Mayflower Spring 2008 Volume 19 Issue 2
Governmental Affairs
Maureen McLaughlin, BSN, RN, CPAN, CAPA
Maureen McLaughlin, BSN, RN, CPAN, CAPA
After a Christmas break, Massachusetts legislators are back in session. Bills to watch and offer comment on include:
Senate 1244 ‘An Act to Promote Safe Patient Care and Support the Nursing Profession.’ Lead Sponsor: Senator Moore.
Alternative to the mandated staffing ratios proposed by the MNA and contained in House 2059.
House 1144 and Senate 1236 ‘An Act Relative to Advanced Practice Nursing.’ Lead sponsor Representative Khan and Senator
Montigny. This bill would add Nurse Anesthetists to APN groups that have prescriptive writing authority and remove physician
supervision language from four categories of APN prescription writing authority.
House 2140 ‘An Act Relative to Nursing Advisory Board.’ Lead sponsor Representative Khan. Advisory Board advises and
makes recommendations to the Governor and General Court regarding issues related to the nursing shortage and nursing
policy initiatives.
Senate 2437 ‘An Act Adopting the Nurse Licensure Compact.’ Lead sponsor Senator Moore. This bill would allow
Massachusetts to join the Nursing Licensure Compact.
Senate 685 ‘An Act to Support Pandemic Preparation and Response.’ (Flu Pandemic Bill). Provides appropriations of
essential supplies needed to prepare for a pandemic flu – vaccine, beds, and ventilators. Also strengthens the public health
system and recommends statutory changes needed to mobilize resources to respond to an outbreak.
Senate 689 ‘An Act Relative to Pandemic Disaster Planning by Health Care Providers.’ This bill provides essential liability
coverage and legal protections for health care providers who volunteer to assist during a state-declared disaster or pandemic. It
ensures that no health care provider shall be liable in a suit for damages or administrative sanctions as a result of good faith
acts or omissions while performing their duties rendering emergency care or treatment in a response to a declared disaster.
House 2052 ‘An Act Providing for Safe Patient Handling.’ Lead sponsor Representative Callahan. This bill would set
standards for lifting, moving, and handling of patients designed to curb RN injuries. Provides financial incentives to hospitals
to acknowledge and offset costs associated with compliance.
Senate 1294 ‘An Act to Require the Use of Evidenced-Based Practices for Safe Patient Handling and Movement.’ This bill
contains requirements to address safe patient handling including the use of lift teams, requiring hospitals to purchase
equipment and includes language related to compliance monitoring by the DPH. The bill also addresses the need for training
in nursing and nursing assistance programs.
Senate 674 and House 2109 (passed in the Senate) ‘An Act Relative to the Nursing and Allied Workforce Development Trust
Fund.’ Lead sponsors Senator Moore and Representative Grant. This bill creates a trust fund needed to support and fund the
collaborative initiatives between the Board of Higher Education and the nursing and allied health care partners – initiatives
aimed at increasing the supply of nurses and allied health professionals.
House 4376. ‘An Act to Promote Proper School Nutrition.’ Lead sponsor Representative Koutoujian. This bill would ensure
that school provide nutritious food options for children to help foster good eating habits that will reduce the risk of diabetes,
obesity and other related health problems.
Of note: There were 6, 000 bills filed for the current Legislative calendar year.
Senate 1244 ‘An Act to Promote Safe Patient Care and Support the Nursing Profession.’ Lead Sponsor: Senator Moore.
Alternative to the mandated staffing ratios proposed by the MNA and contained in House 2059.
House 1144 and Senate 1236 ‘An Act Relative to Advanced Practice Nursing.’ Lead sponsor Representative Khan and Senator
Montigny. This bill would add Nurse Anesthetists to APN groups that have prescriptive writing authority and remove physician
supervision language from four categories of APN prescription writing authority.
House 2140 ‘An Act Relative to Nursing Advisory Board.’ Lead sponsor Representative Khan. Advisory Board advises and
makes recommendations to the Governor and General Court regarding issues related to the nursing shortage and nursing
policy initiatives.
Senate 2437 ‘An Act Adopting the Nurse Licensure Compact.’ Lead sponsor Senator Moore. This bill would allow
Massachusetts to join the Nursing Licensure Compact.
Senate 685 ‘An Act to Support Pandemic Preparation and Response.’ (Flu Pandemic Bill). Provides appropriations of
essential supplies needed to prepare for a pandemic flu – vaccine, beds, and ventilators. Also strengthens the public health
system and recommends statutory changes needed to mobilize resources to respond to an outbreak.
Senate 689 ‘An Act Relative to Pandemic Disaster Planning by Health Care Providers.’ This bill provides essential liability
coverage and legal protections for health care providers who volunteer to assist during a state-declared disaster or pandemic. It
ensures that no health care provider shall be liable in a suit for damages or administrative sanctions as a result of good faith
acts or omissions while performing their duties rendering emergency care or treatment in a response to a declared disaster.
House 2052 ‘An Act Providing for Safe Patient Handling.’ Lead sponsor Representative Callahan. This bill would set
standards for lifting, moving, and handling of patients designed to curb RN injuries. Provides financial incentives to hospitals
to acknowledge and offset costs associated with compliance.
Senate 1294 ‘An Act to Require the Use of Evidenced-Based Practices for Safe Patient Handling and Movement.’ This bill
contains requirements to address safe patient handling including the use of lift teams, requiring hospitals to purchase
equipment and includes language related to compliance monitoring by the DPH. The bill also addresses the need for training
in nursing and nursing assistance programs.
Senate 674 and House 2109 (passed in the Senate) ‘An Act Relative to the Nursing and Allied Workforce Development Trust
Fund.’ Lead sponsors Senator Moore and Representative Grant. This bill creates a trust fund needed to support and fund the
collaborative initiatives between the Board of Higher Education and the nursing and allied health care partners – initiatives
aimed at increasing the supply of nurses and allied health professionals.
House 4376. ‘An Act to Promote Proper School Nutrition.’ Lead sponsor Representative Koutoujian. This bill would ensure
that school provide nutritious food options for children to help foster good eating habits that will reduce the risk of diabetes,
obesity and other related health problems.
Of note: There were 6, 000 bills filed for the current Legislative calendar year.
