Limited Space Available December MAAPPN Meeting

If you plan to attend the MAAPPN Quarterly meeting at Tosca in Hingham on Tuesday, December 8, 2015 please register today, space is limited and is filling up fast.  We plan to start a bit earlier to maximize the opportunity to access our sponsor tables (Sunnovian, Arbor, Genomind) as well as to have more networking time.  We also are offering free wine and appetizers!


 When: December 8, 2015

(New) Time: 5:45 PM – 9 PM

Location: Tosca Restaurant, Hingham, MA

Cost: $25 (Complimentary Wine and Appetizers)


MAAPPN (The Massachusetts Association of Advanced Practice Psychiatric Nurses) is a non- profit organization in the state of Massachusetts that exclusively represents the interests of advanced practice psychiatric nurses – both psychiatric clinical nurse specialists and psychiatric nurse practitioners.

Our mission includes legislative goals promoting access to sustainable fiscal policies that support the advanced practice psychiatric nurse as high quality, affordable and accessible providers.

Our speaker for the December MAAPPN meeting will be Kathy Adolina, PMHCNS, BC.  Kathy has a private practice in the Back Bay and specializes in treatment of adults and students with affective and anxiety disorders. She is a graduate of Boston College and long time member of NURS, MAAPPN Board Member and current Treasurer.   Kathy will be speaking about Psychogenomics in Clinical Practice.


Psychogenomic testing allows the opportunity to introduce precision into our prescribing practices. Patients who like personalized medicine, like the idea and payers are looking carefully at cost savings. Yet testing is not without caution. In this presentation, the opportunities and challenges are reviewed as these work in a private practice setting.  Payer policies, patient education and how treatment selection presents new opportunities in prevention are reviewed.

December MAAPPN Meeting Agenda


5:45pm – 7:00pm – Networking, appetizers, complimentary wine, and visit the display tables

7:00pm – 7:15pm – Welcome & Introductions

7:15pm – 7:45pm – Dinner and Speaker Kathy Andolina, PMHCNS, BC*

7:45pm – 9:00pm – Business Meeting


* CEU’s offered

If you are a company interested in having a display table at the MAAPPN quarterly meeting go to MAAPPN Meeting Booth Space.

To sign up and pay for your membership meeting please click on the following link MAAPPN.
For more information visit our website at


Please send agenda items to: MAAPPN Chair, Diane Grimaldi at

Please help us spread the word by encouraging others to become members and by inviting colleagues to attend quarterly MAAPPN member meetings.  We are also interested in having new and existing members join our committees, volunteer as guest speakers and make recommendations for topics you would like to hear about at future meetings.

Other ways you can support MAAPPN is with Membership Dues.  We are moving to January dues cycles with a very easy way to pay online! Go to MAAPPN ANNUAL MEMBERSHIP.

Limited Space available confirm your attendance today for the December 8th meeting. 

MAAPPN sadly notes the passing of Dezra Kenney, Past President, NE Chapter Psychiatric Nurses Association

Dezra L. Kenney, age 56 years of Lynn, formerly of Arlington and Quincy, died unexpectedly at her home. Born in Arlington she was the daughter of the Linda (Zwink) Peluso of Lynn. She attended schools in Quincy and graduated from North Quincy High School, Class of 1976. Dez graduated from Lemuel Shattuck Hospital School of Nursing, as a LPN, class of 1978, graduated from Catherine Laboure School of Nursing in Dorcester as a Registered Nurse. Dez earned her Nurse Practioners Degree, specializing in psychiatry and addiction, from Harvard College in Cambridge.


She was the owner of Kenney & Associates in Salem. Dez was a psychopharmacologist, and was a national speaker for a number of pharmaceutical companies and spoke all over the United States. She was Past President of the Psychiatric Nurses Association. Dez enjoyed traveling to Aruba and Barbados.

In addition to her mother she is survived by one brother Alan and his wife Dawn Kenney of Quincy, and two nephews Alex and Adam Kenney of Quincy.

Services Details: Dez’s visiting hours will be held at the Parker Funeral Home 35 Franklin St. Lynn on Saturday from 3:00 – 8:00 PM, to which relatives and friends are invited to attend. Funeral services will be private. Please make memorial donations to the Northeast Animal Shelter 347 Highland Ave. Salem, MA 01970.

