Michigan Office of Administrative Hearings and Rules

Administrative Rules Division (ARD)

MOAHR-Rules@michigan.gov

REGULATORY IMPACT STATEMENT

and COST-BENEFIT ANALYSIS (RIS)

AGENCY INFORMATION:

Department name:

Licensing and Regulatory Affairs

Bureau name:

Bureau of Professional Licensing

Name of person filling out RIS:

Jennifer Shaltry

Phone number of person filling out RIS:

517-241-3085

Email of person filling out RIS:

ShaltryJ1@michigan.gov

RULE SET INFORMATION:

ARD assigned rule set number:

2025-60 LR

Title of proposed rule set:

Nursing - General Rules

COMPARISON OF RULE(S) TO FEDERAL/STATE/ASSOCIATION STANDARDS

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 nursing, so there are no federal rules or standards set by

a national or state agency that the proposed rules can exceed.

A. Are these rules required by state law or federal mandate?

The rules are not federally mandated. The following state laws require rules:

MCL 333.16148 requires training standards for identifying victims of human trafficking.

MCL 333.16204 states that if a board requires completion of continuing education as a condition for renewal, it

shall require an appropriate number of hours or courses in pain and symptom management.

MCL 333.16287 requires the department, in consultation with the board, to promulgate rules to implement

telehealth services.

MCL 333.17210 requires the board to promulgate rules establishing the qualifications for the training and

competency of the health profession specialty field of clinical nurse specialist.

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.

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)

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Part 1 General Provisions: New rule R 338.10107 pertains to telehealth services and requires a nurse to obtain

patient consent for treatment before providing a telehealth service and keep it as part of the medical record. A nurse

who is a prescriber may prescribe a drug if they refer the patient to a geographically accessible provider, if medically

necessary, and make themselves available to provide follow-up care. Further, a nurse must act within the scope of

their practice and exercise the same standard of care applicable to an in-person healthcare service.

Indiana requires informed consent for telehealth services and that the provider create and maintain a medical record.

Illinois, Indiana, New York, and Pennsylvania require telehealth services to meet the same standard of care as in-

person services. Minnesota, Pennsylvania and Wisconsin require insurance to cover telehealth services, to varying

degrees.

Part 2 Licensure: Changes to Part 2 include the following:

-Credential Evaluation: The changes update the name of CGFNS to TruMerit and add a new credential evaluation

service, International Education Evaluations, LLC (IEE), to give applicants who graduated from registered nurse

program or practical nurse programs outside the United States another option for program evaluation.

Most other Great Lakes states accept credentials evaluations from at least one credential evaluation organization.

Illinois accepts evaluations from IEE, among others. Indiana does not use credentialing services.

-NCLEX Eligibility: The changes clarify that the requirements for NCLEX examination eligibility apply to applicants

seeking to take or repeat the examination. The changes also permit an applicant who did not pass the NCLEX

examination within 3 years after becoming eligible to submit a written certification of skills competency from a program

reviewed and approved by the board chair. These changes are intended to expand the number of programs which

may certify skills competency.

Indiana, Illinois, and Minnesota require NCLEX review courses for candidates who do not pass the examination within

specified timeframes. No other Great Lakes state requires a certification of skills competency.

-3-Year License Cycle: The changes align the relicensure requirements with a 3-year cycle.

Of the Great Lakes states, only New York uses a 3-year renewal cycle. The other Great Lakes states use 2-year

cycles.

Part 3 Nursing Education Programs: Changes to Part 3 include the following:

-Initial Program Approval Requirements: Changes to R 338.10303 require the financial statement to contain the

signature and attestation of a certified public accountant that there is evidence of adequate financial resources

equating to the total tuition for all students enrolled for the first 2 years of the program’s operation; clarify the

requirement that the sponsoring agency must have the ability to provide Title IV funding under the Higher Education

Act of 1965, 220 US 1070 to 1099d; and give the board discretion to void an application for initial approval if

documents supporting the application are not approved on the second resubmission.

