Weekly Legislative Update

The 109th General Assembly are completing their session this week. There are bills, on the calendar, which may affect nurse practitioners working for or owning pain management facilities. Monday, April 20, 2015 3:00pm - House Chamber - House Floor Regular Calendar HB440 B. Terry -- Health Care: Reimbursing physicians - pending a credentialing application. Establishes process for reimbursing physicians for services rendered during the pendency of a credentialing application before a health insurance entity. *SB284 - R. Briggs - 04/16/2015 - Senate passed with amendment 1, which rewrites the bill. Requires insurers who have an existing contract with a medical group practice to provide a list of all the documentation required for credentialing of a new provider. Requires insurer to provide certain notice to an applicant within 5 days. An insurer must notify the applicant of the results within 90 days. Requires insurer to pay claims at the in-networks rate during the period between when the application is complete and when the provider is approved. Excludes TennCare, CoverKids, AccessTN, and other F & A healthcare programs from the provisions of the bill. Position: Watch HB1036 R. Haynes -- Health Care: Addiction Treatment Act of 2015. Enacts the "Addiction Treatment Act of 2015." Prohibits arresting, charging, or prosecuting any individual who, in good faith, seeks medical assistance for a drug overdose themselves, or seeks medical assistance for another person experiencing or believed to be experiencing a drug overdose. Prohibits (1) penalties for a violation of a protective or restraining order, and (2) sanctions for a violation of a condition of pretrial release, probation, parole. Specifies various limitations of the law. Allows certain products containing buprenorphine to be prescribed under various situations and sets limitations for the drug. *SB871 - S. Dickerson - 03/09/2015 - Senate passed. Amendment: House Health Committee amendment 1 provides that the immunity from being arrested, charged or prosecuted applies to the person experiencing a drug overdose only on the person's first such drug overdose. Position: Support HB103 G. McCormick -- Tenncare: Extends CoverKids Act. Extends the CoverKids Act of 2006 from June 30, 2015, to June 30, 2020. Part of Administration Package. *SB114 - M. Norris - 03/05/2015 - Senate passed. Position: Support HB94 G. McCormick -- Workers Compensation: Revisions to the Workers' Compensation Law. Makes various revisions to the Workers Compensation Law. Requires the administrator of the division of worker's compensation to create utilization review system to select outpatient and inpatient healthcare providers for employees claiming benefits under the chapter. Requires all providers to be accredited by specified utilization review organizations. Extends the statute of limitations for claims based on permanent partial disability to two years from the date of last payment of disability benefits where permanent partial disability benefits were paid, but the employer and employee had not entered into a settlement agreement approved by a worker's compensation judge. Redefines "qualified physician" for the purpose of the panel of physicians an employee is entitled to for pain management. Specifies procedures for filing an interlocutory appeal. Revises deadlines for filing certain papers when appealing a compensation order. Allows appeals board to modify or reverse a decision by the worker's compensation judge under certain conditions. Allows the appeals board in exceptional circumstances to extend a deadline to perform an act, excluding the filing of a notice of appeal, by five business days for interlocutory appeals, and 21 calendar days for compensation orders. Authorizes administrator to assess filing fees to fund the administration of the division. Adds swearing in witnesses at hearings and other court of worker's compensation claims functions to the list of actions worker's compensation judges have the authority to perform. Allows judge to appoint a guardian ad litem for a claim of death benefits. Grants judges of workers' compensation claims certain execution authority. Requires approval from a worker's compensation judge to settle a claim for permanent disability benefits and specifies that agreements without the requisite approval are void. Makes other technical modifications. Part of Administration Package. *SB105 - M. Norris - 04/02/2015 - Senate passed with amendment 1, which replaces the word "provider" with "utilization review organization." Position: Watch HB1368 S. Lynn -- Health Care: Requires certain abortion clinics to register as ambulatory centers. Removes dentist office from the list of offices' that are excluded from the definition of ambulatory surgical treatment center. *SB1280 - J. Hensley - 04/15/2015 - Senate passed. Position: Watch HB977 M. Hill -- Health Care: Records physicians who perform abortions are required to keep. Requires a physician who performs an abortion to maintain certain records for five years. Specifies that such requirement applies to any abortion procedure and not just operations. *SB1222 - M. Beavers - 04/15/2015 - Senate passed with amendments 1 and 2. Amendment: House Health Committee Amendment 1, Senate amendment 1 rewrites the bill. Specifies that, except in a medical emergency that prevents compliance, no abortion shall be performed or induced upon a pregnant woman unless the woman has been informed orally and in person by the attending physician who is to perform the abortion, or by the referring physician, of