Previous Governmental Affairs Columns ~ May be Edited for Space Restrictions
Visit Archives for Previous Columns
Visit Archives for Previous Columns
Mayflower Winter 2008 Volume 19 Issue 1
Governmental Affairs
Maureen McLaughlin, BSN, RN, CPAN, CAPA
A summary of the bills currently in the Massachusetts Legislature that affect nursing and/or health care:
Safe Staffing
House Bill (HB) # 2059: this bill, if enacted, will establish nurse to patient ratios in acute care facilities and charge the
Department of Public Health with the responsibility of ensuring compliance.
Senate Bill (SB) # 1244: a broader bill that allows the institutions to establish their staffing patterns. The Department of
Public Health will monitor the staffing plans.
A hearing was held on October 24 in the State House. Legislators heard testimony from various nursing representatives. It is
expected discussion on this key issue will continue after the New Year.
Other Bills:
HB 2052: Safe Patient Handling, sponsored by Representative Jennifer Callahan: requires all health care facilities to develop
and implement safe patient handling policies, to identify, assess, and develop strategies to control risk of injury to patients and
health care workers associated with the lifting, transferring, repositioning, or movement of a patient or equipment. This bill
also regulates implementation of such policies. It would establish credits for costs associated with implementing the above
policies.
HB 921: Ensure Consumer Choice of Nurse Practitioner, sponsored by Rep. Jennifer Callahan: would allow consumers to
choose a Nurse Practitioner of their choice as their primary health provider.
HB 2060: An Act Relative to a Registered Nurse Seat on the Public Health Council, sponsored by Rep. Stephen Canessa:
mandates the inclusion of one registered nurse on the Public Health Council within the Department of Public Health.
HB 2088: An Act Relative to the Shortage of Registered Nurses, sponsored by Rep. Mark Falzone: classifies certified EMT-
paramedics with two years experience and with a Bachelor of Science degree from an accredited college or university as
graduates of an approved school of nursing. *** Please note that MASPAN does not support this bill!!***
HB 2140: An Act Creating a Nursing Advisory Board, sponsored by Rep. Kay Khan: establishes the Nursing Advisory Board in
the Executive Office of Health and Human Services, advising the Governor on matters related to the nursing shortage. It will
consist of eight members representing various areas of nursing practice.
Mayflower Fall 2007 Volume 18 Issue 4
Governmental Affairs
Maureen McLaughlin, BSN, RN, CPAN, CAPA
There are several bills on the legislative calendar that may affect nurses if enacted.
Massachusetts State Government
Mandated Staffing Ratios
Senate 1244 - An Act to Promote Safe Patient Care and Support the Nursing Profession. Lead Sponsor Senator Richard Moore
Alternative to proposed mandated staffing ratios. Supports funding for nursing education and an analysis of the nursing
workforce.
House 2059 - An Act Relative to Patient Safety. Lead Sponsor Christine Canavan.
This is the mandated staffing ratio bill supported and developed by the Massachusetts Nurses Association (MNA). Please note
that this is not a compromise bill as is often suggested by the MNA. This bill has simply undergone revision and its original
opponents remain opposed to the language and the concept of mandated staffing ratios.
There will be a public hearing on both of these bills on October 24, 2007.
Advanced Practice Nurses
House 1144 and Senate 1236 - An Act Relative to Advanced Practice Nursing. Lead Sponsor Rep. Kay Khan and Senator Mark
Montigny.
This bill would add nurse anesthetists and clinical nurse specialists to Advanced Practice Nurse (APN) groups that have
prescriptive authority.
Nurse Licensure Compact
Senate 1288 - An Act Adopting the Nurse Licensure Compact. Lead Sponsor Senator Richard Moore.
The bill would allow Massachusetts to join the Nursing Licensure Compact, which facilitates interstate communication and
recognition on nursing licensure and disciplinary action. Currently, there are 38 states in the Licensure Compact. Benefits
cited are increased access to nursing care during emergen-
cies and states of disaster, as well as an improved relocation process.
Pandemic Flu Preparation
Senate 685 and Senate 689 - An Act to Support Pandemic Preparation and Response and An Act Relative to Pandemic
Disaster Planning by Health Care Providers. Lead sponsor Senator Richard Moore.
These bills, as indicated by their titles, provide for appropriations for essential supplies to prepare for a pandemic flu. The
latter bill provides liability coverage and legal protection for health care providers who volunteer to assist during a pandemic
event or a state-declared emergency. These bills have currently stalled due to funding issues.
Safe Patient Handling
House 2052 - An Act Providing for Safe Patient Handling. Lead Sponsor Jennifer Callahan.
This bill would set standards for lifting, moving, and handling of patients and is designed to curb injuries suffered by RNs
during the lifting and moving of patients. Many states have either recently enacted or are considering similar legislation.
Violence in the Workplace
House 1700 and Senate 1345 - An Act Relative to Assault and Battery of Health Care Providers and An Act Requiring Health
Care Employers to Develop and Implement programs to Prevent Workplace Violence. Lead Sponsors Rep. Michael Rodrigues
and Senator Jarrett Barrios.
Both of these bills address workplace violence. The Senate bill would require employers to perform an annual assessment of
risk of violence to their employees and develop and implement programs to decrease the risk of workplace violence for their
employees. The House bill would impose punishment by either imprisonment or a fine on patients who assault health care
providers in the process of providing care to the patient.
Massachusetts Universal Health Insurance
According to a recent article in the Boston Globe (Saturday, August 11) the offices that are processing applications for the
state-subsidized health insurance have been overwhelmed, causing a substantial delay in coverage for many residents of
Massachusetts. Many applications have been lost or misplaced, which has led to increased confusion and additional delays.
More than 6,000 people applied per week in the two weeks before the July 1st deadline and it is estimated that in total 105,000
have been enrolled in Commonwealth Care.
