§ 63-19-107 — Practices for collaboration with physician assistants

Tennessee § 63-19-107

• Jurisdiction: Tennessee
• Title: 63

Text

A licensed physician collaborating with a physician assistant shall comply with the following practices: (1) Ensure that protocols or a collaborative agreement, as applicable, is in place for each physician assistant with whom the physician collaborates and that such protocols or collaborative agreement meets the requirements of this chapter and the duly promulgated rules. More than one (1) physician may collaborate with the same physician assistant; provided, that alternative collaborating physicians are available to collaborate with the physician assistant in the absence or unavailability of the primary collaborating physician. Each physician assistant shall notify the board of physician assistants of the name, address, and license number of the physician assistant's primary collaborating physician and shall notify the board of physician assistants of a change in the primary collaborating physician within fifteen (15) days of the change. The number of physician assistants for whom a physician may serve as the collaborating physician must be determined by the physician at the practice level, consistent with good medical practice. The collaborating physician shall designate one (1) or more alternate physicians who have agreed to accept the responsibility of collaborating with the physician assistant on a prearranged basis in the collaborating physician's absence; (2) Complete the patient chart reviews of each physician assistant with whom the collaborating physician collaborates as set forth in this chapter, in rules promulgated pursuant to this chapter, and in protocols or a collaborative agreement, as applicable; (3) Conduct reviews of charts submitted to the collaborating physician by the physician assistant deemed by the physician assistant medically indicated for consultation. The collaborating physician is responsible for reviewing one hundred percent (100%) of patient charts within thirty (30) days when the physician assistant issues a prescription for a controlled drug pursuant to protocols. The collaborating physician is responsible for reviewing one hundred percent (100%) of patient charts within thirty (30) days when the physician assistant issues a prescription for any drug containing buprenorphine for use in recovery or medication-assisted treatment or a Schedule II controlled drug pursuant to a collaborative agreement; (4) Conduct the requisite remote site visits with each physician assistant with whom the physician collaborates, as set forth in this chapter or by rule, and in protocols or a collaborative agreement, as applicable; (5) Each physician assistant shall notify the board of physician assistants of the name and address of the physician assistant's primary practice location and shall notify the board within fifteen (15) days of a practice location change; (6) The board of physician assistants is authorized to monitor the prescriptive practices of the physician assistant through site visits by members of the board or their authorized agents; (7) Complaints against physician assistants must be reported to the office of investigations of the division of health related boards; (8) (A) Every prescription order issued by a physician assistant pursuant to this section must be entered in the medical records of the patient, and every handwritten prescription must be written on a preprinted prescription pad bearing the name, address, and telephone number of the physician assistant, and the physician assistant shall sign each prescription order so written; (B) A handwritten prescription order for a drug prepared by a physician assistant who is authorized by law to prescribe a drug must be legible so that it is comprehensible by the pharmacist who fills the prescription. The handwritten prescription order must contain the name of the prescribing physician assistant, the name and strength of the drug prescribed, the quantity of the drug prescribed, handwritten in letters or in numerals, instructions for the proper use of the drug and the month and day that the prescription order was issued, recorded in letters or in numerals or a combination thereof. The prescribing physician assistant shall sign the handwritten prescription order on the day it is issued, unless it is a standing order issued in a hospital, a nursing home, or an assisted-care living facility as defined in § 68-11-201 ; (C) A typed or computer-generated prescription order for a drug issued by a physician assistant who is authorized by law to prescribe a drug must be legible so that it is comprehensible by the pharmacist who fills the prescription order. The typed or computer-generated prescription order must contain the name of the prescribing physician assistant, the name and strength of the drug prescribed, the quantity of the drug prescribed, recorded in letters or in numerals, instructions for the proper use of the drug, and the month and day that the typed or computer-generated prescription order was issued, recorded in letters or in numerals or a combination thereof. The prescribing physician assistant shall sign the typed or computer-generated prescription order on the day it is issued, unless it is a standing order issued in a hospital, a nursing home, or an assisted-care living facility as defined in § 68-11-201 ; (D) This section does not prevent a physician assistant from issuing a verbal prescription order; and (E) (i) Handwritten, typed, or computer-generated prescription orders must be issued on either tamper-resistant prescription paper or printed utilizing a technology that results in a tamper-resistant prescription that meets the current centers for medicare and medicaid services guidance to state medicaid directors regarding § 7002(b) of the federal United States Troop Readiness, Veterans' Care, Katrina Recovery, and Iraq Accountability Appropriations Act of 2007 (Pub. L. No. 110-28), and meets or exceeds specific TennCare requirements for tamper-resistant prescriptions; and (ii) Subdivision (8)(E)(i) does not apply to prescriptions written for inpatients of a hospital, outpatients of a hospital where the doctor or other person authorized to write prescriptions writes the order into the hospital medical record and then the order is given directly to the hospital pharmacy and the patient never has the opportunity to handle the written order, a nursing home or an assisted-care living facility as defined in § 68-11-201 , inpatients or residents of a mental health hospital or residential facility licensed under title 33, or individuals incarcerated in a local, state, or federal correctional facility; (9) A physician assistant authorized to prescribe drugs under this section who provides services in a free or reduced fee clinic under the Volunteer Health Care Services Act, compiled in chapter 6, part 7 of this title, may arrange for required personal review of the physician assistant's charts by a collaborating physician in the office or practice site of the physician or remotely via HIPAA-compliant electronic means rather than at the site of the clinic; (10) A physician assistant authorized to prescribe drugs under this section who provides services in a community mental health center, as defined in § 33-1-101 , or federally qualified health center, as defined in § 63-10-601 , or solely via telehealth, as defined in § 63-1-155 , may arrange for the required personal review of the physician assistant's charts by a collaborating physician, with the same authority to render prescriptive services that the physician assistant is authorized to render, in the remote office or practice site of the physician, or any required visit by a collaborating physician to any remote site, or both, via HIPAA-compliant electronic means rather than at the site of the clinic; (11) Except as provided in subdivisions (9) and (10): (A) A physician assistant licensed to prescribe drugs who provides services at a remote healthcare setting may arrange for any required personal review of the physician assistant's charts by a collaborating physician either via HIPAA-compliant electronic means or in person; and (B) A physician assistant licensed to prescribe drugs may arrange for up to ten (10) of the required annual remote site visits by a collaborating physician by HIPAA-compliant electronic means rather than at the site of the clinic. All other of the required site visits by a collaborating physician to a remote site must take place in person at the site of the clinic. As used in this subdivision, "annual" means a rolling twelve-month period; (12) A patient receiving services from a physician assistant must be fully informed that the individual is a physician assistant and a sign must be conspicuously placed within the office indicating that certain services may be rendered by a physician assistant; (13) A physician who does not normally provide patient care shall not enter into protocols with, collaborate with, or utilize the services of a physician assistant; and (14) (A) A physician assistant shall only perform invasive procedures involving a portion of the spine, spinal cord, sympathetic nerves of the spine, or block of major peripheral nerves of the spine in any setting not licensed under title 68, chapter 11, under the direct supervision of a physician licensed pursuant to chapter 6 or 9 of this title who is actively practicing spinal injections and has current privileges to do so at a facility licensed pursuant to title 68, chapter 11. The direct supervision provided by a physician in this subdivision (14) must only be offered by a physician who meets the qualifications established in § 63-6-244(a)(1) or (a)(3) or § 63-9-121(a)(1) or (a)(3) ; (B) For purposes of subdivision (14)(A), "direct supervision" means being physically present in the same building as the physician assistant at the time the invasive procedure is performed; and (C) This subdivision (14) does not apply to a physician assistant performing major joint injections, except sacroiliac injections, or to performing soft tissue injections or epidurals for surgical anesthesia or labor analgesia in unlicensed settings.

