PUBLIC HEALTH ADVISORY CONCERNING FENTANYL AND FENTANYL-LACED SUBSTANCES

Board of Nursing Home Administrators

Legislative

Current through July 31, 2017

If you wish to review any of the following Public Chapters in their entirety, please visit:

http://sos.tn.gov/division-publications/acts-and-resolutions.

Board Specific Updates

Public Chapter 392

This legislation authorizes the Department of Health, in cooperation with the Board of Pharmacy, to establish a prescription drug donation repository program under which a person or organization may donate prescription drugs and supplies for use by an eligible nonprofit organization.  The law requires these nonprofit organizations to report data to the department about the number of donors, donations, types of prescriptions and other data.  The law allows donated drugs to be dispensed at no cost if they are in their original sealed packaging, are inspected by a pharmacist, and are prescribed by a healthcare practitioner and dispensed by a pharmacist.  Additionally, the law provides for limited civil and criminal liability for matters related to the donation, acceptance, or dispensing of drugs pursuant to this repository program.  Finally, the law allows the department of health, in consultation with the Board of Pharmacy, to promulgate rules to effectuate the purposes of this part.  This act will take effect on January 1, 2018.   

Public Chapter 355

This Act allows nursing homes to participate in the drug donation repository program.  Furthermore, it directs the board for licensing health care facilities to use emergency rulemaking to permit facilities to dispose of drugs by any DEA permitted manner including disposal by donation to a drug donation repository program.  This legislation took effect on May 11, 2017.

Public Chapter 350

This legislation will allow healthcare providers to satisfy one hour of continuing education requirements through the performance of one hour of voluntary provision of healthcare services.  The maximum amount of annual hours of continuing education that a provider can receive through providing volunteer healthcare services is the lesser of 8 hours or 20% of the provider’s annual continuing education requirement.  The legislation allows for rulemaking by the division of health related boards in order to administer this section.  This took effect on May 12, 2017.

Public Chapter 215

This legislation requires state governmental entities that establish or adopt guides to practice to do so through the promulgation of rules, rather than policy.  The rules so promulgated must specify all provisions included in and relating to the guide to practice.  Any changes to guides to practice made after the guides are adopted must also be promulgated by rule in order to be effective.   For purposes of this part, guides to practice includes codes of ethics and other quality standards, but does not include tests, examinations, building codes, safety codes, or drug standards.  This legislation took effect on April 28, 2017.

Public Chapter 240

This legislation authorizes entities that regulate health professionals to issue limited licenses and makes various changes related to reporting of disciplinary matters to licensure entities. This legislation will:

Insure the integrity of licensure examinations by making examination questions, answer sheets, scoring keys, and other examination data confidential and closed to public inspection.

Allow the issuance of limited licenses to applicants who have been out of clinical practice or inactive, or who are engaged in administrative practice.Limited licenses may be of restricted scope, restricted duration, and have additional conditions placed upon them in order to obtain full licensure.

Clarify that other documents prepared by or on behalf of the Department with regard to an investigation are confidential until such time as formal disciplinary charges are filed against the provider.

Eliminate the “locality rule” for administrative law.

Require the chief administrative official for each health care facility to report within 60 days any disciplinary action taken against an employee for matters related to ethics, incompetence or negligence, moral turpitude, or substance abuse, to the employee’s respective licensing board.All records pertaining to the disciplinary action shall be made available for examination to the licensing board.

This act became effective on May 2, 2017.

Public Chapter 481

This legislation creates a new violation of a healthcare practitioner’s practice act if that practitioner refuses to submit to or tests positive for any drug the practitioner does not have a lawful prescription for or a valid medical reason for using the drug.  It is the duty of the employer to report any violation to the Department of Health.  If the practitioner fails a drug test, the practitioner has 3 business days to either produce the requisite prescription or medical reason, or report to their board approved peer assistance program.  If the practitioner does not comply with any of these measures, it is the duty of the employer to report this violation of the practice act to the employee’s licensing board for investigation and action.  If the practitioner reports to the peer assistance program and obtains and maintains advocacy of the program, the employer is not required to notify the board. 

