Rhode Island

At A Glance
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MEDICAID REIMBURSEMENT

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

PRIVATE PAYER LAW

  • Law Exists: Yes
  • Payment Parity: Yes

PROFESSIONAL REQUIREMENTS

  • Licensure Compacts: None
  • 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

Last updated 02/10/2022

Audio-Only Delivery

Medicaid:  COVID-19 Telehealth Guidance

STATUS: Active until further notice

Last updated 02/09/2022

Cross-State Licensing

No Reference Found

Last updated 02/10/2022

Easing Prescribing Requirements

No Reference Found

Last updated 02/10/2022

Miscellaneous

Health Insurance Commissioner: Network Adequacy

STATUS: Active during State of Emergency

Last updated 02/10/2022

Originating Site

Medicaid:  COVID-19 Telehealth Guidance

STATUS: Active until further notice

Last updated 02/10/2022

Private Payer

Health Insurance Commissioner:  Insurance Coverage

STATUS:  Active during State of Emergency

Health Insurance Commissioner and Medicaid: Program Instructions During COVID-19

STATUS: Active, until end of RI State of Emergency

Health Insurance Commissioner: Extension of Temporary Emergency Measures Regarding Benefit Determination Review and
Network Plans and Health Care Accessibility and Quality Assurance

STATUS: Active

Last updated 02/10/2022

Provider Type

Medicaid:  COVID-19 Telehealth Guidance

STATUS: Active until further notice

Last updated 02/10/2022

Service Expansion

Medicaid:  COVID-19 Telehealth Guidance

STATUS: Active until further notice

Office of Health Insurance Commissioner:  FAQs

STATUS: Active, until end of RI State of Emergency

Department of Health: Online Prescribing of EpiPens

STATUS: Active

Last updated 02/10/2022

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. 2022).

Last updated 02/10/2022

Email, Phone & Fax

No Reference Found

Last updated 02/10/2022

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. 2022).


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. 27-81-4, (Accessed Feb. 2022).

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. 2022).


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.. 2022).


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. 2022).

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.

SOURCE: Rhode Island Medicaid Program Feb. 2022 Provider Update. (Accessed Feb. 2022).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

Last updated 02/10/2022

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.

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. 27-81-4 (Accessed Feb. 2022).

Last updated 02/10/2022

Out of State Providers

No Reference Found

Last updated 02/10/2022

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 not located documentation from RI Medicaid that they are implementing the store-and-forward and remote patient monitoring pieces yet.

Last updated 02/10/2022

Remote Patient Monitoring

POLICY

No Reference Found


CONDITIONS

No Reference Found


PROVIDER LIMITATIONS

No Reference Found


OTHER RESTRICTIONS

No Reference Found

Last updated 02/10/2022

Store and Forward

POLICY

No Reference Found


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

Last updated 02/11/2022

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. 2022).

Last updated 02/11/2022

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. 2022).


PAYMENT PARITY

All such 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. 2022).

Last updated 02/11/2022

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.

“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.

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. as amended by RI SB 4 (2021 Session) & HB 6032 (2021 Session) (Accessed Feb. 2022)

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. 2022).

Last updated 02/10/2022

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 noncompensated 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 Feb. 2022).

Last updated 02/10/2022

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. 2022).

Last updated 02/11/2022

Licensure Compacts

No Reference Found

Last updated 02/10/2022

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. 2022).

Last updated 02/10/2022

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.

An established in-person physician-patient relationship is required prior to prescribing controlled substances. However, a covering physician may prescribe a controlled substance if an established coverage agreement is in place and the quantity reflects the prescription is only for a short duration.

SOURCE: RI Department of Health. Telemedicine. (Accessed Feb. 2022).

Last updated 02/11/2022

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. 2022).