Gov. Baker Announces New Department Heads

Dr. Monica Bharel, the chief medical officer for the Boston Health Care for the Homeless Program, will take over for Cheryl Bartlett as commissioner of the Department of Public Health, overseeing a broad array of programs, including the implementation of medical marijuana. Bharel earned her medical degree from Boston University and a graduate degree in public health from Harvard University. “Doctor Bharel has an impressive background as a physician serving the homeless, some of the most vulnerable citizens of the commonwealth,” said Marylou Sudders, the incoming health and human services secretary.

Update on Prescription Monitoring Program – Webinar Offered

Deborah S. Allwes, BS, BSN, RN, MPH,  Director of Bureau of Health Care Safety and Quality from the Massachusetts Department of Public Health has provided the following update for all Massachusetts Prescribers. For FAQ, PMP_regulations_FAQ_Final_11_2014

Update on PMP Delegates

  • The MA Prescription Monitoring and Drug Control Program (PM/DCP) is finalizing the form to assign delegates to Primary Account Holders
  • These forms are expected to be completed and available online the week of December 15, 2014
  • The PM/DCP will announce the process for identifying and registering Delegates the week of December 22, 2014 (including how to sign-up a delegate and delegate PMP policies and procedures)
  • Enrollment of Delegates into the PMP (Delegates accessing the PMP on behalf of Primary Account Holders) will begin on December 22, 2014

PMP Educational Webinar

  • With the pending enrollment of delegates, the PM/DCP will be holding a series of educational webinars
  • The webinars will be available for delegates, prescribers and dispensers for a total of 8 different times throughout January 2015
  • The content of each hour-long webinar will be the same and the PM/DCP will send out a notice of the webinar dates the week of December 22, 2014
  • Anyone interested in participating in a webinar can sign up in advance to receive the teleconference and webinar information
  • Once the webinar is complete, participants will understand when and how to look up a patient in the PMP, how to interpret the PMP data, how to do a batch look-up and other important information

Content of the webinars will also include how to:

  1. Sign up to be a delegate
  2. Enroll in the Executive Office of Health and Human Service’s Virtual Gateway
  3. Log into the online PMP
  4. Search for a patient
  5. Understand a patient’s prescription history
  6. Print a patient’s history
  7. Perform a Batch Look-up for those clinics that have scheduled appointments
  8. Know when you need to look up a patient’s prescription history (based on regulations)
  9. Go online for information from the PM/DCP website
  10. Get help and support for questions or issues with the PMP

Frequently Asked Questions

Please see the attached PDF document


BX/BS Foundation Forum: Tackling Racial and Ethnic Disparities in Mental Health Care


Seating is limited and filling up quickly for the upcoming forum,“The Time is Now: Tackling Racial and Ethnic Disparities in Mental and Behavioral Health Services in Massachusetts.” Please register today!

This forum will examine the magnitude and persistence of racial and ethnic health care disparities with a focus on the delivery of behavioral health services. Ongoing challenges and potential solutions will be examined in light of health care system and financing changes under state and national reform. The research will quantify the problem, costs and consequences. The forum will explore potential options and action steps to reduce disparities and move towards a more equitable distribution of critical resources.

Date:              Thursday, December 11, 2014
Time:              8:30 a.m. – noon
Location:       Omni Parker House Hotel, Boston, MA

A continental breakfast will be served during registration between 8:00 a.m. –  8:30 a.m.

To view the full agenda please visit the Massachusetts Health Policy Forum Website. If you have any questions, please contact Senior Events Manager, Ashley Brooks at or (781) 736-3940. We hope that you will be able to join us.
This email communication was sent by:
Massachusetts Health Policy Forum
415 South Street, MS 035
Waltham, MA 02453

DOI Issues Bulletin to Make Medical Necessity Criteria Easily Findable

November 4, 2014

Advanced Practice Psychiatric Nurses working in private practice or in health care facilities will welcome the DOI Bulletin that requires that private insurance companies make their medical necessity criteria findable and accessible on web sites by January 1, 2015.

