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Board of Dentistry

Public Chapter 4 (second extraordinary session)

This public chapter deals with telehealth and reimbursement.  The majority of the legislation is focused on provisions related to insurance and reimbursement for telehealth services.  Section 9 of the public chapter, however, focuses on the definition of telehealth and what health practitioners are authorized to do telehealth.

Section 9 of the bill defines "telehealth," "telemedicine," and "provider-based telemedicine" as the use of real time audio, video, or other electronic media and telecommunication technology that enables interaction between a healthcare provider and a patient for the purpose of diagnosis, consultation, or treatment of a patient at a distant site where there may be no in-person exchange between a healthcare provider and a patient. The definition also includes store-and-forward telemedicine services.

Until April 1, 2022, all licensed providers under title 63 (as well as licensed alcohol and drug abuse counselors under title 68, or any state-contracted crisis service provider that is employed by a facility licensed under title 33) are defined as healthcare providers under the telehealth bill.  After April 1, 2022, the definition of a healthcare provider eligible to perform telehealth services will change to an individual acting within the scope of a valid license issued pursuant to title 63 (as well as licensed alcohol and drug abuse counselors under title 68, or any state-contracted crisis service provider that is employed by a facility licensed under title 33).  Telehealth is not authorized for use at pain management clinics or for the treatment of chronic nonmalignant pain.  It is also not available for veterinarians. 

A patient-provider relationship in regard to telehealth is created by mutual consent and communication.  No new standards of care are created, and the provider will be held to the same standard of care as if the case was in person.  Finally, the board shall not establish a more restrictive standard of practice for telehealth than what is specifically authorized by the provider's practice act or other applicable statutes.

This act took effect August 20, 2020.

Current through August 11, 2020

Public Chapter 573

This act amends the Tennessee Together statutes.  It expands the definition of “alternative treatments” by adding “nonopioid medicinal drugs or drug products, occupational therapy, and interventional procedures or treatments.”  This is primarily relevant to the treatments that must be disclosed and explained by a healthcare practitioner to a patient or the patient's legal representative as a prerequisite to obtaining informed consent to treatment with an opioid.

This act took effect on March 19, 2020.

Public Chapter 594

This act was the Department of Health’s Licensure Accountability Act.  The bill allows all health related boards to take action against a licensee that has been disciplined by another state for any acts or omissions that would constitute grounds for discipline in Tennessee.  The law also expands available emergency actions, allowing actions beyond simply a summary suspension.  Finally, the act establishes that the notification of law changes to health practitioners can be satisfied by the online posting of law changes by the respective boards.  Notice must be maintained online for at least 2 years following the change.

This act took effect March 20, 2020.

Public Chapter 724

While typical general supervision of hygienists by a dentist remains limited to three (3) at any one time, this public chapter allows a dentist to directly supervise no more than ten (10) dental hygienists while the dentist and each hygienist is providing dental services on a volunteer basis through a nonprofit provider of free mobile clinics.

This act took effect July 1, 2020.

Public Chapter 738

This act amends prohibits a governmental entity from authorizing destruction of public records if the governmental entity knows the records are subject to a pending public record request.  Prior to authorizing destruction of public records an entity must contact the public record request coordinator to ensure the records are not subject to any pending public record requests.  Records may still be disposed of in accordance with an established records retention schedule/policy as part of an ordinary course of business as long as the records custodian is without knowledge the records are subject to a pending request.

This act took effect on June 22, 2020.

Public Chapter 761

This act allows certain midlevel practitioners to prescribe buprenorphine when employed in a community mental health center (CMHC) or a federally qualified health center (FQHC).  To be eligible under this law, the practitioner must be licensed, and practice as, a family, adult, or psychiatric nurse practitioner or physician assistant.  They also must have a DATA waiver issued by SAMHSA/DEA.  There can be no limitations or conditions imposed on the provider’s license within the previous three (3) years. Prescriptions by the practitioner must not exceed a sixteen (16) milligram daily equivalent.  The practitioner also must not prescribe mono product or buprenorphine without naloxone.  The provider may only prescribe buprenorphine products to patients treated through the organization that employs the provider.  Prescriptions can only be dispensed by a licensed pharmacy to ensure entry into the CSMD.  The provider has a cap of fifty (50) patients at any given time.  The law also requires the provider to initiate and lead a discussion regarding patient readiness to taper off medications in their treatment at any time upon the patient’s request, but no later than one (1) year after initiating treatment, and then every six (6) months thereafter.

