HB2318113th GA (Historical)Enacted

Amends TCA Title 55; Title 63 and Title 68.

AUTHORIZED SERVICES OF PHYSICIAN ASSISTANTS Present law authorizes a physician assistant to perform selected medical services only in collaboration with a licensed physician. The range of services that may be provided by a physician assistant must be set forth in a written protocol, jointly developed by the collaborating physician and the physician assistant. Under present law, rules that purport to regulate the collaboration of physician assistants with physicians must be jointly adopted by the board of medical examiners and the board of physician assistants. This bill both expands upon and replaces the present law described above with the provisions under this heading and the next two headings: This bill authorizes a physician assistant to do the following: (1) Perform medical diagnosis and treatment as a physician assistant pursuant either to a protocol or collaborative agreement, as applicable, for which the physician assistant has been prepared by education, training, and experience, and that the physician assistant is competent to perform only if licensed by the board of physician assistants and only within the usual scope of practice of the collaborating physician; (2) Perform minor procedures, including, but not limited to: (i) simple laceration repair; (ii) excision of skin lesions, moles, warts, cysts, or lipomas; (iii) incision and draining of superficial abscesses; (iv) skin biopsies; (v) arthrocentesis; (vi) thoracentesis; (vii) paracentesis; (viii) endometrial biopsies; (ix) IUD insertion; and (x) colposcopy; (3) Assist a physician who performs procedures considered Level II office-based surgery or Level III office-based surgery, as those are defined under state law, or a more complex procedure, if: (i) the physician assistant is credentialed or receives privileges from the medical staff of the facility to assist a physician with enumerated procedures; (ii) the physician performing the procedure is credentialed or privileged to perform the procedure by the medical staff of the facility; and (iii) the physician is present or immediately available for consultation with the physician assistant during and after the procedure; (4) Issue drugs authorized by law pursuant to protocols or collaborative agreement, and as applicable: (A) Prescribe, dispense, order, administer, and procure appropriate medical devices, legend drugs, and controlled substances that are within the physician assistant's scope of practice if the physician assistant has registered and complied with all applicable requirements of state law and rule and the FDA; (B) A physician assistant may only prescribe or issue a Schedule II or Schedule III opioid for a maximum of a nonrefillable, 30-day course of treatment. However, this (4) does not apply to a prescription issued in a hospital, a nursing home licensed state law, or an inpatient facility licensed under state law; (5) Unless a physician assistant's protocols or collaborative agreement indicate otherwise, plan and initiate a therapeutic regimen that includes ordering and prescribing non-pharmacological interventions, including (i) durable medical equipment; (ii) nutrition; (iii) blood and blood products; and (iv) diagnostic support services that include, but are not limited to, home health care, hospice, and physical and occupational therapy; and (6) Complete, sign, and file medical certifications of death, if authorized to do so in the physician assistant's protocol or collaborative agreement. PHYSICIAN ASSISTANTS NOT ENDORSED BY THE BOARD OF PHYSICIAN ASSISTANTS This bill requires a physician assistant who has not been endorsed by the board of physician assistants to practice under protocols jointly developed by the collaborating physician and the physician assistant. The physician assistant must maintain a copy of the protocols either on paper or electronically at each of the physician assistant's practice locations and must make the protocols available upon request by the board of physician assistants, the licensing board of the collaborating physician, or an authorized agent thereof. The protocols must set forth the range of services that may be provided by the physician assistant and must also contain a discussion of the problems and conditions likely to be encountered by the physician assistant and the appropriate treatment for such problems and conditions. Physician assistant practice under protocols requires active and continuous overview of the physician assistant's activities to ensure that the physician's directions and advice are implemented, but does not require the continuous and constant physical presence of the collaborating physician. This bill prohibits a physician assistant from performing tasks that are not within the physician assistant's range of skills and competence, that are not within the usual scope of practice of the collaborating physician, and that are not consistent with the protection of the health and well-being of the patients. This bill requires that the protocols include, at a minimum, the following: (1) The physician assistant's name, license number, and primary practice location; (2) The collaborating physician's name, license number, medical specialty, and primary practice location; (3) A general description of the oversight of the physician assistant by the collaborating physician; (4) A general description of the physician assistant's process for collaboration with physicians and other members of the healthcare team; (5) A process by which 100 percent of patient charts are reviewed by the collaborating physician within 10 days when a controlled drug is issued by the physician assistant; (6) A process by which at least 20 percent of the physician assistant's patient charts are reviewed by the collaborating physician every 30 days; (7) That, if the physician assistant changes practice settings to practice in a new medical specialty, a description of a process by which the patient medical charts prepared by the physician assistant are reviewed by the collaborating physician for a minimum of six months or until the physician assistant becomes eligible for endorsement, whichever period is longer; (8) That if the physician assistant practices in a remote location site from the collaborating physician's practice site, the collaborating physician must conduct a remote site visit at least every 30 days; (9) That the physician assistant collaborates with, consults with, or refers to, the collaborating physician or appropriate healthcare professional as indicated by the patient's condition and the applicable standard of care: (i) when a patient presents with a condition outside of the competence, scope, or experience of the physician assistant or collaborating physician; or (ii) when a patient's condition fails to adhere to the treatment plan or fails to respond to the treatment plan within a timeframe that is not within the expected disease progression; and (10) Designation of one or more alternative physicians for consultation in situations in which the collaborating physician is not available for consultation. PHYSICIAN ASSISTANTS THAT HAVE BEEN ENDORSED BY THE BOARD This bill requires a physician assistant who has been endorsed by the board of physician assistants to have a collaborative agreement with a physician. The physician assistant must maintain a copy of the collaborative agreement either on paper or electronically at each of the physician assistant's practice locations and make the collaborative agreement available upon request by the board of physician, the licensing board of the collaborating physician, or an authorized agent of such boards. This bill requires that in order to receive endorsement from the board of physician assistants, a physician assistant must have, at a minimum, 6,000 hours of documented postgraduate clinical experience, have a physician willing to enter into a collaborative agreement with the physician assistant, and meet such other requirements as set forth in rules promulgated by the board of physician assistants. This bill prohibits a physician assistant with 6,000 hours or more of documented postgraduate clinical experience from practicing without first receiving endorsement by the board of physician assistants. This bill requires that collaborative agreements governing physician assistants who have 6,000 hours or more of documented postgraduate clinical experience and are endorsed by the board of physician assistants include, at a minimum, the following information: (1) The physician assistant's name, license number, and primary practice location; (2) The collaborating physician's name, license number, medical specialty, and primary practice location; (3) That the physician assistant performs only those services that are within the physician assistant's competence, knowledge, and skills that are within the usual scope of practice of the collaborating physician, and that are consistent with the protection of the health and well-being of patients; (4) A process by which 100 percent of patient charts are reviewed by the collaborating physician within 30 days when a controlled drug is issued by the physician assistant; (5) That if the physician assistant changes practice settings to practice in a new medical specialty, a description of a process by which a sample of patient medical charts prepared by the physician assistant are reviewed by the collaborating physician, or a physician designated by the collaborating physician, for a minimum of six months; (6) That the physician assistant collaborates with, consults with, or refers to the collaborating physician or appropriate healthcare professional as indicated by the patient's condition and the applicable standard of care; (7) Methods of communication between the physician assistant and collaborating physician; and (8) Requirements of patient chart review and remote site visits, if any, established at the practice level and commensurate with the level of training, experience, and competence of the physician assistant within the expected scope of practice of the physician assistant. STANDARD OF CARE This bill clarifies that the standard of care for a physician assistant is the same standard of care as applicable to a physician who performs the same service. SPECIALIST BOARDS MUST ADOPT RULES FOR COLLABORATION This bill requires rules that purport to regulate the collaboration of physician assistants with licensed osteopathic physicians to be jointly adopted by the board of osteopathic medical examination and the board of physician assistants. Rules that purport to regulate the collaboration of physician assistants with licensed podiatrists must be jointly adopted by the board of podiatric medical examiners and the board of physician assistants. PRACTICES FOR COLLABORATION WITH PHYSICIAN ASSISTANTS Present law establishes that more than one physician may collaborate with the same physician assistant if each physician assistant has a primary collaborating physician and may have additional alternate collaborating physicians who collaborate with the physician assistant in the absence or unavailability of the primary collaborating physician. Each physician assistant must notify the board of physician assistants of the name, address, and license number of the physician assistant's primary collaborating physician and must notify the board of physician assistants of a change in the primary collaborating physician within 15 days of the change. This bill adds to present law by requiring a physician assistant to notify the board of physician assistants of the name and address of the physician assistant's primary practice location and to notify the board of physician assistants within 15 days of a practice location change. Under present law, the prescriptive practices of physician assistants and the collaborating physicians with whom the physician assistants are rendering services must be monitored by the board of medical examiners and the board of physician assistants. As used in this provision, "monitor" does not include the regulation of the practice of medicine or the regulation of the practice of a physician assistant, but may include site visits by members of the board of medical examiners and the board of physician assistants. This bill authorizes the board of physician assistants to monitor the prescriptive practices of the physician assistant through site visits by authorized agents of the board of physician assistants. Under present law, complaints against physician assistants or collaborating physicians must be reported to the director of the division of health-related boards, board of medical examiners, and the board of physician assistants, as appropriate. This bill revises this provision to, instead, require complaints against physician assistants to be reported to the office of investigations of the division of health-related boards. Present law requires that every prescription order issued by a physician assistant be entered in the medical records of the patient and must be written on a preprinted prescription pad bearing the name, address, and telephone number of the collaborating physician and of the physician assistant, and the physician assistant must sign each prescription order so written. This bill removes the requirement that every prescription order issued by a physician assistant be written on a preprinted prescription pad. However, prescriptions that are handwritten must be