Tennessee

Disclaimer

PLEASE NOTE: CCHP is providing the following for informational purposes only. We are not providing legal advice or interpretation of the laws and regulations and policies. CCHP encourages you to check with the appropriate state agency for further information and direction. This information should not be construed as legal counsel. Consult with an attorney if you are seeking a legal opinion.

At A Glance
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MEDICAID REIMBURSEMENT

  • Live Video: Yes
  • Store-and-Forward: No
  • Remote Patient Monitoring: No
  • Audio Only: Yes

PRIVATE PAYER LAW

  • Law Exists: Yes
  • Payment Parity: No

PROFESSIONAL REQUIREMENTS

  • Licensure Compacts: ASLP-IC, CC, EMS, IMLC, NLC, OT, PSY, PTC
  • Consent Requirements: Yes

FQHCs

  • Originating sites explicitly allowed for Live Video: Yes
  • Distant sites explicitly allowed for Live Video: No
  • Store and forward explicitly reimbursed: No
  • Audio-only explicitly reimbursed: No
  • Allowed to collect PPS rate for telehealth: No

STATE RESOURCES

  1. Medicaid Program: TennCare
  2. Administrator: Dept. of Human Services
  3. Regional Telehealth Resource Center: South Central Telehealth Resource Center
Disclaimer

PLEASE NOTE: CCHP is providing the following for informational purposes only. We are not providing legal advice or interpretation of the laws and regulations and policies. CCHP encourages you to check with the appropriate state agency for further information and direction. This information should not be construed as legal counsel. Consult with an attorney if you are seeking a legal opinion.

COVID-19

Last updated 03/23/2023

Audio-Only Delivery

Medicaid: Reimbursement for Telehealth and Telephone Post PHE

SOURCE: Active. MCOs are in compliance with Post-PHE policy

Medicaid:  Behavioral Health Group Therapy Telehealth Services

STATUS: Unknown

Medicaid:  Behavioral Health Psychosocial Rehabilitation Telehealth Services

STATUS: Unknown

Medicaid: Behavioral Health Telehealth Services

STATUS: Unknown

Medicaid 1915(c) Waiver: Appendix K – Statewide Home and Community Based Services (or “Statewide”) waiver; Comprehensive Aggregate Cap Home and Community Based Services (or “CAC”) Waiver; Tennessee Self-Determination Waiver Program

STATUS: Active, ends no longer than 6 months following expiration of PHE. See below.

Medicaid 1915(c) Waiver: Appendix K – Statewide Home and Community Based Services (or “Statewide”) waiver; Comprehensive Aggregate Cap Home and Community Based Services (or “CAC”) Waiver; Tennessee Self-Determination Waiver Program

STATUS: Active, ends no longer than 6 months following expiration of PHE.

Last updated 03/23/2023

Cross State Licensing

Previous COVID-19 waivers expired.

Last updated 03/23/2023

Easing Consent Requirements

Previous COVID-19 waivers expired.

Last updated 03/23/2023

Easing Prescribing Requirements

Previous COVID-19 waivers expired.

Last updated 03/23/2023

Miscellaneous

No Reference Found

Last updated 03/23/2023

Originating Site

No Reference Found

Last updated 03/23/2023

Private Payer

Previous COVID-19 waivers expired.

Last updated 03/23/2023

Provider Type

Previous COVID-19 waivers expired.

Last updated 03/23/2023

Service Expansion

Medicaid: Reimbursement for Telehealth and Telephone Post PHE

SOURCE: Active. MCOs are in compliance with Post-PHE policy

Medicaid:  Behavioral Health Group Therapy Telehealth Services

STATUS: Unknown

Medicaid:  Behavioral Health Psychosocial Rehabilitation Telehealth Services

STATUS: Unknown

Medicaid: Behavioral Health Telehealth Services

STATUS: Unknown

Private Payer

Last updated 03/23/2023

Definitions

Telehealth means the use of real-time interactive audio, video telecommunications or electronic technology, or store-and-forward telemedicine services by a healthcare services provider to deliver healthcare services to a patient within the scope of practice of the healthcare services provider when:

  • Such provider is at a qualified site other than the site where the patient is located; and
  • The patient is at a qualified site at a school clinic staffed by a healthcare services provider and equipped to engage in the telecommunications described in this section or a public elementary or secondary school staffed by a health care services provider and equipped to engage in the telecommunications described in this section; and
  • Does not include:
    • Audio only conversation;
    • An electronic mail message; or
    • Facsimile transmission;

SOURCE: TN Code Annotated, Sec. 56-7-1002, (Accessed Mar. 2023).

“Provider-based telemedicine”: Means the use of Health Insurance Portability and Accountability Act (HIPAA) (42 U.S.C. § 1320d et seq.) compliant real-time, interactive audio, video telecommunications, or electronic technology, or store-and-forward telemedicine services, used over the course of an interactive visit by a healthcare services provider to deliver healthcare services to a patient within the scope of practice of the healthcare services provider when:

  • The healthcare services provider is at a qualified site other than the site where the patient is located and has access to the relevant medical record for that patient;
  • The patient is located at a location the patient deems appropriate to receive the healthcare service that is equipped to engage in the telecommunication described in this section; and
    • The healthcare services provider makes use of HIPAA compliant real-time, interactive audio, video telecommunications or electronic technology, or store-and-forward telemedicine services to deliver healthcare services to a patient within the scope of practice of the healthcare services provider as long as the healthcare services provider, the healthcare services provider’s practice group, or the healthcare system has established a provider-patient relationship by submitting to a health insurance entity evidence of an in-person encounter between the healthcare service provider, the healthcare services provider’s practice group, or the healthcare system and the patient within sixteen (16) months prior to the interactive visit; and
    • The requirement of an in-person encounter between the healthcare services provider, the healthcare services provider’s practice group, or the healthcare system and the patient within sixteen (16) months prior to the interactive visit is tolled for the duration of a state of emergency declared by the governor pursuant to § 58-2-107; provided, that the healthcare services provider or the patient, or both, are located in the geographical area covered by the applicable state of emergency;
  • Does not include:
    • An audio-only conversation;
    • An electronic mail message or phone text message;
    • A facsimile transmission;
    • Remote patient monitoring; or
    • Healthcare services provided pursuant to a contractual relationship between a health insurance entity and an entity that facilitates the delivery of provider-based telemedicine as the substantial portion of the entity’s business.

Notwithstanding subdivisions (a)(6)(A) and (B), includes Health Insurance Portability and Accountability Act (HIPAA) (42 U.S.C. § 1320d et seq.) compliant audio-only conversation for the provision of behavioral health services or healthcare services when the means described in subdivision (a)(6)(A) are unavailable.

SOURCE: TN Code Annotated, Sec. 56-7-1003, (Accessed Mar. 2023).

Workers Compensation

“Telehealth” means the distribution of health-related services and information via electronic information and telecommunication technologies.

“Telemedicine” means the use of telehealth by a telehealth provider to provide clinical health care.

SOURCE:  TN Admin Code 0800-02-31.02, (Accessed Mar. 2023).

Last updated 03/23/2023

Parity

SERVICE PARITY

Provider-based Telemedicine

A health insurance entity:

  • Shall provide coverage under a health insurance policy or contract for covered healthcare services delivered through provider-based telemedicine;
  • Shall reimburse a healthcare services provider for a healthcare service covered under an insured patient’s health insurance policy or contract that is provided through provider-based telemedicine without any distinction or consideration of the geographic location or any federal, state, or local designation, or classification of the geographic area where the patient is located;
  • Shall not exclude from coverage a healthcare service solely because it is provided through provider-based telemedicine and is not provided through an in-person encounter between a healthcare services provider and a patient; and
  • Shall reimburse healthcare services providers who are out-of-network for provider-based telemedicine care services under the same reimbursement policies applicable to other out-of-network healthcare services providers.
A health insurance entity shall provide coverage for healthcare services provided during a provider-based telemedicine encounter in a manner that is consistent with what the health insurance policy or contract provides for in-person encounters for the same service, and shall reimburse for healthcare services provided during a provider-based telemedicine encounter without distinction or consideration of the geographic location, or any federal, state, or local designation or classification of the geographic area where the patient is located.

SOURCE: TN Code Annotated, Sec. 56-7-1003 (Accessed Mar. 2023).

