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Legislative Committee Update
NURS Membership Meeting, October 19, 2011
Goal: The Legislative Committee works with the NURS Board and membership to
influence legislation and health care policy in order to promote, protect
and expand the role of Advanced Practice Psychiatric Nurses in
Massachusetts, while ensuring access to behavioral health care for the
patients we serve.
ANNOUNCEMENTS:
- We are pleased to announce that since April, Mary Ann Hart has been
representing NURS as our legislative consultant. Mary Ann runs Hart
Government Relations, a government relations consulting firm, and has
represented non-profit health and human services organizations on Beacon
Hill for over 20 years. She previously worked in the Massachusetts
legislature, is a former Assistant Commissioner of Public Health, and was
the Director of the Office of Health Policy under Governor Michael Dukakis
in the 1980s. She is a family nurse practitioner, an Assistant Clinical
Professor of Nursing at Regis College in Weston, and the Program Director
for Regis’ new Graduate Program in Health Administration. Mary Ann is
working on her Doctorate of Nursing Practice (DNP) at Regis College.
- The newly formed Legislative Committee met on September 17th. Several
members have expressed an interest in co-writing testimony, attending
hearings and/or enrolling in the Citizens Legislative Seminar. NURS
continues to support a number of bills important to our patients and our
practices (e.g. medical necessity, continuity of care, insurance
transparency and some bills related to children’s mental health care) and
periodically NURS members will be receiving Calls to Action regarding these
and other bills. Two committee members will be attending a health care
forum, Beyond Parity: Mental Health and Addiction Care under Delivery System
and Payment Reform, sponsored by the BCBS Foundation, DMH and the MA Health
Policy Forum, on October 26th. This program will examine how the Affordable
Care Act and MA health payment system reform will impact care for
individuals with mental health and addiction disorders. The next Legislative
Committee meeting is scheduled for January 14th.
- In June, NURS began attending meetings of the MA Nursing Leadership
Coalition that grew out of a partnership between the Organization of Nurse
Executives of MA & RI and the MA Department of Higher Education. The purpose
of this group of nursing stakeholders is to improve nursing education,
bridge academics and practice, expand the leadership role of nurses and
promote opportunities for nurses to practice to the full extent of their
education and abilities. We joined just in time to be a part of the
application process that led to the formation of a MA Action Coalition to
carry out the directives of the landmark IOM and Robert Wood Johnson
Foundation report, The Future of Nursing: Leading Change, Advancing Health
which was published last fall. The Robert Wood Johnson Foundation and AARP
are sponsoring this Future of Nursing: Campaign for Action initiative. The
five key recommendation areas to be addressed by a state action coalition
are: access to care/practicing at full scope; education progression and
transformation; inter-professional collaboration; diversity; and workforce
data. At the October 13th meeting, first steps towards meeting the MA Action
Coalition’s three short-term and three long-term goals were identified. NURS
will be working with the other advanced practice groups on the long-term
goals of removing barriers to APN practice and strengthening
interdisciplinary collaboration within the medical community. The next
meeting is on November 10th. For more information on the Campaign for
Action, go to www.thefutureofnursing.org .
- NURS began attending the Children’s Mental Health Campaign Supporters
Meetings, on September 20th. It is one of a number of initiatives under
Health Care for All. Rebecka Evans and Noreen Hogan attended the meeting.
Two bills of interest are 1) the CHINS Bill (S01963), which transforms the
current juvenile court-based system (CHINS) into a system that is community
based and family and child focused and 2) the Fair Sentencing Act (H01346
and S0672) which would allow teens sentenced for life without parole to be
eligible for parole after 15 years. The campaign is also talking about
supporting Health Law Advocates in drafting a bill to strengthen parity law.
The next meeting is scheduled for November 15th. For more information go to
www.childrensmentalhealthcampaign.org.
- NURS will be participating in the October 20th, MARN-organized Roundtable
Meeting. The purpose of these meetings is to bring together representatives
from the many nursing organizations in MA to discuss concerns and identify
where there may be opportunities to work together around shared interests.
One topic already on the agenda is the governor’s health payment reform
bill.
- NURS, along with a number of other organizations has been asked to sign on
to a white paper entitled, Ensuring that Consumers Actually Have the Choice
of Lower Cost, High Quality Providers in Massachusetts’ Efforts to Implement
Cost Containment. The paper highlights the importance of non-MD health care
providers and warns against the risk of anti-competitive practices
preventing them from delivering cost-effective, high quality care under a
new payment system.
