Rhode Island

Disclaimer

PLEASE NOTE: CCHP is providing the following for informational purposes only. We are not providing legal advice or interpretation of the laws and regulations and policies. CCHP encourages you to check with the appropriate state agency for further information and direction. This information should not be construed as legal counsel. Consult with an attorney if you are seeking a legal opinion.

At A Glance
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MEDICAID REIMBURSEMENT

  • Live Video: Yes
  • Store-and-Forward: Yes (teledentistry)
  • Remote Patient Monitoring: No
  • Audio Only: Yes

PRIVATE PAYER LAW

  • Law Exists: Yes
  • Payment Parity: Yes

PROFESSIONAL REQUIREMENTS

  • Licensure Compacts: IMLC, NLC, PSY
  • Consent Requirements: Yes

STATE RESOURCES

  1. Medicaid Program: Rhode Island Medical Assistance Program
  2. Administrator: Rhode Island Dept. of Human Services
  3. Regional Telehealth Resource Center: Northeast Telehealth Resource Center
Disclaimer

PLEASE NOTE: CCHP is providing the following for informational purposes only. We are not providing legal advice or interpretation of the laws and regulations and policies. CCHP encourages you to check with the appropriate state agency for further information and direction. This information should not be construed as legal counsel. Consult with an attorney if you are seeking a legal opinion.

Last updated 02/01/2024

Definitions

“Telemedicine” means the delivery of clinical healthcare services by use of real time, two-way synchronous audio, video, telephone-audio-only communications or electronic media or other telecommunications technology including, but not limited to: online adaptive interviews, remote patient monitoring devices, audiovisual communications, including the application of secure video conferencing or store-and-forward technology to provide or support healthcare delivery, which facilitate the assessment, diagnosis, counseling and prescribing treatment, and care management of a patient’s health care while such patient is at an originating site and the healthcare provider is at a distant site, consistent with applicable federal laws and regulations. “Telemedicine” does not include an, email message, or facsimile transmission between the provider and patient, or an automated computer program used to diagnose and/or treat ocular or refractive conditions.

SOURCE:  RI General Law, Sec. 27-81-3. (Accessed Feb. 2024).

Last updated 02/01/2024

Parity

SERVICE PARITY

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.

SOURCE:  RI General Law, Sec. 27-81-4(b). (Accessed Feb. 2024).


PAYMENT PARITY

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.

SOURCE:  RI General Law, Sec. 27-81-4. (Accessed Feb.  2024).

Last updated 02/01/2024

Requirements

Each health insurer that issues individual or group accident and sickness insurance policies for health-care services and/or provides a health-care plan for health-care services shall provide coverage for the cost of such covered health-care services provided through telemedicine services.

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.

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 Feb. 2024).

“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 Feb. 2024).

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 Feb. 2024).

Last updated 02/01/2024

Definitions

“Telemedicine” means the delivery of clinical healthcare services by use of real time, two-way synchronous audio, video, telephone-audio-only communications or electronic media or other telecommunications technology including, but not limited to: online adaptive interviews, remote patient monitoring devices, audiovisual communications, including the application of secure video conferencing or store-and-forward technology to provide or support healthcare delivery, which facilitate the assessment, diagnosis, counseling and prescribing treatment, and care management of a patient’s health care while such patient is at an originating site and the healthcare provider is at a distant site, consistent with applicable federal laws and regulations. Telemedicine does not include an email message or facsimile transmission between the provider and patient, or an automated computer program used to diagnose and/or treat ocular or refractive conditions.

SOURCE: Rhode Island General Laws Sec. 27-81-3, (Accessed Feb. 2024).

Last updated 02/01/2024

Email, Phone & Fax

An encounter must include a face-to-face or telemedicine (telephone-only and tele video services) visit with a physician (including optometrists and psychiatrists), physician assistant, nurse practitioner (advanced practice registered nurses), clinical social worker, clinical psychologist, certified nurse midwife, clinical nurse specialist, licensed mental health counselor, licensed marriage and family therapist, dentist or registered dental hygienist.

SOURCE:  RI Executive Office of Health and Human Services, Principles of Reimbursement for FQHCs, Aug. 2022, pg. 5-6, (Accessed Feb. 2024).

The Medicaid Program does not pay for: …

  • information provided over the telephone

SOURCE: RI Medicaid Provider Reference Manual – Vision, Jan. 2023, pg. 7, (Accessed Feb. 2024).

Are telephone calls Medicaid billable?  Providers would have to check their contracts with the managed care organizations to see if telehealth is covered.

