legislative reports
TNA Comprehensive Summary
106th General Assembly, 2010 Session
By: Robert Gowan, TNA Lobbyist
Scott White, TNA Lobbyist
This year’s legislative session ended on June 10, about one month later than anticipated. As was the case last year, the State’s budget was the major factor impeding an earlier adjournment, and as last year, the budget was balanced via further cuts in state personnel and services, a few revenue measures (including a tax on hospitals that will raise in excess of $300m) and tapping into the State’s rainy day fund. Close to 4,000 bills were filed during the course of the 106th General Assembly’s two-year session; however, due to the State’s budgetary constraints most bills requiring state funding received little or no debate.
Below is a summary of the significant bills tracked and lobbied this year for the Tennessee Nurses Association. Although there were many other bills filed during the last two years that would have impacted TNA’s members if passed, we have included only those filed this year and those filed last year that were placed on a committee calendar in 2010. The report contains links to public chapters for those bills that became law.
Bills enacted as law during the 2010 legislative session
• Report on plan to reduce asthma in students-SB 0769/HB 0564 – Initially this bill clarified that the Department of Health is to report on the design of a comprehensive plan to reduce the burden of asthma on students. As amended, the bill requires the peace officers standards and training commission to report to the Select Committee on Education Oversight on current law enforcement training and procedures for responding to violent school incidents in elementary and secondary schools and in postsecondary institutions. It was enacted as Public Chapter 0910 and became effective May 26, 2010.
• Prescriptions for narcotic drugs – SB 1790/HB 0568 –This legislation has been enacted as Public Chapter 0795 and was effective for the purposes of administrative rulemaking on April 19, 2010. It is effective for all other purposes on January 1, 2011. It requires all written, printed, or computer-generated prescriptions for Schedule II controlled substances issued by podiatrists, physicians, surgeons, dentists, optometrists, osteopathic physicians, advanced practice nurses, and physician assistants to be written legibly, printed or computer generated as a separate prescription order and to contain all necessary information otherwise required by law. The prescription order must be signed on the day it is issued. The provisions of the law do not apply to prescriptions written for inpatients or outpatients of a hospital where the authorized provider writes the order into the hospital medical record and the patient or patient’s representative never has the opportunity to handle the order. Nor does the law apply to a nursing home, assisted care living facility, residents of a mental health hospital or residential facility, or individuals incarcerated in a local, state, or federal correctional facilities. The provisions of the law specifically state that it shall not be construed to limit a professional nurse’s ability to issue oral contraceptives under Tennessee Code Annotated 63-7-124. TNA successfully lobbied for the inclusion of all advanced practice nurses in this legislation.
• Elderly and Disabled Adult Protection – SB 2297/HB 2284 –This legislation was enacted as Public Chapter 1084, and becomes effective October 1, 2010. As amended, the act requires a licensed health care professional or health care facility, prior to contracting with or employing any person providing direct patient care for whom a background check has not been completed, to initiate and perform a registry check including a search with the national sex offender registry or any adult abuse registry maintained for a state in which the person has lived in the previous seven years or the Department of Health's elder abuse registry. It prohibits the health care professional or facility from employing or contracting with a person if he or she is listed in such registry. A health care professional or facility that complies with the provisions of the bill is immune from civil or criminal liability from any action brought against the professional or facility based solely upon the information collected through the registry check. It requires the Department of Health, the Board for Licensing Health Care Facilities, and any applicable health related board to post on their Web sites a link to all potential databases that the professionals and facilities are required to check. The boards are required to notify their licensees of their obligations under the statute annually through newsletters and license renewals. The provisions of the bill do not apply to veterinarians or to contracted external staff that provides cleaning, maintenance, or other services where direct patient contact is not intended. The act further requires each organization that contracts with the Division of Intellectual Disability Services for residential services, day services or supported employment services to have a criminal background check completed prior to employing any person who will be in a position that involves providing direct care to a service recipient.
• Sunset – council of certified professional midwifery – SB 2457/HB 2603 –As amended, this bill sunsets the Council of Certified Professional Midwifery on June 30, 2016, requires one member of the council to have no affiliation with the midwifery profession or industry, and sets forth requirements and restrictions related to lobbying activities by those who have or will serve on the council. It was enacted as Public Chapter 1011 and became effective June 9, 2010.