Telehealth Services

A health insurance entity:

  • Shall provide coverage under a health insurance policy or contract for covered healthcare services delivered through telehealth;
  • Shall reimburse a healthcare services provider for the diagnosis, consultation, and treatment of an insured patient for a healthcare service covered under a health insurance policy or contract that is provided through telehealth without any distinction or consideration of the geographic location or any federal, state, or local designation, or classification of the geographic area where the patient is located;
  • Shall not exclude from coverage a healthcare service solely because it is provided through telehealth and is not provided through an in-person encounter between a healthcare services provider and a patient; and
  • Shall reimburse healthcare services providers who are out-of-network for telehealth care services under the same reimbursement policies applicable to other out-of-network healthcare services providers.

SOURCE: TN Code Annotated, Title 56, Ch. 7, Part 1002.  (Accessed Mar. 2023).

Remote patient monitoring

A health insurance entity may consider any remote patient monitoring service a covered medical service if the same service is covered by Medicare. The appropriate parties may negotiate the rate for these services in the manner in which is deemed appropriate by the parties.

Reimbursement of expenses for covered remote patient monitoring services must be established through negotiations conducted by the health insurance entity with the healthcare services provider, healthcare system, or practice group in the same manner as the health insurance entity establishes reimbursement of expenses for covered healthcare services that are delivered by in-person means.

SOURCE: TN Code Annotated, Sec. 56-7-1011, (Accessed Mar. 2023)

Worker’s Compensation

Except when a medical fee waiver in accordance with Rule 0800-02-17-.18 is obtained from the bureau, nothing in this Chapter 0800-02-31 shall require an employer to pay a total reimbursement for a telehealth encounter for workers’ compensation, including the use of telehealth equipment, in an amount exceeding the amount that would be paid for the same service provided by a healthcare services provider during an in-person encounter under the medical fee schedule set forth in Chapters 0800-02-17, 18, and 19. The medical fee schedule, including but not limited to Tennessee specific conversion percentages, shall apply to the providers of telehealth services rendered pursuant to the workers’ compensation law.

Billing for telehealth services shall be by standard HCFA-1500 using modifier -95 and the appropriate place of service code as specified by CMS for the date of service or their successors as used by CMS. The provider shall append modifier -95 to the CPT® code with the place of service code -02 (telehealth) or -11 (office) as specified by CMS for the date of service. All other modifiers should also be added to the CPT® code as applicable.

When a procedure is provided using telemedicine, reimbursement shall be as follows:The procedure code is reimbursed at the non-facility Medicare maximum allowable payment or the billed charge, whichever is less, regardless of the practitioner’s physical location at the time of service.

Coding and billing regulations shall follow the Medicare guidelines in effect for the date of service with no geographic qualifier.

SOURCE:  TN Admin Code 0800-02-31.05, (Accessed Mar. 2023).

PAYMENT PARITY

Provider-based Telemedicine

This section does not require a health insurance entity to pay total reimbursement for a provider-based telemedicine encounter in an amount that exceeds the amount that would be paid for the same service provided by a healthcare services provider for an in-person encounter.

This section does not require a health insurance entity to provide coverage for healthcare services that are not medically necessary, unless the terms and conditions of an applicable health insurance policy provide that coverage.

This section does not require a health insurance entity to provide coverage for healthcare services delivered by means of provider-based telemedicine if the applicable health insurance policy would not provide coverage for the same healthcare services if delivered by in-person means.

This section does not require a health insurance entity to pay total reimbursement for a provider-based telemedicine encounter in an amount that exceeds the amount that would be paid for the same service provided by a healthcare services provider for an in-person encounter.

This section does not require a health insurance entity to reimburse a healthcare services provider for healthcare services delivered by means of provider-based telemedicine if the applicable health insurance policy would not reimburse that healthcare services provider if the same healthcare services had been delivered by in-person means.

Insurers shall reimburse healthcare services providers who are out-of-network for provider-based telemedicine care services under the same reimbursement policies applicable to other out-of-network healthcare services providers.

SOURCE: TN Code Annotated, Sec. 56-7-1003 (Accessed Mar. 2023

Telehealth Services

Health Insurance entities are required to reimburse for the diagnosis, consultation, and treatment of an insured patient for a healthcare service covered under a health insurance policy or contract that is provided through telehealth without any distinction or consideration of the geographic location or any federal, state, or local designation, or classification of the geographic area where the patient is located.

The shall also reimburse healthcare services providers who are out-of-network for telehealth care services under the same reimbursement policies applicable to other out-of-network healthcare services providers.

SOURCE: TN Code Annotated, Title 56, Ch. 7, Part 1002. (Accessed Mar. 2023).

Reimbursement of expenses for covered remote patient monitoring services must be established through negotiations conducted by the health insurance entity with the healthcare services provider, healthcare system, or practice group in the same manner as the health insurance entity establishes reimbursement of expenses for covered healthcare services that are delivered by in-person means.

SOURCE: TN Code Annotated, Sec. 56-7-1011 (Accessed Mar. 2023).

Last updated 03/23/2023

Requirements

Telehealth Services

A health insurance entity:

  • Shall provide coverage under a health insurance policy or contract for covered healthcare services delivered through telehealth;
  • Shall reimburse a healthcare services provider for the diagnosis, consultation, and treatment of an insured patient for a healthcare service covered under a health insurance policy or contract that is provided through telehealth without any distinction or consideration of the geographic location or any federal, state, or local designation, or classification of the geographic area where the patient is located;
  • Shall not exclude from coverage a healthcare service solely because it is provided through telehealth and is not provided through an in-person encounter between a healthcare services provider and a patient; and
  • Shall reimburse healthcare services providers who are out-of-network for telehealth care services under the same reimbursement policies applicable to other out-of-network healthcare services providers.

A healthcare services provider must be at a qualified site other than the site where the patient is located; and the patient is at a qualified site, at a school clinic staffed by a healthcare services provider and equipped to engage in the telecommunications described in this section, or at a public elementary or secondary school staffed by a healthcare services provider and equipped to engage in the telecommunications described in this section.

A health insurance entity cannot exclude from coverage a healthcare service solely because it is provided through telehealth and is not provided through an in-person encounter between a healthcare services provider and a patient.

“Qualified site” means the office of a healthcare services provider, a hospital licensed under title 68, a facility recognized as a rural health clinic under federal Medicare regulations, a federally qualified health center, any facility licensed under title 33, or any other location deemed acceptable by the health insurance entity.

This section does not require a health insurance entity to provide coverage for healthcare services that are not medically necessary, unless the terms and conditions of an applicable health insurance policy provide that coverage.

For a healthcare service for which coverage or reimbursement is provided under the Medical Assistance Act of 1968, compiled in title 71, chapter 5, part 1, or provided under title 71, chapter 3, part 11, “medically necessary” means a healthcare service that is determined by the bureau of TennCare to satisfy the medical necessity standard set forth in 71-5-144; and

For all other healthcare services, “medically necessary” means healthcare services that a healthcare services provider, exercising prudent clinical judgment, would provide to a patient for the purpose of preventing, evaluating, diagnosing, or treating an illness, injury, or disease or the symptoms of an illness, injury, or disease, and that are:

    • In accordance with generally accepted standards of medical practice;
    • Clinically appropriate, in terms of type, frequency, extent, site and duration; and considered effective for the patient’s illness, injury or disease; and
    • Not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patient’s illness, injury, or disease excluding any costs paid pursuant to subsection (j).

Subsection (j): A health insurance entity shall reimburse an originating site hosting a patient as part of a telehealth encounter an originating site fee in accordance with the federal centers for Medicare and Medicaid services telehealth services rule 42 C.F.R. § 410.78 and at an amount established prior to August 20, 2020, by the federal centers for Medicare and Medicaid services.

SOURCE: TN Code Annotated, Sec. 56-7-1002 (Accessed Dec. 2022).

Provider-Based Telemedicine

“Qualified site” means the primary or satellite office of a healthcare services provider, a hospital licensed under title 68, a facility recognized as a rural health clinic under federal medicare regulations, a federally qualified health center, a facility licensed under title 33, or any other location deemed acceptable by the health insurance entity.

A provider-based telemedicine provider who seeks to contract with or who has contracted with a health insurance entity to participate in the health insurance entity’s network is subject to the same requirements and contractual terms as any other healthcare services provider in the health insurance entity’s network.