SOURCE: RI Medicaid, Peer Based Recover Support Services, FAQs, (Accessed Feb. 2024).

Last updated 02/01/2024

Live Video

POLICY

Each health insurer [includes Medicaid] 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.

SOURCE: Rhode Island General Laws Sec. 27-81-4. (Accessed Feb. 2024).


ELIGIBLE SERVICES/SPECIALTIES

 A health insurer [includes Medicaid] 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.

“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: Rhode Island General Laws Sec. 27-81-3 & 27-81-4, (Accessed Feb. 2024).

Rhode Island Medicaid’s fee schedule lists several telehealth service CPT codes for outpatient visits and limited emergency department inpatient telehealth consultations under procedure/professional services.  Reimbursement is available for initial inpatient telehealth consultation and follow-up inpatient telehealth consultation.  See their fee schedule look-up tool and telehealth specific codes, including G0406, G0407, G0408, G0425, G0426, G0427.

SOURCE: RI Department of Health. Medicaid Fee Schedule Look-Up. (Accessed Feb. 2024).

Community Health Worker Services

Health System Navigation and Resource Coordination Services that prevent disease, disability, and other health conditions or their progression; prolong life; and/or promote physical and mental health and efficiency.

The following are examples of health system navigation and resource coordination services:

  • Helping a beneficiary with a telehealth appointment and/or educating a member on the use of telehealth technology.

SOURCE: RI Executive Office of Health and Human Services Medicaid Program, Community Health Workers Provider Manual, pg. 8 (Jan. 2024). (Accessed Feb. 2024).


ELIGIBLE PROVIDERS

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.

SOURCE: Rhode Island General Laws Sec. 27-81-4, (Accessed Feb. 2024).

An encounter must include a face-to-face or telemedicine (telephone-only and tele video services) visit with a physician (including optometrists and psychiatrists), physician assistant, nurse practitioner (advanced practice registered nurses), clinical social worker, clinical psychologist, certified nurse midwife, clinical nurse specialist, licensed mental health counselor, licensed marriage and family therapist, dentist or registered dental hygienist.

SOURCE:  RI Executive Office of Health and Human Services, Principles of Reimbursement for FQHCs, Aug. 2022, pg. 5-6, (Accessed Feb. 2024).


ELIGIBLE SITES

“Originating site” means a site at which a patient is located at the time healthcare services are provided to them by means of telemedicine, which can include a patient’s home where medically necessary and clinically appropriate.

SOURCE: Rhode Island General Laws Sec. 27-81-3, (Accessed Feb. 2024).

New Place of Service Code

Due to recent changes made by Medicare, effective as of April 4, 2022 the Rhode Island Executive Office of Health & Human Services (EOHHS) is adding Place of Service Code 10 (Telehealth Provided in Patient’s Home) as a telehealth place of service for Fee-for-Service and Managed Care. Please submit telehealth claims with Place of Service Code 02 (Telehealth Provided Other than in Patient’s Home) or Place of Service Code 10 (Telehealth Provided in Patient’s Home) as applicable.

Fee-for-Service Providers should submit telehealth claims with the applicable Place of Service Code 10 for dates of service of April 4, 2022 forward.

SOURCE: Rhode Island Medicaid Program, Provider Update, Mar. 2023 . (Accessed Feb. 2024).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

Last updated 02/01/2024

Miscellaneous

Except for requiring compliance with applicable state and federal laws, regulations and/or guidance, no health insurer [includes Medicaid] shall impose any specific requirements as to the technologies used to deliver medically necessary and clinically appropriate telemedicine services.

SOURCE: Rhode Island General Laws Sec. 27-81-4 (Accessed Feb. 2024).

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: Rhode Island General Laws Sec. 27-81-7 (Accessed Feb. 2024).

Last updated 02/01/2024

Out of State Providers

No Reference Found

Last updated 02/01/2024

Overview

The Rhode Island Medical Assistance Program reimburses for some specific codes via live-video.  A newly passed law requires Medicaid provide coverage of telemedicine, which includes live video, store-and-forward and remote patient monitoring. CCHP has only located policy indicating RI Medicaid is reimbursing store-and-forward through teledentistry.

An encounter for FQHCS includes a telemedicine visit (telephone-only and tele video services).

