• The Department of Health’s administration bill successfully extended current opioid prescription protections that were put into place in 2018 under the Tennessee Together Act.
• The Department of Health was extended to June 30, 2027, following an audit and subsequent sunset hearings.
• Multiple boards administratively attached to the Department of Health were extended by the legislature following audits and subsequent sunset hearings.
Non-Health Related Legislative Activity of Note
• June 19 th is now designated as a state holiday for Juneteenth.
• State employees are authorized to use sick leave from a sick leave bank to care for a sick minor child of the employee.
• State employees must be provided six paid weeks of leave for the birth of the employee’s child or because of the employee’s adoption of a child.
• “Send Me” is now an additional state motto.
• The legislature passed an extensive transportation modernization act.
• The legislature passed a teacher paycheck protection act that, among other things, raises the minimum teacher salary to $50,000 by 2026.
• Law enforcement officers and the district attorney general’s office may extend criminal immunity to persons who are experiencing a drug overdose and who are seeking medical assistance.
Pertinent Public Chapters
*All Public Chapters are hyperlinked to the actual document on the Secretary of State’s website.
This law prohibits a healthcare provider from knowingly performing or offering to perform on a minor, or administer or offer to administer to a minor, a medical procedure if the performance or administration of the procedure is for the purpose of enabling a minor to identify with or live as an identity inconsistent with the minor’s sex. This bill does not prohibit such medical procedure if the performance or administration is to treat a minor’s congenital defect, precocious puberty, disease, or physical injury or the medical procedure began prior to the effective date of this act and concludes on or before March 31, 2024. This law also prohibits a person from knowingly providing a hormone or puberty blocker by any means to a minor if the provision of the hormone or puberty blocker is not in compliance with this bill. This bill is effective on July 1, 2023.
This law extends the Board of Nursing to June 30, 2027.
This law allows law enforcement or the district attorney general’s office to extend criminal immunity from being arrested, charged, or prosecuted to persons who are experiencing a subsequent drug overdose. This bill takes effect on July 1, 2023. This was a Department of Mental Health and Substance Abuse’s legislative initiative.
This law extends certain provisions within the code regarding Covid-19 established during the 2021 Special Session. This bill was effective on March 21, 2023.
This law codifies the Acts of the 2022 legislative session. This law was effective on March 21, 2023.
This law clarifies that the Medical Assistance Act of 1968 does not require a vendor, healthcare provider, or telehealth provider group that provides healthcare services exclusively via telehealth to have a physical address or site in this state in order to eb eligible to enroll as a vendor, provider, or provider group for that program. This law defines telehealth provider as two or more healthcare providers that share a common employer and provide healthcare services exclusively via telehealth. This law was effective on March 21, 2023.
This law authorizes certified medical assistants, pursuant to a physician’s or nurses’ delegation, to administer or prepare only medications that have been ordered by authorized healthcare provider and that are consistent with policies and procedures of the applicable licensed facility. This law also amends the current list of authorized medications by requiring intramuscular or subcutaneous medications to continue to be in a single dose and adds rectal medications and medications prepared by the certified medical assistant for administration by the provider. This law also prohibits certified medical assistants from preparing the current list of drugs prohibited from delegation by a physician or nurse. This law was effective on March 31, 2023.
This law requires that court clerks notify the health facilities commission, instead of the department of health, when an offender is placed on the registry of persons who have been determined to have abused, neglected, misappropriated, or exploited the property of vulnerable individuals. This law also requires that notice must be provided within 90 days of conviction of the offense. This law became effective on March 31, 2021.
This law authorizes nurse practitioners and physician assistants to refer individuals, either orally or in writing, for physical therapy. This law also removes certain minimum education requirements to engage in the independent practice of physical therapy and allows physical therapists to treat patients without a referral from a physician under certain circumstances. This bill clarifies the definition of “notified” for purposes of treating a patient without a referral. This act became effective on April 4, 2023.
This law changes the terms "general education development credential," "high school equivalency test," and variations of the terms to "high school equivalency credential” as referenced throughout the code. This law also replaces any references in code from GED(R) or HiSET(R) classes, coursework, testing, or services with the phrase “adult education programming to include preparation and testing toward obtaining a high school equivalency credential” throughout the code. This law is effective on July 1,
2023.This was a Department of Labor and Workforce Development legislative initiative.
This law requires hospitals that have a certification from a department-approved, nationally recognized certifying body that recognizes the hospital as capable of providing neuroendovascular treatment to report quarterly data that is consistent with nationally recognized stroke consensus measures on the treatment of individuals with confirmed stroke to the East Tennessee State University College of Public Health. This law was effective on April 4, 2023.
