Board of Medical Examiners Legislative Update — 2021

Public Chapter 26

This act extends the Alzheimer's disease and related dementia advisory council to June 30, 2026.

This act took effect March 23, 2021.

Public Chapter 37

This act prohibits agencies subject to sunset review from promulgating rules or adopting policies to exempt members solely by virtue of their status as members.

This act took effect March 23, 2021.

Public Chapter 62

This act was one of the Department of Mental Health and Substance Abuse Services' legislative initiatives, relative to revising requirements on death reporting. Among other requirements, this act requires the mental health facility to notify the office of the medical examiner having jurisdiction upon discovery of a death as soon as reasonably possible, but no longer than 12 hours after the discovery of the death. The act also clarifies that licensed healthcare providers listed under additional titles in Tennessee Code Annotated (such as title 68) can practice telemedicine.

This act took effect March 29, 2021

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requires T DH in collaboration with other public and private healthcare agencies to incorporate Alzheimer's disease and other dementias into existing public health programs

This act took effect April 13, 2021.

Public Chapter 136

This act was one of the Department of Health's legislative initiatives, relative to the Controlled Substance Monitoring Database (CSMD). First, the act authorizes the state's chief medical examiner, or county medical examiner, to allow designees to approve death investigations. Next, this act allows deidentified CSMD data, rather than only aggregate, to be shared, with the intent of improving information access. Additionally, this act allows for CSMD data to be shared with additional state, county, or federal agencies outside of Tennessee. Lastly, this act decreases the quorum requirements of the CSMD committee by one member, but still have a majority of members present to conduct regular committee business

(6) .

This act took effect April 13, 2021.

Public Chapter 150

This act simply adds FQHC's in Tennessee to the definition of healthcare organizations pursuant to the law around quality improvement committees.

This act took effect July 1, 2021.

Public Chapter 153

creates a new definition of "store-and-forward telemedicine services" to include the use of asynchronous computer-based communications between the healthcare provider and the patient for the purpose of diagnoses, consultation, or treatment of a patient at a distant site where there may be no in-person exchange.

This act took effect April 13, 2021.

Public Chapter 179

This act authorizes unlicensed graduates of certain medical training programs to provide telehealth services, provided they maintain the same existing standards for telehealth that licensed providers must meet.

This act took effect April 20, 2021.

Public Chapter 197

This act requires the Department of Health and other agencies to seek federal, private, or other available funding for the development of substance use disorder recovery programs. It also requires the agencies to report by February 15 ^th of each year to the legislature the amount of funds they've applied for relative to substance use disorder programs, as well as recommendations to statute changes to develop recovery programs. Lastly, the report must include any benefits realized from these programs.

This                        April 22,

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revises the definition of marijuana to clarify that it does not include a product approved as a prescription by the Food and Drug Administration (FDA).

This act took effect April 22, 2021.

Public Chapter 242

This act authorizes records custodians to petition a court for injunctive relief from individuals making frequent public records requests with the intent of disrupting government operations, following a fifth (5 ^th ) public records request. A records custodian can only petition a court if they notify the person in writing stating the specific conduct may constitute intent to disrupt government operations, and that the person continues to do so. The individual upon a court enjoinment would not be able to make public requests at the agency for up to one (1) year.

This chapter took effect April 28^th , 2021 and will sunset July 1, 2025.

Public Chapter 259

This act establishes requirements for a healthcare provider to follow when either an inpatient in a health care facility, or someone who is seeking services in an emergency department, expresses to the provider a recent threat or attempt at suicide or infliction of bodily harm to themselves. In this scenario, the healthcare provider shall enter the attempt or threat into the patient's medical record. Upon discharge from the facility, the facility shall provide the patient with contact information to access a qualified mental health professional or counseling resource unless the patient is discharged to another facility. This referral requirement can be satisfied by providing contact information for this state's mobile crisis services or the statewide crisis hotline. Lastly, the act states that a

healthcare provider who violates this section is subject to discipline by the licensing authority.

This act took effect July 1, 2021.

Public Chapter 272

This act is known as the "Safe Stars Act." This bill requires that certain safety standards be implemented, beginning with the 2022-2023 school year for each LEA and public charter school that provides a youth athletic activity. Additionally, this act requires the department of education and the department of health to develop and post on their websites guidelines and other materials to inform and educate students, parents, and coaches about electrocardiogram testing (EKG) be administered in addition to the student ^l s comprehensive initial pre-participation physical examination. This act also requires the department of education, in collaboration with the department of health, to develop a sudden cardiac arrest symptoms and warning signs information sheet that includes information about EKG testing. The information sheet must address the benefits and limitations of EKG testing.

This act took effect April 30, 2021.

