Tenn. Comp. R. & Regs. 0880 — Medical Examiners

Chapter 0880-01 Rules of Procedures for Hearing Contested Cases

Tenn. Comp. R. & Regs. 0880-01-.01 SUBPOENAS

(1)Purpose - Although this rule applies to persons and entities other than physicians, it is the Board's intent as to physicians that they be free to comprehensively treat and document treatment of their patients without fear that the treatment or its documentation will be unduly subjected to scrutiny outside the profession. Consequently, balancing that intent against the interest of the public and patients to be protected against substandard care and activities requires that persons seeking to subpoena such information and/or materials must comply with the substance and procedures of these rules. It is the intent of the Board that the subpoena power outlined herein shall be strictly proscribed.

Such power shall not be used by the division or board investigators to seek other incriminating evidence against physicians when the division or board does not have a complaint or basis to pursue such an investigation. Thus, unless the division or its investigators have previously considered, discovered, or otherwise received a complaint from either the public or a governmental entity, then no subpoena as contemplated herein shall issue.

(2)Definitions - As used in this chapter of rules the following words shall have the meanings ascribed to them:

(a)Probable Cause 1.For Investigative Subpoenas - shall mean that probable cause, as defined by case law at the time of request for subpoena issuance is made, exists that a violation of the Medical Practice Act or rules promulgated pursuant thereto has occurred or is occurring and that it is more probable than not that the person(s), or items to be subpoenaed possess or contain evidence which is more probable than not relevant to the conduct constituting the violation. 2.The utilization of the probable cause evidentiary burden in proceedings pursuant to this

rule shall not in any way, nor should it be construed in any way to establish a more restrictive burden of proof than the existing preponderance of the evidence in any civil disciplinary action which may involve the person(s) or items that are the subject of the subpoena.

(b)Presiding Officer - For investigative subpoenas shall mean any elected officer of the board, or any duly appointed or elected chairperson of any panel of the board, or any screening panel, and any hearing officer, arbitrator or mediator.

(3)Procedures (a)Investigative Subpoenas 1.Investigative Subpoenas are available only for issuance to the authorized representatives of the Tennessee Department of Health, its investigators and its legal staff. 2.An applicant for such a subpoena must either orally or in writing notify the Board Administrator of the intention to seek issuance of a subpoena. That notification must include the following:

(i)The time frame in which issuance is required so the matter can be timely scheduled; and (ii)A particular description of the material or documents sought, which must relate directly to an ongoing investigation or contested case, and shall, in the instance of documentary materials, be limited to the records of the patient or patients whose complaint, complaints, or records are being considered by the division or board.

(I)In no event shall such subpoena be broadly drafted to provide investigative access to medical records of other patients who are not referenced in a complaint received from an individual or governmental entity, or who have not otherwise sought relief, review, or board consideration of a physician’s conduct, act, or omission.

(II)If the subpoena relates to the prescribing practices of a licensee, then it shall be directed solely to the records of the patient(s) who received the pharmaceutical agents and whom the board of pharmacy or issuing pharmacy(ies) has so identified as recipients; and (iii)Whether the proceedings for the issuance is to be conducted by physical appearance or electronic means; and (iv)The name and address of the person for whom the subpoena is being sought or who has possession of the, items being subpoenaed. 3.The Administrator shall do the following:

(i)In as timely a manner as possible arrange for either an elected officer of the board, or any duly appointed or elected chairperson of any panel of the board, or any screening panel, or any hearing officer, arbitrator or mediator to preside and determine if the subpoena should be issued; and (ii)Establish a date, time and place for the proceedings to be conducted and notify the presiding officer, the applicant and the court reporter; and (iii)Maintain a complete record of the proceedings including an audio tape in such a manner as to:

(I)Preserve a verbatim record of the proceeding ; and (II)Prevent the person presiding over the proceedings and/or signing the subpoena from being allowed to participate in any manner in any disciplinary action of any kind formal or informal which may result which involves either the person or the documents or records for which the subpoena was issued. 4.The Proceedings (i)The applicant shall do the following:

(I)Provide for the attendance of all persons whose testimony is to be relied upon to establish probable cause; and (II)Produce and make part of the record copies of all documents to be utilized to establish probable cause; and (III)Obtain, complete and provide to the presiding officer a subpoena which specifies the following:

I.The name and address of the person for whom the subpoena is being sought or who has possession of the items being subpoenaed; and II.The location of the materials, documents or reports for which production pursuant to the subpoena is sought if that location is known; and III.A brief, particular description of any materials, documents or items to be produced pursuant to the subpoena; and IV.The date, time and place for compliance with the subpoena.

(IV)Provide the presiding officer testimony and/or documentary evidence which in good faith the applicant believes is sufficient to establish that probable cause exists for issuance of the subpoena as well as sufficient proof that all other reasonably available alternative means of securing the materials, documents or items have been unsuccessful.

(ii)The Presiding Officer shall do the following:

(I)Have been selected only after assuring the Board Administrator that he or she has no prior knowledge of or any direct or indirect interest in or relationship with the person(s) being subpoenaed and/or the licensee who is the subject of the investigation; and (II)Commence the proceedings and swear all necessary witnesses; and (III)Hear and maintain the confidentiality, if any, of the evidence presented at the proceedings; and (IV)Control the manner and extent of inquiry during the proceedings and be allowed to question any witness who testifies; and (V)Determine based solely on the evidence presented in the proceedings whether probable cause exists and if so, issue the subpoena for the person(s) or items specifically found to be relevant to the inquiry.; and (VI)Sign the subpoena as ordered to be issued; and (VII)Not participate in any way in any other proceeding whether formal or informal which involves the matters, items or person(s) which are the subject of the subpoena. This does not preclude the presiding officer from presiding at further proceedings for issuance of subpoenas in the matter.

(b)Post-Notice of Charges Subpoenas - If the subpoena is sought for a contested case being heard with an Administrative Law Judge from the Secretary of State's office presiding, this definition shall not apply and all such post-notice of charges subpoenas should be obtained from the office of the Administrative Procedures Division of the Office of the Secretary of State pursuant to the Uniform Administrative Procedures Act and rules promulgated pursuant thereto..

(4)Subpoena Forms (a)All subpoenas shall be issued on forms approved by the Board.

(b)The subpoena forms may be obtained by contacting the Board's Administrative Office.

(5)Subpoena Service - Any method of service of subpoenas authorized by the Tennessee Rules of Civil Procedure or the rules of the Tennessee Department of State, Administrative Procedures Division may be utilized to serve subpoenas pursuant to this rule.

History

Authority: T.C.A. §§4-5-202, 4-5-204, 63-6-101, and 63-6-214.
Administrative History: Original chapter filed November 22, 1978; effective January 8, 1979. Repeal and new rule filed September 9, 1999; effective November 22, 1999.

Tenn. Comp. R. & Regs. 0880-01-.02 RULES FOR CONTESTED CASE BEFORE THE BOARD OF MEDICAL EXAMINERS

(1)All contested cases before the Board of Medical Examiners shall be conducted pursuant to the Rules of Procedure for Contested Cases of the Rules of the Secretary of State as compiled at Chapter 1360-4-1.

History

Authority: T.C.A. §§4-5-202, 4-5-204, 63-6-101, and 63-6-214.
Administrative History: Original chapter filed November 22, 1978; effective January 8, 1979. Repeal and new rule filed September 9, 1999; effective November 22, 1999.

Chapter 0880-02 General Rules and Regulations Governing the Practice of Medicine

Tenn. Comp. R. & Regs. 0880-02-.01 DEFINITIONS

As used in this Chapter of Rules the following terms and acronyms shall have the following meanings ascribed to them:

(1) Board - The Tennessee Board of Medical Examiners.

(2) Board’s Administrative Office - The office of the administrator assigned to the Tennessee Board of Medical Examiners and housed within the Division.

(3) Board Designee - Any person who has received written delegation of authority from the Board to perform Board functions subject to review and ratification by the full Board where provided by these rules.

(4) Derogatory Information - As this term is used in T.C.A. § 63-6-210, shall mean wherever it appears in these rules any communication or information received during the licensure, renewal or reinstatement process which indicates either legal, ethical, competency, mental or physical problems which reflect in any manner not inconsistent with the Americans With Disabilities Act on the individual’s fitness or competency to safely practice or continuing to safely practice medicine in Tennessee without restriction. Such communications or information include but are not limited to, conviction of a crime, malpractice lawsuits, loss or restriction of hospital privileges, licensure discipline in another state or country, previous licensure action either formal or informal in this state, ongoing investigation or prosecution of a disciplinary action in this or any other state or country and any physical/medical condition which is not otherwise ameliorated by compliance with physician orders, treatment program requirements or voluntary restrictions of the individual in compliance with the Americans With Disabilities Act.

(5) Division - The Tennessee Department of Health, Division of Health Related Boards, from which the Board receives administrative support.

(6) E.C.F.M.G. - The Educational Committee for Foreign Medical Graduates or its successor organization.

(7) FCVS - The Federation Credentials Verification Service which is a service offered by the Federation of State Medical Boards that provides primary source identification and verification of physician core credentials as required in licensure applications by the states.

(8) FLEX - The Federation Licensing Examination I-II.

(9) Formulary - A list of legend and non-legend drugs arranged by therapeutic categories, included in the protocols, that are approved to be prescribed and/or issued by a physician assistant, which may include controlled substances listed in Schedules II, III, IV and V of the Tennessee Code Annotated, Title 39, Chapter 17, Part 4.

(10) Licensee - Any person who has been lawfully issued a license to practice medicine in Tennessee by the Board.

(11) Medical Spa - any entity, however named or organized, which offers or performs cosmetic medical services as defined in T.C.A. § 63-1-153, provided that a medical spa shall not include an individual physician’s office or practice owned by a physician unless that physician’s office or practice either (1) advertises or holds itself out as a medical spa or (2) primarily engages in the performance of elective cosmetic medical services such that more than 50% of the patients seen by the office or practice during the preceding twelve months receive an elective cosmetic medical service.

(12) N.B.M.E. - The National Board of Medical Examiners examination.

(13) Physician Assistant - A person who is licensed to practice as a physician assistant in Tennessee pursuant to T.C.A. § 63-19-105.

(14) Protocols - Written guidelines for medical management developed jointly by the supervising physician and the physician assistant.

(15) Supervising Physician - A licensed and actively practicing physician who has been identified as accepting responsibility for supervising a physician assistant.

(16) U.S.M.L.E. - The United States Medical Licensing Examination.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-1-153, 63-6-101, 63-6-105, 63-6-207, 63-19-104, and Chapter 33, Public Acts of 1999.
Administrative History: Original rule filed October 13, 1983; effective November 14, 1983. Subsequently repealed and replaced twice, the last replacement was effective April 12, 1991. Amendment filed April 14, 1994; effective June 28, 1994. Amendment filed February 23, 1995; effective May 9, 1995. Amendment filed September 22, 1997; effective December 6, 1997. Amendment filed February 3, 1998; effective April 19, 1998. Amendment filed April 10, 2000; effective June 24, 2000. Amendment filed September 5, 2002; effective November 19, 2002. Amendment filed September 3, 2014; effective December 2, 2014. Amendments filed July 31, 2018; effective October 29, 2018.

Tenn. Comp. R. & Regs. 0880-02-.02 FEES

(1) The fees authorized by the Tennessee Medical Practice Act (T.C.A. §§ 63-6-101 through 63- 6-104 and T.C.A. §§ 63-6-201 through 63-6-227) and other applicable statutes to be established by the Board are established as follows:

(a) Application Fee - A non-refundable fee to be paid by all licensure applicants regardless of the type of license applied for. It must be paid each time an application for licensure is filed. ......................................................................... ...................................$500.00 (b) Examination Fee - This fee is to be paid each time the USMLE Step 3 examination is taken. .......................................................................... ...................................$100.00 (c) Inactive Pro Bono Licensure Renewal Fee .................. ...................................$00.00 (d) Special Training License Fee ....................................... ...................................$25.00 (e) Licensure Exemption Fee - Visiting Faculty Member. This fee is paid annually for each year of exemption. ........................................................ ...................................$50.00 (f) Licensure Renewal Fee - To be paid biennially by all licensees except Inactive Pro Bono licensees. This fee also applies to licensees who reactivate a retired license or who reactivate an inactive license ........................................................................ $300.00 (g) Annual State Regulatory Fee - To be paid by all licensees upon application and biennially upon renewal. ($10.00 biennially) ............................................................ $5.00 (h) Late Licensure Renewal Fee - To be paid when a licensee fails to timely renew licensure. .............................................................................................................. $200.00 (i) Duplicate License Fee. ........................................................................................... $25.00 (j) Licensure Exemption Fee - Interns, Residents or Clinical Fellows. This fee is paid annually for each year of exemption. ...................................................................... $10.00 (k) Medical Spa Registration Fee.............................................................................. $175.00 (l) Licensure Conversion Fee ....................................................................... $225.00 (m) Surgical Assistant Registration Fee............................................................ $50.00 (n) Surgical Assistant Renewal Fee................................................................. $80.00 (o) Short-Term Visitor Clinical Training License Fee................................................. $400.00 (p) Graduate Physician License Fee......................................................................... $500.00 (q) Foreign Training License Fee............................................................................ $1,000.00 (r) Temporary License Fee........................................................................................ $700.00 (2) All fees may be paid in person, by mail or electronically by cash, check, money order, or by credit and/or debit cards accepted by the Division. If the fees are paid by certified, personal or corporate check they must be drawn against an account in a United States Bank, and made payable to the Tennessee Board of Medical Examiners.

History

Authority: T.C.A. §§ 63-1-106, 63-6-101, 63-6-105, 63-6-201, 63-6-207, 63-6-210, 63-6-211, 63-6-219, and 63-6-230.
Administrative History: Original rule filed October 13, 1983; effective November 14, 1983. Subsequently repealed and replaced twice, the last replacement was effective April 12, 1991. Amendment filed April 14, 1994; effective June 28, 1994. Amendment filed February 23, 1995; effective May 9, 1995. Amendment filed May 2, 1995; effective July 16, 1995. Amendment filed June 12, 1995; effective August 26, 1995. Amendment filed July 12, 1995; effective November 28, 1995. Public Necessity rule filed and effective November 28, 1995. Amendment filed March 25, 1996; effective June 8, 1996, expired by GOC, August 1996. Amendment filed September 4, 1998; effective November 11, 1998. Amendment filed August 25, 2000; effective November 8, 2000. Amendment filed August 16, 2002; effective October 30, 2002. Amendment filed September 5, 2002; effective November 19, 2002. Amendment filed December 5, 2003; effective February 18, 2004. Amendment filed August 23, 2005; effective November 6, 2005. Amendments filed July 31, 2018; effective October 29, 2018. Amendments filed July 25, 2019; effective October 23, 2019. Amendments filed October 4, 2021; effective January 2, 2022. Emergency rules filed June 17, 2025; effective through December 14, 2025. Amendments filed August 15, 2025; effective November 13, 2025.

Tenn. Comp. R. & Regs. 0880-02-.03 or 0880-02-.04.

(e) The Dean of the Medical School and the Director of the three (3) year residency program shall immediately notify the Board in writing of the termination of any faculty members employment and/or enrollment and the reasons therefore delivered to the Board Administrative Office. Such notification terminates the visiting faculty member’s

authority to practice medicine in Tennessee unless such faculty member has obtained a license from the Board pursuant to T.C.A. § 63-6-207 or Rule 0880-02-.03 or 0880- 02-.04.

(6) Medical Interns, Residents and Clinical Fellows (a) Prior to the commencement of practice by any individual in a training program, except individuals covered pursuant to T.C.A. § 63-6-207(d)(2)(C), it shall be the responsibility of the program director or the dean responsible for the training program which meets the requirements of T.C.A. § 63-6-207(d)(2) to make an application to the Board’s Administrative Office which contains all of the following:

Evidence of how the training program meets the requirements of T.C.A. § 63-6- 207(d)(2). Accreditation by the Accreditation Council of Graduate Medical Education or evidence of affiliation with a hospital so accredited is acceptable for purposes of this rule.
The names of the physicians licensed in Tennessee who will have supervisory and control responsibility for the program participants.
For those requiring exemption, a list of each participant’s name, social security number and date of birth.
The licensure exemption fee as established in Rule 0880-02-.02(1)(j) for each participant.

(b) The application for exemption from licensure is effective, if approved, for a period of no longer than one (1) year from the date of approval. Exemption applications previously approved need not be re-filed for the individuals continuing in the program beyond one (1) year expiration date. However, the program is subject to payment of the fee provided in Rule 0880-02-.02(1)(j) as the annual deadline expires for each such individual.

(c) Upon termination of any listed individual’s participation in the training program for any reason, the director of the program shall immediately notify the Board of the termination and the reasons therefore in writing delivered to the Board’s Administrative Office.

Such notification terminates the individual’s authority to practice medicine in Tennessee unless and until a license or a new exemption from the Board has been obtained.

(d) The Board Administrative Office shall issue written notification of all Board dispositions on licensure exemption applications. Exemption issuance decisions pursuant to this

Rule may be made administratively or upon review by any Board member or the Board Designee.

(7) The Board Administrative Office shall issue written notification of all Board dispositions on licensure exemption applications.

(8) Submission of any document or set of documents required by this rule or submission of verification of the authenticity, validity and accuracy of the content of any document or set of documents required by this rule directly from the FCVS to the Board Administrative Office shall be deemed to be submission of originals of those documents or sets of documents by the issuing institution(s).

(9) Applicants attempting to qualify for limited licensure under T.C.A. § 63-6-207(i) shall apply pursuant to Rule 0880-02-.03 and pay the application fee and state regulatory fee. The Board will determine on a case by case basis whether the applicant’s time out of practice and activities during that time warrant a limited license.

(a) Where the Board determines to grant a limited license, the following shall apply:

The limited license shall be of a duration of one (1) year, unless a shorter or longer period is determined by the Board, but in no event shall it be for longer than a two (2) year duration;
The limited license shall be nonrenewable;
The limited license shall be for the accomplishment of training as determined necessary by the Board on a case by case basis, to be accomplished by the licensee during the duration of the limited license;
The limited license shall be subject to those restrictions on practice and practice setting as determined on a case by case basis by the Board; and 5. All other rules and regulations of a full and unrestricted license shall apply to a limited license, and though not disciplinary, a limited license shall be encumbered to the extent that a limited licensee may not serve as a supervising or collaborating physician to an advanced practice registered nurse or physician assistant.

(b) In order to convert to a full and unrestricted license, a limited licensee shall:

Submit an application and disclose the circumstances surrounding any of the following occurring since or not completely disclosed on the initial application for licensure:

(i) Conviction of any criminal law violation of any country, state, or municipality, except minor traffic violation;

(ii) The denial of licensure application by any other state or the discipline of licensure in any state;

(iii) Loss or restriction of hospital privileges;

(iv) Any other civil suit judgment or civil suit settlement in which the applicant was a party defendant including, without limitation, actions involving medical malpractice, breach of contract, antitrust activity or any other civil action remedy recognized under any country’s or state’s statutory, common, or case law; and (v) Failure of any medical licensure examination;

The applicant shall cause the results of a criminal background check to be submitted to the Board’s Administrative Office directly from the vendor identified in the Board’s licensure application materials;
Pay the Limited Licensure Conversion Fee;
Provide proof that he or she has successfully completed the training determined necessary by the Board for which the limited license was granted.

(c) A limited license is subject to the same disciplinary proceedings as a full and unrestricted license and if a limited licensee commits a violation of the practice act or rules and regulations promulgated thereto, that violation shall be grounds to deny the limited licensee’s conversion application or grounds for discipline of either the limited license or the licensee’s full and unrestricted license where an upgrade application was approved.

(10) Applicants attempting to qualify for an administrative license under T.C.A. § 63-6-207(i) shall apply pursuant to Rule 0880-02-.03 and pay the application fee and state regulatory fee. The Board will determine on a case by case basis whether the applicant’s circumstances warrant an administrative license.

(a) Where the Board determines to grant an administrative license, the following shall apply:

An administrative licensee shall only practice administrative medicine and is not licensed to practice clinical medicine;
All rules and regulations of a full and unrestricted license shall apply to an administrative license;
The administrative license may be renewed pursuant to Rule 0880-02-.09;
The due date for the administrative license renewal is the expiration date, which shall be the last day of the month in which the administrative licensee’s birthday falls pursuant to the Division of Health Related Boards “biennial birthdate renewal system” contained in Rule 1200-10-01-.10.

(b) If an administrative licensee wishes to pursue a full and unrestricted license to practice medicine, that licensee shall submit a new application pursuant to Rule 0880-02-.03.

There shall be no process by which an administrative license can be converted to a full and unrestricted license.

(d) Administrative medicine means administration or management utilizing the medical and clinical knowledge, skill, and judgment of a licensed physician which may affect the health and safety of the public but does not involve direct patient care. Administrative medicine does not include the clinical practice of medicine including examining, diagnosing, caring for, or treating patients, prescribing medications, or supervision of or collaboration with healthcare practitioners in the provision of direct patient care, or delegating medical acts or prescriptive authority to others.

(e) An administrative license is subject to the same disciplinary proceedings as a full and unrestricted license and if an administrative licensee commits a violation of the practice act or rules and regulations promulgated thereto, that violation shall be grounds for discipline of the administrative license or grounds to deny an application for a full and unrestricted license or discipline a full and unrestricted license where such an application was approved.

(11) In order to employ a physician who does not possess a full and unrestricted license to practice medicine in Tennessee at St. Jude Children’s Research Hospital, it is the responsibility of St. Jude Children’s Research Hospital to submit an application on behalf of a prospective employee. Such applications shall be made pursuant to Rule 0880-02-.03 or

Tenn. Comp. R. & Regs. 0880-02-.04 , and require payment of the application fee and state regulatory fee, except that the St. Jude application shall be used, and an applicant who has met all other qualifications for licensure is not required to have completed a residency or training program required by T.C.A. § 63-6-207(a)(1)(C) or (a)(2)(F).

(a) Where the Board determines to grant a St. Jude license the following shall apply:

A St. Jude licensee shall only practice within the duties and responsibilities as an employee of St. Jude Children’s Research Hospital;
All rules and regulations of a full and unrestricted license shall apply to a St. Jude license, including:

(i) The St. Jude licensee is subject to the same continuing education requirements as a full and unencumbered license, and St. Jude licensees must comply with the continuing education requirements of Rule 0880-02- .19;

(ii) The St. Jude licensee is subject to licensure discipline and civil penalties pursuant to Rule 0880-02-.12;

(iii) The St. Jude license may be renewed pursuant to Rule 0880-02-.09; and (iv) The due date for the St. Jude license renewal is the expiration date, which shall be the last day of the month in which the administrative licensee’s birthday falls pursuant to the Division of Health Related Boards “biennial birthdate renewal system” contained in Rule 1200-10-01-.10.

(b) If the holder of a St. Jude license wishes to pursue a full and unrestricted license to practice medicine, that licensee shall submit a new application pursuant to Rule 0880- 02-.03 or 0880-02-.05. There shall be no process by which a St. Jude license can be converted to a full and unrestricted license.

History

Authority: T.C.A. §§ 63-6-101, 63-6-201, 63-6-207, 63-6-208, 63-6-209, 63-6-210, 63-6-211, and 63-6- 214.
Administrative History: Original rule filed October 13, 1983; effective November 14, 1983. Repeal and new rule filed May 10, 1987; effective July 24, 1987. Repeal and new rule filed February 26, 1991; effective April 12, 1991. Amendment filed July 12, 1995; effective November 28, 1995. Amendment filed February 3, 1998; effective April 19, 1998. Amendment filed December 5, 2003; effective February 18, 2004. Amendment filed August 23, 2005; effective November 6, 2005. Amendments filed March 14, 2006; effective May 28, 2006. Amendment filed July 1, 2008; effective September 14, 2008. Amendments filed October 4, 2021; effective January 2, 2022. Emergency rules filed June 17, 2025; effective through December 14, 2025. Amendments filed August 15, 2025; effective November 13, 2025.

Tenn. Comp. R. & Regs. 0880-02-.05 , the only examination acceptable for licensure is the USMLE Steps 1, 2 and 3.

(b) The Board will accept any of the following examinations or combinations of examinations if completed prior to December 31, 1999:

The NBME Parts I, II and III; or 2. FLEX Components I and II; or 3. Predecessor FLEX Days I, II and III; or 4. NBME Part I or USMLE Step 1 plus NBME Part II or USMLE Step 2 plus NBME Part III or USMLE Step 3; or 5. FLEX Component I plus USMLE Step 3; or 6. NBME Part I or USMLE Step 1 plus NBME Part II or USMLE Step 2 plus FLEX Component II 7. Combinations of the Predecessor FLEX Days I, II and III are not allowed with any other examination.

(2) Passing Scores - The Board accepts the following scores as constituting successful completion of the licensure examinations:

(a) The Board adopts the NBME’s and the USMLE’s determination of the passing scores for each Part or Step of their examinations.

(b) The passing scores adopted by the Board for the FLEX examinations are as follows:

FLEX I and II Component I = 75 Component II = 75 2. Predecessor FLEX Days I, II and III - A FLEX weighted average (FWA) of 75 or greater.

(c) If an applicant fails any step of the USMLE or FLEX examinations more than four (4) times, then the Board shall require proof of board-certification by an ABMS-recognized specialty board and proof of meeting requirements for Maintenance of Certification prior to application before consideration for licensure.

(3) Oral examination may be required pursuant to Rule 0880-02-.07(4). The Board may also, in its discretion, require an applicant for licensure to take and pass the SPEX examination prepared by the FSMB. The circumstances under which the Board may require the SPEX examination include, but are not limited to, applicants for licensure who have been disciplined in another state; applicants who would be subject to discipline in Tennessee based on their conduct or condition; or applicants who have not engaged in the clinical practice of medicine for more than two (2) years.

(4) Deadlines - An applicant must have achieved passing scores on the licensure examinations within the following time frames:

(a) FLEX and Predecessor FLEX and NBME - Ten (10) years from the date on which either the Day I or Component I or Part I of the examinations was taken.

(b) USMLE - Ten (10) years from the date of whichever step of the examination was successfully completed first.

(c) The deadlines in subparagraphs (a) and (b) apply regardless of the combination of examinations utilized to apply for licensure. Provided however, if the ten (10) year limitation set forth in subsections (a) and/or (b) are not met, the applicant will be subsequently considered for licensure once it can be documented that the applicant has retaken and successfully completed the necessary steps or parts of the examination(s) in such a manner that all steps or parts of the examination(s) have been successfully completed within a ten (10) year time period.

(d) The ten (10) year limitation for the USMLE contained in subparagraph (4)(b) of this rule will not apply to applicants who:

Are or have been working towards both an M.D. and Ph.D. degree in an institution or program accredited by the Association of American Medical Colleges’ Liaison Committee on Medical Education and regional university accrediting body; and 2. Was or is a student in good standing, who was or is enrolled in the institution or program; and 3. Ph.D. studies are in a field of biological sciences tested on Step 1 of the USMLE.

(These fields include but are not limited to anatomy, biochemistry, physiology, microbiology, pharmacology, pathology, genetics, neuroscience, and molecular biology. Fields explicitly not included are business, economics, ethics, history, and other fields not directly related to biological science); and 4. Presents a verifiable and rational explanation for the fact that he or she was unable to meet the ten (10) year limit.

(e) Extensions - The amount of time an applicant has actively served while in continuous training and practice in the armed forces of the United States shall not be counted in calculating the ten (10) year limitation for the USMLE contained in subparagraph (4)(b) of this rule. Further, the ten (10) year limitation for the USMLE will not apply to applicants who:

Are board-certified at the time of application by a board recognized by the American Board of Medical Specialties; or 2. Have been and are at the time of application currently in active clinical practice in a single state or territory for a period of at least one year and have held a full, unencumbered license in that state for at least one year since successfully completing the USMLE; or 3. Present satisfactory evidence of extraordinary circumstances as determined by the Board which prevented the applicant from timely completing the steps.

(5) All applicants for the USMLE shall submit all application inquiries, applications, fees and all necessary admission documentation, including evidence satisfactory to the USMLE administering agency of successful completion of a one (1) year post graduate medical educational training program for applicants for Step 3 of that examination, directly to the USMLE administering agency. The Board does not distribute or process applications for the USMLE.

(6) Submission of any document or set of documents required by this rule or submission of verification of the authenticity, validity and accuracy of the content of any document or set of documents required by this rule directly from the FCVS to the Board Administrative Office shall be deemed to be submission of originals of those documents or sets of documents by the issuing institution(s).

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-6-101, and 63-6-207.
Administrative History: Original rule filed February 26, 1991; effective April 12, 1991. Amendment filed January 10, 1992; effective February 24, 1992. Amendment filed April 14, 1994; effective June 28, 1994. Amendment filed March 29, 1996; effective June 12, 1996. Amendment filed February 3, 1998; effective April 19, 1998. Amendment filed September 4, 1998; effective November 11, 1998. Amendment filed August 25, 2000; effective November 8, 2000. Amendment filed December 5, 2003; effective February 18, 2004. Amendment filed December 28, 2004; effective March 13, 2005. Amendment filed July 27, 2006; effective October 10, 2006. Amendment filed April 17, 2007; effective July 1, 2007. Amendment filed May 27, 2008; effective August 10, 2008. Amendments filed January 26, 2015; effective April 26, 2015. Amendments filed February 1, 2017; effective May 2, 2017. Amendments filed March 8, 2022; effective June 6, 2022.

Tenn. Comp. R. & Regs. 0880-02-.06 TRAINING LICENSES AND LICENSURE EXEMPTIONS

Those persons who pursuant to T.C.A. § 63-6-207(d)(1) may be eligible to practice medicine in Tennessee with a special training license issued by the Board may secure such license pursuant to paragraph (1) of this rule. Those persons who pursuant to T.C.A. § 63-6-248 may be eligible to practice medicine in Tennessee with a short-term visitor clinical training license issued by the Board for a period not to exceed ninety (90) days may secure such a license pursuant to paragraph (2) of this rule. Those persons who pursuant to T.C.A. § 63-6-207 may be eligible to practice medicine in Tennessee with a foreign training license issued by the Board may secure such a license pursuant to paragraph (3) of this rule. Those persons who pursuant to T.C.A. §§ 63-6-201 or 63-6-207(d)(2) may be eligible to practice medicine in Tennessee with a Board issued exemption from licensure may secure such exemptions pursuant to paragraphs (4), (5) or (6) of this rule. Persons who have been issued a license to practice medicine pursuant to either Rule 0880-02-.03, 0880-02-.04, or

Tenn. Comp. R. & Regs. 0880-02-.07 APPLICATION REVIEW, APPROVAL, DENIAL, INTERVIEWS AND CONDITIONED,

RESTRICTED AND LOCUM TENENS LICENSURE. Review and decisions on applications for licensure or exemption from licensure shall be governed by this rule.

(1) The Board’s administrative staff shall determine when an application file is complete.

(2) If an application is incomplete when received by the Board Administrative Office, the applicant shall be notified of the information required. Except as provided in subparagraph (b), the applicant shall cause the requested information to be received by the Board Administrative Office on or before the ninetieth (90th) day after the initial letter notifying the applicant of the required information is sent.

(a) Except as provided in subparagraph (b), if requested information is not timely received, the application file shall be closed and the applicant notified that the Board will not consider licensure or exemption until a new application is received pursuant to the rules governing that process, including another payment of all fees applicable to the applicant’s circumstances.

(b) The ninety (90) day return requirement shall not apply to applications which require action by the Immigration and Naturalization Service. Action on those applications pursuant to subparagraph (a) shall not take place until the expiration of six (6) months from the date the applications are received.

(3) If a completed application is denied, conditioned or restricted by the Board the following shall occur:

(a) A notification of the denial shall be sent by the Board Administrative Office by certified mail, return receipt requested which shall contain all the specific statutory or rule authorities for the denial.

(b) The notification, when appropriate, shall also contain a statement of the applicant’s right to request a contested case hearing under the Tennessee Administrative Procedures Act (T.C.A. §§ 4-5-101, et seq.) to contest the denial and the procedure necessary to accomplish that action.

An applicant has a right to a contested case hearing only if the adverse decision on an application was based upon subjective or discretionary criteria and only if the request is in writing and received on or before the thirtieth (30th) day after receipt of the notice by the applicant.
An applicant may be granted a contested case hearing if licensure denial is based upon objective, clearly defined criteria only if after review and attempted resolution by the Board’s administrative staff the licensure application cannot be approved and the reasons for continued denial present genuine issues of fact and/or law which are appropriate for appeal.

(4) Any applicant who has successfully complied with all requirements of the rules governing the licensure or exemption process for the type of licensure or exemption applied for shall be issued a license or an exemption from licensure to practice medicine in Tennessee with the following exceptions:

(a) Applicants who by virtue of any criteria for licensure in the areas of mental, physical, moral or educational capabilities, as contained in the application and review process which indicates derogatory information or a potential risk to the public health, safety and welfare may be required to present themselves to the Board, a duly constituted panel of the Board, a Board member, a screening panel when the individual is under investigation or the Board Designee for an interview before final licensure may be granted. If sufficient cause exists an applicant may be required pursuant to T.C.A. § 63- 6-214(c) to submit to a mental and/or physical examination.

(b) An applicant whose examination (except reciprocity applicants) is certified as having been successfully completed on or before the fifth (5th) year preceding the date of application shall be required to successfully complete the FLEX “Special Purpose Examination” as administered by the Board.

part of the licensure process.

(d) The issuance or renewal of licensure to applicants who otherwise may be entitled to full licensure or renewal, may be withheld, denied, conditioned or restricted in any manner the Board deems necessary to protect the public in any of the following circumstances:

When an applicant has had licensure disciplinary action taken or is under investigation by another state or territory of the United States for any acts or omissions which would constitute grounds for discipline of a license issued in this state. A certified copy of the initial or final order or other equivalent document memorializing the disciplinary action or investigation from the disciplining state or territory shall constitute prima facie evidence of violation of this section and be sufficient grounds upon which to deny, restrict or condition licensure or renewal and/or discipline a license issued in this state.
When any applicant’s application indicates a problem in the areas of mental, physical, moral or educational criteria for licensure or renewal which the Board determines may create a potential threat to the public health, safety or welfare.
When any applicant has violated any provision of T.C.A. § 63-6-214(b) or rules promulgated pursuant thereto.
When any applicant fails to fully and timely comply with all licensure application and renewal requirements.

(5) Any physician licensed by any state or country sponsored by a hospital located in Tennessee and/or at least one physician licensed by the Board may, in the Board’s discretion, without further qualifications receive a restricted “single purpose” license under the following circumstances:

(a) The physician has credentials which indicates that he or she is licensed in good standing in another state or country; and (b) The physician submits satisfactory evidence that he or she is either to engage in advanced study in a particular field of medicine in Tennessee or teach or demonstrate a new medical technique to medical professionals in Tennessee; and (c) The physician’s credentials are verified by the appropriate national specialty organization in this country or by the American Medical Association or a similar organization acceptable to the Board; and (d) The physician shall cause to be submitted to the Board’s administrative office directly from the vendor identified in the Board’s licensure application materials, the result of a criminal background check; and (e) The hospital and/or sponsoring physician must supply all necessary documentation of licensure, credentialing and verification of the same along with a completed Board approved application form; and (f) The hospital and/or sponsoring physician must pay the full cost to the Board of researching, processing and issuing the restricted “single purpose” license which is the application and state regulatory fee provided in Rule 0880-02-.02; and (g) The license will be issued authorizing medical practice in the sponsoring hospital or the sponsoring physician’s training program only and shall be designated as a “single

purpose” license. It will not allow practice outside that hospital or the designated training program; and (h) The restricted “single purpose” license will be issued for a specified period of time not to exceed one (1) year and be subject to whatever other practice restrictions deemed appropriate by the Board. The training received in any program pursuant to this license shall not be used to qualify for full, unrestricted licensure in Tennessee; and (i) The sponsoring physician has full responsibility for the activities of any physician granted a restricted “single purpose” license.

(j) All such restricted “single purpose” licenses are subject to discipline for the same causes and pursuant to the same procedures as active unrestricted licenses.

(6) An applicant who is; licensed in good standing in another state; maintains an unencumbered certification in a recognized specialty area; or is eligible for such certification and indicates an intended residence outside the State of Tennessee but proposes to practice intermittently within the physical boundaries of the State of Tennessee, shall in the discretion of the Board be issued a Locum Tenens license.

(a) To obtain a Locum Tenens license, an applicant shall compile the following and when completed, submit them to the Board Administrative Office:

A Board approved application form; and 2. All documentation required by Rule 0880-02-.05 paragraphs (2), (4), (5), (6), (7) and (10).

(b) The practice of any person issued a Locum Tenens license shall be restricted to the specialty area of medicine in which that person is certified or in which the person is eligible for certification.

(c) Any physician holding a Locum Tenens license shall notify the Board of the location and duration of each Tennessee practice as soon as reasonably possible under the circumstances before that practice occurs.

(d) All Locum Tenens licenses must be renewed, inactivated or retired according to the same procedure as active unrestricted licenses.

(e) All Locum Tenens licenses are subject to discipline for the same causes and pursuant to the same procedures as active unrestricted licenses.

(f) Any person holding a Locum Tenens license who practices in this state for a period of time in any one year that the Board in its discretion feels is inordinate for the purposes of this licensure status may have his or her Locum Tenens license revoked or be required to apply for a full active license.

(7) Submission of any document or set of documents required by this rule or submission of verification of the authenticity, validity and accuracy of the content of any document or set of documents required by this rule directly from the FCVS to the Board Administrative Office shall be deemed to be submission of originals of those documents or sets of documents by the issuing institution(s).

History

Authority: T.C.A. §§ 4-5-102(3), 4-5-202, 4-5-204, 63-6-101, 63-6-101(a), 63-6-201(a), 63-6-207, 63-6- 208, 63-6-209, 63-6-210, 63-6-211, 63-6-214, 63-6-214(a), (c), (d), and (j), 63-6-216, 63-6-230, and 63-6- 233.
Administrative History: Original rule filed October 13, 1983; effective November 14, 1983. Subsequently repealed and replaced twice, the last replacement was effective April 12, 1991. Amendment filed November 27, 1991; effective February 26, 1992. Amendment filed January 21, 1993; effective March 7, 1993. Amendment filed April 14, 1994; effective June 28, 1994. Amendment filed February 23, 1995; effective May 9, 1995. Amendment filed March 29, 1996; effective June 12, 1996. Amendment filed September 22, 1997; effective December 6, 1997. Amendment filed February 3, 1998; effective April 19, 1998. Amendment filed November 30, 1998; effective February 13, 1999. Amendment filed April 16, 1999; effective June 30, 1999. Amendment filed January 4, 2002; effective March 20, 2002. Amendment filed September 5, 2002; effective November 19, 2002. Amendment filed May 28, 2003; effective August 11, 2003. Amendment filed December 5, 2003; effective February 18, 2004. Amendment filed August 23, 2005; effective November 6, 2005. Amendments filed March 14, 2006; effective May 28, 2006.

Tenn. Comp. R. & Regs. 0880-02-.08 EXAMINATION

All persons intending to apply for licensure as a physician in Tennessee must successfully complete a written examination pursuant to this rule. Such written examination must be completed prior to application for licensure. Certification of successful completion must be submitted by the examining agency directly to the Board Administrative Office as part of the application process contained in Rules 0880-02-.03, 0880-02-.04 and 0880-02-.05.

(1) The Board adopts FLEX, USMLE and the National Board of Medical Examiners (NBME) examination as its written licensure examinations. Successful completion of one of those examinations is a prerequisite to licensure according to the following:

(a) After December 31, 1999, with the exception of applicants applying pursuant to Rule

Tenn. Comp. R. & Regs. 0880-02-.09 . Notwithstanding Rule 0880-02-.09, however, licenses not timely renewed will not be subject to reinstatement and affected individuals wishing to engage in the practice of medicine on patients located in Tennessee will be required to make application for a full license, including payment of the application fee.

(b) Telemedicine license holders must maintain current ABMS specialty board-certification.

Licensees who do not maintain ABMS specialty board-certification will not be entitled to renewal of the license.

(c) Licensees retaining a telemedicine license are limited to the provision of medical interpretation services in the area of their specialty board-certification. Such license holders do not possess prescriptive authority in Tennessee.

(d) All telemedicine licenses are subject to discipline for the same causes and pursuant to the same procedures as active, unrestricted licenses.

(3) Effect of License - The issuance by the Board of a license to practice medicine subjects the licensee to the jurisdiction of the Board in all matters set forth in the Medical Practice Act and implementing rules and regulations, including all matters related to discipline. The licensee agrees by acceptance of such license to produce patient medical records and materials as requested by the Board and to appear before the Board upon receipt of notice from the Board commanding such appearance. Failure of the licensee to appear and/or to produce records or materials as requested, after appropriate notice, shall constitute grounds to suspend or revoke the license at the Board’s discretion.

(4) Exempted from the provisions of these rules are the following:

(a) Licensed physicians of other states when called in consultation regarding specific clinical or scientific aspects of the field of medicine by a Tennessee licensed/registered physician as provided by T.C.A. § 63-6-204(a)(3);

(b) U.S. Military physicians operating within the Federal jurisdiction and regulations related to their duties as provided by T.C.A. § 63-6-204(a)(3);

(c) The informal practice of medicine between physicians in the form of uncompensated professional dialogue regarding aspects of the field of medicine; and (d) A recognized, highly specialized, licensed physician from another state or country who specializes in the diagnosis and/or treatment of rare or orphan diseases and who provides consultation to research hospitals, with or without compensation or the expectation of compensation.

(5) Physicians who are contractually obligated to provide and/or deliver medical services in Tennessee must be licensed to practice medicine in Tennessee, regardless of whether such services are in exchange for direct compensation.

(6) Notwithstanding the requirements of Rule 0880-02-.14(7), a physician licensed in Tennessee may engage in the practice of telemedicine under the following circumstances:

(a) Except as provided under paragraphs seven (7) and eight (8) of this rule, the patient encounter to establish or maintain the physician-patient relationship via telemedicine between the physician in a remote location and the patient in Tennessee may occur with or without the use of a facilitator so long as such encounter is consistent with parts 1. and 2. of this rule:

If no facilitator is present:

(i) The patient must utilize adequately sophisticated technology to enable the remote provider to verify the patient’s identity and location with an appropriate level of confidence; and (ii) The patient must transmit all relevant health information at the level of store-and-forward technology or secure video conferencing; and (iii) The remote provider must disclose his or her name, current and primary practice location, medical degree and recognized specialty area, if any, and in accordance with T.C.A. § 63-1-109.

If a facilitator is present:

(i) The facilitator must personally verify the identity of the patient; however, all relevant health information must be transmitted to the remote provider using at least the level of store-and-forward technology. The facilitator and the patient may interact with the provider at the remote location via secure video conferencing or store-and-forward technology; and (ii) The facilitator must identify themselves, their role, and their title to the patient and the remote physician; and (iii) The remote provider must disclose his or her name, current and primary practice location, medical degree and recognized specialty area, if any, and all additional information required pursuant to T.C.A. § 63-1-109.

(b) For patient encounters conducted via telemedicine, the physician should have appropriate patient record(s) or be able to obtain such information during the telemedicine encounter.

(c) The physician engaging in telemedicine is responsible for ensuring that the medical record contains all pertinent data and information gleaned from the encounter. Any physician conducting a patient encounter via telemedicine must so document in the patient record and must state the technology used. All records for Tennessee patients are subject to inspection pursuant to T.C.A. § 63-1-117.

(d) If the information transmitted through electronic or other means as part of a patient’s encounter is not of sufficient quality or does not contain adequate information for the physician to form an opinion, the physician must declare they cannot form an opinion to make an adequate diagnosis and must request direct referral for inspection and actual physical examination, request additional data, or recommend the patient be evaluated by the patient’s primary physician or other local health care provider.

(7) A physician licensed by the Board may, if requested to do so by another physician licensed by the Board, engage in medical interpretation as defined in these rules and render an opinion based on data which is transmitted electronically. In such cases, the physician providing the medical interpretation need not examine the patient and need not have the complete medical record accessible, unless the interpreting physician believes that additional information is necessary. Any opinion rendered by such interpreting physician must be reduced to writing which includes the name and electronic signature of the interpreting physician.

(8) No patient seeking care via telemedicine who is under the age of eighteen (18) years of age can be treated unless there is a facilitator present, except as otherwise authorized by law.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-6-101, 63-6-209, 63-6-214, and Chapter 261, Public Acts of 2015.
Administrative History: Original rule filed January 26, 1998; effective April 11, 1998. Amendment filed February 3, 1998; effective April 19, 1998. Amendment filed November 23, 2005; effective February 6, 2006. Amendment filed March 14, 2006; effective May 28, 2006. Amendments filed August 2, 2016; effective October 31, 2016.

Tenn. Comp. R. & Regs. 0880-02-.10 LICENSURE RETIREMENT/INACTIVATION AND REACTIVATION

(1) Inactivation of License - Individuals who submitted an application for the inactivation of their license under previous rule: As of the effective date of this rule, the Board will no longer accept applications for the inactivation of a license. Individuals who are currently in inactive status will be given until their current expiration date to either reinstate or voluntarily retire their license. The reinstatement fee will be waived for those individuals who submit an application for reinstatement before their expiration date.

(2) Licensure Retirement (a) Licensees who wish to retain their licenses but not actively practice medicine may avoid automatic revocation of licensure and/or compliance with the licensure renewal process by doing the following:

Obtain from, complete and submit to the Board Administrative Office an affidavit of retirement form.
Submit any documentation which may be required by the form to the Board Administrative Office.

(b) Upon successful application for retirement of licensure with completion and receipt of all proper documentation to the Board’s satisfaction, the Board shall register the license as retired. Any person who has a retired license may not practice medicine in Tennessee.

(3) Reactivation - Any licensee whose license has been retired or placed on inactive status may re-enter active practice by doing the following:

(a) Fully complete and submit the Board’s Renewal/Reinstatement/Reactivation Application along with payment of the licensure renewal fee as provided in Rule 0880- 02-.02 to the Board’s Administrative Office. If retirement was pursuant to Rule 0880-02- .09(1)(f) and reactivation was requested prior to the expiration of one (1) year from the date of retirement, the Board may require payment of the late penalty and past due renewal fees as provided in Rule 0880-02-.02; and (b) Submit, along with the application, documentation of successful completion of twenty (20) hours of continuing medical education in compliance with Rule 0880-02-.19 for each period of twelve (12) months or less preceding the reactivation request, up to forty (40) hours. An applicant for reinstatement who has been out of clinical practice for more than two years may be required to complete re-entry requirements to be determined by the board based on the applicant’s period of clinical inactivity, record of CME, and other relevant factors.

(c) If requested, after review by the Board or a designated Board member, appear before either the Board, or a duly constituted panel of the Board, or another Board member, or the Board Designee for an interview regarding continued competence in the event of licensure retirement or inactivity in excess of two (2) years or the receipt of derogatory information or communication during the reactivation process and/or be prepared to meet or accept other conditions or restrictions as the Board may deem necessary to protect the public. An applicant who is currently under investigation may be required to appear before a screening panel of the Board.

(d) In the case of a physician holding an inactive license, the licensee shall provide evidence of the active practice of medicine in another state during the full period the licensee held an inactive Tennessee license. Additionally, the licensee may be requested to provide such other details surrounding his or her inactive status as the Board may require.

(e) If licensure retirement was in excess of five (5) years, or the inactive licensee was not continuously and actively engaged in the practice of medicine in another state during the period he or she held an inactive Tennessee license, the licensee may be required to successfully complete the FLEX “Special Purpose Examination” as administered by the Board and/or meet such other requirements the Board feels necessary to establish current levels of competency.

(4) Submission of any document or set of documents required by this rule or submission of verification of the authenticity, validity and accuracy of the content of any document or set of documents required by this rule directly from the FCVS to the Board Administrative Office shall be deemed to be submission of originals of those documents or sets of documents by the issuing institution(s).

History

Authority: T.C.A. §§ 63-6-101, 63-6-210, 63-6-230, and 63-6-233.
Administrative History: Original rule filed September 28, 1990; effective November 12, 1990. Repeal and new rule filed February 26, 1991; effective April 12, 1991. Amendment filed May 2, 1995; effective July 16, 1995. Amendment filed July 10, 1997; effective September 23, 1997. Amendment filed September 22, 1997; effective December 6, 1997. Amendment filed February 3, 1998; effective April 19, 1998. Amendment filed September 5, 2002; effective November 19, 2002. Amendment filed March 22, 2006; effective June 5, 2006. Amendments filed March 8, 2022; effective June 6, 2022. Emergency rules filed June 17, 2025; effective through December 14, 2025. Amendments filed August 15, 2025; effective November 13, 2025.

Tenn. Comp. R. & Regs. 0880-02-.11 OFFICERS, RECORDS, MEETING REQUESTS, CERTIFICATES OF FITNESS,

REPLACEMENT LICENSES, CONSULTANTS, ADVISORY RULINGS, DECLARATORY ORDERS AND

SCREENING PANELS.

(1) Officers - The Board shall elect every second year from its members the following officers who shall hold office for two years or until the election of a successor who shall fulfill the remainder of the predecessor’s term:

(a) President - who shall preside over all Board meetings.

(b) Vice President - who shall preside over Board meetings in the absence of the President.

(2) Records and Requests - (a) Minutes of the board meetings and all records, documents, applications, and correspondence will be maintained in the Board’s Administrative Offices.

(b) All requests, applications, notices, complaints, other communications and correspondence shall be directed to the Board’s Administrative Office.

(c) Meeting Agenda Deadline - With the exception of documents relating to disciplinary actions, declaratory orders or hearing requests, any requests or inquiries requiring a Board decision or official Board action must be received in the Board’s Administrative Office fourteen (14) days prior to a scheduled Board meeting. Requests or inquiries timely received will be retained in the administrative office and presented to the Board at the Board meeting. Requests or inquiries not timely received shall be set over to the next Board meeting.

(3) Requests for Certificate of Fitness or Duplicate or Replacement Licenses - (a) Requests for certificates of fitness for licensees desiring to practice in another state must be made in writing to the Board Administrative Office.

(b) Requests for duplicate or replacement licenses must be made in writing to the Board Administrative Office and be accompanied by the fee provided in Rule 0880-02-.02.

(4) Consultants - The Board members or a physician designated by the Board are individually vested with authority as consultants to the Board to do the following acts:

(a) Review and make recommendations on licensure, certification, exemption, renewal, reinstatement and reactivation applications subject to the rules governing those respective applications.

(b) Decide the following:

What, if any, investigation should be instituted upon complaints received by the Division.
Whether a licensee who is the subject of a complaint received and/or an investigation conducted by the Division is an appropriate candidate pursuant to Board established guidelines for diversion to a professional peer review organization and/or impaired professional association.
What, if any, disciplinary actions should be instituted upon investigations conducted by the Division.
What, if any, terms of settlements should be offered in formal disciplinary matters based upon investigations conducted by the Division. A proposed settlement will not become final unless it is subsequently ratified by the Board or a duly constituted panel of the Board.
Whether and under what terms a complaint, case or disciplinary action might be settled. A proposed settlement will not become final unless it is subsequently ratified by the Board or a duly constituted panel of the Board.

(5) The chair(s) of any acting panel(s) of the Board, are authorized to make determinations regarding stays pursuant to Rule 1360-04-01-.18 and reconsiderations filed in contested case matters heard before the panel on which they serve. If the contested case is heard before the full Board, the President is authorized to make those determinations.

(6) Advisory Rulings - Any person who is affected by any matter within the jurisdiction of the Board and who holds a license issued pursuant to Chapter 6 of Title 63 of the Tennessee Code Annotated, may submit a written request for an advisory ruling subject to the limitations imposed by T.C.A. § 63-6-101(a)(4). The procedures for obtaining and issuance of advisory rulings are as follows:

(a) The licensee shall submit the request to the Board Administrative Office on the form contained in paragraph (6)(e) providing all the necessary information; and (b) The request, upon receipt, shall be referred to the Board’s administrative staff for research, review and submission of a proposed ruling to the Board for its consideration at the next meeting after the draft ruling has been approved by the Board’s Medical Director and advisory attorney; and (c) The Board shall review the proposed ruling and either make whatever revisions or substitutions it deems necessary for issuance or refer it back to the administrative staff for further research and drafting recommended by the Board; and (d) Upon adoption by the Board the ruling shall be transmitted to the requesting licensee.

The ruling shall have only such affect as is set forth in T.C.A. § 63-6-101(a)(4).

(e) Any request for an advisory ruling shall be made on the following form, a copy of which may be obtained from the Board’s Administrative Office:

Board of Medical Examiners Request for Advisory Ruling Date:_____________________ Licensee’s Name: _______________________________________________ Licensee’s Address:______________________________________________ ______________________________________________________________ Zip Code___________ License Number:_________________________ 1. The specific question or issue for which the ruling is requested: ____________________________________________________ ____________________________________________________ 2. The facts that gave rise to the specific question or issue: ____________________________________________________ ____________________________________________________ ____________________________________________________ ____________________________________________________ 3. The specific statutes and/or rules which are applicable to the question or issue: ____________________________________________________ ____________________________________________________ ____________________________________________________ ____________________________________________________ _________________________ Licensee’s Signature Mail or Deliver to:

Administrator, Tennessee Board of Medical Examiners 665 Mainstream Drive Nashville, TN 37243 (7) Declaratory Orders - The Board adopts, as if fully set out herein, Rule 1200-10-01-.11, of the Division of Health Related Boards and as it may from time to time be amended, as its rule governing the declaratory order process. All declaratory order petitions involving statutes, rules or orders within the jurisdiction of the Board shall be addressed by the Board pursuant to that rule and not by the Division. Declaratory Order Petition forms can be obtained from the Board’s administrative office.

(8) Screening Panels - Any screening panel(s) established pursuant to T.C.A. § 63-6-214(i):

(a) Shall have concurrent authority with the Board members and any individual physician designated by the Board pursuant to paragraph (4), to do the acts enumerated in paragraph (4)(b) subject to the conditions contained therein.

A screening panel(s) comprised of two (2) or more persons shall elect a chairperson prior to convening to conduct business.
A screening panel(s) comprised of two (2) or more persons is required to conduct the informal hearings authorized in subparagraph (b) immediately below.

(b) After completion of an investigation by the Division, may upon request of either the state, or the licensee who is the subject of an investigation but only with the agreement of the state, or upon request of both the licensee and the state, conduct a non-binding informal hearing and make recommendations as a result thereof as to what, if any, terms of settlement of any potential disciplinary action are appropriate.

Neither the Rules of Civil Procedure, the Rules of Alternative Dispute Resolution, the Rules of Evidence or Contested Case Procedural Rules under the Administrative Procedures Act shall apply in informal hearings before the screening panel(s).

(i) Evidence may be presented or received in any manner and in whatever order agreed upon by the parties.

(ii) Prior to convening the panel and in the absence of an agreement of the parties, the screening panel chairperson shall determine the manner and order of presentation of evidence.

Informal hearings may be conducted without the participation of the licensee who is the subject of the investigation.
A licensee who is the subject of an investigation being considered by a screening panel cannot be compelled to participate in any informal hearing.
It is not required that prior or subsequent notice of any informal hearing be given to any licensee who is the subject of an investigation being considered by a screening panel.
Proposed settlements reached as a result of any informal hearing will not become binding and final unless they are:

(i) Approved by a majority of the members of the screening panel which issued them; and (ii) Agreed to by both the Department of Health, by and through its attorney(s), and the licensee; and (iii) Subsequently presented to and ratified by the Board or a duly constituted panel of the Board.

History

Authority: T.C.A. §§ 4-5-105, 4-5-202, 4-5-204, 4-5-223, 4-5-224, 4-5-225, 63-1-106(c), 63-1-118(b), 63- 6-101, 63-6-101(a), 63-6-103, 63-6-201, 63-6-207, 63-6-209, 63-6-210, 63-6-211, 63-6-212, 63-6-213, and 63-6-214.
Administrative History: Original rule filed February 26, 1991; effective April 12, 1991. Amendment filed August 26, 1998; effective November 9, 1998. Amendment filed April 16, 1999; effective June 30, 1999. Withdrawal of amendment to Rule 0880-02-.11(8)(c) filed and effective November 12, 1999. Amendment filed August 30, 1999; effective November 13, 1999. Amendment filed April 10, 2000; effective June 24, 2000. Amendment filed September 5, 2002; effective November 19, 2002. Amendments filed February 1, 2017; effective May 2, 2017.

Tenn. Comp. R. & Regs. 0880-02-.12 LICENSURE DISCIPLINE AND CIVIL PENALTIES

(1) Upon a finding by the Board that a licensee has violated any provision of the Tennessee Medical Practice Act (T.C.A. §§ 63-6-101 et seq.) or the rules promulgated pursuant thereto, the Board may impose any of the following actions separately or in any combination which is deemed appropriate to the offense:

(a) Private Censure - This is a written action issued to the licensee for minor or near infractions. It is informal and advisory in nature and does not constitute a formal disciplinary action.

(b) Public censure or reprimand - This is a written action issued to a licensee for one time and less severe violations. It is a formal disciplinary action.

This action may be combined with any other formal disciplinary action and include conditions which must be met before probation can be lifted and/or which restrict or condition the licensee’s activities during the probationary period.
Once ordered, probation may not be lifted unless and until the licensee petitions and appears, pursuant to paragraph (2) of this rule, before the Board after the period of initial probation has run and all conditions placed on the probation have been met and the Board is satisfied that a further probationary period is not warranted.

(d) Licensure Suspension - This is a formal disciplinary action which suspends a licensee’s right to practice medicine for a fixed period of time. It contemplates the reentry of the licensee into practice under the license previously issued.

Once ordered, a suspension may not be lifted unless and until the licensee petitions and appears, pursuant to paragraph (2) of this rule, before the Board after the period of initial suspension has run and:

(i) All conditions placed on the suspension have been met; and (ii) The Board is satisfied that the licensee is competent to return to practice and that no further period of suspension is warranted.

It is the Board’s intent that the licensee not practice medicine at all during the period of suspension. If a licensee practices medicine in another state during the period of any ordered suspension, the length of time of practice in another state shall not be counted toward fulfilling the suspension ordered by the Board.
It is the Board’s intent that during the period of any suspension, a licensee may not practice any health related profession or in any health related field unless permission is sought and granted by the Board.

