State Overview: Tennessee

Prior authorization requirements are up to the discretion of the state Medicaid Program or private insurance company.

Resolution acknowledging prior authorization requirements are a burden for providers and limit access to care for patients and should be removed for medication-assisted treatment for a substance use disorder. Tenn. Senate Joint Resolution 181 (2019)

Tennessee credentials two types of addiction counselors. A Licensed Alcohol and Drug Counselor (LADC) I requires, at minimum, a high school diploma, 270 hours of relevant education courses and 6,000 hours of supervised experience. A LADC II must have a bachelor's degree in behavioral health or a master's degree in any field and complete 4,000 hours of supervised experience. Tenn. Code Ann. §68-24-601 and Tennessee Board of Alcohol and Drug Abuse Counselors

Licensed professional counselors (LPCs) provide services to individuals, groups, organizations, or the general public. Counselors prevent, diagnose and treat mental, emotional or behavioral disorders and associated disorders that interfere with mental health. LPCs also conduct assessments and diagnoses for the purpose of establishing treatment goals and objectives and plan, implement and evaluate treatment plans. Tenn. Gen. Rules §0450-01-.01(30)

The certification standards and procedures for peer recovery specialists are developed and administered by the state's Department of Mental Health and Substance Abuse Services. The standards include requirements for experience, training, examination and continued education.

Physician relationship required.

"Advanced practice registered nurse" means a registered nurse with a master's degree or higher in a nursing specialty and national specialty certification as a NP, nurse anesthetist, NM or clinical nurse specialist.

NPs may prescribe Schedules II-V controlled substances upon receiving a certificate of fitness from the State Board of Nursing and adoption of physician supervisory rules. Schedules II-IV may only be prescribed after consultation with the physician. Tenn. Code Ann. §63-7-126

Physician relationship is required for practice and prescriptive authority.

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. A written protocol shall be jointly developed that outlines the applicable standard of care, is reviewed and updated biennially and shall include a method for documenting consultation and referral. Other requirements include chart review and remote site visits.

NPs may prescribe Schedules II-V controlled substances upon receiving a certificate of fitness from the State Board of Nursing and adoption of physician supervisory rules. Schedules II-IV may only be prescribed after consultation with the physician. Tenn. Code Ann. §63-7-123

NPs are authorized to sign physician orders for scope of treatment forms if they are recognized by the board of nursing as an advanced practice nurse to provide POLST treatment. Tenn. Code. Ann. § 68-11-224

NPs are recognized in state policy as primary care providers. Primary care providers are health care professionals capable of providing a wide variety of basic health services. Primary care providers include practitioners of family, general or internal medicine; pediatricians and obstetricians; nurse practitioners; midwives; and physician assistants in general or family practice. Tenn. Admin. Code §1200-13-13.01(98)

Optometrists may examine, diagnose, manage and treat conditions and diseases of the eye and eyelid, including lumps and bumps. Tenn. Code Ann. § 63-8-102(12)

Optometrists may use injections for anaphylaxis or an anaphylactic reaction as well as local anesthesia. Tenn. Code Ann. § 63-8-102(12)

Optometrists may prescribe Schedule III-V controlled substances and also Schedule II hydrocodone or hydrocodone combination medications. Tenn. Code Ann. § 63-8-102(12)

Pursuant to a written protocol, dental hygienists may provide preventive services, as outlined by law or regulation, to patients in nursing homes, skilled care facilities, nonprofit clinics and public health programs, under the general supervision of a dentist. Dental hygienists may apply dental sealants or topical fluoride under the direction of a state or local health department without a dentist's initial evaluation under a protocol established by the state or a metropolitan health department. No supervision is required for dental hygienists participating in preventive oral health education events and free health screenings. Tenn. Code Ann. §63-5-109

Statute does not identify dental therapists as an oral health provider.

Tennessee allows for the practice of teledentistry through live video and store-and-forward modalities. Tenn. Code Ann. §63-5-108(16)

Tennessee has not enacted legislation allowing pharmacists to administer the COVID-19 vaccine. However, the federal PREP Act allowed pharmacists to administer the COVID-19 vaccine through the duration of the public health emergency.

Tennessee does not allow pharmacists to modify prescriptions.

A pharmacist may provide hormonal contraceptives, according to a collaborative pharmacy practice agreement, to individuals who are 18 years of age or older or under 18 years of age, if the individual is an emancipated minor. The pharmacist must complete a training program related to the provision of hormonal contraceptives, provide the patient with a self-screening risk assessment tool, provide the patient with information about the hormonal contraceptives and advise the patient to consult with a primary care practitioner or women's healthcare practitioner and either dispense the hormonal contraceptive, or refer the patient to a pharmacy that may dispense the hormonal contraceptive, as soon as practicable after the pharmacist determines that the patient should receive the medication. Tenn. Code Ann. §63-10-219

Tennessee does not allow pharmacists to prescribe tobacco cessation aids.

Collaboration allowed with a physician for practice and prescriptive authority.

A PA is authorized to perform selected medical services only in collaboration with a licensed physician. […] (3) The range of services that may be provided by a PA shall be set forth in a written protocol, jointly developed by the collaborating physician and the PA. The protocol must also contain a discussion of the problems and conditions likely to be encountered by the PA and the appropriate treatment for these problems and conditions. The PA shall maintain the protocol at the physician assistant's practice location and shall make the protocol available upon request by the board of medical examiners, board of PA, or the authorized agents of the boards. (4) A PA may perform only those tasks that are within the PA's range of skills and competence, that are within the usual scope of practice of the collaborating physician, and that are consistent with the protection of the health and well-being of the patients. Tenn. Code Ann. §63-19-106

In accordance with rules adopted by the board of medical examiners and the board of PA's a collaborating physician may delegate to a PA working in collaboration with the physician the authority to prescribe or issue legend drugs and controlled substances listed in Schedules II, III, IV and V. Tenn. Code Ann. §63-19-107(2)

Statute does not limit the number of PAs a physician may supervise.

The number of PAs 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. […] Tenn. Code Ann. §63-19-107(1)

Chart co-signatures are required by statute to practice or prescribe as a PA in certain settings.

Tennessee requires chart co-signatures for PAs working in a free or reduced fee clinic, community mental health center, federally qualified health center or who is providing services remotely from their supervising physician.

Statute does not allow adaptable proximity.

Collaboration requires active and continuous overview of the PA's activities to ensure that the physician's directions and advice are in fact implemented but does not require the continuous and constant physical presence of the collaborating physician. Tenn. Code Ann. §63-19-106

The range of services that a PA may provide is determined in the written protocol. A PA may only perform those tasks that are within the PA's skills and competence and within the usual scope of practice of the collaborating physician. Tenn. Code Ann. §63-19-106