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Board of Osteopathic Examination

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 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 574

This act allows federally qualified health centers (FQHCs) and rural health clinics to employ physicians as long as the employment includes some documentation (a contract, job description, etc.) that contains language making it clear that the physician is not restricted from exercising independent medical judgment in diagnosing and treating patients.

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 645

This act establishes the Rare Disease Advisory Council under the Bureau of

TennCare.  The council is comprised of eleven members (nine appointed by the Governor, one by Lt. Governor, one by Speaker of the House).  Two physicians with experience treating rare disease and one RN or APRN with experience treating rare disease are among those members to be appointed by the Governor.  The council exists to advise TennCare’s pharmacy advisory committee and drug utilization review committee in regard to rare and orphan diseases.

For the purpose of appointing members to the advisory council, this act took effect April 1, 2020.  For all other purposes, this act took effect July 1, 2020.

 

Public Chapter 684

This chapter modifies the time period for which a hospital and certain other facilities (community health clinic, birthing center, out-patient “walk-in” clinic, emergency medical services facility) shall receive possession of any newborn infant from the mother wishing to give up the child.  Previously the time period was 72 hours.  The new time window is 2 weeks. 

This act took effect June 15, 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.

 

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 764

This act addresses multiple provisions related to abortion in the state of

Tennessee.  First, it deletes the requirement that the Department of Children’s Services provide court advocates and other information about judicial procedures to minors who are considering abortion.  

Second, it establishes an ultrasound requirement.  Prior to a woman giving informed consent for an abortion, an ultrasound must be performed.  The physician must determine the gestational age and provide it to the woman.  There must be a determination of whether a fetal heartbeat exists, and if audible, make it audible to the woman.  The physician must show ultrasound images to the woman and explain what they depict.  The gestational age and presence or absence of heartbeat must be recorded in the woman’s medical record.  The physician must also obtain certification from the woman that she was provided the information required by this statute.  The ultrasound requirements of this statute may be delegated by a physician to an ultrasound technician with appropriate certifications/registrations under the statute.  

The act also establishes a prohibition on abortions at certain gestational milestones.  Abortions are prohibited after detection of a fetal heartbeat, at 6 weeks gestational age or older, as well as 8, 10, 12, 15, 18, 20, 21, 22, 23, and 24 weeks gestational age or older.  There is a medical emergency exception if certain criteria are met.  Abortions are prohibited based on race, sex, or diagnosis of Down syndrome. 

It is a class C felony for a physician to perform an abortion in violation of this statute.  It is a class E felony for an ultrasound technician to not fulfill delegated duties related to the ultrasound provisions, if that non-performance results in an abortion.  A physician charged with violation of this statute must report the charge within seven (7) days to the Board of Medical Examiners. 

The final portion of this act requires that certain information be provided regarding reversing chemical abortions.  Specifically it requires the conspicuous posting of a sign in offices or facilities providing more than fifty (50) abortions per year which states: 

“Recent developing research has indicated that mifepristone alone is not always effective in ending a pregnancy. It may be possible to avoid, cease, or even reverse the intended effects of a chemical abortion utilizing mifepristone if the second pill has not been taken. Please consult with a healthcare professional immediately.”

Failure to post the signage when/where necessary, requires the department of health to assess a $10,000 civil monetary penalty.  Each day an abortion is performed without the required signage is a separate violation.  The same language on the signage is required to be given to woman in medical discharge instructions after the first drug is given in a chemical abortion.  

The majority of this act took effect July 13, 2020.  The provisions relating to chemical abortion reversal take effect October 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.

 

 

 

Legislative Update 2019: Board of Osteopathic Examination

 

Public Chapter 12

This act allows a qualified registered nurse, if the nurse has a cooperative working relationship with a physician and follows hospital protocols, to determine whether a patient presenting to a hospital has an emergency medical condition. Emergency medical condition and qualified registered nurse are defined in the statute. This legislation was brought by the Tennessee Hospital Association.

