Michigan Office of Administrative Hearings and Rules  
Administrative Rules Division (ARD)  
611 W. Ottawa Street  
Lansing, MI 48909  
Phone: 517-335-8658 Fax: 517-335-9512  
REGULATORY IMPACT STATEMENT  
and COST-BENEFT ANALYSIS (RIS)  
Agency Information:  
Department name:  
Licensing and Regulatory Affairs  
Bureau name:  
Bureau of Professional Licensing  
Name of person filling out RIS:  
Dena Marks  
Phone number of person filling out RIS:  
517-335-3679  
E-mail of person filling out RIS:  
MarksD1@michigan.gov  
Rule Set Information:  
ARD assigned rule set number:  
2020-109 LR  
Title of proposed rule set:  
Public Health Code - General Rules  
Comparison of Rule(s) to Federal/State/Association Standard  
1. Compare the proposed rules to parallel federal rules or standards set by a state or national licensing agency or  
accreditation association, if any exist.  
Each state establishes its own requirements with respect to license and registration renewal and other requirements for  
licensure or registration. Consequently, there are no federal rules or standards set by a national or state agency to  
which the proposed rules can be compared.  
A. Are these rules required by state law or federal mandate?  
MCL 333.16194 requires that the department prescribe the expiration dates for licenses and registrations for health  
care professions.  
MCL 333.16174 requires the department to establish the minimum standards for determining if an applicant for  
licensure or registration has a working knowledge of the English language.  
The rules are not required by federal mandate.  
B. If these rules exceed a federal standard, please identify the federal standard or citation, describe why it is  
necessary that the proposed rules exceed the federal standard or law, and specify the costs and benefits arising out  
of the deviation.  
The proposed rules do not exceed a federal standard.  
2. Compare the proposed rules to standards in similarly situated states, based on geographic location, topography,  
natural resources, commonalities, or economic similarities.  
MCL 24.245(3)  
RIS-Page 2  
The proposed rules are consistent with the standards required by the Public Health Code and are largely consistent  
with the requirements of other states in the Great Lakes region. Every state in the Great Lakes region provides for the  
length of a license or registration cycle and license or registration renewal dates.  
On July 9, 2020, Governor Whitmer issued Executive Directive 2020-07 requiring the department to establish implicit  
bias training standards for health care professionals. The training is intended to improve equity in the delivery of  
health care to Michigan residents. The proposed rule pertaining to implicit bias training establishes the training  
standards that an applicant, licensee, or registrant must complete to ensure that Michigan residents do not encounter  
barriers or disparities in the access to or in the delivery of health care services.  
A. If the rules exceed standards in those states, please explain why and specify the costs and benefits arising out of  
the deviation.  
Most states in the Great Lakes region do not require implicit bias training for licensure, registration, or renewal.  
Illinois has a law requiring implicit bias training for obstetricians.  
The cost of completing implicit bias training in Michigan will vary, depending on the program that an individual  
chooses to attend. For example, Mary Free Bed Hospital in Grand Rapids, as well as several other hospitals in  
Michigan, offer implicit bias training courses free of charge. Additionally, this rule is required pursuant to Executive  
Directive 2020-07.  
Research indicates that there is an economic burden associated with health care inequities. As such, reducing barriers  
to health care access and disparities in the delivery of health care will yield social and economic benefits long term.  
The time investment required to obtain implicit bias training (2 hours for initial licensure or registration and 1 hour  
per year for renewal applicants) is relatively small when compared to the potential benefits that will be realized by  
Michigan residents.  
3. Identify any laws, rules, and other legal requirements that may duplicate, overlap, or conflict with the proposed  
rules.  
There are no other laws, rules, or other legal requirements that may duplicate, overlap, or conflict with these proposed  
rules.  
A. Explain how the rules have been coordinated, to the extent practicable, with other federal, state, and local laws  
applicable to the same activity or subject matter. This section should include a discussion of the efforts undertaken  
by the agency to avoid or minimize duplication.  
No coordination is needed because there are no other applicable laws that regulate the areas addressed in the proposed  
rules.  
4. If MCL 24.232(8) applies and the proposed rules are more stringent than the applicable federally mandated  
standard, provide a statement of specific facts that establish the clear and convincing need to adopt the more  
stringent rules.  