Last updated 02/01/2024

Remote Patient Monitoring

POLICY

No Reference Found


CONDITIONS

No Reference Found


PROVIDER LIMITATIONS

No Reference Found


OTHER RESTRICTIONS

No Reference Found

Last updated 02/01/2024

Store and Forward

POLICY

Teledentistry Policy 

Teledentistry is not a specific service but a mode of accomplishing a particular service. Teledentistry may include communication from one dental provider to another. Providers are asked to bill nonpaying codes D9995 (Synchronous teledentistry) and D9996 (Asynchronous teledentistry) for documentation but should use applicable D codes. Frequency limitations for service codes apply. Dentists billing for exams completed by dentistry acknowledge they have received and reviewed essential information to make a diagnosis, comparable to what would be used in an in-person visit.

SOURCE: RI Executive Office of Health and Human Services Medicaid Program, Dental Manual, pg. 11. (Nov 2023). (Accessed Feb. 2024).


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

Last updated 02/01/2024

Cross State Licensing

A physician who is licensed to practice medicine in another state or states, but not in this state, and who is in good standing in such state or states, may exercise the privilege to practice medicine for a patient located in this state under the following circumstances only:

  • The physician is employed by a branch of the United States military, Department of Defense, Department of Veterans’ Affairs Division of Veterans’ Health Administration, or similar federal entity.
  • The physician is present in the state on a singular occasion as a member of an air ambulance treatment team or organ harvesting team.
  • The physician, whether or not physically present in this state, is being consulted on a singular occasion by a physician licensed in this state, or is providing teaching assistance in a medical capacity, for a period not to exceed seven (7) days. Under no circumstance may a physician who is not present in this state provide consultation to a patient in this state who does not have a physician-patient relationship with that physician unless that patient is in the physical presence of a physician licensed in this state.
  • The physician is present in the state for a period not to exceed seven (7) days as a volunteer physician serving in a non-compensated role for a charitable function.
  • The physician is present in this state while providing medical services to a sports team incorporated in the United States or another country.

See statute for additional requirements.

SOURCE:  RI General Law, Sec. 5-37-16.2. (Accessed Nov. 2023).

Speech Language Pathologists

No person shall practice as, advertise as, or use the title of speech-language pathologist or audiologist unless licensed in accordance with the provisions of the act and this section. The provisions of the act and this section shall not apply to individuals specifically exempt from the provisions thereof by § 5-48-10.

A provisional license for the clinical fellow as defined in this chapter shall be required in speech-language pathology for that period of postgraduate professional experience as required in §§ 5-48-7 and 5-48.2-5. A provisional license shall authorize an individual to practice speech language pathology solely in connection with the completion of the supervised postgraduate professional experience.

Any person residing in and/or licensed in another state who provides telepractice services in the area of speech-language pathology and audiology within the State of Rhode Island regardless of their legal residence must be licensed in the state in accordance with the provisions of the act and this chapter. The provisions of the act and this chapter shall not apply to individual specifically exempt from the provisions thereof by § 5-48-10.

In addition to the requirements set forth in § 5-48-7.2, persons seeking initial licensure as an audiologist providing in-person or telepractice services shall meet certain requirements.  See law for license qualifications.

SOURCE: RI Statute 5-48.2-4 & 5, (Accessed Feb. 2024).

Last updated 02/01/2024

Definitions

Telemedicine is defined very generally as the delivery of healthcare where there is no in-person exchange. Telemedicine, more specifically, is a mode of delivering healthcare services and public health utilizing information and communication technologies to enable the diagnosis, consultation, treatment, education, care management, and self-management of patients at a distance from health care providers.

SOURCE: RI Department of Health. Telemedicine. (Accessed Feb. 2024).

“Telemedicine” means, as defined in R.I. Gen. Laws § 27-81-3, the delivery of clinical healthcare services by use of real time, two (2) way synchronous audio, video, telephone-audio-only communications or electronic media or other telecommunications technology including but not limited to: online adaptive interviews, remote patient monitoring devises, audiovisual communications, including the application of secure video conferencing or store-and-forward technology to provide or support healthcare deliver, which facilitate the assessment, diagnosis, counseling an prescribing treatment and care management of a patient’s healthcare while such patient is at an originating site and the healthcare provider is at a distant site, consistent with applicable Federal laws and Regulation. Telemedicine does not include an email message or facsimile transmission between the provider and patient, or an automated computer program used to diagnose and/or treat ocular or refractive conditions.

SOURCE: Code of RI Rules, 216-40-05-1 & Rhode Island General Laws Sec. 27-81-3, (Accessed Feb. 2024).