This bill enacts the "Topical Medical Waste Reduction Act of 2023," which allows facilities, defined as a hospital operating room, hospital emergency room department, or ambulatory surgical treatment center, to offer a patient an unused portion of certain medications required for continuing treatment upon discharge when the medication was ordered at least 24 hours in advance for surgical procedures and is administered to the patient at the facility. If a medication is used in an operating room or emergency department setting, then the prescriber shall counsel the patient on a medications proper use and administration, and the requirement of pharmacist counseling is waived. This law was effective on April 13, 2023.
This law extends the Department of Health to June 30, 2027. This law was effective on April 17, 2023.
This law prohibits counties, municipalities, and metropolitan governments from expending funds for the purpose of assisting a person in obtaining a criminal abortion. This prohibition includes using funds as part of a health benefit plan or for travel to another state for the purpose of obtaining an abortion. This law was effective on April 17, 2023.
Public Chapter No. 188—SB277/HB325—Johnson/Lamberth
This law extends legislation enacted in 2018 to preserve opioid prescription limitations for acute care. In addition, this law exempts individuals who had recent cancer treatment from this prescription limitation. “Recent cancer treatment” is defined as six months following the end of an active cancer treatment. This law creates an exception for informed consent where a healthcare practitioner who issued the initial prescription does not have to obtain and document informed consent, if the subsequent prescription is for the same opioid and for the same episode of treatment. Outside of this exception, informed consent must be updated periodically. This law also requires the
Commissioner of the Department of Health to provide a letter, in consultation with the health-related boards, no to certain elected officials that includes information on the impact and the effects of this legislation in each even-numbered year. This law was effective on April 24, 2023. This law was a Department of Health legislative initiative.
This law allows an out of state hospital or an affiliated entity to employ emergency physicians to treat patients at a satellite emergency department, a primary care clinic, or an urgent care clinic, if they are located in this state and owned or controlled by the hospital or affiliated entity. The hospitals must meet certain qualifications and the physicians must be licensed in Tennessee. This law is limited to counties that have a population of less than 27,000 according to the 2020 federal census. This law takes effect July 1, 2023.
This law authorizes a qualified advance practitioner to issue a certificate of need in support of hospitalization for emergency diagnosis, evaluation, and treatment. A qualified advance practitioner is an individual working in collaboration with a licensed physician and who is a nationally certified psychiatric-mental health advanced practice nurse or physician assistant with additional qualifications in psychiatry. The admitting hospital or treatment resource may rescind the certificate of need if a licensed physician or other qualified professional in examining the patient determines that the patient no longer meets admission criteria. Additionally, this law authorizes a licensed physician who is a board-certified psychiatrist to execute a certificate of need in support of hospitalization for a patient’s admission without a second certificate of need in support of hospitalization. This law takes effect July 1, 2023.
This law re-writes the prescription drug donation repository program act. This law creates prescription drug donation repository program where pharmacies may donate prescription drugs that meet certain qualifications. Donation and facilitation of a donation are not considered wholesale distribution, and a person donating or facilitating a donation does not require licensure as a wholesaler. Drugs will be dispensed based on a property system where indigent persons, a person whose income is below 600% of the federal poverty level, are the first to receive them. This law does not authorize the resale of prescription drugs. This law takes effect January 1, 2024.
This law exempts a patient who is receiving an initial behavioral health evaluation or assessment from the requirement from an in-person encounter between the health care service provider, the healthcare services provider's practice group, or the healthcare system and the patient to be within sixteen months prior to the interactive visit. This law also authorizes a physician assistant who is authorized to prescribe drugs and who provides services solely via telehealth to arrange for chart review by a collaborating physician via HIAA-compliant electronic means. This law was effective on April 24, 2023.
This law authorizes the Board of Medical Examiners to issue temporary license for two years to international medical school graduates who meet certain criteria. An international medical school graduate must only provide medical services at a healthcare provider that has in place a post-graduate training program accredited by the accreditation council for graduate medical education. The Board must grant a full and unrestricted license to practice medicine to a temporary licensee who is in good standing two years after the date of temporary licensure. The Board of Medical Examiners will need to promulgate rules for this public chapter. For the purpose of promulgating rules, this rule was effective on April 24, 2023. For all other purposes, this law takes effect July 1, 2024.
This law requires the division of health-related boards to consult with the Board of Medical Examiners in the hiring of a medical consultant. This law also gives the medical consultant authority to consult on various issues and to work with the board’s attorney on certain portions of the complaint and settlement process. Additionally, the division must provide biannual surveys to the Board for its feedback and review of the consultant. This law authorizes the Board to promulgate rules to effectuate this process. This law was effective on April 28, 2023.
This makes changes to the allowable number of beds in private for-profit and private not-for-private intermediate care facilities for individuals with intellectual disabilities. This law takes was effective on April 28, 2023. This was a Department of Intellectual and Development Disabilities legislative initiative.
