PUBLIC HEALTH ADVISORY CONCERNING FENTANYL AND FENTANYL-LACED SUBSTANCES

Board of Nursing

Legislative Update - 2017

Public Chapter 266

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

Public Chapter 334

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

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

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

Public Chapter 350

This will allow healthcare providers to satisfy one hour of continuing education requirements through the performance of one hour of voluntary provision of healthcare services.  The maximum amount of annual hours of continuing education that a provider can receive through providing volunteer healthcare services is the lesser of 8 hours or 20% of the provider’s annual continuing education requirement.  The legislations allows for rulemaking by the division of health related boards in order to administer this section.  This took effect on May 12, 2017.

Public Chapter 483

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

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

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

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

This act took effect on June 6, 2017. 

Public Chapter 215

This will require state governmental entities that establish or adopt guides to practice to do so through the promulgation of rules, rather than policy.  The rules so promulgated must specify all provisions included in and relating to the guide to practice.  Any changes to guides to practice made after the guides are adopted must also be promulgated by rule in order to be effective.   For purposes of this part, guides to practice includes codes of ethics and other quality standards, but does not include tests, examinations, building codes, safety codes, or drug standards.  This legislation took effect on April 28, 2017.

Public Chapter 84

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

Public Chapter 256

This authorizes local education agencies and nonpublic schools to maintain opioid antagonists in schools.  A school nurse or other trained school personnel may administer opioid antagonists to respond to drug overdoses, under a standing protocol from a physician.  A school nurse or other trained school personnel will not be held responsible for resulting injury unless the medication was administered with an intentional disregard for safety.  The State Board of Education, in consultation with the Department of Health, shall develop guidelines for schools.  This took effect on July 1, 2017.

Public Chapter 240

This legislation was brought by the Department of Health and was designed to address a number of issues throughout all licensing boards, committees, and councils.  This legislation will:

  • Insure the integrity of licensure examinations by making examination questions, answer sheets, scoring keys, and other examination data confidential and closed to public inspection.
  • Allow the issuance of limited licenses to applicants who have been out of clinical practice or inactive, or who are engaged in administrative practice.Limited licenses may be of restricted scope, restricted duration, and have additional conditions placed upon them in order to obtain full licensure.
  • Clarify that other documents prepared by or on behalf of the Department with regard to an investigation are confidential until such time as formal disciplinary charges are filed against the provider.
  • Eliminate the “locality rule” for administrative law.
  • Require the chief administrative official for each health care facility to report within 60 days any disciplinary action taken against an employee for matters related to ethics, incompetence or negligence, moral turpitude, or substance abuse, to the employee’s respective licensing board.All records pertaining to the disciplinary action shall be made available for examination to the licensing board.

This act became effective on May 2, 2017.

Public Chapter 481

This legislation creates a new violation of a healthcare practitioner’s practice act if that practitioner refuses to submit to or tests positive for any drug the practitioner does not have a lawful prescription for or a valid medical reason for using the drug.  It is the duty of the employer to report any violation to the Department of Health.  If the practitioner fails a drug test, the practitioner has 3 business days to either produce the requisite prescription or medical reason, or report to their board approved peer assistance program.  If the practitioner does not comply with any of these measures, it is the duty of the employer to report this violation of the practice act to the employee’s licensing board for investigation and action.  If the practitioner reports to the peer assistance program and obtains and maintains advocacy of the program, the employer is not required to notify the board. 

As long as a practitioner obtains, maintains and complies with the terms of a peer assistance program, the board shall not take action on the licensee for the sole reason of a failed or refused drug test.  If a practitioner fails to obtain or maintain advocacy from the peer assistance program, the program is required to report that information to the appropriate licensing board.  The board SHALL suspend the license of a practitioner who fails to comply with the terms of the program.  Employer drug testing must be compliant with the Drug-free Workplace requirements.  This legislation allows a quality improvement committee to share information regarding substance abuse by a practitioner with other quality improvement committees.  Additionally, this legislation specifies that the Department of Health is not required to obtain prior approval from the Attorney General in order to take any emergency action on a licensee. This legislation took effect on July 1, 2017.

Public Chapter 230

This legislation authorizes commissioners or supervising officials of departments to evaluate certain actions by a regulatory board to determine whether the action may constitute a potentially unreasonable restraint of trade.  Supervising officials must ensure that the actions of regulatory boards that displace competition are consistent with a clearly articulated state policy.  If a board action constitutes a potentially unreasonably restraint of free trade, the supervising official must conduct a further review of the action and either approve, remand or veto the action.  The supervising official may not be licensed by, participate in, or have a financial interest in the occupation, business or trade regulated by the board who is subject to further review, nor be a voting or ex officio member of the board.  The supervising official must provide written notice of any vetoed actions to the senate and house government operations committees. 

Prior to filing a regulatory board's rule with the secretary of state, the commissioner or chief executive officer of the administrative department under which a regulatory board operates or to which a regulatory board is administratively attached, or a designee to the extent a conflict of interest may exist with respect to the commissioner or chief executive officer, must remand a rule that may constitute a potentially unreasonable restraint of trade to the regulatory board for additional information, further proceedings, or modification, if the rule is not consistent with a clearly articulated state policy or law established by the general assembly with respect to the regulatory board.  This act took effect on April 24, 2017.