Except for Wisconsin, all Great Lakes states require evidence of adequate financial resources for initial program

approval. Wisconsin requires evidence of the availability of sufficient clinical facilities and resources. Illinois, Indiana,

Minnesota, New York, and Ohio require a site visit. None of the other Great Lakes states require evidence of Title IV

funding for program approval. However, the New York State Board of Regents is recognized to accredit practical and

registered nursing programs and serves as the Title IV gatekeeper for practical nursing programs.

-Full Program Approval Requirements: Changes to R 338.10303a require a program to select a national nursing

education accrediting body and provide evidence of approval to provide federal financial aid to students before the

board grants full approval. The changes also give the board discretion to require a site visit by a board-approved

nurse site reviewer before considering full approval and to deny full approval if the program does not satisfy the

criteria for full approval under the rule or if the program fails to timely resolve deficiencies noted in the site visit report.

All Great Lakes states have processes for full program approval.

-Continued Program Approval: Changes to R 338.10303b update the requirements of the self-study content to align

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with current curriculum and campus resource requirements and require proof of the program’s continued ability to

provide Title IV funding.

All Great Lakes States have processes for continued program approval.

-Major program changes: Changes to R 338.10303c clarify that a site visit may be required before an additional

location separate from the program’s primary campus is approved.

Illinois requires programs establishing an extension of an existing program to go through the same process as a new

program. New York does not allow a branch campus or extension unless approved by the Board of Regents. The

other Great Lakes states do not have specific requirements addressing additional locations.

-Accreditation and board reporting requirements: Changes to R 338.10303d clarify what happens if a program fails to

meet the accreditation requirement in R 338.10303d. New cohorts are not permitted until the program meets the

accreditation requirements within the timeframe set by the board.

Indiana does not require national or regional accreditation for nursing programs because they are accredited by the

board of nursing. The New York State Board of Regents is an accrediting body for nursing programs. However, New

York also accepts accreditation by the Commission on Collegiate Nursing Education (CCNE) or the Accrediting

Commission for Education in Nursing (ACEN) for registered nursing education programs. The remaining Great Lakes

States require accreditation by a body recognized by the U.S. Department of Education, at least for registered nursing

programs.

Illinois and Wisconsin require the loss of accreditation to be reported to the board within 30 days. In Illinois, loss of

accreditation may result in a warning letter and probationary status. In Wisconsin, failure to maintain accreditation

shall result in withdrawal of approval.

-Director of Nursing and Faculty Requirements: The proposed rules update the requirements for the director of

nursing and faculty to ensure that they have the appropriate educational preparation or experience in academic

teaching, experience in nursing practice, and current knowledge of nursing practice in order to work within the

program.

All Great Lakes states have requirements for administrators and faculty.

-Curriculum: The proposed rules update curriculum requirements and add alternative accrediting standards for a

program’s simulation laboratory.

All Great Lakes states have curriculum requirements.

-Board Evaluation of a Nursing Education Program: The proposed rules clarify situations that rise to the level of when

a board can evaluate a program. Additionally, the changes clarify the content of a board-ordered action plan. Lastly, if

board approval of a program is withdrawn, the proposed rules require a program to wait at least 1 year before

applying for initial approval to reopen.

All Great Lakes states have processes for nursing education programs that do not meet their requirements. Illinois,

Ohio, and Pennsylvania may place program on a probationary or provisional approval status until deficiencies are

corrected or until a specified time period expires. Minnesota may conduct a survey and, if compliance is not

determined, hold a conference with a board review panel or hold a contested case hearing. If compliance is not

determined by the board review panel or hearing officer, the board may issue a reprimand, revoke approval, or issue

a correction order. In New York, nursing programs may be denied reregistration. Wisconsin specifies certain

situations, including loss of accreditation, which trigger a review of the program that may lead to the withdrawal of

approval.

Part 4 Nurse Specialty Certification: Changes to Part 4 include the following:

-Advertisement of Services: The changes include a recission of R 338.10403 requiring only nurses certified in a

specialty field to hold themselves out to the public as nurse specialists using the title clinical nurse specialist, nurse

anesthetist, nurse midwife, or nurse practitioner. This rule is not needed because those titles are already protected

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under MCL 333.16261 and MCL 333.17211. Further, the Michigan Public Health Code does not authorize rulemaking

concerning advertising.