A health insurance entity:

  • Shall provide coverage under a health insurance policy or contract for covered healthcare services delivered through provider-based telemedicine;
  • Shall reimburse a healthcare services provider for a healthcare service covered under an insured patient’s health insurance policy or contract that is provided through provider-based telemedicine without any distinction or consideration of the geographic location or any federal, state, or local designation, or classification of the geographic area where the patient is located;
  • Shall not exclude from coverage a healthcare service solely because it is provided through provider-based telemedicine and is not provided through an in-person encounter between a healthcare services provider and a patient; and
  • Shall reimburse healthcare services providers who are out-of-network for provider-based telemedicine care services under the same reimbursement policies applicable to other out-of-network healthcare services providers.
A health insurance entity shall provide coverage for healthcare services provided during a provider-based telemedicine encounter in a manner that is consistent with what the health insurance policy or contract provides for in-person encounters for the same service, and shall reimburse for healthcare services provided during a provider-based telemedicine encounter without distinction or consideration of the geographic location, or any federal, state, or local designation or classification of the geographic area where the patient is located.
This section does not require a health insurance entity to pay total reimbursement for a provider-based telemedicine encounter in an amount that exceeds the amount that would be paid for the same service provided by a healthcare services provider for an in-person encounter.
This section does not require a health insurance entity to provide coverage for healthcare services that are not medically necessary, unless the terms and conditions of an applicable health insurance policy provide that coverage.
A health insurance entity shall provide coverage for healthcare services provided during a provider-based telemedicine encounter in a manner that is consistent with what the health insurance policy or contract provides for in-person encounters for the same service, and shall reimburse for healthcare services provided during a provider-based telemedicine encounter without distinction or consideration of the geographic location, or any federal, state, or local designation or classification of the geographic area where the patient is located.
This section does not require a health insurance entity to pay total reimbursement for a provider-based telemedicine encounter in an amount that exceeds the amount that would be paid for the same service provided by a healthcare services provider for an in-person encounter.
This section does not require a health insurance entity to provide coverage for healthcare services that are not medically necessary, unless the terms and conditions of an applicable health insurance policy provide that coverage.
or a healthcare service for which coverage or reimbursement is provided under the Medical Assistance Act of 1968, compiled in title 71, chapter 5, part 1, or provided under title 71, chapter 3, part 11, “medically necessary” means a healthcare service that is determined by the bureau of TennCare to satisfy the medical necessity standard set forth in 71-5-144; and

For all other healthcare services, “medically necessary” means healthcare services that a healthcare services provider, exercising prudent clinical judgment, would provide to a patient for the purpose of preventing, evaluating, diagnosing, or treating an illness, injury, or disease or the symptoms of an illness, injury, or disease, and that are:

  • In accordance with generally accepted standards of medical practice;
  • Clinically appropriate, in terms of type, frequency, extent, site and duration; and considered effective for the patient’s illness, injury or disease; and
  • Not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patient’s illness, injury, or disease.

This section does not require a health insurance entity to provide coverage for healthcare services delivered by means of provider-based telemedicine if the applicable health insurance policy would not provide coverage for the same healthcare services if delivered by in-person means.

This section does not require a health insurance entity to reimburse a healthcare services provider for healthcare services delivered by means of provider-based telemedicine if the applicable health insurance policy would not reimburse that healthcare services provider if the same healthcare services had been delivered by in-person means.

This section does not apply to accident-only, specified disease, hospital indemnity, plans described in § 1251 of the Patient Protection and Affordable Care Act, Public Law 111-148, as amended and § 2301 of the Health Care and Education Reconciliation Act of 2010, Public Law 111-152, as amended (both in 42 U.S.C. § 18011), plans governed by the Employee Retirement Income Security Act of 1974 (ERISA) (29 U.S.C. § 1001 et seq.), Medicare supplement, disability income, long-term care, or other limited benefit hospital insurance policies.

SOURCE: TN Code Annotated, Sec. 56-7-1003, (Accessed Mar. 2023).

Notwithstanding § 56-7-1002(e), a health insurance entity shall provide reimbursement for healthcare services provided during a telehealth encounter in a manner that is consistent with what the health insurance policy or contract provides for in-person encounters for the same service, and shall reimburse for healthcare services provided during a telehealth encounter without distinction or consideration of the geographic location, or any federal, state, or local designation or classification of the geographic area where the patient is located.

Notwithstanding § 56-7-1003(e), a health insurance entity shall provide reimbursement for healthcare services provided during a provider-based telemedicine encounter in a manner that is consistent with what the health insurance policy or contract provides for in-person encounters for the same service, and shall reimburse for healthcare services provided during a provider-based telemedicine encounter without distinction or consideration of the geographic location, or any federal, state, or local designation or classification of the geographic area where the patient is located.

This section does not require a health insurance entity to provide reimbursement for healthcare services that are not medically necessary, unless the terms and conditions of an applicable health insurance policy provide that coverage.

For a healthcare service for which coverage or reimbursement is provided under the Medical Assistance Act of 1968, compiled in title 71, chapter 5, part 1, or provided under title 71, chapter 3, part 11, “medically necessary” means a healthcare service that is determined by the bureau of TennCare to satisfy the medical necessity standard set forth in §71-5-144; and

For all other healthcare services, “medically necessary” means healthcare services that a healthcare services provider, exercising prudent clinical judgment, would provide to a patient for the purpose of preventing, evaluating, diagnosing, or treating an illness, injury, or disease or the symptoms of an illness, injury, or disease, and that are:

  • In accordance with generally accepted standards of medical practice;
  • Clinically appropriate, in terms of type, frequency, extent, site and duration; and considered effective for the patient’s illness, injury or disease; and
  • Not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patient’s illness, injury or disease.

This section does not require a healthcare services provider to seek reimbursement from a health insurance entity for healthcare services provided by telehealth or provider-based telemedicine.

SOURCE:  Sec. 56-7-1012, (Accessed Mar. 2023).

A health insurance entity may consider any remote patient monitoring service a covered medical service if the same service is covered by Medicare. The appropriate parties may negotiate the rate for these services in the manner in which is deemed appropriate by the parties.

Reimbursement of expenses for covered remote patient monitoring services must be established through negotiations conducted by the health insurance entity with the healthcare services provider, healthcare system, or practice group in the same manner as the health insurance entity establishes reimbursement of expenses for covered healthcare services that are delivered by in-person means.

Remote patient monitoring services are subject to utilization review under the Health Care Service Utilization Review Act, compiled in chapter 6, part 7 of this title.

This section does not apply to a health incentive program operated by a health insurance entity that utilized an electronic device for physiological monitoring.

SOURCE: TN Code Annotated, Sec. 56-7-1011, (Accessed Mar. 2023).

Workers Compensation

Telehealth for workers’ compensation is an available option for medically appropriate healthcare services to be provided with the voluntary consent and agreement of the injured worker and the willingness of the healthcare services provider as provided in these rules.  Medically appropriate healthcare services do not include treatment where an in-person physical examination is necessary (see rule for examples).

Telehealth providers shall be held to the same standard of care as healthcare services providers providing the same healthcare services through in-person encounters.

An employer shall provide coverage for workers’ compensation medical services provided during a telehealth encounter in a manner that is consistent with what the workers’ compensation law requires for in-person encounters for the same healthcare service(s). Payment shall be in accordance with the Tennessee workers’ compensation medical fee schedule in Rule 0800-02-18 and corresponding rules for medical payments in Rule 0800-02- 17 in effect on the date of service.

Records/recordings requirements for telehealth services shall be the same as if the visit with the provider were in person and face-to-face. A telehealth provider shall be compliant with all federal and state of Tennessee laws for records/recordings. A recording shall not substitute for a written record.

Telehealth services are subject to any and all appropriate utilization review protocols or other protocols for healthcare treatment adopted by the bureau, shall be based on evidence-based guidelines, and shall be in accordance with the Tennessee standards of medical practice.

All services shall be delivered to the eligible employee at no cost to the employee in accordance with the provisions of section 50-6-204.

The provision of medical services via telehealth does not change or in any way affect the requirements for causation, date of maximum medical improvement, or permanent impairment ratings required of an authorized treating physician pursuant to the workers’ compensation law. In all workers’ compensation claims, statements of causation, date of maximum medical improvement, permanent restrictions, and permanent impairment rating(s) must be provided by a medical doctor, doctor of osteopathy, or doctor of chiropractic in accordance with the workers’ compensation law.

SOURCE:  TN Admin Code 0800-02-31.03, (Accessed Mar. 2023).

Medicaid

Last updated 03/23/2023

Consent Requirements

Privacy policies must be reviewed with the individual before beginning a telehealth assessment and the review must be documented in the patient record.  The patient must be informed about privacy policies and given an opportunity to request an in-person assessment before receiving a telehealth assessment.

SOURCE: TN Dept. of Mental Health and Substance Abuse Services. Office of Crisis Services and Suicide Prevention. Minimal Standards of Care.  p. 49-50, (2017) (Accessed Mar. 2023).

The individual being evaluated via telehealth must be informed of the process and given an opportunity to request an in-person face-to-face assessment before conducting a telehealth assessment. This should be documented in his/her record.