written on a preprinted prescription pad bearing the name, address, telephone number, and signature of the physician assistant. Present law authorizes a physician assistant to prescribe drugs under state law, who provides services in a community mental health center or federally qualified health center, or solely via telehealth, may arrange for the required personal review of the physician assistant's charts by a collaborating physician, with the same authority to render prescriptive services that the physician assistant is authorized to render, in the office or practice site of the physician, or the required visit by a collaborating physician to any remote site, or both, via HIPAA-compliant electronic means rather than at the site of the clinic. This bill removes telehealth as an option in this provision. Present law requires (i) a patient of a physician who is receiving services from a physician assistant to be fully informed that the service provider is a physician assistant, or (ii) a sign to be conspicuously placed within the office of the physician indicating that certain services may be rendered by a physician assistant. This bill requires both that the patient be fully informed that the individual is a physician assistant and that a sign be conspicuously placed. GROUNDS FOR DENIAL, SUSPENSION, OR REVOCATION OF LICENSES OF PHYSICIAN ASSISTANTS Under present law, the grounds on which the board of physician assistants may exercise its power to deny, suspend, or revoke a physician assistant license are (i) the conviction of a crime; (ii) fraud in procuring or attempting to procure a license to practice medicine as a physician assistant; (3) the commission of unprofessional or unethical conduct; (iv) an addiction to the use of alcohol, narcotics, or other drugs; (v) engaging in the inappropriate prescribing, dispensing, or otherwise distributing a controlled substance or other drug in the course of professional practice; (vi) suspension or revocation of a license in another state for disciplinary reasons; or (vii) failure to comply with the lawful order or duly promulgated rules of the board of physician assistants. This bill adds to the list in the above provision holding oneself out as board-certified in a medical specialty, or utilizing a medical specialty designation with (i) a title or title reference; (ii) an advertisement; (iii) the name of any healthcare setting that is majority owned by physician assistants, unless services are provided by a physician actively practicing such medical specialty to more than 50 percent of patients at the site; (iv) credentialing with any licensed healthcare facility or health insurance entity; or (v) an application for healthcare liability insurance coverage. DEATH REGISTRATION Under present law, a funeral director who first assumes custody of a dead body, medical examiner, or attending or pronouncing physician in a hospital may file the death certificate. The funeral director, medical examiner, or attending or pronouncing physician in a hospital shall obtain the personal data from the next of kin or the best qualified person or source available, and shall obtain the medical certification from the person responsible for medical certification. This bill authorizes the following to file the death certificate: (i) a physician assistant authorized by protocol or collaborative agreement; or (ii) an advance practice registered nurse authorized by protocol or collaborative agreement. Under present law, the medical certification must be completed, signed and returned to the funeral director by the physician in charge of the patient's care for the illness or condition that resulted in death within 48 hours after death, except when inquiry is required by the county medical examiner or to obtain a veteran's medical records. In the absence of the physician, the certificate may be completed and signed by another physician designated by the physician or by the chief medical officer of the institution in which the death occurred. In cases of deaths that occur outside of a medical institution and are either unattended by a physician or not under hospice care, the county medical examiner must investigate and certify the death certificate when one of the following conditions exists: (1) There is no physician who had attended the deceased during the four months preceding death, except that any physician who had attended the patient more than four months preceding death may elect to certify the death certificate if the physician can make a good faith determination as to cause of death and if the county medical examiner has not assumed jurisdiction; or (2) The physician who had attended the deceased during the four months preceding death communicates, orally or in writing, to the county medical examiner that, in the physician's best medical judgment, the patient's death did not result from the illness or condition for which the physician was attending the patient. This bill requires a physician assistant or advance practice registered nurse in charge of the patient's care for the illness or conditions that resulted in death to complete, sign, and return the medical certification to the funeral director. A physician assistant authorized by protocol or collaborative agreement, or advance practice registered nurse authorized by protocol or collaborative agreement, who attended the patient more than four months preceding death may (i) certify the death certification if the physician assistant or advance practice nurse can make a good faith determination as to cause of death and if the county medical examiner has not assumed jurisdiction; and (ii) communicate, orally or in writing, that in the physician assistant's or advance practice registered nurse's best medical judgment, the patient's death did not result from the illness or condition for which the physician assistant or advance practice registered nurse was attending the patient. Under present law, if the cause of death cannot be determined within 48 hours after death, the medical certification must be completed as provided by regulation. The attending physician or medical examiner must give the funeral director notice of the reason for the delay, and final disposition of the body must not be made until authorized by the attending physician or medical examiner. This bill requires an attending physician assistant authorized by protocol or collaborative agreement, or advance practice registered nurse authorized by protocol or collaborative agreement, to give the funeral director such notice. GENETIC COUNSELING SERVICES Under present law, "referral" within the Genetic Counselors' Licensing Act means a written or telecommunicated authorization for genetic counseling services from a physician licensed to practice medicine in all its branches or an advanced practice registered nurse or physician assistant who has an agreement and signed protocols with a supervising physician that authorizes referrals to a genetic counselor. This bill includes an advance practice registered nurse or physician assistant who has protocols or a collaborative agreement to act within the meaning of "referral." PHYSICIAN ORDERS FOR SCOPE OF TREATMENT Under present law, a physician order for scope of treatment (POST) may be issued by a physician assistant, nurse practitioner, or clinical nurse specialist if the authority to issue the POST is contained in the physician assistant's, nurse practitioner's, or clinical nurse's protocols. This bill authorizes a physician assistant, nurse practitioner, or clinical nurse specialist to issue a post if the authority to do so is contained in the physician assistant's, nurse practitioner's, or clinical nurse's collaborative agreement. Under present law, a physician assistant, nurse practitioner, or clinical nurse specialist may issue a POST if a patient is a minor or is otherwise incapable of making an informed decision regarding consent for such an order under the Tennessee Health Care Decisions Act and the agent, surrogate, or other person authorized to consent on the patient's behalf under the Tennessee Health Care Decisions Act is not reasonably available and such authority to issue is contained in the physician assistant, nurse practitioner or clinical nurse specialist's protocols and the physician assistant or nurse determines that the provision of cardiopulmonary resuscitation would be contrary to accepted medical standards. This bill authorizes the physician assistant, nurse practitioner, or clinical nurse specialist to issue a POST if the authority to do so is contained within a collaborative agreement. POWERS AND DUTIES OF THE NURSING BOARD Under present law, the board of nursing must establish and examine the qualifications, competencies, training, education and experience required of a registered nurse applying for a certificate of fitness as a nurse practitioner, as defined by the board of nursing, sufficient to prepare such person to write and sign prescriptions and/or issue drugs in accordance with state law. This bill revises this provision by replacing "nurse practitioner" with "advance practice registered nurse." CERTIFIED NURSE PRACTITIONER RULES Present law requires a nurse who has been issued a certificate of fitness as a nurse practitioner to file a notice with the board of nursing, containing the name of the nurse practitioner, the name of the licensed physician collaborating with the nurse practitioner who has control and responsibility for prescriptive services rendered by the nurse practitioner, and a copy of the formulary describing the categories of legend drugs to be prescribed or issued by the nurse practitioner. The nurse practitioner is responsible for updating this information. This bill removes these provisions. GROUNDS FOR DENIAL, REVOCATION OR SUSPENSION OF CERTIFICATE OR LICENSE--ADVANCE PRACTICE REGISTERED NURSES Under present law, the board of nursing has the power to deny, revoke or suspend any certificate or license to practice nursing or to otherwise discipline a licensee upon proof that the person (i) is guilty of fraud or deceit in procuring or attempting to procure a license to practice nursing; (ii) is guilty of a crime; (iii) is unfit or incompetent by reason of negligence, habits or other cause; (iv) is addicted to alcohol or drugs to the degree of interfering with nursing duties; (v) is mentally incompetent; (vi) is guilty of unprofessional conduct; or (vii) has violated or attempted to violate, directly or indirectly, or assisted in or abetted the violation of or conspired to violate any provision of this chapter or any lawful order of the board of nursing issued pursuant thereto. This bill authorizes the board of nursing to deny, revoke, or suspend the certificate or license of advance practice registered nurse if the advance practice registered nurse holds themselves out as, or utilized a medical specialty designation with (i) a title or title reference; (ii) an advertisement; (iii) the name of a healthcare setting that is majority-owned by advance practice registered nurses, unless services are provided by a physician actively practicing such medical specialty to more than 50 percent of patients at the site; (iv) credentialing with any licensed healthcare facility or health insurance entity; or (v) an application for healthcare liability insurance coverage. AUTHORITY TO ISSUE ORAL CONTRACEPTIVES AND DRUGS RELATING TO STDs Present law prohibits a physician from issuing oral contraceptives and drugs relating to STDs unless the physician has examined the patient for the condition for which such drugs are issued. However, this requirement does not supersede any protocol under which a nurse practitioner is rendering service. This bill adds that this requirement also does not supersede any collaborative agreement under which a nurse practitioner is rendering service. AUTHORIZED PRACTICE FOR ADVANCE PRACTICE REGISTERED NURSES For purposes of this bill, the administration of medications and treatments as prescribed by a licensed physician, dentist, podiatrist, or nurse authorized to prescribe, or selected, ordered, or administered by an advanced practice registered nurse specializing as a certified registered nurse anesthetist (CRNA) is governed by state law relative to nursing. This bill authorizes the following practices for an advance practice registered nurse: (1) Perform medical diagnosis and treatment as an advance practice registered nurse pursuant either to protocols or collaborative agreement, as applicable, for which the advance practice registered nurse has been prepared by education, training, and experience, and that the advance practice registered nurse is competent to perform only if licensed by the board of nursing and only within the usual scope of practice of the collaborating physician; (2) Perform minor procedures, including (i) simple laceration repair; (ii) excision of skin lesions, moles, warts, cysts, or lipomas; (iii) incision and draining of superficial abscesses; (iv) skin biopsies; (v) arthrocentesis; (vi) thoracentesis; (vii) paracentesis; (viii) endometrial biopsies; (ix) IUD insertion; and (x) colposcopy; (3) Assist a physician who performs procedures considered Level II office-based surgery or Level III office-based surgery, as defined under state law, or a more complex procedure; if (i) the advance practice registered nurse is credentialed or receives privileges from the medical staff of the facility to assist a physician with enumerated procedures; (ii) the