All Great Lakes states have title protection for nurses, a prohibition on false or deceptive conduct, or both.

-Credentialing and License Cycle Updates: The changes update the names of credentialing organizations for nurse

practitioners and the time periods for licensees to obtain recertification or maintain certification are updated to reflect a

3-year license cycle.

Of the Great Lakes states, only New York uses a 3-year renewal cycle. The other Great Lakes states use 2-year

cycles.

Part 6 Continuing Education:

The proposed rules update the continuing education requirements to reflect a 3-year license cycle.

Of the Great Lakes states, only New York uses a 3-year renewal cycle. The other Great Lakes states use 2-year

cycles.

A. If the rules exceed standards in those states, please explain why and specify the costs and benefits

arising out of the deviation.

The standards pertaining to licensure, training, renewal, and duties differ from state to state. There are some

differences between states, however, the regulatory framework is very similar. 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.

Anticipated updates to R 338.7001a and R 338.7002 of the Public Health Code – General Rules, which are currently

open, are expected to change the length of the nursing license cycle from 2 years to 3 years.

There are no other laws, rules, or legal requirements that may 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.

The proposed rules contain updates throughout the set to align requirements with the anticipated change to a 3-

year license cycle under the Public Health Code – General Rules.

Also, the proposed rules remove the requirement that a nurse who applies for license renewal who is also

applying for a controlled substance license shall complete a 1-time training in opioids and controlled substances

as required by R 338.3135 of the Pharmacy – Controlled Substances rules. The requirement is not needed in

this rule set because it is covered by the Pharmacy Controlled Substances rules. Further, the requirement

pertains to a controlled substance license, not a nursing license.

PURPOSE AND OBJECTIVES OF THE RULE(S)

4. Identify the behavior and frequency of behavior that the proposed rules are designed to alter.

Part 1: General Provisions: R 338.10107 was added to provided guidelines on how nurses should handle telehealth

interactions. The rule requires that the nurse maintain proof of the consent for telehealth treatment and allows a nurse

with prescribing privileges to prescribe a drug if they refer the patient to a provider who is geographically accessible to

the patient when medically necessary. The nurse must make themselves available to provide follow-up care, act

within their scope of practice, and exercise the same standard of care applicable to a traditional, in person service.

These changes were made to ensure public safety for telehealth patients.

Part 2: Licensure: The changes to this section change the references to the Commission on Graduates of Foreign

Nursing Schools to TruMerit because the entity changed names. Lastly, to increase the availability of skills

competency programs available for nurses seeking to refresh their skills before reentering the profession, or as a

condition of discipline required by the board, the rules allow for the approval of a program approved by the board chair

MCL 24.245(3)

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in the event that there are no programs available to the nurse in the same geographic area. These changes were

made to ensure accuracy in identifying approved credentialing services and to increase availability of skills

competency programs to allow for nurses to reenter the workforce with more convenience. Also, changes were made

to reflect the change from a 2-year license cycle to a 3-year cycle, which is forthcoming under a change to the Public

Health Code – General Rules.

Part 3: Nursing Education Programs: Several changes were made to this section to provide updates and clarification

to rule language to assist with understanding the requirements. The substantive changes include the following:

-Definitions: Some definitions were edited to include current terminology that is used to define the words for clarity and

easier understanding.

-Initial program approval requirements: Clarification was made to the required content of the financial statement. A

certified public accountant must now sign an affidavit attesting that a sponsoring agency has adequate financial

resources to support the proposed nursing program. Additionally, clarification was provided to explain what is meant

by a sponsoring agency having the ability to provide Title IV funding under the Higher Education Act of 1965, 20 USC

1070 to 1099d. Lastly, the rules place a limit on the number of times a sponsoring agency seeking to obtain initial

approval can file papers for review by the board. This is done to encourage complete and coherent filings, or the

hiring of a nurse consultant, to assist with authoring or reviewing the materials to improve the quality of the

submission.