Federal Government
Title VIII Funding
The House of Representatives passed their version of FY 2008 appropriations on July 19th. Included was a $16 million
increase in funding for Nursing Workforce Funding. The Senate will be considering their budget in September and it is
expected that their Bill will contain a $20 million increase for Title VIII funding. Overall, H.R. 3043, the Labor and Health
and Human Services funding bill, would appropriate $165.6 million for Title VIII programs. (www.capitolupdate.org)
Wicker Amendment
Rep. Roger Wicker (R-MS) has attempted to introduce an amendment to remove the requirement for annual fit testing of
respirators for health care workers. Opponents to this amendment state that this amendment, if passed, would place health
care workers at an unnecessary risk for contracting an airborne type of disease, such as TB. The Occupational Safety and
Health Administration (OSHA) has recommended that health care workers have annual fit testing of these respirators to
ensure proper fit. The annual cost for fit testing is estimated to be $16.80 per person. Rep. Wicker withdrew his amendment
following active opposition from nurses. (www.capitolupdate.org)
Mandatory Overtime
On July 20th, Senators Kennedy and Kerry, along with 14 other co-sponsors, reintroduced the Safe Nursing and Patient Care
Act, which would prohibit the use of mandatory overtime as a staffing tool. S. 1842 would bar health care facilities that receive
Medicare funding from requiring an RN or LPN to work more than their assigned, predetermined, regularly scheduled shift.
The bill also contains language that prevents facilities from requiring nurses to work more that 12 hours in a 24 hour period
or more than 80 hours in a 2 week period. In addition, the bill would prevent employers from penalizing or retaliating against
a nurse who either refused to work mandatory overtime or who is cooperating in an investigation regarding the use of
mandatory overtime.
There are several states that have prohibited or limited the use of mandatory overtime but at the present time, there are no
federal regulations in place that address the problem. (www.capitolupdate.org)
Mayflower Summer 2007 Volume 18 Issue 3
Governmental Affairs
Maureen McLaughlin, BSN, RN, CPAN, CAPA
Massachusetts State News
Pay for Performance Plans
MassHealth officials have unveiled their “pay for performance” initiative that is slated to start in October, when hospitals
contracting with the program will be eligible for bonus rate increases by meeting new quality standards. The program seeks to
reward providers for excelling in or improving quality of care delivered to MassHealth members and it is estimated that it will
initially cost $20 million during its first year. MassHealth provides health care coverage to nearly one million financially needy
children, families, seniors, and people with disabilities in the state.
The new initiative is part of the health care reform law enacted a year ago, which calls for MassHealth hospital rate increases
to be contingent on quality standards and performance measures, including the reduction of racial and ethnic disparities.
The ‘pay for performance plan’ stipulates that all acute care hospitals contracting with MassHealth will be asked to provide
information relative to five measures: maternity, pediatric/asthma, pneumonia, health disparities and surgical
infection/prevention. Hospitals will also be required to participate in at least one public reporting initiative, which discloses
basic safety practices.
After the data is assessed, MassHealth would reward “bonus points” to hospitals based on their ability to meet industry
benchmarks, minimum thresholds and improvement markers.
Due to the fact that MassHealth has not collected data on some of the measures, hospitals will be compensated for
improvement in some comparative areas and for reporting only in new areas. (State House News Service, May 23, 2007)
Senate Bill 1288: An Act Adopting the Nurse Licensure Compact
Senator Moore has introduced a bill that would add Massachusetts to the National Council of State Boards of Nursing
Licensure Compact. The Nursing Licensure Compact is a mutual recognition model of nursing licensure that allows a nurse
to have one license in his/her state of residency and to practice in other states, either physically or via the use of technology.
The nurse would be expected to adhere to each individual state’s nursing practice act and regulations pertinent to nursing.
Under mutual recognition, a nurse may practice across state lines unless otherwise restricted. At the present time, 22 states
have joined. (For further information go to: www.ncsbn.org/index.htm.)
In order to achieve mutual recognition, each state must enact legislation that authorizes the Nurse Licensure Compact, such as
Senate Bill 1288. As cited in the text of the bill, the Nurse Licensure Compact: “will increase public access to safe nursing
care, provide for the rapid deployment of qualified nurses in response to a state of emergency, address the emerging practice of
nursing through telecommunications technology, and build effective interstate communication on licensure and enforcement
issues.”
This Bill has not yet been approved.
National News
HRSA Releases Report on RN Survey
The Department of Health Resources and Services Administration’s (HRSA) Bureau of Health Professions has released its
report on its periodic survey of RNs. The latest of these reports is called The Registered Nurse Population: Findings from the
March 2004 National Sample Survey of Registered Nurses. The report includes data from seven recurring surveys, 1980
through 2004. Findings are as follows:
In her comments, HRSA Administrator Betty Duke said, “While we are encouraged by the growth in the number of RNs, we
are concerned about the aging of the nursing work force and how this will impact the future supply of nurses.” (www.ena.
org/government/washington March 2007 edition)
(A copy of this survey is available at www.hrsa.gov)
Breast Cancer Patient Protection Act
Both the Senate and the House in Washington have similar bills related to the hospitalization of mastectomy patients. S. 459
and H.R. 119 are titled ‘Breast Cancer Patient Protection Act of 2007.’ These bills, if enacted would require health insurance
carriers and group health plans to offer benefits for both inpatient and outpatient care related to breast cancer surgery and
breast cancer treatment. It further stipulates that inpatient coverage for a patient who has had a mastectomy or lumpectomy
should not be limited to less than 48 hours and that coverage for procedures for lymph node dissection should not be less than
24 hours. However, if both the attending physician and the patient determine that a shorter hospital stay is medically
appropriate, then that decision will supersede the 48 hour and 24 hour mandate. These bills are in committee at the present
time.
Mayflower Spring 2007 Volume 18 Issue 2
Governmental Affairs
Maureen McLaughlin, BSN, RN, CPAN
Health Insurance
It is estimated that the cost of health insurance for the average individual in Massachusetts will be as high as $380/month. The
Board that is overseeing the state’s universal health insurance law is requesting bids from insurers in hopes of lowering the
cost passed on to the individual. Individuals in Massachusetts who do not already possess health insurance will be required to
obtain coverage by July 1, 2007 or pay a penalty. The Commonwealth is seeking coverage that offers comprehensive coverage
and would limit out-of-pocket costs to $5000 for an individual and $10,000 for a family and also include prescription drug
coverage. Advocacy groups are concerned that many cannot afford the costs that are being discussed. Senator Moore is
considering supporting the idea of delaying the penalty application for another year.
Safe Patient Handling/Lifting Legislation
H. 2662 is legislation aimed at ensuring safe patient handling. This bill seeks to establish standards for the lifting and
handling of patients to reduce the amount of nurses injured during this patient care activity. Work-related lifting injuries may
significantly contribute to nurses leaving the profession.
Prevent Falls Among Older Adults
Senator Moore is planning on introducing legislation addressing the high number of falls experienced by older adults. This
legislation focuses primarily on education of older adults to reduce falls and prevent repeat falls.
