Amends TCA Title 33; Title 63 and Title 68.

This bill authorizes the commissioner of health to implement the following measures if the commissioner determines a healthcare staffing crisis exists: (1) Allow a healthcare professional, who is licensed in another state and does not hold a valid license in this state, to temporarily engage in the practice of the professional's profession in this state while employed by a licensed mental health, intellectual and development disability, substance abuse, or healthcare facility (referred to collectively in this summary as facilities licensed under title 33 or title 68). A healthcare professional practicing in this state pursuant to provision will be subject to the licensing fees, rules, and disciplinary actions applicable to licensed healthcare professionals in this state that are not contrary to this provision; (2) Allow a state-licensed healthcare professional to perform tasks outside of the professional's scope of practice, if the tasks are performed in a hospital or in a psychiatric hospital, in a behavioral health residential facility, or by a behavioral health crises services provider. The commissioner must approve a professional pursuant to this provision pursuant to a facility-specific or provider-specific plan of delegation, as set out in detail in this bill. The plan of delegation must include the specific types of licensees covered, the specific tasks outside of the professional's licensed scope of practice that are permitted, and the specific circumstances and directives under which the tasks are permitted. The approval of the plan may be subject to conditions set by the commissioner, or the commissioner's designee, and may be rescinded in that person's sole discretion. A professional performing tasks pursuant to this provision will remain subject to rules and disciplinary action as if the professional were acting within the professional's licensed scope of practice; (3) Allow a student actively enrolled in a graduate school program or an undergraduate respiratory care program, the educational standards of which meet the training requirements for a healthcare professional license in this state, to perform supervised tasks within the licensed scope of practice of that license, if the tasks are performed in a hospital or in a psychiatric hospital, in a behavioral health residential facility, or by a behavioral health crises services provider, pursuant to a facility-specific or provider-specific plan of delegation, as set out in detail in this bill. The plan of delegation must include the specific types of programs in which a student must be enrolled to perform tasks in accordance with the plan, the specific tasks within the relevant scope of practice that the student is permitted to perform, and the specific circumstances and directives under which the tasks are permitted. The commissioner or the commissioner's designee approving the plan may include conditions and may rescind approval in that person's sole discretion. A student performing tasks pursuant to this provision may be subject to disciplinary action upon applying for a license described in this provision for actions inconsistent with the scope of practice for that license; and (4) Temporarily suspend the effectiveness of a rule applicable to facilities under title 33 or title 68 and applicable to licensed healthcare providers, if: (A) The temporary suspension is consistent with regulations, or the waiver of regulations, issued by the federal centers for medicare and medicaid services; and (B) In the case of a facility or provider licensed under title 33, the temporary suspension is effective only to the extent that the commissioner of mental health and substance abuse services has concurred in the temporary suspension of the rule. Under this bill, it will be within the commissioner of health's sole discretion to determine whether a healthcare staffing crisis exists. However, if the commissioner makes that determination and implements the measures described above in (1)-(4), then the commissioner must provide the governor, the speaker of the senate, and the speaker of the house written notice of the healthcare staffing crisis and the intended measures prior to implementation of those measures. This bill authorizes the commissioner to impose geographic and time limitations on the measures authorized by the above-described provision, but provides that the commissioner may not extend the measures for longer than 180 days, unless the commissioner provides an additional finding addressed to the governor, the speaker of the senate, and the speaker of the house of representatives that a healthcare staffing crisis still exists. This bill adds specific authorization for a graduate nurse to engage in the practice of practical nursing without a license for a period not to exceed 120 calendar days from the date of receipt of the first authorization to take the NCLEX-PN examination, subject to the following: (A) The graduate nurse's practice must occur in a facility licensed under title 33 or 68, or an affiliate of the facility; (B) The graduate nurse must at all times be working under the supervision of an individual licensed in this state to practice practical nursing or professional nursing. The graduate nurse must provide the healthcare institution or affiliate of the institution in which the nurse is practicing with the following: proof of the first authorization to take the NCLEX-PN examination; and proof of graduation from an approved school of nursing within the previous 90 days; (C) The supervising individual may supervise only one graduate nurse at a time; and (D) The graduate nurse is not deemed a licensed practical nurse and may not use another title or identify as anything but a "graduate nurse" in a clinical setting. This bill defines "graduate nurse" as an individual who holds a diploma or degree from an approved school of nursing that entitles the individual to take the NCLEX-PN licensing examination and has received authorization to take the NCLEX-PN examination. ON MARCH 24, 2022, THE HOUSE ADOPTED AMENDMENT #1 AND PASSED HOUSE BILL 2667, AS AMENDED. AMENDMENT #1 revises various provisions of this bill, as follows: (1) Clarifies that this bill applies to healthcare professionals licensed in another state who "would otherwise be subject" to the applicable licensing requirements of this state; (2) Adds a licensed nursing facility that provides enhanced respiratory care reimbursed by TennCare to the locations in which a student actively enrolled in a graduate school program or undergraduate respiratory care program by perform supervised tasks. This amendment sets out the requirements for a plan of delegation in such situations; (3) Clarifies, in regard to facilities and providers licensed under title 33, which commissioner (the commissioner of commissioner of mental health and substance abuse services or commissioner of intellectual and developmental disabilities) must concur in the suspension of rules as authorized by this bill; and (4) Clarifies that the provisions regarding graduate nurses apply to graduate "practical" nurses and requires supervision of such nurses by "professional or registered nurses." ON APRIL 7, 2022, THE SENATE SUBSTITUTED HOUSE BILL 2667 FOR SENATE BILL 2550, ADOPTED AMENDMENT #1, AND PASSED HOUSE BILL 2667, AS AMENDED. AMENDMENT #1 revises various provisions of this bill as amended by House Amendment #1, as follows: (1) Clarifies that the commissioner will establish the process for professionals to practice under this amendment "by rule" and that approval of the plan is subject to conditions set by the commissioner in rules; (2) Removes the provision for approval of a plan by a commissioner's designee; (3) Revises the provision whereby a professional performing tasks pursuant to this amendment will remain subject to rules and disciplinary action as if the professional were acting within the professional's licensed scope of practice to specify that the provision applies if the professional is licensed and to add that if the professional is unlicensed, the professional may be prohibited from obtaining a license in the future if found to be in violation of the plan of delegation or any related rules; and (4) Revises this bill's authorization for the commissioner to impose geographic and time limitations on the measures to provide that the imposition of such limitation is limited to no more than 120 days and to authorize the commissioner to extend the measures up to an additional 120 days if the commissioner makes a determination that a healthcare staffing crisis exists (this amendment removes the requirement for submitting a finding to the governor and speakers).