- Email: [email protected]
Tennessee
TENNESSEE
The legal basis for the nurse-midwifery practice in Tennessee is formed by components of the Nurse Practice Act and the Medical Practice Act, and through the Licensure Board for the Healing Arts. CNMs practice under general rules and regulations of the Nurse Practice Act that allow for expanded roles of nurses. In addition, the Board of Nursing issues a “certificate of fitness as a nurse practitioner” to those candidates who meet its criteria for prescriptive authority. In order to qualify for prescriptive authority, the Board requires graduation from a nurse practitioner program with specified amounts of time in the curriculum devoted to pharmacology. Beginning in January 1985, the Board will also require nurse practitioners who want prescriptive authority to have graduated from a master’s degree program in a clinical specialty area. The Board’s regulations require that CNMs who want to write prescriptions must be certified by the ACNM. The Medical Practice Act provides the basis for certain aspects of nursemidwifery practice through a delegatoy clause that says that the services a nurse performs “under the supervision, control and responsibility of a licensed physician” are exempted from the terms of the Act. This delegatoy clause has been interpreted to mean that physicians, using written protocols, can delegate medical tasks that would come under the statutory definition of the practice of medicine and are not included in the statutory definition of nursing practice. The statute further states that the Medical Practice Act does not apply to midwives. The Medical Practice Act defines medicine as care of physical illness, disease, and infirmity. The Licensure Board for the Journal of Nurse-Midwifery
??
Healing Arts statute states that nurse practitioners who write prescriptions are “rendering services pursuant to” the delegatoy clause of the Medical Practice Act. A Primary Care Advisoy Board must approve as underserved those sites of practice where nurse practitioners will write prescriptions. The practice of lay-midwifery in Tennessee is not illegal nor is it regulated under law. The issue of hospital privileges for nurse-midwives has been raised in several legal forums in Tennessee. In 1980, a private nurse-midwifery practice was denied hospital privileges in the three Nashville hospitals at which their collaborating obstetrician had privileges. Soon thereafter, the physician’s malpractice insurance was not renewed by the physicianowned insurance company that has 80% of the medical malpractice insurance market in the state. The CNMs, the physician, and two consumers have filed a federal antitrust suit against the insurance company, the hospitals, and several individual physicians. The case, Nurse-Midwilfey Associates u. B. K. Hibbett, is not expected to go to trial until summer 1984. The insurance company, State Volunteer Mutual Insurance Company (SVMIC) filed a motion for dismissal of the charges against it on the grounds that the antitrust laws do not apply to the business of insurance. In the summer 1982, the judge denied the motion, iinding that if SVMIC did what the suit alleges, those acts are not part of the business of insurance and are, in fact, subject to the antitrust laws. In the summer 1983, the Federal Trade Commission (FTC) investigated the behavior of the insurance company. The FTC investigation led
Vol. 29, No. 2, March/April 1984
Copyright 0 1984 by the American College of Nurse-Midwives
to a consent decree in which SVMIC promises not to discriminate against physicians on the basis of their association with nurse-midwives, nor to distinguish in its policies and rates between physicians who employ nursemidwives and those who work with nurse-midwives under some other kind of business arrangement. Although this consent decree has no legal impact on the law suit, it does change SVMIC’s practices and probably will have an impact on the policies and practices of other malpractice insurance companies. The Department of Health and Environment has issued amendments to its Hospital Licensing Regulations that now state that a hospital’s bylaws “may” include provision for hospital privileges for nurse-midwives. The Tennessee Board for Licensing Health Care Facilities granted approval for the opening of the first freestanding birth center in late 1983. The birth center is classified as an ambulatory surgical treatment center under state laws. An informal opinion from the state’s Medicaid office indicated that only physicians are reimbursed under current Tennessee law; therefore, unless the law is changed, CNMs will be denied Medicaid reimbursement.
