TMA Raises Concerns Over Collaboration Rules Change in Executive Order # 28

April 23, 2020

TMA has been fighting the issue of advance practice nurse independent practice for a number of years.  This year TMA successful in persuading the sponsors to take the bill off notice due to lack of support by committee members.

On Friday, April 17, the Governor issued Executive Order # 28 which temporarily allows advance practice nurses and physician assistants to practice without a collaborating physician. It will expire on May 15.  

The TMA immediately contacted the administration with our concerns. The modifications in Executive Order # 28 went far beyond the previous executive order allowed.  

Executive Order # 15 reduced mostly procedural and administrative requirements regarding chart reviews and TMA did not object to those changes because they were made early during the crisis and the uncertainty as to how fast and how severe the COVID-19 virus might spread. Executive Order # 28 went much further. It suspending all rules and statutes; essentially giving all APRNs and PAs complete autonomy during the remainder of the crisis. 

Scope of practice is one of TMA’s top priorities. TMA objected to the dramatic change because most areas of Tennessee appear to be on the downside of the curve.  With many medical practices operating at less than 20% capacity, access to care is not a reason to have expanded mid-level scope of practice, even temporarily.
Below are the responses we received from the Governor’s office yesterday.

·  This request came through the Tennessee Department of Health as part of model suggestions to states from HHS.
·  This order is by no means an end run around current law or a backdoor effort to expand scope of practice for nurses and physician assistants.
·  This response is similar to many actions the Administration is being asked to take during this time of emergency and does not imply that the Governor supports or endorses the actions in the executive order in perpetuity.
·  At this time, there is no plan to extend this provision of the Executive Order beyond its May 15 expiration.

The Governor’s office did say it has no plans to introduce independent practice legislation in the future, but did not commit that the issue was off the table.