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:  
Rule Set Information:  
ARD assigned rule set number:  
2021-38 LR  
Title of proposed rule set:  
Acupuncture – 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 the practice of acupuncture, so there are no federal rules or  
standards set by a national or state agency that the proposed rules can be compared to.  
A. Are these rules required by state law or federal mandate?  
MCL 24.245(3)  
RIS-Page 2  
MCL 333.16145 requires the board to promulgate rules to specify the requirements for licenses, renewals,  
examination, and required passing scores.  
MCL 333.16148 requires the department to promulgate rules to include training standards for identifying victims of  
human trafficking.  
MCL 333.16287 requires the department, in consultation with the board, to promulgate rules to implement telehealth  
services.  
MCL 333.16515 requires the promulgation of rules to establish criteria for licensure for an applicant who has the  
education, training, and experience appropriate to the practice of acupuncture.  
MCL 333.16517 requires the department, in consultation with the board, to promulgate rules requiring that a licensee  
furnish evidence of completing continuing education for license renewal.  
MCL 333.16525 requires the department, in consultation with the board, to promulgate rules that establish the  
minimum standards for licensure.  
There is no federal mandate applicable to these rules.  
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.  
The proposed rules are consistent with the standards required in the Michigan Public Health Code, and the rules are  
largely consistent with the requirements of other states in the Great Lakes region. Every state in the Great Lakes  
region provides for the regulation of this profession.  
A. If the rules exceed standards in those states, please explain why and specify the costs and benefits arising out of  
the deviation.  
Overall, the standards in the proposed rules do not exceed those of the other states in the Great Lakes region.  
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  
Part 1: The current rules provide general provisions pertaining to the profession including the training standards for  
identifying victims of human trafficking and the approval and adoption of the national standards of competence in  
acupuncture and oriental medicine established by the National Certification Commission for Acupuncture and  
Oriental Medicine (NCCAOM).  
The proposed rules will clarify the training standards for identifying victims of human trafficking so an applicant for  
licensure or renewal understands that the training must be completed before application. The proposed rule is  
intended to assist an applicant in complying with the statutorily required training standards for identifying victims of  
human trafficking, MCL 333.16148.  
The certification standards rule will be amended to approve and adopt examinations and standards of the NCCAOM  
to ensure that a licensee has acquired the necessary education and skills to be competent in providing acupuncture  
services to the public.  
Part 2: The current rules pertain to licensure and relicensure. Several rules in this part will be rescinded and the  
substance moved to new rule numbers to comply with current drafting rules and for organization and clarity. The  
proposed new rules in this section will advise the reader of the applicable dates for licensure of currently registered  
applicants, non-NCCAOM certified applicants, and limited license applicants. The proposed new rules will clarify  
the documentation a non-NCCAOM certified applicant must submit for the board to determine if the applicant has  
met the requirements for licensure and will advise that requirements for licensure may be contained in other rule sets,  
such as the Public Health Code General Rules. The proposed new licensure by endorsement rule will recognize the  
recent changes to MCL 333.16186, and it will require the applicant to disclose each health care credential ever held  
and to have resolved any disciplinary action taken against the individual before being licensed by endorsement. The  
new proposed rule pertaining to relicensure will require the applicant to disclose each health care credential ever held  
and to have resolved any disciplinary action taken against the individual before being relicensed. The proposed new  
rules are intended to assist an applicant in becoming licensed or relicensed and to ensure public safety.  
Part 3: The current rules pertain to license renewal and continuing education. Current rules R 338.13026 and R  
338.13028 will be rescinded and the substance of those rules relocated to proposed new rules R 338.13031 and R  
338.13033. Current rule R 338.13035 will be rescinded and the substance revised and relocated to R 338.13041 in  
new Part 4 of the proposed rules. The proposed new rules in Part 3 are intended to inform licensees of all renewal  
requirements and identify the programs and activities that are approved for the accumulation of continuing education  
credits required for license renewal. The proposed new rules are intended to assist the licensee in accumulating all  
required training and continuing education needed for license renewal.  
Part 4: The proposed new rule in this new part pertains to registered acupuncturists and the delegation needed to  
practice. MCL 333.16511 permits a registered acupuncturist to engage in his or her practice until March 31, 2024.  
The proposed new rule is intended to clarify the requirements for continuing to practice as a registered acupuncturist.  
A. Estimate the change in the frequency of the targeted behavior expected from the proposed rules.  
The frequency of use is not expected to change.  
