Michigan Office of Administrative Hearings and Rules  
611 W. Ottawa Street  
Lansing, MI 48909  
Phone: 517-335-8658 Fax: 517-335-9512  
AGENCY REPORT TO THE  
JOINT COMMITEE ON ADMNINISTRATIVE RULES (JCAR)  
1. Agency Information  
Agency name:  
Health and Human Services  
Division/Bureau/Office:  
Policy and Legislative  
Name of person completing this form:  
Mary Brennan  
Phone number of person completing this form:  
517-284-4850  
E-mail of person completing this form:  
BrennanM@michigan.gov  
Name of Department Regulatory Affairs Officer reviewing this form:  
Mary Brennan  
2. Rule Set Information  
MOAHR assigned rule set number:  
2021-31 HS  
Title of proposed rule set:  
Michigan Physician Orders for Scope of Treatment  
3. Purpose for the proposed rules and background:  
The purpose of these rules is to comply with the statutory mandate of MCL 333.5676(1)(c) in creating  
a form and instructions on how to complete the form, reauthorize, and/ or revoke the form. Michigan  
Physician's Orders for Scope of Treatment (MI POST) is an optional, 1 page, 2-sided medical order  
documenting a person's wish regarding his or her care in a health crisis. MI POST is a part of the  
advance care planning process that include choices about Cardiopulmonary Resuscitation (CPR),  
critical care, and other wanted care. It is intended to guide care only if the person cannot tell others  
what to do at that time. MI POST is signed by the patient/patient representative and the physician,  
nurse practitioner, or physician’s assistant. MI POST's intended population is people with serious  
advanced illness or frailty.  
4. Summary of proposed rules:  
MCL 24.242 and 24.245  
Agency Report to JCAR-Page 2  
Michigan Physician's Orders for Scope of Treatment (MI POST) is an optional, 1 page, 2-sided  
medical order documenting a person's wish regarding his or her care in a health crisis. MI POST is a  
part of the advance care planning process that include choices about Cardiopulmonary Resuscitation  
(CPR), critical care, and other wanted care. It is intended to guide care only if the person cannot tell  
others what to do at that time. The purpose of these rules is to comply with the statutory mandate of  
MCL 333.5676(1)(c) in creating this form and instructions on how to complete the form, reauthorize,  
and/ or revoke the form.  
5. List names of newspapers in which the notice of public hearing was published and  
publication dates:  
Oakland Press, November 10, 2021; Battle Creek Enquirer, November 10, 2021; Marquette Mining  
Journal, November 9, 2021.  
6. Date of publication of rules and notice of public hearing in Michigan Register:  
12/1/2021  
7. Date, time, and location of public hearing:  
12/6/2021 09:00 AM at South Grand Tower-First Floor, Room 1A , 333 South Grand Avenue,  
Lansing, MI 48933  
8. Provide the link the agency used to post the regulatory impact statement and cost-benefit  
analysis on its website:  
https://ARS.apps.lara.state.mi.us/Transaction/RFRTransaction?TransactionID=1289  
9. List of the name and title of agency representative(s) attending public hearing:  
Brad Barron, Manager, Policy and Strategic Planning  
10. Persons submitting comments of support:  
Shannon Orlowski RN, BSN, Graham Healthcare Group  
11. Persons submitting comments of opposition:  
None  
12. Persons submitting other comments:  
Gabe Schneider, Munson Healthcare; Paige Fults, Michigan Health and Hospital Association; Diane  
Shields, MyMichigan Health; Monica Ward, Michigan Health Information Network Shared Services  
(MiHIN); Karen Smith, LCSW, Ph.D.,HEC-C, Henry Ford Health System; Amy Vandenbroucke, JD,  
National POLST; L. Raquel Clary-Lantis, DO, CMD, Trinity Health; Rena Ruehle, Spectrum Health;  
Linda Caurdy-Bess, LMSW Clinical & Macro, ACSW, ACM-SW  
13. Identify any changes made to the proposed rules based on comments received during the  
public comment period:  
MCL 24.242 and 24.245  
Agency Report to JCAR-Page 3  
Name &  
Organization public hearing  
Comments made at Written  
Agency Rationale Rule number  
for Rule Change & citation  
and Description changed  
of Change(s)  
Comments  
Made  
1
Gabe  
Remove “elderly” MDHHS agrees  
R 325.82(1)  
Schneider,  
Munson  
Healthcare  
from rule and  
replace with  
with the requested  
change. The rule  
adult; adult with has been changed.  
advanced illness The enacting  
legislation defines  
patient as "an adult  
with an advanced  
illness or means an  
adult with another  
medical condition  
that, despite  
(Same  
comment from :  
Paige Fults,  
Diane Sheilds,  
Monica Ward,  
Karen Smith,  
Linda Caudry-  
Bess, Amy  
Vandenbroucke,  
L. Raquel Clary  
-Lantis.)  
available curative  
therapies or  
modulation,  
compromises his  
or her health so as  
to make death  
within 1 year  
foreseeable though  
not a specific or  
predicted  
prognosis.  
2
Gabe  
Schneider,  
Modify the date MDHHS agrees  
“January 1, 2018” with the requested  
R 325.82(9)  
Munson  
in Rule 325.82  
change. The rule  
Healthcare  
(9) to reflect the has been changed  
(Same  
delay in State  
rollout, rules  
promulgation  
process, and a 12-  
month transition  
process.  
• DHHS note-the  
majority of the  
public  
to extend effective  
date of June 30,  
2023.  
comment from :  
Paige Fults,  
Diane Sheilds,  
Monica Ward,  
Karen Smith,  
Linda Caudry-  
Bess, L. Raquel  
Clary-Lantis.  
commenters  
requested a June  
30, 2023 effective  
date.  
3
Rena  
"The first comment is  
MDHHS agrees  
R 325.82(3)  
MCL 24.242 and 24.245  
Agency Report to JCAR-Page 4  
Ruehle,Spectru around, the rules  
m Health around, pink card  
with the requested  
change. The rule  
has been changed.  
stock. And we believe  
that part of the  
strength of the MI-  
POST are the  
portability of these  
orders and we share  
information and  
transfer information  
digitally as health  
systems in our care  
entities.  
And so using pink  
card stock then as  
things get sent and  
resent and passed, it  
will make it very  
difficult to read.  
We’ve connected with  
other states who’ve  
expressed that same,  
that have been doing  
POST for many more  
years than we have,  
and so we really ask  
that instead of card  
stock, if we could use  
a pink border to  
highlight the MI-  
POST orders instead  
of card stock. This  
would also help with  
operations as we have  
many care locations  
that would be serving  
patients that could do  
a MI-POST and the  
complexity of  
operations of ensuring  
they have a printer that  
is able to print card  
stock and also have  
the pink card stock  
available adds  
complexity. And we  
MCL 24.242 and 24.245  
Agency Report to JCAR-Page 5  
believe our, in our  
communities, we been  
using the out-of-  
hospital DNR orders  
on white paper for  
many years and our  
first responders have  
been successful in  
honoring those orders  
that are on white  
paper."  
14.Date report completed:  
3/18/2022  
MCL 24.242 and 24.245  
;