The DOI announced these changes in today’s ‘Listening Session’ for Transparency of Medical Necessity Criteria.  While other DOI Listening Sessions have focused on the process steps in authorization, appeals and denials, today’s session was used to announce the release of Bulletin 2014-10.  Participants in today’s session included private insurance carriers, state agencies, providers and advocacy groups.  Transparency of medical necessity criteria has been a simmering issue between providers and carriers with complaints aimed at each other on both sides of the divide. Carriers complain that they have no access to the medical doctor or provider who knows the most about what is clinically necessary. Providers are critical of carriers who seem to make subjective denials of care without understanding the needs of the client.

The DOI while responsible for overseeing private carrier compliance with state and federal laws, also receives information, concerns and complaints directly from consumers, advocates, providers and other state agencies(such as the OPP).  The DOI’s intention with Listening Sessions is to clarify the issues, promote solutions and define strategies fair to all concerns.  In today’s session, opportunities were provided to the carriers to describe the changes they have made in transparency since the law went into effect on July 1, 2014.  Other stakeholders went on to discuss concerns about how far or limited the Bulletin goes in resolving conflicts associated with getting services and treatments approved for patients.

The issue of Proprietary (purchased) Criteria was also addressed and prominently mentioned in Bulletin 2014-10.  Proprietary criteria (i.e.McKesson Interqual)  is treated differently then other medical necessity criteria because of its commercial value to the carriers and its exemption from public sharing.  However, Bulletin 2014-10 states that proprietary criteria MUST be shared with providers as it is relevant to the particulars of a patient situation.  While not publicly shared and only shared as relevant to specific patient needs, this does represent a step forward. Still, proprietary data can present difficulties such as with subjective interpretation and provider access to full criteria documentation (especially in appeals situations).

Key Aspects of Bulletin 2014-10

Non-Proprietary Medical Necessity Criteria: 
Where the insured or prospective insured, health care provider is seeking non-proprietary criteria: 
  • Utilization review criteria, medical necessity criteria and protocols shall be made available to the public at no charge;
  • Carriers shall provide access to non-proprietary criteria and protocols by posting the criteria and protocols on a public website.
  • Carriers shall make such criteria and protocols available on a public website as soon as possible but no later than January 1, 2015.
  • Criteria and protocols posted on a public website must be easily accessible and up-to-date.
Licensed, Proprietary Medical Necessity Criteria:
 Where the insured or prospective insured, health care provider, Office of Patient Protection or the Division of Insurance is seeking licensed, proprietary criteria:
  • the carrier may limit the information provided to that which is relevant to the particular treatments or services identified by the insured or prospective insured or the services identified by the health care provider.
  • Access for OPP and the Division:  Carriers shall provide all criteria and protocols upon request to OPP and the Division free of charge, including licensed, proprietary criteria and protocols purchased by a carrier.
  • Any such licensed, proprietary criteria and protocols purchased by a carrier provided to OPP and the Division shall not be public records and shall be exempt from disclosure under the public records laws.
  • OPP and the Division may request the entire set of utilization review criteria, medical necessity criteria and protocols, and in response to such a request the carrier shall provide all requested documents.

Lingering Issues:  Questions and concerns remain going forward…

Participants identified that there are still issues with respect to details published in rejection letters, participant selection of criteria Panels and subjectivity  in interpreting criteria.

  1. Adverse Determination Letters:  when services are denied, what information goes into the letter?  How is the proper balance struck between publishing the specific particulars of the case (that another family member might see) or general statements about why there was an adverse determination?
  2. Criteria Development Panels: Who is represented on panels deciding criteria?, who is qualified, who is not represented, who is excluded?
  3. Subjectivity in Criteria Interpretation Risk:  Is criteria used narrowly or broadly? as a ceiling or a guideline? Who is making decisions on the phone and what happens when the decision is made without adequate information? Are service requests unfairly labeled as ‘futile’ and thus denied?and how can all involved in the process be knowledgeable and aware of criteria before they get on the phone ?

