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UPDATED ADVISORY CONCERNING ELECTRONIC CIGARETTES, THE PRACTICE OF “VAPING,” “JUULING” AND USE OF OTHER ELECTRONIC NICOTINE DELIVERY SYSTEMS OR ENDS

Board of Nursing

Legislative Update - 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 takes effect July 1, 2018.

Public Chapter 638

This chapter prohibits healthcare prescribers and their employees, agents, or independent contractors from in-person solicitation, telemarketing, or telephonic solicitation of victims within 30 days of an accident or disaster for the purpose of marketing services of the healing arts related to the accident or disaster.  There are specific exceptions laid out in the chapter. This act takes effect July 1, 2018.

Public Chapter 674

This chapter allows buprenorphine mono or buprenorphine without naloxone to be directly administered by a healthcare provider acting within the scope of practice.  The administration must be for a substance use disorder and pursuant to a medical or prescription order from a physician licensed under title 63 chapter 6 or 9.  This does not allow dispensing that would permit administration away from the premises at which it is dispensed. 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 750

This chapter updates the specific language required to be in the notice given to mammogram patients that are revealed to have dense breasts or extremely dense breasts. This act takes 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 844

This act requires the department of education to establish a student support collaborative to review and define the roles and responsibilities for school social workers, school counselors, school  psychologists, and school nurses.  The collaborative shall identify available resources and areas the groups can collaborate on to provide high quality support to students.  The collaborative shall include (among others) representatives of:

1.     The National Association of Social Workers, TN Chapter

2.     The Tennessee Association of School Social Workers

3.     The Tennessee Association of School Counselors

4.     The Tennessee Association of School Nurses

5.     The Tennessee Association of School Psychologists

This act took effect April 26, 2018.

Public Chapter 862

This act requires that induced termination of pregnancy (ITOP) reports to include whether a heartbeat was detected IF an ultrasound was performed prior to the ITOP.  The department of health  shall include data about the detection of heartbeats and the method employed for ITOPs in an annual report.  The report shall differentiate between medical and surgical methods and between  surgical methods to the extent data permits. 

This act also requires that if an ultrasound is performed prior to an abortion, the person who performs the ultrasound shall offer the woman the opportunity to learn the results of the ultrasound.  If the woman elects to learn the results, the person performing the ultrasound or a qualified healthcare provider shall inform her of the presence or absence of a heartbeat and  document that the patient was informed. This act takes effect January 1, 2019.

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 901

This act requires that prior to prescribing more than a three day supply of an opioid or an opioid dosage that exceeds at total of 180 MME to a woman of childbearing age (15-44 yo), a prescriber  must do the following:

1.     Advise of risks associated with opioid use during pregnancy;

2.     Counsel patient on effective forms of birth control; and

3.     Offer information on availability of free or reduced cost birth control

Doesn’t apply if previously informed by prescriber in previous three months or prescriber reasonably believes patient is incapable of becoming pregnant.  Requirements may be met with a patient  under 18 years of age by informing parent of the patient. 

The department of health is to publish guidance to assist prescribers in complying with this act. This act takes effect July 1, 2018.

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 964

This legislation requires the department of children’s services (DCS) to develop instructional guidelines for child safety training programs by January 1, 2019 for members of professions that  frequently deal with children at risk of abuse.  DCS is required to work with each licensing board to ensure any child safety programs created by a licensing board fully and accurately reflect the  best practices for identifying and reporting abuse as appropriate for each profession. This act took effect May 15, 2018.   Child Abuse Reporting Training

Public Chapter 978

This act makes a number of revisions to opioid treatment regulations.  The definition of “nonresidential office-based opiate treatment facility” (OBOT) has been changed to encompass more  facilities.

The commissioner of mental health is required to revise the rules of OBOTs to be consistent with state and federal law for such facilities to establish certain new protocols.

Rules regarding OBOTs are to be reviewed each even-numbered year and the department of mental health and substance abuse services shall submit the rules for OBOTs to each health related board that licenses any practitioner authorized by the state to prescribe products for treatment of an opioid use disorder.  Each board is required to enforce the rules.  Each board is required to post the rules on the board’s website. Violation of a rule is grounds for disciplinary action by the board.

The act also makes revisions to the licensing fees of OBOTs.

The act requires revision of the buprenorphine treatment guidelines. 

The legislation also requires (subject to 42 CFR part 2) that dispensing of buprenorphine be subject to the Controlled Substance Monitoring Database (CSMD) requirements.

The act prohibits dispensing of buprenorphine except by certain individuals/facilities and requires pharmacies/distributors to report to the department of health (TDH) the quantities of  buprenorphine that are delivered to OBOTs in the state.