As long as a practitioner obtains, maintains and complies with the terms of a peer assistance program, the board shall not take action on the licensee for the sole reason of a failed or refused drug test.  If a practitioner fails to obtain or maintain advocacy from the peer assistance program, the program is required to report that information to the appropriate licensing board.  The board SHALL suspend the license of a practitioner who fails to comply with the terms of the program.  Employer drug testing must be compliant with the Drug-free Workplace requirements.  This legislation allows a quality improvement committee to share information regarding substance abuse by a practitioner with other quality improvement committees.  Additionally, this legislation specifies that the Department of Health is not required to obtain prior approval from the Attorney General in order to take any emergency action on a licensee. This legislation took effect on July 1, 2017.

Public Chapter 230

This legislation authorizes commissioners or supervising officials of departments to evaluate certain actions by a regulatory board to determine whether the action may constitute a potentially unreasonable restraint of trade.  Supervising officials must ensure that the actions of regulatory boards that displace competition are consistent with a clearly articulated state policy.  If a board action constitutes a potentially unreasonably restraint of free trade, the supervising official must conduct a further review of the action and either approve, remand or veto the action.  The supervising official may not be licensed by, participate in, or have a financial interest in the occupation, business or trade regulated by the board who is subject to further review, nor be a voting or ex officio member of the board.  The supervising official must provide written notice of any vetoed actions to the senate and house government operations committees. 

Prior to filing a regulatory board's rule with the secretary of state, the commissioner or chief executive officer of the administrative department under which a regulatory board operates or to which a regulatory board is administratively attached, or a designee to the extent a conflict of interest may exist with respect to the commissioner or chief executive officer, must remand a rule that may constitute a potentially unreasonable restraint of trade to the regulatory board for additional information, further proceedings, or modification, if the rule is not consistent with a clearly articulated state policy or law established by the general assembly with respect to the regulatory board.  This act took effect on April 24, 2017.    

Public Chapter 377

This is annual legislation regarding nursing home assessments and took effect on July 1, 2017. 

Public Chapter 349

This legislation allows disabled adults to hire paid personal aides to perform health maintenance tasks for them in the adult’s home.  “Home” is defined as the dwelling in which the person resides, whether the person owns, leases or rents the residence or whether the person resides in a dwelling owned, leased or rented by someone else.  “Health maintenance task” is defined as a healthcare task that a person without a disability would customarily and personally perform without assistance, the disabled person is unable to perform on their own, the licensed healthcare provider has determined can be safely performed by the aide, and can include tasks like: administration of glucometer tests, administration of eye or ear drops, nebulizer treatment, and ostomy care.  This act will take effect on January 1, 2018.    

Public Chapter 611

This extends the board of examiners for nursing home administrators six years to June 30, 2022.  It also establishes minimum attendance requirements for board members and requires the removal of members who do not meet the requirement of attending at least 50% of the scheduled meetings in a calendar year.

Public Chapter 763

Permits licensees whose licenses have expired due to non-payment to obtain reinstatement when payment of past due renewal fees, which are capped at twice the annual renewal fee, and unattained continuing education are completed.   This replaces the current requirement of payment of all past due fees before reinstatement. This act will take effect on July 1, 2016.

Public Chapter 990

This legislation requires an insurer to reimburse and provide coverage for telehealth services provided by a practitioner licensed in Tennessee, regardless of the patient’s location.  This act will take effect on January 1, 2017.

Public Chapter 1051

This legislation makes changes to the current requirements for medication aides.  Specifically, this legislation:

Reduces from 75 to 60 the number of required hours of instruction in a medication aide training program, consisting of 40 classroom hours and 20 clinical hours.

Establishes that a medication aide may not administer medications delivered by aerosol or nebulizers, or administer medications by metered hand-held inhalers without a spacer or a non-metered inhaler.

Authorizes the use of medication aides in any Program for All-Inclusive Care for the Elderly (PACE)

Adds language to require any nursing home, assisted-care living facility, or PACE program that utilizes one or more medication aides to administer medications, to implement a policy to track and record any incidents of medication errors and opioid or benzodiazepine diversions, and requires such incidents be made available to the Department of Health.