ACTIVITIES AND UPDATES:
- Since April, NURS member Debbie Farber has been attending monthly meetings
of the Behavioral Health Integration Work Group which is part of the
Patient-Centered Medical Home Initiative. This initiative is a three year,
45-site demonstration project on how to transition primary care into a
patient-centered medical home model. The Work Group is clinically oriented,
focusing on integrating behavioral health services with participating
primary care practice sites. Potential problems for the work group to
address have been identified, including practice level training needs,
practice level resource needs and systems issues. Desired work group
outcomes have also been identified such as developing recommendations to
address the problems, defining levels of integration (currently there are 4
levels with 40 identified integration elements) as a roadmap for practices
to use, identifying and developing resources both within the practice and in
the community to support the integration of behavioral health into medical
home models and a possible ongoing advisory role of the work group. The most
recent meeting was held on October 14th. The next meeting is October 31st.
- The Coalition of Advanced Practice Nurses began meeting again in January
at the prompting of our Practice Committee. The group meets to share
experiences and perspectives on their respective practice environments and
to identify possible areas of mutual concern, including legislative
priorities. The Legislative Committee works with the Practice Committee to
promote any legislative initiatives that are identified and supported by NURS. The CNMs (who have their own bill) and NURS are the two groups most
interested in exploring independent practice. At the most recent meeting on
September 22nd, coalition members began working on a white paper regarding
barriers to practice in MA. The coalition has been actively supporting
Representative Khan’s bill to establish a Commission on Advanced Practice
Nursing. The next meeting of the coalition is on October 20th.
- On September 23rd, NURS had its fifth quarterly meeting with BCBSMA with
Helen Connaughton, the Regional Director of Network Management and Lyssa
Opdyke, Senior Networks Manager. Ginny Tay, Donna Principato and Sharon
Reynolds have been involved in planning and/or attending these meetings. 1)
We learned at this meeting, that after much internal debate, BCBS finally
dropped their requirement that supervising psychiatrists have to be BCBS
providers; the only requirement is that they be board certified. 2)
Regarding their recredentialing requirement of non-prescribing CNSs/NPs
having to have an agreement with a supervising MD, it appears that if
non-prescribers are singled out in their system (which they would be if they
declare themselves as non-prescribers), it could decrease their likelihood
of being included on BCBS panels as they are not automatically credentialing
clinicians who provide psychotherapy only. 3) As of September 1st, so that
advanced practice psychiatric nurses would be on par with NPs, our rates
were raised from about 75% to 85% of MD rates (which were also increased
concurrently). If you are interested, there is training offered at http://www.brainshark.com/bcbsma/rbrvs
which explains how BCBSMA determines their reimbursement rates using a
formula that involves CMS rates. 4) In a prior meeting, BCBS strongly
recommended getting registered on the BlueLinks for Providers website,
https://www.bluecrossma.com/provider, by going to the “Register Now” prompt.
They have made the process simple and if you have any difficulty, you can
reach someone on their Provider Self Service Line, 800 771-4097. There are
many resources and tools on this site including product trainings, medical
policies, the provider blue book, applications and treatment forms, and
signing up for electronic billing and reimbursement. 5) Questions about
administrative procedures, applications, contracting questions, etc. can be
addressed by calling their Network Management Service, 800 316-2583. Our
next meeting with BCBS is scheduled for January 13th.
- BCBSMA’s Behavioral Health Provider Advisory Council’s quarterly meetings
are attended by Georgie Marks. At the October 11th meeting, BCBS mentioned
they are exploring using the online One Recovery Substance Abuse Treatment
Program (www.OneRecovery.com). Some insurance companies are already using
this program as a support system for before, during and after treatment for
addiction. It can only be accessed by patients in a participating insurance
company or their providers. They also shared their plan to only allow an
initial opiate prescription for one week; close monitoring would be required
in order to obtain refills. Also they noted that Suboxone is being
prescribed by clinicians who do not have the special DEA license that is
required to prescribe it and pharmacies are filling them. BCBS is talking
about developing a policy whereby a patient’s pain medications would need to
be monitored by one clinician (or group practice) and dispensed through one
pharmacy (or chain).
