Board of Pharmacy
Legislative Update -2022
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 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 wither 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 Pharmacy Technicians. This public chapter expands the scope of practice of pharmacy technicians to include performing tasks delegated by the pharmacist such as participation in drug, dietary supplement and device selection, storage, and distribution and administration, consistent with the pharmacy technician’s education training and experience, as defined by rules promulgated by the Board of Pharmacy.
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 Public Meetings. Permits boards or agencies of state government to have electronic meetings. If an electronic meeting is being held, requires that members of the public be allowed to view and/or listen to the meeting in real time. There must also be a method of members of the public to participate in the meeting electronically, if they would otherwise be permitted to participate in person. Instructions for participate are to be included in the notice of the meeting. An electronic meeting shall be recorded and that recording must be posted on the website of the organization
within 3 days. The governing body shall maintain that electronic record of the meeting for at least 3 years.
Effective on July 1, 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 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 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 “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 Cannabinoid 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 Pharmacy Benefit Managers. Creates minimum payment schedule for pharmacy benefit managers.
Effective upon signage on May 25, 2022, for rulemaking purposes. Otherwise, takes effect on January 1, 2023 for all newly entered into agreements and contracts.
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: 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.
Legislative Update - 2021
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 makes changes in the process of regulating compounding pharmacies. First, this act requires that prior to renewing or applying for their license in Tennessee, an out-of-state pharmacy practice site must submit to the Tennessee board of pharmacy its most recent inspection by the regulatory agency of their respective state, conducted within the past year. It also authorizes the Tennessee board of pharmacy to request more information if needed. Second, it requires the out-of-state pharmacy to notify the board within fourteen (14) business days of receipt of any order or decision by any regulatory agency in their state, rather than simply their in-state licensing entity. Lastly, rather than a quarterly report on the quality of products dispensed, this act requires out-of-state pharmacies who engage in sterile compounding make this information available to the board of pharmacy upon request and in a timely manner as defined by the board. A pharmacy that engages in sterile compounding, except hospital pharmacies compounding for inpatients of a hospital, shall make the quantity of sterile compounded products available to the board of pharmacy upon request. However, the executive director of the board of pharmacy may request the information from a hospital pharmacy for cause. 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 (5th) public records request. A records custodian can only petition a court if they notify the person in writing stating the specific conduct may constitute intent to disrupt government operations, and that the person continues to do so. The individual upon a court enjoinment would not be able to make public requests at the agency for up to one (1) year. This chapter took effect April 28th, 2021 and will sunset July 1, 2025.
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 one of the Division of TennCare’s legislative initiatives, relative to collaborative pharmacy practice agreements. In doing so, it authorizes the Chief Medical Officer of the department of health to implement a statewide collaborative pharmacy practice agreement specific to the distribution and administering of COVID-19 vaccine, to be reimbursed through TennCare. This act requires pharmacists to maintain copies of the agreement and documentation of the vaccine administration training program on file and make them available to the department of health on request. This act took effect May 6, 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 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.
Legislative Update - 2020
This act amends the Tennessee Together statutes. It expands the definition of “alternative treatments” by adding “non-opioid 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 amends prohibits a governmental entity from authorizing destruction of public records if the governmental entity knows the records are subject to a pending public record request. Prior to authorizing destruction of public records an entity must contact the public record request coordinator to ensure the records are not subject to any pending public record requests. Records may still be disposed of in accordance with an established records retention schedule/policy as part of an ordinary course of business as long as the records custodian is without knowledge the records are subject to a pending request. This act took effect on June 22, 2020.
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 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
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.
This act redefines hemp in 43-27-101 to mirror the federal Hemp Farming Act of 2018. The act excludes hemp and any nonnarcotic substance approved by the FDA that can lawfully be sold over the counter without a prescription from a schedule. A license from the Department of Agriculture is required in order to produce hemp. The Commissioner of Agriculture shall promulgate rules within 120 days of this bill becoming law. This act took effect April 4, 2019.
This act adds a definition of “alternative treatments” to 63-1-164 pertaining to the restrictions and limitations on treating patients with opioids. This act took effect April 9, 2019.
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.
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.
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.
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.
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.
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.
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.
