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. ON APRIL 3, 2023, THE SENATE ADOPTED AMENDMENT #1 AND PASSED SENATE BILL 937, AS AMENDED. AMENDMENT #1 makes the following revisions to this bill: DEFINITIONS (1) Clarifies that a "qualifying graduate physician" means a medical school graduate who has also 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 or combination of examinations that is approved either by the board of medical examiners or the board of osteopathic examination, 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; (2) Removes the requirement that the graduate physician 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; (3) Removes the requirement that the graduate physician demonstrate proficiency in the English language; (4) Clarifies that "primary care services" means medical services, not outpatient services; (5) Defines a "rural health clinic" in accordance with federal law; LICENSURE (6) Removes a provision that provided that a graduate physician is considered a physician assistant for purposes of the regulations of the centers for Medicare and Medicaid services; (7) Removes provisions that provided that in order to remain licensed as a graduate physician, the graduate physician must successfully complete Step 3 of the United States Medical Licensing Exam (USMLE) no later than one year from the date that the graduate obtained a graduate physician license and if the graduate physician does not successfully complete Step 3 of the USMLE, then the graduate physician's license must be revoked; (8) Clarifies that a graduate physician’s license issued pursuant to this act and the rules promulgated by the board of medical examiners is only valid for two years from the date of issuance and is not subject to renewal; (9) Removes provisions that deal with renewals; SUPERVISING PHYSICIANS (10) Clarifies that only a licensed physician may enter into a graduate physician collaborative practice arrangement with a graduate physician; (11) Requires that the collaborating physician must complete a certification course, which may include material on the laws pertaining to the professional relationship, that must be approved by either the board of medical examiners or board of osteopathic examination; GRADUATE PHYSICIAN COLLABORATIVE PRACTICE ARRANGEMENT (12) Requires that the arrangement contain a provision specifying that a graduate physician must not prescribe controlled substances; (13) Removes the requirement that a list of all offices and locations, other than the offices and locations provided pursuant to this bill where the collaborating physician has authorized the graduate physician to prescribe be contained within the agreement, and, instead, requires that the graduate physician practice at the same location as the collaborating physician; (14) Requires the arrangement provide that a collaborating physician be on premises if the graduate physician performs services in a hospital or emergency department; (15) Removes provisions that authorized a graduate physician to prescribe certain controlled substances and any provision authorizing the graduate physician to practice without the direct supervision of the collaborating physician; and APPLICABILITY (16) Specifies that for purposes of promulgating rules, this bill takes effect upon becoming a law and, for all other purposes, this bill takes effect January 1, 2025. ON APRIL 20, 2023, THE HOUSE SUBSTITUTED SENATE BILL 937 FOR HOUSE BILL 1311, ADOPTED AMENDMENT #2 AND PASSED HOUSE BILL 1311, AS AMENDED. AMENDMENT #2 makes the following revisions to this bill: (1) Removes the requirement that the qualifying graduate physician 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 and that the graduate physician not have completed an approved postgraduate residency; (2) Adds, with regard to the board's authority to set fees under this bill, that the fees must include a requirement that the total fees collected each year must be greater than or equal to the total costs necessary to facilitate the graduate physician collaborative practice arrangement each year; and (3) Removes the requirement that rules related to the dispensing or distribution of medications or devices by prescription or prescription drug orders under this bill require approval of the state board of pharmacy.