reglab/statecodes huggingface dataset:
Michigan Administrative Code › Department - Environmental Quality › Water Resources Division › Part 3. Subdivisions of Land › Part 3 - DEPARTMENT OF ENVIRONMENTAL QUALITY › Section R. 560.304 - Building in areas affected by floodplains

Current through Vol. 24-12, July 15, 2024
Rule 304.
(1) The
				  purpose of this rule is to prescribe minimum standards for a new development
				  for residential purposes and occupancy within or affected by a
				  floodplain.
(2) A proprietor shall
				  file and record with the final plat restrictive deed covenants that state, in
				  perpetuity, that no filling or occupation of the floodplain area will be
				  allowed without approval of the department of environmental quality and that
				  any building used or capable of being used for residential purposes and
				  occupancy within or affected by the floodplain shall comply with all of the
				  following requirements:
(a) Be located on a
				  lot having a minimum buildable site of 3,000 square feet of its area at its
				  natural grade above the elevation of the line defining the floodplain limits.
				  The buildable site shall exclude all setbacks and easements.
(b) Be served by streets within the proposed
				  subdivision having surfaces not lower than 1 foot below the elevation defining
				  the floodplain limits.
(c) Have
				  lower floors, excluding basements, not lower than the elevation defining the
				  floodplain limits.
(d) Have
				  openings into the basement not lower than the elevation defining the floodplain
				  limits.
(e) Have basement walls and
				  floors, if below the elevation defining the floodplain limits, that are
				  watertight and designed to withstand hydrostatic pressures from a water level
				  equal to the elevation of the contour defining the floodplain limits following
				  methods and procedures outlined in chapter 5 for type A construction and
				  chapter 6 for class 1 loads found in the publication entitled "Flood Proofing
				  Regulations," EP 1165 2 314, prepared by the office of the chief of engineers,
				  United States Army, Washington, DC, March 1992. Figure 6 on page 14-5 of the
				  regulations shows typical foundation drainage and waterproofing details. This
				  document is adopted by reference in these rules and is available, at no cost,
				  from the Department of Environmental Quality, Land and Water Management
				  Division, P.O. Box 30458, Lansing, Michigan 48909-7958, or the Department of
				  the Army, Corps of Engineers, Publications Depot, 890 S. Pickett, Alexandria,
				  Virginia 22304.
(f) Be equipped
				  with a positive means of preventing sewer backup from sewer lines and drains
				  that serve the building.
(g) Be
				  properly anchored or weighted to prevent flotation.
Michigan Administrative Code › Department - Health and Human Services › Policy and Planning Administration › Michigan Physician Orders For Scope Of Treatment › Section R. 325.81 - Definitions

Current through Vol. 24-12, July 15, 2024
Rule 81.
(1) As used
				in these rules:
(a) "Advanced illness" means a
				medical or surgical condition with significant functional impairment that is
				not reversible by curative therapies and that is anticipated to progress toward
				death despite attempts at curative therapies or modulation.
(b) "Attending health professional" means a
				physician, physician's assistant, or certified nurse practitioner, who has
				primary responsibility for the treatment of a patient and is authorized to
				issue the orders on a MI-POST form.
(c) "Change in level of care or care setting"
				results from a formal healthcare or needs assessment, or both, that supports
				the increase or decrease in care services required to provide a safe and least
				restrictive setting for the patient. A change in care setting does not refer to
				reassignments within the same facility.
(d) "Department" means the department of
				health and human services.
(e)
				"Emergency medical services personnel" or "EMS personnel" means that term as
				defined in section 20904 of the public health code, 1978 PA 368, MCL 333.20904,
				but does not include an emergency medical services
				instructor-coordinator.
(f)
				"Guardian" means a person with the powers and duties to make medical treatment
				decisions on behalf of a patient to the extent granted by court order under
				section 5314 of the estates and protected individuals code, 1998 PA 386, MCL
				700.5314.
(g) "Patient advocate"
				means an individual presently authorized to make medical treatment decisions on
				behalf of a patient under sections 5506 to 5515 of the estates and protected
				individuals code, 1998 PA 386, MCL 700.5506 to 700.5515.
(h) "Patient representative" means a patient
				advocate or a guardian.
(i)
				"Physician orders for scope of treatment form" or "MI-POST " means a form
				created by the department to be used as part of an advance care planning
				process that, with medical orders, reflect both the patient's expressed wishes
				or best interests and the attending health professional's medical advice or
				recommendation. A MI-POST is not an advance health care directive.
Michigan Administrative Code › Department - Health and Human Services › Policy and Planning Administration › Michigan Physician Orders For Scope Of Treatment › Section R. 325.82 - General Rules

