In our ongoing project to clarify and interpret each Minimum Program Requirement for the clinical sites, below is the interpretation for MPR #10.
The MPR reads:
The health center staff shall operate within their scope of practice as determined by certification and applicable agency policies:
- The center shall be staffed by a certified nurse practitioner (FNP, PNP, or SNP), licensed physician, or a licensed physician assistant working under the supervision of a physici Nurse practitioners must be certified or eligible for certification in Michigan; accredited by an appropriate national certification association or board; and have a current, signed collaborative practice agreement and prescriptive authority agreement with the medical director or designee. Physicians and physician assistants must be licensed to practice in Michigan.
- The health center must be staffed with a minimum of a .50 FTE licensed Masters level mental health provider (i. counselor or Social Worker). Alternative clinical centers must be staffed with a minimum of a .30 FTE licensed Masters level mental health provider. Appropriate supervision must be available.
The first section deals with the main clinical provider. A Nurse Practitioner, Physician, or Physician Assistant is required to staff the center. For NPs, three certifications are acceptable—FNP (Family Nurse Practitioner), PNP (Pediatric Nurse Practitioner) or SNP (School Nurse Practitioner). Adult Nurse Practitioners are not allowed as they cannot see the full age range required through the CAHC program. The requirement for this position is 30 hours over 5 days a week for full clinical, 24 hours over 3 consistent days for alternative clinical. All providers must be licensed by the State of Michigan.
The collaborative practice agreement should be a mutually agreed upon document which clearly states the responsibilities of both partners in regard to their relationship to the practice situation. Language of the agreement should be specific to what the NP and physician actually do, and not contain extraneous information that is not occurring (i.e review practice protocols when there are none, or use of formularies). Delegation of prescriptive authority is stated in the collaborative practice agreement. This document should be reviewed and renewed on an annual basis. Examples of collaborative practice agreements can be found in the New Provider Toolkit (located at www.michigan.gov/cahc), as well as through the Michigan Nurses Association website (www.minurses.org).
The second section deals with the mental health staffing requirement. All clinical centers must be staff with a licensed Masters level mental health provider. This can be a counselor, social worker or psychologist. Full clinical centers must provide .5 FTE and alternative clinical .3 FTE.
Regardless of years of experience and status of licensure, the CAHC program requires each Mental Health (MH) provider have access to a supervisor. Your level of supervision will depend on whether you are fully licensed (need less supervision) versus limited license (need more supervision). Either way, a supervisor should be available to you and those interactions should be documented (at minimum with date and time). You should also maintain documentation for all your continuing education credits. If there is no one available in your sponsoring agency to provide mental health supervision to you, then one must be contracted (paid for by the sponsoring agency, if necessary) to provide that for you.