The DOI reminded participants that its authority is only over insured plans (not MASS health, self funded, out of state or government plans).  The DOI further emphasized that they intend to monitor the compliance of carriers to accomplish the public access by January 1, 2015 and to further monitor the key aspects of the Bulletin such as findability, the presence or absence of up-to-date information and consistent terminology across carriers.  The DOI remain open to filing further regulations should they be required.

Feedback is welcome to the attention of


TBT: Review of Gains for Advanced Practice Psych NP’s in Conn.

April 9, 2014 Senate votes to allow nurse practitioners to practice independent of doctors (CT)

The Connecticut state Senate voted 25 to 11 Wednesday night to allow nurse practitioners to practice independent of physicians, a controversial concept that has gained traction amid growing concerns about the availability of primary care providers in the state.

The proposal, which now goes to the House, originated in Gov. Dannel P. Malloy’s administration, which pitched it as a way to increase access to primary care at lower costs as thousands more state residents gain insurance as part of the federal health law.

But critics have raised concerns about the effects the change could have on patient care and primary care physicians.

The ability of nurse practitioners to work independent of doctors has long been a contentious matter between the two professions. Connecticut law required nurse practitioners to be supervised by doctors until 1999, when legislators loosened the requirement, calling instead for nurse practitioners to work “in collaboration” with a physician.

The bill the Senate passed Wednesday would allow nurse practitioners — also known as advance practice registered nurses, or APRNs — to practice independently, but only after practicing under a collaborative agreement with a doctor for at least three years.

Public Health Committee Co-Chairwoman Sen. Terry Gerratana noted that nurse practitioners already have the authority to treat patients and prescribe medication. They also have their own practices, she said.

“What we are doing here is making them independent of the collaboration,” Gerratana, D-New Britain, said.

Nurse practitioners have argued that the current requirement makes it hard to open their own practices and leaves them at risk of being unable to practice legally if their collaborating physician dies, retires, relocates or chooses to sever the agreement. Some have reported having to pay significant fees to the collaborating doctors or having trouble finding a doctor to collaborate with. And APRNs say there’s no evidence that removing the collaborative practice requirement would put patients at risk.

But many physicians oppose removing the collaborative practice requirement, pointing to the differences in education and clinical training between the two professions. Nurse practitioners aren’t a substitute for doctors, particularly when it comes to caring for patients with complex health issues, they say.

More than two dozen physician organizations signed on to written testimony that said the proposal would “lower the standards of care and therefore the clinical quality provided to Connecticut patients.”

During a two-hour debate Wednesday night, Sen. Toni Boucher, R-Wilton, said she had a relative who underwent a medical procedure and later faced significant complications because an APRN had overestimated her abilities and had not complied with a doctor’s orders.

Even in more routine matters, Boucher said, there are potentially serious conditions a nurse practitioner could miss, and areas where an APRN’s education is no match for the years doctors spend in school and clinical training.

“I think we’re going too far now,” she said.

But Sen. Jason Welch, R-Bristol, said he supported the proposal as a way to increase the availability of primary care in the state.

“Unfortunately, I think as the Affordable Care Act moves forward and certain pressures are created because of that, it’s going to be even harder to get primary care practitioners to practice here in the state of Connecticut,” he said. “So I think that there is a need now. I think that need is going to grow, and I think this bill is at least a piece of meeting that need.”

In addition to Welch, several lawmakers crossed party lines in their votes. Republicans Kevin Witkos, Kevin Kelly, Art Linares and Tony Guglielmo voted for the bill. Democrats Ed Meyer and Anthony Musto voted against it.

Critics of the bill raised concerns about potential consumer confusion about the type of provider they’re seeing, and about other changes in the health care system.

Sen. Len Fasano, R-North Haven, expressed frustration that there would be no requirement to notify regulators when a nurse practitioner begins to work outside of a collaborative agreement.

And while Fasano praised the idea of increasing the number of medical professionals, he said he worries about private physician practices getting squeezed out by hospitals.

“In a very short period of time, private practices will not exist in this state,” he said.

Malloy released a statement praising the vote, saying that nearly 200,000 state residents now have access to health care because of the federal health law.

