BME Interprets APRN and PA Site Visit Requirement for Telehealth

February 14, 2022
 

Nashville, TN – State rules in place for over 25 years addressing the collaborative team relationship between physicians and advance practice registered nurses (APRNs) and physician assistants (PAs) require that the collaborating physician make on-site visits at least once every thirty (30) days to the remote site where the APRN/PA practices.

There are exceptions for APRNs and PAs who provide voluntary health care services or services in a free clinic as well as those who practice in a community mental health center. Those practice settings do not require the collaborating physician to make monthly on-site visits to remote sites. Required monthly visits at those clinics may be conducted by HIPAA-compliant electronic means instead. There is a bill in 2022 to add FQHCs.

For all other collaborative relationships, several questions arose during 2021 as to what constitutes the remote site when the health care practitioners practice telehealth. At its January 2022 meeting, the Tennessee Board of Medical Examiners (BME) addressed some of these issues via private advisory rulings.

Except for the exceptions outlined above, required monthly site visits cannot be conducted by HIPAA-compliant electronic means according to the BME’s interpretation of its existing rules. Inquiries arose from physicians who collaborate with APRNs who conduct telehealth visits on patients from the APRNs’ homes. The doctors asked where is the remote site, the patients’ homes or the APRN’s home?

The BME determined that the remote site for purposes of the required remote site monthly visits by collaborating physicians was the APRN’s home or a site agreed upon by the collaborating physician and APRN in their collaborative practice agreement. The BME opined that such visits could not be via HIPAA compliant electronic means.

These advisory opinions did not impact chart reviews. Those can be conducted via electronic means.

Physicians who collaborate with APRNs and PAs who practice via telehealth should agree on a site for the monthly in-person site visits in their collaborative practice agreements. At APRN and PA practice sites which are brick and mortar clinics, the clinic would be considered the remote site for purposes of the required monthly in-person visit.

The BME is authorized by statute to issue advisory private letter rulings to any affected licensee who makes such a request regarding any matters within the board's primary jurisdiction. The private letter advisory ruling only affects the licensee making the request and shall have no precedential value for any other inquiry or future contested case to come before the board. Although such rulings by the BME are private, they are discussed in both the public BME’s Development Committee and full board meetings. TMA passes along these rulings to its members as guidance as to how the BME might interpret and enforce its laws.

TMA members can contact the TMA legal department at legal@tnmed.org for assistance at in crafting private advisory letter ruling requests or with any other questions.