physician performing the procedure is credentialed or privileged to perform the procedure by the medical staff of the facility; and (iii) the physician is present or immediately available for consultation with the advance practice registered nurse during and after the procedure; (4) Issue drugs authorized by law pursuant to protocols or collaborative agreement, and as applicable: (A) Prescribe, dispense, order, administer, and procure appropriate medical devices, legend drugs, and controlled substances that are within the advance practice registered nurse's scope of practice if the advance practice registered nurse has registered and complied with all applicable requirements of state law and regulation and the FDA; and (B) Only prescribe or issue a Schedule II or Schedule III opioid for a maximum of a nonrefillable, 30-day course of treatment. However, this (4)(B) does not apply to prescriptions issued in a hospital, a licensed nursing home, or a licensed inpatient facility; (5) Unless an advance practice registered nurse's protocols or collaborative agreement indicate otherwise, an advance practice registered nurse may plan and initiate a therapeutic regimen that includes ordering and prescribing non-pharmacological interventions. Such interventions include durable medical equipment, nutrition, blood and blood products, and diagnostic support services that include home health care, hospice, and physical and occupational therapy; and (6) Complete, sign, and file medical certifications of death if authorized to do so in the advance practice registered nurse's protocol or collaborative agreement. ADVANCE PRACTICE REGISTERED NURSES WITHOUT ENDORSEMENT FROM BOARD This bill requires an advance practice registered nurse who has not received endorsement from the board of nursing to practice under protocols jointly developed by a collaborating physician and the advance practice registered nurse. An advance practice registered nurse must maintain a copy of the protocols either on paper or electronically at each of the advance practice registered nurse's practice locations and must make the protocols available upon request by the board of nursing, the licensing board of the collaborating physician, or an authorized agent of such boards. The protocols must set forth the range of services that may be provided by the advance practice registered nurse and must also contain a discussion of the problems and conditions likely to be encountered by the advance practice registered nurse and the appropriate treatment for such problems and conditions. Protocols must set forth the range of services that may be provided by the advance practice registered nurse and must also contain a discussion of the problems and conditions likely to be encountered by the advance practice registered nurse and the appropriate treatment for such problems and conditions. This bill requires the active and continuous overview of the advance practice registered nurse's activities, if practicing pursuant to protocols, to ensure that the physician's directions and advice are implemented, but does not require the continuous and constant physical presence of the collaborating physician. This bill prohibits an advance practice registered nurse from performing those tasks that are not within the advance practice registered nurse's range of skills and competence, that are not within the usual scope of practice of the collaborating physician, and that are not consistent with the protection of the health and well-being of patients. This bill requires protocols to include, at a minimum, the following: (1) The advance practice registered nurse's name, license number, and primary practice location; (2) The collaborating physician's name, license number, medical specialty, and primary practice location; (3) A general description of the oversight of the advance practice registered nurse by the collaborating physician; (4) A general description of the advance practice registered nurse's process for collaboration with physicians and other members of the healthcare team; (5) A process by which 100 percent of patient charts are reviewed by the collaborating physician within 10 days when a controlled drug is issued by the advance practice registered nurse; (6) A process by which at least 20 percent of the advance practice registered nurse's patient charts are reviewed by the collaborating physician every 30 days; (7) That, if the advance practice registered nurse changes practice settings to practice in a new medical specialty, a description of a process by which the patient medical charts prepared by the advance practice registered nurse are reviewed by the collaborating physician for a minimum of six months or until the advance practice registered nurse becomes eligible for endorsement, whichever period is longer; (8) That if the advance practice registered nurse practices in a remote location site from the collaborating physician's practice site, the collaborating physician conducts a remote site visit at least every 30 days; (9) That the advance practice registered nurse collaborates with, consults with, or refers to, the collaborating physician or appropriate healthcare professional as indicated by the patient's condition and the applicable standard of care: (i) when a patient presents with a condition outside of the competence, scope, or experience of the advance practice registered nurse or collaborating physician; or (ii) when a patient's condition fails to adhere to the treatment plan or fails to respond to the treatment plan within a timeframe that is not within the expected disease progression; and (10) Designation of one or more alternative physicians for consultation in situations in which the collaborating physician is not available for consultation. ADVANCE PRACTICE REGISTERED NURSE WITH ENDORSEMENT FROM BOARD This bill requires an advance practice registered nurse who has received endorsement from the board of nursing to have a collaborative agreement with a physician. The advance practice registered nurse must maintain a copy of the collaborative agreement either on paper or electronically at each of the advance practice registered nurse's practice locations and make the collaborative agreement available upon request by the board of nursing, the licensing board of the collaborating physician, or an authorized agent of such boards. This bill requires that in order to be eligible for endorsement by the board of nursing, an advance practice registered nurse must, at a minimum, have 6,000 hours of documented postgraduate clinical experience, have a physician willing to enter into a collaborative agreement with the advance practice registered nurse, and meet such other requirements as set forth in rules promulgated by the board of nursing. An advance practice registered nurse with 6,000 hours or more of documented postgraduate clinical experience must not practice pursuant to state nursing law or rules promulgated thereto for endorsed advance practice registered nurses without first receiving endorsement by the board of nursing. This bill requires collaborative agreements governing advance practice registered nurses who have 6,000 hours or more of documented postgraduate clinical experience and are endorsed by the board of nursing to include, at a minimum, the following: (1) The advance practice registered nurse's name, license number, and primary practice location; (2) The collaborating physician's name, license number, medical specialty, and primary practice location; (3) That the advance practice registered nurse performs only those services that are within the advance practice registered nurse's competence, knowledge, and skills that are within the usual scope of practice of the collaborating physician, and that are consistent with the protection of the health and well-being of patients; (4) A process by which 100 percent of patient charts are reviewed by the collaborating physician within 30 days when a controlled drug is issued by the advance practice registered nurse; (5) That if the advance practice registered nurse changes practice settings to practice in a new medical specialty, a description of a process by which a sample of patient medical charts prepared by the advance practice registered nurse are reviewed by the collaborating physician, or physician designated by the collaborating physician, for a minimum of six months; (6) That the advance practice registered nurse collaborates with, consults with, or refers to, the collaborating physician or appropriate healthcare professional as indicated by the patient's condition and the applicable standard of care; (7) Methods of communication between the advance practice registered nurse and collaborating physician; and (8) Requirements of patient chart review and remote site visits, if any, established at the practice level and commensurate with the level of training, experience, and competence of the advance practice registered nurse within the expected scope of practice of the advance practice registered nurse. ADVANCE PRACTICE REGISTERED NURSE COLLABORATION WITH PODIATRIST An advance practice registered nurse practicing in collaboration with a licensed podiatrist, in addition meeting the requirements of state nursing law: (i) must not provide services that are outside the scope of practice of a podiatrist as set forth under state law; (ii) must comply with the requirements of, and rules adopted pursuant to, this bill and state law governing the collaboration with an advance practice registered nurse; and (iii) may only prescribe drugs that are rational to the practice of podiatry. EMERGENCY MEDICAL SERVICES This bill authorizes an advance practice registered nurse to render emergency medical services in cases where immediate diagnosis and treatment are necessary to avoid patient death or disability. STANDARD OF CARE This bill establishes that the standard of care for an advance practice registered nurse is the same standard of care as applicable to a physician who performs the same service. RULES FOR COLLABORATION WITH PHYSICIANS This bill requires that rules that purport to regulate the collaboration of advance practice registered nurses with licensed physicians be jointly adopted by the board of medical examiners and the board of nursing. This bill requires that rules that purport to regulate the collaboration of advance practice registered nurses with osteopathic physicians be jointly adopted by the board of osteopathic medical examination and the board of nursing. This bill requires that rules that purport to regulate the collaboration of advance practice registered nurses with podiatrists be jointly adopted by the board of podiatry and the board of nursing. ADVANCE PRACTICE REGISTERED NURSE COLLABORATION WITH PHYSICIANS This bill authorizes an advance practice registered nurse to collaborate with more than one physician as long as alternate collaborating physicians are available to collaborate with the advance practice registered nurse in the absence or unavailability of the primary collaborating physician. Each advance practice registered nurse must notify the board of nursing of the name, address, and license number of the advance practice registered nurse's primary collaborating physician and must notify the board of nursing of a change in the primary collaborating physician within 15 days of the change. The number of advance practice registered nurses for whom a physician may serve as the collaborating physician must be determined by the physician at the practice level, consistent with good medical practice. The collaborating physician must designate one or more alternate physicians who have agreed to accept the responsibility of collaborating with the advance practice registered nurse on a prearranged basis in the collaborating physician's absence. This bill requires each advance practice registered nurse to notify the board of nursing of the name and address of the advance practice registered nurse's primary practice location and must notify the board of nursing within 15 days of a practice location change. This bill authorizes the board of nursing to monitor the prescriptive practices of the advance practice registered nurse through site visits by members of the board or their authorized agents. This bill requires that complaints against advance practice registered nurses be reported to the office of investigations of the division of health-related boards. PRESCRIPTIONS This bill requires that every prescription order issued by an advance practice registered nurse pursuant to this bill be entered in the medical records of the patient, and every handwritten prescription must be written on a preprinted prescription pad bearing the name, address, and telephone number of the advance practice registered nurse, and the advance practice registered nurse must sign each prescription order so written. This bill requires that a handwritten prescription order for a drug prepared by an advance practice registered nurse who is authorized by law to prescribe a drug must be legible so that it is comprehensible by the pharmacist who fills the prescription. The handwritten prescription order must contain the name of the prescribing advance practice registered nurse, the name and strength of the drug prescribed, the quantity of the drug prescribed, handwritten in letters or in numerals, instructions for the proper use of the drug and the month and day that the prescription order was issued, recorded in letters