• Continuation of certain permanent rules – SB 2472/HB 2454 –This legislation is filed annually, and its purpose is to make permanent all rules filed with the Secretary of State which are otherwise scheduled for expiration on June 30 each year. The Senate version of the bill contained a provision that would specifically exclude the Board of Nursing’s license renewal fee rules that became effective in February of this year, thus causing them to expire at the end of June 2010. The House version did not contain this provision. TNA was supportive of the Board of Nursing fee increase and, therefore, opposed the bill as amended. The Senate ultimately agreed to withdraw the amendment; the bill was enacted as Public Chapter 1085, and went into effect on June 23, 2010.
• Health care reporting: person seeking controlled substances – SB 2561/HB 2581 –This legislation amends current law related to certain healthcare providers’ (including advanced practice nurses with certificates of fitness) duty to report fraudulent acts related to obtaining, manufacturing or distributing controlled substances. It requires health care providers with actual knowledge of such acts to report the information to local law enforcement or a judicial district or multi-judicial district drug task force where no local law enforcement exists. The report must be made within five days (prior law was three days) of acquiring such knowledge. It specifies that health care providers treating patients with mental illnesses are not required, but may report such activities and further specifies that such requirement does not apply in the case of TennCare recipients. It allows law enforcement limited access to information obtained by a healthcare provider from the State’s controlled substance database. Health care providers are immune from civil liability if the reporting of the information is in good faith. Sanctions against a health care provider for failure to make a report are limited to those instances where there is a pattern of willful failure. The Controlled Substance Database Advisory Committee is required to develop a form by August 1, 2010, that healthcare providers may choose to use to make the required report, and the Department of Health is required to make such form available on its website. Healthcare providers who fail to make the required report shall not be guilty of a felony. This legislation has been enacted as Public Chapter 0663 and became effective on
March 30, 2010. TNA successfully lobbied for the inclusion of all advanced practice nurses in this legislation.
• Fees for medical records – SB 2959/HB 3049 –This legislation sets a healthcare provider’s maximum charge for a medical records request at $20 for the first five pages and fifty cents for each additional page. Current law sets these charges at $20.00 for medical records 40 pages or less in length and 25 cents per page for each page copied after the first 40 pages. The law further provides that a health care provider shall not charge a fee for copying or notarizing a medical record when requested by the Department of Health pursuant to a complaint, inspection or survey. Charges to the Department of Human Services for copying and certifying medical records requests shall remain the same as existed on January 1, 2010, and any increase shall not apply to requests for medical records made by that department. A health care provider may charge up to $20.00 for a certifying affidavit. This legislation has been enacted as Public Chapter 0865 and became effective on July 1, 2010.
• Group medical health insurance – LEA support staff – SB 3125/HB 3193 –Enacted as Public Chapter 1144 and effective June 30, 2010, this legislation sets minimum health insurance contribution levels Local Education Authorities (LEAs) must make on behalf of support staff. TNA supported this bill. Beginning January 1, 2011, it should positively impact school nurses working for LEAs not currently meeting the new minimum standards.
• Use of medication aides by nurses – SB 3144/HB 3368 –Under prior law, medication aides were required to be supervised by a “licensed nurse”. The Board of Nursing interpreted this to mean a registered nurse. This legislation specifies that that a “licensed nurse” means either a registered nurse or licensed practical nurse. Although TNA expressed opposition to this bill in support of the interpretation of the Board of Nursing on this issue, the legislation was enacted as Public Chapter 0926 and became effective on May 26, 2010.
• Boards and commissions – SB 3819/HB 3465 –The original language of this bill sought to encourage any professional board, including the Board of Nursing, to adopt a method for timely notification to licensees against whom a complaint has been filed. The bill was rewritten to amend law related to the Board of Architects and Engineers and as enacted, it does not affect the nursing profession. It was enacted as Public Chapter 0945 and became effective May 26, 2010.