-Full program approval requirements: The proposed rules require programs seeking full approval to have selected a

national nursing education accrediting body before the board will grant full approval. This change was made to assist

the programs with starting the accreditation process as it takes approximately 3 years to complete. Programs must

achieve accreditation within 6 years of receiving full approval per R 338.10303d. The changes also require programs

seeking full approval to demonstrate proof of the ability to provide Title IV funding.

-Continued program approval: The proposed rules update the requirements of the self-study content to align with

current curriculum and campus resource requirements and require proof of the program’s ability to provide Title IV

funding.

-Accreditation: The proposed rules clarify what happens if a program fails to meet the accreditation requirement in R

338.10303d. New cohorts are not permitted until the program meets the accreditation requirements within the

timeframe set by the board.

-Major program changes: The proposed rules clarify that a site visit may be required before an additional location that

is separate from a program’s primary campus is approved.

-Director of Nursing and Faculty Requirements: The proposed rules update the requirements for the director of

nursing and faculty to ensure that they have the appropriate educational preparation or experience in academic

teaching, experience in nursing practice, and current knowledge of nursing practice in order to work within the

program. This is to ensure that properly credentialed and experienced faculty are teaching students.

-Curriculum: The proposed rules update curriculum requirements and add alternative accrediting standards for a

program’s simulation laboratory. These changes were made to ensure students are taught the most up-to-date

concepts and using facilities that have resources that meet current standards for learning.

-Board evaluation of a nursing education program: The proposed rules clarify situations that rise to the level of when a

board can evaluate a program. Additionally, the content of a board-ordered action plan was clarified. Lastly, if board

approval of a program is withdrawn, the proposed rules require a program to wait at least 1 year before applying for

initial approval to reopen. This was done to ensure the program takes the time necessary to truly evaluate the areas

of deficiency and make required changes.

Part 4: Nurse Specialty Certification: The proposed rules rescind R 338.10403 Advertisement of services as there is

no statutory authority for this rule. Also, proposed changes update the names of credentialing organizations for nurse

practitioners to ensure licensees can accurately identify the organization, and the time periods for licensees to obtain

recertification or maintain certification are updated to reflect a 3-year license cycle.

Part 6: Continuing Education: The proposed rules update the continuing education requirements to reflect a 3-year

license cycle.

A. Estimate the change in the frequency of the targeted behavior expected from the proposed rules.

Promulgation of rules related to licensure and nursing education programs is necessary under statute. This

supplies a regulatory framework for the practice of nursing and nursing education. The proposed changes

supply greater clarity to licensees and nursing education programs and aid in understanding the requirements

of the rules.

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The length of the license cycle for nurses is expected to change from 2 years to 3 years under the Public Health

Code – General Rules, a different rule set. Nurses will renew their licenses every 3 years instead of every 2

years. Changes to this rule set have been made to align the rules with the upcoming change in license renewal

frequency.

B. Describe the difference between current behavior/practice and desired behavior/practice.

Statute regulates the practice of nursing and nursing education programs. This mandates licensure for

provision of those services and board approval to offer a nursing education program. Adding clarifications on

points that may have been ambiguous under the prior rules, and updating content will make compliance easier

for applicants, licensees, and nursing programs.

C. What is the desired outcome?

Regulation is necessary for individuals who wish to practice as nurses and for sponsoring agencies that offer

nursing education programs. By improving and clarifying the rules, applicants, licensees, and sponsoring

agencies should find compliance easier. This should result in fewer questions, fewer regulatory problems and

greater safety and protection of the public.

5. 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.

Outdated rules create conflict and confusion for nurses and nurse education programs. The proposed rules include

edits throughout the rule set to comply with current drafting standards and improve clarity. Changes made specifically

address the following:

R 338.10101 provides definitions used throughout the set. The changes provide updates and new definitions to

improve the ease of reading.

R 338.10107 is a new rule pertaining to telehealth. This rule is mandated by MCL 333.16287.

R 338.10204 and R 338.10210 pertain to examinations for licensure as a registered nurse and licensed practical

nurse. The changes update the approved credential evaluation services and clarify that an applicant who has not

taken the NCLEX within 3 years after becoming eligible is no longer eligible until the applicant receives a written

certification of skills competency. Also, the changes provide that the board chair may approve a program to conduct

the skills competency certification. This is intended to increase the number of programs conducting skills competency

certification so applicants will have more choices.

