Michigan Office of Administrative Hearings and Rules  
Administrative Rules Division (ARD)  
MOAHR-Rules@michigan.gov  
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:  
Weston MacIntosh  
Phone number of person filling out RIS:  
517-241-9269  
E-mail of person filling out RIS:  
MacIntoshW1@michigan.gov  
Rule Set Information:  
ARD assigned rule set number:  
2021-54 LR  
Title of proposed rule set:  
Osteopathic Medicine and Surgery – 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.  
There are no parallel federal rules or standards set by a state or national licensing agency or accreditation association.  
A. Are these rules required by state law or federal mandate?  
Promulgation of the rules is a requirement under state law, MCL 333.16145, 333.16148, 333.16174, 333.16201,  
333.16204, 333.16215, 333.16287, 333.17531, 333.17533, and 333.17548, as well as Executive Reorganization Nos.  
1991-9,  
1996-2, 2003-1 and 2011-4, MCL 338.3501, 445.2001, 445.2011, and 445.2030.  
No federal mandate demands the 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 rules do not exceed a federal standard or law.  
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  
Licensure of osteopathic medical doctors is necessary in Michigan under MCL 333.17511. The rules specify the  
conditions and requirements for licensure, relicensure, renewal, and continuing education.  
All 7 of the other Great Lakes states have rules regulating the licensing of osteopathic medical doctors, as listed  
below:  
Illinois – Applicants for licensure must have good moral character, graduate from an osteopathic medical education  
program, complete postgraduate clinical training, and successfully pass Steps 1, 2, and 3 of the United States Medical  
Licensing Examination (USMLE) prior to obtaining full licensure.  
Indiana – Applicants for licensure must not have a conviction for a crime that has a direct bearing on the applicant's  
ability to practice competently, must possess the degree of doctor of osteopathic medicine from an approved  
osteopathic medical school, complete postgraduate clinical training, and successfully pass Levels 1, 2, and 3 of the  
Comprehensive Osteopathic Medical Licensing Examination (COMLEX) or Steps 1, 2, and 3 of the USMLE prior to  
obtaining full licensure.  
Minnesota – Applicants for licensure must show good moral character, not be under license suspension or revocation  
by the licensing board of the jurisdiction in which the misconduct occurred, have graduated from an accredited  
osteopathic medical school, completed clinical medical training, and successfully pass Levels 1, 2, and 3 of the  
COMLEX or Steps 1, 2, and 3 of the USMLE prior to obtaining full licensure.  
New York – Applicants for licensure must have good moral character, graduated from an accredited osteopathic  
medical program, complete postgraduate clinical training, and successfully pass Levels 1, 2, and 3 of the COMLEX or  
Steps 1, 2, and 3 of the USMLE prior to obtaining full licensure.  
Ohio – Applicants for licensure must have good moral character, graduated from an accredited osteopathic medical  
school, complete postgraduate clinical training, and successfully pass Levels 1, 2, and 3 of the COMLEX or Steps 1,  
2, and 3 of the USMLE prior to obtaining full licensure.  
Pennsylvania – Applicants for licensure must have good moral character, graduated from an accredited osteopathic  
medical college, received a passing score on the practical examination in osteopathic diagnosis and manipulative  
therapy developed and administered by the board or a designated professional testing organization, complete  
postgraduate clinical training, and successfully pass Levels 1, 2, and 3 of the COMLEX prior to obtaining full  
licensure.  
Wisconsin – Applicants for licensure must have graduated from an accredited osteopathic medical college, complete  
postgraduate clinical training, and successfully pass Levels 1, 2, and 3 of the COMLEX or Steps 1, 2, and 3 of the  
USMLE prior to obtaining full licensure.  
When compared to other Great Lakes states, Michigan’s licensure requirements for osteopathic medical doctors are  
like other Great Lakes states.  
A. If the rules exceed standards in those states, please explain why and specify the costs and benefits arising out of  
the deviation.  
Statute demands promulgation of rules related to licensure. The rules do not exceed the licensing requirements of  
other states.  
3. Identify any laws, rules, and other legal requirements that may duplicate, overlap, or conflict with the proposed  
rules.  
There are no federal regulations for licensing of osteopathic medical doctors. There are no other laws, rules, or other  
legal requirements that duplicate, overlap, or conflict with the 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.  
MCL 24.245(3)  
RIS-Page 3  
Review of applicable statutory law avoided unnecessary duplication in the 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.  
There is no applicable federal standard for these 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.  
There is no applicable federal standard for these rules.  