Reforming the Medical Malpractice System
Senator Moore has also introduced legislation that addresses medical malpractice in Massachusetts. This bill, if enacted, would
place stricter control on expert witnesses, require physicians to provide education to their patients to reduce postoperative
complications, and it would also require that hospitals file staffing plans to ensure adequate nursing care is being provided.
Emergency Preparedness
On December 19, President Bush signed legislation aimed at improving America’s preparedness for pandemic flu and a
biological terrorist attack. A bill titled ‘The Pandemic and All-Hazards Preparedness Act, S. 3678, was approved by Congress.
This new legislation establishes an office within Health and Human Services (HHS) that will serve as a single point of
authority for vaccine development.
This law also makes HHS the overseer of the National Disaster Medical System and the lead agency for a public health and
medical response during a national emergency.
In addition, the legislation allocates $1 billion each year in federal grants to states to assist with preparedness. The President
has authorized $474 million in 2007 to help hospitals improve surge capacity and $35 million in grants for improved real-time
disease detection. However, Congress must still appropriate the funding.
Mayflower Winter 2007 Volume 18 Issue 1
Governmental Affairs
Maureen McLaughlin, BSN, RN, CPAN
Mandated Staffing Ratios
Rep Christine Canavan (D-Brockton) has informed legislative colleagues that she intends to re-file the House staffing bill (HB
4988), which if enacted would implement mandated staffing ratios. MASPAN remains opposed to this legislation.
Statewide Health Insurance
In April 2006, the Massachusetts legislature approved the Health Care Access and Affordability Act, aimed at ensuring that the
majority of uninsured Massachusetts residents (estimated to be 150,000) have access to affordable health insurance within the
next three years. This new law is the first of its kind in the country. The Health Care Access and Affordability Act:
• Requires employers with eleven or more employees to either provide health insurance to their employees or pay $295 to the
state
• Requires individuals to purchase health insurance if a comprehensive plan is available at an affordable price or face tax
penalties
• Preserves Medicaid coverage and benefits and expands them to cover more low-income unemployed people, immigrants,
people with disabilities, and children and families. This measure also restored adult dental care for Medicaid recipients.
• Makes health insurance more affordable for uninsured working people through the Commonwealth Care Health Insurance
Program, which will subsidize the cost of health insurance for those earning up to 300% of the poverty level.
• Requires insurers to cover young people up to the age of 25 under their parents’ family plans
• Increases Medicaid payments to providers, maintains funding for safety net hospitals, and requires providers to meet certain
quality-improvement goals and reduce racial and ethnic health care disparities.
• Establishes a new state agency called the Commonwealth Health Insurance Connector to define “affordable” health
insurance for different income levels and to sell policies that are of value. (Hart, MA. (2006) Policy and politics.
Massachusetts: Expanding access to care. American Journal of Nursing, 106, 10: 38-39.)
There have been many meetings to develop strategies for a successful implementation of this new access to health insurance
plan. Recent meetings have mainly focused on the group of uninsured people who are not eligible for the state-subsidized
“Commonwealth Care” plan because they earn above 300% (see above) of the federal poverty level and for small employers not
offering employer-sponsored insurance. Board members reported that they need to define specifically what it means to be
“underinsured,” so coverage can be offered to address that situation.
Bob Carey, the Connector's director of planning and development, said 200,000 people are uninsured and not eligible for the
Commonwealth Care program. About 50 percent of those are between 19 to 44 years old, he said.
The board needs to determine the “minimum credible coverage” criteria by the next meeting on Nov. 30 so officials can issue
a Request for Responses (RFR) in December to commercial insurance carriers hoping to offer coverage programs to those who
are uninsured. Some board members have expressed concerns that Massachusetts residents would encounter too many choices
and struggle to make the best decisions.
Currently, the Connector has entered into contract with four Medicaid Managed Care Organizations to provide "affordable"
and subsidized insurance plans to uninsured individuals and families who earn up to 300 percent of the federal poverty level.
The Connector Authority spent much of this fall developing guidelines for subsidized plans. According to the state mandate,
on July 1, 2007 nearly all residents are required to carry health insurance that meets the state’s minimum coverage
requirement or face financial penalties that would be exacted through tax returns. The Connector plans to have its Policy
Subcommittee review and develop recommendations for the minimum creditable coverage criteria and the Connector plans to
vote on the recommendations on Nov. 30. The Connector started enrolling all the individuals who earn below the 100 percent
of the federal poverty level in full-state subsidized health insurance plans in October. As of Nov. 3, the latest figure disclosed,
3,569 individuals have enrolled in one of the four state-sponsored health insurance plans. About 20,000 residents are eligible
for the first phase of the Commonwealth Care program. In January, the board plans to launch the second phase of the
program and enroll individuals and families that earn between 100 to 300 percent of the federal poverty level in “affordable”
and partly state-subsidized health plans.
(State House News Service, Nov 9, 2006)
Health Reform Law Education
At a Blue Cross Blue Shield Foundation summit this week, experts in health care said they fear too many Massachusetts
residents don't know enough about their roles and
responsibilities under the dramatic health care law outlined above that will require individuals to have insurance by July 1,
2007. A major public outreach and education campaign is needed, but proponents of that campaign are worried because
Gov. Romney just cut $2.7 million allocated for outreach. A foundation-commissioned poll found majority support for the
law and its new program premiums for low-income residents. It also found fears that the law will trigger tax hikes on small
business. In addition, there are concerns that residents who earn less that $50,000 will be opposed and/or financially
challenged if they need to purchase health insurance.
(State House News Service, Nov. 17, 2006)
Massachusetts Health Care Costs
A recent survey found that the healthcare costs in Massachusetts are among the highest in the nation and they are increasing
at a faster rate than in most other states. Average healthcare costs for an individual employee, including medical, dental,
dependent coverage and worker premium contribution, reached $9,428 in 2006 in Massachusetts. The only other states that
contribute higher amounts are Alaska, New Hampshire, and Wisconsin. This figure indicates an increase of 8.2% over costs in
2005, also a faster rate of increase than most states.
There are several factors that contribute to this cost. One factor is the large number of teaching hospitals in Boston, as well as
the fact the Massachusetts has a high standard of healthcare.