R 338.10207 and R 338.10213 pertain to the relicensure requirements for a lapsed registered nurse and licensed

professional nurse. The changes adjust the number of continuing education hours required to align with 3-year license

cycle. The changes also provide that the board chair may approve a program to conduct the skills competency

certification so that applicants will have more choices.

The changes to R 338.10208, pertaining to the education program requirements for graduates from a registered nurse

education program outside the U.S. or Canada; R 338.10208a, pertaining to the education program requirements for

graduates from a registered nurse program in Canada; R 338.10212, pertaining to the education program

requirements for graduates from a practical nurse education program outside the U.S. and Canada; and R

338.10212a, pertaining to the education program requirements for graduates from a practical nurse program in

Canada, update the approved credential evaluation services.

R 338.10301 provides definitions used in Part 3 Nursing Education Programs. The changes add new definitions and

updates to existing definitions to improve clarity.

R 338.10303 pertains to initial program approval. The changes remove a requirement that a proposed nursing

program survey the schools within a 50-mile radius, require a financial statement signed by a certified public

accountant attesting that there is evidence of financial resources equating to the total tuition for all students enrolled

for the first 2 years of the program's operation, clarify that a program’s sponsoring agency must have institutional

accreditation from and demonstrate eligibility to participate in Title IV financial aid programs, and give the board

discretion to void an application and impose a waiting period if the documents supporting the application for initial

approval are not approved after three submissions.

R 338.10303a pertains to full program approval. The changes require a program to select an approved accrediting

agency and provide a timeline for approval and provide evidence of the ability to participate in Title IV financial aid

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programs when applying for full approval. The changes also clarify that the board may require a site visit before

considering full approval and that if any deficiencies identified in the site visit are not timely resolved, the board may

deny full approval.

R 338.10303b pertains to continued program approval, self-study and reporting requirements. The changes clarify the

contents of the self-study, reporting requirements of the sponsoring agency, and the contents of the nursing education

program report. The changes include providing proof of the program’s continuing ability to participate in federal Title

IV financial aid programs.

R 338.10303c pertains to major program changes and temporary seat increase requirements. The changes give the

board discretion to require a site visit before an additional location will be approved, regardless of whether only the

theory portion of the curriculum will be taught there. The changes require the additional location to obtain initial

approval if it will serve a different group of students not previously approved by the board.

R 338.10303d pertains to accreditation and board reporting requirements. The changes provide for the board to give a

program that fails to achieve accreditation a reasonable time to cure the deficiency before the program is removed

from the list of approved programs. During the time to cure, the program is prohibited from admitting any new student

or cohort. The changes also prohibit the admittance of any new student or cohort if a program loses its accreditation.

Finally, the changes require an accredited program to submit copies to the board of all notifications and decision

letters received from the nursing accreditation organization within 90 days of the date on the correspondence and

provide that failure to comply with the rule will result in withdrawal of approval after the graduation of the last cohort of

currently enrolled students.

R 338.10305a pertains to registered professional nursing education program requirements and faculty requirements

and R 338.10305b pertains to practical nursing education program requirements and faculty requirements. The

changes to both rules clarify that clinical faculty teaching outside of Michigan must have a current unrestricted license

in the state of Michigan as well as the state or Canadian province where the site is located. Nursing faculty shall be

academically and experientially qualified and demonstrate current clinical experience related to the area of their

assigned teaching responsibilities. The changes require a faculty exception request to be submitted on a department

form and set forth the information to be included in the request. Further, the changes clarify that nursing faculty shall

be professionally, academically, and clinically qualified, sufficient in number, and have the expertise to accomplish

program outcomes and quality improvement. Finally, a change to R 338.10305a requires a program director for a

registered nurse program to have educational preparation or experience in academic teaching, experience in nursing

practice, and current knowledge of registered nursing practice.

R 338.10305c pertains to preceptor requirements. The changes require a clinical preceptor to hold an unencumbered

license in the state or Canadian province where the clinical experience occurs, at or above the level of licensure for

which the student is being prepared.