The facility must employ one or more physicians and have adopted clinical protocols for medication assisted treatment.  The midlevel’s collaborating physician must hold an active DATA waiver and be treating patients with buprenorphine at the same facility.  The facility must employ providers that accept TennCare and are accepting new TennCare patients.  The facility must verify identification of patients.  The collaborating physician must review 100% of the charts of patients being prescribed a buprenorphine product and can only collaborate/supervise four (4) nurse practitioners or physician assistants.   

This act took effect July 1, 2020.

Public Chapter 771

This act allows certain midlevel practitioners to prescribe buprenorphine when employed in a non-residential office-based opiate treatment facility (OBOT) licensed by the Department of Mental Health and Substance Abuse Services (MHSAS).    To be eligible under this law, the practitioner must be licensed, and practice as, a family, adult, or psychiatric nurse practitioner or physician assistant.  They also must have a DATA waiver issued by SAMHSA/DEA.  Prescriptions by midlevel providers under this statute are capped at a sixteen (16) milligram daily dose, and must not be for a mono-product or buprenorphine without naloxone, except when utilizing injectable or implantable buprenorphine products.  Midlevel providers under this statute are capped at 100 patients.

 The OBOT in these situations must employ the midlevel’s collaborating physician (who also must hold an active DATA waiver and be treating patients with buprenorphine at the same OBOT) and the OBOT must not have the authority to dispense buprenorphine products.  The collaborating/supervising physician under this statute cannot supervise more than two (2) midlevel practitioners.

The OBOT also must employ providers that are credentialed and contracted to accept TennCare patients and bill TennCare for services for treatment of opioid use disorder with buprenorphine.  Finally the OBOT must be accepting new TennCare patients. 

This act took effect August 1, 2020.

Current through July 12, 2019

Public Chapter 61

This act states that an entity responsible for an AED program is immune from civil liability for personal injury caused by maintenance or use of an AED if such conduct does not rise to the level of willful or wanton misconduct or gross negligence.

This act took effect on March 28, 2019.

 

Public Chapter 117

This act adds a definition of “alternative treatments” to 63-1-164 pertaining to the restrictions and limitations on treating patients with opioids.

This act took effect April 9, 2019.

 

Public Chapter 124

This act makes a variety of small changes and additions to the TN Together opioid initiative put in place in 2018.  One addition is allowing access to CSMD data to a healthcare practitioner under review by a quality improvement committee (QIC), as well as to the QIC, if the information is furnished by a healthcare practitioner who is the subject of the review by the QIC. 

The requirement for e-prescribing of all schedule II substances by January 1, 2020 has been delayed to January 1, 2021 and is modified to require all schedule II through V prescriptions to be e-prescribed except under certain circumstances.  The law also requires all pharmacy dispensing software vendors operating in the state to update their systems to allow for partial filling of controlled substances.

Definitions are given by this act to the terms palliative care, severe burn and major physical trauma.  Along with its new definition, palliative care has now joined severe burn and major physical trauma as an exception to the opioid dosage limits otherwise required under TN Together. 

An unintended consequence of last year’s Public Chapter 1039 was on cough syrup.  This act establishes that the law does not apply to opioids approved by the FDA to treat upper respiratory symptoms or cough, but limits such cough syrup to a 14 day supply.

Also changed from last year’s act is the requirement to partial fill.  Partial filling of opioids is now permissive.

Finally, the opioid limits under have been simplified from the previous year’s act.  The twenty day supply and morphine milligram equivalent limit has been eliminated.  Three day and ten day requirements remain the same.  Instances such as more than minimally invasive surgery, which previously fell under the twenty day provision, now can be treated under the limits of the thirty day category.

This act took effect on April 9, 2019.       