- Jeanette Maddix continues to represent NURS on the DPH Health Care
Workforce Advisory Council. The most recent meeting was held on October
11th. Development of the Massachusetts Primary Care Workforce has been one
area of discussion in the past with two main recommendations: 1) to build
the infrastructure necessary to monitor, assess, and plan for the adequacy
of the primary care workforce and 2) to develop new strategies and
incentives – and build on effective existing ones – to recruit and retain a
primary care workforce sufficient to meet demand. The importance of removing
barriers to practice for APRNs and PAs was noted in the draft. Next meeting
to be scheduled.
- MBHP’s Quality Advisory Committee meets quarterly to provide an
opportunity for MBHP to present quality and programmatic initiatives and to
further improve and develop innovative approaches to the delivery of
behavioral health care. It is also an opportunity for attendees to share
information. Marin Konstadt represents NURS at these meetings. The last
meeting was on September 22nd.
- NURS member Janice Goodman, was appointed to the Special Commission on
Postpartum Depression. The commission has not yet convened.
- NURS continues to be an active member of the Mental Health Coalition which
meets monthly. The most recent meeting was on October 19th. Members of the
MHC have initiated meetings with the Division of Insurance to discuss issues
around rate-setting, medical necessity criteria, transparency, utilization
review, retroactive paybacks and the timeliness of BCBSMA’s rate change
announcements. The coalition continues to address the issue of health
payment system reform. Two particular concerns are 1) how a change in the
payment system will affect the many behavioral health clinicians who are in
private practice (a small business issue) and 2) how the many patients being
seen by them will be incorporated into a different payment model (access to
care issue). A survey is being developed which will be sent to clinicians in
order to gather data regarding these concerns. The next meeting is on
November 16th.
There are quarterly stakeholders meetings, Implementing Federal Health
Care Reform in Massachusetts, hosted by the Executive Office of Health and
Human Services, which offer updates on the work being done to implement
federal health care reform in Massachusetts. The information presented at
these meetings is available on the following website: http://mass.gov/national
health reform by selecting the Stakeholder Meetings prompt.
Please consider - two or more years of volunteer service fulfills the
Professional Service category for ANCC recertification: “Accepted volunteer
activities include board of directors, committees, editorial boards, review
boards and task forces.”
Contact:
Sharon Reynolds
Legislative Committee Chair
sreyn-jwil@comcast.net
Legislative
Committee Update, NURS Membership Meeting, June 25, 2011
(PDF
COPY)
Goal: The Legislative Committee works with the NURS Board and
membership to influence legislation and health care policy in order to
promote, protect and expand the role of Advanced Practice Psychiatric Nurses
in Massachusetts, while ensuring access to behavioral health care for the
patients we serve.
ANNOUNCEMENTS:
- We are pleased to announce that Mary Ann Hart is now representing NURS
as our legislative consultant. Mary Ann runs Hart Government Relations, a
government relations consulting firm, and has represented non-profit
health and human services organizations on Beacon Hill for over 20 years.
She previously worked in the Massachusetts legislature, is a former
Assistant Commissioner of Public Health, and was the Director of the
Office of Health Policy under Governor Michael Dukakis in the 1980s. She
is a family nurse practitioner, an Assistant Clinical Professor of Nursing
at Regis College in Weston, and the Program Director for Regis’ new
Graduate Program in Health Administration. Mary Ann is working on her
Doctorate of Nursing Practice (DNP) at Regis College.
- NURS will begin attending the Children’s Mental Health Campaign,
beginning on July 19th. It is one of a number of initiatives under Health
Care for All. Several NURS members have expressed an interest in
attending. For more information go to
www.childrensmentalhealthcampaign.org.
- MCNP is hosting a fundraiser for Representative Kay Khan, on Tuesday,
July 19th from 6 – 8pm. Emails have gone out to members. Please let me
know if you are planning to attend or will be sending in a donation.
ACTIVITIES AND UPDATES:
- NURS member Debbie Farber was selected to join the Behavioral Health
Integration Work Group which is part of the Patient-Centered Medical Home
Initiative. This initiative is a three year, 45-site demonstration project
on how to transition primary care into a patient-centered medical home
model. The Work Group is clinically oriented, focusing on integrating
behavioral health services with participating primary care practice sites.
