Tennessee Code Title 68. Health, Safety and Environmental Protection § 68-11-202

(a)(1) The department is empowered to license and regulate hospitals, recuperation centers, nursing homes, homes for the aged, residential HIV supportive living facilities, assisted-care living facilities, home care organizations, residential hospices, birthing centers, prescribed child care centers, renal dialysis clinics, ambulatory surgical treatment centers, outpatient diagnostic centers, adult care homes and traumatic brain injury residential homes.

(2) Licensing and regulation shall be accomplished through a board to be created in the manner provided in this part, and such other employees as are provided for in this part.

(b)(1)(A) The department has the authority to conduct reviews of all facilities licensed under this part, in order to determine compliance with fire and life safety code regulations as promulgated by the board.

(B) Chapter 102 of this title does not apply to facilities subject to review and licensure under this part.

(C) The board has the power to adopt fire and life safety code regulations to be applied to such facilities.

(D) In adopting the regulations, the board may in its discretion adopt, in whole or in part, by reference, recognized national or regional building and fire safety codes.

(E) Adult care homes and traumatic brain injury residential homes shall meet all state and local building, sanitation, utility and fire code requirements applicable to single family dwellings.  The board for licensing health care facilities may adopt in rules more stringent standards as it deems necessary in order to ensure the health and safety, including adequate evacuation of residents consistent with this part.  As used in this section “adequate evacuation” means the ability of the adult care home provider, traumatic brain injury residential home provider, resident manager, or substitute caregiver, including such additional minimum staff as may be required by the board in regulation in accordance with this part, to evacuate all residents from the dwelling within five (5) minutes.  Adult care home providers and traumatic brain injury residential home providers must install smoke detectors in all resident bedrooms, hallways or access areas that adjoin bedrooms, and common areas where residents congregate, including living or family rooms and kitchens.  In addition, in multi-level homes, smoke alarms must be installed at the top of stairways.  At least one (1) fire extinguisher with a minimum classification as specified by the board for licensing health care facilities must be in a visible and readily accessible location in each room, including basements, and be checked at least once a year by a qualified entity.  Adult care home providers and traumatic brain injury residential home providers shall not place residents who are unable to walk without assistance or who are incapable of independent evacuation in a basement, split-level, second story or other area that does not have an exit at ground level.  There must be a second safe means of exit from all sleeping rooms.  Providers whose sleeping rooms are above the first floor shall be required to demonstrate an evacuation drill from that room, using the secondary exit, at the time of licensure, renewal, or inspection.

(2) The board, in its evaluation of prospective rules and regulations, shall consider recommendations and professional assessments from the Tennessee society of architects and the Tennessee society of professional engineers.

(3) Should regulations adopted by the board not be consistent with federal regulations for facilities participating in Titles XVIII, compiled in 42 U.S.C. § 1395 et seq., and XIX, compiled in 42 U.S.C. § 1396 et seq., of the Social Security Act, the department shall request appropriate waivers from the federal government for facilities previously deemed in compliance.

(4) Until the board adopts building and fire safety regulations pursuant to this section, the codes and regulations in effect on July 1, 1981, shall be applicable to those facilities licensed under this part.  Any facility that complies with the required applicable building and fire safety regulations at the time the board adopts new codes or regulations shall, so long as such compliance is maintained, either with or without waivers of specific provisions, be considered to be in compliance with the requirements of the new codes or regulations.

(5)(A) The commissioner of commerce and insurance or commissioner of health shall review subsequently adopted codes and may recommend to the board for adoption provisions of such codes that the commissioner deems material to the life and fire safety of residents and patients.

(B) Subdivision (b)(5)(A) applies to all appropriate facilities in the respective provider categories, such as nursing homes, hospitals, homes for the aged, residential HIV supportive living facilities, adult care homes, traumatic brain injury residential homes, etc.

(6) This section shall not affect the authority of the state fire marshal regarding the prevention and investigation of fires pursuant to chapter 102 of this title.

(7) The building and life safety regulations adopted by the board shall be the exclusive regulations applicable for those purposes.  To the extent that regulations adopted by local governments conflict with the regulations adopted by the board, the board's regulations shall control.

(c)(1) When construction is planned by any facility required to be licensed by the department, except home care organizations as defined in § 68-11-201 , for any building, additions to an existing building or substantial alterations to an existing building, two (2) sets of plans and specifications shall be submitted to the department to be approved.  However, only one (1) set of schematics shall be submitted to the department for approval of plans and specifications converting an existing single family dwelling into:

(A) A licensed residential health care facility with six (6) or fewer beds;

(B) A licensed adult care home with five (5) or fewer residents;  and

(C) Traumatic brain injury residential homes with eight (8) or fewer residents.

(2) Before construction is started, approval of the plans and specifications must be obtained from the department with respect to compliance with the minimum standards or regulations, or both, of the board.

(3) The board may determine by regulation specific types of site activity that may be initiated prior to approval.

(4) The plans shall be accurate and shall be detailed plans, containing the information and drafted and submitted in a manner that the board may require by regulation.

(5) The department shall expeditiously process its review of plans that have been submitted in the full and final form required by regulation.

(6) At the request of the owner of the proposed project or the design professional, the department shall make plan review staff available for advice and consultation regarding programmatic concepts and preliminary plans early in the planning process.