In addition, Massachusetts has been slow to adopt a “consumer-directed” health care plan, in which the consumer pays a large
upfront deductible before benefits kick in. This type of plan has lower costs that the typical HMO plans, although these plans,
by their design, require the member to contribute the first dollar of cost.
Healthcare costs in Massachusetts have increased by at least 10% every year for the past 6 years. For 2007, the major health
care insurers are predicting premium increases between 8 and 13%. (Boston Globe, Nov. 20, 2006, p. E1, E4)
The City of Boston’s healthcare costs have nearly doubled in the past six years and now require the property tax of five families
to pay the premium on one city employee’s family health plan. In order to bring some of the costs under control the city may
begin shifting some of the healthcare policies and join the state’s healthcare plan. The estimated cost of health insurance for
the city of Boston is $235 million, an increase of 92% since 2001. This year health insurance absorbed half of the city’s total
budget increase. There are 28,600 subscribers to the city’s healthcare services, of which 45,000 are retirees. (Boston Globe,
November 30, 2006, p. B 5.)
Charge Nurses as Supervisors
In a long awaited ruling, the National Labor Relations Board (NLRB) has ruled that charge nurses are supervisors under
federal law and thus are exempt from union protections. This ruling defines a supervisor as a worker who gives assignments to
other workers, is held responsible for the performance of those assignments, and exercises independent judgment.
Hundreds of nurses could be affected by this new ruling, which would impact on their ability to bargain collectively. While
supervisors can join unions, they are not legally protected from being fired or disciplined.
(RN, Vol. 69, No. 11, p. 12)
Pandemic Preparation
The American Public Health Association (APHA) met in Boston in November. One of the hot topics was how to best address
preparedness in the event of an influenza pandemic. APHA has recommended comprehensive national planning for this event.
They feel that the U.S. Department of Health and Human Services (HHS) should be administratively responsible for this
planning, not the Homeland Security Department.
The coordination of agencies in the event of a pandemic was also discussed in their recommendations. The APHA urges
revision of the National Response Plan to ensure that federal, state, and local officials are included in any planning. They also
urged increased funding in order for public health care workers and health care institutions to be able to scale up their efforts
to respond to a pandemic flu.(www.apha.org). For additional information related to the pandemic flu and other concerns,
please see related articles at www.cdc.gov.
Governmental Affairs
Maureen McLaughlin, BSN, RN, CPAN, CAPA
A summary of the bills currently in the Massachusetts Legislature that affect nursing and/or health care:
Safe Staffing
House Bill (HB) # 2059: this bill, if enacted, will establish nurse to patient ratios in acute care facilities and charge the
Department of Public Health with the responsibility of ensuring compliance.
Senate Bill (SB) # 1244: a broader bill that allows the institutions to establish their staffing patterns. The Department of
Public Health will monitor the staffing plans.
A hearing was held on October 24 in the State House. Legislators heard testimony from various nursing representatives. It is
expected discussion on this key issue will continue after the New Year.
Other Bills:
HB 2052: Safe Patient Handling, sponsored by Representative Jennifer Callahan: requires all health care facilities to develop
and implement safe patient handling policies, to identify, assess, and develop strategies to control risk of injury to patients and
health care workers associated with the lifting, transferring, repositioning, or movement of a patient or equipment. This bill
also regulates implementation of such policies. It would establish credits for costs associated with implementing the above
policies.
HB 921: Ensure Consumer Choice of Nurse Practitioner, sponsored by Rep. Jennifer Callahan: would allow consumers to
choose a Nurse Practitioner of their choice as their primary health provider.
HB 2060: An Act Relative to a Registered Nurse Seat on the Public Health Council, sponsored by Rep. Stephen Canessa:
mandates the inclusion of one registered nurse on the Public Health Council within the Department of Public Health.
HB 2088: An Act Relative to the Shortage of Registered Nurses, sponsored by Rep. Mark Falzone: classifies certified EMT-
paramedics with two years experience and with a Bachelor of Science degree from an accredited college or university as
graduates of an approved school of nursing. *** Please note that MASPAN does not support this bill!!***
HB 2140: An Act Creating a Nursing Advisory Board, sponsored by Rep. Kay Khan: establishes the Nursing Advisory Board in
the Executive Office of Health and Human Services, advising the Governor on matters related to the nursing shortage. It will
consist of eight members representing various areas of nursing practice.
Mayflower Fall 2007 Volume 18 Issue 4
Governmental Affairs
Maureen McLaughlin, BSN, RN, CPAN, CAPA
There are several bills on the legislative calendar that may affect nurses if enacted.
Massachusetts State Government
Mandated Staffing Ratios
Senate 1244 - An Act to Promote Safe Patient Care and Support the Nursing Profession. Lead Sponsor Senator Richard Moore
Alternative to proposed mandated staffing ratios. Supports funding for nursing education and an analysis of the nursing
workforce.
House 2059 - An Act Relative to Patient Safety. Lead Sponsor Christine Canavan.
This is the mandated staffing ratio bill supported and developed by the Massachusetts Nurses Association (MNA). Please note
that this is not a compromise bill as is often suggested by the MNA. This bill has simply undergone revision and its original
opponents remain opposed to the language and the concept of mandated staffing ratios.
There will be a public hearing on both of these bills on October 24, 2007.
Advanced Practice Nurses
House 1144 and Senate 1236 - An Act Relative to Advanced Practice Nursing. Lead Sponsor Rep. Kay Khan and Senator Mark
Montigny.
This bill would add nurse anesthetists and clinical nurse specialists to Advanced Practice Nurse (APN) groups that have
prescriptive authority.
Nurse Licensure Compact
Senate 1288 - An Act Adopting the Nurse Licensure Compact. Lead Sponsor Senator Richard Moore.
The bill would allow Massachusetts to join the Nursing Licensure Compact, which facilitates interstate communication and
recognition on nursing licensure and disciplinary action. Currently, there are 38 states in the Licensure Compact. Benefits
cited are increased access to nursing care during emergen-
cies and states of disaster, as well as an improved relocation process.
Pandemic Flu Preparation
Senate 685 and Senate 689 - An Act to Support Pandemic Preparation and Response and An Act Relative to Pandemic
Disaster Planning by Health Care Providers. Lead sponsor Senator Richard Moore.
These bills, as indicated by their titles, provide for appropriations for essential supplies to prepare for a pandemic flu. The
latter bill provides liability coverage and legal protection for health care providers who volunteer to assist during a pandemic
event or a state-declared emergency. These bills have currently stalled due to funding issues.