B. Describe the difference between current behavior/practice and desired behavior/practice.  
MCL 24.245(3)  
RIS-Page 4  
Part 1: The current rules provide general provisions pertaining to the profession including the training standards for  
identifying victims of human trafficking and the approval and adoption of the national standards of competence in  
acupuncture and Oriental Medicine established by the National Certification Commission for Acupuncture and  
Oriental Medicine (NCCAOM).  
The proposed rules will clarify the training standards for identifying victims of human trafficking. The desired  
behavior is compliance with the statutorily required training standards for identifying victims of human trafficking.  
The certification standards rule will be amended to approve and adopt the standards of NCCAOM to ensure that a  
licensee has acquired the necessary education and skills to be competent in providing acupuncture services to the  
public. The desired behavior is compliance with licensure requirements.  
Part 2: The current rules pertain to licensure and relicensure. Several rules in this part will be rescinded and the  
substance moved to new rule numbers to comply with current drafting rules and for organization and clarity. The  
proposed new rules in this section will advise the reader of the applicable dates for licensure of currently registered  
applicants, non-NCCAOM certified applicants, and limited license applicants. The proposed new rules will clarify  
the documentation a non-NCCAOM certified applicant must submit for the board to determine if the applicant has  
met the requirements for licensure. The proposed new rules will also advise that requirements for licensure may be  
contained in other rule sets, such as the Public Health Code General Rules. The proposed new licensure by  
endorsement rule will recognize the recent changes to MCL 333.16186, and it will require the applicant to disclose  
each health care credential ever held and to have resolved any disciplinary action taken against the individual before  
being licensed by endorsement. The proposed new relicensure rule will require the applicant to disclose each health  
care credential ever held and to that the applicant has resolved any disciplinary action taken before becoming  
relicensed. The desired behavior is compliance with the requirements for licensure or relicensure and to ensure public  
safety.  
Part 3: The current rules pertain to license renewal, continuing education, and delegation and supervision. Current  
rules R 338.13026, R 338.13028, and R 338.13025 will be rescinded and the substance relocated to new rule numbers  
to comply with current drafting rules and for organization and clarity. The proposed new rules in this part are  
intended to inform licensees of renewal requirements and identify approved programs and activities for the  
accumulation of continuing education required for renewal. The desired behavior is licensee compliance with all  
requirements for license renewal.  
Part 4: The proposed new rule in this new part pertains to currently registered acupuncturists. The substance of  
current rule R 338.13035 will be updated in this proposed new rule. MCL 333.16511 permits a registered  
acupuncturist to engage in his or her practice until March 31, 2024. The desired behavior is compliance by a  
registered acupuncturist.  
C. What is the desired outcome?  
R 338.13002 The proposed rule is intended to advise an applicant for licensure or renewal of the date when the  
training standards for identifying victims of human trafficking must be met for licensure or renewal.  
R 338.13004 The proposed rule is intended to approve and adopt the examination and standards of competence  
established by the NCCAOM.  
R 338.13005 The current rule will be rescinded and the substance of the rule moved to proposed new rule R 338.13011  
to comply with current drafting rules.  
R 338.13006 The current rule will be rescinded and the substance of the rule moved to proposed new rule R 338.13012  
for organization and clarity.  
R 338.13007 The current rule will be rescinded and the substance of the rule moved to proposed new rule R 338.13013  
for organization and clarity.  
MCL 24.245(3)  
RIS-Page 5  
R 338.13008 The current rule will be rescinded and the substance of the rule moved to proposed new rule R 338.13014  
for organization and clarity.  
R 338.13010 The current rule will be rescinded and the substance of the rule moved to proposed new rule R 338.13016  
for organization and clarity.  
R 338.13011 The proposed new rule is intended to provide the applicable dates and clarify the requirements for  
licensure when the applicant holds a current Michigan acupuncturist registration.  
R 338.13012 The proposed new rule is intended to provide the applicable dates and clarify the requirements for  
licensure of an acupuncturist who is practicing, but not currently registered in Michigan, as provided by MCL  
333.16515(2)(b).  
R 338.13013 The proposed new rule is intended to clarify the requirements for initial licensure of an applicant who is  
NCCAOM certified.  
R 338.13014 The proposed new rule is intended to provide the applicable dates and clarify the requirements to obtain a  
limited license, as provided by MCL 333.16515(3).  
R 338.13016 The proposed new rule is intended to clarify the requirements for licensure by endorsement for an  
applicant who is licensed or registered in another state or licensed in Canada.  
