Our healthcare and business law firm previously published a blog post on the federal telemedicine rules. Both Federal and State rules govern the provision of telemedicine. Each state’s rules governing telemedicine are different, but the applicable laws and rules are generally found in the state medical board’s rules, insurance code, and when applicable, Medicaid rules. This post focuses specifically on Tennessee’s telemedicine prescribing rules. Our firm previously posted an overview of Tennessee’s general telemedicine rules. If you have questions about telemedicine rules or would like to discuss this blog post, you may contact our healthcare and business law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, email@example.com. You may also learn more about our law firm by visiting www.hamillittle.com.
Tennessee Rules on Prescribing Based on a Telemedicine Visit
A. General Telemedicine Prescribing Rules
In Tennessee, prescriptions for medication, including for controlled substances, may be issued pursuant to telemedicine encounters so long as otherwise medically appropriate and in compliance with relevant state and federal law. See Tenn. R. & Reg. § 0880-02-.14(7); Tenn. R. & Reg. § 1050-02-.13; see also Position Statement of Tennessee State Board of Medical Examiners, “Prerequisites to Prescribing or Dispensing Drugs – In Person, Electronically or over the Internet.” Tennessee Rule 0880-02-.14(7) includes specific requirements that must be met before a provider can prescribe from a telemedicine visit. More specifically, the Physician must complete the following before prescribing:
- Performed an appropriate history and physical examination; and
- Made a diagnosis based upon the examinations and all diagnostic and laboratory tests consistent with good medical care; and
- 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
- Insured availability of the physician or coverage for the patient for appropriate follow-up care.
The Tennessee Board of Medical Examiners has not defined “an appropriate history and physical examination.” As such, we suggest discussing these requirements with counsel to analyze whether an in-person physical exam is required. There may also be situations when a telemedicine visit provides insufficient information to determine a treatment plan or prescribe medication. Tenn. R. & Reg. § 0880-02-.16. There are also situations when the above four requirements need not be required. Tenn. R. & Reg. § 0880-02-.14(7). It is also an ethical violation for a physician to prescribe any drug to any individual the physician has never met solely on answers to a set of questions. Tenn. R. & Reg. § 0880-02-.14(7); Tenn. R. & Reg. § 1050-02-.13(6).
B. Prescribing Rules for Specific Situations
As with most states, all prescriptions for dangerous drugs or controlled substances for the treatment of pain may occur only after a physical examination by the prescribing-physician. Tenn. R. & Reg. §§ 0880-02-.14(6) & 1050-02-.13(5). Similarly, a physical examination is required prior to initiating hormone replacement therapy. Tenn. Code Ann. § 63-6-243.
As is clear from the above, medical practices must be thoughtful before prescribing from a telemedicine visit. If you have questions about telemedicine rules or would like to discuss this blog post, you may contact our healthcare and business law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, firstname.lastname@example.org. You may also learn more about our law firm by visiting www.hamillittle.com.
*Disclaimer: Thoughts shared here do not constitute legal advice.