Tennessee Telehealth Laws & Reimbursement Policies

About Alabama Telehealth Laws | Alina TeleHealth

Medicaid Telehealth Reimbursement

Summary

TennCare reimburses for live video only for crisis-related services. 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.

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Definitions

“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.”

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Live Video

Policy
Health insurance entities (including managed care organizations) participating in the medical assistance program are required to provide coverage for telehealth (which includes live video) delivered services in a manner that is consistent with the health insurance policy or contract provided for in-person services.

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Eligible Services/Specialties
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.

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Eligible Providers
Eligible Sites
Click to view list of eligible sites.

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Geographic Limits
Reimbursement and coverage must be provided for telehealth services 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.

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Facility/Transmission Fee

Store-and-Forward

Policy
Telehealth systems must be live and interactive, however TN Medicaid Managed Care plans must cover and reimburse for store-and-forward telemedicine services. Click for details.

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Eligible Services/Specialties
Geographic Limits
Manged Care: Reimbursement and coverage must be provided for telehealth services 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.

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Transmission Fee

Remote Patient Monitoring

Policy
Conditions
Provider Limitations

Email/Phone/Fax

No reimbursement for telephone. No reimbursement for fax. No reimbursement for email.

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Consent

The patient must be informed and given an opportunity to request an in-person assessment before receiving a telehealth assessment.

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Out of State Providers

Miscellaneous

Private Payer Laws

Definitions

Telehealth means the use of real-time interactive audio, video telecommunications or electronic technology, or store-and-forward telemedicine services by a healthcare 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 or 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.

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Requirements

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.

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Parity

Health insurance entities (including managed care organizations) participating in the medical assistance program are required to provide coverage for telehealth (which includes live video) delivered services in a manner that is consistent with the health insurance policy or contract provided for in-person services.

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Professional Regulation/Health & Safety

Definitions

Telemedicine is the practice of medicine using electronic communication, information technology or other means, between a licensee in one location and a patient in another location. Telemedicine is not an audio only telephone conversation, email/instant messaging conversation or fax. It typically involves the application or secure video conferencing or store-and-forward to provide or support healthcare delivery by replicating the interaction of a traditional encounter between a provider and a patient.

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Consent

Online Prescribing

Click to see list of activities a provider must complete prior to prescribing online or through the telephone.

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Cross State Licensing

Member of the following: Interstate Medical Licensure Compact, Nurse Licensure Compact, Physical Therapy Compact.

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Miscellaneous

Teledentistry 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.”

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Source: Center for Connected Health Policy
https://www.cchpca.org

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