Public Chapter 154

This act allows the Commissioner of Health or his designee to have electronic access to medical records in order to facilitate investigations when responding to an immediate threat to public health. Today the Commissioner of Health or his designee already has this authority but must go to the facility to review the medical records.

Public Chapter 94

This act defines “abuse” and “neglect” for purposes of placing a person on the registry of persons who have abused, neglected, or misappropriated the property of vulnerable individuals specifically within the statutes that govern the Dept. of Health. It does not impact the definitions within the statutes that govern the Dept. of Intellectual and Developmental Disabilities nor the Dept. of Human Services.  It also increases the time within which placement on the registry may be appealed from 30 to 60 days.

Public Chapter 153

As enacted, this authorizes the board for licensing healthcare facilities and the departments of mental health and substance abuse services, human services, and intellectual and developmental disabilities to amend licensure rules to be consistent with the federal home-based and community-based settings final rule, but it prohibits the use of emergency rulemaking to promulgate such rules. 

Public Chapter 502

This act allows the Joint Government Operations Committee (the legislative committee that reviews all rules) to stay a rule up to 75 days instead of 60 days.  Present law authorizes the Joint Government Operations Committee to consider the following factors when reviewing rules: authority, clarity, consistency, justification, necessity and reference. This act adds arbitrariness and capriciousness as two new considerations.

Public Chapter 376

This creates the “Tennessee Right to Try Act.” It authorizes eligible patients to utilize investigational drugs, biological products or devices that have completed phase 1 of a clinical trial, but has not yet been approved for general us by the FDA. The clinical trial must be documented by the National Institutes of Health.  An eligible patient is:

  • someone with an advanced illness that is attested to by the patient’s treating physician and confirmed by a second physician
  • has considered all other FDA-approved treatment options
  • has received a recommendation from the patient’s physician for an investigational drug, biological product, or device
  • has given written, informed consent for the use of an investigational drug, biological product, or device
  • has documentation from such physician that the patient meets all the aforementioned requirements.

All expenses related to the use of investigational treatment will be borne by the patient.  Manufacturers are authorized to make investigational products available to patients with or without compensation.  This bill specifically prohibits Medicare or any licensing board from taking any adverse action against a licensee based solely on a recommendation for treatment with an investigational product and holds manufacturers and providers harmless if operating in good faith.  This act takes effect on July 1, 2015.

Public Chapter 268

This act makes disclosures of protected healthcare information permissible in medical malpractice lawsuits.

Public Chapter 411

This act requires any healthcare facility providing care with regards to dementia with Lewy bodies and frontotemporal dementia to provide written disclosure of the form of care, treatment, and activities provided to individuals receiving such care.  

Public Chapter 230-  Provides that each health-related board shall establish a procedure to expedite the issuance of a license, certificate, or permit for an applicant who is certified or licensed in another state to perform the same profession that is the subject of the application; whose spouse is a member of the armed forces; whose spouse is the subject of a military transfer to Tennessee; and who has left employment to accompany the person’s spouse to Tennessee.  The procedure shall include issuing the applicant a license, certificate, or permit if the licensure requirements in the other state are substantially equivalent to Tennessee’s requirements or developing a method to authorize the applicant to practice in Tennessee with a temporary permit in accordance with current law (T.C.A. §63-1-142). 

Public Chapter 358- Continues the Board for Nursing Home Administrators until June 30, 2011.

 

Updates Applicable to All Boards

Public Chapter 340 -

This bill extends the interstate nurse licensure compact through June 30, 2018

Public Chapter 575 -

This act extends civil immunity to health care providers providing services at clinics that charge patients based on a sliding scale to health care providers offering services at a clinic that does not charge a patient for services.

Public Chapter 585 -

This legislation allows the Commissioner of Health to set the pharmacy formulary for medications that are issued from local health departments. It allows input from the Board of Pharmacy on the medications to be listed. This will streamline the process and allow for more prompt changes to the formulary.

Public Chapter 590 -

This legislation adds advanced practice nurses to individuals exempt from subpoena to trial. Advanced practice nurses, like physicians assistants, are still subject to subpoena to deposition.

