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PUBLIC CHAPTER NO. 509
HOUSE BILL NO. 979
By Representatives Williams, White, Parkinson, Hardaway, Scarbrough
Substituted for: Senate Bill No. 764
By Senators Bailey, Reeves, Jackson, Stevens
AN ACT to amend Tennessee Code Annotated, Title 47; Title 63 and Title 68, relative to
health care.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF TENNESSEE:
SECTION 1. Tennessee Code Annotated, Section 63-6-204, is amended by deleting
subdivisions (f)(1 ), (f)(4), (f)(6), and (f)(7) and substituting:
(f)
(1)
(A) Notwithstanding this section, a hospital licensed under title 68,
chapter 11, or title 33, chapter 2, or an affiliate of a hospital, may employ
licensed physicians to provide medical services in:
(i) A hospital located in a county with a population of one
hundred five thousand (105,000) or less, according to the 2020
federal census;
(ii) A hospital located in a county with a population of more
than one hundred five thousand (105,000), according to the 2020
federal census, if such licensed physicians are other than
radiologists, anesthesiologists, pathologists, or emergency
physicians; or
(iii) A hospital if such hospital is a children's hospital;
provided, that any radiologists, anesthesiologists, pathologists, or
emergency physicians employed by such children's hospital are
board certified or board eligible.
(8) A hospital, as described in subdivision (f)(1)(A), may employ
licensed physicians to provide medical services subject to the following
conditions:
(i) An employing entity shall not restrict or interfere with
medically appropriate diagnostic or treatment decisions;
(ii) An employing entity shall not restrict or interfere with
physician referral decisions unless:
(a) The physician so employed has agreed in
writing to the specific restrictions at the time that the
contract is executed;
(b) The restriction does not, in the reasonable
medical judgment of the physician, adversely affect the
health or welfare of the patient; and
(c) The employing entity discloses any such
restrictions to the patient; and
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(iii) In the event that there is any dispute relating to
subdivision (f)(1 )(8)(i) or (ii), the employing entity has the burden
of proof.
(4) In any event, this section does not prohibit any of the following from
employing physicians:
(A) A licensed physician; or
(8) A group of licensed physicians, including either of the
following:
(i) A physicians' professional corporation registered under
title 48, chapter 101; or
(ii) A domestic nonprofit public benefit corporation:
(a) That is recognized as exempt under§ 501 (c)(3)
of the Internal Revenue Code (26 U.S.C. § 501 (c)(3)), or
any successor section;
(b) A purpose of which is to engage in medical
education and medical research in conjunction with a
college or university operating an accredited medical
school in this state; and
(c) Whose physician-employees practice through a
faculty practice plan for purposes of Title XVI 11 of the
federal Social Security Act (42 U.S.C., Chapter 7,
subchapter XVIII), and related promulgated regulations, or
any wholly owned subsidiary of the foregoing 501 (c)(3)
institution.
(6)
(A) Except as set forth in subdivision (f)(1) or in§ 68-11-205(b), a
radiologist, anesthesiologist, pathologist, or emergency physician shall
not be employed by a hospital or an affiliate of a hospital, and a hospital
or an affiliate of a hospital shall not employ any physician to provide
medical services provided by radiologists, anesthesiologists, pathologists,
or emergency physicians; provided, that a physician may be employed to
provide emergency medical services if such physician is employed to
provide other medical services.
(8) Notwithstanding subdivisions (f)(1) and (f)(6)(A), a research
hospital may employ radiologists, anesthesiologists, or pathologists under
the same terms and conditions as other physicians.
(C) Hospitals that employ anesthesiologists shall, to the extent
applicable, ensure that an anesthesiologist is able to comply with
medicare conditions for payment for medically directed or personally
performed anesthesia services. This section does not prohibit a hospital
from using other medicare conditions of payment, including medical
supervision.