(e) Revocation with Leave To Apply - This is a formal disciplinary action which removes a licensee from the practice of medicine in Tennessee and terminates the license previously issued. It relegates the licensee to the status possessed prior to initial application for licensure.

A revocation of this nature anticipates that if conditions contained in the revocation order are met that person may apply for a new license to practice medicine. This does not guarantee that a new license will be issued unless or until the Board is satisfied that the person is competent to re-enter practice and is not a threat to the public health, safety or welfare.
Petitions for reinstatement of licensure will not be accepted or entertained.
Unless a shorter or longer period of time is included in the revocation order, application for a new license will not be accepted or entertained prior to the expiration of at least one (1) year from the effective date of the revocation. Under no circumstances will a new license be issued until the Board is satisfied that the applicant is competent to re-enter the practice of medicine and has met all the then existing licensure requirements. Former disciplinary actions against a licensee can and will be considered in any decision on such licensure applications.

(f) Permanent Licensure Revocation - This is the most severe form of disciplinary action which permanently removes a licensee from the practice of medicine in Tennessee and terminates the license previously issued. It is the Board’s intent that any licensee’s whose license is permanently revoked may never practice medicine in Tennessee again. Petitions for reinstatement or new applications for licensure will not be accepted or entertained.

(g) Conditions - Any action deemed appropriate by the Board to be required of a disciplined licensee in any of the following circumstances:

During any period of probation, suspension or revocation with leave to apply; or 2. As a prerequisite to the lifting of probation or suspension; or 3. As a stand-alone requirement(s) in any disciplinary order.

(h) Civil penalty - A monetary disciplinary action assessed by the Board pursuant to paragraph (4) of this rule.

(i) Summary Suspension - This is a formal preliminary disciplinary action which immediately suspends a licensee’s right to practice medicine until a final disposition of the matter is had after a promptly instituted, full hearing before the Board. This type of suspension is ordered ex parte, pursuant to the notice procedures contained in T.C.A. § 4-5-320 and then only upon a finding by the Board that the public health, safety or welfare Imperatively Requires Emergency Action.

(j) Assessment of costs in disciplinary proceedings shall be as set forth in T.C.A. §§ 63-1- 144 and 63-6-214.

(2) Order of Compliance - This procedure is a necessary adjunct to previously issued disciplinary orders and is available only when a petitioner has completely complied with the provisions of a previously issued disciplinary order, including an unlicensed practice civil penalty order, and wishes or is required to obtain an order reflecting that compliance.

(a) The Board will entertain petitions for an Order of Compliance as a supplement to a previously issued order upon strict compliance with the procedures set forth in subparagraph (b) in only the following two (2) circumstances:

When the petitioner can prove compliance with all the terms of the previously issued order and is seeking to have an order issued reflecting that compliance; or 2. When the petitioner can prove compliance with all the terms of the previously issued order and is seeking to have an order issued lifting a previously ordered suspension or probation.

(b) Procedures 1. The petitioner shall submit a Petition for Order of Compliance, as contained in subparagraph (c), to the Board’s Administrative Office that shall contain all of the following:

(i) A copy of the previously issued order; and (ii) A statement of which provision of subparagraph (a) the petitioner is relying upon as a basis for the requested order; and (iii) A copy of all documents that prove compliance with all the terms or conditions of the previously issued order. If proof of compliance requires testimony of an individual(s), including that of the petitioner, the petitioner must submit signed statements from every individual the petitioner intends to rely upon attesting, under oath, to the compliance. The Board’s consultant and administrative staff, in their discretion, may require such signed statements to be notarized. No documentation or testimony other than that submitted will be considered in making an initial determination on, or a final order in response to, the petition.

The Board authorizes its consultant and administrative staff to make an initial determination on the petition and take one of the following actions:

(i) Certify compliance and have the matter scheduled for presentation to the Board as an uncontested matter; or (ii) Deny the petition, after consultation with legal staff, if compliance with all of the provisions of the previous order is not proven and notify the petitioner of what provisions remain to be fulfilled and/or what proof of compliance was either not sufficient or not submitted.

If the petition is presented to the Board the petitioner may not submit any additional documentation or testimony other than that contained in the petition as originally submitted.
If the Board finds that the petitioner has complied with all the terms of the previous order an Order of Compliance shall be issued.
If the petition is denied either initially by staff or after presentation to the Board and the petitioner believes compliance with the order has been sufficiently proven the petitioner may, as authorized by law, file a petition for a declaratory order pursuant to the provisions of T.C.A. § 4-5-223 and Rule 1200-10-01-.11.

Petitioner’s Mailing Address:

Petitioner’s E-Mail Address:

Telephone Number:

Attorney for Petitioner:

Attorney’s Mailing Address:

Attorney’s E-Mail Address:

Telephone Number:

The petitioner respectfully represents, as substantiated by the attached documentation, that all provisions of the attached disciplinary order have been complied with and I am respectfully requesting: (circle one)

An order issued reflecting that compliance; or 2. An order issued reflecting that compliance and lifting a previously ordered suspension or probation.

Note - You must enclose all documents necessary to prove your request including a copy of the original order. If any of the proof you are relying upon to show compliance is the testimony of any individual, including yourself, you must enclose signed statements from every individual you intend to rely upon attesting, under oath, to the compliance. The Board’s consultant and administrative staff, in their discretion, may require such signed statements to be notarized. No documentation or testimony other than that submitted will be considered in making an initial determination on, or a final order in response to, this petition.

Respectfully submitted this the day of , 20 __.

Petitioner’s Signature (3) Order Modifications - This procedure is not intended to allow anyone under a previously issued disciplinary order, including an unlicensed practice civil penalty order, to modify any findings of fact, conclusions of law, or the reasons for the decision contained in the order. It is also not intended to allow a petition for a lesser disciplinary action, or civil penalty other than the one(s) previously ordered. All such provisions of Board orders were subject to reconsideration and appeal under the provisions of the Uniform Administrative Procedures Act (T.C.A. §§ 4-5-301, et seq.). This procedure is not available as a substitute for reconsideration and/or appeal and is only available after all reconsideration and appeal rights have been either exhausted or not timely pursued. It is also not available for those who have accepted and been issued a reprimand.

(a) The Board will entertain petitions for modification of the disciplinary portion of previously issued orders upon strict compliance with the procedures set forth in subparagraph (b) only when the petitioner can prove that compliance with any one or more of the conditions or terms of the discipline previously ordered is impossible. For purposes of this rule the term “impossible” does not mean that compliance is inconvenient or impractical for personal, financial, scheduling or other reasons.

(b) Procedures 1. The petitioner shall submit a written and signed Petition for Order Modification on the form contained in subparagraph (c) to the Board’s Administrative Office that shall contain all of the following:

(i) A copy of the previously issued order; and (ii) A statement of why the petitioner believes it is impossible to comply with the order as issued; and (iii) A copy of all documents that proves that compliance is impossible. If proof of impossibility of compliance requires testimony of an individual(s), including that of the petitioner, the petitioner must submit signed and notarized statements from every individual the petitioner intends to rely upon attesting, under oath, to the reasons why compliance is impossible.

No documentation or testimony other than that submitted will be considered in making an initial determination on, or a final order in response to, the petition.

The Board authorizes its consultant and administrative staff to make an initial determination on the petition and take one of the following actions:

(i) Certify impossibility of compliance and forward the petition to the Office of General Counsel for presentation to the Board as an uncontested matter; or (ii) Deny the petition, after consultation with legal staff, if impossibility of compliance with the provisions of the previous order is not proven and notify the petitioner of what proof of impossibility of compliance was either not sufficient or not submitted.

If the petition is presented to the Board the petitioner may not submit any additional documentation or testimony other than that contained in the petition as originally submitted.
If the petition is granted a new order shall be issued reflecting the modifications authorized by the Board that it deemed appropriate and necessary in relation to the violations found in the previous order.
If the petition is denied either initially by staff or after presentation to the Board and the petitioner believes impossibility of compliance with the order has been sufficiently proven the petitioner may, as authorized by law, file a petition for a declaratory order pursuant to the provisions of T.C.A. § 4-5-223 and Rule 1200- 10-01-.11.

Petitioner’s Mailing Address:

Petitioner’s E-Mail Address:

Telephone Number:

Attorney for Petitioner:

Attorney’s Mailing Address:

Attorney’s E-Mail Address:

Telephone Number:

The petitioner respectfully represents that for the following reasons, as substantiated by the attached documentation, the identified provisions of the attached disciplinary order are impossible for me to comply with:

Note - You must enclose all documents necessary to prove your request including a copy of the original order. If any of the proof you are relying upon to show impossibility is the testimony of any individual, including yourself, you must enclose signed and notarized statements from every individual you intend to rely upon attesting, under oath, to the reasons why compliance is impossible. No documentation or testimony other than that submitted will be considered in making an initial determination on, or a final order in response to, this petition.

Respectfully submitted this the day of , 20 __.

Petitioner’s Signature (4) Civil Penalties (a) Purpose - The purpose of this is to set out a schedule designating the minimum and maximum civil penalties which may be assessed pursuant to T.C.A. § 63-1-134.

(b) Schedule of Civil Penalties 1. A Type A civil penalty may be imposed whenever the Board finds the person who is required to be licensed or certified, permitted or authorized by the Board guilty of a willful and knowing violation of the practice act, or regulations promulgated pursuant thereto, to such an extent that there is, or is likely to be an imminent, substantial threat to the health, safety and welfare of an individual client or the public. For purposes of this section, willfully and knowingly practicing medicine without a license, certification or other authorization from the Board is one of the violations of the Medical Practice Act for which a Type A civil penalty is assessable.

A Type B civil penalty may be imposed whenever the Board finds the person who is required to be licensed or certified, permitted or authorized by the Board is guilty of a violation of the Medical Practice Act, or regulations promulgated pursuant thereto, in such a manner as to impact directly on the care of patients or the public.
A Type C civil penalty may be imposed whenever the Board finds the person who is required to be licensed by the Board or certified, permitted or authorized by the Board is guilty of a violation of the Medical Practice Act, or regulations promulgated pursuant thereto, which are neither directly detrimental to the patients or public, nor directly impact their care, but have only indirect relationship to patient care or the public.

(c) Amount of Civil Penalties 1. Type A Civil Penalties shall be assessed in the amount of not less than $500 or more than $1,000.

Type B Civil Penalties may be assessed in the amount of not less than $100 and not more than $500.
Type C Civil Penalties may be assessed in the amount of not less than $50 and not more than $100.

(d) Procedures for Assessing Civil Penalties 1. The Division of Health Related Boards may initiate a civil penalty assessment by filing a Memorandum of Assessment of Civil Penalty. The Division shall state in the memorandum the facts and law upon which it relies in alleging a violation, the proposed amount of the civil penalty and the basis for such penalty. The Division may incorporate the Memorandum of Assessment of Civil Penalty with a Notice of Charges which may be issued attendant thereto.

Civil Penalties may also be initiated and assessed by the Board during consideration of any Notice of Charges. In addition, the Board may, upon good cause shown, assess a type and amount of civil penalty which was not recommended by the Division.
In assessing the civil penalties pursuant to these rules the Board may consider the following factors:

(i) Whether the amount imposed will be a substantial economic deterrent to the violator;

(ii) The circumstances leading to the violation;

(iii) The severity of the violation and the risk of harm to the public;

(iv) The economic benefits gained by the violator as a result of noncompliance; and, (v) The interest of the public.

All proceedings for the assessment of civil penalties shall be governed by the contested case provisions of Title 4, Chapter 5, Tennessee Code Annotated.

History

Authority: T.C.A. §§ 4-5-101, 4-5-202, 4-5-204, 4-5-217, 4-5-223, 63-1-122, 63-1-134, 63-1-144, 63-6- 101, 63-6-124, 63-6-213, 63-6-214, and 63-6-216.
Administrative History: Original rule filed February 26, 1991; effective April 12, 1991. Amendment filed July 7, 1995; effective September 20, 1995. Amendment filed August 26, 1998; effective November 9, 1998. Amendment filed April 10, 2000; effective June 24, 2000. Amendment filed September 5, 2002; effective November 19, 2002. Amendment filed June 30, 2004; effective September 13, 2004. Amendment filed July 1, 2008; effective September 14, 2008.

Tenn. Comp. R. & Regs. 0880-02-.13 ADVERTISING

(1) Policy Statement. The lack of sophistication on the part of many of the public concerning medical services, the importance of the interests affected by the choice of a physician and the foreseeable consequences of unrestricted advertising by physicians which is recognized to pose special possibilities for deception, require that special care be taken by physicians to avoid misleading the public. The physician must be mindful that the benefits of advertising depend upon its reliability and accuracy. Since advertising by physicians is calculated and not spontaneous, reasonable regulation designed to foster compliance with appropriate standards serves the public interest without impeding the flow of useful, meaningful, and relevant information to the public.

(2) Definitions (a) Advertisement - Informational communication to the public in any manner designed to attract public attention to the practice of a physician who is licensed to practice in Tennessee.

(b) Licensee - Any person holding a license to practice medicine in the State of Tennessee. Where applicable this shall include partnerships and/or corporations.

(c) Material Fact - Any fact which an ordinary reasonable and prudent person would need to know or rely upon in order to make an informed decision concerning the choice of practitioners to serve his or her particular needs.

(d) Bait and Switch Advertising - An alluring but insincere offer to sell a product or service which the advertiser in truth does not intend or want to sell. Its purpose is to switch consumers from buying the advertised service or merchandise, in order to sell something else, usually for a higher fee or on a basis more advantageous to the advertiser.

(e) Discounted Fee - Shall mean a fee offered or charged by a person or product or service that is less than the fee the person or organization usually offers or charges for the product or service. Products or services expressly offered free of charge shall not be deemed to be offered at a “discounted fee.”

(3) Advertising Fees and Services (a) Fixed Fees - Fixed fees may be advertised for any service.

It is presumed unless otherwise stated in the advertisement that a fixed fee for a service shall include the cost of all professional recognized components within generally accepted standards that are required to complete the service.

(b) Range of Fees. A range of fees may be advertised for services and the advertisement must disclose the factors used in determining the actual fee, necessary to prevent deception of the public.

The discount fee is in fact lower than the licensee’s customary or usual fee charged for the service; and 2. The licensee provides the same quality and components of service and material at the discounted fee that are normally provided at the regular, non-discounted fee for that service.

(d) Related Services and Additional Fees. Related services which may be required in conjunction with the advertised services for which additional fees will be charged must be identified as such in any advertisement.

(e) Time Period of Advertised Fees. Advertised fees shall be honored for those seeking the advertised services during the entire time period stated in the advertisement whether or not the services are actually rendered or completed within that time.

If no time period is stated in the advertisement of fees, the advertised fee shall be honored for thirty (30) days from the last date of publication or until the next scheduled publication whichever is later whether or not the services are actually rendered or completed within that time.

(f) Remote Services. Any physician, except those providing services on behalf of the Department of Health, Department of Correction, or Department of Mental Health and Developmental Disabilities, who pursuant to T.C.A. § 63-6-204(b), is required to have control over and responsibility for medical services being provided at any location other than the primary location or office at which he or she practices medicine a majority of the time must have the following included in any advertisement for that location and on the most conspicuous sign at that location:

The physician’s name; and 2. An indication of what, if any, specialty or board certification is held by the physician; and 3. An indication of whether the physician is available on-site or remotely.

(4) Advertising Content. The following acts or omissions in the context of advertisement by any licensee shall constitute unethical and unprofessional conduct, and subject the licensee to disciplinary action pursuant to T.C.A. § 63-6-214(b)(9).

(a) Claims that the services performed, personnel employed, materials or office equipment used are professionally superior to that which is ordinarily performed, employed, or used, or that convey the message that one licensee is better than another when superiority of services, personnel, materials or equipment cannot be substantiated.

(b) The misleading use of an unearned or non-health degree in any advertisement.

(c) Promotion of professional services which the licensee knows or should know is beyond the licensee’s ability to perform.

(d) Techniques of communication which intimidate, exert undue pressure or undue influence over a prospective client.

(e) Any appeals to an individual’s anxiety in an excessive or unfair manner.

(f) The use of any personal testimonial attesting to a quality of competency of a service or treatment offered by a licensee that is not reasonably verifiable.

(g) Utilization of any statistical data or other information based on past performances for prediction of future services, which creates an unjustified expectation about results that the licensee can achieve.

(h) The communication of personal identifiable facts, data, or information about a patient without first obtaining patient consent.

(i) Any misrepresentation of a material fact.

(j) The knowing suppression, omission or concealment of any materials fact or law without which the advertisement would be deceptive or misleading.

(k) Statements concerning the benefits or other attributes of medical procedures or products that involve significant risks without including:

A realistic assessment of the safety and efficiency of those procedures or products; and 2. The availability of alternatives; and 3. Where necessary to avoid deception, descriptions or assessment of the benefits or other attributes of those alternatives.

(l) Any communication which creates an unjustified expectation concerning the potential results of any treatment.

(m) Failure to comply with the rules governing advertisement of fees and services, or advertising records.

(n) The use of “bait and switch” advertisements. Where the circumstances indicate “bait and switch” advertising, the Board may require the licensee to furnish data or other evidence pertaining to those sales at the advertised fee as well as other sales.

(o) Misrepresentation of a licensee’s credentials, training, experience, or ability.

(p) Failure to include the corporation, partnership or individual licensee’s name, address, and telephone number in any advertisement. Any corporation, partnership or association which advertises by use of a trade name or otherwise fails to list all licensees practicing at a particular location shall:

Upon request provide a list of all licensees practicing at that location; and 2. Maintain and conspicuously display at the licensee’s office, a directory listing all licensees practicing at that location.

(q) Failure to disclose the fact of giving compensation or anything of value to a representative of the press, radio, television or other communicative medium in anticipation of or in return for any advertisement (for example, newspaper article) unless the nature, format or medium of such advertisement make the fact of compensation apparent.

(r) After thirty (30) days of the licensee’s departure, the use of the name of any licensee formerly practicing at or associated with any advertised location or on office signs or buildings. This rule shall not apply in the case of a retired or deceased former associate who practiced in association with one or more of the present occupants if the status of the former associate is disclosed in any advertisement or sign.

(s) Stating or implying that a certain licensee provides all services when any such services are performed by another licensee.

(t) Directly or indirectly offering, giving, receiving, or agreeing to receive any fee or other consideration to or from a third party for the referral of a patient in connection with the performance of professional services.

(5) Advertising Records and Responsibility (a) Each licensee who is a principal partner, or officer of a firm or entity identified in any advertisement, is jointly and severally responsible for the form and content of any advertisement. This provision shall also include any licensed professional employees acting as an agent of such firm or entity.

(b) Any and all advertisement are presumed to have been approved by the licensee named therein.

(c) A recording of every advertisement communicated by electronic media, and a copy of every advertisement communicated by print media, and a copy of any other form of advertisement shall be retained by the licensee for a period of two (2) years from the last date of broadcast or publication and be made available for review upon request by the Board or its designee.

(d) At the time any type of advertisement is placed, the licensee must possess and rely upon information which, when produced, would substantiate the truthfulness of any assertion, omission or representation of material fact set forth in the advertisement or public information.

(6) Severability. It is hereby declared that the sections, clauses, sentences and part of these rules are severable, are not matters of mutual essential inducement, and any of them shall be rescinded if these rules would otherwise be unconstitutional or ineffective. If any one or more sections, clauses, sentences or parts shall for any reason be questioned in court, and shall be adjudged unconstitutional or invalid, such judgment shall not affect, impair or invalidate the remaining provisions thereof, but shall be confined in its operation to the specific provision or provisions so held unconstitutional or invalid, and the in applicability or invalidity of any section, clause, sentence or part in any one or more instance shall not be taken to affect or prejudice in any way its applicability or validity in any other instance.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-1-145, 63-6-101, 63-6-204, 63-6-214, and 63-6-215.
Administrative History: Original rule filed February 26, 1991; effective April 12, 1991. Amendment filed November 27, 1991; effective February 26, 1992. Amendment filed December 29, 2006; effective March 14, 2007. Amendment filed July 1, 2008; effective September 14, 2008.

Tenn. Comp. R. & Regs. 0880-02-.14 SPECIALLY REGULATED AREAS AND ASPECTS OF MEDICAL PRACTICE

(1) Policy Statement - The scope of practice of physicians in Tennessee is broadly defined and includes many aspects which if not particularly regulated could lead to serious ramifications for the consuming public. This Rule is to designate specific areas in the practice of medicine for regulation the violation of which may result in disciplinary action pursuant to either T.C.A. § 63-6-214(b)(1) or 63-6-214(b)(4) or 63-6-214(b)(12).

(2) Pharmaceutical Dispensing - Physicians who elect to dispense medication for remuneration must comply with the following:

(a) All Federal Regulations (21 CFR 1304 through 1308) for the dispensing of controlled substances.

(b) Requirements for dispensing of non-controlled drugs are as follows:

Drugs are to be dispensed in an appropriate container labeled with at least, the following:

(i) Patient’s name.

(ii) Date.

(iii) Complete directions for usage.

(iv) The physician’s name and address.

(v) A unique number, or the name and strength of the medication.

Physicians may dispense only to individuals with whom they have established a physician/patient relationship. It shall be a violation of this rule for a physician to dispense medication at the order of any other physician not registered to practice at the same location.
Whenever dispensing takes place, appropriate records shall be maintained. A separate log must be maintained for controlled substances dispensing.

(c) It is not the intention of this Rule to interfere with the individual physician’s appropriate use of professional samples, nor to interfere in any way with the physician’s right to directly administer drugs or medicines to any patient.

(d) Dispensing or prescribing controlled substances in amounts or for durations not medically necessary, advisable or justified is considered to be practicing beyond the scope of the professional practice.

(3) Amphetamines, Amphetamine-Like Substances, and Central Nervous System Stimulants.

(a) It shall be a prima facie violation of T.C.A. § 63-6-214(b)(1) and 63-6-214(b)(12) to prescribe, order, administer, sell or otherwise distribute any amphetamine drug except:

For treatment of the following:

(i) Attention deficit disorder;

(ii) Drug-induced brain dysfunction;

(iii) Narcolepsy;

(iv) Dementia or organic brain syndrome with severe psychomotor retardation;

(v) Chronic depression refractory to other drugs. Such diagnosis must be included on the prescription.

When the licensee has applied for and received from the Board of Medical Examiners a written approval for the clinical investigation of such drugs under a protocol satisfactory to the Board. Any such approval by the Board of Medical Examiners will be filed with the Board of Pharmacy and disseminated by the Board of Pharmacy to any pharmacy which would fill prescriptions written during the research.

(b) The list of amphetamine drugs governed by subparagraph (3)(a) of this Rule includes the following controlled substances:

Amphetamine, its salts, optical isomers and salts of its optical isomers;

(examples are Biphetamine, Dexadrine, Benzedrine and others).

Methamphetamine, its salts, isomers and salts of isomers; (an example is Desoxyn).
Any salt, any type of isomer and salts of such isomers, or any chemical element or any mixture, compound, material or preparation, containing any quantity of any of the substances listed above or their salts, any type of isomers and salts of such isomers, or chemical elements are also governed by this rule.

(c) It shall be a prima facie violation of T.C.A. § 63-6-214(b)(1) and 63-6-214(b)(12) to prescribe, order, administer, sell or otherwise distribute any amphetamine-like substance listed below, except when the licensee has applied for and received from the Board of Medical Examiners a written approval for the clinical investigation of such drugs under a protocol satisfactory to the Board. Any such approval by the Board of Medical Examiners will be filed with the Board of Pharmacy and disseminated by the Board of Pharmacy to any pharmacy which would fill prescriptions written during the research.

The list of amphetamine-like substances governed by this rule are the following controlled substances:

(i) Phenmetrazine and its salts; (an example is Preludin)

(ii) Benzphetamine; (an example is Didrex)

(iii) Chlorphentermine; (an example is Pre Sate)

(iv) Phendimetrazine; (examples are Plegine, Bontril, Meltiat, Prelu-2, Adipost, Wehles, and others)

(v) Diethylproprion; (examples are Tenuate and Tepanil)

(vi) Mazindol; (examples are Mazandor and Sanorex)

(vii) Phentermine; (examples are Ionamin, Fastin, Adipex and others), except as authorized pursuant to T.C.A. § 63-6-214;

(viii) Fenfluramine HS; (an example is Pondimin), except as authorized pursuant to T.C.A. § 63-6-214.

Any salt, any type of isomer and salts of such isomers, or any chemical element or any mixture, compound, material or preparation, containing any quantity of any of the substances listed above or their salts, any type of isomers and salts of such isomers, or chemical elements, except as authorized pursuant to T.C.A. § 63-6-214, are also governed by this rule.

(d) It shall be a prima facie violation of T.C.A. § 63-6-214(b)(1) and 63-6-214(b)(12) to prescribe, order, administer, sell or otherwise distribute any central nervous system stimulant listed below except:

For treatment of any of the following:

(i) Attention deficit disorder;

(ii) Drug-induced brain dysfunction;

(iii) Narcolepsy;

(iv) Dementia or organic brain syndrome with severe psychomotor retardation;

(v) Chronic depression refractory to other drugs. Such diagnosis must be included on the prescription.

When the licensee has applied for and received from the Board of Medical Examiners a written approval for the clinical investigation of such drugs under a protocol satisfactory to the Board. Any such approval by the Board of Medical Examiners will be filed with the Board of Pharmacy and disseminated by the Board of Pharmacy to any pharmacy which would fill prescriptions written during the research.

(e) The list of central nervous system stimulants governed by subparagraph (3)(d) of this

rule are the following controlled substances:

Methylphenidate; (an example is Ritalin)
Pemoline (including organometallic complexes and chelates thereof; an example is Cylert)
Any salt, any type of isomer and salts of such isomers, or any chemical element or any mixture, compound, material or preparation, containing any quantity of any of the substances listed above or their salts, any type of isomers and salts of such isomers, or chemical elements are also governed by this rule.

(4) Prescription writing shall be governed by Tennessee Code Annotated, § 63-6-236 and Title 53, Chapter 10, Part 2.

(5) Universal Precautions for the Prevention of HIV Transmission - The Board adopts, as if fully set out herein, Rules 1200-14-03-.01 through 1200-14-03-.03 inclusive, of the Department of Health and as they may from time to time be amended, as its rule governing the process for implementing universal precautions for the prevention of HIV transmission for health care workers under its jurisdiction.

(6) Authority of Physician to Prescribe for the Treatment of Pain - Purpose - The purpose of this

chapter is to recognize that some dangerous drugs and controlled substances are indispensable for the treatment of pain, and are useful for relieving and controlling many other related symptoms that patients may suffer. It is the position of the Board that these drugs may be prescribed for the treatment of pain and other related symptoms after a reasonably based medical diagnosis has been made, in adequate doses, and for appropriate lengths of time, which in some cases may be as long as the pain or related symptoms persist. The Board recognizes that pain, including intractable pain, and many other related symptoms are subjective complaints and that the appropriateness and the adequacy of drug and dose will vary from individual to individual. The practitioner is expected to exercise sound medical judgment in treating pain and related symptoms with dangerous drugs and controlled substances.

(a) Definitions. The following words and terms, as used in this rule shall have the following meanings in the context of providing medications for pain and related symptoms.

Abuser of narcotic drugs, controlled substances and dangerous drugs - A person who takes a drug or drugs for other than legitimate medical purposes.
Intractable pain - A pain state in which the cause of the pain cannot be removed or otherwise treated and which in the generally accepted course of medical practice no relief or cure of the cause of the pain is possible or none has been found after reasonable efforts.
Non-therapeutic in nature or manner - A medical use or purpose that is not legitimate.
Prescribing pharmaceuticals or practicing consistent with the public health and welfare - Prescribing pharmaceuticals and practicing medicine for a legitimate medical purpose in the usual course of professional practice.

(b) No physician is required to provide treatment to patients with intractable pain with opiate medications but when refusing to do so shall inform the patient that there are physicians whose primary practice is in the treatment of severe, chronic, intractable pain with methods including the use of opiates. If the patient requests a referral to such a physician, and the physician makes such a referral that referral shall be noted in the patient’s medical records.

(c) If a physician provides medical care for persons with intractable pain, with or without the use of opiate medications, to the extent that those patients become the focus of the physician’s practice the physician must be prepared to document specialized medical education in pain management sufficient to bring the physician within the current standard of care in that field which shall include education on the causes, different and recommended modalities for treatment, chemical dependency and the psycho/social aspects of severe, chronic intractable pain.

(d) The treatment of persons with an acute or chronic painful medical condition who also require treatment for chemical dependency by a physician shall be governed by T.C.A. § 63-6-1107(c) and (d).

(e) Guidelines - The Tennessee Board of Medical Examiners will use the following guidelines to determine whether a physician’s conduct violates T.C.A. § 63-6- 214(b)(12) through (14) in regard to the prescribing, administering, ordering, or dispensing of pain medications and other drugs necessary to address their side effects.

The treatment of pain, including intractable pain, with dangerous drugs and controlled substances is a legitimate medical purpose when done in the usual course of professional practice.
A physician or surgeon duly authorized to practice medicine in Tennessee and to prescribe controlled substances and dangerous drugs in this state shall not be subject to disciplinary action by the Board for prescribing, ordering, administering, or dispensing dangerous drugs or controlled substances for the treatment and relief of pain, including intractable pain, in the usual course of professional practice for a legitimate medical purpose in compliance with applicable state and federal law.
Prescribing, ordering, administering, or dispensing dangerous drugs or controlled substances for pain will be considered to be for a legitimate medical purpose if based upon accepted scientific knowledge of the treatment of pain, including intractable pain, not in contravention of applicable state or federal law, and if prescribed, ordered, administered, or dispensed in compliance with the following guidelines where appropriate and as is necessary to meet the individual needs of the patient:

(i) After a documented medical history, which may be provided orally or in writing by the patient, and physical examination by the physician providing the medication including an assessment and consideration of the pain, physical and psychological function, any history and potential for substance abuse, coexisting diseases and conditions, and the presence of a recognized medical indication for the use of a dangerous drug or controlled substance;

(ii) Pursuant to a written treatment plan tailored for the individual needs of the patient by which treatment progress and success can be evaluated with stated objectives such as pain relief and/or improved physical and psychosocial function. Such a written treatment plan shall consider pertinent medical history and physical examination as well as the need for further testing, consultations, referrals, or use of other treatment modalities;

(iii) The physician should discuss the risks and benefits of the use of controlled substances with the patient or guardian;

(iv) Subject to documented periodic review of the care by the physician at reasonable intervals in view of the individual circumstances of the patient in regard to progress toward reaching treatment objectives which takes into consideration the course of medications prescribed, ordered, administered, or dispensed as well as any new information about the etiology of the pain;

(v) Complete and accurate records of the care provided as set forth in parts (i) -(iv) of this paragraph should be kept. When controlled substances are prescribed, names, quantities prescribed, dosages, and number of authorized refills of the drugs should be recorded, keeping in mind that pain patients with a history of substance abuse or who live in an environment posing a risk for medication misuse or diversion require special consideration. Management of these patients may require closer monitoring by the physician managing the pain and consultation with appropriate health care professionals.

A decision by a physician not to strictly adhere to the provisions of paragraph (3) of this section will, for good cause shown, be grounds for the Board to take no disciplinary action in regard to the physician. Each case of prescribing for pain will be evaluated on an individual basis. The physician’s conduct will be evaluated to a great extent by the treatment outcome, taking into account whether the drug used is medically and/or pharmacologically recognized to be appropriate for the diagnosis, the patient’s individual needs including any improvement in functioning, and recognizing that some types of pain cannot be completely relieved.
If the provisions as set out in subparagraphs (1)-(4) of this section are met, and if all drug treatment is properly documented, the Board will consider such practices as prescribing in a therapeutic manner, and prescribing and practicing medicine in a manner consistent with public health and welfare.
Quantity of pharmaceutical and chronicity of prescribing will be evaluated on the

basis of the documented appropriate diagnosis and treatment of the recognized medical indication, documented persistence of the recognized medical indication, and properly documented follow-up evaluation with appropriate continuing care as set out in this rule.

A physician may use any number of treatment modalities for the treatment of pain, including intractable pain, which are consistent with legitimate medical purposes.
These rules shall not be construed so as to apply to the treatment of acute pain with dangerous drugs or controlled substances for purposes of short-term care.

(7) Prerequisites to Issuing Prescriptions or Dispensing Medications - In Person, Electronically, and Over the Internet (a) Except as provided in subparagraph (b), it shall be a prima facie violation of T.C.A. § 63-6-214(b)(1), (4), and (12) for a physician to prescribe or dispense any drug to any individual, whether in person or by electronic means or over the Internet or over telephone lines, unless the physician, or his/her licensed supervisee pursuant to appropriate protocols or medical orders, has first done and appropriately documented, for the person to whom a prescription is to be issued or drugs dispensed, all of the following:

Performed an appropriate history and physical examination; and 2. Made a diagnosis based upon the examinations and all diagnostic and laboratory tests consistent with good medical care; and 3. Formulated a therapeutic plan, and discussed it, along with the basis for it and the risks and benefits of various treatments options, a part of which might be the prescription or dispensed drug, with the patient; and 4. Insured availability of the physician or coverage for the patient for appropriate follow-up care.

(b) A physician, or his/her licensed supervisee pursuant to appropriate protocols or medical orders, may prescribe or dispense drugs for a person not in compliance with subparagraph (a) consistent with sound medical practice, examples of which are as follows:

In admission orders for a newly hospitalized patient; or 2. For a patient of another physician for whom the prescriber is taking calls or for whom the prescriber has verified the appropriateness of the medication; or 3. For continuation medications on a short-term basis for a new patient prior to the patient’s first appointment; or 4. For established patients who, based on sound medical practices, the physician feels do not require a new physical examination before issuing new prescriptions; or 5. In compliance with paragraph (9) of this rule.

(c) It shall be a prima facie violation of T.C.A. § 63-6-214(b)(1), (4), and (12) for a physician, or his/her licensed supervisee pursuant to appropriate protocols or medical orders, to prescribe or dispense any drug to any individual for whom the physician, or his/her licensed supervisee pursuant to appropriate protocols or medical orders, has not complied with the provisions of this rule based solely on answers to a set of questions regardless of whether the prescription is issued directly to the person or electronically over the Internet or telephone lines.

(8) Code of Ethics - The Board adopts, as if fully set out herein and to the extent that it does not conflict with state law, rules or Board Position Statements, as its code of medical ethics the “Code of Medical Ethics” published by the A.M.A. Council on Ethical and Judicial Affairs as it may, from time to time, be amended.

(a) In the case of a conflict the state law, rules or position statements shall govern.

Violation of the Board’s code of ethics shall be grounds for disciplinary action pursuant to T.C.A. § 63-6-214(b)(1).

(b) A copy of the A.M.A. “Code of Medical Ethics” may be obtained from the Order Department of the A.M.A. at 515 N. State Street, Chicago, IL 60610 or by phone at 1- 800-621-8335, or on the Internet at http://www.ama-assn.org.

(9) Treatment of Chlamydia trachomatis (a) Purpose - This rule provides an acceptable deviation from the normal standard of care in the treatment of Chlamydia trachomatis (hereafter Ct) and provides a means for physicians to help reduce Tennessee’s rate of Ct infection which currently exceeds the national rate by over ten percent (10%), and which, if left untreated, can cause serious health problems including pelvic inflammatory disease, ectopic pregnancies, infertility, cervical cancer and an increased risk of HIV infection. This rule will allow physicians and those over whom they exercise responsibility and control to provide an effective and safe treatment to the partners of patients infected with Ct who for various reasons may not otherwise receive appropriate treatment.

(b) For purpose of this rule “partner(s)” shall mean any person who comes into sexual contact with the infected patient during the sixty (60) days prior to the onset of patient’s symptoms or positive diagnostic test results.

(c) Prerequisites - Physicians and those who provide medical services under their responsibility and control who have first documented all of the following in the medical records for patients may provide partner treatment pursuant to subparagraph (d) of this

rule:

A laboratory-confirmed Ct infection without evidence of co-infection with gonorrhea or other complications suggestive of a relationship to Ct infection; and 2. Provision of treatment of the patient for Ct; and 3. An attempt to persuade the infected patient to have all partners evaluated and treated and the patient indicated that partners would not comply; and 4. Provision of a copy of reproducible, department-provided Ct educational fact sheet or substantially similar Ct-related literature available from other professional sources to the patient with copies for all partners; and 5. Counseling the patient on sexual abstinence until seven (7) days after treatment and until seven (7) days after partners have been treated; and (d) Partner Treatment - Upon documentation in the patient’s medical records of all prerequisites in subparagraph (c) physicians or those who provide medical services under their responsibility and control may either:
Provide to the treated patient non-named signed prescriptions for, or dispense to the patient, the appropriate quantity and strength of azithromycin sufficient to provide curative treatment for the total number of unnamed “partners” as defined in subparagraph (b) and indicated by the patient.
Provide to the treated patient signed, name-specific prescriptions for, or dispense to the patient, the appropriate quantity and strength of azithromycin sufficient to provide curative treatment for the total number of known partners as defined in subparagraph (b) and named by the patient.

(10) Use of Laser Equipment - Any procedure encompassed within the definition of the practice of medicine contained in T.C.A. § 63-6-204 that is to be performed by use of a laser shall be considered, except as provided in T.C.A. §§ 63-26-102(5) and 63-9-106, to be the practice of medicine and any person performing such procedure must be under the supervision of a licensed physician.

(11) Use of Titles - Any person who possesses a valid, current and active license issued by the Board that has not been suspended or revoked has the right to use the title “Medical Doctor” or “M.D.” and to practice medicine, as defined in T.C.A. § 63-6-204. Any person licensed by the Board to whom this rule applies must use one of the titles authorized by this rule in every “advertisement” [as that term is defined in Rule 0880-02-.13(2)(a)] he or she publishes or the failure to do so will constitute an omission of a material fact which makes the advertisement misleading and deceptive and subjects the physician to disciplinary action pursuant to T.C.A. § 63-6-214(b)(1), (b)(3), (b)(8) and (b)(9).

(12) Any physician who, pursuant to T.C.A. § 63-6-204(b), is required to have control over and responsibility for medical services being provided by any allied health professional regardless of where those services are being provided must have an unencumbered license just as is currently required for physicians who supervise physician assistants pursuant to Rule 0880- 02-.18(1) and certified nurse practitioner prescription writers pursuant to Rule 0880-06-.02(1).

(13) Medical certification on death certificates - Any physician who is required to and refuses to or consistently fails to comply with the provisions of T.C.A. § 68-3-502 regarding medical certification on death certificates shall be subject to disciplinary action pursuant to T.C.A. § 63-6-214(b)(1).

(14) Practice of Interventional Pain Management as Defined and Restricted Pursuant to T.C.A. § 63-6-244.

(a) For purposes of T.C.A. § 63-6-244(a)(2), a recent graduate who is not yet eligible to sit for board-certification by one of the boards listed in § 63-6-244(a)(1) may engage in interventional pain management provided the recent graduate is in a practice relationship with a supervising physician who does meet the qualifications of § 63-6- 244(a)(1), as long as such practice relationship meets the following standards:

The recent graduate must be an employee, associate or partner of the supervising physician;
During the first six months of the practice relationship, the supervising physician must directly supervise the non-eligible, recent graduate in the performance of at least twenty-four (24) interventional pain management procedures; and 3. The supervising physician shall make a personal review of no less than 10% of the recent graduate’s procedure notes/charts on a quarterly basis and shall so certify by signature on the chart.

(b) The exemption provided under T.C.A. § 63-6-244(a)(2) and this rule for a recent graduate not yet eligible for board certification expires five years from the date of completion of the recent graduate’s post-graduate medical training, at which time the non-eligible recent graduate must cease and desist such practice if board-certification pursuant to T.C.A. § 63-6-244(a)(1) has not been achieved and such practice may not be re-instituted until such board-certification is achieved.

(c) For purposes of T.C.A. § 63-6-244(a)(3), a physician who is board-certified in a different ABMS or ABPS/AAPS specialty than those listed in (a)(1) may practice interventional pain management upon successful completion of an ACGME pain fellowship or becoming board-certified through the American Board of Interventional Pain Physicians.

(15) For purposes of T.C.A. § 53-11-311 regarding use of buprenorphine products and in order to qualify as an “addiction specialist”, a physician must meet one of the following definitions:

(a) A physician licensed by the Tennessee Board of Medical Examiners or the Tennessee Board of Osteopathic Examination who is certified by the American Board of Addiction Medicine (ABAM), or is certified in addiction medicine by the American Osteopathic Association or is subspecialty certified by the American Board of Psychiatry and Neurology (ABPN) in addiction psychiatry or has completed the residency and fellowship requirements for same and is in the board certification process; or (b) A physician licensed by the Tennessee Board of Medical Examiners or the Tennessee Board of Osteopathic Examination who has a primary ABMS (American Board of Medical Specialties) or AOA (American Osteopathic Association) board certification and at least three (3) years of full-time equivalent experience treating patients with a primary substance abuse disorder while the physician is employed by or practicing in a facility that is licensed by the Tennessee Department of Mental Health and Substance Abuse Services or in a facility of equivalent licensure in another state. At least six (6) months full-time equivalent of that experience must be gained while caring for patients who are receiving care in licensed Alcohol and Drug Residential Detoxification Treatment facilities, as defined in 0940-05-44-.01 or Alcohol and Drug Residential Rehabilitation Treatment facilities, as defined in 0940-05-45-.01, or their equivalent in other states.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 53-11-311, 63-1-145, 63-6-101, 63-6-204, 63-6-214, 63-6-244, and 68-3-502.
Administrative History: Original rule filed February 26, 1991; effective April 12, 1991. Amendment filed September 17, 1991; effective November 1, 1991. Amendment filed November 27, 1991; effective February 26, 1992. Amendment filed April 20, 1994; effective July 4, 1994. Amendment filed May 18, 1994; effective August 1, 1994. Amendment filed May 19, 1994; effective August 2, 1994. Emergency rule filed and effective March 27, 1997, expired September 6, 1997. Amendment filed September 24, 1997; effective December 8, 1997. Amendment filed April 16, 1999; effective June 30, 1999. Amendment filed March 9, 2001; effective May 23, 2001. Amendment filed September 5, 2002; effective November 19, 2002. Amendment filed September 26, 2002; effective December 10, 2002. Notice of withdrawal of Rule 0880-02-.14(10)(c) to be effective on December 18, 2002 was filed and effective November 6, 2002. Amendment filed October 4, 2002; effective December 18, 2002. Amendment filed April 21, 2003; effective July 5, 2003. Amendment filed August 23, 2005; effective November 6, 2005. Amendment filed March 22, 2006; effective June 5, 2006. Amendment filed April 17, 2006; effective July 1, 2006. Amendment filed December 29, 2006; effective March 14, 2007. Amendment filed February 13, 2008; effective April 28, 2008. Amendment filed April 4, 2014; effective July 3, 2014. Amendments filed January 31, 2017; effective May 1, 2017.

Tenn. Comp. R. & Regs. 0880-02-.15 MEDICAL RECORDS

(1) Purposes - The purposes of these rules are:

(a) To recognize that medical records are an integral part of the practice of medicine as defined in T.C.A. § 63-6-204.

(b) To give physicians, their professional and non-professional staff, and the public direction about the content, transfer, retention, and destruction of those records.

(c) To recognize that a distinction exists between a physician’s medical records for a patient receiving services in the physician’s office and those records created by the physician for that patient for purposes of services provided in a hospital as defined by T.C.A. § 68-11-302(4) and that the distinction exists regardless of the fact that the physician may also be an employee of the hospital or of a medical group employed or owned by the hospital.

(2) Conflicts - As to medical records, these rules should be read in conjunction with the provisions of T.C.A. §§ 63-2-101 and 102, and are not intended to conflict with those statutes in any way. Those statutes, along with these rules, govern the subjects that they cover in the absence of other controlling state or federal statutes or rules to the contrary.

(3) Applicability - These rules regarding medical records shall apply only to those records, the information for which was obtained by physicians or their professionally licensed employees, or those over whom they exercise supervision, for purposes of services provided in any clinical setting other than those provided in a hospital as defined by T.C.A. § 68-11-302(4), a hospital emergency room or hospital outpatient facility.

(4) Medical Records - (a) Duty to Create and Maintain Medical Records - As a component of the standard of care and of minimal competency a physician must cause to be created and cause to be maintained a medical record for every patient for whom he or she, and/or any of his or her professionally licensed supervisees, performs services or provides professional consultation.

(b) Notice - Anywhere in these rules where notice is required to be given to patients of any physician that notice shall be required to be issued within thirty (30) days of the date of the event that triggers the notice requirement, and may be accomplished by public notice.

(c) Distinguished from Hospital Medical Records - The medical records covered by these rules are separate and distinct from those records generated for the patient by the physician during the course of providing medical services for the patient in a hospital as defined by T.C.A. § 68-11-302(4) regardless of the fact that the physician may also be an employee of the hospital or of a medical group employed or owned by the hospital.

The provisions of T.C.A. Title 68, Part 11, Chapter 3 govern medical records generated in a hospital as defined by T.C.A. § 68-11-302(4).
The medical records covered by these rules are those:

(i) That are created prior to the time of the patient’s admission to or confinement and/or receipt of services in a hospital as defined by T.C.A. § 68-11-302(4), hospital emergency room and/or hospital outpatient facility, and/or (ii) That are created after the patient’s discharge from a hospital as defined by T.C.A. § 68-11-302(4), hospital emergency room or hospital outpatient facility.

(iii) That are created during the practice of medicine as defined by T.C.A. § 63- 6-204 outside of a hospital as defined by T.C.A. § 68-11-302(4), hospital emergency room or hospital outpatient facility.

Even though the records covered by these rules may, of necessity, reference provision of services in the hospital setting and the necessary initial work-up and/or follow-up to those services, that does not make them “hospital records” that are regulated by or obtainable pursuant to T.C.A. Title 68, Part 11, Chapter 3.

(d) Content - All medical records, or summaries thereof, produced in the course of the practice of medicine for all patients shall include all information and documentation listed in T.C.A. § 63-2-101(c)(4) and such additional information that is necessary to insure that a subsequent reviewing or treating physician can both ascertain the basis for the diagnosis, treatment plan and outcomes, and provide continuity of care for the patient.

(e) Transfer - 1. Records of Physicians upon Death or Retirement - When a physician retires or dies while in practice, patients seen by the physician in his/her office during the immediately preceding thirty-six (36) months shall be notified by the physician, or his/her authorized representative and urged to find a new physician and be informed that upon authorization, copies of the records will be sent to the new physician. This notification requirement shall not apply to a patient when there have been fewer than two (2) office patient encounters within the immediately preceding eighteen (18) months.

Records of Physicians upon Departure from a Group - The responsibility for notifying patients of a physician who leaves a group practice whether by death, retirement or departure shall be governed by the physician’s employment contract.

(i) Whomever is responsible for that notification must notify patients seen by the physician in his/her office during the immediately preceding thirty-six (36) months of his/her departure, except that this notification requirement shall not apply to a patient when there have been fewer than two (2) office patient encounters within the immediately preceding eighteen (18) months.

(ii) Except where otherwise governed by provisions of the physician’s contract, those patients shall also be notified of the physician’s new address and offered the opportunity to have copies of their medical records forwarded to the departing physician at his or her new practice. Provided however, a group shall not withhold the medical records of any patient who has authorized their transfer to the departing physician or any other physician.

(iii) The choice of physicians in every case should be left to the patient, and the patient should be informed that upon authorization his/her records will be sent to the physician of the patient’s choice.

Sale of a Medical Practice - A physician or the estate of a deceased physician may sell the elements that comprise his/her practice, one of which is its goodwill, i.e., the opportunity to take over the patients of the seller by purchasing the physician’s medical records. Therefore, the transfer of records of patients is subject to the following:

(i) The physician (or the estate) must ensure that all medical records are transferred to another physician or entity that is held to the same standards of confidentiality as provided in these rules.

(ii) Patients seen by the physician in his/her office during the immediately preceding thirty-six (36) months shall be notified that the physician (or the estate) is transferring the practice to another physician or entity who will retain custody of their records and that at their written request the copies of their records will be sent to another physician or entity of their choice. This notification requirement shall not apply to a patient when there have been fewer than two (2) office patient encounters within the immediately preceding eighteen (18) months.

Abandonment of Records - For purposes of this section of the rules death of a physician shall not be considered as abandonment.

(i) It shall be a prima facie violation of T.C.A. § 63-6-214(b)(1) for a physician to abandon his practice without making provision for the security, or transfer, or otherwise establish a secure method of patient access to their records.

(ii) Upon notification that a physician in a practice has abandoned his practice and not made provision for the security, or transfer, or otherwise established a secure method of patient access to their records patients should take all reasonable steps to obtain their medical records by whatever lawful means available and should immediately seek the services of another physician.

(f) Retention of Medical Records-Medical records shall be retained for a period of not less than ten (10) years from the physician’s or his supervisees’ last professional contact with the patient except for the following:

Immunization records shall be retained indefinitely.
Medical records for incompetent patients shall be retained indefinitely.
X-rays, radiographs and other imaging products shall be retained for at least four (4) years after which if there exist separate interpretive records thereof they may be destroyed. However, mammography imaging and reports shall be maintained for ten (10) years.
Medical records of minors shall be retained for a period of not less than one (1) year after the minor reaches the age of majority or ten (10) years from the date of the physician’s or his supervisees’ last professional contact with the patient, whichever is longer.
Notwithstanding the foregoing, no medical record involving services which are currently under dispute shall be destroyed until the dispute is resolved.

(g) Destruction of Medical Records - 1. No medical record shall be singled out for destruction other than in accordance with established office operating procedures.

Records shall be destroyed only in the ordinary course of business according to established office operating procedures that are consistent with these rules.
Records may be destroyed by burning, shredding, or other effective methods in keeping with the confidential nature of the records.
When records are destroyed, the time, date and circumstances of the destruction shall be recorded and maintained for future reference. The record of destruction need not list the individual patient medical records that were destroyed but shall be sufficient to identify which group of destroyed records contained a particular patient’s medical records.

(5) Violations - Violation of any provision of these rules is grounds for disciplinary action pursuant to T.C.A. § 63-6-214(b)(1), and/or (2).

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-2-101, 63-2-102, 63-6-101, 63-6-204, and 63-6-214.
Administrative History: Original rule filed April 29, 2003; effective July 13, 2003. Amendment filed October 12, 2004; effective December 26, 2004. Amendments filed April 10, 2014; effective July 9, 2014.

Tenn. Comp. R. & Regs. 0880-02-.16 TELEMEDICINE LICENSURE AND THE PRACTICE OF TELEMEDICINE

No person shall engage in the practice of medicine, either in person or remotely using information transmitted electronically or through other means, on a patient within the state of Tennessee unless duly licensed by the Board in accordance with the provisions of the current statutes and rules. Unless specifically set out in this rule, this rule is not intended to and does not supersede any pre-existing federal or state statutes or rules and is not meant to alter or amend the applicable standard of care in any particular field of medicine or to amend any requirement for the establishment of a physician-patient relationship.

(1) Definitions - (a) Facilitator - The facilitator is an individual often affiliated with a local system of care or a parent or legal guardian of the patient. The facilitator must be physically present with the patient and is responsible for verifying the identity and location of the patient and for the origination, collection and transmission of data in the form of images or clinical data to the physician performing the evaluation remotely.

(b) Medical interpretation - The performance of a medical interpretation by a physician is the rendering of a diagnosis regarding a particular patient by examination of radiologic imaging studies, tissue specimens, bodily fluid specimens (including, but not limited to urine, blood and cerebrospinal fluid) or medical records requested by another physician or licensed health care provider.

(c) Patient encounter - The rendering of a documented medical opinion concerning evaluation, diagnosis, and/or treatment of a patient whether the physician is physically present in the same room, in a remote location within the state or across state lines.

(d) Physician-patient relationship - A physician-patient relationship exists when a physician serves a patient’s medical needs whether or not there has been an encounter in person between the physician and patient.

(e) Research hospital - A hospital at which fifty percent (50%) or more of the inpatients treated during the previous calendar year were treated pursuant to research protocols.

(f) Store-and-forward technology - The use of asynchronous electronic communications between a patient and healthcare services provider at a distant site for the purpose of diagnostic and therapeutic assistance in the care of patients and includes the transferring of medical data from one site to another through the use of a device that records or stores images that are sent or forwarded via electronic communication to another site for consultation.

(g) Telemedicine - Telemedicine is the practice of medicine using electronic communication, information technology or other means, between a licensee in one location and a patient in another location. Telemedicine is not an audio only telephone conversation, email/instant messaging conversation or fax. It typically involves the application of secure video conferencing or store-and-forward to provide or support healthcare delivery by replicating the interaction of a traditional encounter between a provider and a patient.

(2) Telemedicine Licenses Issued Under Previous Rule - As of the effective date of this rule, the Board will no longer issue what was previously termed a “telemedicine license.” Individuals previously granted a telemedicine license under the former version of this rule may apply to have the license converted to a full license. Such individuals must complete the application for a full license and provide all necessary documentation, though no new application fee will be required as long as application is made within two years of the effective date of this rule.

Individuals who do not convert to a full license (or do not qualify for full licensure) will retain the telemedicine license subject to the following conditions:

(a) The license must be timely renewed on a biennial basis, as required pursuant to Rule

Tenn. Comp. R. & Regs. 0880-02-.17 CONSUMER RIGHT-TO-KNOW REQUIREMENTS

(1) Malpractice Reporting Threshold - The threshold amount below which medical malpractice judgments, awards or settlements in which payments are awarded to complaining parties need not be reported pursuant to the “Health Care Consumer Right-To-Know-Act of 1998” shall be seventy-five thousand dollars ($75,000).

(2) Criminal Conviction Reporting Requirements - For purposes of the “Health Care Consumer Right-To-Know-Act of 1998” the following criminal convictions must be reported:

(a) Conviction of any felony; and (b) Conviction or adjudication of guilt of any misdemeanor, regardless of its classification, in which any element of the misdemeanor involves any one or more of the following:

Sex.
Alcohol or drugs.
Physical injury or threat of injury to any person.
Abuse or neglect of any minor, spouse or the elderly.
Fraud or theft.

(c) If any misdemeanor conviction reported under this rule is ordered expunged, a copy of the order of expungement signed by the judge must be submitted to the Department before the conviction will be expunged from any profile.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-6-101, and 63-51-101, et seq.
Administrative History: New rule filed October 30, 1998; effective January 13, 1999.

Tenn. Comp. R. & Regs. 0880-02-.18 SUPERVISION OF PHYSICIAN ASSISTANTS

The following requirements apply to a supervising physician who supervises one or more physician assistants:

(1) A supervising physician or a substitute supervising physician must possess a current, unencumbered license to practice in the state of Tennessee.

(2) Supervision does not require the continuous and constant presence of the supervising physician; however, the supervising physician must be available for consultation at all times or shall make arrangements for a substitute physician to be available.

(3) A supervising physician and/or substitute supervising physician shall have experience and/or expertise in the same area of medicine as the physician assistant.

(4) Physician assistants who hold temporary licenses pursuant to T.C.A. § 63-19-105(a)(2)

(those waiting to take the licensure examination) may not provide services unless a supervising physician is on site while the services are being provided.

(5) Protocols are required and:

(a) Shall be jointly developed and approved by the supervising physician and physician assistant;

(b) Shall outline and cover the applicable standard of care;

(d) Shall be maintained at the practice site;

(e) Shall account for all protocol drugs by appropriate formulary;

(f) Shall be specific to the population seen;

(g) Shall be dated and signed; and (h) Shall be made available upon request for inspection by the board or committee.

(6) The supervising physician shall be responsible for ensuring compliance with the applicable standard of care under (5). Additionally, the supervising physician shall develop protocols in collaboration with the physician assistant to include a method for documenting consultation and referral.

(7) Within ten (10) business days after the physician assistant has examined a patient who falls in one of the following categories, the supervising physician shall make a personal review of the historical, physical, and therapeutic data gathered by the physician assistant on that patient and shall so certify in the patient’s chart within thirty (30) days:

(a) When medically indicated;

(b) When requested by the patient;

(d) When prescriptions are written by a physician assistant who possesses a temporary license; and (e) When a controlled drug has been prescribed.

(8) In any event, a supervising physician shall personally review at least twenty percent (20%) of charts monitored or written by the physician assistant every thirty (30) days.

(9) The supervising physician shall be required to visit any remote site at least once every thirty (30) days.

(10) If more than one physician supervises a physician assistant in a practice setting (such as in a hospital emergency room), one protocol may be developed for that practice setting.

(11) If a physician assistant and the same supervising physician work in more than one practice setting, one protocol may be developed which covers all these practice settings.

(12) The number of physician assistants for whom a physician may serve as the supervising physician shall be determined by the physician at the practice level, consistent with good medical practice.

(13) The supervising physician may delegate to a physician assistant working under the physician’s supervision the authority to issue prescriptions or medication orders for legend drugs and controlled substances listed in Schedules II, III, IV, and V of Tennessee Code Annotated, Title 39, Chapter 17, Part 4 in accordance with written protocols which are mutually developed and agreed upon by the physician assistant and the supervising physician.

(14) A licensed physician who supervises the services of a physician assistant in a manner that is inconsistent with the Tennessee Medical Practice Act or these rules shall be subject to disciplinary action.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-6-101, 63-19-104, 63-19-106, 63-19-107, and Chapter 33, Public Acts of 1999.
Administrative History: Original rule filed April 10, 2000; effective June 24, 2000. Amendment filed March 9, 2001; effective May 23, 2001.

Tenn. Comp. R. & Regs. 0880-02-.19 . These licenses are also subject to disciplinary action for the same causes and pursuant to the same procedures as active licenses.

(d) Inactive pro bono licenses are distinguished from the inactive licenses referred to in

Rule 0880-02-.10 only by the fact that licenses issued pursuant to this rule allow the practice of medicine in Tennessee with the restrictions placed on it by this rule.

(4) Practice Pursuant to the “Volunteer Health Care Services Act” T.C.A. §§ 63-6-701, et seq.

