Bill
HD 3383
The bill allows APRNs to fulfill certain coverage decisions (diagnostic eval, medical necessity, certifications, orders, prescriptions, treatment recommendations) for insurance pur
Bill Information
- Bill Number: HD 3383
- Title: An Act to remove barriers to patient care
- Status: Proposed bill (Introduced in the 194th General Court; House Docket No. 3383)
- Introduced: January 17, 2025 (House No. 1140); filed by Rep. Daniel M. Donahue (16th Worcester)
- Classification: Proposed bill in the Massachusetts General Court
Overview and Purpose
- The bill aims to reduce barriers to patient care by allowing advanced practice registered nurses (APRN) to fulfill certain diagnostic and coverage-related requirements that currently may necessitate a physician’s involvement.
- Key stated goal: ensure that coverage or reimbursement decisions tied to diagnostic evaluation, medical necessity, certifications, written orders, prescriptions, or treatment recommendations can be made by an APRN under existing authority (section 80B of chapter 112) without expanding the APRN’s overall scope of practice.
Key Provisions
- Across multiple chapters (insurance and health care payment provisions):
- If a health service coverage or reimbursement decision requires any of the following by a physician (attending, treating, or consulting) for coverage purposes, an APRN practicing under section 80B of chapter 112 may fulfill that requirement instead:
- Diagnostic evaluation
- Medical necessity determination
- Certification
- Written order
- Prescription
- Treatment recommendation
- The explicit language in each affected chapter states that this substitution by an APRN does not expand the APRN’s scope of practice.
- Chapters affected (with new sections):
- Chapter 175: Insertion of Section 47VV, authorizing APRNs to fulfill the above requirements for coverage decisions.
- Chapter 176A: Insertion of Section 8WW, same authorization.
- Chapter 176B: Insertion of Section 4WW, same authorization.
- Chapter 176G: Insertion of Section 4OO, same authorization.
- Chapter 176O amendments:
- Subsection (a) of section 16 now includes “advanced practice registered nurse” alongside “physician” in relevant wording.
- Subsection (a) also changes “treating physician” to “treating provider” where appropriate.
- Subsection (b) adds “treating advanced practice registered nurse” after “treating physician” to acknowledge APRNs as treating providers in coverage decisions.
Affected Parties and Impact
- APRNs: Potentially greater parity in payer decision-making processes; can impact how services are evaluated for coverage and reimbursement.
- Physicians and other providers: Their role in coverage determinations may be reduced in formal billings contexts, though this does not change scope of practice.
- Patients: Potential for faster access to covered services if APRN-driven evaluations and orders are accepted for reimbursement decisions.
- Payers/insurers: May need to adjust claims processing to recognize APRN-authenticated diagnostic evaluations, prescriptions, and treatment recommendations as meet coverage requirements.
Timeline and Process Considerations
- The bill is a proposed measure for the 2025-2026 session (194th General Court).
- As introduced, it does not specify an explicit effective date; typical language would enact upon passage or at a stated future date, but the text provided does not specify this.
- The bill explicitly states that it is not intended to expand APRN scope of practice.
Notes
- The central policy objective is to remove payer barriers to patient care by enabling APRNs to fulfill certain physician-required coverage criteria, while preserving existing scope-of-practice boundaries.
Compiled from official sources — confirm details with the bill’s official record.
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