This law protects a person's statement regarding the use or possession of marijuana to a healthcare provider through the course of a person's medical care for the purpose of obtaining medical advice on the adverse effects of marijuana with other medications or medical treatments. Under this law, such statement is not admissible as evidence in a criminal proceeding in which the person is a defendant unless a person expressly waives this prohibition and requests that the statement be admitted as evidence. This law was effective on April 28, 2023.
This law requires, in connection with an interscholastic athletic activity or event where membership in the TSSAA (Tennessee Secondary Athletic Association) is required, a student enrolled in a private school in this state to participate in an athletic activity or event only in accordance with the student’s sex as defined in code. This does not prohibit a student whose sex is female from participating on a team designated for male students if the school does not offer a separate team for female students in that sport. This law was effective on April 28, 2023.
This law removes the requirement that a parent-teacher of a home school student provide proof of the student's immunizations and receipt of health services or examinations required by law generally for children in this state to the local education agency. Under this law, if a home school student participates in an LEA-sponsored interscholastic activity or event or an LEA-sponsored extracurricular activity, then the LEA may request and receive proof that the school received a health service or examination that is required for the LEA’s students to participate in the activity or event. This law was effective on April 28, 2023
This law requires governmental entities to provide a period of public comment for public meetings but authorizes the governmental entities to place reasonable restrictions on the period for public comment. This does not apply to a meeting of a governing body, or a portion thereof, where the governing body is conducting a disciplinary hearing or a meeting for which there are no actionable items on the agenda. This takes effect July 1, 2023.
This law adds as an enhancement factor that can be considered during sentencing if a defendant has been convicted of aggravated assault or attempted first degree murder on the grounds or premises of a healthcare facility. Healthcare facility is defined as a hospital licensed under title 33 or 68. This law takes effect July 1, 2023.
This law specifies that terminating an ectopic or molar pregnancy does not constitute a criminal abortion. This law removes the current affirmative defense in law and instead provides that it is not an offense of criminal abortion if the abortion is performed or attempted by a licensed physician in a licensed hospital or ambulatory surgical treatment center and certain conditions are met. This law also requires the Department of Health to collect reports submitted under this law and report quarterly the number of abortions performed in this state to certain individuals in the executive and legislative branches no later than January 1, April 1, July 1, and October 1 of each year. This law is effective April 28, 2023.
This law requires an appointed member of a governing body for a state entity to serve in such capacity until the member's successor is duly appointed and qualified. Under this, an appointed member of a board, commission, or other governing body for a state governmental entity may be removed by the member's appointing authority with or without cause. A vacancy created by the removal of a member must be filled by the appointing authority in the same manner as the original appointment. This law also creates an advisory council on state procurement. This law was effective on April 28, 2023.
This law terminates the Radiologic Imaging and Radiation Therapy Board of Examiners with no wind down period. This law authorizes the Board of Medical Examiners to establish and issue limited and full X-ray certifications. This law was effective on April 28, 2023.
This law makes permanent rules filed with the Secretary of State on or after January 1, 2022, which are set to expire on June 30, 2023, remain in effect until repealed, amended or superseded by legislative enactment. This law was effective on May 5, 2023.
This law designates June 19 th as as a new official state holiday for Juneteenth. This law was effective on May 5, 2023, and applies to June 19, 2023. This was one of Governor Lee’s legislative initiatives.
This law requires an LEA to obtain the written, informed, and voluntary signed consent of a student’s parent or legal guardian, or the student if they are 18 years of age or older, before the student participates in a survey, analysis, or evaluation. A parent or legal guardian who wishes to excuse the student from participating in health screenings as part of a coordinate school health program must submit a request in writing to the school’s nurse, instructor, school, counselor, or principal. As used in this law, “health screening” means vision, dental, blood pressure, and hearing screenings. This law makes other changes regarding a student’s receiving of instruction of sexual orientation curriculum or gender identity curriculum or a student’s membership of a club or organization. This law is effective July 1, 2023.
This law requires that a health benefit plan that provides coverage for a screening mammogram must provide coverage for diagnostic imaging and supplemental breast screening without imposing a cost-sharing requirement on the patient. This law is effective 90 days after May 11, 2023.
This law adds fentanyl, carfentanil, remifentanil, alfentanil, and thiafentanil to what constitutes a qualifying controlled substance for purposes of certain felony offenses. This law is on July 1, 2023, and applies to offenses after that date.
This law makes it a Class A misdemeanor to knowingly possess xylazine and makes it a Class C felony to knowingly manufacture, deliver, or sell xylazine, or to knowingly possess xylazine with intent to manufacture, deliver, or sell xylazine. This law exempts veterinarians. This law is effective July 1, 2023.