(a) Any physician licensed in this or any other state, territory, district or possession of the United States whose license is not under a disciplinary order of suspension or revocation may practice medicine in this state but only under the auspices of an organization that has complied with the provisions of this rule and T.C.A. §§ 63-6-701 through 707 and Rule 1200-10-01-.12 of the Division of Health Related Boards.

(b) Any person who may lawfully practice medicine in this or any other state, territory, district or possession of the United States under an exemption from licensure and who is not under a disciplinary order of suspension or revocation and who is not and will not “regularly practice,” as defined by T.C.A. § 63-6-703(3) may practice medicine in this state but only under the auspices of an organization that has complied with the provisions of this rule and T.C.A. §§ 63-6-701 through 707 and Rule 1200-10-01-.12 of the Division of Health Related Boards.

(c) A physician or anyone who practices under an exemption from medical licensure pursuant to this rule may not charge any fee or receive compensation or remuneration of any kind from any person or third party payor including insurance companies, health plans and state or federal benefit programs for the provision of medical or any other services; and may not practice for any organization that imposes any charge on any individual to whom health care services are rendered or submits charges to any third party payor including insurance companies, health plans and state or federal benefit programs for the provision of any services.

(d) Any organization that organizes or arranges for the voluntary provision of health care services on residents of Tennessee may utilize persons described in subparagraphs (a) and (b) to practice medicine only when it has complied with the provisions of T.C.A. §§ 63-6-701 through 707 and Rule 1200-10-01-.12 of the Division of Health Related Boards.

(5) Submission of any document or set of documents required by this rule or submission of verification of the authenticity, validity and accuracy of the content of any document or set of documents required by this rule directly from the FCVS to the Board Administrative Office shall be deemed to be submission of originals of those documents or sets of documents by the issuing institution(s).

(6) Application review and licensure decisions for these types of medical licensure or organization registration shall be governed by Rule 0880-02-.07.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-1-201 through 63-1-203, 63-6-101, 63-6-230, 63-6-235, and 63-6-701 through 63-6-707.
Administrative History: Original rule filed August 23, 2005; effective November 6, 2005. Amendment filed April 17, 2006; effective July 1, 2006.

Tenn. Comp. R. & Regs. 0880-02-.20 MEDICAL PROFESSIONAL CORPORATIONS AND MEDICAL PROFESSIONAL

LIMITED LIABILITY COMPANIES.

(1) Medical Professional Corporations (MPC) - Except as provided in this rule Medical Professional Corporations shall be governed by the provisions of Tennessee Code Annotated, Title 48, Chapter 101, Part 6.

(a) Filings - A MPC need not file its Charter or its Annual Statement of Qualifications with the Board.

(b) Ownership of Stock - With the exception of the health care professional combinations specifically enumerated in Tennessee Code Annotated, § 48-101-610 only the following may form and own shares of stock in a foreign or domestic MPC doing business in Tennessee:

Physicians licensed pursuant to Tennessee Code Annotated Title 63, Chapter 6 and/or Chapter 9 or licensed in another state; and/or 2. A foreign or domestic general partnership, MPC or MPLLC in which all partners, shareholders, members or holders of financial rights are either:

(i) Physicians licensed pursuant to Tennessee Code Annotated Title 63,

Chapter 6 and/or Chapter 9 to practice medicine in Tennessee or physicians licensed by other states, or composed of entities which are directly or indirectly owned by such licensed physicians; and/or (ii) Professionals authorized by Tennessee Code Annotated §§ 48-101-610 or 48-248-401 or Part 1109 of Section 1 of Public Chapter 286 of the Public Acts of 2005 to either own shares of stock in an MPC or be a member or holder of financial rights in an MPLLC; and/or (iii) A combination of professionals authorized by subparts (i) and (ii).

(c) Officers and Directors of Medical Professional Corporations - 1. All, except the following officers, must be persons who are eligible to form or own shares of stock in a medical professional corporation as limited by T.C.A. § 48- 101-610(d) and subparagraph (1)(b) of this rule:

(i) Secretary;

(ii) Assistant Secretary;

(iii) Treasurer; and (iv) Assistant Treasurer.

With respect to members of the Board of Directors, only persons who are eligible to form or own shares of stock in a medical professional corporation as limited by T.C.A. § 48-101-610(d) and subparagraph (1)(b) of this rule shall be directors of a MPC.

(d) Practice Limitations - 1. Physician incorporators, shareholders, officers, or directors of a MPC, acting individually or on behalf of, or collectively as the MPC, shall exercise only such

authority as an “employing entity” may exercise pursuant to Tennessee Code Annotated, § 63-6-204(f)(1)(A), (B) and (C) regarding diagnosis, treatment and/or referral decisions made by any physician employed by or contracting with or otherwise providing medical services within the scope of their practice within the MPC.

A physician shall not enter into an employment, compensation, or other contractual arrangement with a MPC that may violate the code of ethics or which gives the MPC more authority over the physician’s diagnosis, treatment and/or referral decisions than an “employing entity” may exercise pursuant to Tennessee Code Annotated, § 63-6-204(f)(1)(A), (B) and (C) regarding those decisions.
Engaging in, or allowing another physician incorporator, shareholder, officer, or director, while acting on behalf of the MPC, to engage in, medical practice in any area of practice or specialty beyond that which is specifically set forth in the charter may be a violation of the code of ethics and/or either Tennessee Code Annotated, §§ 63-6-214(b)(1) or 63-9-111 (b)(1).
Nothing in these rules shall be construed as prohibiting any health care professional licensed pursuant to Tennessee Code Annotated, Title 63 from being an employee of or a contractor to a MPC.
Nothing in these rules shall be construed as prohibiting a MPC from electing to incorporate for the purposes of rendering professional services within two (2) or more professions or for any lawful business authorized by the Tennessee Business Corporations Act so long as those purposes do not interfere with the exercise of independent medical judgment by the physician incorporators, directors, officers, shareholders, employees or contractors of the MPC who are practicing medicine as defined by Tennessee Code Annotated, §§ 63-6-204 and 63-9-106.
Nothing in these rules shall be construed as prohibiting a physician from owning shares of stock in any type of professional corporation other than a MPC so long as such ownership interests do not interfere with the exercise of independent medical judgment by the physician while practicing medicine as defined by Tennessee Code Annotated, §§ 63-6-204 and 63-9-106.

(2) Medical Professional Limited Liability Companies (MPLLC) - Except as provided in this rule Medical Professional Limited Liability Companies shall be governed by either the provisions of Tennessee Code Annotated, Title 48, Chapter 248 or Public Chapter 286 of the Public Acts of 2005.

(a) Filings - Articles filed with the Secretary of State shall be deemed to be filed with the Board and no Annual Statement of Qualifications need be filed with the Board.

(b) Membership - With the exception of the health care professional combinations specifically enumerated in Tennessee Code Annotated, § 48-248-401 or Part 1109 of

Section 1 of Public Chapter 286 of the Public Acts of 2005 only the following may be members or holders of financial rights of a foreign or domestic MPLLC doing business in Tennessee:

Physicians licensed pursuant to Tennessee Code Annotated Title 63, Chapter 6 and/or Chapter 9 or licensed in other states; and/or 2. A foreign or domestic general partnership, MPC or MPLLC in which all partners, shareholders, members or holders of financial rights are either:

(i) Physicians licensed pursuant to Tennessee Code Annotated Title 63,

Chapter 6 and/or Chapter 9 to practice medicine in Tennessee or physicians licensed by other states or composed of entities which are directly or indirectly owned by such licensed physicians; and/or (ii) Professionals authorized by Tennessee Code Annotated §§ 48-101-610 or 48-248-401 or Part 1109 of Section 1 of Public Chapter 286 of the Public Acts of 2005 to either own shares of stock in an MPC or be a member or holder of financial rights in an MPLLC; and/or (iii) A combination of professionals authorized by subparts (i) and (ii).

(c) Managers, Directors or Governors of a MPLLC 1. All, except the following managers, must be persons who are eligible to form or become members or holders of financial rights of a medical professional limited liability company as limited by T.C.A. § 48-248-401 and subparagraph (2)(b) of this rule:

(i) Secretary (ii) Treasurer 2. Only persons who are eligible to form or become members or holders of financial rights of a medical professional limited liability company as limited by T.C.A. § 48-248-401 and subparagraph (2)(b) of this rule shall be allowed to serve as a director, or serve on the Board of Governors of a MPLLC.

(d) Practice Limitations 1. Physician members or holders of financial rights, managers, directors, or governors of a MPLLC, acting individually or on behalf of, or collectively as the MPLLC, shall exercise only such authority as an “employing entity” may exercise pursuant to T.C.A. § 63-6-204(f)(1)(A), (B) and (C) regarding diagnosis, treatment and/or referral decisions made by any physician employed by or contracting with or otherwise providing medical services within the scope of their practice within the MPLLC.

A physician shall not enter into an employment, compensation, or other contractual arrangement with a MPLLC that may violate the code of ethics or which gives the MPLLC more authority over the physician’s diagnosis, treatment and/or referral decisions than an “employing entity” may exercise pursuant to T.C.A. § 63-6-204(f)(1)(A), (B) and (C) regarding those decisions.
Engaging in, or allowing another physician member, officer, manager, director, or governor, while acting on behalf of the MPLLC, to engage in, medical practice in any area of practice or specialty beyond that which is specifically set forth in the articles of organization may be a violation of the code of ethics and/or either Tennessee Code Annotated, §§ 63-6-214(b)(1) or 63-9-111(b)(1).
Nothing in these rules shall be construed as prohibiting any health care professional licensed pursuant to Tennessee Code Annotated, Title 63 from being an employee of or a contractor to a MPLLC.
Nothing in these rules shall be construed as prohibiting a MPLLC from electing to form for the purposes of rendering professional services within two (2) or more professions or for any lawful business authorized by the Tennessee Limited Liability Company Act or the Tennessee Revised Limited Liability Company Act so long as those purposes do not interfere with the exercise of independent medical judgment by the physician members or holders of financial rights, governors, officers, managers, employees or contractors of the MPLLC who are practicing medicine as defined by Tennessee Code Annotated, §§ 63-6-204 and 63-9-106.
Nothing in these rules shall be construed as prohibiting a physician from being a member of any type of professional limited liability company other than a MPLLC so long as such membership interests do not interfere with the exercise of independent medical judgment by the physician while practicing medicine as defined by Tennessee Code Annotated, §§ 63-6-204 and 63-9-106.
All MPLLCs formed in Tennessee pursuant to Tennessee Code Annotated, § 48- 248-104 or Public Chapter 286 of the Public Acts of 2005, to provide services only in states other than Tennessee shall annually file with the Board a notarized statement that they are not providing services in Tennessee.

(3) Dissolution - The procedure that the Board shall follow to notify the attorney general that a MPC or a MPLLC has violated or is violating any provision of Title 48, Chapters 101 and/or 248 or Public Chapter 286 of the Public Acts of 2005, shall be as follows but shall not terminate or interfere with the secretary of state’s authority regarding dissolution pursuant to Tennessee Code Annotated, §§ 48-101-624 or 48-248-409.

(a) Service of a written notice of violation by the Board on the registered agent of the MPC and/or MPLLC or the secretary of state if a violation of the provisions of Tennessee Code Annotated, Title 48, Chapters 101 and/or 248 or Public Chapter 286 of the Public Acts of 2005 occurs.

(b) The notice of violation shall state with reasonable specificity the nature of the alleged violation(s).

(c) The notice of violation shall state that the MPC and/or MPLLC must, within sixty (60) days after service of the notice of violation, correct each alleged violation or show to the Board’s satisfaction that the alleged violation(s) did not occur.

(d) The notice of violation shall state that, if the Board finds that the MPC and/or MPLLC is in violation, the attorney general will be notified and judicial dissolution proceedings may be instituted pursuant to Tennessee Code Annotated, Title 48.

(e) The notice of violation shall state that proceedings pursuant to this section shall not be conducted in accordance with the contested case provisions of the Uniform Administrative Procedures Act, compiled in Title 4, Chapter 5 but that the MPC and/or MPLLC, through its agent(s), shall appear before the Board at the time, date, and place as set by the Board and show cause why the Board should not notify the attorney general and reporter that the organization is in violation of the Act or these rules. The Board shall enter an order that states with reasonable particularity the facts describing each violation and the statutory or rule reference of each violation. These proceedings shall constitute the conduct of administrative rather than disciplinary business.

(f) If, after the proceeding the Board finds that a MPC and/or MPLLC did violate any provision of Title 48, Chapters 101 and/or 248 or these rules, and failed to correct said violation or demonstrate to the Board’s satisfaction that the violation did not occur, the Board shall certify to the attorney general and reporter that it has met all requirements of either Tennessee Code Annotated, §§ 48-101-624(1)-(3) and/or 48-248-409(1)-(3) and/or Public Chapter 286 of the Public Acts of 2005.

(4) Violation of this rule by any physician individually or collectively while acting as a MPC or as a MPLLC may subject the physician(s) to disciplinary action pursuant to Tennessee Code Annotated, § 63-6-214(b)(1), or § 63-9-111(b)(1).

(5) The authority to own shares of stock or be members or holders of financial rights in an MPC or an MPLLC granted by statute or these rules to professionals not licensed in this state shall in no way be construed as authorizing the practice of any profession in this state by such unlicensed professionals.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 48-101-605, 48-101-608, 48-101-610, 48-101-618, 48-101-624, 48-101-628, 48-101-629, 48-101-630, 48-248-104, 48-248-202, 48-248-401, 48-248-404, 48-248-409, 48-248-501, 48-248-601, 48-248-602, 48-248-603, 63-6-101, 63-6-201, 63-6-204, 63-6-214, and Chapter 286, Public Acts of 2005.
Administrative History: Original rule filed June 3, 2003; effective August 17, 2003. Amendment filed June 10, 2004; effective August 24, 2004. Amendment filed March 22, 2006; effective June 5, 2006. Amendment filed March 22, 2007; effective June 5, 2007.

Tenn. Comp. R. & Regs. 0880-02-.21 OFFICE BASED SURGERY

A license to practice medicine issued pursuant to T.C.A. § 63-6-204 authorizes the holder to perform surgery. To the extent that any licensee performs surgery in his or her office rather than a hospital, abortion clinic, or ASTC, that licensee, or the governing body of the entity lawfully authorized to practice medicine wherein the surgery is to be performed, shall comply with these rules.

(1) General Statement and Precaution - The Board will always judge the decision to perform surgery in the office setting based upon what was in the patient’s best interest and through strict application of these rules.

(2) Intent and Application (a) Intent - It is not the intent of these rules to circumvent the law and rules and regulations governing ambulatory surgical treatment centers. The intent of these rules is to provide physicians, who perform Level I, II, IIA, and III surgeries as part of a medical practice whose focus is on provision of medical services and procedures that are not related to surgery (and procedures and services incidental thereto), an option to provide on-site surgical and surgical related services that are within the scope of the physician’s specialty and training and in the best interest of the patient.

(b) Application - These rules do not apply to physicians or the governing body of entities lawfully authorized to practice medicine whose practice location(s) has as its primary

purpose the provision of Level I, II, IIA and III surgical or surgical preparatory services and/or procedures. Those types of practice locations must comply with all laws, rules and regulations applicable to ambulatory surgical treatment centers including Rules 0720-10, 11 and 12.

(3) Definitions (a) Acceptable Plan of Correction - The Department approves an Office Based Surgery Suite’s plan to correct deficiencies identified during an on-site survey conducted by the Division. The plan of correction shall be a written documents and shall provide, but not be limited to, the following information:

How the deficiency will be corrected;
The date upon which each deficiency will be corrected;
What measures or systemic changes will be put in place to ensure that the deficient practice does not recur; and 4. How the corrective action will be monitored to ensure that the deficient practice does not recur.

(b) ACLS (Advanced Cardiac Life Support) - A certification that means a person has successfully completed an advanced cardiac life support course offered by a recognized accrediting organization in accordance with American Heart Association (AHA) guidelines.

(d) ASTC - An ambulatory surgical treatment center licensed by the Department of Health Division of Health Care Facilities.

(e) Block - 1. Digital Block - The injection of a local anesthetic to stop or prevent painful sensation in a digit (i.e., finger or toe).

Minor Regional Block or Minor Regional Anesthesia - The administration of local anesthetics to interrupt nerve impulses in an extremity, or other minor region of the body, including but not limited to upper and lower extremity plexus blocks.
Major Regional Block or Major Regional Anesthesia - The administration of local anesthetic agents to interrupt nerve impulses in a major region of the body, including but not limited to spinal blocks, epidural blocks, caudal blocks, and intravenous regional anesthetic.

(f) Board - The Tennessee Board of Medical Examiners.

(g) BCLS (Basic Cardiac Life Support) - A certification that means a person has successfully completed a basic cardiac life support course offered by a recognized accrediting organization in accordance with AHA guidelines.

(h) Conscious Sedation/Moderate Sedation/Sedation-Analgesia - A drug induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are usually required to maintain a patient airway, and spontaneous ventilation is usually adequate. Cardiovascular function is usually maintained.

(i) Deep Sedation - A drug induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired.

Patients often require assistance in maintaining a patient airway, and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained.

(j) General Anesthesia - A drug induced loss of consciousness during which patients are not arousable even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. Patients often require assistance in maintaining a patient airway, and positive-pressure ventilation may be required because of depressed spontaneous ventilation or drug induced depression of neuromuscular function. Cardiovascular function may be impaired.

(k) Hospital - A hospital licensed by the Department of Health Division of Health Care Facilities.

(l) Local Anesthetic - The administration of an agent which produces a transient and reversible loss of sensation in a circumscribed portion of the body.

(m) PALS (Pediatric Advanced Life Support) - A certification that means a person has successfully completed a pediatric advanced life support course offered by a recognized accrediting organization in accordance with AHA guidelines.

(n) Physician - A person licensed to practice medicine and surgery pursuant to Tennessee Code Annotated Title 63, Chapter 6.

(o) Surgery - The excision or resection, partial or complete, destruction, incision or other structural alteration of human tissue by any means (including through the use of lasers) performed upon the body of a living human for purposes of preserving health, diagnosing or curing disease, repairing injury, correcting deformity or defects, prolonging life, relieving suffering, or for aesthetic, reconstructive or cosmetic purposes, to include, but not limited to: incision or curettage of tissue or an organ; suture or other repair of tissue or organ, including a closed or an open reduction of a fracture; extraction of tissue, including premature extraction of products of conception from the uterus; and insertion of natural or artificial implants. For the purpose of this rule, certain diagnostic and therapeutic procedures requiring medication to immobilize the patient are contained within the definition of surgery.

(4) Surgery on Infants and Children (a) Infants - Infants shall include only those persons in the neonatal age group. For such infants, only those procedures that can be reasonably performed under local anesthetic, such as neonatal circumcisions, may be performed in a physician’s office.

(b) Children - 1. Level I surgeries may be performed in a physician’s office on a patient under the age of fourteen (14).

No Level II, Level IIA or Level III surgeries or any surgery requiring any level of sedation may be performed on patients under the age of (2) years in a physician’s office.
Most Level II and IIA surgeries are not allowed to be performed in a physician’s office on any patient under the age of fourteen (14) years. Provided however, it is recognized that in the pediatric population, certain types of surgeries may be performed under mild sedation in a physician’s office. Those Level II and IIA surgeries are limited to the following conditions and circumstances all of which must be met before the surgery is allowed:

(i) The child is at least two (2) years of age but younger than fourteen (14) years of age and is healthy according to ASA risk classification criteria; and (ii) The surgery is anticipated to be brief and superficial and is of such a nature that it is more safely performed while the patient is not agitated; and (iii) Sedative or anxiolytic medications are not to be administered at home as

part of a pre-procedural sedating plan; and (iv) Only minimal sedation is to be used which shall include only one (1) sedating drug that is administered only one (1) time, in a low dose in addition to a local anesthetic or appropriate block such that at all times the child is awake and interactive. An antagonist to the sedating drug used must be immediately available; and (v) A pediatric equipped emergency cart is available and a person who has a current certification in PALS is assigned with the task of staying in close proximity to the child at all times to observe the child throughout the preoperative and surgical procedures and until such time as the child is declared fit to be released from the office.

No Level III surgeries may be performed in a physician’s office on a patient under the age of fourteen (14).

(c) If the patient has not recovered sufficiently to be safely discharged within twelve (12) hours after the initial administration of anesthesia, the patient must be transferred to a hospital for continued postoperative care.

(5) Level I Office Based Surgery (a) Level of Anesthesia - Level I Office Surgery is the type of surgery in which preoperative medications are not required or used other than minimal pre-operative tranquilization/anxiolysis of the patient. There is no anesthesia or it is a local, topical, or appropriate block. No drug-induced alteration of consciousness other than minimal preoperative tranquilization of the patient is permitted and the chances of complication requiring hospitalization are remote.

(b) Level I Surgical Procedures - Procedures authorized to be performed under Level I anesthesia include, but are not limited to, the following:

Minor procedures including, but not limited to, the following:

(i) Excision of skin lesions, moles, warts, cysts, lipomas; and (ii) Repair of lacerations or surgery limited to the skin and subcutaneous tissue, 2. Liposuction involving the removal of less than 250 cc supernatant fat, 3. Incision and drainage of superficial abscesses, 4. Limited endoscopies such as proctoscopies, 5. Skin biopsies, arthrocentesis, thoracentesis, paracentesis, endometrial biopsy, 6. IUD’s, colposcopy, 7. Dilation of urethra, cysto-scopic procedures, and 8. Closed reduction of simple fractures or small joint dislocations (i.e., finger and toe joints).

Training required of personnel involved in Level I Surgical Procedures. The physician’s continuing medical education should include instruction in proper dosages of regional anesthetic drugs and management of toxicity or hypersensitivity to those drugs. It is required that either the physician or someone in the operating room at the time of the surgery has a current BCLS certification.
Equipment and Supplies Required - Basic medications and equipment to manage toxic or hypersensitivity reactions which shall be age and procedure appropriate.
Assistance of Other Personnel Required - No assistance from other personnel is required unless the specific surgical procedure being performed should reasonably involve an assistant.

(d) If the patient has not recovered sufficiently to be safely discharged within twelve (12) hours after the initial administration of anesthesia, the patient must be transferred to a hospital for continued postoperative care.

(6) Levels II and IIA Office Surgery (a) Level of Anesthesia - The following levels of anesthesia are authorized for use in performing Level II and IIA surgical procedures:

Pre-operative medication and sedation introduced intravenously, intramuscularly, inhalation, orally, or rectally, thus making intra and postoperative monitoring necessary; and/or 2. Local or peripheral major nerve block, including Bier Block; and/or 3. Intravenous, oral, rectal or intramuscular sedation that preserve vital reflexes.

However, the use of nitrous oxide in conjunction with other types of sedatives is not allowed for Level II or IIA surgical procedures.

Any level or type of anesthesia in which the patient is placed in a state that allows the patient to tolerate unpleasant procedures while maintaining adequate cardio respiratory function and the ability to respond purposefully to verbal command and/or light tactile stimulation. Patients whose only response is reflex withdrawal from a painful stimulus are sedated to a greater degree than is authorized for Level II and/or IIA surgeries.

(b) Level II Surgical Procedures - Procedures authorized to be performed under Level II anesthesia include, but are not limited to, the following:

Hemorrhoidectomy, 2. Hernia repair, 3. Reduction of closed, uncomplicated fractures, 4. Large joint dislocations, 5. Breast biopsies, 6. Colonoscopy and other endoscopic procedures, 7. Diagnostic radiologic procedures requiring sedation, 8. Liposuction involving the removal of up to 4000 cc supernatant fat, and 9. Diagnostic cardiac procedures which usually require sedation.

(c) Level IIA Surgical Procedures - are those Level II office surgical procedures with a maximum planned duration of thirty (30) minutes or less and in which chances of complications requiring hospitalization are remote. This category includes procedures requiring sedation for diagnostic purposes including, but not limited to, endoscopic procedures and radiologic procedures.

(d) Standards for Level II and IIA Office Based Surgery.

Transfers - The physician performing the surgery must have staff privileges at a licensed hospital within reasonable proximity or a written transfer protocol to a licensed hospital within reasonable proximity.
Training required of personnel involved in Level II and IIA Surgical Procedures.

(i) The physician must be able to document satisfactory completion of training such as Board certification or Board eligibility by a Board approved by the American Board of Medical Specialties or comparable background, training, or experience.

(ii) The physician or one (1) assistant must have current certification in ACLS or there must be a qualified anesthetic provider practicing within the scope of the provider’s license present to manage the anesthetic.

(iii) Individuals responsible for patients receiving sedation/analgesia should understand the pharmacology of the agents that are administered, as well as the role of pharmacologic antagonists for opioids and benzodiazepines.

(iv) Individuals monitoring patients receiving these agents shall be able to recognize the associated complications.

(v) At least one (1) individual with current ACLS certification who is capable of establishing a patient airway and positive pressure ventilation shall be continuously present whenever sedation/analgesia are administered.

There must also be a means immediately available for summoning additional assistance.

Equipment and Supplies - All of the following which shall be age and procedure appropriate are required:

(i) Suction devices, endotracheal tubes, laryngoscopes, etc.

(ii) Positive pressure ventilation device (e.g., Ambu) plus oxygen supply.

(iii) Double tourniquet for the Bier block procedure.

(iv) Monitors for blood pressure, EKG, Oxygen saturation, and temperature.

(v) Emergency intubation equipment.

(vi) Adequate operating room lighting.

(vii) Appropriate sterilization equipment.

(viii) IV solution and IV equipment.

(ix) Reversal or antagonist agents for medications used.

(x) A standard and emergency ACLS equipped cart and other such equipment as is necessary for the procedure being performed.

Assistance of Other Personnel Required.

(i) During the procedure (I) Level II Surgical Procedures - The physician must be assisted by a professional licensed pursuant to Tennessee Code Annotated Title 63, Chapters 6, 7, 9, or 19 and practicing within the lawful scope of their licensure functioning as an assisting anesthesia provider who cannot function in any other capacity during the procedure.

(II) Level IIA Surgical Procedures - A certified nurse practitioner, physician assistant, registered nurse, advanced practice nurse or licensed practical nurse must assist the physician. Additional assistance may be required by specific procedure or patient circumstances and if so, it must be provided by a person licensed pursuant to either Tennessee Code Annotated, Title 63, Chapters 6, 7, 9 or 19, or a nationally certified operating room technician.

(ii) Following the procedure (I) There must be a person with current ACLS certification present at all times with the patient while in the recovery area; and (II) An additional professional who has post-anesthesia care unit experience or its equivalent and a current ACLS certification and who is licensed pursuant to either Tennessee Code Annotated, Title 63 Chapter 6, 9 or 19 or a registered or advanced practice nurse licensed pursuant to Tennessee Code Annotated, Title 63 Chapter 7 must also be immediately available on the premises to assist in monitoring the patient in the recovery room until the patient has recovered from anesthesia.

Pre, Intra, Postoperative Services In General.

(i) An operative/procedure note shall be created for each surgery describing the procedure performed, the techniques used, participating personnel and their titles, postoperative diagnosis, type of anesthesia, and complications.

Where similar procedures are performed at an office routinely, partially preprinted forms may be utilized as a guide, provided that original data and conclusions applicable to the specific patient are contemporaneously entered to create a complete report.

(ii) A post-procedure note shall be created for each surgery and completed prior to discharge of a patient from the office, which shall include such post-procedure data as the patient’s general condition, vital signs, treatments ordered, and all drugs prescribed, administered or dispensed including dosages and quantities.

(iii) All patients, except those who receive minor regional blocks and/or local anesthetic only, shall receive appropriate postoperative management. A patient may be excused from a stay in the recovery area only by a specific order of the anesthesia personnel or the operating physician.

(iv) The patient shall be transported to the recovery area accompanied by a member of the anesthesia care team who is knowledgeable about the patient’s condition. The patient shall be continually evaluated and treated during transport appropriate to the patient’s condition.

(v) An oral report on the patient’s condition shall be given to the health care personnel responsible for the patient in the recovery area who were not present in the anesthetizing location.

(vi) The patient’s recovery area condition shall be evaluated and recorded in the medical record. The blood pressure, pulse rate, respiratory rate, blood oxygen saturation, level of consciousness, and when appropriate temperature shall be assessed at least every fifteen (15) minutes (five [5] minutes for pediatric patients) until they are stable and returned to preoperative baseline values and/or normal values consistent with the patient’s age and medical condition.

(vii) Objective criteria (for example a scoring system such as PARR or Aldrete Score) shall be established to determine when a patient is medically ready or “fit ” to be discharged.

(viii) Before discharge, the patient shall be given written and verbal instructions for follow-up care and advice concerning complications. Emergency phone number shall be provided to the patient.

(ix) If sedation or regional blocks have been used, a responsible adult must be available to accompany the patient and be instructed with regard to the patient care and follow-up.

(x) If a patient has not recovered sufficiently to be safely discharged within twelve (12) hours after the initial administration of anesthesia, the patient must be transferred to a hospital for continued postoperative care.

Sufficient space in the room in which the surgical procedure is being performed shall be available to accommodate all necessary equipment and personnel and to allow for expeditious access to the patient and all resuscitation and monitoring equipment.
Pharmaceutical Services - The office shall maintain and provide drugs and biologicals in a safe and effective manner in accordance with accepted standards of practice. Such drugs and biologicals must be stored in a separate room or cabinet which shall be kept locked at all times and a log of all such drugs and biologicals dispensed shall be maintained.
Ancillary Services - All ancillary or supportive health medical services, including but not limited to, radiological, pharmaceutical, or medical laboratory services shall be provided in accordance with all applicable state and federal laws and regulations.

(e) ASA Risk Classifications - Level II and IIA surgeries are limited to patients who fall within ASA Class 1, 2, and 3 risk classification criteria.

(7) Level III Office Based Surgery (a) Levels of Anesthesia - Includes all levels of anesthesia which sedate a patient beyond the levels described in subparagraph (6)(a) of this rule which includes:

Deep sedation as defined by subparagraph (3)(i) of this rule; and/or 2. Major Conduction Anesthesia (epidural, spinal, caudal); and/or 3. Major conduction anesthesia and pre-operative sedation; and/or 4. General Anesthesia as defined in subparagraph (3)(j) of this rule; and/or 5. The use of nitrous oxide in conjunction with other types of sedatives.

(b) Level III Surgical Procedures - Procedures authorized to be performed under Level III anesthesia are those contained on the Centers for Medicare & Medicaid Services (CMS) list of procedures published in Volume 71, Number 226 of the Federal Register dated November 24, 2006 as it may from time to time be amended that are authorized for reimbursement at the Ambulatory Surgical Center (ASC) level and only those cosmetic surgical procedures that, based upon reasonable medical judgment, would require Level III sedation. The surgical procedures authorized pursuant to this subparagraph are limited to those that also have all the following characteristics:

Have a planned duration of less than four (4) hours. This includes multiple surgeries regardless of the level of surgery; the combined planned duration of all planned procedures shall be less than four (4) hours; and 2. Generally result in blood loss of less than ten percent (10%) of estimated blood volume in a patient with normal hemoglobin; and 3. Will not require major or prolonged intracranial or intrathoracic procedures; and 4. Will not require major or prolonged abdominal or major hip replacement procedures (this criteria does not apply to laparoscopic procedures); and 5. Will not be generally emergent or life threatening in nature.

(c) Application for Certification and Renewal - 1. Application for Certification - A physician office which contains operating and recovery rooms wherein Level III office based surgeries are to be performed, which shall be referred to as “surgical suites” for purposes of this rule, must obtain certification from the Board before any Level III surgical procedures may be performed therein. The process for obtaining that certification is as follows:

(i) Obtain the Board’s Level III Office Based Surgery Certification application (which shall also serve as the official request for a site survey) and provide all the information requested thereon which shall include the following:

(I) The name of a responsible physician in whose name the surgical suite certification shall be issued who shall also arrange to have provided, for each physician in the office who will be performing Level III procedures, the following information and/or documentation:

(II) A statement identifying all Level III procedures expected to be performed by each such physician; and (III) A copy of what, if any, specialty board certification or board eligibility has been obtained by each such physician; and (IV) Written verification of medical malpractice coverage from each physicians’ malpractice insurance carrier; and (V) Written verification of hospital staff privileges from at least one hospital at which each of the physicians has been granted staff privileges that is within thirty (30) miles or thirty (30) minutes from the surgical suite.

(ii) Submit copies of both the office’s by-laws and its documentation of the management system that will insure that no more than three (3) patients that are in surgery or recovery are incapable of self-preservation at the same time.

(iii) Submit the Surgical Suite Certification fee in the amount of one thousand eighty dollars ($1,080.00) and the state regulatory fee of five dollars ($5.00).

(iv) Obtain a surgical suite site survey performed by the Department of Health to determine compliance with the standards set forth in this rule. The Department of Health shall have the authority to:

(I) Require plans of correction from the physician office for any deficiencies they may find in compliance with the standards set forth in this rule and to make a determination of the acceptability of the submitted plans of correction, and verify that the plans of correction have been implemented.

(II) Initiate subsequent, unannounced site surveys during regular business hours as long as the physician office continues to be used to perform Level III office-based surgeries but no more frequently than once every twelve (12) months.

(III) Respond to any complaints made by patients or the public against a physician who performs office-based surgery or a physician’s office at which Level III office-based surgery is being performed at the request of the Department’s office of investigations.

(v) Receive approval from the Board on the result of the surgical suite site survey.

Renewal of Certification - A physician office which obtains Level III Office Based Surgery Certification for its surgical suites, must renew that certification every year by submitting to the Board the annual renewal fee in the amount of one thousand and eighty dollars ($1,080.00) and the state regulatory fee of five dollars ($5.00), on or before its anniversary date.
The information required to be included on and/or with the application form as itemized in subparagraph (c)1.(i) and (ii) of this rule must be updated within thirty (30) days of the date on which any of the provided information or documentation has changed or additions need to be made.
Transition Provisions - (i) In order for a physician office at which Level III office-based surgeries have been performed prior to October 1, 2007, (pursuant to certifications/accreditations received pursuant to prior Board rules) to continue doing so, the office must submit an application and a request for a site survey and remit payment of the Surgical Suite Certification fee and the state regulatory fee to the Department by October 1, 2007. If such office makes a timely filing in accordance with this provision, the physician’s office may continue to be a site for office-based surgeries pending completion of a survey confirming compliance with Board rules and subsequent issuance of a certification of the surgical suite(s).

(ii) A physician office at which office-based surgeries have not been performed as of October 1, 2007, (pursuant to certifications/accreditations received pursuant to prior Board rules) shall not perform any such procedures until an application form and payment of the Surgical Suite Certification fee and the state regulatory fee are submitted to the Board and a site survey is completed and a certification of the surgical suite is issued by the board.

(d) Level III Surgery Standards - All physician offices for which certification for performance of Level III surgeries is to be sought and obtained shall meet the following standards:

Infection Control (i) The surgical suite(s) must provide a sanitary environment to avoid sources and transmission of infections and communicable diseases. There must be an active performance improvement program for the prevention, control, and investigation of infections and communicable diseases.

(ii) The physical environment of the surgical suite(s) shall be maintained in a safe, clean and sanitary manner.

(I) Any condition on the surgical suite(s) site conducive to the harboring or breeding of insects, rodents or other vermin shall be prohibited.

Chemical substances of a poisonous nature used to control or eliminate vermin shall be properly identified. Such substances shall not be stored with or near food or medications.

(II) Cats, dogs or other animals shall not be allowed in any part of the surgical suite except for specially trained animals for the handicapped and except as addressed by physician office policy for pet therapy programs. The physician’s office shall designate in its policies and procedures those areas where animals will be excluded.

The areas designated shall be determined based upon an assessment of the surgical suite performed by medically trained personnel.

(III) A bed complete with mattress and pillow shall be provided. In addition, patient units shall be provided with at least one chair, a bedside table, an over bed tray and adequate storage space for toilet articles, clothing and personal belongings.

(IV) Individual wash cloths, towels and bed linens must be provided for each patient. Linen shall not be interchanged from patient to patient until it has been properly laundered.

(V) Bath basin water service, emesis basin, bedpan and urinal shall be individually provided.

(VI) Water pitchers, glasses, thermometers, emesis basins, douche apparatus, enema apparatus, urinals, mouthwash cups, bedpans and similar items of equipment coming into intimate contact with patients shall be disinfected or sterilized after each use unless individual equipment for each is provided and then sterilized or disinfected between patients and as often as necessary to maintain them in a clean and sanitary condition. Single use, patient disposable items are acceptable but shall not be reused.

(iii) The physician office shall assure that an infection control committee including members of the medical, nursing, and administrative staff develops guidelines and techniques for the prevention, surveillance, control and reporting of facility infections. Duties of the committee shall include the establishment of:

(I) Written infection control policies;

(II) Techniques and systems for identifying, reporting, investigating and controlling infections in the facility;

(III) Written procedures governing the use of aseptic techniques and procedures in all areas of the facility;

(IV) Written procedures concerning food handling, laundry practices, disposal of environmental and patient wastes, traffic control and visiting rules in high risk areas, sources of air pollution, and routine culturing of autoclaves and sterilizers;

(V) A log of incidents related to infectious and communicable diseases;

(VI) A method of control used in relation to the sterilization of supplies and water, and a written policy addressing reprocessing of sterile supplies;

(VII) Formal provisions to educate and orient all appropriate personnel in the practice of aseptic techniques such as hand washing and scrubbing practices, proper grooming, masking and dressing care techniques, disinfecting and sterilizing techniques, and the handling and storage of patient care equipment and supplies; and, (VIII) Continuing education provided for all office personnel on the cause, effect, transmission, prevention, and elimination of infections, as evidenced by front line employees verbalizing understanding of basic techniques.

(iv) The physician office must ensure that the facility-wide performance improvement program and training programs address problems identified by the infection control committee and must be responsible for the implementation of successful corrective action plans in affected problem areas.

(v) The physician office shall develop policies and procedures for testing a patient’s blood for the presence of the hepatitis B virus and the HIV (AIDS) virus in the event that any person, employee or other health care provider rendering services at the facility is exposed to a patient’s blood or other body fluid. The testing shall be performed at no charge to the patient, and the test results shall be confidential.

(vi) The physician office and its employees shall adopt and utilize standard precautions (per CDC) for preventing transmission of infections, HIV, and communicable diseases.

(vii) The physician office shall adopt 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 2. Life Safety (i) All surgical suites and recovery areas shall conform to the current addition of the Standard Building Code, the National Fire Protection Code (NFPA), the National Electrical Code, the AIA Guidelines for Design and Construction of Hospital and Health Care Facilities (if applicable), and the U.S Public Health Service Food Code as adopted by the Board for Licensing Health Care Facilities. When referring to height, area or construction type, the Standard Building Code shall prevail. All new and existing surgical suites and recovery areas are subject to the requirements of the Americans with Disabilities Act (A.D.A.). Where there are conflicts between requirements in the above listed codes and regulations and provisions of this chapter, the most restrictive shall apply.

(ii) Any surgical suite(s) and recovery area(s) which complies with the required applicable building and fire safety regulations at the time the Board adopts new codes or regulations will, 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.

(iii) A surgical suite(s) and recovery area(s) shall be provided fire protection by the elimination of fire hazards, by the installation of necessary fire fighting equipment and by the adoption of a written fire control plan. All fires which result in a response by the local fire department shall be reported to the Board within seven (7) days. The report shall contain sufficient information to ascertain the nature and location of the fire, its probable cause and any injuries incurred by any person or persons as a result of the fire. Initial reports by the facility may omit the name(s) of patient(s) and parties involved, however, should the Department find the identities of such persons to be necessary to an investigation, the facility shall provide such information.

(iv) The following alarms are required in surgical suites and recovery areas and shall be monitored twenty-four (24) hours per day:

(I) Fire alarms; and (II) Generators (if applicable).

(v) A negative air pressure shall be maintained in all the following rooms encompassed within the surgical suites and recovery areas: the soiled utility area, toilet room, janitor’s closet, dishwashing and other such soiled spaces. A positive air pressure shall be maintained in all clean areas encompassed within the surgical suites and recovery areas including, but not limited to, clean linen rooms and clean utility rooms.

(vi) The emergency power system for surgical suites and recovery areas shall:

(I) Use either propane, gasoline or diesel fuel. The generator shall be designed to meet the surgical suite and recovery area’s HVAC and essential needs and shall have a minimum of twenty-four (24) hours of fuel designed to operate at its rated load. The fuel quantity shall be based on its expected or known connected load consumption during power interruptions.

(II) Automatically transfer within ten (10) seconds in Surgery Suites conducting invasive surgical procedures.

(III) Be inspected monthly and exercised at the actual load and operating temperature conditions and not on dual power for at least thirty (30) minutes each month, including automatic and manual transfer of equipment. A log shall be maintained for all inspections and tests and kept on file for a minimum of three (3) years. The suite shall have trained staff familiar with the generator’s operation.

(IV) Emergency generators are not required if the suite does not utilize anesthesia that renders the patient incapable of self preservation.

However, the suite shall have an emergency power source able to produce adequate power to run required equipment for a minimum of two (2) hours.

(vii) Emergency electrical power connections shall be through a switch which shall automatically transfer the circuits to the emergency power source in case of power failure. (It is recognized that some equipment may not sustain automatic transfer and provisions will have to be made to manually change these items from a non-emergency powered outlet to an emergency powered outlet or other power source.)

Patient Rights (i) Each patient has at least the following rights:

(I) To privacy in treatment and personal care;

(II) To be free from mental and physical abuse. Should this right be violated, the physician office must notify the Department within five (5) business days and the Tennessee Department of Human Services, Adult Protective Services immediately as required by T.C.A. §§ 71-6-101 et seq;

(III) To refuse treatment. The patient must be informed of the consequences of that decision, the refusal and its reason must be reported to the physician and documented in the medical record;

(IV) To refuse experimental treatment and drugs. The patient’s or health care decision maker’s written consent for participation in research must be obtained and retained in his or her medical record;

(V) To have their records kept confidential and private. Written consent by the patient must be obtained prior to release of information except to persons authorized by law. If the patient lacks capacity, written consent is required from the patient’s health care decision maker.

The physician office must have policies to govern access and duplication of the patient’s record;

(VI) To have appropriate assessment and management of pain; and (VII) To be involved in the decision making of all aspects of their care.

(ii) Each patient has a right to self-determination, which encompasses the right to make choices regarding life-sustaining treatment (including resuscitative services). This right of self-determination may be effectuated by an advance directive.

Hazardous Waste (i) Each physician office must develop, maintain and implement written policies and procedures for the definition and handling of its infectious and hazardous wastes, these policies and procedures must comply with the standards of this section and all other applicable state and federal regulations.

(ii) The following waste shall be considered to be infectious waste:

(I) Waste contaminated by patients who are isolated due to communicable disease, as provided in the U.S. Centers for Disease Control “Guidelines for Isolation Precautions in Hospitals”;

(II) Cultures and stocks of infectious agents including specimen cultures collected from medical and pathological laboratories, cultures and stocks of infectious agents from research and industrial laboratories, wastes from the production of biologicals, discarded live and attenuated vaccines, and culture dishes and devices used to transfer, inoculate, and mix cultures;

(III) Waste human blood and blood products such as serum, plasma, and other blood components;

(IV) Pathological waste, such as tissues, organs, body parts, and body fluids that are removed during surgery and autopsy;

(V) All discarded sharps (including but not limited to, hypodermic needles, syringes, Pasteur pipettes, broken glass, scalpel blades) used in patient care or which have come into contact with infectious agents during use in medical, research, or industrial laboratories;

(VI) Contaminated carcasses, body parts, and bedding of animals that were exposed to pathogens in research, in the production of biologicals, or in the in vivo testing of pharmaceuticals;

(VII) Other waste determined to be infectious by the physician office in its written policy.

(iii) Infectious and hazardous waste must be segregated from other waste at the point of generation (i.e., the point at which the material becomes a waste) within the physician office.

(iv) Waste must be packaged in a manner that will protect waste handlers and the public from possible injury and disease that may result from exposure to the waste. Such packaging must provide for containment of the waste from the point of generation up to the point of proper treatment or disposal.

Packaging must be selected and utilized for the type of waste the package will contain, how the waste will be treated and disposed, and how it will be handled and transported, prior to treatment and disposal.

(I) Contaminated sharps must be directly placed in leakproof, rigid, and puncture-resistant containers which must then be tightly sealed;

(II) Whether disposable or reusable, all containers, bags, and boxes used for containment and disposal of infectious waste must be conspicuously identified. Packages containing infectious waste which pose additional hazards (e.g., chemical, radiological) must also be conspicuously identified to clearly indicate those additional hazards;

(III) Reusable containers for infectious waste must be thoroughly sanitized each time they are emptied, unless the surfaces of the containers have been completely protected from contamination by disposable liners or other devices removed with the waste;

(IV) Opaque packaging must be used for pathological waste.

(v) After packaging, waste must be handled and transported by methods ensuring containment and preserving the integrity of the packaging, including the use of secondary containment where necessary.

(I) Waste must not be compacted or ground (i.e., in a mechanical grinder) prior to treatment, except that pathological waste may be ground prior to disposal;

(II) Plastic bags of infectious waste must be transported by hand.

(vi) Waste must be stored in a manner which preserves the integrity of the packaging, inhibits rapid microbial growth and putrefaction, and minimizes the potential of exposure or access by unknowing persons.

(I) Waste must be stored in a manner and location which affords protection from animals, precipitation, wind, and direct sunlight, does not present a safety hazard, does not provide a breeding place or food source for insects or rodents and does not create a nuisance.

(II) Pathological waste must be promptly treated, disposed of, or placed into refrigerated storage.

(vii) In the event of spills, ruptured packaging, or other incidents where there is a loss of containment of waste, the physician office must ensure that proper actions are immediately taken to:

(I) Isolate the area from the public and all except essential personnel;

(II) To the extent practicable, repackage all spilled waste and contaminated debris in accordance with the requirements of subpart (vi) of this part;

(III) Sanitize all contaminated equipment and surfaces appropriately.

Written policies and procedure must specify how this will be done; and (IV) Complete incident report and maintain copy on file.

(viii) Except as provided otherwise in this section a physician office must treat or dispose of infectious waste by one or more of the methods specified in this

part.

(I) A physician office may treat infectious waste in an on-site sterilization or disinfection device, or in an incinerator or a steam sterilizer, which has been designed, constructed, operated and maintained so that infectious wastes treated in such a device are rendered non-infectious and is, if applicable, authorized for that

purpose pursuant to current rules of the Department of Environment and Conservation. A valid permit or other written evidence of having complied with the Tennessee Air Pollution Control Regulations shall be available for review, if required. Each sterilizing or disinfection cycle must contain appropriate indicators to assure conditions were met for proper sterilization or disinfection of materials included in the cycle, and records kept. Proper operation of such devices must be verified at least monthly, and records of these monthly checks shall be available for review. Waste that contains toxic chemicals that would be volatilized by steam must not be treated in steam sterilizers. Infectious waste that has been rendered to a carbonized or mineralized ash shall be deemed non-infectious. Unless otherwise hazardous and subject to the hazardous waste management requirements of the current rules of the Department of Environment and Conservation, such ash shall be disposable as a (nonhazardous) solid waste under current rules of the Department of Environment and Conservation.

(II) The physician may discharge liquid or semi-liquid infectious waste to the collection sewerage system of a wastewater treatment facility which is subject to a permit pursuant to T.C.A. §§ 69-3-101, et seq., provided that such discharge is in accordance with any applicable terms of that permit and/or any applicable municipal sewer use requirements.

(III) Any physician office accepting waste from another state must promptly notify the Department of Environment and Conservation, county and city public health agencies, and must strictly comply with all applicable local, state and federal regulations.

(ix) The physician office may have waste transported off-site for storage, treatment, or disposal. Such arrangements must be detailed in a written contract, available for review. If such off-site location is located within Tennessee, the physician office must ensure that it has all necessary State and local approvals, and such approvals shall be available for review. If the off -site location is within another state, the physician office must notify in writing all public health agencies with jurisdiction that the location is being used for management of the facility’s waste. Waste shipped off-site must be packaged in accordance with applicable Federal and State requirements. Waste transported to a sanitary landfill in this state must meet the requirements of current rules of the Department of Environment and Conservation.

(x) Human anatomical remains which are transferred to a mortician for cremation or burial shall be exempt from the requirements of this subparagraph. Any other human limbs and recognizable organs must be incinerated or discharged (following grinding) to the sewer.

(xi) All garbage, trash and other non-infectious wastes shall be stored and disposed of in a manner that must not permit the transmission of disease, create a nuisance, provide a breeding place for insects and rodents, or constitute a safety hazard. All containers for waste shall be water tight, be constructed of easily cleanable material and be kept on elevated platforms.

Equipment and Supplies (i) Adequate equipment and supplies must be available to the operating room suites and to the postoperative care area which, when applicable shall be age and procedure appropriate and shall include but not be limited to the following;

(I) Call-in system (OR)

(II) Cardiac monitor (III) Pulse Oximeter (IV) Resuscitator (V) Defibrillator (VI) Aspirator (VIII) Tracheotomy set (ii) A crash cart must be available and include at a minimum all the medication and supplies recommended by the current ACLS guidelines of the American Heart Association and:

(I) Dantrolene.

Administration (i) Physician offices that perform office-based surgery must adopt bylaws that put in place a management system and documentation that will insure that no more than three (3) patients that are in surgery or recovery are incapable of self-preservation at the same time.

(ii) Except for emergencies, a surgical suite certified for office based surgery may be utilized only by physician employees of the practice in which the surgical suite is located. Surgical suites may not be shared with other practices or other physicians.

(iii) When licensure is applicable for a particular job within the surgery suite, a copy of the current license must be included as a part of the personnel file.

Each personnel file shall contain accurate information as to the education, training, experience, and personnel background of the employee.

(iv) The Surgery Suite shall have available a plan for emergency transportation to a licensed local hospital.

(v) As needed, the patient and family members or interested persons must be taught and/or counseled to prepare them for post-operative care.

(vi) There must be a complete history and physical work-up in the chart of every patient within 30 days prior to surgery and updated within 24 hours prior to surgery. If the history has been dictated, but not yet recorded in the patient’s chart, there must be a statement to that effect and an admission note in the chart by the practitioner who admitted the patient.

(vii) Properly executed informed consent forms must be in the patient’s chart before surgery, except in emergencies.

Reporting (i) Surgery Suites are subject to all reporting requirements in Tenn. Code Ann. §§ 63-6-221(1) and 68-11-211, as well as any other reporting required by law.

(ii) The Surgery Suite shall report information contained in the medical records of patients who have cancer or pre-cancerous or tumorous diseases as provided by existing regulations. These reports shall be sent to the Cancer Reporting System of the department on a quarterly schedule no later than six (6) months after the date of the diagnosis or treatment.

(iii) The Surgery Suite shall report to the Department of Health each case of communicable disease detected in the center. Repeated failure to report communicable diseases shall be cause for revocation of a Surgery Suite’s license.

Hospital Staff Privileges Required - The physician performing the surgery must have staff privileges to perform the same procedure as that being performed in the office setting at a licensed hospital within reasonable proximity.
Training Required - The physician performing the surgery must have documentation of training to perform the particular surgical procedures and must have knowledge of the principles of general anesthesia. The physician performing the surgery and at least one (1) assistant must be currently certified in ACLS.
Assistance of Other Personnel Required.

(i) An anesthesiologist or certified registered nurse anesthetist licensed pursuant to Tennessee Code Annotated, Title 63, Chapter 7 and practicing within the lawful scope of that license, must administer the general or regional anesthesia. The anesthesia provider cannot function in any other capacity during the procedure and shall be physically present with the patient at all times during the intra-operative period.

(ii) When general anesthesia using volatile anesthetic gases, succinylcholine or other agents known to trigger malignant hyperthermia are administered, the facility shall maintain or have immediate access to thirty-six (36) ampules of dantrolene and its diluent for injection. If dantrolene is administered, appropriate monitoring must be provided postoperatively.

(iii) Following the procedure - (I) There must be a person with current ACLS certification present at all times with the patient while in the recovery area; and (II) An additional professional who has post-anesthesia care unit experience or its equivalent and a current ACLS certification and who is licensed pursuant to either Tennessee Code Annotated, Title 63 Chapter 6, 9 or 19 or a registered or advanced practice nurse licensed pursuant to Tennessee Code Annotated, Title 63 Chapter 7 must also be immediately available on the premises to assist in monitoring the patient in the recovery room until the patient has recovered from anesthesia.

(III) If the patient has not recovered sufficiently to be safely discharged within twelve (12) hours after the initial administration of anesthesia, the patient must be transferred to a hospital for continued postoperative care.

Level III surgical suites shall be used exclusively for surgery and recovery, respectively and for no other purpose.
Physicians performing Level III surgery in an office setting shall obtain written informed consent prior to the procedure from the patient or the patient’s representative which shall be documented in the patient’s health record. The consent shall explain to the patient the risks and benefits of the procedure; the alternative treatments to the surgical procedure; the type of anesthesia to be used and its risks; and the qualifications of the professional who is expected to administer the anesthesia during the procedure.
A physician performing Level III surgery in an office setting must inform the patient, in writing, that the medical office is not a licensed facility and that the patient may elect to have the surgery performed at a licensed ASTC or hospital.

The patient or the patient’s representative must consent in writing to have the surgery performed in a medical office.

(e) ASA Risk Classifications - Only patients classified under the ASA risk classification criteria as Class 1 or 2 are appropriate candidates for Level III office based surgical procedures.

(f) The Board shall post on its web site a list, including the names and locations of physician offices that have qualified as sites for Level III surgeries and have been issued certification by the Board. Information on the list shall be updated at least quarterly.

(8) Procedure Specific Restrictions (a) Liposuction - Liposuction procedures performed pursuant to these rules shall be performed only by physicians with appropriate training following prescribed national professional guidelines. These procedures shall be within the scope of practices of the physician and capabilities of the office. Provided however, no such procedures may be performed if the anticipated supernatant fat removal is to be greater than 4000 cc. In addition the following shall also apply:

When combined with other surgical procedures, liposuction may not exceed 2000 cc of supernatant fat.
A maximum of 50mg/kg of Lidocaine can be injected for tumescent liposuction in the office setting. A maximum of 35mg/kg of Lidocaine can be injected for nontumescent liposuction in the office setting.

(b) Laser surgery - Laser surgeries performed pursuant to these rules require written policies and procedures that include, but are not limited to, laser safety, education, training, and the supervision of other licensed health care practitioners who are performing laser treatments. A safe environment shall be maintained for laser surgery.

(9) The Board shall appoint a standing Office Based Surgery Committee comprised of three (3) members of the Board who shall meet twice a year to review and make whatever recommendations for revision of these rules as circumstances require. All comments and suggestions for revision and improvement of these rules should be addressed to that committee and sent to the Board’s Administrative Office.

(10) Any violation of these rules shall be grounds for disciplinary actions before the Board pursuant to T.C.A. § 63-6-214(b)(1), (2) or (4) or Public Chapter 373 of the Public Acts of 2007.

(a) When an office-based surgical suite is found by the Department to have committed a violation of this rule, the Department will issue to the office a statement of deficiencies.

Within ten (10) days of the receipt of the statement of deficiencies the office must return a plan of correction indicating the following:

(i) How the deficiency will be corrected;

(ii) The date upon which each deficiency will be corrected;

(iii) What measures or systemic changes will be put in place to ensure that the deficient practice does not recur; and (iv) How the corrective action will be monitored to ensure that the deficient practice does not recur.

(b) Failure to submit a plan of correction in a timely manner, a finding by the department that the plan of correction is unacceptable, or a finding that the plan of correction was not implemented shall subject the office based surgical suite’s certification to possible disciplinary action.

History

Authority: T.C.A. §§ 63-6-101, 63-6-204, 63-6-214, and Chapter 373, Public Acts of 2007.
Administrative History: Original rule filed August 3, 2005; effective October 17, 2005. Amendment filed August 23, 2005; effective November 6, 2005. Amendment filed December 29, 2006; effective March 14, 2007. Amendment filed June 12, 2007; effective August 26, 2007. Public necessity rule filed October 8, 2007; effective though March 21, 2008. Emergency rule filed March 20, 2008; effective through September 1, 2008. Repeal and new rule filed March 5, 2008; effective May 19, 2008.

Tenn. Comp. R. & Regs. 0880-02-.22 FREE HEALTH CLINIC, INACTIVE PRO BONO AND VOLUNTEER PRACTICE

REQUIREMENTS.

(1) Free Health Clinic Practice Pursuant to T.C.A. § 63-1-201 (a) Any physician licensed to practice medicine in this state or any other state who has not been disciplined by any medical licensure board may have their license converted to or receive a Tennessee “Special Volunteer License,” as defined in T.C.A. § 63-1-201, which will entitle the licensee to practice without remuneration solely within a “free health clinic,” as defined by T.C.A. § 63-1-201, at a specified site or setting by doing the following:

Obtaining from the Board’s Administrative Office a “Special Volunteer License” application, completing it and submitting it along with any required documentation to the Board’s Administrative Office; and 2. Have the licensing authority of every state in which the physician holds or ever held a license to practice medicine submit directly to the Board’s Administrative Office the equivalent of a “certificate of fitness” as described in T.C.A. § 63-1-118 which shows that the license has never been subjected to any disciplinary action and is free and clear of all encumbrances; and 3. For physicians who have not been licensed in Tennessee, comply with all provisions of paragraphs (2), (3), (4), and (7) of Rule 0880-02-.05 and the Health Care Consumer-Right-To-Know Act compiled at T.C.A. §§ 63-51-101, et seq.; and 4. Submitting the specific location of the site or setting of the free health clinic in which the licensee intends to practice along with proof of the clinic’s private, and not-for-profit status.

(b) A physician holding a Special Volunteer License is not required to pay any fee for its issuance or the required biennial renewal pursuant to the Division of Health Related Board’s biennial birthdate renewal system (c) A physician holding a Special Volunteer License may not do any of the following:

Practice medicine anywhere other than in the free health clinic site or setting specified in the application; and 2. Charge any fee or receive compensation or remuneration of any kind from any person or third party payor including insurance companies, health plans and state or federal benefit programs for the provision of medical or any other services; and 3. Practice for any free health clinic that imposes any charge on any individual to whom health care services are rendered or submits charges to any third party payor including insurance companies, health plans and state or federal benefit programs for the provision of any services.