Current through Vol. 24-12, July 15, 2024
Rule 82.
(1) MI-POST
				is intended only for those adult patients with advanced illness or frailty for
				whom, based on his or her current medical condition, death would occur within 1
				year. A healthcare professional's prognosis of life expectancy is not
				required.
(2) MI-POST cannot be
				required for admission to any healthcare or community facility
				setting.
(3) The standard form must
				be printed on pink 65-pound card stock, white card stock paper with a pink
				border, or paper of similar style and quality to make the form easily
				identifiable.
(4) The department
				must make available electronic blank copies.
(5) The original form in its most current
				version remains the property of the individual patient. Copies, including
				paper, facsimile, and all digital versions, are permissible and valid. Health
				care facilities and physician offices must retain the most current copy of the
				patient's MI-POST form in the patient's medical record.
(6) The MI-POST is binding in any health care
				facility other than acute care. Acute care settings shall utilize the MI-POST
				as evidence of the patient's healthcare decisions when evaluating the patient;
				however, treatments may differ according to the best clinical judgement of the
				healthcare professional currently treating the patient.
(7) The MI-POST directs the care provided by
				EMS. EMS must follow the protocol established by the department.
(8) Forms labeled "Michigan POST" or
				"MI-POST" are valid from 1 year of the most recent attending health
				professional signature date.
(9)
				MI-POST forms completed after June 30, 2023 must be completed on the MI-POST
				form created under the act.
(10)
				Orders indicated on a properly executed MI-POST are presumed to express the
				patient's current decisions over a previously executed advanced
				directive.
(11) If a MI-POST is
				validly executed after a do-not-resuscitate order is executed under the
				Michigan do-not-resuscitate procedure act, 1996 PA 193, MCL 333.1051 to
				333.1067, the medical orders indicated on the MI-POST are presumed to express
				the patient's current wishes.
Michigan Administrative Code › Department - Health and Human Services › Policy and Planning Administration › Michigan Physician Orders For Scope Of Treatment › Section R. 325.83 - Completing the MI-POST

Current through Vol. 24-12, July 15, 2024
Rule 83.
(1) Prior
				to signing the MI-POST, the attending health professional must address the
				following with the patient:
(a) The patient
				information sheet regarding the MI-POST must be reviewed, signed, and placed in
				the patient's permanent medical record.
(b) If the patient does not have a patient
				representative, the attending health professional shall recommend to the
				patient that the patient consider designating an individual to serve as patient
				advocate to make future medical decisions on behalf of the patient if the
				patient becomes unable to do so.
Michigan Administrative Code › Department - Health and Human Services › Policy and Planning Administration › Michigan Physician Orders For Scope Of Treatment › Section R. 325.84 - Reaffirming or Revoking the MI-POST; General

Current through Vol. 24-12, July 15, 2024
Rule 84.
(1) The
				MI-POST may be reaffirmed or revoked under either of the following
				circumstances:
(a) 1 year from the date since
				the form was last signed or reaffirmed.
(b) 30 days from a change in the patient's
				attending health professional; or a change in the patient's place of care,
				level of care, or care setting; or an unexpected change in the patient's
				medical condition.
Michigan Administrative Code › Department - Health and Human Services › Policy and Planning Administration › Michigan Physician Orders For Scope Of Treatment › Section R. 325.85 - Reaffirming the MI-POST

Current through Vol. 24-12, July 15, 2024
Rule 85.
(1) The
				MI-POST must be signed and dated by the attending health professional and the
				patient or patient representative on the corresponding affirmation
				line.
(2) The form must be
				reaffirmed if a previously blank section in the form is completed.
(3) Changes may not be made to previously
				completed sections. If changes are needed, a new MI-POST must be
				completed.
Michigan Administrative Code › Department - Health and Human Services › Policy and Planning Administration › Michigan Physician Orders For Scope Of Treatment › Section R. 325.86 - Revoking the MI-POST

Current through Vol. 24-12, July 15, 2024
Rule 86.
(1) When
				revoking the MI-POST, the attending health professional or the patient or the
				patient's representative shall write "revoked" over the most recent signatures
				of the patient or patient representative and the attending health
				professional.
(2) The individual
				revoking the form shall write "void" in large, bold ink diagonally across both
				sides of the form.
(3) If the
				patient or patient representative revokes the MI-POST, reasonable action must
				be taken to notify at least 1 of the following:
(a) The attending health
				professional.
(b) The health
				professional who is treating the patient.
(c) The health facility responsible for the
				medical treatment of the patient.
Michigan Administrative Code › Department - Health and Human Services › Policy and Planning Administration › Michigan Physician Orders For Scope Of Treatment › Section R. 325.87 - Compliance with MI-POST Form

Current through Vol. 24-12, July 15, 2024
Rule 87. EMS will treat patients according to the orders on a
				  MI-POST per department- approved MI-POST emergency medical protocol unless any
				  of the following apply:
(a) The
				services being provided are the result of an injury or medical condition that
				is unrelated to the diagnosis or medical condition that is indicated on the
				patient's MI-POST.
(b) The valid
				MI-POST requests the initiation of resuscitation if the patient suffers
				cessation of both spontaneous respiration and circulation, and the emergency
				medical services personnel has actual notice of a do-not-resuscitate order that
				was executed under the Michigan do-not-resuscitate procedure act, 1996 PA 193,
				MCL 333.1051 to 333.1067, after the MI-POST was validly executed.
(c) The valid MI-POST has been revoked and
				EMS has actual notice of the revocation.
Michigan Administrative Code › Department - Health and Human Services › Behavioral Health and Developmental Disabilities Administration › Chronic Disease Reporting › Section R. 330.131 - Definitions

