Michigan Office of Administrative Hearings and Rules  
Administrative Rules Division (ARD)  
MOAHR-Rules@michigan.gov  
REQUEST FOR RULEMAKING (RFR)  
1. Department:  
Health and Human Services  
2. Bureau:  
Public Health Administration  
3. Promulgation type:  
Full Process  
4. Title of proposed rule set:  
Statewide ST-Elevation Myocardial Infarction (STEMI) System  
5. Rule numbers or rule set range of numbers:  
R 330.201 - R 330.230  
6. Estimated time frame:  
12 months  
Name of person filling out RFR:  
Jennifer Warner  
E-mail of person filling out RFR:  
WarnerJ19@michigan.gov  
Phone number of person filling out RFR:  
517-243-7645  
Address of person filling out RFR:  
333 South Grand Avenue  
5th Floor  
7. Describe the general purpose of these rules, including any problems the changes are intended  
to address.  
The proposed rules describe the structure, organization, and components of the STEMI system and  
how that will integrate into the existing trauma system. The rules outline the responsibilities of  
the department and the participants in the system and describe the process of STEMI program  
verification and designation; triage and transport and transfer; system evaluation; data collection;  
STEMI registry establishment; and STEMI performance improvement. The proposed rules will  
provide structure, clarity, and detail to operationalize the existing boilerplate language that briefly  
outlines the system. The rules represent a stakeholder supported approach to system development  
that is practical, needed, and designed to optimize quality care and positive outcomes for  
Michigan residents who have had a STEMI. Outside of this rule set, there is not an organized  
effort in the state to ensure that those encountering a time intensive event like a STEMI get to the  
right resource in the right amount of time to salvage as much heart tissue as possible.  
8. Please cite the specific promulgation authority for the rules (i.e. department director,  
commission, board, etc.).  
Department Director.  
A. Please list all applicable statutory references (MCLs, Executive Orders, etc.).  
By authority conferred on the director of the department of health and human services by sections  
2233, 9227, and 20910 of the public health code, 1978 PA 368, MCL 333.2233, 333.9227 and  
333.20910, and 2022 PA 0166, section 1186 of the Omnibus Appropriations Bill.  
MCL 24.239  
RFR-Page 2  
B. Are the rules mandated by any applicable constitutional or statutory provision? If so, please  
explain.  
The rules are not mandated by any applicable constitutional or statutory provision.  
9. Please describe the extent to which the rules conflict with or duplicate similar rules,  
compliance requirements, or other standards adopted at the state, regional, or federal level.  
The rules will not conflict with existing rules they are intended to work synergistically and  
integrate with the existing Statewide Trauma System rule set in the Michigan Administrative  
Code, R 325.125 through R 325.138. The rules will not conflict with or duplicate similar rules,  
compliance requirements, or other standards adopted at the state, regional, or federal level.  
10. Is the subject matter of the rules currently contained in any guideline, handbook, manual,  
instructional bulletin, form with instructions, or operational memoranda?  
Systems of Care for ST-Segment Elevation Myocardial Infarction: A Policy Statement from the  
American Heart Association  
https://www.ahajournals.org/doi/10.1161/CIR.0000000000001025  
The Joint Commission  
https://www.jointcommission.org/accreditation-and-certification/certification/certifications-by-  
setting/hospital-certifications/cardiac-certification/advanced-cardiac-certification/advanced-  
cardiac/primary-heart-attack-center  
American College of Cardiology STEMI accreditation  
Accreditation: Operation STEMI Care: An Update - American College of Cardiology  
Value of Registries I ST-Segment Elevation Myocardial Infarction Care in Both the Pre-  
Coronavirus Disease 2019 and the Coronavirus Disease 2019 Eras  
https://www.ahajournals.org/doi/epub/10.1161/JAHA.120.019958  
American College of Cardiology NCDR  
https://cvquality.acc.org/NCDR-Home/data-collection/what-each-registry-collects  
Development of Systems of Care for ST-Elevation Myocardial Infarction Patients  
https://doi.org/10.1161/CIRCULATIONAHA.107.184043  
Development of Systems of Care for ST-Elevation Myocardial Infarction Patients: Gaps, Barriers,  
and Implications  
https://doi.org/10.1161/CIRCULATIONAHA.107.184052  
Regionalizing Emergency Care  
Institute of Medicine (US). Regionalizing Emergency Care: Workshop Summary. Washington  
(DC): National Academies Press (US); 2010. Available from:  
https://www.ncbi.nlm.nih.gov/books/NBK220329/ doi: 10.17226/12872  
Improving Systems of Care in Time-Sensitive Emergencies - JEMS: EMS, Emergency Medical  
Services - Training, Paramedic, EMT News  
11. Are the rules listed on the department’s annual regulatory plan as rules to be processed  
for the current year?  
The rules were listed on the department’s annual regulatory plan for the current year.  
12. Will the proposed rules be promulgated under Section 44 of the Administrative Procedures  
Act, 1969 PA 306, MCL 24.244, or under the full rulemaking process?  
Full Process  
13. Please describe the extent to which the rules exceed similar regulations, compliance  
requirements, or other standards adopted at the state, regional, or federal level.  
The proposed rules do not exceed national standards, existing regulations, or compliance  
requirements or other standards adopted at the state, regional, or federal level.  
MCL 24.239  
RFR-Page 3  
14. Do the rules incorporate the recommendations received from the public regarding any  
complaints or comments regarding the rules? If yes, please explain.  
The draft rules represent eleven years of discussion and, recently, 20 meetings over the past year  
with hundreds of stakeholders the result of which is a design for a system of care for STEMI. The  
stakeholders are invested in this work and have dedicated countless hours of planning to bring this  
concept of a system of care for STEMI patients to this point. The rules also reflect  
recommendations from the trauma stakeholders regarding their recent and ongoing experience  
operationalizing the trauma system.  
15. If amending an existing rule set, please provide the date of the last evaluation of the rules  
and the degree, if any, to which technology, economic conditions, or other factors have changed  
the regulatory activity covered by the rules since the last evaluation.  
This is a new rule set.  
16. Are there any changes or developments since implementation that demonstrate there is no  
continued need for the rules, or any portion of the rules?  
These rules are needed. The healthcare challenges in the current pandemic environment make it  
imperative that the system capitalize on efficiencies, use resources judiciously, and reduce gaps.  
17. Is there an applicable decision record (as defined in MCL 24.203(6) and required by MCL  
24.239(2))? If so, please attach the decision record.  
No  
MCL 24.239  
;