2018 Legislative Session Summary

To:      Leading Age Tennessee

From: Meagan Frazier

Date:   June 12, 2018

Re:      2018 Legislative Wrap-up                                                                                                                                                      

The second session of the 110th Tennessee General Assembly adjourned on April 25, 2018. 

The Budget

As it is constitutionally required, the 110th Tennessee General Assembly passed a $37.6 billion-dollar budget for FY 2018-19.  The budget was billed as a focus on people versus programs and included significant appropriations for education, employment, economic opportunity and law enforcement.  The TennCare program was fully funded, including an addition of $136.3 million in medical inflation and cost increases, and experienced no unexpected cuts. The budget includes over $15 million to combat the state’s opioid epidemic and another $30 million for school safety as well as $119 million in higher education initiatives and $247 million in new state funding for K-12 education

Legislation impacting ACLFs

Governor Haslam’s administration passed SB2244/HB1820 which are requirements for Healthcare Facilities from the Department of Health.  Leading Age TN met with a representative from the department during the Day on the Hill to learn its ramifications. One of the main concerns from Leading Age was the desire to have an actual timeline of a certain amount of days for department to return to review after a plan of correction is submitted.  14 business days was added as that timeline.  Leading Age TN plans to be involved as this legislation is implemented.  The highlights are below: 

  • Allows the Commissioner to suspend admissions to Assisted Care Living Facilities in the same manner that he can for other facilities where the commissioner has a factual basis upon which to believe the conditions in any such facility or licensee are, or are likely to be, detrimental to the health, safety or welfare of a patient or resident.
  • For the purposes of this section, "facility or licensee" means any entity licensed under title 68, such as hospitals, ambulatory surgical treatment centers, nursing homes, etc.
  • Adds homes for the aged to the current provision authorizing the department to assess a civil penalty not to exceed $5,000 against any person or entity operating an assisted-care living facility, adult care home or traumatic brain injury residential home without having a license
  • The commissioner may suspend admissions pending a prompt hearing before the board or an administrative judge if the board cannot be promptly convened. 
  • The commissioner will initiate a suspension of admissions by delivering to the facility or licensee a notice stating the commissioner's decision to suspend the admissions of new patients.
  • The commissioner's notice to suspend admissions must: (1) Detail what conditions are considered detrimental to the health, safety or welfare of the patients; (2) Provide an explanation of the specific time frame when and conditions under which the facility or licensee can reasonably expect the suspension to be lifted; and (3) Be received by the facility or licensee within 10 business days of the conclusion of the department's survey.
  • Within 10 business days of the conclusion of the department's investigation, the department also must mail to the facility or licensee the commissioner's order, which must detail the alleged facts and pertinent law with particularity; and inform the facility or licensee of its right to contest the action.
  • Any facility or licensee subject to a suspension of admissions by the commissioner has the right to contest the factual or legal basis for a suspension of admission imposed against it through a prompt contested case hearing before the board or an administrative judge if the board cannot be promptly convened.
  • An order in all cases contesting a suspension of admissions must be issued within 10 business days after the hearing contesting the suspension of admissions, regardless of whether the hearing is conducted before the board or an administrative judge.
  • Within 10 days of receiving the commissioner's order to suspend admissions, any facility or licensee for which admissions have been suspended must submit a corrective action plan to the board delineating the measures to be taken to address violations and associated time frames.
  • If the facility or licensee asserts that it has corrected the underlying conditions upon which the suspension of admissions is based, or if the facility or licensee complies with the conditions for the suspension to be lifted as set forth in the commissioner's order, the department must verify such corrections after receiving notice and evidence of such corrections from the facility or licensee within 14 business days unless waived by the facility or licensee.
  • Unless other specific conditions exist that warrant an additional suspension or continuation of the suspension of admissions, the commissioner will promptly lift the suspension of admissions upon verification by the department that the facility or licensee has corrected the underlying conditions upon which the suspension of admissions is based or complied with the conditions for the suspension to be lifted.
  • This amendment authorizes the Board for Licensing Health Care Facilities to: (1) Continue, revoke or modify the suspension of admissions; and (2) Enter such other orders as it deems necessary.
  • Adds that to add an individual to the registry of offense against vulnerable persons, the copy of the court's criminal disposition order must indicate that: the individual was notified that, as a consequence of the conviction, the individual will be placed on the abuse registry; the offense constitutes an offense against a vulnerable person; and the court has ordered placement on the abuse registry and the clerk is required to forward such judgment to the department.