R 338.10306 pertains to curriculum requirements. The changes add requirements for experiential learning and require

distance education methods to be held to the same standards as traditional methods.

R 338.10308 and R 338.10309 pertain to curriculum and implementation for registered professional nursing programs

and licensed practical nursing education programs. The changes update required content to ensure graduates are

adequately prepared, and a second option for simulation lab standards has been added to provide more flexibility.

R 338.10310 pertains to the board evaluation of a nursing education program. The changes update the circumstances

under which the board may evaluate a program.

R 338.10310a pertains to board action following the evaluation of a nursing education program. The updates set out

the process for when a board is determined to be in noncompliance with any provision of the Code or rules. The

program shall be given written notice from the board specifying the deficiency. The program shall submit an action

plan as directed by the board addressing the specified deficiencies.

R 338.10311 pertains to failure of a program to comply with the rules and withdrawal of approval. The updates add a

requirement that a sponsoring agency of a program whose approval was withdrawn by the board wait no less than 1

year from the graduation date of the last cohort before applying as a new program. Failure to comply will result in

withdrawal of school approval after the graduation of the last cohort.

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R 338.10312 pertains to program termination and interruption or reduction of admissions. The changes require the

program to provide a plan approved by the board for students to complete the program and provide the board with

written confirmation that the plan has been implemented within 30 days of completion. A program owner or

sponsoring agency that terminates admissions may not apply for initial approval of a program for at least 1 year after

the last cohort graduates. Failure to comply with the rule may negatively affect the ability of the program owner or

sponsoring agency to restart the program.

R 338.10402 pertains to the automatic suspension or revocation of a specialty certification. The changes state that the

suspension or revocation of a registered nurse license shall result in a specialty certification or certifications being

suspended or revoked rather than voided.

R 338.10404a and R 338.10404b pertain to the specialty certification qualifications for a nurse midwife and nurse

practitioner. The changes update the names of credentialling organizations.

R 338.10405, R 338.10405a, R 338.10405b, and R 338.10405c pertain to the specialty certification renewal or

reregistration of a nurse anesthetist, nurse midwife, nurse practitioner, and clinical nurse specialist. The changes align

the certification renewal period with a 3-year license cycle and update the names of the credentialling organizations

for nurse practitioners.

R 338.10601 pertains to the continuing education requirements for license renewal. The changes align the rule with a

3-year license cycle. Also, a requirement to comply with R 338.3135 was removed because it is duplicative.

R 338.10602 pertains to acceptable continuing education requirements and limitations. The changes were made to

align the requirements with a 3-year license cycle.

A. What is the rationale for changing the rules instead of leaving them as currently written?

The proposed rule set provides clarity to rules on licensure, nursing education, and nurse specialty certification.

6. 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 nursing and nursing education programs. 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. The rules ensure that applicants receive proper education and training prior

to licensure and that licensees are competent to practice. There is no less burdensome way to ensure that applicants

and licensees satisfy minimum requirements for practice.

7. Describe any rules in the affected rule set that are obsolete or unnecessary and can be rescinded.

R 338.10403 pertaining to advertisement of services can be rescinded. The Michigan Public Health Code does not

authorize rulemaking concerning advertising. Further, the titles protected under the rule are already protected under

MCL 333.16261.

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.

8. 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 department does not expect the implementation of the proposed rules to result in additional costs or savings for

the department.

9. Describe whether or not an agency appropriation has been made or a funding source provided for any

expenditures associated with the proposed rules.

MCL 24.245(3)

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There has been no agency appropriation for the proposed rules because there are no expected agency expenditures

associated with the proposed rules.

10. 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.

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 a Licensed Practical Nurse and Registered Nurse will be $196.50 every 3 years.

To add a specialty certification for a Registered Nurse, the cost will be an additional $45.60.

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

11. 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 decreases in revenues or costs to other state or local government units as a

result of the proposed rules.

12. 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, county, 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 actions that the governmental units must take to comply with the proposed rules.

13. 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 these rules. No additional expenditures

are anticipated or intended with the proposed rules.

