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News & Press: State Legislative News

MCNP, MANA and NAPNAP Pass Language to Support IOM Recommendations in the Senate Budget

Friday, May 30, 2014  
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Craven & Ober Policy Strategists, LLC

H. 2009/S. 1079 An Act to Improve Health Care Quality and Reduce Costs, filed by MCNP, MANA and NAPNAP was voted upon by the members of the Joint Public Health Committee on May 20th and sent to a study after the House Chair contacted committee members encouraging them to do so. Despite overwhelming evidence presented to the committee that passage was the right thing to do, organized medicine used their political muscle in an intense political struggle to block the bill and lobbied the House, which has more members on the joint committee than the Senate does. Senate members of the committee voted instead to support a re-drafted version of the bill written by Chair Keenan and his staff.

However, Senator Richard Moore, in anticipation of this outcome, filed an amendment to the Senate Budget that basically created an opportunity for passage of the measure still, via an alternate course. This Amendment #935, with your grassroots support last week, PASSED in the Senate budget late on May 22nd!

The changes in law sought by our coalition, are now part of the budget negotiations for the budget Conference Committee, which will commence its negotiations right away. The legislature needs to adopt the state's next annual budget, which begins July 1. The Conference Committee charged with resolving the differences in the House and Senate budget and getting a budget document to the Governor's desk for signature will make the decision as to whether our measure stays in the document that they send to the Governor.

Below we outline what the language looks like in the Senate Budget and what it means for your practice. We think this chart will help you to understand the "legalese" of the amendment that was adopted by the Senate last week. 


Issue


Current Law


Amendment Change


What it means for
NPs and CRNAs


Role of the Board of Medicine


NP and CRNA regulations must be jointly promulgated by both the Board of Registration in Medicine (BORM) and the Board of Registration in Nursing (BORN).


NP and CRNA basic practice will be regulated only the Board of Registration in Nursing.


The BORN will finally, after nearly 10 years, be able to modernize the regulations for APRN practice.

Moving forward, NPs and CRNAs will NOT need practice guidelines with a "supervising physician” who is regulated by the BORM for practice in nurse anesthesia or as an NP.


Recognition of NPS and CRNAs in Chapter 94C the Drug Control Program as "Practitioners”


NPs and CRNAs currently are not on par with physicians in the Drug Control Program and have limited authority to "issue written prescriptions.”


Upon licensure and authorization by the BORN, all NPs and CRNAs will be recognized as "practitioners” under Chapter 94C, the same as MDs.


This ensures rights and responsibilities: you can issue prescriptions and medication orders, decide upon a drug and dose for a patient and immediately administer it to the ultimate user, and do research. It also means you will be required to utilize the Prescription Monitoring Program to stem prescription drug abuse.


Electronic Health Records (HER) and Meaningful Use


Physicians must comply with EHR and "Meaningful Use” as a criteria for re-licensure according to federal regulations. They also have financial incentives for compliance.


NPs and CRNAs will have to comply with EHR and meaningful use according to Federal regs.


Many NPs and CRNAs are already complying and their employment systems are supporting movement in that direction for health care delivery.


Professional Profiles


The BORM must post disciplinary actions taken against MD licensees.


The BORN will have to post disciplinary actions in a manner similar to that which BORM uses.


The BORN already does this for all licensees. The posting will now likely designate if the licensee is an NP or a CRNA.


Prescriptive Practice and "Independent Practice Authority”


All NPs and CRNAs must have a "supervising physician” who is on the prescription pad, and must retrospectively review a subset of prescriptions written every 3 months during the time the NP and CRNA is practicing, for the rest of their professional life. BORM already has a definition for "supervising physician” in its regs.


For 2 years, NPs and CRNAs must have a supervising physician or seasoned NP or CRNA who will oversee their writing of prescriptions, tests and therapeutics according to regulations written by the BORN. After that time frame the NP or CRNA is considered to have "independent practice authority.”


BORM is no longer in control of whether an NP or CRNA can use their legal "prescriptive practice” authority. Based on the licensee's setting the 2 year supervision can be with an MD or an NP or CRNA.

Once the 2 years is passed, there are no longer any "supervision” requirements. Mentoring from someone from the profession is likely to be an asset for professional support and development.


CRNA Criteria for "Independent Practice Authority”


As above


In addition to the criteria above, CRNAs must also have a Master's in Nurse Anesthesia.


Along with recommendations of the BORN, we will draft a "grandfathering clause” to recognize current CRNAs who could not previously find a "supervising physician” willing to permit them to write prescriptions.


Medication  Orders


No definition in Chapter 94C of the Drug Control Program


Clarification in the law that "prescriptive authority” must allow the issuing of medication orders.


NPs and CRNAs will be able to write medication orders in the patient's chart for RNs/LPNS to administer.


Peri-operative  Period


CNRAs can currently only write prescriptions within the 24 hour period before surgery for the patients they care for.


Removed


CRNAs will be able to write prescriptions and medication orders whenever they care for a patient.


Practice Regulations


BORM and BORN jointly in consultation with DPH regarding prescriptive authority.


BORN only in consultation with DPH Drug Control Program for prescriptive authority.


BORN's role over the practice of CRNAs and NPs and for their prescriptive practice in conjunction with DPH will create a much improved and safer regulatory framework.

The passage of this language would not have been possible without significant support from the Senate. Specifically, Senators Therese Murray, the Senate President; Richard Moore, the Senate President Pro Tempore and our lead bill sponsor; Stanley Rosenberg, the Majority Leader; Bruce Tarr the Minority Leader; Marc Pacheco, the Vice-Chair of the Committee on Public Health and John Keenan the Chair of the Committee.

In addition, YOUR grassroots was politically powerful. Over 1,300 e-mails were secured from Monday May 19h through Thursday May 22nd! That is unprecedented. We also had the support from the larger nursing community including ANA Massachusetts, the Chief Nursing Officers of many of the hospitals, Atrius Health Care, AARP and others

Although we are not done, we wanted to share where we are at, what the proposal looks like, the advancement already achieved, the vision that the language supports and the need to stay the course.

This text is now part of the budget to be deliberated by a 6 member Conference Committee. There are three members from the House and three from the Senate. There is no doubt that organized medicine will try to strip this language entirely from the budget. Our job will be to keep it in. If accomplished, it will be part of the budget that goes to the Governor's desk by July 1 to be signed into law. We will also need to be certain that the Governor supports the language…..So keep looking for our legislative alerts. Do not take your foot off the gas pedal….we need to drive this over the finish line.  


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