Current through Vol. 24-12, July 15, 2024
Rule 131.
(1) As
				used in these rules:
(a) "Chronic disease
				registry" means the database maintained by the department that contains
				patient-level health information about individuals with a diagnosed chronic
				disease, including, but not limited to, diagnostic and demographic
				information.
(b) "Code" means the
				public health code, 1978 PA 368, MCL
				333.1101 to 333. 25211.
(c) "Department" means the department of
				health and human services.
(d)
				"Director" means the director of the department.
(e) "Health information" means information
				about an individual, whether oral or recorded in any form or medium that
				relates to the past, present, or future physical or mental health or condition
				of an individual, and the provision of health care to an individual. Health
				information includes aggregate information if, in the opinion of the
				department, it could potentially lead to reidentification of an
				individual.
(f) "Health
				professional" means an individual licensed under article 15 of the code, MCL
				333.16101 to
				333.18838, to work as a
				physician, a physician's assistant, or a nurse practitioner.
(g) "Local health department" means a health
				department established under the provisions of part 24 of the code, MCL
				333.2401 to
				333.2498.
(h) "Public health investigation" means the
				collection of medical, epidemiologic, exposure, and other information to
				determine the cause of illness or disability, which is used to determine
				appropriate actions to prevent or mitigate additional illness or
				disability.
(i) "Report" means
				documents or data containing health information provided to the department
				consistent with this ruleset.
Michigan Administrative Code › Department - Health and Human Services › Behavioral Health and Developmental Disabilities Administration › Chronic Disease Reporting › Section R. 330.132 - Reportable information

Current through Vol. 24-12, July 15, 2024
Rule 132.
(1) Health
				professionals and health facilities must provide reports to the department in a
				format that ensures the inclusion of all patient information, if available and
				applicable, as follows:
(a) Last and first
				name and middle initial.
(b)
				Sex.
(c) Race.
(d) Ethnicity.
(e) Birth date or age.
(f) Current residential address.
(g) Telephone number.
(h) If the individual is a minor, the name of
				the individual's parent or guardian.
(i) Social security number.
(j) The date of symptom onset, if
				applicable.
(k) The date of
				diagnosis.
(l) The diagnosis,
				including diagnostic code.
(m)
				Prescribed medications, if they are available to the health professional or
				health facility, and the health professional or health facility is able to
				report them in the format prescribed by the department.
(n) Brief narrative of the patient's signs
				and symptoms, clinical findings, results of other diagnostic tests, and
				clinical outcome, if available to the health professional or health
				facility.
Michigan Administrative Code › Department - Health and Human Services › Behavioral Health and Developmental Disabilities Administration › Chronic Disease Reporting › Section R. 330.133 - Reporting responsibilities

Current through Vol. 24-12, July 15, 2024
Rule 133.
(1) Health
				professionals and health facilities capable of reporting to the department via
				an electronic health record must do so on a real-time, ongoing basis.
(2) Health professionals and health
				facilities that do not submit reports consistent with subrule (1) of this rule
				shall provide reports to the department as follows:
(a) Reports must be made within 3 months
				following a request by the department or local health department.
(b) The department shall notify health
				professionals and health facilities when reports of a chronic disease must be
				submitted.
Michigan Administrative Code › Department - Health and Human Services › Behavioral Health and Developmental Disabilities Administration › Chronic Disease Reporting › Section R. 330.134 - Chronic disease registry advisory board

Current through Vol. 24-12, July 15, 2024
Rule 134.
(1) The
				department shall create a chronic disease registry advisory board that convenes
				at the time and place instructed by the director and considers proposals and
				requests for the addition or removal of new reportable chronic
				diseases.
(2) The chronic disease
				registry advisory board shall consist of not less than 12 members appointed by
				the director as follows:
(a) One individual
				representing the Michigan Health and Hospital Association.
(b) Two individuals representing the
				department's public health administration.
(c) One individual representing a chronic
				disease organization.
(d) One
				individual representing a local health department.
(e) One individual representing the Michigan
				State Medical Society.
(f) One
				individual representing emergency medical services.
(g) One individual representing the chronic
				disease academic community.
(h) One
				individual representing a minority-serving community-based
				organization.
(i) One individual
				representing a tribal health agency.
(j) One individual representing a health
				system or hospital in this state.
(k) One individual representing the general
				public.
Michigan Administrative Code › Department - Health and Human Services › Behavioral Health and Developmental Disabilities Administration › Chronic Disease Reporting › Section R. 330.135 - Investigation and quality assurance

