TENNESSEE Bill Would Allow Physician Assistants to Collaborate

Bill Name: Senate Bill 2136 (SB 2136) and House version HB 2318

Primary Sponsor: Senator Shane Reeves, for HB 2318 Representative Ryan Williams

Status: SB 2136 3/20/24 Reset on Final calendar of Senate Health and Welfare Committee

HB 2318 3/20/24 Placed on s/c cal Health Subcommittee

AmSpa’s Take: Reducing the amount of regulation and paperwork that advanced practitioners such as physician assistants (PAs) and nurse practitioners (NPs) need to comply with to practice frees up time and resources that can be better spent seeing patients, improving skills and developing their practices.

Outlook: These bills are in the first steps of the process.

Analysis: Currently, Tennessee physician assistants (PAs) practice under the supervision of a physician. This supervising physician delegates the health care tasks that the PA may perform. The relationship is formalized using a written supervision agreement, which lays out what tasks and medications are authorized. Under SB 2136, PAs would instead work under collaboration with a physician.

SB 2136 would require PAs with fewer than 6,000 hours of clinical experiences to work under a protocol with a collaborating physician. The protocol would need to contain:

1. The PA’s name, license number and primary practice location;
2. The collaborating physician’s name, license number, specialty, and primary practice location;
3. A general description of the oversight provided by the physician;
4. A description of the process the PA uses for collaboration with physicians and other members of the health care team;
5. A process where 100% of the patient charts are reviewed by the physician where the PA prescribed controlled substances within 10 days;
6. A process where 20% of patient charts are reviewed by the physician every 30 days;
7. Patient charts must be reviewed for at least six months whenever the PA changes specialty or practice setting; and
8. If the PA practices at a remote site, the physician must visit every 30 days.

When PAs have accrued more than 6,000 hours of clinical experience, they become eligible for endorsement, which would allow them to practice in collaboration with a physician and to practice to their level of competence, education, training, and experience. The board is responsible for reviewing and issuing the endorsements to the PA. Once the PA has obtained the endorsement, they would need to enter into a collaborative agreement with a physician. These agreements must contain:

1. The PA’s name, license number and primary practice location;
2. The collaborating physician’s name, license number, specialty, and primary practice location;
3. That the PA only practices within the scope of their competence, knowledge, and skill and within the usual scope of the collaborating physician;
4. A process where 100% of the patient charts are reviewed by the physician when a controlled substance is issued to the patient within 30 days;
5. A process where patient charts are reviewed for at least six months whenever the PA changes specialty or practice setting;
6. That the PA collaborates with, consults with, or refers to the collaborating physician or appropriate health care professional as indicated by the patient’s condition and the applicable standard of care;
7. Methods for communication between the PA and physician; and
8. A requirement for chart review and remote site visits to a level commensurate with the training and competence of the PA.

The majority of states allow nurse practitioners to practice independently. More recently, states have extended similar freedom and autonomy to physician assistants. In that regard, SB 2136 and HB 2318 are squarely within this trend. If you would like additional information, to read the language of the bill or to contact the sponsors or committee, you can find the information you need through this link.