DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS  
BUREAU OF PROFESSIONAL LICENSING  
PUBLIC HEALTH CODE—GENERAL RULES  
Filed with the secretary of state on March 16, 2022  
These rules take effect immediately upon filing with the secretary of state unless adopted  
under section 33, 44, or 45a(9) of the administrative procedures act of 1969, 1969 PA  
306, MCL 24.233, 24.244, or 24.245a. Rules adopted under these sections become  
effective 7 days after filing with the secretary of state.  
(By authority conferred on the director of the department of licensing and regulatory  
affairs by sections 16145, 16194, 16201, and 16221 of the public health code, 1978 PA  
368, MCL 333.16145, 333.16194, 333.16201, and 333.16221, and Executive  
Reorganization Order Nos. 1991-9, 1996-2, 2003-1, and 2011-4, MCL 338.3501,  
445.2001, 445.2011, and 445.2030)  
R 338.7001a, R 338.7002, R 338.7002b, R 338.7003, and R 338.7004 of the Michigan  
Administrative Code are amended, as follows:  
R 338.7001a Biennial license and registration renewal; expiration.  
Rule 1a. (1) The following licenses and registrations expire biennially and must be  
renewed every 2 years on or before the date indicated:  
Acupuncture  
Audiology  
Chiropractic  
Dental Therapy  
Marriage and family therapy  
Midwifery  
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Nursing  
Nursing home administrators  
Occupational therapy  
Optometry  
Pharmacy  
Physical therapy  
Physician's assistants  
Psychology  
Respiratory care  
Sanitarians  
Speech-language pathology  
(2) A license or registration having a limitation may be renewed for a term less than 2  
years.  
R 338.7002 Triennial license or registration renewal; expiration.  
October 21, 2021  
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Rule 2. (1) The following licenses and registrations expire triennially and must be  
renewed every 3 years on or before the date indicated:  
Athletic trainer  
Counseling  
Dentistry  
Dental Assistant  
Dental Hygienist  
Massage therapy  
Medicine  
Osteopathic medicine and surgery  
Podiatric medicine and surgery  
Social work  
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Veterinary medicine  
(2) A license or registration having a limitation may be renewed for a term less than 3  
years.  
R 338.7002b Minimum English language standard.  
Rule 2b. (1) Pursuant to section 16174(1)(d) of the code, MCL 333.16174, an applicant  
seeking licensure or registration must demonstrate a working knowledge of the English  
language under the minimum standards established by the department.  
(2) To demonstrate a working knowledge of the English language, the applicant must  
establish that he or she meets 1 of the following:  
(a) The applicant’s health professional educational program was taught in English.  
(b) The applicant supplies transcripts establishing that he or she earned not less than 60  
college level credits from an English-speaking undergraduate or graduate school.  
(c) The applicant’s credentials and English proficiency have been evaluated and  
determined to be equivalent to the credentials required in this state by a board-approved  
credentialing agency.  
(d) The applicant obtained a passing score of 650 or higher on the Examination for the  
Certificate of Competency in English (ECCE) test developed by Michigan Language  
Assessment, as demonstrated by a certificate of competency or certificate of competency  
with honors.  
(e) The applicant obtained a passing score of 650 or higher on the Examination for the  
Certificate of Proficiency in English (ECPE) test developed by Michigan Language  
Assessment, as demonstrated by a certificate of proficiency or certificate of proficiency  
with honors.  
(f) The applicant obtained a total score of not less than 6.5 on the International English  
Language Testing System (IELTS) Academic test within 2 years of the date of  
application.  
(g) The applicant obtained an overall score of not less than 55 on the 4-skill Michigan  
English Test (MET) developed by Michigan Language Assessment.  
(h) The applicant obtained an overall score of not less than 300 on the Occupational  
English Test (OET).  
(i) The applicant obtained a total score of not less than 80 on the Test of English as a  
Foreign Language Internet-Based Test (TOEFL-IBT) administered by the Educational  
Testing Service within 2 years of the date of application.  
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R 338.7003 "Stark Law" revision; adoption by reference.  
