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(a) As used in this section:
(1) “Health insurance entity” has the same meaning as defined in § 56-7-109 and includes managed care organizations participating in the medical assistance program under title 71, chapter 5;
(2) “Healthcare services” has the same meaning as defined in § 56-61-102 ;
(3) “Healthcare services provider” means an individual acting within the scope of a valid license issued pursuant to title 63;
(4) “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;
(5) “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;
(A) 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:
(i) Such provider is at a qualified site other than the site where the patient is located; and
(ii) 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; and
(B) Does not include:
(i) An audio-only conversation;
(ii) An electronic mail message; or
(iii) A facsimile transmission; and
(7) “Telehealth provider” means a healthcare services provider engaged in the delivery of healthcare services through telehealth.
(b) Healthcare services provided through a telehealth encounter shall comply with state licensure requirements promulgated by the appropriate licensure boards. Telehealth providers shall be held to the same standard of care as healthcare services providers providing the same healthcare service through in-person encounters.
(c) 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.
(d) Subject to subsection (c), a health insurance entity:
(1) Shall provide coverage under a health insurance policy or contract for covered healthcare services delivered through telehealth;
(2) 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;
(3) 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
(4) 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.
(e) 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.
(f) Nothing in this section shall require a health insurance entity to pay total reimbursement for a telehealth encounter, including the use of telehealth equipment, in an amount that exceeds the amount that would be paid for the same service provided by a healthcare services provider in an in-person encounter.
(g) Any provisions not stipulated by this section shall be governed by the terms and conditions of the health insurance contract.
(h) Nothing in this section shall 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 compiled in 42 U.S.C. § 18011 , plans described in the Employee Retirement Income Security Act of 1974 (ERISA), compiled in 29 U.S.C. § 1001 et seq., Medicare supplement, disability income, long-term care, or other limited benefit hospital insurance policies.
Cite this article: FindLaw.com - Tennessee Code Title 56. Insurance § 56-7-1002 - last updated January 01, 2020 | https://codes.findlaw.com/tn/title-56-insurance/tn-code-sect-56-7-1002.html
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