The Massachusetts Health & Hospital Association (MHA), on behalf of our member hospitals, health systems, physician organizations and allied health care providers, appreciates the opportunity to submit comments on the following bills regarding scope of practice changes and prescriptions.  

MHA supports HB1067/ SB1109, which would expand the authority of a psychiatric clinical nurse specialist to have full ability to prescribe medications as well as order and interpret tests without physician oversight.  In addition, it would streamline regulatory oversight so that these nurses would be overseen through the Board of Registration in Nursing (BORN) only, instead of having to meet oversight by both the BORN as well as the Board of Registration in Medicine.  MHA believes that this bill addresses the ongoing problems in accessing medically necessary behavioral health services in the Commonwealth.  

MHA also supports HB1066, which seeks to expand the ability for psychiatric clinical nurse specialists to provide the same level of services as a physician.  Currently, a Nurse Practitioner has the full authority to sign and verify the physical and mental health treatment for a patient similar to a physician.  HB1066 would expand this authority to include psychiatric clinical nurse specialists.  

MHA supports the expansion of scope of practice for psychiatric clinical nurse specialists and of pathways to independent practice authority.  Consistent with the recommendations of the MHA APRN (Advanced Practice Registered Nurse) Task Force, MHA is supportive of:  1) proposals to require additional post-graduate training prior to full practice authority or independent practice, including some sort of orientation, mentorship, preceptorship or support;  2) the recommendation that the BORN should solely promulgate APRN regulations and scope of practice in Massachusetts;  3)  the recommendation that APRNs should also be held to the same standards of transparency, accountability, and professional responsibility under which physicians practice; and 4) comparable to physicians, APRNs currently must carry professional liability insurance in order to practice.

At a time when there is a serious shortage of psychiatrists in the Commonwealth who are able to evaluate, approve and provide services; expanding the authority for psychiatric clinical nurse specialists through HB1067/ SB1109 and HB1066 will ensure greater access and care services for behavioral health patients, and hopefully reduce overall ED boarding statewide.

MHA also supports HB3205/SB1085 as it provides further solutions to address the continued problems patients are having with accessing medically necessary inpatient mental health services.  With the shortage of available psychiatrists, having the expanded scope of authority for other licensed providers to be able to evaluate and determine the need for inpatient level services will help remove the strain on the system.  This will also assist with decreasing the delays in patients accessing care if they have to wait for an evaluation from a psychiatrist, which could be appropriately provided by a physician assistant pursuant to HB3205/SB1085.

MHA supports HB1060, which seeks to expand coverage for behavioral health services to licensed psychologists for MassHealth patients. In the report issued by the “Task Force on Behavioral Health Data Policies and Long Term Stays”, the task force specifically outlined the need to develop policies that support the expansion and reimbursement of evidence-based group psychotherapy treatment for behavioral health.  MassHealth currently limits members’ ability to access certain therapeutic services offered by psychologists and independently licensed behavioral health providers. Specifically, 130 CMR 411.406 states that MassHealth “does not pay a psychologist for diagnostic (other than by testing) or treatment services, including services the psychologist performs when working under the supervision of a psychiatrist or when responding to a referral from a psychiatrist.” Removing these barriers will allow greater use of community-based services that will benefit patient care and may reduce the number patients in need of acute care services and better facilitate timely access to appropriately-sited services for all patients.

MHA supports the provisions of SB1110, which amends section 140 of Ch. 165 of the Acts of 2014 by providing important exceptions to limiting prescription medications when there is a need for continuity of care as well as removing barrier for patients to receive psychotropic medications for palliative or end-of-life services.  This bill provides important patient protections that should be strongly considered by the Committee.

MHA further supports SB1098, which seeks to eliminate the sunset of the state’s prescription drug manufacturer stewardship program and make the program permanent.  This is an important step to ensuring that pharmaceutical companies are providing various resources for patients and families to properly dispose of unused opiate and addictive medications.  

MHA opposes HB3204, which would implement an informed consent requirement on hospitals and hospice facilities prior to administering a psychotropic medication.  The most pressing concern with this bill is that the informed consent must be verbal or written, and must be obtained prior to use in an emergency or when a patient is experiencing a crisis during an acute level of care.  The provider community supports the overall push to reduce the use of certain opioids and psychiatric medications that are not clinically necessary or appropriate.  However, we are very concerned with HB3204 which seeks to limit such use during an emergency situation when it may be needed to immediately stabilize a patient.  Furthermore, for those patients who are in a hospice situation, it is inappropriate to require an extensive informed consent when a patient is seeking palliative or end-of-life care.  While this bill may be well intended, it would improperly inhibit medically necessary care for patients during acute episodes of care.  For these reasons we urge caution on advancing this bill as drafted.