Public Chapter 124                                                  

 

Public Chapter 195

The majority of this act pertains to boards governed by the Department of Commerce and Insurance.  One small section applies to the health related boards. Currently, the health related boards have an expedited licensure process for military members and their spouses.  Previously, a spouse of an active military member had to leave active employment to be eligible for this expedited process.  This act removes that requirement.  This section applies to all health related boards.  The Commissioner of Health is permitted to promulgate rules, but rules are not needed to implement the act.

This act takes effect July 1, 2019.

 

Public Chapter 214

This act permits private businesses to adopt the Healthy Workplace Policy created by TACIR, which initially only applied to government entities. However, nothing in this act creates a cause of action against an employer who does not adopt the model policy.

This act took effect April 23, 2019.

 

Public Chapter 229

This act allows healthcare professionals to accept goods or services as payment in direct exchange of barter for healthcare services. Bartering is only permissible if the patient to whom services are provided is not covered by health insurance. All barters accepted by a healthcare professional must be submitted to the IRS annually. This act does not apply to healthcare services provided at a pain management clinic.

This act took effect April 30, 2019.

 

Public Chapter 243

This act mandates that an agency that requires a person applying for a license to engage in an occupation, trade, or profession in this state to take an examination must provide appropriate accommodations in accordance with the Americans with Disabilities Act (ADA). Any state agency that administers a required examination for licensure (except for examinations required by federal law) shall promulgate rules in regard to eligibility criteria. This legislation was introduced to assist individuals with dyslexia.

 This act took effect May 2, 2019 for the purpose of promulgating rules, and for all other purposes, takes effect July 1, 2020.

 

Public Chapter 255

The act permits a medical professional who has a current license to practice from another state, commonwealth territory, or the District of Columbia is exempt from the licensure requirements of such boards if: (1) the medical professional is a member of the armed forces; and (2) the medical professional is engaged in the practice of the medical profession listed in 68-1-101 through a partnership with the Federal Innovative Readiness Training. The respective health boards may promulgate rules for implementation.

This act took effect April 18, 2019 for the purpose of promulgating rules, and for all other purposes, takes effect July 1, 2019.

 

Public Chapter 264

This act permits the attorney general, reporter, and personnel to access confidential data from the Controlled Substance Monitoring Database upon request for the purposes of investigation or litigation of a civil action. Release of this information to other parties must be accompanied by an appropriate protective order. This bill was brought by the Office of the Attorney General.

This act took effect April 30, 2019.

 

Public Chapter 319

This act expands the practice of dental hygiene to include prescriptive authority limited to fluoride agents, topical oral anesthetic agents, and non-systemic oral antimicrobials provided that it is not a controlled substance under state and federal laws and it does not require a license by the federal drug enforcement agency. A dental hygienist’s prescriptive authority must be exercised under the  general supervision of a licensed dentist, pursuant to board rules, and in compliance with all applicable law concerning prescription packaging, labeling, and record keeping requirements. A prescription written by a dental hygienist must be reviewed by a dentist within thirty days. The board shall promulgate rules to implement this act.

This act took effect May 8, 2019 for the purpose of promulgating rules. For all other purposes, this act will take effect on July 1, 2020.

 

Public Chapter 327

This act requires the Commissioner of Health, by January 1, 2020, to study instances when co-prescribing of naloxone with an opioid is beneficial and publish the results to each prescribing board and to the board of pharmacy.  The findings shall be included in the chronic pain guidelines adopted by the Chronic Pain Guidelines Committee.

This act took effect May 8, 2019.

 

Public Chapter 447

This act permits law enforcement agencies to subpoena materials and documents pertaining to an investigation conducted by the Department of Health prior to formal disciplinary charges being filed against the provider. This bill was brought by the Tennessee Bureau of Investigation.

This act went into effect May 22, 2019.

 

*Insurance Legislation*

Multiple acts were passed during the 2019 legislative session that affect healthcare plans and insurance and create certain obligations on providers and facilities.  A few pieces of legislation include Public Chapter 407 and Public Chapter 239.  Healthcare providers and facilities are encouraged to review these to make sure they meet their statutory obligations.