68-1-201. Power to quarantine.

1. The commissioner has the power to:
   1. Declare quarantine whenever, in the commissioner's judgment, the welfare of the public requires it; and
   2. Prescribe such rules and regulations as may be deemed proper for the prevention of the introduction of yellow fever, cholera and other epidemic diseases into the state.
2. 1. Whenever yellow fever, cholera, smallpox or other epidemic diseases appear in any locality within the state, and information thereof is brought to the knowledge of the department, the commissioner shall prepare and carry into effect such rules and regulations as, in the commissioner's judgment, will, with the least inconvenience to commerce and travel, prevent the spread of the disease.
   2. Whenever the commissioner determines that an influenza outbreak may pose a threat of an epidemic, the commissioner shall prepare and carry into effect rules and regulations that, in the commissioner's judgment, will, with the least inconvenience to commerce and travel, prevent the spread of the disease.

Acts 1879, ch. 151, § 2; Shan., § 3096; impl. am. Acts 1923, ch. 7, § 46; Code 1932, § 5758; T.C.A. (orig. ed.), § 53-105; Acts 2006, ch. 588, § 2.

Cross-References. Isolation and quarantine of dogs suspected of being rabid, § 68-8-109.

Isolation and quarantine of tubercular infected persons, title 68, ch. 9, part 2.

Isolation or quarantine of persons infected with sexually transmitted diseases, establishment and termination, § 68-10-106.

Penalty for escaping from quarantine, § 68-5-104.

Quarantine of HIV, § 39-13-108.

Quarantine of person with communicable or contagious disease, § 68-5-104.

Collateral References.

Demurrage as affected by quarantine. 44 A.L.R. 841.

General delegation of power to guard against spread of contagious disease as including power to quarantine. 8 A.L.R. 837.

Typhoid carrier, quarantine of. 22 A.L.R. 845.

Venereal diseases, constitutionality, construction and application of statutes or ordinances concerning quarantine for. 127 A.L.R. 424.

68-1-202. Quarantine stations.

1. The commissioner shall select suitable localities for establishing quarantine stations, and may erect necessary temporary buildings for the disinfection of passengers, baggage, cargo and other matter believed to convey the contagious principle of cholera, yellow fever, smallpox and other epidemic diseases, and may enforce the transshipment of passengers as the commissioner may deem necessary.
2. The commissioner shall assign to the charge of each station a competent physician and necessary assistants, who shall receive such compensation as the commissioner may deem reasonable and just.

Acts 1879, ch. 151, § 2; Shan., §§ 3097, 3098; impl. am. Acts 1923, ch. 7, § 46; Code 1932, §§ 5759, 5760; T.C.A. (orig. ed.), §§ 53-106, 53-107.

Collateral References.

Personal liability of health officer. 24 A.L.R. 798.

68-1-203. Violating quarantine a misdemeanor.

Any person who willfully disregards or evades quarantine, or violates any rule or regulation made in attempting to prevent the spread of any epidemic disease, commits a Class B misdemeanor.

Acts 1879, ch. 151, § 3; Shan., § 3099; mod. Code 1932, § 5761; T.C.A. (orig. ed.), § 53-108; Acts 1989, ch. 591, § 112.

Cross-References. Penalty for Class B misdemeanor, § 40-35-111.

68-1-204. Recommendations by commissioner to governor on allocation of health care resources in affected areas.

In the event that an emergency or disaster as defined in § 58-2-101 occurs, that involves outbreaks of disease that present a danger of an epidemic, the commissioner shall make appropriate recommendations to the governor for actions under this title and title 58, chapter 2, to allocate all available heath care resources in the affected areas for immediate and long-term health care needs of the affected populations.

Acts 2006, ch. 588, § 3.

Part 3
Dental Hygiene

68-2-201, 68-2-202. [Repealed.]

Compiler's Notes. Former part 2, §§ 68-2-201, 68-2-202 (Acts 1877, ch. 28, § 1; 1877, ch. 98, § 7; Code 1932, §§ 5770, 5771; Shan., §§ 3101, 3102; T.C.A. (orig. ed.), §§ 53-315, 53-316), concerning municipal boards of health, was repealed by Acts 1985, ch. 172, § 1.

Part 3
District Health Departments [Repealed]

NOTES TO DECISIONS

1. Mother.

Trial court erred in prohibiting the Tennessee Department of Health from listing a surrogate as mother on the original birth certificate and to list the mother as “unknown” because the definition of “mother” for the purpose of completing the birth certificate was the same as that used in preparing the standard birth certificate promulgated by the National Center for Health Statistics. In re Adoption of Male Child A. F. C., 491 S.W.3d 316, 2014 Tenn. App. LEXIS 414 (Tenn. Ct. App. July 16, 2014), appeal denied, In re Adoption of A.F.C., — S.W.3d —, 2014 Tenn. LEXIS 985 (Tenn. Nov. 20, 2014).

“Mother” to be entered on the certificate of live birth required by the Vital Records Act of 1977 is the same as that used in preparing the standard certificate, i.e., the woman who delivers the child; “mother” as used in the Act is the woman who produced the “live birth,” and using the same definition of mother enables the state and federal governments to collaborate in pursuit of their respective goals. In re Adoption of Male Child A. F. C., 491 S.W.3d 316, 2014 Tenn. App. LEXIS 414 (Tenn. Ct. App. July 16, 2014), appeal denied, In re Adoption of A.F.C., — S.W.3d —, 2014 Tenn. LEXIS 985 (Tenn. Nov. 20, 2014).

68-3-201. Kinds of information collected and recorded.

The information collected and recorded under this chapter shall be such as will aid the public health of the state, and furnish and preserve evidence affecting personal and property rights of the individual citizen.

Acts 1977, ch. 128, § 5; T.C.A., § 53-421.

Law Reviews.

1985 Tennessee Survey: Selected Developments in Tennessee Law, 53 Tenn. L. Rev. 373 (1986).

68-3-202. Content of certificates and reports — Evidence.

1. In order to promote and maintain nationwide uniformity in the system of vital records, the forms of certificates, reports and other returns required by this chapter, or by regulations adopted under this chapter, shall include, as a minimum, the items recommended by the federal agency responsible for national vital statistics.
2. Each certificate, report and form required to be filed and registered under this chapter shall be on a form or in a format prescribed by the state registrar and shall contain the date received for registration.
3. Each certificate provided for in this chapter, filed within six (6) months after the recorded event occurred, shall be prima facie evidence of the facts stated in the certificate.

Acts 1977, ch. 128, § 4; T.C.A., § 53-422.

Cross-References. Certified copy as prima facie evidence, § 68-3-206.

Textbooks. Tennessee Law of Evidence (2nd ed., Cohen, Paine and Sheppeard), § 803(9).1.

68-3-203. Amendment of records.

1. In order to protect the integrity and accuracy of vital records, a certificate or record registered under this chapter may be amended only in accordance with this chapter and regulations adopted by the department.
2. Except as otherwise provided by subsection (f), a certificate or record that is amended under this section shall be marked “amended.” The date of amendment and a summary description of the evidence submitted in support of the amendment shall be endorsed on or made a part of the record. The department shall prescribe, by regulation, the conditions under which additions or minor corrections may be made to certificates or records within one (1) year after the date of the event, without the certificate or record being considered “amended.” “Minor corrections” means amendment of obvious errors, transposition of letters in words of common knowledge, or omissions.
3. Upon receipt of a certified copy of a court order changing the name of a person born in the state, and upon request of such person or such person's parents, guardian or legal representative, the state registrar shall amend the certificate of birth to show the new name.
4. The sex of an individual shall not be changed on the original certificate of birth as a result of sex change surgery.
5. When an applicant does not submit the minimum documentation required in the regulations for amending a vital record, or when the state registrar has reasonable cause to question the validity or adequacy of the applicant's sworn statements or the documentary evidence, and if the deficiencies are not corrected, the state registrar shall not amend the vital record and shall advise the applicant of the reason for this action.
6. In addition to other methods of amending certificates that may be provided by statute or by duly authorized department rule, the state registrar, if presented by an applicant with evidence that a reasonable person would conclude proves beyond a reasonable doubt that an original entry on a certificate was factually inaccurate at the time of recordation, shall block out the misinformation and make the necessary correction. When such an amendment is made, no record of the amendment shall appear upon the face of the certificate; provided, that a record of all evidence submitted relative to the amendment, along with the registrar's analysis of the evidence, shall be maintained by the office of vital records.
7. If a form approved, as provided in § 68-3-305(b), acknowledging the paternity of a child is signed by both parents of the child and is submitted to the office of vital records at any time after the original certificate is filed and prior to the child's nineteenth birthday, the legal surname of the father may be entered on the certificate as that of the child, and the father's name and other personal information may be shown on the certificate of birth in the manner prescribed by regulation; provided, that paternity is not already shown on the certificate of birth. The state registrar may mark the record as amended, but not on the portion to be disclosed pursuant to § 68-3-205. Further, a legitimation by subsequent marriage of the individuals shown on the certificate as the father and mother shall not require a new certificate of birth and §§ 68-3-310(3), 68-3-311 and 68-3-313 shall not apply.
8. In the event a voluntary acknowledgment of paternity is rescinded and a new father is not named, the name and personal information of the originally named father shall be removed by blocking, and the child's surname shall be blocked and the legal surname of the mother at the time of the birth shall be entered as the surname of the child. In the event a voluntary acknowledgment of paternity is rescinded and a new father is named, the changes in the birth certificate shall be made in accordance with subsection (g).

Acts 1977, ch. 128, § 21; 1979, ch. 123, §§ 1, 2; T.C.A., § 53-423; Acts 1985, ch. 11, § 1; 1994, ch. 988, § 13; 1997, ch. 551, § 39.

Cross-References. Paternity and legitimation, title 36, ch. 2, part 3.

Attorney General Opinions. Where designation of a person's sex has been made on police booking sheets, warrants, and other court records in accordance with the person's birth certificate, those documents may not be altered as a result of sex-change surgery.  OAG 14-70, 2014 Tenn. AG Lexis 72 (7/16/14).

68-3-204. Reproduction of records.

1. To preserve vital records, the state registrar is authorized to prepare typewritten, photographic, electronic or other reproductions of original records and files in the office of vital records.
2. The reproductions, when certified by the state registrar, shall be accepted as the original records.

Acts 1977, ch. 128, § 22; T.C.A., § 53-424.

Textbooks. Tennessee Law of Evidence (2nd ed., Cohen, Paine and Sheppeard), § 1002.1.

68-3-205. Disclosure of information — Regulations.

1. 1. To protect the integrity of vital records, to ensure their proper use, and to ensure the efficient and proper administration of the system of vital records, it is unlawful for any person to permit inspection of, or to disclose information contained in, vital records, or to copy or issue a copy of all or part of any such records, except as authorized by this chapter, by regulations promulgated pursuant to this chapter, or as otherwise authorized by law, or by order of a court of competent jurisdiction.
   2. Regulations promulgated pursuant to this chapter shall provide for adequate standards of security and confidentiality of vital records.
2. The department may authorize, by regulation, the disclosure of information contained in vital records for research purposes.
3. Appeals from decisions of the custodians of permanent local records refusing to disclose information, or to permit inspection of or copying of records under the authority of this section and regulations issued under this section, shall be made to the state registrar, whose decisions shall be binding upon the local custodians of permanent local records.
4. 1. As used in this subsection (d), “authenticating document” means the certificate, license, order, decree, report or other document that makes legal, official and final the occurrence of a certain event.
   2. 1. Notwithstanding any other provision of this chapter, or any rule promulgated pursuant to this chapter, to the contrary, an application for a marriage license and the authenticating document for the events of birth, death, marriage, divorce, or annulment of marriage, whether maintained or stored by or in the possession of a county clerk, court clerk, state registrar or other custodian authorized by the state registrar, shall be considered a public record, and further, that verified information from such documents may be provided upon request. Nothing in this section shall be construed to permit the disclosure of information contained in the “Information for Medical and Health Use Only” section of the birth certificate or the “Confidential Information” section of the certificate of marriage or certificate of divorce or annulment, unless specifically authorized by the state registrar for statistical or research purposes. This data is not subject to subpoena or court order and is not admissible before any court or judicial body.
      2. Verified information from birth records may only be provided by the state registrar or the local registrar in a local health department in a county with a population of two hundred fifty thousand (250,000) or greater, according to the 1970 federal census.
      3. Certified or noncertified copies or abstracts of birth certificates of persons in the federal witness protection program shall be provided only to a person requesting a copy of the person's own birth certificate or that person's supervising federal marshal.
      4. A certified copy or other copy of a death certificate containing the cause of death information shall not be issued, except:
         1. Upon specific request of the spouse, children, parents, or other next of kin of the decedent or their respective authorized representatives;
         2. When a documented need for the cause of death to establish a legal right or claim has been demonstrated;
         3. When the request for the copy is made by or on behalf of an organization that provides benefits to the decedent's survivors or beneficiaries;
         4. Upon specific request by local, state, or federal agencies for research or administrative purposes approved by the state registrar;
         5. When needed for research activities approved by the state registrar;
         6. Upon receipt of an order from a court of competent jurisdiction ordering such release; or
         7. Upon receipt of a written request from a department representative authorized by chapter 142, part 1, of this title to obtain the records.
      5. The state registrar and other custodians of vital records authorized by the state registrar to issue certified copies shall, upon receipt of an application, issue a certified copy of a vital record in the registrar's or custodian's custody, or a part of the vital record to the registrant, the registrant's spouse, children, parents, or guardian, or their respective authorized representative. Others may be authorized to obtain certified copies when they demonstrate that the records are needed for the determination or protection of their personal or property rights.
   3. Except as provided in subdivision (d)(2), nothing in this subsection (d) shall be construed as altering the legal status as an open or confidential record of any information, document, record or report used to compile or produce the information contained on the authenticating document, including, but not limited to, applications, medical or law enforcement reports, settlement agreements, or court pleadings and filings.
   4. The state registrar shall promulgate rules to effectuate the provisions and intent of this subsection (d), including rules concerning the provision of verified information from authenticating documents to members of the public.
5. When one hundred (100) years have elapsed, after the date of birth, or fifty (50) years have elapsed after the date of death, marriage, divorce or annulment of marriage, the records of these events in the custody of the state registrar shall be made available to the public in accordance with regulations that provide for the continued safekeeping of the records.
6. Any microfilm copy of a vital record in the possession of the state library and archives, or a local library, shall be available for public inspection.

Acts 1977, ch. 128, § 23; T.C.A., § 53-425; Acts 1988, ch. 891, § 1; 1993, ch. 432, §§ 1, 2; 2007, ch. 588, § 1.

Compiler's Notes. For tables of U.S. decennial populations of Tennessee counties, see Volume 13 and its supplement.

Cross-References. Confidentiality of public records, § 10-7-504.

Law Reviews.

Updating Tennessee's Public Records Law (Douglas Pierce), 24 Tenn. B.J. 24 (1988).

Attorney General Opinions. Public access to social security numbers on marriage license applications, OAG 98-065 (3/17/98).

68-3-206. Copies of records.

In accordance with § 68-3-205 and the regulations adopted pursuant to § 68-3-205:

1. The state registrar and other custodian or custodians authorized by the state registrar to issue certified copies shall, upon receipt of written application, issue a certified copy of a vital record in the state registrar's or custodian's custody or a part of the vital record to any applicant showing a direct and tangible interest in the vital record. Each copy issued shall show the date of registration and copies issued from records marked “delayed” and “amended” shall be similarly marked and show the effective date. All forms and procedures used in the issuance of certified copies of vital records in this state shall be approved or provided by the state registrar;
2. A certified copy of a vital record or any part of the vital record, issued in accordance with subdivision (1), shall be considered for all purposes the same as the original and shall be prima facie evidence of the facts stated in the vital record;
3. The federal agency responsible for national vital statistics may be furnished copies or data from the system of vital records it may require for national statistics; provided, that the federal agency shares in the cost of collecting, processing and transmitting the data; and provided further, that the data shall not be used for other than statistical purposes by the federal agency, unless so authorized by the state registrar;
4. Federal agencies, the state of Tennessee, Tennessee courts and municipal and county law enforcement agencies, upon official request, may be furnished verification of information for statistical or administrative purposes upon such terms or conditions as may be prescribed by regulation; provided, that the copies or information shall not be used for other than the purpose for which it was requested, unless so authorized by the state registrar;
5. 1. The state registrar may, by agreement, transmit transcripts of records and other reports required by this chapter to offices of vital records outside this state, when the records or other reports relate to residents of those jurisdictions or persons born in those jurisdictions. The agreement shall require that the transcripts be used for statistical and administrative purposes only as specified in the agreement. Any agreement shall provide that the transcripts shall not be retained by the other jurisdiction for more than two (2) years from the date of the event or after the statistical tabulation has been accomplished, whichever time period is shorter;
   2. Transcripts received from other jurisdictions by the office of vital records in this state shall be handled in the same manner as prescribed in subdivision (5)(A);
6. 1. The department of health shall implement a pilot program to authorize, but not require, county clerks to issue certified copies of computer abstract birth certificates to walk-in customers pursuant to this subdivision (6). The program shall only be implemented in one (1) site within a county.
   2. County clerks may issue certified copies of birth certificates, which copies shall have the force and effect of certified copies issued by the office of vital records. The state registrar may promulgate regulations or emergency rules as may be necessary to effectuate this subdivision (6), including, but not limited to, rules governing the issuance, inventories, and security and confidentiality standards of the birth certificates or certified copies or both, in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
   3. The department shall provide state security paper for issuing copies of birth certificates pursuant to this section. The county clerk shall be responsible for all other expenses including, but not limited to, connectivity, hardware and direct cost of training staff; provided, however, that each county clerk is authorized to charge a reasonable fee in addition to the fee established by regulations and paid to the department to defray any reasonable costs associated with issuing the certificates. From the proceeds collected from the fee established by regulations, the county clerk shall remit to the department the portion of the fee due the state and shall remit to any local health department located within the county the portion of the fee due such local health department in the manner prescribed by contract.
   4. County clerks and the department may utilize existing T-carrier signaling schemes for the purpose of transmitting data.
   5. [Deleted by 2014 amendment.]
7. Local health departments in counties with a population of two hundred fifty thousand (250,000) or greater, according to the 1970 federal census or any subsequent federal census, may issue copies of birth certificates, which copies shall have the force and effect of certified copies issued by the office of vital records. The local health departments in those counties are designated as branch offices of the central office of vital records for the purpose of issuance of copies of birth certificates only, but not for the purpose of alteration of birth certificates;
8. Local health departments may issue copies of death certificates, which copies have the force and effect of certified copies issued by the office of vital records; and
9. No person shall prepare or issue any certificate that purports to be an original, certified copy, or copy of a vital record, except as authorized in this chapter or regulations adopted pursuant to this chapter.

Acts 1977, ch. 128, § 24; T.C.A., § 53-426; Acts 2007, ch. 282, §§ 1, 2; 2010, ch. 712, § 1; 2014, ch. 637, §§ 1, 2.

Compiler's Notes. For tables of U.S. decennial populations of Tennessee counties, see Volume 13 and its supplement.

Amendments. The 2014 amendment, in (6), deleted the former second sentence in (A) which read: “The pilot program shall exist only for four (4) years, through the end of fiscal year 2013-2014.” and deleted former (E) which read: “Such pilot program shall apply only in counties having a population in excess of three hundred thousand (300,000), according to the 2000 federal census or any subsequent federal census, and in counties having the following populations, according to the 2000 federal census or any subsequent federal census:not less than  nor more than 17,600 17,67549,000 49,10051,200 51,30058,100 58,20071,100 71,20071,300 71,400105,800 105,900”

Effective Dates. Acts 2014, ch. 637, § 3. April 4, 2014.

Cross-References. Confidentiality of public records, § 10-7-504.

Law Reviews.

A Critical Survey of Developments in Tennessee Family Law in 1976-77, III. Marriage Formalities (Neil P. Cohen), 45 Tenn. L. Rev. 430.

Collateral References.

Requirement of notice as condition for admission in evidence of summary of voluminous records. 80 A.L.R.3d 405.

68-3-207. Fees for copies and for searches.

1. 1. The department shall prescribe the fees to be paid for certified copies or certificates or records, or for a search of the files or records when no copy is made, or for copies or information provided for research, statistical or administrative purposes.
   2. The department shall not collect any fee under this section for a copy of a death certificate for a deceased person who was a veteran of an armed service of the United States, if:
      1. The person requesting the copy presents the department with adequate proof of the veteran status of the deceased;
      2. The person requesting the copy is related to the deceased within two (2) degrees of collateral or lineal kinship; and
      3. Not more than two (2) copies of the death certificate have been previously provided on behalf of the deceased veteran without collection of the fee.
2. Fees collected under this section by the state registrar shall be deposited in the general fund of this state, according to the prevailing procedures governing collection.

Acts 1977, ch. 128, § 25; T.C.A., § 53-427; Acts 1990, ch. 850, § 1.

68-3-208. Medical records.

Medical records will be made available to the state registrar or any direct representative of the registrar for the limited purpose of gathering information on birth certificates, death certificates and reports of fetal deaths.

Acts 1977, ch. 128, § 27; T.C.A., § 53-428.

68-3-209. Applicability to previously received certificates or reports.

This chapter also apply to all certificates of birth, death, marriage, and divorce, dissolution or annulment and reports of fetal death and induced termination of pregnancy previously received by the office of vital records or by any custodian of permanent local records.

Acts 1977, ch. 128, § 29; T.C.A., § 53-429.

Part 3
Births

NOTES TO DECISIONS

1. Applies to Venereal Disease.

By § 68-5-101 venereal diseases are excepted from communicable diseases dealt with under this chapter, but by § 68-10-101 (see now § 68-10-112), venereal diseases are expressly declared to be communicable diseases subject to quarantine. Hence, in the application of the pari materia rule, this provision for punishment may well be extended to those quarantined for venereal diseases who escape before recovery. State ex rel. Kennedy v. Head, 182 Tenn. 249, 185 S.W.2d 530, 1945 Tenn. LEXIS 215 (1945).

Collateral References.

Demurrage as affected by quarantine. 44 A.L.R. 841.

General delegation of power to guard against spread of contagious disease as including power to quarantine. 8 A.L.R. 837.

Typhoid carrier, quarantine of. 22 A.L.R. 845.

Venereal diseases, constitutionality, construction and application of statutes or ordinances concerning quarantine for. 127 A.L.R. 424.

68-5-201. [Repealed.]

Compiler's Notes. Former § 68-5-201 (Acts 1915, ch. 52, § 1; Shan., § 6756a2; Code 1932, § 11174; modified; T.C.A. (orig. ed.), § 53-621), concerning the naming and approval of a prophylaxis or preventive to be used in treating the eyes of newly-born children, was repealed by Acts 2008, ch. 847, § 1, effective April 30, 2008.

68-5-202. Treatment specified for infant at birth — Reports of redness, swelling, inflammation or pus — Religious exemption.

1. It is the duty of any physician, nurse or midwife who assists and is in charge at the birth of any infant, or has the care of the infant after birth, to treat the eyes of the infant with a prophylaxis to prevent ophthalmia neonatorum or infections leading to blindness. The treatment shall be given as soon as practicable after the birth of the infant and always within one (1) hour; and if any redness, swelling, inflammation, or gathering of pus appears in the eyes of the infant or upon the lid or about the eyes within two (2) weeks after birth, then any nurse, midwife or other person having care of the infant shall report the condition within six (6) hours after its discovery to a physician licensed and practicing medicine in this state.
2. Nothing in this part shall require medical treatment under subsection (a) for the minor child of any person who files with the department of health a signed, written statement that such medical treatment conflicts with the person's religious tenets and practices, affirmed under penalties of perjury.

Acts 1915, ch. 52, §§ 2, 3; Shan., §§ 6756a3, 6756a4; Code 1932, §§ 11175, 11176; modified; T.C.A. (orig. ed.), §§ 53-622, 53-623; Acts 1989, ch. 591, § 113; 2008, ch. 847, § 2; 2016, ch. 989, § 1.

Amendments. The 2016 amendment rewrote (b) which read: “A violation of this section is a Class C misdemeanor.”

Effective Dates.  Acts 2016, ch. 989, § 2. July 1, 2016.

Cross-References. Newborn testing and metabolic defects, title 68, ch. 5, part 4.

Part 3
[Reserved]

68-9-201. Report of diseased persons — Immunity from liability.

1. If any attending physician or other person knows or has good reason to suspect that a person having tuberculosis is behaving so as to expose other persons to infection, or is about to so conduct themselves, the attending physician or other person shall notify the state, district, municipal or county health officer of the name and address of the diseased person and the essential facts in the case.
2. State, district, municipal and county health officers involved in tuberculosis control and elimination shall notify appropriate health authorities of jurisdictions in the appropriate states, territories, and municipalities when an individual with confirmed or clinically diagnosed infectious tuberculosis or currently under treatment for tuberculosis disease relocates from Tennessee into another jurisdiction, such notification being subject to approval of the state health officer or such officer's designee. Notwithstanding any law to the contrary, the commissioner of health is authorized to notify the appropriate tuberculosis infection control staff of this or another state of an individual's tuberculosis infection for the sole purpose of containing a potential threat to the public health and welfare or to assure completion of proper treatment of the diseased person. All persons who receive notification of the infectious condition of an individual under this subsection (b) shall hold the information in the strictest confidence and shall not reveal the information to others. A person making disclosure by providing patient identifying information and medical information related to the patient's tuberculosis status is immune from liability for making this disclosure of information for the purpose of preventing the further spread of disease and assuring completion of proper treatment of the diseased person.

Acts 1971, ch. 210, § 19; T.C.A., § 53-1038; Acts 2000, ch. 786, § 1.

Cross-References. Quarantine generally, title 68, ch. 1, part 2.

68-9-202. Examination and quarantine of suspects.

The commissioner and all state, district, county or municipal health officers or their authorized deputies within their respective jurisdictions, are authorized, directed and empowered, when in their judgment it is necessary to protect the public health, to make or have examinations made by a duly licensed and practicing physician of this state to be selected by the health officer, of persons reasonably suspected because of known clinical or epidemiological evidence of having infectious tuberculosis, and to require persons found to have infectious tuberculosis to comply with all provisions of this chapter for protection of the public from exposure to tuberculosis, and also, when in the judgment of the commissioner or state, district, municipal or county health officers, it is necessary to protect the public health, the officers are directed and empowered to isolate or quarantine persons who, because of known clinical or epidemiological evidence, are suspected of having infectious tuberculosis; provided, that any person so suspected may have present at the time of examination a physician of the person's own choosing to participate in the examination.

Acts 1971, ch. 210, § 20; 1977, ch. 145, § 11; T.C.A., § 53-1039.

Collateral References.

Demurrage as affected by quarantine. 44 A.L.R. 841.

General delegation of power to guard against spread of contagious disease as including power to quarantine. 8 A.L.R. 837.

68-9-203. Quarantine conditions.

In establishing isolation or quarantine, the commissioner or state, district, municipal or county health officer having jurisdiction shall designate and define the length of time, site and any other conditions required of the person to be isolated or quarantined.

Acts 1971, ch. 210, § 21; 1977, ch. 145, § 12; T.C.A., § 53-1040.

68-9-204. Quarantine — Commencement — Termination — Standards.

1. No one but the commissioner, a state, municipal, district or county health officer or such person's duly authorized representative shall establish and terminate isolation or quarantine of persons with infectious tuberculosis.
2. Isolation or quarantine may be established when clinical signs of the disease are shown to be present with the aid of such laboratory examination for diagnosis as the health officer may deem necessary, or isolation or quarantine may be established when tuberculosis is shown to be present in a communicable stage.
3. The release of a person from isolation or quarantine for tuberculosis shall be made when, in the judgment of the commissioner or the health officer, the disease is no longer communicable.
4. It is the duty of the commissioner to set up such clinical and laboratory criteria as may be necessary for the guidance of health officers in the performance of their duties as outlined in this section.

Acts 1971, ch. 210, § 22; 1977, ch. 145, § 13; T.C.A., § 53-1041.

68-9-205. Detention facilities.

The department may establish and maintain one (1) or more detention facilities as the commissioner deems appropriate to sufficiently confine all persons who refuse to be examined, treated, isolated or quarantined as provided for by this part.

Acts 1971, ch. 210, § 23; 1977, ch. 145, § 14; T.C.A., § 53-1042.

68-9-206. Incarceration of suspect — Procedure — Appeal — Violation of quarantine.

1. 1. Whenever, in the judgment of the commissioner or a state, municipal, district or county health officer, there is reasonable clinical or epidemiological evidence to suspect that any person or persons have infectious tuberculosis that may be communicable, and the person or persons refuse to be examined or comply as provided for in this chapter, the commissioner or health officer or such person's duly authorized deputy is authorized to go before a magistrate or a judge of a court of general sessions and swear out a warrant of arrest for the person or persons.
   2. However, the magistrate or judge is not bound to issue the warrant, unless and until there is a showing of reasonable cause on the basis of sound clinical and epidemiological evidence to believe the person has infectious tuberculosis.
   3. If reasonable cause is shown for the arrest and examination of the person or persons, the magistrate or judge shall direct that an examination be made of the person or persons to determine whether or not they are infectious.
   4. The examination shall be made by the health officer or by a duly licensed and practicing physician of this state to be selected by the health officer, and the accused person or persons may also have a physician of their own choosing present to participate in the examination.
   5. If the physicians are not in accordance as to their diagnosis, then the court shall reach its decision after a hearing.
   6. If after a full hearing the court is of the opinion that the person examined has infectious tuberculosis that may be communicable, the court may commit the person to the custody of the commissioner for detention as provided in § 68-9-205, the person to remain under treatment until the disease, in the opinion of the commissioner or health officer, is no longer communicable.
   7. No appeal or certiorari from the decision of the court committing the person to the place of isolation shall stay the commitment, nor shall any court have the power to supersede the order, but the person or persons shall immediately be placed in the detention facility, there to remain until released by the commissioner or the health officer as no longer communicable, or released by order of court.
   8. Any person committed under this chapter may appeal from the judgment of the magistrate or court of general sessions as now provided by law for civil cases.
   9. Whenever any person violates isolation or quarantine under this chapter by leaving quarantine or isolation except as provided in this chapter, the health officer in charge of the place of isolation or quarantine may invoke the aid of all processes of law and all state, county and municipal authorities to effect the return of the person to the quarantine or isolation.
2. If a person, who is admitted either voluntarily or as the result of commitment by the processes authorized in this part, violates quarantine by leaving the place of quarantine designated by a health officer, or becomes unruly, boisterous, offensive or recalcitrant or violates in any manner the reasonable rules and regulations of the institution in which the person is quarantined, then the commissioner or health officer may go before the judge of the court of general sessions to ask the court to commit the person to the detention facility, as provided for in this section.

Acts 1971, ch. 210, § 24; 1977, ch. 145, § 15; T.C.A., § 53-1043.

68-9-207. Release for voluntary hospital treatment — Recommitment.

1. If, at any time after being isolated or quarantined, any person so isolated or quarantined shall, in the opinion of the commissioner or health officer in charge of the place of isolation or quarantine, be a fit and proper person for release from the isolation or quarantine to become a voluntary patient in any hospital for the treatment of tuberculosis, then the commissioner or health officer is  authorized and empowered to release the isolated or quarantined person for admission into such a hospital.
2. If the isolated or quarantined person so released shall ever hereafter for any reason become a proper person against whom § 68-9-206 should be again invoked, the former release of the person from isolation or quarantine under this section shall not constitute a bar against again invoking § 68-9-206 or any other provisions of this chapter against the person, but the necessity for again invoking § 68-9-206 or any other provisions of this chapter shall be deemed and constitute a new and separate violation of this chapter.

Acts 1971, ch. 210, § 25; T.C.A., § 53-1044.

68-11-201. Part definitions.