Wellesley Hills Office Space

MAAPPN Quarterly Meeting Announcement

The Massachusetts Association of Advanced Practice Psychiatric Nurses (MAAPPN) will hold our quarterly meeting on Thursday, September 17, 2015 at The Royal Sonesta Hotel, Cambridge, MA from 6pm – 9pm

MAAPPN Quarterly Meeting Announcement


Location: The Royal Sonesta Hotel Cambridge, MA

Date:  Thursday, Sept 17, 2015

Time: 6:00pm – 9:00pm

6:00pm – 7:00pm – Networking

7:00pm – 7:15pm – Welcome & Introductions

7:15pm – 7:45pm – Dinner and Speaker TBA

7:45pm – 9:00pm – Business Meeting



Legislative Committee and Update

Peggy Chapman discusses the Committee activity involving the CNS Supervision bill, Psych NP bill, Affiliate bill activity (Telehealth initiative, disability parity), fund raiser attendance, activity related to hearings, giving testimony and any calls to action.  Mary Ann Hart, our MAAPPN Legislative Advocate, will give an update on the progress of the bills we have filed and the strategies employed to further the bill

Practice Committee and Update

Ginny Tay discusses the Practice Committee research and writing of H 1801, the bill filed for independent practice, and the fact sheet and how to use it.

Membership Committee and Update

Michelle Malnati discusses the membership numbers, growth in 2015, and dues drive.

Insurance and Reimbursement Issues

Diane Grimaldi and Sharon Reynolds will discuss reimbursement issues and strategies for rate negotiation.

Treasurer Report

Kathy Andolina reports on MAAPPN revenues and expenses.

Technology and Networking Committee and Update

Kathy Andolina discusses the web site evolution, features, and revenue generating activities associated with social media, advertising campaigns and postings. She will also discuss opportunities for networking through the ad hoc peer supervision groups across the state, social media, Google groups, and client referral mechanisms, and Constant Contact emails and website.

Organizational Update

Diane Grimaldi, Chair, MAAPPN discusses nomination process, form to nominate and elect officers, invitations to join Board, Committees, name change and alignment across of MA Division of Corporations, IRS and MA Dept of Revenue.

If you have items from your area that you would like discussed, please contact Diane Grimaldi at so she can add them to the agenda.

To sign up and pay for your membership meeting please click on the following link  Choose MAAPPN Member Meetings.  The cost is $50.00.

For more information visit our website at

The Recovery Enhancement for Addiction Treatment Act (TREAT Act) Senator Edward J. Markey (D-Mass.)

Maappn members we would like to hear your thoughts on the Treat Act. You can read about it below.


Overdoses from opioids, including prescription pain relievers and heroin, have increased dramatically in the United States. Nationwide, drug overdoses now claim more lives than car accidents. Opioid addiction is a chronic disease that, untreated, places a large burden on the healthcare system. Roughly 480,000 emergency room visits each year are attributable to the misuse and abuse of opioid pain killers. Effective medication-assisted therapy for opioid addiction, such as buprenorphine, combined with social and behavioral supports, can decrease overdose deaths, be cost-effective, reduce transmissions of HIV and viral hepatitis, and can reduce other social harms such as criminal activity.


Unfortunately, of the approximately 2.4 million Americans who abused or were dependent on opioids in 2013, only half received treatment for their condition. That’s because access to effective and evidence based treatments to help treat opioid addiction in outpatient and primary care settings, remains limited in part due to current federal restrictions.


More than ten years of experience in the United States with buprenorphine (Suboxone) to help treat opioid addiction has informed best practices for delivering successful, high quality care for patients with opioid use disorders. Thoughtfully expanding existing federal restrictions, with a focus on expertise and quality will help increase the number of patients who have access to life-saving treatment and will decrease long waiting lists that currently exist for many treatment facilities.


Unlike any other treatment regimen for any other disease, under current law in order for physicians to prescribe and use certain opioid addiction medicines, they must meet specific conditions and apply for a special federal waiver. Even with such a waiver, physicians are severely limited in the number of patients they can treat, contributing to long waitlists and the inability of patients to get treatment for their addiction when they need it.