(7) As used in this section, unless the context otherwise requires:
(A) "Affiliate" of a hospital:
(i) Means an entity that directly or indirectly is controlled
by, or is under common control with, a hospital licensed under title
68, chapter 11 or title 33, chapter 2; and
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(ii) Does not include a health maintenance organization
licensed under the Health Maintenance Organization Act of 1986
compiled in title 56, chapter 32;
(8) "Anesthesiologist" means a physician who has completed a
residency in anesthesiology and whose practice is primarily limited to
anesthesiology, including nerve block, pain management, cardiac and
respiratory resuscitation, respiratory therapy, management of fluids,
electrolyte and metabolic disturbances, or a dentist licensed in this state
who completed a residency program in anesthesiology at an accredited
medical school in years 1963 through 1977;
(C) "Board certified" or "board eligible" means a physician who is
board certified in the applicable medical specialty by the American Board
of Medical Specialists or a comparable board or a physician who has
completed an approved residency but has not yet completed the exam
given by one (1) of the recognized boards;
(D) "Children's hospital" means a free-standing hospital that
serves primarily children seventeen (17) years of age or younger with a
separate emergency department staffed and equipped to provide
emergency services to pediatric patients;
(E) "Emergency physician":
(i) Means a physician who has either completed a
residency in emergency medicine, or practiced emergency
medicine full time for a three-year period, and whose practice is
limited to emergency medicine; and
(ii) Does not include a physician who has been previously
employed to provide nonemergent medical services who, over a
period of twelve (12) months or more, becomes a full-time
emergency physician and who remains employed by mutual
agreement;
(F) "Employing entity":
(i) Means a hospital licensed under title 68, chapter 11, or
title 33, chapter 2, or an affiliate of such an entity, that employs
one (1) or more physicians; and
(ii) Does not include a health maintenance organization
licensed under the Health Maintenance Organization Act of 1986
compiled in title 56, chapter 32;
(G) "Pathologist" means a physician who has completed a
residency in pathology and whose practice is primarily limited to
pathology, including, without limitation, anatomic and clinical pathology;
(H) "Physician" means a person licensed pursuant to chapter 6 or
9 of this title;
(I) "Psychiatrist" means a physician who has completed a
residency in psychiatry and whose practice is primarily limited to
psychiatry;
(J) "Radiologist" means a physician who has completed a
residency in radiology and whose practice is primarily limited to radiology,
including diagnostic radiology, radiation therapy, and radiation oncology;
and
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(K) "Research hospital" means a hospital at which fifty percent
(50%) or more of the inpatients treated during the previous calendar year
were treated pursuant to research protocols.
SECTION 2. Tennessee Code Annotated, Section 63-9-104(f)(3), is amended by
deleting the subdivision and substituting:
(3) For the purposes of this section, the term "employing" does not allow the
employing of osteopathic physicians with the same specialties as those physicians
exempted in § 63-6-204(e)(2)(B) except as permitted by§ 63-6-204(f)(4).
SECTION 3. Tennessee Code Annotated, Title 63, is amended by adding the following
as a new chapter:
63-21-101. Chapter definitions.
As used in this chapter:
(1) "Anesthesiologist" means a physician who is licensed pursuant to
chapter 6 or 9 of this title and who has completed a residency in anesthesiology
approved by the American Board of Anesthesiology or the American Osteopathic
Board of Anesthesiology, or equivalent training in anesthesiology;
(2) "Anesthesiologist assistant" means a person who meets the
requirements of§ 63-21-103 and is board-approved to assist in the practice of
medicine under delegation of an anesthesiologist;
(3) "Assists" means, in regard to an anesthesiologist assistant, that the
anesthesiologist assistant personally performs those duties and responsibilities
delegated by the anesthesiologist;
(4) "Board" means the board of medical examiners established by chapter
6, part 1 of this title;
(5) "Certification examination" means the initial certifying examination
approved by the board for the certification of anesthesiologist assistants,
including the examination administered by the National Commission for the
Certification of Anesthesiologist Assistants or another national anesthesiologist
assistant certifying agency that has been reviewed and approved by the board;
and
(6) "Supervision" means the availability of an anesthesiologist who can
delegate, coordinate, direct, consult, or oversee the implementation of the
anesthesiologist's intentions.
63-21-102. Boards - Powers and duties.
(a) The board shall review and determine the qualifications and fitness of all
persons applying for a license to practice as an anesthesiologist assistant.
(b) The board shall:
(1) Grant, deny, renew, revoke, and reinstate licenses;
(2) Set and collect fees for licensure under this chapter;
(3) Establish continuing education requirements for anesthesiologist
assistants;
(4) Investigate allegations that an anesthesiologist assistant or the
supervising anesthesiologist has engaged in conduct constituting a ground for
revocation;
(5) Conduct informal interviews and hearings;
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(6) Take disciplinary or other administrative action, which must comply
with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, to
enforce this chapter;
(7) Adopt rules governing the licensure and practice of anesthesiologist
assistants, and such other rules as are necessary to implement and enforce this
chapter; and
(8) Retain jurisdiction over only those licensees to whom temporary or full
licenses are granted pursuant to this chapter, regardless of whether the license
has expired or lapsed, been retired, or was relinquished during or after any
alleged occurrence of conduct.
63-21-103. Licensure - Unauthorized practice - Use of title - Duplicate license -
Temporary licensure - Fees.