This law requires certain health related boards to either render a decision on the application or inform the applicant of the need to appear before such board within 60 days from the date the respective board receives a completed application for licensure from either an initial applicant or an applicant who is licensed in another state or territory of the United States or in the District of Columbia. This law was effective on May 11, 2023, and applies to applications submitted on or after that date.
This law requires the Board of Medical Examiners, the Board of Osteopathic
Examination, the Board of Nursing, the Board of Physician Assistants, and the Alcohol and Drug Abuse Counselors Board to, upon the receipt of a completed application for licensure from an applicant who is licensed in another state or territory of the United States or in the District of Columbia, render a decision on the application or inform the applicant of the need to appear before the board within 45 days from the date the board receives the application. This law requires the Board of Athletic Trainers to, upon the receipt of a completed application for licensure from an applicant who is licensed in another state or territory of the United States or in the District of Columbia, render a decision on the application or inform the applicant of the need to appear before the board within 60 days from the date the board receives the application. "Completed application" means an application that satisfies all statutory and board rule requirements. This law takes effect May 17, 2023.
This law makes several changes concerning the powers and authorities of the Health Facilities Commission, including but not limited to authorizing the Commission to license facilities also licensed by the Department of Mental Health and Substance Abuse Services for the purpose of provide acute care services, authorizes the licensing and regulating of assisted-care facility administrators, amends the duties and responsibilities of the board for licensing health care facilities, authorizes the recovery and collection of civil monetary penalties under certain circumstances, and cleans up references to the Department of Health. This law has multiple effective dates. However, the law in its entirety will become effective on July 1, 2024.
This law creates the “Mature Minor Doctrine Clarification Act.” This act prohibits a healthcare provider from providing a vaccination to a minor unless the healthcare provider first receives informed consent from a parent or legal guardian of the minor. The healthcare provider must document receipt of and include in the minor's medical record proof of prior parental or guardian informed consent. This law also requires written consent from a parent or legal guardian before providing a minor with a COVID19 vaccine. Additionally, this law prohibits an employee or agent of the state to provide, request, or facilitate the vaccination of a minor child in state custody except when certain situations apply. This law was effective May 17, 2023.
The law prohibits a health insurance issuer or a managed health insurance issuer from (1) denying a licensed medical laboratory the right to participate as a participating provider in a policy, contact, or plan on the same terms and conditions as offered to another medical laboratory under the same circumstances and (2) preventing a person who is a party to or beneficiary of a policy, contract, or plan from selecting a licensed medical laboratory of a person’s choice to furnish services under the contract, policy, or plan. This law becomes effective July 1, 2023.
This law defines “sex” in code to mean a person's immutable biological sex as determined by anatomy and genetics existing at the time of birth and evidence of a person's biological sex. “Evidence of a person’s biological sex” includes, but is not limited to, a government-issued identification document that accurately reflects a person's sex listed on the person's original birth certificate. This law takes effect on July 1, 2023.
Please note that these are high-level overviews of each public chapter. They do not include every detail or provide all bill information. Please review the text of the bill in its entirety at your own discretion. If you have any questions or need further clarity, please reach out to your attorney.
Re: Covid-19 Vaccine Exemptions. This public chapter requires that an employer grant certain exemptions to requirements of proof/receipt of vaccinations if the request for exemption is either (1) supported by signed/date statement by a licensed physician that the staff member has a condition recognized under generally accepted medical standards as a basis for the medical exemption or (2) the staff member attests in writing (including electronic means) that the staff member has a sincerely held religious believe that prevents the staff member from complying the requirement in accordance with guidance from Medicare and Medicaid services. This public chapter creates a civil penalty of $10,000 for violation of this statute.
Effective as of March 11, 2022.
Re Child Protective Teams. This public chapter authorizes child protective teams that are established in each county to include a representative from one mental health discipline and one appropriately credentialed medical provider, as needed.
Effective as of March 15, 2022.
Re Insurance Prior Authorization Notifications. This public chapter requires a healthcare facility to notify a patient of communication between the healthcare facility and a health insurance entity or provider concerning additional information needed to process a prior authorization request for the patient within five business days after the communication has occurred. This requirement does not apply to the TennCare program or a successor program. This public chapter also includes requirements for utilization review agents if needed more information to determine a request for prior authorization.
For the purposes of rulemaking by the Commissioner of Commerce and Insurance, effective as of March 18, 2022. For all other purposes, effective on January 1, 2023 and applies to communications made pursuant to insurance policies entered into, issued, renewed, or amended on or after that date.
Re Autoclave Requirements. This public chapter exempts autoclaves from the clearance requirements of the Board of Boilers Rules if the autoclave sterilizes reusable medical or dental equipment used by an individual licensed under title 68 or 63, is installed in accordance with the manufacturer’s recommendations, contains a boiler, and is regulated by the FDA.
Effective as of March 28, 2022. The Governor did not sign this public chapter.