“As the healthcare industry grows and changes, the role of advance practice registered nurses remains critical,” he said. “This legislation will make sure that residents have access to high-quality preventative care, so they can lead healthier lives.”

If the bill becomes law, Connecticut would become one of 19 states that, along with Washington, D.C., allow nurse practitioners to practice independently.

The bill comes on the heels of a state Department of Public Health review on the scope of practice of nurse practitioners.

The review committee’s report noted that some members had significant concerns about allowing nurse practitioners to practice independently, including “what they believe to be deficiencies in education, training and certification requirements” for nurse practitioners compared to those required for doctors and physician assistants.

“There was however no evidence or data provided as part of the scope of review process to validate that removing the mandatory collaborative agreement would alter APRN patient care or place patients at risk, or that patients are at risk or care has deteriorated in other states where there is no required collaborative practice agreement,” the report said.

Connecticut had 3,841 APRNs and 17,130 physicians with active licenses at the end of 2012, according to DPH. The Malloy administration has said there are now more than 4,000 APRNs.

MAAPPN Member Meeting to be held Monday, Dec 8, 2014

Mark the Date!

Please join us for our final 2014 Member Meeting to be held on Monday, December 8th, 2014 at Seasons 52, Burlington, MA.  Our last meeting at this venue proved to be a terrific setting for a wonderful meal, discussion of issues, networking and planning the MAAPPN initiatives for 2015-2016 legislative year.  2 CEU’s are offered that will count towards the non-ANCC approved CEU requirements.

Proposed Agenda:

  • Reimbursement rates for Psych APRNs (Psych CNS and Psych NPs)
  • Strategy Update on Removal of Supervisory Requirements
  • Launch New MAAPPN web site and Social Media connections
  • Practice Committee: Campaign for Action,  Psych APRN laws in other states
  • Legislation: MAAPPN bills for 20015-16
  • Psych CNS/NP transition issues:  Update on Dual Program (CNS/NP) graduates and status with exam
  • Nominations* and elections fro Treasurer and Secretary

Support for the meeting provided by Lundbeck PharmaceuticalsBrintellix) 




Counteracting Ebola Stress

It is hard to escape the stories about ebola today.  As the country and  individual states scramble to form public health policy, media reports of health care worker exposures are emerging daily.  The latest, a nurse in Texas, triggers the question “Just how contagious is this?” and now a possible exposure in Braintree, MA.  As psychiatric nurses working in health care facilities and seeing multicultural clients in a multicultural city, these are important times to get educated about actual risks and preventative practices. The Boston Public Health Commission  released a statement Sunday night saying that the man in question in Braintree did not meet criteria to be considered at high risk for Ebola but that the commission would continue to monitor the situation.  The Department of Public Health web site provides information for clinicians, universities and colleges and general information about ebola virus. Additionally, Psychiatric CNS’s and Psychiatric NP‘s are mindful of our own concerns and fears as well as those of our clients.  These times provide another opportunity to empower our patients and ourselves with education and strategies to cope with traumatizing news, as well as actual risks.


How Should We Talk About Mental Health?

Stigma and discrimination of those who suffer with mental health issues finds fertile ground where mis-communication rules.  Could better communication skills amongst us lead to improved outcomes for the mentally ill?  Thu-Huong Ha interviewed 7 mental health experts  and offers 10 ways to talk about mental health to end stigma and discrimination. Psych Clinical Nurse Specialists and Psychiatric Nurse Practitioners are natural teachers and communicators who can open the dialogue with those who don’t know how to talk about mental health issues and illuminate the numerous ways communication can be improved and thus reduce stigma and discrimination.

The Mental Health Parity and Addiction Equity Act of MHPAEA Protections

Massachusetts Psych APRN’s will benefit from parity initiatives that seek to equalize access and reimbursement for treatment across Mental Health and Addiction treatment.  As our clients have an ever advancing  access to mental health and addiction services just as they do for primary care, there will be more opportunities to treat our mental health and addiction clients and achieve better outcomes if we can fully and completely treat them as the issues demand – not subject to arbitrary cut offs and ineffective treatment options.