The first meeting was held on April 15th. Potential problems for the work
group to address were identified, including practice level training needs,
practice level resource needs and systems issues. Desired work group
outcomes were also identified such as developing recommendations to
address the problems outlined above, defining levels of integration as a
roadmap for practices to use, identifying and developing resources both
within the practice and in the community to support the integration of
behavioral health into medical home models and a possible ongoing advisory
role of the work group. A second meeting was held on May 25th. Identified
problems and a proposed outcomes list were addressed as well as the
mission statement. Results of a survey to assess the current state of
integration in practices and the implications for the problem list were
reviewed. Eight integration models were considered. Consumer
representation was discussed. The most recent meeting was to have occurred
yesterday, June 24th.
- The Advanced Practice Nursing Coalition began meeting again in January
at the prompting of our Practice Committee. The group meets to share
experiences and perspectives on their respective practice environments and
to identify possible areas of mutual concern, including legislative
priorities. The Legislative Committee will work with the Practice
Committee to promote any legislative initiatives that are identified and
supported by NURS. At the meeting on March 26th, Laurie Talarico, Nursing
Practice Coordinator for BORN, presented a draft of the revised advanced
practice nursing regulations (posted on www.NURS.org). This revision is
part of a nationwide effort spearheaded by the APRN Consensus Work Group
and the National Council of State Boards of Nursing APRN Advisory
Committee who have been addressing regulatory inconsistencies across
states and between different APN groups. In this enormous effort, state
boards of nursing have been attempting to align licensure, accreditation,
certification and education across states in order to expand patient
access to APNs, while continuing to ensure patient safety (full report:
http://www.apna.org/files/public/Consensus_Model_Full_Report.pdf). At the
most recent meeting on May 21st, it became clearer that the NPs and NAs
are not ready to pursue independent practice at this time. The CNMs (who
have their own bill) and NURS are much more interested. The coalition
recently submitted joint testimony in support of Representative Kay Khan’s
bill to establish a Commission on Advanced Practice Nursing. The next
meeting is scheduled for July 14th.
- On June 17th, NURS had its fourth quarterly meeting with BCBS Director
of Behavioral Health, Stephen Kozak and the Regional Director of Network
Management, Helen Connaughton. Ginny Tay, Donna Principato and Sharon
Reynolds have been involved in planning and/or attending these meetings.
1) Many of you probably received an FYI about rate increases. They
explained to us that advanced practice psychiatric nurses were not on par
with non-psych NPs whose fees have been 85% of the MD rates. Ours have
been 75%. As of September 1st we will be reimbursed at 85% of the MD
rates, which as it turns out, are also being increased. There is a
training offered at http://www.brainshark.com/bcbsma/rbrvs which explains
how BCBSMA determines their reimbursement rates using a formula that
involves CMS rates. This training may also be accessed by signing onto
BlueLinks and going to “resource center”, selecting ”training” from the
menu, then selecting “RBRVS training” from the Behavioral Health drop down
window. 2) They strongly recommend getting registered on the BlueLinks for
Providers website, https://www.bluecrossma.com/provider, by going to the
“Register Now” prompt. They have made the process simple and if you have
any difficulty, you can reach someone on their Provider Self Service line,
800 771-4097. There are many resources and tools on this site including
product trainings, medical policies, the provider blue book and
applications and treatment forms. 3) They also wanted us to know that they
are offering free professional claim entry on line and direct deposit.
Both can be set up through BlueLinks. They are moving in the direction of
having all billing and reimbursements done electronically. 4) Regarding
their recredentialing requirements of non-prescribing CNSs/NPs having to
have an agreement with a supervising MD and prescribing CNSs/NPs having to
have a supervising psychiatrist who is at least a BCBS indemnity provider,
they have assured us that they are keeping the issue very much alive and
promoting our concerns in a number of appropriate venues at BCBSMA.
However, they pointed out that by their not making a distinction between
prescribing and non-prescribing CNSs/NPs, non-prescribing CNSs/NPs are
guaranteed inclusion on their panels as long as they have a supervising
psychiatrist. If and when they find a way to separate them out in their
system, there is a good chance that some non-prescribing nurses will not
be included on their panels as they are not automatically credentialing
clinicians who provide psychotherapy only. Questions about administrative
procedures, applications, contracting questions, etc. can be addressed by
calling their Network Management Service, 800 316-2583. Our next meeting
with BCBSMA is scheduled for September 23rd.