(7) The department shall assign adequate numbers of qualified staff to the plan review section, to ensure that a thirty-day review cycle is provided on any submittal.

(8) If, upon final inspection or reinspection of the completed project, the department's representative finds that only minor items remain to be completed or corrected that do not significantly affect the health or safety of the occupants, the department's representative shall permit occupancy pending completion or correction of such items.

(d) Any standards adopted by the board regarding accessibility by the handicapped shall be no less strict than those in chapter 120 of this title.

(e) This subsection (e) shall establish the criteria for the creation of branch offices by a home care organization operating pursuant to its certificate of need authority or pursuant to its license as of May 11, 1998.  Nothing in this subsection (e) shall permit a home care organization to expand its authority beyond the limitations of its certificate of need or its license as of May 11, 1998.  Notwithstanding this section to the contrary, the offices of a home care organization providing home health care services shall be classified as either a parent office of the home care organization or as a branch office of the home care organization.  In determining whether the office of a home care organization providing home health care services is either a parent home care organization or a branch office, the board shall apply the following criteria:

(1) A parent office shall develop and maintain administrative controls of the branch office and house the administrative functions of the home care organization.  The parent office shall be ultimately responsible for human resource activities and all financial and contractual agreements for the home care organization, including both parent and branch offices;

(2) The administrator and director of nursing for the home care organization shall be primarily located in the parent office.  The home care organization administrator and director of nursing shall make on-site supervisory visits to each branch office at least quarterly;

(3) A branch office is an office that provides services within the geographical area for which the home care organization is licensed.  A branch office must be sufficiently close to share administrative services with the parent office.  A branch office shall be deemed to be sufficiently close if it is within one hundred (100) miles of the parent office;  provided, that the remaining criteria set forth in this subsection (e) are also applicable.  A branch office that is greater than one hundred (100) miles from a parent office may be considered a branch office by the board, if it otherwise meets the criteria set forth in this subsection (e);

(4) The parent office of a home care organization shall have a clearly defined process to ensure that effective interchange occurs between the parent and branch regarding various functions, including branch staffing requirements, branch office patient census, total visits provided by the branch, complaints, incident reports and referrals;

(5) The branch office of a home care organization shall maintain the same name and standards of practice as the parent office of the home care organization, including forms, policies, procedures and service delivery standards.  The parent office of a home care organization shall maintain documentation of integration between the parent office and its branch offices;

(6) The parent office of a home care organization shall maintain regular administrative contact with its branch offices at least weekly.  Documentation of this contact shall be maintained by the parent office.  The parent office shall receive weekly written staffing reports from its branch offices, including, but not limited to, information regarding staffing needs, staffing patterns and staff productivity;  and

(7) A branch office of a home care organization existing as of May 11, 1998, that is more than one hundred (100) miles from the parent office of such home care organization and that has been previously approved as a branch office by the board, may continue to be classified as a branch office, if it otherwise meets the criteria set forth in this subsection (e).

(f)(1) In a gastrointestinal endoscopy clinic that is regulated as an ambulatory surgical treatment center which performs endoscopic procedures, the use of an endoscopy technician, without other technicians, to assist a physician performing an endoscopic procedure in the clinic shall be deemed to be sufficient staffing for the procedure.

(2) For the purposes of this subsection (f), an endoscopy technician is a person who is trained to function in an assistive role in a gastroenterology setting.  An endoscopy technician's scope of practice includes:

(A) Assisting in data collection to identify the patient's needs, problems, concerns or human responses;

(B) Assisting, under the direction of the gastroenterology registered nurse and physician, in the implementation of the established plan of care;

(C) Assisting the gastroenterology registered nurse and physician before, during, and after diagnostic and therapeutic procedures;

(D) Providing and maintaining a safe environment for the patient and staff by complying with regulatory agency requirements and standards set forth by professional organizations and employers;

(E) Taking responsibility for personal continuing education;

(F) Having knowledge of practice issues related to the field of gastroenterology;

(G) Compliance with ethical, professional and legal standards inherent in patient care and professional conduct;

(H) Participating in quality management activities as directed;  and

(I) Collaborating within the gastroenterology team and with other healthcare professionals to ensure quality and continuity of care.

(g)(1) An ambulatory surgical treatment center shall provide radiological staff services commensurate with the needs of the center within the facility or by means of other appropriate arrangement.

(2) If radiologic services are utilized by an ambulatory surgical treatment center, the governing body of the center shall appoint an individual who shall be responsible for assuring that all radiologic services are provided in accordance with applicable law and rules.  The individual shall be qualified in accordance with state law and the policies of the center.

(h) Notwithstanding any law to the contrary, the board shall have the authority to amend its rules for licensure of any board-regulated facility or entity as needed to be consistent with the federal home-based and community-based settings final rule, published in the Federal Register at 79 FR 2947 (January 16, 2014) , including the authority to differentiate licensure requirements for any board-regulated facility or entity contracted to provide medicaid-reimbursed home- and community-based services pursuant to title 71, chapter 5, part 14, in order to allow the facility or entity to comply with the federal rule and continue to receive medicaid reimbursement for home- and community-based services.  Rules adopted by the board under this subsection (h) shall be developed with input from stakeholders and promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5;  provided, however, that the board shall not promulgate emergency rules under this subsection (h) as defined in § 4-5-208 .  Licensure survey and enforcement shall be conducted in a manner consistent with any rule issued under this subsection (h).

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