Amendments	Fiscal Memos
HA0850	Amendment 1-0 to HB2060

	Amendments	Fiscal Memos
SA0702	Amendment 1-1 to SB2019

NOTE: Each fiscal memorandum applies only to the amendment(s) identified in the memorandum. The fiscal memorandum must be matched to any amendments that have been adopted.

Fiscal Summary

NOT SIGNIFICANT

Bill Summary

Present law generally establishes that a licensed physician is the only healthcare provider authorized to prescribe any buprenorphine product for any FDA-approved use in recovery or medication-assisted treatment. However, a healthcare provider who is not a licensed physician, and who is otherwise permitted to prescribe Schedule II or III drugs under state law, may prescribe such medication for such purpose if the person meets a number of qualifications.

EMPLOYMENT AT CERTAIN FACILITIES

Present law provides that one such qualification is that the healthcare provider must be employed at a facility at which healthcare providers are contracted and credentialed with TennCare and TennCare's managed care organizations to treat opioid use disorder with buprenorphine products for use in recovery or medication-assisted treatment. This bill adds that the healthcare provider must be employed at a facility that is a contracted, buprenorphine enhanced medication-assisted recovery and treatment (BESMART) program, or a successor program, provider.

PREGNANT WOMEN OR PATIENTS WITH HISTORY OF ADVERSE REACTIONS

Present law provides that another such qualification is that the healthcare provider must not prescribe or dispense a mono product or buprenorphine without naloxone. This bill authorizes the healthcare provider to prescribe or dispense a mono product or buprenorphine without naloxone to a pregnant woman or patient with a documented history of an adverse reaction or hypersensitivity to naloxone.

LIMIT ON SUPERVISION OR COLLABORATION

Present law provides that another such qualification is that the healthcare provider must be supervised by or collaborate with a physician who is limited to the supervision of, or collaboration for, a maximum of four qualified licensed nurse practitioners or physician assistants. This bill limits the physician to the supervision of or collaboration with a maximum of 10 licensed nurse practitioners or physician assistants.

LIMIT ON PRESCRIPTIONS

Present law provides that another such qualification is that the healthcare provider is limited to writing prescriptions of buprenorphine products to 50 or fewer patients at any given time. This bill increases the number of patients to 100 or fewer at any given time.

SUPERVISION

Present law provides that another such qualification is that the healthcare provider works under the supervision of a physician who holds an active federal Drug Addiction Treatment Act of 2000 (DATA 2000) waiver registration from the federal drug enforcement agency that authorizes the physician to prescribe buprenorphine products and is actively treating patients with buprenorphine products for recovery or medication-assisted treatment. This bill removes this qualification.

WAIVER REGISTRATION

Present law provides that another such qualification is that the healthcare provider must obtain a waiver registration pursuant to the federal Drug Addiction Treatment Act of 2000 (DATA 2000) from the federal drug enforcement agency that authorizes the provider to prescribe buprenorphine products under federal law. This bill removes this qualification.

NONRESIDENTIAL OFFICE-BASED OPIATE TREATMENT FACILITIES

Under present law, a "nonresidential office-based opiate treatment facility" includes stand-alone clinics, treatment resources, individual physical locations occupied as the professional practice of a licensed prescriber or prescribers, or other entities prescribing products containing buprenorphine, or products containing any other controlled substance designed to treat opiate addiction by preventing symptoms of withdrawal to 25 percent or more of its patients or to 150 or more patients.

For purposes of this bill, "nonresidential office-based opiate treatment facility" does not include (i) a facility that meets the definition of a nonresidential substitution-based treatment center for opiate addiction, (ii) a community mental health center, or (iii) a federally qualified health center.

ON MARCH 25, 2024, THE SENATE ADOPTED AMENDMENT #1 AND PASSED SENATE BILL 2019, AS AMENDED.

AMENDMENT #1 clarifies that a healthcare provider who is not licensed under state law relative to medicine and surgery, or to osteopathic physicians, and who is otherwise permitted to prescribe Schedule II or III drugs under state law, is prohibited from prescribing any buprenorphine product for the treatment of opioid use disorder unless the provider is supervised by or collaborates with a physician who is limited to the supervision of, or collaboration for, a maximum of five, rather than four, licensed nurse practitioners or physician assistants.