HPC Regulation 958 CMR 8.00 to Implement the ICU Nurse Staffing Law


Chapter 155 of the Acts of 2014, An Act relative to patient limits in all hospital intensive care units (codified at MGL c. 111, sec. 231) was signed into law by Governor Deval Patrick on June 30, 2014. The law establishes patient assignment limits for registered nurses in intensive care units (ICUs) in acute hospitals licensed by the Massachusetts Department of Public Health and in hospitals operated by the Commonwealth. The law provides in part that “in all intensive care units the patient assignment for the registered nurse shall be 1:1 or 1:2 depending on the stability of the patient as assessed by the acuity tool and by the staff nurses in the unit, including the nurse manager or the nurse manager’s designee when needed to resolve a disagreement.” The law became effective on September 28, 2014.

MGL c. 111, sec. 231 charges the Health Policy Commission (HPC) with promulgating regulations governing the implementation and operation of the law, including: (1) the formulation of an acuity tool to assess ICU patient stability; (2) the method of reporting to the public on staffing compliance in hospitals ICUs; and (3) the identification, measurement, and public reporting by hospitals of 3 to 5 related patient safety quality measures. Pursuant to the statutory requirement, the HPC developed and promulgated 958 CMR 8.00, Patient Assignment Limits for Registered Nurses in Intensive Care Units in Acute Hospitals.

Regulatory Development

Following the law’s passage, the HPC engaged in an extensive research and information gathering process as a critical foundation for regulatory development. In addition to discussion at its regularly scheduled public meetings, the HPC’s Quality Improvement and Patient Protection (QIPP) Committee held two listening sessions in the fall of 2014 to collect general comment and testimony on issues related to implementation of the law, including the formulation of acuity tools, methods of public reporting, and relevant patient safety quality indicators. Further, the HPC met multiple times with and received significant input from key stakeholders including the Massachusetts Nurses Association, the Massachusetts Hospital Association, the Organization of Nurse Leaders, and the American Nurses Association-Massachusetts Chapter. The HPC also performed site visits to several ICUs around the Commonwealth and consulted with the Massachusetts Department of Public Health. As part of this process, the HPC solicited information and examined quality measures in connection with the statutory requirement of identifying 3 to 5 related patient safety quality indicators for acute hospitals to measure and report to the public.

On January 6, 2015, the QIPP Committee voted to advance the proposed regulation to the full Commission. On January 20, 2015, the Commission voted to advance the proposed regulation to the official public comment period. During the public comment period (which concluded on April 13, 2015, following a one-week extension), the QIPP Committee held public hearings in Boston and Worcester. The HPC heard over four hours of testimony on the proposed regulation from 45 nurses, hospital administrators, Massachusetts Legislators, patient and consumer advocates, and quality experts. The HPC also received nearly 50 written submissions on the proposed regulation. Copies of written testimony, audio recordings from the public hearings, and testimony from the listening sessions are available here.

On May 20, 2015, the QIPP Committee voted to advance a recommended final regulation to the full Commission. At its meeting on June 10, 2015, the Commission made a minor amendment to the text and unanimously approved the final regulation 958 CMR 8.00. The Commission also finalized the quality measures to be specified in guidance of the HPC. The regulation will be effective upon publication in the Massachusetts Register.

Next Steps

Under MGL c. 111, sec. 231, the Massachusetts Department of Public Health (DPH) has authority to certify the acuity tool(s) developed or chosen by each hospital. Following the promulgation of 958 CMR 8.00, DPH will develop and establish requirements for acuity tool certification and compliance with 958 CMR 8.00 and M.G.L. c. 111, sec. 231. The Health Policy Commission defers to DPH on all hospital compliance and enforcement matters. Inquiries regarding acuity tool certification and compliance may be directed to the Bureau of Health Care Safety and Quality at the Massachusetts Department of Public Health at www.mass.gov/dph/bhcsq or 617-753-8000.

Pursuant to 958 CMR 8.11, the HPC will issue guidance in the form of a bulletin specifying the ICU-related quality measures for collection and reporting. The bulletin will be available on the HPC’s website and distributed widely.

For inquiries related to 958 CMR 8.00, please contact the HPC at HPC-info@state.ma.us.

Related Content

Bulletin 2015-04 - ICU Nurse Staffing Quality Measures

MGL c. 111, sec. 231

Public Comments, Audio Recordings, and Additional Testimony

105 CMR 130.000 (DPH's Hospital Licensure Regulation)