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

Regulation 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) 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.”

Pursuant to the statutory requirement to promulgate regulations governing the implementation and operation of the law, the HPC developed and promulgated 958 CMR 8.00, Patient Assignment Limits for Registered Nurses in Intensive Care Units in Acute Hospitals.

Regulatory Development

Overseen by the HPC’s Quality Improvement and Patient Protection (QIPP) Committee, the HPC engaged in an extensive research and information gathering process as a critical foundation for regulatory development. The process included public listening sessions, meetings with key stakeholders, site visits to several ICUs, and consultations with the Department of Public Health. The HPC also 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 June 10, 2015, the Commission approved the final regulation 958 CMR 8.00 and finalized the quality meaures to be specified in guidance of the HPC. The regulation became effective upon publication in the Massachusetts Register on July 3, 2015.

Pursuant to 958 CMR 8.11, the HPC issued guidance specifying the ICU related quality measures for collection and reporting on November 6, 2015 (Bulletin HPC-2015-04, ICU Nurse Staffing Quality Measures).

Acuity Tool Certification

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 developed and established guidelines for acuity tool certification (last updated on September 30, 2016) pursuant to 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.


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

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