Enacted as Public Chapter 655. Effective July 1, 2018.


Bills Affecting the Elderly

Resource Mapping for Older Adults: Public Chapter 548 requires the Commission on Aging and Disabilities to create an inventory of funding sources and streams that provide support to adults in this state who are 60 years of age or older. It also requires the Commission to design and oversee a resource mapping of all federal and state funding sources and streams as well as resources for nonprofit and other nongovernmental entities that support the health, safety, and welfare of persons 60 years of age or older. On or before December 15, 2019, the Commission must provide a preliminary report to the Health committees of the Senate and the House, with a full report due on or before December 15, 2020. The full report must include the resource map and any recommendations for improving the efficiency and effectiveness of programs offered to older adults in the state. The report will be updated annually.

Elderly & Vulnerable Adult Protection Act of 2018: Public Chapter 1050 is the third bill in the last three years on this same subject and title.  This bill focused on abuse, neglect and sexual abuse of the elderly and came with the strong support of the District Attorney General’s Association.  In its final form, the legislation has strong penalties including jail time for offenses.  Additionally, anyone who suspects abuse must report it or face penalties.  Inclusion on the abuse registry is required for anyone convicted of an offense.  An amendment from the nursing home industry clarified that any offense must be “willingly and knowingly” committed and not solely “knowingly.”   The legislation also acknowledged that financial abuse was covered under a different statute and would not include a bank if the bank was acting within the scope of employment. 

Limited Respite Care: Public Chapter 607 exempts limited respite care services programs from the present licensure requirement. Under this bill, limited respite care services programs are programs that provide primary caregivers of appropriate adults with relief from normal caregiving duties and responsibilities.  They also must be operated by a religious institution or religious organization that provides custodial care for aging adults and adults with limitations on activities of daily living who are able to function in a group setting, are able to feed and perform toilet functions themselves with or without the assistance of a personal aide and attend the program no more than three days each calendar week, not more than 12 hours in any one week, and not more than six hours each day. The program must be registered with the department of health pursuant to rule promulgated by the commissioner and can only care for less than 15 adults at the same time. The department is authorized to make site visits to a program in order to ensure compliance with the terms of the exemption permitted under this bill. The program is also prohibited from administration of medications to adults while under the program's care.

Other items of Interest

TN Together:  One of the most significant pieces of the Governor’s 2018 legislative package were a series of bills dealing with attacking the opioid epidemic in an effort to treat, prevent and criminalize the problem.  Multiple bills were drafted, debate, amended and passed.  The TN Medical Association and TN Pharmacists Association and various other stakeholders held weekly meetings to discuss amendatory language and physician and pharmacist flexibility.  The House and Senate had very different approaches but ultimately, all came together in a package of bills.  The best summary can be found at this website created by the TN Together initiative: https://www.tn.gov/content/tn/governor/2018-legislative-priorities/tn-together.html

Administration’s Drug Scheduling bill:  Public Chapter 1040 was the administration’s annual scheduling bill and was the bill that helped to introduce all involved with the substance Kratom.  The Senate insisted that Kratom stay as a scheduled drug and the House removed Kratom from the state scheduling system.  The compromise is that Kratom in its natural form will not be scheduled and is legal to purchase for those over 21, but any derivative is illegal as is the purchase by anyone under 21.  The other drugs impacted by scheduling changes were all approved as introduced including gabapentin as a Schedule V drug. 

TennCare Work Requirements:  Public Chapter 869 requires the TennCare Bureau to submit a waiver application to CMS authorizing TN to implement a work requirement on able-bodied working age adult enrollees of the TennCare program.  TennCare is further directed to request that the federal government authorize the use of TANF (temporary assistance to needy families) program funding for the expenses TennCare will experience in implementing this requirement.

