An Act To Promote Team Based Health Care

Text of legislation filed by MMS for the 2015-16 session of the Massachusetts Legislature:


Section 1. 

Purpose:

The Legislature hereby finds and declares that:

A. Accountable Care Organizations (ACOs), the Patient Centered Medical Home, and other innovative models of health care delivery, all which require teamwork and integration to achieve improved health outcomes and reduced costs, work best with leadership by physicians who lead these teams with the highest level of training and preparation.

B. Increased use of physician-led health care teams has the potential to offset the increase in demand for physician services while improving access to care, thereby averting a primary care physician shortage.

C. According to survey data, a vast majority of patients believe that patients with one or more chronic conditions benefit when a physician leads the primary health care team; and four out of five patients prefer a physician to have primary responsibility for leading and coordinating their health care.

Section 2. Definitions

Chapter 112 of the Massachusetts General Laws is hereby amended at the end thereof by inserting after section 5M the following new section:

Section 5N – Team Based Care

Definitions:

A. “Patient care team” means a multidisciplinary team of health care providers actively functioning as a unit with the management and leadership of one or more patient care team physicians for the purposes of providing and delivering health care to a patient or group of patients.

B. “Patient care team physician” means a physician who is actively licensed to practice medicine in the commonwealth by the board of registration in medicine, and who provides management and leadership in the care of all patients as part of a patient care team.

C. “Collaboration” means the communication and decision-making process among members of a physician-led patient care team related to the treatment and care of a patient and includes (i) communication of data and information about the treatment and care of a patient, including exchange of clinical observations and assessments; and (ii) development of an appropriate plan of care, including decisions regarding the health care provided, accessing and assessment of appropriate additional resources or expertise, and arrangement of appropriate referrals, testing, or studies.

D. “Consultation” means a process whereby an advance practice nurse or physician assistant seeks the advice or opinion of a physician or another health care practitioner.

E. “Advanced practice nurse” means a registered nurse who holds authorization as a nurse practicing under an expanded role under section 80B of this chapter and regulations under said section; and includes, but is not limited to, nurse practitioners, psychiatric nurse mental health clinical specialists, certified nurse specialists , and nurse anesthetists as provided in section 80H of this chapter. Advanced practice nurse does not, for the purpose of this section, mean a certified nurse midwife as provided in section 80C of this section.

F. “Physician assistant” means a physician assistant who holds authorization to perform medical services under section 9E of this chapter.

Section 3. Requirements – Licensure and practice of advanced practice nurses.

Chapter 112 of the Massachusetts General Laws is hereby amended at the end thereof by inserting at the end of line 44 of section 80B the following new text:

Advance practice nursing regulations shall dictate that advanced practice nurses only practice as part of a physician-led patient care team.  Each member of a physician-led patient care team shall have specific responsibilities related to the care of the patient or patients and shall provide health care services within the scope of his or her usual professional activities and legal scope of practice. Advance practice nurses practicing as part of a physician-led patient care team shall maintain appropriate collaboration and consultation, as evidenced in a written or electronic practice agreement including individually developed prescribing guidelines, with at least one patient care team physician. Advance practice nurses who are certified registered nurse anesthetists shall practice in collaboration and consultation with a physician, consistent with Section 80H of Chapter 112, but also not exceeding the scope laid out in this paragraph. Practice of patient care teams in all settings shall include the periodic review of patient charts or electronic health records and may include visits to the site where health care is delivered in the manner and at the frequency determined by the physician led patient care team.

B. An advance practice nurse shall be required to be covered by a professional liability insurance policy which meets the same statutory and regulatory levels required of physician team members. Service on or leadership of a patient care team by a physician-led patient care team member or leader shall not, by the existence of such service or leadership alone, establish or create liability for the actions or inactions of other team members.

C. Physicians serving as a physician-led patient care team physician on a patient care team shall comply with all requirements of the Board of Registration in Medicine, including practicing with a number of advanced practice nurses that is consistent with the standards of care of the given specialty.

