Code of Massachusetts Regulations
243 CMR - BOARD OF REGISTRATION IN MEDICINE
Title 243 CMR 3.00 - The Establishment Of And Participation In Qualified Patient Care Assessment Programs, Pursuant To M.G.L. c. 112, Section 5, and M.G.L. c. 111, Section 203
Section 3.13 - Medical Care Quality/Reporting to the Board - Nursing Homes
Universal Citation: 243 MA Code of Regs 243.3
Current through Register 1531, September 27, 2024
It is the policy of the Board under M.G.L. c. 111, § 203(e) to monitor the quality of medical care and advice delivered by licensees in the nursing home setting and to require that certain information related to potential deficiencies in such care be reported periodically to the Board. Accordingly, notwithstanding anything in 243 CMR 3.00 to the contrary the following (and any others specifically incorporated by reference, including the definitions set forth at 243 CMR 3.02) apply to nursing homes in the Commonwealth that provide levels of care I, II or III (or any combination of them), and to certain physicians who practice medicine or hold administrative positions in such nursing homes. A licensee of the Board may accept employment, be an independent contractor or provide patient care at any such nursing home only if the nursing home meets or exceeds the following requirements.
(1) Review of Professional Competence: Medical Directors and Advisory Physicians.
(a) A nursing home
shall not appoint a medical director or advisory physician (or any individual
performing a similar function) who is a licensee, unless the nursing home does
the following:
1. In the case of a licensee
who, at the time of such appointment and at the time of each required biennial
review thereafter, has staff privileges at a licensed or state-operated
hospital in the Commonwealth, the nursing home shall inquire, prior to the
appointment and at least biennially thereafter, of the status of the licensee's
staff privileges at the hospital in the Commonwealth where the licensee spends
the greatest proportion of his or her time (the Primary
Hospital), and the primary hospital shall submit to the nursing
home a written statement with regard to such status. Said statement shall
either:
a. note that the licensee's staff
privileges are in full force and effect; or
b. detail any modification in said privileges
during the past three years, including any disciplinary action involving the
licensee initiated or closed during the past three years
In the case of 243 CMR 3.13(1)(a)1.b., the nursing home shall assess the relevance of such modification and/or disciplinary action on the licensee's performance, judgment and clinical skills.
2. In the case of a licensee who
does not have staff privileges at a hospital consistent with 243 CMR
3.13(1)(a)1., then the nursing home shall review the professional competence of
such licensee by obtaining the following documents and making the following
assessments:
a. The nursing home shall verify
that the licensee holds a current license to practice medicine, by inspecting
the licensee's license card or requesting verification from the
Board.
b. The nursing home shall
require the licensee to provide and shall obtain and review a copy of the
licensee's most recent application for initial or renewal registration to
practice medicine in the Commonwealth, including all attachments and
explanatory materials submitted with the application, whether required or
voluntarily submitted. To the extent allowed by M.G.L. c. 151B, § 4, the
licensee may delete from such application information disclosing:
(i) an arrest, detention or disposition,
regarding any violation of law in which no conviction resulted;
(ii) a first conviction for any of the
following misdemeanors: drunkenness, simple assault, speeding, minor traffic
violations, affray or disturbance of the peace; and
(iii) any conviction for a misdemeanor where
the date of such conviction or the completion of any period of incarceration
resulting therefrom, whichever date is later, occurred five or more years prior
to the date of the review of professional competence, unless the licensee has
been convicted of any offense within five years immediately preceding the date
of said review.
c. The
nursing home shall require the licensee to provide and shall obtain and review
a listing and description of all malpractice claims and malpractice lawsuits
involving the licensee pending or closed during the previous ten years,
including the information listed in 243 CMR 3.13(1)(a)2.d. and any further
relevant information that it requests. This requirement applies, whether or not
the transaction giving rise to the malpractice claim arose at the nursing home,
and whether or not the malpractice claim is filed with or presented to an
insurance carrier, a court or another entity.
d. The nursing home shall require the
licensee to authorize his or her medical malpractice liability insurance
carrier or carriers to release to the nursing home the following information,
described in M.G.L. c. 112, § 5C, as to claims or actions for damages
pending or closed during the previous ten years, whether or not there has been
a final disposition:
(i) the name and age of
the claimant or plaintiff;
(ii) the
nature and substance of the claim;
(iii) the date and place at which the claim
arose;
(iv) the amounts paid, if
any, and the date and manner of disposition, whether by judgment, settlement or
otherwise; and
(v) the date and
reason for final disposition, if there was no judgment or settlement.
e. With respect to the past ten
years, the nursing home shall obtain from the licensee the name and address of
each hospital and clinic where the licensee has or has had employment,
practice, association for the purpose of providing patient care, or privileges,
and each nursing home where the licensee serves or has served as medical
director or advisory physician (or in any similar position). It shall also
require that the licensee provide the reasons for any discontinuance of any
such employment, practice, association or privileges at any such hospital,
clinic or nursing home.