(d) Special Volunteer Licenses are subject to all of the following 1. All rules governing renewal, retirement, reinstatement and reactivation as provided by Rules 0880-02-.09 and 0880-02-.10, except those requiring the payment of any fees; and 2. The rules governing continuing medical education as provided by Rule 0880-02- .19; and 3. Disciplinary action for the same causes and pursuant to the same procedures as all other licenses issued by the Board.

(2) Special Volunteer License for Out-of-State Practice.

(a) Any physician whose license to practice medicine in Tennessee is in retired or inactive status and who has not been disciplined by any medical licensure board may receive a “Special Volunteer License for Out-of-State Practice,” which will entitle the licensee to practice without remuneration at benevolent or humanitarian service projects locations outside of the state by doing the following:

Comply with the provisions of parts (1)(a)1., (1)(a)2. and (1)(a)3. of this rule; and 2. Submit to the Board’s Administrative Office the location and details of the benevolent or humanitarian service projects at which the licensee intends to practice.

(b) The provisions of subparagraphs (1)(b) and (1)(d) of this rule are applicable to Special Volunteer Licenses for Out-of-State Practice.

(c) Unless appropriately licensed elsewhere, a physician holding a Special Volunteer License for Out-of-State Practice may not practice medicine anywhere other than at the benevolent or humanitarian service projects specified in the application.

(3) Inactive Pro Bono Practice Pursuant to T.C.A. § 63-6-230 - Applicants who intend to exclusively practice medicine without compensation on patients who receive medical services from organizations granted a determination of exemption pursuant to Section 501(c)(3) of the Internal Revenue Code may obtain an inactive pro bono license to do so by doing as follows:

(a) Applicants who currently hold a valid Tennessee license to practice medicine issued by the Board pursuant to this rule which is in good standing must:

Retire their active licenses pursuant to the provisions of Rule 0880-02-.10(2); and 2. Have submitted to the Board Administrative Office directly from the qualified organization proof of the determination of exemption issued pursuant to Section 501(c)(3) of the Internal Revenue Code; and 3. Submit a written certification that they are practicing medicine exclusively on the patients of the qualified entity and that such practice is without compensation.

(b) Applicants who do not currently hold a valid Tennessee license to practice medicine must:

Obtain a license by complying with all provisions of paragraphs (2), (3), (4), (6) and (7) of Rule 0880-02-.05 and the Health Care Consumer-Right-To-Know Act compiled at T.C.A. §§ 63-51-101, et seq.; and 2. Have submitted to the Board Administrative Office directly from the qualified organization proof of the determination of exemption issued pursuant to Section 501(c)(3) of the Internal Revenue Code; and 3. Submit a written certification that they are practicing medicine exclusively on the patients of the qualified entity and that such practice is without compensation.

(c) Inactive pro bono licenses are subject to all rules governing renewal, retirement, reinstatement and reactivation as provided by Rules 0880-02-.09 and 0880-02-.10, and are subject to all rules governing continuing medical education as provided by Rule

Tenn. Comp. R. & Regs. 0880-02-.23 TAMPER-RESISTANT PRESCRIPTIONS

(1) Purpose.

This rule is designed to implement the law requiring that licensed physicians have all written, typed, or computer-generated prescriptions issued on tamper-resistant prescription paper.

(2) Definitions.

The following definitions are applicable to this rule:

(a) “Drug” shall have the same meaning as set forth in T.C.A. § 63-10-204(16).

(b) “Prescriber” means an individual licensed in Tennessee as a medical doctor, podiatrist, advanced practice nurse with a certificate of fitness to prescribe, dentist, optometrist, osteopathic physician, or physician assistant.

(d) “Tamper-resistant prescription” means a written prescription order with features that are designed to prevent unauthorized copying, erasure, modification, and use of counterfeit prescription forms.

(3) Tamper-Resistant Prescription Requirements.

(a) A prescriber shall ensure that all handwritten, typed, or computer-generated prescription orders are issued on tamper-resistant prescriptions. Tamper-resistant prescriptions shall contain the following features:

Either a void or illegal pantograph or a watermark designed to prevent copying;
Either quantity check-off boxes with refill indicators or a uniform, non-white background color designed to prevent erasure or modification; and 3. Security features and descriptions listed on the prescriptions designed to prevent use of counterfeit forms.

(4) Security Measures and Recordkeeping.

(a) Each prescriber shall undertake adequate safeguards and security measures to ensure against loss, improper destruction, theft, or unauthorized use of the tamper-resistant prescriptions in the prescriber’s possession.

(5) Use of Tamper-Resistant Prescriptions.

(a) Facsimile Prescription Transmission.

Prescriptions sent by facsimile transmission are not required to be placed on tamper-resistant prescription paper.
If a prescriber transmits a prescription order to a pharmacy by facsimile transmission, the prescriber or someone designated by the prescriber shall document in the patient’s medical record the name of the drug, strength, and quantity prescribed. The prescriber may, but is not required to, document the means by which the prescription was transmitted.

(b) Electronic Prescription Transmission.

Prescriptions sent by electronic transmission are not required to be placed on tamper-resistant prescription paper.
If a prescriber transmits a prescription order to a pharmacy by electronic transmission, the prescriber shall document the prescription in the patient’s file and in accordance with the applicable laws and rules for each of the prescribers’ respective professions as well as applicable federal laws and rules. The prescriber may, but is not required to, document the means by which the prescription was transmitted.

History

Authority: Chapter 1035, Public Acts of 2008 and T.C.A. §§ 53-10-401, 63-6-101, and 63-6-236. [effective October 1, 2008 for TennCare prescriptions and July 1, 2009 for non-TennCare prescriptions].
Administrative History: Public necessity rule filed June 25, 2009; effective through December 7, 2009. Public necessity rule filed June 25, 2009 expired; on December 8, 2009, the rule reverted to its prior status. Emergency rule filed December 21, 2009; effective through June 19, 2010. Original rule filed March 22, 2010; effective June 20, 2010.

Tenn. Comp. R. & Regs. 0880-02-.24 MEDICAL SPA REGISTRATION

(1) Any medical spa offering cosmetic medical services, as those terms are defined in T.C.A. §§ 63-1-153 and 63-6-105, in Tennessee must register with the Tennessee Board of Medical Examiners, prior to operation or within sixty calendar days of the effective date of this rule, by providing Board staff with the following:

(a) A completed Application for Registration of a Medical Spa along with the nonrefundable Medical Spa Registration Fee required pursuant to Rule 0880-02-.02; and (b) The name and physical address of the medical spa; and (c) The name and Tennessee license number of the medical director or supervising physician responsible for services at the practice; and (d) The name and physical address of the primary practice of the medical director or supervising physician; and (e) Certification information of the medical director or supervising physician as required by T.C.A. § 63-1-153(b) and (c); and (f) An attestation that the medical director or supervising physician registering the medical spa assumes and accepts responsibility for the cosmetic medical services provided at the medical spa.

(2) Registration is valid for twelve (12) months. Prior to expiration, the medical spa must complete a new Application for Registration of a Medical Spa and pay the registration fee.

(3) The medical director or supervising physician who is responsible for or supervises a medical spa is responsible for providing the Board with the information described in paragraph (1) of this rule; ensuring the annual registration of the medical spa; and complying with the signage and advertisement requirements contained in T.C.A. § 63-1-153.

(4) The medical director or supervising physician must be a medical doctor or osteopathic physician with an active Tennessee license and an active medical practice in Tennessee.

(5) Operation without current registration constitutes unprofessional conduct on the part of the medical director or any supervising physician providing services, including supervision services, at such unregistered medical spa and is grounds for disciplinary action by the licensing board of such physician.

History

Authority: T.C.A. §§ 63-1-153, 63-6-101, and 63-6-105.
Administrative History: Original rule filed July 31, 2018; effective October 29, 2018.

Tenn. Comp. R. & Regs. 0880-02-.25 MINIMUM DISCIPLINE FOR OPIOID PRESCRIBING

(1) If the Board or committee finds that its licensee has prescribed, dispensed, or administered opioids in a manner that violates the Board’s or committee’s statutes or rules (for example, by prescribing in a manner that constitutes gross healthcare liability or a pattern of continued or repeated health care liability, ignorance, negligence or incompetence), the Board or committee shall make a finding that the licensee engaged in a significant deviation or pattern of deviation from sound medical judgment. For purposes of such a finding, sound medical judgment is the equivalent to the standard of care as defined in T.C.A. § 63-1-122.

(2) Having made such a finding, the minimum discipline that the Board or committee assesses shall include the following:

(a) Reprimand;

(b) Successful completion of a Board or committee approved intensive continuing education course or program regarding treatment with opioids;

(c) A restriction against prescribing opioids for at least six (6) months, and until successful completion of the required continuing education;

(d) One or more Type A civil penalties;

(e) Proof to the licensee’s board or committee that they have notified any physicians, podiatrists, advanced practice registered nurses, or physician assistants with whom they collaborate of the discipline; and (f) Where the licensee is a physician or podiatrist, a restriction against collaborating with any advanced practice registered nurses or physician assistants for issuing opioids during the period in which the licensee is restricted from prescribing opioids.

(3) The prescribing boards and committee recognize that a higher level of minimum discipline is required for those licensees who have been disciplined for opioid-related prescribing violations but continue to violate the standard of care. As set out in paragraph (1) of this rule, the following findings are synonymous, though the boards or committee may have used one or more sets of language to describe a violation. If a licensee commits an order violation in which the prior order contains one or more of the following findings, the licensee has committed an opioid-related order violation for purposes of paragraph (5) of this rule:

(a) That the licensee had prescribed, dispensed, or administered opioids in a manner that constituted gross healthcare liability or a pattern of continued or repeated health care liability, ignorance, negligence or incompetence;

(b) That the licensee engaged in a significant deviation or pattern of deviation from sound medical judgment related to the issuance of opioids;

(d) That the licensee had dispensed, prescribed or administered opioids not in the course of professional practice, or not in good faith to relieve pain and suffering or not to cure an ailment, physical infirmity or disease;

(e) That the licensee was unfit or incompetent by reason of negligence, habits or other cause related to the licensee’s prescribing or issuance of opioids; or (f) That the licensee violated the rules of the licensing entity with regard to prescribing or issuance of opioids.

(4) If within one (1) year from the date a licensee’s opioid-prescribing privileges are reinstated, having been restricted by an opioid-related order, that licensee’s board or committee finds that, during that year the licensee had prescribed, dispensed, or administered opioids in a manner that violates the board’s or committee’s statutes or rules (for example, by prescribing in a manner that constitutes gross healthcare liability or a pattern of continued or repeated health care liability, ignorance, negligence or incompetence), the board or committee shall make a finding that the licensee re-engaged in a significant deviation or pattern of deviation from sound medical judgment such that they are a repeat offender. For purposes of such a finding, sound medical judgment is the equivalent to the standard of care as defined in T.C.A. § 63-1-122.

(5) If the licensee commits an opioid-related order violation within one year of the opioid-related order, or if the licensee is found to be a repeat offender, the minimum discipline that the board or committee assesses shall include the following:

(a) Probation;

(b) Successful completion of a practice monitoring program which shall include at a minimum:

Board or committee approval of the monitor or monitoring program;
Quarterly reports to the board or committee which include the practice monitor’s findings with regard to the licensee’s:

(i) Non-opioid prescribing practices;

(ii) Medical record keeping;

(iii) Pain management;

(iv) Opioid treatment practices—where the practice monitoring is longer than the restriction against prescribing opioids; and (v) Compliance with the practice monitor’s recommendations, including completion of any additional education recommended by the practice monitor;

(c) A restriction against prescribing opioids for twice the amount of time that was assessed in the initial board or committee order, and for no less than one (1) year;

(d) One or more Type A civil penalties totaling at least twice the amount that was assessed in the initial board or committee order;

(e) Proof to the licensee’s board or committee that they have notified any physicians, podiatrists, advanced practice registered nurses, or physician assistants with whom they collaborate of the discipline; and (f) Where the licensee is a physician or podiatrist, a restriction against collaborating with any advanced practice registered nurses or physician assistants during the period in which the licensee is restricted from prescribing opioids.

(6) Nothing in this rule shall prohibit the Board or committee from taking action in excess of the minimum disciplinary action outlined herein. Each case shall be judged independently and may result in additional discipline including other restrictions or a higher level of discipline, including revocation, where appropriate. Further, nothing in this rule shall prohibit the board or committee from taking disciplinary action against a licensee based on a finding that the licensee violated the practice act in manners additional to those outlined in paragraph (1) above, suggesting a need for a higher level of discipline.

History

Authority: T.C.A. § 63-1-162.
Administrative History: Emergency rule filed March 29, 2019; effective through September 25, 2019. Original rule filed May 14, 2019; effective August 12, 2019.

Tenn. Comp. R. & Regs. 0880-02-.26 SURGICAL ASSISTANT REGISTRATION

(1) To use or assume the title “registered surgical assistant” in Tennessee, a person must first possess a lawfully issued registration from the board. The procedure to obtain a registration is as follows:

(a) A surgical assistant shall obtain an application form from the Board Administrative Office, respond truthfully and completely to every question or request for information contained in the form and submit it along with all documentation and fees required by the form and this rule to the Board Administrative Office.

(b) An applicant shall submit satisfactory evidence that the applicant:

Holds and maintains a current credential as a surgical assistant or surgical first assistant issued by:

(i) The National Board of Surgical Technology and Surgical Assisting (NBSTSA);

(ii) The National Surgical Assistant Association (NSAA); or (iii) The National Commission for Certification (NCCSA); or 2. Has successfully completed a surgical assistant training program during the applicant’s service as a member of any branch of the armed forces of the United States; or 3. Has practiced as a surgical assistant within the six (6) months prior to July 1, 2017, provided the applicant registers with the Board by December 31, 2019.

(c) An applicant shall submit the Surgical Assistant Registration Fee and the state regulatory fee as provided in Rule 0880-02-.02(1).

(2) Review and decisions on registration applications shall be governed as follows:

(a) The Board’s administrative staff shall determine when a registration file is complete.

(b) If an application is incomplete when received by the Board Administrative Office, the applicant shall be notified of the information required. The applicant shall cause the requested information to be received by the Board Administrative Office on or before the ninetieth (90th) day after the initial letter notifying the applicant of the required information is sent. If requested information is not timely received, the application file shall be closed, and the applicant notified that the Board will not consider registration until a new application is received.

(c) If a completed application is denied, conditioned, or restricted by the Board, a notification of the denial shall be sent by the Board Administrative Office by certified mail, return receipt requested, which shall contain the specific authority for the denial.

The applicant is not entitled to a contested case hearing. If an applicant believes that the denial was in error, the applicant may request, in writing within 30 days of receipt of the denial, to appear before the Board for an interview.

(3) All registrants must renew their registration to be able to legally continue in practice as a registered surgical assistant. Registration renewal is governed by the following:

(a) The due date for registration renewal is its expiration date, which is the last day of the month in which a registrant’s birthday falls pursuant to the Division of Health Related Boards “biennial birthdate renewal system” contained in Rule 1200-10-01-.10.

(b) Methods of Renewal - Registrants may accomplish renewal by one of the following methods:

Internet Renewals - Individuals may apply for renewal and pay the necessary Surgical Assistant Renewal Fee via the Internet. The application to renew can be accessed at: www.tn.gov/health 2. Paper Renewals - Registrants who have not renewed their authorization online via the Internet will have a renewal application form mailed to them at the last address provided by them to the Board prior to the expiration date of their current registration. Failure to receive such notification does not relieve the individual of the responsibility of timely meeting all requirements for renewal. To be eligible for renewal a registrant must submit to the Division of Health Related Boards on or before the registrant’s expiration date the following:

(i) A completed and signed renewal application form.

(ii) The Surgical Assistant Renewal Fee and state regulatory fees as provided in Rule 0880-02-.02.

(c) Any renewal application received after the expiration date but before the last day of the month following the expiration date must be accompanied by the Late Renewal Fee provided in Rule 0880-02-.02.

(d) Any individual who fails to comply with the registration renewal rules and/or notifications sent to them concerning failure to timely renew shall have their registration processed pursuant to Rule 1200-10-01-.10.

(e) Anyone submitting a signed renewal form, electronically or otherwise, which is found to be fraudulent or untrue may be subject to disciplinary action.

(f) Any registrant who receives notice of failure to timely renew pursuant to T.C.A. § 63-6- 210 and Rule 1200-10-01-.10, and who, on or before the last day of the month following the month in which the registration expires, executes, and files in the Board’s administrative office an affidavit of retirement pursuant to Rule 0880-02-.10 may have their registration retired effective on their registration expiration date.

(4) Registrants who have failed to renew timely may be reinstated upon meeting the following conditions:

(a) Submitting a complete renewal/reinstatement application;

(b) Submitting payment of the Surgical Assistant Registration Renewal Fee and late renewal fee provided in Rule 0880-02-.02;

(c) Submit, along with the application, documentation of successful completion of fifteen (15) hours of continuing education in compliance with Rule 0880-02-.26(8) for each period of twelve (12) months or less preceding the renewal/reinstatement request, up to sixty (60) hours; and (d) At the discretion of the Board, either appear before it or submit a notarized statement setting forth the good cause for failure to renew. An applicant for reinstatement who has been out of clinical practice for more than two years may be subject to any re-entry policy or guidelines the Board is using at the time of the reinstatement request.

(5) If derogatory information or communication is received during the renewal process, if requested by the Board or its duly authorized representative, the renewal/reinstatement applicant must appear before the Board, a duly constituted panel of the Board, a Board member, or a screening panel for an interview, and/or be prepared to meet or accept other conditions or restrictions as the Board may deem necessary to protect the public.

(6) Renewal issuance and reinstatement decisions pursuant to this rule may be made administratively subject to review by the Board, any Board member, or the Board Designee.

(7) Upon a finding by the Board that a registrant has violated any provision of the Tennessee Medical Practice Act at T.C.A. § 63-6-214, or these rules, discipline and civil penalties shall be governed by Rule 0880-02-.12.

(8) All registrants must complete thirty (30) hours of continuing education during the twenty-four (24) months that precede licensure renewal.

(a) Proof of Compliance - 1. Documentation verifying the registrant’s completion of the continuing education hours must consist of either:

(i) Original certificates or original letters from course providers verifying the registrant’s attendance and completion of the course; and (ii) Verification of the continuing education hours from NBSTSA, NSAA, or NCCSA; or (iii) Successful completion of the National Commission for the Certification of Surgical Assistants examination. Registrants must sit for and pass this examination prior to the expiration of the twenty-four (24) months that precede their registration renewal. Passage of this examination prior to the registrant’s expiration date will satisfy the thirty (30) hours of required continuing education for the preceding licensure cycle.

All registrants must retain independent documentation of completion of all continuing education and compliance with the provisions of these rules for a period of four (4) years from the end of the calendar year in which the continuing education was acquired.
This documentation must be produced for inspection and verification, if requested in writing by the Division during its verification process.

(b) Violations - Any registrant who fails to obtain the required continuing education hours or otherwise comply with the provisions of these rules will be subject to disciplinary action. Continuing education hours obtained as a result of compliance with the terms of Board Orders in any disciplinary action or obtained pursuant to licensure or renewal conditions mandated by the Board shall not be credited toward the continuing education required to be obtained in any calendar year.

(c) Waiver - The Board may waive the requirements of these rules in cases where illness, disability, or other undue hardship beyond the control of the registrant prevents a registrant from complying. Requests for waivers must be sent in writing to the Board prior to the expiration of the calendar year in which the continuing education is due.

History

Authority: T.C.A. § 63-6-219.
Administrative History: New rule filed October 4, 2021; effective January 2, 2022.

Tenn. Comp. R. & Regs. 0880-02-.27 LICENSURE PROCESS - GRADUATE PHYSICIAN

To practice as a graduate physician in Tennessee a person must possess a lawfully issued license from the Board. The Board in its discretion may issue licensure according to the following criteria, process, and qualifications:

(1) Definitions. In addition to the definitions contained in T.C.A. § 63-20-102, the following terms, are applicable to graduate physicians:

(a) “Collaborating physician” means a physician who holds an unencumbered license issued pursuant to Title 63, Chapter 6 or Chapter 9 with no disciplinary history, who is actively practicing in Tennessee, has entered into a graduate collaborative arrangement with a graduate physician licensee, and is board-certified in the specialty in which the graduate physician licensee is practicing.

(b) “Medically underserved rural area of the state” means:

An area or population group in this state designated by the United States Department of Health and Human Services as an area with a shortage of health care services; or 2. An area that the Tennessee Department of Health considers to be medically underserved based on relevant demographic, geographic, and environmental factors.

(c) “Supervision” means overseeing the activities of and accepting responsibility for the primary care services rendered by the graduate physician licensee. Supervision of each graduate physician licensee by the collaborating physician shall be continuous and require the physical presence of the collaborating physician at the place where primary care services are rendered except as provided in T.C.A. § 63-20-108(c)(5)(B).

(2) Qualifications for licensure. To practice medicine as a graduate physician licensee in Tennessee a person must possess a lawfully issued graduate physician license from the Board of Medical Examiners or Board of Osteopathic Examination. The procedure for obtaining such a license is as follows:

(a) An applicant shall obtain an application form from the Board Administrative Office or from the Board’s website, respond truthfully and completely to every question or request for information contained in the form, and submit it along with all documentation and fees required by the form and this rule to the Board’s Administrative Office.

(b) An applicant shall cause FCVS to release the applicant’s physician information profile to the Board.

(c) An applicant shall submit proof of United States citizenship or of being lawfully present in the United States pursuant to T.C.A. § 4-58-103.

(d) An applicant shall submit a clear and recognizable, recently taken, bust photograph which shows the full head, face forward from at least the top of the shoulders up.

(e) All applicants shall cause to be submitted a certificate of successful completion of Step 1 and Step 2 of the U.S.M.L.E., or Level 1 and Level 2 of the COMLEX-USA, or a combination of examinations approved by the Board of Medical Examiners or Board of Osteopathic Examination if not included in the FCVS physician information profile.

Successful completion must have occurred within the two-year period immediately preceding the date of application for licensure, but not more than three years after graduation from a medical school or osteopathic school.

(f) An applicant shall pay the applicable application fee and state regulatory fee as provided in 0880-02-.02.

(g) An applicant shall cause the result of a criminal background check to be submitted to the Board’s Administrative Office directly from the vendor identified in the Board’s licensure application materials.

(h) Application review and licensure shall be governed by Rule 0880-02-.07.

(i) An applicant shall submit any other documents as specifically requested by the Board of Medical Examiners or Board of Osteopathic Examination.

(3) In addition to the other requirements of this rule, graduates from any allopathic or osteopathic school outside of the United States shall submit the following:

(a) An E.C.F.M.G. certification status report if not included in the FCVS physician information profile.

(b) All documents required to be submitted by this rule shall be translated into English and such translation certified along with the original document as to authenticity by the issuing source.

(4) Issuance of the graduate physician license:

(a) If a graduate physician license is granted, the following shall apply:

The graduate physician license is restricted, though not disciplinary, to allow the practice of primary care services in the practice settings set forth in T.C.A. § 63- 20-103.
The graduate physician license shall be of a duration of two (2) years from the date of issuance.
The graduate physician license shall be nonrenewable and cannot be converted to a full and unrestricted license.
A graduate physician licensee may not serve as a supervising or collaborating physician to an advanced practice registered nurse or physician assistant.
A graduate physician licensee is subject to the same disciplinary proceedings as a full and unrestricted license under T.C.A. § 63-6-214 and T.C.A. § 63-9-111.

(b) Notification of intent to practice. Prior to practicing as a graduate physician, a licensed graduate physician must enter into a graduate physician collaborative practice arrangement, (“Collaborative arrangement”) with a collaborating physician no later than six (6) months after initial licensure and in accordance with T.C.A. §§ 63-20-101, et seq. Failure to enter into a collaborative arrangement with a collaborating physician within this timeframe shall invalidate the license. Any attempt to practice medicine on the invalidated license will constitute the unlicensed practice of medicine. A graduate physician licensee in this state must submit on forms provided by the Board of Medical Examiners and Board of Osteopathic Examination verification of a collaborative arrangement. This notification form shall include but is not limited to the following:

The name, license number, business address, email address, telephone number, and specialty in which board certification of the collaborating physician; and 2. The name, license number, business address, email address, telephone number, and the specialty in which the graduate physician is practicing.
An attestation by both the graduate physician licensee and the collaborative physician that they have entered into a collaborative arrangement, have accepted the responsibilities of that arrangement, and have read and understand the rules and statutes that govern the practice of graduate physicians in Tennessee.
Proof of the collaborating physician completing a certification course that meets the requirements set forth in this rule.

(c) A graduate physician licensee shall notify the Board of Medical Examiners or Board of Osteopathic Examination of any additions or changes, including termination of a collaborative arrangement, with a collaborating physician within thirty (30) calendar days of such occurrence.

(5) Scope of practice. A graduate physician licensee is limited to only performing primary care services under the supervision of a collaborating physician in the practice settings specified in T.C.A. § 63-20-103.

(a) A graduate physician licensee shall not provide patient care during the absence of the collaborating physician.

(b) A graduate physician licensee may perform those duties and responsibilities delegated by the collaborative arrangement, including the prescribing, administering, and dispensing of drugs and providing treatment as long as the primary care services are within the scope of the graduate physician licensee’s practice and is consistent with the graduate physician licensee’s skill, training, and competence and the skill, training, and competence of the collaborating physician.

(6) Collaborative arrangements. A written collaborative arrangement must be in place prior to the practice of medicine by a graduate physician licensee and it must comply with all provisions of T.C.A. §§ 63-20-101, et seq. along with the following additional requirements:

(a) The collaborative arrangement shall be signed and dated by the collaborating physician and the graduate physician licensee signifying that both parties are aware of its contents and agree to be subject to the terms of the collaborative arrangement.

(b) The collaborative arrangement shall contain mutually agreed upon protocols and any standing orders for the delivery of primary care services.

(d) The collaborative arrangement shall establish the relationship and access to the collaborating physician such that guidelines for consultation and referral to the collaborating physician or designated health care facility for services or emergency care that is beyond the education, training, competence, or scope of practice of the graduate physician licensee are developed.

(e) The collaborative arrangement shall outline how the graduate physician licensee will provide charts to the collaborating physician for review.

(f) The collaborative arrangement shall not allow a graduate physician licensee to see patients through telemedicine. The graduate physician licensee must treat all patients in person.

(g) The collaborative arrangement shall create written, measurable, and objective performance goals for evaluating the quality of care provided to patients by the graduate physician licensee.

(h) The collaborative arrangement shall require that all prescriptions and orders issued by the graduate physician licensee identify their collaborating physician and conform to all applicable state and federal statutes, rules, or regulations.

(i) The collaborative arrangement shall indicate the process for modification or termination of the arrangement by either party.

(j) The collaborative arrangement shall be reviewed annually and revised as needed by the collaborating physician and the graduate physician licensee. Documentation of the annual review shall be maintained as part of the collaborative arrangement and shall be made available upon request to the Board of Medical Examiners or Board of Osteopathic Examination.

(k) The collaborative arrangement and any subsequent addendum, modification or termination of the collaborative arrangement shall be in writing, signed and dated by the parties, and shall be maintained by the collaborating parties. The collaborating parties shall produce a copy of the collaborative arrangement, including any addendum, modification, or termination upon request by the Board of Medical Examiners or Board of Osteopathic Examination.

(l) Physicians shall report to the Board of Medical Examiners or Board of Osteopathic Examination the name of each graduate physician licensee with whom the physician has entered into an arrangement within thirty (30) days of entering into the arrangement, and also within thirty (30) days of the termination of any arrangement.

(7) Collaborating physician. In addition to the collaboration requirements and restrictions contained in T.C.A. §§ 63-20-101, et seq., the following requirements, are applicable to the collaborating physician:

(a) The collaborating physician must possess a current, unencumbered license to practice in the state of Tennessee.

(b) The collaborating physician must be board-certified in the specialty in which the graduate physician licensee is practicing and is limited to pediatrics, internal medicine, and family medicine.

(c) The collaborating physician shall not enter into a collaborative arrangement with more than three (3) graduate physician licensees at the same time.

(d) The collaborating physician must conduct a personal review of one hundred percent (100%) of the charts documenting the graduate physician licensee’s delivery of primary care services every day for the first month and every other day for months two (2) and three (3). For months four (4) through twelve (12), the collaborating physician must conduct a weekly personal review of seventy-five (75%) of the primary care services delivered by the graduate physician licensee. For months thirteen (13) through twentyfour (24), the collaborating physician shall conduct a personal review of twenty-five (25%) of the charts documenting the graduate physician licensee’s delivery of primary care services every fourteen (14) days. The graduate physician licensee is responsible for the submission of the charts to the collaborating physician. The documentation submission may be accomplished in person or by other electronic means.

(e) The collaborating physician shall complete a certification course prior to the practice of medicine by the graduate physician. Such course shall include at a minimum instruction on ethics, supervision principles, review and/or assessment, and risk management and must be at least six (6) hours in length. If the collaborating physician is on the faculty at an accredited medical or osteopathic school, proof of career development courses regarding education and supervising of healthcare trainees may satisfy this requirement. If these hours meet acceptable continuing education requirements, they may also be used to satisfy continuing medical education hours required for state licensure.

(f) The collaborating physician shall consider the level of skill, training, and competence of the graduate physician licensee and ensure that the delegated responsibilities are consistent with that level of skill, training, and competence and are within the collaborating physician’s level of competence.

History

Authority: T.C.A. § 63-20-105.
Administrative History: Emergency rules filed June 17, 2025; effective through December 14, 2025. New rule filed August 15, 2025; effective November 13, 2025.

Chapter 0880-03 Transferred to 1130-01

Tenn. Comp. R. & Regs. 0880-03-.01 TRANSFERRED

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-1-107, 63-6-101, 63-19-104, and 63-19-105; Public Chapter 33 of 1999; and Public Chapter 565 of 2021.
Administrative History: Original rule filed October 7, 1986; effective November 21, 1986. Amendment filed December 9, 1988; effective January 20, 1989. Amendment filed January 29, 1990; effective March 15, 1990. Amendment filed September 16, 1991; effective October 31, 1991. Repeal and new rule filed August 5, 1993; effective October 18, 1993. Repeal and new rule filed July 7, 1995; effective September 20, 1995. Amendment filed November 13, 1996; effective January 27, 1997. Amendment filed August 13, 1998; effective October 27, 1998. Amendment filed April 19, 1999; effective July 3, 1999. Amendment filed March 31, 1999; effective July 29,1999. Amendment filed April 10, 2000; effective June 24, 2000. Amendment filed March 9, 2001; effective May 23, 2001. Amendment filed August 6, 2002; effective October 20, 2002. Amendment filed August 28, 2002; effective November 11, 2002. Transferred to chapter 1130-01 on August 16, 2021, pursuant to Public Chapter 565 of 2021.

Tenn. Comp. R. & Regs. 0880-03-.02 TRANSFERRED

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-6-101, 63-19-104, 63-19-106, and 68-3-512; Public Chapter 33 of 1999; and Public Chapter 565 of 2021.
Administrative History: Original rule filed October 7, 1986; effective November 21, 1986. Amendment filed December 9, 1988; effective January 20, 1989. Amendment filed January 29, 1990; effective March 15, 1990. Amendment filed September 16, 1991; effective October 31, 1991. Repeal and new rule filed August 5, 1993; effective October 18, 1993. Repeal and new rule filed July 7, 1995; effective September 20, 1995. Amendment filed November 13, 1996; effective January 27, 1997. Amendment filed August 13, 1998; effective October 27, 1998. Repeal and new rule filed March 31, 1999; effective July 29, 1999. Amendment filed April 10, 2000; effective June 24, 2000. Amendment filed June 23, 2006; effective September 6, 2006. Transferred to chapter 1130-01 on August 16, 2021, pursuant to Public Chapter 565 of 2021.

Tenn. Comp. R. & Regs. 0880-03-.03 TRANSFERRED

History

Authority: T.C.A. §§ 4-5-202, 63-1-116, 63-1-145, 63-1-146, 63-6-101, 63-19-104, 63-19-105, 63-19- 108, and 63-19-114 and Public Chapter 565 of 2021.
Administrative History: Original rule filed August 5, 1993; effective October 18, 1993. Repeal and new rule filed July 7, 1995; effective September 20, 1995. Repeal and new rule filed March 31, 1999; effective July 29, 1999. Amendment filed August 5, 2010; effective November 3, 2010. Transferred to chapter 1130-01 on August 16, 2021, pursuant to Public Chapter 565 of 2021.

Tenn. Comp. R. & Regs. 0880-03-.04 TRANSFERRED

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-6-101, 63-19-104, and 63-19-105 and Public Chapter 565 of 2021.
Administrative History: Original rule filed December 9, 1988; effective January 20, 1989. Repeal and new rule filed August 5, 1993; effective October 18, 1993. Repeal and new rule filed July 7, 1995; effective September 20, 1995. Amendment filed August 13, 1998; effective October 27, 1998. Repeal and new rule filed March 31, 1999; effective July 29, 1999. Amendment filed March 9, 2001; effective May 23, 2001. Transferred to chapter 1130-01 on August 16, 2021, pursuant to Public Chapter 565 of 2021.

Tenn. Comp. R. & Regs. 0880-03-.05 TRANSFERRED

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-6-101, 63-6-214, 63-19-104, 63-19-105, 63-19-106, and 63- 19-107 and Public Chapter 565 of 2021.
Administrative History: Original rule filed March 27, 1989; effective May 11, 1989. Repeal and new rule filed August 5, 1993; effective October 18, 1993. Repeal and new rule filed July 7, 1995; effective September 20, 1995. Amendment filed August 13, 1998; effective October 27, 1998. Repeal and new rule filed March 31, 1999; effective July 29, 1999. Amendment filed March 9, 2001; effective May 23, 2001. Amendment filed August 6, 2002; effective October 20, 2002. Amendments filed March 17, 2006; effective May 31, 2006. Transferred to chapter 1130-01 on August 16, 2021, pursuant to Public Chapter 565 of 2021.

Tenn. Comp. R. & Regs. 0880-03-.06 TRANSFERRED

History

Authority: T.C.A. §§ 4-3-1011, 4-5-202, 63-1-103, 63-1-106, 63-1-108, 63-1-112, 63-19-104; 63-19-105, and 63-19-113 and Public Chapter 565 of 2021.
Administrative History: Original rule filed November 27, 1990; effective January 11, 1991. Repeal and new rule filed August 5, 1993; effective October 18, 1993. Repeal and new rule filed July 7, 1995; effective September 20, 1995. Amendment filed October 14, 1998; effective December 28, 1998. Repeal and new rule filed March 31, 1999; effective July 29, 1999. Amendment filed January 20, 2012; effective April 19, 2012. Amendments filed March 23, 2016; effective June 21, 2016. Transferred to chapter 1130-01 on August 16, 2021, pursuant to Public Chapter 565 of 2021.

Tenn. Comp. R. & Regs. 0880-03-.07 TRANSFERRED

History

Authority: T.C.A. §§ 4-5-102(3), 4-5-202, 4-5-204, 4-5-301, et seq., 63-6-101, 63-19-104, 63-19-105, and 63-19-111 and Public Chapter 565 of 2021.
Administrative History: Original rule filed September 16, 1991; effective October 31, 1991. Repeal and new rule filed August 5, 1993; effective October 18, 1993. Repeal and new rule filed July 7, 1995; effective September 20, 1995. Amendment filed November 13, 1996; effective January 27, 1997. Amendment filed October 14, 1998; effective December 28, 1998. Repeal and new rule filed March 31, 1999; effective July 29, 1999. Amendment filed August 6, 2002; effective October 20, 2002. Amendment filed August 28, 2002; effective November 11, 2002. Amendment filed August 5, 2010; effective November 3, 2010. Transferred to chapter 1130-01 on August 16, 2021, pursuant to Public Chapter 565 of 2021.

Tenn. Comp. R. & Regs. 0880-03-.08 TRANSFERRED

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-19-104, and 63-19-105 and Public Chapter 565 of 2021.
Administrative History: Original rule filed August 5, 1993; effective October 18, 1993. Repeal and new rule filed July 7, 1995; effective September 20, 1995. Repeal and new rule filed March 31, 1999; effective July 29, 1999. Amendment filed August 6, 2002; effective October 20, 2002. Transferred to chapter 1130- 01 on August 16, 2021, pursuant to Public Chapter 565 of 2021.

Tenn. Comp. R. & Regs. 0880-03-.09 TRANSFERRED

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-1-107, 63-19-104, and 63-19-105 and Public Chapter 565 of 2021.
Administrative History: Original rule filed August 5, 1993; effective October 18, 1993. Repeal and new rule filed July 7, 1995; effective September 20, 1995. Amendment filed November 13, 1996; effective January 27, 1997. Amendment filed August 13, 1998; effective October 27, 1998. Repeal and new rule filed March 31, 1999; effective July 29, 1999. Amendment filed August 28, 2002; effective November 11, 2002. Transferred to chapter 1130-01 on August 16, 2021, pursuant to Public Chapter 565 of 2021.

Tenn. Comp. R. & Regs. 0880-03-.10 TRANSFERRED

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-6-101, 63-19-104, 63-19-106, and 63-19-107; Public Chapter 33 of 1999; and Public Chapter 565 of 2021.
Administrative History: Original rule filed August 5, 1993; effective October 18, 1993. Repeal and new rule filed July 7, 1995; effective September 20, 1995. Amendment filed May 7, 1997; effective July 21, 1997. Amendment filed March 31, 1999; effective July 29,1999. Amendment filed April 10, 2000; effective June 24, 2000. Amendment filed March 9, 2001; effective May 23, 2001. Transferred to chapter 1130-01 on August 16, 2021, pursuant to Public Chapter 565 of 2021.

Tenn. Comp. R. & Regs. 0880-03-.11 TRANSFERRED

History

Authority: T.C.A. §§ 4-5-202, 63-19-104, and 63-19-113 and Public Chapter 565 of 2021.
Administrative History: Original rule filed August 5, 1993; effective October 18, 1993. Repeal and new rule filed July 7, 1995; effective September 20, 1995. Amendment filed November 13, 1996; effective January 27, 1997. Repeal and new rule filed March 31, 1999; effective July 29, 1999. Transferred to chapter 1130-01 on August 16, 2021, pursuant to Public Chapter 565 of 2021.

Tenn. Comp. R. & Regs. 0880-03-.12 TRANSFERRED

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-6-101, 63-19-104, and 63-19-105 and Public Chapter 565 of 2021.
Administrative History: Original rule filed August 5, 1993; effective October 18, 1993. Amendment filed August 18, 1994; effective November 1, 1994. Repeal and new rule filed July 7, 1995; effective September 20, 1995. Amendment filed November 13, 1996; effective January 27, 1997. Amendment filed August 13, 1998; effective October 27, 1998. Repeal and new rule filed March 31, 1999; effective July 29, 1999. Amendment filed July 31, 2000; effective October 14, 2000. Amendment filed March 9, 2001; effective May 23, 2001. Amendment filed August 6, 2002; effective October 20, 2002. Amendment filed May 18, 2007; effective August 1, 2007. Amendments filed March 23, 2016; effective June 21, 2016. Transferred to chapter 1130-01 on August 16, 2021, pursuant to Public Chapter 565 of 2021.

Tenn. Comp. R. & Regs. 0880-03-.13 TRANSFERRED

History

Authority: T.C.A. §§ 4-5-202, 63-19-104, and 63-19-108 and Public Chapter 565 of 2021.
Administrative History: Original rule filed July 7, 1995; effective September 20, 1995. Repeal and new rule filed March 31, 1999; effective July 29, 1999. Transferred to chapter 1130-01 on August 16, 2021, pursuant to Public Chapter 565 of 2021.

Tenn. Comp. R. & Regs. 0880-03-.14 TRANSFERRED

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-6-101, 63-19-104, and 63-19-105 and Public Chapter 565 of 2021.
Administrative History: Original rule filed July 7, 1995; effective September 20, 1995. Repeal and new rule filed March 31, 1999; effective July 29, 1999. Amendment filed August 6, 2002; effective October 20, 2002. Amendment filed August 5, 2010; effective November 3, 2010. Transferred to chapter 1130-01 on August 16, 2021, pursuant to Public Chapter 565 of 2021.

Tenn. Comp. R. & Regs. 0880-03-.15 TRANSFERRED

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 4-5-217, 4-5-223, 63-1-102, 63-1-122, 63-1-144, 63-6-101, 63-19- 104, 63-19-111, and 63-19-114 and Public Chapter 565 of 2021.
Administrative History: Original rule filed July 7, 1995; effective September 20, 1995. Amendment filed November 13, 1996; effective January 27, 1997. Amendment filed August 13, 1998; effective October 27, 1998. Repeal and new rule filed March 31, 1999; effective July 29, 1999. Amendment filed July 31, 2000; effective October 14, 2000. Amendment filed August 28, 2002; effective November 11, 2002. Amendment filed September 8, 2004; effective November 22, 2004. Amendment filed June 23, 2006; effective September 6, 2006. Amendment filed August 5, 2010; effective November 3, 2010. Amendments to rules (1)(j), (2), (3), (4), and (5) filed January 20, 2012; effective April 19, 2012. On April 17, 2012, the Board of Medical examiners filed a withdrawal of amendments to (2), (3), (4), and (5). Transferred to chapter 1130-01 on August 16, 2021, pursuant to Public Chapter 565 of 2021.

Tenn. Comp. R. & Regs. 0880-03-.16 TRANSFERRED

History

Authority: T.C.A. §§ 4-5-202, 63-1-106, 63-19-104, and 63-19-105 and Public Chapter 565 of 2021.
Administrative History: Original rule filed July 7, 1995; effective September 20, 1995. Repeal and new rule filed March 31, 1999; effective July 29, 1999. Transferred to chapter 1130-01 on August 16, 2021, pursuant to Public Chapter 565 of 2021.

Tenn. Comp. R. & Regs. 0880-03-.17 TRANSFERRED

History

Authority: T.C.A. §§ 4-5-202, 63-1-108, and 63-19-104 and Public Chapter 565 of 2021.
Administrative History: Original rule filed July 7, 1995; effective September 20, 1995. Repeal and new rule filed March 31, 1999; effective July 29, 1999. Transferred to chapter 1130-01 on August 16, 2021, pursuant to Public Chapter 565 of 2021.

Tenn. Comp. R. & Regs. 0880-03-.18 TRANSFERRED

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-1-201, 63-6-701 through 63-6-707, 63-19-104, 63-19-105, and 63-19-115 and Public Chapter 565 of 2021.
Administrative History: Original rule filed December 2, 2005; effective February 15, 2006. Transferred to chapter 1130-01 on August 16, 2021, pursuant to Public Chapter 565 of 2021.

Tenn. Comp. R. & Regs. 0880-03-.19 TRANSFERRED

History

Authority: T.C.A. §§ 4-5-105, 4-5-202, 4-5-204, 4-5-223, 4-5-224, 63-1-115, 63-1-117, 63-1-138, 63-6- 101, 63-19-103, 63-19-104, 63-19-105, 63-19-111, and 63-19-113 and Public Chapter 565 of 2021.
Administrative History: Original rule filed July 7, 1995; effective September 20, 1995. Amendment filed August 21, 1997; effective November 4, 1997. Repeal and new rule filed March 31, 1999; effective July 29, 1999. Amendment filed April 19, 1999; effective July 3, 1999. Amendment filed June 23, 2006; effective September 6, 2006. Amendment filed April 17, 2007; effective July 1, 2007. Transferred to chapter 1130-01 on August 16, 2021, pursuant to Public Chapter 565 of 2021.

Tenn. Comp. R. & Regs. 0880-03-.20 TRANSFERRED

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-1-145, 63-1-146, 63-6-101, 63-19-104, and 63-19-114 and Public Chapter 565 of 2021.
Administrative History: Original rule filed July 7, 1995; effective September 20, 1995. Repeal and new rule filed March 31, 1999; effective July 29, 1999. Amendment filed March 22, 2007; effective June 5, 2007. Transferred to chapter 1130-01 on August 16, 2021, pursuant to Public Chapter 565 of 2021.

Tenn. Comp. R. & Regs. 0880-03-.21 TRANSFERRED

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 53-10-201, et seq., 63-6-101, 63-19-104, and 63-19-107 and Public Chapter 565 of 2021.
Administrative History: Original rule filed July 7, 1995; effective September 20, 1995. Amendment filed May 7, 1997; effective July 21, 1997. Amendment filed April 19, 1999; effective July 3, 1999. Amendment filed March 31, 1999; effective July 29, 1999. Amendment filed April 10, 2000; effective June 24, 2000. Amendment filed March 9, 2001; effective May 23, 2001. Amendment filed June 26, 2003; effective September 9, 2003. Amendment filed June 23, 2006; effective September 6, 2006. Transferred to chapter 1130-01 on August 16, 2021, pursuant to Public Chapter 565 of 2021.

Tenn. Comp. R. & Regs. 0880-03-.22 TRANSFERRED

History

Authority: T.C.A. §§ 4-5-202, 63-19-104, and 68-11-222 and Public Chapter 565 of 2021.
Administrative History: Original rule filed July 7, 1995; effective September 20, 1995. Repeal and new rule filed March 31, 1999; effective July 29, 1999. Transferred to chapter 1130-01 on August 16, 2021, pursuant to Public Chapter 565 of 2021.

Tenn. Comp. R. & Regs. 0880-03-.23 TRANSFERRED

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-19-104, 63-51-105 (Public Chapter 1073 of the Public Acts of 1998, Section 5, Subsection (5)), and 63-51-106 and Public Chapter 565 of 2021.
Administrative History: Original rule filed February 10, 2000; effective April 25, 2000. Transferred to chapter 1130-01 on August 16, 2021, pursuant to Public Chapter 565 of 2021.

Tenn. Comp. R. & Regs. 0880-03-.24 TRANSFERRED

History

Authority: T.C.A. §§ 53-10-401, 63-19-104, and 63-19-107(2)(E) [effective October 1, 2008 for TennCare prescriptions and July 1, 2009 for non-TennCare prescriptions]; Public Chapter 1035 of 2008; and Public Chapter 565 of 2021.
Administrative History: Public necessity rule filed June 30, 2009; effective through December 12, 2009. Public necessity rule filed June 30, 2009 expired; on December 13, 2009, the rule reverted to its prior status. Emergency rule filed December 21, 2009; effective through June 19, 2010. Original rule filed March 22, 2010; effective June 20, 2010. Transferred to chapter 1130-01 on August 16, 2021, pursuant to Public Chapter 565 of 2021.

Tenn. Comp. R. & Regs. 0880-03-.25 TRANSFERRED

History

Authority: T.C.A. § 63-1-162 and Public Chapter 565 of 2021.
Administrative History: Emergency rule filed March 29, 2019; effective through September 25, 2019. Original rule filed May 14, 2019; effective August 12, 2019. Transferred to chapter 1130-01 on August 16, 2021, pursuant to Public Chapter 565 of 2021.

Chapter 0880-04 Transferred to 0150

Tenn. Comp. R. & Regs. 0880-04 Transferred to 0150

RULES

OF THE TENNESSEE BOARD OF MEDICAL EXAMINERS

THE PRACTICE OF ATHLETIC TRAINERS

RESERVED

Chapter 0880-05 General Rules and Regulations Governing the Utilization of X-Ray Operators in Physician's Offices

Tenn. Comp. R. & Regs. 0880-05-.01 DEFINITIONS

As used in this Chapter of rules the following terms and acronyms will have the meaning ascribed to them:

(1) A.R.R.T. - American Registry of Radiologic Technologists.

(2) Full Certification - Certification obtained by submitting certification issued by the A.R.R.T. which will enable the holder to perform, except for bone densitometry, any and all radiographic procedures or functions in a physician's office.

(3) Limited Certification - Certification issued by the Tennessee Board of Medical Examiners which enables the holder to perform only those radiological procedures or functions intended for the body areas or specialty indicated on the issued certification, other than those procedures involving the administration of contrast media.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-6-101, 63-6-224, and Public Chapter 956 of the Public Acts of 2000.
Administrative History: Original rule filed March 4, 1985; effective April 3, 1985. Repeal and new rule filed December 7, 1993; effective February 20, 1994. Amendment filed August 31, 2000; effective November 14, 2000. Amendment filed March 22, 2006; effective June 5, 2006.

Tenn. Comp. R. & Regs. 0880-05-.02 FEES

The following fees are nonrefundable and apply to all applicants and certificate holders. All fees may be paid in person, by mail or electronically by cash, check, money order, or by credit and/or debit cards accepted by the Division. If the fees are paid by certified, personal or corporate check they must be drawn against an account in a United States Bank, and made payable to the Tennessee Board of Medical Examiners.

(1) Application and Certification Fee - To be paid by all applicants at the time an application is filed.

Limited Certification $100.00 Full Certification $ 50.00 (2) Biennial Certification Renewal Fee - To be paid $ 50.00 by all persons holding certification.

(3) State Regulatory Fee - To be paid upon application $ 5.00 and annually thereafter to be collected at biennial ($10.00 biennially) renewal from all certificate holders.

(4) Late Renewal - Reactivation Fee $100.00

History

Authority: T.C.A. §§ 4-3-1011, 4-5-202, 4-5-204, 63-6-101, and 63-6-224.
Administrative History: Original rule filed March 4, 1985; effective April 3, 1985. Repeal and new rule filed December 7, 1993; effective February 20, 1994. Amendment filed May 7, 1997; effective July 21, 1997. Amendment filed August 16, 2002; effective October 30, 2002.

Tenn. Comp. R. & Regs. 0880-05-.03 CERTIFICATION REQUIREMENT

All persons operating x-ray machines in physicians’ offices in Tennessee must possess a certificate issued by the Board pursuant to this Chapter of rules with the exception of the following who are exempted from certification:

(1) Licensed medical doctors (2) Medical interns, residents and clinical fellows (3) Students engaged in clinical practice while enrolled in a Board approved radiological education course required to receive radiological certification.

(4) Graduates of a Board approved radiological education course who are awaiting examination but only for a period not to exceed six (6) months from the date that the course was completed. After sitting for the examination this exemption shall continue for a period not to exceed seventy five (75) days. At all times while awaiting examination or examination results and until certification is received, graduates shall practice only under supervision as set forth in rule 0880-05-.05 (2)(c).

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-6-101, 63-6-224, and Public Chapter 956 of the Public Acts of 2000.
Administrative History: Original rule filed March 4, 1985; effective April 3, 1985. Amendment filed April 23, 1986; effective May 23, 1986. Repeal and new rule filed December 7, 1993; effective February 20, 1994. Amendment filed May 7, 1997; effective July 21, 1997. Amendment filed August 31, 2000; effective November 14, 2000.

Tenn. Comp. R. & Regs. 0880-05-.04 QUALIFICATIONS FOR FULL AND LIMITED CERTIFICATION

(1) Certification areas:

(a) Limited certification is available until June 1, 2008 from the Board in the following specific specialty areas:

Chest 2. Extremities 3. Skull - AP/PA and Lateral Skull Only, and Sinuses 4. Lumbar Spine - AP and Lateral Lumbar Spine Only (b) After June 1, 2008 limited certification is available from the Board in only the following specific specialty areas:
Chest 2. Extremities 3. Skull and Sinus 4. Spine (c) Persons who hold a limited certification in "Lumbar Spine - AP and Lateral Lumbar Spine Only" pursuant to part (1)(a)4. may have their certification changed to reflect the expanded specialty area "Spine" listed in part (1)(b)4. by submitting to the Board's administrative office on or before June 1, 2012 documentation of having completed a course(s) that includes instruction in all of the following subject areas.
Cervical – includes AP/PA, lateral, obliques, and open mouth odontoid.
Thoracic – includes AP/PA, lateral, and Swimmers.
Lumbar – includes AP/PA, lateral, spot lateral of L5-S1, and obliques.

(d) On June 1, 2012 those who have not submitted the necessary documentation to obtain the expanded designation as required by subparagraph (1)(c) shall not be authorized to participate in the expanded areas in the "spine" certification and their certification will entitle them to only take AP and Lateral Lumbar Spine radiographs.

(e) On June 1, 2008, the certificates that are designated "Skull - AP/PA and Lateral Skull Only, and Sinuses" shall automatically be converted to the designation "Skull and Sinus" without any further action by the holder of such limited certification.

(2) Unless otherwise qualified pursuant to paragraph (3) of this rule, to be eligible for a limited or full radiological certification a person must meet the following minimum qualifications:

(a) Be at least eighteen (18) years of age; and (b) Possess a high school diploma or a GED certificate; and (c) Be of good moral character; and (d) Be free from physical or mental impairment which would interfere with the performance of duties or otherwise constitute a hazard to the health and safety of patients; and (e) Cause to have submitted verification of attendance and successful completion of a Board approved radiological certification training course for the type of certification sought pursuant to Rule 0880-05-.05(2) or cause to be submitted verification of an A.R.R.T. certificate; and (f) Have successfully completed the Board approved examination pursuant to Rule 0880- 05-.06 or possess an A.R.R.T. certificate; and (g) Cause to be submitted to the Board’s administrative office directly from the vendor identified in the Board’s licensure application materials, the result of a criminal background check; and (h) Have made application for certification pursuant to Rule 0880-05-.07 and paid all fees.

(3) Any person who holds a radiological certificate issued by another state obtained pursuant to standards and procedures substantially equivalent to the standards set by these Rules may receive a certification at an appropriate level at the Board’s discretion upon compliance with subparagraph (2)(g) of this rule.

(4) Any person who holds a certification issued by the A.R.R.T. who meets the qualifications of paragraph (2) of this rule may receive full certification from the Board.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-6-101, 63-6-214, 63-6-224, and Public Chapter 956 of the Public Acts of 2000.
Administrative History: Original rule filed March 4, 1985; effective April 3, 1985. Amendment filed April 23, 1986; effective May 23, 1986. Repeal and new rule filed December 7, 1993; effective February 20, 1994. Amendment filed July 12, 1995; effective September 25, 1995. Amendment filed August 31, 2000; effective November 14, 2000. Amendment filed May 28, 2003; effective August 11, 2003. Amendments filed March 14, 2006; effective May 28, 2006. Amendment filed May 27, 2008; effective August 10, 2008

Tenn. Comp. R. & Regs. 0880-05-.05 EDUCATIONAL COURSE, APPROVAL AND CURRICULUM FOR LIMITED

CERTIFICATION.

(1) Course approval (a) To be approved to provide limited radiological certification training the educational course director must obtain Board approval by submitting the following information to the Board Administrative Office:

Location of the course; and 2. Names of physicians, A.R.R.T. technologists, physicists, or other work qualified personnel who are acting as instructors. Individuals with just a limited x-ray certification, without further credentials that this rule allows or the Board feels uniquely qualifies them to instruct students in a particular subject, may not under any circumstances teach or otherwise provide limited radiological certification training; and 3. Course description and curriculum.

(b) If the substance of the requirements in subparagraph (1)(a) changes the course provider must submit, within fifteen (15) days of the change, a new request for course approval. Course approval may be withdrawn for failure to timely submit the new request and/or for changes that result in the course no longer meeting the requirements of subparagraph (1)(a).

(c) To remain approved to provide limited radiological certification training the educational course director must obtain Board approval every two (2) years by submitting the information required in subparagraph (1)(a).

(2) The following curriculum is mandatory for all limited certification education programs and course approval shall be based upon the level of radiological education obtainable through the program courses according to the following:

(a) Basic Course - Defined as the core, theory or foundation education basic to radiography. The basic course is prerequisite to any specialty area certification but need be successfully completed only once. The basic radiological course shall include, but not be limited to, imaging equipment, principles of radiographic exposure, radiation protection, radiographic quality and radiographic film processing. This course shall consist of fifty (50) clock hours. Successful completion of this basic course can be substituted for the course required for limited certification in bone densitometry.

(b) Specialty Areas - Defined as the study of radiography of a particular anatomical part including human structure and function, radiographic positioning and procedures, and evaluation of radiographs. Each separate specialty area course shall minimally consist of the following amount of classroom clock hours:

Chest — ten (10) classroom clock hours;
Extremities — until June 1, 2008 ten (10) classroom clock hours and thereafter forty (40) classroom clock hours;
Skull and Sinuses — ten (10) classroom clock hours; and 4. Spine — until June 1, 2008 ten (10) classroom clock hours and thereafter thirty (30) classroom clock hours.

(c) Clinical Training - Defined as "hands-on" observation and participation in the production of diagnostic radiographs. Clinical training must be supervised by either a residency-trained radiologist, or by a licensed physician in conjunction and consultation with a fully-licensed and registered operator (A.R.R.T. technologist) with at least three (3) years experience when appropriate. This training shall minimally consist of the following amount of clinical clock hours for each specialty area in which certification is sought:

Chest — until June 1, 2008 sixty (60) clinical clock hours and thereafter thirty (30) clinical clock hours;
Extremities — until June 1, 2008 sixty (60) clinical clock hours and thereafter eighty (80) clinical clock hours;
Skull and Sinuses — until June 1, 2008 sixty (60) clinical clock hours and thereafter thirty (30) clinical clock hours; and 4. Spine — until June 1, 2008 sixty (60) clinical clock hours and thereafter eighty (80) clinical clock hours.

(d) Specialty areas defined 1. Chest - includes visceral thorax only; routine projections are PA, AP, Lateral, Oblique, Decubitus, and Apical Lordotic, but does not include ribs or sternum.

Extremities (i) Upper Extremity — includes all routine views of the fingers up through the pectoral girdle.

(ii) Lower Extremity includes the toes up through the femur including routine unilateral hip joint views, but not the pelvis.

Skull and Sinuses (i) Skull — includes AP/PA, Townes and Lateral.

(ii) Sinuses — includes upright PA/Caldwell, Lateral, and Waters.

Spine - Prior to June 1, 2008 shall be limited to only the AP/PA and Lateral Lumbar Spine but thereafter for those who have complied with rule 0880-05-.04 (1)(c) shall include the following:

(i) Cervical — includes AP/PA, lateral, obliques, and open mouth odontoid.

(ii) Thoracic — includes AP/PA, lateral, and Swimmers.