Telemedicine is defined very generally as the delivery of health care where there is no in-person exchange. Telemedicine, more specifically, is a mode of delivering health care services and public health utilizing information and communication technologies to enable the diagnosis, consultation, treatment, education, care management, and self-management of patients at a distance from health care providers.

SOURCE: Rhode Island Board of Medical Licensure and Discipline, Guidelines for the Appropriate Use of Telemedicine and the Internet in Medical Practice, (Accessed Feb. 2024).

Speech Language Pathologists

“Telepractice” means the use of telecommunication technology to deliver speech language pathology and audiology services remotely. Other terms such as teleaudiology, telespeech and speech teletherapy are also used in addition to telepractice. Use of telepractice should be of equal quality to services provided in person and consistent with adherence to ASHA’s Code of Ethics (ASHA, 2016a), Scope of Practice in Audiology (ASHA, 2018), Scope of Practice in Speech-Language Pathology (ASHA, 2016b), and Assistants Code of Conduct (ASHA, 2020).

SOURCE: Rhode Island Gen. Laws Sec. 5-48.2-3, (Access Feb. 2024).

Last updated 02/01/2024

Licensure Compacts

Member of Psychology Interjurisdictional Compact.

SOURCE: PSYPACT Compact. (Accessed Feb. 2024).

Member of the Interstate Medical Licensure Compact.

SOURCE: Interstate Medical Licensure Compact. (Accessed Feb. 2024).

Nurse Licensing Compact

SOURCE: NCSBN, Nurse Licensing Compact Map, (Accessed Feb. 2024).

* See Compact websites for implementation and license issuing status and other related requirements.

Last updated 02/01/2024

Miscellaneous

See Department of Health Policy for Department of Health Telemedicine Guidelines for other requirements on RI providers, including medical records, disclosures, and advertising.

SOURCE: RI Department of Health. Telemedicine. (Accessed Feb. 2024).

Virtual Assessment Mechanisms for Eye Exams

An assessment mechanism to conduct an eye assessment or to generate a prescription for contact lenses or visual aid glasses in Rhode Island shall:

  • Provide synchronous or asynchronous interaction between the patient and the provider;
  • Collect the patient’s medical history, previous prescription for corrective eyewear, and length of time since the patient’s most recent in-person comprehensive eye health examination.
  • Disclose to patients and require acceptance in advance as a term of use that:
    • This assessment is not a replacement of an in-person comprehensive eye health examination;
    •  This assessment cannot be used to generate an initial prescription for contact lenses or a follow-up or first renewal of the initial prescription.
    • This assessment may only be used if the patient has had an in-person comprehensive eye health examination within the previous twenty-four (24) months if the patient is conducting an eye assessment or receiving a prescription for visual aid glasses; and
    • The United States Centers for Disease Control and Prevention (CDC) advises contact lens wearers to visit an eye doctor one time a year or more often if needed.

SOURCE:  RI General Law Title 23-97-3. (Accessed Feb. 2024).

Last updated 02/01/2024

Online Prescribing

Treatment and consultation recommendations made in an online setting, including issuing a prescription via electronic means, will be held to the same standards of appropriate practice as those in face-to-face settings. Treatment, including issuing a prescription, based solely on an online questionnaire without an appropriate evaluation does not constitute an acceptable standard of care and is considered unprofessional conduct.

Sufficient security measures must be in place and documented to assure confidentiality and integrity of patient-identifiable information. Transmissions, including patient e-mail, prescriptions and laboratory results must be secure within existing technology (i.e., password protected, encrypted electronic prescriptions, or other reliable authentication techniques). Patient-physician e-mail, as well as other patient-related electronic communications that is pertinent to the diagnosis and treatment of the patient should be stored and filed in the patient’s medical record.

SOURCE: RI Department of Health. Telemedicine. (Accessed Feb. 2024).

Treatment and consultation recommendations made in an online setting, including issuing a prescription via electronic means, will be held to the same standards of appropriate practice as those in face-to-face settings. Therefore, consistent with the definition of telemedicine, provided in § 1.2(A)(25) of this Part, treatment, including issuing a prescription, based solely on an online questionnaire without an appropriate evaluation does not constitute an acceptable standard of care and is considered unprofessional conduct. Asynchronous evaluation of a patient, without contemporaneous real-time, interactive exchange between the physician and patient, is not appropriate.

SOURCE: Code of RI Rules, 216-40-05-1, (Accessed Feb. 2024).