Current through Vol. 24-12, July 15, 2024
Rule 135.
(1) The
				department, upon receiving a report under R 330.133, may request more
				information from the reporting entity. The reporting entity must provide the
				information to the department no later than 30 days after the request is
				made.
(2) The department shall
				consult with local health departments in the development of procedures for
				processing chronic disease reports and conducting follow-up investigations to
				ensure efficient, non-duplicative, and effective public health
				response.
(3) Requests by the
				department or local health departments for individual medical and epidemiologic
				information to validate the completeness and accuracy of reporting are
				specifically authorized. Persons or organizations that receive such requests
				must provide the information sought to the requesting organization promptly and
				no later than 30 days after the request is made.
(4) Health information from reported chronic
				disease cases shall be stored in a reasonably secure manner by the
				department.
Michigan Administrative Code › Department - Health and Human Services › Behavioral Health and Developmental Disabilities Administration › Chronic Disease Reporting › Section R. 330.136 - Confidentiality of reports

Current through Vol. 24-12, July 15, 2024
Rule 136.
(1) To the
				maximum extent permitted by law, reports and health information collected under
				these rules are not public records and are exempt from disclosure under the
				freedom of information act, 1976 PA 442, MCL
				15.231 to
				15.246.
(2) Reports and health information collected
				under this rule are medical records for the purpose of section 13(1)(l) of the
				freedom of information act, 1976 PA 442, MCL
				15.243.
(3) Except as provided in subrule (5) of this
				rule, health information that is gathered in connection with an investigation
				is confidential and is not open to public inspection. All persons in possession
				of reports and health information collected under these rules shall maintain
				the confidentiality of reports and health information and shall not reveal the
				identity of any person.
(4) Records
				released to a legislative body must not contain information that identifies or
				could reasonably be expected to identify a specific individual.
(5) Information collected under these rules
				must be used for epidemiologic investigation and evaluation. The department and
				local health departments may release reports or information under any of the
				following conditions:
(a) The department
				receives written consent from the individual or consent from a minor's parent
				or legal guardian after requesting the release of information.
(b) As necessary for the department to carry
				out its duties designated by the code.
(c) If necessary for the purpose of research
				designed to contribute to generalizable knowledge, with documented approval by
				the department's institutional review board.
Michigan Administrative Code › Department - Health and Human Services › Behavioral Health and Developmental Disabilities Administration › Statewide Stemi System › Part 1 - GENERAL PROVISIONS › Section R. 330.201 - Definitions; A to E

Current through Vol. 24-12, July 15, 2024
Rule 1. As used in these rules:
(a) "ACC" means the American College of
				  Cardiology.
(b) "Accreditation"
				  means a process that a healthcare facility undergoes to demonstrate compliance
				  with standards developed by a department-approved nationally recognized
				  professional accrediting organization.
(c) "Administrative hearing" means a hearing
				  conducted pursuant to the administrative procedures act of 1969, 1969 PA 306,
				  MCL 24.201 to
				  24.328.
(d) "AHA" means the American Heart
				  Association.
(e) "Certification"
				  means a process that a healthcare facility undergoes to meet predetermined
				  standards of a department-approved nationally recognized professional
				  certifying organization.
(f) "Code"
				  means the public health code, 1978 PA 368, MCL
				  333.1101 to
				  333.25211.
(g) "Department" means the department of
				  health and human services.
(h)
				  "Designation" means a status that is conferred by the department on STEMI
				  centers and facilities that have been verified by a nationally recognized
				  professional accrediting and certifying organization.
(i) "Disciplinary action" means an action
				  taken by the department against a healthcare facility or a regional STEMI
				  network for failure to comply with the code, rules, or protocols approved by
				  the department.
(j) "ECG" or
				  "electrocardiogram" means a test that measures the electrical activity of a
				  heartbeat.
(k) "EMS" means
				  emergency medical services.
Michigan Administrative Code › Department - Health and Human Services › Behavioral Health and Developmental Disabilities Administration › Statewide Stemi System › Part 1 - GENERAL PROVISIONS › Section R. 330.202 - Definitions; F to N

Current through Vol. 24-12, July 15, 2024
Rule 2. As used in these rules:
(a) "Healthcare facility" means a facility
				  licensed under section 20141 or 21511 of the code, MCL
				  333.20141 and
				  333.21511, that operates a
				  service for treating emergency patients, 24 hours per day, 7 days per
				  week.
(b) "Hold itself out" means
				  an agency, healthcare facility, or STEMI care center or facility advertises,
				  announces, or charges specifically for providing STEMI care services.
(c) "Inter-facility STEMI transfer" means
				  identifying the group of STEMI patients that require additional STEMI resources
				  with the goal of providing optimal care by the timely transfer of these
				  patients to an appropriate level of care to optimize outcome.
(d) "MCA" or "medical control authority"
				  means an organization designated by the department to provide medical
				  control.
(e) "MCA area" means the
				  geographic area comprised of a county, group of counties, or parts of an
				  individual county, as designated by the department.
(f) "Medical control" means the supervision
				  and coordination of emergency medical services through an MCA, as prescribed,
				  adopted, and enforced through department-approved protocols, within an
				  emergency medical system.
(g)
				  "Non-designated healthcare facility" means a healthcare facility that has
				  chosen not to be a part of this state's STEMI system of care or a healthcare
				  facility that the department has not designated as a STEMI center or
				  facility.
Michigan Administrative Code › Department - Health and Human Services › Behavioral Health and Developmental Disabilities Administration › Statewide Stemi System › Part 1 - GENERAL PROVISIONS › Section R. 330.205 - Participation in system; department prohibitions; coordinated care

