Tennessee

Counselors

Source

(Rule 0450-02-.13, continued)

April, 2020 (Revised) 28

“(4) In addition to the other requirements of this rule, all licensees and certificate holders who

practice marital and family therapy electronically shall comply with the Online Ethical

Advisory Opinions adopted by the AAMFT, www.aamft.org, except to the extent that they

conflict with the laws of the state of Tennessee or the rules of the Board. If the standards for

the ethical practice of marital and family therapy over the Internet conflict with state law or

rules, the state law or rules govern the matter. Violation of the standards for the ethical

practice of marital and family therapy over the Internet or state law or rules may subject a

licensee or certificate holder to disciplinary action.”

Source

“Section H Distance Counseling, Technology, and Social Media Introduction Counselors understand that the profession of counseling may no longer be limited to in-person, face-to-face interactions. Counselors actively attempt to understand the evolving nature of the profession with regard to distance counseling, technology, and social media and how such resources may be used to better serve their clients. Counselors strive to become knowledgeable about these resources. Counselors understand the additional concerns related to the use of distance counseling, technology, and social media and make every attempt to protect confidentiality and meet any legal and ethical requirements for the use of such resources. H.1. Knowledge and Legal Considerations H.1.a. Knowledge and Competency Counselors who engage in the use of distance counseling, technology, and/ or social media develop knowledge and skills regarding related technical, ethical, and legal considerations (e.g., special certifications, additional course work). H.1.b. Laws and Statutes Counselors who engage in the use of distance counseling, technology, and social media within their counseling practice understand that they may be subject to laws and regulations of both the counselor’s practicing location and the client’s place of residence. Counselors ensure that their clients are aware of pertinent legal rights and limitations governing the practice of counseling across state lines or international boundaries.

H.2. Informed Consent and Security H.2.a. Informed Consent and Disclosure Clients have the freedom to choose whether to use distance counseling, social media, and/or technology within the counseling process. In addition to the usual and customary protocol of informed consent between counselor and client for face-to-face counseling, the following issues, unique to the use of distance counseling, technology, and/ or social media, are addressed in the informed consent process: • distance counseling credentials, physical location of practice, and contact information; • risks and benefits of engaging in the use of distance counseling, technology, and/or social media; • possibility of technology failure and alternate methods of service delivery; • anticipated response time; • emergency procedures to follow when the counselor is not available; • time zone differences; • cultural and/or language differences that may affect delivery of services;

• possible denial of insurance benefits; and • social media policy. H.2.b. Confidentiality Maintained by the Counselor Counselors acknowledge the limitations of maintaining the confidentiality of electronic records and transmissions. They inform clients that individuals might have authorized or unauthorized access to such records or transmissions (e.g., colleagues, supervisors, employees, information technologists). H.2.c. Acknowledgment of Limitations Counselors inform clients about the inherent limits of confidentiality when using technology. Counselors urge clients to be aware of authorized and/ or unauthorized access to information disclosed using this medium in the counseling process. H.2.d. Security Counselors use current encryption standards within their websites and/or technology-based communications that meet applicable legal requirements. Counselors take reasonable precautions to ensure the confidentiality of information transmitted through any electronic means. H.3. Client Verification Counselors who engage in the use of distance counseling, technology, and/ or social media to interact with clients take steps to verify the client’s identity at the beginning and throughout the therapeutic process. Verification can include, but is not limited to, using code words, numbers, graphics, or other nondescript identifiers. H.4. Distance Counseling Relationship H.4.a. Benefits and Limitations Counselors inform clients of the benefits and limitations of using technology applications in the provision of counseling services. Such technologies include, but are not limited to, computer hardware and/or software, telephones and applications, social media and Internet-based applications and other audio and/or video communication, or data storage devices or media”

Social Workers

We are not aware of any specific rules and regulations of the practice of telemental health services for Social Workers.

Marriage and Family Therapists

Source

(Rule 0450-02-.13, continued)

April, 2020 (Revised) 28

“(4) In addition to the other requirements of this rule, all licensees and certificate holders who

practice marital and family therapy electronically shall comply with the Online Ethical

Advisory Opinions adopted by the AAMFT, www.aamft.org, except to the extent that they

conflict with the laws of the state of Tennessee or the rules of the Board. If the standards for

the ethical practice of marital and family therapy over the Internet conflict with state law or

rules, the state law or rules govern the matter. Violation of the standards for the ethical

practice of marital and family therapy over the Internet or state law or rules may subject a

licensee or certificate holder to disciplinary action.”