• Licensing revisions: medical occupations – SB 3846/HB 3805 – Part of the Governor’s legislative package, this legislation, as amended, makes various changes to the administration of the health related boards by the Department of Health. Among these changes is the removal of a current provision in law that required the Division of Health Related Boards to provide the Board of Pharmacy with the names of all nurse practitioners and physician assistants who are authorized to write and sign prescriptions and/or issue legend drugs and the names of their supervising physicians. This bill was enacted as Public Chapter 1043 and became effective June 11, 2010.
• Home care providers: license requirements – SB 3853/HB 3813 – Enacted as Public Chapter 0642 and effective on March 17, 2010, this bill was part of Governor Bredesen’s legislative package. Prior law required Level 2 adult care home providers serving residents with traumatic brain injury to have a professional license or employ a resident manager who had a professional license as a physician, nurse practitioner, registered nurse or respiratory therapist. This legislation deletes the reference to respiratory therapists and adds references to licensed rehabilitation professionals and licensed mental health professionals.
Bills filed and/or considered but not enacted as law during the 2010 legislative session
• Tennessee Colon Cancer Screening Program Act – SB 0508/HB0396–As amended, this bill required the Department of Health to develop a plan to establish a statewide colorectal cancer screening awareness, prevention, early detection, and treatment program to ensure colorectal screenings for uninsured and underinsured individuals. If enacted, it would have also required health insurance policies delivered, issued, amended, or renewed on or after January 1, 2011, to provide coverage for colorectal screening tests. The bill passed the Senate Commerce, Labor & Agriculture Committee; however, due to cost concerns from small business and the health insurance industry, the House Commerce Industrial Impact Subcommittee chose not to send the bill to the full Commerce Committee.
• Conflict of interest policies of health related boards – SB 0780/HB 0570 –This bill specified that conflict of interest policies of health related boards and committees could not be used to restrict a person from serving as an officer or in a policy-making role in a trade or professional organization. No action was taken on the bill during last year’s session. This year, it was taken off notice in the Senate General Welfare Committee. It was referred to the House Professional Occupations Subcommittee, but never debated.
• Non-Smoker Protection Act – age restricted venue definition – SB 0863/HB 0163 –This bill expanded exclusions to the Non-Smoker Protection Act by verifying that the word “person” in the definition of “age-restricted venue” does not include employees, vendors, service providers, or performers of the age-restricted venue. As a CHART member, TNA would not support additional exemptions to the Act. It was deferred many times in the House Agriculture Subcommittee where it finally failed on April 6, 2010 for lack of a motion. On the Senate side, it was referred to the Senate Commerce, Labor & Agriculture Committee in 2009 and had no further actions during the 2010 session.
• Adult establishments not allowed to employ people under 21 – SB 1346/HB 0021 –This bill prohibited adult-oriented establishments from employing any person who is not at least 21 years of age. The Senate Judiciary Committee took no action on the bill and it was taken off notice in the House Local Government Subcommittee.
• Administering medication in assisted care living facilities – SB 1991/HB 2078 –The purpose of this bill was to develop rules and regulations for a program for training, certifying and regulating certified medication technicians. These technicians would have been be regulated by the Board for Licensing Healthcare Facilities, and would have been permitted to administer medications to residents of assisted care living facilities and residential homes for the aged. This bill was referred to the House Professional Occupations Subcommittee during last year’s session where it remained throughout the 2010 session with no action being taken. On the Senate side, it was taken off notice in the Senate General Welfare Committee earlier this year.
• Requirements for home health companies – SB 2071/HB 2337 –This bill allowed unlicensed, unsupervised individuals to administer any medication prescribed by a licensed physician. The bill was fought hard by TNA members during the 2009 session and ultimately ended up in summer study last year. TNA worked with the sponsors, Senator Burks and Representative Winningham, over the summer to communicate all concerns. Although calendared in both the Senate General Welfare Committee and the House Professional Occupations Subcommittee numerous times in 2010, the bill was taken off notice in both, due in large part to TNA’s efforts.
• Infants addicted to alcohol or controlled substances – SB 2095/HB 2136 –As amended, this bill established assistance for both a mother and infant to receive treatment for their conditions related to the mother’s abuse of alcohol or controlled substances. TNA deferred on the bill as amended. It passed the House with amendment 1 on May 14, 2009. The Senate took no action on the bill this year.
