Download Report-of-Counsel-Sept-2014-1-2

MASSACHUSETTS CHAPTER, AMERICAN ACADEMY OF PEDIATRICS
EXECUTIVE BOARD
REPORT OF COUNSEL
EDWARD J. BRENNAN, JR., ESQ.
SEPTEMBER 9, 2014
The formal session of the Legislature ended on July 31, 2014. The Legislature continues to meet
in informal sessions for the remainder of 2014. It can move legislation during that period, but
only by unanimous consent. No roll calls are allowed. Therefore, any one member can stop a bill
by objecting or putting a hold on it.
This report is a summary of bills monitored by the Chapter during the 2014 session, as well as
recent regulatory activities.
I. LEGISLATION
Enacted Laws:
1. Childhood Vaccine Program. The Chapter’s priority legislative initiative was passed by
the Legislature and signed into law by Governor Patrick in February as Chapter 28 of the
Acts of 2014. The Childhood Vaccine Program will create a stable financing framework
enabling Massachusetts to guarantee that all children 0-18 years of age receive all the
vaccines recommended by the Advisory Committee on Immunization Practices, which
sets national standards for immunizations Not only will the legislation allow access to all
recommended vaccines for children over time, it also will fund the Massachusetts
Immunization Registry which assists providers in keeping immunizations up-to-date by
identifying those who are not vaccinated. A special recognition goes to Sen. Richard
Moore (D.Uxbridge) for sponsoring the bill and moving it through the Senate and Rep.
Jason Lewis (D. Winchester) for leading the effort for passage in the House.
2.
Gun Safety. On the last day of the formal session the legislature passed compromise gun
safety legislation that was signed into law by Governor Patrick as Chapter 284 of the
Acts of 2014. The Chapter supported passage of the gun safety law. The law provides:

Add Massachusetts to the National Instant Background Check System. In
addition to criminal information the state must transmit information about
substance abuse and mental health commitments to the data base.

Creates a Web-based portal within the Executive Office of Public Safety to
allow real-time background checks in private gun sales. Such checks are
required.

Local police chiefs have authority to go to court to deny a firearm ID card (FID)
for a rifle or shotgun if they believe the applicant is unsuitable. Suitability
determination was already applicable to handguns.

Increase penalties for violent acts using a fire-arm, for illegal possession and
carrying a firearm and improper storage of a firearm, rifle or shotgun.