Source

“Section H Distance Counseling, Technology, and Social Media Introduction Counselors understand that the profession of counseling may no longer be limited to in-person, face-to-face interactions. Counselors actively attempt to understand the evolving nature of the profession with regard to distance counseling, technology, and social media and how such resources may be used to better serve their clients. Counselors strive to become knowledgeable about these resources. Counselors understand the additional concerns related to the use of distance counseling, technology, and social media and make every attempt to protect confidentiality and meet any legal and ethical requirements for the use of such resources. H.1. Knowledge and Legal Considerations H.1.a. Knowledge and Competency Counselors who engage in the use of distance counseling, technology, and/ or social media develop knowledge and skills regarding related technical, ethical, and legal considerations (e.g., special certifications, additional course work). H.1.b. Laws and Statutes Counselors who engage in the use of distance counseling, technology, and social media within their counseling practice understand that they may be subject to laws and regulations of both the counselor’s practicing location and the client’s place of residence. Counselors ensure that their clients are aware of pertinent legal rights and limitations governing the practice of counseling across state lines or international boundaries.

H.2. Informed Consent and Security H.2.a. Informed Consent and Disclosure Clients have the freedom to choose whether to use distance counseling, social media, and/or technology within the counseling process. In addition to the usual and customary protocol of informed consent between counselor and client for face-to-face counseling, the following issues, unique to the use of distance counseling, technology, and/ or social media, are addressed in the informed consent process: • distance counseling credentials, physical location of practice, and contact information; • risks and benefits of engaging in the use of distance counseling, technology, and/or social media; • possibility of technology failure and alternate methods of service delivery; • anticipated response time; • emergency procedures to follow when the counselor is not available; • time zone differences; • cultural and/or language differences that may affect delivery of services;

• possible denial of insurance benefits; and • social media policy. H.2.b. Confidentiality Maintained by the Counselor Counselors acknowledge the limitations of maintaining the confidentiality of electronic records and transmissions. They inform clients that individuals might have authorized or unauthorized access to such records or transmissions (e.g., colleagues, supervisors, employees, information technologists). H.2.c. Acknowledgment of Limitations Counselors inform clients about the inherent limits of confidentiality when using technology. Counselors urge clients to be aware of authorized and/ or unauthorized access to information disclosed using this medium in the counseling process. H.2.d. Security Counselors use current encryption standards within their websites and/or technology-based communications that meet applicable legal requirements. Counselors take reasonable precautions to ensure the confidentiality of information transmitted through any electronic means. H.3. Client Verification Counselors who engage in the use of distance counseling, technology, and/ or social media to interact with clients take steps to verify the client’s identity at the beginning and throughout the therapeutic process. Verification can include, but is not limited to, using code words, numbers, graphics, or other nondescript identifiers. H.4. Distance Counseling Relationship H.4.a. Benefits and Limitations Counselors inform clients of the benefits and limitations of using technology applications in the provision of counseling services. Such technologies include, but are not limited to, computer hardware and/or software, telephones and applications, social media and Internet-based applications and other audio and/or video communication, or data storage devices or media”

Psychologists

Source

Tennessee is a PSYPACT PARTICIPATING STATE- TN S 161 (Enacted 5/11/2021)

"To practice telepsychology under the authority of PSYPACT, you will need to apply for and obtain an E.Passport from the Association of State and Provincial Psychology Boards (ASPPB) and apply for and obtain an Authority to Practice Interjurisdictional Telepsychology (APIT) from the PSYPACT Commission."

Refer to the source provided for all requirements and limitations.

Psychiatrists

Source

Tennessee Code Annotated, Section 63-1-155 

“"Store-and-forward telemedicine services" means the use of asynchronous

computer-based communications 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;

and

(3) "Telehealth," "telemedicine," and "provider-based telemedicine" mean:

(A) 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

(B) Store-and-forward telemedicine services.”

Source

0880-02-.16 TELEMEDICINE LICENSURE AND THE PRACTICE OF TELEMEDICINE. 

“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.

(1) Definitions -

(a) Facilitator – The facilitator is an individual often affiliated with a local system of care or

a parent or legal guardian of the patient. The facilitator must be physically present with

the patient and is responsible for verifying the identity and location of the patient and 

GENERAL RULES AND REGULATIONS GOVERNING CHAPTER 0880-02

THE PRACTICE OF MEDICINE

(Rule 0880-02-.16, continued)

May, 2017 (Revised) 52

for the origination, collection and transmission of data in the form of images or clinical

data to the physician performing the evaluation remotely.