The Recovery Enhancement for Addiction Treatment Act (TREAT Act):


  • Increases the number of patients a provider is initially allowed to treat from 30 patients to 100 patients per year.
  • Allows certain nurse practitioners and physicians assistants to treat up to 100 patients per year, provided they:
    • Are licensed in a state that already allows them to prescribe controlled substances
    • Complete approved training on opioid addiction treatment and
    • Are supervised by a physician who is approved to prescribe opioid addiction medicine, or are certified addiction treatment nurse practitioners who practice in collaboration with such a physician in a “qualified practice setting,” where allowable by state law.
  • Allows certain physicians, after one year, to request removal of the limit on the number of patients they can treat. To be eligible:
    • Physicians must be substance abuse treatment specialists, as recognized by specific board or society certifications, or
    • Non-specialist physicians must complete approved training and practice in a “qualified practice setting.”
  • “Qualified practice settings” are named in the legislation and include clinical settings that have defined oversight, performance metrics, or quality review, or that are part of systems serving populations with high need.
  • Requires the GAO to examine changes in treatment availability and utilization; quality of treatment programs; integration with routine healthcare services; diversion; impact on state-level policies and legislation; and use of nurse practitioner and physician’s assistant prescribers.

The TREAT Act is supported by the following organizations:


  • American Medical Association (AMA),
  • American Society for Addiction Medicine (ASAM),
  • Trust for America’s Health (TFAH),
  • American Association of Nurse Practitioners (AANP),
  • Association of American Medical Colleges (AAMC),
  • Harm Reduction Coalition,
  • Big Cities Health Coalition,
  • National Association of State and Territorial AIDS Directors (NASTAD),
  • Drug Policy Alliance,
  • Association of State and Territorial Health Officials (ASTHO),
  • National Association of County and City Health Officials (NACCHO),
  • Massachusetts Sheriffs’ Association,
  • Association for Behavioral Healthcare Massachusetts,
  • Connecticut Certification Board, Inc.,
  • Massachusetts Medical Society,
  • Massachusetts Association of Behavioral Health Systems, Inc.
  • The Massachusetts Hospital Association

Once Again It’s Time For Our Annual Maappn Membership Drive

Dear Friends and Supporters,

Once again it’s time for our annual membership campaign drive. Your support really means a lot to us and allows us to continue to represent the interests of advanced practice psychiatric nurses and the clients we serve.

Our members have enabled us to accomplish so much this year. We were able to redesign our website The new website features a completely redesigned layout in addition to several new pieces of functionality. Among the new changes are:

  • Online Streamlined Membership Enrollment – The new website includes membership enrollment through a “create and join MAAPPN” form. The new website design is user-friendly, educational, and informative. We want to ensure that our members are equipped with the latest information.
  • Career Center Services – Thanks to this new feature, for a small fee, employers can post employment and internship opportunities and job candidates can post their resumes.
  • Opportunities for Advertising – We are nothing without our loyal sponsors who support our efforts and advertise with us. Our new website provides for advertising opportunities on myriad levels.

In the coming year we will continue our work on behalf of our members on a number of projects including strategic lobbying at the state level, providing resources for psychiatric mental health nursing, continually improving our website, supporting self-advocacy, creating networking opportunities, gaining sponsorships, and membership recruitment.

This year we are celebrating our 40th anniversary as an organization, and our goal is to double our membership. As an incentive for joining MAAPPN we are offering 20% off of quarterly membership meeting fees (use coupon code: maappndiscount) , along with the opportunity to post your resume or post a job opening on our website for 1-month duration free of charge. For more information on current initiative on members behalf please see the following link

Funds that we raise through our membership campaign help us to continue to pay for legislative consultation and representation, fund our membership drive, make more improvements to our web site, and to create and disseminate brochures and handouts, used to communicate with advocates and supporters.

Thanks again for helping to make this a successful membership fund-raising campaign. Please continue to share the goals and work of MAAPPN with people you know in your workplace and community. You can help us spread the word by encouraging others to become members and by inviting colleagues to attend quarterly MAAPPN member meetings. We are also interested in having new and existing members join our committees. Financial donations are always welcome as another form of support for the work ahead.

New members please click on the following link to register and start the process in becoming a MAAPPN member. If you are renewing your membership please click on this link.

Thanks again for your generous support!

Diane Grimaldi, DNP, PMHCNS, BC

State employees protest proposed health insurance changes

BOSTON – A union representing state employees is asking the Legislature to reconsider Gov. Charlie Baker’s proposal to increase health insurance premiums for some employees.

