Current through Register 1518, March 29, 2024
(1)
Purpose. The purpose of
244
CMR 4.07 is to establish, pursuant to M.G.L.
c. 112, §§ 80B, 80C, 80E, 80G and 80H, regulations governing the
practice of those APRNs who are registered prescribers.
The following APRNs are eligible to register with the
Department of Public Health pursuant to M.G.L. c. 94C and the U.S. Drug
Enforcement Administration to engage in prescriptive practice.
(a) A Certified Nurse Midwife authorized to
practice within a healthcare system as a nurse midwife by the Board pursuant to
M.G.L. c. 112, §§ 80B, 80C and 80G, and
244 CMR
4.00.
(b)
A Certified Nurse Practitioner authorized to practice as a nurse practitioner
by the Board pursuant to M.G.L. c. 112, §§ 80B and 80E, and
244 CMR
4.00.
(c)
A Psychiatric Clinical Nurse Specialist authorized to practice as a psychiatric
nurse mental health clinical specialist by the Board pursuant to M.G.L. c. 112,
§§ 80B and 80E, and
244 CMR
4.00.
(d)
A Certified Registered Nurse Anesthetist authorized to practice as a nurse
anesthetist by the Board pursuant to M.G.L. c. 112, §§ 80B and 80H,
and 244 CMR
4.00.
For purposes of
244
CMR 4.07, a Qualified Healthcare Professional
means a person who meets the following criteria:
1. a physician who:
a. holds an unrestricted full license issued
by the Board of Registration in Medicine (BORIM) that is in good
standing;
b. is Board-certified in
a specialty area appropriately related to the APRN's area of practice, or has
hospital admitting privileges in a specialty area appropriately related to the
APRN's area of practice; and
c.
holds a valid controlled substances registration issued by the U.S. Drug
Enforcement Administration, or the Department of Public Health, or
both.
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.
(2)
Prescriptive
Practice. CNMs may engage in prescriptive practice as authorized
pursuant to M.G.L. c. 94C, § 7(g) and M.G.L. c. 112, §§ 80C and
80G. CRNAs, CNPs or PNMHCSs may engage in prescriptive practice as authorized
pursuant to M.G.L. c. 94C, § 7 and M.G.L. c. 112, §§ 80B, 80E
and 80H.
(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.
(b) If applying for authorization in
Massachusetts by reciprocity, the CRNA, CNP or PNMHCS may engage in
prescriptive practice without supervision upon the submission of an attestation
to the Board that the CRNA, CNP or PNMHCS has practiced independently or with
supervision as a CRNA, CNP or PNMHCS in a jurisdiction other than Massachusetts
for a minimum of two years.
(c)
CRNAs, CNPs or PNMHCSs with less than two years of supervised practice
experience, or its equivalent, may engage in prescriptive practice with
supervision by a Qualified Healthcare Professional. CRNAs, CNPs or PNMHCSs with
less than two years supervised practice will develop mutually agreed upon
guidelines with the Qualified Healthcare Professional which will:
1. identify the supervising Qualified
Healthcare Professional, including a mechanism for ongoing supervision by
another Qualified Healthcare Professional, including but not limited to,
duration and scope of the supervision;
2. describe circumstances in which Qualified
Healthcare Professional consultation or referral is required;
3. CRNA guidelines do not need to be signed.
CNP and PNMHCS guidelines shall be signed. The guidelines will be kept on file
in the workplace; and
4. conform to
M.G.L. c. 94C, the regulations of the Department of Public Health at
105 CMR
700.000:
Implementation of M.G.L. c.
94C,
105 CMR
721.000:
Standards for Prescription Format and
Security in Massachusetts, M.G.L. c. 112, §§ 80B, 80E, 80H
and 80I, and
244 CMR
4.00.
The Board may request at any time an opportunity to review the
APRN prescriptive practice guidelines. Failure to provide guidelines to the
Board is a basis for and may result in disciplinary action. The Board may
require changes in the guidelines if it determines that they do not comply with
244 CMR
4.00 and accepted standards of nursing
practice.
(3)
Prescribing Hydrocodone-only
Extended Release Medication. Prior to prescribing a
hydrocodone-only extended release medication that is not in an abuse deterrent
form, a licensee must:
(a) Thoroughly assess
the patient, including an evaluation of the patient's risk factors, substance
abuse history, presenting condition(s), current medication(s) and a check of
the online Prescription Monitoring Program;
(b) Discuss the risks and benefits of the
medication with the patient;
(c)
Enter into a Pain Management Treatment Agreement with the patient that shall
appropriately address drug screening, pill counts, safe storage and disposal
and other requirements based on the patient's diagnoses, treatment plan, and
risk assessment;
(d) Supply a
Letter of Medical Necessity as required by the Board of Registration in
Pharmacy that includes the patient's diagnoses and treatment plan, verifies
that other pain management treatments have failed, indicates that a risk
assessment was performed and that the licensee and the patient have entered
into a Pain Management Treatment Agreement; and
(e) Document
244
CMR 4.07(3)(a) through (d)
in the patient's medical record.
The purpose of
244
CMR 4.07(3) is to enhance
the public health and welfare by promoting optimum therapeutic outcomes,
avoiding patient injury and eliminating medication errors. Nothing in
244
CMR 4.07(3) shall alter the
standard of care a licensee must use when prescribing any Schedule II, III or
IV controlled substance.
(4)
Self-prescribing and
Prescribing for Family Members. An APRN authorized to prescribe
medication is prohibited from prescribing drugs in Schedules II, III, and IV
for personal use. Except in an emergency, such APRN is prohibited from
prescribing Schedule II drugs to a member of his or her immediate family,
including spouse or equivalent, a parent, a child, sibling, parent-in-law,
son/daughter-in-law, brother/sister-in-law, step- parent, step-child, step
sibling and any other relative residing in the same household.
(5) At the time of initial application for
Massachusetts Controlled Substance Registration and subsequently during each
APRN authorization renewal period the APRN must comply with all state and
federal requirements for continuing education.
All continuing education offerings must be consistent with
Board requirements at
244 CMR
5.00: Continuing
Education.
