Consent And Agreement Of Injured Worker

(1) Telehealth services providers must obtain electronic or written informed consent of an injured worker to accept telehealth services for any or all parts of the medical benefits to which the injured worker may be entitled under the workers’ compensation law. For authorized telephone visits, verbal consent given by the patient before the service shall be documented by the provider. This service shall be in accordance with applicable CMS guidelines at the time of service. (2) Pursuant to T.C.A. § 50-6-204, in all reported workers’ compensation claims in which the injured worker expresses a need for medical care, the employer must provide the injured worker with a panel of three (3) or more independent reputable physicians, surgeons, chiropractors or specialty practice groups on a Form C-42 Choice of Physicians form in accordance with bureau rules and pursuant to the workers’ compensation law. Provided that an injured worker is given a choice by the employer of three (3) or more medical providers who are qualified, willing and able to timely treat the injured worker’s injury in person, medical providers listed on a panel may, with both the injured worker’s consent and the willingness of the panel-listed medical provider, provide their services via telehealth, in accordance with the provisions of the Tennessee workers’ compensation law and all applicable rules and regulations of the state of Tennessee. Telehealth provider(s) listed on the Form C-42 Choice of Physicians form may be considered as an additional option(s) to those providers who are willing to treat the injured worker in person. (3) Before receiving medical benefits in the form of telehealth, an injured worker must be given an opportunity to request and receive in-person medical assessment and treatment. (4) An injured worker may refuse a telehealth encounter at the time of the panel choice without affecting future care or treatment to which the injured worker is entitled. If the telehealth choice is refused, the Form C-42 Choice of Physicians form offered shall include three (3) or more independent reputable physicians, surgeons, chiropractors or specialty practice groups who are qualified, willing and able to timely see and treat the injured worker in person. (5) The injured worker has the option to refuse telehealth during the initial visit or follow-up visits and to request that visits occur in person. If this occurs, and if the authorized treating physician agrees, the initial or remaining office visits with the authorized treating physician shall be in person. If the authorized treating physician declines to see the worker in person, the worker shall select a new authorized treating physician from the names remaining on the original panel TELEHEALTH FOR WORKERS’ COMPENSATION CHAPTER 0800-02-31 offered to the worker at the time the injury was reported. This subsequent choice becomes the new authorized treating physician. (6) Whenever an injured worker consents to a telehealth encounter, the injured worker shall have access to healthcare information as provided by any state of Tennessee and federal laws. The telehealth provider shall retain all medical records and documentation of the telehealth encounter in accordance with any state of Tennessee and federal laws. (7) Before an injured worker agrees to accept telehealth as part or all of his/her workers’ compensation medical benefits, a telehealth provider shall identify himself/herself by name and location and provide photo identification, a full spelling of his/her name, degree, specialty, and a Tennessee state professional license number. The telehealth provider shall also identify the names and job titles of any other health care professionals or persons present in the room with the telehealth provider before and during the telehealth encounter. (8) Before an injured worker receives telehealth treatment or care, the injured worker shall identify himself/herself by name and location and by showing to the provider a valid state or federally issued form of identification containing the injured worker’s name and photograph. Upon notice to the medical provider, an injured worker may allow other person(s) who shall be identified to the provider to be present on the injured worker’s behalf during the telehealth encounter. (9) Before electronically recording a telehealth encounter, the telehealth provider shall provide notice of such recording to an injured worker. An injured worker may object to the recording of a telehealth encounter. If such an objection is raised, the telehealth encounter shall not be recorded, and the telehealth provider shall make a traditional medical note of the telehealth encounter. (10) In addition to telehealth treatment consent before the telehealth encounter, the injured worker and the telehealth provider shall both acknowledge at the end of the session that they agreed that telehealth was appropriate for the injured workers’ medical condition, that the injured worker had agreed to receive medical care through telehealth, and that the technology used for the telehealth encounter was functioning correctly. (11) Any additional individual in attendance at any part or all of a telehealth visit, such as a case manager, shall identify himself/herself by name, affiliation, photo identification, title, degree, and location.