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 Stroke System  
5. Rule numbers or rule set range of numbers:  
R 330.251 – R 330.280  
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:  
1001 Terminal Rd. Lansing, Michigan 48906  
7. Describe the general purpose of these rules, including any problems the changes are intended  
to address.  
The rules describe the structure, organization, and components of the stroke system and how it  
will integrate into the existing trauma system. They outline the responsibilities of the department  
and the participants in the system. The rules describe the process of stroke program verification  
and designation; triage, transport, and transfer; system evaluation; data collection; stroke registry  
establishment; and stroke performance improvement.  
The requested 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 stroke.  
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 stroke get to the right resource in the right amount of  
time to salvage as much brain 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, as they are intended to work synergistically and  
integrate with the existing Statewide Trauma System rule set, Mich Admin Code R 325.125  
through 325.138. The rules do not duplicate or conflict with any 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?  
Recommendations for the Establishment of Stroke Systems of Care  
https://www.ahajournals.org/doi/10.1161/STR.0000000000000173  
The Joint Commission Stroke Certification  
https://www.jointcommission.org/accreditation-and-certification/certification/certifications-by-  
setting/hospital-certifications/stroke-certification/  
Accreditation Commission for Health Care (ACHA)  
https://www.achc.org/stroke-certification/  
Get With the Guidelines Stroke Registry https://www.clinicaltrials.gov/ct2/show/NCT02693223  
Recommendations for the establishment of stroke systems of care: recommendations from the  
American Stroke Association's Task Force on the Development of Stroke Systems - PubMed  
(nih.gov)  
Improving Systems of Care in Time-Sensitive Emergencies - JEMS: EMS, Emergency Medical  
Services - Training, Paramedic, EMT News  
Stroke Systems of Care Framework | cdc.gov  
National Stroke Registries: What can we learn from them?  
David Tanne, Silvia Koton, Natan M. Bornstein  
Neurology Oct 2013, 81 (14) 1257-1259; DOI: 10.1212/WNL.0b013e3182a6ca52  
Sustaining A Coordinated, Regional Approach To Trauma And Emergency Care Is Critical To  
Patient Health Care Needs | Health Affairs  
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 as rules to be processed 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.  
MCL 24.239  
RFR-Page 3  
The proposed rules do not exceed similar regulations, compliance requirements, or other standards  
adopted at the state, regional, or federal level.  
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, more recently, 20 meetings over the past  
year with hundreds of stakeholders, the result of which is a design for a system of care for stroke.  
The stakeholders are invested in this work and have dedicated countless hours of planning to bring  
this concept of a system of care for stroke 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?  
This is a new rule set. 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  
;