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Information from TN Dept of Health about the Ongoing Novel Coronavirus Outbreak

Board of Nursing Home Administrators

Legislative

 

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

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

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 148

This act requires the board of licensed healthcare facilities to promulgate emergency rules no later than July 1, 2021, relative to permitting qualified temporary nursing aides in nursing homes to become certified nursing assistants in Tennessee to assist with the ongoing pandemic response in healthcare facilities. This act also clarifies that they would be added to the nurse aid registry.

This act took effect April 13, 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 (5th) 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 28th, 2021 and will sunset July 1, 2025.

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 rule.

This act took effect July 1, 2021.

Public Chapter 328

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 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 458

This act adds nurses to the list of victims warranting enhanced penalties under the crime of assault against first responders (a Class A misdemeanor), as well aggravated assault of first responder (a Class C felony).

This act takes effect July 1, 2021.

Public Chapter 461

This act requires TDH 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 II 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 530

This act grants extends the TennCare annual nursing home assessment fee to June 30, 2022. Additionally, this act clarifies that provisions in existing code relative to late fees also applies to quarterly assessment fees by TennCare and adds a five-percent (5%) penalty of the quarterly assessment fee balance for each month that the balance is unpaid to TennCare.

This act took effect July 1, 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 557

This thirty-page act does a complete overhaul of the certificate of need process through the health services and development agency. Among the changes are adjustments to various population thresholds, modifications to the fee schedule, and changes in bed numbers. One of the components of the bill requires the executive director of HSDA to submit a plan to consolidate into a health facilities commission, the powers and duties of HSDA and the board for licensing health

care facilities. The plan is to be submitted to the chairs of senate and house health by January 1, 2023.

Some portions of this act took effect May 26, 2021. The rest of the act will take effect October 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 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.

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 644

This act extends the nursing home annual assessment to June 30, 2021.

This act took effect April 1, 2020.

 

Public Chapter 738

This act 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.

Legislative Update 2019: Nursing Home Administrators Board

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 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 144

This act amends the Prevention of Youth Access to Tobacco and Vapor Products Act by limiting the places in which one may use vapor products.  The act defines vapor products and prohibits the use of such products in a number of locations including child care centers, group care homes, healthcare facilities (excluding nursing homes), residential treatment facilities, school grounds, and several other areas.  Several locations have specific exceptions set forth in the statute.

This act took effect on April 17, 2019.

 

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 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 245

This act prohibits any person who is not licensed or certified by the Board of Nursing from using the title “nurse” or any other title that implies that the person is a practicing nurse. The Board is empowered to petition any circuit or chancery court having jurisdiction to enjoin: (1) a person attempting to practice or practicing nursing without a valid license; (2) a licensee found guilty of any of the acts listed in 63-7-115; or (3) any person using the title “nurse” who does not possess valid license or certificate from the Board.  

This act took effect May 2, 2019.

 

Public Chapter 324

This act authorizes any existing licensed and operating nursing home to relocate 62 or fewer of its licensed beds to a new separate licensed nursing home if certain conditions are satisfied, including obtaining a certificate of need through the Health Services and Development Agency.

There is only one nursing home that currently meets these conditions (in East Tennessee).  

This act takes effect July 1, 2019.

 

Public Chapter 423

This act extends the nursing home assessment fee through June 30, 2020. The act will assess

4.75% of each included nursing facility’s annual coverage assessment base for fiscal year 2020.

This act will take effect July 1, 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. 

 

Public Chapter 474

This act is known as the “Elderly and Vulnerable Adult Protection Act of 2019.” The act adds definitions of abuse, sexual exploitation, financial exploitation, and neglect. Convictions for the preceding offences are required to be reported to the Abuse Registry. Penalties for these offenses are also increased for aggravated abuse of an elderly or vulnerable adult. In addition, this act requires any relative conservator, agent, employee of the Tennessee Commission on Aging and Disability, or guardian ad litem to be mandatory reporters if they have knowledge that an elderly or vulnerable adult is a victim of any of the offenses listed above.

