MPA | COVID-19

• State Updates Pandemic CE Requirements (2/24/21)

Pharmacists applying for renewal after Oct. 1, 2020, will be required to have completed all requisite continuing education (CE) credits, and will not be exempted based on previous pandemic orders, according to additional guidance from the Michigan Department of Licensing and Regulatory Affairs (LARA). Michigan Pharmacists Association (MPA) received clarification about the guidance on Feb. 24, 2021. During the pandemic, Gov. Gretchen Whitmer issued an executive order that, among other things, allowed pharmacists to count hours worked toward their live CE requirement. However, the Michigan Supreme Court in October struck down the governor’s executive orders, immediately nullifying them.

According to LARA’s new guidance, “Although previous Executive Orders allowed the Bureau to waive continuing education (CE) requirements for health professionals licensed under the Public Health Code, effective Oct. 2, 2020, BPL (the Bureau of Professional Licensing) no longer has this legal authority. Therefore, health licensees renewing after 11:59 p.m. Oct. 1, 2020, are required to have completed all required CEs or request a waiver as permitted under the Michigan Public Health Code.”

This guidance affirms that any licensee who applied for renewal before Oct. 2, 2020, would be allowed to count their hours worked toward their CE requirement. However, anyone who applied after that date would need to receive their CE in the usual manner, consisting of board-approved live educational programming. 

Licensees are able to request a waiver of continuing education by the Michigan Board of Pharmacy as laid out in MCL 333.16205 of the Michigan Public Health Code. Please note, requests must be received before the expiration date of the license. However, approval of a waiver is not guaranteed and the final determination rests with the board. If requesting a waiver, a licensee is encouraged to provide documentation to support his or her written request.

• Will LARA recognize hours worked during the COVID-19 emergency as continuing education credit?

  According to the State of Michigan Office of the Governor Executive Order 2020-49, the Michigan Department of Licensing and Regulatory Affairs (LARA) may recognize hours that licensed healthcare providers worked during the COVID-19 emergency as hours worked toward continuing education courses or programs required for licensure. In anticipation of LARA accepting these hours toward licensure renewal, Michigan Pharmacists Association (MPA) has created a documentation form to assist pharmacy professionals in tracking legitimate hours worked during the novel coronavirus (COVID-19) pandemic.

• My license is set to expire and I need to renew, how can I do this?

  Executive order 2020-30 states:

Any law or regulation is temporarily suspended to the extent that it requires for any health care professional, as a condition of licensure, certification, registration, or the renewal of a license, certification, or registration:

An exam, to the extent that the exam’s administration has been canceled while the emergency declaration is in effect. 

Fingerprinting, to the extent that, in the judgment of the director of the Department of Licensing and Regulatory Affairs, locations to have fingerprints taken are substantially unavailable on account of closures arising from the COVID-19 pandemic.

Continuing education while the emergency declaration is in effect.

• Has the Board of Pharmacy relaxed any licensure requirements during the COVID-19 situation?

  Given the demand on the health care workforce, Michigan Licensing and Regulatory Affairs (LARA) and the Board of Professional Licensing (BPL) have issued the following clarification to allow providers to hire individuals to help in the efforts to appropriately respond and care for those who are affected by the virus. The following provision should help health care providers develop the personnel resources needed to cover all shifts to appropriately handle patient needs during this pandemic and Time of Disaster/State of Emergency.

  Michigan law provides:

  MCL 333.16171
  Under the circumstances and subject to the limitations stated in each case, the following individuals are not required to have a license issued under this article for practice of a health profession in this state:
  (c) An individual who by education, training, or experience substantially meets the requirements of this article for licensure while rendering medical care in a time of disaster or to an ill or injured individual at the scene of an emergency.

  Situations that fall under MCL 333.16171 are exempt and therefore those individuals that meet the criteria for this exception are not required to have a license issued under Article 15 for practice of a health profession in this state. This provision does not require an individual apply for or be granted an exemption by the Department.

  If the Bureau of Professional Licensing were to receive a complaint regarding unlicensed activity, it would evaluate each case to determine whether the individual meets the criteria for an exemption.