As used in this part, unless the context otherwise requires:

1. “Adult care home” means a single family residence licensed pursuant to this part in which twenty-four-hour residential care, including assistance with activities of daily living, is provided in a homelike environment to no more than five (5) adults who are elderly or have a disability. Adult care homes shall be licensed as Level 2 homes, and meet standards prescribed in this part and in regulations promulgated by the board pursuant to this part. “Adult care home” does not include any facility otherwise licensed by the department of mental health and substance abuse services;
2. “Adult care home provider” means a person twenty-one (21) years of age or older who owns and operates an adult care home and meets all education, training and experience requirements prescribed in this part and in regulations promulgated by the board pursuant to § 68-11-209. An adult care home provider may serve up to five (5) adults who are elderly or have a disability and who are unrelated to the adult care home provider by blood or marriage. An adult care home provider may choose to serve one (1) or more adult members of their own family if those adult members are elderly or have a disability, in which case, the adult care home provider shall be required to serve at least two (2) additional adults who are elderly or have a disability if those additional adults are unrelated to the adult care home provider by blood or marriage, for a total of no more than five (5) residents in the adult care home who are elderly or have a disability. An adult care home provider shall live in the adult care home or employ a resident manager to live in the residence;
3. “Ambulatory surgical treatment center” means any institution, place, or building devoted primarily to the maintenance and operation of a facility for the performance of surgical procedures or any facility in which a surgical procedure is utilized to terminate a pregnancy. Such facilities shall not provide beds or other accommodations for the stay of a patient to exceed twelve (12) hours duration; provided, that the length of stay may be extended for an additional twelve (12) hours in the event such stay is deemed necessary by the attending physician, the facility medical director, or the anesthesiologist for observation or recovery, but in no event shall the length of stay exceed twenty-four (24) hours. No patient for whom a surgical procedure is utilized to terminate a pregnancy shall stay at such a facility for a period exceeding twelve (12) hours. Individual patients shall be discharged in an ambulatory condition without danger to the continued well-being of the patients or shall be transferred to a hospital. Excluded from this definition are private physicians' office practices where a total of fifty (50) or fewer surgical abortions are performed in any calendar year;
4. The purpose of assisted-care living facility services is to promote the availability of residential alternatives to institutional care for persons who are elderly or who have disabilities in the least restrictive and most homelike environment appropriate. Assisted-care living facility services shall be driven by a philosophy that emphasizes personal dignity, respect, autonomy, independence and privacy and should, to the maximum extent appropriate, enhance the person's ability to age in place, while also ensuring that the person's medical and other needs are safely and effectively met;
   1. “Assisted-care living facility” means a facility, building, establishment, complex or distinct part thereof that accepts primarily aged persons for domiciliary care and services as described in this section;
   2. An assisted-care living facility shall provide on site to its residents room and board and non-medical living assistance services appropriate to each resident's needs, such as assistance with bathing, dressing, grooming, preparation of meals and other activities of daily living;
   3. Subject to limitations specified in this subdivision (4), an assisted-care living facility may also provide on site to its residents administration of medications that are typically self-administered, excluding intravenous injections, except as permitted pursuant to subdivisions (5)(D) and (E), and all other medical services as prescribed by each resident's treating physician that could be provided to a private citizen in the person’s own home by an appropriately licensed or qualified health care professional or entity, such as part-time or intermittent nursing care, various therapies including physical, occupational and speech therapy, podiatry care, medical social services, medical supplies other than drugs and biologicals, durable medical equipment and hospice services;
      1. Such medical services that may be provided in the assisted-care living facility must be provided by appropriately licensed or qualified staff or contractors of the assisted-care living facility, a licensed home care organization, another appropriately licensed entity or by the appropriately licensed staff of a nursing home, acting within the scope of their respective licenses;
      2. Nothing in this subdivision (4) shall authorize assisted-care living facilities to provide medical services to assisted-care living facility residents if the services are reimbursable under the federal medicare program;
      3. Oversight of medical services provided by licensed health care professionals and entities in an assisted-care living facility shall be provided in a manner that is consistent with the oversight of services provided by the licensed health care professionals or entities in private residential settings as defined through rules and regulation promulgated by the applicable licensing board and as may be further defined through rules and regulations promulgated by the board for licensing health care facilities pursuant to this section to ensure the quality of care received;
      4. The assisted-care living facility shall be responsible for the development of a plan of care that ensures the safety and well-being of the resident's living environment and for the provision of the resident's health care needs. Furthermore, any licensed health care professional or entity that is delivering services to the resident in the assisted-care living facility shall be available to assist in the plan of care development and to assess, plan, monitor, direct and evaluate the resident's care in conjunction with the resident's physician and in cooperation with the assisted-care living facility;
      5. Assisted-care living facilities shall be subject to licensure and must meet such requirements and minimum standards as the board prescribes in regulations pursuant to § 68-11-209. In the regulations, the board shall specifically address the needs of residents who may receive medical services provided pursuant to this part, including documentation of physician orders and nursing and treatment records of all medical services provided in the assisted-care living facility in an appropriate medical record maintained by the facility, regardless of whether the services are rendered by appropriately licensed or qualified staff of the assisted-care living facility or by arrangement with an outside entity;
      6. The board shall also, in consultation with the state fire marshal, include in such regulations fire safety standards that afford reasonable protection to assisted-care living facility residents without unduly disturbing the residential atmosphere to which they are accustomed;
5. “Assisted-care living facility resident” means primarily an aged person who requires domiciliary care and who, upon admission to the facility, if not ambulatory, is capable of self-transfer from the bed to a wheelchair or similar device and is capable of propelling the wheelchair or similar device independently. Such resident may require one (1) or more of the services described in subdivision (4);
   1. An assisted-care living facility resident shall be transferred to a licensed hospital, licensed nursing home or other appropriate setting if the resident, the appropriate person with legal authority to make such decisions on behalf of the resident, the assisted-care living facility administrator or the resident's treating physician determine that the services available to the resident in the assisted-care living facility, including medical services provided pursuant to subdivision (4)(C), will not safely and effectively meet the resident's needs. This subdivision (5)(A) shall not be interpreted as limiting the authority of the board or the department to require the transfer or discharge of individuals to different levels of care as required by statute when the resident's needs cannot be safely and effectively met by care provided in the assisted-care living facility, including medical services provided pursuant to subdivision (4)(C);
   2. Subject to limitations specified in subdivisions (5)(C) and (D), an assisted-care living facility may admit and permit the continued stay of a person who meets medical eligibility, i.e., level of care requirements for nursing facility services as defined by the bureau of TennCare, so long as the person's treating physician certifies that the person's needs can be safely and effectively met by care provided in the assisted-care living facility, including medical services provided pursuant to subdivision (4)(C), and the assisted-care living facility can provide assurance of timely evacuation in a fire or emergency;
   3. Assisted-care living facilities shall not admit nor permit the continued stay of:
      1. A person requiring treatment for a stage III or IV decubitus ulcer or with exfoliative dermatitis;
      2. A person who requires continuous nursing care. For purposes of this subdivision (5)(C)(ii), “continuous nursing care” means round-the-clock observation, assessment, monitoring, supervision or provision of nursing services that can only be performed by a licensed nurse;
      3. A person who has an active, infectious and reportable disease in a communicable state that requires contact isolation;
      4. A person whose verbal or physical aggressive behavior poses an imminent physical threat to the person or others, based not on the person's diagnosis, but on the behavior of the person;
      5. A person requiring physical or chemical restraints, not including psychotropic medications prescribed for a manageable mental disorder or condition; or
      6. A person whose needs cannot be safely and effectively met in the assisted-care living facility;
   4. Assisted-care living facilities shall not admit, but may permit the continued stay in the facility of, existing residents who require the treatments specified in subdivisions (5)(D)(i)-(iv) only on an intermittent basis or who are receiving hospice care from an appropriately licensed provider, as permitted pursuant to subdivision (5)(E). If the treatments are intermittent and extend beyond twenty-one (21) days, no more than two (2) additional twenty-one-day extensions may be granted by the assisted-care living facility; provided, that the resident's treating physician certifies that the person's intermittent need for the treatment can be safely and effectively met by care provided in the assisted-care living facility, including medical services provided pursuant to subdivision (4)(C). Assisted-care living facilities shall not permit the continued stay in the facility of existing residents who require the treatments on an ongoing, rather than intermittent basis, unless a resident who requires the treatments on an ongoing basis does not qualify for nursing facility level of care, in which case a waiver may be granted by the board for licensing health care facilities allowing the person to remain in the assisted-care living facility. A person who requires any of the treatments specified in subdivisions (5)(D)(i)-(iv) and who is able to self-care for the person's condition without the assistance of facility personnel or other appropriately licensed entity shall not be subject to these limitations and may be admitted or permitted to continue as a resident in an assisted-care living facility:
      1. Nasopharyngeal or tracheotomy aspiration;
      2. Nasogastric feedings;
      3. Gastrostomy feedings; or
      4. Intravenous therapy or intravenous feedings;
   5. Notwithstanding any other provision of this subdivision (5), any assisted-care living facility resident, including residents and new admissions who have qualified for hospice care prior to admission to the assisted-care living facility, shall be able to receive hospice care services and continue as a resident of the assisted-care living facility as long as the resident's treating physician certifies that hospice care can be appropriately provided at the facility. In addition, the hospice provider and the assisted-care living facility are jointly responsible for the development of a plan of care that ensures the safety and well-being of the resident's living environment and for the provision of the resident's health care needs. Furthermore, the hospice provider shall be available to assess, plan, monitor, direct and evaluate the resident's palliative care in conjunction with the resident's physician and in cooperation with the assisted-care living facility;
   6. The board for licensing health care facilities shall not promulgate any regulation, make any determination, issue any waiver, take any action or refuse to take action that has the effect of permitting an assisted-care living facility to provide care to persons or to admit or permit the continued stay of such persons except in accordance with this subdivision (5);
6. “Assistive technology practitioner (ATP)” means service providers primarily involved in evaluating the consumer's needs and training in the use of a prescribed wheeled mobility device;
7. “Assistive technology supplier (ATS)” means service providers involved in the sale and service of commercially available wheeled mobility devices;
8. “Birthing center” means any institution, facility, place or building devoted exclusively or primarily to the provision of routine delivery services and postpartum care for mothers and their newborn infants;
9. “Board,” unless otherwise indicated, means the board for licensing health care facilities;
10. “Commissioner” means the commissioner of health, the commissioner's authorized representative, or in the event of the commissioner's absence or a vacancy in the office of commissioner, the deputy commissioner of health;
11. [Deleted by 2013 amendment.]
12. “Dentist” means a doctor of dental science who is duly licensed to practice dentistry in this state;
13. “Department” means the department of health;
14. “Evaluation” means the determination and documentation of the physiological and functional factors that impact the selection of an appropriate seating and wheeled mobility device;
15. “Facility” means any institution, place or building providing health care services that is required to be licensed under this chapter;
16. “HIV resident” means any individual who is in need of domiciliary care and who has been diagnosed and certified in writing by a licensed physician as being human immunodeficiency virus (HIV) positive;
17. 1. “Home care organization” provides home health services, home medical equipment services, professional support services or hospice services to patients on an outpatient basis in either their regular or temporary place of residence. An entity is a home care organization if it does any of the following:
       1. Holds itself out to the public as providing home health services, home medical equipment services or hospice services;
       2. Contracts or agrees to deliver home health services, home medical equipment services or hospice services;
       3. Accepts, in the organization's name, physician orders for home health services, home medical equipment services or hospice services;
       4. Accepts responsibility for the delivery of home health services, home medical equipment services or hospice services; or
       5. Contracts to provide professional support services with the state agency financially responsible for services to individuals with mental intellectual or developmental disabilities;
    2. The absence of one (1) or more of the factors in (17)(A)(i)-(v) does not necessarily exclude the entity from the meaning of this definition;
    3. If the entity is not included within the terms of this definition, the entity shall not be considered to be a home care organization solely because it offers to refer individuals who are available for employment by consumers through personal contract or individual agreement to deliver home health services, home medical equipment services, professional support services or hospice services that are either within the scope of the individual's professional license or is a homemaker service, and which service must be delivered independently of the agency or organization that made the referral;
    4. The board shall establish, by rules, standards of authorization for a home care organization to be qualified to provide home health services, home medical equipment services or hospice services. No person shall provide a designated category of services unless appropriately authorized by the board. Licensure surveys of a home care organization shall be specific to the type of service categories for which the home care organization has been authorized. The standards for hospice shall include requirements for a medically directed team of professionals and volunteers to create a program of care to meet the medical, nursing, social, psychological, emotional, spiritual and other special needs that are experienced in the final stages of illness, during dying and bereavement for families following the death of the patient. The standards for licensure of professional support services shall be the same as those applicable to personal support services agencies licensed under title 33; provided, that the department adopts by rule additional standards specifically for professional support services after consultation with the commissioner of mental health and substance abuse services. In regulating home care organizations authorized to provide professional support services, the department shall rely on the review of the organizations conducted by the department of mental health and substance abuse services, and the survey by the department of the organization shall not duplicate the reviews conducted by the department of mental health and substance abuse services;
18. 1. “Home for the aged” means a home represented and held out to the general public as a home which accepts primarily aged persons for relatively permanent, domiciliary care. A home for the aged provides room, board and personal services to four (4) or more nonrelated persons;
    2. The residential home for the aged shall be subject to licensure and meet such requirements and minimum standards as the board shall prescribe in regulations pursuant to § 68-11-209. The board shall, after consultation with the state fire marshal, include in the regulations fire safety standards that afford reasonable protection to homes for the aged residents without unduly disturbing the residential atmosphere to which they are accustomed. No license to operate a residential home for the aged shall be issued if the home is not approved by the local zoning, building and fire safety authorities to provide residential custodial care. The board shall employ one (1) or more fire safety experts who shall be annually certified to be qualified in fire safety by the state fire marshal. Notwithstanding approval of a home by the local authorities, the board shall consider any recommendation of its staff member or members thus certified to be qualified in deciding whether an application for a license to operate a residential home for the aged ought to be granted. In the absence of local authority and when deemed necessary by the board, approval of the home by the board's certified fire safety expert is required. The board has sole authority to issue and revoke licenses for homes for the aged. The board has the authority to establish fees. The board has the authority to determine whether or not any institution or agency comes within the scope of this part, and its decisions in that regard shall be subject only to such rights of review as the courts exercise with respect to administrative actions;
    3. A residential home for the aged is authorized to administer medications to residents only if it employs or contracts with a physician, nurse, or physician assistant to administer medications to residents;
19. “Home for the aged resident” means a person who is ambulatory and who requires permanent, domiciliary care but will be transferred to a licensed hospital, a licensed assisted living facility, or a licensed nursing home when health care services are needed that must be provided in those other facilities;
20. “Home health service” means a service provided an outpatient by an appropriately licensed health care professional or an appropriately qualified staff member of a licensed home care organization in accordance with orders recorded by a physician, that includes one (1) or more of the following:
    1. Skilled nursing care, including part-time or intermittent supervision;
    2. Physical, occupational or speech therapy;
    3. Medical social services;
    4. Home health aide services;
    5. Medical supplies and medical appliances, other than drugs and pharmaceuticals, when provided or administered as part of, or through the provision of, the services described in subdivisions (17)(A)-(D);
    6. Any of the items and services listed in subdivisions (20)(A)-(E) that are provided on an outpatient basis under arrangements made by the home care organization at a hospital, nursing home facility or rehabilitation center and the furnishing of which involves the use of equipment of such a nature that the items and services cannot readily be made available to the individual in the individual's home, or that are furnished at such facility while the individual is there to receive any such item or service, but not including transportation of the individual in connection with any such item or service;
    7. 1. For the purpose of defining “home health service” only, “physician” also includes a person who is licensed to practice medicine or osteopathy in a state contiguous to Tennessee, to the extent the physician has referred a patient residing in this state to a home care organization licensed under this part; provided, that nothing in this subdivision (20)(G) shall be construed as authorizing a non-resident physician or osteopath to practice in violation of § 63-6-201 or § 63-9-104, respectively. A physician who is not licensed to practice medicine or osteopathy in this state shall not refer a patient who is a resident of this state to a home care organization licensed under this part, unless the physician has previously provided treatment to the patient and has had an ongoing physician-patient relationship with the person for whom the referral is made;
       2. For the purposes of defining “home health service” only, “physician” includes a podiatrist licensed under title 63, chapter 3; provided, however, that any home health service ordered is a follow-up to treatment provided to the patient by the podiatrist;
    8. Notwithstanding any other law to the contrary, a licensed practical nurse employed by a home care organization, acting pursuant to the written order of a licensed physician, may provide respiratory care to a home care organization patient, except for the maintenance and management of life support equipment;
    9. Home- and community-based services provided to individuals through the department of education or a local education agency (LEA) and home- and community-based services provided to individuals by a county health department are not home health services for purposes of this chapter; and
    10. “Home health service” does not include services provided in the home by a sole practice therapist, when such services are within the scope of the therapist's license and incidental to services provided by the sole practice therapist in the office. For purposes of this subdivision (20)(J), a sole practice therapist means a therapist licensed under title 63, chapter 13 or 17, who is in sole practice and not in a business arrangement with any other therapist or other healthcare provider. Nothing in this subdivision (20)(J) shall exclude a sole therapist from the requirement of this section relative to professional support services;
21. 1. “Home medical equipment” means medical equipment intended for use by the consumer, including, but not limited to, the following:
       1. A device, instrument, apparatus, machine, or other similar article whose label bears the statement: “Caution: Federal law requires dispensing by or on the order of a physician.”;
       2. Ambulating assistance equipment;
       3. Mobility equipment;
       4. Rehabilitation seating;
       5. Oxygen care equipment and oxygen delivery systems;
       6. Respiratory care equipment and respiratory disease management devices;
       7. Rehabilitation environmental control equipment;
       8. Ventilators;
       9. Apnea monitors;
       10. Diagnostic equipment;
       11. Feeding pumps;
       12. A bed prescribed by a physician to treat or alleviate a medical condition;
       13. Transcutaneous electrical nerve stimulator;
       14. Sequential compression devices; and
       15. Neonatal home phototherapy devices;
    2. “Home medical equipment” does not include:
       1. Medical equipment used or dispensed in the normal course of treating patients by hospitals and nursing facilities as defined in this part, other than medical equipment delivered or dispensed by a separate unit or subsidiary corporation of a hospital or nursing facility or agency that is in the business of delivering home medical equipment to an individual's residence;
       2. Upper and lower extremity prosthetics and related orthotics;
       3. Canes, crutches, walkers, and bathtub grab bars;
       4. Medical equipment provided through a physician's office incident to a physician's service;
       5. Equipment provided by a pharmacist which is used to administer drugs or medicine that can be dispensed only by a pharmacist; or
       6. Enteral and parenteral equipment provided by a pharmacist;
22. “Home medical equipment provider” means any person who provides home medical equipment services;
23. “Home medical equipment services” means a service provided by any person who sells or rents home medical equipment for delivery to the consumer's place of residence in this state, regardless of the location of the home medical equipment provider. For purposes of this subdivision (23), “delivery to the consumer's place of residence” includes shipment by the home medical equipment provider to the consumer's residence or shipment to a predetermined location with the understanding that the home medical equipment shall be picked up by the consumer or the consumer's representative;
24. “Hospice patient” means only a person who has:
    1. Been diagnosed as terminally ill;
    2. Been certified by a physician, in writing, to have an anticipated life expectancy of six (6) months or less; and
    3. Voluntarily requested admission to, and been accepted by a licensed hospice;
25. “Hospice services” means a coordinated program of care, under the direction of an identifiable hospice administrator, providing palliative and supportive medical and other services to hospice patients and their families in the patient's regular or temporary place of residence. Hospice services shall be available twenty-four (24) hours a day, seven (7) days a week pursuant to the patient's hospice plan of care. Notwithstanding any other law, a licensed hospice may provide services to a person who is not a hospice patient; provided, that services to a non-hospice patient shall be limited to palliative care only. Hospice services may be provided in an area designated by a hospital for exclusive use by a home care organization certified as a hospice provider to provide care at the hospice inpatient or respite level of care in accordance with the hospice's medicare certification. Admission to the hospital is not required in order for a patient to receive hospice services, regardless of the patient's length of stay. The designation by a hospital of a portion of its facility for exclusive use by a home care organization to provide hospice services to its patients shall not:
    1. Alter the license to bed complement of such hospital; or
    2. Result in the establishment of a residential hospice;
26. 1. “Hospital” means any institution, place, building or agency represented and held out to the general public as ready, willing and able to furnish care, accommodations, facilities and equipment for the use, in connection with the services of a physician or dentist, of one (1) or more nonrelated persons who may be suffering from deformity, injury or disease or from any other condition for which nursing, medical or surgical services would be appropriate for care, diagnosis or treatment;
    2. “Hospital” does not include any hospital or institution, operated by the department of mental health and substance abuse services or the department of intellectual and developmental disabilities, specially intended for use in the diagnosis, care and treatment of those suffering from mental illness, intellectual disabilities, convulsive disorders, or other abnormal mental conditions;
    3. All hospitals, including such hospitals as are strictly maternity hospitals, shall come within this part;
    4. The board has the authority to determine whether or not any institution or agency comes within the scope of this part, and its decisions in that regard shall be subject only to such rights of review as the courts exercise with respect to administrative actions;
    5. It is unlawful for any institution, place, building or agency to be called a hospital if it is not a hospital as defined in this section;
27. “Hospitalization” in a hospital means the reception and care of any person for a continuous period longer than twenty-four (24) hours, for the purpose of giving advice, diagnosis, nursing service or treatment bearing on the physical health of such persons, and maternity care involving labor and delivery for any period of time;
28. “Independent living facility” means a single-family residence, building, establishment, or complex used as a boarding home; an active adult community; a 55+ community; senior apartments; a retirement community; or a retirement home that provides housing for adults who are fifty-five (55) years of age or older. An independent living facility may provide meals, housekeeping services, and social activities for the entertainment of its residents, but does not provide any nursing or medical care, including medication administration or assistance with medication administration, and each resident is able to live independently, though a resident may independently contract for medical or nursing care with a home health agency or similar service;
29. 1. “Nursing home” means any institution, place, building or agency represented and held out to the general public for the express or implied purpose of providing care for one (1) or more nonrelated persons who are not acutely ill, but who do require skilled nursing care and related medical services;
    2. “Nursing home” shall be restricted to facilities providing skilled nursing care and related medical services to individuals, beyond the basic provision of food, shelter and laundry, admitted because of illness, disease or physical infirmity for a period of not less than twenty-four (24) hours per day;
30. “Oral surgeon” means a dentist who has been certified by the Tennessee board of dentistry to perform oral surgery;
31. 1. “Outpatient diagnostic center,” except as otherwise limited in this subdivision (31), means any facility providing outpatient diagnostic services, unless the outpatient diagnostic services are provided as the services of another licensed healthcare institution that reports such outpatient diagnostic services on its joint annual report, or the facility is otherwise excluded from this subdivision (31). As used in this subdivision (31), “outpatient diagnostic services” means the following services provided to any person who is not an inpatient of a hospital: computerized tomography, magnetic resonance imaging, positron emission tomography, or other imaging technology developed after June 9, 2005, that provides substantially the same functionality as computerized tomography, magnetic resonance imaging, or positron emission tomography and for which a certificate of need is required by this chapter. With respect to an outpatient diagnostic center, data shall be reported to the commissioner of health pursuant to § 68-1-119, but the commissioner shall not make such data available to any third parties, except approved vendors that process the data, until the data is made publicly available;
    2. “Outpatient diagnostic center” does not mean a physician or dental practice that is conducted at a location occupied and controlled by one (1) or more physicians or dentists licensed under title 63, if the outpatient diagnostic services are ancillary to the specialties of the physicians' practice or are provided primarily for persons who are patients of the physicians or dentists in the practice for purposes other than outpatient diagnostic services. Outpatient diagnostic services provided in settings other than outpatient diagnostic centers or ambulatory surgery treatment centers shall be reported to the department of health, in the same manner as if such services were provided in an outpatient diagnostic center;
32. “Patient” includes, but is not limited to, any person who is suffering from an acute or chronic illness or injury or who is crippled, convalescent or infirm, or who is in need of obstetrical, surgical, medical, nursing or supervisory care;
33. “Person” means any individual, partnership, association, corporation, other business entity, state or local governmental agencies and entities, and federal agencies and entities to the extent permitted by federal law;
34. “Physician” means a doctor of medicine or doctor of osteopathy who is duly licensed to practice the profession in the state of Tennessee;
35. “Prescribed child care center” means a nonresidential child care, health care/child care center providing physician prescribed services and appropriate developmental services for six (6) or more children who are medically or technology dependent and require continuous nursing intervention. “Child care” for purposes of this section means the provision of supervision, protection, and meeting the basic needs of children, who are not related to the primary care givers, for three (3) or more hours a day, but less than twenty-four (24) hours a day;
36. “Professional support services” means nursing and occupational, physical or speech therapy services provided to individuals with intellectual or developmental disabilities pursuant to a contract with the state agency financially responsible for such services;
37. “Qualified rehabilitation professional” means:
    1. A health care professional within the professional's scope of practice licensed under title 63; or
    2. An individual who has appropriately obtained the designation of ATP or ATS, meeting all requirements of the designation of ATP or ATS, as established by the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA);
38. 1. “Recuperation center” means an establishment with permanent facilities that include inpatient beds, with an organized medical staff, and with medical services, including physician services and continuous nursing services, to provide treatment for patients who are not in an acute phase of illness, but who currently require primarily convalescent or restorative services, usually post-acute hospital care of relatively short duration;
    2. An establishment furnishing primarily domiciliary care is not within this definition;
    3. Matters pertaining to recuperation centers shall come within the purview of the board;
39. “Renal dialysis clinic” means any institution, facility, place or building devoted to the provision of renal dialysis on an outpatient basis to persons diagnosed with end stage renal disease;
40. “Resident manager” means a person twenty-one (21) years of age or older who lives in an adult care home and oversees the day-to-day operation of the adult care home on behalf of the adult care home provider and meets all education, training and experience requirements prescribed in this part and in regulations promulgated by the board pursuant to § 68-11-209;
41. “Residential HIV supportive living facility” means any institution, facility, place or building devoted exclusively to the provision of residential supportive living services to residents diagnosed with human immunodeficiency virus (HIV);
42. “Residential hospice” means a licensed homelike residential facility designed, staffed and organized to provide hospice or HIV care services, or both, except the services shall be provided at the residential facility rather than the patient's regular or temporary place of residence. A residential hospice shall not provide hospice or HIV care services to any person other than a hospice patient defined in subdivision (24), or HIV resident defined in subdivision (16). The board shall establish, by rules and regulations, residential hospice standards, which shall include provisions for building construction and fire and safety features, in addition to standards otherwise applicable to hospice or HIV care services provided by home care organizations;
43. “Substitute caregiver” means any person twenty-one (21) years of age or older who temporarily oversees care and services in an adult care home during the short-term absence of the adult care home provider or resident manager and meets all education, training and experience requirements prescribed in this part and in regulations promulgated by the board pursuant to § 68-11-209;
44. “Traumatic brain injury residential home” means a facility owned and operated by a community-based traumatic brain injury (TBI) adult care home provider in which residential care, including assistance with activities of daily living, is provided in a homelike environment to disabled adults suffering from the effects of a traumatic brain injury as defined in § 68-55-101;
45. “Traumatic brain injury residential home provider” means a person twenty-one (21) years of age or older who owns and operates a traumatic brain injury residential home. A traumatic brain injury residential home provider shall hold national certification by the Academy of Certified Brain Injury Specialists as a Certified Brain Injury Specialist (CBIS) or hold a current professional license as a physician, nurse practitioner, registered nurse, licensed rehabilitation professional, or licensed mental health professional who is trained and experienced in the care and rehabilitation of disabled adults suffering from the effects of a traumatic brain injury; and
46. “Wheeled mobility device” means a wheelchair or wheelchair and seated positioning system prescribed by a physician and required for use by the patient for a period of six (6) months or more. The following medicare wheelchair base codes are exempt: K0001, K0002, K0003, K0004, K0006, and K0007, as long as the consumer weighs less than three hundred pounds (300 lbs.).

Acts 1947, ch. 13, §§ 2, 5, 14; mod. C. Supp. 1950, § 5879.1; Acts 1951, ch. 198, §§ 2, 3; 1953, ch. 113, § 26 (Williams, §§ 4432.2, 4432.5, 4432.14); Acts 1968, ch. 225, § 1; 1971, ch. 522, § 1; 1975, ch. 215, § 1; impl. am. Acts 1975, ch. 248, § 1; Acts 1975, ch. 276, § 1; 1976, ch. 471, § 1; 1978, ch. 930, § 1; 1979, ch. 77, § 1; 1981, ch. 397, § 1; T.C.A. (orig. ed.), § 53-1301; Acts 1984, ch. 880, §§ 1-3; 1985, ch. 88, §§ 1, 2; 1988, ch. 928, § 4; 1988, ch. 930, § 1; 1992, ch. 805, § 1; 1993, ch. 110, § 1; 1993, ch. 234, § 12; 1994, ch. 747, §§ 4-7; 1995, ch. 244, §§ 2-4; 1995, ch. 369, § 2; 1996, ch. 674, § 2; 1996, ch. 818, §§ 1, 2; 1998, ch. 869, §§ 1-3; 1998, ch. 1021, §§ 1-3; 1999, ch. 489, § 1; 2000, ch. 947, § 6; 2000, ch. 981, § 81; 2000, ch. 985, §§ 1, 2; 2001, ch. 272, §§ 1, 2; 2001, ch. 282, § 10; 2001, ch. 285, § 1; 2001, ch. 438, § 1; 2002, ch. 652, §§ 2-7; 2003, ch. 6, § 1; 2003, ch. 16, § 1; 2003, ch. 18, § 1; 2003, ch. 121, § 2; 2004, ch. 917, § 1; 2005, ch. 56, § 1; 2005, ch. 158, § 1; 2005, ch. 383, § 1; 2007, ch. 20, § 1; 2007, ch. 25, § 1; 2007, ch. 377, §§ 1, 2; 2008, ch. 764, §§ 1, 2; 2008, ch. 769, § 1; 2008, ch. 1190, §§ 21, 22; 2009, ch. 36, §§ 1, 2; 2009, ch. 186, § 50; 2009, ch. 579, § 2; 2010, ch. 1100, §§ 107-109; 2011, ch. 47, § 76; 2011, ch. 158; 2012, ch. 575, §§ 1, 2; 2012, ch. 1086, § 2; 2013, ch. 89, § 1; 2015, ch. 419, § 1; 2016, ch. 984, § 1; 2017, ch. 242, §§ 3, 4.

Compiler's Notes. Acts 2003, ch. 121, § 1 provided that the act shall be known and may be cited as the “Consumer Protection Act for Wheeled Mobility.”

Acts 2005, ch. 383, § 2 provided that nothing in that act shall require an outpatient diagnostic center in existence prior to June 9, 2005, to obtain a certificate of need. Outpatient diagnostic centers in existence prior to June 9, 2005, shall be required to obtain licensure by the department of health and comply with relevant reporting requirements.

Acts 2005, ch. 383, § 3 provided that the commissioner is authorized to promulgate rules and regulations to effectuate the purposes of that act. All such rules and regulations shall be promulgated in accordance with the provisions of the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.

Acts 2008, ch. 1190, § 20 provided that, except as otherwise specified, the commissioner is authorized to promulgate rules and regulations to effectuate the purposes of the act. The rules and regulations shall be promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.

Acts 2008, ch. 1190, § 24 provided that the board for licensing health care facilities is authorized to promulgate rules and regulations pertaining to licensure of assisted-care living facilities as set forth in §§ 68-11-201(4) and (5) and 68-11-213(i)(3), including any changes necessary to ensure the health and safety of assisted-care living facility residents with higher levels of need. The rules and regulations shall be promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.

For the Preamble to the act regarding long-term care, please refer to Acts 2008, ch. 1190.

Acts 2009, ch. 579, § 1 provided that the title of the act is, and may be cited as, the Critical Adult Care Home Act of 2009.

Acts 2010, ch. 1100, § 153 provided that the commissioner of mental health and developmental disabilities, the commissioner of mental health, the commissioner of intellectual and developmental disabilities, and the commissioner of finance and administration are authorized to promulgate rules and regulations to effectuate the purposes of the act. All such rules and regulations shall be promulgated in accordance with the provisions of the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.

Acts 2011, ch. 47, § 107 provided that nothing in the legislation shall be construed to alter or otherwise affect the eligibility for services or the rights or responsibilities of individuals covered by the provision on the day before the date of enactment of this legislation, which was July 1, 2011.

Acts 2011, ch. 47, § 108 provided that the provisions of the act are declared to be remedial in nature and all provisions of the act shall be liberally construed to effectuate its purposes.

Acts 2012, ch. 1086, § 1 provided that the act, which added the definitions of “traumatic brain injury residential home” and “traumatic brain injury residential home provider,” shall be known and may be cited as the “Traumatic Brain Injury Residential Home Act of 2012.”

Acts 2016, ch. 984, § 2 provided that it is the intent of the general assembly that any traumatic brain injury residential home currently operating has until January 1, 2017, to be licensed by the board for licensing healthcare facilities. Any such traumatic brain injury residential home may continue operations prior to being licensed.

Amendments. The 2013 amendment deleted the definition of “council” which read: “ ‘Council’ means, unless otherwise indicated, the state public health council;”.

The 2015 amendment, in the definition of “Ambulatory surgical treatment center”,  deleted “medical or” preceding “surgical procedure is utilized” in the first and third sentences, and rewrote the last sentence, which read:  “Excluded from this definition are the private physicians' and dentists' office practices, except those private physicians' and dentists' offices in which a substantial number of medical or surgical pregnancy terminations are performed”.

The 2016 amendment, in the definition of “Traumatic brain injury residential home”, substituted “facility owned and operated” for “single family residence owned and operated”, and deleted “no more than eight (8)” preceding “disabled adults”.

The 2017 amendment added (C) in the definition of  “home for the aged”; and added the definition of “independent living facility”.

Effective Dates. Acts 2013, ch. 89, § 5. July 1, 2013.

Acts 2015, ch. 419, §  2. July 1, 2015.

Acts 2016, ch. 984 § 3.  April 27, 2016.

Acts 2017, ch. 242, § 5.  May 2, 2017.

Cross-References. Abortion, title 39, ch. 15, part 2.

Access to medical records, § 63-1-117.

Ambulatory surgical care centers terminating pregnancies, licensing, § 68-11-223.

Annual report of hospital statistics, §§ 68-1-108, 68-11-310.

Definitions for mental health, alcohol and drug abuse prevention, and other intellectual and developmental disabilities, § 33-2-402.

Duties of hospital personnel regarding known or suspected child sexual abuse, §§ 37-1-403, 37-1-605.

Parental consent for abortion by minor, title 37, ch. 10, part 3.

Peer review committees, confidentiality of information, § 63-11-220.

Respiratory care practitioners, title 63, ch. 27.

Safeguards for retirement living facilities guaranteeing continued medical care and services, § 4-3-1305.

Attorney General Opinions. Legality of proposed amendment regarding licensure of beds in nursing homes, OAG 96-065 (4/8/96).

Nonresidential methadone treatment facilities, OAG 97-099 (7/1/97).

Home health services and home care organizations, OAG 99-220 (11/4/99).

A pharmacy which holds itself out to the public as providing home medical equipment services is subject to the statutes and rules which require licensure and regulation of free-standing home care organizations providing home medical equipment, OAG 01-150 (9/24/01).

Standards for nursing services in residential hospices.  OAG 10-32, 2010 Tenn. AG LEXIS 32 (3/11/10).

While Public Chapter 419 clearly requires all private physicians' office practices that perform more than fifty surgical abortions annually to obtain a license as an ambulatory surgical treatment center from the Department of Health, such already-existing practices are not also required to obtain a certificate of need for the establishment of an ambulatory surgical treatment center before the July 1, 2015, effective date of the statutory amendments. OAG 15-52, 2015 Tenn. AG LEXIS 52  (6/11/15).

Cited: McLemore v. Elizabethton Med. Investors, Ltd. P'ship, 389 S.W.3d 764, 2012 Tenn. App. LEXIS 415 (Tenn. Ct. App. June 22, 2012).

68-11-202. Licensing and regulation by department — Creation and powers of board — Fire and life safety regulations — Municipal regulatory conflicts — Submission of construction plans to department — Standards for accessibility by handicapped — Use of endoscopy technicians — Radiologic services — Amendment of licensure rules.

