PUBLIC HEALTH ADVISORY CONCERNING FENTANYL AND FENTANYL-LACED SUBSTANCES

Board of Osteopathic Examination

Board of Osteopathic Examination

 Legislative Update - 2015

 

Public Chapter 154

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.  This act took effect on April 16, 2015.

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.  For rulemaking purposes, this bill became effective on April 10, 2015.  All other provisions become effective on July 1, 2015.

Public Chapter 26

This legislation deletes the Intractable Pain Act.  It has been assigned Public Chapter 26 of 2015.  This becomes effective on July 1, 2015.

Public Chapter 189

As enacted, this deletes the requirement that a supervising physician for a physician’s assistant have complete and absolute authority over the physician’s assistant’s action.  It retains the current law that makes clear the physician’s assistant functions under the control and responsibility of the physician.  This becomes effective on July 1, 2015.

Public Chapter 7

This extends the Board of Osteopathic Examination through June 20, 2019 and has been assign Public Chapter 7 of 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 386

This bill requires a health insurance entity to provide a list of all information and documents required for a credentialing application of a new provider to be considered complete to any practice with which they have an existing contract.  They must notify the applicant of the application status within 5 days of its receipt and must note any information or documents that render the application incomplete.  It further requires the insurance company to notify the new provider of the application results within 90 days after receipt of a completed application.  If all necessary information is not received by the company after a notice of incomplete application, the credentialing process is discontinued.  It prohibits an applicant from submitting claims while the application is pending.  After notification by the company, all claims held from complete application submittal date to notification by insurance date shall be paid at the contracted in-network rate for covered services.  This bill becomes effective on January 1, 2016 and does not apply to any TennCare, state employee, education or local government group insurance plans.

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 494

This requires the BME, in consultation with the BOE, to establish and maintain an online registry for med spas and allows for rule promulgation and fee setting to effectuate this law.  Any medical director or supervising physician shall report the following to the registry:

  • the name and address of the med spa
  • name, license number and designation of the medical director or supervising physician
  • certification information previously required under 63-1-153

Information regarding this law must be placed on the BME and BOE board websites. The provisions of this registry shall also apply to private physician’s offices and practices if they are providing cosmetic medical services.  This act takes effect on January 1, 2016.

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. 

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 473

This legislation specifies that, except for a medical emergency, no induced termination of pregnancy (ITOP) shall be performed unless the woman has been informed in-person by the attending physician, and has given informed consent of:

  • the woman is pregnant
  • the probable gestation time
  • the viability of the child
  • the public and private agencies and services available to assist with pregnancy and adoption
  • medical benefits and/or risks of undergoing the procedure or carrying full term
  • a general description of the method of ITOP to be used

The woman must provide informed consent freely and without coercion.

This bill places a 48 hour waiting period from the time of informed consent to the time the procedure may be performed, unless it is a medical emergency.  The patient is required to sign a consent form after the waiting period but before the procedure.  The physician is required to give the woman a copy of the signed consent forms.

A medical emergency is defined as a condition that complicates the medical condition of a pregnant woman as to necessitate an immediate procedure to avert her death or for which a delay will create serious risk of substantial and irreversible impairment of major bodily function, as determined by the physician.  When a medical emergency arises, the physician is required to inform the woman of and document the medical reasons supporting the physician’s determination.

This bill creates a new Class E felony for a physician who performs an ITOP and fails to provide the required information, wait the 48 hours, or receive written informed consent.  It creates a Class E misdemeanor if a physician fails to provide a copy of the signed informed consent document.  Any physician who intentionally, knowingly, or recklessly violates any requirement of this bill is guilty of unprofessional conduct and shall be subject to license suspension or revocation.

This bill has a springing provision where, if the 48 hour waiting period is declared unconstitutional, it is rolled back to a 24 hour waiting period.  If that decision is vacated or reversed, the 48 hour provision is reinstated.  The legislation takes effect on July 1, 2015.

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

Public Chapter 475

  • Changes the requirements for who can become a certificate holder of a pain clinic. Certificate holders:
    • Must be a Tennessee licensed Medical Doctor, Doctor of Osteopathy, Advanced Practice Nurse or Physician’s Assistant and
    • Must have an unrestricted unencumbered license
  • Requires anyone with any ownership interest in a pain clinic to be eligible to meet the requirements of the certificate holder
  • Adds requirements to be a pain medicine specialist to the law
    • ABMS certification
    • ABPM diplomate
    • ABIPP exam 1 passage
    • An active pain management practice in a clinic accredited in outpatient interdisciplinary pain rehabilitation by the commission on accreditation of rehabilitation facilities
  • All medical directors of pain clinics must be pain medicine specialists by July 1, 2016
  • All Physicians Assistants and Advanced Practice Nurses must be supervised by any pain medicine specialist to practice in a certified pain clinic
  • Requires the pain clinic certificate holder to be an owner of the clinic for which he or she holds the certificate
  • Requires the pain clinic certificate to show that the pain clinic has a medical director that is a pain specialist

Directs the commissioner of the department of health to develop pain clinic standards that can be used by a pain clinic as guidelines for operation

Public Chapter 419

This act requires any facility or private physician’s office to become licensed as an ASTC if more than 50 surgically induced terminations of pregnancy are performed in any calendar year.  This act takes effect on July 1, 2015.

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.