R 338.13017 The proposed rule amends the requirements for relicensure after lapse.  
R 338.13025 The current rule will be rescinded and the substance of the rule moved to proposed new rule R 338.13017  
for organization and clarity.  
R 338.13026 The current rule will be rescinded and the substance of the rule moved to proposed new rule R 338.13031  
to comply with current drafting rules.  
R 338.13028 The current rule will be rescinded and the substance of the rule moved to proposed new rule R 338.13033  
for organization and clarity.  
R 338.13031 The proposed rule amends the requirements for license renewal to advise the applicant that he or she  
must also satisfy the requirements set out in the Public Health Code General Rules before applying for renewal.  
R 338.13033. The proposed new rule pertains to acceptable continuing education required for renewal. The substance  
of this rule was previously in R 338.13028 and is being renumbered for organization and clarity.  
R 338.13035 The current rule will be rescinded and the substance of the rule moved to proposed rule R 338.13041 to  
comply with current drafting rules.  
R 338.13041 The proposed new rule pertains to delegation and supervision for registered acupuncturists. MCL  
333.16511 permits a registered acupuncturist to engage in his or her practice until March 31, 2024. The amendments  
will ensure compliance by a registered acupuncturist.  
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.  
MCL 24.245(3)  
RIS-Page 6  
Part 1: The current rule pertaining to the training standards for identifying victims of human trafficking contains  
outdated information. The harm that may result is applicant noncompliance.  
The current rule pertaining to the board’s approval of the competence standards of the NCCAOM fails to approve and  
adopt the examinations required for certification by the NCCAOM. The harm that may result is confusion and  
noncompliance with licensure requirements.  
Part 2: Currently, the licensure rules only provide reference to the promulgation dates and fail to advise that other  
administrative rules may impact the application process. The proposed new rules are intended to clearly identify  
applicable dates and clarify the requirements for licensure, licensure by endorsement, relicensure, and limited  
licensure. The proposed new rules also require that an applicant for licensure by endorsement or relicensure disclose  
any health care credential he or she holds and advise that each credential must be verified by the issuing entity and  
will require that the applicant to have resolved any disciplinary action taken against the individual before being  
licensed by endorsement or relicensed. The harm that may result without the changes is applicant noncompliance.  
Part 3: The current rules do not include a reference to the renewal requirements contained in the Public Health Code  
General Rules . The harm that may result is that the applicant may not comply with renewal requirements.  
Part 4: The current rule pertaining to the delegation requirements of a registered acupuncturist does not contain the  
date when this type of practice ends under the statute. The harm that may result is that a registered acupuncturist may  
not comply with the limitations placed on this type of practice.  
A. What is the rationale for changing the rules instead of leaving them as currently written?  
Part 1 is being changed because the information for compliance for acquiring the required training for identifying  
victims of human trafficking is out of date. Additionally, the rule pertaining to the board’s approval and adoption of  
NCCAOM certification standards fails to approve and adopt the required examination, which may cause confusion.  
Part 2 is being changed because it lacks the applicable dates for licensure for several license types and the current  
rules fail to reference other rules where licensure requirements may need to be met. The proposed rules will also  
require an applicant for licensure by endorsement or relicensure to disclose each health care credential he or she has  
ever held and require verification of each credential from the issuing entity. The proposed rules will also require the  
applicant to have resolved any disciplinary action taken against the individual before being licensed by endorsement  
or relicensed. As currently written, the applicant may fail to meet all licensure requirements.  
Part 3 is being changed to ensure that all requirements for license renewal and the accumulation of continuing  
education credits are clear to assist the renewal applicant. As currently written, the applicant may fail understand all  
requirements for license renewal.  
Part 4 is being changed to ensure compliance with all practice requirements for those individuals who choose to  
continue their current practice as a registered acupuncturist until March 31, 2024.  
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.  
MCL 24.245(3)  
RIS-Page 7  
Part 1: A licensee must acquire knowledge to identify victims of human trafficking, which will protect the health,  
safety, and welfare of Michigan citizens. This training is required by statute.  
The rules in this part protect the health, safety, and welfare of Michigan citizens by approving and adopting the  
national standards of competence requirements and the examination of NCCAOM to ensure that the applicant has  
been appropriately educated and trained to provide acupuncture services. There is no less burdensome way to ensure  
that a licensee is prepared to practice.  
Part 2: The rules in this part protect the health, safety, and welfare of Michigan citizens by ensuring that an  
acupuncturist is licensed.  