1. 1. The department is empowered to license and regulate hospitals, recuperation centers, nursing homes, homes for the aged, residential HIV supportive living facilities, assisted-care living facilities, home care organizations, residential hospices, birthing centers, prescribed child care centers, renal dialysis clinics, ambulatory surgical treatment centers, outpatient diagnostic centers, adult care homes and traumatic brain injury residential homes.
   2. Licensing and regulation shall be accomplished through a board to be created in the manner provided in this part, and such other employees as are provided for in this part.
2. 1. 1. The department has the authority to conduct reviews of all facilities licensed under this part, in order to determine compliance with fire and life safety code regulations as promulgated by the board.
      2. Chapter 102 of this title does not apply to facilities subject to review and licensure under this part.
      3. The board has the power to adopt fire and life safety code regulations to be applied to such facilities.
      4. In adopting the regulations, the board may in its discretion adopt, in whole or in part, by reference, recognized national or regional building and fire safety codes.
      5. Adult care homes and traumatic brain injury residential homes shall meet all state and local building, sanitation, utility and fire code requirements applicable to single family dwellings. The board for licensing health care facilities may adopt in rules more stringent standards as it deems necessary in order to ensure the health and safety, including adequate evacuation of residents consistent with this part. As used in this section “adequate evacuation” means the ability of the adult care home provider, traumatic brain injury residential home provider, resident manager, or substitute caregiver, including such additional minimum staff as may be required by the board in regulation in accordance with this part, to evacuate all residents from the dwelling within five (5) minutes. Adult care home providers and traumatic brain injury residential home providers must install smoke detectors in all resident bedrooms, hallways or access areas that adjoin bedrooms, and common areas where residents congregate, including living or family rooms and kitchens. In addition, in multi-level homes, smoke alarms must be installed at the top of stairways. At least one (1) fire extinguisher with a minimum classification as specified by the board for licensing health care facilities must be in a visible and readily accessible location in each room, including basements, and be checked at least once a year by a qualified entity. Adult care home providers and traumatic brain injury residential home providers shall not place residents who are unable to walk without assistance or who are incapable of independent evacuation in a basement, split-level, second story or other area that does not have an exit at ground level. There must be a second safe means of exit from all sleeping rooms. Providers whose sleeping rooms are above the first floor shall be required to demonstrate an evacuation drill from that room, using the secondary exit, at the time of licensure, renewal, or inspection.
   2. The board, in its evaluation of prospective rules and regulations, shall consider recommendations and professional assessments from the Tennessee society of architects and the Tennessee society of professional engineers.
   3. Should regulations adopted by the board not be consistent with federal regulations for facilities participating in Titles XVIII, compiled in 42 U.S.C. § 1395 et seq., and XIX, compiled in 42 U.S.C. § 1396 et seq., of the Social Security Act, the department shall request appropriate waivers from the federal government for facilities previously deemed in compliance.
   4. Until the board adopts building and fire safety regulations pursuant to this section, the codes and regulations in effect on July 1, 1981, shall be applicable to those facilities licensed under this part. Any facility that complies with the required applicable building and fire safety regulations at the time the board adopts new codes or regulations shall, so long as such compliance is maintained, either with or without waivers of specific provisions, be considered to be in compliance with the requirements of the new codes or regulations.
   5. 1. The commissioner of commerce and insurance or commissioner of health shall review subsequently adopted codes and may recommend to the board for adoption provisions of such codes that the commissioner deems material to the life and fire safety of residents and patients.
      2. Subdivision (b)(5)(A) applies to all appropriate facilities in the respective provider categories, such as nursing homes, hospitals, homes for the aged, residential HIV supportive living facilities, adult care homes, traumatic brain injury residential homes, etc.
   6. This section shall not affect the authority of the state fire marshal regarding the prevention and investigation of fires pursuant to chapter 102 of this title.
   7. The building and life safety regulations adopted by the board shall be the exclusive regulations applicable for those purposes. To the extent that regulations adopted by local governments conflict with the regulations adopted by the board, the board's regulations shall control.
3. 1. When construction is planned by any facility required to be licensed by the department, except home care organizations as defined in § 68-11-201, for any building, additions to an existing building or substantial alterations to an existing building, two (2) sets of plans and specifications shall be submitted to the department to be approved. However, only one (1) set of schematics shall be submitted to the department for approval of plans and specifications converting an existing single family dwelling into:
      1. A licensed residential health care facility with six (6) or fewer beds;
      2. A licensed adult care home with five (5) or fewer residents; and
      3. Traumatic brain injury residential homes with eight (8) or fewer residents.
   2. Before construction is started, approval of the plans and specifications must be obtained from the department with respect to compliance with the minimum standards or regulations, or both, of the board.
   3. The board may determine by regulation specific types of site activity that may be initiated prior to approval.
   4. The plans shall be accurate and shall be detailed plans, containing the information and drafted and submitted in a manner that the board may require by regulation.
   5. The department shall expeditiously process its review of plans that have been submitted in the full and final form required by regulation.
   6. At the request of the owner of the proposed project or the design professional, the department shall make plan review staff available for advice and consultation regarding programmatic concepts and preliminary plans early in the planning process.
   7. The department shall assign adequate numbers of qualified staff to the plan review section, to ensure that a thirty-day review cycle is provided on any submittal.
   8. If, upon final inspection or reinspection of the completed project, the department's representative finds that only minor items remain to be completed or corrected that do not significantly affect the health or safety of the occupants, the department's representative shall permit occupancy pending completion or correction of such items.
4. Any standards adopted by the board regarding accessibility by the handicapped shall be no less strict than those in chapter 120 of this title.
5. This subsection (e) shall establish the criteria for the creation of branch offices by a home care organization operating pursuant to its certificate of need authority or pursuant to its license as of May 11, 1998. Nothing in this subsection (e) shall permit a home care organization to expand its authority beyond the limitations of its certificate of need or its license as of May 11, 1998. Notwithstanding this section to the contrary, the offices of a home care organization providing home health care services shall be classified as either a parent office of the home care organization or as a branch office of the home care organization. In determining whether the office of a home care organization providing home health care services is either a parent home care organization or a branch office, the board shall apply the following criteria:
   1. A parent office shall develop and maintain administrative controls of the branch office and house the administrative functions of the home care organization. The parent office shall be ultimately responsible for human resource activities and all financial and contractual agreements for the home care organization, including both parent and branch offices;
   2. The administrator and director of nursing for the home care organization shall be primarily located in the parent office. The home care organization administrator and director of nursing shall make on-site supervisory visits to each branch office at least quarterly;
   3. A branch office is an office that provides services within the geographical area for which the home care organization is licensed. A branch office must be sufficiently close to share administrative services with the parent office. A branch office shall be deemed to be sufficiently close if it is within one hundred (100) miles of the parent office; provided, that the remaining criteria set forth in this subsection (e) are also applicable. A branch office that is greater than one hundred (100) miles from a parent office may be considered a branch office by the board, if it otherwise meets the criteria set forth in this subsection (e);
   4. The parent office of a home care organization shall have a clearly defined process to ensure that effective interchange occurs between the parent and branch regarding various functions, including branch staffing requirements, branch office patient census, total visits provided by the branch, complaints, incident reports and referrals;
   5. The branch office of a home care organization shall maintain the same name and standards of practice as the parent office of the home care organization, including forms, policies, procedures and service delivery standards. The parent office of a home care organization shall maintain documentation of integration between the parent office and its branch offices;
   6. The parent office of a home care organization shall maintain regular administrative contact with its branch offices at least weekly. Documentation of this contact shall be maintained by the parent office. The parent office shall receive weekly written staffing reports from its branch offices, including, but not limited to, information regarding staffing needs, staffing patterns and staff productivity; and
   7. A branch office of a home care organization existing as of May 11, 1998, that is more than one hundred (100) miles from the parent office of such home care organization and that has been previously approved as a branch office by the board, may continue to be classified as a branch office, if it otherwise meets the criteria set forth in this subsection (e).
6. 1. In a gastrointestinal endoscopy clinic that is regulated as an ambulatory surgical treatment center which performs endoscopic procedures, the use of an endoscopy technician, without other technicians, to assist a physician performing an endoscopic procedure in the clinic shall be deemed to be sufficient staffing for the procedure.
   2. For the purposes of this subsection (f), an endoscopy technician is a person who is trained to function in an assistive role in a gastroenterology setting. An endoscopy technician’s scope of practice includes:
      1. Assisting in data collection to identify the patient's needs, problems, concerns or human responses;
      2. Assisting, under the direction of the gastroenterology registered nurse and physician, in the implementation of the established plan of care;
      3. Assisting the gastroenterology registered nurse and physician before, during, and after diagnostic and therapeutic procedures;
      4. Providing and maintaining a safe environment for the patient and staff by complying with regulatory agency requirements and standards set forth by professional organizations and employers;
      5. Taking responsibility for personal continuing education;
      6. Having knowledge of practice issues related to the field of gastroenterology;
      7. Compliance with ethical, professional and legal standards inherent in patient care and professional conduct;
      8. Participating in quality management activities as directed; and
      9. Collaborating within the gastroenterology team and with other healthcare professionals to ensure quality and continuity of care.
7. 1. An ambulatory surgical treatment center shall provide radiological staff services commensurate with the needs of the center within the facility or by means of other appropriate arrangement.
   2. If radiologic services are utilized by an ambulatory surgical treatment center, the governing body of the center shall appoint an individual who shall be responsible for assuring that all radiologic services are provided in accordance with applicable law and rules. The individual shall be qualified in accordance with state law and the policies of the center.
8. Notwithstanding any law to the contrary, the board shall have the authority to amend its rules for licensure of any board-regulated facility or entity as needed to be consistent with the federal home-based and community-based settings final rule, published in the Federal Register at 79 FR 2947 (January 16, 2014), including the authority to differentiate licensure requirements for any board-regulated facility or entity contracted to provide medicaid-reimbursed home- and community-based services pursuant to title 71, chapter 5, part 14, in order to allow the facility or entity to comply with the federal rule and continue to receive medicaid reimbursement for home- and community-based services. Rules adopted by the board under this subsection (h) shall be developed with input from stakeholders and promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5; provided, however, that the board shall not promulgate emergency rules under this subsection (h) as defined in § 4-5-208. Licensure survey and enforcement shall be conducted in a manner consistent with any rule issued under this subsection (h).

Acts 1947, ch. 13, § 1; C. Supp. 1950, § 5879.2 (Williams, § 4432.1); Acts 1968, ch. 522, § 2; 1971, ch. 225, § 2; 1975, ch. 276, § 2; 1976, ch. 471, § 2; 1981, ch. 397, §§ 2, 4, 5; T.C.A. (orig. ed.), § 53-1302; Acts 1992, ch. 805, § 3; 1993, ch. 234, § 13; 1994, ch. 747, § 5; 1994, ch. 842, § 1; 1996, ch. 674, § 3; 1996, ch. 818, § 3; 1998, ch. 929, § 1; 1998, ch. 1021, § 4; 1999, ch. 353, § 1; 2000, ch. 981, § 82; 2001, ch. 285, § 2; 2001, ch. 438, §§ 2, 3; 2004, ch. 524, § 1; 2004, ch. 917, § 2; 2005, ch. 176, § 1; 2009, ch. 186, §§ 9, 48; 2009, ch. 579, §§ 3-6; 2012, ch. 676, § 1; 2012, ch. 1086, §§ 4-7; 2015, ch. 39, § 1; 2015, ch. 153, §  2.

Compiler's Notes. Acts 1999, ch. 353, § 3 provided that the commissioner of health is authorized to promulgate rules in accordance with the provisions of the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, to provide for the charging of adequate fees to recover the costs to the department of health of implementing the provisions of Acts 1999, ch. 353.

Acts 2001, ch. 438, § 3 purported to amend (c)(1) by adding renal dialysis clinics to the facilities listed in that subdivision; however, Acts 2001, ch. 285, § 2 modified the language intended to be amended and the amendment by Acts 2001, ch. 438 was not implemented. Nevertheless, renal dialysis clinics are included in the facilities covered by the affected subdivision prior to their licensure on July 1, 2002.

Acts 2005, ch. 176, § 2 provided that it is the legislative intent that in making the transition to a branch office system, that the aggregate fees collected by the new system be equal to the fees collected by the old system thus making this legislation budget neutral.

Acts 2009, ch. 579, § 1 provided that the title of the act is, and may be cited as the “Critical Adult Care Home Act of 2009.”

Acts 2012, ch. 1086, § 1 provided that the act, which amended subsections (a)-(c), shall be known and may be cited as the “Traumatic Brain Injury Residential Home Act of 2012.”

Amendments. The 2015 amendment, by ch. 39, added (g).

The 2015 amendment, by ch. 153, added (h).

Effective Dates. Acts 2015, ch. 39, § 2. July 1, 2015.

Acts 2015, ch. 153, § 4. April 16, 2015.

Cross-References. Prevention of HIV transmission, rulemaking authority, § 68-11-222.

Collateral References.

Propriety of, and liability related to, issuance or enforcement of do not resuscitate (DNR) orders. 46 A.L.R.5th 793.

68-11-203. Board for licensing health care facilities.

1. 1. The board shall consist of nineteen (19) members, who shall be appointed by the governor, two (2) of whom shall be graduates of recognized schools of medicine with the degree, doctor of medicine, and shall have an unlimited license to practice medicine in the state of Tennessee; one (1) of whom shall be a dentist who shall be an oral surgeon licensed to practice in Tennessee; one (1) of whom shall be a graduate pharmacist who shall hold a degree in pharmacy from a recognized school of pharmacy and shall be licensed to practice pharmacy in Tennessee; one (1) of whom shall be a registered nurse; two (2) of whom shall be persons engaged in hospital administration of short term acute hospitals; one (1) of whom shall be licensed to practice osteopathic medicine in Tennessee; three (3) of whom shall be representatives of the nursing home industry, and one (1) of the three (3) representatives so appointed shall represent a hospital-operated nursing home; one (1) of whom shall be an architect who is knowledgeable by training or experience in health care facility design or construction; one (1) of whom shall be the operator of a home care organization; one (1) of whom shall be either the operator of a licensed residential home for the aged or a representative of the assisted living industry; one (1) of whom shall be either the operator of an ambulatory surgical treatment center or a representative of the ambulatory surgical treatment center industry; and two (2) of whom shall be consumer members who are not engaged in any health care-related profession, occupation, or field of endeavor. The two (2) remaining members shall be ex officio members, namely the commissioner, or the commissioner's designated representative from the department, and the executive director of the state commission on aging and disability, each of whom shall serve concurrently with the term of each of their respective offices.
   2. The commissioner or the commissioner's designated representative from the department shall be chair of the board.
   3. As the terms of members of the board as at present constituted expire, their successors shall be named, each for a term of four (4) years, except as otherwise provided in this section. The three (3) new members which are added to the board as of April 4, 1968, shall be appointed by the governor as follows: of the representatives of the nursing home industry, one (1) shall be appointed for a term to expire April 1, 1969, and one (1) for a term to expire on April 1, 1970; the new member from the medical profession shall be appointed for a term to expire on April 1, 1971; and all subsequent appointments, including the successors of the three (3) new members shall be for a term of four (4) years. The new member from the osteopathic profession shall be added to the board as of March 1, 1970, and shall be appointed by the governor for a term to expire April 1, 1972; and all subsequent appointments for filling the osteopathic position on the board shall be for a term of four (4) years. The new member from the architectural profession shall be appointed for a term of three (3) years. Alternating appointments shall be made by the governor for the member appointed to represent either the operators of licensed residential homes for the aged or the assisted living industry. Each term shall be four (4) years; provided, that the first such alternating appointment following May 22, 2001, shall be a person to represent the assisted living industry, such appointment to be made following the expiration of the term of the member currently representing operators of licensed residential homes. If any vacancy occurs in the board for any reason other than expiration of term, the appointment shall be for the unexpired term. Any vacancy shall be filled from the same group as was represented by the outgoing member. In making appointments to the board, the governor shall strive to ensure at all times that at least two (2) persons gubernatorially appointed to serve on the board are members of a racial minority or are female, or both, and that at least one (1) person so appointed to serve on the board is at least sixty (60) years of age or older.
2. 1. The board shall meet at least twice each year on dates to be fixed by the commissioner.
   2. In the first of the two (2) annual meetings each year the board shall elect from the members for a period of one (1) year a secretary, who shall keep a record of all meetings.
   3. Special meetings of the board shall be called by the chair of the board, either in the chair's discretion or upon the written request of three (3) members of the board.
   4. Ten (10) members shall constitute a quorum for the transaction of all business.
3. All reimbursement for travel expenses shall be in accordance with the comprehensive travel regulations as promulgated by the department of finance and administration and approved by the attorney general and reporter.
4. The board shall weigh and consider the health care needs of Tennessee's racial minorities and economically disadvantaged whenever the board performs duties or responsibilities assigned by law.

Acts 1947, ch. 13, §§ 3, 4; mod. C. Supp. 1950, §§ 5879.3, 5879.4 (Williams, §§ 4432.3, 4432.4); Acts 1968, ch. 522, §§ 3, 4; 1970, ch. 553, § 1; 1973, ch. 15, § 1; 1974, ch. 495, §§ 2, 3; 1976, ch. 806, § 1(89); T.C.A. (orig. ed.), §§ 53-1303, 53-1304; Acts 1984, ch. 880, § 4; 1986, ch. 898, § 2; 1988, ch. 665, § 1; 1988, ch. 895, §§ 1-3; 1988, ch. 1013, § 62; 1989, ch. 163, §§ 1, 2; 1989, ch. 294, §§ 3, 4; 1990, ch. 1042, § 2; 1992, ch. 976, § 1; 1993, ch. 234, § 20; 1994, ch. 747, § 5; 2001, ch. 283, §§ 1, 2; 2009, ch. 186, §§ 10, 11; 2013, ch. 89, § 2; 2016, ch. 921, § 1.

Compiler's Notes. The board for licensing healthcare facilities, created by this section, terminates June 30, 2023. See §§ 4-29-112, 4-29-244.

Acts 2012, ch. 598, § 3 provided that, in 2013, the comptroller of the treasury shall issue questions and answers to the board regarding surveyors in response to the audit conducted by the centers for medicare and medicaid services.

The term “commission on aging and disability” was substituted for “commission on aging” pursuant to Acts 2001, ch. 397.

Amendments. The 2013 amendment, in (a)(1), substituted “eighteen (18) members” for “nineteen (19) members” near the beginning of the first sentence, and, in the last sentence, substituted “The two (2) remaining members” for “The three (3) remaining members” at the beginning and deleted “the chair of the council,” preceding “and the executive director” near the end.

The 2016 amendment, in the first sentence of (a)(1), substituted “nineteen (19) members” for “eighteen (18) members” near the beginning and inserted “one (1) of whom shall be either the operator of an ambulatory surgical treatment center or a  representative of the ambulatory surgical treatment center industry;” near the end.

Effective Dates. Acts 2013, ch. 89, § 5. July 1, 2013.

Acts 2016, ch. 921, § 2. July 1, 2016.

Collateral References.

Propriety of, and liability related to, issuance or enforcement of do not resuscitate (DNR) orders. 46 A.L.R.5th 793.

68-11-204. Requirement for license — Governmental institutions exempted.

1. 1. No person, partnership, association, corporation or any state, county or local government unit, or any division, department, board or agency of the governmental unit, shall establish, conduct, operate or maintain in this state any hospital, recuperation center, nursing home, home for the aged, residential HIV supportive living facility, assisted-care living facilities, home care organization, residential hospice, birthing center, prescribed child care center, renal dialysis clinic, outpatient diagnostic center, ambulatory surgical treatment center, adult care homes or traumatic brain injury residential homes as defined in this part, without having a license.
   2. State or local government home care organizations may be excluded by the board.
   3. An independent living facility is exempt from the licensure requirements of this part.
2. Any health care facility or local health department operated by the federal government shall be exempt from this part.
3. The board, in its discretion, shall be authorized to issue licenses to several licensees in such form as it may deem necessary to distinguish between and identify any of the facilities required to be licensed by the department.
4. Nothing in this part requires a person or entity providing hospice residential services as of July 1, 1992, to obtain a certificate of need as a residential hospice, if such person or entity, prior to July 1, 1992, had qualified for reimbursement as a hospice under the federal medicare program.

Acts 1947, ch. 13, § 6; C. Supp. 1950, § 5879.5 (Williams, § 4432.6); Acts 1953, ch. 113, § 27; 1968, ch. 552, § 2; 1971, ch. 225, § 3; 1975, ch. 276, § 3; 1976, ch. 471, § 3; T.C.A. (orig. ed.), § 53-1305; Acts 1992, ch. 805, §§ 4, 5; 1993, ch. 234, § 14; 1994, ch. 747, § 5; 1996, ch. 674, § 4; 1996, ch. 818, § 3; 1998, ch. 1021, § 4; 2000, ch. 981, §§ 83, 84; 2001, ch. 285, §§ 3, 4; 2001, ch. 438, §§ 4-6, 18; 2004, ch. 917, § 3; 2009, ch. 186, § 12; 2009, ch. 579, § 7; 2012, ch. 1086, § 8; 2017, ch. 242, § 1.

Compiler's Notes. Acts 1994, ch. 747, § 8 provided that nothing in that act shall require an entity that is licensed as a home health agency prior to July 1, 1994, to obtain a certificate of need in order to provide services; provided, that such entity may not provide hospice services until it has been authorized to do so by the board for licensing health care facilities. Nothing in that act shall require an entity that has been certified by medicare as a hospice prior to July 1, 1994, to obtain a certificate of need in order to become licensed as a home care organization authorized only to provide hospice services.

Acts 2001, ch. 438, §§ 5 and 6 purported to amend (b) and (c), respectively, by adding renal dialysis clinics to the facilities listed in those subsections; however, Acts 2001, ch. 285, §§ 3 and 4, respectively, modified the language intended to be amended and the amendment by Acts 2001, ch. 438 was not implemented. Nevertheless, renal dialysis clinics are included in the facilities covered by the affected subsections prior to their licensure on July 1, 2002.

Acts 2009, ch. 579, § 1 provided that the title of the act is, and may be cited as the “Critical Adult Care Home Act of 2009.”

Acts 2012, ch. 1086, § 1 provided that the act, which amended subdivision (a)(1) shall be known and may be cited as the “Traumatic Brain Injury Residential Home Act of 2012.”

Amendments. The 2017 amendment added (a)(3).

Effective Dates. Acts 2017, ch. 242, § 5.  May 2, 2017.

Cross-References. Assisted suicide, § 39-13-216.

Attorney General Opinions. A pharmacy which holds itself out to the public as providing home medical equipment services is subject to the statutes and rules which require licensure and regulation of free-standing home care organizations providing home medical equipment, OAG 01-150 (9/24/01).

Cited: Eyring v. Fort Sanders Parkwest Med. Ctr., Inc., 991 S.W.2d 230, 1999 Tenn. LEXIS 247 (Tenn. 1999).

68-11-205. Practice in healing arts or medicine by partnership, person, association or corporation unauthorized.

1. Nothing in this part shall authorize any person, partnership, association, corporation, or any state, county, or local governmental unit, or any division, department, board or agency of the governmental unit, to engage, in any manner, in the practice of the healing arts, or the practice of medicine, as defined by law; provided, that nothing in this section shall prohibit a person, corporation, organization, or other entity from employing a physician to treat only its own employees, the entity's retirees, or dependents of the entity's employees or retirees, in accordance with § 63-6-204.
2. 1. Notwithstanding this section, nothing shall prohibit a hospital licensed under this chapter or an affiliate of a hospital from employing physicians, other than radiologists, anesthesiologists, pathologists, or emergency physicians, licensed under title 63, chapter 6 or 9, subject to the following conditions:
      1. Employing entities shall not restrict or interfere with medically appropriate diagnostic or treatment decisions;
      2. Employing entities shall not restrict or interfere with physician referral decisions, unless:
         1. The physician so employed has agreed in writing to the specific restrictions at the time that the contract is executed;
         2. The restriction does not, in the reasonable medical judgment of the physician, adversely affect the health or welfare of the patient; and
         3. The employing entity discloses any such restrictions to the patient; and
      3. In the event that there is any dispute relating to subdivision (b)(1)(A) or (B), the employing entity shall have the burden of proof.
   2. Employing entities shall not restrict the employed physician's right to practice medicine upon the termination or conclusion of the employment relationship, except as allowed by § 63-6-204(f)(2).
   3. Notwithstanding subdivision (b)(2), in the event that the employment contract with a physician employed independently of a bona fide practice purchase is terminated by the employing entity for reasons other than breach by the employee, any such restrictions shall be void.
   4. In any event, nothing in this section shall prohibit a licensed physician, group of licensed physicians, including, but not limited to, a physicians' professional corporation registered under title 48, chapter 101, from employing physicians.
   5. A hospital affiliate that employs physicians shall not engage in any business other than the employment of physicians, the management of physicians and health care facilities or the ownership of property and facilities used in the provision of health care services. An affiliate of a hospital that employs physicians pursuant to this part shall be subject to the authority of the applicable licensing board under this chapter or title 33, chapter 2, in connection with employment of physicians. Any violation of this subdivision (b)(5) by an affiliate shall subject any hospital, at which the physician has staff privileges, and that controls or is under common control with the affiliate, to the penalties and sanctions applied to hospitals that employ physicians.
   6. No radiologist, anesthesiologist, pathologist, or emergency physician may be employed by a hospital or an affiliate of a hospital and no hospital or an affiliate of a hospital may employ any physician to provide medical services provided by radiologists, anesthesiologists, pathologists, or emergency physicians; provided, that a physician may be employed to provide emergency medical services if the physician is employed to provide other medical services.
   7. Employing entities shall not require, by contract or policy, that as a condition or consequence of employment, written or otherwise, employed physicians relinquish medical staff privileges, or the rights related to medical staff privileges, upon the commencement of, upon any event during the pendency of, or at the termination or conclusion of, the employment relationship. In any event, nothing in this section shall be construed as affecting or negating the ability of an employing hospital to revoke or suspend a physician's staff privileges in accordance with the procedures set forth in the medical staff bylaws. Hospitals shall not substitute physician employment contracts for medical staff privileges. Nonemployed and employed physicians holding staff privileges at a hospital that is an employing entity, or hospitals on which employed physicians hold staff privileges that are affiliates of employing entities, shall enjoy the same privileges, rights and protections with respect to medical staff membership. Employment of a physician shall not affect any other physician's medical staff privileges. Physicians who hold membership on medical staffs at a hospital which is an employing entity, or a hospital on which employed physicians hold staff privileges that are affiliates of employing entities, shall be provided with the rights and protections, including rights of self-governance, afforded by the applicable state licensing board, and, when accredited, the accrediting entity or agency.
   8. If a physician, in connection with a claim for breach of contract or other dispute related to § 63-6-204, establishes in a court of competent jurisdiction, or other forum, including in a peer review action or arbitration proceeding, that the conditions of § 63-6-204 have been violated by the employing entity, the physician shall be entitled to recover the physician's cost of litigation, arbitration, or peer review defense, and a reasonable attorney's fee.
   9. 1. No radiologist, anesthesiologist, pathologist, or emergency physician may be employed by a hospital or an affiliate of a hospital, and no hospital or an affiliate of a hospital may employ any physician to provide services provided by radiologists, anesthesiologists, pathologists, or emergency physicians; provided, that a physician may be employed to provide emergency medical services, if the physician is employed to provide other medical services.
      2. Notwithstanding subdivisions (b)(6) and (9)(A), a radiologist, anesthesiologist or pathologist may be employed by a research hospital, as defined in subdivision (e)(9). The radiologist, anesthesiologist or pathologist shall be employed by the research hospital under the same terms and conditions as other physicians.
   10. Notwithstanding this subsection (b) to the contrary, the general assembly finds that it is unreasonable per se to require a racial minority physician who practices in a county with a racial minority population in excess of twenty percent (20%) to move more than two (2) miles from the physician's primary practice site. Because such a requirement is also harmful to and will adversely affect the public interest and health, nothing in this subsection (b) shall operate to require the physician to move more than two (2) miles from the primary practice site.
   11. Employing entities shall not restrict or interfere with patient referral decisions in a manner that unnecessarily increases the cost to the patient of the medical services provided.
3. 1. Notwithstanding this section, nothing shall prohibit a renal dialysis clinic licensed under this chapter or an affiliate of a renal dialysis clinic from employing physicians, other than radiologists, anesthesiologists, pathologists or emergency physicians licensed under title 63, chapter 6 or 9, subject to the following conditions:
      1. Employing entities shall not restrict or interfere with medically appropriate diagnostic or treatment decisions;
      2. Employing entities shall not restrict or interfere with physician referral decisions, unless:
         1. The physician so employed has agreed in writing to the specific restrictions at the time that the contract is executed;
         2. The restriction does not, in the reasonable medical judgment of the physician, adversely affect the health or welfare of the patient; and
         3. The employing entity discloses the restrictions to the patient; and
      3. In the event that there is any dispute relating to subdivision (c)(1)(A) or (c)(1)(B), the employing entity shall have the burden of proof.
   2. Employing entities shall not restrict the employed physician's right to practice medicine upon the termination or conclusion of the employment relationship, except as allowed by § 63-1-148 or any successor section.
   3. Notwithstanding § 63-1-148 or any successor section, in the event that the employment contract with a physician employed independently of a bona fide practice purchase is terminated by the employing entity for reasons other than breach by employee, the restrictions shall be void.
   4. In any event, nothing in this section shall prohibit a licensed physician, group of licensed physicians, including, but not limited to, a physicians' professional corporation registered under title 48, chapter 101 from employing physicians.
   5. An affiliate of a renal dialysis clinic that employs physicians shall not engage in any business other than the employment of physicians, the management of physicians and health care facilities, the ownership of property and facilities used in the provision of health care services or a tissue bank or organ procurement agency. An affiliate of a renal dialysis clinic that employs physicians pursuant to this part shall be subject to the authority of the applicable licensing board under this chapter in connection with employment of physicians. Any violation of this subdivision (c)(5) by an affiliate shall subject any renal dialysis clinic at which the physician has staff privileges and that controls or is under common control with the affiliate to the penalties and sanctions applied to renal dialysis clinics that employ physicians.
   6. No radiologist, anesthesiologist, pathologist or emergency physician may be employed by a renal dialysis clinic or an affiliate of a renal dialysis clinic and no renal dialysis clinic or an affiliate of a renal dialysis clinic may employ any physician to provide medical services provided by radiologists, anesthesiologists, pathologists or emergency physicians; provided, that a physician may be employed to provide emergency medical services if the physician is employed to provide other medical services.
   7. Employing entities shall not require, by contract or policy, that as a condition or consequence of employment, written or otherwise, employed physicians relinquish staff privileges or the rights related to staff privileges upon the commencement of, upon any event during the pendency of or at the termination or conclusion of the employment relationship. In any event, nothing in this section shall be construed as affecting or negating the ability of an employing renal dialysis clinic to revoke or suspend a physician's staff privileges in accordance with the procedures set forth in the staff bylaws. Renal dialysis clinics shall not substitute physician employment contracts for staff privileges. Nonemployed and employed physicians holding staff privileges at a renal dialysis clinic that is an employing entity or renal dialysis clinics at which employed physicians hold staff privileges that are affiliates of employing entities shall enjoy the same privileges, rights and protections with respect to staff membership. Employment of a physician shall not affect any other physician's staff privileges. Physicians who hold membership on staff at a renal dialysis clinic that is an employing entity or a renal dialysis clinic at which employed physicians hold staff privileges that are affiliates of employing entities shall be provided with the rights and protections, including rights of self-governance, afforded by the applicable state licensing board and, when accredited, the accrediting entity or agency.
   8. If a physician, in connection with a claim for breach of contract or other dispute related to § 63-6-204, establishes in a court of competent jurisdiction or other forum, including in a peer review action or arbitration proceeding, that the conditions of § 63-6-204 have been violated by the employing entity, the physician shall be entitled to recover the physician's cost of litigation, arbitration or peer review defense and a reasonable attorney's fee.
   9. Employing entities shall not restrict or interfere with patient referral decisions in a manner that unnecessarily increases the cost to the patient of the medical services provided.
4. No teaching institution shall be held vicariously liable for any act or omission of an intern, resident or fellow in the course of a training program of a medical school owned or operated by the state of Tennessee, under a legal theory of implied or apparent agency, ostensible agency, or any other theory of vicarious liability except actual agency. In determining whether the intern, resident or fellow was an actual agent of the teaching institution, the fact that the intern, resident or fellow was in the teaching institution and providing treatment or services or otherwise caring for patients and was following the institution's bylaws, rules and regulations, policies, procedures, and protocols is insufficient, standing alone, to prove that the intern, resident or fellow was acting as the institution's actual agent.
5. For purposes of this section, unless the context otherwise requires:
   1. 1. “Affiliate” of a hospital means an entity that directly or indirectly is controlled by, or is under common control with, a hospital licensed under this chapter or title 33, chapter 2. “Affiliate” does not mean, however, a health maintenance organization licensed under title 56, chapter 32;
      2. “Affiliate” of a renal dialysis clinic means an entity that directly or indirectly is controlled by or is under common control with a renal dialysis clinic licensed under this chapter. “Affiliate” does not mean, however, a health maintenance organization licensed under title 56, chapter 32;
   2. “Anesthesiologist” is defined as a physician who has completed a residency in anesthesiology and whose practice is primarily limited to anesthesiology, including, but not limited to, nerve block, pain management, cardiac and respiratory resuscitation, respiratory therapy, management of fluids, electrolyte and metabolic disturbances;
   3. “Emergency physician” is defined as a physician who has completed a residency in emergency medicine, or practiced emergency medicine full time for a three-year period, and whose practice is limited to emergency medicine. “Emergency physician” does not include, however, a physician who has been previously employed to provide non-emergent medical services who, over a period of twelve (12) months or more, becomes a full-time emergency physician and who remains employed by mutual agreement;
   4. 1. “Employing entity” means a hospital licensed under this chapter or title 33, chapter 2, or an affiliate of such an entity that employs one (1) or more physicians. “Employing entity” does not mean, however, a health maintenance organization licensed under title 56, chapter 32;
      2. “Employing entity” for purposes of subsection (c) means a renal dialysis clinic licensed under this chapter or an affiliate of such an entity that employs one (1) or more physicians. “Employing entity” does not mean, however, a health maintenance organization licensed under title 56, chapter 32;
   5. “Intern”, “resident” or “fellow” means any person receiving instruction through, and acting within the scope of, a training program of a medical school owned or operated by the state of Tennessee and who, in such capacity, receives compensation payable by the state of Tennessee and is entitled to individual immunity as an employee of the state of Tennessee pursuant to § 9-8-307(h).
   6. “Pathologist” is defined as a physician who has completed a residency in pathology and whose practice is primarily limited to pathology, including, but not limited to, anatomic and clinical pathology;
   7. “Physician” means a person licensed pursuant to title 63, chapter 6 or 9;
   8. “Radiologist” is defined as a physician who has completed a residency in radiology and whose practice is primarily limited to radiology, including, but not limited to, diagnostic radiology, radiation therapy, and radiation oncology;
   9. “Research hospital” means a hospital at which fifty percent (50%) or more of the inpatients treated during the previous calendar year were treated pursuant to research protocols; and
   10. “Teaching institution” means a hospital or mental health hospital, operating within the scope of an affiliation agreement with any medical school owned or operated by the state of Tennessee, and shall further include, but not be limited to, any sole proprietorship, partnership, corporation, limited liability company, or other public or private entity that owns, controls, or is affiliated with any such institution.
6. 1. Notwithstanding this section or any other law, nothing shall prohibit an employing entity from employing a physician; provided, however, that the employment relationship between the physician and the employing entity is evidenced by a written contract, job description or documentation, containing language which does not restrict the physician from exercising independent medical judgment in diagnosing, referring or treating patients. The employment of physicians authorized by this subsection (f) is subject to the following conditions:
      1. The employed physician must have completed residency training in internal medicine, family medicine, primary care, geriatric medicine or gerontology, or a related medical specialty area, or have become board certified in one (1) of those medical specialties;
      2. An employing entity shall not restrict or interfere with medically appropriate diagnostic, referral or treatment decisions. In the event that there is any dispute relating to this subdivision (f)(1)(B), the employing entity shall have the burden of proof;
      3. An affiliate of a nursing home that employs physicians shall not engage in any business other than the employment of physicians, the management of physicians and healthcare facilities, the ownership of property and facilities used in the provision of healthcare services;
      4. If a physician, in connection with a claim for breach of contract or other dispute related to § 63-6-204, establishes in a court of competent jurisdiction or other forum, including in a peer review action or arbitration proceeding, that the conditions of § 63-6-204 have been violated by the employing entity, the physician shall be entitled to recover the physician's cost of litigation, arbitration or peer review defense and a reasonable attorney's fee;
      5. An employing entity shall not restrict or interfere with patient referral decisions in a manner that unnecessarily increases the cost to the patient of the medical services provided; and
      6. The written contract between an employing entity and the physician, in addition to the other items required by this subsection (f), shall include the name and location of each site where the physician may see patients.
   2. Employing entities shall not restrict the employed physician's right to practice medicine upon the termination or conclusion of the employment relationship, except an employing entity may only restrict the employed physician from entering into another employment relationship with another employing entity; provided, such restriction complies with § 63-1-148.
   3. For purposes of this subsection (f):
      1. “Affiliate” of a nursing home means an entity that, through ownership or management relationship, is directly or indirectly controlled by, or is under common control with, a nursing home;
      2. “Employing entity” means a nursing home, or an affiliate of such a nursing home, that employs one (1) or more physicians. “Employing entity” does not mean, however, a health maintenance organization licensed under title 56, chapter 32;
      3. “Nursing home” means a nursing home licensed as such under this chapter; and
      4. “Referral” or “referring” means a decision by the employed physician to send a patient to another practitioner or specialty program for consultation, service or procedures that the employed physician cannot provide. Referral shall not include sending a patient for consultation, service or procedures that are available within the facility, unless, in the medical judgment of the employed physician, the patient would be better served by a practitioner or specialty program not employed by or contracted to the employing entity.

Acts 1947, ch. 13, § 7; C. Supp. 1950, § 5879.6 (Williams, § 4432.7); T.C.A. (orig. ed.), § 53-1306; Acts 1995, ch. 200, § 2; 1995, ch. 466, § 3; 1996, ch. 986, §§ 1, 4; 2004, ch. 944, §§ 1, 2; 2009, ch. 70, §§ 2-4; 2012, ch. 649, § 1; 2012, ch. 761, §§ 1, 2.

Compiler's Notes. Acts 2004, ch. 944, § 3 provided that the act shall apply to all causes of actions arising on or after July 1, 2004.

Cross-References. Practice of medicine, § 63-6-204.

Attorney General Opinions. Provision of medical services by a certified nurse practitioner, registered nurse, advanced practice nurse, licensed practical nurse or physician assistant, OAG 07-116 (8/8/07).

There is no state or federal constitutional right to be employed. T.C.A. § 68-11-205(b)(6) and § 68-11-205(b)(9)(A)  do not prevent radiologists, anesthesiologists, pathologists, or emergency physicians from providing their services to patients at hospitals as independent contractors, but they have no constitutional right to be employees of any hospital. OAG 18-39, 2018 Tenn. AG LEXIS 38 (8/17/2018).

68-11-206. Application for license — Form of contents — Procedure — Term of license — Renewal — Inactive status.