Explanation of the process shall include a statement that services will not be withheld if the telehealth encounter is refused and the individual may terminate the telehealth assessment at any time.

Documentation must contain a statement that the telehealth process was explained to the individual and whether or not an objection was raised.

SOURCE: TN Dept. of Mental Health and Substance Abuse Services. Office of Crisis Services Telecommunications Guidelines, p. 8, (2012) (Accessed Mar. 2023).

Last updated 03/23/2023

Definitions

Telehealth means the use of real-time interactive audio, video telecommunications or electronic technology, or store-and-forward telemedicine services by a healthcare services provider to deliver healthcare services to a patient within the scope of practice of the healthcare services provider when:

  • Such provider is at a qualified site other than the site where the patient is located; and
  • The patient is at a qualified site at a school clinic staffed by a healthcare services provider and equipped to engage in the telecommunications described in this section or a public elementary or secondary school staffed by a health care services provider and equipped to engage in the telecommunications described in this section; and
  • Does not include:
    • Audio only conversation;
    • An electronic mail message; or
    • Facsimile transmission;

SOURCE: TN Code Annotated, Sec. 56-7-1002, (Accessed Mar. 2023).

“Provider-based telemedicine”: Means the use of Health Insurance Portability and Accountability Act (HIPAA) (42 U.S.C. § 1320d et seq.) compliant real-time, interactive audio, video telecommunications, or electronic technology, or store-and-forward telemedicine services, used over the course of an interactive visit by a healthcare services provider to deliver healthcare services to a patient within the scope of practice of the healthcare services provider when:

  • The healthcare services provider is at a qualified site other than the site where the patient is located and has access to the relevant medical record for that patient;
  • The patient is located at a location the patient deems appropriate to receive the healthcare service that is equipped to engage in the telecommunication described in this section; and
    • The healthcare services provider makes use of HIPAA compliant real-time, interactive audio, video telecommunications or electronic technology, or store-and-forward telemedicine services to deliver healthcare services to a patient within the scope of practice of the healthcare services provider as long as the healthcare services provider, the healthcare services provider’s practice group, or the healthcare system has established a provider-patient relationship by submitting to a health insurance entity evidence of an in-person encounter between the healthcare service provider, the healthcare services provider’s practice group, or the healthcare system and the patient within sixteen (16) months prior to the interactive visit; and
    • The requirement of an in-person encounter between the healthcare services provider, the healthcare services provider’s practice group, or the healthcare system and the patient within sixteen (16) months prior to the interactive visit is tolled for the duration of a state of emergency declared by the governor pursuant to § 58-2-107; provided, that the healthcare services provider or the patient, or both, are located in the geographical area covered by the applicable state of emergency;
  • Does not include:
    • An audio-only conversation;
    • An electronic mail message or phone text message;
    • A facsimile transmission;
    • Remote patient monitoring; or
    • Healthcare services provided pursuant to a contractual relationship between a health insurance entity and an entity that facilitates the delivery of provider-based telemedicine as the substantial portion of the entity’s business.

Notwithstanding subdivisions (a)(6)(A) and (B), includes Health Insurance Portability and Accountability Act (HIPAA) (42 U.S.C. § 1320d et seq.) compliant audio-only conversation for the provision of behavioral health services or healthcare services when the means described in subdivision (a)(6)(A) are unavailable.

SOURCE: TN Code Annotated, Sec. 56-7-1003, (Accessed Mar. 2023).

TN Department of Mental Health and Substance Abuse Services

“Telehealth is the use of electronic information and telecommunication technologies to support clinical care between an individual with mental illness and/or substance abuse issues and a healthcare practitioner.”

“Telehealth systems provide a live, interactive audio-video communication or videoconferencing connection between the individual in need of services and the crisis service delivery system.”

SOURCE: TN Dept. of Mental Health and Substance Abuse Services. Office of Crisis Services and Suicide Prevention. Minimal Standards of Care. p. 46, (2017) & TN Dept. of Mental Health and Substance Abuse Services. Office of Crisis Services Telecommunications Guideline. p. 4 (Accessed Mar. 2023).

Last updated 03/23/2023

Email, Phone & Fax

“Provider-based telemedicine” does not include:

    • An audio-only conversation;
    • An electronic mail message or phone text message;
    • A facsimile transmission;
    • Remote patient monitoring; or
    • Healthcare services provided pursuant to a contractual relationship between a health insurance entity and an entity that facilitates the delivery of provider-based telemedicine as the substantial portion of the entity’s business.

Provider-based telemedicine includes Health Insurance Portability and Accountability Act (HIPAA) (42 U.S.C. § 1320d et seq.) compliant audio-only conversation for the provision of behavioral health services or healthcare services when the means described in subdivision (a)(6)(A) are unavailable.

A healthcare provider, office staff, or party acting on behalf of the healthcare provider submitting for reimbursement of an audio-only encounter under subdivision (a)(6)(C)(ii) shall:

  • Confirm and maintain documentation that the patient:
    • Does not own the video technology necessary to complete an audio-video provider-based telemedicine encounter;
    • Is at a location where an audio-video encounter cannot take place due to lack of service; or
    • Has a physical disability that inhibits the use of video technology; and
  • Notify the patient that the financial responsibility for the audio-only encounter will be consistent with the financial responsibility for other in-person or video encounters, prior to the audio-only telemedicine encounter.
SOURCE: TN Code Annotated, Sec. 56-7-1003, (Accessed Mar. 2023).

Telehealth does not include:

  • An audio-only conversation;
  • An electronic mail message; or
  • A facsimile transmission

SOURCE: TN Code Annotated, Sec. 56-7-1002 (Accessed Mar. 2023).

Last updated 03/23/2023

Live Video

POLICY

Telehealth Services

A health insurance entity shall provide coverage for healthcare services provided during a telehealth encounter in a manner that is consistent with what the health insurance policy or contract provides for in-person encounters for the same service, and shall reimburse for healthcare services provided during a telehealth encounter without distinction or consideration of the geographic location, or any federal, state, or local designation or classification of the geographic area where the patient is located.

SOURCE: TN Code Annotated, Title 56, Ch. 7, Part 1002, (Accessed Mar. 2023).

Notwithstanding § 56-7-1002(e), a health insurance entity shall provide reimbursement for healthcare services provided during a telehealth encounter in a manner that is consistent with what the health insurance policy or contract provides for in-person encounters for the same service, and shall reimburse for healthcare services provided during a telehealth encounter without distinction or consideration of the geographic location, or any federal, state, or local designation or classification of the geographic area where the patient is located.

SOURCE: TN Code Annotated, Sec. 56-7-1012, (Accessed, Mar. 2023).

Provider-based Telemedicine

A health insurance entity shall provide coverage for healthcare services provided during a provider-based telemedicine encounter in a manner that is consistent with what the health insurance policy or contract provides for in-person encounters for the same service, and shall reimburse for healthcare services provided during a provider-based telemedicine encounter without distinction or consideration of the geographic location, or any federal, state, or local designation or classification of the geographic area where the patient is located.

This section does not require a health insurance entity to pay total reimbursement for a provider-based telemedicine encounter in an amount that exceeds the amount that would be paid for the same service provided by a healthcare services provider for an in-person encounter.

This section does not require a health insurance entity to provide coverage for healthcare services that are not medically necessary, unless the terms and conditions of an applicable health insurance policy provide that coverage.

The healthcare services provider makes use of HIPAA compliant real-time, interactive audio, video telecommunications or electronic technology, or store-and-forward telemedicine services to deliver healthcare services to a patient within the scope of practice of the healthcare services provider as long as the healthcare services provider, the healthcare services provider’s practice group, or the healthcare system has established a provider-patient relationship by submitting to a health insurance entity evidence of an in-person encounter between the healthcare service provider, the healthcare services provider’s practice group, or the healthcare system and the patient within sixteen (16) months prior to the interactive visit.

The requirement of an in-person encounter between the healthcare services provider, the healthcare services provider’s practice group, or the healthcare system and the patient within sixteen (16) months prior to the interactive visit is tolled for the duration of a state of emergency declared by the governor pursuant to § 58-2-107; provided, that the healthcare services provider or the patient, or both, are located in the geographical area covered by the applicable state of emergency.

SOURCE: TN Code Annotated, Sec. 56-7-1003, (Accessed Mar. 2023).

Notwithstanding § 56-7-1003(e), a health insurance entity shall provide reimbursement for healthcare services provided during a provider-based telemedicine encounter in a manner that is consistent with what the health insurance policy or contract provides for in-person encounters for the same service, and shall reimburse for healthcare services provided during a provider-based telemedicine encounter without distinction or consideration of the geographic location, or any federal, state, or local designation or classification of the geographic area where the patient is located.