This act took effect March 20, 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 defines “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 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 156

This public chapter creates a commemorative certificate of nonviable birth.  The licensed healthcare practitioner who attends or diagnoses a nonviable birth, may, based on the practitioner’s best medical judgment and knowledge of the patient, advise a patient that experiences a nonviable birth that the patient may obtain a commemorative certificate from the Department of Health.  The Department shall provide a form on its website that the practitioner shall execute and provide to the patient.  Upon the request of the patient, the Department shall issue the commemorative certificate within 60 days after the request and shall charge a fee not to exceed the actual cost for issuing the certificate.

This act took effect April 18, 2019.

 

Public Chapter 183

This act permits advanced practice registered nurses (APRNs) and physician assistants (PAs) working in a community mental health center to have their chart review done remotely by their collaborating physician. The electronic means by which the transmission occurs must be HIPAA- compliant.

This act took effect April 23, 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 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 259

This act allows a licensed nonresidential office-based opiate treatment facility to employ or contract with a physician if: (1) the facility has a physician in the ownership structure; and (2) the employment relationship is evidenced by a written contract. The contract must contain language that does not restrict a physician from exercising independent professional medical judgement in regard to his/her patients.

This act took effect April 30, 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 268

This act rewrites the criminal offense for female genital mutilation.  Those who knowingly mutilate a female, facilitate the mutilation, or knowingly transport or facilitate the transportation of a female for the purposes of mutilation are subject to a class D felony.  Such individuals are also liable civilly.  Any physician, physician in training, certified nurse or midwife or any other medical professional that performs, participates in, or facilitates a mutilation shall be subject to disciplinary action by the appropriate licensing board in addition to criminal penalties.  Certain medical procedures listed in the statute are not considered violations.

This act takes effect July 1, 2019.

 

Public Chapter 307

This act requires the Department of Health to include data related to complications of induced abortions, including the number and type of complications in its annual induced termination of pregnancy (ITOP) data report. The department shall not release any data that could identify individual patients. The department may promulgate rules necessary to implement this act.

This act took effect May 8, 2019 for the purpose of promulgating rules, and for all other purposes will take effect July 7, 2019.

 

Public Chapter 327

This act requires the Commissioner of Health, by January 1, 2020, to study instances when coprescribing 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 357

This act states that a massage establishment license is no longer required for the office of a licensed medical doctor, osteopathic doctor, or chiropractor if a massage for compensation is provided within that office by a licensed massage therapist.

This act became effective May 10, 2019. 

 

Public Chapter 424

This act modifies the Child Rape Protection Act of 2006 by requiring a physician to report when a minor who is at least 13 but no more than 17 requests an elective abortion. Reporting is required only if the physician has reasonable cause to believe child abuse is involved.

Requirements for reporting abortions for minors under the age of thirteen remain the same.

This act took effect May 21, 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.  

 

Board of Osteopathic Examination  Legislative Update - 2018

 

Public Chapter 610

This changes the terminology regarding the relationship between physicians and physician assistants.  Previously the relationship was described in terms of

“supervision.”  The new description of the relationship is described as

“collaboration.”

This act takes effect on July 1, 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.

 

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.

 

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 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.

855

Prohibits alcohol and drug treatment facilities (ADTF), healthcare providers and healthcare facilities from certain practices in regard to solicitation and marketing of alcohol and drug treatment services.  

This act takes effect July 1, 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 (15-44yo), 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. 

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 1037

This act clarifies that a physician may accept goods or services as payment in a direct exchange of barter for healthcare services provided by the physician if the patient to whom the healthcare services are provided is not covered by health insurance coverage.  This does not apply to healthcare services provided at pain management clinics.

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 1040

This act revises various provisions of the law regarding controlled substances and their analogues and derivatives, including updating identifications of drugs categorized in Schedules I - V.  The act also creates an offense for the sale or offer to sell Kratom, unless it is labeled and in its natural form.  It is also an offense to distribute, sell, or offer for sale, kratom to a person under 21 years of age.  It is also an offense to purchase or possess kratom if under 21 years of age.   

This act takes effect July 1, 2018.