rutledge of Western Wayne Family Health Centers said the requirement has blocked hiring psychiatric nurse practitioners in her organization after a part‑time psychiatrist left. "We could easily hire a psychiatric nurse practitioner," Rutledge said, but the center could not because no psychiatrist would agree to be the required collaborating physician; the organization instead diverted patients to community mental health, increasing waits for specialty care.

Frank Waters of the Michigan Primary Care Association said federally qualified health centers rely on nurse practitioners to serve underserved populations and that full practice authority could help address workforce shortages.

Opponents, including the Michigan Osteopathic Association and physician groups represented in committee testimony, said the bill goes too far in removing physician oversight and raised concerns about differences in training, prescribing patterns, and quality outcomes. "House Bill 43 99 would allow NPs to independently practice after 4 years of nursing ... and 2 or 3 years of master or PhD level education," said Dr. Edward Canfield, speaking for the Michigan Osteopathic Association, urging caution and additional consumer clarity about credentials. He and others pointed to studies and data they said show higher utilization and higher per‑capita health spending in some full‑practice states; a medical society witness cited Minnesota as having the highest per‑capita health care expenditure among neighboring states with full practice authority.

Representatives and witnesses also debated the statutory and business implications. A legal expert advising the committee reviewed how Michigan’s LLC and professional entity statutes apply, saying that under existing law a nurse practitioner who gains independent practice authority could form an LLC or PLLC for lawful professional services unless the statute explicitly prohibits it. Medical society witnesses said the committee should explicitly specify any limits the legislature intends regarding practice ownership.

Committee members asked about malpractice insurance requirements (Michigan does not require professional liability insurance for nurse practitioners by statute), telemedicine and rural access, whether collaborative contracts actually improve supervision, and whether studies cited by proponents reflect team‑based care rather than independent practice. Testimony included a mix of peer‑review citations, organizational experience and anecdotal patient stories.

The committee ended testimony on HB 43 99 with plans to continue consideration at a later date; no vote was taken.