SOURCE: TN Code Annotated, Sec. 56-7-1012, (Accessed Mar. 2023).

ELIGIBLE SERVICES/SPECIALTIES

This section does not require a health insurance entity to provide coverage for healthcare services that are not medically necessary, unless the terms and conditions of an applicable health insurance policy provide that coverage.

For a healthcare service for which coverage or reimbursement is provided under the Medical Assistance Act of 1968, compiled in title 71, chapter 5, part 1, or provided under title 71, chapter 3, part 11, “medically necessary” means a healthcare service that is determined by the bureau of TennCare to satisfy the medical necessity standard set forth in 71-5-144; and

For all other healthcare services, “medically necessary” means healthcare services that a healthcare services provider, exercising prudent clinical judgment, would provide to a patient for the purpose of preventing, evaluating, diagnosing, or treating an illness, injury, or disease or the symptoms of an illness, injury, or disease, and that are:

  • In accordance with generally accepted standards of medical practice;
  • Clinically appropriate, in terms of type, frequency, extent, site and duration; and considered effective for the patient’s illness, injury or disease; and
  • Not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patient’s illness, injury or disease,  excluding any costs paid pursuant to subsection (j).

Section (j): A health insurance entity shall reimburse an originating site hosting a patient as part of a telehealth encounter an originating site fee in accordance with the federal centers for medicare and medicaid services telehealth services rule 42 C.F.R. § 410.78 and at an amount established prior to August 20, 2020, by the federal centers for Medicare and Medicaid services.

SOURCE: TN Code Annotated, Sec. 56-7-1002 & Sec. 56-7-1012 [excludes reference to section (j)], (Accessed Dec. 2022).

A health insurance entity:

  • Shall provide coverage under a health insurance policy or contract for covered healthcare services delivered through provider-based telemedicine;
  • Shall reimburse a healthcare services provider for a healthcare service covered under an insured patient’s health insurance policy or contract that is provided through provider-based telemedicine without any distinction or consideration of the geographic location or any federal, state, or local designation, or classification of the geographic area where the patient is located;
  • Shall not exclude from coverage a healthcare service solely because it is provided through provider-based telemedicine and is not provided through an in-person encounter between a healthcare services provider and a patient; and
  • Shall reimburse healthcare services providers who are out-of-network for provider-based telemedicine care services under the same reimbursement policies applicable to other out-of-network healthcare services providers.

A health insurance entity shall provide coverage for healthcare services provided during a provider-based telemedicine encounter in a manner that is consistent with what the health insurance policy or contract provides for in-person encounters for the same service, and shall reimburse for healthcare services provided during a provider-based telemedicine encounter without distinction or consideration of the geographic location, or any federal, state, or local designation or classification of the geographic area where the patient is located.

This section does not require a health insurance entity to pay total reimbursement for a provider-based telemedicine encounter in an amount that exceeds the amount that would be paid for the same service provided by a healthcare services provider for an in-person encounter.

This section does not require a health insurance entity to provide coverage for healthcare services that are not medically necessary, unless the terms and conditions of an applicable health insurance policy provide that coverage.

For a healthcare service for which coverage or reimbursement is provided under the Medical Assistance Act of 1968, compiled in title 71, chapter 5, part 1, or provided under title 71, chapter 3, part 11, “medically necessary” means a healthcare service that is determined by the bureau of TennCare to satisfy the medical necessity standard set forth in 71-5-144; and For all other healthcare services, “medically necessary” means healthcare services that a healthcare services provider, exercising prudent clinical judgment, would provide to a patient for the purpose of preventing, evaluating, diagnosing, or treating an illness, injury, or disease or the symptoms of an illness, injury, or disease, and that are:

  • In accordance with generally accepted standards of medical practice;
  • Clinically appropriate, in terms of type, frequency, extent, site and duration; and considered effective for the patient’s illness, injury or disease; and
  • Not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patient’s illness, injury, or disease.

This section does not require a health insurance entity to provide coverage for healthcare services delivered by means of provider-based telemedicine if the applicable health insurance policy would not provide coverage for the same healthcare services if delivered by in-person means.

This section does not require a health insurance entity to reimburse a healthcare services provider for healthcare services delivered by means of provider-based telemedicine if the applicable health insurance policy would not reimburse that healthcare services provider if the same healthcare services had been delivered by in-person means.

Any provisions not required by this section are governed by the terms and conditions of the health insurance policy or contract.

Provider-based telemedicine is subject to utilization review under the Health Care Service Utilization Review Act, compiled in chapter 6, part 7 of this title.

SOURCE: TN Code Annotated, Sec. 56-7-1003, (Accessed Mar. 2023).

Mental Health & Substance Abuse Services

TennCare will reimburse for live video for crisis-related services or an assessment for emergency admission by an in-patient psychiatric facility.

Please see Telecommunications Guidelines for policy guidance.

SOURCE: TN Dept. of Mental Health and Substance Abuse Services. Office of Crisis Services Telecommunications Guidelines, p. 4 (2012) & TN Dept. of Mental Health and Substance Abuse Services. Office of Crisis Services and Suicide Prevention. Minimal Standards of Care.  p. 46 & 56, (2017) (Accessed Mar. 2023).

ELIGIBLE PROVIDERS

Provider based telemedicine

A provider-based telemedicine provider who seeks to contract with or who has contracted with a health insurance entity to participate in the health insurance entity’s network is subject to the same requirements and contractual terms as any other healthcare services provider in the health insurance entity’s network.

“Healthcare services provider” means an individual acting within the scope of a valid license issued pursuant to title 63 or title 68, chapter 24, part 6, or any state-contracted crisis service provider employed by a facility licensed under title 33 .

SOURCE:  TN Code Annotated, Sec. 56-7-1003, (Accessed Mar. 2023).

Telehealth Services

“Healthcare services provider” means an individual acting within the scope of a valid license issued pursuant to title 63 or any state-contracted crisis service provider employed by a facility licensed under title 33.

SOURCE: TN Code Annotated, Sec. 56-7-1002, (Accessed Mar. 2023).

ELIGIBLE SITES

Telehealth Services

“Qualified site” means the office of a healthcare services provider, a hospital licensed under title 68, a facility recognized as a rural health clinic under federal Medicare regulations, a federally qualified health center, any facility licensed under title 33, or any other location deemed acceptable by the health insurance entity.

“Originating site” means the location where a patient is located pursuant to subdivision (a)(7)(A) and that originates a telehealth service to another qualified site

SOURCE: TN Code Annotated, Sec. 56-7-1002 (Accessed Mar. 2023).

Provider-Based Telemedicine

“Qualified site” means the primary or satellite office of a healthcare services provider, a hospital licensed under title 68, a facility recognized as a rural health clinic under federal medicare regulations, a federally qualified health center, a facility licensed under title 33, or any other location deemed acceptable by the health insurance entity.

SOURCE: TN Code Annotated, Sec. 56-7-1003, (Accessed Mar. 2023).

Recently Passed Legislation

A vendor or healthcare provider who provides healthcare services exclusively via telehealth to maintain a physical address or site in this state in order to be eligible to enroll as a vendor or provider for the medical assistance program; or A telehealth provider group to have a service address in this state in order to be eligible to enroll as a vendor or provider group for the medical assistance program, as long as the healthcare providers that comprise the telehealth provider group are licensed with the appropriate healthcare licensing authority in this state or are otherwise authorized by law to provide healthcare services in this state.

SOURCE: TN House Bill 895 and Senate Bill 680 (2023 Session), (Accessed Mar. 2023).

Mental Health & Substance Abuse Services

Crisis service providers may connect from:

  • Emergency departments;
  • Jails;
  • Detention centers; and
  • Other similar locations

All telehealth sites shall ensure that telehealth equipment is located in a space conducive to a clinical environment.

SOURCE: TN Dept. of Mental Health and Substance Abuse Services. Office of Crisis Services and Suicide Prevention. Minimal Standards of Care.  p. 46 & 50, (2017) (Accessed Nov. 2021) & TN Dept. of Mental Health and Substance Abuse Services. Office of Crisis Services Telecommunications Guidelines, p. 4 & 8, (2012) (Accessed Mar. 2023).

GEOGRAPHIC LIMITS

A health insurance entity … Shall reimburse a healthcare services provider for the diagnosis, consultation, and treatment of an insured patient for a healthcare service covered under a health insurance policy or contract that is provided through telehealth without any distinction or consideration of the geographic location or any federal, state, or local designation, or classification of the geographic area where the patient is located.