- BCBSMA’s Behavioral Health Provider Advisory Council’s quarterly
meetings are now being attended by Georgie Marks. The focus at the
February meeting was on the new tool for online claim submission for
providers via Blue Links. BCBS is trying to make the process simple and
there is no cost to providers. Direct deposit for providers – PaySpan – is
available but not widely used. The May meeting was cancelled and the PAC
will reconvene in the fall. BCBSMA is waiting to receive data updates on
the Medical Behavioral Integration initiative. BCBSMA is considering
inviting PAC members to a larger fall event/conference to examine the
unique role of behavioral health providers in the context of Accountable
Care Organizations and global payment methodologies. Ken Duckworth, MD is
the new Associate Medical Director for Behavioral Health. He is Board
Certified in Child and Adolescent Psychiatry and in Forensics and has a
background in behavioral health systems and clinical management. The
advisory council will meet again in the fall.
- Jeanette Maddix continues to represent NURS on the DPH Health Care
Workforce Advisory Council. The most recent meeting was held in February.
The draft of Recommendations for the Development of the Massachusetts
Primary Care Workforce was on the agenda for discussion. The two main
recommendations were: 1) to build the infrastructure necessary to monitor,
assess, and plan for the adequacy of the primary care workforce and 2) to
develop new strategies and incentives – and build on effective existing
ones – to recruit and retain a primary care workforce sufficient to meet
demand. The importance of removing barriers to practice for APRNs and PAs
was noted in the draft. Next meeting to be scheduled.
- MBHP’s Quality Advisory Committee meets quarterly to provide an
opportunity for MBHP to present quality and programmatic initiatives and
to further improve and develop innovative approaches to the delivery of
behavioral health care. It is also an opportunity for attendees to share
information. Marin Konstadt represents NURS at these meetings. National
and state trends in behavioral health were addressed at the most recent
meeting on April 1st. Eligibility expansion, benchmarking, treatment,
prevention, rehabilitation for the mentally ill and substance abusing
populations, evidence based practices and the need to reduce costs were
discussed. MBHP discussed that 64% of the 76% of persons on SSI because of
chronic illness, have comorbid mental health or substance abuse diagnoses
– and after 18 months, chronically disabled Medicaid recipients cross over
to Medicare which is a fee for service model. MBHP performance incentives
around how quickly patients could be seen post-hospitalization and for 30
day follow up visits were presented. The importance of parity being
consistent across medical and behavioral health diagnoses was discussed.
How to deliver addiction services with the emphasis on primary care needs
to be ironed out. While children are being screened for mental illness and
substance abuse, there are still insufficient services for this
population.
- NURS member Janice Goodman, was appointed to the Special Commission on
Postpartum Depression. The commission has not yet convened.
- NURS continues to be an active member of the Mental Health Coalition
which meets monthly. 1) The MHC presented testimony, Statement of
Principles: Mental Health and Accountable Care Organizations, at the May
16th hearing on Governor Patrick’s health payment reform bill. NURS was
one of 8 signatories and we also presented our own testimony. (The text of
both letters of testimony as well as Gov. Patrick’s bill can be found on
the www.nurs.org website under Legislative News.) The testimony reflected
that we would like to see the information from pilot ACOs before
supporting widespread implementation of the ACO model or inclusion of
behavioral health in such a model. We also advocated for certain
principles to be part of any ACO model: accessibility, choice and
continuity of patient care; all providers being trained to recognize and
refer appropriately for behavioral health conditions; reimbursements being
risk adjusted for multiple factors impacting on provision of care; burden
of proof for denials of care resting with the party denying the care; a
well-defined appeals process; and behavioral health representation on both
individual ACO boards and the state oversight board. 2) Also, NURS, along
with a number of other disciplines, has requested a meeting with the
Division of Insurance, to discuss some issues around rate-setting, medical
necessity criteria, transparency, utilization review, retroactive paybacks
and the timeliness of the availability of BCBSMA’s rate changes. 3) We
continue to support bills of mutual concern (e.g. medical necessity,
continuity of care, insurance transparency and antitrust bills) with other
MHC members.
- There are quarterly stakeholders meetings, Implementing Federal Health
Care Reform in Massachusetts, hosted by the Executive Office of Health and
Human Services, which offer updates on the work being done to implement
federal health care reform in Massachusetts. The information presented at
these meetings is available on the following website:
www.mass.gov/nationhealthreform.