(iii) Lumbar — includes AP/PA, lateral, spot lateral of L5-S1, and obliques.

(3) Course approval may be withdrawn if the Board finds the course is in violation of any of its statutes or regulations or if the Board finds the course inadequate for certification purposes based upon random auditing of the course and/or its effectiveness in producing qualified graduates. The minimum standard for continued course approval shall be based upon at least a sixty-five percent (65%) graduate pass rate for first time takers on the examinations over at least a six (6) month period.

(4) The Board of Medical Examiner’s designee may issue course approval subject to subsequent Board ratification.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-6-101, and 63-6-224.
Administrative History: Original rule filed March 4, 1985; effective April 3, 1985. Repeal and new rule filed December 7, 1993; effective February 20, 1994. Amendment filed July 12, 1995; effective September 25, 1995. Amendment filed August 31, 2000; effective November 14, 2000. Amendment filed October 4, 2002; effective December 18, 2002. Amendment filed May 28, 2003; effective August 11, 2003. Amendment filed March 22, 2007; effective June 5, 2007. Amendment filed May 27, 2008; effective August 10, 2008.

Tenn. Comp. R. & Regs. 0880-05-.06 .

(c) The original certification will be amended indicating all appropriate certification areas and returned to the applicant.

(4) Application review and decisions shall be governed by Rule 0880-2-.07 (1) through (5).

History

Authority: T.C.A. §§ 4-3-1011, 4-5-202, 4-5-204, 63-6-101, and 63-6-224.
Administrative History: Repeal and new rule filed December 7, 1993; effective February 20, 1994. Amendment filed May 7, 1997; effective July 21, 1997. Amendment filed May 28, 2003; effective August 11, 2003. Amendment filed May 27, 2008; effective August 10, 2008.

Tenn. Comp. R. & Regs. 0880-05-.07 OBTAINING AND UPGRADING FULL AND LIMITED CERTIFICATION

(1) Initial Certification (a) An applicant shall obtain an application form from the Board Administrative Office, respond truthfully and completely to every question or request for information contained in the form and submit it along with all documentation and fees required by the form and this rule to the Board Administrative Office. It is the intent of this rule that all steps necessary to accomplish the filing of the required documentation be completed prior to filing an application and that all documentation be filed simultaneously.

(b) For Limited Certification 1. An applicant shall cause to be submitted from the radiological educational course director to the Board Administrative Office certification of successful completion of the basic course and any specialty area(s) course(s) required by rule 0880-05- .05(2) which shall include certification from the supervising physician(s) of successful completion of the required clock hours of clinical training for each separate area of specialty certification applied for.

An applicant shall submit the Application and Certification Fee as provided in

Rule 0880-05-.02(1) and the State Regulatory Fee as provided in Rule 0880-05- .02(3). Limited certification requires only these fees unless limited certification is extended into other areas at a later time.

Applicants applying pursuant to Rule 0880-05-.04(3) need only submit the following:

(i) The application form; and (ii) A certificate of fitness or endorsement from the States in which the applicant holds certification; and (iii) A copy of all documents necessary to show the educational and procedural requirements for certification in all states in which the applicant holds certification, and (iv) A clear, recognizable, recently taken bust photograph which shows the full head, face forward from at least the top of the shoulder up; and (v) The Application and Certification Fee as provided in Rule 0880-05-.02(1) and the State Regulatory Fee as provided in 0880-05-.02(3).

(c) For Full Certification 1. An applicant shall submit with the application a copy of his or her A.R.R.T. identification card which must be current and in good standing.

An applicant shall pay the application and certification fee and the state regulatory fee provided by rule 0880-05-.02(1) and (3).
An applicant shall submit a clear, recognizable, recently taken bust photograph which shows the full head, face forward from at least the top of the shoulder up.

(2) Upon approval for issuance of certification, the Board shall issue a certificate which contains either the specific radiological limitations as reflected by the application materials received or "full certification" as that term is defined in Rule 0880-05-.01(2).

(3) Upgrading Limited Certification - Persons holding limited certifications may upgrade their certification by submitting a written request along with their original certificate to the Board Administrative Office and complying with the following:

(a) Having the director of a Board approved specialty area(s) radiological education course(s) submit directly to the Board Administrative Office documentation indicating the additional clock hours and type of education received as required by rule 0880-05- .05(2)(b) and (c) along with certification from the supervising physician(s) of successful completion of the clock hours of clinical training for each separate area in which certification is sought.

(b) Have submitted proof of successful completion of all examinations required by Rule

Tenn. Comp. R. & Regs. 0880-05-.08 MAINTAINING CERTIFICATION, RENEWAL, RETIREMENT AND REINSTATEMENT

(1) All certificate holders must renew their certificates to be able to legally continue in practice.

Renewal is governed by the following:

(a) The due date for renewal is its expiration date which is the last day of the month in which a certificate holder's birthday falls pursuant to the Division of Health Related Boards "biennial birthdate renewal system" contained in rule 1200-10-01-.10.

(b) Methods of Renewal - Renewal may be accomplished by one of the following methods:

Internet Renewals - Individuals may apply for renewal and pay the necessary fees via the Internet. The application to renew can be accessed at: https://apps.tn.gov/hlrs/ 2. Paper Renewals - Certificate holders who have not renewed their authorization online via the Internet will have a renewal application form mailed to them at the last address provided by them to the Board prior to the expiration date of their current certificate. Failure to receive such notification does not relieve the individual of the responsibility of timely meeting all requirements for renewal. To be eligible for renewal a certificate holder must submit to the Division of Health Related Boards on or before the certificate’s expiration date the following:

(i) A completed and signed renewal application form.

(ii) The renewal and state regulatory fees as provided in Rule 0880-05-.02.

(d) Any individual who fails to comply with the renewal rules and/or notifications sent to them concerning failure to timely renew shall have their certificates processed pursuant to rule 1200-10-01-.10.

(e) Anyone submitting a signed renewal form, electronically or otherwise, which is found to be fraudulent or untrue may be subject to disciplinary action.

(f) Any certificate holder who receives notice of failure to timely renew pursuant to rule

Tenn. Comp. R. & Regs. 1200-10-01-.10 , and who, on or before the last day of the month following the month in which the certificate expires, executes and files in the Board's administrative office an affidavit of retirement pursuant to paragraph (2) of this rule may have their certificate retired effective on their certificate’s expiration date.

(2) Certificate Retirement (a) Certificate holders who wish to retain their certification but not actively practice will not be required to comply with the certification renewal process by doing the following:

Obtain from, complete and submit to the Board Administrative Office an affidavit of retirement form.
Submit any documentation which may be required by the form to the Board Administrative Office.

(b) Upon successful application for retirement of certification with completion and receipt of all proper documentation to the Board's satisfaction, the Board shall register the certificate as retired. Any person who has a retired certificate may not practice in Tennessee.

(3) Reactivation - Any certificate holder whose certificate has been retired or processed pursuant to rule 1200-10-01-.10 for failure to timely renew may re-enter active practice by doing the following:

(a) Submit a written request for a Reactivation Application to the Board Administrative Office; and (b) Fully complete and submit the Board's Reactivation Application along with payment of:

For those reactivating a retired certificate the certification renewal fee.
For those who are reactivating a certificate processed pursuant to rule 1200-10- 1-.10 for failure to timely renew all past due renewal fees and the late renewal fee.

(c) To reactivate an expired certification submit, along with the Board's Reactivation Application, documentation of successful completion of the continuing education requirements provided in rule 0880-05-.09 for all the calendar years (January 1 – December 31) that the certification was expired that precede the calendar year during which the reactivation is requested; or (d) To reactivate a retired certification submit, along with the Board's Reactivation Application, documentation of successful completion of twenty (20) hours of continuing education, as provided in rule 0880-05-.09, during the two (2) calendar years (January 1 – December 31) that precede the calendar year during which the reactivation is requested.

(e) If requested, after review by the Board, a designated Board member, or the Board’s consultant appear before either the Board, or a duly constituted panel of the Board, or another Board member, or the Board Designee for an interview regarding continued competence in the event of certification retirement, administrative revocation or other practice inactivity in excess of two (2) years and meet such other requirements the Board feels necessary to establish current levels of competency.

(4) Renewal issuance and reactivation decisions pursuant to this rule may be made administratively subject to review by the Board, any Board member or the Board Designee.

History

Authority: T.C.A. §§ 4-3-1011, 4-5-202, 4-5-204, 63-6-101, and 63-6-224.
Administrative History: Repeal and new rule filed December 7, 1993; effective February 20, 1994. Amendment filed May 7, 1997; effective July 21, 1997. Amendment filed August 31, 2000; effective November 14, 2000. Amendment filed September 5, 2002; effective November 19, 2002. Amendment filed November 23, 2005; effective February 6, 2006.

Tenn. Comp. R. & Regs. 0880-05-.09 CONTINUING EDUCATION

(1) Continuing Education - Hours Required (a) Each person certified by the Board must biennially attend and complete twenty (20) hours of radiological related continuing education in courses approved by the Board.

(b) Two (2) of the required twenty (20) biennial continuing education hours must be pertaining to appropriate statutes, rules and regulations, and other subjects that would be directly related to compliance with, and/or penalties for non-compliance with the statutes, rules and regulations. This course must include content pertaining to the A.R.R.T.'s Standards of Ethics if the certificate holder is fully certified.

(c) The Board approves courses for only the number of hours contained in the course. The approved hours of any individual course will not be counted more than once in a two (2) year period toward the required hourly total regardless of the number of times the course is attended or completed by any individual certificate holder.

(2) Continuing Education - Proof of Compliance (a) The due date for proof of attendance and completion of the required continuing education hours each certificate holders biennial renewal due date.

(b) Each person must, on a Board provided form, check a box and/or enter signature which indicates attendance and completion of the required continuing education hours and that such hours were obtained during the preceding two (2) calendar years.

(c) Each person must retain proof of attendance and completion of all continuing education courses. This documentation must be retained for a period of four (4) years from the end of the calendar year in which the course is completed. This documentation must be produced for inspection and verification, if requested in writing by the Board during its verification process.

(3) Continuing Education - Course Approval (a) Courses to be offered for credit toward the required continuing education hours must, unless otherwise provided, receive prior approval from the Board.

(b) Prior approval of a course may be obtained by submitting the following information to the Board Administrative Office at least thirty (30) days prior to the scheduled date of the course.

a course description or outline.
names of all lecturers.
brief resume of all lecturers.
number of hours of educational credit requested.
date of course.
copies of materials to be utilized in the course.
how verification of attendance is to be documented.

Lecture.
Audiovisual - with successful completion of a written post experience examination to evaluate material retention.
Correspondence - with successful completion of a written post experience examination to evaluate material retention.
Any combination of the above.

(d) The following courses need not receive prior approval and shall constitute Board approved continuing education courses:

Courses sponsored or approved by any of the following organizations:

(vii) American College of Radiology 2. Educational courses sponsored by an accredited school of medicine or radiological health. If such course is taken for or assigned quarter or semester credit hours, three (3) quarter hours or equivalent semester hours shall be equivalent to fifteen (15) continuing education hours. No credits will be counted for courses failed.

(e) Individual Board members and the Board’s designee are vested with the authority to approve continuing education courses submitted in compliance with this rule. All such approvals must be presented to the full Board for ratification.

(4) Violations (a) Any person who falsely attests to attendance and completion of the required hours of continuing education may be subject to decertification.

(b) Any person who fails to obtain the required continuing education hours may be subject to decertification.

(c) Education hours obtained as a result of compliance with the terms of an informal settlement or Board Orders in any disciplinary action shall not be counted toward the continuing education hours required to be obtained by Rule 0880-05-.09(1)(a).

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-6-101, 63-6-224, and Public Chapter 956 of the Public Acts of 2000.
Administrative History: Repeal and new rule filed December 7, 1993; effective February 20, 1994. Amendment filed August 31, 2000; effective November 14, 2000. Amendment filed November 23, 2005; effective February 6, 2006. Amendment filed May 27, 2008; effective August 10, 2008.

Tenn. Comp. R. & Regs. 0880-05-.10 SCOPE OF PRACTICE

(1) Each person certified by the Board must practice only in the certified specialty areas contained on the certificate as issued or upgraded and only for the types of radiographs specified in these rules. Practicing radiography beyond the scope of certification is grounds for decertification.

(2) Board issued certificates shall be posted in a location visible to all patients receiving radiographic examinations.

(3) Certificates issued by the Board are subject to being disciplined for the same causes, to the same extent and pursuant to the same procedures as issued medical licenses.

(4) A.R.R.T. certificate holders are fully certified and, except as provided in subparagraph (a), may perform any and all radiographic procedures or functions in a physician’s office that are within the American Society of Radiologic Technologists’ (A.S.R.T.) scope of practice for radiographers.

(a) Performing bone densitometry is not considered to be within the Board’s scope of practice for fully certified A.R.R.T. certificate holders.

(b) A.R.R.T. certificate holders who wish to perform bone densitometry and who receive initial certification as an x-ray operator in Tennessee after July 1, 2006 are required to:

obtain the A.R.R.T.’s certification in bone densitometry (BD) by successfully completing the A.R.R.T.’s Bone Densitometry Clinical Experience Requirements; or 2. obtain limited certification in bone densitometry, pursuant to Rule 0880-05-.11.

(5) Under no circumstances may a person with limited certification perform any procedure utilizing contrast media or any invasive radiological procedure.

(6) Under no circumstances may a person with limited certification perform any procedure utilizing CT (Computer-assisted Tomography) or Fluoroscopy (including C-Arm units).

(7) Certification pursuant to these rules does not authorize the certificate holder to perform MRI (Magnetic Resonance Imaging) or Ultrasound procedures, both of which are beyond the scope and capabilities of limited licensed operators.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-6-101, 63-6-224, and Public Chapter 956 of the Public Acts of 2000.
Administrative History: Repeal and new rule filed December 7, 1993; effective February 20, 1994. Amendment filed August 31, 2000; effective November 14, 2000. Amendment filed May 28, 2003; effective August 11, 2003. Amendment filed March 22, 2006; effective June 5, 2006.

Tenn. Comp. R. & Regs. 0880-05-.11 BONE DENSITOMETRY

All persons unless otherwise exempted who operate bone densitometry equipment in Tennessee must comply with the following:

(1) Fees - The same fees contained in rule 0880-05-.02 shall apply to individuals under this rule.

(2) Exemptions - The same persons exempted pursuant to rule 0880-05-.03 are exempted from the provisions of this rule.

(3) Qualifications for Certification - (a) To be eligible for a limited radiological certification in bone densitometry a person must meet the following minimum qualifications:

Be at least eighteen (18) years of age; and 2. Possess a high school diploma or a GED certificate; and 3. Be of good moral character; and 4. Be free from physical or mental impairment which would interfere with the performance of duties or otherwise constitute a hazard to the health and safety of patients; and 5. Cause to have submitted verification of attendance and successful completion of a Board-approved radiological certification training course; and 6. Have successfully completed the Board-approved examination pursuant to subparagraph (4)(f) of this rule; and 7. Cause to be submitted to the Board’s administrative office directly from the vendor identified in the Board’s licensure application materials, the result of a criminal background check; and 8. Have made application for certification pursuant to Rule 0880-05-.07 and paid all fees.

(b) Any person who holds a radiological certificate issued by another state obtained pursuant to standards and procedures substantially equivalent to the standards set by these rules may receive a certification at the Board’s discretion.

(c) Any person who now holds a limited certification issued by the Board may receive limited certification upgrade in bone densitometry without compliance with the provisions of paragraphs (4)(b) through (d) of this rule.

(d) Any person who has successfully completed the course described in rule 0880-05- .05(2)(a) and has not applied for any limited certification from the Board may receive limited certification in bone densitometry without compliance with the provisions of paragraphs (4)(b) through (d) of this rule.

(4) Educational Course, Approval and Curriculum for Certification - (a) Course approval under this rule shall be governed by rule 0880-05-.05(1) and (3).

(b) The Basic Course - Defined as the core, theory of foundation education basic to operation of bone densitometry equipment. This basic course shall include, but not be limited to: radiation protection & safety; principles of exposure of bone densitometry scanning machines; patient care; and anatomy of long bones and spine, including construction of bone, destruction of bone, and measurement of bone mass.

(c) Course approval shall be based upon the level of radiological education obtainable through the program courses. This course shall consist of twenty-four (24) clock hours.

(d) Completion of this basic course will not qualify anyone for limited certification in any body area other than bone densitometry.

(e) All applicants must have machine specific training according to the following:

The applicant must receive training on the same type machine that (s)he will be operating.
This machine-specific training may be done by the Manufacturer (or authorized Representative) or by a person holding a Certificate in Bone Densitometry and who has received machine-specific training by the Manufacturer on the appropriate machine.
The machine-specific training shall include, but not be limited to: Identification of machine components; Operation of machine; Exposure doses for various scans from the machine; Positioning for each scan procedure; Adjusting for errors;

Image Acquisitions; Reference Databases; Quality Control Procedures.

All training must result in a Statement of Training being signed by the Manufacturer (or authorized Representative) or by a person holding a Certificate in Bone Densitometry and who has received machine-specific training by the Manufacturer on the appropriate machine. The Statement of Training shall be issued to the trainee, and sent to the Board’s Administrative Office.

(f) Examination 1. All applicants must provide proof of having successfully completed the A.R.R.T.’s Limited Bone Densitometry Equipment Operators Examination.

An applicant will be deemed to have successfully completed the A.R.R.T.’s Limited Bone Densitometry Equipment Operators Examination upon correctly answering sixty-five percent (65%) of all questions contained on the examination.

(g) Clinical bone scanning must be supervised by a licensed physician.

(h) The clinical training obtained pursuant to this rule cannot be utilized as clinical training hours in qualification for limited certification in any other body areas.

(i) The following rules apply to certifications applied for and issued pursuant to this rule and are enforceable as if fully set out herein:

Rule 0880-05-.06(3) and (4); and 2. Rule 0880-05-.07; and 3. Rule 0880-05-.08; and 4. Rule 0880-05-.09; and 5. Rule 0880-05-.10; and 6. Rule 0880-05-.12.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-6-101, 63-6-214, 63-6-224, and Public Chapter 956 of the Public Acts of 2000.
Administrative History: Original rule filed August 31, 2000; effective November 14, 2000. Amendment filed November 1, 2002; effective January 15, 2003. Amendment filed May 28, 2003; effective August 11, 2003. Amendment filed March 14, 2006; effective May 28, 2006. Amendment filed March 22, 2006; effective June 5, 2006. Amendment filed March 22, 2007; effective June 5, 2007.

Tenn. Comp. R. & Regs. 0880-05-.12 SUPERVISION

(1) Before being authorized to perform any x-ray procedure or operate any x-ray equipment in a physician’s office, the physician shall place a copy of the person’s renewal certificate in the person’s personnel file to prove the person being authorized has the appropriate certification required for either or both the procedure being performed and/or the equipment being used and that such certification is current.

(2) The employing physician(s), or a physician designated by the employing physician(s) as a substitute supervisor, shall exercise close supervision and assume full control and responsibility for the services provided by any person certified under this chapter of rules employed in the physician(s’) practice. That supervision, control and responsibility, except when it involves contrast imaging or involves sedation, does not require the physical presence of the physician(s) at all times at the site where the services are being provided.

However, it does require that the physician(s) have his/her primary medical practice physically located within the boundaries of the state of Tennessee and that he/she be capable of being physically present at the site where the services are being provided within a reasonable time depending upon the type of x-ray being performed and the severity of the medical complications that may arise from that type of x-ray.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-6-101, and 63-6-224.
Administrative History: Original rule filed August 23, 2001; effective November 6, 2001. Repeal and new rule filed November 23, 2005; effective February 6, 2006.

Chapter 0880-06 Rules and Regulations Governing the Utilization and Supervision of the Services of a Nurse Practitioner/Prescription Writer

Tenn. Comp. R. & Regs. 0880-06-.01 DEFINITIONS

As used in these rules the following terms shall have the meanings ascribed to them:

(1) Certified nurse practitioner - A registered nurse who is certified by the Board of Nursing pursuant to T.C.A. §§ 63-7-123 and 63-7-207 (14) and has been issued a certificate of fitness by the Board of Nursing.

(2) Formulary - A list of legend and non-legend drugs arranged by therapeutic categories, included in the protocols, that are approved to be prescribed and/or issued by a certified nurse practitioner, which may include controlled substances listed in Schedules II, III, IV and V of Tennessee Code Annotated, Title 39, Chapter 17, Part 4.

(3) Protocols - Written guidelines for medical management developed jointly by the supervising physician and the certified nurse practitioner.

(4) Supervising physician - A licensed and actively practicing physician who has been identified as accepting the responsibility for supervising certified nurse practitioners or nurse practitioners with a temporary certificate of fitness.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-6-101, 63-6-204, 63-6-214, 63-7-103, 63-7-123, and 63-7-207.
Administrative History: Original rule filed September 30, 1987; effective November 14, 1987. Repeal and new rule filed March 18, 1999; effective June 1, 1999.

Tenn. Comp. R. & Regs. 0880-06-.02 CLINICAL SUPERVISION REQUIREMENTS

It is the intent of these rules to maximize the collaborative practice of certified nurse practitioners and supervising physicians in a manner consistent with quality health care delivery.

(1) A supervising physician, certified nurse practitioner or a substitute supervising physician must possess a current, unencumbered license to practice in the state of Tennessee.

(3) A supervising physician and/or substitute supervising physician shall have experience and/or expertise in the same area of medicine as the certified nurse practitioner.

(4) Nurse Practitioners who hold a temporary certificate of fitness shall be supervised pursuant to T.C.A. § 63-7-123 and Board of Nursing rule 1000-04-.04. Such supervision requires the physical presence of either the supervising physician or certified nurse practitioner.

PRACTITIONER/PRESCRIPTION WRITER

(5) Protocols are required and:

(a) Shall be jointly developed and approved by the supervising physician and nurse practitioner;

(b) Shall outline and cover the applicable standard of care;

(d) Shall be maintained at the practice site;

(e) Shall account for all protocol drugs by appropriate formulary;

(f) Shall be specific to the population seen;

(g) Shall be dated and signed; and (h) Copies of protocols and formularies shall be maintained at the practice site and shall be made available upon request for inspection by the respective boards.

(6) The supervising physician shall be responsible for ensuring compliance with the applicable standard of care under (5). Additionally, the supervising physician shall develop clinical guidelines in collaboration with the certified nurse practitioner to include a method for documenting consultation and referral.

(7) Once every ten (10) business days the supervising physician shall make a personal review of the historical, physical and therapeutic data and shall so certify by signature on any patient within thirty (30) days:

(a) When medically indicated;

(b) When requested by the patient;

(d) When prescriptions are written by a nurse practitioner who possesses a temporary certificate of fitness; and (e) when a controlled drug has been prescribed.

(8) In any event, a supervising physician shall personally review at least twenty percent (20%) of charts monitored or written by the certified nurse practitioner every thirty (30) days.

(9) The supervising physician shall be required to visit any remote site at least once every thirty (30) days (10) Any prescription written and signed or drug issued by a nurse practitioner under the supervision and control of a supervising physician shall be deemed to be that of the nurse practitioner.

(11) The supervising physician shall make provision for preprinted prescription pads bearing the name, address and telephone number of the supervising physician and that of the nurse practitioner. The nurse practitioner shall sign his or her own name on each prescription so written. Where the preprinted prescription pad contains the names of more than one (1)

PRACTITIONER/PRESCRIPTION WRITER physician, the nurse practitioner shall indicate on the prescription which of those physicians is the nurse practitioner's primary supervising physician by placing a checkmark beside or a circle around the name of that physician.

(12) Eligible certified nurse practitioners shall use numbers assigned to them by the DEA when prescribing controlled substances.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-6-101, 63-6-204, 63-6-214, 63-7-103, 63-7-123, and 63-7-207.
Administrative History: Original rule filed September 30, 1987; effective November 14, 1987. Repeal and new rule filed March 18, 1999; effective June 1, 1999. Amendment filed June 8, 2004; effective August 22, 2004.

Tenn. Comp. R. & Regs. 0880-06-.03 PENALTIES

Any licensed physician who supervises the services of a certified nurse practitioner who practices in a manner that is inconsistent with the Tennessee Medical Practice Act shall be subject to disciplinary action.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-6-101, 63-6-204, 63-6-214, 63-7-103, 63-7-123, and 63-7-207.
Administrative History: Original rule filed September 30, 1987; effective November 14, 1987. Repeal and new rule filed March 18, 1999; effective June 1, 1999.

Chapter 0880-07 General Rules Governing Respiratory Care Practitioners

Tenn. Comp. R. & Regs. 0880-07-.01 REPEALED

History

Authority: T.C.A. §§4-5-202, 4-5-204, 63-1-107 (d), 63-6-402, 63-6-404, 63-6-405, 63-6-413, 63-6-416, 63-6-417, and 63-27-104.
Administrative History: Original rule filed May 21, 1988; effective June 26,1988. Repeal and new rule filed May 31, 1996; effective August 11, 1996. Repeal filed January 31, 2000; effective April 15, 2000.

Tenn. Comp. R. & Regs. 0880-07-.02 REPEALED

History

Authority: T.C.A. §§4-5-202, 4-5-204, 63-6-101, 63-6-404, 63-6-405, 63-6-406, 63-6-407, 63-6-408, 63-6-411, 63- 6-414, 63-6-415, 63-6-417, 68-11-122, and 63-27-104.
Administrative History: Original rule filed May 21, 1988; effective June 26,1988. Amendment filed December 8, 1989; effective January 22, 1990. Amendment filed April 26, 1991; effective June 10, 1991. Repeal and new rule filed May 31, 1996; effective August 11, 1996. Repeal filed January 31, 2000; effective April 15, 2000.

Tenn. Comp. R. & Regs. 0880-07-.03 REPEALED

History

Authority: T.C.A. §§4-5-202, 4-5-204, 63-1-123, 63-6-404, 63-6-405, 63-6-411, 63-6-413, 63-6-414, 63-6-416, and 63-27-104.
Administrative History: Original rule filed May 21, 1988; effective June 26,1988. Amendment filed March 27, 1989; effective May 11, 1989. Repeal and new rule filed May 31, 1996; effective August 11, 1996. Repeal filed January 31, 2000; effective April 15, 2000.

Tenn. Comp. R. & Regs. 0880-07-.04 REPEALED

History

Authority: T.C.A. §§4-5-202, 4-5-204, 63-6-402, 63-6-404, 63-6-406, 63-6-407, 63-6-408, 63-6-415, 63-6-416, 63- 6-417, and 63-27-104.
Administrative History: Original rule filed May 21, 1988; effective June 26,1988. Repeal and new rule filed May 31, 1996; effective August 11, 1996. Repeal filed January 31, 2000; effective April 15, 2000.

Tenn. Comp. R. & Regs. 0880-07-.05 REPEALED

History

Authority: T.C.A. §§4-5-202, 4-5-204, 63-6-402, 63-6-404, 63-6-405, 63-6-406, 63-6-407, 63-6-408, 63-6-413, 63- 6-416, 63-6-417, and 63-27-104.
Administrative History: Original rule filed October 12, 1988; effective November 26, 1988. Repeal and new rule filed May 31, 1996; effective August 11, 1996. Repeal filed January 31, 2000; effective April 15, 2000.

Tenn. Comp. R. & Regs. 0880-07-.06 REPEALED

History

Authority: T.C.A. §§4-3-1011, 4-5-202, 4-5-204, 63-1-107 (d), 63-1-108, 63-1-118, 63-6-404, 63-6-405, 63-6-409, and 63-27-104.
Administrative History: Original rule filed March 27,1989; effective May 11, 1989. Repeal and new rule filed May 31, 1996; effective August 11, 1996. Amendment filed February 17, 1998; effective May 3,1998. Repeal filed January 31, 2000; effective April 15, 2000.

Tenn. Comp. R. & Regs. 0880-07-.07 REPEALED

History

Authority: T.C.A. §§4-5-202, 4-5-204, 4-5-301, 63-6-404, 63-6-405, 63-6-409, 63-6-412, 63-6-416, and 63-27- 104.
Administrative History: Original rule filed August 7, 1989; effective September 21, 1989. Amendment filed April 28, 1991; effective June 10, 1991. Repeal and new rule filed May 31, 1996; effective August 11, 1996. Repeal filed January 31, 2000; effective April 15, 2000.

Tenn. Comp. R. & Regs. 0880-07-.08 REPEALED

History

Authority: T.C.A. §§4-5-202, 63-6-402, 63-6-404, 63-6-410, 63-6-416, 63-6-417, and 63-27-104.
Administrative History: Original rule filed April 17, 1990; effective June 1,1990. Repeal and new rule filed May 31, 1996; effective August 11, 1996. Repeal filed January 31, 2000; effective April 15, 2000.

Tenn. Comp. R. & Regs. 0880-07-.09 REPEALED

History

Authority: T.C.A. §§4-5-202, 4-5-204, 63-6-404, 63-6-405, 63-6-409, 63-6-413, 63-6-416, and 63-27-104.
Administrative History: Original rule filed April 26, 1991; effective June 10,1991. Repeal and new rule filed May 31, 1996; effective August 11, 1996. Amendment filed February 17, 1998; effective May 3, 1998. Repeal filed January 31, 2000; effective April 15, 2000.

Tenn. Comp. R. & Regs. 0880-07-.10 THROUGH 0880-7-.23 REPEALED

History

Authority: T.C.A. §§4-5-202, 4-5-204, 63-6-402, 63-6-404, 63-6-417, and 63-27-104.
Administrative History: Original rule filed May 31, 1996; effective August 11, 1996. Repeal filed January 31, 2000; effective April 15, 2000.

Chapter 0880-08-01 Repealed

Tenn. Comp. R. & Regs. 0880-08-01 Repealed

RULES

OF THE TENNESSEE BOARD OF MEDICAL EXAMINERS

DIVISION OF HEALTH RELATED BOARDS

Authority: T.C.A. §§4-5-202, 4-5-204, and 63-6-101. Administrative History: Original rule filed April 16, 1996; effective June 30, 1996. Repeal filed June 3, 2003; effective August 17, 2003.

Chapter 0880-08-02 Repealed

Tenn. Comp. R. & Regs. 0880-08-02 Repealed

RULES

OF THE TENNESSEE BOARD OF MEDICAL EXAMINERS

DIVISION OF HEALTH RELATED BOARDS

Authority: T.C.A. §§4-5-202, 4-5-204, and 63-6-101. Administrative History: Original rule filed September 10, 1997; effective November 24, 1997. Repeal filed June 3, 2003; effective August 17, 2003.

Chapter 0880-09 General Rules and Regulations Governing Radiologist Assistants

Tenn. Comp. R. & Regs. 0880-09-.01 DEFINITIONS

As used in this Chapter of rules the following terms and acronyms will have the meaning ascribed to them:

(1) A.R.R.T. - American Registry of Radiologic Technologists.

(2) Full Certification - Certification obtained by submitting certification issued by the A.R.R.T. which will enable the holder to perform any and all procedures or functions in a physician’s office.

(3) Radiologist – A physician licensed by the Tennessee Board of Medical Examiners who is certified or eligible to be certified by the American Board of Radiology.

(4) Radiologist Assistant Certification - Certification obtained by submitting proof of A.R.R.T. certification as a radiologist assistant which will enable the holder to perform any and all radiologist assistant procedures or functions as defined in Section 0880-09-.08 in a radiology practice or radiologist’s office.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-6-101, 63-6-224, and 63-6-237.
Administrative History: Original rule filed November 23, 2005; effective February 6, 2006.

Tenn. Comp. R. & Regs. 0880-09-.02 FEES

(1) Application and Certification Fee - To be paid by all $ 50.00 applicants at the time an application is filed.

(2) Biennial Certification Renewal Fee - To be paid by all $ 50.00 persons holding certification.

(3) State Regulatory Fee (biennial) - To be paid with $ 10.00 initial applications and with renewal applications.

(4) Late Renewal - Reactivation Fee $100.00

History

Authority: T.C.A. §§ 4-3-1011, 4-5-202, 4-5-204, 63-6-101, 63-6-224, and 63-6-237.
Administrative History: Original rule filed November 23, 2005; effective February 6, 2006.

Tenn. Comp. R. & Regs. 0880-09-.03 QUALIFICATIONS FOR CERTIFICATION

To be certified as a radiologist assistant (RA), an applicant must:

(1) On or after July 1, 2007, be a graduate of a radiologist assistant educational program and a radiologist directed clinical preceptorship culminating in the award of a baccalaureate degree or its equivalent from an institution offering a program accredited by an entity recognized by the American Registry of Radiologic Technologists for certification purposes; and (2) Be currently certified by the American Registry of Radiologic Technologists as a radiologist assistant (RA); and (3) Be currently certified by the American Registry of Radiologic Technologists as a radiologic technologist (RT); and (4) Be currently certified in advanced cardiac life support (ACLS); and (5) Possess current and unencumbered full certification as an x-ray operator by the Tennessee Board of Medical Examiners, pursuant to Rule 0880-05-.04.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-6-101, 63-6-224, and 63-6-237.
Administrative History: Original rule filed November 23, 2005; effective February 6, 2006.

Tenn. Comp. R. & Regs. 0880-09-.04 PROCEDURES FOR CERTIFICATION

(1) An applicant shall submit with the application a copy of his/her A.R.R.T. identification card which must be current, in good standing, and shows certification as a radiologist assistant (RA) and as a radiologic technologist (RT).

(2) An applicant shall submit with the application a copy of his or her certification in advanced cardiac life support (ACLS) which must be current and in good standing.

(3) An applicant shall submit with the application a form provided by the Board containing a physician’s credentials as a radiologist, acknowledgement of the physician’s responsibility to supervise the radiologist assistant, and the signature of the supervising physician.

(4) On or after July 1, 2007, an applicant shall cause a transcript to be submitted directly from the school to the Board Administrative Office. The transcript must show graduation from a radiologist assistant educational program, and that a baccalaureate degree or its equivalent from an institution offering a program accredited by an entity recognized by the American Registry of Radiologic Technologists for certification purposes, which includes a radiologist directed clinical preceptorship has been conferred, and contains the official seal of the institution.

(5) An applicant shall submit with the application the Application and Certification Fee and the State Regulatory Fee as provided in Rule 0880-09-.02.

(6) An applicant shall submit with the application a clear, recognizable, recently taken bust photograph which shows the full head, face forward from at least the top of the shoulder up.

(7) An applicant shall cause to be submitted to the Board’s administrative office directly from the vendor identified in the Board’s certification application materials, the result of a criminal background check.

(8) Application review and decisions shall be governed by Rule 0880-02-.07 (1) through (4).

History

Authority: T.C.A. §§ 4-3-1011, 4-5-202, 4-5-204, 63-6-101, 63-6-214, 63-6-224, and 63-6-237.
Administrative History: Original rule filed November 23, 2005; effective February 6, 2006. Amendment filed March 14, 2006; effective May 28, 2006.

Tenn. Comp. R. & Regs. 0880-09-.05 EXAMINATION FOR CERTIFICATION

(1) The Board adopts as its certification examination the radiologist assistant examination provided by the A.R.R.T.

(2) A.R.R.T. certification will substitute for all examinations required by the Board and will be the

basis for radiologist assistant certification.

(3) It is the applicant’s responsibility to apply directly to the examination agency for admission to the examinations. The Board does not process applications for examination.

(4) The passing score shall be determined by the A.R.R.T.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-6-101, 63-6-224, and 63-6-237.
Administrative History: Original rule filed November 23, 2005; effective February 6, 2006.

Tenn. Comp. R. & Regs. 0880-09-.06 CERTIFICATION RENEWAL, RETIREMENT AND REACTIVATION

(1) All certificate holders must renew their certificates to be able to legally continue in practice.

Renewal is governed by the following:

(a) The due date for renewal is its expiration date which is the last day of the month in which a certificate holder’s birthday falls pursuant to the Division of Health Related Boards “biennial birthdate renewal system” contained in rule 1200-10-01-.10.

(b) Methods of Renewal - Renewal may be accomplished by one of the following methods:

Internet Renewals - Individuals may apply for renewal and pay the necessary fees via the Internet. The application to renew can be accessed at: https://apps.tn.gov/hlrs/.
Paper Renewals - Certificate holders who have not renewed their authorization online via the Internet will have a renewal application form mailed to them at the last address provided by them to the Board prior to the expiration date of their current certificate. Failure to receive such notification does not relieve the individual of the responsibility of timely meeting all requirements for renewal. To be eligible for renewal a certificate holder must submit to the Division of Health Related Boards on or before the certificate’s expiration date the following:

(i) A completed and signed renewal application form.

(ii) The Biennial Certification Renewal and State Regulatory Fees as provided in Rule 0880-09-.02.

(c) Any renewal application received after the expiration date but before the last day of the month following the expiration date must be accompanied by the Late Renewal - Reactivation Fee provided in Rule 0880-09-.02.

(e) Anyone submitting a signed renewal form, electronically or otherwise, which is found to be fraudulent or untrue may be subject to disciplinary action.

(f) Any certificate holder who receives notice of failure to timely renew pursuant to rule

Tenn. Comp. R. & Regs. 1200-10-01-.10 , and who, on or before the last day of the month following the month in which the certificate expires, executes and files in the Board’s administrative office an affidavit of retirement pursuant to paragraph (2) of this rule may have their certificate retired effective on their certificate’s expiration date.

Obtain from, complete and submit to the Board Administrative Office an affidavit of retirement form.
Submit any documentation which may be required by the form to the Board Administrative Office.

(b) Upon successful application for retirement of certification with completion and receipt of all proper documentation to the Board’s satisfaction, the Board shall register the certificate as retired. Any person who has a retired certificate may not practice in Tennessee.

(a) Submit a written request for a Reactivation Application to the Board Administrative Office; and (b) Fully complete and submit the Board’s Reactivation Application along with payment of:

For those reactivating a retired certificate the Biennial Certification Renewal Fee.
For those who are reactivating a certificate processed pursuant to rule 1200-10- 01-.10 for failure to timely renew all past due Biennial Certification Renewal Fees and the Late Renewal – Reactivation Fee; and (c) To reactivate an expired certification submit, along with the Board’s Reactivation Application, documentation of successful completion of the continuing education requirements provided in rule 0880-09-.07 for all the calendar years (January 1 – December 31) that the certification was expired that precede the calendar year during which the reactivation is requested; or (d) To reactivate a retired certification submit, along with the Board’s Reactivation Application, documentation of successful completion of twenty-four (24) hours of continuing education, as provided in rule 0880-09-.07, during the two (2) calendar years (January 1 – December 31) that precede the calendar year during which the reactivation is requested.

(e) If requested, after review by the Board, a designated Board member, or the Board’s consultant appear before either the Board, or a duly constituted panel of the Board, or another Board member, or the Board Designee for an interview regarding continued competence in the event of certification retirement, certification expiration or other practice inactivity in excess of two (2) years and meet such other requirements the Board feels necessary to establish current levels of competency.

(4) Renewal issuance and reactivation decisions pursuant to this rule may be made administratively subject to review by the Board, any Board member or the Board Designee.

History

Authority: T.C.A. §§ 4-3-1011, 4-5-202, 4-5-204, 63-6-101, 63-6-224, and 63-6-237.
Administrative History: Original rule filed November 23, 2005; effective February 6, 2006.

Tenn. Comp. R. & Regs. 0880-09-.07 CONTINUING EDUCATION

(1) Continuing Education - Hours Required (a) Each person certified by the Board must biennially attend and complete twenty-four (24) hours of radiological related continuing education in courses approved by the Board.

(b) The Board approves courses for only the number of hours contained in the course. The approved hours of any individual course will not be counted more than once in a two (2) year period toward the required hourly total regardless of the number of times the course is attended or completed by any individual certificate holder.

(2) Continuing Education - Proof of Compliance (a) Each person must, on a Board provided form, check a box and/or enter signature which indicates attendance and completion of the required continuing education hours and that such hours were obtained during the preceding two (2) calendar years.

(b) Each person must retain proof of attendance and completion of all continuing education courses. This documentation must be retained for a period of four (4) years from the end of the calendar year in which the course is completed. This documentation must be produced for inspection and verification, if requested in writing by the Board during its verification process.

(3) Continuing Education - Course Approval (a) Courses to be offered for credit toward the required continuing education hours must, unless otherwise provided, receive prior approval from the Board.

(b) Prior approval of a course may be obtained by submitting the following information to the Board Administrative Office at least thirty (30) days prior to the scheduled date of the course.

a course description or outline.
names of all lecturers.
brief resume of all lecturers.
number of hours of educational credit requested.
date of course.
copies of materials to be utilized in the course.
how verification of attendance is to be documented.

Lecture.
Audiovisual - with successful completion of a written post experience examination to evaluate material retention.
Correspondence - with successful completion of a written post experience examination to evaluate material retention.
Any combination of the above.

(d) The following courses need not receive prior approval and shall constitute Board approved continuing education courses:

Courses sponsored or approved by any of the following organizations:

(i) Tennessee Society of Radiologic Technologists (ii) Tennessee Radiological Society (iii) Tennessee Medical Association (iv) American Medical Association (v) American Society of Radiologic Technologists (vi) American Registry of Radiologic Technologists (vii) American College of Radiology 2. Educational courses sponsored by an accredited school of medicine or radiological health. If such course is taken for or assigned quarter or semester credit hours, three (3) quarter hours or equivalent semester hours shall be equivalent to fifteen (15) continuing education hours. No credits will be counted for courses failed.

(4) Violations (a) Any person who falsely attests to attendance and completion of the required hours of continuing education may be subject to decertification.

(b) Any person who fails to obtain the required continuing education hours may be subject to decertification.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-6-101, 63-6-224, and 63-6-237.
Administrative History: Original rule filed November 23, 2005; effective February 6, 2006.

Tenn. Comp. R. & Regs. 0880-09-.08 RADIOLOGIST ASSISTANT SCOPE OF PRACTICE AND ROLE DELINEATION

(1) Before being authorized to perform any x-ray procedure or operate any x-ray equipment in a physician’s office, the supervising staff radiologist shall place a copy of the person’s renewal certificate in the person’s personnel file to prove the person being authorized has the appropriate certification required for either or both the procedure being performed and/or the equipment being used and that such certification is current.

(2) The radiologist assistant shall evaluate the day’s schedule of procedures with the supervising staff radiologist and determine where the radiologist assistant’s skills will be best utilized.

(3) After demonstrating competency the radiologist assistant when ordered to do so by the supervising radiologist may:

(a) perform selected procedures under the direct supervision of a radiologist including static and dynamic fluoroscopic procedures;

(b) assess and evaluate the physiologic and psychological responsiveness of patients undergoing radiologic procedures;

(c) participate in patient management including acquisition of additional imaging for completion of the examination and record documentation in medical records;

(d) evaluate image quality, make initial image observations and communicate observations to the supervising radiologist; and (e) administer intravenous contrast media or other prescribed medications.

(4) The use of conscious sedation/moderate sedation requires the physical presence in the room, with the patient, of the supervision radiologist.

(5) The radiologist assistant may not interpret images, make diagnoses, or prescribe medications or therapies.

(6) The radiologist assistant shall adhere to the code of ethics of the American Registry of Radiologic Technologists and to national, institutional and/or departmental standards, policies and procedures regarding the standards of care for patients.

(7) For the purposes of this rule, “direct supervision” means the radiologist must be present in the office suite and immediately available to furnish assistance and direction throughout the performance of all procedures. “Direct supervision” does not mean that the supervising radiologist must be present in the room when the procedure is performed.

(8) A certificate holder may be disciplined in the same manner, for the same causes and pursuant to the same procedures as any physician pursuant to T.C.A. §63-6-214.

History

Authority: T.C.A. §§4-5-202, 4-5-204, 63-6-101, 63-6-224, and 63-6-237.
Administrative History: Original rule filed November 23, 2005; effective February 6, 2006. Amendment to rule filed July 24, 2006; effective October 10, 2006.

Chapter 0880-10 Transferred to 1130-02

Tenn. Comp. R. & Regs. 0880-10-.01 TRANSFERRED

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-1-107, 63-1-115, 63-6-216, 63-19-102, 63-19-103, 63-19-104, 63-19-201, 63-19-203, 63-19-204, 63-19-205, 63-19-210, and 68-1-701 and Public Chapter 565 of 2021.
Administrative History: Original rule filed July 10, 1997; effective September 23, 1997. Amendment filed June 10, 1998; effective October 28, 1998. Amendment filed June 25, 1998; effective October 30, 1998. Amendment filed August 28, 2002; effective November 11, 2002. Transferred to chapter 1130-02 on August 16, 2021, pursuant to Public Chapter 565 of 2021.

Tenn. Comp. R. & Regs. 0880-10-.23 TRANSFERRED

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-19-104, 63-51-105 (Public Chapter 1073 of 1998, Section 5, Subsection (5)), and 63-51-106 and Public Chapter 565 of 2021.
Administrative History: Original rule filed February 10, 2000; effective April 25, 2000. Transferred to chapter 1130-02 on August 16, 2021, pursuant to Public Chapter 565 of 2021.

Tenn. Comp. R. & Regs. 0880-10-.02 TRANSFERRED

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-19-104, 63-19-201, 63-19-202, 63-19-203, 63-19-204, 63-19- 205, 63-19-206, 63-19-207, and 63-19-208 and Public Chapter 565 of 2021.
Administrative History: Original rule filed July 10, 1997; effective September 23, 1997. Amendment filed June 10, 1998; effective October 28, 1998. Transferred to chapter 1130-02 on August 16, 2021, pursuant to Public Chapter 565 of 2021.

Tenn. Comp. R. & Regs. 0880-10-.03 TRANSFERRED

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-1-116, 63-1-145, 63-1-146, 63-6-101, 63-19-104, 63-19-201, 63-19-202, 63-19-206, 63-19-208, and 63-19-210 and Public Chapter 565 of 2021.
Administrative History: Original rule filed July 10, 1997; effective September 23, 1997. Amendment filed June 10, 1998; effective October 28, 1998. Amendment filed August 5, 2010; effective November 3, 2010. Transferred to chapter 1130-02 on August 16, 2021, pursuant to Public Chapter 565 of 2021.

Tenn. Comp. R. & Regs. 0880-10-.04 TRANSFERRED

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-19-104, 63-19-105, 63-19-201, and 63-19-202 and Public Chapter 565 of 2021.
Administrative History: Original rule filed July 10, 1997; effective September 23, 1997. Amendment filed June 10, 1998; effective October 28, 1998. Amendment filed April 19, 1999; effective July 3, 1999. Transferred to chapter 1130-02 on August 16, 2021, pursuant to Public Chapter 565 of 2021.

Tenn. Comp. R. & Regs. 0880-10-.05 TRANSFERRED

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-6-101, 63-6-214, 63-19-104, 63-19-201, 63-19-202, 63-19- 203, and 63-19-204 and Public Chapter 565 of 2021.
Administrative History: Original rule filed July 10, 1997; effective September 23, 1997. Amendment filed June 10, 1998; effective October 28, 1998. Amendment filed June 25, 1998; effective October 30, 1998. Amendments filed March 17, 2006; effective May 31, 2006. Transferred to chapter 1130-02 on August 16, 2021, pursuant to Public Chapter 565 of 2021.

Tenn. Comp. R. & Regs. 0880-10-.06 TRANSFERRED

History

Authority: T.C.A. §§ 4-3-1011, 4-5-202, 4-5-204, 63-1-103, 63-1-106, 63-1-108, 63-1-112, 63-19-104, and 63-19-201 and Public Chapter 565 of 2021.
Administrative History: Original rule filed July 10, 1997; effective September 23, 1997. Amendment filed June 10, 1998; effective October 28, 1998. Amendment filed January 20, 2012; effective April 19, 2012. Amendment filed March 23, 2016; effective June 21, 2016. Transferred to chapter 1130-02 on August 16, 2021, pursuant to Public Chapter 565 of 2021.

Tenn. Comp. R. & Regs. 0880-10-.07 TRANSFERRED

History

Authority: T.C.A. §§ 4-5-102(3), 4-5-202, 4-5-204, 4-5-301, et seq., 63-19-104, 63-19-105, 63-19-111, 63-19-201, 63-19-202, and 63-19-206 and Public Chapter 565 of 2021.
Administrative History: Original rule filed July 10, 1997; effective September 23, 1997. Amendment filed June 10, 1998; effective October 28, 1998. Amendment filed September 11, 1998; effective November 25, 1998. Amendment filed August 6, 2002; effective October 20, 2002. Amendment filed August 28, 2002; effective November 11, 2002. Transferred to chapter 1130-02 on August 16, 2021, pursuant to Public Chapter 565 of 2021.

Tenn. Comp. R. & Regs. 0880-10-.08 TRANSFERRED

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-19-104, 63-19-201, and 63-19-202 and Public Chapter 565 of 2021.
Administrative History: Original rule filed July 10, 1997; effective September 23, 1997. Amendment filed June 10, 1998; effective October 28, 1998. Transferred to chapter 1130-02 on August 16, 2021, pursuant to Public Chapter 565 of 2021.

Tenn. Comp. R. & Regs. 0880-10-.09 TRANSFERRED

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-1-107, 63-19-104, 63-19-201, 63-19-206, and 63-19-209 and Public Chapter 565 of 2021.
Administrative History: Original rule filed July 10, 1997; effective September 23, 1997. Amendment filed June 10, 1998; effective October 28, 1998. Amendment filed June 25, 1998; effective October 30, 1998. Amendment filed August 28, 2002; effective November 11, 2002. Transferred to chapter 1130-02 on August 16, 2021, pursuant to Public Chapter 565 of 2021.

Tenn. Comp. R. & Regs. 0880-10-.10 TRANSFERRED

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-19-104, 63-19-201, 63-19-203, 63-19-204, 63-19-205, 63-19- 206, 63-19-207, and 63-19-208 and Public Chapter 565 of 2021.
Administrative History: Original rule filed July 10, 1997; effective September 23, 1997. Amendment filed June 10, 1998; effective October 28, 1998. Transferred to chapter 1130-02 on August 16, 2021, pursuant to Public Chapter 565 of 2021.

Tenn. Comp. R. & Regs. 0880-10-.11 TRANSFERRED

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-19-104, 63-19-201, 63-19-202, and 63-19-209 and Public Chapter 565 of 2021.
Administrative History: Original rule filed July 10, 1997; effective September 23, 1997. Amendment filed June 10, 1998; effective October 28, 1998. Transferred to chapter 1130-02 on August 16, 2021, pursuant to Public Chapter 565 of 2021.

Tenn. Comp. R. & Regs. 0880-10-.12 TRANSFERRED

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-1-107, 63-19-104, and 63-19-201 and Public Chapter 565 of 2021.
Administrative History: Original rule filed July 10, 1997; effective September 23, 1997. Amendment filed June 10, 1998; effective October 28, 1998. Amendment filed June 25, 1998; effective October 30, 1998. Amendment filed July 31, 2000; effective October 14, 2000. Transferred to chapter 1130-02 on August 16, 2021, pursuant to Public Chapter 565 of 2021.

Tenn. Comp. R. & Regs. 0880-10-.13 TRANSFERRED

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-19-104, 63-19-201, 63-19-206, 63-19-207, and 63-19-210 and Public Chapter 565 of 2021.
Administrative History: Original rule filed July 10, 1997; effective September 23, 1997. Amendment filed June 10, 1998; effective October 28, 1998. Transferred to chapter 1130-02 on August 16, 2021, pursuant to Public Chapter 565 of 2021.

Tenn. Comp. R. & Regs. 0880-10-.14 TRANSFERRED

History

Authority: Public Chapter 565 of 2021.
Administrative History: Original rule filed July 10, 1997; effective September 23, 1997. Transferred to chapter 1130-02 on August 16, 2021, pursuant to Public Chapter 565 of 2021.

Tenn. Comp. R. & Regs. 0880-10-.15 TRANSFERRED

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 4-5-217, 4-5-223, 63-1-102, 63-1-122, 63-1-134, 63-1-144, 63-1- 146, 63-6-101, 63-19-104, 63-19-111, 63-19-201, and 63-19-210 and Public Chapter 565 of 2021.
Administrative History: Original rule filed July 10, 1997; effective September 23, 1997. Amendment filed June 10, 1998; effective October 28, 1998. Amendment filed June 25, 1998; effective October 30, 1998. Amendment filed July 31, 2000; effective October 14, 2000. Amendment filed August 28, 2002; effective November 11, 2002. Amendment filed September 8, 2004; effective November 22, 2004. Amendment filed June 23, 2006; effective September 6, 2006. Amendment filed August 5, 2010; effective November 3, 2010. Amendments to rules (1)(j), (2), (3), (4), and (5) filed January 20, 2012; effective April 19, 2012. On April 17, 2012, the Board of Medical Examiners filed a withdrawal of amendments to (2), (3), (4), and (5). Transferred to chapter 1130-02 on August 16, 2021, pursuant to Public Chapter 565 of 2021.

Tenn. Comp. R. & Regs. 0880-10-.16 TRANSFERRED

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-1-106, 63-19-104, and 63-19-201 and Public Chapter 565 of 2021.
Administrative History: Original rule filed July 10, 1997; effective September 23, 1997. Amendment filed June 10, 1998; effective October 28, 1998. Transferred to chapter 1130-02 on August 16, 2021, pursuant to Public Chapter 565 of 2021.

Tenn. Comp. R. & Regs. 0880-10-.17 TRANSFERRED

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-1-108, 63-19-104, and 63-19-201 and Public Chapter 565 of 2021.
Administrative History: Original rule filed July 10, 1997; effective September 23, 1997. Amendment filed June 10, 1998; effective October 28, 1998. Transferred to chapter 1130-02 on August 16, 2021, pursuant to Public Chapter 565 of 2021.

Tenn. Comp. R. & Regs. 0880-10-.18 TRANSFERRED

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-1-201, 63-6-701 through 63-6-707, 63-19-115, 63-19-201, 63- 19-205, and 63-19-209 and Public Chapter 565 of 2021.
Administrative History: Original rule filed December 2, 2005; effective February 15, 2006. Transferred to chapter 1130-02 on August 16, 2021, pursuant to Public Chapter 565 of 2021.

Tenn. Comp. R. & Regs. 0880-10-.19 TRANSFERRED

History

Authority: T.C.A. §§ 4-5-105, 4-5-202, 4-5-204, 4-5-223, 4-5-224, 63-1-115, 63-1-117, 63-1-138, 63-6- 101, 63-19-104, 63-19-105, 63-19-201, 63-19-202, and 63-19-209 and Public Chapter 565 of 2021.
Administrative History: Original rule filed July 10, 1997; effective September 23, 1997. Amendment filed June 10, 1998; effective October 28, 1998. Amendment filed April 19, 1999; effective July 3, 1999. Amendment filed June 23, 2006; effective September 6, 2006. Amendment filed April 17, 2007; effective July 1, 2007. Transferred to chapter 1130-02 on August 16, 2021, pursuant to Public Chapter 565 of 2021.

Tenn. Comp. R. & Regs. 0880-10-.20 TRANSFERRED

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-1-145, 63-1-146, 63-6-101, 63-19-104, and 63-19-201 and Public Chapter 565 of 2021.
Administrative History: Original rule filed July 10, 1997; effective September 23, 1997. Amendment filed June 10, 1998; effective October 28, 1998. Amendment filed March 22, 2007; effective June 5, 2007. Transferred to chapter 1130-02 on August 16, 2021, pursuant to Public Chapter 565 of 2021.

Tenn. Comp. R. & Regs. 0880-10-.21 TRANSFERRED

History

Authority: Public Chapter 565 of 2021.
Administrative History: Original rule filed July 10, 1997; effective September 23, 1997. Transferred to chapter 1130-02 on August 16, 2021, pursuant to Public Chapter 565 of 2021.

Tenn. Comp. R. & Regs. 0880-10-.22 TRANSFERRED

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-19-104, 63-19-201, and 68-11-222 and Public Chapter 565 of 2021.
Administrative History: Original rule filed July 10, 1997; effective September 23, 1997. Amendment filed June 10, 1998; effective October 28, 1998. Transferred to chapter 1130-02 on August 16, 2021, pursuant to Public Chapter 565 of 2021.

Chapter 0880-11 General Rules and Regulations Governing the Practice of Clinical Perfusionists

Tenn. Comp. R. & Regs. 0880-11-.01 DEFINITIONS

As used in these rules, the following terms and acronyms shall have the following meanings ascribed to them:

(1) ABCP - American Board of Cardiovascular Perfusion or its successor organization.

(2) ACPE - Accreditation Committee for Perfusion Education or its successor organization.

(3) Administrative Office - The office of the administrator assigned to the Board and Committee located at 665 Mainstream Drive, Nashville, TN 37243.

(4) AmSECT - American Society of Extra-Corporeal Technology.

(5) Board - Tennessee Board of Medical Examiners.

(6) C.A.H.E.A. - The Committee on Allied Health Education and Accreditation of the American Medical Association or its successor accrediting agency.

(7) Committee - The Committee for Clinical Perfusionists.

(8) Division - The Division of Health Related Boards, Tennessee Department of Health, from which the Committee receives administrative support.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-6-101, 63-28-114, and 63-28-118.
Administrative History: Original rule filed April 26, 2002; effective July 10, 2002.

Tenn. Comp. R. & Regs. 0880-11-.02 SCOPE OF PRACTICE

The scope of practice of all clinical perfusionists is governed by T.C.A. § 63-28-102(6).

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-6-101, 63-28-102, and 63-28-118.
Administrative History: Original rule filed April 26, 2002; effective July 10, 2002.

Tenn. Comp. R. & Regs. 0880-11-.03 USE OF TITLES

Any person who possesses a valid, current and active license issued by the Committee that has not been suspended or revoked has the right to use the title “Licensed Clinical Perfusionist” or “L.C.P.” and to practice perfusion, as defined in T.C.A. § 63-28-102. Any person licensed by the Committee to whom this rule applies must use one of the titles authorized by this rule in every “advertisement” [as that term is defined in rule 0880-11-.20(2)(a)] he or she publishes or the failure to do so will constitute an omission of a material fact which makes the advertisement misleading and deceptive and subjects the clinical perfusionist to disciplinary action pursuant to T.C.A. § 63-28-117(3)(c).