1. Any person, partnership, association, corporation, any state, county or local governmental unit, or any division, department, board or agency of the governmental unit, in order to lawfully establish, conduct, operate or maintain a hospital, recuperation center, nursing home, home for the aged, residential HIV supportive living facility, assisted-care living facility, home care organization, residential hospice, birthing center, prescribed child care center, renal dialysis clinic, outpatient diagnostic center, ambulatory surgical treatment center, adult care home or traumatic brain injury residential homes in this state, shall obtain a license from the department, upon the approval and recommendation of the board in the following manner:
   1. The applicant shall submit an application on a form to be prepared by the department with the approval of the board, showing that the applicant is of reputable and responsible character and able to comply with the minimum standards for a facility and with rules and regulations lawfully promulgated under this part. The application shall contain the following additional information:
      1. The name or names of the applicant or applicants;
      2. The type of institution to be operated;
      3. The location of the institution;
      4. The name of the person or persons to be in charge of the institution or, for adult care home applicants, the name of the resident manager, if applicable;
      5. A certification that the applicant has implemented a policy of informing its employees of their obligations under § 71-6-103 to report incidents of abuse or neglect;
      6. If an application for a nursing home license, a list of all nursing homes that the applicant, or any person or entity holding a majority legal or equitable interest in the applicant, owns or operates and, if the applicant has not operated a nursing home in this state for a continuous period of twenty-four (24) months preceding the application, the information specified in § 68-11-804(c)(1) for each such nursing home located outside this state; and
      7. Such other information as the department, with the approval of the board, may require;
   2. 1. In addition to the requirements in subdivision (a)(1), an application for an adult care home or traumatic brain injury residential home license shall include the following additional information:
         1. The maximum number of residents;
         2. Type of license;
         3. If any residents are family members of the applicant;
         4. Names and locations of all other facilities in and outside this state for which the applicant has any license and the compliance history of each facility, including penalties, suspensions or other disciplinary actions;
         5. The extent to which a resident manager, substitute caregivers and other staff will be used in the facility;
         6. A list of any unsatisfied judgments;
         7. Past or pending litigation against the applicant;
         8. Unpaid local, state and federal taxes;
         9. Notification regarding any bankruptcy filings made by the applicant;
         10. Demonstration of the applicant's financial ability to maintain sufficient financial resources to support the operating costs of the adult care home or traumatic brain injury residential home; and
         11. A comprehensive business plan for the first two (2) years of operation;
      2. The board shall promulgate regulations specifying additional financial requirements, such as bonds or liability insurance;
      3. An adult care home provider shall obtain a separate license for each adult care home. An adult care home provider may, upon operation of a licensed adult care home for a minimum period of one (1) year and completion of an annual licensure survey without any findings of noncompliance resulting in penalties, suspensions or other disciplinary actions, submit application to separately license a second adult care home. Only upon operation of two (2) licensed adult care homes for a consecutive period of at least one (1) year, licensure survey in each facility without any findings of noncompliance resulting in penalties, suspensions or other disciplinary actions, may an adult care home provider submit application to separately license additional adult care homes. The board may grant an exception to the one-at-a-time license requirement for Level 2 adult care homes for nursing facilities, assisted-care living facilities and other providers when such nursing facility, assisted-care living facility or provider has demonstrated expertise in delivering the specialized services necessary to the specified population that would be served by the licensed adult care homes. The board may establish in regulations a limit on the total number of adult care homes that can be operated by a single adult care home provider;
      4. A Level 2 license allows an adult care home provider to serve adults requiring specialized services. As used in this section, “specialized services” means services provided to ventilator dependent residents and residents with a traumatic brain injury as defined in § 68-55-101. The applicant shall specify the type of license sought as a part of its application. The board shall promulgate regulations specifying additional requirements for a Level 2 license;
      5. A license authorized by this part allows a traumatic brain injury residential home provider to serve disabled adults suffering from the effects of a traumatic brain injury as defined in § 68-55-101. A traumatic brain injury residential home provider shall not be required to obtain a Level 2 or any other licensure, other than a license to operate its day services through a separate facility licensed by this state. The board shall promulgate regulations specifying additional requirements for traumatic brain injury residential home licensure consistent with this part;
   3. At a minimum, Level 2 adult care home providers serving ventilator-dependent residents shall meet all of the following requirements:
      1. Have an audible, redundant alarm system located outside of resident’s room to alert the adult care home provider or resident manager of a resident disconnection or ventilator failure;
      2. Have a functioning emergency back-up generator adequate to maintain electrical service for residents’ needs until regular service is restored;
      3. All ventilators shall be equipped with internal battery backup systems;
      4. A backup ventilator shall be available at all times;
   4. The board shall promulgate in regulation additional licensure requirements that define appropriate health and safety standards necessary to protect the health and welfare of residents. Specific elements to be addressed include, but are not limited to:
      1. Facility and building standards;
      2. Minimum size and number of bedrooms and bathrooms;
      3. Number of residents to a bedroom and a bathroom;
      4. Sanitation;
      5. Hazardous waste disposal;
      6. Disaster preparedness;
      7. Medication administration and storage; and
      8. Resident record requirements;
   5. 1. The board shall maintain current information on all licensed adult care home providers. The information shall include:
         1. Name, location and mailing address of the facility;
         2. Description of the facility;
         3. Date of last inspection;
         4. Penalties;
         5. Suspensions; and
         6. Other disciplinary actions;
      2. The information shall be made available upon request to a prospective resident, resident, or family member;
   6. If the board determines that a license for any facility will not be granted, it shall so notify the applicant. The decision of the board shall be final;
   7. If the board finds that the applicant complies with this part and the rules and regulations promulgated under this part, then the board shall recommend and approve the issuance of a license, and thereupon a license shall be issued by the department licensing the applicant to operate the facility for the remainder of the fiscal year; and
   8. Each license to operate a facility shall expire annually on the anniversary date of its original issuance and shall become invalid on that date unless renewed. A licensee may renew its license within sixty (60) days following the license expiration date upon payment of the renewal fee in addition to a late penalty established by the board for each month or fraction of a month that payment for renewal is late; provided, that the late penalty shall not exceed twice the renewal fee. If a licensee fails to renew its license within sixty (60) days following the license expiration date, then the licensee shall reapply for licensure in accordance with the rules established by the board. However, during the transition period, renewed licenses may be issued at prorated monthly renewal fee rates for terms of no less than five (5) months nor more than eighteen (18) months. A license shall not be assignable or transferable, shall be issued only for the premises named in the application, shall be posted in a conspicuous place in the facility, and may be renewed from year to year.
2. 1. Upon request by a licensee, the board shall have authority to place a license in an inactive status for a period determined by the board upon a finding that:
      1. The licensee has a need to temporarily suspend operations; and
      2. The licensee intends to continue operations after a period of suspension.
   2. Placing a license in an inactive status shall not relieve the licensee from the annual license fees imposed by § 68-11-216.
3. Any condition placed on the issuance of a certificate of need pursuant to § 68-11-1605 shall be deemed a condition on any subsequently issued license under this section.

Acts 1947, ch. 13, § 8; C. Supp. 1950, § 5879.7 (Williams, § 4432.8); Acts 1968, ch. 522, § 2; 1971, ch. 225, § 4; 1974, ch. 495, §§ 4, 5; 1975, ch. 276, §§ 4-7; 1976, ch. 471, §§ 4-7; T.C.A. (orig. ed.), § 53-1307; Acts 1987, ch. 312, § 7; 1992, ch. 805, § 4; 1993, ch. 234, § 15; 1994, ch. 747, § 5; 1996, ch. 674, § 5; 1996, ch. 818, § 3; 1998, ch. 1021, § 4; 2000, ch. 616, § 1; 2000, ch. 981, § 85; 2001, ch. 285, §§ 5-7; 2001, ch. 438, §§ 7-10; 2004, ch. 917, § 4; 2008, ch. 846, § 1; 2009, ch. 186, § 13; 2009, ch. 327, § 1; 2009, ch. 579, § 8; 2012, ch. 635, § 1; 2012, ch. 1086, §§ 9-11.

Compiler's Notes. Acts 2001, ch. 438, §§ 8-10 purported to amend (a)(1), (4) and (5), respectively, by adding renal dialysis clinics to the facilities listed in those subdivisions; however, Acts 2001, ch. 285, §§ 5-7, respectively, modified the language intended to be amended and the amendment by Acts 2001, ch. 438 was not implemented. Nevertheless, renal dialysis clinics are included in the facilities covered by the affected subsections prior to their licensure on July 1, 2002.

Acts 2009, ch. 579, § 1 provided that the title of the act is, and may be cited as the “Critical Adult Care Home Act of 2009.”

Acts 2012, ch. 1086, § 1 provided that the act, which amended subsection (a), shall be known and may be cited as the “Traumatic Brain Injury Residential Home Act of 2012.”

Attorney General Opinions. Status of ambulatory surgical treatment center license after closure, OAG 00-063 (4/3/00).

68-11-207. Suspension or revocation of license — Grounds — Procedure — Probation.

1. The board may suspend or revoke the license issued under this part on any of the following grounds:
   1. A violation of this part or of the rules and regulations or minimum standards issued pursuant to this part, or, in the event of a nursing home that has entered into an agreement with the department to furnish services under Title XVIII or XIX of the Social Security Act, compiled in 42 U.S.C. § 1395 et seq. and 42 U.S.C. § 1396 et seq., respectively, any of the requirements for participation in the medical assistance program set out in title 42 of the Code of Federal Regulations, to such an extent that the board considers the licensee a chronic violator;
   2. Permitting, aiding or abetting the commission of any illegal act in such institutions; or
   3. Conduct or practice found by the board to be detrimental to the welfare of the patients in such institutions.
2. [Deleted by 2018 amendment.]
3. In imposing the sanctions authorized in this section, the board may consider all factors that it deems relevant, including, but not limited to, the following:
   1. The degree of sanctions necessary to ensure immediate and continued compliance;
   2. The character and degree of impact of the violation on the health, safety and welfare of the patients in the facility;
   3. The conduct of the facility against whom the notice of violation is issued in taking all feasible steps or procedures necessary or appropriate to comply or correct the violation; and
   4. Any prior violations by the facility of statutes, regulations or orders of the board.
4. The board may, in its discretion, after the hearing, hold the case under advisement and make a recommendation as to requirements to be met by the facility in order to avoid either suspension or revocation of license or suspension of admissions.
5. The board shall promulgate regulations defining the sanction structure and associated penalties.
6. 1. In addition to the authority granted in subsections (a)-(e) and in § 68-11-252, the board shall have the authority to place a facility on probation. In the case of a nursing facility, to be considered for probation, a nursing facility must have had at least two (2) separate substantiated complaint investigation surveys within six (6) months, where each survey had at least one (1) deficiency cited at the level of substandard quality of care or immediate jeopardy, as those terms are defined at 42 CFR 488.301. None of the surveys may have been initiated by an unusual event or incident self-reported by the nursing facility.
   2. If a facility meets the criteria for a violation pursuant to regulations established by the board or, in the case of a nursing facility, meets the criteria pursuant to subdivision (f)(1), the board may hold a hearing at its next regularly scheduled meeting to determine if the facility should be placed on probation. Prior to initiating the hearing, the board shall provide notice to the facility detailing what specific noncompliance the board has identified that the facility must respond to at the probation hearing.
   3. Prior to imposing probation, the board may consider and address in its findings all factors that it deems relevant, including, but not limited to, the following:
      1. What degree of sanctions is necessary to ensure immediate and continued compliance;
      2. Whether the noncompliance was an unintentional error or omission, or was not fully within the control of the facility;
      3. Whether the facility recognized the noncompliance and took steps to correct the identified issues, including whether the facility notified the department of the noncompliance, either voluntarily or as required by state law or regulations;
      4. The character and degree of impact of the noncompliance on the health, safety and welfare of the patient or patients in the facility;
      5. The conduct of the facility in taking all feasible steps or procedures necessary or appropriate to comply or correct the noncompliance; and
      6. The facility's prior history of compliance or noncompliance.
   4. If the board places a facility on probation, the facility shall detail in a plan of correction those specific actions that, when followed, will correct the noncompliance identified by the board.
   5. During the period of probation, the facility shall make reports on a schedule determined by the board. These reports shall demonstrate and explain to the board how the facility is implementing the actions identified in its plan of correction. In making such reports, the board shall not require the facility to disclose any information protected as privileged or confidential under any state or federal law or regulation.
   6. The board is authorized at any time during the probation to remove the probational status of the facility's license, based on information presented to it showing that the conditions identified by the board have been corrected and are reasonably likely to remain corrected.
   7. The board shall rescind the probational status of the facility, if it determines that the facility has complied with its plan of correction as submitted and approved by the board, unless the facility has additional noncompliance that warrants an additional term of probation.
   8. A single period of probation for a facility shall not extend beyond twelve (12) months. If the board determines during or at the end of the probation that the facility is not taking steps to correct noncompliance or otherwise not responding in good faith pursuant to the plan of correction, the board may take any additional action as authorized by law.
7. The hearing to place a facility on probation and judicial review of the board's decision shall be in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
8. This section in no way relieves any party from the responsibility to report suspected adult abuse, neglect or exploitation to, or to share information with, the adult protective services program in accordance with the Tennessee Adult Protection Act, compiled in title 71, chapter 6, part 1.
9. After determinations of violations have been made that are subsequent to any complaint investigation survey that could lead to a suspension or revocation of the license of a nursing home or the loss of federal funds relating to any agreement to furnish services by a nursing home under Title XVIII, compiled in 42 U.S.C. § 1395 et seq. or Title XIX, compiled in 42 U.S.C. § 1396 et seq., of the Social Security Act, and unless the immediate protection of the health and safety of the residents of a nursing home requires otherwise, the department shall seek to provide, if practicable, a period of up to thirty (30) days for further fact finding relative to violations and their correction before any findings that would require the suspension or revocation of license or the loss of federal funds.
10. 1. Homes for the aged, traumatic brain injury residential homes, assisted care living facilities, and adult care homes shall inform residents verbally and in writing of their right to file a complaint with the state at any time, the process for filing a complaint, and contact information for filing a complaint. The facility shall also advise residents of the availability of a long-term care ombudsman and how to contact the ombudsman for assistance. Verbal and written communication to the resident must indicate, at a minimum, that complaints regarding suspected adult abuse, neglect, or exploitation must be reported to the adult protective services program. Complaints regarding licensure must be reported to the board. All other complaints must be reported to the appropriate state designated oversight entity. Complaints received by a home for the aged, traumatic brain injury residential home, assisted care living facility, or adult care home provider regarding suspected adult abuse, neglect, exploitation, or misappropriation must be forwarded to the appropriate state oversight entity.
    2. A facility licensed pursuant to this part shall not prohibit or discourage the filing of complaints or use intimidation against any person filing a complaint.
    3. A facility licensed pursuant to this part shall not retaliate against the resident or the person acting on behalf of the resident in any way. Such nonpermissible actions include, but are not limited to:
       1. Increasing charges;
       2. Decreasing services, rights, or privileges;
       3. Taking or threatening to take any action to coerce or compel the resident to leave the facility; or
       4. Harassing, abusing, or threatening to harass or abuse a resident in any manner.
    4. Persons acting in good faith in filing a complaint are immune from any liability, civil or criminal.
    5. A facility licensed pursuant to this part shall place a resident manager, substitute caregiver, or employee against whom an allegation of abuse, neglect, or exploitation has been made on administrative leave of absence until the investigation is complete.
    6. Investigations must be completed by the appropriate state oversight entity within time frames established in applicable statutes or regulations, or as expeditiously as necessary to ensure the health, safety, and welfare of residents.
    7. Board administrative staff shall maintain a file of reported complaints. The file must include the name of the facility against whom the complaint is filed, the date the complaint is filed, the action taken by the board, if any, on the complaint, and the date of the action taken.

Acts 1947, ch. 13, § 9; C. Supp. 1950, § 5879.8 (Williams, § 4432.9); Acts 1968, ch. 522, § 2; modified; Acts 1975, ch. 276, § 8; 1976, ch. 471, § 8; 1980, ch. 854, § 1; 1981, ch. 129, § 1; T.C.A. (orig. ed.), § 53-1308; Acts 1984, ch. 880, § 5; 1987, ch. 312, § 9; 2003, ch. 169, § 3; 2008, ch. 840, § 1; 2008, ch. 886, § 1; 2009, ch. 579, § 9; 2012, ch. 1086, § 12; 2018, ch. 655, §§ 1, 3, 9.

Compiler's Notes. Acts 2003, ch. 169, § 1 provided that the act shall be known and may be cited as the “Nursing Home Compassion, Accountability, Respect and Enforcement Reform Act.”

Acts 2009, ch. 579, § 1 provided that the title of the act is, and may be cited as the “Critical Adult Care Home Act of 2009.”

Acts 2012, ch. 1086, § 1 provided that the act, which amended subsections (b) and (j), shall be known and may be cited as the “Traumatic Brain Injury Residential Home Act of 2012.”

Amendments. The 2018 amendment deleted former (b) which read: “(b)(1)  In those cases where the conditions of any nursing home, home for the aged, traumatic brain injury residential home or adult care home are, or are likely to be, detrimental to the health, safety or welfare of the patient or resident, the commissioner has the authority to suspend the admission of any new patients or residents to the facility pending a prompt hearing before the board, or an administrative judge if the board cannot be convened promptly.“(2)  The commissioner is authorized, at any time prior to a hearing, based on information presented to the commissioner showing that such conditions have been and will continue to remain corrected, to revoke the suspension of admissions.“(3)  Whenever the commissioner suspends the admission of any new patients, the commissioner shall detail, in a notice to the facility, the specific violations causing the suspension.“(4)  Notice shall detail what conditions are considered detrimental to the health, safety or welfare of the patients and an explanation of the specific time frame when and conditions under which the facility can reasonably expect the suspension to be lifted.“(5)  Within ten (10) days of receiving this notice or lesser time frame when deemed necessary by the board to ensure the health, safety and welfare of adult care home or traumatic brain injury residential home residents, an adult care home provider or a traumatic brain injury residential home provider shall submit a corrective action plan to the board delineating the measures to be taken to address violations and associated time frames. If it is deemed by the board to be necessary to ensure the health, safety and welfare of adult care home or traumatic brain injury residential home residents, the commissioner may require the adult care home provider or traumatic brain injury residential home provider to take all necessary actions to correct violations immediately.“(6)  If the facility complies with these conditions, the commissioner shall lift the suspension within the time frame, unless other conditions exist that warrant an additional suspension or continuation of the suspension. The board has the authority to:“(A)  Continue, revoke or modify the suspension of admissions;“(B)  Revoke, suspend or condition the license of the facility; and“(C)  Enter such other orders as it deems necessary.“(7)  Unless the immediate protection of the health, safety or welfare of residents of a nursing home requires otherwise, the commissioner, after ordering a suspension of admissions to a nursing home pursuant to this section, shall provide notice of the suspension as soon as practicable to the members of the senate and house of representatives of the general assembly in whose district the nursing home is located.”; inserted “and in § 68-11-252” in the first sentence of (f)(1); and rewrote (j) which read: “(j)(1)  The adult care home provider or traumatic brain injury residential home provider shall inform residents verbally and in writing of their right to file a complaint with the state at any time, the process for filing a complaint and contact information for filing a complaint. The facility shall also advise residents of the availability of a long-term care ombudsman, and how to contact the ombudsman for assistance. Verbal and written communication to the resident shall indicate, at a minimum, that complaints regarding suspected adult abuse, neglect or exploitation shall be reported to the adult protective services program. Complaints regarding licensure shall be reported to the board. All other complaints shall be reported to the appropriate state designated oversight entity. Complaints received by the adult care home provider or traumatic brain injury residential home provider shall be forwarded to the appropriate state oversight entity.“(2)  The adult care home provider or traumatic brain injury residential home provider shall not prohibit or discourage the filing of complaints or use intimidation against any person filing a complaint.“(3)  The adult care home provider or traumatic brain injury residential home provider may not retaliate against the resident or the person acting on behalf of the resident in any way. Such nonpermissible actions include, but are not limited to:“(A)  Increasing charges;“(B)  Decreasing services, rights or privileges;“(C)  Taking or threatening to take any action to coerce or compel the resident to leave the facility; or“(D)  Abusing or threatening to harass or abuse a resident in any manner.“(4)  Persons acting in good faith in filing a complaint are immune from any liability, civil or criminal.“(5)  An adult care home provider or traumatic brain injury residential home provider shall place a resident manager, substitute caregiver or employee against whom an allegation of abuse, neglect or exploitation has been made on administrative leave of absence until the investigation is complete.“(6)  Investigations shall be completed by the appropriate state oversight entity within time frames established in applicable statutes or regulations, or as expeditiously as necessary to ensure the health, safety and welfare of adult care home or traumatic brain injury residential home residents.“(7)  Investigation findings shall be reported to the board in an anonymous probable cause presentation for the purpose of determining the appropriate discipline. Once this determination is made by the board, the adult care home provider or traumatic brain injury residential home provider shall be informed by written correspondence. The complainant shall also be advised of the complaint's resolution.“(8)  The board shall maintain a file of reported complaints. The file shall include the name of the adult care home provider or traumatic brain injury residential home provider against whom the complaint is filed, the date the complaint is filed, the action taken by the board on the complaint and date of action taken.”

Effective Dates. Acts 2018, ch. 655, § 15. July 1, 2018.

Cross-References. Confidentiality of public records, § 10-7-504.

Exercise of nursing home enforcement powers by commissioner of mental health, § 68-11-830.

Suspension or revocation of hospital's licenses for inpatient transfer violations, § 68-11-704.

Law Reviews.

Respecting Our Elders: Can Tennessee Do More to Protect its Elder Population from Institutional Abuse and Neglect?, 66 Tenn. L. Rev. 819 (1999).

Cited: McLemore v. Elizabethton Med. Investors, Ltd. P'ship, 389 S.W.3d 764, 2012 Tenn. App. LEXIS 415 (Tenn. Ct. App. June 22, 2012).

68-11-208. Hearings before board — Judicial review.

1. Any licensee, or applicant for license, aggrieved by a decision or action of the department or board, pursuant to this part, may request a hearing before the board.
2. These proceedings and judicial review of the board's decision shall be in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.

Acts 1947, ch. 13, § 10; C. Supp. 1950, § 5879.9 (Williams, § 4432.10); Acts 1968, ch. 522, § 2; 1971, ch. 225, § 5; 1975, ch. 276, § 9; 1976, ch. 471, § 9; 1981, ch. 397, § 3; T.C.A. (orig. ed.), § 53-1309.

68-11-209. Rules and regulations governing operation — Adoption by board — Waiver — Certification of administrator — Rules governing training and testing of nursing assistants — Outpatient services off main campus — Compliance with board rules.

1. 1. The board has the duty and power to adopt such rules and regulations pertaining to the operation and management of any facilities required to be licensed under this part, and to rescind, amend or modify such rules and regulations from time to time, as are necessary in the public interest and particularly for the establishment and maintenance of standards of hospitalization required for the efficient care of patients or home for the aged, residential HIV supportive living facility,  assisted-care living facility, adult care home residents, or traumatic brain injury residential home residents.
   2. For renal dialysis clinics, any rules promulgated after July 1, 2001, but before January 1, 2004, shall not be implemented until January 1, 2004. In addition to any filing or hearing required by the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, regarding such initial rules for renal dialysis clinics, the department shall file a notice of proposed rulemaking concerning such rules promulgated pursuant to this section with the health committee of the house of representatives and the health and welfare committee of the senate, at least thirty (30) days prior to the filing of such rules with the secretary of state pursuant to the Uniform Administrative Procedures Act. The department shall present the substance of such rules in hearings before the previously named committees before the hearing of the rules by the government operations committee. No rule may be filed with the secretary of state, unless the department has complied with this section.
2. The board has the power to waive any of the rules and regulations pertaining to any health care facility covered within the scope of this part, where such waiver would not have a detrimental effect on the health, safety and welfare of the public.
3. 1. The board shall prescribe, by rules and regulations adopted by the board, the minimum standards as to equipment and provision for the care of patients or home for the aged, residential HIV supportive living facility, assisted-care living facility, adult care home residents, or traumatic brain injury residential home residents to which an institution must conform in order to operate lawfully as any facilities required to be licensed under this part.
   2. The board shall assess, in writing, the fiscal impact on licensed nursing homes relating to the adoption, repeal or amendment of any rule or minimum standard as to equipment or operating procedure. The cost necessary to bring a facility into compliance with such a directive by the board shall be made available to the comptroller of the treasury as a component of allowable cost in accordance with medicare reimbursement principles. Such costs, however, shall be subject to all reimbursement limits and procedures specified in statute and state regulations for the reimbursement of nursing home services.
4. 1. Any person who wishes to serve as the chief administrator of a licensed residential or institutional home for the aged, residential HIV supportive living facility, or assisted-care living facility shall first be certified by the board as a residential/institutional home administrator. This subsection (d) shall not apply to any individual licensed as a nursing home administrator pursuant to title 63, chapter 16. To be certified as a residential/institutional home administrator, a person must be a high school graduate or the holder of a general equivalence diploma; provided, that this requirement shall not apply to a person who served as the chief administrator of a licensed residential home for the aged, residential HIV supportive living facility, or assisted-care living facility during any continuous period of at least nine (9) months' duration preceding January 1, 1990, or who served as the chief administrator of a licensed institutional home for the aged, residential HIV supportive living facility, or assisted-care living facility during any continuous period of at least nine (9) months' duration preceding January 1, 1992. Certification shall not be issued, maintained, or renewed for any person convicted of a criminal offense involving the abuse or intentional neglect of an elderly or vulnerable individual. As a requisite for biennial renewal of certification, a person shall submit written proof of attendance during at least twenty-four (24) classroom hours of continuing education courses approved by the board and designed to enhance or reinforce the skills, knowledge and competence required of residential and institutional home administrators.
   2. The twenty-four (24) hours of continuing education courses required by subdivision (d)(1) shall include:
      1. State rules and regulations for homes for the aged;
      2. Health care management;
      3. Nutrition and food service;
      4. Financial management; and
      5. Health lifestyles.
   3. Persons conducting continuing education courses pursuant to this subsection (d) shall be subject to the following:
      1. A program offered for credit must be related to the operations of the homes for the aged, the activities of daily living of the residents, or other pertinent information deemed appropriate to the quality of life for residents; and
      2. All curricula pertaining to the educational courses and the names of the instructors must be submitted to the board for approval prior to offering any course to administrators.
   4. In accordance with the Uniform Administrative Procedures Act, the board shall promulgate such rules as shall be necessary to implement this subsection (d) in an orderly and efficient manner; provided, that such rules shall not, as a requisite for certification or recertification, impose any substantive requirements in addition to those set forth in this subsection (d). The rules shall establish fees for initial certification and for biennial renewal of certification. The fees shall be set in an amount sufficient to pay all expenses incurred by the board in implementing this subsection (d).
5. 1. Pursuant to the authority granted in subsection (a), the board, in consultation with the Tennessee Health Care Association, shall promulgate rules for the training and testing of nursing assistants in nursing homes that:
      1. Require annual publishing of testing schedules and sites;
      2. Require that test sites be located so that no individual seeking to take the test has to drive any farther than thirty (30) miles to reach a test site;
      3. Require tests to be held as scheduled regardless of the number of individuals scheduled for the test, unless no individuals are scheduled at a particular test site;
      4. Require publishing of the number of individuals passing and failing each test;
      5. Establish a minimum passing grade for the examination; and
      6. Establish a seventy-five-hour training program.
   2. Nothing in this subsection (e) is to be construed to alter or impede nursing assistant training and testing programs already in place pending the implementation of the rules described in subdivision (e)(1).
   3. Any existing committee charged with developing the nursing assistant test shall include at least three (3) representatives of the nursing home industry with an education or nursing background and nominated by the Tennessee Health Care Association.
   4. Nursing assistant testing may, at the nursing assistant's option, be conducted at the facility in which the nursing assistant is or will be employed, unless the facility has had its nursing assistant training program withdrawn pursuant to state or federal regulations. The testing of nurse assistants may be proctored by facility personnel, as long as such testing is secure from tampering, is standardized and is scored by a testing, educational or other organization approved by the board. Such testing shall require no scoring by facility personnel. The board shall revoke a facility's right to proctor such testing in any situation in which the board finds evidence of tampering by facility staff. For purposes of this subdivision (e)(4), “proctor” means supervision of an examination or test.
6. Notwithstanding any rules and regulations of the board, a hospital may provide outpatient diagnostic and therapeutic services at locations other than the hospital's main campus without obtaining a waiver from the board; provided, that such other locations are under the sole control of the hospital.
7. Notwithstanding any rule adopted by the board or any other provisions of this chapter, a hospital that satisfies the standards established by the joint commission on accreditation of health care organizations relative to the timely completion of medical records shall be deemed to comply with the rules of the board relative to the timely completion of medical records.
8. 1. The board shall promulgate in regulations requirements for education, experience and training, continuous education, background check and abuse registry checks for Level 2 adult care home providers and traumatic brain injury residential home providers, resident managers, substitute caregivers and staff. These requirements shall be commensurate with the expected responsibilities and care of residents in each applicable setting, and shall be dependent upon the level of licensure. The education, experience and requirements for Level 2 adult care home providers and traumatic brain injury residential home providers shall be sufficient to demonstrate competency in caring for residents and the ability to adequately maintain the health, safety and welfare of residents. The board shall develop additional standards for Level 2 adult care home providers and traumatic brain injury residential home providers that require education, training and experience necessary to adequately address the needs of persons with traumatic brain injury or ventilator dependent persons.
   2. The rules required under subdivision (h)(1) shall include, but not be limited to, the following:
      1. A resident manager for a Level 2 adult care home provider must meet the education, experience and training requirements of a Level 2 adult care home provider;
      2. A Level 2 adult care home provider serving ventilator dependent residents must hold a current professional license or employ a resident manager who holds a current professional license as a physician, nurse practitioner, registered nurse or respiratory therapist who is trained and experienced in the care of ventilator dependent residents;
      3. A Level 2 adult care home provider serving residents with traumatic brain injury must hold a national certification by the Academy of Certified Brain Injury Specialists as a Certified Brain Injury Specialist (CBIS), or hold a current professional license or employ a resident manager who holds a current professional license as a physician, nurse practitioner, registered nurse, licensed rehabilitation professional, CBIS or licensed mental health professional who is trained and experienced in the care and rehabilitation of residents with traumatic brain injury;
      4. A substitute caregiver for a Level 2 adult care home for persons with traumatic brain injury must hold a national certification by the Academy of Certified Brain Injury Specialists as a CBIS, or hold a current professional license as a physician, nurse practitioner, registered nurse, licensed rehabilitation professional or licensed mental health professional who is trained and experienced in the care and rehabilitation of residents with traumatic brain injury and must demonstrate competency in caring for persons with traumatic brain injury;
      5. A Level 2 resident manager serving residents with traumatic brain injury must hold a national certification by the Academy of Certified Brain Injury Specialists as a CBIS, or hold a current professional license as a physician, nurse practitioner, registered nurse, licensed rehabilitation professional or licensed mental health professional who is trained and experienced in the care and rehabilitation of residents with traumatic brain injury and must demonstrate competency in caring for persons with traumatic brain injury;
      6. A substitute caregiver for a Level 2 adult care home serving ventilator dependent residents must hold a current professional license as a physician, nurse practitioner, registered nurse or respiratory therapist who is trained and experienced in the care of ventilator dependent residents and must demonstrate competency in caring for ventilator dependent residents;
      7. A traumatic brain injury residential home provider shall hold national certification by the Academy of Certified Brain Injury Specialists as a Certified Brain Injury Specialist (CBIS) or hold a current professional license as a physician, nurse practitioner, registered nurse, licensed rehabilitation professional, or licensed mental health professional who is trained and experienced in the care and rehabilitation of disabled adults suffering from the effects of a traumatic brain injury; and
      8. Traumatic brain injury residential home providers shall not be required to live in or employ a resident manager or substitute caregiver to live in a traumatic brain injury residential home. However, a traumatic brain injury residential home provider shall employ staff members to supervise the residents at all times, within the residence, including overnights and during weekends. The staff members providing overnight care and/or supervision must hold a national certification by the Academy of Certified Brain Injury Specialists as a Certified Brain Injury Specialist (CBIS), or hold a current professional license as a physician, nurse practitioner, registered nurse, licensed rehabilitation professional, or licensed mental health professional who is trained and experienced in the care and rehabilitation of residents with traumatic brain injury.
   3. All adult care home providers, resident managers and substitute caregivers shall complete annually twelve (12) hours of continuing education related to care of the elderly and persons with disabilities and business operations of adult care homes.
   4. The adult care home provider shall train all staff to meet the routine and emergency needs of residents. The adult care home provider is also responsible for training resident managers, substitute caregivers and staff on the health care tasks that can be administered through self-direction.
   5. The adult care home provider shall be responsible for supervision, training and overall conduct of resident managers, substitute caregivers and staff as it relates to their job performance and responsibilities.
9. For developing a plan of care in Level 2 adult care homes, a licensed healthcare professional may include, when appropriate, persons holding a national certification by the Academy of Certified Brain Injury Specialists as a Certified Brain Injury Specialist (CBIS).

Acts 1947, ch. 13, § 11; C. Supp. 1950, § 5879.10 (Williams, § 4432.11); Acts 1968, ch. 522, §§ 2, 5; 1971, ch. 225, § 6; 1975, ch. 276, § 10; 1976, ch. 447, § 1; 1976, ch. 471, § 10; T.C.A. (orig. ed.), § 53-1310; Acts 1989, ch. 295, § 1; 1991, ch. 476, §§ 2-4; 1992, ch. 668, § 1; 1992, ch. 805, § 4; 1993, ch. 234, § 16; 1993, ch. 423, § 1; 1994, ch. 747, § 5; 1996, ch. 674, § 6; 1996, ch. 818, § 3; 1996, ch. 876, § 1; 1997, ch. 166, § 1; 1998, ch. 1021, § 4; 1999, ch. 353, § 2; 2000, ch. 620, § 1; 2000, ch. 981, §§ 86, 87; 2001, ch. 285, §§ 8, 9; 2001, ch. 438, §§ 11, 12, 19; 2009, ch. 579, §§ 10-12; 2010, ch. 642, § 1; 2012, ch. 978, §§ 1, 2; 2012, ch. 1086, §§ 13-16; 2013, ch. 236, § 55.

Compiler's Notes. Acts 1999, ch. 353, § 3 provided that the commissioner of health is authorized to promulgate rules in accordance with the provisions of the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, to provide for the charging of adequate fees to recover the costs to the department of health of implementing the provisions of Acts 1999, ch. 353.

Acts 2001, ch. 438, §§ 11 and 12 purported to amend (a) and (c)(1), respectively, by adding renal dialysis clinics to the facilities listed in those subsections; however, Acts 2001, ch. 285, §§ 8 and 9, respectively, modified the language intended to be amended and the amendment by Acts 2001, ch. 438 was not implemented. Nevertheless, renal dialysis clinics are included in the facilities covered by the affected subsections prior to their licensure on July 1, 2002.

Acts 2009, ch. 579, § 1 provided that the title of the act is, and may be cited as the “Critical Adult Care Home Act of 2009.”

Acts 2012, ch. 1086, § 1 provided that the act, which amended subsections (a), (c), and (h), shall be known and may be cited as the “Traumatic Brain Injury Residential Home Act of 2012.”

Amendments. The 2013 amendment substituted “the health committee of the house of representatives and the health and welfare committee of the senate” for “the health and human resources committee of the house of representatives and the general welfare, health and human resources committee of the senate” near the end of the second sentence in (a)(2).

Effective Dates. Acts 2013, ch. 236, § 94. April 19, 2013.

Law Reviews.

Respecting Our Elders: Can Tennessee Do More to Protect its Elder Population from Institutional Abuse and Neglect?, 66 Tenn. L. Rev. 819 (1999).

Attorney General Opinions. Certified nurse aide skills examination, OAG 99-213 (10/27/99).

Restrictions on type of outpatient diagnostic and therapeutic services that can be provided in off-campus hospital-based facility; necessity of certificate of need. OAG 14-95, 2014 Tenn. AG LEXIS 98 (10/27/14).

Collateral References.

Hospital's liability to patient or prospective patient injured as a result of physical condition of premises. 16 A.L.R.3d 1237.

68-11-210. Inspections — Reports — Federal accreditation exemption.