Transform Deep Brain Stimulation – Mass General Hospital

The Psychiatric CNS and Psychiatric NP working in Massachusetts have opportunities to inform and refer our most challenging clients with severe lifelong depression to those who are on the cutting edge of treatment.  The Psychiatric CNS and Psychiatric NP will be encountering clients with implants in the near future. We have a role in continuing therapy and conventional treatment in those with implants who can now expect a higher quality of life.   Psychiatric APRN’s will have opportunities to help clients form new life goals that they might have not imagined and use their capabilities to live the life they always intended to live.  Novel treatments provide the opportunity to reduce the burden of illness. Psych APRN’s will be key in giving therapy and care  to those emerging from a painful past and reducing the impact of depressive habits that could  interfere with achieving optimum outcomes.

Can the Damaged Brain Repair Itself?

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In this Ted Talk , Siddharthan Chandran explores how to heal damage from degenerative disorders such as MS and motor neuron disease (ALS).  As Psychiatric APRN’s we are continually interested in novel treatments and the opportunities neuroscience might offer our patients who suffer with mental disorders.   Psychiatric CNS‘s and Psychiatric Nurse Practitioners routinely screen for non-psychiatric disorders that may present with psychiatric symptoms. We direct our clients to address the non-psychiatric issues in tandem with the psychiatric issues impeding qualtity of life.  As professionals who are expert in interprofessional collaboration , Psych APRN’s  are highly qualified to communicate with the professionals in medicine and neuroscience to direct care and treatment of our clients with serious neurological co-morbid disorders.

TED Talk: Mental Health for All by Involving All

[ted id=1557]

Psych APRN‘s (CNS and Psych NP’s)  play larger roles in global mental health more often then you think.  Psychiatric CNS’s and Psychiatric Nurse Practitioners teach in diverse universities, take  global service trips to war torn countries and guest lecture at schools of nursing in remote areas.  But how do we take our skills to reach the mentally ill in those places –  including the mentally ill within our own state – when when we can’t always be there?   Vikram Patel describes a way to improve mental health at the local levels by training others to the “SUNDAR” model, an empowering, “dare to care” way to involve those affected by mental illness and their caregivers.   As part of that, The Movement for Global Mental Health established as a platform where mental health providers and those with mental illness can stand together.

MassEHealth: Effective and Proper Use of the Mass HIway Directory October 9, 2014

As Advanced Practice Psychiatric APRN’s we are involved in every aspect of professional care of our clients, including documenting care, protecting privacy and ensuring effective care collaboration and data sharing.  Look under the hood into the MassEHealth Initiatives and get familiar with how data is being used in everyday health care and how it relates to the larger issues such as the Affordable Care Act and Accountable Care Organization frameworks



Education: Nursing Theories and Nursing Practice

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Psychiatric Advanced Practice Nurses are trained in nursing theory that informs our practice.  This text book (inits entirety) offers the perspective that nursing theory is eventually connected with nursing practice. Great resource for those mid-career Psychiatric CNSs and Psychiatric Nurse Practitioners who want to compare clinical and practical knowledge with how it was originally predicted by the nurses who wrote theoretically about what we do to guide our thought and actions as nurses.

Health Reform in Massachusetts 2012

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At State House ceremony, Governor credits broad coalition for making landmark law possible; Cites better care at lower costs, savings of nearly $200 billion over 15 years & increase in take home pay for workers, savings for families

Governor Patrick signs the health care reform bill in Nurses Hall at the State House. (Photo Credit: Eric Haynes / Governor’s Office) View full size photo.

BOSTON – Monday, August 6, 2012 – Governor Deval Patrick today launched the next phase of health care reform, signing legislation that builds on the Commonwealth’s nation-leading access to care through landmark measures that will lower costs and make quality, affordable care a reality for all Massachusetts residents.

“Today, we take our next big step forward. Massachusetts has been a model to the nation for access to health care. Today we become the first to crack the code on cost. And we have come this far together,” said Governor Patrick. “The law I have signed makes the link between better health and lower costs, that we need a real health care system in place of the sick care system we have today. What we’re really doing is moving towards a focus on health outcomes, and a system to reward that. We are ushering in the end of fee-for-service care in Massachusetts in favor of better care at lower cost.” (Read the Governor’s full remarks here.)