MCL 24.232(8) does not apply.  
5. If MCL 24.232(9) applies and the proposed rules are more stringent than the applicable federal standard,  
provide either the Michigan statute that specifically authorizes the more stringent rules OR a statement of the  
specific facts that establish the clear and convincing need to adopt the more stringent rules.  
MCL 24.232(9) does not apply.  
Purpose and Objectives of the Rule(s)  
6. Identify the behavior and frequency of behavior that the proposed rules are designed to alter.  
MCL 24.245(3)  
RIS-Page 3  
The intended purpose of the proposed rules is set forth below:  
R 338.7001 This rule provides definitions used in this rule set. A new definition will be added for “implicit bias".  
The addition is designed to increase the reader’s understanding of the term used in the rule set.  
R 338.7001a This rule provides for biennial license and registration renewal. Amendments will be made to clarify  
when a license or registration must be renewed, and the renewal date for acupuncture, audiology, chiropractic,  
marriage and family therapy, nursing home administrators, psychology, sanitarians, and speech-language pathology  
will be changed to the date of the year when the licensee’s initial license or a registrant’s initial registration was  
issued. The proposed rule will add dental therapy and advise that the renewal date will be the date of the year when  
the licensee’s initial license was issued. The rule is designed to advise a licensee or registrant of the renewal date for a  
biennial license or registration.  
R 338.7002 This rule provides for triennial license and registration renewal. Amendments will be made to clarify  
when a license or registration must be renewed, and the renewal date for athletic trainers and massage therapy will be  
changed to the date of the year when the licensee’s initial license was issued. The proposed rule will add dental  
assistant and dental hygienist and advise that the renewal date will be the date of the year when the licensee’s initial  
license was issued. The rule is designed to advise a licensee or registrant of the renewal date for a triennial license or  
registration.  
R 338.7002b This provides the minimum English language standard for licensure or registration. Amendments will  
be made to clarify the name of the Michigan English Test (MET) and the score required. This amendment is designed  
to ensure that an applicant for licensure or registration understands which test is approved and how to comply with the  
standard.  
R 338.7004 This is a new proposed rule that will establish the implicit bias training requirements for health care  
professionals to ensure that Michigan residents do not encounter barriers or disparities in the access to or in the  
delivery of health care services.  
A. Estimate the change in the frequency of the targeted behavior expected from the proposed rules.  
The proposed rules are intended to increase awareness of health care inequities among licensees and registrants and  
decrease the frequency of the targeted behavior.  
B. Describe the difference between current behavior/practice and desired behavior/practice.  
R 338.7001 This rule provides definitions used in this rule set. The proposed addition of a new definition of implicit  
bias is intended to improve a reader’s understanding of the rule using this term.  
R 338.7001a This rule provides for biennial license and registration renewal. The proposed amendments are intended  
to inform a licensee or registrant when the license or registration must be renewed.  
R 338.7002 This rule provides for triennial license and registration renewal. The proposed amendments are intended  
to inform a licensee or registrant when the license or registration must be renewed.  
R 338.7002b This rule provides the minimum English language standard for licensure or registration. The proposed  
amendment is intended to ensure that the applicant understands which MET is approved and how to comply with the  
standard.  
R 338.7004 This is a new proposed rule that will establish the implicit bias training requirements for health care  
professionals to ensure that Michigan residents do not encounter barriers or disparities in the access to or in the  
delivery of health care services. This is a new requirement for an applicant for licensure, registration, or renewal. The  
desired behavior is greater equity in the access to and provision of health care services by training health care  
professionals on how to recognize and mitigate their own implicit biases.  
C. What is the desired outcome?  
MCL 24.245(3)  
RIS-Page 4  
R 338.7001 This rule provides definitions used in this rule set. The desired outcome is better reader understanding.  
R 338.7001a This rule provides for biennial license and registration renewal. The desired outcome is timely renewal  
of a biennial license or registration.  
R 338.7002 This rule provides for triennial license and registration renewal. The desired outcome is timely renewal of  
a triennial license or registration.  
R 338.7002b This rule provides the minimum English language standard for licensure or registration. The desired  
outcome is compliance by the applicant.  
