Mass. Law Expands Nurse Scope of Practice, Patient Access to Care

Massachusetts Governor Charlie Baker rang in the new year by signing state legislation that he said will improve patient access to care.

An Act Promoting a Resilient Health Care System That Puts Patients First, which largely carries out healthcare priorities set in 2019 before the COVID-19 pandemic, expands scope of practice for nurse practitioners and other advanced practice registered nurses, as well as optometrists. Baker and Massachusetts Lieutenant Governor Karyn Polito stated that such scope of practice expansion will improve patient access to high-quality healthcare.

“Massachusetts has long been a leader in ensuring health care quality and access and with this new law, we are making further progress in building a strong, accessible and affordable health care system, a goal that is more important now than ever,” Baker said in a statement. 

Expanded practice authority for nurse practitioners and advanced practice registered nurses is a key measure healthcare leaders employ to expand patient access to care. Traditionally, advanced practice providers, which include NPs, have had to received certain permissions from physicians to deliver certain types of patient care.

More recently, nationwide medical professional shortages have helped make the case for expanded scope of practice. When APPs are able to practice at the top of their licenses, the professionals say they can deliver more care to more patients. This should improve more timely and widespread patient access to care.

Many states that did not already grant full practice authority to NPs and other advanced practice registered nurses did so on a temporary basis during the COVID-19 pandemic crisis. This included Massachusetts, which tapped NPs to help supplement its stretched-thin medical system.

This latest legislation codifies that temporary provision, Baker said.

Medical professionals now seeing expanded scope of practice include NPs, nurse anesthetists, psychiatric nurse mental health specialists, and optometrists.

This move has been lauded by leading nursing groups, including the American Association of Nurse Practitioners.

"The signing of this law represents nearly a decade of effort by many stakeholders to improve health care access in Massachusetts," Leah McKinnon-Howe, DNP, ANP-BC, AANP Massachusetts State Representative, said in a statement.

"Today we applaud the state legislature and Governor Baker for recognizing the integral role of NPs in the health care delivery system,” McKinnon-Howe continued. “This legislation makes permanent executive orders that allowed NPs to fully respond to COVID-19 and will better position the state to rebuild and meet the health care challenges ahead."

With this legislation’s signing, Massachusetts joins 22 more states, plus the District of Columbia, in hosting full scope of practice for NPs and other APPs.

"Massachusetts is the latest state to embrace a better care delivery model that recognizes NPs as part of the solution for addressing increasing health care needs," said AANP President Sophia L. Thomas, DNP, APRN, FNP-BC, PPCNP-BC, FNAP, FAANP. "This decision aligns with the evidence and recommendations for NP licensure from leading health policy groups like the National Academy of Medicine. Research shows that states with Full Practice Authority maintain strong safety and quality outcomes and improve both access to care and cost savings."

Practice authority for nurse practitioners and other advanced practice providers, which include physician assistants, has long been a heated debate. While some groups like AANP staunchly advocate for full practice authority for APPs, others such as the American Medical Association contend that only physicians can lead a patient care team.

In July, for example, AMA and its Georgia offshoot lobbied Georgia Governor Brian Kemp to veto a bill that would expand scope of practice for APRNs. The organization has long argued that APPs and APRNs do not have the same training physicians have received for delivering patient care.

“All health care professionals play a critical role in providing care to patients; however, their skillsets are not interchangeable with that of fully trained physicians,” AMA and Medical Association of Georgia wrote to Kemp. “While nurse practitioners are valuable members of the health care team, with only two to three years of education, no residency requirement and approximately 500-720 hours of clinical training, they are not trained to practice independently.”

Physicians are required to complete four years of medical school, as well as between three and seven years of residency training and between 10,000 and 16,000 hours of clinical training.

To be clear, APRNs usually have to have completed a four-year bachelor’s program to become a registered nurse before applying for a two- or three-year advanced degree, totaling to between six and seven years of education. According to AANP, NPs receive more than six years of education and must complete national board certification and state NP licensure.

The new Massachusetts healthcare legislation goes beyond the scope of practice debate. The bill also includes some provisions protecting patients from surprise medical billing, following legislative moves made on the federal level. Additionally, the Massachusetts law codifies telehealth reimbursement, removes barriers to urgent care centers for MassHealth members in the state, and offers up some other COVID-19 policy.

“I am proud to sign this legislation which promotes telehealth services that have become vital during this pandemic, expands access to high-quality, affordable care, takes steps to protect consumers from surprise medical bills, and preserves access to COVID-19 testing and treatment,” Baker said. “We look forward to working with our partners in the Legislature and the health care community to build on these reforms in the future.”