or in numerals or a combination thereof. The prescribing advance practice registered nurse must sign the handwritten prescription order on the day it is issued, unless it is a standing order issued in a hospital, a nursing home, or an assisted-care living facility. This bill requires that a typed or computer-generated prescription order for a drug issued by an advance practice registered nurse who is authorized by law to prescribe a drug must be legible so that it is comprehensible by the pharmacist who fills the prescription order. The typed or computer-generated prescription order must contain the name of the prescribing advance practice registered nurse, the name and strength of the drug prescribed, the quantity of the drug prescribed, recorded in letters or in numerals, instructions for the proper use of the drug, and the month and day that the typed or computer-generated prescription order was issued, recorded in letters or in numerals or a combination thereof. The prescribing advance practice registered nurse must sign the typed or computer-generated prescription order on the day it is issued, unless it is a standing order issued in a hospital, a nursing home, or an assisted-care living facility. This bill does not prevent an advance practice registered nurse from issuing a verbal prescription order. This bill requires that handwritten, typed, or computer-generated prescription orders must be issued on either tamper-resistant prescription paper or printed utilizing a technology that results in a tamper-resistant prescription that meets the current centers for medicare and medicaid service guidance to state medicaid directors regarding the federal United States Troop Readiness, Veterans' Care, Katrina Recovery, and Iraq Accountability Appropriations Act, and meets or exceeds specific TennCare requirements for tamper-resistant prescriptions. This does not apply to prescriptions written for inpatients of a hospital, outpatients of a hospital where the doctor or other person authorized to write prescriptions writes the order into the hospital medical record and then the order is given directly to the hospital pharmacy and the patient never has the opportunity to handle the written order, a nursing home or an assisted-care living facility, or inpatients or residents of a mental health hospital or residential facility licensed under state law or individuals incarcerated in a local, state, or federal correctional facility. NOTICE THAT HEALTH PROVIDER IS AN ADVANCE PRACTICE REGISTERED NURSE This bill requires an advance practice registered nurse to inform a patient receiving services from the advance practice registered nurse that the individual is an advance practice registered nurse, and a sign must be conspicuously placed within the office indicating that certain services may be rendered by an advance practice registered nurse. COLLABORATION PHYSICIAN MUST WORK WITH PATIENTS This bill prohibits a physician who does not normally provide patient care from entering into protocols with, collaborating with, or utilizing the services of an advance practice registered nurse. ASSISTANCE TO DISABLED DRIVERS Under present law, a licensed nurse practitioner and a licensed physician assistant have the same authority that a physician has under state law pursuant to disabled drivers to issue certified statements of disability or deafness to accompany the application of disabled or deaf persons to obtain the appropriate registration, license plates, placards and decals from the department, only if the authority is expressly included in the written protocol developed jointly by the supervising physician and the nurse practitioner or physician assistant, whichever is applicable, setting forth the range of services that may be performed by the nurse practitioner or physician assistant. This bill adds to the present law above by providing that a licensed nurse practitioner and a licensed physician assistant have the same authority described above if the authority is expressly included in the written collaborative agreement developed jointly by the supervising physician and the nurse practitioner or physician assistant setting forth the range of services that may be performed by the nurse practitioner or physician assistant. REGISTRY OF PHYSICIANS WILLING TO ENTER INTO COLLABORATIVE AGREEMENTS This bill requires the board of medical examiners to establish and maintain an online registry of licensed physicians who are willing to enter into a collaborative agreement with an advance practice registered nurse or physician assistant. The online registry must include, at a minimum (i) the physician's name and physical practice address; (ii) designation as a medical doctor or doctor of osteopathy; (iii) the physician's medical specialty and board certifications, if any; (iv) the region or regions of the state in which the physician is willing to enter into a collaborative agreement with an advance practice registered nurse or physician assistant; and (v) an address, telephone number, or email address at which the physician can be contacted by an advance practice registered nurse and physician assistant who may desire to enter into a collaborative relationship with the physician. This bill requires that a physician included on the registry update the physician's information when it changes. However, inclusion by a physician on the registry does not obligate a physician to enter into a collaborative agreement with an advance practice registered nurse or a physician assistant. ON APRIL 15, 2024, THE SENATE ADOPTED AMENDMENT #1 AND PASSED SENATE BILL 2136, AS AMENDED. AMENDMENT #1 rewrites the bill as follows: PERMISSIBLE PHYSICIAN ASSISTANT ACTIVITIES (1) Authorizes a physician assistant to do the following: (A) Perform medical diagnosis and treatment as a physician assistant pursuant either to a protocol or collaborative agreement, as applicable, for which the physician assistant has been prepared by education, training, and experience, and that the physician assistant is competent to perform only if licensed by the board of physician assistants ('board") and only within the usual scope of practice of the collaborating physician; (B) Perform minor surgical procedures, including (i) simple laceration or surgery repair; (ii) excision of skin lesions, moles, warts, cysts, or lipomas; (iii) incision and draining of superficial abscesses; (iv) skin biopsies; (v) arthrocentesis; (vi) thoracentesis; (vii) paracentesis; (viii) endometrial biopsies; (ix) IUD insertion; and (x) colposcopy; (C) Assist a physician who performs procedures considered Level II office-based surgery or Level III office-based surgery, as those are defined in state law, or a more complex procedure, if (i) the physician assistant is credentialed or receives privileges from the medical staff of the facility to assist a physician with enumerated procedures; (ii) the physician performing the procedure is credentialed or privileged to perform the procedure by the medical staff of the facility; and (iii) the physician is present or immediately available for consultation with the physician assistant during and after the procedure; (D) Issue drugs authorized by law pursuant to protocols or collaborative agreement, and as applicable, (i) prescribe, dispense, order, administer, and procure appropriate medical devices, legend drugs, and controlled substances that are within the physician assistant's scope of practice if the physician assistant has registered and complied with all applicable requirements of state law and rule and the federal drug enforcement administration; and (ii) only prescribe or issue a Schedule II or Schedule III opioid for a maximum of a nonrefillable, thirty-day course of treatment. This (1)(D) does not apply to a prescription issued in a hospital, a licensed nursing home, or a licensed inpatient facility; (E) Unless a physician assistant's protocols or collaborative agreement indicate otherwise, plan and initiate a therapeutic regimen that includes ordering and prescribing non-pharmacological interventions, including (i) durable medical equipment; (ii) nutrition; (iii) blood and blood products; and (iv) diagnostic support services that include, but are not limited to, home health care, hospice, and physical and occupational therapy; and (F) Complete, sign, and file medical certifications of death, if authorized to do so in the physician assistant's protocol or collaborative agreement; PHYSICIAN ASSISTANTS WHO HAVE NOT BEEN ENDORSED BY THE BOARD (2) Requires a physician assistant who has not received endorsement from the board to practice under protocols jointly developed by the collaborating physician and the physician assistant; (3) Requires the physician assistant to maintain a copy of the protocols either on paper or electronically at each of the physician assistant's practice locations and make the protocols available upon request by the board, the licensing board of the collaborating physician, or an authorized agent thereof; (4) Requires the protocols to set forth the range of services that may be provided by the physician assistant and must also contain a discussion of the problems and conditions likely to be encountered by the physician assistant and the appropriate treatment for such problems and conditions; (5) Establishes that physician assistant practice under protocols requires active and continuous overview of the physician assistant's activities to ensure that the physician's directions and advice are implemented, but does not require the continuous and constant physical presence of the collaborating physician; (6) Authorizes a physician assistant to perform only those tasks that are within the physician assistant's range of skills and competence, that are within the usual scope of practice of the collaborating physician, and that are consistent with the protection of the health and well-being of the patients; (7) Requires protocols to also include, at a minimum, the following: (A) The physician assistant's name, license number, and primary practice location; (B) The collaborating physician's name, license number, medical specialty, and primary practice location; (C) A general description of the oversight of the physician assistant by the collaborating physician; (D) A general description of the physician assistant's process for collaboration with physicians and other members of the healthcare team; (E) A process by which 100 percent of patient charts are reviewed by the collaborating physician within 10 days when a prescription for a controlled drug is issued by the physician assistant; (F) A process by which at least 20 percent of the physician assistant's patient charts are reviewed by the collaborating physician every 30 days; (G) If the physician assistant changes practice settings to practice in a new medical specialty, a description of a process by which the patient medical charts prepared by the physician assistant are reviewed by the collaborating physician for a minimum of six months or until the physician assistant becomes eligible for endorsement, whichever period is longer; (H) If the physician assistant practices in a remote location site from the collaborating physician's practice site, that the collaborating physician conduct a remote site visit at least every 30 days; (I) That the physician assistant collaborates with, consults with, or refers to, the collaborating physician or appropriate healthcare professional as indicated by the patient's condition and the applicable standard of care when a patient presents with a condition that is outside of the competence, scope of practice, or experience of the physician assistant or collaborating physician; and (J) Designation of one or more alternative physicians for consultation in situations in which the collaborating physician is not available for consultation; COLLABORATIVE AGREEMENTS FOR BOARD-ENDORSED PHYSICIAN ASSISTANTS (8) Requires a physician assistant who has received an endorsement from the board to have a collaborative agreement with a physician; (9) Requires the physician assistant to maintain a copy of the collaborative agreement either on paper or electronically at each of the physician assistant's practice locations and make the collaborative agreement available upon request by the board of physician assistants, the licensing board of the collaborating physician, or an authorized agent of such boards; (10) To be eligible to receive endorsement from the board, requires a physician assistant to, at a minimum, have 6,000 hours of documented postgraduate clinical experience, have a physician willing to enter into a collaborative agreement with the physician assistant, and meet such other requirements as set forth in rules promulgated by the board. A physician assistant with 6,000 hours or more of documented postgraduate clinical experience must not practice pursuant to the requirements in state physician assistant law or rules promulgated thereto for endorsed physician assistants without first receiving endorsement by the board. State physician assistant law does not require a physician assistant to become endorsed by the board. Unless a physician assistant has received an endorsement from the board, the requirements under this heading apply; (11) Requires collaborative agreements governing physician assistants who have 6,000 or more hours of documented postgraduate clinical experience and are endorsed by the board to include, at a minimum, the following: (i) the physician