the following facts and has a signed consent provided her informed written consent: (1) that according to the best judgment of her attending physician or referring physician she is pregnant; (2) the probable gestational age of the unborn child at the time the abortion is to be performed, based upon information provided by her as to the time of her last menstrual period or after a history, physical examination, and appropriate laboratory tests; (3) that if 24 or more weeks have elapsed from the first day of her last menstrual period or 22 or more weeks have elapsed from the time of conception, her unborn child may be viable, that is capable of sustained survival outside of the womb, with or without medical assistance, and that if a viable child is prematurely born alive in the course of an abortion, the physician performing the abortion has a legal obligation to take steps to preserve the life and health of the child; (4) that numerous public and private agencies and services are available to assist her during her pregnancy and after the birth of her child or place the child for adoption, and that her attending physician or referring physician will provide her with a list of the agencies and the services available is she so requests; (5) the normal and foreseeable medical benefits, risks, or both of undergoing an abortion or continuing the pregnancy to term; and (6) a general description of the method of abortion to be used and the medical instructions to be followed subsequent to the abortion. Specifies that the pregnant woman must provide her informed written consent, given freely and without coercion. Such consent shall be treated as confidential. Specifies that except in a medical emergency that prevents compliance, no abortion shall be performed until a waiting period of 48 hours have elapsed after the attending or referring physician has provided the aforementioned information, including the day on which the information was provided. After the 48 hours have elapsed and prior to the performance of the abortion, the patient is required to sign such consent form. If this waiting period is subsequently declared unconstitutional, the waiting period shall be 24 hours, subject to the same medical emergency exemption. If the injunction or declaration is subsequent vacated or reversed, the waiting period shall remain 48 hours. The physician attending or inducing the abortion is required provide the pregnant woman with a duplicate copy of the signed consent form. Defines a medical emergency, as applicable, as a medical condition that, on the basis of the physician's good faith medical judgment, so complicates a medical condition of a pregnant woman as to necessitate an immediate abortion of her pregnancy to avert her death or for which a delay will create serious risk of substantial and irreversible impairment of major bodily function. When a medical condition compels the performance of an abortion, the physician is required to inform the woman of the medical reasons supporting the physician's judgment to perform the abortion. The physician is required to state in the pregnant women's medical reasons the basis for such determination. Establishes a new Class E felony offense for a physician who performs an abortion that has failed to provide the information required of this legislation, wait the required 48 hours before performing the abortion, or failing to receive written informed consent from the woman. Crease a new Class E misdemeanor offense for a physician which fails to provide the woman with a copy of the signed consent form. Specifies that any physician who intentionally, knowingly, or recklessly violates any requirements of this legislation is guilty of unprofessional conduct and such physician's license for the practice of medicine and surgery or osteopathy shall be suspect to suspension or revocation. Requires the Attorney General and Report to notify the Secretary of State and the executive secretary of the Tennessee Code Commission upon the occurrence of any court rendering these provisions unconstitutional. SENATE AMENDMENT 2 adds language identical to current state law. Position: Watch HB693 R. Akbari -- Health Care: Certain state agencies to collaborate on diabetes plans and reports. Requires the bureau of TennCare, the department of health, the department of human resources, and the department of finance and administration to jointly develop certain plans and reports concerning diabetes to be made to the health and welfare committee of the senate and the health committee of the house every two years. *SB988 - M. Norris - 03/30/2015 - Senate passed with amendment 1. Amendment: Senate amendment 1, House Health Committee amendment 1 removes the department of human resources and: (1) Changes the date of the annual joint report from January 10 to February 1; (2) Removes the requirement that the report include the development of a detailed budget blueprint identifying needs, costs, and resources required to implement the plan identified in (4) above in the bill; and (3) Specifies that the role of the department of health in developing the plans will be limited to primary prevention. Position: Watch HB1163 J. Turner -- Health Care: Alzheimer's-related dementia in disclosure of specialized care. Clarifies that Alzheimer's-related dementia, includes, but is not limited to, dementia with Lewy bodies for purposes of the required disclosure of specialized care at certain treatment facilities. *SB1142 - R. Tate - 04/15/2015 - Senate passed with amendment 1. Amendment: Senate amendment 1, House Health Committee