Legislative History

Amended by 2024 Tenn. Acts, ch. 1042,s 3, eff. upon promulgation of rules governing the collaborative agreements of physician assistants with physicians; see T.C.A. § 63-19-106(h)(1). Amended by 2023 Tenn. Acts, ch. 201, s 2, eff. 4/24/2023. Amended by 2022 Tenn. Acts, ch. 949, Secs.s 3, s 4 eff. 4/29/2022. Amended by 2021 Tenn. Acts, ch. 565, s 6, eff. 5/26/2021. Amended by 2019 Tenn. Acts, ch. 183, s 2, eff. 4/23/2019. Amended by 2018 Tenn. Acts, ch. 883, s 9, eff. 1/1/2019. Amended by 2018 Tenn. Acts, ch. 610, Secs.s 15, s 16, s 17, s 18, s 19, s 20, s 21, s 22, s 23, s 24 eff. 7/1/2018. Amended by 2018 Tenn. Acts, ch. 610, s 14, eff. 7/1/2018. Amended by 2016 Tenn. Acts, ch. 769, s 2, eff. 4/19/2016. Amended by 2013 Tenn. Acts, ch. 396, s 2, eff. 7/1/2013. Amended by 2013 Tenn. Acts, ch. 74,s 8, eff. 4/1/2013. Amended by 2013 Tenn. Acts, ch. 74,s 8, eff. 4/1/2013. Amended by 2013 Tenn. Acts, ch. 74,s 8, eff. 4/1/2013. Acts 1985, ch. 376, § 1; T.C.A., §63-19-207; Acts 1994, ch. 722, § 2; 1996, ch. 659, §§ 4, 5; 1998, ch. 842, §§ 5 - 7; 1999, ch. 33, §§ 2, 3; 2000, ch. 584, § 3; 2002, ch. 527, § 1; 2004, ch. 678, § 10; 2005, ch. 12, § 8; 2008 , ch. 1035, §§ 8, 9; 2010 , ch. 795, §§ 7, 18.