D. The advanced practice nurse shall disclose to the patient at the initial encounter that he or she is an advanced practice nurse. Any member of a physician-led patient care team shall disclose, upon request of a patient or his legal representative, the name of the physician-led patient care team physician and information regarding how to contact the patient care team physician.

E. The board of registration in medicine and the board of registration in nursing shall jointly promulgate regulations specifying collaboration and consultation among physicians and advance practice nurses working as part of physician-led patient care teams that shall include the development of, and periodic review and revision of, a written or electronic practice agreement; guidelines for availability and ongoing communications that define consultation among the collaborating parties and the patient; and periodic joint evaluation of the services delivered. Practice agreements shall include a provision for appropriate physician input wherever needed, such as in complex clinical cases and patient emergencies and for referrals. The practice agreement shall be maintained by the patient care team and provided to the Boards upon request. For advance practice nurses providing care to patients within a hospital or health care system, the practice agreement may be included as part of documents delineating the advance practice nurse’s clinical privileges or the electronic or written delineation of duties and responsibilities in collaboration and consultation with a patient care team physician.  These requirements shall be consistent with provisions of Chapter 94 C Sections 7 and 9.

Section 4. Requirements – Licensure and practice of Physician assistants

Chapter 112 of the Massachusetts General Laws is hereby amended at the end thereof by inserting at the end of section 9E the following new text:

Physician assistant regulations shall dictate that physician assistants only practice as part of a physician-led patient care team.  Each member of a physician-led patient care team shall have specific responsibilities related to the care of the patient or patients and shall provide health care services within the scope of his or her usual professional activities and legal scope of practice. Physician assistants practicing as part of a physician-led patient care team shall maintain appropriate collaboration and consultation, as evidenced in a written or electronic practice agreement including individually developed prescribing guidelines, with at least one patient care team physician. Practice of patient care teams in all settings shall include the periodic review of patient charts or electronic health records and may include visits to the site where health care is delivered in the manner and at the frequency determined by the physician led patient care team.

B. Physicians serving as a physician-led patient care team physician on a patient care team shall comply with all requirements of the Board of Registration in Medicine, including practicing with a number of physician assistants that is consistent with the standards of care of the given specialty.

C. The physician assistant shall disclose to the patient at the initial encounter that he or she is a physician assistant. Any member of a physician-led patient care team shall disclose, upon request of a patient or his legal representative, the name of the physician-led patient care team physician and information regarding how to contact the patient care team physician.

D. The board of registration in medicine and the board of registration of physician assistants shall jointly promulgate regulations specifying collaboration and consultation among physicians and physician assistants working as part of physician-led patient care teams that shall include the development of, and periodic review and revision of, a written or electronic practice agreement; guidelines for availability and ongoing communications that define consultation among the collaborating parties and the patient; and periodic joint evaluation of the services delivered. Practice agreements shall include a provision for appropriate physician input wherever needed, such as in complex clinical cases and patient emergencies and for referrals. The practice agreement shall be maintained by the patient care team and provided to the Boards upon request. For physicians assistants providing care to patients within a hospital or health care system, the practice agreement may be included as part of documents delineating the physician assistant’s clinical privileges or the electronic or written delineation of duties and responsibilities in collaboration and consultation with a patient care team physician.  These requirements shall be consistent with provisions of Chapter 94 C Sections 7 and 9.

Section 5. Prescriptive Authority

In accordance with the provisions of this section and pursuant to the limitations of section 80C, 80E, and 80H of this chapter, of paragraph (g) of section 7 of Chapter 94C, of section 9 of Chapter 94C, and of regulations developed subject to these statutes, an advance practice nurse and a physician assistant shall have the authority to prescribe controlled substances and devices and order tests and therapeutics.

Section 6. Effective. This Act shall become effective immediately upon being enacted into law.

Section 7. Severability. If any provision of this Act is held by a court to be invalid, such invalidity shall not affect the remaining provisions of this Act, and to this end the provisions of this Act are hereby declared severable.

 

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