amendment 1 clarifies that Alzheimer's-related dementia includes lewy bodies and frontotemporal dementia by changing the phrase "lewy bodies" to "lewy bodies and frontotemporal dementia." Position: Watch HB629 M. Littleton -- Health Care: Certified registered nurse anesthetist - prescribing of drugs. Revises the definition of "prescription order" and "professional nursing" to reflect the ability of certified registered nurse anesthetists (CRNA) are not required to order to select, order, and administer the appropriate drugs and related services during the perioperative period or to provide services in collaboration with a physician within the scope of the practice of CRNAs. Clarifies that orders for drugs and related services by a CRNA can only be administered where the anesthesia services are being provided. Defines "perioperative period" as it relates to CRNAs. *SB1014 - S. Dickerson - 04/17/2015 - Set for Senate Floor Regular Calendar 04/21/15. Amendment: House Health Committee amendment 1, Senate Health & Welfare Committee amendment 1 deletes all language after the enacting clause. Expands the definition of professional nursing to include administration of medications selected, ordered, or administered by an advanced practice nurse specializing as a certified registered nurse anesthetist (CRNA) during services ordered by a physician, dentist, or podiatrist and provided by a CRNA in collaboration with the ordering physician, dentist, or podiatrist that are within the scope of practice of the CRNA and authorized by clinical privileges granted by the medical staff of the facility. Adds to the current definition of "prescription order" in statute, effectively authorizing any CRNA to order, select, or administer appropriate drugs, without a certificate of fitness, during the provision of services ordered by a physician, dentist, or podiatrist that are within the scope of practice of the CRNA and authorized by the clinical privileges granted by the medical staff of the respective facility. An order by a CRNA for drug is only valid for dispensing at the facility where the anesthesia services are being provided. Position: Support HB1157 B. Ramsey -- Health Care: Pain management clinic requirements for medical directors and others. Defines the terms certificate holder, medical director, and pain management specialist as they relate to pain management clinics. Revises qualifications for medical directors of pain management clinics and increases the time medical directors have to spend on site. Requires pain management clinics to obtain a certificate to operate which are only granted to an owner of a clinic who is also a certificate holder. Broadly captioned. *SB1266 - K. Yager - 04/06/2015 - Senate passed with amendment 1 & 2. Amendment 1 rewrites the bill. Provides that anyone with an ownership interest in a pain management clinic shall be eligible to be the certificate holder. Redefines "medical director" to include an individual who is a pain management specialist on or after July 1, 2016. Redefines "pain management specialist" to provide further qualifications to be eligible. Establishes that all advanced practice nurses and physician assistants who practice in a certified pain clinic shall be supervised by a pain medicine specialist. Requires the commissioner of health, by January 1, 2016, to develop recommended treatment guidelines for prescribing opioids that can be used by prescribers as a guide for caring for patients, and to develop, by January 1, 2017, recommended pain clinic standards for the operation of a pain management clinic. Provides that the guidelines shall be submitted to the appropriate prescribing boards and the board of pharmacy, and each board shall notify its licensees of the existence of the standards. Amendment 2 removes language concerning pain management specialists of who qualifies to take the ABPM exam. Position: Watch HB403 B. Ramsey -- Health Care: Reduces time period for TennCare applicants to mail changes. Reduces from 30 days to 15 days the period of time for an applicant for TennCare to mail documentation of a material change affecting the application. Broadly Captioned. *SB570 - S. Dickerson - 03/30/2015 - Senate passed with amendment 1 and amendment 2 (005359). Amendment: Senate amendment 1, House Health Committee Amendment 1 rewrites the bill to enact the "Opioid Abuse Reduction Act." This amendment requires the commissioner of mental health and substance abuse services to convene a working group to examine the problem of opioid abuse in this state, with a primary focus on persons enrolled in TennCare, and the potential impact of the use of FDA-approved abuse-deterrent opioids. The working group must include representatives of TennCare, the Tennessee department of safety, the Tennessee department of health, the healthcare insurance industry, manufacturers of abuse-deterrent opioids, law enforcement, the Tennessee medical association, and other persons whom the commissioner may deem appropriate. The full text of this amendment lists subjects that the working group will examine. Any costs associated with participation in the working group will be borne by the individual participants or their respective associations or companies and not by the state of Tennessee, except for those who are employed by this state. No later than January 1, 2016, the working group must submit a report regarding its findings and recommendations to the governor, the insurance and banking committee of the house of representatives, and the commerce and labor committee of the senate, at which time the working