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 Quarterly Meeting Announcement | September 2015


Join us for an evening of colleagueship, networking, education, job opportunities, Legislative updates and a great dinner.  The Massachusetts Association of Advanced Practice Psychiatric Nurses (MAAPPN) will hold our quarterly meeting on Thursday, September 17, 2015 at Royal Sonesta Cambridge Hotel, Cambridge, MA from 6pm – 9pm.

Visit the display tables of GenOMind – leaders in personalized medicine and psychogenomic testing  and Arbor Pharmaceuticals,  makers on Zenzedi and Evekeo,  new treatments for ADHD.  More displays to come!

MAAPPN Quarterly Meeting Announcement | September 2015

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

Location: Royal Sonesta Cambridge Hotel, Cambridge, MA
Date:  Thursday, Sept 17, 2015
Time: 6:00pm – 9:00pm


The Massachusetts Association of Advanced Practice Psychiatric Nurses (MAAPPN) is an 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.

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

MAAPPN Quarterly Meeting Announcement

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.

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.

If you are a company interested in having a display table at the MAAPPN quarterly meeting please contact Diane Grimaldi at

To sign up and pay for your membership meeting please click on the following link  Choose MAAPPN Member Meetings.  The cost is $25.00.

For more information visit our website at

We look forward to seeing you at the MAAPPN Quarterly meeting on Thursday, September 17, 2015.


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

In July 2013 APNA released a position statement supporting expansion of APRN prescriptive authority

In July 2013 APNA released a position statement supporting expansion of APRN prescriptive authority to include buprenorphine/naloxone for the treatment of opioid addiction: APNA Supports the Expansion of APRN Prescriptive Authority to Include Prescription of Buprenorphine & Buprenorphine/Naloxone (Suboxone)

This week, U.S. Senators Markey and Paul were joined by bipartisan group of Senators, as well as sponsors in the House of Representatives, to introduce legislation that would expand treatment for heroin and prescription drug addiction, including prescriptive authority of buprenorphine/naloxone for APRNs. The legislation, the TREAT Act, would increase access to evidence-based medication-assisted treatment according to this press release issued by Senator Ed Markey’s office. You can view a one page summary of the legislation here.

Please educate your U.S. legislators about the ability of APRNs to provide safe, evidence-based care for opioid dependent patients with approved medication assisted treatment.  In combination with behavioral therapy, medication-assisted treatment for opioid addiction can decrease opioid overdose deaths, reduce transmission of HIV and hepatitis C, and reduce other social harms such as criminal activity and recidivism.

Now is a critical time to advocate for health care policy that will improve access to care and improve health and social outcomes for patients we serve.


Susie Adams, PhD, RN, PMHNP, FAANP
American Psychiatric Nurses Association
3141 Fairview Park Drive, Suite 625
Falls Church, VA 22042

Mitt Romney and some of his top aides used private email accounts

Some of the emails obtained by AP describe Romney’s internal deliberations on his health care policy and the state’s 2006 budget crisis: “I hate appearing as if I am just playing national politics,” Romney wrote in November 2006 during sensitive negotiations on state budget cuts, when he was preparing his 2008 presidential campaign. Romney chose to use his full name as his Hotmail username.

The emails can be viewed here .

The private email accounts raise questions about why Romney and his aides sometimes bypassed Massachusetts‘ official communications system — and how many of those emails remain and whether they could be disclosed to the public. Late last year, Romney acknowledged that near the end of his governor’s term in 2007 he approved a sweeping purge of executive emails from the state government’s computer servers, and the removal of top aides’ hard drives and computers. Romney justified the purge as legal, prompted by privacy worries.

Read more:

APNs should be very concerned about this legislation and cannot afford to be complacent.

Our opposition has unlimited financial, organizational, and institutional resources. If we are to have any chance at advancing our legislation and preventing further restrictions to APN practice in Massachusetts, we need your engagement.

We will be holding town-hall style meetings with legislators across the state over the coming months, and we ask you to be on the lookout for invitations and attend these meetings in your region. We have received news that the Massachusetts Medical Society is already doing this in support of their Physician-Led Team Based Health Care legislation.

Please read the text of this legislation copied below and let this motivate you to get involved and advocate for your practice!

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

MAAPPN Lends Support to MHLA Legislative Priorities

MAAPPN plays an active role in supporting legislation from other MA mental health groups.   As a member of the Mental Health Coalition, MAAPPN has the opportunity to hear of the legislative priorities from the professional groups (the guilds), advocacy and other mental health policy groups.  Susan Fendell, Senior Attorney for Mental Health Legal Advisors Committee announced MHLAC’s legislative priorities for 2015-16 and has asked MAPPN’s support.  MAAPPN will be lending support and endorsement to the following initiatives:

Susan can be reached at  24 School Street, 8th Floor, Boston, MA 02108, 617-338-2345 x129, 617-338-2347 (fax)

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.

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.

NSO States Commitment to Evolve Liability Policies with NP Practice

Below is a posted a letter from Nurses Service Organization (NSO).  The letter isn’t the typical correspondence from NSO. The content was an interesting request for  NP loyalty in choosing a carrier  for malpractice representation.  NSO sites its 20 year commitment to NP’s and the ability to adapt to changing needs of the NP as advanced practice evolves. Specifically,  NSO makes a point of how they agreed to add the MD to the NP’s policy as an additional assured  to cover the exposure risks associated with  MDs entering into collaborative agreements.  NSO has also added  more tools for risk reduction, including the publications of several claims reports, risk newsletters and presentations.   As more liability product companies get into the market and seek enrollees,  NP/CNS organizations will be in a greater position to compare, evaluate, negotiate and endorse policies and companies that offer the greatest and most economical protections for its members.

Here are some links to additional risk management resources for NP’s:

NP Risk Management Checklist

NP Claims Study 2012

Defensive Documentation