An Act to remove barriers to patient care

194th Legislature (2025-2026) Introduced by Dan Donahue

Allow APRNs to satisfy diagnostic and coverage-related requirements for insurance determinations, improving access while not expanding APRN scope.

Reporting date extended to Friday, July 31, 2026

Purpose

H.4617 aims to reduce barriers to access to care by allowing advanced practice registered nurses (APRNs) to fulfill certain diagnostic and coverage-related requirements that today are typically tied to physicians. The bill clarifies that such requirements for diagnostic evaluation, medical necessity determinations, certifications, written orders, prescriptions, or treatment recommendations needed for coverage or reimbursement may be fulfilled by an APRN practicing under the scope defined in section 80B of chapter 112. The bill explicitly states that this does not expand the APRN scope of practice.

Key Provisions (by section)

Section 1 – Chapter 175: Adds Section 47AAA. Whenever coverage or reimbursement requires a physician’s evaluation or recommendation, an APRN under §80B can fulfill that requirement. No expansion of APRN practice scope is intended.

Section 2 – Chapter 176A: Adds Section 8EEE with the same language allowing APRNs to satisfy diagnostic/medical necessity/certification/prescription requirements for coverage.

Section 3 – Chapter 176B: Adds Section 4EEE, mirroring the above for this chapter’s provisions.

Section 4 – Chapter 176G: Adds Section 4WW, mirroring the above for this chapter’s provisions.

Section 5 – Chapter 176O (§16(a)): Amend language to insert “advanced practice registered nurse” after “physician,” broadening who may be referenced in coverage determinations.

Section 6 – Chapter 176O (§16(a)): Replace “treating physician” with “treating provider” to reflect the broader provider terminology.

Section 7 – Chapter 176O (§16(b)): Add “treating advanced practice registered nurse” after “treating physician,” further clarifying who can fulfill treatment-related determinations.

Who Is Affected

APRNs practicing under section 80B of chapter 112.

Health plans, insurers, and reimbursement programs governed by Chapters 175, 176A, 176B, 176G, and 176O.

Physicians and other treating providers who currently serve as the primary evaluators for coverage decisions (the bill shifts certain determinations to APRNs where appropriate).

Procedural and Timeline Aspects

Introduced: October 20, 2025.

Filed: October 9, 2025.

Status: Reported favorably by the House Committee on Financial Services and referred to the Committee on Health Care Financing.

Related action: A new draft identified as H.1140 circulated concurrently.

Legislative context: Part of the 194th General Court (2025-2026).

Potential Impact

Improves patient access by reducing delays and barriers tied to physician-only coverage determinations.

Promotes consistency across multiple health coverage provisions by applying APRN authorization uniformly.

Maintains patient safety and professional boundaries by explicitly stating that the bill does not expand the APRN scope of practice.

May affect administrative processes within insurers and providers as coverage determinations can be made based on APRN evaluations.

If you’d like, I can add a brief comparison to similar reforms in other states or provide a one-page briefing for stakeholders.

Bill