A health insurance entity shall provide coverage for healthcare services provided during a telehealth encounter in a manner that is consistent with what the health insurance policy or contract provides for in-person encounters for the same service, and shall reimburse for healthcare services provided during a telehealth encounter without distinction or consideration of the geographic location, or any federal, state, or local designation or classification of the geographic area where the patient is located.

SOURCE: TN Code Annotated, Title 56, Ch. 7, Part 1002, (Accessed Mar. 2023).

A health insurance entity: … Shall reimburse a healthcare services provider for a healthcare service covered under an insured patient’s health insurance policy or contract that is provided through provider-based telemedicine without any distinction or consideration of the geographic location or any federal, state, or local designation, or classification of the geographic area where the patient is located.

A health insurance entity shall provide coverage for healthcare services provided during a provider-based telemedicine encounter in a manner that is consistent with what the health insurance policy or contract provides for in-person encounters for the same service, and shall reimburse for healthcare services provided during a provider-based telemedicine encounter without distinction or consideration of the geographic location, or any federal, state, or local designation or classification of the geographic area where the patient is located.

SOURCE: TN Code Annotated, Part 1003, (Accessed Mar. 2023).

FACILITY/TRANSMISSION FEE

A health insurance entity shall reimburse an originating site hosting a patient as part of a telehealth encounter an originating site fee in accordance with the federal centers for Medicare and Medicaid services telehealth services rule 42 C.F.R. § 410.78 and at an amount established prior to August 20, 2020, by the federal centers for Medicare and Medicaid services.

SOURCE: TN Code Annotated, Sec. 56-7-1002, (Accessed Mar. 2023).

 

Last updated 03/23/2023

Miscellaneous

See FAQ document for The Triage, Navigate, Treat and Transport (TN-T2) payment model for telehealth reimbursement information.

SOURCE:  TN Medicaid, TN-T2 Model, FAQ, (2/15/23), (Accessed Mar. 2023).

Last updated 03/23/2023

Out of State Providers

No Reference Found

Last updated 03/23/2023

Overview

TennCare reimburses for live video only for crisis-related services. A law requires reimbursement for additional telehealth services and provider-based telemedicine, which includes store-and-forward.  Remote patient monitoring may be offered by health insurance entities.

TennCare services are offered through managed care entities. Each MCO has its own telehealth policy. Coverage and reimbursement for live video and store-and-forward may vary between MCOs.

Last updated 03/23/2023

Remote Patient Monitoring

POLICY

“Remote patient monitoring services” means using digital technologies to collect medical and other forms of health data from a patient and then electronically transmitting that information securely to healthcare providers in a different location for interpretation and recommendation.

A health insurance entity may consider any remote patient monitoring service a covered medical service if the same service is covered by Medicare. The appropriate parties may negotiate the rate for these services in the manner in which is deemed appropriate by the parties.

SOURCE: TN Code Annotated, Sec. 56-7-1011, (Accessed Mar. 2023).

CONDITIONS

No Reference Found

PROVIDER LIMITATIONS

No Reference Found

OTHER RESTRICTIONS

Reimbursement of expenses for covered remote patient monitoring services must be established through negotiations conducted by the health insurance entity with the healthcare services provider, healthcare system, or practice group in the same manner as the health insurance entity establishes reimbursement of expenses for covered healthcare services that are delivered by in-person means.

Remote patient monitoring services are subject to utilization review under the Health Care Service Utilization Review Act, compiled in chapter 6, part 7 of this title.

This section does not apply to a health incentive program operated by a health insurance entity that utilized an electronic device for physiological monitoring.

SOURCE: TN Code Annotated, Sec. 56-7-1011, (Accessed Mar. 2023).

Last updated 03/23/2023

Store and Forward

POLICY

“Store-and-forward telemedicine services”: (A) Means the use of asynchronous computer-based communications between a patient and healthcare services provider at a distant site for the purpose of diagnostic and therapeutic assistance in the care of patients; and (B) Includes the transferring of medical data from one (1) site to another through the use of a camera or similar device that records or stores an image that is sent or forwarded via telecommunication to another site for consultation.

SOURCE: TN Code Annotated, Sec. 56-7-1002 & 1003, (Accessed Mar. 2023).

This section does not require a health insurance entity to provide coverage for healthcare services that are not medically necessary, unless the terms and conditions of an applicable health insurance policy provide that coverage.

This section does not require a health insurance entity to provide coverage for healthcare services delivered by means of telehealth if the applicable health insurance policy would not provide coverage for the same healthcare services if delivered by in-person means.

This section does not require a health insurance entity to reimburse a healthcare services provider for healthcare services delivered by means of telehealth if the applicable health insurance policy would not reimburse that healthcare services provider if the same healthcare services had been delivered by in-person means.

SOURCE: TN Code Annotated, Sec. 56-7-1002, (Accessed Dec. 2022).

This section does not require a health insurance entity to pay total reimbursement for a provider-based telemedicine encounter in an amount that exceeds the amount that would be paid for the same service provided by a healthcare services provider for an in-person encounter.

This section does not require a health insurance entity to provide coverage for healthcare services that are not medically necessary, unless the terms and conditions of an applicable health insurance policy provide that coverage.

This section does not require a health insurance entity to provide coverage for healthcare services delivered by means of provider-based telemedicine if the applicable health insurance policy would not provide coverage for the same healthcare services if delivered by in-person means.

This section does not require a health insurance entity to reimburse a healthcare services provider for healthcare services delivered by means of provider-based telemedicine if the applicable health insurance policy would not reimburse that healthcare services provider if the same healthcare services had been delivered by in-person means.

SOURCE: TN Code Annotated, Sec. 56-7-1003, (Accessed Mar. 2023).

Mental Health & Substance Abuse Services

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

SOURCE: TN Dept. of Mental Health and Substance Abuse Services. Office of Crisis Services and Suicide Prevention. Minimal Standards of Care.  p. 46, (2017) (Accessed Sept. 2022) & TN Dept. of Mental Health and Substance Abuse Services. Office of Crisis Services Telecommunications Guidelines, p. 4, (2012) (Accessed Mar. 2023).

ELIGIBLE SERVICES/SPECIALTIES

No Reference Found

GEOGRPAHIC LIMITS

A health insurance entity … Shall reimburse a healthcare services provider for the diagnosis, consultation, and treatment of an insured patient for a healthcare service covered under a health insurance policy or contract that is provided through telehealth without any distinction or consideration of the geographic location or any federal, state, or local designation, or classification of the geographic area where the patient is located.

A health insurance entity shall provide coverage for healthcare services provided during a telehealth encounter in a manner that is consistent with what the health insurance policy or contract provides for in-person encounters for the same service, and shall reimburse for healthcare services provided during a telehealth encounter without distinction or consideration of the geographic location, or any federal, state, or local designation or classification of the geographic area where the patient is located.

SOURCE: TN Code Annotated, Title 56, Ch. 7, Part 1002, (Accessed Mar. 2023).

A health insurance entity: … Shall reimburse a healthcare services provider for a healthcare service covered under an insured patient’s health insurance policy or contract that is provided through provider-based telemedicine without any distinction or consideration of the geographic location or any federal, state, or local designation, or classification of the geographic area where the patient is located.

A health insurance entity shall provide coverage for healthcare services provided during a provider-based telemedicine encounter in a manner that is consistent with what the health insurance policy or contract provides for in-person encounters for the same service, and shall reimburse for healthcare services provided during a provider-based telemedicine encounter without distinction or consideration of the geographic location, or any federal, state, or local designation or classification of the geographic area where the patient is located.

SOURCE: TN Code Annotated, Part 1003, (Accessed Mar. 2023).

TRANSMISSION FEE

No Reference Found

 

Professional Requirements

Last updated 03/23/2023

Consent Requirements

For the purposes of this section, a healthcare provider-patient relationship with respect to telemedicine or telehealth is created by mutual consent and mutual communication, except in an emergency, between the patient and the provider. The consent by the patient may be expressed or implied consent; however, the provider-patient relationship is not created simply by the receipt of patient health information by a provider unless a prior provider-patient relationship exists. The duties and obligations created by the relationship do not arise until the healthcare provider:

  • Affirmatively undertakes to diagnose or treat the patient; or
  • Affirmatively participates in the diagnosis or treatment.

SOURCE:  TN Code Sec. 63-1-155 (Accessed Mar. 2023).

Dentists who are licensed in this state and who deliver services using teledentistry shall establish protocols for the practice that should include proper methods of keeping the patient fully informed.

SOURCE: TN Code Annotated 63-5-108, (Accessed Mar. 2023).