The act also makes revisions to the high-volume prescriber list compiled by TDH.

The act requires the comptroller to complete a study of statistically abnormal prescribing patterns.  After the study, TDH shall identify prescribers and shall inquire with the boards of action taken against the prescribers and the board is required to respond within 30 days.  Each board is required to report the total number of prescribers disciplined each year, as well as other information.   TDH shall report a summary of the data and of the disciplinary actions to the chairs of the health committees.

The act also comprises a task force to create minimum disciplinary actions for prescribing practices that are a significant deviation from sound medical judgment.  The board of medical  examiners, osteopathic examination, dentistry, podiatric medical examiners, optometry, nursing and medical examiner’s committee on physician assistants shall select one member each for the task force before September 1, 2018. 

This act took effect for rulemaking on May 21, 2018 and takes effect July 1, 2018 for all other purposes.

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.

 

Legislative Update - 2017

Public Chapter 266

Current law authorizes physicians and health officers to treat minors with STDs without parental knowledge or consent and incur no civil or criminal liability except for negligence.  This legislation adds nurse practitioners, nurse midwives, and physician’s assistants to those authorized to treat minors with STDs without parental knowledge or consent.  This act took effect on July 1, 2017.

Public Chapter 334

This legislation revises the terminology used to describe the relationship between APRN’s and physicians in certain situations and instances in the Code from “supervise, supervision, etc.” to “collaborate, collaboration, etc.”  The situations are:

  • Practice in a certified pain clinic under T.C.A. 63-3-106.
  • Prescriptive services under T.C.A. 63-7-123.
  • Definition of Prescription Order under T.C.A. 63-10-204.
  • Collaborative Practice Pharmacy Agreements under T.C.A. 63-10-217.
  • The Health Care Consumer Right-to-Know Act of 1998 under T.C.A. 63-51-115.
  • Top Prescribers of Controlled Substances under T.C.A. 68-1-128.

The intent of the legislation is a change in terminology only and not to alter the relationships and responsibilities between APRN’s and physicians.    This legislation took effect on July 1, 2017.

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 483

This requires TDH, beginning July 1, 2017, to identify high-risk prescribers based on clinical outcomes including patient overdoses and makes the prescribers subject to selected chart review and investigation by TDH.  It requires TDH, if a prescriber is identified as a high-risk prescriber, to submit the high-risk prescriber’s information to the board that issued the prescriber’s license for appropriate action.  It requires the licensing board, upon receiving the information, to notify the prescriber, and, if applicable, the prescriber’s supervising physician, of their high-risk status and require the prescriber to meet certain criteria.  If a prescriber is identified as high risk, he or she must:

  • Participate in continuing education about opioid addiction.
  • Make opioid addiction literature available in the prescriber’s waiting room.
  • Obtain written consent from certain long-term opioid patients.This consent must be renewed every 4 weeks for patients who remain on opioid therapy.
  • Comply with these requirements for one year.

All costs associated with this section are to be paid by the identified provider.  Providers identified as high-risk who dispute such identification may request TDH to conduct an internal review of the identification, which is to be done by the Commissioner or the Commissioner’s designee. 

Additionally, this legislation requires the Commissioner, on or before January 15, 2018, in consultation with the Perinatal Advisory Committee and with the assistance of relevant state agencies, to report to the Health Committee of the House of Representatives and the Health and Welfare Committee of the Senate concerning the aspects of births involving neonatal abstinence syndrome (NAS) and opioid use by women of childbearing age for the last two available fiscal years or calendar years.  It also requires TennCare to issue RFIs for initiatives aimed at primary and secondary prevention of NAS births. 

This act took effect on June 6, 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 84

This legislation requires the State Board of Education, in consultation with the Board of Nursing, Board of Pharmacy, Department of Health and Department of Children’s Services, to adopt rules for the administration of adrenal insufficiency medication to students by school personnel.  Educational training on the treatment of adrenal insufficiency required by this legislation shall be conducted under the supervision of a physician or nurse practitioner.  This legislation took effect on July 1, 2017.

Public Chapter 256

This authorizes local education agencies and nonpublic schools to maintain opioid antagonists in schools.  A school nurse or other trained school personnel may administer opioid antagonists to respond to drug overdoses, under a standing protocol from a physician.  A school nurse or other trained school personnel will not be held responsible for resulting injury unless the medication was administered with an intentional disregard for safety.  The State Board of Education, in consultation with the Department of Health, shall develop guidelines for schools.  This took effect on July 1, 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 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.