R 338.7004 This is a new proposed rule that will require an applicant for licensure, registration, and renewal to have  
completed implicit bias training. The desired outcome is applicant compliance, increased awareness, and greater equity  
in access to and the provision of health care services.  
7. Identify the harm resulting from the behavior that the proposed rules are designed to alter and the likelihood  
that the harm will occur in the absence of the rule.  
R 338.7001 This rule provides definitions used in this rule set. The proposed changes are designed to avoid  
misunderstanding and assist an applicant, licensee, or registrant in complying with the rules.  
R 338.7001a This rule provides for biennial license and registration renewal. The proposed rules are designed to  
inform a licensee or registrant regarding the license or registration renewal date and to assist the licensee or registrant  
in complying with renewal requirements.  
R 338.7002 This rule provides for triennial license and registration renewal. The proposed rules are designed to  
inform a licensee or registrant regarding the license or registration renewal date and to assist the licensee or registrant  
in complying with renewal requirements.  
R 338.7002b This rule provides the minimum English language standards for licensure or registration. The proposed  
rule is designed to assist the applicant in complying with licensure or registration requirements.  
R 338.7004: This is a new proposed rule requiring an applicant for licensure, registration, or renewal to have  
completed implicit bias training. The rule is intended to promote equity in access to and the provision of health care  
services in Michigan.  
A. What is the rationale for changing the rules instead of leaving them as currently written?  
R 338.7001 The rationale for changing this rule is to prevent reader misunderstanding and to include a new definition  
for implicit bias as that term is used in the proposed rule set.  
R 338.7001a The rationale for changing this rule is to provide clarification for renewal of a biennial license or  
registration and advise that the renewal date for acupuncture, audiology, chiropractic, marriage and family therapy,  
nursing home administrators, psychology, sanitarians, and speech-language pathology will be the date of the year  
when the licensee’s initial license or the registrant’s initial registration was issued. Dental Therapy will be added to  
the rule.  
R 338.7002 The rationale for changing this rule is to provide clarification for renewal of a triennial license or  
registration and advise that the renewal date for athletic trainer and massage therapy will be changed to the date of the  
year when the licensee’s initial license was issued. Dental Assistant and Dental Hygienist will be added to the rule.  
R 338.7002b The rationale for changing this rule is to clarify for an applicant for licensure or registration which  
MET is approved and the score that must be achieved.  
R 338.7004 The rationale for adding this rule is to educate health care professionals regarding implicit bias and its  
effect on their behavior. This will improve equity in the delivery of health care to Michigan residents.  
MCL 24.245(3)  
RIS-Page 5  
8. Describe how the proposed rules protect the health, safety, and welfare of Michigan citizens while promoting a  
regulatory environment in Michigan that is the least burdensome alternative for those required to comply.  
R 338.7001 This rule provides definitions used in this rule set. The proposed changes will protect the health, safety,  
and welfare of Michigan residents by ensuring that the terms used in this rule set are clearly defined, which will aid an  
applicant, licensee, or registrant in understanding and complying with the rules.  
R 338.7001a This rule provides for biennial license and registration renewal. The proposed rule will protect the  
health, safety, and welfare of Michigan residents by ensuring that a licensee or registrant renews the license or  
registration on time.  
R 338.7002 This rule provides for triennial license and registration renewal. The proposed rule will protect the  
health, safety, and welfare of Michigan residents by ensuring that a licensee or registrant renews the license or  
registration on time.  
R 338.7002b This rule provides the minimum English language standard required for licensure or registration. The  
proposed rule will protect the health, safety, and welfare of Michigan residents by ensuring that a licensee or registrant  
can communicate effectively with a patient or client.  
R 338.7004 This is a new proposed rule that will require an applicant for licensure, registration, or renewal to have  
completed implicit bias training. The proposed rules will protect the health, safety, and welfare of Michigan residents  
by ensuring equitable access to and provision of health care services.  
9. Describe any rules in the affected rule set that are obsolete or unnecessary and can be rescinded.  
No rules can be rescinded.  