RURAL IMPACT

14. 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 on public or private interests in rural areas because of the proposed

rules.

ENVIRONMENTAL IMPACT

15. 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.

MCL 24.245(3)

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SMALL BUSINESS IMPACT STATEMENT

16. Describe whether and how the agency considered exempting small businesses from the proposed rules.

The Michigan Public Health Code authorizes the board and the department to regulate individuals with nursing

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.

17. 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. There is no expected economic impact on small businesses because of the

proposed rules.

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 compliance requirements or reporting requirements for 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 set up performance standards to replace design or operation standards.

18. 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.

19. 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 require any reports. There are no reports that a small business would have to complete.

20. 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.

21. 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.

22. 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 competition in the marketplace.

MCL 24.245(3)

RIS-Page 11

23. 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 is not in the best interest of the public. It would likely cost the agency more to devote staff time to

determining which licensees work for small businesses and then enforce different requirements for those individuals.

24. 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.

25. Describe whether and how the agency has involved small businesses in the development of the proposed

rules.

The department worked with the Michigan Board of Nursing in the development of the proposed rules. The board is

composed of professional and public members. Some members of the board may work in a small business, but the

members were not involved in the development of the rules as representatives of small businesses.

A. If small businesses were involved in the development of the rules, please identify the business(es).

No small businesses took part in the development of the rules.

COST-BENEFIT ANALYSIS OF RULES (INDEPENDENT OF STATUTORY IMPACT)

26. 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.

The proposed rules directly affect licensees and nursing education programs. Licensees and the sponsoring

agencies for the nursing program bear the cost of and directly 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.

The department does not expect the proposed rules to result in any additional costs such as new equipment,

supplies, labor, accounting, or recordkeeping on businesses or other groups.

27. 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 a Licensed Practical Nurse and Registered Nurse will be $196.50 every 3 years. To add a

specialty certification for a Registered Nurse, the cost will be an additional $45.60.

A. How many and what category of individuals will be affected by the rules?

All nursing applicants, licensees, approved and prospective nursing programs are affected by the proposed

rules. In this state, there are approximately 20,850 licensed practical nurses, 2 licensed practical nurse –

special volunteers, 2 licensed practical nurse – temporary military spouse licensees, 181,739 registered nurses,

21 registered nurse-special volunteers, and 4 registered nurse-temporary military spouse licensees.

B. What qualitative and quantitative impact do the proposed changes in rules have on these individuals?

The qualitative impact of the proposed rules on the citizens of Michigan will be that they will know a licensee

who supplies services has achieved the level of education and training necessary to meet the minimum

requirements for licensure. The quantitative impact of the proposed rules on the citizens of Michigan is that

there will be no increase in the cost of services due to the rule amendments. The proposed amendments help to

ensure the health, safety, and welfare of Michigan citizens without more costs.

The qualitative impact on licensees and applicants by the proposed rules will be the knowledge that they and

their peers have achieved the minimum requirements for licensure and can appropriately support the needs of

the citizens of Michigan. The quantitative impact on licensees and applicants by the proposed rules is that they

MCL 24.245(3)

RIS-Page 12

will have credentials that will meet the minimum requirements of licensure. These credentials will allow them to

have access to job opportunities and compensation in line with their education and work experience.

28. 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.

29. 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 any 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.

30. 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.

31. 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 disproportionate effect on any individuals or businesses by their industrial

sector, segment of the public, business size, or geographical location.

32. 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.

Illinois

https://idfpr.illinois.gov/profs/nursing.html

https://ilga.gov/legislation/ILCS/details?MajorTopic=&Chapter=&ActName=Nurse%20Practice%20Act.&ActID=1312&

ChapterID=24&SeqStart=&ChapAct=FullText

https://www.ilga.gov/Legislation/ILCS/Articles?ActID=3807&ChapterID=24&Chapter=PROFESSIONS,%20OCCUPAT

IONS,%20AND%20BUSINESS%20OPERATIONS&MajorTopic=REGULATION

https://www.ilga.gov/agencies/JCAR/Sections?PartID=06801300&TitleDescription=TITLE%2068:%20%20PROFESSI