During a ceremony at the State House, Governor Patrick joined medical, business and labor leaders, caregivers and patient advocates, and legislators and policy makers, crediting the broad coalition for delivering on the promise of the Commonwealth’s 2006 health care reform law that expanded coverage to over 98% of residents, including 99.8% of children. The Governor noted that the first phase of health care reform, which the Patrick-Murray Administration successfully implemented, has led to more residents having a primary care physician, more businesses offering coverage and an increase in preventive care.

“Our Administration has worked to increase access to quality health care for Massachusetts residents, and we have built a strong partnership with providers, consumers, and other stakeholders to address the affordability of care within the system,” said Lieutenant Governor Timothy Murray. “We thank the state legislature and all who have been dedicated to working with us as we prepare for the next phase of health care reform, reducing the rising cost within our health care system and easing the burden on Massachusetts families, businesses, and residents.”

“By striking just the right balance, this bill will help slow the spiraling health care costs faced by businesses and individual consumers while also allowing the marketplace to grow and function,” said Attorney General Martha Coakley. “We are proud to be part of this first-in-the-nation effort and are prepared to ensure the law’s fair and effective implementation. I thank Governor Patrick for his leadership on this issue and applaud the Legislature, particularly the work of Chairmen Walsh and Moore, as well as Senate President Murray and Speaker DeLeo, for this landmark health care bill.”

Payment Reform: The Massachusetts Experiment


JAMA Forum — The Massachusetts Health Care Reform Experiment: A Success

To some extent, the Affordable Care Act (ACA) is based on the “Massachusetts experiment,” the health care legislation passed by the state in 2006, leading politicians on both sides of the political aisle to claim it as a success or failure. Supporters assert that the legislation resulted in nearly universal health insurance coverage in Massachusetts. Detractors point out that the quality of coverage may be suboptimal and its costs are exorbitant. Both sides have overstated their cases.Massachusetts health care reform was evolutionary, not revolutionary. In 1985, the state established a “free care pool” paid for by profitable facilities to support the safety net hospitals. Hospital rate deregulation in 1991 resulted in a cost crisis, leading both conservative and liberal politicians in Massachusetts to cooperate on legislation. In 2006, a Republican Governor, a Democratic Speaker of the House, and a Democratic President of the State Senate collaborated to develop Massachusetts health insurance reform. The Republican Governor insisted on a proposal originally written by Stuart Butler, PhD, of the conservative Heritage Foundation (and a JAMA Forum contributor), which included an individual mandate to purchase health insurance. Butler said, “If a young man wrecks his Porsche and has not had the foresight to obtain insurance, we may commiserate, but society feels no obligation to repair his car. But health care is different. If a man is struck down by a heart attack in the street, Americans will care for him whether or not he has insurance.”

Although it is true that the legislation resulted in near-universal health insurance coverage in Massachusetts, including 98% of the state’s population and nearly 100% of children, baseline rates of insurance were high before the law went into effect. In 2007-2008, when the law was just being implemented, uninsured rates in Massachusetts were only 5% at a time when up to 25% of the population of California, another progressive state, was uninsured.

Submitting a Job Listing

To submit a job listing, we ask that all interested parties use our submission form. This ensures that your posting will be featured on the site in a timely manner.

April 7, 2016

April 7, 2016

A custom online listing and linked descriptions in the weekly member newsletter are offered for $150/month. To make a payment, click HERE

After downloading and completing the form, please email it to

Once the submission form and receipt of payment are received by MAAPPN then you will be notified of your published listing.

Our Purpose

  • Provide a presence and testimony as needed at the State House on bills pertinent to our professional work
  • Consistent tracking of legislation relevant to the interests of MAAPPN members
  • Foster high standards of advanced nursing practice & education
  • Promote the professional development of nurse clinicians
  • Develop position statements on relevant issues
  • Provide feedback and collective support to politicians who consistently advocate for our professional interests
  • Increase involvement of members with committee work to enhance efficacy and productivity