Requirements
Each health insurer that issues individual or group accident and sickness insurance policies for healthcare services and/or provides a healthcare plan for healthcare services shall provide coverage for the cost of such covered healthcare services provided through telemedicine services, as provided in this section.
A health insurer shall not exclude a healthcare service for coverage solely because the healthcare service is provided through telemedicine and is not provided through in-person consultation or contact, so long as such healthcare services are medically necessary and clinically appropriate to be provided through telemedicine services.
All medically necessary and clinically appropriate telemedicine services delivered by in-network primary care providers, registered dietitian nutritionists, and behavioral health providers shall be reimbursed at rates not lower than services delivered by the same provider through in-person methods.
Benefit plans offered by a health insurer shall not impose a deductible, copayment, or coinsurance requirement for a healthcare service delivered through telemedicine in excess of what would normally be charged for the same healthcare service when performed in person.
Prior authorization requirements for medically necessary and clinically appropriate telemedicine services shall not be more stringent than prior authorization requirements for in-person care. No more stringent medical or benefit determination and utilization review requirements shall be imposed on any telemedicine service than is imposed upon the same service when performed in person.
Except for requiring compliance with applicable state and federal laws, regulations, and/or guidance, no health insurer shall impose any specific requirements as to the technologies used to deliver medically necessary and clinically appropriate telemedicine services.
SOURCE: RI General Law, Sec. 27-81-4, (Accessed May 2025).
“Medically necessary” means medical, surgical, or other services required for the prevention, diagnosis, cure, or treatment of a health-related condition, including services necessary to prevent a decremental change in either medical or mental health status.
SOURCE: RI General Law, Sec. 27-81-3, (Accessed May 2025).
Each health insurer shall collect and provide to the office of the health insurance commissioner (OHIC), in a form and frequency acceptable to OHIC, information and data reflecting its telemedicine policies, practices, and experience. OHIC shall provide this information and data to the general assembly on or before January 1, 2022, and on or before each January 1 thereafter.
SOURCE: RI General Law, Sec. 27-81-7. (Accessed May 2025).
“Primary care expenditures” means all claims-based and non-claims-based payments by the health insurer directly to a Primary Care Practice or Integrated System of Care for primary care services delivered to Rhode Island residents at a primary care site of care, which shall include a primary care outpatient setting, federally qualified health center, school-based health center, or via telehealth, but shall not include a third-party telehealth vendor that does not contract with such sites of care to deliver services. A primary care site of care also does not include urgent care centers or retail pharmacy clinics.
Health insurers shall establish written standards and procedures to notify providers of all eligibility determinations electronically and telephonic at the time eligibility determination is requested by the provider.
The primary care specialty provider taxonomy codes to be used by health insurers to meet the primary care expenditure requirements defined in § 4.10(B)(1) of this Part shall be as follows.
- Telephone evaluation codes, interprofessional phone/internet codes, and digital evaluation codes are listed.