“Shifting these additional costs onto the backs of state workers who have sacrificed greatly, and given back consistently throughout the fiscal crisis, is not the answer,” wrote David Holway, president the National Association of Government Employees, in a letter to House Speaker Robert DeLeo, D-Winthrop, and House Ways and Means Committee Chairman Brian Dempsey, D-Haverhill.

The budget Baker, a Republican, proposed on Wednesday counts on saving the state $125 million from changes made through the Group Insurance Commission, the organization that provides health insurance for state and municipal employees and retirees.

For the complete story:

Eileen McAnneny, president of the Massachusetts Taxpayers Foundation, a business-oriented fiscal policy group, said the increase in premium co-pays to 25 percent is not unreasonable compared to private sector health plans. “Employees are being asked to pay more, but what they’re asked to pay is in line with the private sector,” McAnneny said

Please Join Us for Speaker DeLeo

Please join us at an intimate breakfast for Speaker

April 9, 2015
8:30 – 10:00 AM
6 Beacon Street


Suggested Contribution: $100.00 per

Please make donations payable to the Committee for Bob
DeLeo.Corporate checks prohibited by law. $500 maximum per person
percalendar year. $200 annual maximum for registered lobbyists and

Political contributions are not tax deductible.


Prescription Monitoring Program – FAQ

Massachusetts Online Prescription Monitoring Program Frequently Asked Questions

What is the Massachusetts Online Prescription Monitoring  Program?

 The Massachusetts Online Prescription Monitoring Program (PMP) is a secure website hosted by the Massachusetts Department of Public Health.

The PMP is a database for a patient’s prescription history for controlled substance prescription medications. The PMP shows a patient’s prescription history for the prior 12 months. Data is reported into the PMP by all Massachusetts pharmacies and by out-of-state pharmacies delivering to people who live in Massachusetts.

 Why is the Prescription Monitoring Program Important?

 Controlled substance medications can play an important role in a patient’s medical treatment and care. When not properly prescribed, however, they can lead to patient harm from duplicate drug therapy, prescription drug misuse or abuse, and illegal use.

Having this information available to prescribers before they prescribe a controlled substance prescription helps them to make the best possible clinical decision for their patient.

 Who is (the) allowed to use the Prescription Monitoring Program  (Important)*?

 Physicians, dentists and podiatrists have been automatically enrolled in the PMP since January 1, 2013. The Massachusetts Department of Public Health’s Drug Control Program (DCP) automatically enrolls these providers when they obtain a new Massachusetts Controlled Substance Registration (MCSR) or have their existing MCSR recalled (renewed).

Beginning on January 1, 2015, the Drug Control Program began automatically enrolling nurse practitioners and physician assistants as participants in the PMP. This will be done when they obtain a new MCSR or renew their MCSR.

Physicians, dentists, and podiatrists also can now grant access to the PMP to users under their direct supervision, such as a registered nurse or medical assistant working in their office.  Known as delegates, these individuals will be enrolled in the PMP and have access to view a patient’s controlled substance prescription history.

Though voluntary, pharmacists may also enroll in the PMP.

*this question contains errors in syntax as issued by the DPH  

 When does my physician have to use the  PMP?

 A registered individual practitioner (physician, dentist, podiatrist, nurse practitioner, physician assistant) must utilize the PMP, prior to prescribing a narcotic prescription drug in Drug Enforcement Agency (DEA) Schedule II or III, or a prescription drug containing a benzodiazepine, to a patient for the first time.

“First time” refers to patients who have not received a narcotic prescription drug in Schedule II or III, or a drug containing a benzodiazepine, from another authorized prescriber within the previous 12 months.

Medications considered Schedule II or III are defined as drugs with a high potential for abuse, with use potentially leading to psychological or physical dependence.

Benzodiazepines are a broad class of medications commonly referred to as tranquilizers.

Authorized prescribers are, however, encouraged to utilize the PMP each time they are prescribing a controlled substance prescription to a patient.

 Where is the PMP and how do I access it  PMP?

 The Massachusetts Online Prescription Monitoring Program (PMP) is a website hosted by what’s known as the Virtual Gateway – the. The Virtual Gateway is the secure web portal of the Executive Office of Health and Human Services (EOHHS).

