Neither the most strict nor most lenient state when it comes to the practice of telemedicine, Tennessee has made significant strides in the last few years in leveling the playing field for those who hope to expand access to care through technology.
With the signature of Gov. Bill Haslam in April 2014, Tennessee became the 21st state to enact a statewide telehealth parity law. The law, which requires commercial insurers to cover care delivered remotely in the same manner as they would in-office visits, went into effect Jan. 1, 2015.
“Essentially, you can’t treat a telehealth provider in network differently than you would a face-to-face, in-network encounter,” said Colbey Reagan, a partner in Waller’s Healthcare Compliance & Operations Group and member of the law firm’s telehealth team. “An insurer can’t exclude payment for a healthcare service solely because it was provided by telehealth.”
He added commercial payers are now also required to pay for out-of-network telehealth services under the same reimbursement policies they would use for other out-of-network providers. Reagan noted the state’s parity laws apply to commercial payers only. “Medicare has its own rules that supersede Tennessee law,” he said.
On July 1, 2015, another new law also made it easier to practice telemedicine in the state. “The Board of Medicine has been a little reluctant to embrace this technology,” said Reagan. “That isn’t specific to Tennessee. There’s a natural inclination to be more restrictive rather than less restrictive,” he added of a national trend.
Proposed rules issued in 2014 for Tennessee called for a face-to-face appointment before telehealth could be subsequently utilized and then required at least one in-person visit a year thereafter. “The bill that went into effect in 2015 stripped away a lot of those proposed restrictions and made it easier to practice telehealth in Tennessee,” Reagan said.
HB 699, which was signed by the governor in April 2015, established that a licensed provider delivering services through the use of telehealth should be held to the same standard of professional practice as a colleague providing the same services through in-person encounters. “Essentially, you can’t treat telemedicine differently than you would any other healthcare service provider with the exception of abortion,” Reagan continued, adding the law puts providers on equal footing.
Launching a Telehealth Practice
Reagan said these laws are good news to physicians and hospitals hoping to expand their reach and to patients who now face fewer barriers to receiving specialty care closer to home. “I think there are more people out there dipping their toes in the water,” he noted of a growing interest in telehealth. “If you are an entrepreneur who wants to roll this out, Tennessee’s a fine place to be.”
There are, however, several issues that deserve consideration before moving forward, he noted.
1) Make sure you have the capital to invest in appropriate technology. For example, Reagan said, using Skype for telehealth won’t cut it. Speed, clarity and security are all essential.
2) Make sure you are in compliance with federal and state regulations. “Just because it’s telehealth doesn’t mean HIPAA isn’t in play here,” Reagan pointed out. “One of the main things I tell people is to make sure you’ve got a secure platform from a privacy view.” Similarly, out-of-state providers looking to come into Tennessee still must meet the state’s corporate practice of medicine rules.
3) Telehealth start-ups should be very aware of the changing reimbursement landscape across the country. “Not everyone has parity laws,” Reagan said. “Every state is going to be different in how restrictive they are going to be on this.” And, he added, “Medicare most certainly does not pay on an equal footing as commercial payers even in states with parity laws like Tennessee.”
However, Reagan said it’s hard to conceive of a scenario where the use of telehealth doesn’t continue to grow for many years to come.
“It’s going to take a little while for practice to catch up with technology, but I don’t see a future where this hasn’t expanded greatly. It’s just the way of the world,” he concluded.