Public Chapter 594 -

The act requires certain entities to make available information and instruction of infant CPR to at least one future parent or caregiver.

Public Chapter 602 -

This bill extends the Board of Nursing through June 30, 2018.

Public Chapter 614 -

This legislation authorizes (not mandates) LEA’s to allow school personnel trained by a registered nurse to administer insulin to a student. It requires the Tennessee Department of Health and the Tennessee Department of Education to jointly draft guidelines governing appropriate procedures for RN’s to use in training personnel, but it also requires the Board of Nursing to review the guidelines before they take effect. Training to administer glucagon and insulin shall take place annually and competencies shall be demonstrated twice a year. Registered nurses providing the training and trained personnel shall have immunity.

Public Chapter 622 -

Current law requires that, prior to writing a script for an opiate or benzodiazepine; a practitioner must check the database for their patient. This act allows that patient’s profile to be placed in their medical record, which is subject to HIPAA. This further allows the Department of Health to make available upon request aggregate, de-identified data from the CSMD.

Public Chapter 623 -

Naloxone is an opioid antagonist designed to stop the effects of an opiate related overdose. This act allows a licensed healthcare practitioner to prescribe naloxone to a person at risk of having an opiate related overdose, or a family member or friend of the at-risk individual. It further requires training in administration of naloxone prior to the drug being prescribed. Civil immunity is provided for both the prescribing practitioner and the individual administering naloxone.

Public Chapter 638 -

This act allows optometrists to use local anesthetics in conjunction with the primary care of an eyelid lesion. It requires optometrists to follow board promulgated rules governing the care of eyelid lesions and they must be CPR certified and show proof of certification to the board in order to use such anesthesia. It further prohibits reconstructive surgery from being performed.

Public Chapter 651 -

The act allows Quality Improvement Committees (QIC’s) to share information with their counterparts and keeps this information confidential, privileged and protected from subpoena, discovery or trial evidence. It removes liability surrounding those who give information to QIC’s and removes liability solely on actions taken by the QIC.

Public Chapter 675 -

The act allows telehealth providers to contract with insurance companies to have their services covered in offered plans. Insurance providers cannot deny payment solely because the encounter was not in person.

Public Chapter 700 -

The act defines chronic non-malignant pain treatment as “prescribing or dispensing opioids, benzodiazepines, barbiturates or carisoprodol for ninety (90) days or more in a twelve (12) month period for pain unrelated to cancer or palliative care.” A pain clinic has been redefined in statute.

Public Chapter 763 -

This act revises delinquent privilege tax provisions that would require the Department of Revenue to notify the licensee that failure to cure the delinquency or deficiency prior to their licensure renewal date can result in renewal abeyance. For purposes of the bill, “cure” means payment in full, entering into an agreed payment plan, or abatement of tax liability. Licensing boards will be provided monthly with list of licensees who are delinquent 90 days or more and boards may not process licensure renewal.

Public Chapter 791 -

This act creates a pilot program where three drug courts will have the ability to retrieve data from the controlled substance monitoring database. The pilot programs will be in rural, semi-urban, and urban counties and the retrieval process will mirror the current manner in which law enforcement is able to access data. The drug courts must show a need for the data, as their retrieval ability is very limited in scope.

Public Chapter 809 -

This act deletes superfluous language in the existing practice act statute. It adds forensic evaluation and parent coordination to the scope of practice. Further, this bill authorizes the board to promulgate rules regarding the practice of telepsychology.

Public Chapter 820 -

This act allows for prosecution, up to a class A misdemeanor, of a woman who gives birth to a child with neonatal abstinence syndrome, if the mother was illegally using narcotics. It is an affirmative defense for the mother if she was enrolled in a recovery program prior to the birth and successfully completes the program. (link to FAQ’s for PC 820 – coming soon)

Public Chapter 828 -

This requires a pharmacy to submit a data entry error correction to the NPLEx, upon learning of a data entry error. It prohibits the NPLEx from generating a stop sale alert where quantity limit is exceeded due to data entry error for which a correction was submitted.