Re Naloxone Standing Order. This public chapter allows licensed healthcare workers to prescribe, directly or through standing order, naloxone or other similarly acting and equally safe drugs approved by the FDA to an organization or municipal or county entity, including but not limited to a recovery organization, hospital, school, or county jail. This public chapter also allows an individual or entity under a standing order to receive and store an opioid antagonist and provide an opioid antagonist directly or indirectly to an individual. Additionally, this public chapter authorizes a first responder acting under a standing order to receive and store an opioid antagonist and to provide an opioid antagonist to an individual at risk of experiencing a drug-related overdose or to a family member friend or other individual in a position to assist an at-risk individual. This public chapter includes “unresponsiveness, decreased level of consciousness, and respiratory depression” to be included within the definition of drug related overdose.
Effective on July 1, 2022.
Re Conditions of Participation. This public chapter removes the requirement that a healthcare provider enrolled in Medicare or Medicaid be subject to conditions of participation to be exempt from the definition of “private business” or “governmental entity” for purposes of the Title 14/Covid-19 state laws.
Effective as of March 31, 2022.
Re Drug Paraphernalia. This public chapter excludes narcotic testing equipment used to determine whether a controlled substance contains a synthetic opioid from the definition of “drug paraphernalia” as used within the criminal code unless the narcotic testing equipment is possessed for purposes of the defendant’s commission of certain drug related offenses. This public chapter will be repealed on July 1, 2025.
Effective as of March 31, 2022.
Re Telehealth. This public chapter extends the ability for healthcare providers to receive reimbursement for healthcare services provided during a telehealth encounter. This public chapter also clarifies that a healthcare provider acting within the scope of a valid license is not prohibited from delivering services through telehealth. Lastly, this public chapter adds that the requirement of an in-person encounter between the healthcare services provider, the provider’s practice group, or the healthcare system and patient within sixteen months prior to the interactive visit is tolled for the duration of a state of emergency declared by the Governor provided that healthcare services provider or patient, or both, are located in the geographical area covered by the state of emergency.
Effective as of April 1, 2022 and applies to insurance policies or contracts issued, entered into, renewed, or amended on or after that date.
Re Anatomical Gifts. This public chapter prohibits a healthcare provider, a hospital, an ambulatory surgical treatment center, a home care organization or any other entity responsible for matching anatomical gifts or organ donors to potential recipients from, solely on the basis of whether an individual has received or will receive a Covid-19 vaccine, (1) consider an individual ineligible for transplant or receipt of an anatomical gift, (2) deny medical or other services related to transplantation, (3) refuse to refer an individual to a transplant center or specialist, (4) refuse to place an individual on an organ or tissue waiting list, or (5) place an individual at a position on an organ or tissue waiting list lower than the position the person at which the individual would have been placed if not for the individual’s vaccine status.
Effective as of April 8, 2022.
Re Drug Paraphernalia. This public chapter includes pill press devices and pieces of pill press devices to the definition of drug paraphernalia for the purposes of drug offenses. Pill devices or pieces of pill press devices are not included within this definition if used by a person or entity that lawfully possesses drug products in the course of legitimate business activities, such as a pharmacy or pharmacist.
Effective on July 1, 2022 and applies to offenses committed on or after that date.
Re HIPPA Compliant Provider-Based Telemedicine. This public chapter recognizes HIPPA complaint audio only conversation for the provision of certain behavioral health services and healthcare services as “provider-based telemedicine” when the use of HIPPA compliant real-time, interactive video, video telecommunications, electronic technology, or store-and-forward telemedicine services are unavailable. Additionally, this public chapter specifies requirements for a healthcare provider, office staff, or party acting on behalf of the healthcare provider submitting for reimbursement of an audio-only encounter.
Effective as of April 8, 2022.
Re CSMD. Creates data protection and pathways through the CSMD for reporting of Part 2 data and methadone. Expands data sharing within the CSMD committee process but requires that the commissioner enter into agreements in order to disseminate such data. Health’s Administration Bill.
Effective as of April 14, 2022.
Re UAPA. Clarifies that the ALJ shall decide a procedural questions of law. Allows the director of the administrative procedures division of the secretary of state’s office to issue subpoenas. Allows electronic participation in hearings, by agreement of the parties. The hearing officer may allow electronic testimony if the absence of the witness would otherwise cause of delay of the hearing. Requires that a final orders be issued within 90 days. Allows that a petition for reconsideration be filed within 15 days of the entry of the final order or initial order.
Effective as of April 19, 2022.
Re Buprenorphine. Prohibits prescribing of buprenorphine via telehealth unless the healthcare provider is employed by a licensed non-residential opioid treatment facility, a community mental health center, an FQHC, a hospital, or through TennCare.
Effective as of April 14, 2022.