group will cease to exist. SENATE AMENDMENT 2 adds the health committee of the house of representatives and the health and welfare committee of the senate to whom the working group will have to submit its report. Position: Watch Tuesday, April 21, 2015 10:00am - LP 12 - Senate Finance, Ways & Means Committee Final Meeting -- Please note: The calendar is divided up into two parts. Items #1 and #2 are the Bills Before the Budget and items #3-#30 are the Bills Behind the Budget. MEMBERS: Chair Sen. R. McNally (R), Vice Chair Sen. B. Watson (R), 2nd Vice Chair Sen. D. Overbey (R), Sen. S. Dickerson (R), Sen. F. Haile (R), Sen. T. Harper (D), Sen. J. Hensley (R), Sen. B. Ketron (R), Sen. M. Norris (R), Sen. J. Stevens (R), Sen. R. Tate (D) SB469 M. Bell -- Transportation Vehicles: Helmet exemption for motorcycle riders in funeral procession. Exempts drivers and passengers who are 18 or older from wearing a helmet while riding a motorcycle in a funeral procession, memorial ride, or body escort detail. *HB395 - T. Goins - 04/01/2015 - House Finance Subcommittee placed behind the budget. Amendment: HOUSE TRANSPORTATION AMENDMENT 1 rewrites the bill. Permits passengers in a parade ride not exceeding 30 miles per hour, and both passengers and drivers in a funeral procession, memorial ride under a police escort, and in a body detail not exceeding 60 miles per hour, to not use a helmet. SENATE TRANSPORTATION & SAFETY COMMITTEE AMENDMENT 1 which places speed requirements in all scenarios where a helmet is not lawfully required when operating or riding on a motorcycle at 30 miles per hour or under. Position: Oppose 11:30am - Senate Chamber - Senate Floor Regular Calendar SB44 B. Massey -- Health Care: Testing for lysosomal disorders in newborns. Adds lysosomal disorders, including Krabbe, Fabry, Gaucher, Pompe, Hurler Syndrome and Niemann-Pick, to the list of disorders that must be tested for newborns. *HB33 - B. Dunn - 04/14/2015 - House Government Operations Committee recommended. Sent to House Finance. Amendment: Senate Health & Welfare Committee Amendment 1, House Insurance & Banking Committee amendment 1 (004045) names the act the "Mabry Kate Webb Act." Position: Watch SB1287 J. Hensley -- Health Care: Explanations justifying amount of drugs prescribed. Extends the time in which the top 50 prescribers of controlled substances must provide an explanation to the department of health justifying the amount of controlled substances they prescribed from 15 business days to 30 business days. *HB1216 - B. Doss - 04/15/2015 - House Health Committee recommended with amendment 1. Sent to House Finance. Amendment: House Criminal Justice Committee amendment 1 deletes the language the top 50 prescribers of controlled substances and instead substitutes the top prescribers of controlled substances in the state and the top ten prescribers of controlled substances in all of the counties combined having a population of less than sixty five thousand. SENATE HEALTH & WELFARE COMMITTEE AMENDMENT 1 requires the top ten prescribers of controlled substances in all of the counties combined having a population of less than 50,000 according to the 2010 federal census to submit an explanation to the Department of Health (DOH) justifying the amounts of controlled substances prescribed and demonstrate that these amounts were medically necessary for the patients treated and that the supervising physician reviewed and approved the prescribing amounts of advanced practice nurses and physician assistants. Currently this requirement is limited to the top fifty prescribers of controlled substances in the state. Position: Support SB1014 S. Dickerson -- Health Care: Certified registered nurse anesthetist - prescribing of drugs. Revises the definition of "prescription order" and "professional nursing" to reflect the ability of certified registered nurse anesthetists (CRNA) are not required to order to select, order, and administer the appropriate drugs and related services during the perioperative period or to provide services in collaboration with a physician within the scope of the practice of CRNAs. Clarifies that orders for drugs and related services by a CRNA can only be administered where the anesthesia services are being provided. Defines "perioperative period" as it relates to CRNAs. *HB629 - M. Littleton - 04/17/2015 - Set for House Floor Regular Calendar 04/20/15. Amendment: House Health Committee amendment 1, Senate Health & Welfare Committee amendment 1 (004821) deletes all language after the enacting clause. Expands the definition of professional nursing to include administration of medications selected, ordered, or administered by an advanced practice nurse specializing as a certified registered nurse anesthetist (CRNA) during services ordered by a physician, dentist, or podiatrist and provided by a CRNA in collaboration with the ordering physician, dentist, or podiatrist that are within the scope of practice of the CRNA and authorized by clinical privileges granted by the medical staff of the facility. Adds to the current definition of "prescription order" in statute, effectively authorizing any CRNA to order, select, or administer appropriate drugs, without a certificate of fitness, during the provision of services ordered by a physician, dentist, or podiatrist that are within the scope of practice of the CRNA and authorized by the clinical privileges granted by the medical staff of the respective facility. An order by a CRNA for drug is only valid for dispensing at the facility where the anesthesia services are being provided. Position: Support