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.