Safe Patient Handling
House 2052 - An Act Providing for Safe Patient Handling. Lead Sponsor Jennifer Callahan.
This bill would set standards for lifting, moving, and handling of patients and is designed to curb injuries suffered by RNs
during the lifting and moving of patients. Many states have either recently enacted or are considering similar legislation.
Violence in the Workplace
House 1700 and Senate 1345 - An Act Relative to Assault and Battery of Health Care Providers and An Act Requiring Health
Care Employers to Develop and Implement programs to Prevent Workplace Violence. Lead Sponsors Rep. Michael Rodrigues
and Senator Jarrett Barrios.
Both of these bills address workplace violence. The Senate bill would require employers to perform an annual assessment of
risk of violence to their employees and develop and implement programs to decrease the risk of workplace violence for their
employees. The House bill would impose punishment by either imprisonment or a fine on patients who assault health care
providers in the process of providing care to the patient.
Massachusetts Universal Health Insurance
According to a recent article in the Boston Globe (Saturday, August 11) the offices that are processing applications for the
state-subsidized health insurance have been overwhelmed, causing a substantial delay in coverage for many residents of
Massachusetts. Many applications have been lost or misplaced, which has led to increased confusion and additional delays.
More than 6,000 people applied per week in the two weeks before the July 1st deadline and it is estimated that in total 105,000
have been enrolled in Commonwealth Care.
Federal Government
Title VIII Funding
The House of Representatives passed their version of FY 2008 appropriations on July 19th. Included was a $16 million
increase in funding for Nursing Workforce Funding. The Senate will be considering their budget in September and it is
expected that their Bill will contain a $20 million increase for Title VIII funding. Overall, H.R. 3043, the Labor and Health
and Human Services funding bill, would appropriate $165.6 million for Title VIII programs. (www.capitolupdate.org)
Wicker Amendment
Rep. Roger Wicker (R-MS) has attempted to introduce an amendment to remove the requirement for annual fit testing of
respirators for health care workers. Opponents to this amendment state that this amendment, if passed, would place health
care workers at an unnecessary risk for contracting an airborne type of disease, such as TB. The Occupational Safety and
Health Administration (OSHA) has recommended that health care workers have annual fit testing of these respirators to
ensure proper fit. The annual cost for fit testing is estimated to be $16.80 per person. Rep. Wicker withdrew his amendment
following active opposition from nurses. (www.capitolupdate.org)
Mandatory Overtime
On July 20th, Senators Kennedy and Kerry, along with 14 other co-sponsors, reintroduced the Safe Nursing and Patient Care
Act, which would prohibit the use of mandatory overtime as a staffing tool. S. 1842 would bar health care facilities that receive
Medicare funding from requiring an RN or LPN to work more than their assigned, predetermined, regularly scheduled shift.
The bill also contains language that prevents facilities from requiring nurses to work more that 12 hours in a 24 hour period
or more than 80 hours in a 2 week period. In addition, the bill would prevent employers from penalizing or retaliating against
a nurse who either refused to work mandatory overtime or who is cooperating in an investigation regarding the use of
mandatory overtime.
There are several states that have prohibited or limited the use of mandatory overtime but at the present time, there are no
federal regulations in place that address the problem. (www.capitolupdate.org)
Mayflower Summer 2007 Volume 18 Issue 3
Governmental Affairs
Maureen McLaughlin, BSN, RN, CPAN, CAPA
Massachusetts State News
Pay for Performance Plans
MassHealth officials have unveiled their “pay for performance” initiative that is slated to start in October, when hospitals
contracting with the program will be eligible for bonus rate increases by meeting new quality standards. The program seeks to
reward providers for excelling in or improving quality of care delivered to MassHealth members and it is estimated that it will
initially cost $20 million during its first year. MassHealth provides health care coverage to nearly one million financially needy
children, families, seniors, and people with disabilities in the state.
The new initiative is part of the health care reform law enacted a year ago, which calls for MassHealth hospital rate increases
to be contingent on quality standards and performance measures, including the reduction of racial and ethnic disparities.
The ‘pay for performance plan’ stipulates that all acute care hospitals contracting with MassHealth will be asked to provide
information relative to five measures: maternity, pediatric/asthma, pneumonia, health disparities and surgical
infection/prevention. Hospitals will also be required to participate in at least one public reporting initiative, which discloses
basic safety practices.
After the data is assessed, MassHealth would reward “bonus points” to hospitals based on their ability to meet industry
benchmarks, minimum thresholds and improvement markers.
Due to the fact that MassHealth has not collected data on some of the measures, hospitals will be compensated for
improvement in some comparative areas and for reporting only in new areas. (State House News Service, May 23, 2007)
Senate Bill 1288: An Act Adopting the Nurse Licensure Compact
Senator Moore has introduced a bill that would add Massachusetts to the National Council of State Boards of Nursing
Licensure Compact. The Nursing Licensure Compact is a mutual recognition model of nursing licensure that allows a nurse
to have one license in his/her state of residency and to practice in other states, either physically or via the use of technology.
The nurse would be expected to adhere to each individual state’s nursing practice act and regulations pertinent to nursing.
Under mutual recognition, a nurse may practice across state lines unless otherwise restricted. At the present time, 22 states
have joined. (For further information go to: www.ncsbn.org/index.htm.)
In order to achieve mutual recognition, each state must enact legislation that authorizes the Nurse Licensure Compact, such as
Senate Bill 1288. As cited in the text of the bill, the Nurse Licensure Compact: “will increase public access to safe nursing
care, provide for the rapid deployment of qualified nurses in response to a state of emergency, address the emerging practice of
nursing through telecommunications technology, and build effective interstate communication on licensure and enforcement
issues.”
This Bill has not yet been approved.
National News
HRSA Releases Report on RN Survey
The Department of Health Resources and Services Administration’s (HRSA) Bureau of Health Professions has released its
report on its periodic survey of RNs. The latest of these reports is called The Registered Nurse Population: Findings from the
March 2004 National Sample Survey of Registered Nurses. The report includes data from seven recurring surveys, 1980
through 2004. Findings are as follows:
- The number of licensed RNs in the United States grew by almost 8% between 2000 and 2004 to a new high of 2.9
million - Real earnings for RNs grew significantly.