assistant's name, license number, and primary practice location; (ii) the collaborating physician's name, license number, medical specialty, and primary practice location; (iii) that the physician assistant performs only those services that are within the physician assistant's competence, knowledge, and skills that are within the usual scope of practice of the collaborating physician, and that are consistent with the protection of the health and well-being of patients; (iv) a process by which 100 percent of patient charts are reviewed by the collaborating physician within 30 days when a prescription for any drug containing buprenorphine for use in recovery or medication treatment or a Schedule II controlled drug is issued by the physician assistant; (v) that if the physician assistant changes practice settings to practice in a new medical specialty, a description of a process by which a sample of patient medical charts prepared by the physician assistant are reviewed by the collaborating physician, or a physician designated by the collaborating physician, for a minimum of six months; (vi) that the physician assistant collaborates with, consults with, or refers to the collaborating physician or appropriate healthcare professional as indicated by the patient's condition and the applicable standard of care; (vii) methods of communication between the physician assistant and collaborating physician; and (viii) requirements of patient chart review and remote site visits, if any, established at the practice level and commensurate with the level of training, experience, and competence of the physician assistant within the expected scope of practice of the physician assistant; PHYSICIAN ASSISTANTS PRACTICING WITH PODIATRISTS (12) Establishes that, regarding a physician assistant practicing in collaboration with a licensed podiatrist, in addition to meeting the requirements of other relevant state law, the following apply: (i) prohibits providing services that are outside the scope of practice of a podiatrist; (ii) requires complying with the requirements of, and rules adopted pursuant to, the bill and other relevant state law governing the collaboration with a physician assistant; and (iii) authorizes only prescribing drugs that are rational to the practice of podiatry; (13) Authorizes a physician assistant to render emergency medical services in cases where immediate diagnosis and treatment are necessary to avoid patient death or disability; (14) Establishes that the standard of care for a physician assistant is the same standard of care as applicable to a physician who performs the same service; (15) Requires that the initial rules governing the collaboration of physician assistants with licensed physicians be established and promulgated in accordance with the Uniform Administrative Procedures Act, by a task force composed of (i) one member from the board of medical examiners; (ii) one member from the board of osteopathic examination; (iii) one member from the board of podiatric medical examiners; and (iv) three members from the board of physician assistants; (16) Requires the task force to create uniform rules governing the collaboration of physician assistants with licensed physicians, which are binding on each board listed in (15); (17) Requires the rules created by the taskforce to create standard protocols to determine the responsibility for the review of patient medical charts; (18) Requires each board listed in (15) to select and appoint by a majority vote of its members a board member to serve on the task force before September 1, 2024; (19) Requires the task force to select and appoint a member to serve as chair of the task force; (20) Establishes that a majority of the task force constitutes a quorum, and a majority vote of the task force members present is required for any action; (21) Requires the task force to hear public comment at any required hearing on behalf of all boards listed in (15) when a hearing is required. The task force is authorized to vote to promulgate the rules governing the collaboration of physician assistants with licensed physicians for each board listed in (15); (22) Requires the task force to terminate upon the effective date of a permanent rule establishing collaboration pursuant to the bill. All future rules regarding collaboration pursuant to the bill after the termination of the task force must be adopted jointly by each relevant board in (15); (23) Establishes that the bill does not prohibit the licensing boards listed in (15) from promulgating additional rules regarding the licensees of such boards; REQUIRED PRACTICES FOR PHYSICIANS COLLABORATING WITH PHYSICIAN ASSISTANTS (24) Requires a licensed physician collaborating with a physician assistant to comply with the following practices: (A) Ensure that protocols or a collaborative agreement, as applicable, is in place for each physician assistant with whom the physician collaborates and that such protocols or collaborative agreement meets the requirements of the bill and the duly promulgated rules. More than one physician may collaborate with the same physician assistant if alternative collaborating physicians are available to collaborate with the physician assistant in the absence or unavailability of the primary collaborating physician. Each physician assistant must notify the board of physician assistants of the name, address, and license number of the physician assistant's primary collaborating physician and notify the board of physician assistants of a change in the primary collaborating physician within 15 days of the change. The number of physician assistants for whom a physician may serve as the collaborating physician must be determined by the physician at the practice level, consistent with good medical practice. The collaborating physician must designate one or more alternate physicians who have agreed to accept the responsibility of collaborating with the physician assistant on a prearranged basis in the collaborating physician's absence; (B) Complete the patient chart reviews of each physician assistant with whom the collaborating physician collaborates as set forth in the bill, in rules promulgated pursuant to the bill, and in protocols or a collaborative agreement, as applicable; (C) Conduct reviews of charts submitted to the collaborating physician by the physician assistant deemed by the physician assistant medically indicated for consultation. The collaborating physician is responsible for reviewing 100 percent of patient charts within 30 days when the physician assistant issues a controlled drug pursuant to protocols. The collaborating physician is responsible for reviewing 100 percent of patient charts within 30 days when the physician assistant issues any drug containing buprenorphine for use in recovery or medication-assisted treatment or a Schedule II controlled drug pursuant to a collaborative agreement; (D) Conduct the requisite remote site visits with each physician assistant with whom the physician collaborates, as set forth in the bill or by rule, and in protocols or a collaborative agreement, as applicable; (E) Each physician assistant must notify the board of the name and address of the physician assistant's primary practice location and notify the board within 15 days of a practice location change; (F) The board of physician assistants is authorized to monitor the prescriptive practices of the physician assistant through site visits by members of the board or their authorized agents; (G) Complaints against physician assistants must be reported to the office of investigations of the division of health related boards; (H) Every prescription order issued by a physician assistant pursuant to the bill must be entered in the medical records of the patient, and every handwritten prescription must be written on a preprinted prescription pad bearing the name, address, and telephone number of the physician assistant, and the physician assistant must sign each prescription order so written; (I) A handwritten prescription order for a drug prepared by a physician assistant who is authorized by law to prescribe a drug must be legible so that it is comprehensible by the pharmacist who fills the prescription. The handwritten prescription order must contain the name of the prescribing physician assistant, the name and strength of the drug prescribed, the quantity of the drug prescribed, handwritten in letters or in numerals, instructions for the proper use of the drug and the month and day that the prescription order was issued, recorded in letters or in numerals or a combination thereof. The prescribing physician assistant must sign the handwritten prescription order on the day it is issued, unless it is a standing order issued in a hospital, a nursing home, or an assisted-care living facility; (J) A typed or computer-generated prescription order for a drug issued by a physician assistant who is authorized by law to prescribe a drug must be legible so that it is comprehensible by the pharmacist who fills the prescription order. The typed or computer-generated prescription order must contain the name of the prescribing physician assistant, the name and strength of the drug prescribed, the quantity of the drug prescribed, recorded in letters or in numerals, instructions for the proper use of the drug, and the month and day that the typed or computer-generated prescription order was issued, recorded in letters or in numerals or a combination thereof. The prescribing physician assistant must sign the typed or computer-generated prescription order on the day it is issued, unless it is a standing order issued in a hospital, a nursing home, or an assisted-care living facility; (K) The bill does not prevent a physician assistant from issuing a verbal prescription order; (L) Handwritten, typed, or computer-generated prescription orders must be issued on either tamper-resistant prescription paper or printed utilizing a technology that results in a tamper-resistant prescription that meets the current centers for medicare and medicaid services guidance to state medicaid directors regarding § 7002(b) of the federal United States Troop Readiness, Veterans' Care, Katrina Recovery, and Iraq Accountability Appropriations Act of 2007, and meets or exceeds specific TennCare requirements for tamper-resistant prescriptions; (M) Establishes that (L) does not apply to prescriptions written for inpatients of a hospital, outpatients of a hospital where the doctor or other person authorized to write prescriptions writes the order into the hospital medical record and then the order is given directly to the hospital pharmacy and the patient never has the opportunity to handle the written order, a nursing home or an assisted-care living facility, inpatients or residents of a mental health hospital or residential facility, or individuals incarcerated in a local, state, or federal correctional facility; (N) A physician assistant authorized to prescribe drugs under the bill who provides services in a free or reduced fee clinic under the Volunteer Health Care Services Act may arrange for required personal review of the physician assistant's charts by a collaborating physician in the office or practice site of the physician or remotely via HIPAA-compliant electronic means rather than at the site of the clinic; (O) A physician assistant authorized to prescribe drugs under the bill who provides services in a community mental health center, or federally qualified health center, or solely via telehealth, may arrange for the required personal review of the physician assistant's charts by a collaborating physician, with the same authority to render prescriptive services that the physician assistant is authorized to render, in the remote office or practice site of the physician, or any required visit by a collaborating physician to any remote site, or both, via HIPAA-compliant electronic means rather than at the site of the clinic; (P) A physician assistant licensed to prescribe drugs who provides services at a remote healthcare setting may arrange for any required personal review of the physician assistant's charts by a collaborating physician either via HIPAA-compliant electronic means or in person; (Q) A physician assistant licensed to prescribe drugs may arrange for up to 10 of the required annual remote site visits by a collaborating physician by HIPAA-compliant electronic means rather than at the site of the clinic. All other of the required site visits by a collaborating physician to a remote site must take place in person at the site of the clinic. As used in this subdivision, "annual" means a rolling twelve-month period; (R) A patient receiving services from a physician assistant must be fully informed that the individual is a physician assistant and a sign must be conspicuously placed within the office indicating that certain services may be rendered by a physician assistant; (S) A physician who does not normally provide patient care must not enter into protocols with, collaborate with, or utilize the services of a physician assistant; (T) A physician assistant must only perform invasive procedures involving a portion of the spine, spinal cord, sympathetic nerves of the spine, or block of major peripheral nerves of the spine in any setting not licensed as a health facility or resource, under the direct supervision of a licensed physician licensed who is actively practicing spinal injections and has current privileges to do so at a licensed