1. 1. Unless exempt under subdivision (c)(5), every facility licensed under this part as an adult care home, ambulatory surgical treatment center, assisted care living facility, home for the aged, hospice, hospital, nursing home, residential hospice, or traumatic brain injury residential home shall be inspected within fifteen (15) months following the date of the last inspection. All other facilities for which a license has been issued shall be inspected within three (3) years following the date of the last inspection. All inspections shall be conducted by a duly appointed representative of the department under the rules promulgated under this part.
   2. Inspection reports shall be prepared on forms prescribed by the department.
   3. No institutions or agencies licensed pursuant to this part shall be required to be inspected or licensed under the laws of this state relative to hotels, restaurants, lodging houses, boardinghouses and places of refreshment.
   4. Adult care homes are subject to the following inspection standards:
      1. The board shall inspect an adult care home prior to issuing an initial license.
      2. The board shall conduct an unannounced inspection of an adult care home in accordance with subdivision (a)(1).
      3. The board shall be permitted access to enter and inspect any adult care home upon the receipt of an oral or written complaint, any time the board has cause to believe that an adult care home is operating without a license, or any time there exists a perceived threat to the health, safety or welfare of any resident.
   5. Traumatic brain injury residential homes are subject to the following inspection standards:
      1. The board shall inspect a traumatic brain injury residential home prior to issuing an initial license;
      2. The board shall conduct an unannounced inspection of a traumatic brain injury residential home in accordance with subdivision (a)(1); and
      3. The board shall be permitted access to enter and inspect any traumatic brain injury residential home upon the receipt of an oral or written complaint, any time the board has cause to believe that a traumatic brain injury residential home is operating without a license, or any time there exists a perceived threat to the health, safety or welfare of any resident.
2. 1. 1. Each facility licensed pursuant to this title and performing more than fifty (50) surgical abortions in a year shall conduct a mandatory interim assessment of the facility's compliance with quality measures as specified by the board, in addition to regular inspections conducted pursuant to this section.
      2. Such mandatory interim compliance assessment shall include contents prescribed by the board.
      3. The facility shall develop a plan of correction with appropriate time for correction of any deficiency discovered in connection with an interim assessment and shall submit the plan of correction to the department.
      4. The department is authorized to accept the plan or timeline for correction or to request changes in the plan of correction or the timeline for compliance.
   2. 1. Each facility licensed pursuant to this title and performing more than fifty (50) surgical abortions in a year shall report sentinel events.
      2. The board shall provide interpretive guidelines to facilities regarding the meaning of sentinel event.
      3. The department is authorized to require the facility to provide a plan of correction for preventing future occurrence of the reported sentinel event.
   3. In addition to reporting sentinel events, each facility in which a surgical abortion is performed shall make and maintain a record of the disposition of the aborted fetus or aborted fetal tissue as required in § 68-3-505(a) and shall produce such records at the time of an inspection of the facility and upon request from the department.
   4. Failure to comply with this subsection (b) shall be grounds for discipline by the board pursuant to this chapter.
3. 1. The purpose of this subsection (c) is to require that state agencies, including the department of human services or the department of children's services, the department of health, and those agencies with which each contracts, who perform surveys, inspections and investigations of health care facilities, do not duplicate their procedures or subject such health care facilities to duplicate rules and regulations.
   2. For the purposes of this subsection (c), unless the context otherwise requires:
      1. “Health care facility” includes hospital, recuperation center, nursing home, birthing center, prescribed child care center, home for the aged, residential HIV supportive living facility, assisted-care living facility, adult care home and traumatic brain injury residential home, as defined in this part; and
      2. “Inspection” means all surveys, inspections, investigations and other procedures necessary for a state agency, or a division or unit of a state agency, to perform in order to carry out various obligations imposed on such agency by applicable state and federal law and regulations.
   3. 1. State agencies shall make, or cause to be made, only such inspections necessary to carry out the various obligations imposed on such agencies by applicable state and federal law and regulations.
      2. Any on-site inspection by a state agency, division licensing board, or unit thereof, that substantially complies with the inspection requirements of any other state agency, other division licensing boards, or unit of the inspecting agency charged with making similar inspections shall be accepted as an equivalent inspection, instead of an on-site inspection by such agency, division licensing board, or unit of the inspecting agency.
      3. The governor shall be authorized to coordinate the inspections of health care facilities by state agencies required to conduct such inspections.
      4. Notwithstanding this section or any other law to the contrary, the department shall conduct such on-site inspections and investigations as may be necessary to safeguard and ensure, at all times, the public's health, safety and welfare.
      5. The department shall conduct such inspections and investigations as may be necessary to appropriately respond to complaints received from the public and to immediately act upon any determination by the board that the public's health, safety or welfare is, or appears to be, threatened.
   4. The department, under part 1 of this chapter, the board, under this part, the Tennessee state board of examiners for nursing home administrators, under title 63, chapter 16, and any hospital authority, under title 7, chapter 57, shall conduct one (1) joint inspection for each licensing period or shall accept the investigation of one (1) of such entities, under subdivision (c)(3), unless otherwise required by federal law or regulation.
   5. 1. All health care facilities licensed by the department that have obtained accreditation from a federally recognized accrediting health care organization shall be deemed to meet all applicable licensing requirements. Such facilities may be subject to an inspection by the department and shall continue to be subject to subdivisions (c)(3)(D) and (E) but may be exempt from subdivision (a)(1) so long as the facility remains accredited.
      2. In order to be issued a license by the department, such hospitals shall be required to annually remit the statutory licensing fees and a copy of a letter of current accreditation and accompanying report from the joint commission on accreditation of hospitals.
      3. The report shall be maintained as a confidential record pursuant to § 10-7-504.
   6. No licensure fee shall be reduced by  this subsection (c).
4. If a violation, citation, deficiency, or civil monetary penalty is found during the nursing home survey process, in which the violation is based upon an action or actions that are directly pursuant to a physician's order, the board of medical examiners' consultant, or the consultant's physician designee, shall be contacted for a consultation on the determination as to the medical necessity of the physician's order in question. The determination of medical necessity shall be based upon the recognized medical standards of practice and shall include, but not be limited to, a review of the physician's order, the date the order was given, the status of the patient at the time the actions occurred and the outcomes of the actions, the applicable state and federal regulations, and shall include contact between the consultant or designee and the treating physician or the facility's medical director. Any consultation between the consultant or designee and the treating physician or medical director must be completed within the time frames of the survey process. If it is determined that the violation is based upon or relates to a physician's order determined to be medically necessary, no violation, citation, deficiency, or civil monetary penalty shall be assessed against the facility and any deficiency cited in violation of this subsection (d) will be removed. The department shall report back to the board of medical examiners and the appropriate standing committees at the end of six (6) months regarding the effectiveness and the resources necessary to meet the requirements of this subsection (d).
5. Any nursing home that files for federal bankruptcy protection shall immediately inform the commissioner of health regarding its financial condition and the status of the legal proceedings. In overseeing a facility that has filed for federal bankruptcy protection, the department of health shall follow any existing policies or regulations pertaining to any special inspection or oversight of such a facility. The fund established by § 68-11-827 may be used for the purpose of protecting the residents of such a nursing home, if the facility's noncompliance with the conditions of continued licensure, applicable state and federal statutes, rules, regulations and contractual standards threatens the residents' continuous care, the residents' property, the nursing home's continued operation, or the nursing home's continued participation in the medical assistance program of title 71, chapter 5. The commissioner shall inform the attorney general and reporter regarding the status of the legal proceedings.
6. 1. When inspecting a hospital licensed under this title, the department shall include in its inspection a determination of the hospital's compliance with the reporting requirements of subdivision (f)(2). The hospital must document its compliance with a record of its communication with local law enforcement with respect to the commitments. A hospital's failure to comply with the reporting requirements shall subject the hospital to civil penalties or other action against the hospital's license under this part.
   2. 1. If a patient is involuntarily committed to inpatient treatment at a hospital licensed under this title, the hospital shall report the service recipient to local law enforcement as soon as practicable, but no later than the third business day following the date of such commitment, who shall report the service recipient to the federal bureau of investigation-NICS Index and the department of safety as soon as practicable, but no later than the third business day following the date of receiving such notification, for the purposes of complying with the NICS Improvement Amendments Act of 2007, Public Law 110-180, as enacted and as may be amended in the future.
      2. If hospital is required to report pursuant to subdivision (f)(2)(A), the hospital shall report the following information:
         1. Complete name of the person involuntarily committed;
         2. Date involuntary commitment was ordered;
         3. Private or state hospital or treatment resource to which the individual was involuntarily committed;
         4. Date of birth of the person involuntarily committed;
         5. Race and sex of the person involuntarily committed; and
         6. Social security number of the person involuntarily committed.
      3. The information in subdivisions (f)(2)(B)(i)-(vi), the confidentiality of which is protected by other statutes or regulations, shall be maintained as confidential and not subject to public inspection pursuant to such statutes or regulations, except for such use as may be necessary in the conduct of any proceedings pursuant to §§ 39-17-1316, 39-17-1353, and 39-17-1354.

Acts 1947, ch. 13, § 12; C. Supp. 1950, § 5879.11 (Williams, § 4432.12); Acts 1968, ch. 522, § 2; 1971, ch. 225, § 7; 1975, ch. 276, § 11; 1976, ch. 471, § 11; 1978, ch. 796, §§ 1-6; 1979, ch. 169, §§ 1-3; 1982, ch. 683, § 1; T.C.A. (orig. ed.), § 53-1311; Acts 1984, ch. 880, § 6; 1987, ch. 17, §§ 1-3; 1987, ch. 235, § 3; 1992, ch. 805, § 4; 1993, ch. 234, § 17; 1994, ch. 747, § 5; 1996, ch. 674, § 7; 1996, ch. 818, § 3; 1996, ch. 1079, § 150; 1998, ch. 1021, § 4; 2000, ch. 787, §§ 1, 2; 2000, ch. 978, § 3; 2000, ch. 981, §§ 88, 89; 2001, ch. 214, § 1; 2001, ch. 285, § 10; 2001, ch. 438, § 13; 2003, ch. 169, § 6; 2009, ch. 579, §§ 13, 14; 2012, ch. 1086, §§ 17, 18; 2016, ch. 1003, § 6; 2017, ch. 242, § 2; 2018, ch. 1015, § 2.

Code Commission Notes.

This section was amended twice in 1987, first by ch. 17 and later by ch. 253, neither amendment referring to the other. The amendment by ch. 17 deleted references to nursing homes in present (b)(5)(A) and (B), and made other changes. The amendment by ch. 235 amended present (b)(5)(A), containing the phrase “and nursing homes”; however, this act did not insert a reference to nursing homes in present (b)(5)(B). Present (b)(5)(A) is as amended by ch. 253 and present (b)(5)(B) is as amended by ch. 17.

Compiler's Notes. Acts 2001, ch. 438, § 13 purported to amend (a)(1) by adding renal dialysis clinics to the facilities listed in that subdivision; however, Acts 2001, ch. 285, § 10 modified the language intended to be amended and the amendment by Acts 2001, ch. 438 was not implemented. Nevertheless, renal dialysis clinics are included in the facilities covered by the affected subdivision prior to their licensure on July 1, 2002.

Acts 2003, ch. 169, § 1 provided that the act shall be known and may be cited as the “Nursing Home Compassion, Accountability, Respect and Enforcement Reform Act.”

Acts 2009, ch. 579, § 1 provided that the title of the act is, and may be cited as the “Critical Adult Care Home Act of 2009”.

Acts 2012, ch. 1086, § 1 provided that the act, which amended subsections (a) and (b),  shall be known and may be cited as the “Traumatic Brain Injury Residential Home Act of 2012.”

Acts 2016, ch. 1003, § 7 provided that notwithstanding this act or the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, any rule promulgated to implement the provisions of this act shall be provided to the chairs of the health committee of the house of representatives and the health and welfare committee of the senate by the secretary of state, after approval by the attorney general and reporter, at the same time the text of the rule is made available to the government operations committees of the senate and the house of representatives for purposes of conducting the review required by § 4-5-226 in order for the health committee of the house of representatives and the health and welfare committee of the senate to be afforded the opportunity to comment on the rule.

Amendments. The 2016 amendment added (b); and redesignated former (b)-(d) as present (c)-(e).

The 2017 amendment rewrote (a)(1) which read: “(a)(1)  Every facility for which a license has been issued shall be inspected within fifteen (15) months following the date of the last inspection by a duly appointed representative of the department under the rules and regulations to be promulgated under this part.”

The 2018 amendment added (f).

Effective Dates. Acts 2016, ch. 1003, § 8. April 27, 2016.

Acts 2017, ch. 242, § 5.  May 2, 2017.

Acts 2018, ch. 1015, § 4.  July 1, 2018.

Cross-References. Sanitary inspections, § 4-3-1803.

68-11-211. Reporting incidents of abuse, neglect and misappropriation — Reporting specific incidents that might result in a disruption in the delivery of health care services — Confidentiality.

1. As used in this section:
   1. “Abuse” means the willful infliction of injury, unreasonable confinement, intimidation or punishment with resulting physical harm, pain or mental anguish;
   2. “Board” means the board for licensing health care facilities;
   3. “Commissioner” means the commissioner of health;
   4. “Department” means the department of health;
   5. “Facility” means any facility licensed under this part and any physician's office where Level III office-based surgery occurs;
   6. “Misappropriation of patient property” means the deliberate misplacement, exploitation or wrongful, temporary or permanent use of a resident's belongings or money without the resident's consent;
   7. “Neglect” means the failure to provide goods and services necessary to avoid physical harm, mental anguish or mental illness; and
   8. “Patient” means a person receiving health care services from a facility, and includes a resident at a nursing home facility.
2. Except for those facilities required to report abuse, neglect or misappropriation pursuant to 42 CFR 483.13, each facility shall report incidents of abuse, neglect and misappropriation that occur at the facility to the department within seven (7) business days from the facility's identification of the incident.
3. An incident report or any amended incident report obtained by the department pursuant to this section shall be confidential and not subject to discovery, subpoena or legal compulsion for release to any person or entity, nor shall the report be admissible in any civil or administrative proceeding, other than a disciplinary proceeding by the department or the appropriate regulatory board. The report is not discoverable or admissible in any civil or administrative action, except that information in the report may be transmitted to an appropriate regulatory board having jurisdiction for disciplinary or licensing sanctions against the impacted facility; however, the department must reveal, upon request, its awareness that a specific incident has been reported. The affected patient and the patient's family, as may be appropriate, shall also be notified of the incident by the facility. This subsection (c) and § 68-11-804(c)(23) shall not affect § 63-1-150 or the protections provided by § 63-1-150.
4. Each facility shall also report specific incidents, including, but not limited to, the following that might result in a disruption in the delivery of health care services at the facility within seven (7) days after the facility becomes aware of the incident:
   1. A strike by the staff at the facility;
   2. An external disaster impacting the facility;
   3. A disruption of any service vital to the continued safe operation of the facility or to the health and safety of its patients and personnel; and
   4. Any fires at the facility that disrupt the provision of patient care services or cause harm to the patients or staff, or that are reported by the facility to any entity, including, but not limited to, a fire department charged with preventing fires.
5. In the event that health care services are provided in the patient's home, then the facility shall only report those incidents that are witnessed or known by the person delivering health care services.
6. The department shall have access to facility records that are allowed in part 3 of this chapter. The department may copy any portion of a facility medical record relating to the reported event, unless otherwise prohibited by rule or statute. This section and § 68-11-804(c)(23) do not change or affect the privilege and confidentiality provided by § 63-1-150.
7. This section does not preclude the department from using information obtained under this section in a disciplinary action commenced against a facility or from taking disciplinary action against a facility. This section does not preclude the department from sharing such information with any appropriate governmental agency charged by federal or state law with regulatory oversight of the facility; however, all such information shall be confidential and not a public record. A facility's failure to report an incident of abuse, neglect or misappropriation may be grounds for disciplinary action against the facility pursuant to § 68-11-207.
8. Nothing in this section shall be construed to eliminate or alter in any manner the required reporting of abuse, neglect or exploitation of children or adults or any other provisions of title 37, chapter 1, parts 4 and 6, and title 71, chapter 6, part 1.

Acts 2002, ch. 508, § 1; 2007, ch. 373, §§ 2-4; 2009, ch. 318, § 1; 2017, ch. 4, §§ 6, 7.

Compiler's Notes. Former § 68-11-211 (Acts 1947, ch. 13, § 13; C. Supp. 1950, § 5879.12 (Williams, § 4432.13); T.C.A. (orig. ed.), § 53-1312), concerning rules and regulations, was repealed by Acts 1984, ch. 880, § 7.

Acts 2007, ch. 373, § 6 provided that the board of medical examiners and the board of osteopathic examination are authorized to promulgate public necessity rules (now emergency rules) necessary to carry out the provisions of the act in accordance with the provisions of the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.

Acts 2009, ch. 318, § 3 provided that Tennessee understands the need for the collection of certain relevant health data to ensure quality patient care and to protect the health, safety and welfare of Tennesseans and encourages health care facilities to report such data to other organizations that collect, assimilate and aggregate such data, such as the joint commission on accreditation of healthcare organizations, the institute for safe medicine practices, the food and drug administration, patient safety organizations authorized by federal law, and other authorized entities.

Amendments. The 2017 amendment substituted “shall not affect § 63-1-150 or the protections provided by § 63-1-150” for “shall not affect § 63-6-219 [repealed] or the protections provided by § 63-6-219 [repealed]” at the end of (c); and substituted “§ 63-1-150” for “§ 63-6-219 [repealed]” at the end of (f).

Effective Dates. Acts 2017, ch. 4, § 11. March 15, 2017.

Cross-References. Confidentiality of public records, § 10-7-504.

68-11-212. Placement and adoption of children unaffected.

This part shall not be construed in any way to restrict or modify any law pertaining to the placement and adoption of children.

Acts 1947, ch. 13, § 14; C. Supp. 1950, § 5879.13 (Williams, § 4432.14); T.C.A. (orig. ed.), § 53-1313.

68-11-213. Injunctions and penalties — Promulgation of regulations.

1. 1. The department is authorized to initiate proceedings seeking injunctive and any other form of relief available in law or equity against any person who owns, operates, manages or participates in the operation of or management of any facilities required to be licensed under this part, or any resident or residents in any facility required to be licensed under this part, without having the license required by this part.
   2. The department may also seek such relief against any person who owns, operates, manages or participates in the operation or management of any facility required to be licensed under this part, if such person or facility violates this part, rules, regulations or orders issued under this part, or terms and conditions of the license.
   3. Proceedings under this section may be initiated in the chancery court of Davidson County or the chancery court of the county in which all or part of the activities complained of occur.
2. Based upon a complaint that a home for the aged, assisted-care living facility, adult care home or traumatic brain injury residential home, subject to licensure under this part may be operating without a license, the department, with consent of an owner, operator, manager, or person who participates in the operation, or patient or resident, or the guardian of the patient or resident, may enter the facility in order to investigate or inspect the complaint for the necessity of or compliance with licensure under this part.
3. If consent is not obtained and the area sought to be inspected is a closed or non-public area, right of entry and inspection shall not be made by the department, unless a civil warrant, upon probable cause, is first obtained authorizing such entry or inspection.
4. Inspections conducted pursuant to this section shall be conducted in a manner so as to minimize disruption.
5. If a determination is made by the department that a facility or entity is subject to the requirements of licensure under this part, a notice shall be issued by the department stating the determination and requiring that application for licensure must be made to the department within thirty (30) days of the receipt of that notice. The thirty-day application period does not serve to waive any civil penalties that may be assessed for unlicensed operation of a facility under this part.
6. Failure of a facility or entity requiring licensure to make application to the department for licensure within thirty (30) days from the date of the receipt of the notice may result in the initiation of injunctive relief and any other relief available in law or equity against any person who owns, operates, manages, or participates in the management of a facility or entity.
7. In addition to requiring that a facility or entity make application for licensure, the department may immediately initiate a petition for injunctive relief or any other relief available in law or equity. The department may direct the facility or entity to immediately cease and desist operations when the health, safety, or welfare of the patients or residents requires emergency action. If the facility or entity does not comply with the directive to cease and desist, then the department may initiate proceedings for injunctive relief and any other relief available in law or equity.
8. 1. It is unlawful for any person to receive or accept any patient or patients or any resident or residents in any facility required to be licensed under this part without having applied for and obtained a license as required by this part.
   2. A violation of this requirement is a Class B misdemeanor.
   3. Each day of operation without a license constitutes a separate offense.
9. 1. The department may assess a civil penalty not to exceed five thousand dollars ($5,000) against any person or entity operating an assisted care living facility, home for the aged, adult care home, or traumatic brain injury residential home without having the license required by this chapter. Each day of operation is a separate violation.
   2. The board for licensing health care facilities is authorized to establish as part of its comprehensive system of quality assurance and enforcement a system for assessing civil monetary penalties, including appropriate due process, for assisted care living facilities, homes for the aged, adult care homes, and traumatic brain injury residential homes that are in serious violation of state laws and regulations, resulting in endangerment to the health, safety, and welfare of residents.
   3. All penalties for adult care homes or traumatic brain injury residential homes shall be deposited by the department with the state treasurer to a general fund account specifically designated for the purpose of providing adult care home educational training programs and continuing education requirements for adult care home providers and traumatic brain injury residential home providers, resident managers, substitute caregivers and staff. The commissioner of finance and administration shall determine the appropriate use for these funds.
   4. Beginning one hundred eighty (180) days after the promulgation of regulations under this part by the department, the department may assess a civil penalty not to exceed three thousand dollars ($3,000) against any licensed assisted-care living facility for admitting or retaining residents not meeting the definition of assisted-care facility resident set forth in this chapter. Each such resident shall constitute a separate violation.
10. 1. The department may assess a civil penalty not to exceed one thousand dollars ($1,000) against any person or entity operating a prescribed child care facility without the license required by this chapter or in violation of any other statute or regulation promulgated under this chapter. Each day of operation is a separate offense.
    2. The board is specifically authorized to promulgate regulations for the assessment and procedures to be used in the assessment of civil penalties against a prescribed child care center, including, but not limited to, a schedule of the minimum and maximum penalties, factors to be considered in making the assessment, procedures to be used in the assessment, appeals, and finality of assessments.
    3. The board is authorized to conduct contested cases regarding appeals of the penalties assessed pursuant to this subsection (j).
11. 1. After notification of deficiencies following a licensure or complaint survey, any facility licensed under this part has ten (10) days from the date of notification to submit an acceptable plan of correction. Should the facility submit a plan of correction that is deemed unacceptable by the department, then the facility has an additional ten (10) days from the date of notification that the plan of correction is unacceptable to submit an acceptable plan of correction. The department shall provide a facility with no less than three (3) opportunities to submit an acceptable plan of correction and provide clear guidelines so that the facility understands what a plan of correction must include to be deemed acceptable.
    2. If a facility is not able to submit an acceptable plan of correction after three (3) attempts, then a representative from the facility shall appear before the board and submit a plan of correction for the board's approval.
12. After receipt of an acceptable plan of correction, the department shall promptly revisit a facility or conduct an administrative review within fourteen (14) business days, unless waived by the facility or licensee, to determine whether the cited deficiencies have been corrected in accordance with the plan. If the same or different deficiencies are cited on the third revisit survey, then the department may pursue disciplinary action against the facility before the board, including seeking reimbursement for the unrecouped costs associated with subsequent revisit surveys that were incurred by the department.

Acts 1947, ch. 13, § 15; mod. C. Supp. 1950, § 5879.14 (Williams, § 4432.15); Acts 1953, ch. 113, § 28; 1968, ch. 522, §§ 2, 5; 1971, ch. 225, § 8; 1975, ch. 276, § 12; 1976, ch. 471, §§ 12-14; T.C.A. (orig. ed.), § 53-1314; Acts 1984, ch. 880, § 8; 1989, ch. 591, § 112; 1993, ch. 234, § 18; 1994, ch. 747, § 5; 1996, ch. 674, § 8; 1996, ch. 818, § 4; 1998, ch. 1021, § 4; 2000, ch. 981, §§ 90, 91; 2001, ch. 285, §§ 11-13; 2001, ch. 438, §§ 14-16; 2004, ch. 846, § 1; 2008, ch. 1190, § 23; 2009, ch. 186, § 14; 2009, ch. 579, §§ 15-17; 2012, ch. 1086, §§ 19-22; 2018, ch. 655, §§ 10-12.

Compiler's Notes. Acts 2001, ch. 438, §§ 14-16 purported to amend (a)(1), (2), and (b)(1) respectively, by adding renal dialysis clinics to the facilities listed in those subdivisions; however, Acts 2001, ch. 285, §§ 11-13, respectively, modified the language intended to be amended and the amendment by Acts 2001, ch. 438 was not implemented. Nevertheless, renal dialysis clinics are included in the facilities covered by the affected subdivisions prior to their licensure on July 1, 2002.

Acts 2008, ch. 1190, § 20 provided that, except as otherwise specified, the commissioner is authorized to promulgate rules and regulations to effectuate the purposes of the act. The rules and regulations shall be promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.

Acts 2008, ch. 1190, § 24 provided that the board for licensing health care facilities is authorized to promulgate rules and regulations pertaining to licensure of assisted-care living facilities as set forth in §§ 68-11-201(4) and (5) and 68-11-213(i)(3), including any changes necessary to ensure the health and safety of assisted-care living facility residents with higher levels of need. The rules and regulations shall be promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.

For the Preamble to the act regarding long-term care, please refer to Acts 2008, ch. 1190.

Acts 2009, ch. 579, § 1 provided that the title of the act is, and may be cited as the “Critical Adult Care Home Act of 2009.”

Acts 2012, ch. 1086, § 1 provided that the act, which amended subsections (b), (g), and (i),  shall be known and may be cited as the “Traumatic Brain Injury Residential Home Act of 2012.”

Amendments. The 2018 amendment rewrote (e)-(g) which read: “(e)  If a determination is made by the department that a home for the aged, assisted-care living facility or alcohol and drug treatment center is subject to the requirements of licensure under this part, a notice shall be issued by the department stating the determination and requiring that application for licensure shall be made to the department within thirty (30) days of the receipt of that notice. The thirty-day application period does not serve to waive any and all civil penalties that may be assessed for unlicensed operation of a facility under this part. “(f)  Failure of the home for the aged, assisted-care living facility or alcohol and drug treatment center to make application to the department for licensure within thirty (30) days from the date of the receipt of the notice may result in the initiation of injunctive relief and any other relief available in law or equity against any person who owns, operates, manages or participates in the management of the facility.“(g)  In addition to requiring that the home for the aged, assisted-care living facility, adult care home or traumatic brain injury residential home make application for licensure, the department may immediately initiate a petition for injunctive relief or any other relief available in law or equity. The department may recommend and direct the home for the aged, assisted-care living facility, adult care home or traumatic brain injury residential home to immediately cease and desist operations when the health, safety or welfare of the patients or residents requires emergency action.”; inserted “home for the aged” in the first sentence of (i)(1); inserted “homes for the aged” in (i)(2);  and added (k) and (l ).

Effective Dates. Acts 2018, ch. 655, § 15. July 1, 2018.

Cross-References. Injunctions, generally, title 29, ch. 23.

Penalty for Class B misdemeanor, § 40-35-111.

68-11-214. Personnel and inspectors.

1. The department is authorized to employ all necessary administrative and clerical employees; and to employ one (1) or more inspectors, for such time as, in the judgment of the commissioner, may be necessary, who shall be well experienced in the operation of hospitals, and whose duty it is to:
   1. Visit all institutions coming under the scope of this part and inspect them, insofar as it may be necessary to arrive at the necessary facts required to make a true and informative report to the board; and
   2. Give advice, aid and encouragement to such institutions, in maintaining high professional ideals and good care of patients.
2. The department shall cooperate in the inspections and coordinate them with its other work.
3. 1. The department shall not assign an individual to be a member of an inspection team for purposes of conducting an annual survey required for medicare or medicaid certification at a nursing home facility in which the individual works, or, at any previous time, has worked as an employee, as employment agency staff at the facility, or as an officer, consultant, or agent for the facility to be inspected. Prior to being employed by the department, all such individuals shall be required to disclose any previous employment at any and all nursing home facilities, including employment as an employee, as employment agency staff, or as an officer, consultant or agent.
   2. The department shall not assign an individual to lead an inspection team conducting an inspection as a result of a complaint filed against a nursing home facility if the individual works, or, at any previous time, has worked as an employee, as employment agency staff at the facility, or as an officer, consultant, or agent for the facility to be inspected.
   3. 1. The department shall not assign an individual to be a part of an inspection team conducting an inspection as a result of a complaint filed against a nursing home facility if the individual works, or, at any previous time, has worked as an employee, as employment agency staff at the facility, or as an officer, consultant, or agent for the facility to be inspected.
      2. Notwithstanding subdivision (c)(3)(A) to the contrary, the commissioner may allow for exceptions to subdivision (c)(3)(A) if the commissioner deems it necessary for the immediate protection of the health, safety or welfare of residents of a nursing home.

Acts 1947, ch. 13, §§ 16, 17; mod. C. Supp. 1950, § 5879.15 (Williams, §§ 4432.16, 4432.17); T.C.A. (orig. ed.), § 53-1315; Acts 2008, ch. 982, § 1.

Collateral References.

Hospital's liability for negligence in selection or appointment of staff physician or surgeon. 51 A.L.R.3d 981.

68-11-215. Salaries and expenses.

1. The salaries of all employees shall be fixed by the department of human resources upon the advice of the commissioner.
2. All employees and members of the board shall be reimbursed for necessary expenses in the discharge of their official duties.
3. All reimbursement for travel expenses shall be in accordance with the comprehensive travel regulations as promulgated by the department of finance and administration and approved by the attorney general and reporter.
4. The expenses provided for in this section shall be incorporated as part of the budget of the department.

Acts 1947, ch. 13, § 18; C. Supp. 1950, § 5879.16 (Williams, § 4432.18); Acts 1976, ch. 806, § 1(145); T.C.A. (orig. ed.), § 53-1316.

68-11-216. Promulgation of rules and regulations as to fees — Licensures and annual renewal fees.

1. 1. The board is authorized to promulgate, in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, such rules and regulations as are necessary to set fees for licensure, renewal of licensure, late renewal fees and such other fees as are necessary to comply with the intent of subsection (b), for the entities and facilities listed in § 68-11-202(a)(1).
   2. The entities and facilities referenced in subdivision (a)(1), except those operated by the United States government or the state of Tennessee, shall make application for licensure and renewal under this part and shall pay the fees applicable to them to the department for regulatory purposes.
   3. The licensure and annual renewal fees for the following types of home care organizations shall not exceed twenty-five percent (25%) of the total licensure and annual renewal fees set by the board for all other home care organizations:
      1. Home care organizations that also pay a fee to be licensed by the department of mental health and substance abuse services;
      2. Home care organizations owned and operated by therapists who pay a fee to be licensed under title 63, chapter 13 or chapter 17; or
      3. Home care organizations that are owned and controlled by another home care organization that pays an annual license or renewal fee.
   4. Excluded from payment of the fees as an ambulatory surgical treatment center and an outpatient diagnostic center are hospital based ambulatory surgical treatment centers and outpatient diagnostic centers that are included in the licensing and renewal fee of the hospital in which they are located.
   5. Prior to the promulgation of a rule increasing fees for licensed health care facilities, the department of health shall present to the board a detailed report justifying the proposed fee amount. The report shall include at least the following elements:
      1. The fees currently charged, the proposed new fees, and the percentage increase expected from the proposed fees;
      2. The total number of full-time equivalent positions funded, and  how those positions are funded, if not entirely from fee revenue;
      3. Justification for any increase in fees, including an itemization of actual or expected increases in costs to the board, and inspection or licensure activities on which any proposed increases in funding will be spent; and
      4. A specific breakdown that differentiates the costs incurred for licensure activities under state law from any other activity required by a contractual or legal requirement with the federal government.
   6. Not later than sixty (60) calendar days prior to the presentation of the report and the information outlined in subdivision (a)(5) to the board, the report and the information outlined in subdivision (a)(5) shall be provided to the board and any provider association representing such a facility affected by a proposed change in licensure fees. The report and information shall be provided in both paper and electronic format, and shall be made available to any affected licensed facility upon request.
   7. Any increase or decrease in fees proposed or approved by the board must increase or decrease the fees for all licensed facilities by a similar percentage amount, which shall not vary more than five percent (5%) between facility types.
2. 1. The fees established by the board shall be submitted with the appropriate applications. All fees so collected shall be deposited by the department with the state treasurer to the credit of the general fund, and shall be expended by the department and included in the appropriation made for the board in the general appropriations act.
   2. It is the intent of the general assembly that the board establish and collect fees in an amount sufficient to pay the costs of operating the board, including, but not limited to, licensure and inspection costs. On or before December 31 of each year, the commissioner shall certify and report to the government operations committee of each house of the general assembly, if the board did not, during the fiscal year, collect fees in an amount sufficient to pay the costs of operating the board. If the board fails to collect sufficient fees to pay the costs of operating the board for a period of two (2) consecutive fiscal years, the board shall be reviewed by the joint evaluation committees and shall be subject to a revised termination date of June 30 of the fiscal year immediately following the second consecutive fiscal year during which the board operated at a deficit.
3. [Deleted by 2019 amendment.]

Acts 1947, ch. 13, § 19; C. Supp. 1950, § 5879.17 (Williams, § 4432.19); Acts 1968, ch. 522, § 6; 1971, ch. 225, § 9; 1975, ch. 215, § 2; 1975, ch. 276, § 13; 1976, ch. 471, §§ 15-17; T.C.A. (orig. ed.), § 53-1317; Acts 1984, ch. 880, § 9; 1989, ch. 434, §§ 4, 6; 1990, ch. 1090, §§ 1-7; 1991, ch. 459, §§ 1-5; 1991, ch. 475, §§ 1-4, 6; 1992, ch. 913, §§ 1, 14; 1992, ch. 953, §§ 1, 2, 4-6; 1993, ch. 234, § 21; 1993, ch. 422, §§ 1-4; 1994, ch. 747, § 5; 1994, ch. 993, §§ 1-3; 1995, ch. 316, §§ 1-3; 1996, ch. 674, § 9; 1996, ch. 818, § 3; 1997, ch. 553, §§ 1-4; 1998, ch. 1021, §§ 4, 5; 1999, ch. 431, §§ 1-4; 2000, ch. 902, §§ 3-5; 2000, ch. 981, § 92; 2000, ch. 991, §§ 1-4; 2001, ch. 431, §§ 1-7; 2001, ch. 438, § 17; 2002, ch. 652, § 8; 2002, ch. 861, § 1; 2003, ch. 242, § 1; 2003, ch. 387, §§ 1-4; 2004, ch. 917, § 5; 2004, ch. 923, § 1; 2005, ch. 100, § 1; 2005, ch. 327, §§ 1-4; 2005, ch. 397, §§ 1, 2; 2007, ch. 309, §§ 1-4; 2009, ch. 460, §§ 1-6; 2009, ch. 566, § 12; 2010, ch. 1100, § 110; 2011, ch. 478, §§ 1-5; 2012, ch. 575, § 1; 2012, ch. 767, § 1; 2013, ch. 356, § 1; 2013, ch. 410, §§ 1, 2; 2019, ch. 423, § 13.

Code Commission Notes.

Former subsection (c), concerning the levy of a hospital services license fee, was deleted as obsolete by authority of the code commission in 2006.

Compiler's Notes. Acts 2009, ch. 566, § 12 provided that the Tennessee code commission is directed to change all references to public necessity rules, wherever such references appear in this code, to emergency rules, as sections are amended and volumes are replaced.

Acts 2010, ch. 1100, § 153 provided that the commissioner of mental health and developmental disabilities, the commissioner of mental health, the commissioner of intellectual and developmental disabilities, and the commissioner of finance and administration are authorized to promulgate rules and regulations to effectuate the purposes of the act. All such rules and regulations shall be promulgated in accordance with the provisions of the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.

Acts 2013, ch. 356, § 1 provided that the nursing home annual assessment fee established by subsection (c) shall terminate June 30, 2014.

Acts 2013, ch. 410, § 2 provided that subdivision (c)(7)(C) shall terminate on July 1, 2015, unless reenacted or extended by the general assembly prior to such date.