Fiscal Impact on the Agency  
Fiscal impact is an increase or decrease in expenditures from the current level of expenditures, i.e. hiring additional staff,  
higher contract costs, programming costs, changes in reimbursements rates, etc. over and above what is currently  
expended for that function. It does not include more intangible costs for benefits, such as opportunity costs, the value of  
time saved or lost, etc., unless those issues result in a measurable impact on expenditures.  
10. Please provide the fiscal impact on the agency (an estimate of the cost of rule imposition or potential savings  
for the agency promulgating the rule).  
The proposed rules are not expected to have a fiscal impact on the agency.  
11. Describe whether or not an agency appropriation has been made or a funding source provided for any  
expenditures associated with the proposed rules.  
No agency appropriation has been made or a funding source provided because there are no expenditures associated  
with the proposed rules.  
12. Describe how the proposed rules are necessary and suitable to accomplish their purpose, in relationship to the  
burden(s) the rules place on individuals. Burdens may include fiscal or administrative burdens, or duplicative  
acts.  
MCL 24.245(3)  
RIS-Page 6  
R 338.7001 This rule provides definitions used in this rule set. The proposed rule does not place a burden on an  
individual.  
R 338.7001a This rule provides for biennial license and registration renewal. The proposed rule does not place a  
burden on an individual.  
R 338.7002 This rule provides for triennial license and registration renewal. The proposed rule does not place a  
burden on an individual.  
R 338.7002b This rule provides the minimum English language standards required for licensure or registration. The  
proposed amendment to the rule does not place a burden on the individual, it clarifies the name of the approved MET  
and the requirement minimum score.  
R 338.7004 This is a new proposed rule that will require an applicant for licensure, registration, or renewal to have  
completed implicit bias training. The cost of obtaining this training will vary, depending on the program the  
individual chooses. Several Michigan hospitals offer implicit bias training free of charge. This rule will impose a  
burden on health care professionals by requiring that they invest time in obtaining implicit bias training; however,  
promoting equity in access to and the provision of health care services to the residents of Michigan greatly outweighs  
that burden.  
A. Despite the identified burden(s), identify how the requirements in the rules are still needed and reasonable  
compared to the burdens.  
The cost to take implicit bias training will vary, depending on the program chosen. Several Michigan hospitals offer  
free implicit bias training. Health care professionals will need to invest their time to obtain implicit bias training, but  
the investment of time is outweighed by the overall benefit of ensuring greater equity in access to and the provision  
of health care services.  
Impact on Other State or Local Governmental Units  
13. Estimate any increase or decrease in revenues to other state or local governmental units (i.e. cities, counties,  
school districts) as a result of the rule. Estimate the cost increases or reductions for other state or local  
governmental units (i.e. cities, counties, school districts) as a result of the rule. Include the cost of equipment,  
supplies, labor, and increased administrative costs in both the initial imposition of the rule and any ongoing  
monitoring.  
There are no anticipated increases or reductions for other state or local governmental units as result of the proposed  
rules.  
14. Discuss any program, service, duty, or responsibility imposed upon any city, county, town, village, or school  
district by the rules.  
There are no anticipated or intended programs, services, duties, or responsibilities imposed on any city, town, village,  
or school district as a result of these proposed rules.  
A. Describe any actions that governmental units must take to be in compliance with the rules. This section should  
include items such as record keeping and reporting requirements or changing operational practices.  
There are no anticipated or intended programs, services, duties, or responsibilities imposed on any city, town, village,  
or school district as a result of these proposed rules.  
15. Describe whether or not an appropriation to state or local governmental units has been made or a funding  
source provided for any additional expenditures associated with the proposed rules.  
No appropriations have been made to any governmental units as result of the proposed rules. No additional  
expenditures are anticipated or intended with the proposed rules.  
Rural Impact  
16. In general, what impact will the rules have on rural areas?  
MCL 24.245(3)  
RIS-Page 7  
The proposed rules impose requirements on individual licensees or registrants, so rural areas are not impacted by the  
rules. Even if a licensee’s or registrant’s workplace is located in a rural area, the department could not exempt the  
licensee or registrant from these requirements because it would create a disparity in the regulation of the profession.  
A. Describe the types of public or private interests in rural areas that will be affected by the rules.  
The proposed rules will not impact public or private interests in rural areas.  
