Tennessee State Telehealth Laws and Reimbursement Policies

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Information Provided ByCenter for Connected Health Policy

© Public Health Institute/ Center for
Connected Health Policy 2019: http://cchpca.org

TennCare

Tennessee

Medicaid Program: TennCare
Note: TennCare is operated entirely as a managed care program.

Medicaid Program Administrator: Dept. of Human Services

Regional Telehealth Resource Center:

South Central Telehealth Resource Center
4301 W. Markham St. #519
Little Rock, AR 72205
(855) 664-3450

learntelehealth.org

STATE LAW/REGULATIONS MEDICAID PROGRAM

Definition of telemedicine/telehealth

Telehealth means the use of real-time interactive audio, “Telehealth is the use of electronic information and
video or other telecommunications or electronic telecommunication technologies to support clinical care
technology, or store and forward telemedicine services a between an individual with mental illness and/or
healthcare provider to deliver healthcare services to a substance abuse issues and a healthcare practitioner.”
patient within the scope of practice of the healthcare
services provider when such provider is at a qualified “Telehealth systems provide a live, interactive audio-
site other than the site where the patient is located; and video communication or videoconferencing connection
the patient is at a qualified site or at a school clinic between the individual in need of services and the crisis
staffed by a healthcare services provider and equipped service delivery system.”
to engage in the telecommunications described in this
section and does not include audio only conversation; Source: TN Dept. of Mental Health and Substance Abuse Services
an electronic mail message or facsimile transmission. p. 4, (July 2012) (Accessed Oct. 2017).
Source: TN Code Annotated, Title 56, Ch. 7, Part 10.
Telemedicine is the practice of medicine using electronic
communication, information technology or other means,
between a licensee in one location and a patient in
another location. Telemedicine is not an audio only
telephone conversation, email/instant messaging
conversation or fax. It typically involves the application
or secure video conferencing or store-and-forward to
provide or support healthcare delivery by replicating the
interaction of a traditional encounter between a provider
and a patient.
Source: TN Rule Annotated, Rule 0880-02.-16.

Live Video Reimbursement

Health insurance entities (including managed care TennCare will reimburse for live video for crisis-related
organizations) participating in the medical assistance services.
program are required to provide coverage for telehealth
(which includes live video) delivered services in a Source: TN Dept. of Mental Health and Substance Abuse
manner that is consistent with the health insurance Services, p. 4, (July 2012) (Accessed Oct. 2017).
policy or contract provided for in-person services. TennCare services are offered through managed care

Source: TN Code Annotated, Title 56, Ch. 7, Part 10. entities. Each MCO has their own unique telehealth
policy.

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STATE LAW/REGULATIONS MEDICAID PROGRAM

(also see Private Payer section)

Store and Forward Reimbursement

Health insurance entities required to cover telehealth services, which by definition includes store-and-forward.

Source: TN Code Annotated, Title 56, Ch. 7, Part 10.

TennCare will not reimburse for store and forward based upon definition of “telehealth systems” which describes it as “live interactive video”.

Source: TN Dept. of Mental Health and Substance Abuse Services, p. 4, (July 2012) (Accessed Oct. 2017).

Remote Patient Monitoring Reimbursement

No reference found. No reference found.

Email/Phone/FAX

Telemedicine is not an audio only telephone No reference found.
conversation, email/instant messaging conversation or
fax.
Source: TN Rule Annotated, Rule 0880-02.-16.
http://share.tn.gov/sos/rules_filings/08-03-16.pdf.

Online Prescribing

Prior to online or telephone prescribing, providers must No reference found.
document and:
Perform an appropriate history and physical
examination;
Make a diagnosis, consistent with good medical
care;
Formulate a therapeutic plan and discuss it with
the patient;
Ensure the availability for appropriate follow-up
care.
Source: TN Composite Rules & Regulations 0880-02-.14.
A physician-patient relationship can be established via
telemedicine with or without a facilitator present. Certain
conditions apply in each case. See rule for details.
Source: TN Rule Annotated, Rule 0880-02.-16.
If otherwise authorized by law, a physician may
prescribe by means of telemedicine, however with
respect to controlled substances, the physician must
comply with requirements and guidelines set out in state
and federal law.
Source: TN Bill SB 1223/HB 699 (2015).

Consent

No reference found. The patient must be informed and given an opportunity
to request an in-person assessment before receiving a
telehealth assessment.

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STATE LAW/REGULATIONS MEDICAID PROGRAM

This consent must be documented in the patient’s
record.
Source: TN Dept. of Mental Health and Substance Abuse
Services, p. 8, (July 2012) (Accessed Oct. 2017).

Location

Private payers are only required to reimburse for No reference found.
telehealth when the patient is located at a qualified site
or a school clinic. Insurers may decide to reimburse for
additional sites but are not required to.
Source: TN Code Annotated, Title 56, Ch. 7, Part 1002.

Cross-State Licensing

Tennessee enacted the Interstate Medical Licensure No reference found.
Compact.
Source: TN Code 63-6-1300 (HB 664 – 2017).
Tennessee may issue telemedicine licenses to board-
certified physicians from out of state (although not
required to do so).
Source: TN Code Annotated Sec. 63-6-209(b).
The Tennessee Medical Board eliminated the
telemedicine license. Individuals granted a telemedicine
license under the former version of the rule may apply to
have the license converted to a full license. Under
certain circumstances individuals who do not convert to
a full license can retain their telemedicine license.
Source: TN Rule Annotated, Rule 0880-02.-16.
The TN Osteopathic Board will still issue a telemedicine
license.
Source: TN Rule Annotated, Rule 1050.02.17.

Private Payers

Health insurance entities (including managed care No reference found.
organizations) participating in the medical assistance
program are required to provide coverage for telehealth
delivered services in a manner that is consistent with the
health insurance policy or contract provided for in-
person services.
Source: TN Code Annotated, Title 56, Ch. 7, Part 10.

Site/Transmission Fee

No reference found. No reference found.

Miscellaneous

Teledentistry means “the delivery of dental health care

© 2017 Public Health Institute Center for Connected Health Policy

STATE LAW/REGULATIONS MEDICAID PROGRAM

and patient consultation through the use of telehealth
systems and technologies, including live, two-way
interactions between a patient and a dentist licensed in
this state using audiovisual telecommunications
technology, or the secure transmission of electronic
health records and medical data to a dentist licensed in
this state to facilitate evaluation and treatment of the
patient outside of a real-time or in-person interaction.”
Initial and subsequent examinations by dentists may be
performed via teledentistry technology.
Source: TN Code Annotated 976. SB 1214 (2016).

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