This relationship is complex and based on the mutual understanding between physician and patient of the shared responsibility for the patient’s health care. The physician should recognize that the patient-physician relationship in Telemedicine and Internet medicine is inherently different. It is possible, if not probable, that the physician and patient will never meet in-person. It is the physician who has the professional responsibility to consider these differences in their evaluation and management of the patient. The BMLD defines the beginning of the physician-patient relationship as being clearly established when the physician agrees to undertake diagnosis and treatment of the patient and the patient agrees, whether or not there has been an in-person encounter between the physician (or other health care practitioner) and patient.

The physician-patient relationship is fundamental to the provision of acceptable medical care. It is the expectation of the BMLD that physicians recognize the obligations, responsibilities and patient rights associated with establishing and maintaining an appropriate physician-patient relationship whether or not face-to-face contact between physician and patient has occurred. However, whenever a patient’s clinical presentation suggests the need for an in-person physical examination, the patient should be referred for an in-person evaluation which is documented in the medical record. Failure to make necessary referrals or progressions to treatments without doing so constitutes unprofessional conduct.

Treatment and consultation recommendations made in an online setting, including issuing a prescription via electronic means, will be held to the same standards of appropriate practice as those in face-to-face settings. Treatment, including issuing a prescription, based solely on an online questionnaire without an appropriate evaluation does not constitute an acceptable standard of care and is considered unprofessional conduct. The BMLD specifically highlights that prescribing controlled substances without an established in-person physician-patient relationship is prohibited. (Exception* a covering physician may prescribe a controlled substance if an established coverage agreement is in place and the quantity reflects the prescription is for a short duration)

SOURCE: Rhode Island Board of Medical Licensure and Discipline, Guidelines for the Appropriate Use of Telemedicine and the Internet in Medical Practice, (Accessed Feb. 2024).

Life-Saving Allergy Medication – Emergency Administration

An authorized entity that acquires a stock supply of epinephrine auto-injectors pursuant to a prescription issued in accordance with this chapter, may make such epinephrine auto-injectors available to individuals other than those trained individuals described in § 23-6.4-6, and such individuals may administer such epinephrine auto-injector to any individual believed in good faith to be experiencing anaphylaxis, if the epinephrine auto-injectors are stored in a locked, secure container and are made available only upon remote authorization by an authorized healthcare provider after consultation with the authorized healthcare provider by audio, televideo, or other similar means of electronic communication. Consultation with an authorized healthcare provider for this purpose shall not be considered the practice of telemedicine or otherwise be construed as violating any law or rule regulating the authorized healthcare provider’s professional practice.

SOURCE: RI Gen. Laws 23-6.4-5, (Accessed Feb. 2024).

Emergency Rule – Prescribing of EpiPens

An authorized entity which chooses to acquire and stock a supply of epinephrine auto-injectors must maintain an Operations plan on the premises. The plan shall include at a minimum: …

  • Description of the process to allow individuals, other than those trained per R.I. Gen. Laws § 23-6.4-6, to be provided the epinephrine auto-injectors via remote authorization by an authorized health care provider, after consultation with the authorized health care provider by audio, tele-video, or other similar means of electronic communication, pursuant to R.I. Gen. Laws § 23-6.4-5.

SOURCE:  RI Regulations Title 216, Sec. 20-10-5, (Accessed Feb. 2024).

Last updated 02/01/2024

Professional Board Standards

Professionals licensed utilizing telemedicine in the practice of dentistry are subject to the same standard of care that would apply to the provision of the same dental care service or procedure in an in-person setting.

SOURCE: RI General Law Chapter 5-31.1-40 (Accessed Feb. 2024).

RI Department of Health, Board of Medical Licensure and Discipline has Guidelines for the Appropriate Use of Telemedicine and the Internet in Medical Practice to follow.

SOURCE: Rhode Island Board of Medical Licensure and Discipline, Guidelines for the Appropriate Use of Telemedicine and the Internet in Medical Practice, (Accessed Feb. 2024).

Speech Language Pathologists

Telepractice requirements for speech language patholoigsts are contained in statute.

SOURCE:  RI Statute 5-48.2-3 to 11, (Accessed Feb. 2024).

See Misc. section for virtual eye assessment requirements.

Last updated 02/01/2024

Definition of Visit

Visit/Encounter Definition:  The APM is designed to reflect the cost for all the services associated with a comprehensive primary care, behavioral health or dental visit, even if not all the services occur on the same day. Stand-alone billable visits are typically evaluation and management type of services or screenings for certain preventive services. The professional component of a procedure is usually a covered service, but is not a stand-alone billable visit, even when furnished by an FQHC practitioner.  As such, some services do not count as encounters eligible for the PPS or APM rate.