Environmental Impact  
17. Do the proposed rules have any impact on the environment? If yes, please explain.  
The proposed rules will not have any impact on the environment.  
Small Business Impact Statement  
18. Describe whether and how the agency considered exempting small businesses from the proposed rules.  
The proposed rules impose requirements on individual licensees and registrants rather than small businesses. Even if  
a licensee’s or registrant’s workplace qualifies as a small business, the department could not exempt the business  
because it would create a disparity in the regulation of the profession.  
19. If small businesses are not exempt, describe (a) the manner in which the agency reduced the economic impact  
of the proposed rules on small businesses, including a detailed recitation of the efforts of the agency to comply  
with the mandate to reduce the disproportionate impact of the rules upon small businesses as described below (in  
accordance with MCL 24.240(1)(a-d)), or (b) the reasons such a reduction was not lawful or feasible.  
The rules cannot exempt small businesses because the rules do not directly regulate small businesses. The rules  
regulate individual licensees and registrants. Further, the Public Health Code requires the included professions to be  
licensed or registered, and the licensee or registrant may work in a small business.  
While a licensee or registrant may work independently or as part of a small business, the law does not allow the rules  
to exempt these individuals from the requirements of these rules. However, the impact on a licensee or registrant who  
works as part of a small business is minimized in the proposed rules, as the rules are written broadly. The proposed  
rule changes will have minimal or no impact on a licensee or registrant. As a result, a licensee or registrant, whether  
in small business or not, should not be significantly impacted by the changes.  
A. Identify and estimate the number of small businesses affected by the proposed rules and the probable effect on  
small businesses.  
It is estimated that small businesses will not be affected by the proposed rules. The proposed rules affect individuals  
only.  
B. Describe how the agency established differing compliance or reporting requirements or timetables for small  
businesses under the rules after projecting the required reporting, record-keeping, and other administrative costs.  
The agency did not establish separate compliance or reporting requirements for small businesses. The proposed rules  
will apply to all licensees and registrants. The rules were drafted to be the least burdensome on all affected licensees  
and registrants.  
C. Describe how the agency consolidated or simplified the compliance and reporting requirements for small  
businesses and identify the skills necessary to comply with the reporting requirements.  
The agency did not consolidate or simplify compliance and reporting requirements for small businesses with the  
proposed rules because the proposed rules do not impact small businesses.  
D. Describe how the agency established performance standards to replace design or operation standards required  
by the proposed rules.  
The agency did not establish performance standards to replace design or operation standards required by these rules.  
20. Identify any disproportionate impact the proposed rules may have on small businesses because of their size or  
geographic location.  
The proposed rules do not impact small business. They impact an individual registrant or licensee. Therefore, there  
is no disproportionate impact on a small business because of its size or geographic location.  
21. Identify the nature of any report and the estimated cost of its preparation by small businesses required to  
comply with the proposed rules.  
MCL 24.245(3)  
RIS-Page 8  
The proposed rules affect individuals applying for licensure and renewal, regardless if they practice in a small  
business. There is no separate cost to a small business.  
22. Analyze the costs of compliance for all small businesses affected by the proposed rules, including costs of  
equipment, supplies, labor, and increased administrative costs.  
There are no expected costs for equipment, supplies, labor, or administrative costs that a small business would incur  
in complying with the proposed rules.  
The rules impact licensees and registrants and not small businesses.  
23. Identify the nature and estimated cost of any legal, consulting, or accounting services that small businesses  
would incur in complying with the proposed rules.  
There are no expected costs for legal, consulting, or accounting services that a small business would incur in  
complying with the proposed rules.  
24. Estimate the ability of small businesses to absorb the costs without suffering economic harm and without  
adversely affecting competition in the marketplace.  
There are no expected costs to a small business that will cause economic harm to a small business or the marketplace  
as a result of the proposed rules.  
25. Estimate the cost, if any, to the agency of administering or enforcing a rule that exempts or sets lesser  
standards for compliance by small businesses.  
The proposed rules impose requirements on individual licensees and registrants rather than a small business. Even if  
a licensee’s or registrant’s practice qualifies as a small business, the department could not exempt the business  
because it would create disparity in the regulation of the profession.  