- Average age of the RN work force 46.8 years in 2004. This represents the highest average age since the first comparable
report was published in 1980 - Just over 41% of RNs were 50 years of age or older in 2004, a dramatic increase from 33% in 2000 and 25% in 1980.
- Only 8% of RNs were under the age of 30 in 2004, compared to 25% in 1980.
- More than 83% of RNs with active licenses were employed in nursing in 2004, the highest employment rate since1980
- Average annual earnings for RNs in 2004 were $57,785, a nearly 14% increase in salaries since 2000 and the first
significant increase since 1992 - The number of RNs with master’s or doctorate degrees rose to 376,901 in 2004, an increase of 37% from 2000 and up
from 85,860 in 1980.
In her comments, HRSA Administrator Betty Duke said, “While we are encouraged by the growth in the number of RNs, we
are concerned about the aging of the nursing work force and how this will impact the future supply of nurses.” (www.ena.
org/government/washington March 2007 edition)
(A copy of this survey is available at www.hrsa.gov)
Breast Cancer Patient Protection Act
Both the Senate and the House in Washington have similar bills related to the hospitalization of mastectomy patients. S. 459
and H.R. 119 are titled ‘Breast Cancer Patient Protection Act of 2007.’ These bills, if enacted would require health insurance
carriers and group health plans to offer benefits for both inpatient and outpatient care related to breast cancer surgery and
breast cancer treatment. It further stipulates that inpatient coverage for a patient who has had a mastectomy or lumpectomy
should not be limited to less than 48 hours and that coverage for procedures for lymph node dissection should not be less than
24 hours. However, if both the attending physician and the patient determine that a shorter hospital stay is medically
appropriate, then that decision will supersede the 48 hour and 24 hour mandate. These bills are in committee at the present
time.
Mayflower Spring 2007 Volume 18 Issue 2
Governmental Affairs
Maureen McLaughlin, BSN, RN, CPAN
Health Insurance
It is estimated that the cost of health insurance for the average individual in Massachusetts will be as high as $380/month. The
Board that is overseeing the state’s universal health insurance law is requesting bids from insurers in hopes of lowering the
cost passed on to the individual. Individuals in Massachusetts who do not already possess health insurance will be required to
obtain coverage by July 1, 2007 or pay a penalty. The Commonwealth is seeking coverage that offers comprehensive coverage
and would limit out-of-pocket costs to $5000 for an individual and $10,000 for a family and also include prescription drug
coverage. Advocacy groups are concerned that many cannot afford the costs that are being discussed. Senator Moore is
considering supporting the idea of delaying the penalty application for another year.
Safe Patient Handling/Lifting Legislation
H. 2662 is legislation aimed at ensuring safe patient handling. This bill seeks to establish standards for the lifting and
handling of patients to reduce the amount of nurses injured during this patient care activity. Work-related lifting injuries may
significantly contribute to nurses leaving the profession.
Prevent Falls Among Older Adults
Senator Moore is planning on introducing legislation addressing the high number of falls experienced by older adults. This
legislation focuses primarily on education of older adults to reduce falls and prevent repeat falls.
Reforming the Medical Malpractice System
Senator Moore has also introduced legislation that addresses medical malpractice in Massachusetts. This bill, if enacted, would
place stricter control on expert witnesses, require physicians to provide education to their patients to reduce postoperative
complications, and it would also require that hospitals file staffing plans to ensure adequate nursing care is being provided.
Emergency Preparedness
On December 19, President Bush signed legislation aimed at improving America’s preparedness for pandemic flu and a
biological terrorist attack. A bill titled ‘The Pandemic and All-Hazards Preparedness Act, S. 3678, was approved by Congress.
This new legislation establishes an office within Health and Human Services (HHS) that will serve as a single point of
authority for vaccine development.
This law also makes HHS the overseer of the National Disaster Medical System and the lead agency for a public health and
medical response during a national emergency.
In addition, the legislation allocates $1 billion each year in federal grants to states to assist with preparedness. The President
has authorized $474 million in 2007 to help hospitals improve surge capacity and $35 million in grants for improved real-time
disease detection. However, Congress must still appropriate the funding.
Mayflower Winter 2007 Volume 18 Issue 1
Governmental Affairs
Maureen McLaughlin, BSN, RN, CPAN
Mandated Staffing Ratios
Rep Christine Canavan (D-Brockton) has informed legislative colleagues that she intends to re-file the House staffing bill (HB
4988), which if enacted would implement mandated staffing ratios. MASPAN remains opposed to this legislation.
Statewide Health Insurance
In April 2006, the Massachusetts legislature approved the Health Care Access and Affordability Act, aimed at ensuring that the
majority of uninsured Massachusetts residents (estimated to be 150,000) have access to affordable health insurance within the
next three years. This new law is the first of its kind in the country. The Health Care Access and Affordability Act:
• Requires employers with eleven or more employees to either provide health insurance to their employees or pay $295 to the
state
• Requires individuals to purchase health insurance if a comprehensive plan is available at an affordable price or face tax
penalties
• Preserves Medicaid coverage and benefits and expands them to cover more low-income unemployed people, immigrants,
people with disabilities, and children and families. This measure also restored adult dental care for Medicaid recipients.
• Makes health insurance more affordable for uninsured working people through the Commonwealth Care Health Insurance
Program, which will subsidize the cost of health insurance for those earning up to 300% of the poverty level.
• Requires insurers to cover young people up to the age of 25 under their parents’ family plans
• Increases Medicaid payments to providers, maintains funding for safety net hospitals, and requires providers to meet certain
quality-improvement goals and reduce racial and ethnic health care disparities.
• Establishes a new state agency called the Commonwealth Health Insurance Connector to define “affordable” health
insurance for different income levels and to sell policies that are of value. (Hart, MA. (2006) Policy and politics.
Massachusetts: Expanding access to care. American Journal of Nursing, 106, 10: 38-39.)
There have been many meetings to develop strategies for a successful implementation of this new access to health insurance
plan. Recent meetings have mainly focused on the group of uninsured people who are not eligible for the state-subsidized
“Commonwealth Care” plan because they earn above 300% (see above) of the federal poverty level and for small employers not
offering employer-sponsored insurance. Board members reported that they need to define specifically what it means to be
“underinsured,” so coverage can be offered to address that situation.