• Sunset – Board of Nursing – SB 2449/HB 2600 –TNA supported this bill as it extended the existence of the board of nursing. As amended in the House, this bill would have extended the existence of the Board of Nursing for another six years. The House version also contained a provision that would have prohibited members of the Board from serving more than two consecutive four year terms. The Senate adopted the House version of the bill and added provisions that: 1) required a registered lobbyist appointed to the Board to terminate all employment and business associations as a lobbyist with any entity whose business endeavors or professional activities are regulated by the board, and 2) prohibited a member of the Board from being employed as a lobbyist by any entity regulated by the board until one year after leaving the Board. The House would not agree to the Senate amendment and the bill died, causing the Board of Nursing to go into “wind-down” mode. This is not an unusual occurrence, and at least 19 other agencies are in the same situation. A new bill will almost certainly be introduced in 2011 that will extend the Board. Though highly unlikely, if such bill did not pass, the Board of Nursing would terminate on, June 30, 2011. TNA will watch for the sunset bill to be introduced during next year’s session and will monitor its progress.
• Theft of certain controlled substances – SB 2494/HB 2560 –This bill sought to create a Class C felony for any health care provider who takes, exercises control over, denies use of, withholds or otherwise deprives a patient of a controlled substance, or any portion of the full prescribed dosage of a controlled substance, that has been prescribed for the patient. A House amendment defined “health care provider” as anyone who is licensed, certified or otherwise authorized to administer health care and includes, but is not limited to, any physician, osteopathic physician, chiropractor, nurse, hospital personnel, mental health professional, other health care professional, employee of a health care provider, or a person who impersonates a health care provider. TNA worked with sponsors of the bill to express concerns that the bill could be read so as to unintentionally criminalize aspects of the practice of nursing. The bill failed to progress beyond the finance committees due to a fiscal note of $1,065,900 for incarceration costs.
• Gross negligence in medical malpractice cases – SB 2522/HB 2543 –This bill changed the standard of liability in medical malpractice cases for certain care rendered in a hospital emergency room and would assist in alleviating the liability burden on certain health care providers. TNA monitored this bill as it would directly affect the health care industry and watched for any amendments that would change the bill to specifically include nurses. Little to no action was taken on the bill, and it never moved out of committee.
• Helmet exemption for nonresident motorcycle owners – SB 2562/HB 2648 –Under this bill, a nonresident owner of a motorcycle registered in a state with no helmet requirements who is 21 years of age or older, would not be required to wear a helmet while operating a motorcycle in Tennessee. TNA was opposed to the bill. The Senate Transportation Committee took no action on the bill and it was taken off notice in the House Transportation Public Safety Subcommittee.
• Notification of interchange option on a prescription – SB 2639/HB 2655 –As amended, this bill would have required pharmacists to notify prescribers and patients when making a medication interchange under certain circumstances. Supported by a pharmaceutical manufacturer, this bill received a great deal of debate, but ultimately stalled in the House and Senate due to its fiscal impact on TennCare.
• Nursing license revocation, suspension or denial for felony – SB 2685/HB 3547 –Likely a caption bill, TNA monitored this bill due to the fact that it would have made changes to the abilities of the Board of Nursing to deny, revoke, or suspend a nursing license. No action was taken on the bill after it was referred to the Senate General Welfare Committee and the House Professional Occupations Subcommittee.
• Pilot project established for prescription drug disposal – SB 2719/ HB 2514 –This bill created a pilot project for law enforcement officers to be able to receive certain controlled substances in order to dispose of them in a manner that is consistent with federal law. It was referred to the Senate Judiciary Committee and House Judiciary Criminal Practice Subcommittee; however, neither took action on the bill.
• Penalty for practicing medicine without a license, forgery – SB 2887/HB 2985 –This bill increased to a Class A misdemeanor, from a Class B misdemeanor, the offense of practicing medicine or surgery without a license. It would also increase to a Class D felony, from a Class E felony, the offense of filing or attempting to file as one’s own diploma or license of another or a forged affidavit of identification. Another likely caption bill, it received no action in the House or Senate.