To access this system, you need to obtain a user name and password to login into the Virtual Gateway and you need to be granted access to the PMP.

This process begins when the prescriber completes an application for enrollment into the PMP and sends it to the DPH Drug Control Program for processing.

Because the PMP is a web-based application, you can access it from any computer.

How is the information in the PMP  used?

 To guarantee patient confidentiality and ensure absolute privacy of patient health information, the PMP operates exclusively on a secure web portal and requires nothing more than the entry of basic patient demographic information (name, date of birth, gender, and address). Additional information such as prescriber name, name of the medication, directions for use, and quantity to be dispensed are also required.

PMP data about a patient’s controlled substance prescription history is viewable by the prescriber at the time he or she is considering prescribing a controlled substance medication to that patient. Prescribers will also receive automatic electronic notifications advising them of concerns in their prescribing.

This information is also available to select DCP staff to help develop statistical reports such as the number of prescriptions prescribed for a certain medication. These reports contain no patient specific information (i.e. patient name, address).

Select DCP staff also develops analyses for Department of Public Health such as comparing the number of controlled substance prescriptions prescribed in each county in Massachusetts each year or comparing the total number of controlled substance prescriptions prescribed from one year to the next. Again, these analyses contain no specific patient information.

APRNs to be automatically Enrolled in Massachusetts Prescription Monitoring Program

Sharon Reynolds, MAAPPN Board member, recently checked with DPH and the Fact Sheet that came out in January was not accurate in that all APRNS and PAs  are supposed to be automatically enrolled this year (not just NPs and PAs).  As they are having a difficult time implementing the change, it won’t be happening until May renewal dates. We don’t have to wait to enroll in the PMP program but once enrolled we are expected to comply with “first time” user checks.  For more info:


MAAPPN, through its ties with the Mental Health Coalition will be monitoring the activities of the Task Force on Behavioral Health Data Policies.  The task force is charged with data collection for behavioral health system improvements but is also focusing on data pertaining to Long Term Stays. MAAPPN is seeking clarification from the task force on if the data focus will also include other behavioral health system issues such as data related to service gaps and nondiscriminatory access to mental health providers. The task force meets monthly from now until June, 2015, at which time it must file a report.   The Task Force has had 2 meetings so far – in Nov and Dec and the next one will be Tues. 1/27 from 9:30 – noon at the CHIA offices.  MAAPPN members are asked to respond to contact if you have input into this issue. You can read more about the Task Force on the CENTER FOR HEALTH INFORMATION AND ANALYSIS (CHIA) website but here are its focus areas:
  1. Make recommendations on how best to evaluate performance of the behavioral health system;
  2. Identify data needed to evaluate performance based on initial Task Force recommendations
  3. Make recommendations on what investments in data systems or resources or policies are needed to allow policy makers to make informed decisions that lead to improved care delivery;
  4. Make recommendations on how to reduce the number of long-term care patients in DMH continuing care facilities, acute psychiatric units and emergency depts..  Read more.



MAAPPN will  re-file the bill seeking supervisory independence by January 15, 2015.  The bill will act to eliminate mandated, career-long, physician supervisory requirements placed on seasoned, advanced practice psychiatric nurses.

With the law as it stands now, nurses practices are dependent on the physician supervisory arrangement. Should the physician re-locate out of state, become ill or otherwise disabled, the nurse would legally be required to close his/her practice.  MAAPPN believes that this bill will eliminate those risks and barriers.  The Practice Committee, will issue a document of educational points to refer to when educating supporters of the bill.

The next steps involve seeking co-sponsors by the end of January. Following that the Speaker with assign the bill to a committee for review, debate and hearings where eventually it will be voted on.  There will be key points along the way where MAAPPN members will be asked to contact their legislators. Additionally,  MAAPPN will  continue to concentrate efforts on finding common ground with the Board of Registration in Medicine and the Mass Psychiatric Society.

Other states in New England and across the nation continue to change their legislative statutes giving independent practice to Psych CNSs and Psych NPs, though some states require a set number of hours or years of practice before independence is achieved. When we have the bill information, we will be notifying you to get in touch with your legislators to request their co-signing onto the bill.  

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


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.

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.

Health Reform in Massachusetts 2012

[slideshare id=15251371&doc=masshealthreformpresentation-121119131653-phpapp01]


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.”