Featured Legal News: Prior Authorization

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4/22/2024

 

Prior Authorization 
The prior authorization process with insurance plans is a burden for physician practices and can disrupt patient care. TMA worked during the 2023 session of the General Assembly to pass the Prior Authorization Fairness Act. This Law Guide topic, Prior Authorization for Insurance Plans, provides detail on this new law that is effective Jan. 1, 2025.

Doctor Shopping Guide
If a prescriber has actual knowledge that a patient has knowingly, willfully and with an intent to deceive, obtained or attempted to obtain a controlled substance or one with similar therapeutic use within the previous 30 days from another prescriber, the patient must be reported to law enforcement. See our Law Guide topic, Doctor Shopping Guidance, for all the reporting requirements and how to report.  

E-rx controlled substances & Waiver renewal
Any prescription for a Schedule II – V controlled substance must be issued electronically unless the prescription falls under an exception or the prescriber has a waiver. A waiver must be requested 60 days prior to the expiration of the current waiver. The list of exceptions, a link to the waiver application, and the process to renew the waiver are discussed in our Law Guide topic, Prescriptions. Member login required.

Opioid Resource Center
In 2018, the Tennessee General Assembly passed comprehensive legislation to address the state’s opioid abuse epidemic. TMA’s Opioid Resource Center helps members remain compliant with opioid prescription requirements in Tennessee. Our resources include a one-page Prescriber Guide, a template Informed Consent to Receive Opioid Therapy, downloadable office posters for patients and employees, and a pocket card for patients that explains the requirements of the law.

Telemedicine LG topic
Tennessee law requires payment parity for telemedicine visits and allows reimbursement for audio only visits in specific circumstances. Review our Law Guide topic, Telemedicine, for all the details and requirements that must be met to receive the parity and audio-only payments.  

Wound & Overdose Reporting
The Wound and Overdose Reporting Law Guide by the Tennessee Medical Association discusses the reporting requirements when a physician sees a patient with specific wounds or injuries, including the possibility of reporting to local law enforcement.
 

 

 

For more information, email legal@tnmed.org.