Therefore, there is no cost to the agency for administering or enforcing the rules because exempting or setting lesser  
standards of compliance for a small business is not in the best interest of the public.  
26. Identify the impact on the public interest of exempting or setting lesser standards of compliance for small  
businesses.  
The proposed rules have no impact on a small business, so no exemption was considered.  
27. Describe whether and how the agency has involved small businesses in the development of the proposed rules.  
The department conducted 17 stakeholder engagement meetings prior to the development of the proposed rules. The  
activities commenced with 2 initial discussions to gather feedback, best practices, and resources. Both sessions had  
more than 100 people in attendance representing many different organization, disciplines, and perspectives. The  
attendees of the engagement meetings represented 86 organizations including individuals from the business  
community.  
A. If small businesses were involved in the development of the rules, please identify the business(es).  
Many representatives from the business community participated in the stakeholder engagement meetings. None of  
the businesses represented were specifically identified as small businesses by the representative in attendance.  
Cost-Benefit Analysis of Rules (independent of statutory impact)  
28. Estimate the actual statewide compliance costs of the rule amendments on businesses or groups.  
There are no estimated compliance costs with these rule amendments on businesses or groups.  
A. Identify the businesses or groups who will be directly affected by, bear the cost of, or directly benefit from the  
proposed rules.  
No businesses or groups will be directly affected or benefitted by the proposed rules. No additional costs will be  
imposed on any businesses or groups.  
B. What additional costs will be imposed on businesses and other groups as a result of these proposed rules (i.e.  
new equipment, supplies, labor, accounting, or recordkeeping)? Please identify the types and number of businesses  
and groups. Be sure to quantify how each entity will be affected.  
The estimated cost to complete implicit bias training will vary, depending on the program chosen by the health care  
professional. Several Michigan hospitals offer implicit bias training free of charge.  
MCL 24.245(3)  
RIS-Page 9  
29. Estimate the actual statewide compliance costs of the proposed rules on individuals (regulated individuals or  
the public). Include the costs of education, training, application fees, examination fees, license fees, new  
equipment, supplies, labor, accounting, or recordkeeping.  
A cost is associated with the renewal of a license or registration, but the proposed rules do not address that cost. The  
proposed rules only establish license and registration renewal dates. The estimated cost to take implicit bias training  
will vary, depending on the program chosen. Several Michigan hospitals offer training free of charge.  
A. How many and what category of individuals will be affected by the rules?  
All licensees, registrants, and applicants are affected by the proposed rules.  
B. What qualitative and quantitative impact do the proposed changes in rules have on these individuals?  
The estimated cost to take implicit bias training will vary, depending on the program chosen. Several Michigan  
hospitals offer training free of charge.  
30. Quantify any cost reductions to businesses, individuals, groups of individuals, or governmental units as a result  
of the proposed rules.  
There are no cost reductions to businesses, individuals, groups of individuals, or governmental units as a result of the  
proposed rules.  
31. Estimate the primary and direct benefits and any secondary or indirect benefits of the proposed rules. Please  
provide both quantitative and qualitative information, as well as your assumptions.  
The benefits of the proposed rules include: 1) Ensuring that licensees and registrants will be aware of renewal  
timelines; 2) Ensuring that applicants for licensure, registration, or renewal will become aware of how implicit biases  
result in barriers and disparities in access to and the provision of health care services; and 3) Ensuring that the health  
care professional will be empowered to take appropriate actions to remedy those inequities.  
32. Explain how the proposed rules will impact business growth and job creation (or elimination) in Michigan.  
The rules are not expected to have an impact on business growth, job creation, or job elimination in Michigan.  
33. Identify any individuals or businesses who will be disproportionately affected by the rules as a result of their  
industrial sector, segment of the public, business size, or geographic location.  
The department does not expect any individuals or businesses to be disproportionately impacted by the rules as a  
result of their industrial sector, segment of the public, business size, or geographic location.  
34. Identify the sources the agency relied upon in compiling the regulatory impact statement, including the  
methodology utilized in determining the existence and extent of the impact of the proposed rules and a cost-  
benefit analysis of the proposed rules.  