facility. The direct supervision provided by a physician in this (T) must only be offered by a physician who meets the qualifications established in state law relative to interventional pain management; (U) For purposes of subdivision (T), "direct supervision" means being physically present in the same building as the physician assistant at the time the invasive procedure is performed; and (V) This (V) does not apply to a physician assistant performing major joint injections, except sacroiliac injections, or to performing soft tissue injections or epidurals for surgical anesthesia or labor analgesia in unlicensed settings; ADVERTISING (25) Requires that the board exercise its powers under state law on the grounds of holding oneself out as board-certified in a medical specialty, or utilizing a medical specialty designation with (i) a title or title reference; (ii) an advertisement; (iii) the name of any healthcare setting that is majority-owned by physician assistants; (iv) credentialing with any licensed healthcare facility or health insurance entity; or (v) an application for healthcare liability insurance coverage; (26) Establishes that (25) is not grounds for discipline of a licensee who worked in a healthcare setting that used a medical specialty designation prior to January 1, 2024, as long as: (A) The licensee's collaborating physician (i) is board-certified or board eligible in the designated specialty; (ii) owns part of the practice that provided the services in such healthcare setting; and (iii) sees patients in such healthcare setting on a regular basis; (B) Ownership of the practice has not changed on or after January 1, 2024; (C) Prior to March 1, 2025, a licensee who practices in a healthcare setting described in (26) must submit proof satisfactory to the board that the licensee's healthcare setting meets the requirements of (26); and (D) If a licensee who, prior to March 1, 2025, meets the requirements of (26), ceases to meet such requirements on or after March 1, 2025, then the licensee must notify the board within 30 days; DEATH CERTIFICATES (27) Authorizes the funeral director who first assumes custody of a dead body, medical examiner, attending or pronouncing physician in a hospital, or physician assistant authorized by protocol or collaborative agreement to sign and file the death certificate. The funeral director, medical examiner, attending or pronouncing physician in a hospital, or physician assistant authorized by protocol or collaborative agreement must obtain the personal data from the next of kin or the best qualified person or source available, and obtain the medical certification from the person responsible for medical certification; (28) Requires medical certification to be completed, signed, and returned to the funeral director by the physician or physician assistant in charge of the patient's care for the illness or condition that resulted in death within 48 hours after death, except when inquiry is required by the county medical examiner or to obtain a veteran's medical records. In the absence of the physician or physician assistant, the certificate may be completed and signed by another physician designated by the physician, by the chief medical officer of the institution in which the death occurred, or by a physician assistant authorized by protocol or collaborative agreement. In cases of deaths that occur outside of a medical institution and are either unattended by a physician or physician assistant, or not under hospice care, the county medical examiner must investigate and certify the death certificate when one of the following conditions exists: (A) There is no physician or physician assistant who had attended the deceased during the four months preceding death, except that a physician or physician assistant authorized by protocol or collaborative agreement who had attended the patient more than four months preceding death may elect to certify the death certificate if the physician or physician assistant authorized by protocol or collaborative agreement can make a good faith determination as to cause of death and if the county medical examiner has not assumed jurisdiction; or (B) The physician who had attended the deceased during the four months preceding death or physician assistant authorized by protocol or collaborative agreement communicates, orally or in writing, to the county medical examiner that, in the physician's or physician assistant's best medical judgment, the patient's death did not result from the illness or condition for which the physician or physician assistant was attending the patient; (29) If the cause of death cannot be determined within 48 hours after death, requires that the medical certification be completed as provided by rule. The attending physician, medical examiner, or physician assistant authorized by protocol or collaborative agreement must give the funeral director notice of the reason for the delay, and final disposition of the body must not be made until authorized by the attending physician, medical examiner, or physician assistant authorized by protocol or collaborative agreement; GENETIC COUNSELORS' LICENSING ACT (30) For purposes of this heading, "referral" means a written or telecommunicated authorization for genetic counseling services from a physician licensed to practice medicine in all its branches or a physician assistant who has protocols or a collaborative agreement with a supervising physician that authorizes referrals to a genetic counselor; WITHHOLDING OF RESUSCITATIVE SERVICES (31) Authorizes a physician order for scope of treatment (POST) to be issued by a physician assistant for a patient with whom the physician assistant has a bona fide physician assistant-patient relationship only if, among other conditions, such authority to issue is contained in the physician assistant's protocols or collaborative agreement; (32) Authorizes a POST to be issued by a physician assistant for a patient with whom the physician assistant has a bona fide physician assistant-patient relationship only if, among other conditions, the patient is a minor or is otherwise incapable of making an informed decision regarding consent for such an order and the agent, surrogate, or other person authorized to consent on the patient's behalf under the Tennessee Health Care Decisions Act is not reasonably available and such authority to issue is contained in the physician assistant's protocols or collaborative agreement, and the physician assistant determines that the provision of cardiopulmonary resuscitation would be contrary to accepted medical standards; ISSUING CERTIFIED STATEMENTS OF DISABILITY OR DEAFNESS (33) Requires that a licensed physician assistant have the same authority that a physician has under this heading to issue certified statements of disability or deafness to accompany the application of disabled or deaf persons to obtain the appropriate registration, license plates, placards and decals from the department, only if the authority is expressly included in the written protocol or collaborative agreement developed jointly by the supervising physician and the physician assistant, setting forth the range of services that may be performed by the physician assistant; ONLINE REGISTRY OF PHYSICIANS (34) Requires the board of medical examiners to establish and maintain an online registry of licensed physicians who are willing to enter into a collaborative agreement with a physician assistant; (35) Requires the online registry to include, at a minimum (i) the physician's name and physical practice address; (ii) designation as a medical doctor or doctor of osteopathy; (iii) the physician's medical specialty and board certifications, if any; (iv) the region or regions of the state in which the physician is willing to enter into a collaborative agreement with a physician assistant; and (v) an address, telephone number, or email address at which the physician can be contacted by a physician assistant who may desire to enter into a collaborative relationship with the physician; (36) Requires a physician included on the registry to update the physician's information described in (35); (37) Establishes that inclusion by a physician on the registry does not obligate a physician to enter into a collaborative agreement with a physician assistant; PRACTICE OF MEDICINE DEFINED (38) Prohibits the bill from being construed to prohibit service rendered by a registered nurse, a licensed practical nurse, or a pharmacist pursuant to a collaborative pharmacy practice agreement, if such service is rendered under the supervision, control and responsibility of a licensed physician or to prohibit the provision of anesthesiology services in licensed health care facilities by a dentist licensed in this state who completed a residency program in anesthesiology at an accredited medical school in years 1963 through 1977; and (39) Prohibits the bill from being construed to prohibit service rendered by a physician assistant practicing in collaboration with a physician, osteopathic physician, or podiatrist, whether through protocols or a collaborative agreement. ON APRIL 22, 2024, THE HOUSE SUBSTITUTED SENATE BILL 2136 FOR HOUSE BILL 2318, ADOPTED AMENDMENT #2, AND PASSED SENATE BILL 2136, AS AMENDED. AMENDMENT #2 rewrites the bill as follows: PERMISSIBLE PHYSICIAN ASSISTANT ACTIVITIES (1) Authorizes a physician assistant to do the following: (A) Perform medical diagnosis and treatment as a physician assistant pursuant either to a protocol or collaborative agreement, as applicable, for which the physician assistant has been prepared by education, training, and experience, and that the physician assistant is competent to perform only if licensed by the board of physician assistants ('board") and only within the usual scope of practice of the collaborating physician; (B) Perform minor surgical procedures, including (i) simple laceration or surgery repair; (ii) excision of skin lesions, moles, warts, cysts, or lipomas; (iii) incision and draining of superficial abscesses; (iv) skin biopsies; (v) arthrocentesis; (vi) thoracentesis; (vii) paracentesis; (viii) endometrial biopsies; (ix) IUD insertion; and (x) colposcopy; (C) Assist a physician who performs procedures considered Level II office-based surgery or Level III office-based surgery, as those are defined in state law, or a more complex procedure, if (i) the physician assistant is credentialed or receives privileges from the medical staff of the facility to assist a physician with enumerated procedures; (ii) the physician performing the procedure is credentialed or privileged to perform the procedure by the medical staff of the facility; and (iii) the physician is present or immediately available for consultation with the physician assistant during and after the procedure; (D) Issue drugs authorized by law pursuant to protocols or collaborative agreement, and as applicable, (i) prescribe, dispense, order, administer, and procure appropriate medical devices, legend drugs, and controlled substances that are within the physician assistant's scope of practice if the physician assistant has registered and complied with all applicable requirements of state law and rule and the federal drug enforcement administration; and (ii) only prescribe or issue a Schedule II or Schedule III opioid for a maximum of a nonrefillable, thirty-day course of treatment. This (1)(D) does not apply to a prescription issued in a hospital, a licensed nursing home, or a licensed inpatient facility; (E) Unless a physician assistant's protocols or collaborative agreement indicate otherwise, plan and initiate a therapeutic regimen that includes ordering and prescribing non-pharmacological interventions, including (i) durable medical equipment; (ii) nutrition; (iii) blood and blood products; and (iv) diagnostic support services that include, but are not limited to, home health care, hospice, and physical and occupational therapy; and (F) Complete, sign, and file medical certifications of death, if authorized to do so in the physician assistant's protocol or collaborative agreement; PHYSICIAN ASSISTANTS WHO HAVE NOT BEEN ENDORSED BY THE BOARD (2) Requires a physician assistant who has not received endorsement from the board to practice under protocols jointly developed by the collaborating physician and the physician assistant; (3) Requires the physician assistant to maintain a copy of the protocols either on paper or electronically at each of the physician assistant's practice locations and make the protocols available upon request by the board, the licensing board of the collaborating physician, or an authorized agent thereof; (4) Requires the protocols to set forth the range of services that may be provided by the physician assistant and must also contain a discussion of the problems and conditions likely to be encountered by the physician assistant and the appropriate treatment for such problems and conditions; (5) Establishes that physician assistant practice under protocols requires active and continuous overview of the physician assistant's activities to ensure that the physician's directions and advice are implemented, but does not require the continuous and constant physical presence of the collaborating physician; (6) Authorizes a physician assistant to perform only those tasks that are within the physician assistant's range of skills and competence, that are within the usual scope of practice of the collaborating physician, and that are consistent with