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-1-145, 63-1-146, 63-6-101, 63-28-102, 63-28-110, 63-28-114, and 63-28-117.
Administrative History: Original rule filed March 16, 2007; effective May 30, 2007. Amendment filed December 23, 2009; effective March 23, 2010.

Tenn. Comp. R. & Regs. 0880-11-.05 LICENSURE PROCESS

To become licensed as a clinical perfusionist in Tennessee a person must comply with the following procedures and requirements:

(1) Grandfathering - Any person who is currently actively practicing perfusion is eligible to receive a license as a clinical perfusionist upon compliance with all subparagraphs contained in paragraph (2) except subparagraphs (d) and (i), and upon further showing satisfactory proof of the existence, on January 1, 2000, of all of the following requirements:

(a) Four (4) years experience within the immediately preceding six (6) years (between January 1, 1994 and January 1, 2000) operating cardiopulmonary bypass systems during cardiac surgical cases in a licensed health care facility.

(b) That the experience obtained in that four (4) year period was obtained while the person’s primary function in that health care facility was operation of the cardiopulmonary systems.

Written job description(s) from employing facilities that cover the entire four (4) year period; and 2. Letters from each of the following officials at the licensed health care facilities at which the applicant was employed during the entire four (4) year period attesting to the fact that all requirements of subparagraphs (a) and (b) have been met:

(i) A cardiac surgeon(s)

(ii) The applicant’s immediate supervisor(s)

(iii) The chief of medical staff (d) All documents required to satisfy the requirements of subparagraphs (a), (b) and (c) must be submitted directly from the employing facility or signatory to the Committee’s administrative office.

(2) Licensure by examination - An applicant for licensure by examination shall do the following:

(a) Obtain an application packet.

(b) Respond truthfully and completely to every question or request for information contained in the application form and submit it, along with all documentation and fees required by the form and rules, to the Administrative Office. It is the intent of this rule that activities necessary to accomplish the filing of the required documentation be completed prior to filing an application and that all documentation be filed simultaneously.

(c) Submit a clear, recognizable, recently taken bust photograph which shows the full head, face forward from at least the top of the shoulder up.

(d) Request that a graduate transcript from a perfusion education program, the educational standards of which have been established by the ACPE and approved by CAHEA or its successor, be submitted directly from the educational institution to the Administrative Office. The transcript must show that the program has been successfully completed and carry the official seal of the institution.

(e) Submit evidence of good moral character. Such evidence shall be two (2) recent (within the preceding 12 months) original letters from medical professionals, attesting to the applicant’s personal character and professional ethics on the signator’s letterhead.

(f) Disclose the circumstances surrounding any of the following:

Conviction of any criminal law violation of any country, state or municipality, except minor traffic violations.
The denial of professional licensure/certification application by any other state or the discipline of licensure/certification in any state.
Loss or restriction of professional licensure/certification.
Any civil suit judgment or civil suit settlement in which the applicant was a party defendant including, without limitation, actions involving malpractice, breach of contract, antitrust activity or any other civil action remedy recognized under the country’s or state’s statutory common or case law.
Failure of any professional licensure or certification examination.

(g) Cause to be submitted to the Committee’s administrative office directly from the vendor identified in the Committee’s licensure application materials, the result of a criminal background check.

(h) Cause to be submitted the equivalent of a Tennessee Certificate of Endorsement (verification of licensure/certification) from each licensing board of each state or country in which the applicant holds or has ever held a license/certificate to practice any profession that indicates the applicant holds or held an active license/certificate and whether it is in good standing presently or was at the time it became inactive. It is the applicant’s responsibility to request this information be sent directly from each such licensing board to the Administrative Office.

(i) Submit the fees required in Rule 0880-11-.06.

(j) Cause to be submitted, directly from the examining agency to the Administrative Office, documentation of successful completion of the examination for licensure as governed by Rule 0880-11-.08.

(3) Licensure by Reciprocity. To become licensed in Tennessee as a clinical perfusionist based on licensure or certification in another state or certification from the ABCP, an applicant must (a) Pursuant to licensure/certification in another state:

Comply with all the requirements of paragraph (2) of this rule except subparagraphs (d) and (j); and 2. Cause to be submitted the information necessary for the Committee to determine that the state of licensure/certification has licensure or certification requirements substantially equivalent to the requirements of the Tennessee “Clinical Perfusionist Licensure Act” (T.C.A. §§ 63-28-101, et seq.) and this chapter of rules; and 3. Cause the certification issued pursuant to subparagraph (2) (h) to show that the licensure or certification in another state is current, active and is in good standing without any restriction or encumbrance.

(b) Pursuant to ABCP certification:

Comply with all requirements of paragraph (2) of this rule except subparagraphs (d) and (j); and 2. Have the ABCP submit directly to the Committee’s administrative office satisfactory evidence of current ABCP certification as a certified clinical perfusionist.

(4) Application review and licensure decisions shall be governed by Rule 0880-11-.07.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-1-101, 63-6-101, 63-28-103, 63-28-104, 63-28-105, 63-28-106, 63-28-109, 63-28-114, 63-28-117, 63-28-118, and 68-11-114.
Administrative History: Original rule filed April 26, 2002; effective July 10, 2002. Amendment filed May 8, 2003; effective July 22, 2003. Amendment filed April 5, 2006; effective June 19, 2006.

Tenn. Comp. R. & Regs. 0880-11-.06 .

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-1-106, 63-6-101, 63-28-114, and 63-28-118.
Administrative History: Original rule filed April 26, 2002; effective July 10, 2002.

Tenn. Comp. R. & Regs. 0880-11-.07 APPLICATION REVIEW, APPROVAL, AND DENIAL

(1) Review of all applications to determine whether or not the application file is complete may be delegated to the Committee’s administrator.

(2) A temporary authorization to practice, as described in T.C.A. § 63-1-142 may be issued to an applicant pursuant to an initial determination made by a Committee and Board designee who have both reviewed the completed application and determined that the applicant has met all the requirements for licensure, renewal or reinstatement. The temporary authorization to practice is valid for a period of six (6) months from the date of issuance of the temporary authorization to practice and may not be extended or renewed. If the Committee or Board subsequently makes a good faith determination that the applicant has not met all the requirements for licensure, renewal or reinstatement and therefore denies, limits, conditions or restricts licensure, renewal or reinstatement, the applicant may not invoke the doctrine of estoppel in a legal action brought against the state based upon the issuance of the temporary authorization to practice and the subsequent denial, limitation, conditioning or restricting of licensure.

(3) If an application is incomplete when received by the Administrative Office, or the reviewing Committee and/or Board member or the Committee’s/Board’s designee determine additional information is required from an applicant before an initial determination can be made, the Board administrator shall notify the applicant of the information required. The applicant shall cause the requested information to be received in the Administrative Office on or before the sixtieth (60th) day after receipt of the notification.

(a) Such notifications shall be sent certified mail, return receipt requested, from the Administrative Office.

(b) If requested information is not timely received, the application file may be considered abandoned and may be closed by the administrator. If that occurs, the applicant shall be notified that the Committee and Board will not consider issuance of a license until a new application is received pursuant to the rules governing that process, including another payment of all fees applicable to the applicant’s circumstances and submission of such new supporting documents as is required by the Committee and Board.

(4) If a reviewing Committee and/or Board member or Committee and/or Board designee initially determines that a completed application should be denied, limited, conditioned or restricted, a temporary authorization shall not be issued. The applicant shall be informed of the initial decision and that a final determination on the application will be made by the Committee and the Board at their next appropriate meeting. If the Committee and Board ratify the initial denial, limitation, condition or restriction, the action shall become final and the following shall occur:

(a) A notification of the denial, limitation, condition or restriction shall be sent by the Administrative Office by certified mail, return receipt requested, that contains the specific reasons for denial, limitation, condition or restriction, such as incomplete information, unofficial records, examination failure, or matters judged insufficient for licensure, and such notification shall contain all the specific statutory or rule authorities for the denial, limitation, condition or restriction.

(b) The notification, when appropriate, shall also contain a statement of the applicant’s right to request a contested case hearing under the Tennessee Administrative Procedures Act (T.C.A. §§ 4-5-301, et seq.) to contest the denial, limitation, condition or restriction and the procedure necessary to accomplish that action.

An applicant has a right to a contested case hearing only if the licensure denial, limitation, condition or restriction is based on subjective or discretionary criteria.
An applicant may be granted a contested case hearing if the licensure denial, limitation, condition or restriction is based on an objective, clearly defined criteria only if after review and attempted resolution by the Committee’s Administrative Staff, the application can not be approved and the reasons for continued denial, limitation, condition or restriction present genuine issues of fact and/or law which are appropriate for appeal. Requests for a hearing must be made in writing to the Administrative Office within thirty (30) days of the receipt of the notice of denial, limitation, condition or restriction from the Committee and/or Board.

(5) The initial determination procedures of this rule will not apply if the Committee reviews and makes a final determination on any application during its meetings.

(6) If the Committee finds it has erred in the issuance of a license, it will give written notice by certified mail of its intent to revoke or cancel the license. The notice will allow the applicant the opportunity to meet the requirements for licensure within thirty (30) days from the date of receipt of the notification. If the applicant does not concur with the stated reason and the intent to revoke or cancel the license, the applicant shall have the right to proceed according to paragraph (4) of this rule.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-6-101, 63-28-105, 63-28-114, and 63-28-118.
Administrative History: Original rule filed April 26, 2002; effective July 10, 2002.

Tenn. Comp. R. & Regs. 0880-11-.08 EXAMINATION

(1) Licensure Examinations - With the exception of applicants qualified pursuant to Rule 0880-11- .05(1) and (3), all persons intending to apply for licensure must successfully complete the examination pursuant to this Rule as a prerequisite to licensure. Such examinations must be completed prior to application for licensure. Evidence of successful completion must be submitted by the examining agency directly to the Administrative Office as part of the application process contained in Rule 0880-11-.05.

(2) Competency Examination (a) The Committee adopts the ABCP examination and/or its successor examination as its licensure competency examination.

(b) The Committee adopts the ABCP’s determination as to the passing score on its examination.

(c) Application for, proof of having successfully completed a perfusion education program, the educational standards of which have been established by the ACPE and approved by CAHEA or its successor, and fees necessary to take the ABCP examination must be sent to the ABCP and not the Committee.

(3) Any applicant who does not successfully complete the competency examination on the second (2 nd ) attempt and every second (2 nd ) attempt thereafter must do the following prior to being authorized to take the examination again:

(a) Successfully complete a review course, as approved by the Committee; and (b) Pay the examination fee required by the ABCP.

(4) Education hours obtained as a result of compliance with subparagraph (3)(a) shall not be credited toward the continuing education hours required to be obtained in any renewal period pursuant to Rule 0880-11-.12(1).

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-6-101, 63-28-105, 63-28-106, and 63-28-118.
Administrative History: Original rule filed April 26, 2002; effective July 10, 2002.

Tenn. Comp. R. & Regs. 0880-11-.09 LICENSURE RENEWAL

All licensed clinical perfusionists must renew their licenses to be able to legally continue in practice. License renewal is governed by the following:

(1) The due date for license renewal is its expiration date which is the last day of the month in which a license holder’s birthday falls pursuant to the Division of Health Related Boards “biennial birthdate renewal system” pursuant to rule 1200-10-01-.10.

(2) Methods of Renewal - licensees may accomplish renewal by one of the following methods:

(a) Internet Renewals - Individuals may apply for renewal via the Internet. The application to renew can be accessed at: https://apps.tn.gov/hlrs/ (b) Paper Renewals - Licensees who have not renewed their authorization online via the Internet, will have a renewal application form mailed to them at the last address provided by them to the Committee. Failure to receive such notification does not relieve the individual of the responsibility of timely meeting all requirements for renewal. To be eligible for renewal a licensee must submit to the Division of Health Related Boards on or before the license’s expiration date the following:

A completed and signed renewal application form.
The renewal and state regulatory fees as provided in Rule 0880-11-.06.

(3) Any renewal application received after the expiration date but before the last day of the month following the expiration date must be accompanied by the Late Renewal Fee provided in Rule

Tenn. Comp. R. & Regs. 0880-11-.10 SUPERVISION

All persons practicing clinical perfusion pursuant to authorizations from the Committee and Board must be supervised according to the following:

(1) Licensed Clinical Perfusionists - Must be performing services under the order and supervision of a physician licensed pursuant to either Chapter 6 or Chapter 9 of Title 63 of the Tennessee Code Annotated. Supervision may be provided through “perfusion protocols” as defined in T.C.A. § 63-28-102. Such protocols must be in writing, signed by the health care facility’s authorized representative, and a physician, regularly updated, maintained at the health care facility, and produced upon request by the duly authorized agents of the Committee and/or Board.

(2) Provisional Licensees - Must be under the supervision of a licensed clinical perfusionist at all times during which they are performing perfusion. This supervision does not require the immediate physical presence of the supervising perfusionist but does require the following:

(a) Supervision may be provided through “perfusion protocols” as defined in T.C.A. § 63- 28-102. Such protocols must be in writing, signed by the health care facility’s authorized representative, a physician, and the supervising clinical perfusionist, regularly updated, maintained at the health care facility, and produced upon request by the duly authorized agents of the Committee and/or Board.

(b) Protocols shall be reviewed and updated biennially.

(c) The supervising perfusionist shall exercise close supervision and assume full control and responsibility for the services provided by the provisional licensee. That supervision, control and responsibility does not require the physical presence of the supervising perfusionist at all times where the services are being provided. However, it does require that the supervising perfusionist be capable of being physically present where the services are being provided within thirty (30) minutes.

(d) The supervising clinical perfusionist may not sign a provisional licensure renewal application request for a provisional licensee unless the provisional licensee has taken the certification examination identified in rule 0880-11-.08 at least once during the current provisional licensure period.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-6-101, 63-28-102, 63-28-108, and 63-28-118.
Administrative History: Original rule filed April 26, 2002; effective July 10, 2002.

Tenn. Comp. R. & Regs. 0880-11-.11 RETIREMENT AND REACTIVATION OF LICENSE

(1) Licensees who wish to retain their licenses but not actively practice as a clinical perfusionist may avoid compliance with the licensure renewal process by obtaining, completing, and submitting, to the Administrative Office, an affidavit of retirement form along with any documentation required by the form.

(2) Upon successful application for retirement of licensure with completion and receipt of all proper documentation to the Committee’s and Board’s satisfaction, the license shall be registered as retired. Any person who has a retired license may not practice as a clinical perfusionist in Tennessee.

(3) Reactivation - Any licensee whose license has been retired may re-enter active practice by doing the following:

(a) Submit a written request for a Reactivation Application to the Administrative Office; and (b) Complete and submit the Reactivation Application along with the licensure renewal fee as provided in Rule 0880-11-.06 to the Administrative Office. If reactivation was requested prior to the expiration of one (1) year from the date of retirement, the Committee may require payment of the licensure restoration fee and past due renewal fees as provided in Rule 0880-11-.06; and (c) Submit any documentation which may be required by the form to the Administrative Office; and (d) If requested, after review by the Committee and/or Board or a designated Committee and/or Board member, appear before either the Committee and/or Board, or a duly constituted panel of the Board, or another Committee or Board member, or the Committee and/or Board Designee for an interview regarding continued competence.

(e) In the event of licensure retirement or inactivity in excess of two (2) years or the receipt of derogatory information or communication during the reactivation process, the applicant should be prepared to meet or accept other conditions or restrictions as the Committee and/or Board may deem necessary to protect the public.

(f) If licensure retirement was in excess of five (5) years, the licensee may be required to successfully complete whatever educational and/or testing requirements the Committee and/or Board feels necessary to establish current levels of competency.

(4) License reactivation applications shall be treated as licensure applications and review decisions shall be governed by Rule 0880-11-.07.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-1-111, 63-6-101, and 63-28-118.
Administrative History: Original rule filed April 26, 2002; effective July 10, 2002.

Tenn. Comp. R. & Regs. 1200-10-01-.10 .

(5) Renewal of an Expired License:

(a) Renewal of a license that has expired as a result of failure to timely renew in accordance with Rule 1200-10-01-.10 may be accomplished upon meeting the following conditions:

For persons whose licenses have expired for not more than two (2) years:

(i) Submission of a completed renewal application; and (ii) Payment of late renewal fee; and (iii) Submission of proof of having completed all required continuing education.

Persons whose licenses have expired for two (2) years or more may not renew licensure but must apply for a new license pursuant to rule 0880-11-.05.
For persons whose licenses have expired and who have moved to, been licensed in, and have practiced in another state for the (2) years immediately preceding application for licensure renewal:

(i) Submission of a completed renewal application; and (ii) Payment of late renewal fee; and (iii) Submission of proof that the licenses held in all other states are not subject to penalty or restriction; and (iv) Submission of proof of having completed all required continuing education.

If derogatory information or communication is received during the renewal process, if requested by the Committee and/or Board or their duly authorized representative(s), appear for an interview before the Committee and/or Board, a duly constituted panel of the Board, a Committee and/or Board member, a screening panel of the Board when the individual is under investigation or the Committee and/or Board Designee and/or be prepared to meet or accept other conditions or restrictions as the Board may deem necessary to protect the public.

(6) Renewal issuance decisions pursuant to this rule may be made administratively, or upon review by the Committee and Board or their designees.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-1-107, 63-6-101, 63-28-107, and 63-28-118.
Administrative History: Original rule filed April 26, 2002; effective July 10, 2002.

Tenn. Comp. R. & Regs. 0880-11-.12 CONTINUING EDUCATION

All persons licensed as a clinical perfusionist must comply with the following continuing education rules as a prerequisite to licensure renewal.

(1) Continuing Education - Hours Required (a) All licensed clinical perfusionists must complete fifteen (15) hours of continuing education in courses approved by the Committee and Board every calendar year (January 1-December 31).

(b) Three (3) hours of the fifteen (15) hour requirement must be ABCP Category I courses.

(c) Continuing education for new licensees - For new licensees, submitting proof of successful completion of all education and training requirements required for licensure in Tennessee, pursuant to Rule 0880-11-.05, shall be considered proof of sufficient preparatory education to constitute continuing education credit for the calendar year in which such education and training requirements were completed.

(d) The Committee and Board approve a course for only the number of hours contained in the course. The approved hours of any individual course will not be counted more than once in a calendar year toward the required hourly total regardless of the number of times the course is attended or completed by any individual.

(e) The Committee and/or Board may waive or otherwise modify the requirements of this

rule in cases where there is retirement, or an illness, disability or other undue hardship that prevents a licensee from obtaining the requisite number of continuing education hours. Requests for waivers or modification must be sent in writing to the Administrative Office prior to the expiration of the renewal period in which the continuing education is due.

(2) Continuing Education - Proof of Compliance (a) The due date for completion of the required continuing education is December 31 st of every calendar year.

(b) All clinical perfusionists must, on the license renewal form, enter a signature, electronic or otherwise, which indicates completion of the required continuing education hours and that such hours were obtained during the applicable calendar years.

(c) All clinical perfusionists must retain independent documentation of completion of all continuing education hours. This documentation must be retained for a period of four (4) years from the end of the renewal period in which the continuing education was acquired. This documentation must be produced for inspection and verification, if requested in writing by the Division during its verification process. Documentation verifying the licensed individual’s completion of the continuing education program(s) may consist of any one or more of the following:

Certificates from the continuing education program’s sponsor, indicating the date, length in minutes awarded (continuing education units must be converted to clock hours), program title, licensed individual’s name, license number and social security number; or 2. An original letter on official stationery from the continuing education program’s sponsor indicating date, length in minutes awarded (continuing education units must be converted to clock hours), program title, licensed individual’s name, license number and social security number.

(d) If a person submits documentation for continuing education that is not clearly identifiable as appropriate continuing education, the Committee and/or Board will request a written description of the education and how it applies to the practice as a clinical perfusionist.

(3) Acceptable continuing education - To be utilized for satisfaction of the continuing education requirements of this rule, the continuing education program must be approved in content, structure and format by either the ABCP, the AMA or the TMA or any other AMA recognized medical specialty certification organization. If the continuing education is not approved or sponsored by the ABCP, the content and structure must be as strict as the standards utilized by the ABCP in approving or sponsoring continuing education.

(4) Violations (a) Any clinical perfusionist who falsely attests to completion of the required hours of continuing education may be subject to disciplinary action pursuant to Rule 0880-11- .15.

(b) Any clinical perfusionist who fails to obtain the required continuing education hours may be subject to disciplinary action pursuant to Rule 0880-11-.15 and may not be allowed to renew licensure.

(c) Education hours obtained as a result of compliance with the terms of Committee and/or Board Orders in any disciplinary action shall not be credited toward the continuing education hours required to be obtained in any calendar year.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-6-101, 63-28-107, 63-28-114, and 63-28-118.
Administrative History: Original rule filed April 26, 2002; effective July 10, 2002.

Tenn. Comp. R. & Regs. 0880-11-.13 PROFESSIONAL ETHICS

All clinical perfusionists shall comply with the code of ethics adopted by the AmSECT except to the extent that they conflict with the laws of the state of Tennessee or the rules of the Committee and/or Board. If the AmSECT Code of Ethics conflicts with state law or rules, the state law or rules govern the matter. Violation of the Code of Ethics or state law or rules may subject a licensee to disciplinary action pursuant to Rule 0880-11-.15.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-6-101, 63-28-114, and 63-28-118.
Administrative History: Original rule filed April 26, 2002; effective July 10, 2002.

Tenn. Comp. R. & Regs. 0880-11-.14 PROVISIONAL LICENSES

(1) A provisional license may be issued to an applicant who has applied for but has yet to take the licensure examination upon compliance with all provisions of rule 0880-11-.05(2) except subparagraph (j), and submission of proof of having applied to take the examination.

(2) Provisional licenses are valid for a period of one (1) year from the date of issuance but may be renewed in accordance with rule 0880-11-.09 upon receipt of a renewal form signed by both the applicant and the supervising clinical perfusionist.

(3) A provisional license becomes invalid and must be surrendered upon either of the following:

(a) The one (1) year licensure period has expired and the licensee fails to renew or fails to obtain the supervising clinical perfusionists’ signature on the renewal form; or (b) The licensee fails any portion of the licensure examination.

(4) Supervision of provisional licensees is governed by rule 0880-11-.10.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-6-101, 63-28-108, 63-28-114, 63-28-117, and 63-28-118.
Administrative History: Original rule filed April 26, 2002; effective July 10, 2002. Amendment filed April 5, 2006; effective June 19, 2006.

Tenn. Comp. R. & Regs. 0880-11-.15 DISCIPLINARY GROUNDS, ACTIONS, AND CIVIL PENALTIES

(1) Grounds and Authority For Disciplinary Actions - The Committee and Board shall have the power to deny, limit, restrict or condition an application for a license to any applicant who applies for the same. The Committee and Board shall have the authority to suspend or revoke, place on probation, reprimand or otherwise discipline any person holding a license to practice as a clinical perfusionist. The grounds upon which the Committee and Board shall exercise such powers include, but are not limited to, the following:

(a) Violation of any provision of T.C.A. § 63-28-117;

(b) Habitual intoxication or personal misuse of any drugs or the use of intoxicating liquors, narcotics, controlled substances, or other drugs or stimulants in such manner as to adversely affect the person’s ability to practice as a clinical perfusionist;

(c) The advertising of a clinical perfusionist’s business in which untrue or misleading statements are made, or causing the publication or circulation of fraudulent advertising relative to any disease, human ailment, or condition;

(d) Making or signing in one’s professional capacity any certificate that is known to be false at the time one makes or signs such certificate;

(e) Giving or receiving, or aiding or abetting the giving or receiving of rebates, either directly or indirectly, for referrals of business or patients;

(f) Engaging in the practice of clinical perfusion when mentally or physically unable to safely do so;

(g) Violation of the continuing education provisions of Rule 0880-11-.12;

(h) Violation of the scope of practice statute T.C.A. § 63-28-102;

(i) Disciplinary action against a person licensed, certified, registered, or permitted to practice as a clinical perfusionist by another state or territory of the United States for any acts or omissions which would constitute grounds for discipline of a person licensed in this state. A certified copy of the initial or final order or other equivalent document memorializing the disciplinary action from the disciplining state or territory shall constitute prima facie evidence of violation of this section and be sufficient grounds upon which to deny, restrict or condition licensure or renewal and/or discipline a person licensed in this state.

(2) Upon a finding by the Committee and Board that a licensee has violated any provision of the T.C.A. §§ 63-28-101, et seq., or the rules promulgated pursuant thereto, the Committee and Board may take any of the following actions separately or in any combination which is deemed appropriate to the offense;

(a) Warning Letter - This is a written action issued for minor or near infractions. It is informal and advisory in nature and does not constitute a formal disciplinary action.

(b) Reprimand - This is a written action issued for one time and less severe violations. It is a formal disciplinary action.

(c) Probation - This is a formal disciplinary action which places a clinical perfusionist on close scrutiny for a fixed period of time. This action may be combined with conditions that must be met before probation will be lifted and/or which restrict the individual’s activities during the probationary period.

(d) License Suspension - This is a formal disciplinary action that suspends the right to practice for a fixed period of time. It contemplates the re-entry into practice under the license previously issued.

(e) License Revocation - This is the most severe form of disciplinary action which removes an individual from the practice of the profession and terminates the licensure previously issued. The Committee and/or Board, in their discretion, may allow reinstatement of a revoked license upon conditions and after a period of time which they deem appropriate. No petition for reinstatement and no new application for licensure from a person whose license was revoked for cause shall be considered prior to the expiration of at least six (6) months from the effective date of the revocation order.

(f) Conditions - Any action deemed appropriate by the Committee and/or Board to be required of a disciplined license holder during any period of probation or suspension or as a pre-requisite to the lifting of probation or suspension or the reinstatement of a revoked license.

(g) Civil penalty - A monetary disciplinary action assessed by the Committee and Board pursuant to the paragraph (6) of this rule.

(3) Once ordered, probation, suspension, revocation, assessment of a civil penalty, or any other condition of any type of disciplinary action may not be lifted unless and until the licensee petitions, pursuant to paragraph (4) of this rule, and appears before the Committee after the period of initial probation, suspension, revocation, or other conditioning has run and all conditions placed on the probation, suspension, revocation, have been met, and after any civil penalties assessed have been paid.

(4) Order of Compliance - This procedure is a necessary adjunct to previously issued disciplinary orders and is available only when a petitioner has completely complied with the provisions of a previously issued disciplinary order, including an unlicensed practice civil penalty order, and wishes or is required to obtain an order reflecting that compliance.

(a) The Committee and Board will entertain petitions for an Order of Compliance as a supplement to a previously issued order upon strict compliance with the procedures set forth in subparagraph (b) in only the following three (3) circumstances:

When the petitioner can prove compliance with all the terms of the previously issued order and is seeking to have an order issued reflecting that compliance; or 2. When the petitioner can prove compliance with all the terms of the previously issued order and is seeking to have an order issued lifting a previously ordered suspension or probation; or 3. When the petitioner can prove compliance with all the terms of the previously issued order and is seeking to have an order issued reinstating a license previously revoked.

(b) Procedures 1. The petitioner shall submit a Petition for Order of Compliance, as contained in subparagraph (c), to the Committee’s Administrative Office that shall contain all of the following:

(i) A copy of the previously issued order; and (ii) A statement of which provision of subparagraph (a) the petitioner is relying upon as a basis for the requested order; and (iii) A copy of all documents that prove compliance with all the terms or conditions of the previously issued order. If proof of compliance requires testimony of an individual(s), including that of the petitioner, the petitioner must submit signed statements from every individual the petitioner intends to rely upon attesting, under oath, to the compliance. The Committee’s consultant and administrative staff, in their discretion, may require such signed statements to be notarized. No documentation or testimony other than that submitted will be considered in making an initial determination on, or a final order in response to, the petition.

The Committee authorizes its consultant and administrative staff to make an initial determination on the petition and take one of the following actions:

(i) Certify compliance and have the matter scheduled for presentation to the Committee and Board as an uncontested matter; or (ii) Deny the petition, after consultation with legal staff, if compliance with all of the provisions of the previous order is not proven and notify the petitioner of what provisions remain to be fulfilled and/or what proof of compliance was either not sufficient or not submitted.

If the petition is presented to the Committee and Board the petitioner may not submit any additional documentation or testimony other than that contained in the petition as originally submitted.
If the Committee and Board finds that the petitioner has complied with all the terms of the previous order an Order of Compliance shall be issued.
If the petition is denied either initially by staff or after presentation to the Committee or Board and the petitioner believes compliance with the order has been sufficiently proven the petitioner may, as authorized by law, file a petition for a declaratory order pursuant to the provisions of T.C.A. § 4-5-223 and rule 1200- 10-01-.11.

(c) Form Petition Petition for Order of Compliance Board of Medical Examiners Committee for Clinical Perfusionists Petitioner’s Name:

Petitioner’s Mailing Address:

Petitioner’s E-Mail Address:

Telephone Number:

Attorney for Petitioner:

Attorney’s Mailing Address:

Attorney’s E-Mail Address:

Telephone Number:

An order issued reflecting that compliance; or 2. An order issued reflecting that compliance and lifting a previously ordered suspension or probation; or 3. An order issued reflecting that compliance and reinstating a license previously revoked.

The Committee’s consultant and administrative staff, in their discretion, may require such signed statements to be notarized. No documentation or testimony other than that submitted will be considered in making an initial determination on, or a final order in response to, this petition.

Respectfully submitted this the day of , 20___. __________________________________ Petitioner’s Signature (5) Order Modifications - This procedure is not intended to allow anyone under a previously issued disciplinary order, including an unlicensed practice civil penalty order, to modify any findings of fact, conclusions of law, or the reasons for the decision contained in the order. It is also not intended to allow a petition for a lesser disciplinary action, or civil penalty other than the one(s) previously ordered. All such provisions of Committee and Board orders were subject to reconsideration and appeal under the provisions of the Uniform Administrative Procedures Act (T.C.A. §§ 4-5-301, et seq.). This procedure is not available as a substitute for reconsideration and/or appeal and is only available after all reconsideration and appeal rights have been either exhausted or not timely pursued. It is also not available for those who have accepted and been issued a reprimand.

(a) The Committee and Board will entertain petitions for modification of the disciplinary portion of previously issued orders upon strict compliance with the procedures set forth in subparagraph (b) only when the petitioner can prove that compliance with any one or more of the conditions or terms of the discipline previously ordered is impossible. For purposes of this rule the term “impossible” does not mean that compliance is inconvenient or impractical for personal, financial, scheduling or other reasons.

(b) Procedures 1. The petitioner shall submit a written and signed Petition for Order Modification on the form contained in subparagraph (c) to the Committee’s Administrative Office that shall contain all of the following:

No documentation or testimony other than that submitted will be considered in making an initial determination on, or a final order in response to, the petition.

The Committee authorizes its consultant and administrative staff to make an initial determination on the petition and take one of the following actions:

(i) Certify impossibility of compliance and forward the petition to the Office of General Counsel for presentation to the Committee and Board as an uncontested matter; or (ii) Deny the petition, after consultation with legal staff, if impossibility of compliance with the provisions of the previous order is not proven and notify the petitioner of what proof of impossibility of compliance was either not sufficient or not submitted.

If the petition is presented to the Committee and Board the petitioner may not submit any additional documentation or testimony other than that contained in the petition as originally submitted.
If the petition is granted a new order shall be issued reflecting the modifications authorized by the Committee and Board that it deemed appropriate and necessary in relation to the violations found in the previous order.
If the petition is denied either initially by staff or after presentation to the Committee or Board and the petitioner believes impossibility of compliance with the order has been sufficiently proven the petitioner may, as authorized by law, file a petition for a declaratory order pursuant to the provisions of T.C.A. § 4-5- 223 and rule 1200-10-01-.11.

(c) Form Petition Petition for Order Modification Board of Medical Examiners Committee for Clinical Perfusionists Petitioner’s Name:

Petitioner’s Mailing Address:

Petitioner’s E-Mail Address:

Telephone Number:

Attorney for Petitioner:

Attorney’s Mailing Address:

Attorney’s E-Mail Address:

Telephone Number:

Note – You must enclose all documents necessary to prove your request including a copy of the original order. If any of the proof you are relying upon to show impossibility is the testimony of any individual, including yourself, you must enclose signed and notarized statements from every individual you intend to rely upon attesting, under oath, to the reasons why compliance is impossible. No documentation or testimony other than that submitted will be considered in making an initial determination on, or a final order in response to, this petition.

Respectfully submitted this the day of , 20___. __________________________________ Petitioner’s Signature (6) Civil Penalties (a) Purpose - The purpose of this rule is to set out a schedule designating the minimum and maximum civil penalties which may be assessed pursuant to T.C.A. § 63-1-134.

(b) Schedule of Civil Penalties.

A “Type A” Civil Penalty may be imposed whenever the Committee finds a person who is required to be licensed, certified, permitted, or authorized by the Committee, guilty of a willful and knowing violation of the Clinical Perfusionists Licensure Act, or regulations promulgated pursuant thereto, to such an extent that there is, or is likely to be, an imminent, substantial threat to the health, safety and welfare of an individual patient or the public. For purposes of this section, willfully and knowingly practicing as a clinical perfusionist without a permit, license, certificate, or other authorization from the Committee is one of the violations of the Clinical Perfusionists Act for which a “Type A” Civil Penalty is assessable.
A “Type B” Civil Penalty may be imposed whenever the Committee finds the person required to be licensed, certified, permitted, or authorized by the Committee is guilty of a violation of the Clinical Perfusionists Licensure Act or regulations promulgated pursuant thereto in such manner as to impact directly on the care of patients or the public.
A “Type C” Civil Penalty may be imposed whenever the Committee finds the person required to be licensed, certified, permitted, or authorized by the Committee is guilty of a violation of the Clinical Perfusionists Licensure Act or regulations promulgated pursuant thereto, which are neither directly detrimental to the patients or public, nor directly impact their care, but have only an indirect relationship to patient care or the public.

“Type A” Civil Penalties shall be assessed in the amount of not less than $500 nor more than $1000.
“Type B” Civil Penalties may be assessed in the amount of not less than $100 and not more than $500.
“Type C” Civil Penalties may be assessed in the amount of not less than $50 and not more than $100.

(d) Procedures for Assessing Civil Penalties.

The Division of Health Related Boards may initiate a civil penalty assessment by filing a Memorandum of Assessment of Civil Penalty. The Division shall state in the memorandum the facts and law upon which it relies in alleging a violation, the proposed amount of the civil penalty and the basis for such penalty. The Division may incorporate the Memorandum of Assessment of Civil Penalty with a Notice of Charges which may be issued attendant thereto.
Civil Penalties may also be initiated and assessed by the Committee during consideration of any Notice of Charges. In addition, the Committee may, upon good cause shown, assess a type and amount of civil penalty which was not recommended by the Division.
In assessing the civil penalties pursuant to these rules the Committee may consider the following factors:

(i) Whether the amount imposed will be a substantial economic deterrent to the violator;

(ii) The circumstances leading to the violation;

(iii) The severity of the violation and the risk of harm to the public;

(iv) The economic benefits gained by the violator as a result of noncompliance; and (v) The interest of the public.

All proceedings for the assessment of civil penalties shall be governed by the contested case provisions of Title 4, Chapter 5, T.C.A.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 4-5-217, 4-5-223, 63-1-122, 63-1-134, 63-6-101, 63-6-214, 63-28- 114, 63-28-117, and 63-28-118.
Administrative History: Original rule filed April 26, 2002; effective July 10, 2002. Amendment filed September 24, 2004; effective December 8, 2004. Amendment filed December 23, 2009; effective March 23, 2010.

Tenn. Comp. R. & Regs. 0880-11-.16 REPLACEMENT LICENSE

A license holder whose “artistically designed” license has been lost or destroyed may be issued a replacement document upon receipt of a written request in the Administrative Office. Such request shall be accompanied by an affidavit (signed and notarized) stating the facts concerning the loss or destruction of the original document and the fee required pursuant to Rule

Tenn. Comp. R. & Regs. 0880-11-.17 CHANGE OF NAME AND/OR ADDRESS

(1) Change of Name - Any licensee shall notify the Committee in writing within 30 days of a name change and will provide both the old and new names. A name change notification must also include a copy of the official document involved and reference the individual’s profession, committee/board, social security, and license number.

(2) Change of Address - Each person holding a license who has had a change of address shall file in writing with the Administrative Office his/her current address providing both the old and new addresses. Such requests must be received in the Administrative Office no later than 30 days after such change is effective and must reference the individual’s name, profession, social security number, and license number.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-1-108, 63-6-101, 63-28-114, and 63-28-118.
Administrative History: Original rule filed April 26, 2002; effective July 10, 2002.

Tenn. Comp. R. & Regs. 0880-11-.18 COMPLAINTS AND INVESTI GATIONS

(1) The Committee finds that the Division’s Complaint and Investigations procedures fully comply with the requirements of T.C.A. §§ 63-28-115 and 116 and adopts those procedures as its own. Copies of those procedures may be obtained by a written request addressed to the Administrative Office.

(2) The only circumstance in which the Committee would consider employing private investigators would be if a conflict of interest existed between the person being investigated and the Division’s investigative staff, and then only if all other resources of that nature within state government were exhausted without effect. If that should ever occur, the process for employing a private investigator would be the competitive bid process used by the State of Tennessee in employing all outside vendors.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-6-101, 63-28-115, 63-28-116, and 63-28-118.
Administrative History: Original rule filed April 26, 2002; effective July 10, 2002.

Tenn. Comp. R. & Regs. 0880-11-.19 COMMITTEE MEMBERS, OFFICERS, CONSULTANTS, RECORDS, DECLARATORY

ORDERS, AND SCREENING PANELS.

(1) The Committee shall annually elect from its members the following officers:

(a) Chair - who shall preside at all meetings of the Committee; and (b) Vice Chair - who along with the Committee Administrator shall be responsible for correspondence from the Committee.

(2) Records and Complaints (a) Minutes of the Committee meetings and all records, documents, applications and correspondence will be maintained in the Administrative Office.

(b) All requests, applications, notices, other communications and correspondence shall be directed to the Administrative Office. Any requests or inquiries requiring a Committee decision or official Committee action except documents relating to disciplinary actions or hearing requests must be received fourteen (14) days prior to a scheduled meeting and will be retained in the Administrative Office and presented to the Committee at the Committee meeting. Such documents not timely received shall be set over to the next Committee meeting.

(c) All records of the Committee, except those made confidential by law, are open for inspection and examination, under the supervision of an employee of the Division at the Administrative Office during normal business hours.

(d) Copies of public records shall be provided to any person upon payment of a fee.

(e) All complaints should be directed to the Division’s Investigations Section.

(3) The Committee has the authority to select a Committee consultant who shall serve as a consultant to the Division and who is vested with the authority to do the following acts:

(a) Review and make determinations on licensure, renewal and reactivation of licensure applications subject to the rules governing those respective applications and subject to the subsequent ratification by the Committee and Board.

(b) Decide whether and what type disciplinary actions should be instituted upon complaints received or investigations conducted by the Division.

(c) Decide whether and under what terms a complaint, case or disciplinary action might be settled. Any proposed settlement must be subsequently ratified by the Committee and Board.

(d) Undertake any other matter authorized by a majority vote of the Committee and/or Board.

(4) The Committee authorizes the member who chaired the Committee for a contested case to be the agency member to make the decisions authorized pursuant to rule 1360-04-01-.18 regarding petitions for reconsiderations and stays in that case.

(5) Requests for Verification of Licensure for Clinical Perfusionists desiring to practice in another state must be made in writing to the Administrative Office.

(6) Declaratory Orders - The Committee adopts, as if fully set out herein, Rule 1200-10-01-.11, of the Division of Health Related Boards and as it may from time to time be amended, as its rule governing the declaratory order process. All declaratory order petitions involving statutes, rules or orders within the jurisdiction of the Committee shall be addressed by the Committee pursuant to that rule and not by the Division. Declaratory Order Petition forms can be obtained from the Committee’s Administrative Office.

(7) Screening Panels - The Committee adopts, as if fully set out herein, rule 1200-10-01-.13, of the Division of Health Related Boards and as it may from time to time be amended, as its rule governing the screening panel process.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-1-138, 63-6-101, 63-28-114, 63-28-117, and 63-28-118.
Administrative History: Original rule filed April 26, 2002; effective July 10, 2002. Amendment filed March 16, 2007; effective May 30, 2007.

Tenn. Comp. R. & Regs. 0880-11-.20 ADVERTISING

(1) Policy Statement. The lack of sophistication on the part of many in the health care community concerning clinical perfusion, the importance of the interests affected by the choosing of clinical perfusionists and the foreseeable consequences of unrestricted advertising by clinical perfusionists which is recognized to pose special possibilities for deception, require that special care be taken by clinical perfusionists to avoid misleading the health care community.

Clinical perfusionists must be mindful that the benefits of advertising depend upon its reliability and accuracy. Since advertising by clinical perfusionists is calculated and not spontaneous, reasonable regulation designed to foster compliance with appropriate standards serves the public interest without impeding the flow of useful, meaningful, and relevant information to the health care community.

(2) Definitions (a) Advertisement - Informational communication to the health care community in any manner designed to attract attention to the clinical perfusionists which are licensed to practice in Tennessee.

(b) Licensee - Any entity holding a license as a clinical perfusionist in the State of Tennessee. Where applicable this shall include partnerships and/or corporations.

(c) Material Fact - Any fact which a health care provider would need to know or rely upon in order to make an informed decision concerning the choice of clinical perfusionists to serve its particular needs.

(d) Health Care Community - Shall mean hospitals, ambulatory surgical treatment centers, medical practices, individual physicians, and other health care providers with legal

authority to utilize clinical perfusionists.

(3) Advertising Content. The following acts or omissions in the context of advertisement by any licensee shall constitute unprofessional conduct, and subject the licensee to disciplinary action pursuant to T.C.A. § 63-28-117(3).

(b) The misleading use of an unearned or non-health degree in any advertisement.

(c) Promotion of professional services which the licensee knows or should know is beyond the licensee's ability to perform.

(d) Techniques of communication which intimidate, exert undue pressure or undue influence over a prospective client.

(e) Any appeals to an individual's anxiety in an excessive or unfair manner.

(f) The use of any personal testimonial attesting to a quality of competency of a service or treatment offered by a licensee that is not reasonably verifiable.

(h) The communication of personal identifiable facts, data, or information about a patient without first obtaining patient consent.

(i) Any misrepresentation of a material fact.

(j) The knowing suppression, omission or concealment of any material fact or law without which the advertisement would be deceptive or misleading.

(k) Statements concerning the benefits or other attributes of medical procedures or products that involve significant risks without including:

A realistic assessment of the safety and efficiency of those procedures or products; and 2. The availability of alternatives; and 3. Where necessary to avoid deception, descriptions or assessment of the benefits or other attributes of those alternatives.

(l) Any communication which creates an unjustified expectation concerning the potential results of any procedure.

(m) Failure to comply with the rules governing advertising records.

(n) Misrepresentation of a licensee's credentials, training, experience, or ability.

(o) Failure to include the corporation, partnership or individual licensee's name, address, and telephone number in any advertisement. Any corporation, partnership or association which advertises by use of a trade name or otherwise fails to list all clinical perfusion personnel practicing at a particular location shall:

Upon request provide a list of all clinical perfusion personnel practicing at that location; and 2. Maintain and conspicuously display at the licensee's office, a directory listing all clinical perfusion personnel practicing at that location.

(p) Failure to disclose the fact of giving compensation or anything of value to representatives of the press, radio, television or other communicative medium in anticipation of or in return for any advertisement (for example, newspaper article) unless the nature, format or medium of such advertisement make the fact of compensation apparent.

(q) After thirty (30) days of the licensee’s departure, the use of the name of any clinical perfusion personnel formerly practicing at or associated with any advertised location or on office signs or buildings. This rule shall not apply in the case of a retired or deceased former associate who practiced in association with one or more of the present licensees if the status of the former associate is disclosed in any advertisement or sign.

(r) Stating or implying that a certain licensee provides all services when any such services are performed by another licensee.

(4) Advertising Records and Responsibility (a) Each licensee who is a principal partner, or officer of a firm or entity identified in any advertisement, is jointly and severally responsible for the form and content of any advertisement. This provision shall also include any licensed professional employees acting as an agent of such firm or entity.

(b) Any and all advertisement are presumed to have been approved by the licensee named therein.

(5) Severability. It is hereby declared that the sections, clauses, sentences and parts of these rules are severable, are not matters of mutual essential inducement, and any of them shall be rescinded if these rules would otherwise be unconstitutional or ineffective. If any one or more sections, clauses, sentences or parts shall for any reason be questioned in court, and shall be adjudged unconstitutional or invalid, such judgment shall not affect, impair or invalidate the remaining provisions thereof, but shall be confined in its operation to the specific provision or provisions so held unconstitutional or invalid, and the in applicability or invalidity of any

section, clause, sentence or part in any one or more instance shall not be taken to affect or prejudice in any way its applicability or validity in any other instance.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-6-101, 63-28-117, and 63-28-118.
Administrative History: Original rule filed April 26, 2002; effective July 10, 2002. Amendment filed March 16, 2007; effective May 30, 2007.

Chapter 0880-12 General Rules and Regulations Governing the Practice of Acupuncturists

Tenn. Comp. R. & Regs. 0880-12-.01 DEFINITIONS

As used in these rules, the following terms and acronyms shall have the following meanings ascribed to them:

(1) ACAOM - The Accreditation Commission for Acupuncture and Oriental Medicine.

(2) Administrative Office - The office of the administrator assigned to the Board and the Committee located at 665 Mainstream Drive, Nashville, TN 37243.

(3) ADS - An acupuncture detoxification specialist trained in, and who performs only, the five (5) points auricular detoxification treatment.

(4) Board - Tennessee Board of Medical Examiners.

(5) Committee - The Advisory Committee for Acupuncture.

(6) Certificate or Certification - The document issued authorizing practice. Wherever these terms appear in this chapter of rules unless they are specifically designated by the language of the

rule as applying only to limited certification, the terms apply to both limited and full certificate holders.

(7) Division - The Division of Health Related Boards, Tennessee Department of Health, from which the Committee receives administrative support.

(8) NADA - The National Acupuncture Detoxification Association.

(9) NCCAOM - The National Certification Commission for Acupuncture and Oriental Medicine.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-6-101, and 63-6-1001, et seq.
Administrative History: Original rule filed October 18, 2002; effective January 1, 2003.

Tenn. Comp. R. & Regs. 0880-12-.02 SCOPE OF PRACTICE

(1) The scope of practice for all acupuncturists is governed by T.C.A. § 63-6-1001(7).

(2) The scope of practice for all acupuncture detoxification specialists is governed by T.C.A. §§ 63-6-1001(3) and 63-6-1002(b)(2)(B) and (D).

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-6-101, 63-6-1001, 63-6-1002, and 63-6-1004.
Administrative History: Original rule filed October 18, 2002; effective January 1, 2003.

Tenn. Comp. R. & Regs. 0880-12-.04 ACUPUNCTURE CERTIFICATION PROCESS

To become certified in Tennessee a person must comply with one of the following sets of procedures and requirements:

(1) Grandfathering - Any person is eligible to receive a certificate upon compliance with all subparagraphs contained in paragraph (2) except subparagraphs (e), (i), and (j) and upon further showing satisfactory proof of one (1) of the following:

(a) Tennessee residency on January 1, 2001, and successful completion of an approved apprenticeship or tutorial program that meets NCCAOM standards.

Tennessee residency may be proven by submission of a copy of either a voter registration card indicating residency in Tennessee on or prior to January 1, 2001, or a Tennessee driver license issued on or prior to January 1, 2001.
All documentation to support the apprenticeship or tutorial program and how it meets NCCAOM standards must be sent directly from the program or NCCAOM to the Administrative Office.

(b) Continuous practice of acupuncture in Tennessee since January 1, 2001, and having a license/certificate in good standing to practice acupuncture in another state immediately prior to practicing in Tennessee.

Continuous practice in Tennessee since January 1, 2001, may be proven by submission of either of the following:

(i) Photocopies of paycheck(s), paycheck stub(s), or Internal Revenue Service (IRS) Forms W-2, 1099-Misc., or Schedules C or C-EZ for IRS Form 1040 to verify proof of income from the practice of acupuncture; or (ii) Notarized letters from two (2) individuals other than family members attesting to the applicant’s continuous practice.

A certificate of licensure/certification in good standing in another state must be submitted directly from that state licensure/certification agency to the Administrative Office and show a date of issuance prior to the date on which the applicant commenced practice in Tennessee.

(2) Certification by diplomate status - An applicant for certification by diplomate status shall do the following:

(a) Request an application packet from the Administrative Office.

(c) Submit a clear, recognizable, recently taken bust photograph which shows the full head, face forward from at least the top of the shoulder up.

(d) Submit evidence of good moral character. Such evidence shall be two (2) recent (within the preceding 12 months) original letters from medical professionals, attesting to the applicant’s personal character and professional ethics on the signator’s letterhead.

(e) Have submitted directly from the NCCAOM to the Administrative Office proof of current diplomate status in acupuncture.

(f) Disclose the circumstances surrounding any of the following:

Conviction of any criminal law violation of any country, state or municipality, except minor traffic violations.
The denial of professional licensure/certification application by any other state or the discipline of licensure/certification in any state.
Loss or restriction of licensure/certification.
Any civil suit judgment or civil suit settlement in which the applicant was a party defendant including, without limitation, actions involving malpractice, breach of contract, antitrust activity or any other civil action remedy recognized under the country’s or state’s statutory, common or case law.
Failure of any professional licensure or certification examination.

(g) An applicant shall cause to be submitted to the Committee’s Administrative Office directly from the vendor identified in the Committee’s certification application materials, the result of a criminal background check.

(h) Cause to be submitted the equivalent of a Tennessee Certificate of Endorsement (verification of licensure/certification) from each licensing/certifying board of each state or country in which the applicant holds or has ever held a license/certificate to practice any profession that indicates the applicant holds or held an active license/certificate and whether it is in good standing presently or was at the time it became inactive. It is the applicant’s responsibility to request this information be sent directly from each such licensing/certifying board to the Administrative Office.

(i) Have proof of completion of a three (3) year post-secondary acupuncture training program or college acupuncture program sent directly from the training program or college to the Administrative Office. This proof must also include the following:

Proof that the college or training program either:

(i) Holds ACAOM accreditation; or (ii) Is in ACAOM candidacy status; or (iii) Meets ACAOM standards.

Notation of successful completion or graduation from the acupuncture training program or college acupuncture program and carry the official seal of the institution.

(j) Have proof of successful completion of a NCCAOM-approved clean needle technique course sent directly from the course provider to the Administrative Office.

(k) Submit the fees required in Rule 0880-12-.06.

(3) Certification by reciprocity - To become certified in Tennessee based on licensure or certification in another state, an applicant must (a) Comply with all the requirements of paragraph (2) of this rule except subparagraph (e); and (b) Have proof of licensure or certification in a state that has licensure or certification requirements substantially equivalent, as determined by the Committee, to the requirements of T.C.A. §§ 63-6-1001, et seq., and this chapter of rules sent directly from the state licensing/certifying agency to the Administrative Office.

(4) Application review and certification decisions shall be governed by Rule 0880-12-.07.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-6-101, 63-6-214, 63-6-1004, 63-6-1005, and 63-6-1007.
Administrative History: Original rule filed October 18, 2002; effective January 1, 2003. Amendment filed March 17, 2006; effective May 31, 2006.

Tenn. Comp. R. & Regs. 0880-12-.05 ADS CERTIFICATION PROCESS

(1) To be issued a limited acupuncture certification as an ADS in Tennessee a person must comply with the following sets of procedures and requirements:

(a) Request an application packet from the Administrative Office.

(c) Submit a clear, recognizable, recently taken bust photograph which shows the full head, face forward from at least the top of the shoulder up.

(e) Have submitted directly from the training program to the Administrative Office documentation of successful completion of a board-approved training program in auricular detoxification acupuncture. To become board-approved, the training program must meet or exceeds standards of training set by NADA.

(f) Disclose the circumstances surrounding any of the following:

Conviction of any criminal law violation of any country, state or municipality, except minor traffic violations.
The denial of professional licensure/certification application by any other state or the discipline of licensure/certification in any state.
Loss or restriction of licensure/certification.
Any civil suit judgment or civil suit settlement in which the applicant was a party defendant including, without limitation, actions involving malpractice, breach of contract, antitrust activity or any other civil action remedy recognized under the country’s or state’s statutory, common or case law.
Failure of any professional licensure or certification examination.

(i) Submit the fees required in Rule 0880-12-.06.

(2) Application review and limited certification decisions shall be governed by Rule 0880-12-.07.

(3) Prior to the commencement of practice as an ADS, an ADS certificate holder must provide the following documentation to the Committee’s Administrative Office:

(a) Satisfactory written acknowledgement that the practice of auricular detoxification treatment will be in a hospital, clinic, or treatment facility which provides comprehensive alcohol and substance abuse or chemical dependency services including counseling, and (b) Certification from the supervising licensed acupuncturist or medical director (a physician licensed under Chapter 6 or 9 of Title 63 of the Tennessee Code Annotated) of the institution, facility, or entity attesting to employment and acceptance of supervisory responsibility.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-6-101, 63-6-214, 63-6-1002, 63-6-1004, 63-6-1005, and 63-6- 1007.
Administrative History: Original rule filed October 18, 2002; effective January 1, 2003. Amendment filed March 17, 2006; effective May 31, 2006. Amendments filed June 7, 2017; effective September 5, 2017.

Tenn. Comp. R. & Regs. 0880-12-.06 FEES

All fees provided for in this rule are non-refundable.

Acupuncturist Acupuncture Dextoxification Specialist (1) Application fee to be submitted at the time $150.00 $ 75.00 of application.

(2) Initial certification fee to be submitted at the $200.00 $ 25.00 time of application.

(3) Biennial renewal fee to be submitted $200.00 $ 50.00 every two (2) years when certification renewal is due.

(4) Late renewal fee. $100.00 $ 50.00 (5) Certification reinstatement and/or $100.00 $ 50.00 restoration fee.

(6) Duplication of certificate fee. $ 25.00 $ 10.00 (7) Biennial state regulatory fee to be $ 10.00 $ 10.00 submitted at the time of application.

(8) All fees may be paid in person, by mail or electronically by cash, check, money order, or by credit and/or debit cards accepted by the Division of Health Related Boards. If the fees are paid by certified, personal or corporate check they must be drawn against an account in a United States Bank, and made payable to the Advisory Committee for Acupuncture.

History

Authority: T.C.A. §§ 63-1-106, 63-1-107, 63-6-1004, and 63-6-1009.
Administrative History: Original rule filed October 18, 2002; effective January 1, 2003. Amendment filed January 5, 2004; effective March 20, 2004. Amendment filed January 22, 2013; effective April 22, 2013. Amendment filed April 20, 2016; effective July 19, 2016. Amendments filed March 4, 2025; effective June 2, 2025.

Tenn. Comp. R. & Regs. 0880-12-.07 APPLICATION REVIEW, APPROVAL, AND DENIAL

(1) Review of all applications to determine whether or not the application file is complete may be delegated to the Committee’s administrator.

(2) A temporary authorization to practice, as described in T.C.A. § 63-1-142 may be issued to an applicant pursuant to an initial determination made by a Committee and Board designee who have both reviewed the completed application and determined that the applicant has met all the requirements for certification, renewal or reinstatement. The temporary authorization to practice is valid for a period of six (6) months from the date of issuance of the temporary authorization to practice and may not be extended or renewed. If the Committee or Board subsequently makes a good faith determination that the applicant has not met all the requirements for certification, renewal or reinstatement and therefore denies, limits, conditions or restricts certification, renewal or reinstatement, the applicant may not invoke the doctrine of estoppel in a legal action brought against the state based upon the issuance of the temporary authorization to practice and the subsequent denial, limitation, conditioning or restricting of certification.

(3) If an application is incomplete when received by the Administrative Office, or the reviewing Committee and/or Board member or the Committee’s/Board’s designee determine additional information is required from an applicant before an initial determination can be made, the Board administrator shall notify the applicant of the information required. The applicant shall cause the requested information to be received in the Administrative Office on or before the ninetieth (90th) day after the initial letter notifying the applicant of the required information is sent.

(4) If requested information is not timely received, the application file may be considered abandoned and may be closed by the administrator. If that occurs, the applicant shall be notified that the Committee and Board will not consider issuance of a certificate until a new application is received pursuant to the rules governing that process, including another payment of all fees applicable to the applicant’s circumstances and submission of such new supporting documents as is required by the Committee and Board.

(5) If a reviewing Committee and/or Board member or Committee and/or Board designee initially determines that a completed application should be denied, limited, conditioned or restricted, a temporary authorization shall not be issued. The applicant shall be informed of the initial decision and that a final determination on the application will be made by the Committee and the Board at their next appropriate meeting. If the Committee and Board ratify the initial denial, limitation, condition or restriction, the action shall become final and the following shall occur:

(a) A notification of the denial, limitation, condition or restriction shall be sent by the Administrative Office by certified mail, return receipt requested, that contains the specific reasons for denial, limitation, condition or restriction, such as incomplete information, unofficial records, examination failure, or matters judged insufficient for certification, and such notification shall contain all the specific statutory or rule authorities for the denial, limitation, condition or restriction.

(b) The notification, when appropriate, shall also contain a statement of the applicant’s right to request a contested case hearing under the Tennessee Administrative Procedures Act (T.C.A. §§ 4-5-301, et seq.) to contest the denial, limitation, condition or restriction and the procedure necessary to accomplish that action.

An applicant has a right to a contested case hearing only if the certification denial, limitation, condition or restriction is based on subjective or discretionary criteria.
An applicant may be granted a contested case hearing if the certification denial, limitation, condition or restriction is based on an objective, clearly defined criteria only if after review and attempted resolution by the Committee’s Administrative Staff, the application can not be approved and the reasons for continued denial, limitation, condition or restriction present genuine issues of fact and/or law which are appropriate for appeal. Requests for a hearing must be made in writing to the Administrative Office within thirty (30) days of the receipt of the notice of denial, limitation, condition or restriction from the Committee and/or Board.