This act became effective May 24, 2019 for the purpose of promulgating rules. For all other purposes, this act will go into effect January 1, 2020.

 

*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.  

 

Nursing Home Administrators Wraps – 2018

Public Chapter 611

This law requires an agency holding a public hearing as part of its rulemaking process, to make copies of the rule available in “redline form” to people attending the hearing. 

This act takes effect July 1, 2018.

Public Chapter 655

This is the department of health (TDH) administration bill CORE.  This act makes a variety of changes to existing law regarding nursing homes, assisted care facilities and the abuse registry. 

This act establishes that the TDH commissioner has the authority to suspend admission of any new patients or residents to any facility or licensee in those cases where there is a factual basis that the conditions are, or are likely to be, detrimental to the health, safety, or welfare of a patient or resident.

The act lays out the suspension process, appeals process, and time windows required.  It also establishes that the board has the authority to continue, revoke, or modify the suspension of admissions and enter other such orders as it deems necessary.

The act also creates a requirement on homes for the aged, traumatic brain injury residential homes, assisted care living facilities, and adult care homes to notify residents of their right to file a complaint and the process to do so.  The legislation also prohibits facilities from retaliatory actions against residents for filing a complaint.  Those filing complaints in good faith are immune from civil liability.

The CORE act also establishes TDH’s ability to act in regard to entities operating unlicensed facilities and establishes the penalties that TDH may pursue or assess.

Finally the act makes clarifications of those individuals that TDH will list on the abuse registry and the requirements of the disposition order from TBI.

This act takes effect July 1, 2018.

Public Chapter 671

This act redefines “trauma service codes.”

Previously it was defined as “the ICDA-9-CM discharge codes designated as trauma service codes by the American College of Surgeons committee on trauma.”

The new definition will be “a subset of the ICD-10-CM diagnosis codes, or the most relevant versions of the lnternational Classification of Diseases and Related Health Problems (lCD) required by the centers for medicare and medicaid services, for coding hospital discharges designated as trauma service codes by the American College of Surgeons committee on trauma.”

This act took effect April 12, 2018.

Public Chapter 675

This act requires the department of health to accept allegations of opioid abuse or diversion and for the department to publicize a means of reporting allegations.  

Any entity that prescribes, dispenses, OR handles opioids is required to provide information to employees about reporting suspected opioid abuse/diversion.  That notice is to either be provided individually to the employee in writing and documented by the employer OR by posting a sign in a conspicuous, non-public area of minimum height and width stating: “NOTICE: PLEASE REPORT ANY SUSPECTED ABUSE OR DIVERSION OF OPIOIDS, OR ANY OTHER IMPROPER BEHAVIOR WITH RESPECT TO OPIOIDS, TO THE DEPARTMENT OF HEALTH'S COMPLAINT INTAKE LINE: 800-852-2187.”

Whistleblower protections are also established.  An individual who makes a report in good faith may not be terminated or suffer adverse licensure action solely based on the report.  The individual also is immune from any civil liability related to a good faith report. 

This act takes effect January 1, 2019.

Public Chapter 744

This statute allows a licensing entity the discretion to not suspend/deny/revoke a license in cases where the licensee has defaulted or become delinquent on student loans IF a medical hardship significantly contributed to the default or delinquency.

This act took effect January 1, 2019.

Public Chapter 745 and Public Chapter 793

These public chapters work together to create and implement the “Fresh Start Act.”  Licensing authorities are prohibited from denying an application or renewal for a license/certificate/registration due to a prior criminal conviction that does not directly relate to the applicable occupation.  Lays out the requirements on the licensing authorities as well as the exceptions to the law (ex: rebuttable presumption regarding A and B level felonies). 

These acts take effect July 1, 2018.

Public Chapter 754

This chapter prevents any board, commission, committee, etc. created by statute from promulgating rules, issuing statements, or issuing intra-agency memoranda that infringe on an entity member’s freedom of speech. 

Freedom of speech includes, but is not limited to, a member’s freedom to express an opinion concerning any matter relating to that governmental entity, excluding matters deemed to be confidential under TCA 10-7-504.