Current through Vol. 24-12, July 15, 2024
Rule 5. A healthcare facility may participate in the system
					 to the extent or level that it commits the resources necessary for the
					 appropriate management of STEMI patients. The department shall not limit the
					 number of healthcare facilities that seek to qualify for a given level of STEMI
					 designation under this system to ensure that all STEMI patients are served by a
					 system of coordinated care.
Michigan Administrative Code › Department - Health and Human Services › Behavioral Health and Developmental Disabilities Administration › Statewide Stemi System › Part 1 - GENERAL PROVISIONS › Section R. 330.206 - STEMI center or facility verification; designation and re-designation

Current through Vol. 24-12, July 15, 2024
Rule 6.
(1) A
				  healthcare facility, which intends to hold itself out to provide STEMI care,
				  shall obtain designation as a STEMI receiving center or STEMI referral
				  facility. A healthcare facility shall not self-designate itself, advertise, or
				  otherwise describe itself as a STEMI receiving center or STEMI referral
				  facility without obtaining and maintaining that designation from the
				  department. Facilities that are not designated by the department will be noted
				  as non-designated healthcare facilities.
(2) The department shall re-designate the
				  STEMI care capabilities of each STEMI center or facility based on verification
				  and designation requirements in effect when the re-designation takes
				  place.
(3) To obtain designation as
				  a STEMI center or facility, the healthcare facility shall apply for designation
				  to the department. A healthcare facility has a right to an administrative
				  hearing if denied a specific STEMI center or facility level
				  designation.
(4) The department
				  shall designate the existing STEMI care resources of all participating
				  healthcare facilities in the state, based on the following categories:
(a) A STEMI receiving center shall provide
				  evidence of current certification or accreditation by a department-approved
				  nationally recognized professional certifying and accrediting organization that
				  the healthcare facility has the resources required to be certified as meeting
				  all the criteria for a certified STEMI receiving center equivalent to a TJC-AHA
				  comprehensive STEMI center or TJC-AHA primary heart attack center or an ACC
				  chest pain center with PCI or a Corazon PCI/Catheterization program, or
				  subsequent equivalent certification or accreditation as approved by the
				  department with the advice of the STEMI advisory subcommittee, pursuant to
				  R 330.204(1)(l), and
				  all the following:
(i) Comply with data
				  submission requirements in
				  R 330.209 and
				  R 330.210.
(ii) Participate in coordinating and
				  implementing regional STEMI risk reduction plans.
(iii) Participate in the regional performance
				  improvement process.
(iv) Provide
				  staff assistance to the department for the state designation and verification
				  process of STEMI referral centers when applicable pursuant to
				  R
				  330.204(1)(l).
Michigan Administrative Code › Department - Health and Human Services › Behavioral Health and Developmental Disabilities Administration › Statewide Stemi System › Part 1 - GENERAL PROVISIONS › Section R. 330.207 - Triage and transport

Current through Vol. 24-12, July 15, 2024
Rule 7.
(1) The
				  department, with the advice and recommendations of the statewide STEMI care
				  advisory subcommittee and state EMS coordination committee, shall develop
				  recommendations, based on standards pursuant to
				  R 330.204,
				  R 330.212,
				  R 330.213, and
				  R 330.214 for protocols that are
				  established and adopted by local MCAs for the triage, transport, and
				  inter-facility STEMI transfer of STEMI patients to the appropriate STEMI
				  centers and facilities.
(2) The
				  standards under R 330.204,
				  R 330.212,
				  R 330.213, and
				  R 330.214 for the triage, transport,
				  and the inter-facility STEMI transfer of STEMI patients provide recommended
				  minimum standards of care for protocols that are established and adopted by the
				  local MCAs and that must be utilized in the care during transport of STEMI
				  patients. On an annual basis, or as needed, the department shall review and
				  update these recommended minimum standards with the advice and recommendations
				  of the statewide STEMI care advisory subcommittee and state EMS coordination
				  committee.
(3) The department, with
				  the advice and recommendations of the statewide STEMI care advisory
				  subcommittee and state EMS coordination committee, shall create regional STEMI
				  systems that meet all of the following criteria and are responsible for
				  developing triage and transport procedures within that geographical area:
(a) Each regional STEMI system must be
				  integrated into the regional systems of care authority created within the
				  existing trauma regions pursuant to
				  R 325.132.
(b) Each regional STEMI system may create its
				  own triage and transport criteria and protocols, destination criteria and
				  protocols, and inter-facility STEMI transfer criteria and protocols, which are
				  established and adopted by the local MCAs, provided they meet or exceed the
				  standards that are incorporated by reference in these rules pursuant to
				  R 330.212,
				  R 330.213, and
				  R 330.214, and are reviewed by the
				  quality assurance task force and approved by the department.
This may include coordination of triage and transport
					 criteria and protocols, which are established and adopted by local medical
					 control, across geographic regions if in the best interest of providing optimal
					 STEMI care to patients.
(c)
				  STEMI care still must be provided to patients at healthcare facilities as
				  necessary pursuant to 42 USC
				  1395dd and other applicable laws.
Michigan Administrative Code › Department - Health and Human Services › Behavioral Health and Developmental Disabilities Administration › Statewide Stemi System › Part 1 - GENERAL PROVISIONS › Section R. 330.208 - STEMI care regions