Public Chapter 291

This act requires the attorney general and reporter to not approve an emergency rule if the emergency rule does not meet the statutory criteria for adoption of the

This                        July 1,

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This act requires that starting December 1, 2023, state agencies submit a report of their effective rules to the chairs of the government operations committee every eight (8) years. The report is required to include a brief description of the department's operations that each chapter affects, as well as each rule and its administrative history, which would include the original promulgated date and the dates the rule was last amended, if applicable. Additionally, the report would include a determination of each rule on whether it is adheres to current state or federal law or court rulings, should be amended or repealed, reviewed further, or continue in effect without amendment. Lastly, if there are any intentionally false statements in the report, the government operations committee would have the ability to vote to request the general assembly to remove a rule or suspend the department's rulemaking authority for any reasonable period of time.

This act took effect July 1, 2021

Public Chaoter 348

This act requires fetal remains from a surgical abortion to be disposed of solely by burial or cremation. Under this act, an abortion facility is defined as any ASTC, private office, or other facility as defined by TCA 68-11-201 in which abortions are induced or performed. The act does not include hospitals licensed under Title 68 as long as the hospital policies and regulations concerning disposal of fetal remains substantially complies with the requirements of this act. A pregnant woman who has a surgical abortion has the right to choose burial or cremation of the fetal remains as well as the location for the final disposition. The woman is to be provided with forms created by the Department of Health informing her of that right and selecting the means and location. If the woman does not wish the exercise this right, the abortion facility shall determine whether disposition is by cremation or interment. The act also establishes a variety of record keeping requirements on the facility.

This act took effect on May 6, 2021 for rulemaking purposes. The rest of the public chapter takes effect July 1, 2021.

Public Chapter 357

This act authorizes an exception to existing telehealth requirements governing healthcare providers in Tennessee. In doing so, it allows individuals licensed in another state to practice telehealth in Tennessee while providing healthcare services on a volunteer basis through a free clinic.

This act took effect May 11, 2021.

Public Chapter 362

This act is known as the "Jim Coley Protection for Rape Survivors Act," and revises existing provisions relative to the protocol for forensic medical examinations of victims of sexually oriented crimes. It requires healthcare providers to notify law enforcement that an evidence collection kit is ready for release within 24 hours of concluding the examination. It also requires law enforcement to pick up the kit for storage or transmission within 48 hours of being notified and revises the storage requirements for maintaining records of the kits. Lastly, in the event that a victim elects not to report the alleged offense to police at the time of examination, the collection kit becomes a hold kid and the healthcare provider is required to assign a number to identify the kit rather than using the victim's name.

This act partly took effect May 11, 2021, but not for T DH concerns. The rest of the July 1,

396

This act establishes provisions governing the practice of certified medical assistants in Tennessee. The act specifically authorizes licensed hospitals to employ certified medical assistants under a set of work requirements, specifically around administering approved medications to admitted patients in an ambulatory outpatient hospital clinic. Ambulatory outpatient hospital clinic is defined as a clinic or physician office that is owned and operated by a hospital licensed under Title 68 and provides treatments to patients who are not admitted as inpatients to the hospital. Individuals employed in such a role are required to wear a visible nametag designating them as a certified medical assistant while working. Lastly, this act clarifies that this new section of code does not apply to personnel employed by physicians performing duties in settings other than an ambulatory outpatient hospital clinic.

This act took effect May 11, 2021.

Public Chapter 441

This act prohibits certain healthcare entities and insurers from discriminating based on disability regarding organ transplant services or coverage. In doing so, this act authorizes an individual who reasonably believes that a covered entity has violated this act to bring a civil action for injunctive or other equitable relief against the covered entity for the purpose of enforcing compliance. Lastly, this act states that it does not create a right to compensatory or punitive damages against a covered entity.

This act took effect July 1, 2021

Public Chapter 453

This act requires public or private entities or businesses that operate a building open to the general public to post signage regarding public restroom access in certain situations. Specifically, this applies to entities or businesses that have restroom policies allowing either biological sex to use any public restroom within their building. The act includes requirements for language, size, location, and even color for the signage. The act excludes unisex, single occupant restrooms or family restrooms intended for use by either sex.

This act took effect July 1, 2021.

Public Chapter 460

This act specifies that standard medical practice does not involve prescribing hormone treatment for gender dysphoric or gender incongruent prepubertal minors. Additionally, this act prohibits a healthcare prescriber from prescribing a course of treatment that involves hormone treatment therapy for gender dysphoric or gender incongruent prepubertal minors, except when prescribing a course of treatment for diagnoses of growth deficiencies or other diagnoses unrelated to gender dysphoria or gender incongruency.

This act took effect May 18, 2021.

Public Chapter 461

This act requires T DH licensing authorities, upon learning a healthcare prescriber was indicted of certain criminal offenses (controlled substance violations or sexual offenses), to automatically restrict the prescriber's ability to prescribe Schedule Il controlled substances until the case reaches a final disposition. The restriction shall be removed upon sufficient proof of acquittal or dismissal/nolle prosequi. The act further requires licensing authorities to automatically revoke the license of a practitioner that is convicted of those same criminal offenses. A new license shall be granted if the conviction is overturned or reversed (but shall be restricted related to prescribing if the case has not reached final disposition). In addition, the act requires the licensing authority to suspend the license of midlevel practitioner (APRN/PA) upon finding the healthcare professional failed to comply with physician collaboration requirements. Finally, this act requires facility administrators to report certain disciplinary actions concerning licensed personnel to the professionals' respective boards.

