HD 986/ SD An Act Improving the Quality of Health Care and Reducing Costs Fact Sheet
 

Nurse Practitioners (NPs) and Certified Registered Nurse Anesthetists (CRNAs) have been recognized nationally and in Massachusetts as Advanced Practice Nurses for more than forty years. NPs and CRNAs are responsible for the care they deliver; must adhere to national professional standards; and retain their own professional malpractice.

Since the early 1990s, NPs have been able to independently bill third party payers and write prescriptions. In 2008, the legislature recognized the NP as a primary care provider that beneficiaries can choose. Further in 2012, the legislature mandated that all beneficiaries must choose a primary care provider and that all licenses must be able to practice to the full extent of their scopes of practice. Further NCQA recognizes that NPs can lead patient centered medical homes.

On January 1, 1989 CRNAs became the first nursing group that could be paid directly for their services under Medicare and have been independently billing third party payers since that time. CRNAs added prescriptive authority in 2010, increasing their capacity to more fully serve the patients in their care.

For over 20 years, the MGLs have tied the Massachusetts Board of Registration in Nursing to promulgating regulations jointly with the Massachusetts Board of Registration in Medicine for NPs and CRNAs. This antiquated mandate, which requires physician supervision of prescription practices for CRNAs and NPs, and requires an agreement between the APRN and the physician for practice guidelines, is: ineffective, arbitrary, inefficient and no longer rational.

In 2010, the Institute of Medicine along with the Robert Wood Johnson Foundation and the National Council of State Boards of Nursing recommended that:

• Nurses should practice to the full extent of their education and training;
• Boards of Nursing should be solely responsible for licensing APRNs;
• The cost of care is increased and much time is wasted by unnecessary physician supervision, and by duplication of services resulting from required “confirming” visits with aphysicianandco-signaturesforprescriptionsororders. APRNsshouldbelicensedas independent practitioners with no regulatory requirements for collaboration, direction or supervision from physicians.

The goals of AN ACT IMPROVING THE QUALITY OF HEALTH CARE AND REDUCING COSTS are to:

1. Remove the mandate of supervision by physicians for the prescriptive practice of the NP and CRNA;
2. Remove the mandate for practice guidelines with a physician;
3. Provide the sole authority for the regulation of NPs and CRNAs to the Board of Registration in Nursing;
4. Remove restrictive time limitations on writing prescriptions for the CRNA; and
5. Update the Nurse Practice Act to reflect that NPs and CRNAs not only order tests and therapeutics, they also interpret them in order to best treat the patient.

For more information contact:
Craven & Ober Policy Strategists, LLC
617-523-6501