Are ChJMs practicing in the jurisdiction: Yes Authorizing law: Nurse Practice Act, Medical Practice Act, and Licensure Board for the Healing Arts statute Regulated by: Board of Nursing Form of legal authorization to practice: RN license 149 0091-2182/84/$03.00
Frequency of renewal of legal authorization: Every two years CNM named in statute: No CNM named in regulations: Yes ACNM certification recognized: Yes RN license required: Yes
ADDRESS
OF MEDICAID OFFICE
Director Division of Program OperationsMedicaid 283 Plus Park Boulevard Nashville, TN 37217
Can CNMs sign birth certificates: Yes man-
s&&us:De-
Can graduate nurse-midwives practice before ACNM certification: YeS CEUs required for CNM: No CEUs required for RN: No ADDRESS AGENCY
Tennessee R.S. Gass Ben Allen Nashville,
150
63-6-
Hospital licensing regulations: Tennessee Administrative Register 1200-8-l-.01 and 1200-S-3-.02
ESSENTIAL LEGAL CITATIONS
Prescriptive authority: Yes
Medicaid reimbursement nied
Section
Birth certificates: Tennessee Code. Annotated. Section 68-3-302
Written evidence of collaboration agreement required: No
Third-party reimbursement dated: No
Code Annotated, 101 et seq.
OF REGULATORY
State Board of Nursing State Office Building Road TN 37216
Nurse practice act: Tennessee Code Annotated, Section 63-7-101 et seq. Nursing regulations: Tennessee Administrative Register 1000-l et seq. Prescriptive authority: Tennessee Code Annotated, Section 63-7123, 63-7-207, 63-l-104, 63-1110, 63-1-129, 63-6-204; Tennessee Administrative Register 1000-4.01 et seq. Licensing Board for the Healing Arts: Tennessee Code Annotated, Section 63-l-101 et seq. Medical
practice
act: Tennessee
Case citations: Nurse Midwifery Associates v. Hibbett, 549 F. Supp. 1185 (M.D. Tenn. 1982) (Judge’s decision to refuse SVMIC’s motion to dismiss charges) FTC Consent Decree, State Volunteer Mutual Insurance Company, Inc, 48 FEDERAL REGISTER 27089 (June 13, 1983); will be published in FK Repotter, available late 1984 To obtain copies of the amended complaint in Nurse Midwifery Associates v. Hibbett, case number 82-3208, write to: US District Court Clerk, Federal Courthouse, 8th Floor, 801 Broadway, Nashville, TN 37203.
Journal of Nurse-Midwifery
??
Vol. 29, No. 2, March/April
1984
The legal basis for the nurse-midwifery practice in Tennessee is formed by components of the Nurse Practice Act and the Medical Practice Act, and through the Licensure Board for the Healing Arts. CNMs practice under general rules and regulations of the Nurse Practice Act that allow for expanded roles of nurses. In addition, the Board of Nursing issues a “certificate of fitness as a nurse practitioner” to those candidates who meet its criteria for prescriptive authority. In order to qualify for prescriptive authority, the Board requires graduation from a nurse practitioner program with specified amounts of time in the curriculum devoted to pharmacology. Beginning in January 1985, the Board will also require nurse practitioners who want prescriptive authority to have graduated from a master’s degree program in a clinical specialty area. The Board’s regulations require that CNMs who want to write prescriptions must be certified by the ACNM. The Medical Practice Act provides the basis for certain aspects of nursemidwifery practice through a delegatoy clause that says that the services a nurse performs “under the supervision, control and responsibility of a licensed physician” are exempted from the terms of the Act. This delegatoy clause has been interpreted to mean that physicians, using written protocols, can delegate medical tasks that would come under the statutory definition of the practice of medicine and are not included in the statutory definition of nursing practice. The statute further states that the Medical Practice Act does not apply to midwives. The Medical Practice Act defines medicine as care of physical illness, disease, and infirmity. The Licensure Board for the Journal of Nurse-Midwifery
??