Worker’s Compensation

Telehealth services providers must obtain electronic or written informed consent of an injured worker to accept telehealth services for any or all parts of the medical benefits to which the injured worker may be entitled under the workers’ compensation law. For authorized telephone visits, verbal consent given by the patient before the service shall be documented by the provider. This service shall be in accordance with applicable CMS guidelines at the time of service. See rule for additional detailed requirements.

SOURCE:  TN Admin Code 0800-02-31.04, (Accessed Mar. 2023).

Optometry

An optometrist shall not render telehealth services, ophthalmic prescribing and eye health services, advice and/or care using telehealth technologies without:

Obtaining appropriate consents from requesting patients after disclosures regarding the delivery models and treatment methods or limitations, including any special informed consents regarding the use of telehealth technologies.

The consent by the patient may be expressed or implied consent; however, the optometrist-patient relationship is not created simply by the receipt of patient health information by an optometrist unless a prior optometrist-patient relationship exists.

SOURCE: TN Rule Annotated 1045-02-.18, (Accessed Mar. 2023).

Last updated 03/23/2023

Cross State Licensing

“Healthcare provider” means:

  • An individual acting within the scope of a valid license issued pursuant to title 63;
  • A state-contracted crisis service provider employed by a facility licensed under title 33;
  • An alcohol and drug abuse counselor licensed under title 68, chapter 24, part 6; or
  • A graduate who has completed, or a student actively enrolled in, a professional training program the educational standards of which meet the training requirements for a license under this title or title 68, chapter 24, part 6, as long as the graduate or student:
    • Is providing telehealth services for the purpose of obtaining hours required for licensure or of otherwise fulfilling the educational requirements to apply for licensure; and is at all times, supervised by an individual who is licensed under this title or title 68, chapter 24, part 6, with an unencumbered license.
    • Is, at all times, supervised by an individual who is licensed under this title or title 68, chapter 24, part 6, with an unencumbered license

Except as provided in subdivisions (g)(2) and (3), to practice under this section a healthcare provider must be licensed to practice in this state or be a graduate or student meeting the requirements of subdivision (a)(1)(D).

A physician must be licensed to practice under chapter 6 or 9 of this title in order to practice telemedicine pursuant to § 63-6-209(b), except as otherwise authorized by law or rule.

An individual licensed in another state who would, if licensed in this state, qualify as a healthcare provider under subsection (a) may practice telehealth under this section while providing healthcare services on a volunteer basis through a free clinic pursuant to title 63, chapter 6, part 7.

Subdivision (a)(1)(A) does not prohibit a healthcare provider otherwise acting within the scope of practice of a valid license issued pursuant to this title from delivering services through the use of telehealth.

SOURCE:  TN Code Sec. 63-1-155 (Accessed Mar. 2023).

The board also has the authority to issue locum tenens and/or conditional licenses as it deems appropriate after reviewing the qualifications of applicants. In addition to the authority granted the board in § 63-6-214, the board has the authority to issue restricted licenses and special licenses based upon licensure to another state for the limited purpose of authorizing the practice of telemedicine to current applicants or current licensees, or both, as it deems necessary, pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.

SOURCE: TN Code Annotated Sec. 63-6-209(b). (Accessed Mar. 2023).

No person shall engage in the practice of medicine, either in person or remotely using information transmitted electronically or through other means, on a patient within the state of Tennessee unless duly licensed by the Board in accordance with the provisions of the current statutes and rules. Unless specifically set out in this rule, this rule is not intended to and does not supersede any pre-existing federal or state statutes or rules and is not meant to alter or amend the applicable standard of care in any particular field of medicine or to amend any requirement for the establishment of a physician-patient relationship.

As of the effective date of this rule, the Board will no longer issue what was previously termed a “telemedicine license.” Individuals previously granted a telemedicine license under the former version of this rule may apply to have the license converted to a full license. Such individuals must complete the application for a full license and provide all necessary documentation, though no new application fee will be required as long as application is made within two years of the effective date of this rule. See rule for details for individuals who do not convert to a full license.

SOURCE: TN Rule Annotated, Rule 0880-02.-16. (Accessed Mar. 2023).

The TN Osteopathic Board will still issue a telemedicine license.  See rule for details.

SOURCE: TN Rule Annotated, Rule 1050.02.17.(2) (Accessed Mar. 2023).

Last updated 03/23/2023

Definitions

“Telehealth,” “telemedicine,” and “provider-based telemedicine” mean: The use of real time audio, video, or other electronic media and telecommunication technology that enables interaction between a healthcare provider and a patient for the purpose of diagnosis, consultation, or treatment of a patient at a distant site where there may be no in-person exchange between a healthcare provider and a patient; or Store-and-forward telemedicine services.

“Store-and-forward telemedicine services” means the use of asynchronous computer-based communications, which may include the transfer of medical data in an image captured or created by a camera or similar device, between a healthcare provider and patient for the purpose of diagnosis, consultation, or treatment of the patient at a distant site where there may be no in-person exchange between the healthcare provider and the patient.

SOURCE:  TN Code Sec. 63-1-155. (Accessed Mar. 2023).

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 of 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, 0880-02.-16(1)(g). (Accessed Mar. 2023).

All behavioral health professional licensure requirements are the same for telehealth as for on-site face-to- face services. However, licensing requirements vary from state to state thus if a professional is providing direct care services across state lines, the behavioral health professional must adhere to the requirements of each state’s licensing authority.

SOURCE: TN Dept. of Mental Health and Substance Abuse Services. Office of Crisis Services Minimum Standards of Care, p. 50, (2017) (Accessed Mar. 2023).

Optometry

The definition of telehealth shall be defined as provided in T.C.A. § 63-1- 155(a)(2).

SOURCE: TN Rule annotated 1045-02-.18, (Accessed Mar. 2023).

Dentistry

“Teledentistry” which, as used in this section, means the delivery of dental health care 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.

SOURCE: TN Code Annotated 63-5-108, (Accessed Dec. 2022).

Last updated 03/23/2023

Licensure Compacts

Member of the Interstate Medical Licensure Compact.

SOURCE: Interstate Medical Licensure Compact. (Accessed Mar. 2023).

Member of the Nurses Licensure Compact.

SOURCE:  Nurse Licensure Compact. (Accessed Mar. 2023).

Member of the Physical Therapy Compact.

SOURCE: Compact Map. Physical Therapy Compact. (Accessed Mar. 2023).

Member of Emergency Medical Services Compact.

SOURCE: Interstate Commission of EMS Personnel Services, Compact Member State, (Accessed Mar. 2023).

Member of Psychology Interjurisdictional Compact.

SOURCE: PSYPACT, Map, (Accessed Mar. 2023).

Member of the Audiology and Speech-language Pathology Interstate Compact.

SOURCE: ASPL-IC Compact Map. (Accessed Mar. 2023).

Member of the Occupational Therapy Licensure Compact.

SOURCE: Occupational Therapy Licensure Compact. (Accessed Mar. 2023). 

Member of the Counseling Compact.

SOURCE: Counseling Compact Map. (Accessed Mar. 2023).

* See Compact websites for implementation and license issuing status and other related requirements.

Last updated 03/23/2023

Miscellaneous

Worker’s Compensation Reimbursement

Payment shall be based on the Medicare guidelines and coding, with the exception of any geographic restriction.

SOURCE: TN Rule Annotated, 0800-2-17-.05. (5) (Accessed Mar. 2023).

Last updated 03/23/2023

Online Prescribing

For the purposes of this section, a healthcare provider-patient relationship with respect to telemedicine or telehealth is created by mutual consent and mutual communication, except in an emergency, between the patient and the provider. The consent by the patient may be expressed or implied consent; however, the provider-patient relationship is not created simply by the receipt of patient health information by a provider unless a prior provider-patient relationship exists. The duties and obligations created by the relationship do not arise until the healthcare provider:

  • Affirmatively undertakes to diagnose or treat the patient; or
  • Affirmatively participates in the diagnosis or treatment.

A healthcare provider who is authorized to prescribe buprenorphine under federal law shall not prescribe via telehealth a buprenorphine product, as approved by the federal food and drug administration for use in recovery or medication-assisted treatment, unless:

  • The healthcare provider is employed by or contracted with:
    • A licensed nonresidential office-based opiate treatment facility or licensed nonresidential opioid treatment program, as defined in§ 33-2-402;
    • A community mental health center, as defined in § 33-1-101;
    • A federally qualified health center, as defined in§ 63-10-601;
    • A hospital licensed under title 68 or 33; or
    • The bureau of TennCare’s comprehensive enhanced buprenorphine treatment network; and
  • The delivery of telehealth is being provided on behalf of the entity that employs or contracts with the provider.