Purpose and Objectives of the Rule(s)  
6. Identify the behavior and frequency of behavior that the proposed rules are designed to alter.  
The specific topics that the proposed rules address, and the purpose of the proposed rules is set forth below:  
R 338.114, R 338.115, R 338.119, R 338.120, R 338.123, R 338.127, and R 338.141 include clean-up, clarifying  
language, reorganization, and typographical revisions to the language in the current rules.  
R 338.121. This rule pertains to accreditation standards for osteopathic medical schools and residency programs. It  
sets forth the standards for accreditation of osteopathic medical schools and postgraduate training programs. The rule  
revision updates accreditation standards.  
R 338.125. This rule pertains to applications for licensure by endorsement. It sets forth the requirements for licensure  
by endorsement. The rule revision incorporates the recent legislative changes that allow licensure by endorsement for  
individuals licensed in another state or a province of Canada and revises the requirements for verification of licenses  
held in other jurisdictions.  
R 338.129. This rule pertains to examinations and limitations. It sets forth the required examination number of  
attempts allowed and the period for completion. The rule revision clarifies that a temporary eligibility pathway  
approved by the NBOME (National Board of Osteopathic Medical Examiners) will function as a substitute for passing  
the COMLEX-USA Level 2-Performance Evaluation (Level 2-PE).  
R 338.133. This rule pertains to relicensure. It sets forth the requirements for relicensure. The revised rule allows  
proof of licensure in another province of Canada as a pathway to relicensure and revises the requirements for  
verification of licenses held in other jurisdictions.  
R 338.143. This rule pertains to acceptable continuing education and limitations. It sets forth the requirements for  
continuing education. The rule revision removes former subrules (2)(l), and (3)(a) and (c), as those means for  
achieving continuing education credit no longer apply.  
A. Estimate the change in the frequency of the targeted behavior expected from the proposed rules.  
Promulgation of rules related to licensure is necessary under statute. This supplies a regulatory framework for the  
practice of osteopathic medicine and surgery. The proposed changes supply greater clarity to licensees and aid in  
understanding the requirements of the rules.  
B. Describe the difference between current behavior/practice and desired behavior/practice.  
Statute regulates the practice of osteopathic medicine and surgery. This mandates licensure for provision of those  
services. The rules update standards of educational programs and add clarifications. These additions will make  
compliance easier for applicants and licensees.  
C. What is the desired outcome?  
Regulation is necessary for individuals who wish to practice as osteopathic medical doctors. By improving and  
clarifying the rules, applicants and licensees should find compliance easier. This should result in fewer questions,  
fewer regulatory problems, and greater safety and protection of the public.  
MCL 24.245(3)  
RIS-Page 4  
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.  
The use of outdated rules that do not comport with statutes governing the osteopathic medical profession creates  
conflict and confusion for osteopathic medical doctors. The proposed rules update previously adopted rules. Changes  
made specifically address the following:  
R 338.121 pertains to accreditation standards for osteopathic medical schools and residency programs. Outdated  
standards supply little help or guidance about proper training of osteopathic medical doctors. The updated standards  
ensure future licensees are properly qualified.  
R 338.125 pertains to applications for licensure by endorsement. The rule revision clarifies the conditions that an  
applicant must satisfy to qualify for licensure by endorsement, to align with recent corresponding legislative changes.  
R 338.129 pertains to examinations and limitations. The rule revision clarifies that a temporary eligibility pathway  
approved by the NBOME will function as a substitute for passing the COMLEX-USA Level 2-Performance  
Evaluation (Level 2-PE), due to recent difficulties in holding in-person examinations.  
R 338.133 pertains to relicensure. The rule revision clarifies the added paths for relicensure available to an applicant.  
R 338.143 pertains to acceptable continuing education and limitations. Clarification of allowed continuing education  
activities, including the removal of no longer applicable activities, aids the licensee in continuing education  
compliance.  
A. What is the rationale for changing the rules instead of leaving them as currently written?  
The proposed rule set updates outdated standards, corrects typographical errors, and supplies clarity to all rules on  
licensure.  
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.  
The proposed rules supply a regulatory mechanism for the practice of osteopathic medicine and surgery. To protect  
the health, safety, and welfare of Michigan’s citizens, it is important that members of the profession adhere to  
educational and professional standards.  
9. Describe any rules in the affected rule set that are obsolete or unnecessary and can be rescinded.  
None of the rules in the rule set are obsolete or unnecessary.  
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).  
There is no expected fiscal impact on the agency for promulgating the proposed rules.  
11. Describe whether or not an agency appropriation has been made or a funding source provided for any  
expenditures associated with the proposed rules.  