Opioid abuse and diversion hotline: Public Chapter 675 by Sen. Ferrell Haile (R) and Rep. Bryan Terry (R), which has an effective date of January 1, 2019, will require the Tennessee Department of Health to accept allegations of opioid diversion or abuse. The new law will also require any entity that prescribes, dispenses, or handles opioids to provide information to employees about reporting suspected opioid diversion or abuse. The information may be provided to each employee individually in writing, documented by the employing entity, or by posting a sign, in a conspicuous location in a non-public area regularly used by employees. 

The new law further requires the Tennessee Department of Health to refer reports received to the appropriate health-related board or law enforcement official. Finally, the new law prohibits an employee of an entity that prescribes, dispenses, or handles opioids from being discharged or terminated solely for reporting information in good faith to the Tennessee Department of Health and grants civil immunity from liability to a person who reports information in good faith to the Tennessee Department of Health.

Partial Fill Prescriptions: Public Chapter 1007 authorizes the partial filling of a controlled substance if the partial fill is requested by the patient or the practitioner who wrote the prescription and the total quantity dispensed through partial fills does not exceed the total quantity prescribed for the original prescription.  This measure was pushed by the TN Pharmacists Association as one potential solution to lessen the amount of opioids being dispensed. 

E-Prescribing: Public Chapter 883 authorizes an e-prescribing requirement for Schedule II controlled substances effective July 1, 2020.  Some exemptions were added in including: prescribers who write less than 20 prescriptions annually; veterinarian prescriptions; technological or electronic failures; standing orders; prescriptions under a research protocol and others.  The delayed effective date is intended to give the impacted Health Related Boards the opportunity to promulgate rules and to give all impacted time to adjust to the requirement.  The legislation was billed as a deterrent to those who attempt to present fraudulent written prescriptions.

Pharmacy Benefit Managers: Public Chapter 838 makes clear that no person or entity may administer the medication or device portion of pharmacy benefits coverage provided by a covered entity or otherwise act as a pharmacy benefits manager in this state unless the person or entity has obtained licensure through the Department of Commerce and Insurance.  Further, it outlines the licensure process and requirements and establishes a fine for failure to be licensed. 

Looking ahead

With the legislative session over, state legislators can now begin to focus on the 2018 election cycle. At the top of the ballot, Tennessee voters will be given the opportunity to elect a new Governor. Current Governor Bill Haslam (R) is term limited after serving in office for 8 years. In the August 2, 2018 primaries, voters will choose from 4 major candidates in the Republican primary and two major Democratic candidates.


In the Republican primary, the 4 major candidates running for Governor are:


  • Congressman Diane Black
  • Former TN Commissioner of Economic and Community Development Randy Boyd
  • Tennessee House Speaker Beth Harwell
  • Middle Tennessee Businessman Bill Lee

In the Democratic primary, the 2 major candidates running for Governor are:

  • Former Nashville Mayor Karl Dean
  • Tennessee House Minority Leader Craig Fitzhugh

Heading into the 2018 election cycle, the 33-member state Senate consists of 28 Republicans and 5 Democrats. State Senators in Tennessee serve staggered, four-year terms with only half of the Senate standing for election during any given election cycle. 18 state Senate seats will stand for election in 2018 with 14 of the seats currently held by Republicans and 4 of the seats held by Democrats. There will be 3 open seats in the Senate during the 2018 election cycle. The current Speaker of the Senate is Lt. Governor Randy McNally (R) and he is expected to retain this position when the 111th Tennessee General Assembly convenes on January 8, 2019. 

The entire 99-member House of Representatives will stand for election in 2018. The House of Representatives currently consists of 73 Republicans and 26 Democrats. House members in Tennessee serve two-year terms. The 2018 election cycle will dramatically alter the House from an experience standpoint, as there will be at least 23 new House members due to retirements and House members seeking other elected offices. The collective loss of experience in the House amounts to more than 300 years of combined service to the state. In 2018, Republicans are guaranteed to retain 9 seats and Democrats are guaranteed to retain 17 seats. House Speaker Beth Harwell (R) is retiring from the House and running for Governor. Harwell has held the title of Speaker of the House since 2011. The race to succeed Harwell as Speaker will likely lead to significant changes in House leadership and committee chairmanships in 2019. 

Public Chapters

The public chapters are accessible via http://www.tn.gov/sos/acts/index by number or subject matter.