SOURCE:  TN Code Sec. 63-1-155, (Accessed Mar. 2023).

Prerequisites to Issuing Prescriptions or Dispensing Medications – In Person, Electronically, and Over the Internet

(a) Except as provided in subparagraph (b), it shall be a prima facie violation of T.C.A. § 63-6-214(b)(1), (4), and (12) for a physician to prescribe or dispense any drug to any individual, whether in person or by electronic means or over the Internet or over telephone lines, unless the physician, or his/her licensed supervisee pursuant to appropriate protocols or medical orders, has first done and appropriately documented, for the person to whom a prescription is to be issued or drugs dispensed, all of the following:

  • 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 Rule Annotated, 0880-02-.14(7)(a). (Accessed Mar. 2023).

Except as provided under paragraphs seven (7) and eight (8) of this rule, the patient encounter to establish or maintain the physician-patient relationship via telemedicine between the physician in a remote location and the patient in Tennessee may occur with or without the use of a facilitator so long as such encounter is consistent with parts 1. and 2. of this Rule: Certain conditions apply in each case. See rule for details.

SOURCE: TN Rule Annotated, 0880-02.-16(6)(a). (Accessed Mar. 2023).

Optometry

Optometrist-patient relationship. Pursuant to T.C.A. § 63-1-155(b), an optometrist- patient relationship with respect to telemedicine or telehealth is created by mutual consent and mutual communication, except in an emergency, between the patient and the optometrist. The consent by the patient may be expressed or implied consent; however, the optometrist-patient relationship is not created simply by the receipt of patient health information by an optometrist unless a prior optometrist-patient relationship exists. The duties and obligations created by the relationship do not arise until the optometrist:

  • Affirmatively undertakes to diagnose or treat the patient; or
  • Affirmatively participates in the diagnosis or treatment.

The optometrist-patient relationship established via telehealth, shall at a minimum, meet the requirements of T.C.A. § 63-1-155(b).

SOURCE: TN Rule Annotated 1045-02-.18, (Accessed Mar. 2023).

 

Last updated 03/23/2023

Professional Board Standards

Board of Medical Examiners

SOURCE: TN Rule Annotated, Rule 0880-02. (Accessed Mar. 2023).

Board of Optometry

SOURCE: TN Rule Annotated, Rule 1045-02-.18 (Accessed Mar. 2023).

Teledentistry

Dentists who are licensed in this state and who deliver services using teledentistry shall establish protocols for the practice that should include proper methods of keeping the patient fully informed; proper safeguards ensuring that all state and federal laws and regulations relative to the privacy of health information are followed; proper documentation of all services or treatment rendered via teledentistry; proper procedures to ensure the referral of those patients requiring treatment beyond what can be provided via teledentistry to a dentist licensed in this state; and any such requirements as prescribed by the board of dentistry. Any and all services provided via teledentistry shall be consistent with the in-person provision of those services. Any and all services provided via teledentistry shall comply with this chapter and shall be provided in accordance with the rules of the board of dentistry.

SOURCE: TN Code Annotated 63-5-108, (Accessed Mar. 2023).

Practice of physical therapy means by in-person encounter or via telehealth, telemedicine or provider-based telemedicine.

SOURCE: TN Code Annotated 63-13-103, (Accessed Mar. 2023).

Federally Qualified Health Center (FQHC)

Last updated 03/23/2023

Definition of Visit

No reference found

Last updated 03/23/2023

Eligible Distant Site

A provider-based telemedicine provider who seeks to contract with or who has contracted with a health insurance entity to participate in the health insurance entity’s network is subject to the same requirements and contractual terms as any other healthcare services provider in the health insurance entity’s network.

SOURCE:  TN Code Annotated, Sec. 56-7-1003, (Accessed Mar. 2023).

A telehealth provider who seeks to contract with or who has contracted with a health insurance entity to participate in the health insurance entity’s network shall be subject to the same requirements and contractual terms as a healthcare services provider in the health insurance entity’s network.

SOURCE:  TN Code Annotated, Sec. 56-7-1002, (Accessed Mar. 2023).

“Healthcare services provider” means an individual acting within the scope of a valid license issued pursuant to title 63 or title 68, chapter 24, part 6, or any state-contracted crisis service provider employed by a facility licensed under title 33 .

SOURCE:  TN Code Annotated, Sec. 56-7-1002 & 1003, (Accessed Mar. 2023).

See: TN Medicaid Live Video Distant Site

Last updated 03/23/2023

Eligible Originating Site

“Qualified site” means the office of a healthcare services provider, a hospital licensed under title 68, a facility recognized as a rural health clinic under federal Medicare regulations, a federally qualified health center, any facility licensed under title 33, or any other location deemed acceptable by the health insurance entity.

SOURCE: TN Code Annotated, Sec. 56-7-1002, (Accessed Mar. 2023).

“Qualified site” means the primary or satellite office of a healthcare services provider, a hospital licensed under title 68, a facility recognized as a rural health clinic under federal medicare regulations, a federally qualified health center, a facility licensed under title 33, or any other location deemed acceptable by the health insurance entity.

SOURCE: TN Code Annotated, Sec. 56-7-1003, (Accessed Mar. 2023).

Reimbursement and coverage must be provided for telehealth services and provider-based telemedicine without any distinction or consideration of the geographic location or any federal, state, or local designation, or classification of the geographic area where the patient is located.

SOURCE: TN Code Annotated, Title 56, Ch. 7, Part 1002, & Part 1003, (Accessed Mar. 2023).

See: TN Medicaid Live Video Eligible Sites.

Last updated 03/23/2023

Facility Fee

A health insurance entity shall reimburse an originating site hosting a patient as part of a telehealth encounter an originating site fee in accordance with the federal centers for Medicare and Medicaid services telehealth services rule 42 C.F.R. § 410.78 and at an amount established prior to the effective date of this act by the federal centers for Medicare and Medicaid services.

SOURCE: TN Code Annotated, Sec. 56-7-1002, (Accessed Mar. 2023).

See: TN Medicaid Live Video Facility/Transmission Fee

Last updated 03/23/2023

Home Eligible

Telehealth Services

“Qualified site” means the office of a healthcare services provider, a hospital licensed under title 68, a facility recognized as a rural health clinic under federal Medicare regulations, a federally qualified health center, any facility licensed under title 33, or any other location deemed acceptable by the health insurance entity.

“Originating site” means the location where a patient is located pursuant to subdivision (a)(7)(A) and that originates a telehealth service to another qualified site.

SOURCE: TN Code Annotated, Sec. 56-7-1002 (Accessed Mar. 2023).

Provider-Based Telemedicine

“Qualified site” means the primary or satellite office of a healthcare services provider, a hospital licensed under title 68, a facility recognized as a rural health clinic under federal medicare regulations, a federally qualified health center, a facility licensed under title 33, or any other location deemed acceptable by the health insurance entity.

SOURCE: TN Code Annotated, Sec. 56-7-1003, (Accessed Mar. 2023).

Last updated 03/23/2023

Modalities Allowed

Live Video

According to statute, a health insurance entity (includes Medicaid) shall provide coverage for healthcare services provided during a telehealth encounter in a manner that is consistent with what the health insurance policy or contract provides for in-person encounters for the same service, and shall reimburse for healthcare services provided during a telehealth encounter without distinction or consideration of the geographic location, or any federal, state, or local designation or classification of the geographic area where the patient is located. Any provisions not stipulated in the telehealth services section of the insurance code shall be governed by the terms and conditions of the health insurance contract. However, no explicit reference to FQHCs was found.

See:  TN Medicaid Live Video.

Store and Forward

TN statute defines store-and-forward telemedicine services, but does not require coverage store-and-forward specifically.  There is also no explicit reference to whether or not FQHCs can be reimbursed for the modality.

See:  TN Medicaid Store and Forward.

Remote Patient Monitoring

According to statute, A health insurance entity may consider any remote patient monitoring service a covered medical service if the same service is covered by Medicare. The appropriate parties may negotiate the rate for these services in the manner in which is deemed appropriate by the parties. There is no clarification if FQHCs can bill for this.

See: TN Medicaid Remote Patient Monitoring.

Audio-Only

According to statute, neither telehealth nor provider-based telemedicine includes audio-only conversation with the exception of HIPAA audio0only conversation for the provision of behavioral health and or healthcare services when other means are unavailable.  There is no clarification if FQHCs can bill for this.

See:  TN Medicaid Email, Phone and Fax.

Last updated 03/23/2023

Patient-Provider Relationship

No reference found

Last updated 03/23/2023

PPS Rate

No reference found

Last updated 03/23/2023

Same Day Encounters

No reference found