Current through Vol. 24-12, July 15, 2024
Rule 8.
(1) The
				  department, with the advice and recommendations of the statewide STEMI care
				  advisory subcommittee and state EMS coordination committee, shall support the
				  establishment and operational activities of the STEMI regions through the
				  commitment of resources.
(2) Each
				  region shall establish a regional STEMI system of care as prescribed and
				  defined by R 330.201 to
				  R 330.211.
(3) All MCAs within an area or region shall
				  participate in the regional STEMI system of care, and life support agencies
				  that care for STEMI patients shall be offered membership on the regional STEMI
				  care advisory council. Regional STEMI care advisory councils must be operated
				  in a manner that maximizes inclusion of their constituents. Regional STEMI care
				  advisory councils must be operated in a manner that maximizes inclusion of
				  their constituents and meets all of the following requirements:
(a) Not less than quarterly, a regional STEMI
				  system of care shall submit evidence of ongoing activity, such as meeting
				  notices and minutes, to the department. Annually, the regional STEMI care
				  advisory council shall file a report with the department that describes ongoing
				  progress toward regional STEMI care plan implementation and includes evidence
				  that members of the regional STEMI care advisory council are currently involved
				  in STEMI care.
(b) The regional
				  STEMI system of care shall develop a regional STEMI care plan. The plan is
				  subject to review by the statewide STEMI care advisory subcommittee and state
				  EMS coordination committee and approval by the department.
(c) The department shall review the plan to
				  ensure that it contains at a minimum, all of the following:
(i) All counties within the regional STEMI
				  system have been included unless a specific county, or portion thereof, has
				  been aligned within an adjacent STEMI system, and all healthcare entities,
				  MCAs, and life support agencies have had an opportunity to participate in the
				  planning process.
(ii) All of the
				  following components have been addressed:
(A)
				  STEMI risk reduction.
(B)
				  Communications.
(C) Regional
				  performance improvement.
(D) STEMI
				  education.
(E)
				  Infrastructure.
(F) Continuum of
				  care.
Michigan Administrative Code › Department - Health and Human Services › Behavioral Health and Developmental Disabilities Administration › Statewide Stemi System › Part 1 - GENERAL PROVISIONS › Section R. 330.209 - Data collection

Current through Vol. 24-12, July 15, 2024
Rule 9.
(1) The
				  department, with the advice and recommendations of the statewide STEMI care
				  advisory subcommittee and state EMS coordination committee, shall develop and
				  maintain a statewide STEMI registry. The registry must contain all the
				  following:
(a) Standard STEMI data elements
				  and definitions as a minimum set of elements for data collection, with the
				  addition of elements as recommended by the statewide STEMI care advisory
				  subcommittee and approved by the department, including subsequent amendments
				  and editions.
(b) A plan for data
				  including the following:
(i) Notifying
				  partners of data dictionary changes and new iterations annually.
(ii) Defining the data validation process for
				  designated STEMI center and facility data submissions to the statewide STEMI
				  registry.
(iii) Participating in
				  state data collaboration activities.
(iv) Establishing and maintain processes for
				  the following:
(A) Submitting data related to
				  STEMI responses to the statewide STEMI registry according to the data
				  submission timelines.
(B)
				  Monitoring national standards, regional issues, STEMI centers and facilities,
				  and RPSROs to determine the need for additional data metrics needed for system
				  function.
(C) For those STEMI
				  responses that met the inclusion criteria identified for data submission,
				  submitting the following data elements to the department:
(1) Standard STEMI data elements approved by
				  the department with the advice and recommendations of the statewide STEMI care
				  advisory subcommittee.
(2)
				  Subsequent amendments or additions recommended by the statewide STEMI care
				  advisory subcommittee.
(v) Developing annual reports using regional
				  and state data defined by the statewide STEMI care advisory subcommittee, which
				  assesses the state STEMI system of care and regional STEMI systems.
(vi) Evaluating and importing additional data
				  from existing databases as needed.
(vii) Supporting and evaluating probabilistic
				  and deterministic data linkages.
Michigan Administrative Code › Department - Health and Human Services › Behavioral Health and Developmental Disabilities Administration › Statewide Stemi System › Part 1 - GENERAL PROVISIONS › Section R. 330.210 - Statewide STEMI registry