An encounter must include a face-to-face or telemedicine (telephone-only and tele video services) visit with a physician (including optometrists and psychiatrists), physician assistant, nurse practitioner (advanced practice registered nurses), clinical social worker, clinical psychologist, certified nurse midwife, clinical nurse specialist, licensed mental health counselor, licensed marriage and family therapist, dentist or registered dental hygienist.

An encounter must involve a patient who is Medicaid eligible on the date of service.

The terms “visit” and “encounter” may be used interchangeably.

SOURCE:  RI Executive Office of Health and Human Services, Principles of Reimbursement for FQHCs, Aug. 2022, pg. 5-6, (Accessed Feb. 2024).

Last updated 02/01/2024

Eligible Distant Site

An encounter must include a face-to-face or telemedicine (telephone-only and tele video services) visit with a physician (including optometrists and psychiatrists), physician assistant, nurse practitioner (advanced practice registered nurses), clinical social worker, clinical psychologist, certified nurse midwife, clinical nurse specialist, licensed mental health counselor, licensed marriage and family therapist, dentist or registered dental hygienist.

SOURCE:  RI Executive Office of Health and Human Services, Principles of Reimbursement for FQHCs, Aug. 2022, pg. 5-6, (Accessed Feb. 2024).

Law requires that all medically necessary and clinically appropriate telemedicine services delivered by in-network primary care providers, registered dietitian nutritionists and behavioral health providers be reimbursed at a rate not lower than services provided in-person. No explicit reference is made to FQHCs.

See: RI Medicaid Live Video Eligible Providers

Last updated 02/01/2024

Eligible Originating Site

RI Medicaid defines the originating site to be the patient’s location at the time healthcare services are provided by means of telemedicine and includes the patient’s home.  No explicit reference is made to FQHCs.

See: RI Medicaid Live Video Eligible Sites

Last updated 02/01/2024

Facility Fee

No Reference found

Last updated 02/01/2024

Home Eligible

Home is allowed as originating site in RI Medicaid, however it is unclear if it applies to FQHCs.

See: RI Medicaid Live Video Eligible Sites

Last updated 02/01/2024

Modalities Allowed

Live Video

An encounter must include a face-to-face or telemedicine (telephone-only and tele video services) visit with a physician (including optometrists and psychiatrists), physician assistant, nurse practitioner (advanced practice registered nurses), clinical social worker, clinical psychologist, certified nurse midwife, clinical nurse specialist, licensed mental health counselor, licensed marriage and family therapist, dentist or registered dental hygienist.

SOURCE:  RI Executive Office of Health and Human Services, Principles of Reimbursement for FQHCs, Aug. 2022, pg. 5-6, (Accessed Feb. 2024).

See:  RI Medicaid Live Video


Store and Forward

No explicit reference has been found to RI Medicaid reimbursing for store-and-forward.

See: RI Medicaid Store-and-Forward.


Remote Patient Monitoring

No explicit reference has been found to RI Medicaid reimbursing for remote patient monitoring. 

See:  RI Medicaid Remote Patient Monitoring


Audio-Only

An encounter must include a face-to-face or telemedicine (telephone-only and tele video services) visit with a physician (including optometrists and psychiatrists), physician assistant, nurse practitioner (advanced practice registered nurses), clinical social worker, clinical psychologist, certified nurse midwife, clinical nurse specialist, licensed mental health counselor, licensed marriage and family therapist, dentist or registered dental hygienist.

SOURCE:  RI Executive Office of Health and Human Services, Principles of Reimbursement for FQHCs, Aug. 2022, pg. 5-6, (Accessed Feb. 2024).

See: RI Medicaid Email, Phone and Fax

Last updated 02/01/2024

Patient-Provider Relationship

No reference found

Last updated 02/01/2024

PPS Rate

No reference found

Last updated 02/01/2024

Same Day Encounters

Visits with more than one (1) professional on the same day will be deemed as one (1) encounter unless one (1) visit is medical, one (1) is behavioral health, or one (1) is dental, or the patient suffers an additional or different illness requiring another visit. The visit must be documented in the patient’s chart and must meet commonly accepted standards for medical record documentation.

SOURCE:  RI Executive Office of Health and Human Services, Principles of Reimbursement for FQHCs, Aug. 2022, pg. 5-6, (Accessed Feb. 2024).