Healing Arts statute states that nurse practitioners who write prescriptions are “rendering services pursuant to” the delegatoy clause of the Medical Practice Act. A Primary Care Advisoy Board must approve as underserved those sites of practice where nurse practitioners will write prescriptions. The practice of lay-midwifery in Tennessee is not illegal nor is it regulated under law. The issue of hospital privileges for nurse-midwives has been raised in several legal forums in Tennessee. In 1980, a private nurse-midwifery practice was denied hospital privileges in the three Nashville hospitals at which their collaborating obstetrician had privileges. Soon thereafter, the physician’s malpractice insurance was not renewed by the physicianowned insurance company that has 80% of the medical malpractice insurance market in the state. The CNMs, the physician, and two consumers have filed a federal antitrust suit against the insurance company, the hospitals, and several individual physicians. The case, Nurse-Midwilfey Associates u. B. K. Hibbett, is not expected to go to trial until summer 1984. The insurance company, State Volunteer Mutual Insurance Company (SVMIC) filed a motion for dismissal of the charges against it on the grounds that the antitrust laws do not apply to the business of insurance. In the summer 1982, the judge denied the motion, iinding that if SVMIC did what the suit alleges, those acts are not part of the business of insurance and are, in fact, subject to the antitrust laws. In the summer 1983, the Federal Trade Commission (FTC) investigated the behavior of the insurance company. The FTC investigation led
Vol. 29, No. 2, March/April 1984
Copyright 0 1984 by the American College of Nurse-Midwives
to a consent decree in which SVMIC promises not to discriminate against physicians on the basis of their association with nurse-midwives, nor to distinguish in its policies and rates between physicians who employ nursemidwives and those who work with nurse-midwives under some other kind of business arrangement. Although this consent decree has no legal impact on the law suit, it does change SVMIC’s practices and probably will have an impact on the policies and practices of other malpractice insurance companies. The Department of Health and Environment has issued amendments to its Hospital Licensing Regulations that now state that a hospital’s bylaws “may” include provision for hospital privileges for nurse-midwives. The Tennessee Board for Licensing Health Care Facilities granted approval for the opening of the first freestanding birth center in late 1983. The birth center is classified as an ambulatory surgical treatment center under state laws. An informal opinion from the state’s Medicaid office indicated that only physicians are reimbursed under current Tennessee law; therefore, unless the law is changed, CNMs will be denied Medicaid reimbursement.
Are ChJMs practicing in the jurisdiction: Yes Authorizing law: Nurse Practice Act, Medical Practice Act, and Licensure Board for the Healing Arts statute Regulated by: Board of Nursing Form of legal authorization to practice: RN license 149 0091-2182/84/$03.00
Frequency of renewal of legal authorization: Every two years CNM named in statute: No CNM named in regulations: Yes ACNM certification recognized: Yes RN license required: Yes
ADDRESS
OF MEDICAID OFFICE
Director Division of Program OperationsMedicaid 283 Plus Park Boulevard Nashville, TN 37217
Can CNMs sign birth certificates: Yes man-
s&&us:De-
Can graduate nurse-midwives practice before ACNM certification: YeS CEUs required for CNM: No CEUs required for RN: No ADDRESS AGENCY
Tennessee R.S. Gass Ben Allen Nashville,
150
63-6-
Hospital licensing regulations: Tennessee Administrative Register 1200-8-l-.01 and 1200-S-3-.02
ESSENTIAL LEGAL CITATIONS
Prescriptive authority: Yes
Medicaid reimbursement nied
Section
Birth certificates: Tennessee Code. Annotated. Section 68-3-302
Written evidence of collaboration agreement required: No
Third-party reimbursement dated: No
Code Annotated, 101 et seq.
OF REGULATORY
State Board of Nursing State Office Building Road TN 37216
Nurse practice act: Tennessee Code Annotated, Section 63-7-101 et seq. Nursing regulations: Tennessee Administrative Register 1000-l et seq. Prescriptive authority: Tennessee Code Annotated, Section 63-7123, 63-7-207, 63-l-104, 63-1110, 63-1-129, 63-6-204; Tennessee Administrative Register 1000-4.01 et seq. Licensing Board for the Healing Arts: Tennessee Code Annotated, Section 63-l-101 et seq. Medical
practice
act: Tennessee
Case citations: Nurse Midwifery Associates v. Hibbett, 549 F. Supp. 1185 (M.D. Tenn. 1982) (Judge’s decision to refuse SVMIC’s motion to dismiss charges) FTC Consent Decree, State Volunteer Mutual Insurance Company, Inc, 48 FEDERAL REGISTER 27089 (June 13, 1983); will be published in FK Repotter, available late 1984 To obtain copies of the amended complaint in Nurse Midwifery Associates v. Hibbett, case number 82-3208, write to: US District Court Clerk, Federal Courthouse, 8th Floor, 801 Broadway, Nashville, TN 37203.
Journal of Nurse-Midwifery
??
Vol. 29, No. 2, March/April
1984