Amendments. The 2013 amendment by ch. 356, effective July 1, 2013, rewrote (c) which read: “(c)(1) It is declared to be the legislative intent that every person is exercising a taxable privilege who engages in the business of providing nursing home care. The tax imposed by this subsection (c) shall be in addition to all other privilege taxes.“(2) Effective for two (2) years beginning July 1, 2011, in addition to the fees set forth in subsection (a), each nursing home shall pay an annual nursing home tax as set forth in this subsection (c). Such tax shall be paid in equal monthly installments of one-twelfth (1/12) of the annual amount established by this subsection (c). The installments are due on the fifteenth of each following month beginning August 15, 2011, for the July 2011 installment and ending with a final payment on July 15, 2013.“(3) The annual nursing home tax shall be based on the number of nursing home beds licensed by the state on July 1, 2011, and on July 1, 2012, for the fiscal year following such date, excluding beds in nursing homes specifically certified as intermediate care beds for the mentally retarded. The tax shall be uniformly applied to all licensed beds at the rate of two thousand two hundred twenty-five dollars ($2,225) per licensed bed per year. Licensed facilities that are owned or operated by an agency of the state are not excluded from paying the tax. There shall be no exclusions, deductions or adjustments applied to the tax of any licensed facility different from any other such facility. Beds licensed after July 1, 2011, and July 1, 2012, shall pay a prorated amount of the annual tax for the fiscal year following such date; provided, that no such tax shall be due to the extent that the beds licensed after July 1, 2011, were the result of the transfer of such beds from one licensed facility to another licensed facility, where the transferor facility had already paid the full amount of the tax on such beds, or where the transferor facility agrees to continue to pay the monthly installments due with respect to such beds.“(4) The commissioner shall adopt rules and regulations governing the collection of such taxes. Notwithstanding any other provision of law, the commissioner is authorized to promulgate such rules as emergency rules pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.“(5) Any challenge to the tax imposed by this subsection (c) shall be brought pursuant to title 67, chapter 1, part 9 and § 9-8-307(a)(1)(O).“(6)(A) All revenue collected pursuant to this subsection (c) shall be deposited in the general fund.“(B) All nursing home privilege tax payments made by nursing homes under this section and received by the state; all investment earnings credited to the nursing home privilege tax payments; any interest and penalties paid under this section by any nursing home; and all funds generated by federal matching payments made relative to the nursing home privilege tax shall be available to and used by the bureau of TennCare for the sole purpose of providing payment to nursing homes.“(C) No part of the nursing home privilege tax payments made by nursing homes under this section and received by the state; the investment earnings credited to the nursing home privilege tax payments; the interest and penalties paid under this section by any nursing home; or the funds generated by federal matching payments made relative to the nursing home privilege tax shall be used for any purpose other than providing payment to nursing facilities.“(7)(A) If any part of any tax imposed under this subsection (c) is not paid on or before the due date, a penalty of five percent (5%) of the amount due shall at once accrue and be added to such tax. Thereafter, on the first day of each month during which any part of any tax or any prior accrued penalty remains unpaid, an additional penalty of five percent (5%) of the then unpaid balance shall accrue and be added to such tax or prior accrued penalty. In addition, taxes under this subsection (c) not paid on the due date shall bear interest at the maximum lawful rate from the due date to the date paid. Payment shall be deemed to have been made upon date of deposit in the United States mail. The commissioner may for good cause approve an alternative payment plan, as long as full payment of the tax plus penalty and interest is made.“(B) If a nursing home is more than sixty (60) days delinquent in paying an installment of its annual nursing home tax, the commissioner shall be authorized to initiate proceedings before the board in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, so that the board may suspend admissions to the facility or otherwise direct the facility to pay the tax and any accrued penalties and interest in full within a prescribed period of time. If the facility does not pay the tax and any accrued penalties and interest in full within the prescribed period of time as directed by the board, the board shall suspend admissions to the facility. Any suspension of admissions imposed according to this section shall immediately be lifted following the full payment of the tax and any accrued penalties and interest by the facility. If full payment of the tax and any accrued penalties and interest is not paid within sixty (60) days from the first day of the suspension of admissions, the commissioner shall be authorized to initiate proceedings before the board in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, so that the board may consider the revocation of the facility's license.“(8) The tax imposed by this subsection (c) may not be billed by the nursing home as a separately stated charge, but this shall not prevent the nursing home from adjusting its rates to defray the cost associated with the tax.“(9) The fiscal review committee shall review and have oversight of the implementation of this subsection (c).“(10) Enactment of this subsection (c) and any amendments to this subsection (c) shall not operate to excuse the monthly installment payment of the nursing home privilege tax due on July 15, 2011.“(11) Any tax obligation imposed by this subsection (c) shall be suspended to the extent that, and for the period that receipt of the tax by the state results in, a corresponding reduction in federal financial participation under Title XIX of the federal Social Security Act, compiled in 42 U.S.C. § 1396 et seq.“(12) The annual nursing home tax established by this subsection (c) shall terminate on June 30, 2013.”

The 2013 amendment by ch. 410, in (c)(7)(B), substituted “ninety (90) days” for “sixty (60) days” and substituted “the commissioner shall initiate” for “the commissioner shall be authorized to initiate”; and, effective until July 1, 2015, added (c)(7)(C) which read: “In cases where a licensed nursing home is delinquent on assessment fees beginning July 1, 2009, and ending June 30, 2012, and is currently participating in a payment plan, the commissioner shall be authorized to reduce the amount of penalties and interest due for that time period to twenty-five percent (25%) of the total assessment fee outstanding balance as of June 30, 2012. For purposes of this subdivision (c)(7)(C), the total assessment fee outstanding balance is calculated as the total assessment fees owed not including any penalties and interest, less any payments made by the facility, beginning July 1, 2009, and ending June 30, 2012. This subdivision (c)(7)(C) shall terminate on July 1, 2015, unless reenacted or extended by the general assembly prior to such date.”

The 2019 amendment deleted former (c) which read: “(c)(1)  It is declared to be the legislative intent that every person is exercising a taxable privilege who engages in the business of providing nursing home care. The assessment fee imposed by this subsection (c) shall be in addition to all other privilege taxes.“(2)  Effective for one (1) year beginning July 1, 2013, in addition to the fees set forth in subsection (a), each nursing home shall pay a nursing home annual assessment fee as set forth in this subsection (c). Such assessment fee shall be paid in equal monthly installments of one-twelfth (1/12) of the annual amount established by this subsection (c). The installments are due on the fifteenth day of each following month beginning August 15, 2013, for the July 2013 installment and ending with a final payment on July 15, 2014.“(3)  The nursing home annual assessment fee shall be based on the number of nursing home beds licensed by this state on July 1, 2013, for the fiscal year following such date, excluding beds in nursing homes specifically certified as intermediate care beds for the mentally retarded. The assessment fee shall be uniformly applied to all licensed beds at the rate of two thousand two hundred twenty-five dollars ($2,225) per licensed bed per year. Licensed facilities that are owned or operated by an agency of this state are not excluded from paying the assessment fee. There shall be no exclusions, deductions or adjustments applied to the assessment fee of any licensed facility different from any other such facility. Beds licensed after July 1, 2013, shall pay a prorated amount of the annual assessment fee for the fiscal year following such date; provided, that no such assessment fee shall be due to the extent that the beds licensed after July 1, 2013, were the result of the transfer of such beds from one (1) licensed facility to another licensed facility, where the transferor facility had already paid the full amount of the assessment fee on such beds, or where the transferor facility agrees to continue to pay the monthly installments due with respect to such beds.“(4)  The commissioner shall adopt rules and regulations governing the collection of such assessment fees. Notwithstanding any other law, the commissioner is authorized to promulgate such rules as emergency rules pursuant to the Uniform Administrative Procedures Act.“(5)  Any challenge to the assessment fee imposed by this subsection (c) shall be brought pursuant to title 67, chapter 1, part 9 and § 9-8-307(a)(1)(O).“(6)(A)  All revenue collected pursuant to this subsection (c) shall be deposited in the general fund.“(B)  All nursing home annual assessment fee payments made by nursing homes under this section and received by this state; all investment earnings credited to the nursing home annual assessment fee payments; any interest and penalties paid under this section by any nursing home; and all funds generated by federal matching payments made relative to the nursing home annual assessment fee shall be available to and used by the bureau of TennCare for the sole purpose of providing payment to nursing homes.“(C)  No part of the nursing home annual assessment fee payments made by nursing homes under this section and received by this state; the investment earnings credited to the nursing home annual assessment fee payments; the interest and penalties paid under this section by any nursing home; or the funds generated by federal matching payments made relative to the nursing home annual assessment fee shall be used for any purpose other than providing payment to nursing homes.“(7)(A)  If any part of any assessment fee imposed under this subsection (c) is not paid on or before the due date, a penalty of five percent (5%) of the amount due shall at once accrue and be added to such assessment fee. Thereafter, on the first day of each month during which any part of any assessment fee or any prior accrued penalty remains unpaid, an additional penalty of five percent (5%) of the then unpaid balance shall accrue and be added to such assessment fee or prior accrued penalty. In addition, assessment fees under this subsection (c) not paid on the due date shall bear interest at the maximum lawful rate from the due date to the date paid. Payment shall be deemed to have been made upon date of deposit in the United States mail. The commissioner may for good cause approve an alternative payment plan, as long as full payment of the assessment fee plus penalty and interest is made.“(B)  If a nursing home is more than ninety (90) days delinquent in paying an installment of its annual nursing home assessment fee, the commissioner shall initiate proceedings before the board in accordance with the Uniform Administrative Procedures Act, so that the board may suspend admissions to the facility or otherwise direct the facility to pay the assessment fee and any accrued penalties and interest in full within a prescribed period of time. If the facility does not pay the assessment fee and any accrued penalties and interest in full within the prescribed period of time as directed by the board, the board shall suspend admissions to the facility. Any suspension of admissions imposed according to this section shall immediately be lifted following the full payment of the assessment fee and any accrued penalties and interest by the facility. If full payment of the assessment fee and any accrued penalties and interest is not paid within sixty (60) days from the first day of the suspension of admissions, the commissioner shall be authorized to initiate proceedings before the board in accordance with the Uniform Administrative Procedures Act so that the board may consider the revocation of the facility's license.“(8)  The assessment fee imposed by this subsection (c) may not be billed by the nursing home as a separately stated charge, but this shall not prevent the nursing home from adjusting its rates to defray the cost associated with the assessment fee.“(9)  The fiscal review committee shall review and have oversight of the implementation of this subsection (c).“(10)  Enactment of this subsection (c) and any amendments to this subsection (c) shall not operate to excuse the monthly installment payment of the nursing home assessment fee due on July 15, 2013.“(11)  Any assessment fee obligation imposed by this subsection (c) shall be suspended to the extent that, and for the period that receipt of the assessment fee by the state results in, a corresponding reduction in federal financial participation under Title XIX of the federal Social Security Act, compiled in 42 U.S.C. § 1396 et seq.“(12)  The nursing home annual assessment fee established by this subsection (c) shall terminate on June 30, 2014.”

Effective Dates. Acts 2013, ch. 356, § 2. July 1, 2013.

Acts 2013, ch. 410, § 3. May 16, 2013.

Acts 2019, ch. 423, § 14. July 1, 2019.

Cross-References. Annual hospital reports relative to patients, § 68-11-310.

“Hospitals” defined, § 68-11-1104.

68-11-217. Christian Science facilities excepted.

1. Nothing in this part or the rules and regulations relative to medical treatment adopted pursuant to this part shall be construed as authorizing the supervision, regulation or control of the remedial care or treatment of patients or residents in, or over, any health care facility conducted for or by those who rely upon treatment by prayer through spiritual means in the practice of religion in accordance with the creed or tenets of the First Church of Christ, Scientist, in Boston, Massachusetts.
2. However, these institutions must comply with all rules and regulations relative to sanitation and safety as other institutions of similar category.

Acts 1968, ch. 522, § 7; T.C.A., § 53-1318.

68-11-218. Disciplinary action reports.

1. 1. The chief administrative official of each hospital or other health care facility shall report to the respective licensing board, committee, council, or agency any disciplinary action taken concerning any person licensed under title 63 or this title, when such action is related to professional ethics, professional incompetence or negligence, moral turpitude, or drug or alcohol abuse.
   2. “Disciplinary action” shall include termination, suspension, reduction, or resignation of hospital privileges for any of the reasons listed in subdivision (a)(1).
   3. The report shall be in writing and made within sixty (60) days of the date of the action.
2. The hospital or health care facility shall make available to the respective licensing board, committee, council, or agency, for examination, all records pertaining to the disciplinary action taken, notwithstanding § 63-1-150, § 63-6-228, or any other provision to the contrary.
3. Any individual who, as a member of any committee, employee, or contractor of any hospital or health care facility, files a report pursuant to this section, shall be immune from liability to the extent provided in § 63-1-150.

Acts 1976, ch. 631, § 1; 1980, ch. 522, § 1; T.C.A., § 53-1330; Acts 2004, ch. 745, § 1; 2017, ch. 4, §§ 8-10; 2017, ch. 240, § 5.

Amendments. The 2017 amendment by ch. 4, effective March 15, 2017 until May 2, 2017, in (b)(1) and (c), substituted “§ 63-1-150” for “§ 63-6-219 [repealed]”; and in (d) added “quality improvement”, substituted “healthcare organization” for “hospital or professional society”, substituted “§ 63-1-150” for “§ 63-6-219 [repealed], and substituted “§ 63-1-150” for § 63-6-219(b) [repealed].”

The 2017 amendment by ch. 4, as amended by ch. 240, effective May 2, 2017, rewrote the  section which read: “(a)(1)  The chief administrative official of each hospital or other health care facility shall report to the board of medical examiners any disciplinary action taken concerning any physician, when such action is related to professional ethics, medical incompetence, moral turpitude, or drug or alcohol abuse.“(2)  Disciplinary action shall include termination, reduction or resignation of hospital privileges for any of the reasons listed in subdivision (a)(1).“(3)  The report shall be in writing and made within sixty (60) days of the date of the action.“(b)(1)  Any professional society within this state, comprised primarily of physicians, that takes formal disciplinary action against a member pursuant to § 63-1-150, shall report the action to the board of medical examiners, when the action taken is related to professional ethics, medical incompetence, moral turpitude or drug or alcohol abuse.“(2) This report shall be in writing and made within sixty (60) days of the action.“(c)  The hospital or professional society shall make available to the board of medical examiners, for examination, any and all records pertaining to the disciplinary action taken, notwithstanding § 63-1-150 to the contrary.“(d)  Any individual who, as a member of any quality improvement committee or employee of any healthcare organization, as defined in § 63-1-150, files a report pursuant to this section, shall be immune from liability as provided in § 63-1-150.

Effective Dates. Acts 2017, ch. 4, § 11. March 15, 2017.

Acts 2017, ch. 240, § 6. May 2, 2017.

68-11-219. Payment to health care agency of assigned insurance benefits — Insurer's duty to request information.

1. Upon assignment of benefits of a health, accident or sickness insurance policy to a hospital, nursing home, home for the aged, residential HIV supportive living facility, assisted-care living facility, alcohol and drug prevention and/or treatment facility, birthing center, prescribed child care center, ambulatory surgical treatment center, community mental health center, home care organization or other such health care agency or to a doctor or dentist for health care services rendered, by the insured under the policy, the health care agency or doctor or dentist shall be paid the benefits due under such policy to the extent of the assignment within thirty (30) days from the time the insurance company has received a final billing statement for such health care services from such health care agency, doctor or dentist; provided, that the insurance company has received information necessary to determine the extent of liability, if any.
2. It is the duty of the insurance company to request the information required for payment of such benefits within fifteen (15) days after receiving claim for benefits under such policy.
3. 1. If any portion of the claim is under dispute because of the nature, necessity or charges for the services, the insurer shall, within the thirty-day period, pay the amount of the claim that is not in dispute and notify the health care provider in writing of the reason or reasons for the dispute and the amount in dispute.
   2. If the dispute is due to the need for verification of services rendered and cannot otherwise be resolved by the insurer and health care provider, then the insurer shall schedule an audit on the premises of the health care provider within thirty (30) days of the notice and shall pay the amount determined to be due under the audit within thirty (30) days of the date of the audit done on the premises.
4. 1. Where a single confinement exceeds thirty (30) days, the provider may submit bills to the insurer on a thirty-day interval.
   2. When the insurer receives a billing statement of this nature, the insurer shall pay the claim for the period covered by the bill in accordance with this section.
5. If any portion of an assigned claim remains unpaid sixty (60) days after a billing statement from the assignee is received by the insurance company, the assignee of the claim may add an interest charge to the unpaid portion of the claim, with the accrual of such interest charge commencing on the thirty-first day, at an interest rate not to exceed one percent (1%) per month for an annual effective rate of interest of twelve percent (12%) per year; provided, that such interest shall not be allowed for that portion of any claim for which the insurance company has not received any requested information necessary to determine the extent of its liability, if any, or for that portion of any claim to which subsection (c) applies.
6. If the health care provider offers a prompt payment discount, it shall apply to any portion of the claim paid within the period specified in the prompt payment plan.
7. Failure of an insurer to comply with this section may be reported to the commissioner.

Acts 1978, ch. 881, § 1; 1980, ch. 686, § 1; 1982, ch. 690, § 1; T.C.A., § 53-1331; Acts 1988, ch. 821, § 1; 1989, ch. 205, § 1; 1990, ch. 758, § 1; 1991, ch. 423, §§ 1, 2; 1993, ch. 234, § 19; 1994, ch. 747, § 5; 1996, ch. 674, § 10; 1996, ch. 818, § 3; 1998, ch. 1021, § 4; 2000, ch. 981, § 93.

Cross-References. Bills concerning health coverage — Impact notes and statements, § 3-2-111.

68-11-220. Hospital billing information statements.

1. As used in this section, “hospital” includes hospitals as defined in § 68-11-201.
2. 1. Within ten (10) days following discharge or release from confinement in a hospital, or within ten (10) days after the earliest date at which the expense from confinement or service may be determined, the hospital providing such services shall submit to the patient, or an authorized representative, a statement or billing containing the same charge or expense information required to be included on the uniform claim form pursuant to § 56-7-1008.
   2. This statement shall not include charges of hospital-based physicians if billed separately.
3. 1. Subsequent to the initial billing for services, the hospital shall, upon written request from the patient, an authorized representative, an insurance company, an employer, or other organization responsible for the reimbursement or payment of such services, provide a more detailed statement of specific services received and expenses incurred by the patient.
   2. The hospital shall be allowed thirty (30) days from the receipt of a request to provide the statement.
   3. All requests shall be made within one (1) year of discharge.

Acts 1984, ch. 730, § 1.

68-11-221. Deficiencies in facilities—Special monitors.

During a suspension of admissions pursuant to § 68-11-252, the commissioner shall appoint one (1) or more special monitors, if the deficiency threatens serious bodily harm to the patients or residents of the facility. The commissioner may appoint a special monitor or monitors at any other time, if the commissioner has reason to believe that deficiencies exist in a facility that are detrimental to the direct care of the patients or residents. Whenever the appointment of monitors is utilized pursuant to this section, the commissioner shall appoint a sufficient number of monitors to ensure their presence in the facility for a minimum of twenty (20) hours per week. The monitors shall observe the operation of the facility, and shall submit written reports periodically to the commissioner on the operation of the facility. Persons appointed as monitors shall be duly qualified to discharge their responsibilities. While employed as monitors, they shall represent the department with the power to observe and review all of the facility's operation, with attention to those aspects for which the suspension of admission was imposed. When appointment of a monitor or monitors is mandated by this section, the facility shall be liable for the costs of the special monitors, until it has been determined that the deficiencies have been corrected. No part of such costs for which a facility is liable shall be recoverable by the facility, either directly or indirectly, from the medical assistance program administered pursuant to title 71, chapter 5, part 1. The commissioner may retain a monitor in a facility after correction to evaluate the facility's continued compliance, but it shall be at the expense of the department. The costs of such monitors shall be recoverable as follows:

1. Deduction of the amount of such costs from amounts otherwise due from the state to the facility and to remittance of such amounts to the department;
2. Addition of such costs to the facility's licensing fee, the renewal of the facility's license to be contingent upon the prior payment of such costs; or
3. By suit of the department in the circuit or chancery court to recover such costs.

Acts 1986, ch. 775, § 1; 2018, ch. 655, § 4.

Amendments. The 2018 amendment substituted “pursuant to § 68-11-252,” for “pursuant to § 68-11-207,” near the beginning of the first sentence.

Effective Dates. Acts 2018, ch. 655, § 15. July 1, 2018.

Cross-References. Safeguards for retirement living facilities guaranteeing continued medical care and services, § 4-3-1305.

68-11-222. Acquired immune deficiency syndrome (AIDS) — Policies.

1. All acute care hospitals, birthing centers, prescribed child care centers, and ambulatory surgical treatment centers in Tennessee licensed pursuant to  this part shall adopt, in the discretion of the institution and in consultation with the institution's medical staff, appropriate policies regarding the testing of patients and staff for human immunodeficiency virus (HIV) and any other identified causative agent of acquired immune deficiency syndrome (AIDS).
2. Acting in consultation with the department of health, the following state entities shall promulgate rules requiring the respective facilities and persons, regulated by such state entities, to adopt and appropriately utilize universal precautions for prevention of HIV transmission:
   1. Board for licensing health care facilities, created under § 68-11-202;
   2. Board of dentistry, created under § 63-5-101;
   3. Board of medical examiners, created under § 63-6-101;
   4. Board of medical examiners' committee on physician assistants, created under § 63-19-103;
   5. Board of nursing, created under § 63-7-201;
   6. Board of occupational therapy, created under § 63-13-216;
   7. Board of optometry, created under § 63-8-103;
   8. Board of osteopathic examination, created under § 63-9-101;
   9. Board of physical therapy, created under § 63-13-318; and
   10. Board of podiatric medical examiners, created under § 63-3-103.
3. 1. In the event that an employee of a health care facility or an inpatient mental health facility licensed under title 33, a student studying at the health care facility or inpatient mental health facility licensed under title 33 or other care provider that renders services at the healthcare facility or inpatient mental health facility licensed under title 33 is exposed to the blood or other body fluid of a patient, the facility may require that patient's blood to be tested for the presence of the hepatitis B virus and the HIV/AIDS virus.
   2. Such testing shall be performed at no charge to the patient and the results of such testing shall be confidential.

Acts 1989, ch. 447, § 1; 1993, ch. 264, §§ 1-3; 1993, ch. 340, § 1; 1996, ch. 674, § 11; 2000, ch. 981, § 94; 2007, ch. 115, § 12; 2008, ch. 848, § 1.

Code Commission Notes

Former subsection (b), regarding the deadline for the promulgation of policies, was deleted as obsolete by authority of the code commission in 2006.

Cross-References. AIDS, aggravated prostitution, § 39-13-516.

Confidentiality of public records, § 10-7-504.

Facilities to test for AIDS, § 68-32-102.

68-11-223. Ambulatory surgical treatment centers performing abortions.

1. The general assembly finds and declares as fact, with regard to ambulatory surgical treatment centers that terminate pregnancies, that:
   1. Over twenty-one thousand (21,000) abortions are performed annually in Tennessee;
   2. The majority of these abortions are performed in ambulatory surgical treatment centers;
   3. Gross negligence, unethical conduct and unprofessional administration of some centers have been documented by the department, including conditions such as:
      1. The existence of unsterile and unsanitary conditions;
      2. Fire and safety violations, electrical code violations and inadequate ventilation;
      3. Improper disposal of infectious waste;
      4. Allowing patients to leave too soon after the abortion procedure;
      5. Lack of records on patients and complications;
      6. Doctors practicing without a license or without local hospital privileges; and
      7. Surgical procedures performed without a nurse in attendance;
   4. Such centers are the only medical facilities in the state that regularly perform surgery on minors without the knowledge or consent of the parents, guardian or custodian; and yet the parents, guardian or custodian are not relieved of their financial liability and familial responsibilities;
   5. Such centers should be held to similarly applicable standards as other health care related facilities;
   6. The state has a legitimate interest in protecting its citizens from exploitation, the spread of infectious diseases, and ensuring that its citizens utilizing such centers are provided with quality health care as is required in all health care facilities licensed and regulated by the state; and
   7. Many such centers do not carry or maintain adequate health care liability insurance, if any, and the state has an interest in ensuring that those persons utilizing such centers have an adequate recourse to recover financially if a health care liability action arises from the use of such facilities.
2. 1. In addition to complying with the rules and regulations promulgated by the board for ambulatory surgical treatment centers, no ambulatory surgical treatment center that terminates pregnancies shall be granted a license, renewal of a license or be authorized to continue operation under this chapter, unless it complies in full with all of the following requirements:
      1. Maintenance of at least two million dollars ($2,000,000) of health care liability insurance in force, annually submitting to the department proof of such insurance coverage;
      2. Satisfaction of all applicable regulations and requirements of the board for compliance with state and local building codes, including electrical, plumbing, fire and other building and safety codes, except where the board determines that a waiver is appropriate;
      3. Is not in violation of department regulations that directly impact the health care of multiple patients with such scope and magnitude as to clearly show consistent and willful neglect of the regulations, fundamental flaws in the facility's operation, or knowing failure to comply with departmental regulations;
      4. 1. The administrator of such facility shall be:
            1. A licensed physician, licensed practical nurse, registered nurse, or have a college degree from a four-year accredited institution and experience in a health-related field; and
            2. Of good moral character.
         2. For purposes of subdivision (b)(1)(D)(i), “administrator” means the person who is responsible for the operation of the medical facility where pregnancies are terminated;
      5. No employee providing direct patient care, officer, director, or owner of the facility, or if a corporation, a stockholder who owns fifty-one percent (51%) or more of the stock in the corporation, shall have been convicted of or pleaded nolo contendere to a felony or any crime involving moral turpitude within five (5) years immediately preceding the date of application; and
      6. No employee providing direct patient care, officer, director, or owner of the facility, or if a corporation, a stockholder who owns fifty-one percent (51%) or more of the stock in the corporation, shall have been convicted of or pleaded nolo contendere to any violation of this chapter.
   2. The board shall suspend or revoke a license of such center if a violation of this subsection (b) occurs following the issuance or renewal of a license.
   3. In addition to any other lawful disciplinary action under this part, the board may assess a civil penalty not exceeding two thousand dollars ($2,000) for each violation of this subsection (b).

Acts 1989, ch. 466, §§ 2, 3; 2012, ch. 798, §§ 56, 57.

Attorney General Opinions. Constitutionality of Acts 1989, ch. 466, regarding increased requirements of ambulatory surgical treatment centers that perform abortions, OAG 89-123 (9/26/89).

68-11-224. Withholding of resuscitative services — Regulations.

1. For the purposes of this section:
   1. “Clinical nurse specialist” means a nurse duly licensed under title 63, chapter 7 who has a master's degree or higher in a nursing specialty, has national specialty certification as a clinical nurse specialist, and is recognized by the board of nursing as an advanced practice nurse under § 63-7-126;
   2. “Do-not-resuscitate order” means a written order, other than a POST as defined by this section, not to resuscitate a patient in the event of cardiac or respiratory arrest in accordance with accepted medical practices;
   3. “Emergency responder” means a paid or volunteer firefighter, law enforcement officer, or other public safety official or volunteer operating within the scope of the person's proper function under the law or rendering emergency care at the scene of an emergency;
   4. “Health care provider”' shall have the same meaning as ascribed to that term in § 68-11-1802(a), and shall include, but shall not be limited to, qualified emergency medical services personnel;
   5. “Nurse practitioner” means a nurse duly licensed under title 63, chapter 7 who has a master's degree or higher in a nursing specialty, has national specialty certification as a nurse practitioner, and is recognized by the board of nursing as an advanced practice nurse under § 63-7-126;
   6. “Person authorized to consent on the patient's behalf” means any person authorized by law to consent on behalf of the patient incapable of making any informed decision or, in the case of a minor child, the parent or parents having custody of the child or the child's legal guardian or as otherwise provided by law;
   7. “Physician assistant” means a person who has graduated from a physician assistant educational program accredited by the Accreditation Review Commission on Education for the Physician Assistant, has passed the Physician Assistant National Certifying Examination, and is currently licensed in Tennessee as a physician assistant under title 63, chapter 19;
   8. “Physician orders for scope of treatment” or “POST” means written orders that:
      1. Are on a form approved by the board for licensing health care facilities;
      2. Apply regardless of the treatment setting that are signed as required herein by the patient's physician, physician assistant, nurse practitioner, or clinical nurse specialist; and
      3. 1. Specify whether, in the event the patient suffers cardiac or respiratory arrest, cardiopulmonary resuscitation should or should not be attempted;
         2. Specify other medical interventions that are to be provided or withheld; or
         3. Specify both (i) and (ii);
   9. “Qualified emergency medical service personnel” includes, but is not limited to, emergency medical technicians, paramedics, or other emergency services personnel, providers, or entities acting within the course of their professions, and other emergency responders; and
   10. “Unlicensed individuals who provide direct care and support to persons supported” means the unlicensed individuals, including their unlicensed direct care and support supervisors, who are employed to provide direct care and support to persons supported within the department of intellectual and developmental disabilities ICF/ID homes and facilities or by agencies that are licensed under title 33 and under contract with this department.
2. The POST may be issued by a physician for a patient with whom the physician has a bona fide physician-patient relationship, but only:
   1. With the informed consent of the patient;
   2. If the patient is a minor or is otherwise incapable of making an informed decision regarding consent for such an order, upon the request of and with the consent of the agent, surrogate, or other person authorized to consent on the patient's behalf under the Tennessee Health Care Decisions Act, compiled in part 18 of this chapter; or
   3. Where 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, if the physician determines that the provision of cardiopulmonary resuscitation would be contrary to accepted medical standards.
3. A POST may be issued by a physician assistant, nurse practitioner or clinical nurse specialist for a patient with whom such physician assistant, nurse practitioner or clinical nurse specialist has a bona fide physician assistant-patient or nurse-patient relationship, but only if:
   1. No physician who has a bona fide physician-patient relationship with the patient is present and available for discussion with the patient (or if the patient is a minor or is otherwise incapable of making an informed decision, with the agent, surrogate, or other person authorized to consent on the patient's behalf under the Tennessee Health Care Decisions Act);
   2. Such authority to issue is contained in the physician assistant's, nurse practitioner's or clinical nurse specialist's protocols;
   3. Either:
      1. The patient is a resident of a nursing home  licensed under this title or an ICF/MR facility licensed under title 33 and is in the process of being discharged from the nursing home or transferred to another facility at the time the POST is being issued; or
      2. The patient is a hospital patient and is in the process of being discharged from the hospital or transferred to another facility at the time the POST is being issued; and
   4. Either:
      1. With the informed consent of the patient;
      2. If the patient is a minor or is otherwise incapable of making an informed decision regarding consent for such an order, upon the request of and with the consent of the agent, surrogate, or other person authorized to consent on the patient's behalf under the Tennessee Health Care Decisions Act; or
      3. If 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, 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.
4. If the patient is an adult who is capable of making an informed decision, the patient's expression of the desire to be resuscitated in the event of cardiac or respiratory arrest shall revoke any contrary order in the POST. If the patient is a minor or is otherwise incapable of making an informed decision, the expression of the desire that the patient be resuscitated by the person authorized to consent on the patient's behalf shall revoke any contrary order in the POST. Nothing in this section shall be construed to require cardiopulmonary resuscitation of a patient for whom the physician or physician assistant or nurse practitioner or clinical nurse specialist determines cardiopulmonary resuscitation is not medically appropriate.
5. 1. A POST issued in accordance with this section shall remain valid and in effect until revoked. In accordance with this section and applicable regulations, qualified emergency medical services personnel; and licensed health care practitioners in any facility, program, or organization operated or licensed by the board for licensing health care facilities, the department of mental health and substance abuse services, or the department of intellectual and developmental disabilities, or operated, licensed, or owned by another state agency, shall follow a POST that is available to such persons in a form approved by the board for licensing health care facilities.
   2. The department of intellectual and developmental disabilities shall allow unlicensed individuals who provide direct support and care to persons supported and who are employed by agencies that are licensed under title 33 and under contract to provide residential or adult day programs and personal assistance or who provide direct support and care to persons supported within the ICF/ID homes and department facilities, to follow universal do not resuscitate orders that are made available to them in a form approved by the board.
6. Nothing in this section shall authorize the withholding of other medical interventions, such as medications, positioning, wound care, oxygen, suction, treatment of airway obstruction or other therapies deemed necessary to provide comfort care or to alleviate pain.
7. If a person has a do not resuscitate order in effect at the time of such person's discharge from a health care facility, the facility shall complete a POST prior to discharge. If a person with a POST is transferred from one health care facility to another health care facility, the health care facility initiating the transfer shall communicate the existence of the POST to qualified emergency medical service personnel and to the receiving facility prior to the transfer. The transferring facility shall provide a copy of the POST that accompanies the patient in transport to the receiving health care facility. Upon admission, the receiving facility shall make the POST a part of the patient's record.
8. This section shall not prevent, prohibit, or limit a physician from using a written order, other than a POST, not to resuscitate a patient in the event of cardiac or respiratory arrest in accordance with accepted medical practices. This action shall have no application to any do not resuscitate order that is not a POST, as defined in this section.
9. Valid do not resuscitate orders or emergency medical services do not resuscitate orders issued before July 1, 2004, pursuant to the then-current law, shall remain valid and shall be given effect as provided in this section.
10. 1. The board for licensing health care facilities shall promulgate rules and create forms regarding procedures for the withholding of resuscitative services from patients in accordance with the Tennessee Health Care Decisions Act, and this section.
    2. The rules shall address:
       1. The mechanism or mechanisms for reaching decisions about the withholding of resuscitative  services from individual patients;
       2. The mechanism or mechanisms for resolving conflicts in decision making, should they arise; and
       3. The roles of physicians, physician assistants, nurse practitioners or clinical nurse specialists and, when applicable, other nursing personnel, other appropriate staff, and family members in the decision to withhold resuscitative services.
    3. The rules shall include provisions designed to assure that patients' rights are respected when decisions are made to withhold resuscitative services and shall include the requirement that appropriate orders be written by the physician, physician assistant, nurse practitioner or clinical nurse specialist, primarily responsible for the patient, and that documentation be made in the patient's current clinical record if resuscitative services are to be withheld.
    4. This section shall not be construed or implemented in any manner which restricts or impairs the decision-making authority of the agent, surrogate, or other person designated in the Tennessee Health Care Decisions Act.
11. A health care provider or institution acting in good faith and in accordance with generally accepted health care standards applicable to the health care provider or institution is not subject to civil or criminal liability for:
    1. Complying with a POST;
    2. Declining to comply with a POST based on reasonable belief that the order then lacked validity; or
    3. Complying with a POST and assuming that the order was valid when made and has not been revoked or terminated.

Acts 1990, ch. 1082, §§ 1, 2; 2004, ch. 862, § 3; 2010, ch. 1100, § 111; 2012, ch. 541, §§ 1, 2; 2012, ch. 575, § 1; 2013, ch. 238, § 3; 2013, ch. 254, § 1.

Compiler's Notes. Acts 2010, ch. 1100, § 153 provided that the commissioner of mental health and developmental disabilities, the commissioner of mental health, the commissioner of intellectual and developmental disabilities, and the commissioner of finance and administration are authorized to promulgate rules and regulations to effectuate the purposes of the act. All such rules and regulations shall be promulgated in accordance with the provisions of the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.

Amendments. The 2013 amendment by ch. 238 deleted the former last sentence of (j)(4) as enacted by Acts 2013, ch. 254, which read: “This section does not authorize a surrogate to give consent for or take any action on behalf of a patient on any matter governed by title 33.”