There has been no agency appropriation for the proposed rules because there are no expected agency 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 5  
The proposed rules supply a mechanism for the licensing and regulation of individuals in this state, as mandated by  
statute. Applicants and licensees will continue to have a cost related burden associated with licensing, renewal, or  
relicensure. The cost of licensure for an Educational Limited Osteopathic Medical Doctor is $91.85. The cost of  
renewal for an Educational Limited Osteopathic Medical Doctor is $32.40. The cost of licensure for a Licensed  
Osteopathic Medical Doctor by examination or endorsement is $367.70. The cost of renewal for a Licensed  
Osteopathic Medical Doctor is $308.25. The cost of relicensure for an Educational Limited Osteopathic Medical  
Doctor is $111.85. The cost of relicensure for a Licensed Osteopathic Medical Doctor is $387.70.  
A. Despite the identified burden(s), identify how the requirements in the rules are still needed and reasonable  
compared to the burdens.  
The rules are necessary to supply a mechanism for licensing and regulation of the profession. The rules are not more  
restrictive than allowed by statute. Despite the cost related burden of licensing, the rules and regulations are  
necessary to supply a framework of standards for educational and licensure requirements.  
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 is no expected increase or decrease in revenues to other state or local government units, nor are there cost  
increases or reductions on other state or local government units expected because of the proposed rules. There is no  
expected increase or decrease in revenues to other state or local government units, nor are there cost increases or  
reductions on other state or local government units expected because 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.  
The proposed rules do not impose any program, service, duty, or responsibility upon any city, county, town, village,  
or school district.  
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.  
No action is necessary for governmental units to follow the rule(s).  
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.  
State and local government units will incur no added expenditures because of implementing the proposed rules.  
Therefore, no appropriation or funding source is necessary.  
Rural Impact  
16. In general, what impact will the rules have on rural areas?  
There is no expected disparate impact on rural areas because of the proposed rules.  
A. Describe the types of public or private interests in rural areas that will be affected by the rules.  
There is no expected disparate impact of public or private interests on rural areas because of the proposed rules.  
Environmental Impact  
17. Do the proposed rules have any impact on the environment? If yes, please explain.  
No, the proposed rules will have no impact on the environment.  
Small Business Impact Statement  
18. Describe whether and how the agency considered exempting small businesses from the proposed rules.  
MCL 24.245(3)  
RIS-Page 6  
The public health code authorizes the board and the department to regulate individuals with osteopathic medical  
doctor licenses, not small businesses. Even if a licensee’s practice qualified as a small business, the department  
could not exempt the licensee’s small business because it would create 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.  
There is no expected economic impact on small businesses because of the proposed rules. The proposed rules affect  
individual licensees rather than small businesses.  
A. Identify and estimate the number of small businesses affected by the proposed rules and the probable effect on  
small businesses.  
The department does not collect or have access to information that would allow it to find and estimate the potentially  
affected number of small businesses. It is impossible to estimate the number of small businesses affected by the  
proposed rules. The only small businesses affected by these rules are health practitioners practicing in small business  
settings. The department does not track or have access to this type of information since it is not a data repository.  
The rules do not affect the operation of the small business. The probable impact on small business is small.  
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.  
Because the proposed rules pertain to individuals and not small businesses, they do not have differing compliance or  
reporting requirements or timetables for small businesses. They are unnecessary for the proposed rules.  
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 proposed rules do not impose any reporting requirements.  
D. Describe how the agency established performance standards to replace design or operation standards required  
by the proposed rules.  
The agency did not set up performance standards to replace design or operation standards.  
20. Identify any disproportionate impact the proposed rules may have on small businesses because of their size or  
geographic location.  
The proposed rules affect individual licensees rather than small businesses. Therefore, there is no expected  
disproportionate impact on small businesses based on size or geographic location because of the rules.  
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 do not need any reports.  
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 is no expectation of an effect on small businesses because of the proposed rules, nor are there any added costs,  
because the proposed rules apply to individuals and not 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.  
The proposed rules, which apply to individuals and not businesses, should not create a need for any legal, consulting,  
or accounting services for small businesses to be able to follow 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.  
Since the rules affect individual licensees rather than small businesses, there is no expected cause of economic harm  
or for the rules to adversely affect a small business’ competition in the marketplace.  
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 small businesses. Even if a licensee’s  
practice qualifies as a small business, the department could not exempt the licensee’s small business because it would  
create disparity in regulation of the profession. Therefore, exempting or setting lesser standards of competence for  
small businesses are not in the best interest of the public.  
MCL 24.245(3)  
RIS-Page 7  
26. Identify the impact on the public interest of exempting or setting lesser standards of compliance for small  
businesses.  
The department is not able to exempt licensees that own a small business. If the department exempted small  
businesses, it would create a disparity in the regulation of a profession and have a negative impact on public safety.  
