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                                                                                 Center for Connected Health Policy

           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 by a licensed healthcare provider to deliver a  between an individual with mental illness and/or
            healthcare service to a patient within the scope of   substance abuse issues and a healthcare practitioner.”
            practice of the licensed healthcare provider at a site
            other than the site at which the patient is located;   “Telehealth systems provide a live, interactive audio-
            provided, however, telehealth does not include:    video communication or videoconferencing connection
               •   An audio-only conversation between a licensed   between the individual in need of services and the crisis
                   healthcare provider and a patient;          service delivery system.”
               •   An electronic mail message between a licensed
                   healthcare provider and a patient; or       Source: TN Dept. of Mental Health and Substance Abuse Svcs., p.
               •   A facsimile transmission between a licensed   4, (July 2012).
                   healthcare provider and a patient.

            Source: TN Code Annotated, Title 56, Ch. 7, Part 10.
            Live Video Reimbursement

            Managed care organizations participating in the medical  TennCare will reimburse for live video for crisis-related
            assistance program are required to provide coverage for  services.
            telehealth under the same reimbursement policies that
            the plan permits for in-person encounters.         Source: TN Dept. of Mental Health and Substance Abuse Svcs., p.
                                                               4, (July 2012).
            Source: TN Code Annotated, Title 56, Ch. 7, Part 10.
            (also see Private Payer section)
            Store and Forward Reimbursement

            The law defines telehealth as occurring in real-time,   TennCare will not reimburse for store and forward based
            excluding store and forward from the definition.   upon definition of “telehealth systems” which describes it
                                                               as “live interactive video”,.
            Source: TN Code Annotated, Title 56, Ch. 7, Part 10.
                                                               Source: TN Dept. of Mental Health and Substance Abuse Svcs., p.
                                                               4, (July 2012).
            Remote Patient Monitoring Reimbursement
            No reference found.                                No reference found.

            Email/Phone/FAX


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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

            No reference found.                                No reference found.
            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.
            Consent

            No reference found.                                The patient must be informed and given an opportunity
                                                               to request an in-person assessment before receiving a
                                                               telehealth assessment.

                                                               This consent must be documented in the patient’s
                                                               record.

                                                               Source: TN Dept. of Mental Health and Substance Abuse Svcs., p.
                                                               8, (July 2012).
            Location
            No reference found.                                No reference found.

            Cross-State Licensing
            Tennessee may issue telemedicine licenses to board-  No reference found.
            certified physicians from out of state.

            Source: TN Code Annotated Sec. 63-6-209(b).

            Private Payers
            Health insurance carriers are required to provide   No reference found.
            coverage for telehealth services under the same
            reimbursement policies that the plan permits for in-
            person encounters.

            Source: TN Code Annotated, Title 56, Ch. 7, Part 10.
            Site/Transmission Fee

            No reference found.                                No reference found.
            Miscellaneous








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