Re UAPA and Judicial Review Standards. Requires that a judge over a contested case not defer to an agency’s interpretation of the statue or rule and shall interpret it de novo. Remaining ambiguity shall be resolved against the agency.
Effective as of April 14, 2022.
Re ETSU Nursing Center Creation. Creates the Tennessee Center for Nursing Advancement at ETSU, which will address issues of nursing workforce development. The center may utilize data collected from healthcare facilities licensed under Titles 68, 33, and THEC.
Effective on July 1, 2022.
Re Title 14. Eliminates the sunset provisions in Title 14 for the definitions section and for the section that prohibits government entities from mandating vaccinations. Deletes a variety of definitions from the Title.
For the deletion of definitions, effective July 1, 2022 at 12:01 AM. For all other purposes, effective as of April 19, 2022.
Re Ivermectin. Permits a pharmacist to enter into a collaborative practice agreement with a physician in order to provide ivermectin. Requires that the Board of Pharmacy adopt rules to establish standard procedures for the provision of ivermectin by pharmacists, including a risk assessment tool and a standardized fact sheet. Provides civil liability protection against pharmacists who dispense ivermectin pursuant to this statute except under gross negligence circumstances.
Effective as of April 22, 2022.
Re Professional License Requirements. Mandates that a person seeking a professional license have US citizenship or be authorized under federal law to work in the US as verified by the SAVE Program (allows DACA children who are now adults to obtain professional licensure if not otherwise prevented by the license).
Effective July 1, 2022.
Re Covid Vaccinations and Acquired Immunity. Amends Title 14 to mandate that acquired immunity from a previous Covid-19 infection be treated the same as a Covid-19 vaccination by a governmental entity, school, or local education authority. Mandates that private businesses who require vaccinations also include recognition for acquired immunity for Covid-19.
Effective as of April 11, 2022—This was not signed by Governor.
Re Nurse Practitioners & FQHCs. Extends NPs the ability to write prescriptions at FQHCs. Allows APRNS to collaborate on up to 10 sites with a physician and the physician’s reviews may be done electronically. Allows PAs to collaborate on up to 10 sites with a physician and the physician’s reviews may be done electronically. There shall be an annual review in-person between the physician and the APRN/PA.
Effective as of April 29, 2022.
Re Appointments of Director of Board of Pharmacy & Board of Nursing. The Board of Nursing will hire and fire the executive director of the Board, along with other employees as necessary. The Board of Pharmacy will hire their executive director, who must have 5 years as a licensed pharmacy.
Effective as of April 29, 2022.
Re Workforce Flexibility for Nurses. Allows the Commissioner to promulgate rules so that during a workforce crisis a nurse from out-of-state can practice on a temporary basis. Allows certain professions to do tasks outside of their scope of practice if approved by the rules. Permits students in respiratory care programs to practice without licensure during a healthcare workforce crisis. The commissioner determines if there is a workforce crisis and shall notify the governor, the Lt. governor, and the Speaker of the House. Flexibility rules also apply to graduate practal nurses.
Effective as of April 29, 2022.
Re “Tennessee Abortion-Inducing Drug Risk Protocol Act.” Mandates that any abortion-inducing drug must be provided in-person. A qualified physician must examine a patient and determine that there is not an ectopic pregnancy, provide RhoGAM medication if needed, and schedule a follow-up visit with the patient. The physician is required to make reasonable efforts to ensure that the patient appears at that visit and shall document those efforts. It is a E Felony for failure to comply with this law. Failure to comply is also the basis for disciplinary action against the licensee.
For rulemaking purposes, effective as of May 5, 2022. For all other purposes, effective January 1, 2023.
Re Alzheimer’s Patients and Payments for Caregivers. “Colonel Thomas G. Bowden Act” Creates a pilot program to provide grants for the purposes of developing payment to caregivers of Alzheimer’s and dementia patients. An agency can use its current infrastructure to develop this program but must report the costs. This program runs from July 1, 2022 through June 30, 2025, and creates an income-based fee structure. Each agency shall provide a report on January 15 of each year of the program.
Effective as of May 25, 2022.
Re Cannabanoid Oil and Quadriplegia. Adds quadriplegia to one of the qualifying ailments that can be in legal possession of cannabanoid oil.
Effective as of May 25, 2022.
Re Opioid Antagonists. Requires that a prescriber offer a prescription for an opioid antagonist when issuing a prescription for an opioid if the prescription is for longer than 3 days and there is a history of or suspicion of abuse. This does not apply in palliative care or veterinarian settings. Penalties are included for failure to comply.
Effective on July 1, 2022 and applies to opioid prescriptions issued after that date.
Re Mammograms for Women at 35 Years Old. Requires that a health benefit plan provide access to annual low-dose mammograms and other breast cancer screenings for women between the ages of 35 and 40 if risk factors exist and for those over 40.
Effective as of May 25, 2022.