• Scope of practice – advanced practice nurses – SB 3332/HB 3580 –This was a Tennessee Medical Association bill that required advanced practice nurses (APNs) and physician assistants (PAs) who perform certain invasive pain management techniques involving the spine to do so only under the direct supervision of certain qualified physicians. The bill defined direct supervision so as to require the physician to be physically present in the same building as the APN or PA. TNA vigorously opposed the bill as it limited the scope of practice of APNs and PAs who are fully trained to perform such procedures. The bill passed out of House
sub-committee, but was taken off notice in the Senate after much debate. This is an issue that TMA will likely bring before the legislature again next year in some form.
• Updated contact information required for nurse to renew license – SB 3364/HB 3387 –This was a TMA caption bill TNA monitored due to its potential to affect the nursing profession. It received no action this session.
• Health and sanitation rules for health care providers – SB 3418/HB 3257 –This bill required the promulgation of health and sanitation regulations for certain clinics, offices, and health care providers. It received no action this session.
• Private duty nursing services – SB 3478/HB 3719 –This bill, which had a fiscal note of over of over $23 million in increased state expenditures, required TennCare to cover private duty nursing services for certain quadriplegics on TennCare. The bill died in both finance committees due to its fiscal impact.
• Nursing staff requirements for hospice – SB 3506/HB 3686 –TNA opposed this bill as it required a nursing presence only as mandated by each patient’s care needs in certain residential hospice care. The bill stated that the available presence of a registered nurse at all times is not necessary unless specific patient care needs so require. Although the bill passed the Senate, it was never heard by the House.
• Official Tennessee Prescription Program Act – SB 3539/HB 3932 –This legislation required the Board of Pharmacy to establish and maintain a prescription program for the state that included regulations for prescription forms to protect against counterfeiting and alterations. No action was taken on the bill in either the House or Senate.
• Student loan repayment programs for certain nurses – SB 3613/HB 3623 –TNA supported this bill as it would have provided direct financial aid to nursing school graduates. It required the Tennessee Student Assistance Corporation (TSAC) to develop and administer a student loan repayment program for certain nursing school graduates. Under the bill, a portion or all of a nurse’s student loans could be repaid by the state in exchange for the performance of community service work or employment by the state that falls within the scope of the individual’s license. Due to a fiscal impact to the State in excess of $1 million, no action was taken on the bill.
• Pilot for donation, redispensing of prescription drugs – SB 3707/HB 3363 –This bill created a pilot program for redispensing prescription drugs through charitable clinics. No action was taken on the bill.
• Board of nursing: candidate nominations and meetings – SB 3849/HB 3835 –This was a Department of Health caption bill TNA monitored due to its potential to affect the nursing profession. It received no action this session.
We would like to thank all nurses, TNA members and TNA staff who participated in the legislative process this year by either contacting their legislators on important issues, participating in the TNA Legislative Summit: Nurses Day on the Hill, or providing us with information necessary to successfully support or oppose legislation. Without the active involvement of its members, TNA would not have realized the positive results seen this year.
Please see the list of legislators below who were particularly helpful in advancing TNA’s efforts this session. Contact information is provided for TNA members and others who would like to send their thanks. For additional specific information on the bills listed above, please visit www.capitol.tn.gov or contact the Tennessee Nurses Association at tna@tnaonline.org.
General Assembly Members’ Contact Information:
Representative Joe Armstrong
25 Legislative Plaza
Nashville, TN 37243
Phone (615) 741-0768
Fax (615) 253-0316
rep.joe.armstrong@capitol.tn.gov
Senator Doug Overbey
4 Legislative Plaza
Nashville, TN 37243
Phone (615) 741-0981
sen.doug.overbey@capitol.tn.gov
Representative Gary Odom
18A Legislative Plaza
Nashville, TN 37243
Phone (615) 741-4410
Fax (615) 741-7528
rep.gary.odom@capitol.tn.gov
Senator Douglas Henry
321 War Memorial Bldg.
Nashville, TN 37243
Phone (615) 741-3291
sen.douglas.henry@capitol.tn.gov
Representative JoAnne Favors
25 Legislative Plaza
Nashville, TN 37243
Phone: (615) 741-2702
Fax: (615) 253-0351
rep.joanne.favors@capitol.tn.gov
Legislative Report Archive - Members Only Area