This act took effect May 18, 2021.

Public Chapter 464

This act recreates the elder abuse task force, which was originally created in 2019 and was terminated January 15, 2021. The task force will consist of ten (10) members, including the Commissioner of Health or their designee. The task force will hold public meetings and utilize technological means to gather feedback on the recommendations from the general public and from persons and families affected by poverty. The commission on aging and disability will provide necessary administrative support for the task force. Lastly, this act requires the task force to submit its findings and recommendations to the governor and the general assembly to combat the abuse of elder persons and other vulnerable adults no later than January 15, 2022, at which time the task force will terminate.

This act took effect May 18, 2021.

Public Chapter 513

This act prohibits the Governor from issuing an executive order and a state agency, department or political subdivision from promulgating, adopting, or enforcing an ordinance or resolution that requires a person to receive an immunization, vaccination, or injection for the SARS-CoV-2 virus or any variant of the SARS-CoV-2 virus. It also deletes the previous override during an epidemic or immediate threat of an epidemic of an objection against vaccination that was made on the basis of religious tenets. The law prohibits requiring the COVID-19 vaccine to attend k-12 schools. The prohibition against requiring vaccines does not apply to governmental entities subject to federal or state statute or rule that prohibits the entity from requiring medical treatment for those who object on religious grounds or right of conscience. The law also does not apply to students of a public institution of higher education delivering healthcare services when the student is participating in/fulfilling requirements of a program in medicine, dentistry, pharmacy, or another healthcare profession.

This act took effect May 25, 2021.

Public Chapter 531

This act limits an agency's authority to promulgate rules without a public hearing. There are exceptions to the public hearing requirement. These exceptions include emergency rules, rules that are nonsubstantive modifications to existing rules (like clerical updates), rules that repeal existing rule, or rules that eliminate or reduce a fee described by an existing rule.

This act took effect July 1, 2021.

Public Chapter 532

This act authorizes the joint government operations committee to stay an agency's rule from going into effect for a period of time not to exceed ninety (90) days. If the government operations committee determines that subsequent stays are necessary, then the joint committee may issue consecutive stays, each for an additional ninety (90) day period, so long as such stays do not extend beyond the fifth legislative day of the year following the year in which the rule is filed with the secretary of state. The initial stay may be done by either the house or senate government operations committee, but subsequent stays must be by agreement by the committees of both chambers. A stay is effective when the respective committee files written notice with the secretary of state, and the respective committee shall specify the length of effectiveness of the stay.

This act took effect May 25, 2021.

Public Chapter 550

This act restricts county health boards to an advisory role to their respective county mayors. The bill also establishes a definition of quarantine in code rather than only in rule. Finally, the bill prohibits governmental entities from requiring vaccine passports.

This act took effect May 26, 2021.

Public Chapter 565

This act transitions the Committee on Physician Assistants under the Board of Medical Examiners to an independent Board of Physician Assistants. The board will receive its transferred rules from the Secretary of State's office from its original committee and those will have full force and effect while new rules are drafted and adopted. The new board will consist of nine members appointed by the Governor. The board will have a sunset date of June 30, 2024.

This act took effect May 26, 2021

Public Chapter 577

This public chapter establishes the medical cannabis commission which is administratively attached to the department of health for purposes of budgeting, audit, use of IT systems, HR support, clerical assistance and administrative support. The commission is composed of 9 members. The Governor appoints 3 members (1 from each grand division), the Lt. Governor appoints 3 members (1 must be a physician and 1 a pharmacist), and the Speaker of the House appoints 3 members (1 must be a physician and 1 a pharmacist). The commission must be impaneled and hold its first meeting by October 1, 2021. The commission is required to meet at least once every two months prior to March 2023. The commission shall appoint an executive director.

The commission is to examine federal laws and other states' laws regarding medical use of cannabis, including issues relating to patient qualification, patient registration, role of practitioners in recommending/prescribing, establishing guidelines for acceptable medical uses, development of a standard of care, etc.

This act took effect May 27, 2021.

Public Chapter 587

This act creates additional resident training spots for universities in Tennessee. A portion of these focus on family medicine, general pediatrics, primary care medicine-pediatrics, and psychiatry, which is administered by the University of Tennessee (UT) and East Tennessee State University (ETSU) in cooperation with the Department of Health and the Tennessee Higher Education Commission. UT and ETSU may contract with accredited medical schools and sponsoring institutions. Another portion focuses on family medicine and general internal medicine provide medical and behavioral health services and is administered by Lincoln Memorial University (LMU) in cooperation with T DH and THEC. LMU may contract with other accredited medical schools and sponsoring institutions or residency programs.

This act takes effect July 1, 2021.

** These are general summaries of legislation. For more detailed information and all specifics/requirements, please review the links to each public chapter*

Public Chapter 350

This 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 legislations 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 will require 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 was brought by the Department of Health and was designed to address a number of issues throughout all licensing boards, committees, and councils.  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 unreasonable 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.