Tennessee health rules set data access and provider oversight requirements

The health commissioner sets conditions for public access to processed, verified health data and rules for releasing limited data sets. The data include information requested for certificate-of-need applicants. Limited data sets must follow HIPAA, the federal health privacy law. The commissioner provides data for certificate-of-need applicants to the health facilities commission within seven days after its request.

The health facilities commission may decide whether a licensed hospital qualifies as a critical access hospital under the federal rural hospital program. The process applies to a licensed hospital seeking critical access hospital designation. The proposing entity must publish notice at least twice within 15 days in a newspaper serving the hospital's county and neighboring counties. A hospital in the same or a neighboring county may object in writing. The commission reviews the executive director's eligibility decision. A neighboring hospital must object within 30 days after the last notice. The executive director reports the eligibility decision at the next regular commission meeting.

The commission may charge applicants or licensees for actual, reasonable site-visit costs and may charge sanctioned licensees for actual, reasonable investigation and prosecution costs. Site-visit costs may be charged to an applicant or licensee. Disciplinary costs may be charged to a licensee sanctioned after a proceeding. Site-visit charges apply when the commission conducts a visit for an initial license or renewal. Disciplinary costs may be charged only after sanctions following a disciplinary proceeding. The order must state the maximum amount owed, and the final assessment cannot exceed it. The commission sends a final site-visit cost assessment within 60 days after the visit and a disciplinary cost assessment within 60 days after the order takes effect.

The executive director may exempt some facility moves from certificate-of-need rules, and certain diagnostic providers must obtain accreditation. The move rules cover existing or certified health care facilities and institutions. Accreditation rules cover outpatient diagnostic centers and PET providers established without a certificate of need. A move exemption requires that at least 95% of expected patients come from the same ZIP codes as current patients, that access for listed underserved groups not decline, and that the payer mix not shift toward more commercial insurance. An exemption cannot cover an approved but unimplemented certificate of need unless the new site is within one mile of the approved site. A home health agency or hospice may move its main office within its licensed service area without a certificate of need. A diagnostic center that misses its accreditation requirement, or a covered PET provider that fails to obtain accreditation, is subject to licensing sanctions. Diagnostic centers must become accredited within two years after receiving a certificate of need. PET providers established without one must submit proof within two years after licensure.

Health licensing boards and the health facilities commission may use screening panels to review complaints and investigations. The panels may be used in the commission's and covered boards', committees', and councils' complaint and discipline processes. A board cannot force a party to take part, and a party faces no penalty for declining or rejecting a panel's offer. Panel activities and mediation or arbitration sessions remain confidential; related records are exempt from public disclosure until charges are filed. A panel may administer oaths, and a board member who served on it cannot take part in a later contested case about the matter.