(a) A person shall not practice in this state as an anesthesiologist assistant or
use the title or represent that the person is a certified anesthesiologist assistant,
anesthesiologist assistant, or use the abbreviations "C.A.A." or "A.A." without having a
license granted by the board pursuant to this chapter. A violation of this subsection (a) is
a Class 8 misdemeanor, punishable by a fine of not more than one thousand dollars
($1,000) or by a term of imprisonment for not more than one (1) year, or both. Each
violation of this subsection (a) constitutes a separate offense.
(b) The board may grant an anesthesiologist assistant license to an applicant
who:
(1) Graduated from an anesthesiologist assistant program accredited by
the Commission on Accreditation of Allied Health Education Programs or its
predecessor or successor organization;
(2) Satisfactorily completed a certification examination administered by
the National Commission for the Certification of Anesthesiologist Assistants or
another national certifying agency that has been reviewed and approved by the
board;
(3) Completes an application form; and
(4) Pays the required application and licensure fees as prescribed by the
board in rule.
(c) The board shall issue a license, other than a temporary license, pursuant to §
63-1-107.
(d) The board may reinstate a lapsed license if the applicant pays a
reinstatement fee as prescribed by the board in rule and meets the requirements for
initial licensure.
(e) The board may issue a temporary license to a person who:
(1) Completes a temporary license application;
(2) Pays the required temporary license fee as prescribed by the board in
rule; and
(3) Successfully completes a Commission on Accreditation of Allied
Health Education program or another board-approved program for educating and
training anesthesiologist assistants but who has not passed a certification
examination. The person shall take the next available certification examination
after receiving a temporary license. A temporary license must not be issued for a
period of more than one (1) year and is subject to other requirements the board
adopts by rule.
(f)
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(1) An anesthesiologist assistant must have a supervising agreement with
a supervising anesthesiologist.
(2) The anesthesiologist assistant shall maintain a copy of the supervising
agreement either on paper or electronically at the anesthesiologist assistant's
practice locations and make the supervising agreement available upon request
by the board or an authorized agent of such board.
63-21-104. Scope of practice.
(a) This section does not apply to a person who is enrolled in an anesthesiologist
assistant education program approved by the board.
(b) An anesthesiologist assistant may assist in the practice of medicine only
under the supervision of an anesthesiologist. The anesthesiologist assistant may
perform only those duties and responsibilities delegated to the anesthesiologist assistant
by the supervising anesthesiologist.
(c) The supervising anesthesiologist shall supervise an anesthesiologist assistant
in a manner consistent with federal rules or regulations for reimbursement for anesthesia
services.
(d) The supervIsIng anesthesiologist must be immediately available to the
anesthesiologist assistant who assists in the delivery of medical care such that the
supervising anesthesiologist is able to intervene if needed.
(e) An anesthesiologist assistant's practice must not exceed the assistant's
education and training, and the scope of practice of the supervising anesthesiologist. A
medical care task assigned by the supervising anesthesiologist to the anesthesiologist
assistant must not be delegated by the anesthesiologist assistant to another person.
(f)
(1) A supervising anesthesiologist shall not employ a person to practice
as an anesthesiologist assistant who is not licensed pursuant to this chapter.
(2) A violation of subdivision (f)(1) is a Class B misdemeanor, punishable
by a fine of not more than one thousand dollars ($1,000) or by a term of
imprisonment for not more than one (1) year, or both.
(3) Each violation of subdivision (f)(1) constitutes a separate offense.
(g) The board shall establish such other qualifications and the scope of practice
as the board deems appropriate for an anesthesiologist assistant. The board is
authorized to adopt rules to effectuate this section. The rules must be promulgated in
accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter
5.
63-21-105. Board disciplinary actions.
(a) The board may refuse to renew and may revoke, suspend, or restrict a
license or take other disciplinary action, including imposing conditions or restrictions on a
license pursuant to this chapter and the rules adopted pursuant to this chapter.
(b) If the board determines that a person is ineligible for licensure, that
application for licensure should be denied or suspended, or another action should be
taken on a current license, then the board shall adopt and enter its written order and
findings. If the board proposes to issue discipline on a current license, then a contested
case hearing must be conducted pursuant to title 4, chapter 5, part 3.
63-21-106. Issuance of new license following revocation - Requirements.
(a) The board may issue a new license to an anesthesiologist assistant whose
license was previously revoked by the board if the applicant applies in writing to the
board and demonstrates to the board's satisfaction that the applicant is completely
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rehabilitated with respect to the conduct that was the basis for the revocation. In making
its decision, the board must determine:
(1) That the applicant has not engaged in conduct during the revocation
period that would constitute a basis for revocation pursuant to rules adopted by
the board;
(2) If a criminal conviction was a basis of the revocation, that the
applicant's civil rights have been fully restored pursuant to statute or another
applicable recognized judicial, gubernatorial, or presidential order;
(3) That the applicant has made restitution to an aggrieved person as
ordered by a court of competent jurisdiction; and
(4) That the applicant demonstrates another standard of rehabilitation the
board determines is appropriate.