The 2013 amendment by ch. 254 rewrote the section which read: “(a) A universal do not resuscitate order may be issued by a physician for a patient with whom the physician has a bona fide physician/patient relationship, but only:“(1) With the consent of the patient;“(2) If the patient is a minor or is otherwise incapable of making an informed decision regarding consent for such an order, upon the request of and with the consent of the agent, surrogate, or other person authorized to consent on the patient's behalf under the Tennessee Health Care Decisions Act, compiled in part 18 of this chapter; or“(3) If 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, compiled in part 18 of this chapter, is not reasonably available, the physician determines that the provision of cardiopulmonary resuscitation would be contrary to accepted medical standards.“(b) If the patient is an adult who is capable of making an informed decision, the patient's expression of the desire to be resuscitated in the event of cardiac or respiratory arrest shall revoke a universal do not resuscitate order. If the patient is a minor or is otherwise incapable of making an informed decision, the expression of the desire that the patient be resuscitated by the person authorized to consent on the patient's behalf shall revoke a universal do not resuscitate order. Nothing in this section shall be construed to require cardiopulmonary resuscitation of a patient for whom the physician determines cardiopulmonary resuscitation is not medically appropriate.“(c)(1) Universal do not resuscitate orders issued in accordance with this section shall remain valid and in effect until revoked. In accordance with this section and applicable regulations, qualified emergency medical services personnel, and licensed health care practitioners in any facility, program or organization operated or licensed by the board or by the department of mental health and substance abuse services or the department of intellectual and developmental disabilities or operated, licensed, or owned by another state agency are authorized to follow universal do not resuscitate orders that are available to them in a form approved by the board.“(2) The department of intellectual and developmental disabilities shall allow unlicensed individuals who provide direct support and care to persons supported and who are employed by agencies that are licensed under title 33 and under contract to provide residential or adult day programs and personal assistance or who provide direct support and care to persons supported within the ICF/ID homes and department facilities, to be authorized to follow universal do not resuscitate orders that are made available to them in a form approved by the board.“(d) Nothing in this section shall authorize the withholding of other medical interventions, such as intravenous fluids, oxygen, or other therapies deemed necessary to provide comfort care or to alleviate pain.“(e) For the purposes of this section:“(1) ‘Emergency responder’ means a paid or volunteer firefighter, law enforcement officer, or other public safety official or volunteer acting within the scope of such person's proper function under law or rendering emergency care at the scene of an emergency;“(2) ‘Health care provider’ shall have the same meaning as ascribed to that term in § 68-11-1802, and shall include, but shall not be limited to, qualified emergency medical services personnel;“(3) ‘Person authorized to consent on the patient's behalf’ means any person authorized by law to consent on behalf of the patient incapable of making an informed decision or, in the case of a minor child, the parent or parents having custody of the child or the child's legal guardian or as otherwise provided by law;“(4) ‘Qualified emergency medical service personnel’ shall include, but shall not be limited to, emergency medical technicians, paramedics, or other emergency services personnel, providers, or entities acting within the usual course of their professions, and other emergency responders;“(5) ‘Unlicensed individuals who provide direct care and support to persons supported’ means the unlicensed individuals, including their unlicensed direct care and support supervisors, who are employed to provide direct care and support to persons supported within the department of intellectual and developmental disabilities ICF/ID homes and facilities or by agencies that are licensed under title 33 and under contract with this department; and“(6) ‘Universal do not resuscitate order’ means a written order that applies regardless of the treatment setting and that is signed by the patient's physician that states that in the event the patient suffers cardiac or respiratory arrest, cardiopulmonary resuscitation should not be attempted.“(f) If a person with a universal do not resuscitate order is transferred from one (1) health care facility to another health care facility, the health care facility initiating the transfer shall communicate the existence of the universal do not resuscitate order to the receiving facility prior to the transfer. The transferring facility shall assure that a copy of the universal do not resuscitate order accompanies the patient in transport to the receiving health care facility. Upon admission, the receiving facility shall make the universal do not resuscitate order a part of the patient's record.“(g) This section shall not prevent, prohibit, or limit a physician from issuing a written order, other than a universal do not resuscitate order, not to resuscitate a patient in the event of cardiac or respiratory arrest in accordance with accepted medical practices. This section shall have no application to any do not resuscitate order that is not a universal do not resuscitate order as defined in this section.“(h) Valid do not resuscitate orders or emergency medical services do not resuscitate orders issued before July 1, 2004, pursuant to the then-current law, shall remain valid and shall be given effect as provided in this section.“(i)(1) The board shall promulgate rules and create forms regarding procedures for the withholding of resuscitative services from patients in accordance with this part and this section.“(2) The rules shall address:“(A) The mechanism or mechanisms for reaching decisions about the  withholding of resuscitative services from individual patients;“(B) The mechanism or mechanisms for resolving conflicts in decision making, should they arise; and“(C) The roles of physicians and, when applicable, of nursing personnel, other appropriate staff, and family members in the decision to withhold resuscitative services.“(3) The rules shall include provisions designed to assure that patients' rights are respected when decisions are made to withhold resuscitative services and shall include the requirement that appropriate orders be written by the physician primarily responsible for the patient, and that documentation be made in the patient's current clinical record if resuscitative services are to be withheld.“(4) This section shall not be construed or implemented in any manner that restricts or impairs the decision-making authority of the agent, surrogate, or other person designated in the Tennessee Health Care Decisions Act, compiled in part 18 of this chapter. This section does not authorize a surrogate to give consent for or take any action on behalf of a patient on any matter governed by title 33.“(j) A health care provider or institution acting in good faith and in accordance with generally accepted health care standards applicable to the health care provider or institution is not subject to civil or criminal liability for:“(1) Complying with a universal do not resuscitate order;“(2) Declining to comply with a universal do not resuscitate order based on a reasonable belief that the order then lacked validity; or“(3) Complying with a universal do not resuscitate order and assuming that the order was valid when made and has not been revoked or terminated.”

Effective Dates. Acts 2013, ch. 238, § 5. July 1, 2013.

Acts 2013, ch. 254, § 2. July 1, 2013; provided, that, for purposes of rulemaking the act shall take effect April 19, 2013.

Attorney General Opinions. Authority under the Tennessee Health Care Decisions Act, OAG 05-093 (6/13/05).

Unlicensed direct care staff of providers in communities that contract with the division of mental retardation services  (now division of intellectual disabilities services) are not addressed by the provisions of T.C.A. § 68-11-224, OAG 07-050 (4/16/07).

68-11-225. Nursing home administrators — Unexpected losses.

1. This section applies to situations in which licensed nursing homes suffer the unexpected loss of an administrator and provide for procedures to be followed in such cases.
2. “Unexpected loss” means the absence of a nursing home administrator due to serious illness or incapacity, unplanned hospitalization, death, resignation with less than thirty (30) days' notice or unplanned termination.
3. The procedures to be followed by the facility upon receiving notice of the unexpected loss of the administrator are as follows:
   1. The facility shall notify the department within twenty-four (24) hours after notice of the unexpected loss of the administrator. Notification to the department shall identify an individual to be responsible for administration of the facility for the immediate future, not to exceed thirty (30) days. This responsible individual need not be licensed as an administrator and may be the facility's director of nursing;
   2. Within seven (7) days of notice of the unexpected loss, the facility shall request a waiver of the appropriate regulations from the board; and
   3. On or before the expiration of thirty (30) days after notice of the unexpected loss, the facility shall appoint a temporary administrator to serve until either a permanent administrator is employed or the request for a waiver is considered by the board, whichever occurs first. The temporary administrator shall be any of the following:
      1. A full-time administrator licensed in Tennessee or any other state;
      2. One (1) or more part-time administrators licensed in Tennessee. Part-time shall not be less than twenty (20) hours per week; or
      3. A full-time candidate for licensure as a Tennessee administrator who has completed the required training.
4. The procedures set forth in subsection (c) shall be followed until the next regularly scheduled meeting of the board in which the board considers the facility's application for a waiver. At that meeting the board, after reviewing the circumstances, may grant, refuse or condition a waiver as necessary to protect the health, safety and welfare of the patients in the facility.
5. Any facility that follows the procedures set forth in subsection (c) shall not be subject to a civil penalty for absence of an administrator at any time preceding the board's consideration of the facility's request for a waiver.

Acts 1994, ch. 813, § 1.

Cross-References. Nursing home administrators, title 63, chapter 16.

68-11-226. Licensing of home medical equipment provider.

1. The board shall establish, by rules and regulations, standards by which a home medical equipment provider shall be licensed. The board shall provide by rule that any home medical equipment provider accredited by the joint commission on accreditation of health care organizations or other home care accrediting organizations recognized by the health care financing administration may submit documents evidencing current accreditation and shall be presumed to comply with the requirements of the board. Licensing of a home medical equipment provider that has been accredited by the joint commission on accreditation of health care organizations or other home care accrediting organizations recognized by the health care financing administration shall become effective upon written notification from the board's staff that the accreditation meets the standards set out in the rules and regulations promulgated pursuant to this section. The board shall also establish, by rule, provisions to ensure that branch offices of a home medical equipment provider are not required to be separately licensed nor charged separate license fees. The board shall establish by rule that a provider of home medical equipment services that has a principal place of business outside this state shall maintain an office or place of business within this state.
2. Nothing in this section or in § 68-11-102 [repealed] or § 68-11-201 or any other law shall require a home medical equipment provider that provides respiratory care equipment and that employs a respiratory care therapist, technician or assistant for the purpose of assisting patients with the use of such equipment to obtain authority as a provider of home health services.
3. Nothing in this section or in § 68-11-201 requires a person providing home medical equipment services to obtain a certificate of need pursuant to part 16 of this chapter.
4. 1. All home care organizations providing prescribed wheeled mobility devices in this state shall have on staff, or contract with, a qualified rehabilitation professional.
   2. Home care organizations providing prescribed wheeled mobility devices shall obtain a complete written evaluation and recommendation by a qualified rehabilitation professional or physical therapist (PT) or occupational therapist (OT) for recipients of prescribed wheeled mobility devices.
   3. Home care organizations providing prescribed wheeled mobility devices shall obtain a complete face-to-face written evaluation and recommendation by a qualified rehabilitation professional for consumers of prescribed wheeled mobility devices.
   4. On and after July 1, 2007, a one-hundred-eighty-day grace period shall be provided to organizations that provide prescribed wheeled mobility devices, if the qualified rehabilitation professional on staff ceases to be employed and the organization has no other qualified rehabilitation professional on staff.
   5. 1. On and after July 1, 2007, all organizations making available prescribed wheeled mobility devices to consumers in this state shall have a repair service department or a contract with a repair service department located in the state. The organization shall have a qualified technician with knowledge and capability of servicing the product provided to the consumer.
      2. As used in this section, unless the context otherwise requires, “consumer” means an individual for whom a wheeled mobility device, manual or powered, has been prescribed by a physician, and required for use for a period of six (6) months or more.
   6. On or after July 1, 2007, delivery and final fitting of a wheeled mobility device shall be determined by a qualified rehabilitation professional. This subsection (d) exempts wheeled mobility devices under category Group 1 medicare codes.
5. Nothing in this section or § 68-11-201 shall require a provider of home medical equipment or services that manufactures or distributes, or both manufactures and distributes, the provider's own company-branded insulin infusion pumps and related supplies and services to have a place of business within the state if the provider:
   1. Maintains an employee presence within the state;
   2. Is accredited by the joint commission; and
   3. Maintains a service telephone number for twenty-four-hour access, seven (7) days a week.

Acts 1995, ch. 244, §§ 5-7; 1997, ch. 26, § 1; 2003, ch. 121, § 3; 2007, ch. 377, §§ 3, 4; 2010, ch. 770, § 1; 2015, ch. 476, § 2.

Compiler's Notes. Acts 2003, ch. 121, § 1 provided that the act shall be known and may be cited as the “Consumer Protection Act for Wheeled Mobility.”

Former § 68-11-102, referred to in this section, was repealed by Acts 2002, ch. 780, § 3, effective July 1, 2002.

Amendments. The 2015 amendment added (e).

Effective Dates. Acts 2015, ch. 476, § 3. May 18, 2015.

Attorney General Opinions. A pharmacy which holds itself out to the public as providing home medical equipment services is subject to the statutes and rules which require licensure and regulation of free-standing home care organizations providing home medical equipment, OAG 01-150 (9/24/01).

68-11-227. Prohibited hospital actions.

1. A hospital shall not require hospital-based physicians to:
   1. Pay for the cost of the use of necessary medical equipment related to the provision of medical services by the hospital-based physicians; or
   2. Share in the cost of advertising related to their services or services of the hospital, unless specifically required by contract.
2. The termination of an oral or written contract between a hospital and a hospital-based physician shall not result in loss of medical staff privileges, through contractual provisions or hospital policy, unless there is a written contract that contains a section separately executed by the parties that provides for the loss of medical staff privileges:
   1. If such physician is provided with at least six (6) months' written notice of the termination of the contract; and
   2. If such physician either:
      1. Provides medical services under the contract to a department of the hospital that has a closed staff and will have a closed staff after termination of the contract; or
      2. Provides medical services under the contract to a department of the hospital that has an open staff, but will have a closed staff after termination of the contract. In the case of an emergency physician, the notice of termination described in this subsection (b) may be less than six (6) months in order to obtain emergency coverage to satisfy requirements of state licensing rules, accreditation or applicable managed care plans.
3. As used in this section, “hospital-based physician” means an anesthesiologist, emergency physician, pathologist, or radiologist.

Acts 1995, ch. 466, § 4.

Collateral References.

Exclusion of, or discrimination against, physician or surgeon by hospital. 28 A.L.R.5th 107.

68-11-228. “Home care organization” and “solicit” defined.

1. As used in §§ 68-11-228 — 68-11-231, “home care organization” has the meaning as set forth in § 68-11-201.
2. 1. Except as otherwise provided, “solicit,” as used in §§ 68-11-228 — 68-11-231, means contact with a patient knowingly being treated by another home care organization for the purpose of attempting to persuade the patient to change home care organizations. “Solicit” specifically includes, but is not limited to, contacts by an existing or former employee of a home care organization for the purpose of persuading a patient of that home care organization to change to another home care organization.
   2. “Solicit,” as used in §§ 68-11-228 — 68-11-231, does not include a home care organization's communications to the general public or any advertising of services through means of direct mail. The prohibition on solicitation set forth in this section shall in no way prevent a physician from making a recommendation to a patient that the patient use a particular home care organization's services based upon the physician's independent judgment.

Acts 1995, ch. 526, § 1.

68-11-229. Solicitation of patients of other home care organizations prohibited.

It is unlawful for any home care organization, through its officers, directors, employees or agents, to knowingly solicit any patient to change home care organizations, if that patient is being treated at the time by another home care organization.

Acts 1995, ch. 526, § 2.

68-11-230. Purpose of §§ 68-11-228 — 68-11-231 — Construction.

The purpose of §§ 68-11-228 — 68-11-231 is to promote and maintain the necessary quality and continuity of care provided by a home care organization to its patients. Nothing contained in these sections shall:

1. Limit the right of a home care organization patient to change home care organizations at any time the patient so chooses;
2. Prohibit any home care organization from discussing services with, or providing services to, someone who voluntarily makes an initial contact with such home care organization for the purpose of seeking services from such home care organization or who responds to a public advertisement by such home care organization;
3. Prohibit any home care organization from discussing services with, or providing services to, a patient when someone acting on the patient's behalf or in the patient's interest makes an initial contact with such home care organization; or
4. Prohibit a managed care organization from requiring its enrollees to use only those home care organizations with which it has entered contracts for services.

Acts 1995, ch. 526, § 3.

68-11-231. Penalties — Injunction — Attorney's fees.

A home care organization found in violation of § 68-11-229 shall be subject to an injunction by either a circuit or chancery court of competent jurisdiction prohibiting further solicitation. An action seeking injunctive relief may be initiated by any home care organization. The prevailing party may, in the court's discretion, be awarded attorney fees. The right to injunctive relief granted pursuant to this section shall not prevent an offended organization from seeking monetary damages or any other relief against the offending organization to which it may be entitled at law or in equity.

Acts 1995, ch. 526, § 4.

Cross-References. Injunctions, generally, title 29, ch. 23.

68-11-232. Construction of chapter regarding providing assisted-care living facility services and care.

1. Nothing in this chapter shall require or authorize the state medicaid agency or a managed care organization to approve, supply or cover the services set out in § 68-11-201 for assisted-care living facilities.
2. Nothing in this chapter shall require or authorize the state medicaid agency or a managed care organization to approve, supply or cover medically necessary home care services provided in an assisted-care living facility, where the home care services are provided, supervised or directed by any person or entity with an ownership or control interest or by a managing employee of an entity with an ownership or control interest in the licensed assisted-care living facility or a licensed nursing home.
3. Nothing in this chapter shall require any other third party payer to approve, supply or cover medically necessary home care services provided in an assisted-care living facility, where the home care services are provided, supervised or directed by any person or entity with an ownership or control interest or by a managing employee of an entity with an ownership or control interest in the licensed assisted-care living facility or a licensed nursing home.

Acts 1996, ch. 818, § 5.

68-11-233. Criminal background check of applicants.

1. A home care organization that provides home health services or hospice services shall require a criminal background check of persons who apply for employment with the organization as a paid employee and provider of direct care to a patient, prior to such persons being employed by the organization. The background check shall be conducted either by the Tennessee bureau of investigation and the federal bureau of investigation, or by a professional background screening organization or criminal background check service or registry.
2. Any person who applies for employment with a home care organization as a paid employee and provider of direct care to a patient shall consent to the following:
   1. The release of all investigative records to such organization for examination for the purpose of verifying the accuracy of criminal violation information contained on an application to work for such organization;
   2. To supply fingerprint samples and submit to a criminal history records check to be conducted by the Tennessee bureau of investigation and the federal bureau of investigation;
   3. To provide past work and personal references to be checked by such organization; and
   4. The release of any information required for a criminal background investigation by a professional background screening organization or criminal background check service or registry.
3. A home care organization shall not disclose criminal background check information obtained under subsection (a) to a person who is not involved in evaluating a person's employment, except as required or permitted by state or federal law.
4. Any costs incurred by the Tennessee bureau of investigation and the federal bureau of investigation in conducting the investigation of applicants shall be paid by the home care organization requesting such investigation and information, in accordance with §§ 38-6-103 and 38-6-109.
5. This section shall also apply to any company, organization, or agency that provides or arranges for the supply of direct care staff to an organization described in subsection (a). The company, organization, or agency shall be responsible for initiating a criminal background check on any person hired by that entity for the purposes of working in a home care organization that provides home health services or hospice services, and shall be required to report the results of the criminal background check to any home care organization in which the company, organization, or agency arranges for that individual to work, upon such a request by a company, organization, or agency.
6. A home care organization that declines to employ or terminates a person based upon criminal background information provided to the organization under this section shall be immune from suit by or on behalf of that person for the termination of or the refusal to employ that person.

Acts 1997, ch. 232, § 1; 2003, ch. 116, §§ 1, 2; 2016, ch. 1044, § 4.

Amendments. The 2016 amendment rewrote the section which read: “(a) A home care organization that provides home health services or hospice services may require any person who applies for employment with the organization as a paid employee or as a volunteer, to do one (1) or more of the following:“(1) Agree to the release of all investigative records to such organization for examination for the purpose of verifying the accuracy of criminal violation information contained on an application to work for such organization or to provide volunteer services; or“(2) Supply fingerprint samples and submit to a criminal history records check to be conducted by the Tennessee bureau of investigation and the federal bureau of investigation.“(b) Any costs incurred by the Tennessee bureau of investigation and the federal bureau of investigation in conducting such investigation of applicants shall be paid by the home care organization requesting such investigation and information. Payment of such costs is to be made in accordance with § 38-6-103.”

Effective Dates.  Acts 2016, ch. 1044, § 11. July 1, 2016.

68-11-234. Criminal background checks for child care center employees.

1. All “prescribed child care centers” as defined in § 68-11-201 shall initiate a criminal background check on any person who is employed by or who wishes to volunteer in a capacity that involves providing direct care to a child, prior to or within seven (7) days of employment or provision of services. Any person who applies for employment in a position or who wishes to volunteer in a capacity that involves providing direct care to a child in such a facility shall consent to any or all of the following:
   1. Provide past work and personal references to be checked by the prescribed child care center;
   2. Agree to the release of any and all information and investigative records to the prescribed child care center or its agent, or to any agency that contracts with the state of Tennessee necessary for the purpose of verifying whether the individual has been convicted of a felony in the state of Tennessee;
   3. Supply a fingerprint sample and submit to a criminal history records check to be conducted by the Tennessee bureau of investigation, other law enforcement agency, or any legally authorized entity; or
   4. Release any information required for a criminal background investigation by a professional background screening organization or criminal background check service or registry.
2. Any costs incurred by the Tennessee bureau of investigation, professional background screening organization, law enforcement agency or other legally authorized entity, in conducting investigations of such applicants or volunteers may be paid by the prescribed child care center, or any agency that contracts with the state of Tennessee requesting such investigation and information, or the individual who seeks employment or is employed or volunteers. Payments of such costs to the Tennessee bureau of investigation are to be made in accordance with §§ 38-6-103 and 38-6-109.
3. A prescribed child care center that declines to employ or terminates a person based upon information provided to the facility under this section shall be immune from suit by or on behalf of that person for the termination of or the refusal to employ that person.

Acts 2000, ch. 981, § 95.

68-11-235. Fire safety in nursing homes — Sprinkler plans — Compliance dates — New facilities — Effect of noncompliance — Fire drills — Reimbursement for Medicaid certified facilities.

1. As used in this section, the term “nursing home” or “facility” means any nursing home as defined in § 68-11-201.
2. No later than August 1, 2004, any nursing home that is not fully sprinklered as of May 3, 2004, must provide a smoke alarm or smoke detector, or both, in each patient room, which may be a single-station smoke alarm that is powered by battery or electrical current, or a series of smoke detectors that are connected together and have a central fire alarm panel, or any combination thereof.
3. Any nursing home that is not fully sprinklered as of May 3, 2004, must submit to the department of health a sprinkler plan for the full sprinklering of the facility.
   1. If the facility provides patient care above the ground floor, the facility must submit the sprinkler plan no later than November 3, 2004.
   2. If the facility provides patient care only on the ground floor, the facility must submit the sprinkler plan no later than April 3, 2005.
4. A facility not fully sprinklered as of May 3, 2004, may choose to completely replace the facility as an alternative to complying with subsection (c). If the facility elects to do so, it must submit to the board a letter stating its intent to replace the facility and estimating the completion dates for the request for a certificate of need, commencement of construction of the facility, and licensure of the facility. This letter must be submitted to the board within the time frame in either subdivision (c)(1) or (c)(2) that would otherwise apply to the facility.
5. Any facility that has submitted a sprinkler plan to the department prior to May 3, 2004, shall not be required to resubmit its plans.
6. The department of health must review and approve or disapprove any sprinkler plan for a nursing home within thirty (30) days of the plan being submitted by or on behalf of the nursing home. Any sprinkler plan for a nursing home submitted prior to July 1, 2004, must be reviewed and approved or disapproved by the department no later than August 1, 2004.
7. If the department disapproves a sprinkler plan submitted by or on behalf of a nursing home, that nursing home or the nursing home's contractor shall promptly resubmit the plan with any needed corrections or clarifying information. Once resubmitted, the department of health must review and approve or disapprove of the plan no later than thirty (30) days after the plan is resubmitted.
8. A licensed nursing home that is not fully sprinklered as of July 1, 2004, shall become fully sprinklered in accordance with the following compliance dates:
   1. If the facility provides patient care above or below the ground floor, the facility must complete installation of sprinklers within twelve (12) months from July 1, 2004, or twelve (12) months from the date of approval of its sprinkler plan, whichever is later.
   2. If the facility provides patient care only on the ground floor, the facility must complete installation of sprinklers within eighteen (18) months from July 1, 2004, or eighteen (18) months from the date of approval of its sprinkler plan, whichever is later.
   3. A facility may request that the department extend its timeframe for installation of sprinklers, if the water service supplied by the local water utility or municipality is insufficient to operate the sprinkler system.
9. A facility not fully sprinklered by July 1, 2004, may choose to completely replace the facility as an alternative to complying with subsection (h). If the facility elects to do so, the new facility must be approved by the health services and development agency, must be constructed according to building plans that have been approved by the department of health, and must be in construction beyond the footing stage no later than three (3) years after July 1, 2004.
10. On and after July 1, 2004, the department of health shall not issue a license to any new facility, unless that facility is fully sprinklered and provides a smoke alarm or smoke detector, or both, in each patient room prior to licensure. The smoke alarms or detectors may be single-station alarms that are powered by battery or electrical current, or a series of smoke detectors that are connected together and have a central fire alarm panel, or any combination thereof.
11. Failure to comply with this section shall be grounds for discipline or licensure action, or both, by the board pursuant to § 68-11-207(a), (c) and (d). Any facility that fails to comply with the requirements and timeframes of this section may be required to appear before the board to explain its noncompliance.
12. At least once per year, each licensed nursing home shall coordinate a fire drill with its local fire department. The local fire department shall observe the fire drill and provide input to the facility relative to the fire safety of the facility.
13. For medicaid-certified facilities that install the required sprinkler and smoke detector systems after July 1, 2004, the cost of such installation shall be reimbursed over a five-year period beginning after the installation is complete and based on the facility's medicaid cost ratio as computed by the comptroller of the treasury. The costs of such installation shall not be included in the facility's medicaid rate calculations, but shall be reimbursed in addition to each facility's medicaid per diem rate and not subject to the medicaid maximum rate.
14. For medicaid-certified facilities that installed sprinkler systems between August 1994 and July 1, 2004, the cost of such installation shall be reimbursed over a five-year period beginning July 1, 2004, based on the facility's medicaid cost ratio as computed by the comptroller of the treasury. The cost reimbursed over the five-year period will be calculated as total installation cost minus any depreciation cost for the sprinkler system the facility has claimed on medicaid cost reports prior to July 1, 2004. The costs of such installation shall not be included in the facility's medicaid rate calculations, but shall be reimbursed in addition to each facility's medicaid per diem rate and not subject to the medicaid maximum rate.
15. This section shall control to the extent that any existing law is in conflict with this section.

Acts 2004, ch. 590, § 1; 2004, ch. 856, § 1.

Code Commission Notes.

Former subsection (f) was deleted as redundant of present subsection (k) by authority of the code commission in 2006.

68-11-236. Fire safety in assisted-care living facilities.

1. The term “facility” as used in this section means any assisted-care living facility, as that term is defined in § 68-11-201.
2. No later than one hundred twenty (120) days after July 1, 2004, any licensed facility that is not fully sprinklered as of July 1, 2004, must provide electronically operated smoke detectors with battery back-up power operating at all times in, at least, sleeping rooms, day rooms, corridors, laundry rooms, and any other hazardous areas.
3. Any facility that is not fully sprinklered as of July 1, 2004, must submit to the department of health a sprinkler plan for the full sprinklering of the facility.
   1. If the facility provides resident care above the ground floor, the facility must submit the sprinkler plan no later than six (6) months from July 1, 2004.
   2. If the facility provides resident care only on the ground floor, the facility must submit the sprinkler plan no later than eleven (11) months from July 1, 2004.
   3. Any facility that submitted a sprinkler plan to the department prior to July 1, 2004, shall not be required to resubmit its plan.
4. The department of health must review and approve or disapprove any sprinkler plan for a facility within thirty (30) days of the plan being submitted by or on behalf of the facility. Any sprinkler plan for a facility submitted prior to July 1, 2004, must be reviewed and approved or disapproved by the department no later than August 1, 2004.
5. If the department disapproves a sprinkler plan submitted by or on behalf of a facility, that facility or the facility's contractor shall promptly resubmit the plan with any needed corrections or clarifying information. Once resubmitted, the department of health must review and approve or disapprove of the plan no later than thirty (30) days after the plan is resubmitted.
6. A licensed facility that is not fully sprinklered as of July 1, 2004, shall become fully sprinklered in accordance with the following compliance dates:
   1. If the facility provides resident care above or below the ground floor, the facility must complete installation of sprinklers within twelve (12) months from July 1, 2004, or twelve (12) months from the date of approval of its sprinkler plan, whichever is later.
   2. If the facility provides resident care only on the ground floor, the facility must complete installation of sprinklers within eighteen (18) months from July 1, 2004, or eighteen (18) months from the date of approval of its sprinkler plan, whichever is later.
   3. A facility may request that the department extend its timeframe for installation of sprinklers, if the water service supplied by the local water utility or municipality is insufficient to operate the sprinkler system.
7. A facility not fully sprinklered as of July 1, 2004, may choose to completely replace the facility as an alternative to complying with subsection (f). If the facility elects to do so, the new facility must be constructed according to building plans that have been approved by the department of health, and must be in construction beyond the footing stage no later than three (3) years after July 1, 2004.
8. On and after July 1, 2004, the department of health shall not issue a license to any new facility, unless that facility is fully sprinklered and provides a smoke detector in each resident room prior to licensure.
9. Failure to comply with this section shall be grounds for discipline or licensure action, or both, by the board pursuant to § 68-11-207. Any facility that fails to comply with the requirements and timeframes of this section may be required to appear before the board to explain its noncompliance.
10. At least once per year, each licensed facility shall coordinate a fire drill with its local fire department. The local fire department shall observe the fire drill and provide input to the facility relative to the fire safety of the facility.
11. This section shall control to the extent that any existing law is in conflict with this section.

Acts 2004, ch. 860, § 1.

68-11-237. Fire safety in licensed homes for the aged.

1. The term “facility” as used in this section means:
   1. Any home for the aged, as such term is defined in § 68-11-201, that is licensed for twelve (12) or more beds in which all residents live on the ground floor; or
   2. Any home for the aged that has two (2) or more stories in which residents live.
2. No later than one hundred twenty (120) days after July 1, 2004, any licensed home for the aged that is not fully sprinklered as of July 1, 2004, must provide electronically operated smoke detectors with battery back-up power operating at all times in, at least, sleeping rooms, day rooms, corridors, laundry rooms, and any other hazardous areas.
3. Any facility that is not fully sprinklered as of July 1, 2004, must submit to the department of health a sprinkler plan for the full sprinklering of the facility.
   1. If the facility provides resident care above the ground floor, the facility must submit the sprinkler plan no later than twelve (12) months from July 1, 2004.
   2. If the facility provides resident care only on the ground floor, the facility must submit the sprinkler plan no later than fifteen (15) months from July 1, 2004.
   3. Any facility that submitted a sprinkler plan to the department prior to July 1, 2004, shall not be required to resubmit its plan.
4. The department of health must review and approve or disapprove any sprinkler plan for a facility within sixty (60) days of the plan being submitted by or on behalf of the facility. Any sprinkler plan for a facility submitted prior to July 1, 2004, must be reviewed and approved or disapproved by the department no later than August 1, 2004.
5. If the department disapproves a sprinkler plan submitted by or on behalf of a facility, that facility or the facility's contractor shall promptly resubmit the plan with any needed corrections or clarifying information. Once resubmitted, the department of health must review and approve or disapprove of the plan no later than thirty (30) days after the plan is resubmitted.
6. A licensed facility that is not fully sprinklered as of July 1, 2004, shall become fully sprinklered in accordance with the following compliance dates:
   1. If the facility provides resident care above or below the ground floor, the facility must complete installation of sprinklers within eighteen (18) months from July 1, 2004, or eighteen (18) months from the date of approval of its sprinkler plan, whichever is later.
   2. If the facility provides resident care only on the ground floor, the facility must complete installation of sprinklers within twenty-four (24) months from July 1, 2004, or twenty-four (24) months from the date of approval of its sprinkler plan, whichever is later.
   3. A facility may request that the department extend its timeframe for installation of sprinklers if the water service supplied by the local water utility or municipality is insufficient to operate the sprinkler system.
7. A facility not fully sprinklered as of July 1, 2004, may choose to completely replace the facility as an alternative to complying with subsection (f). If the facility elects to do so, the new facility must be constructed according to building plans that have been approved by the department of health, and must be in construction beyond the footing stage no later than six (6) years after July 1, 2004.
8. On and after July 1, 2004, the department of health shall not issue a license to any new facility unless that facility is fully sprinklered and provides a smoke detector in each resident room prior to licensure.
9. Failure to comply with this section shall be grounds for discipline or licensure action, or both, by the board pursuant to § 68-11-207. Any facility that fails to comply with the requirements and timeframes of this section may be required to appear before the board to explain its noncompliance.
10. At least once per year, each licensed facility shall coordinate a fire drill with its local fire department. The local fire department shall observe the fire drill and provide input to the facility relative to the fire safety of the facility.
11. This section shall control to the extent that any existing law is in conflict with this section.
12. In order to facilitate the affordability of safety-related changes required by this section, the department of health is authorized to establish a grant program to subsidize a portion or all of the cost of such changes for homes for the aged; provided, however, that the department may only use private donations that it receives for such purpose to fund the grants.

Acts 2004, ch. 860, § 2.

68-11-238. Marketing strategies and strategic plans — Confidentiality of records — Closed meetings.

1. Notwithstanding any law to the contrary, hospitals subject to the open meetings laws compiled in title 8, chapter 44, or the public records laws compiled in title 10, chapter 7, may discuss and develop marketing strategies and strategic plans in closed meetings, not open to the public, and the records addressing marketing strategies and strategic plans, including feasibility studies, may be treated as confidential and not public records, but shall be subject to subpoena. Action by the board of the hospital adopting a specific strategy or plan shall be subject to the open meetings laws and the adopted strategy or plan, and the studies that were considered in the adoption of the specific strategy or plan, shall then be subject to the public records laws. The records shall be available for public inspection at least seven (7) days before any vote to adopt such strategy.
2. Before a meeting of the board of trustees of the hospital shall be closed under this section, the following conditions shall apply:
   1. A quorum of the board shall convene in a public meeting. The presiding officer shall cite or explain to the members and the public assembled the specific legal authority for closing the meeting to the public;
   2. Members of the board shall vote by roll call in the public portion of the meeting on whether closing the meeting to the public is necessary. A simple majority vote of those members of the board in attendance at the meeting shall be required to go into a closed meeting; and
   3. The presiding officer shall explain to the members of the board and any members of the public present at the public portion of the meeting that no other business other than the business described in subsection (a) shall be discussed during the closed meeting.

Acts 2008, ch. 917, § 1.

Cross-References. Confidentiality of public records, § 10-7-504.

Attorney General Opinions. Permissibility of closed sessions of board of public hospital; records of studies considered by board and public inspection. OAG 15-08, 2015 Tenn. AG LEXIS 7 (1/28/15).

68-11-239. Central service technician.

1. As used in this section:
   1. “Central service department” means a department within a healthcare facility that processes, issues, and controls medical supplies, devices and equipment, both sterile and nonsterile, for patient care areas of a healthcare institution;
   2. “Central service technician” means a person who decontaminates, inspects, assembles, packages, and sterilizes reusable medical instruments or devices in a healthcare institution, whether such person is employed by the healthcare institution or provides services pursuant to a contract with the healthcare institution;
   3. “Healthcare institution” means an ambulatory surgical treatment center or a hospital, as those facilities are defined in § 68-11-201; and
   4. “Healthcare provider” means a person that provides healthcare services and is registered, certified, or licensed in accordance with title 63 and is under the division of health-related boards.
2. Unless otherwise permitted pursuant to this section, no person shall practice as a central service technician unless the person:
   1. 1. Has successfully passed a nationally accredited central service exam for central service technicians and holds and maintains one (1) of the following credentials:
         1. A certified registered central service technician credential administered by the International Association of Healthcare Central Service Material Management; or
         2. A certified sterile processing and distribution technician credential administered by the Certification Board for Sterile Processing and Distribution, Inc.; or
      2. Was employed or otherwise contracted for services as a central service technician in a healthcare institution before January 1, 2017; or
   2. Obtains a certified registered central service technician credential administered by the International Association of Healthcare Central Service Material Management or the Certification Board for Sterile Processing and Distribution, Inc., not later than two (2) years after the person's date of hire or contracting for services with a healthcare institution.
3. A person who qualifies to practice as a central service technician in a healthcare institution under subsection (b) shall complete a minimum of ten (10) hours of continuing education annually. The continuing education shall be in areas related to the functions of a central service technician.
4. Nothing in this section shall prohibit the following persons from performing the tasks or functions of a central service technician:
   1. A healthcare provider operating within the scope of practice for that provider established pursuant to title 63;
   2. A surgical technologist operating within the scope of practice established by § 68-57-105;
   3. A diagnostic medical sonographer while performing the duties of a sonographer;
   4. A student or intern performing the functions of a central service technician under the direct supervision of a person authorized under subdivision (d)(1) or (d)(2) as part of the student's or intern's training or internship; or
   5. A person who does not work in a central service department in a healthcare institution, but who has been specially trained and determined competent, based on standards set by a healthcare institution's infection prevention or control committee, acting in consultation with a central service technician certified in accordance with subsection (b), to decontaminate or sterilize reusable medical equipment, instruments, or devices, in a manner that meets applicable manufacturer's instructions and standards.
5. A healthcare institution shall retain a list of persons determined to be competent under subdivision (d)(5). The list shall include job titles for such persons. A person determined to be competent pursuant to subdivision (d)(5) shall annually complete a minimum of ten (10) hours of continuing education in areas related to infection control and the decontamination and sterilization of reusable medical equipment, instruments and devices.
6. 1. For any person practicing as a central service technician at a healthcare institution pursuant to subdivision (b)(1)(A), the healthcare institution shall maintain documentation that the person meets all requirements of subdivision (b)(1)(A).
   2. For any person practicing as a central service technician at a healthcare institution pursuant to subdivision (b)(1)(B), the healthcare institution shall maintain documentation of the dates for which the person was employed or otherwise contracted for services as a central services technician in the healthcare institution to verify that the person meets all requirements of subdivision (b)(1)(B).
7. Any healthcare institution that employs or contracts with a central service technician shall submit to the department of health, upon request, including, but not limited to, during an inspection performed pursuant to this part, documentation demonstrating that the central service technician complies with the requirements of this section.