The proposed new rules will ensure that an applicant has met all of the requirements for licensure by clarifying the  
applicable dates, providing references to the requirements contained in other administrative rules, such as the Public  
Health Code General Rules, and by requiring that an applicant for licensure by endorsement or relicensure disclose  
each health care credential he or she has ever held, and by requiring that there is no unresolved disciplinary action  
against the applicant. The proposed new rules will also clarify the documentation a non-NCCAOM certified applicant  
must submit for the board to determine if the applicant has met the requirements for licensure. There is no less  
burdensome way to ensure that an applicant is prepared and safe to practice, which will protect the health, safety, and  
welfare of Michigan citizens.  
Part 3: The proposed new rules in this part protect the health, safety, and welfare of Michigan citizens by requiring a  
licensee to meet all requirements for renewal set forth in the Public Health Code General Rules, including completing  
implicit bias training, to ensure that the applicant is educated regarding implicit bias and its effect on his or her  
behavior. This will improve equity in the delivery of health care to Michigan citizens.  
Part 4: The proposed new rule in this part protects the health, safety, and welfare of Michigan citizens by ensuring  
that an individual who chooses to continue practicing as a registered acupuncturist instead of being licensed does so  
within the statutorily defined practice parameters.  
9. Describe any rules in the affected rule set that are obsolete or unnecessary and can be rescinded.  
MCL 24.245(3)  
RIS-Page 8  
R 338.13005 will be rescinded and the substance of the rule moved to proposed new rule R 338.13011 to comply  
with current drafting rules.  
R 338.13006 will be rescinded and the substance of the rule moved to proposed new rule R 338.13012 for  
organization and clarity.  
R 338.13007 will be rescinded and the substance of the rule moved to proposed new rule R 338.13013 for  
organization and clarity.  
R 338.13008 will be rescinded and the substance of the rule moved to proposed new rule R 338.13014 for  
organization and clarity.  
R 338.13010 will be rescinded and the substance of the rule moved to proposed new rule R 338.13016 for  
organization and clarity.  
R 338.13025 will be rescinded and the substance of the rule moved to proposed new rule R 338.13017 for  
organization and clarity.  
R 338.13026 will be rescinded and the substance of the rule moved to proposed new rule R 338.13031 to comply  
with current drafting rules.  
R 333.13028 will be rescinded and the substance of the rule moved to proposed new rule R 338.13033 for  
organization and clarity.  
R 338.13035 will be rescinded and the substance of the rule moved to proposed new rule R 338.13041 to comply  
with current drafting rules.  
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 9  
Part 1: A licensee must acquire knowledge to identify victims of human trafficking, which will protect the health,  
safety, and welfare of Michigan citizens. There is no less burdensome way to ensure that a licensee is trained to  
identify victims of human trafficking. This rule is required by statute.  
The rules in this part protect the health, safety, and welfare of Michigan citizens by approving and adopting the  
examination and national standards of competence established by the NCCAOM to ensure that the applicant has been  
appropriately trained, tested, and demonstrated that he or she is competent to provide acupuncture services.  
Part 2: The proposed new rules in this part protect the health, safety, and welfare of Michigan citizens by ensuring  
that an acupuncturist is licensed within the statutorily established time periods. The standards established for  
licensure will also advise the applicant that other requirements within the Michigan administrative code must also be  
satisfied, such as those contained in the Public Health Code General Rules. Additionally, an applicant for licensure  
by endorsement or relicensure will be required to disclose every health care credential he or she has ever held and  
have that credential verified by the issuing entity. The requirements will ensure that an applicant has achieved a  
minimum level of competency before he or she is licensed and is safe to practice. There is no less burdensome way  
to ensure that an applicant is competent and safe to practice.  
Part 3: The proposed new rules in this part protect the health, safety, and welfare of Michigan citizens by requiring a  
licensee seeking renewal to complete continuing education and to comply with the training requirements set out in  
the Public Health Code General Rules, which includes completing implicit bias training. The cost for completing  
implicit bias training will vary depending on the program chosen. Some Michigan hospitals offer implicit bias  
training free of charge, but any cost incurred by the applicant will be outweighed by achieving greater equity in  
access to and the provision of health care services in Michigan.  
Part 4: The proposed new rule in this part protects the health, safety, and welfare of Michigan citizens by ensuring  
that an individual who chooses to continue practicing as a registered acupuncturist instead of being licensed does so  
within the statutorily defined practice parameters.  