27. Describe whether and how the agency has involved small businesses in the development of the proposed rules.  
Development of the proposed rules involved consultation with the Michigan Board of Osteopathic Medicine and  
Surgery, whose members include small business employees.  
A. If small businesses were involved in the development of the rules, please identify the business(es).  
Development of the proposed rules involved consultation with the Michigan Board of Osteopathic Medicine and  
Surgery, whose members include small business employees.  
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 small businesses affected by the proposed rules. Those affected are individuals who are engaged in the  
practice of osteopathic medicine and surgery.  
A. Identify the businesses or groups who will be directly affected by, bear the cost of, or directly benefit from the  
proposed rules.  
Licensees bear the cost and receive the benefit from the proposed rules.  
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.  
There will be no expected added costs imposed upon licensees because of compliance with these proposed rules.  
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.  
Applicants and licensees will continue to have a cost related burden associated with licensing, renewal, or  
relicensure. The cost of licensure for an Educational Limited Osteopathic Medical Doctor is $91.85. The cost of  
renewal for an Educational Limited Osteopathic Medical Doctor is $32.40. The cost of licensure for a Licensed  
Osteopathic Medical Doctor by examination or endorsement is $367.70. The cost of renewal for a Licensed  
Osteopathic Medical Doctor is $308.25. The cost of relicensure for an Educational Limited Osteopathic Medical  
Doctor is $111.85. The cost of relicensure for a Licensed Osteopathic Medical Doctor is $387.70.  
A. How many and what category of individuals will be affected by the rules?  
The rules affect all individuals who seek licensure as osteopathic medical doctors.  
B. What qualitative and quantitative impact do the proposed changes in rules have on these individuals?  
There are no other qualitative or quantitative impacts as it relates to the actual statewide compliance costs of the  
proposed rules because the proposed rules create no expected increased or decreased costs for education, training,  
experience, application fees, examination fees, or licensure fees.  
30. Quantify any cost reductions to businesses, individuals, groups of individuals, or governmental units as a result  
of the proposed rules.  
There are no expected reductions in costs to businesses, individuals, groups of individuals, or governmental units  
because 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, concise language, and implement the statutory requirements for licensing. The clear,  
concise language allows the public, licensees, and schools to better understand the requirements for licensure.  
32. Explain how the proposed rules will impact business growth and job creation (or elimination) in Michigan.  
There is no expected significant impact on business growth, job growth, or job elimination because of the rules.  
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.  
MCL 24.245(3)  
RIS-Page 8  
The department does not expect any disproportionate effect on any individuals or businesses by their industrial  
sector, segment of the public, business size, or geographical 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.  
American Osteopathic Association:  
https://osteopathic.org/  
Accreditation Council for Graduate Medical Education (ACGME):  
https://www.acgme.org/  
National Board of Osteopathic Medical Examiners (NBOME):  
https://www.nbome.org/  
Coalition for Physician Enhancement (CPE):  
http://cpe.memberlodge.org/  
Illinois:  
https://www.idfpr.com/profs/Physicians.asp  
Indiana:  
https://www.in.gov/pla/professions/medical-licensing-board-of-indiana/  
Minnesota:  
https://mn.gov/boards/medical-practice/  
New York:  
http://www.op.nysed.gov/prof/med/medlic.htm  
Ohio:  
https://med.ohio.gov/  
Pennsylvania:  
https://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/OsteopathicMedicine/Pages/default.aspx  
Wisconsin:  
https://dsps.wi.gov/pages/Professions/Physician/Default.aspx  
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 statute mandates the rules, no estimate was necessary.  
Alternative to Regulation  
35. Identify any reasonable alternatives to the proposed rules that would achieve the same or similar goals.  
Since statute mandates the rules, there are no reasonable alternatives to the proposed rules.  
A. Please include any statutory amendments that may be necessary to achieve such alternatives.  
Since statute mandates the rules, there are no reasonable alternatives to the proposed rules.  
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.  
MCL 24.245(3)  
RIS-Page 9  
Since statute mandates the rules, private market-based systems cannot serve as an alternative. The licensing and  
regulation of osteopathic medical doctors are state functions, so a regulatory program independent of state  
intervention cannot be set up. One could consider osteopathic medical professional associations as regulatory  
mechanisms that are independent of state intervention; however, these professional organizations would provide the  
public with significantly less protection because membership in these organizations is voluntary. This means an  
individual who meets the membership requirements, but does not join, would still be able to practice and there would  
be no way to ensure the individual’s competency or hold individual accountable for harm done to patients.  
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 statute mandates the rules, there are no reasonable alternatives to the proposed rules. There were no  
alternatives that the department considered to achieve the intended changes. 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 rules include the instructions for compliance.  
MCL 24.245(3)  
;