Lawmakers hear hours of testimony on bill to grant nurse practitioners independent practice

The Michigan House Health Policy Committee spent its session hearing remaining testimony on House Bill 43 99, a proposal to make physician collaborative agreements for advanced practice registered nurses (APRNs or nurse practitioners) voluntary and effectively grant full practice authority. The committee did not take a vote after multiple hours of testimony for and against the bill.

Supporters told the panel the bill would reduce barriers that now limit where and how nurse practitioners can work. Cassie Thierfelder, manager of advocacy for AARP Michigan, told the committee the change would expand access and reduce costs: "This bill would improve access to that care," she said, citing lower hospitalization rates in states with full practice authority. Tyra Evans, chief operating officer of Authority Health Detroit, said collaborative agreements often function as "bureaucratic, red tape" that can limit a health center’s use of nurse practitioners and delay routine treatments for patients in underserved communities.

Opponents — including several physician groups and specialty societies — urged caution and, in some cases, rejected the bill as written. Shay Raleigh, executive director of Great Lakes Physician Organization, argued the legislation would not reliably improve rural access and could prompt employers to replace physicians with nurse practitioners "in the effort to make their balance sheets look more profitable." Pamela Coffey, a board-certified emergency physician and board member of the Michigan College of Emergency Physicians, warned that emergency care requires the depth of physician training: she described cases she said illustrated risks from less-experienced clinicians and urged alternatives such as residency incentives to place physicians in rural areas.

Several witnesses asked the committee to add guardrails before allowing independent practice. Physician assistants and physician-associate leaders urged parity and transitional requirements, such as structured postgraduate experience or limits to the specialties in which independent practice is allowed. Brian Gallagher, a physician associate and former Tribal Health clinical officer, recommended requiring minimum supervised practice hours and restricting independent practice to the clinician’s trained specialty.

Testimony included a personal account urged by a constituent opposed to the bill. Shannon Henge, identified in the record as a private citizen, described the 2021 death of her mother and blamed a nurse practitioner’s prescribing: "She died at the hands of a nurse practitioner," Henge said. She urged the committee not to "exchange patient safety for convenience." The committee did not question Henge and there was no immediate action following that testimony.

Other witnesses described workforce shortages that support proponents’ arguments. Michael Hunter, president of Team Wellness Center, said his community behavioral-health programs rely heavily on nurse practitioners because of shortages of psychiatrists and limitations on the number of nurse practitioners a physician can collaborate with. Several nurse-practitioner witnesses and nursing associations described Michigan as one of the more restrictive states for APRN practice, and said the bill would remove legal barriers while leaving licensing and certification requirements intact.

Radiologists opposed parts of the bill they said are written too broadly. Leah Davis of the Michigan Radiological Society warned that language on ordering, performing and interpreting imaging ‘‘would permit the ordering, performing, supervising, and interpreting of laboratory and imaging studies’’ by clinicians without radiology training and that nonphysician ordering can increase imaging use.

Representative Preston, sponsor of HB 43 99, told the committee he is open to drafting changes and amendments to address concerns, including entry-level collaborative care requirements and other safeguards. The committee did not schedule a vote during the session.

The committee hearing collected technical and policy recommendations from organized medicine, nursing groups, patient advocates and health systems. Lawmakers will consider those recommendations and whether to amend the bill before any formal committee vote.