(6) If the Committee and/or Board finds it has erred in the issuance of a certification, it will give written notice by certified mail of its intent to revoke or cancel the certificate. The notice will allow the applicant the opportunity to meet the requirements for certification within thirty (30) days from the date of receipt of the notification. If the applicant does not concur with the stated reason and the intent to revoke or cancel the certification, the applicant shall have the right to proceed according to paragraph (5) of this rule.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-1-142, 63-6-101, 63-6-1004, 63-6-1005, 63-6-1006, and 63-6- 1007.
Administrative History: Original rule filed October 18, 2002; effective January 1, 2003.

Tenn. Comp. R. & Regs. 0880-12-.09 CERTIFICATION RENEWAL

All certificates must be renewed to enable continued practice. Renewal is governed by the following:

(1) The due date for certification renewal is its expiration date which is the last day of the month in which a certificate holder’s birthday falls pursuant to the Division of Health Related Boards “biennial birthdate renewal system” as provided in Rule 1200-10-01-.10.

(2) Methods of Renewal - Certificate holders may accomplish renewal by one (1) of the following methods:

(a) Internet Renewals - Individuals may apply for renewal via the internet. The application to renew can be accessed at: https://apps.tn.gov/hlrs/ (b) Paper Renewals - Certificate holders who have not renewed their authorization online via the internet, will have a renewal application form mailed to them at the last address provided by them to the Committee. Failure to receive such notification does not relieve the individual of the responsibility of timely meeting all requirements for renewal.

(3) To be eligible for renewal an individual must submit to the Division of Health Related Boards on or before the expiration date the following:

(a) A completed and signed renewal application form; and (b) The renewal and state regulatory fees as provided in Rule 0880-12-.06; and (c) Unless issued a certification under the grandfathering provisions of T.C.A. § 63-6-1005 1. For certified acupuncturists, proof of current, active NCCAOM certification.

For ADS certificate holders, proof of current active practice in auricular detoxification treatment.

(4) Any renewal application received after the certification expiration date but before the last day of the month following the certification expiration date must be accompanied by the Late Renewal Fee provided in Rule 0880-12-.06.

(5) Any individual who fails to comply with the renewal rules and/or notifications sent to them concerning failure to timely renew shall have their certificate processed pursuant to Rule

Tenn. Comp. R. & Regs. 0880-12-.10 SUPERVISION

All persons practicing with a limited certification as an ADS shall be under the supervision of a certified acupuncturist or a medical director of a hospital, clinic, or treatment facility which provides comprehensive alcohol and substance abuse or chemical dependency services, including counseling.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-6-101, 63-6-1001, 63-6-1002, 63-6-1004, and 63-6-1005.
Administrative History: Original rule filed October 18, 2002; effective January 1, 2003.

Tenn. Comp. R. & Regs. 0880-12-.11 RETIREMENT AND REACTIVATION OF CERTIFICATE

(1) Certificate holders who wish to retain their certificates but not actively practice may avoid compliance with the renewal process by obtaining, completing, and submitting, to the Administrative Office, an affidavit of retirement form along with any documentation required by the form.

(2) Upon successful application for retirement with completion and receipt of all proper documentation to the Committee’s and Board’s satisfaction, the certificate shall be registered as retired. Any person who has a retired certificate may not practice in Tennessee.

(3) Reactivation - Any retired certificate may be reactivated by doing the following:

(a) Submit a written request for a Reactivation Application to the Administrative Office; and (b) Complete and submit the Reactivation Application along with the renewal fee as provided in Rule 0880-12-.06 to the Administrative Office. If reactivation was requested prior to the expiration of one (1) year from the date of retirement, the Board may require payment of the certificate restoration fee and past due renewal fees as provided in Rule 0880-12-.06; and (c) For acupuncturists, submit along with the application, documentation of successful completion of fifteen (15) points of continuing education pursuant to Rule 0880-12-.12; and (d) Submit any documentation which may be required by the form to the Administrative Office; and (e) If requested, after review by the Committee and/or Board or a designated Committee and/or Board member, appear before either the Committee and/or Board, or a duly constituted panel of the Board, or another Committee or Board member, or the Committee and/or Board Designee for an interview regarding continued competence.

(f) In the event of retirement in excess of two (2) years or the receipt of derogatory information or communication during the reactivation process, the applicant should be prepared to meet or accept other conditions or restrictions as the Committee and/or Board may deem necessary to protect the public.

(g) If retirement was in excess of five (5) years, the applicant may be required to successfully complete whatever educational and/or testing requirements the Committee and/or Board feels necessary to establish current levels of competency.

(4) Certificate reactivation applications, review, and decisions shall be governed by Rule 0880- 12-.07.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-1-111, 63-6-101, and 63-6-1004.
Administrative History: Original rule filed October 18, 2002; effective January 1, 2003. Amendment filed March 17, 2006; effective May 31, 2006.

Tenn. Comp. R. & Regs. 1200-10-01-.10 .

(6) Renewal of an Expired Certificate - Renewal of a certificate that has expired as a result of failure to timely renew in accordance with Rule 1200-10-01-.10 may be accomplished upon meeting the following conditions:

(a) For persons whose certificates have expired for less than (2) years:

Submit a completed reinstatement application; and 2. Submit the renewal and late renewal fees as provided in Rule 0880-12-.06; and 3. For acupuncturists, submit along with the application, documentation of successful completion of the continuing education requirements provided in Rule

Tenn. Comp. R. & Regs. 0880-12-.12 CONTINUING EDUCATION

All persons certified as acupuncturists must comply with the following continuing education rules as a prerequisite to certification renewal.

(1) All certified acupuncturists must obtain thirty (30) Professional Development Activity (PDA) points, as defined by NCCAOM, during the two (2) calendar year (January 1–December 31) period that precedes the year in which certification is renewed.

(2) Continuing education for new certificate holders - Submitting proof of successful completion of all education and training requirements required for certification in Tennessee, pursuant to

Rule 0880-12-.04, shall be considered proof of sufficient preparatory education to constitute successful completion of continuing education requirements for the two (2) calendar year (January 1–December 31) period in which such education and training requirements were completed.

(3) The approved hours of any individual course or activity will not be counted more than once in a two (2) calendar year (January 1–December 31) period toward the required point total regardless of the number of times the course or activity is attended or completed by any individual.

(4) The Committee and/or Board may waive or otherwise modify the requirements of this rule in cases where there is illness, disability or other undue hardship that prevents a certificate holder from obtaining the requisite number of continuing education points. Requests for waivers or modification must be sent in writing to the Administrative Office prior to the expiration of the renewal period in which the continuing education is due.

(5) Acceptable Continuing Education Courses and Activities - The following professional courses and activities qualify for PDA points of continuing education:

(a) Courses - One (1) point for each hour of courses that directly enhance an acupuncturist’s knowledge and/or practice of acupuncture. Points may be earned for courses in Oriental medical theory and techniques such as bodywork, nutrition, and herbology, as well as courses in western sciences that relate to the practice of acupuncture. Points may also be earned for the study of tai chi and qi gong.

(b) Research - One point for every two (2) hours of documented research. Acceptable research projects include those that relate to knowledge and/or practice in acupuncture.

(c) Writing for Publication - Ten (10) points for each article; Thirty (30) points for a book or major work. Publications include articles, studies, reports, books, etc., that relate to knowledge and/or practice in acupuncture.

(d) Teaching/Clinic Supervision - One (1) point for each clock hour of instruction or supervision relating to acupuncture. Teaching or supervision refers to the ongoing responsibility for theoretical and/or practical education. Credit can be earned for a variety of teaching positions, including teaching or clinical supervision in a formal school or preceptorship, provided there is appropriate documentation.

(e) Supervised Clinical Experience - One and one-half (1½) points for each clock hour of supervised clinical experience under a senior acupuncturist who has a minimum of five years of experience in acupuncture and is an NCCAOM Diplomate in Acupuncture. The clinical experience may include observation, case discussion, and/or supervised practice.

(6) Proof of Compliance (a) The due date for completion of the required continuing education is December 31st of the two (2) calendar year period that precedes the year in which certification is renewed.

(b) All acupuncturists must, on the certificate renewal form, enter a signature, electronic or otherwise, which indicates completion of the required continuing education obtained during the two (2) calendar year (January 1–December 31) period that precedes the year in which certification is renewed.

(c) All acupuncturists must retain independent documentation of completion of all continuing education courses and activities. This documentation must be retained for a period of four (4) years from the end of the two (2) calendar year (January 1–December 31) period in which the continuing education was acquired. This documentation must be produced for inspection and verification, if requested in writing by the Division during its verification process. Documentation verifying the acupuncturist’s completion of the continuing education may consist of any one (1) or more of the following:

Courses - Dates, locations of continuing education courses, number of hours, course title/content and instructor’s name, documented by notarized photocopies of original certificates of completion or original letters on official stationery from the course provider.
Research - Dates, location, and subject/title of research, documented by a notarized photocopy of an affidavit from a school, hospital, or other official agency detailing the activity.
Writing for Publication - Dates, titles, and names of publishers, documented by a photocopy of the title page.
Teaching Acupuncture Related Courses - Dates and locations of classes, syllabi, course titles and course hours, documented by catalogs, computer records, or notarized photocopies of certificates and other official statements that verify the activities and hours involved.
Preceptorship - Dates, hours, and locations of clinical or apprenticeship activity, documented by a notarized photocopy of an affidavit from the supervising practitioner.

(7) Violations (a) Any acupuncturist who falsely attests to completion of the required continuing education may be subject to disciplinary action pursuant to Rule 0880-12-.15.

(b) Any acupuncturist who fails to obtain the required continuing education may be subject to disciplinary action pursuant to Rule 0880-12-.15 and may not be allowed to renew certification.

(c) Continuing education obtained as a result of compliance with the terms of Committee and/or Board orders in any disciplinary action shall not be credited toward the continuing education required to be obtained in any two (2) calendar year (January 1– December 31) period.

History

Authority: T. C.A. §§ 4-5-202, 4-5-204, 63-6-101, 63-6-214, 63-6-1004, and 63-6-1007.
Administrative History: Original rule filed March 17, 2006; effective May 31, 2006.

Tenn. Comp. R. & Regs. 0880-12-.13 PROFESSIONAL ETHICS

(1) All certificate holders shall comply with the Code of Ethics adopted by the NCCAOM except to the extent that they conflict with the laws of the state of Tennessee or the rules of the Committee and/or Board. If the NCCAOM Code of Ethics conflicts with state law or rules, the state law or rules govern the matter. Violation of the Code of Ethics or state law or rules may subject a certificate holder to disciplinary action pursuant to Rule 0880-12-.15.

(2) A copy of the NCCAOM Code of Ethics may be obtained from NCCAOM at 11 Canal Center Plaza, Suite 300, Alexandria, VA 22314 or by phone at (703) 548-9004, or on the internet at http://www.nccaom.org.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-6-101, 63-6-1004, and 63-6-1006.
Administrative History: Original rule filed October 18, 2002; effective January 1, 2003.

Tenn. Comp. R. & Regs. 0880-12-.15 DISCIPLINARY ACTIONS AND CIVIL PENALTIES

(1) Upon a finding by the Committee and Board that a certificate holder has violated any provision of T.C.A. §§ 63-6-1001, et seq., or the rules promulgated pursuant thereto, the Committee and Board may take any of the following actions separately or in any combination which is deemed appropriate to the offense;

(a) Warning Letter - This is a written action issued for minor or near infractions. It is informal and advisory in nature and does not constitute a formal disciplinary action.

(b) Reprimand - This is a written action issued for one time and less severe violations. It is a formal disciplinary action.

(c) Probation - This is a formal disciplinary action which places a certificate holder on close scrutiny for a fixed period of time. This action may be combined with conditions that must be met before probation will be lifted and/or which restrict the individual’s activities during the probationary period.

(d) Certificate Suspension - This is a formal disciplinary action that suspends the right to practice for a fixed period of time. It contemplates the re-entry into practice under the certificate previously issued.

(e) Revocation for Cause - This is the most severe form of disciplinary action which removes an individual from the practice of the profession and terminates the certificate previously issued. The Committee and/or Board, in their discretion, may allow reinstatement of a revoked certificate upon conditions and after a period of time which they deem appropriate. No petition for reinstatement and no new application for certification from a person whose certificate was revoked for cause shall be considered prior to the expiration of at least six (6) months from the effective date of the revocation order.

(f) Conditions - Any action deemed appropriate by the Committee and/or Board to be required of a disciplined certificate holder during any period of probation or suspension or as a prerequisite to the lifting of probation or suspension or the reinstatement of a revoked certificate.

(g) Civil penalty - A monetary disciplinary action assessed by the Committee and Board pursuant to paragraph (5) of this rule.

(2) Once ordered, probation, suspension, revocation, assessment of a civil penalty, or any other condition of any type of disciplinary action may not be lifted unless and until the certificate holder petitions, pursuant to paragraph (3) of this rule, and appears before the Committee after the period of initial probation, suspension, revocation, or other conditioning has run and all conditions placed on the probation, suspension, revocation, have been met, and after any civil penalties assessed have been paid.

(3) Order of Compliance - This procedure is a necessary adjunct to previously issued disciplinary orders and is available only when a petitioner has completely complied with the provisions of a previously issued disciplinary order, including an uncertified practice civil penalty order, and wishes or is required to obtain an order reflecting that compliance.

When the petitioner can prove compliance with all the terms of the previously issued order and is seeking to have an order issued reflecting that compliance; or 2. When the petitioner can prove compliance with all the terms of the previously issued order and is seeking to have an order issued lifting a previously ordered suspension or probation; or 3. When the petitioner can prove compliance with all the terms of the previously issued order and is seeking to have an order issued reinstating a certificate previously revoked.

(b) Procedures 1. The petitioner shall submit a Petition for Order of Compliance, as contained in subparagraph (c), to the Committee’s Administrative Office that shall contain all of the following:

(i) A copy of the previously issued order; and (ii) A statement of which provision of subparagraph (a) the petitioner is relying upon as a basis for the requested order; and (iii) A copy of all documents that prove compliance with all the terms or conditions of the previously issued order. If proof of compliance requires testimony of an individual(s), including that of the petitioner, the petitioner must submit signed statements from every individual the petitioner intends to rely upon attesting, under oath, to the compliance. The Committee’s consultant and administrative staff, in their discretion, may require such signed statements to be notarized. No documentation or testimony other than that submitted will be considered in making an initial determination on, or a final order in response to, the petition.

The Committee authorizes its consultant and administrative staff to make an initial determination on the petition and take one of the following actions:

If the petition is presented to the Committee and Board the petitioner may not submit any additional documentation or testimony other than that contained in the petition as originally submitted.
If the Committee and Board finds that the petitioner has complied with all the terms of the previous order an Order of Compliance shall be issued.
If the petition is denied either initially by staff or after presentation to the Committee or Board and the petitioner believes compliance with the order has been sufficiently proven the petitioner may, as authorized by law, file a petition for a declaratory order pursuant to the provisions of T.C.A. § 4-5-223 and Rule

Tenn. Comp. R. & Regs. 1200-10-01-.11 .

(c) Form Petition Petition for Order of Compliance Board of Medical Examiners Advisory Committee for Acupuncture Petitioner’s Name:

Petitioner’s Mailing Address:

Petitioner’s E-Mail Address:

Telephone Number:

Attorney for Petitioner:

Attorney’s Mailing Address:

Attorney’s E-Mail Address:

Telephone Number:

An order issued reflecting that compliance; or 2. An order issued reflecting that compliance and lifting a previously ordered suspension or probation; or 3. An order issued reflecting that compliance and reinstating a certificate previously revoked.

Note - You must enclose all documents necessary to prove your request including a copy of the original order. If any of the proof you are relying upon to show compliance is the testimony of any individual, including yourself, you must enclose signed statements from every individual you intend to rely upon attesting, under oath, to the compliance. The Committee’s consultant and administrative staff, in their discretion, may require such signed statements to be notarized. No documentation or testimony other than that submitted will be considered in making an initial determination on, or a final order in response to, this petition.

Respectfully submitted this the day of , 20 . __________________________________ Petitioner’s Signature (4) Order Modifications - This procedure is not intended to allow anyone under a previously issued disciplinary order, including an uncertified practice civil penalty order, to modify any findings of fact, conclusions of law, or the reasons for the decision contained in the order. It is also not intended to allow a petition for a lesser disciplinary action, or civil penalty other than the one(s) previously ordered. All such provisions of Committee and Board orders were subject to reconsideration and appeal under the provisions of the Uniform Administrative Procedures Act (T.C.A. §§ 4-5-301, et seq.). This procedure is not available as a substitute for reconsideration and/or appeal and is only available after all reconsideration and appeal rights have been either exhausted or not timely pursued. It is also not available for those who have accepted and been issued a reprimand.

No documentation or testimony other than that submitted will be considered in making an initial determination on, or a final order in response to, the petition.

The Committee authorizes its consultant and administrative staff to make an initial determination on the petition and take one of the following actions:

If the petition is presented to the Committee and Board the petitioner may not submit any additional documentation or testimony other than that contained in the petition as originally submitted.
If the petition is granted a new order shall be issued reflecting the modifications authorized by the Committee and Board that it deemed appropriate and necessary in relation to the violations found in the previous order.
If the petition is denied either initially by staff or after presentation to the Committee or Board and the petitioner believes impossibility of compliance with the order has been sufficiently proven the petitioner may, as authorized by law, file a petition for a declaratory order pursuant to the provisions of T.C.A. § 4-5- 223 and Rule 1200-10-01-.11.

(c) Form Petition Petition for Order Modification Board of Medical Examiners Advisory Committee for Acupuncture Petitioner’s Name:

Petitioner’s Mailing Address:

Petitioner’s E-Mail Address:

Telephone Number:

Attorney for Petitioner:

Attorney’s Mailing Address:

Attorney’s E-Mail Address:

Telephone Number:

Respectfully submitted this the day of , 20 . __________________________________ Petitioner’s Signature (5) Civil Penalties (a) Purpose - The purpose of this rule is to set out a schedule designating the minimum and maximum civil penalties which may be assessed pursuant to T.C.A. § 63-1-134.

(b) Schedule of Civil Penalties 1. A “Type A” Civil Penalty may be imposed whenever the Committee and Board find a person who is required to be licensed, certified, permitted, or authorized by the Committee and Board, guilty of a willful and knowing violation of T.C.A. §§ 63-6-1001, et seq., or regulations promulgated pursuant thereto, to such an extent that there is, or is likely to be, an imminent, substantial threat to the health, safety and welfare of an individual patient or the public. For purposes of this

section, willfully and knowingly practicing as an acupuncturist or as an ADS without a permit, license, certificate, or other authorization from the Committee and Board is one of the violations for which a “Type A” Civil Penalty is assessable.

A “Type B” Civil Penalty may be imposed whenever the Committee and Board find the person required to be licensed, certified, permitted, or authorized by the Committee and Board is guilty of a violation of T.C.A. §§ 63-6-1001, et seq., or regulations promulgated pursuant thereto in such manner as to impact directly on the care of patients or the public.
A “Type C” Civil Penalty may be imposed whenever the Committee and Board find the person required to be licensed, certified, permitted, or authorized by the Committee and Board is guilty of a violation of T.C.A. §§ 63-6-1001, et seq., or regulations promulgated pursuant thereto, which is neither directly detrimental to the patients or public, nor directly impacts their care, but has only an indirect relationship to patient care or the public.

“Type A” Civil Penalties shall be assessed in the amount of not less than $500 nor more than $1000.
“Type B” Civil Penalties may be assessed in the amount of not less than $100 and not more than $500.
“Type C” Civil Penalties may be assessed in the amount of not less than $50 and not more than $100.

(d) Procedures for Assessing Civil Penalties.

The Division of Health Related Boards may initiate a civil penalty assessment by filing a Memorandum of Assessment of Civil Penalty. The Division shall state in the memorandum the facts and law upon which it relies in alleging a violation, the proposed amount of the civil penalty and the basis for such penalty. The Division may incorporate the Memorandum of Assessment of Civil Penalty with a Notice of Charges which may be issued attendant thereto.
Civil penalties may also be initiated and assessed by the Committee and Board during consideration of any Notice of Charges. In addition, the Committee and Board may, upon good cause shown, assess a type and amount of civil penalty which was not recommended by the Division.
In assessing the civil penalties pursuant to these rules the Committee and Board may consider the following factors:

(i) Whether the amount imposed will be substantial economic deterrent to the violator;

(ii) The circumstances leading to the violation;

(iii) The severity of the violation and the risk of harm to the public;

(iv) The economic benefits gained by the violator as a result of noncompliance; and (v) The interest of the public.

All proceedings for the assessment of civil penalties shall be governed by the contested case provisions of Title 4, Chapter 5, T.C.A.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 4-5-217, 4-5-223, 63-1-122, 63-1-134, 63-6-101, 63-6-1003, 63-6- 1004, and 63-6-1007.
Administrative History: Original rule filed October 18, 2002; effective January 1, 2003. Amendment filed September 24, 2004; effective December 8, 2004.

Tenn. Comp. R. & Regs. 0880-12-.16 REPLACEMENT CERTIFICATES

A certificate holder whose “artistically designed” certificate has been lost or destroyed may be issued a replacement document upon receipt of a written request in the Administrative Office. Such request shall be accompanied by an affidavit (signed and notarized) stating the facts concerning the loss or destruction of the original document and the fee required pursuant to Rule 0880-12-.06.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-1-106, 63-6-101, and 63-6-1004.
Administrative History: Original rule filed October 18, 2002; effective January 1, 2003.

Tenn. Comp. R. & Regs. 0880-12-.17 CHANGE OF NAME AND/OR ADDRESS

(1) Change of Name - Any certificate holder shall notify the Administrative Office in writing within thirty (30) days of a name change and will provide both the old and new names. A name change notification must also include a copy of the official document involved and reference the individual’s profession, committee/board, social security, and certificate numbers.

(2) Change of Address - Each person holding a certificate who has had a change of address shall file in writing with the Administrative Office his/her current address providing both the old and new addresses. Such requests must be received in the Administrative Office no later than thirty (30) days after such change is effective and must reference the individual’s name, profession, social security number, and certificate number.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-1-108, 63-6-101, and 63-6-1004.
Administrative History: Original rule filed October 18, 2002; effective January 1, 2003.

Tenn. Comp. R. & Regs. 0880-12-.19 COMMITTEE OFFICERS, CONSULTANTS, RECORDS, DECLARATORY ORDERS,

AND SCREENING PANELS.

(1) The Committee shall annually elect from its members the following officers:

(a) Chair - who shall preside at all meetings of the Committee; and (b) Co-Chair - who shall preside at meetings in the absence of the Chair and who along with the Committee Administrator shall be responsible for correspondence from the Committee.

(2) The Committee has the authority to select a Committee consultant who shall serve as a consultant to the Division and who is vested with the authority to do the following acts:

(a) Review complaints and recommend whether and what type disciplinary actions should be instituted as the result of complaints received or investigations conducted by the Division.

(b) Recommend whether and upon what terms a complaint, case or disciplinary action might be settled. Any matter proposed for settlement must be subsequently reviewed, evaluated and ratified by the Committee and Board before it becomes effective.

(3) Records and Complaints (a) Minutes of the Committee meetings and all records, documents, applications and correspondence will be maintained in the Administrative Office.

(d) Copies of public records shall be provided to any person upon payment of a fee.

(e) All complaints should be directed to the Division’s Investigations Section.

(4) The Committee members or the consultant are individually vested with the authority to do the following acts:

(a) Review and make determinations on certification, renewal and reactivation of applications subject to the rules governing those respective applications and subject to the subsequent ratification by the Committee and Board.

(b) Serve as consultant to the Division to decide the following:

(Chapter 0880-12-.19, continued)

Whether and what type disciplinary actions should be instituted upon complaints received or investigations conducted by the Division.
Whether and under what terms a complaint, case or disciplinary action might be settled. Any proposed settlement must be subsequently ratified by the Committee and Board before it becomes effective.

(5) The Committee authorizes the member who chaired the Committee for a contested case to be the agency member to make the decisions authorized pursuant to Rule 1360-04-01-.18 regarding petitions for reconsideration and stays in that case.

(6) Requests for Verification of Licensure for an acupuncturist or an ADS desiring to practice in another state must be made in writing to the Administrative Office.

(7) Declaratory Orders - The Committee adopts, as if fully set out herein, Rule 1200-10-01-.11, of the Division of Health Related Boards and as it may from time to time be amended, as its rule governing the declaratory order process. All declaratory order petitions involving statutes, rules or orders within the jurisdiction of the Committee shall be addressed by the Committee pursuant to that rule and not by the Division. Declaratory Order Petition forms can be obtained from the Administrative Office.

(8) Screening Panels - The Committee adopts, as if fully set out herein, Rule 1200-10-01-.13, of the Division of Health Related Boards and as it may from time to time be amended, as its rule governing the screening panel process.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-1-138, 63-6-101, 63-6-1004, and 63-6-1007.
Administrative History: Original rule filed October 18, 2002; effective January 1, 2003. Amendment filed March 16, 2007; May 30, 2007.

Tenn. Comp. R. & Regs. 0880-12-.20 ADVERTISING

(1) Policy Statement. The lack of sophistication on the part of many of the public concerning acupuncture, the importance of the interests affected by the choice of an acupuncturist and the foreseeable consequences of unrestricted advertising by acupuncturists which is recognized to pose special possibilities for deception, require that special care be taken by acupuncturists to avoid misleading the public. The acupuncturist must be mindful that the benefits of advertising depend upon its reliability and accuracy. Since advertising by acupuncturists is calculated and not spontaneous, reasonable regulation designed to foster compliance with appropriate standards serves the public interest without impeding the flow of useful, meaningful, and relevant information to the public.

(2) Definitions (a) Advertisement - Informational communication to the public in any manner designed to attract public attention to the practice of an acupuncturist who is certified to practice in Tennessee.

(b) Certificate Holder - Any person holding a certificate to practice acupuncture in the State of Tennessee. Where applicable this shall include partnerships and/or corporations.

(Chapter 0880-12-.20, continued)

(3) Advertising Fees and Services (a) Fixed Fees. Fixed fees may be advertised for any service. It is presumed unless otherwise stated in the advertisement that a fixed fee for a service shall include the cost of all professional recognized components within generally accepted standards that are required to complete the service.

(b) Range of Fees. A range of fees may be advertised for services and the advertisement must disclose the factors used in determining the actual fee, necessary to prevent deception of the public.

The discount fee is in fact lower than the certificate holder’s customary or usual fee charged for the service; and 2. The certificate holder provides the same quality and components of service and material at the discounted fee that are normally provided at the regular, nondiscounted fee for that service.

(e) Time Period of Advertised Fees.

Advertised fees shall be honored for those seeking the advertised services during the entire time period stated in the advertisement whether or not the services are actually rendered or completed within that time.
If no time period is stated in the advertisement of fees, the advertised fee shall be honored for thirty (30) days from the last date of publication or until the next scheduled publication whichever is later whether or not the services are actually rendered or completed within that time.

(4) Advertising Content. The following acts or omissions in the context of advertisement by any certificate holder shall constitute false or fraudulent conduct, and subject the licensee to disciplinary action pursuant to T.C.A. § 63-6-1007(1):

(a) Claims that the services performed, personnel employed, materials or office equipment used are professionally superior to that which is ordinarily performed, employed, or used, or that convey the message that one certificate holder is better than another when superiority of services, personnel, materials or equipment cannot be substantiated.

(Chapter 0880-12-.20, continued)

(b) The misleading use of an unearned or non-health degree in any advertisement.

(c) Promotion of professional services which the certificate holder knows or should know are beyond the certificate holder’s ability to perform.

(d) Techniques of communication which intimidate, exert undue pressure or undue influence over a prospective client.

(e) Any appeals to an individual’s anxiety in an excessive or unfair manner.

(f) The use of any personal testimonial attesting to a quality of competency of a service or treatment offered by a certificate holder that is not reasonably verifiable.

(h) The communication of personal identifiable facts, data, or information about a patient without first obtaining patient consent.

(i) Any misrepresentation of a material fact.

(j) The knowing suppression, omission or concealment of any material fact or law without which the advertisement would be deceptive or misleading.

(k) Statements concerning the benefits or other attributes of acupuncture procedures or products that involve significant risks without including:

A realistic assessment of the safety and efficiency of those procedures or products; and 2. The availability of alternatives; and 3. Where necessary to avoid deception, descriptions or assessment of the benefits or other attributes of those alternatives.

(l) Any communication which creates an unjustified expectation concerning the potential results of any treatment.

(m) Failure to comply with the rules governing advertisement of fees and services, or advertising records.

(n) The use of “bait and switch” advertisements. Where the circumstances indicate “bait and switch” advertising, the Committee may require the certificate holder to furnish data or other evidence pertaining to those sales at the advertised fee as well as other sales.

(o) Misrepresentation of a certificate holder’s credentials, training, experience, or ability.

(p) Failure to include the corporation, partnership or individual certificate holder’s name, address, and telephone number in any advertisement. Any corporation, partnership or association which advertises by use of a trade name or otherwise fails to list all certificate holders practicing at a particular location shall:

(Chapter 0880-12-.20, continued)

Upon request provide a list of all certificate holders practicing at that location; and 2. Maintain and conspicuously display at the certificate holder’s office, a directory listing all certificate holders practicing at that location.

(q) Failure to disclose the fact of giving compensation or anything of value to representatives of the press, radio, television or other communicative medium in anticipation of or in return for any advertisement (for example, newspaper article) unless the nature, format or medium of such advertisement make the fact of compensation apparent.

(r) After thirty (30) days of the certificate holder’s departure, the use of the name of any certificate holder formerly practicing at or associated with any advertised location or on office signs or buildings. This rule shall not apply in the case of a retired or deceased former associate who practiced in association with one or more of the present occupants if the status of the former associate is disclosed in any advertisement or sign.

(s) Stating or implying that a certain certificate holder provides all services when any such services are performed by another licensee.

(5) Advertising Records and Responsibility (a) Each certificate holder who is a principal partner, or officer of a firm or entity identified in any advertisement, is jointly and severally responsible for the form and content of any advertisement. This provision shall also include any licensed or certified professional employees acting as an agent of such firm or entity.

(b) Any and all advertisements are presumed to have been approved by the certificate holder named therein.

(c) A recording of every advertisement communicated by electronic media, and a copy of every advertisement communicated by print media, and a copy of any other form of advertisement shall be retained by the certificate holder for a period of two (2) years from the last date of broadcast or publication and be made available for review upon request by the Board or its designee.

(d) At the time any type of advertisement is placed, the certificate holder must possess and rely upon information which, when produced, would substantiate the truthfulness of any assertion, omission or representation of material fact set forth in the advertisement or public information.

(6) Severability. It is hereby declared that the sections, clauses, sentences and parts of these rules are severable, are not matters of mutual essential inducement, and any of them shall be rescinded if these rules would otherwise be unconstitutional or ineffective. If any one or more sections, clauses, sentences or parts shall for any reason be questioned in court, and shall be adjudged unconstitutional or invalid, such judgment shall not affect, impair or invalidate the remaining provisions thereof, but shall be confined in its operation to the specific provision or provisions so held unconstitutional or invalid, and the inapplicability or invalidity of any section, clause, sentence or part in any one or more instance shall not be taken to affect or prejudice in any way its applicability or validity in any other instance.

(Chapter 0880-12-.20, continued)

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-1-145, 63-1-146, 63-6-101, 63-6-1004, and 63-6-1007.
Administrative History: Original rule filed October 18, 2002; effective January 1, 2003. Amendment filed March 16, 2007; effective May 30, 2007.

Chapter 0880-13 General Rules and Regulations Governing the Practice of Genetic Counselors

Tenn. Comp. R. & Regs. 0880-13-.01 DEFINITIONS

As used in these rules, the following terms and acronyms shall have the following meanings ascribed to them:

(1) ABGC – The American Board of Genetic Counseling.

(2) ABMG – The American Board of Medical Genetics.

(3) Board – The Tennessee Board of Medical Examiners.

(4) Board’s administrative office - The office of the administrator assigned to the Board located at 665 Mainstream Drive, Nashville, TN 37243.

(5) Division – The Division of Health Related Boards, Tennessee Department of Health, from which the Board receives administrative support.

(6) Genetic counselor – A person licensed to engage in the practice of genetic counseling.

(7) Practice of genetic counseling – The process of helping people understand and adapt to the medical, psychological and familial implications of genetic contributions to disease performed pursuant to a referral. This process integrates the following:

(a) Interpretation of family and medical histories to assess the chance of disease occurrence or recurrence;

(b) Education about inheritance, testing, management, prevention, resources and research; and (c) Counseling to promote informed choices and adaptation to the risk or condition.

(8) Referral – A written or telecommunicated authorization for genetic counseling services from a physician licensed to practice medicine in all its branches or an advanced practice nurse or physician assistant who has an agreement and signed protocols with a supervising physician that authorizes referrals to a genetic counselor.

September, 2008 2 (9) Supervision – The ongoing, direct clinical review, for the purposes of training or teaching, by an approved supervisor who monitors the performance or a person’s supervised interaction with a client and provides regular documented face-to-face consultation, guidance, and instructions with respect to the clinical skills and competencies of the person supervised. Supervision may include, without being limited to, the review of case presentations, audio tapes, video tapes, and direct observation.

History

Authority: T.C.A. §§ 63-6-101, 63-6-802, and 63-6-806.
Administrative History: Original rule filed July 1, 2008; effective September 14, 2008.

Tenn. Comp. R. & Regs. 0880-13-.02 SCOPE OF PRACTICE

The scope of practice of all genetic counselors is governed by T.C.A. §§ 63-6-802(8) and 63-6-803.

History

Authority: T.C.A. §§ 63-6-101 and 63-6-802, 63-6-803, and 63-6-806.
Administrative History: Original rule filed July 1, 2008; effective September 14, 2008.

Tenn. Comp. R. & Regs. 0880-13-.03 NECESSITY OF LICENSURE

(1) Except as provided in paragraph (3), no person shall engage in the practice of genetic counseling, act or represent such person to be a genetic counselor, or use such titles as “genetic counselor”, “licensed genetic counselor”, “gene counselor”, “genetic associate” or any words, letters, abbreviations or insignia indicating or implying that such person is a genetic counselor, unless such person holds a license or temporary license issued by the Board.

(2) Use of Titles - Any person who possesses a valid, current and active license issued by the Board that has not been suspended or revoked has the right to use the titles listed in paragraph (1) and to practice genetic counseling, as defined in T.C.A. §§ 63- 6-802 (8) and 63-6-803. Any person licensed by the Board to whom this rule applies must use one (1) of the titles authorized by this rule in every “advertisement” [as that term is defined in rule 0880-13-.14(2)(a)] he or she publishes or the failure to do so will constitute an omission of a material fact which makes the advertisement misleading and deceptive and subjects the genetic counselor to disciplinary action pursuant to T.C.A. § 63-6-807(b)(1), (b)(7), (b)(9) and (b)(10).

(3) This rule shall not apply to:

(a) Other qualified and licensed health care professionals who are practicing within their scope of practice. Individuals may not use the title “genetic counselor” or any other title tending to indicate they are a genetic counselor unless licensed as such in this state.

(b) Students enrolled in an approved academic program in genetic counseling, if practice constitutes a part of a supervised course of study and such student is designated by a title clearly indicating such student’s status as a student or trainee.

(c) An individual trained as a genetic counselor, who is reapplying for the ABGC certification examination and gathering logbook cases under supervision in an approved genetic counseling training site.

(d) Individuals employed by a state genetics center to provide education regarding single gene conditions, including, but not limited to, sickle cell, cystic fibrosis, and hemoglobinopathies. The individual may not use the title “genetic September, 2008 3 counselor” or any other title tending to indicate they are a genetic counselor unless licensed as such in this state.

(e) Visiting ABGC or ABMG certified genetic counselors from outside the state performing activities and services for a period of thirty (30) days each year.

Visiting genetic counselors must be licensed if available in their home state.

History

Authority: T.C.A. §§ 63-1-145, 63-6-101, 63-6-214, 63-6-804, 63-6-806, 63-6-807.
Administrative History: Original rule filed July 1, 2008; effective September 14, 2008.

Tenn. Comp. R. & Regs. 0880-13-.04 QUALIFICATIONS FOR LICENSURE

To qualify for a license to practice genetic counseling, a person shall have:

(1) Earned a masters degree from a genetic counseling training program that is accredited by the ABGC, or an equivalent as determined by the ABGC or the ABMG; and (2) Met the examination requirement for certification and have current certification as a genetic counselor by the ABGC or the ABMG.

History

Authority: T.C.A. §§ 63-6-101 and 63-6-806.
Administrative History: Original rule filed July 1, 2008; effective September 14, 2008.

Tenn. Comp. R. & Regs. 0880-13-.05 PROCEDURES FOR LICENSURE

(1) To become licensed as a genetic counselor in Tennessee a person shall do all of the following procedures:

(a) Obtain an application from the Board’s Internet web page or from the Board’s administrative office.

(b) Respond truthfully and completely to every question or request for information contained in the application form and submit it, along with all documentation and fees required by the form and by rule 0880-13-.06, to the Board’s administrative office. It is the intent of this rule that activities necessary to accomplish the filing of the required documentation be completed prior to filing an application and that all documentation be filed simultaneously.

(c) Submit a clear, recognizable, recently taken bust photograph which shows the full head, face forward from at least the top of the shoulder up.

(d) Cause a graduate transcript from a genetic counseling training program that is accredited by the ABGC or by an equivalent as determined by the ABGC or the ABMG to be submitted directly from the educational institution to the Board’s administrative office. The transcript must contain the official seal of the institution, must show that the program has been successfully completed, and must indicate that the masters degree has been awarded.

(e) Cause proof of current certification as a genetic counselor to be sent directly from the ABGC or the ABMG to the Board’s administrative office.

(f) Disclose the circumstances surrounding any of the following:

Conviction of any criminal law violation of any country, state or municipality, except minor traffic violations.

September, 2008 4 2. The denial of professional licensure/certification application by any other state or the discipline of licensure/certification in any state.

Loss or restriction of professional licensure/certification.
Any civil suit judgment or civil suit settlement in which the applicant was a party defendant including, without limitation, actions involving malpractice, breach of contract, antitrust activity or any other civil action remedy recognized under the country's or state's statutory common or case law.
Failure of any professional licensure or certification examination.

(g) Cause to be submitted to the Board’s administrative office directly from the vendor identified in the Board’s licensure application materials, the result of a criminal background check.

(2) Temporary License – A temporary license to practice genetic counseling may be issued to an applicant who meets all of the requirements for licensure in Rule 0880- 13-.04 except the examination requirement of Rule 0880-13-.04 (2), and has complied with all subparagraphs contained in paragraph (1) of this rule except subparagraph (e).

(a) Temporary license applicants must have active candidate status conferred by the ABGC and take the next available certification examination.

(b) A temporary license will not be issued if the applicant has failed the ABGC certification examination more than twice.

(c) Temporary licensees must practice under the general supervision of a licensed genetic counselor or a licensed physician with current ABMG certification in clinical genetics.

(d) A temporary license shall expire upon the earliest of one (1) of the following:

issuance of full licensure;
ninety (90) days after notification of failing the certification exam without obtaining current active candidate status; or 3. the date printed on the temporary license.

(3) Grandfathering – For one (1) year after the original effective date of this chapter of rules, any person who has practiced as a genetic counselor since 1980 is eligible to receive a license as a genetic counselor upon compliance with Rule 0880-13-.04 (1), September, 2008 5 and all subparagraphs contained in paragraph (1) of this rule except subparagraph (e) and upon further showing satisfactory proof of work history and scope of practice by submitting to the Board’s administrative office, along with the licensure application:

(a) written job description(s) or letters from employers which cover the entire work period and explain the licensure applicant’s scope of practice; and (b) photocopies of paycheck(s), paycheck stub(s), or Internal Revenue Service (IRS) Forms W-2, 1099-Misc., or Schedules C or C-EZ for IRS Form 1040 to verify proof of income from the practice of genetic counseling.

(4) Application review and licensure decisions shall be governed by Rule 0880-13-.07.

History

Authority: T.C.A. §§ 63-6-101 and 63-6-806.
Administrative History: Original rule filed July 1, 2008; effective September 14, 2008.

Tenn. Comp. R. & Regs. 0880-13-.06 FEES

All fees provided for in this rule are non-refundable.

(1) Application fee to be submitted at the time of application for licensure $ 50.00 (2) Licensure fee to be submitted at the time of application for licensure $ 50.00 (3) Temporary licensure fee to be submitted at the time of application for licensure $ 50.00 (4) Biennial renewal fee to be submitted every two (2) years when licensure renewal is due $ 50.00 (5) Late renewal/reinstatement/reactivation fee $100.00 (6) Duplicate licensure fee $ 25.00 (7) Biennial state regulatory fee to be submitted at the time of application $ 10.00 (8) Continuing education course approval fee $100.00 (9) All fees may be paid in person, by mail or electronically by cash, check, money order, or by credit and/or debit cards accepted by the Division. If the fees are paid by certified, personal or corporate check they must be drawn against an account in a United States Bank, and made payable to the Tennessee Board of Medical Examiners.

History

Authority: T.C.A. §§ 4-3-1011, 63-1-107, 63-6-101, and 63-6-806.
Administrative History: Original rule filed July 1, 2008; effective September 14, 2008. September, 2008 6

Tenn. Comp. R. & Regs. 0880-13-.07 APPLICATION REVIEW, APPROVAL, AND DENIAL

(1) Review of all applications to determine whether or not the application file is complete may be delegated to the Board's administrator.

(2) A temporary authorization to practice, as described in T.C.A. § 63-1-142 may be issued to an applicant pursuant to an initial determination made by a Board designee who has both reviewed the completed application and determined that the applicant has met all the requirements for licensure, renewal or reinstatement. The temporary authorization to practice is valid for a period of six (6) months from the date of issuance of the temporary authorization to practice and may not be extended or renewed. If the Board subsequently makes a good faith determination that the applicant has not met all the requirements for licensure, renewal or reinstatement and therefore denies, limits, conditions or restricts licensure, renewal or reinstatement, the applicant may not invoke the doctrine of estoppel in a legal action brought against the state based upon the issuance of the temporary authorization to practice and the subsequent denial, limitation, conditioning or restricting of licensure.

(3) If an application is incomplete when received by the Board’s administrative office, or the reviewing Board member or designee determine additional information is required from an applicant before an initial determination can be made, the Board administrator shall notify the applicant of the information required. The applicant shall cause the requested information to be received in the Board’s administrative office on or before the sixtieth (60th) day after receipt of the notification.

(a) Such notifications shall be sent certified mail, return receipt requested, from the Board’s administrative office.

(b) If requested information is not timely received, the application file may be considered abandoned and may be closed by the administrator. If that occurs, the applicant shall be notified that the Board will not consider issuance of a license until a new application is received pursuant to the rules governing that process, including another payment of all fees applicable to the applicant's circumstances and submission of such new supporting documents as is required by the Board.

(4) If a reviewing Board member or designee initially determines that a completed application should be denied, limited, conditioned or restricted, a temporary authorization shall not be issued. The applicant shall be informed of the initial decision and that a final determination on the application will be made by the Board at its next appropriate meeting. If the Board ratifies the initial denial, limitation, condition or restriction, the action shall become final and the following shall occur:

(a) A notification of the denial, limitation, condition or restriction shall be sent by the Board’s administrative office by certified mail, return receipt requested, that contains the specific reasons for denial, limitation, condition or restriction, such as incomplete information, unofficial records, examination failure, or matters judged insufficient for licensure, and such notification shall contain all the specific statutory or rule authorities for the denial, limitation, condition or restriction.

(b) The notification, when appropriate, shall also contain a statement of the applicant's right to request a contested case hearing under the Tennessee Administrative Procedures Act (T.C.A. §§ 4-5-301, et seq .) to contest the September, 2008 7 denial, limitation, condition or restriction and the procedure necessary to accomplish that action.

An applicant has a right to a contested case hearing only if the licensure denial, limitation, condition or restriction is based on subjective or discretionary criteria.
An applicant may be granted a contested case hearing if the licensure denial, limitation, condition or restriction is based on an objective, clearly defined criteria only if after review and attempted resolution by the Board's administrative staff, the application can not be approved and the reasons for continued denial, limitation, condition or restriction present genuine issues of fact and/or law which are appropriate for appeal.

Requests for a hearing must be made in writing to the Board’s administrative office within thirty (30) days of the receipt of the notice of denial, limitation, condition or restriction from the Board.

(5) The initial determination procedures of this rule will not apply if the Board reviews and makes a final determination on any application during its meetings.

(6) If the Board finds it has issued a license to any person who did not meet all the necessary prerequisites for that license, it will give written notice by certified mail of its intent to cancel the license. The notice will inform the person that they are not lawfully allowed to continue in practice and shall allow the applicant the opportunity to meet the requirements for licensure within thirty (30) days from the date of receipt of the notification and return to practice without having to file a new application. The provisions of sub paragraph (4)(b)of this rule shall be applied to the prerequisite(s) that was not met in order to determine whether the person is entitled to contest the cancellation.

History

Authority: T.C.A. §§ 63-6-101, 63-6-806, and 63-6-807.
Administrative History: Original rule filed July 1, 2008; effective September 14, 2008.

Tenn. Comp. R. & Regs. 0880-13-.08 EXAMINATION

Licensure Examinations - With the exception of applicants qualified pursuant to Rule 0880-13-.05 (2) and (3), all persons intending to apply for licensure must successfully meet the examination requirement for certification as a genetic counselor by the ABGC or the ABMG.

History

Authority: T.C.A. §§ 63-6-101 and 63-6-806.
Administrative History: Original rule filed July 1, 2008; effective September 14, 2008.

Tenn. Comp. R. & Regs. 0880-13-.09 .

(c) All genetic counselors must retain independent documentation of completion of all continuing education hours. This documentation must be retained for a period of four (4) years from the end of the renewal period in which the continuing education was acquired. This documentation must be produced for inspection and verification, if requested in writing by the Division during its verification process. Documentation verifying the licensed individual's completion of the continuing education program(s) may consist of any one or more of the following:

Certificates from the continuing education program's sponsor, indicating the date, length in minutes awarded, program title, licensed individual's name and license number; or 2. An original letter on official stationery from the continuing education program's sponsor indicating date, length in minutes awarded, program title, licensed individual's name and license number.

(d) If a person submits documentation for continuing education that is not clearly identifiable as appropriate continuing education, the Board will request a written description of the education and how it applies to the practice as a genetic counselor.

(3) Violations (a) Any genetic counselor who submits false documentation of compliance with continuing education requirements or who falsely attests to completion of the required hours of continuing education may be subject to disciplinary action pursuant to Rule 0880-13-.15.

September, 2008 11 (b) Any genetic counselor who fails to obtain the required continuing education hours may be subject to disciplinary action pursuant to Rule 0880-13-.15 and may not be allowed to renew licensure.

(c) Education hours obtained as a result of compliance with the terms of Board orders in any disciplinary action shall not be credited toward the continuing education hours required to be obtained in any calendar year.

History

Authority: T.C.A. §§ 63-6-101, 63-6-806, and 63-6-807.
Administrative History: Original rule filed July 1, 2008; effective September 14, 2008.

Tenn. Comp. R. & Regs. 0880-13-.11 RETIREMENT AND REACTIVATION OF LICENSE

(1) Licensees who wish to retain their licenses but not actively practice as a genetic counselor may avoid compliance with the licensure renewal process by obtaining, completing, and submitting, to the Board’s administrative office, an affidavit of retirement form along with any documentation required by the form.

(2) Upon successful application for retirement of licensure with completion and receipt of all proper documentation to the Board's satisfaction, the license shall be registered as retired. Any person who has a retired license may not practice as a genetic counselor in Tennessee.

(3) Reactivation - Any licensee whose license has been retired may re-enter active practice by doing the following:

(a) Submit a written request for a reactivation application to the Board’s administrative office; and (b) Complete and submit the reactivation application along with the biennial renewal fee as provided in Rule 0880-13-.06 to the Board’s administrative office. If reactivation was requested prior to the expiration of one (1) year from the date of retirement, the Board may require payment of the late renewal fee and past due renewal fees as provided in Rule 0880-13-.06; and (c) Submit proof of having completed all required continuing education as provided in Rule 0880-13-.12.

(d) If requested, after review by the Board or a Board member, appear before either the Board, or a duly constituted panel of the Board, or another Board member, or the Board Designee for an interview regarding continued competence.

(f) If licensure retirement was in excess of five (5) years, the licensee may be required to successfully complete whatever educational and/or testing requirements the Board feels necessary to establish current levels of competency.

(4) License reactivation applications shall be treated as licensure applications and review decisions shall be governed by Rule 0880-13-.07.

History

Authority: T.C.A. §§ 63-1-111, 63-6-101, 63-6-806, 63-6-807, and 63-6-808.
Administrative History: Original rule filed July 1, 2008; effective September 14, 2008.

Tenn. Comp. R. & Regs. 0880-13-.12 CONTINUING EDUCATION

All persons licensed as a genetic counselor must comply with the following continuing education rules as a prerequisite to licensure renewal.

(1) Continuing Education - Hours Required September, 2008 10 (a) All licensed genetic counselors must successfully complete five (5) CEUs (category 1 or 2) or fifty (50) contact hours approved for recertification purposes by the ABGC during the two (2) calendar years (January 1 - December 31) that precede the licensure renewal year.

(b) The approved hours of any individual course will not be counted more than once in a two (2) calendar year period toward the required hourly total regardless of the number of times the course is attended or completed by any individual.

(c) The Board may waive or otherwise modify the requirements of this rule in cases where there is retirement, or an illness, disability or other undue hardship that prevents a licensee from obtaining the requisite number of continuing education hours. Requests for waivers or modification must be sent in writing to the Board’s administrative office prior to the expiration of the renewal period in which the continuing education is due.

(2) Continuing Education - Proof of Compliance (a) The due date for completion of the required continuing education is December 31st of the two (2) calendar year (January 1 - December 31) period that precedes the licensure renewal year.

(b) Submission of proof of compliance with continuing education requirements must be sent along with the biennial renewal application as provided in Rule

Tenn. Comp. R. & Regs. 0880-13-.13 PROFESSIONAL ETHICS

(1) All genetic counselors shall comply with the current Code of Ethics adopted by the National Society of Genetic Counselors except to the extent that they conflict with the laws of the state of Tennessee or the rules of the Board. If the Code of Ethics conflicts with state law or rules, the state law or rules govern the matter. Violation of the Code of Ethics or state law or rules may subject a licensee to disciplinary action pursuant to T.C.A. § 63-6 -807(b)(7) and/or (b)(9).

(2) Each applicant or licensee is responsible for being familiar with and complying with the Code of Ethics.

(3) A copy of the Code of Ethics may be obtained by writing the National Society of Genetic Counselors, 401 N. Michigan Avenue, Chicago, IL 60611 or by visiting the website www.nsgc.org .

History

Authority: T.C.A. §§ 63-6-101, 63-6-805, 63-6-806, and 63-6-807.
Administrative History: Original rule filed July 1, 2008; effective September 14, 2008.

Tenn. Comp. R. & Regs. 0880-13-.14 ADVERTISING

(1) Policy Statement. The lack of sophistication on the part of many in the health care community concerning genetic counseling, the importance of the interests affected by the choosing of genetic counselors and the foreseeable consequences of unrestricted advertising by genetic counselors which is recognized to pose special possibilities for deception, require that special care be taken by genetic counselors to avoid misleading the health care community. Genetic counselors must be mindful that the benefits of advertising depend upon its reliability and accuracy. Since advertising by genetic counselors is calculated and not spontaneous, reasonable

regulation designed to foster compliance with appropriate standards serves the public interest without impeding the flow of useful, meaningful, and relevant information to the health care community.

(2) Definitions (a) Advertisement – Informational communication to the health care community in any manner designed to attract attention to the genetic counselors which are licensed to practice in Tennessee.

(b) Licensee - Any person holding a license as a genetic counselor in the State of Tennessee. Where applicable this shall include partnerships and/or corporations.

September, 2008 12 (c) Material Fact - Any fact which a health care provider would need to know or rely upon in order to make an informed decision concerning the choice of genetic counselors to serve its particular needs.

(d) Health Care Community – Shall mean hospitals, ambulatory surgical treatment centers, medical practices, individual physicians, and other health care providers with legal authority to utilize genetic counselors.

(b) The misleading use of an unearned or non-health degree in any advertisement.

(c) Promotion of professional services which the licensee knows or should know is beyond the licensee's ability to perform.

(d) Techniques of communication which intimidate, exert undue pressure or undue influence over a prospective client.

(e) Any appeals to an individual's anxiety in an excessive or unfair manner.

(f) The use of any personal testimonial attesting to a quality or competency of a service or treatment offered by a licensee that is not reasonably verifiable.

(h) The communication of personal identifiable facts, data, or information about a patient without first obtaining patient consent.

(i) Any misrepresentation of a material fact.

(j) The knowing suppression, omission or concealment of any material fact or law without which the advertisement would be deceptive or misleading.

(k) Statements concerning the benefits or other attributes of medical procedures or products that involve significant risks without including:

A realistic assessment of the safety and efficiency of those procedures or products; and 2. The availability of alternatives; and 3. Where necessary to avoid deception, descriptions or assessment of the benefits or other attributes of those alternatives.

September, 2008 13 (l) Any communication which creates an unjustified expectation concerning the potential results of any procedure.

(m) Failure to comply with the rules governing advertising records.

(n) Misrepresentation of a licensee's credentials, training, experience, or ability.

(o) Failure to include the corporation, partnership or individual licensee's name, address, and telephone number in any advertisement. Any corporation, partnership or association which advertises by use of a trade name or otherwise fails to list all genetic counseling personnel practicing at a particular location shall:

Upon request provide a list of all genetic counseling personnel practicing at that location; and 2. Maintain and conspicuously display at the licensee's office, a directory listing all genetic counseling personnel practicing at that location.

article) unless the nature, format or medium of such advertisement make the fact of compensation apparent.

(q) After thirty (30) days of the licensee’s departure, the use of the name of any genetic counseling personnel formerly practicing at or associated with any advertised location or on office signs or buildings. This rule shall not apply in the case of a retired or deceased former associate who practiced in association with one or more of the present licensees if the status of the former associate is disclosed in any advertisement or sign.

(r) Stating or implying that a certain licensee provides all services when any such services are performed by another licensee.

(b) Any and all advertisements are presumed to have been approved by the licensee named therein.

September, 2008 14 (5) Severability. It is hereby declared that the sections, clauses, sentences and parts of these rules are severable, are not matters of mutual essential inducement, and any of them shall be rescinded if these rules would otherwise be unconstitutional or ineffective. If any one or more sections, clauses, sentences or parts shall for any reason be questioned in court, and shall be adjudged unconstitutional or invalid, such judgment shall not affect, impair or invalidate the remaining provisions thereof, but shall be confined in its operation to the specific provision or provisions so held unconstitutional or invalid, and the inapplicability or invalidity of any section, clause, sentence or part in any one or more instance shall not be taken to affect or prejudice in any way its applicability or validity in any other instance.

History

Authority: T.C.A. §§ 63-1-145, 63-1-146, 63-6-101, 63-6-805, 63-6-806, and 63-6-807.
Administrative History: Original rule filed July 1, 2008; effective September 14, 2008.

Tenn. Comp. R. & Regs. 0880-13-.15 DISCIPLINARY ACTIONS AND CIVIL PENALTIES

(1) Upon a finding by the Board that a licensee has violated any provision of T.C.A. §§ 63-6-801, et seq ., or the rules promulgated pursuant thereto, the Board may take any of the following actions separately or in any combination which is deemed appropriate to the offense;

(a) Reprimand - This is a written action issued for one time and less severe violations. It is a formal disciplinary action.

(b) Probation - This is a formal disciplinary action which places a genetic counselor on close scrutiny for a fixed period of time. This action may be combined with conditions that must be met before probation will be lifted and/or which restrict the individual's activities during the probationary period.

(c) License Suspension - This is a formal disciplinary action that suspends the right to practice for a fixed period of time. It contemplates the re-entry into practice under the license previously issued.

(d) License Revocation -This is the most severe form of disciplinary action which removes an individual from the practice of the profession and terminates the licensure previously issued. The Board, in its discretion, may allow reinstatement of a revoked license upon conditions and after a period of time which it deems appropriate. No petition for reinstatement and no new application for licensure from a person whose license was revoked for cause shall be considered prior to the expiration of at least six (6) months from the effective date of the revocation order.

(e) Conditions - Any action deemed appropriate by the Board to be required of a disciplined licensee in any of the following circumstances:

During any period of probation, suspension; or 2. During any period of revocation after which the licensee may petition for an order of compliance to reinstate the revoked license; or 3. As a prerequisite to the lifting of probation or suspension or as a prerequisite to the reinstatement of a revoked license; or 4. As a stand-alone requirement(s) in any disciplinary order.

September, 2008 15 (f) Civil penalty - A monetary disciplinary action assessed by the Board pursuant to paragraph (5) of this rule (2) Once ordered, probation, suspension, revocation, assessment of a civil penalty, or any other condition of any type of disciplinary action may not be lifted unless and until the licensee petitions, pursuant to paragraph (3) of this rule, and appears before the Board after the period of initial probation, suspension, revocation, or other conditioning has run and all conditions placed on the probation, suspension, revocation, have been met, and after any civil penalties assessed have been paid.

(3) Order of Compliance - This procedure is a necessary adjunct to previously issued disciplinary orders and is available only when a petitioner has completely complied with the provisions of a previously issued disciplinary order, including an unlicensed practice civil penalty order, and wishes or is required to obtain an order reflecting that compliance.

When the petitioner can prove compliance with all the terms of the previously issued order and is seeking to have an order issued reflecting that compliance; or 2. When the petitioner can prove compliance with all the terms of the previously issued order and is seeking to have an order issued lifting a previously ordered suspension or probation; or 3. When the petitioner can prove compliance with all the terms of the previously issued order and is seeking to have an order issued reinstating a license previously revoked.

(b) Procedures 1. The petitioner shall submit a Petition for Order of Compliance, as contained in subparagraph (c), to the Board’s Administrative office that shall contain all of the following:

September, 2008 16 2. The Board authorizes its consultant and administrative staff to make an initial determination on the petition and take one of the following actions:

If the petition is presented to the Board the petitioner may not submit any additional documentation or testimony other than that contained in the petition as originally submitted.
If the Board finds that the petitioner has complied with all the terms of the previous order an Order of Compliance shall be issued.
If the petition is denied either initially by staff or after presentation to the Board and the petitioner believes compliance with the order has been sufficiently proven the petitioner may, as authorized by law, file a petition for a declaratory order pursuant to the provisions of T.C.A. § 4-5-223 and

rule 1200-10-1-.11.