  In reviewing claims of exemption for licensure under this provision the Department would consider all the relevant circumstances, including the following information:

• An individual who by education, training, or experience substantially meets the requirements of this article” this includes, but is not limited to, individuals who are properly licensed in another state, country (i.e. Canada) or are recently retired from the profession in Michigan.

• Individuals who were licensed as a health professional but have been retired for five or less years may be eligible to provide services and practice in his/her previously licensed profession under this provision to assist health care providers during the COVID-19 response and while the State of Emergency is in effect.

• This exemption does not apply to licenses that have been suspended or revoked and does not remove requirements to comply with disciplinary limitations, probationary terms or other requirements imposed by the health professional boards.

• In a “time of disaster” may include an individual event (such as a car accident) but it may also include larger scale “natural” or “manmade” disasters. These include, but are not limited to, events that are declared an “Emergency” or a “State of Emergency” by the proper authority (even after the event happened).

• In “rendering medical care” the individual should only render that care if they have the proper “education, training or experience” to perform that care.

• The exemption does NOT allow unlicensed individuals to prescribe Controlled Substances during a disaster. The exemption is for licensure “under this article”, which is Article 15 of the Michigan Public Health Code. The requirements for Controlled Substance Licensure are in Article 7 of the Michigan Public Health Code.

This exemption does not apply to licenses that have been suspended or revoked and does not remove requirements to comply with disciplinary limitations, probationary terms or other requirements imposed by the health professional boards.

1. For pharmacies that are offering curbside pickup so that patients do not need to go into the store.  Can the patient authorize the pharmacy to sign on their behalf?  
   According to the Medicaid Provider Manual, the pharmacy must maintain a signature log containing the beneficiary’s name, date of receipt of the prescription and the signature of the beneficiary (or that of his/her representative). This requirement is also adopted by other third party payers. The requirement is to have the patient sign at pick up. MPA suggests the pharmacy maintains a paper signature log, that is HIPAA compliant, to comply with this requirement.

   Note that this is an issue seen with medication delivery, as well. Some individuals have reported they are using an alternative electronic method for the patient to sign for their prescription or providing the patient with a stamped envelope to mail a signed consent form to the pharmacy.

2. Has there been any updates on what the emergency refill should look like in the State of Michigan? 
   We are working with the Governor’s office on authorizing pharmacists to dispense emergency refills. We provided the Governor’s office with language for the executive order. We should be hearing something sometime soon.

3. Emergency approval of remote RX processing, can we do it? We need any clarifying documents you have, particularly with : does remote site have to licensed, inspected, etc and by whom? What tasks, besides fill vials and getting product to patient must be done on site?  
   We are still waiting for clarification on remote RX processing from the Governor’s office, when we receive this information we will be sure to share it.

4. Is our state emergency allowing for expeditied licensing of out of state support, accepting licensing from other states? If they are, how is it tied to #2?  
   Yes, the state is allowing for this to happen during this time, more information can be found by clicking here.

5. Is the state limiting the dispensing of hydroxychloroquine or chloroquine? 

   After receiving multiple allegations of inappropriate prescribing of hydroxychloroquine or chloroquine, the Department of Licensing and Regulatory Affairs (LARA) issued guidance to Michigan licensed prescribers and dispensers. The guidance states that any prescribing must be associated with medical documentation showing proof of the medical necessity. The guidance does not limit the prescribing, rather encourages pharmacists to utilize professional judgement to evaluate the legitimacy of all prescription. The full guidance can be found here: https://www.michigan.gov/documents/lara/Reminder_of_Appropriate_Prescribing_and_Dispensing_3-24-2020_684869_7.pdf. 

6. Who is affected by the newest executive order in regards to scope of practice?

   Pharmacists and pharmacy technicians working in hospitals and state owned facilities are now allowed to provide care for routine health maintenance, chronic disease states, or similar conditions, as appropriate to the professional’s education, training, and experience, without physician supervision and without criminal, civil, or administrative penalty related to a lack of such supervision.