Public Chapter 832 -

This authorizes collaborative pharmacy practice agreements (CPPAs) and sets out the legal parameters for CPPAs involving pharmacists and health care practitioners with prescriptive authority. It prohibits a retail pharmacy from employing an individual with prescribing authority for the purpose of maintaining, establishing or entering into a collaborative practice agreement with a patient. Further, it specifies that nothing shall prevent a pharmacy or pharmacist or group of pharmacists from employing or entering into a professional contract with a physician or licensed medical practitioner for the purpose of conducting quality assurance reviews of its pharmacists that are engaged in the practice of collaborative drug therapy.

Public Chapter 842 -

This act expands the provisions for dispensing in pain clinics to allow prescribers at a pain clinic to dispense complimentary samples of non-narcotic schedule V controlled substances for up to a 14-day supply.

Public Chapter 857 -

This act defines maximum allowable cost (MAC) and maximum allowable cost list for pharmacy benefits managers (PBM) and covered entities and requires PBM to find that a drug is generally available for purchase by pharmacies in the state from a national or regional wholesaler, prior to that drug being placed on MAC list. If a drug on the MAC list no longer meets these qualifications, it must be removed from list within 5 business days after discovery. This act does not prohibit a PBM from reimbursing claims for generics at a previously determined MAC, even if a PBM reimburses brand name at contracted rate after drug is determined generally unavailable. PBM’s must make available to each pharmacy contracted with or included in their network, at the beginning of the contract and upon renewal, the following: sources used to determine MAC for drugs and devices on MAC list; every MAC for individual drugs used by PBM for patients served by that pharmacy; and, upon request, every MAC list used by that PBM for patients served by that pharmacy. PBM’s shall: update the MAC list at least every 3 business days; make updated lists available to each pharmacy contracted with or included in network, online; and, utilize updated MACs to calculate payments made to pharmacies within 5 business days. PBM’s shall define how a pharmacy may contest the MAC of a particular drug or device. Pharmacies may appeal if the MAC established is below the cost of that drug or product is generally available and/or the PBM has placed the drug on list without determining that the drug is generally available for purchase by pharmacies in the state from a national or regional wholesaler. The appeal must be filed within 7 business days of submission of initial claim for reimbursement. A PBM must make its final determination of appeal within 7 business days of PBM receiving the appeal. Any denial of appeal requires the PBM to state the reason for denial and provide national drug code of equivalent drug that is generally available for purchase at a price which is equal to or less that MAC for drug. Successful appeals require the PBM to adjust MAC of drug or device for appealing pharmacy, effective from the date the appeal was filed, and within 3 business days to apply to claims submitted by other network pharmacies for the next payment cycle. PBM’s shall make information regarding the appeals process available online. Medical products and devices are limited to those included as pharmacy benefit under the contract. Violations of this law may subject PBM’s to current penalties in law. Pharmacies shall not disclose to any third party any MAC lists or other related information it receives from a PBM except that pharmacies may share such lists and information with pharmacy services administrative organizations or similar entities which the pharmacy contracts with to provide administrative services. Organizations that receive such information from pharmacies shall not disclose the information to any third party. This act takes effect January 1, 2015 and applies to all contracts entered into or renewed on or after that date.

Public Chapter 859 -

This act transfers the collection of the nursing home assessment from the Department of Health to the Bureau of TennCare. It restructures the assessment from a per-bed tax to a per-resident-day basis, excluding Medicare patients. It creates a trust fund of the collections from nursing homes, investment earnings and penalties. Payments are due on the 15th of each month for the previous month’s assessment and are due to TennCare starting on August 15, 2014.

Public Chapter 872 -

This act requires an individual picking up prescription of a schedule II-IV opioid, benzodiazepine, zolpidem, barbiturate, or carisoprodol to show identification. The individual picking up the prescription is not required to be the person for whom the script is written for. Several exemptions apply to this law such as: it is only applicable to prescriptions longer than a 7-day period; dispenser is not required to check ID if the person is personally known by dispenser; minors or homeless individuals that do not have ID may receive prescription based upon dispenser’s personal judgment; does not apply to veterinarians; does not apply to samples dispensed by healthcare professionals. Additionally, this act does not apply to scripts written for: inpatients in a hospital; outpatients of a hospital where prescriber writes order in medical chart and order is given directly to hospital pharmacy; residents of a nursing home or assisted living facility; inpatients or residents of licensed MH facility; inpatients or residents of a DEA registered narcotic treatment program; patients in correctional facilities; mail order patients; pharmacy home delivery patients. Violations of this act are only subject to civil penalty assessed by the licensing board, which is authorized to promulgate rules to effectuate this act.

