Amends TCA Title 49; Title 63 and Title 68.

This bill creates a system of licensure for graduate physicians. For purposes of this bill, "graduate physician" means a medical school graduate who: (1) Is a U.S. resident and citizen or a legal resident alien in the U.S.; (2) Has successfully completed Step 1 and Step 2 of the United States Medical Licensing Examination (USMLE), or the equivalent of Step 1 and Step 2 of any other medical licensing examination that is approved by the board of medical examiners, within the two-year period immediately preceding the date of the person's application for licensure as a graduate physician, but not more than three years after graduation from a medical school or school of osteopathic medicine; (3) Has not completed an approved postgraduate residency and has successfully completed Step 2 of the USMLE, or the equivalent of Step 2 of any other medical licensing examination that is approved by the board of medical examiners, within the immediately preceding two-year period unless, two years from the date of the graduate's successful completion of Step 2, the graduate was serving as a resident physician in an accredited residency in the United States and was serving in that capacity for the 30-day period immediately preceding the date of the graduate's application for licensure as a graduate physician; and (4) Is proficient in the English language. Generally, this bill requires the board of medical examiners, in consultation with the board of osteopathic examination, to promulgate rules to create a framework within which a medical school graduate who possesses certain qualifications but is not a licensed physician may practice pediatrics, internal medicine, and family medicine (collectively referred to as "primary care services"), primarily in underserved and rural areas of the state, pursuant to a collaborative practice arrangement with a licensed physician. A licensed physician who collaborates with a graduate physician is responsible for supervising the activities of the graduate physician and must accept full responsibility for the primary care services provided by the graduate physician. Graduate physician collaborative practice arrangements must take the form of a written agreement that includes mutually agreed-upon protocols and any standing orders for the delivery of primary care services. Graduate physician collaborative practice arrangements may delegate to a graduate physician the authority to administer or dispense drugs and provide treatment, as long as the delivery of the primary care services is within the scope of the graduate physician's practice and is consistent with the graduate physician's skill, training, and competence and the skill, training, and competence of the collaborating physician. The full text of this bill specifies 10 components that must be included in a graduate physician collaborative practice arrangement. Any rules related to the dispensing or distribution of medications, controlled substances, or devices by prescription or prescription drug orders under graduate physician collaborative practice arrangements require approval of the state board of pharmacy. A graduate physician with controlled substance prescriptive authority may prescribe any controlled substance listed in Schedule III, Schedule IV, or Schedule V; provided, that prescriptions for Schedule III medications prescribed by a graduate physician with controlled substance prescriptive authority are restricted to only those medications containing hydrocodone. A collaborating physician must document the completion of at least 120 hours of practice performed by the graduate physician in a 12-month period, during which time the graduate physician practiced with the collaborating physician on-site before the graduate physician prescribed any controlled substances, including any Schedule III, Schedule IV, or Schedule V controlled substances, outside of the collaborating physician's presence. Graduate physician collaborative practice arrangements must be voluntary for both the collaborating physician and the graduate physician. A collaborating physician must document the completion of at least a six-month period of time during which the graduate physician must practice while the collaborating physician is continuously present before practicing in a setting where the collaborating physician is not continuously present.