Acts 2016, ch. 1004, § 1; 2017, ch. 178, §§ 1-5.

Amendments. The 2017 amendment inserted “registered, certified, or” in (a)(4); substituted “person who qualifies to practice as a central service technician in a healthcare institution under subsection (b)” for “central service technician” in the first sentence of (c); added (d)(3) and redesignated former (d)(3) and (d)(4) as present (d)(4) and (d)(5), respectively; substituted “person authorized under subdivision (d)(1) or (d)(2)” for “a healthcare provider” in present (d)(4); substituted “in a healthcare institution” for “in a healthcare facility” in present (d)(5); substituted “subdivision (d)(5)” for “subsection (d)” twice in (e); and added present (f) and redesignated former (f) as present (g).

Effective Dates. Acts 2016, ch. 1004, § 2. January 1, 2017.

Acts 2017, ch. 178, § 6. April 24, 2017.

68-11-240. Participation in drug donation repository program.

Notwithstanding any rule to the contrary, a nursing home, as defined in § 68-11-201, is authorized to participate in a drug donation repository program under title 63, chapter 10 until such time as the board for licensing health care facilities promulgates rules to effectuate such participation. Nothing in this title or title 63 precludes a nursing home from utilizing a drug donation repository program for drug disposal services.

Acts 2017, ch. 355, § 1.

Compiler's Notes. Acts 2017, ch. 355, § 3 provided that notwithstanding this act, which enacted this section, or the Uniform Administrative Procedures Act, compiled in Tennessee Code Annotated, title 4, chapter 5, any rule promulgated to implement this act shall be provided to the chairs of the health committee of the house of representatives and the health and welfare committee of the senate by the secretary of state, after approval by the attorney general and reporter, and at the same time the text of the rule is made available to the government operations committees of the senate and the house of representatives for purposes of conducting the review required by § 4-5-226 in order for chair of the health committee of the house of representatives and chair of the health and welfare committee of the senate to be afforded the opportunity to comment on the rule.

Effective Dates. Acts 2017, ch. 355, § 4. May 11, 2017.

68-11-241. Promulgation of rules to permit disposal of prescription drugs.

1. Notwithstanding this title or any rule, the board for licensing health care facilities is directed to use emergency rulemaking under § 4-5-208 to promulgate rules by January 1, 2018, to permit facilities licensed under this part to dispose of controlled substances and other prescription drugs by destruction using any means permitted by the federal drug enforcement administration.
2. Notwithstanding this title or any rule, the board for licensing health care facilities is directed to use emergency rulemaking under § 4-5-208 to promulgate rules by January 1, 2018, to permit the disposal by donation or other means, including a drug donation repository program, of prescription drugs that are not controlled substances.

Acts 2017, ch. 355, § 2.

Compiler's Notes. Acts 2017, ch. 355, § 3 provided that notwithstanding this act, which enacted this section, or the Uniform Administrative Procedures Act, compiled in Tennessee Code Annotated, Title 4, Chapter 5, any rule promulgated to implement this act shall be provided to the chairs of the health committee of the house of representatives and the health and welfare committee of the senate by the secretary of state, after approval by the attorney general and reporter, and at the same time the text of the rule is made available to the government operations committees of the senate and the house of representatives for purposes of conducting the review required by § 4-5-226 in order for chair of the health committee of the house of representatives and chair of the health and welfare committee of the senate to be afforded the opportunity to comment on the rule.

Effective Dates. Acts 2017, ch. 355, § 4. May 11, 2017.

68-11-242. Differentiation between licensed physicians based on maintenance of certification.

1. For purposes of this section:
   1. “Maintenance of certification” means any process requiring periodic recertification examinations or other activities to maintain specialty medical board certification; and
   2. “Organized medical staff” means an organized body composed of individuals appointed by a facility's governing board that operates under bylaws approved by the governing body and is responsible for the quality of medical care provided to patients by the facility.
2. Except as otherwise provided by this section, facilities licensed under this title may only differentiate between licensed physicians based on a physician's maintenance of certification in medical staff privileging and credentialing when authorized through the following process:
   1. The voting members of the facility's organized medical staff vote to adopt the differentiation; and
   2. The facility's governing body reviews and approves the action of the medical staff.
3. An authorization described by subsection (b) may:
   1. Establish terms applicable to the facility's differentiation, including:
      1. Appropriate grandfathering provisions; and
      2. Limiting the differentiation to certain medical specialties; and
   2. Be rescinded at any time when:
      1. The voting members of the facility's organized medical staff vote to rescind the differentiating action; and
      2. The facility's governing body reviews and approves the rescinding action of the organized medical staff.
4. Nothing in this section restricts a facility's ability to differentiate between physicians in medical staff privileging and credentialing based on a physician's maintenance of certification when:
   1. The facility's designation under law or certification or accreditation by a national certifying or accrediting organization is contingent on the facility requiring a specific maintenance of certification by physicians seeking staff privileges or credentialing at the facility; and
   2. The differentiation is limited to those physicians whose maintenance of certification is required for the facility's designation, certification, or accreditation as described by subdivision (d)(1).
5. Nothing in this section requires a facility's organized medical staff or governing body to reconsider or vote to reconsider maintenance of certification differentiation or requirements made prior to July 1, 2018.

Acts 2018, ch. 694, § 3.

Effective Dates. Acts 2018, ch. 694  § 4. July 1, 2018.

68-11-243. Collection of out-of-network charges by healthcare facility.

1. For the purposes of this section:
   1. “Emergency medical services” means the services used in responding to the perceived individual need for immediate medical care in order to prevent loss of life or aggravation of physiological or psychological illness or injury;
   2. “Healthcare facility” means a hospital as defined in § 68-11-201, or an ambulatory surgical treatment center as defined in § 68-11-201;
   3. “Healthcare provider” means any doctor of medicine, osteopathy, dentistry, chiropractic, podiatry, or optometry; a pharmacist or pharmacy; a hospital; a home health agency; an entity providing infusion therapy services; or an entity providing medical equipment services;
   4. “ln-network healthcare facility” means a healthcare facility that has a current contract provider agreement with the insured's insurer;
   5. “lnsured” means any person who has health insurance coverage as defined in § 56-7-109 through a health insurance entity as defined in § 50-7-109;
   6. “Out-of-network facility-based physician” means a physician:
      1. To whom a participating healthcare facility has granted clinical privileges;
      2. Who provides services to patients of the participating healthcare facility pursuant to those clinical privileges; and
      3. Who does not have a current contract provider agreement with the insured's insurer;
   7. “Stabilized” means, with respect to an emergency medical condition, that no material deterioration of the condition is likely, within a reasonable medical probability, to result from or occur during transfer of the individual from a facility; and
   8. “Transfer” means transporting a patient from one (1) location to another for medical services.
2. Healthcare facilities are prohibited from collecting out-of-network charges from an insured, or the insurer on behalf of the insured, in excess of the cost sharing amount required in accordance with the insured's health benefits coverage for the items and services, unless:
   1. The healthcare facility provides written notice to the insured or the insured's personal representative, prior to medical services being provided, that contains the following:
      1. A statement that the insured agrees to receive medical services by the out-of-network facility and will receive a bill for the amount unpaid by the insured's insurer;
      2. A statement that the nonparticipating out-of-network facility-based physician may not have a current contract provider agreement with the insured's insurer and is an out-of-network provider;
      3. A statement that the insured agrees to receive medical services by an out-of-network provider and will receive a bill for the amount unpaid by the insured's insurer;
      4. If the healthcare facility is out-of-network or otherwise a non-participating provider, the estimated amount that the facility will charge the insured for items and services; and
      5. A listing of anesthesiologists, radiologists, emergency room physicians, and pathologists or the groups of such healthcare providers with which the facility has contracted, including the healthcare provider or group name, phone number, and website, along with the following statement:

         The physicians and other healthcare providers that may treat the patient at this facility may not be employed by this facility and may not participate in the patient's insurance network.

         Anesthesiologists, radiologists, emergency room physicians, and pathologists are not employed by this facility. Services provided by those specialists, among others, will be billed separately.

         Before receiving services, the patient should check with his or her insurance carrier to find out if the patient's providers are in-network. Otherwise, the patient may be at risk of higher out-of-network charges.

   2. The insured or the insured's personal representative signs the written notice, acknowledging agreement to receive medical services by an out-of-network provider or should the insured or insured's personal representative refuse to sign the written notice, the healthcare facility documents in the patient's medical record that it provided the notice and that the patient refused to sign the notice.
3. Prior to admission for a scheduled medical procedure, a healthcare facility shall provide the insured with informational materials that include the following:
   1. The estimated amount of copay, deductible, or coinsurance, or range of estimates, that the facility will charge the insured for scheduled items and/or services provided by the facility in accordance with the insured's health benefit coverage for the items and services or as estimated by the insurance company on its website for its insured or through the available information to the facility at the time of prior authorization;
   2. A listing of anesthesiologists, radiologists, emergency room physicians, and pathologists or the groups of such healthcare providers with which the facility is contracted, including the healthcare provider or group name, phone number, and website; and
   3. The following statement:

      The patient will be billed for additional charges, including out-of-network charges, if the patient is provided medical services by a healthcare provider that is not in-network. ln particular, the patient should ask the facility if he or she will be provided any medical services by anesthesiologists, radiologists, emergency room physicians, or pathologists who are not in the patient's network.

4. 1. Except as provided in subdivision (d)(2), the notice required by subdivision (b)(1) must be provided to the insured, or the insured's personal representative, at the time of admission.
   2. 1. lf the insured is receiving medical services through a hospital emergency department and is incapacitated or unconscious at the time of receiving those services, the notice will not be required at that time.
      2. ln circumstances as described in subdivision (d)(2)(A), the written notice required by subdivision (b)(1) must be provided to the insured, or the insured's personal representative, after receiving medical services and within twelve (12) hours following stabilization. Information about a transfer to an in-network facility must also be provided with the written notice.
5. The failure of the healthcare facility to provide the notice required by subdivision (b)(1) and subsection (c) does not give rise to any right of indemnification or private cause of action against the healthcare facility by an out-of-network facility-based physician for an insurer's disregard of an insured's assignment of benefit.
6. When treated at an out-of-network facility, the insured, or the insured's personal representative, must receive the written notice required by subdivision (b)(1) from the facility before being transferred by an ambulance as defined in § 68-140-302 to another facility for treatment of medical services unless the insured would be at risk of bodily injury by the facility giving the insured the notice. The written notice must provide information about the possibility of a transfer to an in-network facility if the in-network facility has similar treatment available and will not risk the insured's health.
7. A bill to an insured from a healthcare provider or healthcare facility must contain a telephone number for the department and a clear and concise statement that the insured may call the department to complain about any out-of-network charges.
8. An in-network healthcare facility does not need to provide an insured with the notice required in subdivision (b)(1)(E) or (c)(3) if the healthcare facility employs all facility-based physicians or requires all facility-based physicians to participate in all of the insurance networks in which the healthcare facility is a participating provider or if the healthcare facility contractually prohibits all facility-based physicians from balance billing patients in excess of the cost sharing amount required in accordance with the insured's health benefits coverage for the items and services provided.

Acts 2018, ch. 840, § 2; 2019, ch. 239, § 2.

Compiler's Notes. Acts 2018, ch. 840, § 3 provided that the act, which enacted this section, shall apply to services rendered on or July 1, 2018.

Acts 2019, ch. 239, § 3 provided that the act, which amended this section, shall apply to services rendered on or after April 30, 2019.

Amendments. The 2019 amendment, in (a), rewrote the definition of “healthcare provider” which read: “‘Healthcare provider’ means a physician licensed pursuant to chapter 6 or 9 of title 63, who either is employed by a healthcare facility or contracts with a healthcare facility to provide medical services;”; redesignated former (i)-(iii) in the definition of “out-of-network facility-based physician” as present (A)-(C); and rewrote the definition of “stabilized” which read: “‘Stabilized’ means the patient is no longer in need of emergency medical services; and”; in (b), inserted “in excess of the cost sharing amount required in accordance with the insured's health benefits coverage for the items and services,” in the introductory language, inserted “or the insured's personal representative,” in (1); rewrote (1)(D) which read: “(D)  If the healthcare facility is not in-network or otherwise a participating provider, the estimated amount that the facility will charge the insured for items and services in excess of any cost sharing obligations that the insured would otherwise have under the insured's health benefits coverage for the items and services if the facility were in-network or otherwise participating in the coverage; and”, substituted “healthcare providers” for “physicians” and substituted “healthcare provider” for “physician” in (1)(E),  and rewrote (2) which read: “The insured signs the written notice, acknowledging agreement to receive medical services by an out-of-network provider.”; in (c), substituted “Prior to admission for” for “Prior to admission or” at the beginning,  rewrote (1) which read: “  The estimated amount that the facility will charge the insured for items and services provided by the facility in accordance with the insured's health benefits coverage for the items and services;”, substituted “healthcare providers” for “physicians” and substituted “healthcare provider” for “physician” in (2); added present (e) and redesignated former  (e) and (f) as present (f) and (g); in present (f), added “When treated at an out-of-network facility” at the beginning, substituted “another facility” for “another facility or physician” in the first sentence, and deleted “to the insured” following “treatment available” in the last sentence;  and added (h).

Effective Dates. Acts 2018, ch. 840, § 3. July 1, 2018.

Acts 2019, ch. 239, § 3. April 30, 2019.

68-11-244 — 68-11-249. [Reserved.]

1. 1. Health care equipment provided to a health care institution from lessors shall clearly state the name of the lessor and the date of the last inspection by the lessor.
   2. The notice providing such information shall be prominently displayed on the health care equipment.
2. 1. As used in this section, “health care equipment” means a single unit of medical equipment that is used to provide medical and other health services and that costs more than one thousand dollars ($1,000).
   2. “Health care equipment” does not apply to equipment not directly related to patient care.

Acts 1991, ch. 100, § 1.

68-11-251. Rules and regulations — Intent of section — Adequate emergency medical care for children — Committee on pediatric emergency care — Recommendations of committee to the board — Annual report.

1. The board for licensing health care facilities shall promulgate rules and regulations pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, to provide optimal emergency medical and surgical services for pediatric patients in facilities it licenses and shall have the authority, when funding is available, to obtain assistance with development and implementation of its standards and to support delivery of educational services and equipment to providers of emergency pediatric medical services in facilities it licenses. In developing, updating and implementing rules and regulations and providing services and equipment, the board shall be guided by national standards and shall collaborate with the emergency medical services division and its board and the committee on pediatric emergency care created pursuant to subsection (e).
2. It is the intent of this section that the entire spectrum of emergency pediatric medical and critical care services, including primary prevention of illness and injury, a statewide pediatric trauma system, disaster planning and management, acute care, data analysis, evaluation of potential standards of care, and rehabilitation be incorporated into the rules and into any services and equipment provided or required to be furnished pursuant to this section or any grant or contract awarded under this section.
3. The rules authorized by this section shall require adequate emergency medical care for children relative to the following and shall take into account the size and location of facilities and shall require appropriate triage, stabilization and referral of patients:
   1. Facility equipment standards;
   2. Qualifications of facility personnel; and
   3. Continuing professional education of facility personnel.
4. To assist in the implementation of the purposes of this section, the department shall have the authority to solicit and receive grants, donations, and public and private funding. The funding may be used for grants or contracts with 501(c)(3) organizations, as defined in 26 U.S.C. § 501(c)(3), that are capable of providing the advice, services and equipment necessary to assist in the provision of state-of-the-art emergency medical and critical care for ill or injured pediatric patients.
5. 1. The committee on pediatric emergency care shall consist of those members who were originally jointly appointed by the board of licensing health care facilities and the emergency medical services board, and those who are chosen by those boards to replace them, to include representatives of the following organizations:
      1. Tennessee Hospital Association;
      2. Tennessee chapter of the American Academy of Pediatrics;
      3. Tennessee chapter of the American College of Surgeons;
      4. Tennessee chapter of the American College of Emergency Physicians;
      5. Tennessee chapter of the American Academy of Family Physicians;
      6. Tennessee chapter of the Emergency Nurses Association;
      7. Tennessee Ambulance Service Association;
      8. Rural Health Association of Tennessee;
      9. Tennessee School Nurses Association;
      10. Tennessee Congress of Parents and Teachers (PTA);
      11. Tennessee Emergency Services Education Association;
      12. Comprehensive regional pediatric centers (CRPCs); and
      13. Other persons or representatives of such other organizations, groups or entities that the board chairs agree are necessary to accomplish the purposes of this section.
   2. In forming its recommendations to the board, the committee shall have access to the department of health's existing raw and analyzed data regarding pediatric emergency care health issues.
6. On or before July 1 of every year, the board for licensing health care facilities and the emergency medical services board, in collaboration with the committee on pediatric emergency care, shall jointly prepare a report on the current status of emergency medical services for children and on continuing efforts to improve such services. The joint report shall be submitted to the health and welfare committee of the senate, to the health committee of the house of representatives, and the judiciary committee of the senate.

Acts 1998, ch. 991, § 1; 2007, ch. 599, § 1; 2011, ch. 410, § 3(ff); 2013, ch. 236, § 56.

Compiler's Notes. For the Preamble to the act concerning the prohibition against establishment of a special committee if there is a standing committee on the same subject, please refer to Acts 2011, ch. 410.

Amendments. The 2013 amendment substituted “the health and welfare committee of the senate, to the health committee of the house of representatives” for “the general welfare, health and human resources committee of the senate, to the health and human resources committee of the house of representatives” in the last sentence of (f).

Effective Dates. Acts 2013, ch. 236, § 94. April 19, 2013.

68-11-252. Suspension of admission to facilities detrimental to health, safety or welfare of patients or residents.

1. The commissioner has the authority to suspend the admission of any new patients or residents to any facility or licensee in those cases where the commissioner has a factual basis upon which to believe that the conditions in any such facility or licensee are, or are likely to be, detrimental to the health, safety, or welfare of a patient or resident. For the purposes of this section, “facility or licensee” means any entity licensed under this part.
2. The commissioner may suspend admissions pending a prompt hearing before the board, or an administrative judge if the board cannot be convened promptly.
3. The commissioner shall initiate a suspension of admissions by delivering to the facility or licensee a notice stating the commissioner's decision to suspend the admissions of new patients. The commissioner's notice to suspend admissions must:
   1. Detail what conditions are considered detrimental to the health, safety, or welfare of the patients;
   2. Provide an explanation of the specific time frame when and conditions under which the facility or licensee can reasonably expect the suspension to be lifted; and
   3. Be received by the facility or licensee within ten (10) business days of the conclusion of the department's survey.
4. Within ten (10) business days of the conclusion of the department's investigation, the department shall also mail to the facility or licensee the commissioner's order, which shall:
   1. Detail the alleged facts and pertinent law with particularity; and
   2. Inform the facility or licensee of its right to contest the action.
5. The commissioner's suspension of admissions shall take effect on the next calendar day following the order provided to the facility or licensee, as provided for in subsection (d).
6. Any facility or licensee subject to a suspension of admissions by the commissioner has the right to contest the factual or legal basis for a suspension of admission imposed against it through a prompt contested case hearing before the board, or an administrative judge if the board cannot be convened promptly.
7. All contested cases pursuant to subsection (f) shall be conducted according to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, part 3, and shall be heard within thirty (30) days of the facility's or licensee's request for a contested case, unless otherwise agreed to by both parties.
8. An order in all cases contesting a suspension of admissions shall be issued within ten (10) business days after the hearing contesting the suspension of admissions, regardless of whether the hearing is conducted before the board or an administrative judge. The order must determine whether the suspension of admissions was initially valid and whether conditions at the facility or licensee continue to be detrimental to the health, safety, or welfare of a patient or resident to justify the continuation of the suspension of admissions if not previously lifted.
9. The commissioner is authorized, at any time prior to a hearing, based on information presented to the commissioner showing that such conditions have been and will continue to remain corrected, to revoke the suspension of admissions.
10. Within ten (10) days of receiving the commissioner's order to suspend admissions, any facility or licensee for which admissions have been suspended pursuant to this section shall submit a corrective action plan to the board delineating the measures to be taken to address violations and associated time frames. If it is deemed by the board to be necessary to ensure the health, safety, and welfare of patients or residents, the commissioner may require any facility or licensee for which admissions have been suspended to take all necessary actions to correct violations immediately. The board may also set a lesser time frame than ten (10) days for the facility or licensee to submit a corrective action plan when it deems necessary to ensure the health, safety, and welfare of residents.
11. If the facility or licensee asserts that it has corrected the underlying conditions upon which the suspension of admissions is based, or if the facility or licensee complies with the conditions for the suspension to be lifted as set forth in the commissioner's order, the department shall verify such corrections, after receiving notice and evidence of such corrections from the facility or licensee, within fourteen (14) business days unless waived by the facility or licensee.
12. Unless other specific conditions exist that warrant an additional suspension or continuation of the suspension of admissions, the commissioner shall promptly lift the suspension of admissions upon verification by the department that the facility or licensee has corrected the underlying conditions upon which the suspension of admissions is based or complied with the conditions for the suspension to be lifted.
13. The board has the authority to:
    1. Continue, revoke, or modify the suspension of admissions; and
    2. Enter such other orders as it deems necessary.
14. For any suspension of admissions of a nursing home under this section that is accompanied by a civil penalty under  part 8 of this chapter, part 8 of this chapter  shall control to the extent there is a conflict.

Acts 2018, ch. 655, § 2.

Code Commission Notes.

Acts 2018, ch. 655, § 1 purported to enact this section as § 68-11-276; however, this section was enacted as 68-11-252 by authority of the code commission.

Effective Dates. Acts 2018, ch. 655, § 15. July 1, 2018.

68-11-253. Definitions — Regulation of medical gas piping.

1. As used in this section, unless the context otherwise requires:
   1. “Board” means the state board for licensing contractors created by title 62, chapter 6;
   2. “Certified medical gas installer” means a person who has qualified for certification by the successful completion of an approved training course approved by the board on the installation, maintenance and repair of medical gas piping;
   3. “Health care facility” includes any health care facility that is licensed pursuant to this part, and any facility that is defined under the American National Standard Institute-National Fire Protection Association 99 (ANSI-NFPA 99): Health Care Facilities; and
   4. “Medical gas piping” means the piping used solely to transport gases used for medical purposes at a health care facility.
2. It is a Class B misdemeanor for any person to install or repair medical gas piping in any health care facility, unless such person installing, maintaining, or repairing medical gas piping is a certified medical gas installer.
3. 1. The board shall promulgate rules and regulations pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, establishing the minimum qualifications and requirements for the instruction on medical gas installation methods and maintenance techniques and other training for certification of persons for the installation, maintenance and repair of medical gas piping. The board may consult with the state fire marshal, or such other state agencies it deems appropriate to assist the board in the promulgation of such rules and regulations.
   2. The qualifications for certification adopted by the board shall include the qualifications for certification by the American Medical Gas Institute (AMGI) or the Piping Industry Progress and Education Trust Fund (PIPE), with a minimum of thirty-two (32) hours of training with eight (8) of such hours in brazing. The board shall from time to time revise the qualifications for certification to include the most current edition of NFPA 99 “Standard on Gas and Vacuum Systems.”
4. The board shall set fees for training, certification, certificate renewal and any other necessary fees in an amount sufficient to pay the costs of this section relative to certification of persons wishing to install or repair medical gas piping.
5. The board may designate an independent examining agency to administer the training and the examinations required for certification. The board shall publish annually a list of persons certified to install or repair medical gas piping.
6. Upon request by the board, the commissioner of commerce and insurance shall include appropriate instruction in the inspection of medical gas piping in training programs for fire and building code personnel attending the Tennessee Fire Service and Codes Enforcement Academy.
7. Nothing in this section is intended to prevent an emergency repair to medical gas piping by any individual.

Acts 1998, ch. 1094, § 1.

Cross-References. Penalty for Class B misdemeanor, § 40-35-111.

68-11-254. Information required to be posted in nursing homes.

1. All nursing homes are required to post the following in the main public entrance to the facility:
   1. The name of the administrator of the facility, and the names, addresses, and telephone numbers of any entity or company under contract to manage the facility, the state survey and certification agency, the state licensure office, the state ombudsman for the region where the facility is located, the protection and advocacy network, the statewide toll-free number of the division of adult protective services, and the state Medicaid fraud control unit;
   2. A statement that the resident may file a complaint concerning abuse, neglect, exploitation, misappropriation of resident property in the facility, and noncompliance with the advance directives requirements with the state survey and certification agency; and that a resident may also seek assistance or file a complaint with the division of adult protective services;
   3. 1. A statement that the facility does not have:
         1. A fire suppression sprinkler system throughout the facility;
         2. A smoke detector or alarm in each patient room; or
         3. Neither a fire suppression sprinkler system throughout the facility nor a smoke detector or alarm in each patient room;
      2. Such signs shall be printed in not less than twenty-four-point type and, in addition to being displayed at the main public entrance, shall be prominently displayed at all entrances to the facility.
      3. The requirements of this subdivision (a)(3) shall not apply to any nursing home that is fully sprinklered as of April 17, 2004; and
   4. A statement indicating whether the facility has liability insurance and the identity of the primary insurance carrier. If the facility is self-insured, the statement shall reflect that fact and indicate the corporate entity responsible for payment of any claims.
2. The information listed in subsection (a) shall be posted on a sign no smaller than eleven inches (11") in width and seventeen inches (17") in height.

Acts 2000, ch. 826, § 1; 2004, ch. 451, §§ 3, 5; 2004, ch. 780, §§ 2, 3; 2005, ch. 184, § 1.

Cross-References. Adult protection act, § 71-6-101 et seq.

68-11-255. Procedure for surrendering custody of unwanted infant without criminal liability.

1. As used in this section and in § 36-1-142, unless the context otherwise requires:
   1. “Facility” means any hospital as defined by § 68-11-201, birthing center as defined by § 68-11-201, community health clinic, out-patient “walk-in” clinic, fire department that is staffed twenty-four (24) hours a day, law enforcement facility that is staffed twenty-four (24) hours a day or emergency medical services facility;
   2. “Member of the professional medical community” has the meaning provided in § 68-140-102; provided, that the member of the professional medical community is on the premises at the time of a voluntary delivery; and
   3. “Voluntary delivery” means the action of a mother in leaving an unharmed infant aged two (2) weeks or younger on the premises of a facility, with any facility employee or member of the professional medical community at the facility without expressing any intention to return for the infant, and failing to visit or seek contact with the infant for a period of thirty (30) days thereafter.
2. Any facility shall receive possession of any newborn infant left on facility premises with any facility employee or member of the professional medical community, if the infant:
   1. Was born within the preceding two-week period, as determined within a reasonable degree of medical certainty;
   2. Is left in an unharmed condition; and
   3. Is voluntarily left by a person who purports to be the child's mother and who does not express an intention of returning for the infant.
3. The facility, any facility employee and any member of the professional medical community at such facility shall inquire, whenever possible, about the medical history of the mother or newborn, and whenever possible, shall seek the identity of the mother, infant or the father of the infant. The facility shall also inform the mother that she is not required to respond, but that the information will facilitate the adoption of the child. Any information obtained concerning the identity of the mother, infant or other parent shall be kept confidential and may only be disclosed to the department of children's services for use consistent with the purposes of this section, § 36-1-142, and § 36-2-318. The facility may provide the parent contact information regarding relevant social service agencies, shall provide the mother with the name, address and phone number of the department contact person, and shall encourage the mother to involve the department of children's services in the relinquishment of the infant. If practicable, the facility shall also provide the mother with both orally delivered and written information concerning the requirements of this section, § 36-1-142, and § 36-2-318 relating to recovery of the child and abandonment of the child.
4. The facility, any facility employee and any member of the professional medical community at the facility shall perform any act necessary to protect the physical health and safety of the child.
5. As soon as reasonably possible, and no later than twenty-four (24) hours after receiving a newborn infant, the facility shall contact the department of children's services, but shall not do so before the mother leaves the facility. Upon receipt of notification, the department shall immediately assume care, custody and control of the infant.
6. Notwithstanding any law to the contrary, any facility, any facility employee and any member of the professional medical community shall be immune from any criminal or civil liability for damages as a result of any actions taken pursuant to the requirements of this section and § 36-1-142, and no lawsuit shall be predicated thereon; provided, however, that nothing in this section and § 36-1-142 shall be construed to abrogate any existing standard of care for medical treatment or to preclude a cause of action based upon violation of such existing standard of care for medical treatment.
7. No criminal prosecution shall be based upon a mother's act of voluntarily delivering her unharmed infant at a facility pursuant to this section if the mother acts in full compliance with this section.

Acts 2001, ch. 388, §§ 1, 7; 2009, ch. 257, § 1; 2020, ch. 684, §§ 2, 3.

Compiler's Notes. Acts 2001, ch. 388, § 8 provided that the departments of children's services and health are authorized to promulgate rules and regulations pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, as necessary to effectuate the provisions of the act.

Acts 2001, ch. 388, § 9 provided that the department of health, in conjunction with the department of children's services, shall encourage and support, to the extent of existing resources, community programs to raise public awareness of the incidence of infant abandonment and to provide information and intervention services for parents of unwanted infants.

Acts 2001, ch. 388, § 11, provided that nothing in the act shall be construed to be an appropriation of funds and no funds shall be obligated or expended pursuant to the act unless such funds are specifically appropriated by the general appropriations act.

Amendments. The 2020 amendment, in (a)(3), substituted “two (2) weeks” for “seventy-two (72) hours”; and in (b)(1), substituted “two-week period” for “seventy-two-hour period”.

Effective Dates. Acts 2020, ch. 684, § 4. June 15, 2020.

Cross-References. Confidentiality of public records, § 10-7-504.

68-11-256. Criminal background checks on direct care employees of nursing homes.

1. All nursing homes, as defined in § 68-11-201, and assisted-care living facilities, as defined in § 68-11-201, shall have a criminal background check completed prior to employing any person who will be in a position that involves providing direct care to a resident or patient.
2. Any person who applies for employment in a position that involves providing direct care to a resident or patient in such a facility shall consent to any of the following:
   1. Provide past work and personal references to be checked by the nursing home or assisted-care living facility;
   2. Agree to the release and use of any and all information and investigative records necessary for the purpose of verifying whether the individual has been convicted of a criminal offense in this state, to either the assisted-care living facility or nursing home, or its agent, or to any agency that contracts with this state, or to any law enforcement agency, or to any other legally authorized entity;
   3. Supply a fingerprint sample and submit to a state criminal history records check to be conducted by the Tennessee bureau of investigation, or a state and federal criminal history records check to be conducted by the Tennessee bureau of investigation and the federal bureau of investigation; or
   4. Release any information required for a criminal background investigation by a professional background screening organization or criminal background check service or registry.
3. A nursing home or an assisted-care living facility shall not disclose criminal background check information obtained under subsection (b) to a person who is not involved in evaluating a person's employment, except as required or permitted by state or federal law.
4. Any costs incurred by the Tennessee bureau of investigation, professional background screening organization, law enforcement agency, or other legally authorized entity, in conducting the investigations of applicants may be paid by the nursing home, the assisted-care living facility, or any agency that contracts with this state requesting the investigation and information, or the individual who seeks employment or is employed. Payments of the costs to the Tennessee bureau of investigation are to be made in accordance with §§ 38-6-103 and 38-6-109. The costs of conducting criminal background checks shall be an allowable cost under the state medicaid program, if paid for by the nursing home.
5. This section shall also apply to any company, organization, or agency that provides or arranges for the supply of direct care staff to any assisted-care living facility or nursing home licensed in this state. The company, organization, or agency shall be responsible for initiating a criminal background check on any person hired by that entity for the purposes of working in a nursing home or assisted-care living facility and shall be required to report the results of the criminal background check to any facility in which the organization arranges for that individual to work upon such a request by a facility.
6. A nursing home or assisted-care living facility that declines to employ or terminates a person based upon criminal background information provided to the facility under this section shall be immune from suit by or on behalf of that person for the termination of or the refusal to employ that person.

Acts 2003, ch. 301, § 1; 2009, ch. 384, § 1; 2017, ch. 427, § 3.

Amendments. The 2017 amendment inserted “, as defined in § 68-11-201, and assisted-care living facilities,” in (a); deleted “or all” preceding “of the following” at the end of the introductory language of (b); added “or assisted-care living facility” at the end of (b)(1); in (b)(2), substituted “this state” for “the state of Tennessee” twice and inserted “assisted-care living facility or” preceding “nursing home”; inserted “or an assisted-care living facility” in (c); in the first sentence of (d), inserted “the assisted-care living facility,” and substituted “this state” for “the state of Tennessee”; in (e), in the first sentence, inserted “assisted-care living facility or” and substituted “this state” for “the state of Tennessee” at the end, and substituted “nursing home or assisted-care living facility” for “nursing home,” in the second sentence; and inserted “or assisted-care living facility” in (f).

Effective Dates. Acts 2017, ch. 427, § 4. July 1, 2017.

68-11-257. Preadmission or precontract disclosures.

1. 1. In addition to any other disclosure required by this part, prior to the admission of a resident to an assisted-care living facility or residential home for the aged regulated pursuant to this chapter or prior to the execution of a contract for the care of a resident in such a facility, whichever occurs first, the facility shall disclose in writing to the resident or to the resident's guardian, conservator or representative, if any, that the facility does not have:
      1. A fire suppression sprinkler system throughout the facility;
      2. A smoke detector or alarm in each patient room; or
      3. Neither a fire suppression sprinkler system throughout the facility nor a smoke detector or alarm in each patient room.
   2. The disclosure shall be made on a form separate from the contract for the care of the resident and shall be printed in bold type and in no less than twelve-point font. The form must be signed by the resident or the resident's guardian, conservator or representative, if any, and the signature must be witnessed. If the resident cannot read, the form shall be read aloud to the resident. If the facility maintains an Internet web site, the disclosure shall also be made on that Internet web site.
2. 1. All assisted-care living facilities and residential homes for the aged regulated pursuant to this chapter shall post a statement, if applicable, that the facility does not have:
      1. A fire suppression sprinkler system throughout the facility;
      2. A smoke detector or alarm in each resident or patient room; or
      3. Neither a fire suppression sprinkler system throughout the facility nor a smoke detector or alarm in each resident or patient room.
   2. Such signs shall be printed in not less than twenty-four-point type and in addition to being displayed at the main public entrance shall be prominently displayed at all entrances to the facility.
3. The requirements of subsections (a) and (b) shall not apply to any assisted-care living facility or residential home for the aged that is fully sprinklered as of April 17, 2004.
4. 1. In addition to any other disclosure required by this part, prior to the admission of a resident to an assisted-care living facility or residential home for the aged regulated pursuant to this chapter, or prior to the execution of a contract for the care of a resident in such a facility, whichever occurs first, the facility shall disclose in writing to the resident or to the resident's guardian, conservator or representative, if any, whether the facility has liability insurance and the identity of the primary insurance carrier. If the facility is self-insured, the facility's statement shall reflect that fact and indicate the corporate entity responsible for payment of any claims.
   2. The information required to be disclosed in subdivision (d)(1) shall be posted on a sign no smaller than eleven inches (11") in width and seventeen inches (17") in height and displayed at the main public entrance.