Advanced Practice Registered Nurses Eligible to Engage in Prescriptive Practice

(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.