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Indiana instituted a similar POST program. Comparing Michigan’s proposed rules with Indiana, they do appear to be
very similar and accomplish similar requirements to legally complete these medical orders in coordination with the
patient. The Indiana POST Program is an advance care planning tool that helps ensure treatment preferences are
honored. It is designed for patients with advanced chronic or terminal illness or frailties. Preferences for life
sustaining treatments including resuscitation, medical interventions (e.g., comfort care, hospitalization, intubation,
mechanical ventilation), antibiotics, and artificial nutrition are documented as medical orders on the POST form. It
must be reviewed and signed by a physician, advance practice nurse, or physician assistant to be activated. This form
transfers throughout the health care system and the orders are valid in all settings.
A. If the rules exceed standards in those states, please explain why and specify the costs and benefits arising out of
the deviation.
The proposed rules do not exceed standards in the other states with legislation.
3. Identify any laws, rules, and other legal requirements that may duplicate, overlap, or conflict with the proposed
rules.
The proposed rules do not duplicate, overlap, or conflict with laws, rules, or other legal requirements.
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.
The POST form contains a medical order regarding the initiation of resuscitation if the patient suffers cessation of
both spontaneous respiration and circulation, and the emergency medical services personnel has actual notice of a do-
not-resuscitate order that was executed under the Michigan do-not-resuscitate procedure act, 1996 PA 193, MCL
333.1051 to 333.1067, after the POST form was validly executed. As used in this subdivision, "actual notice" means
that term as defined in section 2 of the Michigan do-not-resuscitate procedure act, 1996 PA 193, MCL 333.1052. If a
POST form is validly executed after a do-not-resuscitate order is executed under the Michigan do-not-resuscitate
procedure act, 1996 PA 193, MCL 333.1051 to 333.1067, the medical orders indicated on the POST form are
presumed to express the patient's current wishes.
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.
MCL24.232(8) does not apply to these proposed rules.
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.
MCL24.232(9) does not apply to these proposed rules.
Purpose and Objectives of the Rule(s)
6. Identify the behavior and frequency of behavior that the proposed rules are designed to alter.
MI-POST is intended for use by an attending health professional and only for those elderly patients with advanced
illness for whom, based on his or her current medical condition, death would occur within one year.
A. Estimate the change in the frequency of the targeted behavior expected from the proposed rules.
MI-POST is an optional form for people with serious advanced illness or frailty. It is part of an advance care planning
process. It is intended to guide care only if the person cannot tell others what to do at that time.
B. Describe the difference between current behavior/practice and desired behavior/practice.
The form is not currently available and the rules provide the authority for the creation and utilization of the MI-POST
form.
With the creation of the MI-Post form, a physician’s creates an active order set for the patient’s current medical
condition, which also include resuscitation and treatment decisions. They help ensure that the decisions of a patient
are followed, even if the patient later lacks capacity to make decisions. Seriously ill or frail patients, especially those
whose attending health professionals would not be surprised if they were to die within a year, are encouraged to
complete a MI-POST form. The form takes the patient’s decisions and puts them into a physician’s order set that can
be followed at any Michigan health care facility, as well as by first responders.
C. What is the desired outcome?
MCL 24.245(3)