the protection of the health and well-being of the patients; (7) Requires protocols to also include, at a minimum, the following: (A) The physician assistant's name, license number, and primary practice location; (B) The collaborating physician's name, license number, medical specialty, and primary practice location; (C) A general description of the oversight of the physician assistant by the collaborating physician; (D) A general description of the physician assistant's process for collaboration with physicians and other members of the healthcare team; (E) A process by which 100 percent of patient charts are reviewed by the collaborating physician within 10 days when a prescription for a controlled drug is issued by the physician assistant; (F) A process by which at least 20 percent of the physician assistant's patient charts are reviewed by the collaborating physician every 30 days; (G) If the physician assistant changes practice settings to practice in a new medical specialty, a description of a process by which the patient medical charts prepared by the physician assistant are reviewed by the collaborating physician for a minimum of six months or until the physician assistant becomes eligible for endorsement, whichever period is longer; (H) If the physician assistant practices in a remote location site from the collaborating physician's practice site, that the collaborating physician conduct a remote site visit at least every 30 days; (I) That the physician assistant collaborates with, consults with, or refers to, the collaborating physician or appropriate healthcare professional as indicated by the patient's condition and the applicable standard of care when a patient presents with a condition that is outside of the competence, scope of practice, or experience of the physician assistant or collaborating physician; and (J) Designation of one or more alternative physicians for consultation in situations in which the collaborating physician is not available for consultation; COLLABORATIVE AGREEMENTS FOR BOARD-ENDORSED PHYSICIAN ASSISTANTS (8) Requires a physician assistant who has received an endorsement from the board to have a collaborative agreement with a physician; (9) Requires the physician assistant to maintain a copy of the collaborative agreement either on paper or electronically at each of the physician assistant's practice locations and make the collaborative agreement available upon request by the board of physician assistants, the licensing board of the collaborating physician, or an authorized agent of such boards; (10) To be eligible to receive endorsement from the board, requires a physician assistant to, at a minimum, have 6,000 hours of documented postgraduate clinical experience, have a physician willing to enter into a collaborative agreement with the physician assistant, and meet such other requirements as set forth in rules promulgated by the board. A physician assistant with 6,000 hours or more of documented postgraduate clinical experience must not practice pursuant to the requirements in state physician assistant law or rules promulgated thereto for endorsed physician assistants without first receiving endorsement by the board. State physician assistant law does not require a physician assistant to become endorsed by the board. Unless a physician assistant has received an endorsement from the board, the requirements under this heading apply; (11) Requires collaborative agreements governing physician assistants who have 6,000 or more hours of documented postgraduate clinical experience and are endorsed by the board to include, at a minimum, the following: (i) the physician assistant's name, license number, and primary practice location; (ii) the collaborating physician's name, license number, medical specialty, and primary practice location; (iii) that the physician assistant performs only those services that are within the physician assistant's competence, knowledge, and skills that are within the usual scope of practice of the collaborating physician, and that are consistent with the protection of the health and well-being of patients; (iv) a process by which 100 percent of patient charts are reviewed by the collaborating physician within 30 days when a prescription for any drug containing buprenorphine for use in recovery or medication treatment or a Schedule II controlled drug is issued by the physician assistant; (v) that if the physician assistant changes practice settings to practice in a new medical specialty, a description of a process by which a sample of patient medical charts prepared by the physician assistant are reviewed by the collaborating physician, or a physician designated by the collaborating physician, for a minimum of six months; (vi) that the physician assistant collaborates with, consults with, or refers to the collaborating physician or appropriate healthcare professional as indicated by the patient's condition and the applicable standard of care; (vii) methods of communication between the physician assistant and collaborating physician; and (viii) requirements of patient chart review and remote site visits, if any, established at the practice level and commensurate with the level of training, experience, and competence of the physician assistant within the expected scope of practice of the physician assistant; PHYSICIAN ASSISTANTS PRACTICING WITH PODIATRISTS (12) Establishes that, regarding a physician assistant practicing in collaboration with a licensed podiatrist, in addition to meeting the requirements of other relevant state law, the following apply: (i) prohibits providing services that are outside the scope of practice of a podiatrist; (ii) requires complying with the requirements of, and rules adopted pursuant to, the bill and other relevant state law governing the collaboration with a physician assistant; and (iii) authorizes only prescribing drugs that are rational to the practice of podiatry; (13) Authorizes a physician assistant to render emergency medical services in cases where immediate diagnosis and treatment are necessary to avoid patient death or disability; (14) Establishes that the standard of care for a physician assistant is the same standard of care as applicable to a physician who performs the same service; (15) Requires that the initial rules governing the collaborative agreements of physician assistants with licensed physicians be established and promulgated in accordance with the Uniform Administrative Procedures Act, by a task force composed of (i) one member from the board of medical examiners; (ii) one member from the board of osteopathic examination; (iii) one member from the board of podiatric medical examiners; and (iv) three members from the board of physician assistants; (16) Requires the task force to create uniform rules governing the collaboration of physician assistants with licensed physicians, which are binding on each board listed in (15); (17) Requires the rules created by the taskforce to create standard procedures to determine the responsibility for the review of patient medical charts; (18) Requires each board listed in (15) to select and appoint by a majority vote of its members a board member to serve on the task force before September 1, 2024; (19) Requires the task force to select and appoint a member to serve as chair of the task force; (20) Establishes that a majority of the task force constitutes a quorum, and a majority vote of the task force members present is required for any action; (21) Requires the task force to hear public comment at any required hearing on behalf of all boards listed in (15) when a hearing is required. The task force is authorized to vote to promulgate the rules governing the collaboration of physician assistants with licensed physicians for each board listed in (15); (22) Requires the task force to terminate upon the effective date of a permanent rule establishing collaboration pursuant to the bill. All future rules regarding collaboration pursuant to the bill after the termination of the task force must be adopted jointly by each relevant board in (15); (23) Establishes that the bill does not prohibit the licensing boards listed in (15) from promulgating additional rules regarding the licensees of such boards; REQUIRED PRACTICES FOR PHYSICIANS COLLABORATING WITH PHYSICIAN ASSISTANTS (24) Requires a licensed physician collaborating with a physician assistant to comply with the following practices: (A) Ensure that protocols or a collaborative agreement, as applicable, is in place for each physician assistant with whom the physician collaborates and that such protocols or collaborative agreement meets the requirements of the bill and the duly promulgated rules. More than one physician may collaborate with the same physician assistant if alternative collaborating physicians are available to collaborate with the physician assistant in the absence or unavailability of the primary collaborating physician. Each physician assistant must notify the board of physician assistants of the name, address, and license number of the physician assistant's primary collaborating physician and notify the board of physician assistants of a change in the primary collaborating physician within 15 days of the change. The number of physician assistants for whom a physician may serve as the collaborating physician must be determined by the physician at the practice level, consistent with good medical practice. The collaborating physician must designate one or more alternate physicians who have agreed to accept the responsibility of collaborating with the physician assistant on a prearranged basis in the collaborating physician's absence; (B) Complete the patient chart reviews of each physician assistant with whom the collaborating physician collaborates as set forth in the bill, in rules promulgated pursuant to the bill, and in protocols or a collaborative agreement, as applicable; (C) Conduct reviews of charts submitted to the collaborating physician by the physician assistant deemed by the physician assistant medically indicated for consultation. The collaborating physician is responsible for reviewing 100 percent of patient charts within 30 days when the physician assistant issues a prescription for a controlled drug pursuant to protocols. The collaborating physician is responsible for reviewing 100 percent of patient charts within 30 days when the physician assistant issues a prescription for any drug containing buprenorphine for use in recovery or medication-assisted treatment or a Schedule II controlled drug pursuant to a collaborative agreement; (D) Conduct the requisite remote site visits with each physician assistant with whom the physician collaborates, as set forth in the bill or by rule, and in protocols or a collaborative agreement, as applicable; (E) Each physician assistant must notify the board of the name and address of the physician assistant's primary practice location and notify the board within 15 days of a practice location change; (F) The board of physician assistants is authorized to monitor the prescriptive practices of the physician assistant through site visits by members of the board or their authorized agents; (G) Complaints against physician assistants must be reported to the office of investigations of the division of health related boards; (H) Every prescription order issued by a physician assistant pursuant to the bill must be entered in the medical records of the patient, and every handwritten prescription must be written on a preprinted prescription pad bearing the name, address, and telephone number of the physician assistant, and the physician assistant must sign each prescription order so written; (I) A handwritten prescription order for a drug prepared by a physician assistant who is authorized by law to prescribe a drug must be legible so that it is comprehensible by the pharmacist who fills the prescription. The handwritten prescription order must contain the name of the prescribing physician assistant, the name and strength of the drug prescribed, the quantity of the drug prescribed, handwritten in letters or in numerals, instructions for the proper use of the drug and the month and day that the prescription order was issued, recorded in letters or in numerals or a combination thereof. The prescribing physician assistant must sign the handwritten prescription order on the day it is issued, unless it is a standing order issued in a hospital, a nursing home, or an assisted-care living facility; (J) A typed or computer-generated prescription order for a drug issued by a physician assistant who is authorized by law to prescribe a drug must be legible so that it is comprehensible by the pharmacist who fills the prescription order. The typed or computer-generated prescription order must contain the name of the prescribing physician assistant, the name and strength of the drug prescribed, the quantity of the drug prescribed, recorded in letters or in numerals, instructions for the proper use of the drug, and the month and day that the typed or computer-generated prescription order was issued, recorded in letters or in numerals or a combination thereof. The prescribing physician assistant must sign the typed or computer-generated prescription order on the day it is issued, unless it is a standing order issued in a hospital, a nursing home, or an assisted-care living facility; (K) The bill does not prevent a physician assistant from issuing a verbal prescription