This act expands the practice of dental hygiene to include prescriptive authority limited to fluoride agents, topical oral anesthetic agents, and non-systemic oral antimicrobials provided that it is not a controlled substance under state and federal laws and it does not require a license by the federal drug enforcement agency. A dental hygienist’s prescriptive authority must be exercised under the general supervision of a licensed dentist, pursuant to board rules, and in compliance with all applicable law concerning prescription packaging, labeling, and record keeping requirements. A prescription written by a dental hygienist must be reviewed by a dentist within thirty days. The board shall promulgate rules to implement this act. This act took effect May 8, 2019 for the purpose of promulgating rules. For all other purposes, this act will take effect on July 1, 2020.
This act requires the Commissioner of Health, by January 1, 2020, to study instances when co-prescribing of naloxone with an opioid is beneficial and publish the results to each prescribing board and to the board of pharmacy. The findings shall be included in the chronic pain guidelines adopted by the Chronic Pain Guidelines Committee. This act took effect May 8, 2019.
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.
Legislative Update - 2018
Public Chapter 82
This act prohibits the sale of products containing dextromethorphan to persons less than 18 years of age.
Public Chapter 293
This act allows the Board of Pharmacy to regulate and license third party logistics providers with regard to controlled substances.
Senate Bill 98/House Bill 87
This act allows would allow the Commissioner of Health or his designee to have electronic access to medical records in order to facilitate investigations when responding to an immediate threat to public health. Today the Commissioner of Health or his designee already has this authority but must go to the facility to review the medical records.
Public Chapter 94
This act defines “abuse” and “neglect” for purposes of placing a person on the registry of persons who have abused, neglected, or misappropriated the property of vulnerable individuals specifically within the statutes that govern the Dept. of Health. It does not impact the definitions within the statutes that govern the Dept. of Intellectual and Developmental Disabilities nor the Dept. of Human Services. It also increases the time within which placement on the registry may be appealed from 30 to 60 days.
Public Chapter 59
This act changes the limits and the identification requirements for products that may be sold containing ephedrine or pseudophedrine. This applies to their salts, isomers and salts of isomers as well.
Public Chapter 26
This legislation deletes the Intractable Pain Act. This becomes effective on July 1, 2015.
Public Chapter 352
This legislation would decriminalize the possession of cannabis oil as long as all of the following are met:
The oil contains less than 0.9% of THC and is labeled as such by the manufacturer
The person in possession retains proof of the legal order or recommendation from the issuing state
The person in possession retains proof that the person or person’s family member has been diagnosed with intractable seizures or epilepsy by a physician licensed to practice in TN
This legislation does not allow a physician in TN to prescribe, order or recommend the oil. This act became effective on April 16, 2015.
Public Chapter 40
This act allows pharmacies to participate in pharmacy drug disposal programs. This act will require rulemaking form the board.
Public Chapter 502
This act allows the Joint Government Operations Committee (the legislative committee that reviews all rules) to stay a rule up to 75 days instead of 60 days. Present law authorizes the Joint Government Operations Committee to consider the following factors when reviewing rules: authority, clarity, consistency, justification, necessity and reference. This act adds arbitrariness and capriciousness as two new considerations.
Public Chapter 376
This creates the “Tennessee Right to Try Act.” It authorizes eligible patients to utilize investigational drugs, biological products or devices that have completed phase 1 of a clinical trial, but has not yet been approved for general us by the FDA. The clinical trial must be documented by the National Institutes of Health. An eligible patient is:
someone with an advanced illness that is attested to by the patient’s treating physician and confirmed by a second physician
has considered all other FDA-approved treatment options
has received a recommendation from the patient’s physician for an investigational drug, biological product, or device
has given written, informed consent for the use of an investigational drug, biological product, or device
has documentation from such physician that the patient meets all the aforementioned requirements.
All expenses related to the use of investigational treatment will be borne by the patient. Manufacturers are authorized to make investigational products available to patients with or without compensation. This bill specifically prohibits Medicare or any licensing board from taking any adverse action against a licensee based solely on a recommendation for treatment with an investigational product and holds manufacturers and providers harmless if operating in good faith. This act takes effect on July 1, 2015.