Violations as determined by a joint evaluation committee may result in recommendations to the general assembly concerning the entity’s sunset status, rulemaking authority and funding.

This act took effect April 18, 2018.

Public Chapter 883

This act lays the framework for e-prescribing practices in the state and the exceptions from electronic prescriptions. Requires that all Schedule II prescriptions be e-prescribed by January 1, 2020 except under certain circumstances.  Any health-related board under TCA 68-1-101(a)(8) that is affected by this act shall report to the general assembly by January 1, 2019 on issues related to the implementation of this section.  The commissioner of health is authorized to promulgate rules to effectuate the purposes of this act. 

This act took effect May 3, 2018 for rule purposes.

The act takes effect January 1, 2019 for all other purposes.

Public Chapter 929

This act redefines policy and rule and requires each agency to submit a list of all policies, with certain exceptions, that have been adopted or changed in the previous year to the chairs of the government operations committees on July 1 of each year.  The submission shall include a summary of the policy and the justification for adopting a policy instead of a rule.

This act also prohibits any policy or rule by any agency that infringes upon an agency member’s freedom of speech. 

Finally, this act establishes that an agency’s appointing authority shall have the sole power to remove a member from a board, committee, etc.

This act takes effect July 1, 2018 and applies to policies adopted on or after that date.

Public Chapter 954

This legislation requires the initial licensure fee for low-income persons to be waived.  Low income individuals per the statute are defined as persons who are enrolled in a state or federal public assistance program including but not limited to TANF, Medicaid, and SNAP.  All licensing authorities are required to promulgate rules to effectuate the purposes of this act. 

This act takes effect January 1, 2019.

Public Chapter 1007

This act allows for a prescription for a controlled substance to be partial filled if requested by the patient or the practitioner who wrote the prescription AND the total quantity dispensed through partial fills does not exceed the total quantity prescribed for the original prescription.  The act lays out the requirements on the pharmacists and gives details regarding payments.

This act takes effect January 1, 2019.

Public Chapter 1021

This act allows for appeals of contested case hearings to be in the chancery court nearest the residence of the person contesting the agency action or at that person’s discretion, in the chancery court nearest the place the action arose, or in the chancery court of Davidson County.  Petitions seeking review must be filed within 60 days after entry of the agency’s final order. 

This act takes effect July 1, 2018.

Public Chapter 1039

This legislation places limits and requirements on the amount of opioids prescribed and dispensed.  It limits opioid prescriptions to up to a three day supply with a total of 180 MME (morphine milligram equivalents) for those three days.  This limitation is subject to a number of exceptions under certain circumstances.  These exceptions include up to a ten day supply with a total of 500 MME, up to a twenty day supply with a total of 850 MME for a procedure that is more than minimally invasive, and up to a thirty day supply with a total of 1200 MME when other reasonable and appropriate non-opioid treatments have been attempted and failed and the risk of adverse effects from the pain exceeds the risk of the patient developing an addiction or overdose.  Prescribing under these exceptions requires the prescriber to check the controlled substance monitoring database, personally conduct a physical exam of the patient, consider non-opioid alternatives, obtain informed consent including counseling about neonatal abstinence syndrome and contraception for women of childbearing age, and document the ICD-10 code for the patient’s primary disease (as well as the term “medical necessity” on thirty day prescriptions).  These ten, twenty, and thirty day opioid prescriptions will only be filled by dispensers in an amount that is half of the full prescription at a time, requiring patients and pharmacists to consider whether the patient requires the full amount prescribed.  There are still further exceptions for those patients undergoing active or palliative cancer treatment, receiving hospice care, diagnosed with sickle cell disease, administered to in a hospital, being treated by a pain management specialist or collaborating provider in a pain management clinic, who have received ninety days or more in the year prior to April 2018 or subsequently do so under one of the exceptions, receiving treatment for medication-assisted treatment, or suffering severe burns or major physical trauma. 

This act took effect for rule purposes on May 21, 2018, and for all other purposes shall take effect July 1, 2018.

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.

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.