Re Covid Visitation Policies and Limitations on Covid Treatment Exemptions. Clarifies that a prescriber can be disciplined for prescribing controlled substances and/or narcotics for treatment of Covid, if appropriate. In addition, creates a patient advocate process that hospitals must follow during times of covid concern. Allows that person to enter a facility if they agree to follow procedures but provides certain exceptions to access to locations within the hospital.
Effective as of May 25, 2022.
Re Mandatory Reporting of Fatal Drug Overdoses. Requires that a fatal overdose be reported to law enforcement, including by doctors and nurses.
Effective July 1, 2022.
Re: Extended Liability Protection Against Covid Claims. Extends the liability protection against claims based on Covid exposure until July 1, 2023.
Effective as of June 1, 2022.
Re Staffing Flexibility Study. Requires that the comptroller, in conjunction with TennCare and TDH, study the impact of temporary staffing by healthcare staffing agencies at long-term care facilities. Comptroller’s office required to deliver a report.
Effective as of June 1, 2022.
Re: End-of-Life Visitation at Nursing Homes and Assisted Living Facilities. Requires that nursing homes and assisted living facilities allow for visitation during a disaster, emergency, or public health emergency for Covid-19. Provides an exemption if the visitation would violate federal or state law.
Effective July 1, 2022.
Re Tianeptine as Controlled Substance. Classifies Tianeptine and all derivatives thereof as Schedule II controlled substances.
Effective July 1, 2022.
Re Healthcare Reimbursement Task Force. Creates a task force to study the reimbursement rates of professionals employed in healthcare settings. The task force includes the Commissioner of Health or their designee. The task force is to recommend a strategic plan for the general assembly. Task force ends on December 31, 2023 unless it is reenacted.
For the purposes of appointments, effective as of June 3, 2022. For all other purposes, effective July 1, 2022.
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.
This act was one of the Department of Health’s legislative initiatives, relative to the Controlled Substance Monitoring Database (CSMD). First, the act authorizes the state’s chief medical examiner, or county medical examiner, to allow designees to approve death investigations. Next, this act allows deidentified CSMD data, rather than only aggregate, to be shared, with the intent of improving information access. Additionally, this act allows for CSMD data to be shared with additional state, county, or federal agencies outside of Tennessee. Lastly, this act decreases the quorum requirements of the CSMD committee by one member, but still have a majority of members present to conduct regular committee business (6).
This act took effect April 13, 2021.
This act simply adds FQHC’s in Tennessee to the definition of healthcare organizations pursuant to the law around quality improvement committees.
This act took effect July 1, 2021.
This act creates a new definition of “store-and-forward telemedicine services” to include the use of asynchronous computer-based communications between the healthcare provider and the patient for the purpose of diagnoses, consultation, or treatment of a patient at a distant site where there may be no in-person exchange.
This act took effect April 13, 2021.
This act authorizes unlicensed graduates of certain medical training programs to provide telehealth services, provided they maintain the same existing standards for telehealth that licensed providers must meet.
This act took effect April 20, 2021.
This act revises the definition of marijuana to clarify that it does not include a product approved as a prescription by the Food and Drug Administration (FDA).
This act took effect April 22, 2021.
This act authorizes records custodians to petition a court for injunctive relief from individuals making frequent public records requests with the intent of disrupting government operations, following a fifth (5 th ) public records request. A records custodian can only petition a court if they notify the person in writing stating the specific conduct may constitute intent to disrupt government operations, and that the person continues to do so. The individual upon a court enjoinment would not be able to make public requests at the agency for up to one (1) year.
This chapter took effect April 28 th , 2021 and will sunset July 1, 2025.
This act establishes requirements for a healthcare provider to follow when either an inpatient in a health care facility, or someone who is seeking services in an emergency department, expresses to the provider a recent threat or attempt at suicide or infliction of bodily harm to themselves. In this scenario, the healthcare provider shall enter the attempt or threat into the patient's medical record. Upon discharge from the facility, the facility shall provide the patient with contact information to access a qualified mental health professional or counseling resource unless the patient is discharged to another facility. This referral requirement can be satisfied by providing contact information for this state's mobile crisis services or the statewide crisis hotline. Lastly, the act states that a healthcare provider who violates this section is subject to discipline by the licensing authority.
This act took effect July 1, 2021.
This act extends the board of nursing to June 30, 2023.
The act took effect April 30, 2021.
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.
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.
This act was brought by the Tennessee Hospital Association in an attempt to codify recent practices allowed by executive order in regard to recent nursing school graduates. Graduate nurses may engage in the practice of professional nursing for up to 120 calendar days from the date of receipt of their first authorization to take the NCLEX if certain conditions are met. The practice must be in a licensed healthcare institution or affiliate of the institution. The graduate nurse must be supervised by a licensed nurse and the licensed nurse may only supervise one graduate nurse at a time. Finally, the graduate must show proof of their authorization to take the NCLEX as well as proof of graduation from an approved nursing school within the past 90 days.