Bob Carey, the Connector's director of planning and development, said 200,000 people are uninsured and not eligible for the
Commonwealth Care program. About 50 percent of those are between 19 to 44 years old, he said.
The board needs to determine the “minimum credible coverage” criteria by the next meeting on Nov. 30 so officials can issue
a Request for Responses (RFR) in December to commercial insurance carriers hoping to offer coverage programs to those who
are uninsured. Some board members have expressed concerns that Massachusetts residents would encounter too many choices
and struggle to make the best decisions.
Currently, the Connector has entered into contract with four Medicaid Managed Care Organizations to provide "affordable"
and subsidized insurance plans to uninsured individuals and families who earn up to 300 percent of the federal poverty level.
The Connector Authority spent much of this fall developing guidelines for subsidized plans. According to the state mandate,
on July 1, 2007 nearly all residents are required to carry health insurance that meets the state’s minimum coverage
requirement or face financial penalties that would be exacted through tax returns. The Connector plans to have its Policy
Subcommittee review and develop recommendations for the minimum creditable coverage criteria and the Connector plans to
vote on the recommendations on Nov. 30. The Connector started enrolling all the individuals who earn below the 100 percent
of the federal poverty level in full-state subsidized health insurance plans in October. As of Nov. 3, the latest figure disclosed,
3,569 individuals have enrolled in one of the four state-sponsored health insurance plans. About 20,000 residents are eligible
for the first phase of the Commonwealth Care program. In January, the board plans to launch the second phase of the
program and enroll individuals and families that earn between 100 to 300 percent of the federal poverty level in “affordable”
and partly state-subsidized health plans.
(State House News Service, Nov 9, 2006)
Health Reform Law Education
At a Blue Cross Blue Shield Foundation summit this week, experts in health care said they fear too many Massachusetts
residents don't know enough about their roles and
responsibilities under the dramatic health care law outlined above that will require individuals to have insurance by July 1,
2007. A major public outreach and education campaign is needed, but proponents of that campaign are worried because
Gov. Romney just cut $2.7 million allocated for outreach. A foundation-commissioned poll found majority support for the
law and its new program premiums for low-income residents. It also found fears that the law will trigger tax hikes on small
business. In addition, there are concerns that residents who earn less that $50,000 will be opposed and/or financially
challenged if they need to purchase health insurance.
(State House News Service, Nov. 17, 2006)
Massachusetts Health Care Costs
A recent survey found that the healthcare costs in Massachusetts are among the highest in the nation and they are increasing
at a faster rate than in most other states. Average healthcare costs for an individual employee, including medical, dental,
dependent coverage and worker premium contribution, reached $9,428 in 2006 in Massachusetts. The only other states that
contribute higher amounts are Alaska, New Hampshire, and Wisconsin. This figure indicates an increase of 8.2% over costs in
2005, also a faster rate of increase than most states.
There are several factors that contribute to this cost. One factor is the large number of teaching hospitals in Boston, as well as
the fact the Massachusetts has a high standard of healthcare.
In addition, Massachusetts has been slow to adopt a “consumer-directed” health care plan, in which the consumer pays a large
upfront deductible before benefits kick in. This type of plan has lower costs that the typical HMO plans, although these plans,
by their design, require the member to contribute the first dollar of cost.
Healthcare costs in Massachusetts have increased by at least 10% every year for the past 6 years. For 2007, the major health
care insurers are predicting premium increases between 8 and 13%. (Boston Globe, Nov. 20, 2006, p. E1, E4)
The City of Boston’s healthcare costs have nearly doubled in the past six years and now require the property tax of five families
to pay the premium on one city employee’s family health plan. In order to bring some of the costs under control the city may
begin shifting some of the healthcare policies and join the state’s healthcare plan. The estimated cost of health insurance for
the city of Boston is $235 million, an increase of 92% since 2001. This year health insurance absorbed half of the city’s total
budget increase. There are 28,600 subscribers to the city’s healthcare services, of which 45,000 are retirees. (Boston Globe,
November 30, 2006, p. B 5.)
Charge Nurses as Supervisors
In a long awaited ruling, the National Labor Relations Board (NLRB) has ruled that charge nurses are supervisors under
federal law and thus are exempt from union protections. This ruling defines a supervisor as a worker who gives assignments to
other workers, is held responsible for the performance of those assignments, and exercises independent judgment.
Hundreds of nurses could be affected by this new ruling, which would impact on their ability to bargain collectively. While
supervisors can join unions, they are not legally protected from being fired or disciplined.
(RN, Vol. 69, No. 11, p. 12)
Pandemic Preparation
The American Public Health Association (APHA) met in Boston in November. One of the hot topics was how to best address
preparedness in the event of an influenza pandemic. APHA has recommended comprehensive national planning for this event.
They feel that the U.S. Department of Health and Human Services (HHS) should be administratively responsible for this
planning, not the Homeland Security Department.
The coordination of agencies in the event of a pandemic was also discussed in their recommendations. The APHA urges
revision of the National Response Plan to ensure that federal, state, and local officials are included in any planning. They also
urged increased funding in order for public health care workers and health care institutions to be able to scale up their efforts
to respond to a pandemic flu.(www.apha.org). For additional information related to the pandemic flu and other concerns,
please see related articles at www.cdc.gov.
Governmental Affairs
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Governmental Affairs Director
Maureen McLaughlin, BSN, RN, CPAN, CAPA
Welcome to the Governmental Affairs web page.
The mission of this web page is to keep
members and viewers informed about state
legislative activities.
The governmental affairs articles that are
published in the Mayflower will be posted here
as well.
In addition, there is a link to the ASPAN
governmental affairs web site, which will
contain legislative activities at the federal level.
www.aspan.org
To go to ASPAN Governmental Affairs:
click on "Resources" then "Legislative Resources" near
the bottom of the pull-down menu.
Governmental Affairs Archived Pages
Maureen McLaughlin, BSN, RN, CPAN, CAPA
Welcome to the Governmental Affairs web page.
The mission of this web page is to keep
members and viewers informed about state
legislative activities.
The governmental affairs articles that are
published in the Mayflower will be posted here
as well.
In addition, there is a link to the ASPAN
governmental affairs web site, which will
contain legislative activities at the federal level.
www.aspan.org
To go to ASPAN Governmental Affairs:
click on "Resources" then "Legislative Resources" near
the bottom of the pull-down menu.
Governmental Affairs Archived Pages