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H. 2451/S. 1257
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  H. 2451/S. 1257 - An Act to Contain Health Care Costs and Improve Access to
Value Based 
Nurse Practitioner Care as Recommended by the IOM and FTC

Sponsors: Rep. Paul Donato and Rep. Kay Khan; Sen. Marc Pacheco

ISSUE:  Despite decades of evidence-based research and care delivery outcomes demonstrating that nurse practitioners (NPs) excel in delivering high quality, cost-effective care; antiquated mandates in the Massachusetts Nurse Practice Act have restricted the ability of NPs to practice to the full extent of their education and training. These mandates include the requirement of physician supervision over NP prescriptive practice, which extends beyond the professional oversight by the Board of Registration in Nursing and requires joint promulgation of NP regulations by the Board of Registration in Medicine.

In 2010, the Institute of Medicine released the Future of Nursing Report noting the negative impact of such practice restrictions and issued a set of recommendations which ranked the removal of these artificial barriers by state legislatures as its number one priority. In 2014, the Federal Trade Commission (FTC) issued an opinion letter to the Massachusetts Legislature upholding the IOM’s recommendations to remove NP practice barriers.

As of 2017, Massachusetts is the only state in New England that has yet to remove these restrictive barriers to NP practice.

IMPACT: Restrictions imposed by the current Massachusetts Nurse Practice Act have negative consequences for patients and the Commonwealth and contribute to:

Continued Gaps in Access to Care and Higher Health Care Costs
Lack of access to primary and specialty care  is a problem for patients throughout the Commonwealth, and in particular for patients with Masshealth and those who live in Western MA and Cape Cod. As long as NP care is dependent upon supervisory care models that dictate and limit panel size and participation in state sponsored insurance plans, NPs cannot be effectively deployed to fill gaps in access to care. Lack of timely access to primary and specialty care forces patients to rely on more costly services provided in emergency room settings and increases the cost of care paid by the Commonwealth. 

Higher Administrative Costs for Health Care Services
The price of retrospective NP prescription reviews by physicians is estimated to cost tens of millions of dollars annually. The review of prescriptions that have already been written has not been shown to increase patient safety but has been shown to divert valuable MD and NP time and resources away from patient care and further drive up the cost of providing health care services in the state.

Financial Disincentives for Innovative Practice Models
The regulatory requirement to enter into costly prescribing agreements with a supervising physician creates financial disincentives for nurse practitioners to participate in innovative practice models that improve healthcare outcomes and decrease healthcare costs. NP led programs for chronic disease management and home based care of the elderly are just a few examples of such models that have demonstrated significant cost savings.

Barriers to Medication Assisted Treatment for Opioid Dependence
The opioid epidemic continues to plague the Commonwealth as a public health crisis, and struggling patients are facing long wait times and limited access to medication assisted treatment (MAT) programs. Although federal law allows for NPs to prescribe these life-saving medications, eligible NPs in Massachusetts are restricted from prescribing MAT unless they have a physician who will allow this and is willing to supervise them. 

SOLUTION:  Aligning the Massachusetts Nurse Practice Act with national recommendations for professional licensure will allow patients to have unrestricted access to value based NP care and will give Massachusetts the flexibility to successfully meet workforce demands, address gaps in access to care for vulnerable populations, adapt to changing healthcare delivery models and contain healthcare costs.

H. 2451/S. 1272 can achieve these goals by:

1. Allowing nurse practitioners to exercise their existing statutory authority to prescribe medications and retire the licensure requirement that they secure a supervising physician to retroactively review their prescribing practices.

2. Allowing the Board of Registration in Nursing along with the Department of Public Health, rather than the Board of Registration in Medicine, to oversee the professional practice of nurse practitioners and removing the power of one discipline to restrict the practice of another.

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