order; (L) Handwritten, typed, or computer-generated prescription orders must be issued on either tamper-resistant prescription paper or printed utilizing a technology that results in a tamper-resistant prescription that meets the current centers for medicare and medicaid services guidance to state medicaid directors regarding § 7002(b) of the federal United States Troop Readiness, Veterans' Care, Katrina Recovery, and Iraq Accountability Appropriations Act of 2007, and meets or exceeds specific TennCare requirements for tamper-resistant prescriptions; (M) Establishes that (L) does not apply to prescriptions written for inpatients of a hospital, outpatients of a hospital where the doctor or other person authorized to write prescriptions writes the order into the hospital medical record and then the order is given directly to the hospital pharmacy and the patient never has the opportunity to handle the written order, a nursing home or an assisted-care living facility, inpatients or residents of a mental health hospital or residential facility, or individuals incarcerated in a local, state, or federal correctional facility; (N) A physician assistant authorized to prescribe drugs under the bill who provides services in a free or reduced fee clinic under the Volunteer Health Care Services Act may arrange for required personal review of the physician assistant's charts by a collaborating physician in the office or practice site of the physician or remotely via HIPAA-compliant electronic means rather than at the site of the clinic; (O) A physician assistant authorized to prescribe drugs under the bill who provides services in a community mental health center, or federally qualified health center, or solely via telehealth, may arrange for the required personal review of the physician assistant's charts by a collaborating physician, with the same authority to render prescriptive services that the physician assistant is authorized to render, in the remote office or practice site of the physician, or any required visit by a collaborating physician to any remote site, or both, via HIPAA-compliant electronic means rather than at the site of the clinic; (P) A physician assistant licensed to prescribe drugs who provides services at a remote healthcare setting may arrange for any required personal review of the physician assistant's charts by a collaborating physician either via HIPAA-compliant electronic means or in person; (Q) A physician assistant licensed to prescribe drugs may arrange for up to 10 of the required annual remote site visits by a collaborating physician by HIPAA-compliant electronic means rather than at the site of the clinic. All other of the required site visits by a collaborating physician to a remote site must take place in person at the site of the clinic. As used in this subdivision, "annual" means a rolling twelve-month period; (R) A patient receiving services from a physician assistant must be fully informed that the individual is a physician assistant and a sign must be conspicuously placed within the office indicating that certain services may be rendered by a physician assistant; (S) A physician who does not normally provide patient care must not enter into protocols with, collaborate with, or utilize the services of a physician assistant; (T) A physician assistant must only perform invasive procedures involving a portion of the spine, spinal cord, sympathetic nerves of the spine, or block of major peripheral nerves of the spine in any setting not licensed as a health facility or resource, under the direct supervision of a licensed physician licensed who is actively practicing spinal injections and has current privileges to do so at a licensed facility. The direct supervision provided by a physician in this (T) must only be offered by a physician who meets the qualifications established in state law relative to interventional pain management; (U) For purposes of subdivision (T), "direct supervision" means being physically present in the same building as the physician assistant at the time the invasive procedure is performed; and (V) This (V) does not apply to a physician assistant performing major joint injections, except sacroiliac injections, or to performing soft tissue injections or epidurals for surgical anesthesia or labor analgesia in unlicensed settings; ADVERTISING (25) Requires that the board exercise its powers under state law on the grounds of holding oneself out as board-certified in a medical specialty, or utilizing a medical specialty designation with (i) a title or title reference; (ii) an advertisement; (iii) the name of any healthcare setting that is majority-owned by physician assistants; (iv) credentialing with any licensed healthcare facility or health insurance entity; or (v) an application for healthcare liability insurance coverage; (26) Establishes that (25) is not grounds for discipline of a licensee who worked in a healthcare setting that used a medical specialty designation prior to January 1, 2024, as long as: (A) The licensee's collaborating physician (i) is board-certified or board eligible in the designated specialty; (ii) owns part of the practice that provided the services in such healthcare setting; and (iii) sees patients in such healthcare setting on a regular basis; (B) Ownership of the practice has not changed on or after January 1, 2024; (C) Prior to March 1, 2025, a licensee who practices in a healthcare setting described in (26) must submit proof satisfactory to the board that the licensee's healthcare setting meets the requirements of (26); and (D) If a licensee who, prior to March 1, 2025, meets the requirements of (26), ceases to meet such requirements on or after March 1, 2025, then the licensee must notify the board within 30 days; DEATH CERTIFICATES (27) Authorizes the funeral director who first assumes custody of a dead body, medical examiner, attending or pronouncing physician in a hospital, or physician assistant authorized by protocol or collaborative agreement to sign and file the death certificate. The funeral director, medical examiner, attending or pronouncing physician in a hospital, or physician assistant authorized by protocol or collaborative agreement must obtain the personal data from the next of kin or the best qualified person or source available, and obtain the medical certification from the person responsible for medical certification; (28) Requires medical certification to be completed, signed, and returned to the funeral director by the physician or physician assistant in charge of the patient's care for the illness or condition that resulted in death within 48 hours after death, except when inquiry is required by the county medical examiner or to obtain a veteran's medical records. In the absence of the physician or physician assistant, the certificate may be completed and signed by another physician designated by the physician, by the chief medical officer of the institution in which the death occurred, or by a physician assistant authorized by protocol or collaborative agreement. In cases of deaths that occur outside of a medical institution and are either unattended by a physician or physician assistant, or not under hospice care, the county medical examiner must investigate and certify the death certificate when one of the following conditions exists: (A) There is no physician or physician assistant who had attended the deceased during the four months preceding death, except that a physician or physician assistant authorized by protocol or collaborative agreement who had attended the patient more than four months preceding death may elect to certify the death certificate if the physician or physician assistant authorized by protocol or collaborative agreement can make a good faith determination as to cause of death and if the county medical examiner has not assumed jurisdiction; or (B) The physician who had attended the deceased during the four months preceding death or physician assistant authorized by protocol or collaborative agreement communicates, orally or in writing, to the county medical examiner that, in the physician's or physician assistant's best medical judgment, the patient's death did not result from the illness or condition for which the physician or physician assistant was attending the patient; (29) If the cause of death cannot be determined within 48 hours after death, requires that the medical certification be completed as provided by rule. The attending physician, medical examiner, or physician assistant authorized by protocol or collaborative agreement must give the funeral director notice of the reason for the delay, and final disposition of the body must not be made until authorized by the attending physician, medical examiner, or physician assistant authorized by protocol or collaborative agreement; GENETIC COUNSELORS' LICENSING ACT (30) For purposes of this heading, "referral" means a written or telecommunicated authorization for genetic counseling services from a physician licensed to practice medicine in all its branches or a physician assistant who has protocols or a collaborative agreement with a supervising physician that authorizes referrals to a genetic counselor; WITHHOLDING OF RESUSCITATIVE SERVICES (31) Authorizes a physician order for scope of treatment (POST) to be issued by a physician assistant for a patient with whom the physician assistant has a bona fide physician assistant-patient relationship only if, among other conditions, such authority to issue is contained in the physician assistant's protocols or collaborative agreement; (32) Authorizes a POST to be issued by a physician assistant for a patient with whom the physician assistant has a bona fide physician assistant-patient relationship only if, among other conditions, the patient is a minor or is otherwise incapable of making an informed decision regarding consent for such an order and the agent, surrogate, or other person authorized to consent on the patient's behalf under the Tennessee Health Care Decisions Act is not reasonably available and such authority to issue is contained in the physician assistant's protocols or collaborative agreement, and the physician assistant determines that the provision of cardiopulmonary resuscitation would be contrary to accepted medical standards; ISSUING CERTIFIED STATEMENTS OF DISABILITY OR DEAFNESS (33) Requires that a licensed physician assistant have the same authority that a physician has under this heading to issue certified statements of disability or deafness to accompany the application of disabled or deaf persons to obtain the appropriate registration, license plates, placards and decals from the department, only if the authority is expressly included in the written protocol or collaborative agreement developed jointly by the supervising physician and the physician assistant, setting forth the range of services that may be performed by the physician assistant; ONLINE REGISTRY OF PHYSICIANS (34) Requires the board of medical examiners to establish and maintain an online registry of licensed physicians who are willing to enter into a collaborative agreement with a physician assistant; (35) Requires the online registry to include, at a minimum (i) the physician's name and physical practice address; (ii) designation as a medical doctor or doctor of osteopathy; (iii) the physician's medical specialty and board certifications, if any; (iv) the region or regions of the state in which the physician is willing to enter into a collaborative agreement with a physician assistant; and (v) an address, telephone number, or email address at which the physician can be contacted by a physician assistant who may desire to enter into a collaborative relationship with the physician; (36) Requires a physician included on the registry to update the physician's information described in (35); (37) Establishes that inclusion by a physician on the registry does not obligate a physician to enter into a collaborative agreement with a physician assistant; PRACTICE OF MEDICINE DEFINED (38) Prohibits the bill from being construed to prohibit service rendered by a registered nurse, a licensed practical nurse, or a pharmacist pursuant to a collaborative pharmacy practice agreement, if such service is rendered under the supervision, control and responsibility of a licensed physician or to prohibit the provision of anesthesiology services in licensed health care facilities by a dentist licensed in this state who completed a residency program in anesthesiology at an accredited medical school in years 1963 through 1977; and (39) Prohibits the bill from being construed to prohibit service rendered by a physician assistant practicing in collaboration with a physician, osteopathic physician, or podiatrist, whether through protocols or a collaborative agreement.

Track This Bill

Overview

Track Tennessee Legislation Like a Pro

Join hundreds of professionals using LegisGo to stay ahead of legislative changes.

Instant Alerts

Get notified when bills you track move through the legislature

AI Summaries

Understand complex legislation in seconds with AI-powered analysis

Full Access

All 132 legislators, committee schedules, and voting records

Sponsor

Williams, Ryan

Details

Session

113th General Assembly

Introduced

January 29, 2024

Last Action

May 31, 2024

Comp. became Pub. Ch. 1042

Subjects

Medical OccupationsPhysicians and SurgeonsNurses, NursingHealth Care

Want to track this bill? Get instant alerts and AI-powered insights.