TO:       All Hospital Administrators

FROM:  Deborah Allwes, RN, BS, BSN, MPH, Director of Bureau of Health Care Safety and Quality

DATE:   October 23, 2014

Section 231 of M.G.L. Chapter 111, as inserted by Chapter 155 of the Acts of 2014, became effective on September 28, 2014.  The new 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 nurse manager’s designee when needed to resolve a disagreement.”

The law requires the Commonwealth’s Health Policy Commission (HPC) to “promulgate regulations governing the implementation and operation” of Section 231 including “the formulation of an acuity tool” and a “method of reporting to the public on staffing compliance in hospital intensive care units . . . .”  Section 231 also provides that the acuity tool “developed or chosen by each hospital in consultation with the staff nurses and other appropriate medical staff” must be certified by the Massachusetts Department of Public Health (DPH).  The HPC has begun to develop regulations under the law and has announced a provisional timeline for its regulatory process.

Until those regulations are promulgated, please contact the Division of Health Care Facility Licensure and Certification with any questions related to hospital licensure at

For questions related to the implementation and operation of Section 231, please contact the Health Policy Commission at