Current through Vol. 24-12, July 15, 2024
Rule 10.
(1) The
				  purpose of the STEMI registry is to collect and analyze system data to evaluate
				  the delivery of STEMI care, develop STEMI risk reduction strategies, and
				  provide resources for STEMI research and education.
(2) The department shall coordinate data
				  collected by the STEMI centers or facilities and emergency medical service
				  providers. The department shall develop and publish a data submission manual
				  that specifies all of the following:
(a) Data
				  elements and definitions, including the standards under
				  R 330.209(1)(a), and
				  the following:
(i) Definitions of what
				  constitutes a reportable STEMI case.
(ii) Method of submitting data to the
				  department.
(iii) Timetables for
				  data submission.
(iv) Data
				  submission format.
(v) Protections
				  for individual record confidentiality.
Michigan Administrative Code › Department - Health and Human Services › Behavioral Health and Developmental Disabilities Administration › Statewide Stemi System › Part 1 - GENERAL PROVISIONS › Section R. 330.211 - Regional performance improvement

Current through Vol. 24-12, July 15, 2024
Rule 11.
(1) Each
				  regional STEMI system shall develop and implement a regional STEMI care
				  performance improvement program. This program must include the standards that
				  are incorporated by reference pursuant to
				  R 330.204(1)(d),
				  R 3330.204(1)(j),
				  and R 330.208(5) and
				  include the development of an annual process for reporting to the department a
				  review of all region-wide policies, procedures, and protocols.
(2) Each regional STEMI system is responsible
				  for monitoring, assessing, and evaluating the system to improve STEMI care,
				  reduce death and disability, surveillance of STEMI incidence, and
				  implementation of STEMI risk reduction initiatives.
(3) Each regional STEMI system shall appoint
				  an RPSRO.
(4) Deviations from
				  protocols established and adopted by local MCAs and approved by the department
				  for STEMI patients must be addressed through a documented STEMI care
				  performance improvement process established by a PSRO.
(5) Each regional STEMI care advisory council
				  shall observe the confidentiality provisions of 45 CFR part 164, the health
				  insurance portability and accountability act of 1996,
				  Public Law
				  104-191, data confidentiality provisions under the
				  code and any confidentiality provisions established by the RPSRO.
(6) The performance improvement program must
				  include the standards under
				  R 330.204(1)(p),
				  R 330.208(5), and
				  include all the following:
(a) Components of
				  the regional STEMI care plan.
(b)
				  Triage criteria and effectiveness.
(c) STEMI diversion and bypass.
(d) Data driven provision of care defined by
				  available data metrics supported by the region, the statewide STEMI care
				  advisory subcommittee, and the department.
Michigan Administrative Code › Department - Health and Human Services › Behavioral Health and Developmental Disabilities Administration › Statewide Stemi System › Part 1 - GENERAL PROVISIONS › Section R. 330.212 - Destination protocols

Current through Vol. 24-12, July 15, 2024
Rule 12. Local MCAs shall develop and submit STEMI patient
					 destination protocols to the bureau of emergency preparedness, EMS, and systems
					 of care for review by the statewide quality assurance task force appointed
					 under section 20916 of the code, MCL
					 333.20916. After review and
					 approval by the department, the MCAs must formally adopt and implement the
					 protocol. The following factors must be used in evaluating destination
					 protocols:
(a) STEMI patients must not
				  be transported to a healthcare facility that does not participate in the state
				  STEMI system of care unless there is no other reasonable alternative
				  available.
(b) STEMI patients must
				  be transported to the closest appropriate STEMI center or facility as
				  identified in regional and local MCA protocols. In the event of a STEMI bypass,
				  STEMI care must be provided to patients as necessary pursuant to
				  42 USC
				  1395dd or other applicable laws.
(c) If a STEMI receiving center is not within
				  a reasonable distance from the incident scene, the STEMI patient must be
				  transported to the closest appropriate STEMI referral facility.
(d) Each regional STEMI system shall make
				  appropriate determinations for STEMI patient destination based on what is best
				  for the patient.
(e) In areas of
				  the state close to state borders, the most appropriate STEMI center or facility
				  may be out of the state. If possible, transport STEMI patients within state
				  borders. Local protocols must address this issue.
Michigan Administrative Code › Department - Health and Human Services › Behavioral Health and Developmental Disabilities Administration › Statewide Stemi System › Part 1 - GENERAL PROVISIONS › Section R. 330.213 - STEMI patient inter-facility STEMI transfer protocols

Current through Vol. 24-12, July 15, 2024
Rule 13.
(1) All
				  designated STEMI centers and facilities shall maintain inter-facility STEMI
				  transfer protocols for patients that are consistent with regional and local MCA
				  protocols and that are compliant with
				  42 USC
				  1395dd.
(2) All STEMI centers and facilities shall
				  develop and implement formal policies based on published guidelines for the
				  transfer of STEMI patients who need a higher level of care.
(3) STEMI patients must be transported to an
				  appropriate hospital designated as a STEMI receiving center or STEMI referral
				  facility.
Michigan Administrative Code › Department - Health and Human Services › Behavioral Health and Developmental Disabilities Administration › Statewide Stemi System › Part 1 - GENERAL PROVISIONS › Section R. 330.214 - Criteria for transfer protocols; criteria