- The Legislative Committee is in the process of being reformed.
Consider becoming an active member of the legislative committee especially
as we are going through such a pivotal time in health care and advanced
practice nursing has never been in a better position to help shape health
care policy and expand our scope of practice. It is a wonderful
opportunity for professional development of our field and individually –
and please consider - two or more years of volunteer service fulfills the
Professional Service category for ANCC recertification: “Accepted
volunteer activities include board of directors, committees, editorial
boards, review boards and task forces.”
Contact: Sharon Reynolds, Legislative Committee Chair
sreyn-jwil@comcast.net
NURS Update on
Health Payment System Reform, May 23, 2011:
Recent
actions NURS has taken to address the issue of health payment system reform:
-
Since
2009, NURS, as a member of the Mental Health Coalition, has been exploring
the health payment system reform issue (more information below) which
culminated in a
"Statement of Principles: Mental Health and
Accountable Care Organizations".
-
This
Statement of Principles, with NURS as one of the signatories, was
presented at the May 16th Joint Commission on Health Care
Financing hearing in response to Governor Patrick's health reform bill.
-
In separate
testimony (link), NURS endorsed the
Statement of Principles and highlighted the potential impact of
payment reform on the 67% of us who have full or part time practices.
(Many thanks to those of you who helped by responding to the two questions
that were sent around.)
In
the past:
-
NURS
presented concerns about health payment reform in October, 2009, in
testimony presented at an informational hearing before the Joint Committee
on Health Care Financing.
-
We also
voiced concerns and left an informational packet at one of many small
stakeholder meetings held by Secretary Bigby in February, 2010.
More
information:
Governor
Patrick's bill,
"An Act Improving the Quality of Health Care
and Controlling Costs by Reforming Health Systems and Payments",
was filed on February 17th. It is consistent with ideas that have been
discussed since the report,
"Recommendations of the Special Commission on the
Health Care Payment System", was published in July, 2009
-( refer to executive summary, especially pp. 10-18) recommending a change
from a fee for service model to a global payment model. The model calls for
the creation of Accountable Care Organizations (ACOs) which receive payments
from insurance companies to manage their cohort of patients. It is
reminiscent of the capitated model except that 1) payment will be based on
acuity, 2) there will be measures built in to reduce the financial risk to
the ACOs and 3) there will be financial reward if outcomes reach certain
benchmarks. The care at an ACO will be centered around the PCP, with a clear
focus on prevention and coordination of treatment with other specialties. It
may be that at least some (with the goal of most) other specialties will be
under the umbrella of the ACOs but that has not yet been worked out. If not,
then an ACO would contract out to an outside specialist who might be
reimbursed from the ACO's global payment fund or perhaps continue to be paid
by insurance carriers on a fee for service basis. The ACO model fits with
the idea of the Medical Home (PCP actively coordinates care) that is being
discussed nationally and here. From the start, behavioral health
stakeholders have been telling the administration that we have concerns
about how behavioral health care is going to be delivered and paid for under
a new system and that we want representation on ACO advisory boards and
government oversight boards. On positive notes, the Governor's bill calls
for the formation of a Behavioral Health Task Group. And Secretary Bigby, at
both the 2009 hearing and at the one on May 16th, spoke to the importance
of access to behavioral health care and the problem of health care providers
being undercompensated.
NURS Announces Our New Legislative Consultant
:
HART GOVERNMENT RELATIONS
- We are
pleased to announce that we recently signed a contract with Mary Ann Hart;
of HART GOVERNMENT RELATIONS that will go through the end of 2011. We are
very happy to have Mary Ann on board with us. Her biographical information
is as follows:
Mary Ann Hart is a family nurse practitioner,
an Assistant Clinical Professor of Nursing at Regis College in Weston, and the
Program Director for Regis’ new Graduate Program in Health Administration.
She runs a government relations consulting firm – Hart Government Relations and
has represented non-profit health and human services organizations on Beacon
Hill for over 20 years. She previously worked in the Massachusetts legislature,
is a former Assistant Commissioner of Public Health, and was the Director of the
Office of Health Policy under Governor Michael Dukakis in the 1980s.
Mary Ann holds nursing degrees from Simmons College and the University of Rhode
Island. She is working on her Doctorate of Nursing Practice (DNP) at Regis
College.
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