(b) Except as provided in subsection (c), a person whose license was revoked
shall not apply for a new license earlier than two (2) years after the date of revocation.
(c) If a license revocation was based on a conviction of a felony or an offense
involving moral turpitude and that conviction has been reversed on appeal, then the
board shall vacate its previous order to revoke the license, and the anesthesiologist
assistant may apply for a new license after the court enters the reversal.
(d) An applicant for a new license after revocation shall comply with all initial
licensure requirements prescribed by this chapter and rules adopted by the board
pursuant to this chapter.
63-21-107. Authority to promulgate rules.
The department of health and the board of medical examiners are authorized to
promulgate rules to effectuate this chapter. The rules must be promulgated in
accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter
5.
SECTION 4. Tennessee Code Annotated, Section 68-11-205, is amended by deleting
subdivisions (b)(1 ), (b)(6), and (b)(9) and substituting:
(b)
( 1)
(A) Notwithstanding this section, a hospital licensed under this
chapter or title 33, chapter 2, or an affiliate of a hospital, may employ
licensed physicians to provide medical services in:
(i) A hospital located in a county with a population of one
hundred five thousand (105,000) or less, according to the 2020
federal census;
(ii) A hospital located in a county with a population of more
than one hundred five thousand (105,000), according to the 2020
federal census, if such licensed physicians are not radiologists,
anesthesiologists, pathologists, or emergency physicians; or
(iii) A hospital if such hospital is a children's hospital;
provided, that any radiologists, anesthesiologists, pathologists, or
emergency physicians employed by such children's hospital are
board certified or board eligible, as defined in § 63-6-204(f)(7).
(8) A hospital, as described in subdivision (b)(1 )(A), may employ
licensed physicians to provide medical services subject to the following
conditions:
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(i) An employing entity shall not restrict or interfere with
medically appropriate diagnostic or treatment decisions;
(ii) An employing entity shall not restrict or interfere with
physician referral decisions unless:
(a) The physician so employed has agreed in
writing to the specific restrictions at the time that the
contract is executed;
(b) The restriction does not, in the reasonable
medical judgment of the physician, adversely affect the
health or welfare of the patient; and
(c) The employing entity discloses any such
restrictions to the patient; and
(iii) In the event that there is any dispute relating to
subdivision (b)(1 )(B)(i) or (ii), the employing entity has the burden
of proof.
(C) For purposes of this subdivision (b), "children's hospital"
means a free-standing hospital that serves primarily children seventeen
(17) years of age or younger with a separate emergency department
staffed and equipped to provide emergency services to pediatric patients.
(6) Except as set forth in subdivision (b)(1) or in § 63-6-204(f), a
radiologist, anesthesiologist, pathologist, or emergency physician shall not be
employed by a hospital or an affiliate of a hospital, and a hospital or an affiliate of
a hospital shall not employ any physician to provide medical services provided by
radiologists, anesthesiologists, pathologists, or emergency physicians; provided,
that a physician may be employed to provide emergency medical services if such
physician is employed to provide other medical services.
(9)
(A) Hospitals that employ anesthesiologists shall, to the extent
applicable, ensure that an anesthesiologist is able to comply with
medicare conditions for payment for medically directed or personally
performed anesthesia services. This section does not prohibit a hospital
from using other medicare conditions of payment, including medical
supervision.
(B) Notwithstanding subdivision (b)(6), a radiologist,
anesthesiologist, or pathologist may be employed by a research hospital.
The radiologist, anesthesiologist, or pathologist must be employed by the
research hospital under the same terms and conditions as other
physicians.
SECTION 5. The headings in this act are for reference purposes only and do not
constitute a part of the law enacted by this act. However, the Tennessee Code Commission is
requested to include the headings in any compilation or publication containing this act.
SECTION 6. For purposes of promulgating rules, this act takes effect upon becoming a
law, the public welfare requiring it. Section 3 takes effect January 1, 2026, the public welfare
requiring it. All remaining sections take effect July 1, 2025, the public welfare requiring it.
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HOUSE BILL NO. 979
PASSED: April 22, 2025
• .l'L-r
CAMERON SEXTON, SPEAKER
HOUSE OF REPRESENTATIVES
RANDY MCN~LLl
PEAKER OF THE SENAT
Ji ~ f APPROVED this ':>-\- day of1 2025
/~VJ-
BILL LEE, GOVERNOREvery fact on this page links to its source, starting with the official bill record.