Public Chapter 898 -

This act revises the way Advanced Practice Nurse and Physicians Assistants profiles are maintained on the Consumer Right to Know Database. It does this by making the database searchable by APN, PA or physician name. It further requires notification to the Department within 30 days of any change in supervising relationship by all providers so it can be changed in the database for the public.

Public Chapter 906 -

This is the Methamphetamine Production Reduction Act. The law caps the sale/purchase of ephedrine or pseudoephedrine products at 5.76 g/month or 28.8 g/year, per person requiring prescription. The caps shall not apply with respect to a valid prescription from a practitioner authorized to prescribe. No person under the age of 18 may purchase the products except pursuant to a valid prescription from a practitioner or from a pharmacist generated prescription.

Public Chapter 909 -

The act defines cosmetic medical service as any “service that uses a biologic or synthetic material, a chemical application, a mechanical device, or a displaced energy form of any kind that alters or damages, or is capable of altering or damaging, living tissue to improve the patient’s appearance or achieve an enhanced aesthetic result”. The act further requires any business advertising as a medical spa to display the medical director or supervising physician of the practice on a sign at the practice including board certification.

Public Chapter 918 -

This legislation creates the Applied Behavior Analyst Licensing Committee under the Board of Examiners in Psychology. The committee shall consist of five members appointed by the governor, three of which shall be licensed behavior analysts, one assistant behavior analyst and one consumer member of the public. The law sets forth procedures for obtaining and maintaining licensure for behavior analysts and assistant behavior analysts. It adds the chair of the committee as an ex-officio voting member to the Board of Examiners in Psychology. Further, it sets a minimum quorum for the board at six members and also requires any board action to receive at least six alike votes.

Public Chapter 936 -

This act allows for cannabidiol to be dispensed and administered as part of clinic research trials for treatment of intractable seizures in certain hospitals. The act requires the trials to be supervised by a physician practicing at a hospital or associated clinic that are affiliated with a university with a college or school of medicine. Any physician conducting a trial must report the results to the standing health committees of the Tennessee House and Tennessee Senate as well as both the Speakers of the Senate and House by January 15, 2018.

Public Chapter 949 -

This act allows for initial licensure applications to be accepted online. Currently, renewing licenses is already available online. This also makes available to the public annual inspections of health care facilities and pharmacies, similar to how nursing home inspections are already available.

Public Chapter 953 -

This legislation adds the certification of “Registered Nurse First Assistant” to the purview of the Board of Nursing. It allows a licensed registered nurse, certified in perioperative nursing, and has completed a RNFA educational program, to apply to the board for a RNFA certificate. It authorizes the board to promulgate rules and set fees associated with RNFA certification.

Public Chapter 983 -

This is a pain clinic revision act that requires all healthcare practitioners to notify their appropriate licensing board within 10 days of starting or ending employment at a pain clinic. It prevents health care prescribers from dispensing an opioid or benzodiazepine except under certain conditions. Requires all opioids and benzodiazepine’s not falling under the exemptions to be returned to a reverse distributor or to local law enforcement by Jan. 11, 2015. The act requires pharmacy wholesalers to notify the Board of Pharmacy and other prescribing boards when suspicious orders (unusual size, deviations from normal pattern, and unusual frequency) are discovered. Wholesalers must report a theft or significant loss of controlled substances to the Controlled Substance Monitoring Committee and local law enforcement within one business day of discovery.

Public Chapter 1011 -

The act requires submissions to the Controlled Substance Monitoring Database be made at the close of each business day for all controlled substances dispensed the prior business day. The act does provide good faith effort exemption and gives the Board of Pharmacy the ability to make rules implementing this exemption. This act does not go into effect until January 1, 2016. Veterinary Medical Examiners are exempt from this provision.