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March 15, 2015

Health Policy Commission Releases Proposed Regulation Concerning Nurse-to-Patient Ratios | Public hearings scheduled for late March and early April

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The Health Policy Commission (“HPC”) has announced two public hearings to be held regarding proposed regulations (958 CMR 8.00) designed to implement the new Intensive Care Unit Nurse Staffing Law (“ICU Law”). The ICU Law requires acute care hospitals to maintain a registered nurse-to-patient staffing ratio of 1:1 or 1:2 in ICUs. The public hearings are scheduled for:

Wednesday, March 25, 2015, 12:00 PM
One Ashburton Place, 21st Floor
Boston, MA 02108

Thursday, April 2, 2015, 10:00 AM
Worcester State University, Blue Lounge
486 Chandler Street, Worcester, MA 01602

In order to implement the new law, the HPC is required to develop regulations. The proposed regulations require the following: (1) formulation of an acuity tool to assess ICU patient stability; (2) public reporting on staffing compliance; and, (3) public reporting by hospitals of ICU-related patient safety quality measures. It is important to note that the Department of Public Health is required to approve any acuity tool developed or selected by a hospital. Regarding the patient safety quality measures, the following four indicators have been proposed by the HPC: (1) central line-associated blood stream infection (CLABSI); (2) catheter-associated urinary tract infection (CAUTI); (3) pressure ulcer prevalence (hospital acquired); and, (4) patient fall rate. The HPC expects to finalize these four measures either in the final regulation or through sub-regulatory guidance.

As part of the public hearing process, the HPC has issued the following questions to guide the testimony of interested parties:

What additional information should the Commission consider regarding:

  1. The assessment of patient stability used in determining the Patient Assignment?
  2. The development or selection and implementation of the Acuity Tool for each ICU and the process for such development or selection and implementation?
  3. Required elements of the Acuity Tool?
  4. Records of compliance, both for the development or selection of Acuity Tool(s) and staffing compliance?
  5. Public reporting on nurse staffing compliance?
  6. The collection and reporting of quality measures? (For information on the proposed quality measures to be measured and reported by hospitals to the public, please see here.)
  7. The implementation timeline for submission of the Acuity Tool(s) to the Department of Public Health for certification?

Written testimony and comments must be submitted to HPC-regulations@state.ma.us or to Lois Johnson, General Counsel, Health Policy Commission, 50 Milk Street, 8th Floor, Boston, MA 02109. All testimony and comments must be received by 12:00 noon on Monday, April 6, 2015.

About the Author

Andrew Levine

Andrew Levine is a partner and head of the firm's regulatory practice. He provides regulatory guidance, business and corporate legal services, as well as strategic advice to healthcare clients. You can find him on Google+ and LinkedIn.

Amanda Flood is a clerk at Donoghue Barrett & Singal. She contributed to this report.

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