Current through Vol. 24-12, July 15, 2024
Rule 14. Designated STEMI centers and facilities shall
					 contact the department for current STEMI patient transfer guidelines.
Michigan Administrative Code › Department - Health and Human Services › Behavioral Health and Developmental Disabilities Administration › Statewide Stroke System › Part 1 - GENERAL PROVISIONS › Section R. 330.251 - Definitions; A to D

Current through Vol. 24-12, July 15, 2024
Rule 1. As used in this part:
(a) "Administrative hearing" means a hearing
				  conducted pursuant to the administrative procedures act of 1969, 1969 PA 306,
				  MCL 24.201 to
				  24.328.
(b) "CMS" or "Centers for Medicare and
				  Medicaid Services" means the program that is part of the United States
				  Department of Health and Human Services.
(c) "Certification" means a process that a
				  healthcare facility undergoes to demonstrate it has met predetermined standards
				  of a department-approved, CMS-recognized professional certifying
				  organization.
(d) "Code" means the
				  public health code, 1978 PA 368, MCL
				  333.1101 to
				  333.25211.
(e) "Department" means the department of
				  health and human services.
(f)
				  "Designation" means a status that is conferred by the department on stroke
				  centers that are verified by a CMS-recognized professional certifying
				  organization.
(g) "Disciplinary
				  action" means an action taken by the department against a healthcare facility
				  or a regional stroke network for failure to comply with the code, rules, or
				  protocols approved by the department.
Michigan Administrative Code › Department - Health and Human Services › Behavioral Health and Developmental Disabilities Administration › Statewide Stroke System › Part 1 - GENERAL PROVISIONS › Section R. 330.252 - Definitions; E to O

Current through Vol. 24-12, July 15, 2024
Rule 2. As used in this part:
(a) "EMS" means emergency medical
				  services.
(b) "Healthcare facility"
				  means a facility licensed under section 20141 or 21511 of the code, MCL
				  333.20141 and
				  333.21511, which operates a
				  service for treating emergency patients, 24 hours per day, 7 days per
				  week.
(c) "Hold itself out" means
				  the agency, healthcare facility, or stroke care facility that advertises,
				  announces, or charges specifically for providing stroke care.
(d) "Inter-facility transfer of stroke
				  patient" means identifying the group of stroke patients that require additional
				  stroke resources with the goal of providing optimal care to these patients by
				  the timely transfer to an appropriate level of care to optimize the
				  outcome.
(e) "MCA" or "medical
				  control authority" means an organization designated by the department to
				  provide medical control.
(f) "MCA
				  area" means the geographic area comprised of a county, group of counties, or
				  parts of an individual county as designated by the department.
(g) "Medical control" means the supervision
				  and coordination of EMS through a MCA, as prescribed, adopted, and enforced
				  through department-approved protocols, within an emergency medical
				  system.
(h) "Non-designated
				  healthcare facility" means a healthcare facility that has chosen not to be a
				  part of this state's stroke system of care or a healthcare facility that the
				  department has not designated as a stroke center.
Michigan Administrative Code › Department - Health and Human Services › Behavioral Health and Developmental Disabilities Administration › Statewide Stroke System › Part 1 - GENERAL PROVISIONS › Section R. 330.255 - Stroke center verification; designation and re-designation

Current through Vol. 24-12, July 15, 2024
Rule 5.
(1) A
				  healthcare facility that intends to hold itself out to provide stroke care
				  shall not self-designate itself as a stroke center, advertise, or otherwise
				  describe itself as a "designated stroke center" without obtaining and
				  maintaining a designation from the department. Facilities that are not
				  designated by the department will be noted as a non-designated healthcare
				  facility.
(2) The department shall
				  re-designate the stroke care capabilities of each stroke center based on
				  verification and designation requirements in effect when the re-designation
				  takes place.
(3) To obtain
				  designation as a stroke center, the healthcare facility shall apply to the
				  department. A healthcare facility has a right to an administrative hearing if
				  denied a specific stroke center level designation.
(4) The department shall designate the
				  existing stroke care resources of all participating healthcare facilities in
				  this state, based on the following categories:
(a) A level I or comprehensive stroke center
				  shall provide evidence of current certification by a department-approved,
				  CMS-recognized professional certifying organization that the healthcare
				  facility has the resources required to be certified as meeting all the
				  criteria, or subsequent equivalent certification as approved by the department,
				  with the advice of the stroke advisory subcommittee, for an accredited
				  comprehensive stroke center under
				  R 330.254(1)(e). All
				  the following apply to a level I stroke center:
(i) Comply with data submission requirements
				  in R 330.258 and
				  R 330.259.
(ii) Participate in coordinating and
				  implementing regional stroke risk reduction plans.
(iii) Participate in the regional performance
				  improvement process.
(iv) Provide
				  staff assistance to the department for the designation and verification process
				  of stroke centers when applicable under
				  R
				  330.254(1)(e).