A. Despite the identified burden(s), identify how the requirements in the rules are still needed and reasonable  
compared to the burdens.  
The rules establish licensure and renewal requirements for acupuncturists, and clarify the requirements for a  
registered acupuncturist who wishes to continue his or her practice. An applicant or licensee must obtain the  
necessary education and training to achieve and maintain competency in the profession. And a registered  
acupuncturist must practice within the statutorily defined parameters. There is no less burdensome way to ensure the  
health, safety, and welfare of Michigan citizens and to comply with applicable statutes.  
Additionally, the cost to take implicit bias training will vary, depending on the program chosen. Several Michigan  
hospitals offer free implicit bias training. Acupuncturists 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 a 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.  
MCL 24.245(3)  
RIS-Page 10  
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 actions that a governmental unit must take to comply with the 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 a 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?  
The proposed rules impose requirements on individual registrants and licensees, so the impact is on an individual  
regardless of that person’s location. Even if a registrant’s or licensee’s workplace is in a rural area, the department  
could not exempt his or her business 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 do 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 department did not consider exempting small businesses because they are not impacted by the proposed rules.  
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.  
A. Identify and estimate the number of small businesses affected by the proposed rules and the probable effect on  
small businesses.  
There are approximately 263 acupuncturists currently licensed or registered. The profession is moving from  
registration to licensure.  
A licensee may work in a small business. However, no matter what type of business environment the licensee works  
in, he or she will have to comply with the proposed rules. The rules do not impact small business differently because  
the impact is to the individual licensee 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. The rules were drafted to be the least burdensome on all affected licensees.  
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. There are no skills necessary to comply  
with the reporting requirements.  
MCL 24.245(3)  
RIS-Page 11  
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 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.  
The proposed rules impact 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 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 rather than a small business. Even if a licensee’s  
practice qualifies as a small business, the department could not exempt his or her 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 impose requirements on individual licensees rather than a small business. Even if a licensee’s  
work qualifies as a small business, the department could not exempt his or her business because it would create a  
disparity in the regulation of the profession. Therefore, exempting or setting lesser standards of compliance for a  
small business is not in the best interest of the public.  
27. Describe whether and how the agency has involved small businesses in the development of the proposed rules.  
The department did not involve small businesses in the development of the proposed rules. The department worked  
with the Michigan Board of Acupuncture in the development of the proposed rules. The Board is composed of  
professionals and public members.  
A. If small businesses were involved in the development of the rules, please identify the business(es).  
No small businesses were involved in the development of the rules.  
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.  
MCL 24.245(3)  
RIS-Page 12  
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.  
No additional costs will be imposed on any businesses or groups.  
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.  
The proposed rules establish that the requirements for license renewal set out in the Public Health Code General  
Rules must be met. The cost to take implicit bias training will vary, depending on the program chosen. Several  
Michigan hospitals offer free implicit bias training. Acupuncturists 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.  
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 cost to take implicit bias training will vary, depending on the program chosen. Several Michigan hospitals offer  
free implicit bias training. Acupuncturists 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.  
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 proposed rules use clear and concise language and implement the statutory requirements for licensing and  
license renewal. The clear and concise language allows the public, applicants, and licensees to better understand the  
requirements for licensure and renewal.  
Michigan citizens are benefitted by ensuring that an acupuncturist has the necessary education and training to  
competently provide services before a license is issued. Additionally, Michigan citizens are benefitted by ensuring  
that a practitioner is up-to-date in his or her knowledge and skills by requiring continuing education before a license  
may be renewed and by the benefit of ensuring greater equity in access to and the provision of health care services.  
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 13  
Minnesota: Apply for a License / Minnesota Board of Medical Practice (mn.gov)  
Ohio: Acupuncture (AC) (ohio.gov)  
Pennsylvania: Acupuncturist Licensure Requirements Snapshot (pa.gov)  
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, 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, 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.  
Since the rules are required by statute, private market-based systems cannot serve as an alternative. The licensing  
and regulation of acupuncture professionals are state functions, and states regulate acupuncture professionals by  
statute, regulation, or both. Private market-based systems are not used for licensing and regulation.  
There are professional organizations that establish criteria for membership, but these organizations would provide the  
public with significantly less protection because membership in many of these organizations is voluntary. This  
means an individual who meets the membership requirements but does not join one of the professional organizations  
would be able to practice, and there would be no way to ensure his or her competency or hold him or her  
accountable.  
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, 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)  
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