(b) Medical interpretation – The performance of a medical interpretation by a physician is

the rendering of a diagnosis regarding a particular patient by examination of radiologic

imaging studies, tissue specimens, bodily fluid specimens (including, but not limited to

urine, blood and cerebrospinal fluid) or medical records requested by another physician

or licensed health care provider.

(c) Patient encounter – The rendering of a documented medical opinion concerning

evaluation, diagnosis, and/or treatment of a patient whether the physician is physically

present in the same room, in a remote location within the state or across state lines.

(d) Physician-patient relationship – A physician-patient relationship exists when a

physician serves a patient’s medical needs whether or not there has been an

encounter in person between the physician and patient.

(e) Research hospital – A hospital at which fifty percent (50%) or more of the inpatients

treated during the previous calendar year were treated pursuant to research protocols.

(f) Store-and-forward technology – The use of asynchronous electronic 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 includes the

transferring of medical data from one site to another through the use of a device that

records or stores images that are sent or forwarded via electronic communication to

another site for consultation.

(g) Telemedicine – 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.”

Tennessee Professional Regulation/Health & Safety Online Prescribing

Source

TN Rule Annotated, 0880-02-.14(7(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:
• 1. Performed an appropriate history and physical examination; and
• 2. Made a diagnosis based upon the examinations and all diagnostic and laboratory
• tests consistent with good medical care; and
• 3. Formulated a therapeutic plan, and discussed it, along with the basis for it and
• the risks and benefits of various treatments options, a part of which might be the
• prescription or dispensed drug, with the patient; and
• 4. Insured availability of the physician or coverage for the patient for appropriate
• follow-up care.

Source

TN Rule Annotated, 0880-02.-16(6(a))

“A physician-patient relationship can be established via telemedicine with or without a facilitator present. Certain conditions apply in each case. See rule for details.”

Refer to the source provided for all requirements and limitations.

Nurses

"As a party state to the Nurse Licensure Compact (NLC), Tennessee issues multistate licenses to nurses and applicants who reside in the state and recognizes multistate licenses issued by other party states, for practice in Tennessee. A nurse holding a multistate license is entitled to practice in any NLC party state, but must comply at all times with the laws of the state where he or she is currently practicing.”

“It should be noted that not every state in the US is an NLC party state; a map of participating states, as well as further resources related to the NLC, are available on the Nurse Licensure Compact website.”

Refer to the source provided for all requirements and limitations.

Tennessee Professional Regulation/Health & Safety Online Prescribing

Source

TN Rule Annotated, 0880-02-.14(7(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:
• 1. Performed an appropriate history and physical examination; and
• 2. Made a diagnosis based upon the examinations and all diagnostic and laboratory
• tests consistent with good medical care; and
• 3. Formulated a therapeutic plan, and discussed it, along with the basis for it and
• the risks and benefits of various treatments options, a part of which might be the
• prescription or dispensed drug, with the patient; and
• 4. Insured availability of the physician or coverage for the patient for appropriate
• follow-up care.

Source

TN Rule Annotated, 0880-02.-16(6(a))

“A physician-patient relationship can be established via telemedicine with or without a facilitator present. Certain conditions apply in each case. See rule for details.”

Refer to the source provided for all requirements and limitations.

Medicaid Telehealth Parity Law

Source: TN Code Annotated, Title 56, Ch. 7, Part 1002(e) & (g)

"(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, 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.

(g) Any provisions not stipulated by this section shall be governed by the terms and conditions of the health insurance contract."

Refer to the source provided for all requirements and limitations.

Originating Site Reimbursement: We are not aware of the patient's home or similar location as an approved originating site.

Private Pay Telehealth Parity Law

Source: TN Code Annotated, Title 56, Ch. 7, Part 1002

"(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, 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.

(g) Any provisions not stipulated by this section shall be governed by the terms and conditions of the health insurance contract."

Refer to the source provided for all requirements and limitations.

Payment Parity

Source: TN Code Annotated, Title 56, Ch. 7, Part 1002

"(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, 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.

(g) Any provisions not stipulated by this section shall be governed by the terms and conditions of the health insurance contract."

Refer to the source provided for all requirements and limitations.

*Clinicians who have had an experience with telehealth reimbursement in this state are invited to share their experiences in the comments section below: a) type of service provided; b) insurance provider; c) payment parity, payment issues, or insurance requirements. 

Permission for the Temporary Practice of Clinicians Licensed Outside the State

Tennessee once provided a "Telemedicine License"

TN Rule Annotated, Rule 0880-02.-16.(2)

Refer to the source provided for all requirements and limitations.