Final Updated APRN Regulations Authorizing Full Practice Authority Published

The final version, 244 CMR 4.00: ADVANCED PRACTICE REGISTERED NURSING, was published and took effect on September 3, 2021.

The regulations can be found at: https://www.mass.gov/doc/244-cmr-4-advanced-practice-registered-nursing/download 

The major changes for Certified Nurse Practitioners relate to independent prescriptive practice and authority to serve as a Qualified Healthcare Professional to supervise the prescriptive practice of other APRNs.

As outlined in 244 CMR 4.07 (2):
(a) CRNAs, CNPs or PNMHCSs with a minimum of two years of supervised practice may engage in prescriptive practice without supervision upon submission of an attestation to the Board that the CRNA, CNP or PNMHCS has completed a minimum of two years of supervised practice by a Qualified Healthcare Professional.

Per 244 CMR 4.07 (d), a Qualified Healthcare Professional is defined for APRNs as:
2. a CRNA, CNP or PNMHCS who holds:
a. a valid Registered Nurse license in good standing issued by the Board; and
b. advanced practice authorization issued by the Board that it is in the same clinical category as the person being supervised or advanced practice authorization in an area appropriately related to the practice of the person being supervised; and
3. a controlled substance registration issued by the U.S. Drug Enforcement Administration, or the Department of Public Health, or both, for a minimum of one year;
and
4. either:
a. a combination of supervised practice for a minimum of two years plus independent practice authority for a minimum of one year; or
b. three years of independent practice authority.

The MCNP had requested changes in the language related to the definition of Qualified Healthcare Professional, specifically the removal of the 1-year of independent practice authority requirement. Based on the statutory language in the authorizing legislation which required that a minimum number of years of independent practice be specified in the regulations, the Board is not able to change this language/requirement.

The regulations require that a Qualified Healthcare Professional (QHP) who is an APRN have at least one year of independent prescriptive practice. The regulations do not require any formal attestations for NPs who serve as QHPs. 

We have sought clarification from the BORN as to whether independent practice under the March 2020 - June 2021 COVID Emergency Order (EO) satisfies this requirement.  We have confirmed that the one year of independent practice may have occurred during the EO time period. 

Independent practice eligibility under the emergency order alone however, does not satisfy the requirement. CNPs who would like to claim independent practice during the EO period and start serving as a QHP may need to provide evidence to support their eligibility. This may include, but is not limited to:
1.  Evidence they stopped functioning under prescriptive guidelines; and
2.  Evidence they terminated the supervisory relationship with their collaborating physician (during the period being claimed as independent practice).

The Mass Controlled Substance Registration system has made changes so that APRNs can now formally amend their MCSR to indicate their independent practice status. Once an individual MCSR is updated, the APRN will be listed without an associated supervising physician, and this will serve as an official record of their independent status.

For this reason, we encourage any APRNs who are eager to serve as QHPs and do not have evidence of independent practice under the emergency order to update their MCSR as soon as possible so the 1-year period of independent practice can commence. (See instructions below.)

PLEASE NOTE, if you are employed by a group medical practice or larger healthcare institution, we recommend that you FIRST check with your employer to make sure they have addressed any internal policies or EMR changes that will need to be implemented to support your change to independent practice authority.

The MCNP will be hosting an open Zoom meeting in the coming weeks for members who have questions, and in the meantime feel free to Contact Us.

Thank you to all of our members and volunteers who supported our legislative efforts to pass Full Practice Authority and reach this milestone.

The Massachusetts Coalition of Nurse Practitioners