This act took effect May 4, 2021.
This act requires fetal remains from a surgical abortion to be disposed of solely by burial or cremation. Under this act, an abortion facility is defined as any ASTC, private office, or other facility as defined by TCA 68-11-201 in which abortions are induced or performed. The act does not include hospitals licensed under Title 68 as long as the hospital policies and regulations concerning disposal of fetal remains substantially complies with the requirements of this act. A pregnant woman who has a surgical abortion has the right to choose burial or cremation of the fetal remains as well as the location for the final disposition. The woman is to be provided with forms created by the Department of Health informing her of that right and selecting the means and location. If the woman does not wish the exercise this right, the abortion facility shall determine whether disposition is by cremation or interment. The act also establishes a variety of record keeping requirements on the facility.
This act took effect on May 6, 2021 for rulemaking purposes. The rest of the public chapter takes effect July 1, 2021.
This act authorizes an exception to existing telehealth requirements governing healthcare providers in Tennessee. In doing so, it allows individuals licensed in another state to practice telehealth in Tennessee while providing healthcare services on a volunteer basis through a free clinic.
This act took effect May 11, 2021.
This act is known as the “Jim Coley Protection for Rape Survivors Act,” and revises existing provisions relative to the protocol for forensic medical examinations of victims of sexually oriented crimes. It requires healthcare providers to notify law enforcement that an evidence collection kit is ready for release within 24 hours of concluding the examination. It also requires law enforcement to pick up the kit for storage or transmission within 48 hours of being notified and revises the storage requirements for maintaining records of the kits. Lastly, in the event that a victim elects not to report the alleged offense to police at the time of examination, the collection kit becomes a hold kid and the healthcare provider is required to assign a number to identify the kit rather than using the victim’s name.
This act partly took effect May 11, 2021, but not for TDH concerns. The rest of the act took effect July 1, 2021.
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.
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.
This act specifies that standard medical practice does not involve prescribing hormone treatment for gender dysphoric or gender incongruent prepubertal minors. Additionally, this act prohibits a healthcare prescriber from prescribing a course of treatment that involves hormone treatment therapy for gender dysphoric or gender incongruent prepubertal minors, except when prescribing a course of treatment for diagnoses of growth deficiencies or other diagnoses unrelated to gender dysphoria or gender incongruency.
This act took effect May 18, 2021.
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.
This act prohibits the Governor from issuing an executive order and a state agency, department or political subdivision from promulgating, adopting, or enforcing an ordinance or resolution that requires a person to receive an immunization, vaccination, or injection for the SARS-CoV-2 virus or any variant of the SARS-CoV-2 virus. It also deletes the previous override during an epidemic or immediate threat of an epidemic of an objection against vaccination that was made on the basis of religious tenets. The law prohibits requiring the COVID-19 vaccine to attend k-12 schools. The prohibition against requiring vaccines does not apply to governmental entities subject to federal or state statute or rule that prohibits the entity from requiring medical treatment for those who object on religious grounds or right of conscience. The law also does not apply to students of a public institution of higher education delivering healthcare services when the student is participating in/fulfilling requirements of a program in medicine, dentistry, pharmacy, or another healthcare profession.
This act took effect May 25, 2021.
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.
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.
This public chapter establishes the medical cannabis commission which is administratively attached to the department of health for purposes of budgeting, audit, use of IT systems, HR support, clerical assistance and administrative support. The commission is composed of 9 members. The Governor appoints 3 members (1 from each grand division), the Lt. Governor appoints 3 members (1 must be a physician and 1 a pharmacist), and the Speaker of the House appoints 3 members (1 must be a physician and 1 a pharmacist). The commission must be impaneled and hold its first meeting by October 1, 2021. The commission is required to meet at least once every two months prior to March 2023. The commission shall appoint an executive director.
The commission is to examine federal laws and other states’ laws regarding medical use of cannabis, including issues relating to patient qualification, patient registration, role of practitioners in recommending/prescribing, establishing guidelines for acceptable medical uses, development of a standard of care, etc.
This act took effect May 27, 2021.
**These are general summaries of legislation. For more detailed information and all specifics/requirements, please review the links to each public chapter**
This act adds a representative from the Tennessee Nurses Association, a representative from the Department of Mental Health and Substance Abuse Services, as well as the executive director of the Tennessee Commission on Aging and Disability as members to the Alzheimer’s Advisory Council.
This act took effect on March 6, 2020.
This act extends the Interstate Nurse Licensure Compact to June 30, 2028.
The act took effect March 19, 2020.
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.
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.
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 shall take effect July 1, 2020.
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.
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.
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.
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.
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.