Rule 3. (1) Under section 16221(e)(iv)(B) of the code, MCL 333.16221, the department  
has taken notice that the Stark Law, 42 USC 1395nn, was revised effective February 9,  
2018. The department also takes notice that the regulations promulgated under the Stark  
Law, 42 CFR 411.350 to 411.389, were revised effective January 19, 2021, and January  
1, 2022. The department finds that the revisions to both the Stark Law, 42 USC 1395nn,  
and regulations under the Stark Law, 42 CFR 411.350 to 411.389, pertain to referrals by  
physicians for designated health services and continues to protect the public from  
inappropriate referrals by physicians. Therefore, the department adopts by reference the  
Stark Law, 42 USC 1395nn, as revised February 9, 2018, and regulations promulgated  
under the Stark Law, 42 CFR 411.350 to 411.389, as revised January 19, 2021, and  
January 1, 2022.  
(2) All federal regulations noted in subrule (1) of this rule are available at no cost at  
Designated Health Services (govregs.com). These regulations also are available for  
inspection and distribution at a cost of 10 cents per page from the Bureau of Professional  
Licensing, Michigan Department Licensing and Regulatory Affairs, 611 West Ottawa,  
P.O. Box 30670, Lansing, Michigan 48909.  
R 338.7004 Implicit bias training standards.  
Rule 4. (1) Beginning June 1, 2022, an applicant for licensure or registration under  
article 15 of the code, MCL 333.16101 to 333.18838, except those seeking to be licensed  
under part 188 of the code, MCL 333.18801 to 333.18838, shall have completed a  
minimum of 2 hours of implicit bias training within the 5 years immediately preceding  
issuance of the license or registration.  
(2) Beginning June 1, 2022, and for every renewal cycle thereafter, in addition to  
completing any continuing education required for renewal, reregistration, or relicensure,  
an applicant for license or registration renewal, reregistration, or relicensure under article  
15 of the code, MCL 333.16101 to 333.18838, except those licensed under part 188 of  
the code, MCL 333.18801 to 333.18838, shall have completed a minimum of 1 hour of  
implicit bias training for each year of the applicant’s license or registration cycle.  
(3) The implicit bias training must be related to reducing barriers and disparities in  
access to and delivery of health care services and meet all of the following requirements:  
(a) Training content must include, but is not limited to, 1 or more of the following  
topics:  
(i) Information on implicit bias, equitable access to health care, serving a diverse  
population, diversity and inclusion initiatives, and cultural sensitivity.  
(ii) Strategies to remedy the negative impact of implicit bias by recognizing and  
understanding how it impacts perception, judgment, and actions that may result in  
inequitable decision making, failure to effectively communicate, and result in barriers  
and disparities in the access to and delivery of health care services.  
(iii) The historical basis and present consequences of implicit biases based on an  
individual’s characteristics.  
(iv) Discussion of current research on implicit bias in the access to and delivery of  
health care services.  
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(b) Training must include strategies to reduce disparities in access to and delivery of  
health care services and the administration of pre- and post-test implicit bias assessments.  
(c) Acceptable sponsors of this training include any of the following:  
(i) Training offered by a nationally-recognized or state-recognized health-related  
organization.  
(ii) Training offered by, or in conjunction with, a state or federal agency.  
(iii) Training obtained in an educational program that has been approved by any  
board created under article 15 of the code, MCL 333.16101 to 333.18838, except under  
part 188 of the code, MCL 333.18801 to 333.18838, for initial licensure or registration or  
for the accumulation of continuing education credits.  
(iv) Training offered by an accredited college or university.  
(v) An organization specializing in diversity, equity, and inclusion issues.  
(d) Acceptable modalities of training include any of the following:  
(i) A teleconference or webinar that permits live synchronous interaction.  
(ii) A live presentation.  
(iii) Interactive online instruction.  
(4) Submission of an application for licensure, registration, or renewal constitutes an  
applicant’s certificate of compliance with the requirements of this rule. A licensee or  
registrant shall retain documentation of meeting the requirements of this rule for a period  
of 6 years from the date of applying for licensure, registration, or renewal. The  
department may select and audit a sample of a licensees or registrants and request  
documentation of proof of compliance with this rule. If audited by the department, a  
licensee or registrant shall provide the proof of completion of training, including either of  
the following:  
(a) A completion certificate issued by the training program that includes the date of  
the training, the program sponsor’s name, the title of the program, and licensee’s or  
registrant’s name.  
(b) A self-attestation by the licensee or registrant that includes the date of the training,  
the program sponsor’s name, the title of the program, and licensee’s or registrant’s name.  
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