f. The
nursing home shall obtain from the licensee authorization for release to the
nursing home of any information from any other health care facility, including
any nursing home, where the licensee has or has had employment, practice,
association for the purpose of providing patient care or privileges, if such
information is relevant, directly or indirectly, to the licensee's competence
to practice medicine or to serve as medical director or advisory
physician.
g. The nursing home
shall make reasonable inquiry to each hospital, clinic and nursing home
identified by the licensee pursuant to 243 CMR 3.13(1)(a)2.e., with which the
licensee has or has had employment, practice, association for the purpose of
providing patient care or privileges during the following time periods: a) for
an initial association with the nursing home, during the past ten years; b) for
each subsequent biennial review of the licensee's professional competence,
during the past three years, or during the period from the date of the
immediately prior review to the present, whichever is shorter.
Reasonable Inquiry shall include at least one written
request for:
(i) an assessment of the
licensee's character and competence to practice medicine, and, to the extent
they are relevant to the position of medical director or advisory physician, as
the case may be, an assessment of the licensee's clinical skills; and
(ii) information regarding any pending or
final disciplinary action and malpractice claim. In the case of an inquiry
concerning a period of time when the licensee held a limited license under
M.G.L. c. 112, § 9 (or performed equivalent post-graduate work outside of
the Commonwealth), the hospital where the licensee had his primary assignment
may respond on behalf of its affiliated health care facilities where the
licensee practiced medicine.
(b)243 CMR 3.13(1)(a) shall be implemented as
follows:
1. The professional competence of a
licensee subject to 243 CMR 3.13(1)(a)1. shall be reviewed for the first time
by the nursing home pursuant to
243 CMR 3.00 no later than 90
days following either the licensee's initial credentialing or his or her first
re-credentialing by the primary hospital pursuant to
243 CMR
3.05, whichever occurs first.
2. The professional competence of a licensee
subject to 243 CMR 3.13(1)(a)2. shall be reviewed for the first time by the
nursing home pursuant to 243 CMR 3.13(1)(a)2. no later than 180 days following
the effective date of 243 CMR 3.13 or prior to the licensee's serving as
medical director or advisory physician of the nursing home, whichever occurs
later.
(2) Review of Professional Competence: All Other Licensees. Each licensee shall within 30 days after first providing patient care or practicing medicine at or on behalf of the nursing home furnish the nursing home with his or her name and Massachusetts medical license number.
(3) Major Incident Reporting. When the nursing home files a report with the Department of Public Heath pursuant to its patient abuse regulations ( 105 CMR 155.000: Patient and Resident Abuse Prevention, Reporting, Investigation, Penalties and Registry) or serious incident regulations ( 105 CMR 150.002(G) ) , and said report describes or involves either of the following major incidents, then the nursing home shall file a copy of the report with the Board (with the original of such report to be filed with the Department of Public Health):
(a)
The failure of any licensee responsible for treatment of a nursing home
resident to treat or prescribe a course of treatment for such resident:
1. after said licensee has been contacted by
the nursing home, if:
a. during the course of
events that prompted the nursing home to contact the licensee, the resident
dies or is transferred to a hospital; and
b. such death or transfer may have been
prevented had the physician not failed to treat the resident; or
2. where the licensee is required
by law to examine, treat or prescribe a course of treatment for such resident,
if, during the course of events that would reasonably have been observed if the
licensee had examined or prescribed a course of treatment for the resident, the
resident dies or is transferred to a hospital.
(b) Any medical treatment provided to a
nursing home resident by a licensee, or any failure by a licensee to provide
such treatment, where, directly or indirectly, such treatment or failure to
treat seriously affects the health of a resident, or where it involves or may
involve abuse, mistreatment or neglect. Examples of reportable incidents, for
illustrative purposes only, include an inadequately treated decubitus ulcer, a
medication error or an unevaluated change in mental status.
(4) Compliance Monitoring.
(a) Review of
professional competence under 243 CMR 3.13(1) shall not be deemed "reasonable"
under M.G.L. c. 111, § 203(e), and the Board's determination of reportable
incidents under M.G.L. c. 111, § 203(e) shall not be complete and in
compliance with 243 CMR 3.13 unless the nursing home permits the Board during
ordinary business hours to inspect and copy all resident and nursing home
records and other information developed pursuant to 243 CMR 3.13, and, upon
reasonable notice, to interview appropriate personnel, unless otherwise
prohibited by law. Nothing in
243 CMR 3.00 shall limit any
statutory or regulatory powers of the Board, including but not limited to its
subpoena power under M.G.L. c. 112, § 5.
(b) The enforcement provisions set forth in
243 CMR 3.11(2) and
(3) shall apply to nursing homes.
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