ONS%20AND%20OCCUPATIONS

Indiana

https://www.in.gov/pla/professions/nursing-home/

https://iga.in.gov/laws/2025/ic/titles/25#25-23

https://www.in.gov/pla/resources/telehealth-home/

https://iar.iga.in.gov/code/2026/848

Minnesota

https://mn.gov/boards/nursing/

https://mn.gov/boards/nursing/laws-and-rules/nurse-practice-act/

https://www.revisor.mn.gov/statutes/cite/62A.673

https://mn.gov/boards/nursing/laws-and-rules/rules/

https://mn.gov/boards/nursing/education/requirements-approval-nursing-programs/

New York

MCL 24.245(3)

RIS-Page 13

https://www.op.nysed.gov/professions-index/nursing

https://www.op.nysed.gov/professions/registered-professional-nursing/laws-rules-regulations/article-139

https://www.op.nysed.gov/title8/rules-board-regents/part-29

https://www.op.nysed.gov/professions/registered-professional-nursing/laws-rules-regulations/part-52

https://www.op.nysed.gov/professions/registered-professional-nursing/laws-rules-regulations/part-64

https://www.op.nysed.gov/professions/registered-professional-nursing/license-requirements

https://www.op.nysed.gov/professions/licensed-practical-nurses/license-requirements

https://www.op.nysed.gov/nursing-accreditation

https://www.op.nysed.gov/sites/op/files/2025-09/Program%20Registration%20%28re-

registration%29%20Standards%209.6.24.pdf

https://www.op.nysed.gov/telepractice-guidance

Ohio

https://nursing.ohio.gov/

https://nursing.ohio.gov/licensing-and-certification/renewal-schedule

https://codes.ohio.gov/ohio-revised-code/chapter-4723

https://codes.ohio.gov/ohio-revised-code/section-4743.09

https://codes.ohio.gov/ohio-administrative-code/4723

Pennsylvania

https://www.pa.gov/agencies/dos/department-and-offices/bpoa/boards-commissions/nursing

https://www.pa.gov/agencies/dos/department-and-offices/bpoa/boards-commissions/nursing/renewal-information

https://www.pa.gov/agencies/dos/department-and-offices/bpoa/boards-commissions/nursing/nursing-education-

programs

https://www.pa.gov/agencies/dos/resources/professional-licensing-resources/telemedicine-faqs

https://www.pa.gov/content/dam/copapwp-pagov/en/dos/department-and-offices/bpoa/nursing/Professional-Nursing-

Law-Feb-2023.pdf

https://www.pa.gov/content/dam/copapwp-pagov/en/dos/department-and-offices/bpoa/nursing/Practical-Nursing-Law-

2022.pdf

https://www.pacodeandbulletin.gov/Display/pacode?file=/secure/pacode/data/049/chapter21/chap21toc.html&d=

https://www.palegis.us/statutes/consolidated/view-statute?txtType=HTM&ttl=40&div=0&chapter=48

Wisconsin

https://dsps.wi.gov/pages/BoardsCouncils/Nursing/Default.aspx

MCL 24.245(3)

RIS-Page 14

https://dsps.wi.gov/Pages/RulesStatutes/Nursing.aspx

https://docs.legis.wisconsin.gov/statutes/statutes/441

https://docs.legis.wisconsin.gov/statutes/statutes/440/I/08

https://dsps.wi.gov/Pages/Professions/NursingSchools.aspx

https://dsps.wi.gov/Documents/Fm3031RevisedApr2024.pdf

https://www.forwardhealth.wi.gov/WIPortal/content/html/news/pdf/FAQs_Telehealth.pdf.spage

A. How were estimates made, and what assumptions were made? 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 estimates or assumptions were necessary.

ALTERNATIVE TO REGULATION

33. 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.

34. 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 statute mandates the rules, private market-based systems cannot serve as an alternative. The licensing and

regulation of nurses are state functions, so a regulatory program independent of state intervention cannot be set up.

One could consider nursing related 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 the individual accountable for harm done to clients.

No other states in the Great Lakes region use a private, market-based system to regulate nurses.

35. 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

36. 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)