ICU Patient Assignment Law

This is a joint Advisory from MHA and the Organization of Nurse Leaders -- MA, RI, NH, CT & VT (ONL)


  • Starting October 1, 2016, all hospital ICUs (with the exception of the six AMCs) and the 10 NICUs in Massachusetts may begin submitting their documents to DPH for review to determine if their acuity tools are in compliance with the minimum requirements.
  • MHA, in coordination with ONL and the six AMCs who have received certification for their acuity tools, have developed the enclosed guidance on acuity tool certification and quarterly ICU ratio reporting.


 The Department of Public Health (DPH) recently released these Guidelines for Certification of Acuity Tools pursuant to the Health Policy Commission's (HPC's) regulations 958 CMR 8.00, "Patient Assignment Limits for Registered Nurses in Intensive Care Units in Acute Hospitals." The DPH guidance provides an overview of the timeline as well as the minimum requirements needed to submit documentation to seek certification of a hospital's acuity tool for use in all ICUs.

MHA, in working with ONL and the six AMCs who needed to certify their acuity tools by March of 2016 (which includes Beth Israel Deaconess Medical Center, Boston Medical Center, Brigham and Women's Hospital, Massachusetts General Hospital, Tufts Medical Center, and UMass Memorial Medical Center) developed the attached guidance. This guidance is based on lessons learned from the six AMCs based on their process to obtain certification. While the DPH may issue further guidance, we hope that this information may be helpful for providers as they start to develop their tools and documentation for DPH. MHA and ONL are also planning to post the acuity tool documentation from the six AMCs on the PatientCareLink website for hospitals to reference as they are developing their own materials.

As a reminder, acuity tool certification documents may be submitted to DPH starting on October 1, 2016. The final acuity tool certification deadline for all other hospital ICUs and the 10 NICUs is January 31, 2017.

 ICU Acuity Tool and Quarterly ICU Staffing Reporting Guidance

MHA and ONL recommend that hospitals consider using this Acuity Tool Certification Template that helps provide a framework for submitting information on your acuity tool. To help clarify how to use this suggested template, the following instructions are included in this Acuity Tool Certification Suggested Guidance Document.

In addition to the acuity tool certification, all hospitals with an ICU must provide a quarterly report of your RN ratios within each ICU. To assist with this reporting, MHA and ONL also developed this Nurse-to-Patient Ratios Calculation Template that will assist hospitals use a common process and method for calculating and reporting the quarterly ICU staffing information. This ICU Ratios Guidance Document provides detailed instructions and information on how to develop and report the quarterly data to DPH and on your hospital website.

To assist hospitals in continuing to review and meet the requirements set forth in the DPH and HPC guidelines, please refer to this ICU Staffing Regulations Operational Guidance Document regarding acuity tool certification updates, quarterly ratio reporting requirements, and maintenance of all required documentation. Also, this Proposed Hospital Policy Template may be used when drafting a policy that outlines procedures for implementation of a hospital’s acuity tool.

MHA provided this presentation that provides a general overview of the templates and instructions outlined above.

General Operational Requirements and Reporting on Quality Measures

MHA and ONL have further created this General Operational Requirements guidance to remind hospitals of the additional internal processes that must be in place to comply with the HPC regulations. This includes suggestions on the procedures for the advisory committee, appropriate documentation, and educating ICU staff. Please note that none of these requirements need to be reported to DPH in any of the reporting systems outlined above, but are operational steps that DPH and/or HPC may request to review at any time.

The Health Policy Commission issued this bulletin that specifies the four ICU measures hospitals will need to collect and report to DPH. Please note that reporting should only occur once DPH has issued guidance on (1) how the measures should be collected and (2) the format for reporting to DPH through HCFRS or another system. Please note that providers will be required to calculate the measures according to the NQF definitions as specified in the HPC bulletin. Currently, these measures are to be used for all ICUs and will be reported once DPH issues guidance. MHA/ONL will keep members apprised of this issue.

Samples of Hospital's Acuity Tool Documentation

Beth Israel Deaconess Medical Center

Boston Medical Center - Menino Campus

Boston Medical Center - East-Newton Campus

Brigham and Women's Hospital

Massachusetts General Hospital

Tufts Medical Center

UMass Memorial Medical Center - Memorial Campus

UMass Memorial Medical Center - University Campus