Petitioner’s Mailing Address:

Petitioner’s E-Mail Address:

Telephone Number:

Attorney for Petitioner:

Attorney’s Mailing Address:

Attorney’s E-Mail Address:

Telephone Number:

An order issued reflecting that compliance; or 2. An order issued reflecting that compliance and lifting a previously ordered suspension or probation; or 3. An order issued reflecting that compliance and reinstating a September, 2008 17 license previously revoked.

Note – You must enclose all documents necessary to prove your request including a copy of the original order. If any of the proof you are relying upon to show compliance is the testimony of any individual, including yourself, you must enclose signed statements from every individual you intend to rely upon attesting, under oath, to the compliance. The Board’s consultant and administrative staff, in their discretion, may require such signed statements to be notarized. No documentation or testimony other than that submitted will be considered in making an initial determination on, or a final order in response to, this petition.

Respectfully submitted this the __ day of ,20. __________________________________ Petitioner’s Signature (4) Order Modifications - This procedure is not intended to allow anyone under a previously issued disciplinary order, including an unlicensed practice civil penalty order, to modify any findings of fact, conclusions of law, or the reasons for the decision contained in the order. It is also not intended to allow a petition for a lesser disciplinary action, or civil penalty other than the one(s) previously ordered. All such provisions of Board orders were subject to reconsideration and appeal under the provisions of the Uniform Administrative Procedures Act (T.C.A. §§ 4-5-301, et seq.).

This procedure is not available as a substitute for reconsideration and/or appeal and is only available after all reconsideration and appeal rights have been either exhausted or not timely pursued. It is also not available for those who have accepted and been issued a reprimand.

(b) Procedures 1. The petitioner shall submit a written and signed Petition for Order Modification on the form contained in subparagraph (c) to the Board’s Administrative office that shall contain all of the following:

If proof of impossibility of compliance requires testimony of an individual(s), including that of the petitioner, the petitioner must submit signed and notarized statements from every individual the petitioner intends to rely upon attesting, under oath, to the reasons why compliance is impossible. No documentation or testimony September, 2008 18 other than that submitted will be considered in making an initial determination on, or a final order in response to, the petition.

The Board authorizes its consultant and administrative staff to make an initial determination on the petition and take one of the following actions:

If the petition is presented to the Board the petitioner may not submit any additional documentation or testimony other than that contained in the petition as originally submitted.
If the petition is granted a new order shall be issued reflecting the modifications authorized by the Board that it deemed appropriate and necessary in relation to the violations found in the previous order.
If the petition is denied either initially by staff or after presentation to the Board and the petitioner believes impossibility of compliance with the order has been sufficiently proven the petitioner may, as authorized by law, file a petition for a declaratory order pursuant to the provisions of T.C.A. § 4-5-223 and rule 1200-10-1-.11.

Petitioner’s Mailing Address:

Petitioner’s E-Mail Address:

Telephone Number:

Attorney for Petitioner:

Attorney’s Mailing Address:

Attorney’s E-Mail Address:

Telephone Number:

September, 2008 19 Note – You must enclose all documents necessary to prove your request including a copy of the original order. If any of the proof you are relying upon to show impossibility is the testimony of any individual, including yourself, you must enclose signed and notarized statements from every individual you intend to rely upon attesting, under oath, to the reasons why compliance is impossible. No documentation or testimony other than that submitted will be considered in making an initial determination on, or a final order in response to, this petition.

Respectfully submitted this the ____ day of _ __ _ , 20____. __________________________________ Petitioner’s Signature (5) Civil Penalties (a) Purpose - The purpose of this rule is to set out a schedule designating the minimum and maximum civil penalties which may be assessed pursuant to T.C.A. § 63-1-134.

(b) Schedule of Civil Penalties.

A "Type A" Civil Penalty may be imposed whenever the Board finds a person who is required to be licensed, certified, permitted, or authorized by the Board, guilty of a willful and knowing violation of the Genetic Counselors’ Licensing Act, or regulations promulgated pursuant thereto, to such an extent that there is, or is likely to be, an imminent, substantial threat to the health, safety and welfare of an individual patient or the public. For purposes of this section, willfully and knowingly practicing as a genetic counselor without a permit, license, certificate, or other authorization from the Board is one of the violations of the Genetic Counselors’ Licensing Act for which a "Type A" Civil Penalty is assessable.
A "Type B" Civil Penalty may be imposed whenever the Board finds the person required to be licensed, certified, permitted, or authorized by the Board is guilty of a violation of the Genetic Counselors’ Licensing Act or regulations promulgated pursuant thereto in such manner as to impact directly on the care of patients or the public.
A "Type C" Civil Penalty may be imposed whenever the Board finds the person required to be licensed, certified, permitted, or authorized by the Board is guilty of a violation of the Genetic Counselors’ Licensing Act or regulations promulgated pursuant thereto, which are neither directly September, 2008 20 detrimental to the patients or public, nor directly impact their care, but have only an indirect relationship to patient care or the public.

"Type A" Civil Penalties shall be assessed in the amount of not less than $500 and not more than $1000.
"Type B" Civil Penalties may be assessed in the amount of not less than $100 and not more than $500.
"Type C" Civil Penalties may be assessed in the amount of not less than $50 and not more than $100.

(d) Procedures for Assessing Civil Penalties.

The Division of Health Related Boards may initiate a civil penalty assessment by filing a Memorandum of Assessment of Civil Penalty.

The Division shall state in the memorandum the facts and law upon which it relies in alleging a violation, the proposed amount of the civil penalty and the basis for such penalty. The Division may incorporate the Memorandum of Assessment of Civil Penalty with a Notice of Charges which may be issued attendant thereto.

Civil Penalties may also be initiated and assessed by the Board during consideration of any Notice of Charges. In addition, the Board may, upon good cause shown, assess a type and amount of civil penalty which was not recommended by the Division.
In assessing the civil penalties pursuant to these rules the Board may consider the following factors:

(i) Whether the amount imposed will be a substantial economic deterrent to the violator;

(ii) The circumstances leading to the violation;

(iii) The severity of the violation and the risk of harm to the public;

(iv) The economic benefits gained by the violator as a result of noncompliance; and (v) The interest of the public.

All proceedings for the assessment of civil penalties shall be governed by the contested case provisions of Tennessee Code Annotated, Title 4,

Chapter 5.

History

Authority: T.C.A. §§ 4-5-217, 4-5-223, 63-1-122, 63-1-134, 63-6-101, 63-6-806, and 63-6-807.
Administrative History: Original rule filed July 1, 2008; effective September 14, 2008.

Tenn. Comp. R. & Regs. 0880-13-.16 REPLACEMENT LICENSE

A license holder whose "artistically designed" license has been lost or destroyed may be issued a replacement document upon receipt of a written request in the Board’s administrative office. Such request shall be accompanied by an affidavit September, 2008 21 (signed and notarized) stating the facts concerning the loss or destruction of the original document and the fee required pursuant to Rule 0880-13-.06.

History

Authority: T.C.A. §§ 63-1-106, 63-6-101, 63-6-806.
Administrative History: Original rule filed July 1, 2008; effective September 14, 2008.

Tenn. Comp. R. & Regs. 0880-13-.17 CHANGE OF NAME AND/OR ADDRESS

(1) Change of Name – Any licensee shall notify the Board in writing within thirty (30) days of a name change and will provide both the old and new names. A name change notification must also include a copy of the official document involved and reference the individual's profession and license number.

(2) Change of Address - Each person holding a license who has had a change of address shall file in writing with the Board’s administrative office his/her current address providing both the old and new addresses. Such requests must be received in the Board’s administrative office no later than thirty (30) days after such change is effective and must reference the individual's name, profession, and license number.

History

Authority: T.C.A. §§ 63-1-108, 63-6-101, and 63-6-806.
Administrative History: Original rule filed July 1, 2008; effective September 14, 2008.

Chapter 0880-14 General Rules and Regulations Governing the Practice of Polysomnography

Tenn. Comp. R. & Regs. 0880-14-.01 DEFINITIONS

As used in this Chapter of rules the following terms and acronyms will have the meaning ascribed to them:

(1) “BRPT” means Board of Registered Polysomnographic Technologists.

(2) “Board” means the Board of Medical Examiners.

(3) “C.A.A.H.E.P.” means the Commission on Accreditation of Allied Health Education Programs.

(4) “Committee” means the Polysomnography Professional Standards Committee.

(5) “Committee Designee” means any individual authorized by the Committee to conduct a review of the qualifications of an applicant for a license or temporary permit to practice polysomnography, to make an initial determination as to whether the applicant has met all the requirements to practice polysomnography, and to issue temporary authorizations to practice in accordance with T.C.A. § 63-1-142.

(6) “Committee Office” means the office of the Unit Director assigned to the Committee located at 665 Mainstream Drive, Nashville, TN 37243.

(7) “Department” means Tennessee Department of Health.

(8) “Direct Supervision” means the same as in T.C.A. § 63-31-101(3).

(9) “Division” means the Division of Health Related Boards, in the Department of Health, responsible for all administrative, fiscal, inspectional, clerical and secretarial functions of the health related boards enumerated in T.C.A. § 68-1-101.

(10) “General Supervision” means the same as in T.C.A. § 63-31-101(4).

(11) “License” means document issued by the Committee to an applicant who has completed the process for licensure, or temporary permit, or licensure by endorsement. The license takes the form of an artistically designed license as well as other versions bearing an expiration date.

(12) “Licensee” means a person granted a license as a polysomnographic technologist by the Committee, in the Board’s name.

(13) “Scope of Practice” means the practice by polysomnographic technologists as governed by T.C.A. § 63-31-101(9)(A).

History

Authority: T.C.A. §§ 63-31-101 and 63-31-104.
Administrative History: Original rule filed March 2, 2010; effective May 31, 2010.

Tenn. Comp. R. & Regs. 0880-14-.02 FEES

The following fees are nonrefundable and apply to all applicants and licensees.

(1) Application Fee $375.00 (2) Biennial Renewal Fee $275.00 (3) State Regulatory Fee - To be paid upon application $ 5.00 and annually thereafter to be collected at biennial renewal from all license holders. ($10.00 biennially)

(4) Late Renewal Fee $ 50.00 (5) Replacement License Fee $ 25.00

History

Authority: T.C.A. §§ 63-1-106, 63-1-112, 63-31-104, and 63-31-106.
Administrative History: Original rule filed March 2, 2010; effective May 31, 2010. Amendment filed May 16, 2013; effective August 14, 2013. Amendments filed September 29, 2025; effective December 28, 2025.

Tenn. Comp. R. & Regs. 0880-14-.03 QUALIFICATIONS FOR LICENSURE

(1) Polysomnographic Technologist - To become licensed as a polysomnographic technologist an applicant must comply with the following procedures and requirements:

(a) An applicant shall complete an application that can be obtained from the Committee Office. The application form is not acceptable if any portion of it or any other documents required to be submitted by this rule or the application itself have been executed and dated prior to one year before filing with the Committee.

(b) An applicant shall respond truthfully and completely to every question or request for information contained in the application form and submit it along with all documentation and fees required by the form and these rules to the Committee Office. The required fees (application fee and state regulatory fee) may be paid in person, by mail or electronically by cash, check, money order, or by credit or debit cards accepted by the Division. If the fees are paid by certified, personal or corporate check they must be drawn against an account in a United States Bank, and made payable to the Polysomnography Professional Standards Committee.

(c) An applicant shall submit all documentation in support of an application to the Committee Office. All supporting documents must be received in the Committee Office within ninety (90) days of receipt of the application or the file will be closed. When necessary, all required documents shall be translated into English and such translation as well as the original document certified as to authenticity by the issuing source. Both versions must be submitted.

(d) An applicant shall have the Tennessee Bureau of Investigation send the result of a criminal background check of the applicant directly to the Committee Office.

(e) An applicant shall cause to be submitted to the Committee Office two letters of reference from any of the following providers:

A supervising physician, 2. An instructor who provided training to the applicant in a polysomnography training program, or 3. A licensed polysomnographic technologist.

(f) If an applicant holds or has ever held a license or certification to practice polysomnography or any other profession in Tennessee or any other state, the applicant shall submit the equivalent of a Tennessee Certificate of Endorsement (verification of licensure or certification) from each such licensing agency which indicates the applicant holds or held an active license or certification and whether it has ever been disciplined or restricted.

(g) All applications shall be sworn to and signed by the applicant and notarized. All documents submitted for qualification of licensure become the property of the State of Tennessee and will not be returned.

(h) An applicant who is applying for licensure in Tennessee, and who has never been licensed or practiced in another state, shall complete and obtain a passing score on the national certifying exam given by the BRPT within twelve (12) months of applying for initial licensure.

(i) The applicant shall submit proof of completion of one of the educational requirements in T.C.A. § 63-31-106(b)(1), unless exempted by T.C.A. § 63-31-106(c). The applicant shall have the school send directly to the Committee Office either a certificate of completion, diploma, or final official transcript.

(j) All applicants for licensure must be credentialed by the BRPT.

(k) Polysomnographic technologists by endorsement - The Committee may issue a license by endorsement to an applicant who is currently licensed to practice polysomnography under the laws of another state, territory or country if the qualifications of the applicant are deemed by the Committee to be equivalent to those required in Tennessee.

Endorsement applicants must:

Complete the Committee approved application;
Provide proof of possessing a current license, in good standing, from another state;
Demonstrate that they have completed the educational requirements in T.C.A. § 63-31-106(b)(1);
Demonstrate current credentialing by the BRPT; and 5. Demonstrate that they have obtained a passing score on the national certifying exam given by the BRPT.

(l) An applicant who is applying for licensure in Tennessee, and who has previously practiced in another state that does not require licensure, shall be eligible for licensure in Tennessee if the applicant:

Practiced as a polysomnographic technologist for at least twelve (12) of the preceding thirty-six (36) months from the date of the application, which need not be consecutive;
Submits proof satisfactory to the Committee documenting the applicant’s work

history;

Submits proof of having received a passing score on the national certifying exam given by the BRPT within thirty-six (36) months preceding the application for licensure in Tennessee; and 4. Submits proof of having maintained BRPT credentials.

(m) Application review and licensure decisions shall be governed by Rule 0880-14-.04.

(2) Polysomnographic Technician – An application for a temporary permit to practice as a polysomnographic technician pursuant to T.C.A. § 63-31-107(a)(1) shall comply with all requirements of Rule 0880-14-.03(1) and all application review and permit decisions shall be governed by 0880-14-.04.

(a) Once the Committee receives notice that the technician has obtained a passing score on the national certifying exam the applicant may be issued a license as a polysomnographic technologist.

(b) A technician has twelve months from the date of graduation from their accredited educational program to provide proof that they have passed the national certifying exam or their permit will be withdrawn. The Committee may in its sole discretion grant a one time extension of up to three (3) months beyond this one year period.

(3) Polysomnographic Trainee - Persons seeking to provide services as a polysomnographic trainee pursuant to T.C.A. § 63-31-107(a)(2) shall give written notice to the Board, through the Committee, at least thirty (30) days before providing such services, and shall include the following information in their letter of notification:

(a) Their full name, (b) Their date of birth, (c) Any other licenses, certificates, or permits they hold in Tennessee or another state, (d) The facility or facilities where the person will be providing sleep-related services, (e) Name of the educational program or institution in which the trainee is enrolled and in which he/she is receiving direct supervision, (f) Their social security number, (g) Mailing and physical address, and (h) Home telephone number.

(4) BRPT eligible persons are credentialed in one of the health-related fields accepted by the BRPT and are seeking clinical experience to be eligible to sit for the BRPT examination pursuant to T.C.A. § 63-31-107(a)(4). They shall:

(a) Give written notice to the Board, through the Committee, and shall include the following information in their letter of notification:

Their full name, 2. Mailing and physical address, 3. Home telephone number, 4. Their date of birth, 5. Any other licenses, certificates, or permits they hold in the State of Tennessee or any other state, 6. Name and license number of the technologist providing direct supervision of the individual, and 7. Their social security number.

(b) Only provide polysomnographic services for twelve (12) months from the date they give notice to the Committee of their intent to provide polysomnographic services unless they have been granted a license as a polysomnographic technologist or have completed all of the necessary requirements to provide polysomnographic services under T.C.A. § 63-31-107(a)(5).

(5) All applicants seeking licensure or providing notice to the Committee under Rule 0880-14- .03(1) through (4) shall at the time they begin providing polysomnographic services designate a primary supervising physician or a polysomnographic technologist if allowed by law. The person providing polysomnographic services must submit in writing any change in the primary supervising physician or polysomnographic technologist to the Committee’s Administrative Office within fifteen (15) days of any change.

History

Authority: T.C.A. §§ 63-6-101, 63-31-104, 63-31-106, 63-31-107, and 63-31-109.
Administrative History: Original rule filed March 2, 2010; effective May 31, 2010. Amendments filed September 29, 2025; effective December 28, 2025.

Tenn. Comp. R. & Regs. 0880-14-.04 APPLICATION REVIEW, APPROVAL, AND DENIAL

(1) Application files are not complete until all information and fees have been received by the Committee Office. Preliminary review of all applications to determine whether or not the application file is complete may be delegated by the Committee to the Committee designee.

(2) Completed applications may only be approved by a Committee member, by the Committee consultant, or by the Committee designee for a temporary authorization pursuant to T.C.A. §§ 63-1-142 and 63-31-107.

(3) If an application is incomplete when received in the Committee Office, in addition to other reasonable efforts to correct the deficiency, a deficiency letter will be sent by mail to the applicant notifying them of the deficiency. This letter shall request specified additional material necessary to complete the application. The requested information must be received in the Committee Office on or before the sixtieth (60th) day after the mailing date of the notification. In the event it is not received within sixty (60) days then the application shall be closed and the applicant may reapply.

(4) If a completed application is denied by the Committee, the action shall become final and the following shall occur:

(a) The Committee Office shall send notification of the denial by certified mail, return receipt requested. Specific reasons for denial will be stated, such as incomplete or unofficial records, examination failure, or other matters judged insufficient for licensure, and such notification shall contain all the specific statutory or administrative authorities for the denial.

(b) If an applicant believes that a denial was in error they may request, in writing, to appear before the Committee not less than thirty (30) days before the next regularly scheduled meeting of the Committee.

(5) The issuance of a license or permit to an applicant who otherwise may be entitled to full licensure, may be withheld, denied, conditioned or restricted in any manner the Committee deems necessary to protect the public.

History

Authority: T.C.A. §§ 63-1-107, 63-31-104, 63-31-106, and 63-31-107.
Administrative History: Original rule filed March 2, 2010; effective May 31, 2010.

Tenn. Comp. R. & Regs. 0880-14-.05 LICENSURE RENEWAL

(1) The due date for license renewal is set by the Division’s biennial alternative interval renewal system. The due date is contained on the renewal document designated as the expiration date.

(a) Individuals may renew their licenses by obtaining a renewal application from either the Department’s website on the internet or by using the paper renewal system.

(b) To be eligible for renewal an individual must submit to the Division, on or before the expiration date, the following:

A completed and signed renewal application form;
The renewal and state regulatory fees; and 3. Documentation of compliance with continuing education requirements as provided in Rule 0880-14-.09.

(c) Licensees who fail to comply with the renewal rules concerning failure to timely renew shall have their licenses processed in accordance with Rule 1200-10-01-.10.

(d) Anyone submitting a signed renewal form or letter which is found to be untrue may be subject to disciplinary action.

(2) Initial renewal issuance decisions pursuant to this rule may be made administratively by the Committee consultant pursuant to T.C.A. § 63-31-108 or by the Committee designee pursuant to T.C.A. § 63-1-142, subject to review and subsequent decision by the Committee.

History

Authority: T.C.A. §§ 63-1-107, 63-31-104, 63-31-106, 63-31-108, and 63-31-109.
Administrative History: Original rule filed March 2, 2010; effective May 31, 2010.

Tenn. Comp. R. & Regs. 0880-14-.06 RETIREMENT AND REINSTATEMENT

(1) A licensee who holds a current license and does not intend to practice as a polysomnographic technologist may apply to convert an active license to retired status. A licensee who holds a retired license will not be required to pay a renewal fee to maintain the license in retired status.

(2) A licensee who holds an active license may apply for retired status in the following manner:

(a) Obtain, complete, and submit to the Committee Office an Affidavit of Retirement form; or (b) Submit to the Committee Office any other documentation which may be required.

(3) The effective date of retirement will be the date the Affidavit of Retirement is received in the Committee Office.

(4) A licensee whose license has been retired or expired may re-enter active status by doing the following:

(a) Obtain, complete, and submit to the Committee Office a Reinstatement Application form; and (b) Pay the renewal fee and state regulatory fee as provided in Rule 0880-14-.02.

(c) If reinstatement is requested prior to the expiration of one (1) year from the date of retirement or expiration, then the licensee must pay the past due renewal fee and the late renewal fee.

(d) If an applicant seeks reinstatement of an expired license, then the applicant must submit proof of having obtained all continuing education as required by Rule 0880-14- .09 for each year that the license was expired, provided however, that these hours shall not exceed twenty (20) hours for any person applying for reinstatement of an expired license. The continuing education hours documented at the time of reinstatement of an expired license must have been successfully completed within twelve (12) months preceding the date of reinstatement. Continuing education hours obtained as a prerequisite for reinstating an expired license are in addition to the yearly requirement as provided in Rule 0880-14-.09. If an applicant seeks reinstatement from a retired license, then the applicant should submit verification of completion of all continuing education requirements, as provided in Rule 0880-14-.09, unless the applicant has obtained a waiver or modification of this continuing education requirement pursuant to

Rule 0880-14-.09(1)(a)4.

(e) If licensure retirement or expiration was in excess of two (2) years, the licensee may be required to successfully complete whatever educational and/or testing requirements the Committee determines is necessary to establish current levels of competency.

(5) Reinstatement applications shall be treated as licensure applications and review decisions shall be governed by Rule 0880-14-.04.

History

Authority: T.C.A. §§ 63-1-107, 63-31-104, and 63-31-108.
Administrative History: Original rule filed March 2, 2010; effective May 31, 2010. Amendments filed March 16, 2023; effective June 14, 2023. Amendments filed February 19, 2026; effective May 20, 2026.

Tenn. Comp. R. & Regs. 0880-14-.07 DISCIPLINARY GROUNDS, ACTIONS, AND CIVIL PENALTIES

(1) Actions - Upon a finding by the Committee that any provision of the Polysomnography Act or the rules promulgated pursuant thereto has been violated, the Committee may impose any of the following actions separately or in any combination deemed appropriate to the offense.

(a) “Letter of warning” This is a written action. It is informal and advisory in nature and does not constitute a formal disciplinary action.

(b) “Formal reprimand” This is a written action. It is a formal disciplinary action.

(d) “Licensure suspension” This is a formal disciplinary action which suspends an individual’s right to practice for a fixed period of time. It contemplates the re-entry of the individual into the practice under the licensure previously issued.

(e) “Licensure revocation” This is a formal disciplinary action which removes an individual from the practice of the profession and terminates the license previously issued. No petition for reinstatement and no new application for licensure from a person whose license was revoked shall be considered prior to the expiration of at least one (1) year unless otherwise stated in the Committee’s revocation order.

(f) Conditions - Any action deemed appropriate by the Committee to be required of a disciplined licensee in any of the following circumstances:

During any period of probation, suspension;
As a prerequisite to the lifting of probation or suspension; or 3. As a stand-alone requirement or requirements in any disciplinary action.

(g) Civil penalty - A monetary disciplinary action assessed by the Committee pursuant to paragraph three (3) of this rule.

(h) Once ordered, probation, suspension, assessment of a civil penalty, or any other condition of any type of disciplinary action may not be lifted unless and until the licensee appears before the Committee after the period of initial probation, suspension, or other conditioning has run and all conditions placed on the probation, suspension, have been met, and after any civil penalties assessed have been paid.

(2) Order Modifications - A licensee can petition the Committee to modify a previously issued disciplinary order if the licensee cannot fulfill the conditions of the imposed discipline. This procedure is only available after all reconsideration and appeal rights have been either exhausted or not timely pursued. This procedure cannot be used to modify any findings of fact, conclusions of law, or the reasons for the decision contained in the order.

(a) The Committee will entertain petitions for modification of the disciplinary portion of previously issued orders upon strict compliance with the procedures set forth in subparagraph (b) only when the petitioner can prove that compliance with any one or more of the conditions or terms of the discipline previously ordered is impossible. For purposes of this rule the term “impossible” does not mean that compliance is inconvenient or impractical for personal, financial, scheduling or other reasons.

(b) Procedures 1. The petitioner shall submit a written and signed Petition for Order Modification to the Committee’s Office that shall contain all of the following:

No documentation or testimony other than that submitted will be considered in making an initial determination on, or a final order in response to, the petition.

The Committee authorizes administrative staff to make an initial determination on the petition and take one of the following actions:

(i) Certify impossibility of compliance and forward the petition to the Office of General Counsel for presentation to the Committee as an uncontested matter; or (ii) Deny the petition, after consultation with the Office of General Counsel, if impossibility of compliance with the provisions of the previous order is not proven and notify the petitioner of what proof of impossibility of compliance was either not sufficient or not submitted.

If the petition is granted, a new order shall be issued reflecting the modifications authorized by the Committee that it deemed appropriate and necessary in relation to the violations found in the previous order.
If the petition is denied either initially by staff or after presentation to the Committee and the petitioner believes impossibility of compliance with the order has been sufficiently proven, the petitioner may request, in writing, to appear before the Committee not less than thirty (30) days before the next regularly scheduled meeting of the Committee.

(3) Civil Penalties - The purpose of this rule is to set out a schedule designating the minimum and maximum civil penalties which may be assessed pursuant to T.C.A. § 63-1-134.

(a) Schedule and Amount of Civil Penalties 1. A Type A civil penalty may be imposed whenever the Committee finds the person who is required to be licensed, permitted, or authorized by the Committee is guilty of a willful and knowing violation of T.C.A. §§ 63-31-101, et seq. or regulations promulgated pursuant thereto, to such an extent that there is, or is likely to be an imminent substantial threat to the health, safety and welfare of an individual client or the public. For purposes of this section, a Type A penalty may be imposed in instances including but not limited to, those in which a person willfully and knowingly is or was practicing Polysomnography without a license from the Committee. Type A civil penalties shall be assessed in the amount of not less than $500 and not more than $1,000.

A Type B civil penalty may be imposed whenever the Committee finds the person required to be licensed, permitted, or authorized by the Committee is guilty of a violation of T.C.A. §§ 63-31-101, et seq. or regulations promulgated pursuant thereto in such manner as to impact directly on the care of clients or the public.

Type B civil penalties may be assessed in the amount of not less than $100 and not more than $500.

A Type C civil penalty may be imposed whenever the Committee finds the person required to be licensed, permitted, or authorized by the Committee is guilty of a violation of T.C.A. §§ 63-31-101, et seq. or regulations promulgated pursuant thereto, which is neither directly detrimental to the clients or public, nor directly impacts their care, but only has an indirect relationship to client care or the public. Type C civil penalties may be assessed in the amount of not less than $50 and not more than $100.

(b) Procedures for Assessing Civil Penalties 1. During a contested case proceeding the Committee may assess civil penalties in a type and amount which was not recommended by the Office of General Counsel.

In assessing the civil penalties pursuant to these rules the Committee may consider the following factors:

(i) Whether the amount imposed will be a substantial economic deterrent to the violator;

(ii) The circumstances leading to the violation;

(iii) The severity of the violation and the risk of harm to the public;

(iv) The economic benefits gained by the violator as a result of noncompliance; and (v) The interest of the public.

All proceedings for the assessment of civil penalties shall be governed by the contested case provisions of T.C.A. Title 4, Chapter 5.

History

Authority: T.C.A. §§ 63-1-122, 63-1-134, 63-31-104, 63-31-109, and 63-31-110.
Administrative History: Original rule filed March 2, 2010; effective May 31, 2010.

Tenn. Comp. R. & Regs. 0880-14-.08 OFFICERS, CONSULTANTS, RECORDS, ADVISORY RULINGS, AND SCREENING

PANELS.

(1) The Committee shall elect annually from its members the following officers:

(a) “Chairperson” who shall preside at all Committee meetings, and appoint committees.

(b) “Secretary” who in the absence of the chairperson shall preside at Committee meetings and who, along with the Committee’s Director, shall be responsible for correspondence from the Committee and execution of all official documents requiring the seal of the Committee to be affixed.

(2) The Committee shall select as a Committee consultant a designee(s) who may serve as a consultant(s) to the Division and who may perform the following acts:

(a) Review complaints.

(b) Request patient records under T.C.A. § 63-1-117.

(c) Review and approve all types of applications for issuance of a temporary authorization pursuant to T.C.A. § 63-31-107, subject to subsequent ratification by the Committee before full licensure, renewal or reinstatement can issue.

(3) Records and Complaints (a) All requests, applications, notices, other communications and correspondence shall be directed to the Committee Office. Any requests or inquiries requiring a Committee decision or official Committee action, except documents relating to disciplinary actions or hearing requests, must be received at least fourteen (14) days prior to a scheduled Committee meeting. Requests or inquiries not timely received will be retained in the Committee Office and presented at the next Committee meeting.

(b) All records of the Committee, except those made confidential by law, are open for inspection and examination, under the supervision of an employee of the Division at the Committee Office during normal business hours.

(4) Advisory Rulings - Any licensee who is affected by any matter within the jurisdiction of the Committee may submit a written request for an advisory ruling subject to the limitations imposed by T.C.A. § 63-31-104. The procedures for obtaining and for issuance of advisory rulings are as follows:

(a) The licensee shall submit the request to the Committee Office providing:

The specific question or issue for which the ruling is requested;
The facts that gave rise to the specific question or issue; and 3. The specific statutes and/or rules which are applicable to the question or issue.

(b) The Committee may review the request at its next scheduled meeting.

(c) Upon adoption by the Committee an advisory ruling shall be transmitted to the requesting licensee. The ruling shall have only such affect as is set forth in T.C.A. § 63- 31-104.

(5) Screening Panels - The Committee adopts, as if fully set out herein, Rule 1200-10-01-.13, of the Division of Health Related Boards and as it may from time to time be amended, as its rule governing the screening panel process.

(6) Reconsiderations and Stays - The Committee authorizes the member who chaired the Committee for a contested case to be the agency member to make the decisions authorized pursuant to Rule 1360-04-01-.18 regarding petitions for reconsiderations and stays in that case.

History

Authority: T.C.A. §§ 63-1-115, 63-1-117, 63-1-138, 63-6-101, 63-31-103, 63-31-104, and 63-31-112.
Administrative History: Original rule filed March 2, 2010; effective May 31, 2010. Amendments filed May 25, 2017; effective August 23, 2017.

Tenn. Comp. R. & Regs. 0880-14-.09 CONTINUING EDUCATION

(1) All licensees must comply with the following as a prerequisite to licensure renewal:

(a) Continuing Education - Hours Required 1. A licensee must complete ten (10) hours of continuing education every calendar year (January 1-December 31).

Continuing education for new licensees - For new licensees, submitting proof of successful completion of all education and training requirements required for licensure in Tennessee, pursuant to Rule 0880-14-.03, shall be considered proof of sufficient preparatory education to constitute continuing education credit for the calendar year in which such education and training requirements were completed.
The Committee may approve a course for only the number of hours contained in the course. The approved hours of any individual course will not be counted more than once in a calendar year toward the required hourly total regardless of the number of times the course is attended or completed by any individual.
The Committee may waive or otherwise modify the requirements of this rule in cases where there is retirement, or an illness, disability or other undue hardship that prevents a licensee from obtaining the requisite number of continuing education hours. Requests for waivers or modification must be sent in writing to the Committee Office prior to the expiration of the renewal period in which the continuing education is due.

(b) Continuing Education - Proof of Compliance 1. The due date for completion of the required continuing education is December 31st of every calendar year.

Licensees must, on the license renewal form, enter a signature, electronic or otherwise, which indicates completion of the required continuing education hours and that such hours were obtained during the applicable calendar years.
All licensees must retain independent documentation of completion of all continuing education hours for a period of five (5) years from the end of the renewal period in which the continuing education was acquired. This documentation must be produced for inspection and verification, if requested in writing by the Division during its verification process. Documentation verifying the licensee’s completion of the continuing education program(s) may consist of any one or more of the following:

(i) Certificates from the continuing education program’s sponsor, indicating the date, length in minutes awarded (continuing education units must be converted to clock hours), program title, licensee’s name, license number and social security number; or (ii) An original letter on official stationery from the continuing education program’s sponsor indicating date, length in minutes awarded (continuing education units must be converted to clock hours), program title, licensee’s name, license number and social security number.

(c) Continuing Education 1. Approved Continuing Education – Continuing education programs that are provided by, or approved for continuing education credit by, one of the following shall be acceptable to the Committee for credit towards the continuing education hour requirements of this rule:

(i) Board of Registered Polysomnographic Technologists (ii) American Association of Sleep Technologists (iii) Canadian Sleep Society (iv) Australasian Sleep Technologists Association (v) American Academy of Sleep Medicine 2. Continuing Education Coursework that may be approved - Continuing education courses provided by, or approved for continuing education credit by, one of the following organizations or associations may potentially, on a case-by-case basis, also be recognized as acceptable continuing education to satisfy the requirements of this rule, provided that the course’s primary educational component relates to the practice of polysomnography. In the event that the Committee or Division requests documentation of completion of all continuing education hours during its verification process, the licensee has the duty to provide not only proof of the course completion, but also proof that the course relates to the practice of polysomnography and that it has been provided by or approved by one of the following organizations:

(i) American Association for Respiratory Care and any of its chartered affiliates (ii) American College of Chest Physicians (iii) American Heart Association (iv) American Lung Association (v) American Medical Association (vi) American Nurses Association (vii) American Society of Cardiovascular Professionals (viii) American Society of Anesthesiologists (ix) American Thoracic Society (x) Critical Care Nurse Association (xi) Tennessee Association of Cardiovascular and Pulmonary Rehabilitation (xii) Tennessee Medical Association (xiii) All hospitals or institutions belonging to the Tennessee Hospital Association or which are Joint Commission-accredited.

The Committee consultant is vested with the authority to approve continuing education courses submitted in compliance with this rule. All such approvals must be presented to the full Board for ratification.
If a person submits documentation for coursework that is not clearly identifiable as acceptable continuing education because its primary educational component does not clearly relate to the practice of polysomnography, the Committee or its consultant will request further written description of the coursework and how it applies to the practice of polysomnography. If the Committee determines that it will not approve the continuing education, the individual may be granted an extension, not to exceed ninety (90) days, to replace the coursework hours that were not approved by the Committee. Those hours will be considered replacement hours and cannot be counted during the next calendar year.

(d) Violations 1. A licensee who fails to obtain the required continuing education hours shall pay a fee of $30.00 per hour deficient, may be subject to disciplinary action pursuant to

Rule 0880-14-.07, and shall not be eligible for licensure renewal.

A licensee who falsely attests to completion of the required hours of continuing education may be subject to disciplinary action pursuant to Rule 0880-14-.07.
Education hours obtained as a result of compliance with the terms of Committee and/or Board Orders in any disciplinary action shall not be credited toward the continuing education hours required to be obtained in any calendar year.

History

Authority: T.C.A. §§ 63-6-101, 63-31-104, and 63-31-109.
Administrative History: Original rule filed March 2, 2010; effective May 31, 2010. Amendments filed May 25, 2017; effective August 23, 2017.

Tenn. Comp. R. & Regs. 0880-14-.10 CODE OF ETHICS

(1) It shall be a violation of the Committee’s rules and regulations, that may result in discipline, for a Polysomnographic Technologist, Technician, or person practicing polysomnography pursuant to T.C.A. § 63-31-107(a)(4) to do any of the following:

(a) Fail to maintain in strict confidence all privileged information concerning a patient except as disclosure or use of information is permitted or required by law.

(b) Have sexual relations with a current or former patient unless the practitioner has not provided any polysomnographic services to the patient within the one year period preceding the beginning of the sexual relationship.

(c) Have sexual relations with a close family member of a patient unless the practitioner has not provided any polysomnographic services to the patient within the one year period preceding the beginning of the sexual relationship.

(d) Either directly or indirectly solicit the patronage of patients by way of intimidation, threats, harassing conduct, undue influence, coercion, duress, unwarranted promises of benefits; or either directly or indirectly solicit a patient who is apparently in a mental condition that impairs judgment to make decisions about the products or services being offered.

(e) Claim or assert the authority to practice beyond the scope of practice for a polysomnographic technologist.

(f) Provide treatment or care beyond their competence and/or the instructions of the supervising physician.

(g) Fail to follow the necessary procedural protocols to ensure collection of appropriate data.

(h) Fail to demonstrate the knowledge and skills necessary to recognize and provide agespecific care in the treatment, assessment, and education of pediatric, adolescent, adult and geriatric patients.

History

Authority: T.C.A. §§ 63-1-107, 63-31-104, 63-31-106, 63-31-108, and 63- 31-109.
Administrative History: Original rule filed March 2, 2010; effective May 31, 2010.

Chapter 0880-15 General Rules and Regulations Governing Anesthesiologist Assistants Emergency rules filed May 20, 2026; effective through November 16, 2026.

Tenn. Comp. R. & Regs. 0880-15-.01 .

(i) An applicant shall cause the results of a criminal background check to be submitted to the Board’s Administrative Office directly from the vendor identified in the Board’s licensure application materials.

(j) An applicant shall submit two letters of reference from the applicant’s supervising anesthesiologists or for recent graduates, from the director of the applicant’s training program or faculty anesthesiologist addressing the applicant’s clinical skills and ability.

Each letter must be addressed to the Board and must have been written no more than six months prior to the filing of the application for licensure.

(2) Review and decisions for licensure shall be governed as follows:

(a) The Board’s administrative staff shall determine when an application file is complete.

(b) If an application is incomplete when received by the Board’s Administrative Office, the applicant shall be notified of the information required. The applicant shall cause the requested information to be received by the Board’s Administrative Office on or before May, 2026 3 the ninetieth (90th) day after the initial letter notifying the applicant of the required information is sent. If requested information is not timely received, the application file shall be closed, and the applicant notified that the Board will not consider licensure until a new application is received.

(c) If a completed application is denied, conditioned, or restricted by the Board, a notification of denial shall be sent by the Board Administrative Office by certified mail, return receipt requested, which shall contain the specific authority for the denial. The applicant is not entitled to a contested case hearing. If the applicant believes that the denial was in error, the applicant may request, in writing within 30 days of receipt of the denial, to appear before the Board for an interview.

History

Authority: T.C.A. §§ 63-21-102, 63-21-103, 63-21-105, and 63-21-107.
Administrative History: Emergency rules filed May 20, 2026; effective through November 16, 2026.

Tenn. Comp. R. & Regs. 0880-15-.02 LICENSURE REQUIREMENTS

To practice in Tennessee as an anesthesiologist assistant or use the title or represent that the person is a certified anesthesiologist assistant, anesthesiologist assistant, or use the abbreviations “C.A.A.” or “A.A.” a person must possess a lawfully issued license from the Board. This section does not apply to a person who is enrolled in an anesthesiologist assistant education program approved by the Board.

History

Authority: T.C.A. §§ 63-21-102, 63-21-103, and 63-21-107.
Administrative History: Emergency rules filed May 20, 2026; effective through November 16, 2026.

Tenn. Comp. R. & Regs. 0880-15-.03 LICENSURE PROCESS - ANESTHESIOLOGIST ASSISTANTS

The Board may issue licensure according to the following criteria, process, and qualifications:

(1) Qualifications for licensure. To practice as an anesthesiologist assistant in Tennessee a person must meet the following requirements:

May, 2026 2 (a) An applicant shall obtain an application form from the Board Administrative Office or from the Board’s website, respond truthfully and completely to every question or request for information contained in the form, and submit it along with all documentation and fees required by the form and this rule to the Board’s Administrative Office.

(b) An applicant shall cause to be submitted the equivalent of a Tennessee Certificate of Endorsement (verification of licensure/certification/registration) from each licensing board of each state or county in which the applicant holds or has ever held a license/certificate/registration to practice any profession that indicates the applicant holds or held an active license/certificate/registration and whether it is in good standing presently or was at the time it became inactive. It is the applicant’s responsibility to request this information be sent directly from each such licensing board to the Board’s Administrative Office.

(c) An applicant shall submit proof of United States citizenship or of being lawfully present in the United States pursuant to T.C.A. § 4-58-103.

(d) An applicant shall submit a clear and recognizable, recently taken, bust photograph which shows the full head, face forward from at least the top of the shoulders up.

(e) An applicant shall submit sufficient evidence of successful completion of an anesthesiologist assistant program accredited by the Commission on Accreditation of Allied Health Education Programs or its predecessor or successor organization. A copy of the applicant’s diploma shall be submitted as evidence of satisfactory completion.

(f) An applicant shall submit sufficient evidence of current certification by the National Commission for Certification of Anesthesiologist Assistants (NCCAA) or its successor organization and shall have successfully completed the National Certifying Examination for Anesthesiologist Assistants as administered by the NCCAA. Applicants shall have verification of passage of the certifying examination and active certification submitted to the Board directly from the NCCAA.

(g) An applicant shall submit sufficient evidence of Advanced Cardio Vascular Life Support (ACLS) certification.

(h) An applicant shall submit the application fee and state regulatory fee as provided by Rule

Tenn. Comp. R. & Regs. 0880-15-.04 MAINTAINING LICENSURE, RENEWAL, RETIREMENT, AND REINSTATEMENT

(1) Anesthesiologist assistants holding a full license must renew their license to be able to legally continue to practice as an anesthesiologist assistant in Tennessee. Once issued a full license can be renewed every two years. License renewal is governed by the following:

(a) The due date for licensure renewal is its expiration date, which is the last day of the month in which a licensees’ birthday falls pursuant to the Tennessee Department of Health, Division of Health-Related Board’s (Division) “biennial birthdate renewal system” contained in Rule 1200-10-01-.10.

(b) Methods of Renewal- Licensees may accomplish renewal by one of the following methods:

Internet Renewals- Individuals may apply for renewal and pay the necessary fees via the Internet. The application to renew can be accessed at the Board’s website.
Paper Renewals- Licensees who did not opt in to receive Board communication via email will be mailed an application at their last known address prior to the expiration date of their current license. Failure to receive such notification does not relieve the individual of the responsibility of timely meeting all requirements for renewal. To be eligible for renewal a licensee must submit to the Division on or before the licensee’s expiration date the following:

(i) A completed and signed renewal application form.

(ii) The renewal and state regulatory fees as provided in Rule 0880-15-.01.

(iii) Proof of maintaining certification by the NCCAA or its successor organization.

(d) The license of any individual who fails to comply with the licensure renewal rules and notifications sent to them concerning failure to timely renew shall have to reinstate their license prior to practicing.

May, 2026 4 (e) Anyone submitting a signed renewal form, electronically or otherwise, which is found to be fraudulent or untrue may be subject to disciplinary action.

(f) Any licensee who receives notice of failure to timely renew pursuant to Rule 1200-10- 01-.10, and who, on or before the last day of the month following the month in which the license expires, executes and files in the Board’s Administrative Office an affidavit of retirement pursuant to paragraph (2) of this rule may have their license retired effective on their licensure expiration date.

(2) Licensure Retirement.

(a) License holders who wish to retain their license but not be required to comply with the licensure renewal process may do so by complying with the following:

Obtain from, complete, and submit to the Board Administrative Office, an affidavit of retirement form.
Submit any documentation which may be required by the form to the Board’s Administrative Office.

(3) Reinstatement of an expired license. Any license holder who has failed to timely renew may re-enter active practice by doing the following:

(a) Submit a request for a reinstatement application to the Board’s Administrative Office; and (b) Fully complete and submit the Board’s reinstatement application along with payment of all past due renewal fees and the late renewal fee; and (c) Submit, along with the Board’s reinstatement application, documentation of successful completion of the continuing education requirements provided in Rule 0880-15-.08 for all the calendar years (January 1–December 31) that the license was expired that precede the calendar year during which the reinstatement is requested.

(d) Proof of maintaining certification by the NCCAA or its successor organization will be considered sufficient proof of the required continuing education hours.

(e) If requested, after review by the Board, a designated Board member, or the Board’s consultant, appear before either the Board, another Board member, or the Board Designee for an interview regarding continued competence in the event of licensure retirement, administrative revocation, or other practice inactivity in excess of one year, and meet such other requirements the Board feels is necessary to establish current levels of competency.

(4) Reinstatement of a retired license. Any license holder whose license has been retired may reenter active practice by doing the following:

(a) Submit a request for a reinstatement application to the Board’s Administrative Office; and May, 2026 5 (b) Fully complete and submit the Board’s reinstatement application along with payment of the license renewal fee; and (c) Submit, along with the Board’s reinstatement application, documentation of successful completion of twenty (20) hours of continuing education as provided in Rule 0880-15- .08, during the two (2) calendar years (January 1–December 31) that precede the calendar year during which the reinstatement is requested.

(d) Proof of maintaining certification by the NCCAA or its successor organization will be considered sufficient proof of the required continuing education hours.

(5) Renewal issuance and reinstatement decisions pursuant to this rule may be administratively subject to review by the Board.

History

Authority: T.C.A. §§ 63-21-102 and 63-21-107.
Administrative History: Emergency rules filed May 20, 2026; effective through November 16, 2026.

Tenn. Comp. R. & Regs. 0880-15-.05 TEMPORARY LICENSURE QUALIFICATIONS

(1) The Board may, in its discretion, issue a temporary license to an applicant who meets the qualifications for licensure as an anesthesiologist assistant, except for having successfully completed the National Certifying Examination for Anesthesiologist Assistants as administered by the NCCAA.

(c) An applicant shall submit proof of United States citizenship or of being lawfully present in the United States pursuant to T.C.A. § 4-58-103.

(d) An applicant shall submit a clear and recognizable, recently taken, bust photograph which shows the full head, face forward from at least the top of the shoulders up.

May, 2026 6 (f) An applicant shall submit sufficient evidence of ACLS certification.

(g) An applicant shall submit the application fee and state regulatory fee as provided by Rule

Tenn. Comp. R. & Regs. 0880-15-.06 SCOPE OF PRACTICE

(1) An anesthesiologist assistant may assist in the practice of anesthesia only under the supervision of an anesthesiologist. The anesthesiologist assistant may perform only those duties and responsibilities delegated to the anesthesiologist assistant by the supervising anesthesiologist.

(2) The practice of the anesthesiologist assistant must not exceed the anesthesiologist assistant’s education and training, and the scope of practice of the supervising anesthesiologist. A medical care task assigned by the supervising anesthesiologist to the anesthesiologist assistant must not be delegated by the anesthesiologist assistant to another person.

(3) No anesthesiologist assistant shall practice without a supervising anesthesiologist or in any location where a supervising anesthesiologist is not immediately available for consultation, assistance and intervention within the same facility. Under no circumstances should a CRNA be authorized to train or supervise licensed anesthesiologist assistants or persons enrolled in an anesthesiologist assistant education program approved by the Board.

(4) The scope of practice for an anesthesiologist assistant shall be determined by the credentialing procedures and bylaws of the facility in which the anesthesiologist assistant practices and be consistent with the supervising agreement with the supervising anesthesiologist, T.C.A. § 63- 21-101 et. seq., these rules, and the Centers for Medicare and Medicaid Services rules. Duties of an anesthesiologist assistant may include, but are not limited to the following:

(a) Obtain a comprehensive patient history and present that history to the anesthesiologist who must conduct a pre-anesthesia interview and evaluation sufficient to confirm the anesthesiologist assistant’s evaluation. The supervising anesthesiologist must cosign any evaluation or progress notes written by the anesthesiologist assistant within twentyfour (24) hours;

(b) Pretest and calibrate anesthesia delivery systems and monitor, obtain, and interpret information from the systems and monitors in consultation with the supervising anesthesiologist;

(d) Establish basic and advanced airway interventions, including intubation of the trachea and performing ventilatory support;

(e) Administer intermittent vasoactive drugs and start and adjust vasoactive infusions;

(f) Administer anesthetic drugs, adjuvant drugs, and accessory drugs;

(g) Perform epidural anesthetic procedures and spinal anesthetic procedures as long as the supervising anesthesiologist is immediately available to assist, intervene or take over the procedure if needed;

(h) Administer blood, blood products, and supportive fluids;

(i) Support life functions during anesthesia health care, including induction and intubation procedures, the use of appropriate mechanical supportive devices, and the management of fluid, electrolyte, and blood component balances;

(j) Recognize and take appropriate corrective action for abnormal patient responses to anesthesia, adjunctive medication, or other forms of therapy;

May, 2026 8 (k) Participate in management of the patient while in the post anesthesia recovery area, including the administration of any supporting fluids or drugs; and (l) Place special peripheral and central venous and arterial lines for blood sampling and monitoring as appropriate.

(5) An anesthesiologist assistant may not prescribe, order, or compound any controlled substance, legend drug, or medical device. An anesthesiologist assistant may not dispense sample drugs to patients. Nothing prohibits an anesthesiologist assistant from administering legend drugs or controlled substances; intravenous drugs, fluids, or blood products; or inhalation or other anesthetic agents to patients which are ordered by the supervising anesthesiologist and administered while under the direct supervision of the supervising anesthesiologist.

History

Authority: T.C.A. §§ 63-21-104 and 63-21-107.
Administrative History: Emergency rules filed May 20, 2026; effective through November 16, 2026.

Tenn. Comp. R. & Regs. 0880-15-.07 SUPERVISION OF ANESTHESIOLOGIST ASSISTANTS

(1) A supervising anesthesiologist shall supervise an anesthesiologist assistant within the terms, conditions, and limitations set forth in a supervising agreement with the anesthesiologist assistant. Supervision requires the availability of an anesthesiologist who can delegate, coordinate, direct, consult, or oversee the implementation of the anesthesiologist’s intentions within the same facility.

(2) A supervising anesthesiologist must be immediately available to the anesthesiologist assistant such that the supervising anesthesiologist is able to intervene if needed. A supervising anesthesiologist is considered immediately available if he/she is physically located within the same facility as the anesthesiologist assistant and not otherwise occupied in a way that prevents him/her from immediately conducting hands-on intervention, if needed.

(3) A supervising anesthesiologist shall personally participate in the most demanding procedures in the anesthesia plan, which shall include induction and emergence.

(4) A supervising anesthesiologist shall be responsible for pre-operative, intra-operative and postoperative care and shall be responsible for ensuring compliance with the applicable standard of care by an anesthesiologist assistant acting under the supervising anesthesiologist’s supervision and control.

(5) A supervising anesthesiologist shall be board certified by the American Board of Anesthesiology or the American Osteopathic Board of Anesthesiology or be board eligible, must hold an active, unrestricted and unencumbered license from the Board of Medical Examiners or Board of Osteopathic Examination and have an active practice in the medical specialty of anesthesiology.

(6) A supervising anesthesiologist may supervise up to four anesthesiologist assistants at one time.

(7) Prior to practicing as an anesthesiologist assistant, he/she must have entered into a supervisory agreement with a supervising anesthesiologist. The supervising agreement shall at a minimum:

(a) Delineate the services that the anesthesiologist assistant is authorized to provide and the manner in which the anesthesiologist will supervise the anesthesiologist assistant;

May, 2026 9 (b) Include the method and frequency of review of the anesthesiologist assistant’s practice activities;

(d) Be signed and dated by the supervising anesthesiologist and anesthesiologist assistant prior to implementation; and (e) Contain the mechanisms for evaluation of serious or significant adverse outcomes to a patient(s) and/or deviations from the standard of care.

(8) An anesthesiologist assistant shall have a designated supervising anesthesiologist and shall notify the Board of the name address, and license number of their supervising anesthesiologist.

(9) An anesthesiologist assistant shall maintain a copy of the supervising agreement either on paper or electronically at the anesthesiologist assistant’s practice locations and make the supervising agreement available upon request by the Board or an authorized agent of the Board.

History

Authority: T.C.A. §§ 63-21-104 and 63-21-107.
Administrative History: Emergency rules filed May 20, 2026; effective through November 16, 2026.

Tenn. Comp. R. & Regs. 0880-15-.08 CONTINUING EDUCATION

(1) Proof of maintaining certification by the NCCAA or its successor organization will be considered sufficient proof of the required continuing education hours.

(2) Acceptable continuing education includes continuing education hours accredited by the NCCAA, the American Society of Anesthesiologists, or the American Academy of Anesthesiologist Assistants.

(3) Proof of compliance documentation of all continuing education hours must be retained for a period of four (4) years from the end of the calendar year in which the continuing education was acquired. The documentation must be produced for inspection and verification, if requested by the Division.

(4) Documentation verifying completion of the continuing education hours may consist of any one of the following:

(a) Original certificates or photocopies of original certificates from course providers verifying the licensee’s attendance and/or completion of hours;

(b) Original letters or photocopies of original letters from course providers verifying the licensee’s attendance and/or completion of hours; and (c) Transcripts from course providers verifying the licensee’s attendance and/or completion of hours.

History

Authority: T.C.A. §§ 63-21-102 and 63-21-107.
Administrative History: Emergency rules filed May 20, 2026; effective through November 16, 2026. May, 2026 10

Tenn. Comp. R. & Regs. 0880-15-.09 GROUNDS FOR DISCIPLINE

The Board may deny, refuse to renew, revoke, suspend, or restrict a license or take other disciplinary action, including imposing conditions or restrictions on a license. The grounds upon which the Board shall exercise such power include, but are not limited to:

(1) Unprofessional, dishonorable or unethical conduct;

(2) Habitual intoxication or personal misuse of any drugs or the use of intoxicating liquors, narcotics, controlled substances, controlled substance analogues or other drugs or stimulants in such manner as to adversely affect the person’s ability to practice as an anesthesiologist assistant;

(3) Conviction of a felony, conviction of any offense under state or federal laws relative to the duties and responsibilities of an anesthesiologist assistant, conviction of any offense involving moral turpitude, or being required to register as a sexual offender or violent sexual offender as defined by Title 40, Chapter 39, Part 2;

(4) Making false statements or representations, being guilty of fraud or deceit in obtaining admission to practice or being guilty of fraud or deceit in the course of performing the functions and duties of an anesthesiologist assistant;

(5) Gross health care liability or a pattern of continued or repeated health care liability, ignorance, negligence or incompetence in the course of performing the functions and duties of an anesthesiologist assistant;

(6) Violation or attempted violation, directly or indirectly, or assisting in or abetting the violation of, or conspiring to violate any provision of this chapter or, any lawful order of the board issued pursuant thereto or any criminal statute of this state;

(7) Disciplinary action against a person licensed to practice as an anesthesiologist assistant by another state or territory of the United States for any acts or omissions that would constitute grounds for discipline of a person licensed in this state. A certified copy of the initial or final order or other equivalent document memorializing the disciplinary action from the disciplining state or territory shall constitute prima facie evidence of violation of this section and be sufficient grounds upon which to deny, restrict or condition licensure or renewal and/or discipline a person licensed in this state;

(8) Performing the functions and duties of an anesthesiologist assistant when mentally or physically unable to safely do so;

(9) Performing the functions and duties of an anesthesiologist assistant under a false or assumed name, or the impersonation of another practitioner;

(10) Obtaining or attempting to obtain any fee, charge, or other compensation by fraud, deception, or misrepresentation;

(11) Practicing beyond the scope of an anesthesiologist assistant; or, (12) Delegating a medical care task assigned to the anesthesiologist assistant by the supervising anesthesiologist to another person.

History

Authority: T.C.A. §§ 63-21-102 and 63-21-107.
Administrative History: Emergency rules filed May 20, 2026; effective through November 16, 2026. May, 2026 11

Tenn. Comp. R. & Regs. 0880-15-.10 DISCLOSURE OF LICENSURE STATUS

All licensed anesthesiologist assistants shall wear a photo identification name tag during all patient encounters that shall include a recent photograph of the licensee, the licensee’s full name, and identifies the licensee as an anesthesiologist assistant. The name tag shall be of sufficient size and be worn in a conspicuous manner so as to be visible and apparent.

History

Authority: T.C.A. §§ 63-21-102 and 63-21-107.
Administrative History: Emergency rules filed May 20, 2026; effective through November 16, 2026.

Tenn. Comp. R. & Regs. 0880-02-.02 .

(h) An applicant shall cause the results of a criminal background check to be submitted to the Board’s Administrative Office directly from the vendor identified in the Board’s licensure application materials.

(i) An applicant shall submit two letters of reference from the applicant’s supervising anesthesiologists or for recent graduates, from the director of the applicant’s training program or faculty anesthesiologist addressing the applicant’s clinical skills and ability.

Each letter must be addressed to the Board and must have been written no more than six months prior to the filing of the application for licensure.

(j) Application decisions shall be governed by Rule 0880-15-.02.

(k) If a temporary license is issued:

The temporary licensee shall take the next available certification examination.
The temporary license is valid for up to one year from the date issued.
There shall be no independent unsupervised practice by an anesthesiologist assistant who is issued a temporary license. The supervision of anesthesiologist assistants is governed by Rule 0880-15-.07.

(l) The temporary license may be converted to a full license by:

Submitting an application to the Board’s Administrative Office and paying the license conversion fee and state regulatory fee;
Causing verification of passage of the certifying examination and active certification submitted to the Board directly from the NCCAA;
Causing the results of a criminal background check to be submitted to the Board’s Administrative Office directly from the vendor identified in the Board’s licensure application materials if the last criminal background check is older than six months;
Submitting proof of United States citizenship or of being lawfully present in the United States pursuant to T.C.A. § 4-58-103; and 5. Sufficient proof that the temporary licensee is in good standing at the time of application for a full license. Good standing means having no formal discipline or open investigations on the temporary license.

(m) The temporary license shall automatically expire upon the issuance of a full license.

History

Authority: T.C.A. §§ 63-21-103 and 63-21-107.
Administrative History: Emergency rules filed May 20, 2026; effective through November 16, 2026. May, 2026 7