H. 1867 / S. 1330
An Act to Support Access, Value and Equity in Health Care
Sponsors: Senator Marc Pacheco and Representatives Paul Donato and Kay Khan
ISSUE: Despite leading the nation in healthcare reform, Massachusetts is facing unsustainable health care costs as patients struggle with lack of access to primary and specialty care. While access issues are problematic for patients throughout the Commonwealth, there are heightened inequities for those who live in Western MA and Cape Cod. As supported by the MA Health Policy Commission 2018 Annual Health Cost Trends data, lack of timely access to care continues to force patients to rely on more costly services provided in emergency room settings and substantially increases the cost of care paid by the Commonwealth.
Patients with mental health needs and substance use disorder face even greater access issues. As the opioid epidemic continues to plague the Commonwealth as a public health crisis, patients with substance use disorder are facing long wait times and limited access to medication assisted treatment (MAT) programs, with higher opioid related deaths in geographically underserved areas.
Antiquated mandates in the Massachusetts Nurse Practice Act have restricted the ability of Nurse Practitioners (NPs) to practice to the full extent of their education and training and have prevented MA NPs from being fully utilized in helping the Commonwealth address challenges related to healthcare access and spending.
These mandates include the requirement of physician supervision over NP prescriptive practice and joint promulgation of NP regulations by the Board of Registration in Medicine. As of 2019, Massachusetts is the only state in New England that has yet to remove these restrictive barriers to NP practice.
Removing licensing restrictions for nurse practitioners has been shown to increase access, improve health outcomes and decrease health care spending:
• In states where NPs have full practice authority, patients have benefited from increased frequency of routine checkups, improved care quality, significantly fewer ER visits for non-emergencies and lower hospitalization rates.
• States that have removed unnecessary and restrictive licensing requirements for nurse practitioners have witnessed an increase in the number of practicing nurse practitioners and expanded health care utilization among rural and vulnerable populations.
• In states that do not require physician supervision over NP prescriptive practice, more trained and qualified NPs are able to incorporate office based MAT into their practices.
• The 2009 RAND report, Controlling Health Care Spending in Massachusetts: An Analysis of Options, estimated that between 2010 and 2020, Massachusetts could have saved from 4.2 to 8.4 billion dollars through scope of practice reform and greater reliance on NPs and PAs in the delivery of primary care.
LEGISLATIVE SOLUTION: An Act to Support Access, Value and Equity in Health Care (SAVE Bill)
By removing the requirement for physician supervision of prescriptive practice and aligning the Massachusetts Nurse Practice Act with national recommendations for professional licensure, the SAVE Bill will allow patients to have increased and unrestricted access to value based Nurse Practitioner care, will help decrease health care costs and address inequities in access to care for vulnerable populations.