Rhode Island

CURRENT STATE LAWS & POLICY

AT A GLANCE

Medicaid Program

Rhode Island Medical Assistance Program

Administrator

Rhode Island Dept. of Human Services

Regional Telehealth Resource Center

Northeast Telehealth Resource Center

Medicaid Reimbursement

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

Private Payer Law

Law Exists: Yes
Payment Parity: Yes

Professional Requirements

Licensure Compacts: None
Consent Requirements: Yes

Last updated 06/25/2021

Audio-Only Delivery

Medicaid & Health Insurance Commissioner:  Guidance for Preventive Care Visits

STATUS: Active

Medicaid:  COVID-19 Telehealth Guidance

STATUS: Active until further notice

Medicaid 1915(c) Waiver: Appendix K – Rhode Island Comprehensive Demonstration

STATUS: Expired February 26, 2021

Last updated 06/25/2021

Cross-State Licensing

No Reference Found

Last updated 06/25/2021

Easing Prescribing Requirements

No Reference Found

Last updated 06/25/2021

Miscellaneous

Health Insurance Commissioner: Network Adequacy

STATUS: Active during State of Emergency

Last updated 09/24/2021

Originating Site

Medicaid:  COVID-19 Telehealth Guidance

STATUS: Active until further notice

Last updated 06/25/2021

Private Payer

Health Insurance Commissioner:  Insurance Coverage

STATUS:  Active during State of Emergency

Office of the Governor: Executive Order 20-06: Expanding Access to Telemedicine Services/Insurance Coverage of Telemedicine

STATUS: Active until June 18, 2021 (see EO 21-56)

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

STATUS: Active, until end of RI State of Emergency

Health Insurance Commissioner: Emergency Telemedicine Measures

STATUS: Active, expires when EO 21-06 expires. Currently June 18, 2021.

Last updated 06/25/2021

Provider Type

Medicaid:  COVID-19 Telehealth Guidance

STATUS: Active until further notice

Last updated 06/25/2021

Service Expansion

Medicaid & Health Insurance Commissioner:  Guidance for Preventive Care Visits

STATUS: Active

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

Office of the Governor: Executive Order 20-06: Expanding Access to Telemedicine Services/Insurance Coverage of Telemedicine

STATUS: Active until June 18, 2021 (see EO 21-56)

Department of Health: Online Prescribing of EpiPens

STATUS: Active

Executive Office of Health & Human Services: Managed Care Telemedicine Coverage for Adults and Elders with Disabilities

STATUS: Expired

Last updated 06/25/2021

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 as amended by Senate Bill 4 (2021 Session), (Accessed Sept. 2021).

Last updated 06/25/2021

Email, Phone & Fax

No Reference Found

Last updated 06/21/2021

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 as amended by Senate Bill 4 (2021 Session), (Accessed Sept. 2021).


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 as amended by Senate Bill 4 (2021 Session), (Accessed Sept. 2021).

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 Jun. 2021).


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 as amended by Senate Bill 4 (2021 Session), (Accessed Sept. 2021).


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 as amended by Senate Bill 4 (2021 Session), (Accessed Sept. 2021).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

Last updated 06/25/2021

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 & 7 as amended by Senate Bill 4 (2021 Session), (Accessed Sept. 2021).

Last updated 06/25/2021

Out of State Providers

No Reference Found

Last updated 06/25/2021

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 policy yet.

Last updated 06/25/2021

Remote Patient Monitoring

POLICY

No Reference Found


CONDITIONS

No Reference Found


PROVIDER LIMITATIONS

No Reference Found


OTHER RESTRICTIONS

No Reference Found

Last updated 06/25/2021

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 09/24/2021

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.  as amended by RI SB 4 (2021 Session) (Accessed Sept. 2021).

Last updated 09/24/2021

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


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

Last updated 09/24/2021

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 Sept. 2021)

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

Last updated 06/25/2021

Cross State Licensing

RI allows physicians who have a license in good standing in another state to consult with RI licensed physician on a singular occasion or provide teaching assistance for no more than seven days unless extended with written permission from the director.

Physicians not present in RI may not provide consultation to a patient without an established physician-patient relationship, unless that patient is in the physical presence of a physician licensed in RI.

SOURCE:  RI General Law, Sec. 5-37-16.2(a)(3). (Accessed Jun. 2021).

Last updated 09/24/2021

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 Sept. 2021).

Last updated 06/25/2021

Licensure Compacts

No Reference Found

Last updated 06/25/2021

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 Jun. 2021).

Last updated 06/25/2021

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 Jun. 2021).

Last updated 09/24/2021

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 (Accessed Sept. 2021)