Public Chapter 396
This creates the “Addiction Treatment Act of 2015.” It prevents certain criminal drug charges from being filed against an individual who is experiencing a drug overdose or is in the company of an individual who is experiencing a drug overdose and seeks or is the subject of a request for medical assistance. Any such person is immune to penalties for a violation of a permanent or temporary protective order or restraining order or sanctions for a violation of a condition of pretrial release, condition of probation, or condition of parole based on a drug violation. This immunity does not provide protection against seizure of any evidence or contraband, limit the admissibility of any evidence in connection with the investigation or prosecution of a crime for an individual who doesn’t qualify for the aforementioned exemptions, or limit the authority of a law enforcement officer to detain or take into custody a person in the course of an investigation or to effectuate an arrest for any offense not immune by the aforementioned exemptions. This immunity only applies to the person’s first such drug overdose.
This bill further mandates that only M.D.’s or D.O.’s are permitted to prescribe buprenorphine for opioid dependence and it may only be prescribed for uses recognized by the FDA unless the patient has a documented opiate addiction, receives treatment from a DEA registered addiction treatment practice, and is counted as one of the total allowable number of patients the provider is allowed to treat. Only pregnant women, nursing mothers, or patients with a hypersensitivity to naloxone may be prescribed buprenorphine mono. These provisions do not apply to perioperative surgery or ventilator sedation performed in a licensed facility, or to inpatients and outpatients of a hospital.
The BME and the BOE are required to promulgate rules establishing requirements for licensees to qualify as addiction specialists.
This act takes effect on July 1, 2015.
Public Chapter 268
This act makes disclosures of protected healthcare information permissible in medical malpractice lawsuits and became effective on April 24, 2015.
Public Chapter 371
This act defines biological product and interchangeable biological product and allows their use under all circumstances unless:
- An adverse reaction has previously taken place
- The interchangeable has been previously deemed ineffective
- Any other clinically based prescriber determined need or the interchangeable biologic is not available
When prescriber determines biological is medically necessary he/she must:
- Place these instructions on the prescription showing intent in writing
- If orally the prescriber must alert the pharmacist
- An electronic communication between prescriber and pharmacist that only the biological product be communicated
When a biologic is issued a pharmacist must:
- Notify the patient of the substitution on the prescription label
- Communication within 5 days to the prescriber by:
- Add it to the interoperable electronic medical records system
- Communication can be set forth in collaborative pharmacy agreement
- That this communication only applies to the original communication and not the refill
- Maintain a record of the biologic dispensed
This does not apply if the product if the product is:
- Is directly dispensed to the patient
- Is dispensed in a nursing home or assisted living facility
The board of pharmacy shall maintain a link on its website to the current list of all biological products determined by the FDA to be interchangeable.
Public Chapter 261
The act provides for the practice of telehealth. It outlines the following:
Defines a healthcare provider
Establishes a provider-patient relationship by mutual consent and mutual communication
Specifies that telehealth does not create a new standard care
Prohibits any board from creating a more restrictive standard of professional practice for telehealth service
Allows a physician to prescribe by means of telemedicine and follow all prescribing applicable statutes such as checking the Controlled Substance Monitoring Database; however, pain management clinics are not permitted
There is no separate telehealth license required by the Bd of Medical Examiners.
Public Chapter 476
Currently, the top 50 prescribers of controlled substances in the state are annually identified and sent a letter notifying them of their inclusion on this list and asked to respond with a justification for their prescribing patterns. This legislation expands on this list and requires the top 10 prescribers from all of the combined counties having populations of fewer than 50,000 to also be on this annual list.
Separate from this provision, the bill also specifies that a provider of home medical equipment or services that provides its own company-branded insulin pumps and related supplies does not have to have a physical place of business in the state if the provider maintains an employee presence in the state, is accredited by the Joint Commission on Accreditation of Healthcare Organizations and maintains a 24-7 service telephone number.
This act took effect on April 22, 2015.
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 615
This act allows pharmacists in Tennessee to dispense a prescription without proper authorization or valid prescription to a patient from another state who was displaced by a disaster. This must be done in good faith and the prescription information may be obtained from a prescription label, verbal order, or any other means determined to be legitimate in the professional judgment of the pharmacist. The prescription may be for the number of dosages necessary to allow the patient to secure a valid prescription but no more than a 20 day supply.
This act takes effect on July 1, 2018.
Public Chapter 638
This chapter prohibits healthcare prescribers and their employees, agents, or independent contractors from in-person solicitation, telemarketing, or telephonic solicitation of victims within 30 days of an accident or disaster for the
purpose of marketing services of the healing arts related to the accident or disaster. There are specific exceptions
laid out in the chapter.