MCL 24.245(3)  
RIS-Page 10  
Illinois: http://ilga.gov/legislation/ilcs/ilcs3.asp?ActID=1319&ChapAct=225%26nbsp%3BILCS%26nbsp%3B90%  
2F&ChapterID=24&ChapterName=PROFESSIONS+AND+OCCUPATIONS&ActName=Illinois+Physical+Therapy  
+Act%2E; http://ilga.gov/legislation/ilcs/ilcs3.asp?ActID=1319&ChapAct=225%26nbsp%3BILCS%26nbsp%  
3B90%  
2F&ChapterID=24&ChapterName=PROFESSIONS+AND+OCCUPATIONS&ActName=Illinois+Physical+Therapy  
+Act%2E; https://www.ilga.gov/legislation/101/HB/10100HB5488.htm; https://trackbill.com/bill/illinois-senate-bill-  
132-medical-implicit-bias-training/1658669/; https://www.ilga.gov/legislation/publicacts/fulltext.asp?Name=101-  
0390  
Indiana: http://iga.in.gov/legislative/laws/2018/ic/titles/025#25-1;  
http://iga.in.gov/legislative/2020/bills/house/1250#document-026c392e  
Kentucky: https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=44609  
Minnesota: https://www.revisor.mn.gov/rules/6305.0400/?keyword_type=all&keyword=nurse+english;  
https://www.health.state.mn.us/communities/practice/resources/equitylibrary/facebook-bias.html  
New York: http://www.op.nysed.gov/english.htm;  
https://www.nysenate.gov/legislation/bills/2019/s6797#:~:text=BILL%20NUMBER%3A%20S6797%  
20SPONSOR%3A%20SANDERS%20TITLE%20OF%20BILL%3A,order%20to%20maintain%20their%  
20license%20in%20good%20standing.  
Ohio: https://otptat.ohio.gov/Portals/0/laws/Ohio%20PT%20Practice%20Act%20as%20of%20May%201%  
202018.pdf?ver=2018-05-02-143519-423; http://codes.ohio.gov/oac/4723-7-04v1;  
https://www.ohioafp.org/education/limiting-implicit-bias-training/  
Pennsylvania: https://www.pacode.com/secure/data/049/chapter21/s21.23.html;  
https://www.legis.state.pa.us/CFDOCS/Legis/PN/Public/btCheck.cfm?  
txtType=HTM&sessYr=2019&sessInd=0&billBody=H&billTyp=B&billNbr=2110&pn=2995  
Wisconsin: http://docs.legis.wisconsin.gov/code/admin_code/pt/2/01/8/c  
A. How were estimates made, and what were your assumptions? Include internal and external sources, published  
reports, information provided by associations or organizations, etc., that demonstrate a need for the proposed  
rules.  
Since the rules are required by statute and Executive Directive, no estimates were made.  
Alternative to Regulation  
35. Identify any reasonable alternatives to the proposed rules that would achieve the same or similar goals.  
Since the rules are required by statute and Executive Directive, there are no reasonable alternatives to the proposed  
rules.  
A. Please include any statutory amendments that may be necessary to achieve such alternatives.  
Since the rules are required by statute, a statutory change would be needed to provide an alternative.  
36. Discuss the feasibility of establishing a regulatory program similar to that proposed in the rules that would  
operate through private market-based mechanisms. Please include a discussion of private market-based systems  
utilized by other states.  
It is not feasible to establish a regulatory program similar to the proposed rules because state statute requires that the  
department establish the date pertaining to the renewal of licenses and registrations regulated by the Public Health  
Code, MCL 333.16194(1).  
Private market-based mechanisms do not provide for equity in access to or the provision of health care services.  
MCL 24.245(3)  
RIS-Page 11  
37. Discuss all significant alternatives the agency considered during rule development and why they were not  
incorporated into the rules. This section should include ideas considered both during internal discussions and  
discussions with stakeholders, affected parties, or advisory groups.  
Since the rules are specifically required by statute or Executive Directive, there are no alternatives to the proposed  
rules that the agency could consider. They are necessary for the administration and enforcement of the licensing  
process.  
Additional Information  
38. As required by MCL 24.245b(1)(c), please describe any instructions regarding the method of complying with  
the rules, if applicable.  
The instructions for compliance are included in the rules.  
MCL 24.245(3)  
;