School Violence Prevention. School districts to develop plans to address the
mental health of students; schools to provide suicide awareness and prevention
training to school personnel.
3. Massachusetts Child Psychiatry Access Project (MCPAP). The State Budget included a
provision that would codify the MCPAP program within the Department of Mental
Health budget line-item. The MCPAP program is currently funded solely by state funds
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but 60% of the care MCPAP provides is to children covered by commercial insurers.
The budget line-item requires health insurance companies contribute their fair share to
the operation of the MCPAP program. Without the insurers contributing their fair share,
the MCPAP program would face cut backs in its needed services. The Chapter supported
the budget language.
4. Substance Addiction and Abuse. Responding to the growing epidemic of
prescription drug abuse and heroin deaths, the legislature acted on a compromise
bill to increase patients' access to drug treatment services. The bill would require
public and private insurers to cover at least 14 days of inpatient detoxification
and post-detox care, eliminate prior authorization requirements and prohibit
utilization review procedures from kicking in until 7 days after entering
treatment. It also encourages the use of abuse-deterrent opioids by requiring
pharmacists to substitute abuse-deterrent medications unless directed otherwise
by a physician. Chapter 258 of the Acts of 2014.
5. Expansion of Autism Support services. Governor Patrick signed legislation (Chapter
226 of the Acts of 2014) that would create a tax-free savings account for autism and
disability care; require Medicaid coverage for autism behavioral treatment; and provides
many residents with autism access to state disability services (currently only those whose
IQ is under 70 qualify).
Pending Legislation:
1. Nurse Practitioners - Independent Practice. The Massachusetts Coalition of Nurse
Practitioners filed legislation (H.2009 & S.1079) to eliminate the statutory provision
requiring NPs to practice under the supervision of a physician, and removes the Board of
Registration in Medicine from its current role in jointly regulating with the Board of
Registration of Nursing the scope of practice of NPs. The scope of practice of NPs
would be left solely with the Nursing Board. Moreover, the bill would expand their
scope of practice by allowing NPs to interpret tests. This is tantamount to independent
practice. The Committee on Public Health sent the bills to a study. The nurses got the
Senate at the end of May to adopt similar language to S.1079 in the Senate version of the
State Budget, but the conference committee rejected it. The Chapter opposed the
legislation. The bills are dead for this session.
2. E-cigarettes. H. 3726 would treat nicotine vapor products, such as e-cigarettes, as
tobacco products and ban the sale to children under 18. The bill was reported favorably
by the Public Health Committee and is now before the House Ways & Means
Committee. The Chapter supports H.3726.
3. Cheerleading as a Sport. The Chapter supports a bill that would make cheerleading a
sport, which would afford participants the same level of safety considerations as other
athletes. The bill, H. 445, was redrafted by the Education Committee as H.4334, which
would create a study group to look at interscholastic athletic competition. H. 4334 is in
House Ways & Means
4. Tuition Equity for Undocumented Students. H. 1078 would allow undocumented
students who have attended a Massachusetts high school for at least three years and
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graduated to be eligible for in-state tuition at our public colleges and universities. The
Chapter supports the bill. The Committee on Higher Education sent the bill to a study.
5. Lead Abatement. H 2068 would make 10 micrograms of lead per deciliter of whole
venous blood the level considered "poisoning". This change in definition would
acknowledge the current scientific evidence showing that 10 micrograms of lead in the
blood of a child can cause serious clinical and educational damage, and would enable
physicians, public and environmental health professionals to act to abate (remove the
lead from) housing units that have poisoned children living in them. The Chapter
supports the bill, which was reported favorably from the Public Health Committee and
the Health Care Financing Committee redrafted the bill and sent it to House ways &
Means.
6. Trust Fund for ACA. H.1023 and S.554 would create a Trust Fund which would
help the state preserve the funding from the Affordable Care Act and ensure that
the Medicaid program in Massachusetts can meet its responsibilities in an
expanded capacity as intended under the ACA. The Chapter supports the bills,
which is before the Health Care Financing Committee.
II. REGULATIONS
1. Prescription Monitoring Program. The Department of Public Health has released new
regulations to expand use of the Prescription Monitoring Program (PMP) for all prescribers
of scheduled medications.
The regulations require utilizing the program prior to prescribing, to a patient for the first
time:
a narcotic drug in Schedule II or III; a benzodiazepine; or a Schedule IV or V controlled
substance, as designated in guidance to be issued by DPH. Prescribers must also access the
PMP each time the prescriber issues a prescription to a patient for any drug in Schedule II
or III “which has been determined by the Department to be commonly misused or abused
and which has been designated as a drug that needs additional safeguards in guidance to be
issued by the Department.” There is an exemption for prescribing to children less than 4
years of age.
The DPH will likely bring final regulations to the Public Health Council for approval in
September.
2. Proficiency in Electronic Health Records. The Board of Registration in Medicine has
put out for a hearing and comments proposed regulations implementing the Chapter 224 of
the Acts of 2012 provision requiring all physicians to demonstrate proficiency in EHR for
license renewals beginning in January, 2015. The proposed regulations provide alternative
pathways for physicians to demonstrate EHR proficiency, and are applicable for original
and renewal full licenses. Limited licenses (interns and residents are exempt).
The applicable provisions of the proposed regulations are:
On or after January 1, 2015, a renewing full licensee must demonstrate proficiency in the
use of electronic health records (EHR), as required by M.G.L. c. 112, § 2. A renewing full
licensee shall demonstrate proficiency in the use of EHR once, and in one of the following
ways:
a. Participation in a Stage 1 Meaningful Use program as an eligible health care
professional;
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b. Employment with, credentialed by, or in a contractual agreement with an eligible
hospital or critical access hospital with a CMS-certified Stage 1 Meaningful Use
program;
c. Participation, as either a Participant or Authorized User, in the Massachusetts Health
Information Highway; or
d. Completion of three hours of a Category 1 EHR-related CPD course that discusses, at a
minimum, the core and menu objectives and the CQMs for Stage 1 Meaningful Use.
These three EHR credits may be used toward the required ten risk management CPD
credits.
A hearing on the proposed regulations will be held September 29, 2014 and comments are
due by October 3, 2014.
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