This act takes effect July 1, 2018.
Public Chapter 675
This act requires the department of health to accept allegations of opioid abuse or diversion and for the department to publicize a means of reporting allegations.
Any entity that prescribes, dispenses, OR handles opioids is required to provide information to employees about reporting suspected opioid abuse/diversion. That notice is to either be provided individually to the employee in writing and documented by the employer OR by posting a sign in a conspicuous, non-public area of minimum height and width
stating: “NOTICE: PLEASE REPORT ANY SUSPECTED ABUSE OR DIVERSION OF OPIOIDS, OR ANY OTHER IMPROPER BEHAVIOR WITH RESPECT TO OPIOIDS, TO THE DEPARTMENT OF HEALTH'S COMPLAINT INTAKE LINE: 800-852-2187.”
Whistleblower protections are also established. An individual who makes a report in good faith may not be terminated or suffer adverse licensure action solely based on the report. The individual also is immune from any civil liability related to a good faith report.
This act takes effect January 1, 2019.
Public Chapter 744
This statute allows a licensing entity the discretion to not suspend/deny/revoke a license in cases where the licensee has defaulted or become delinquent on student loans IF a medical hardship significantly contributed to the default or delinquency.
This act took effect January 1, 2019.
Public Chapter 745 and Public Chapter 793
These public chapters work together to create and implement the “Fresh Start Act.” Licensing authorities are prohibited from denying an application or renewal for a license/certificate/registration due to a prior criminal conviction that does not directly relate to the applicable occupation. Lays out the requirements on the licensing authorities as well as the exceptions to the law (ex: rebuttable presumption regarding A and B level felonies).
These acts take effect July 1, 2018.
Public Chapter 754
This chapter prevents any board, commission, committee, etc. created by statute from promulgating rules, issuing statements, or issuing intra-agency memoranda that infringe on an entity member’s freedom of speech.
Freedom of speech includes, but is not limited to, a member’s freedom to express an opinion concerning any matter relating to that governmental entity, excluding matters deemed to be confidential under TCA 10-7-504.
Violations as determined by a joint evaluation committee may result in recommendations to the general assembly concerning the entity’s sunset status, rulemaking authority and funding.
This act took effect April 18, 2018.
Public Chapter 883
This act lays the framework for e-prescribing practices in the state and the exceptions from electronic prescriptions. Requires that all Schedule II prescriptions be e-prescribed by January 1, 2020 except under certain circumstances. Any health-related board under TCA 68-1-101(a)(8) that is affected by this act shall report to the general assembly by January 1, 2019 on issues related to the implementation of this section. The commissioner of health is authorized to promulgate rules to effectuate the purposes of this act.
This act took effect May 3, 2018 for rule purposes.
The act takes effect January 1, 2019 for all other purposes.
Public Chapter 893
This chapter allows for pharmaceutical manufacturers or their representatives to engage in truthful promotion of off-label uses. The act also prohibits action against pharmaceutical manufacturer’s, pharmaceutical representative’s, healthcare institution’s or physician’s license solely for such activity.
This act takes effect July 1, 2018
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:
- Advise of risks associated with opioid use during pregnancy;
- Counsel patient on effective forms of birth control; and
- 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 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 1015
This legislation lays out the specific requirements of hospitals to notify law enforcement of involuntary commitments as well as the possible penalties for failure to comply. Inspections of hospitals by the department of mental health and the department of health shall include a determination of the hospital’s compliance with the reporting requirements of this act.
The act also allows a pharmacist the right to provide information to an insured regarding the amount of the insured’s cost share for a prescription drug. Neither a pharmacy nor a pharmacist shall be penalized by a pharmacy benefits manager for discussing such information or selling a lower priced drug if one is available.
This act takes effect July 1, 2018.
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 1029
This act requires the board of pharmacy to promulgate rules regarding the board’s oversight of facilities that manufacture, warehouse, and distribute medical devices. Rulemaking shall begin no later than September 1, 2018. The rulemaking process shall include the formation of an advisory committee composed of medical device industry representatives and a representative of the department of economic and community development. Rules promulgated shall be reviewed every three years for purposes of reviewing advancements of new medical device technologies.
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.