Rhode Island

MASTER MEDICAID TELEHEALTH LAWS
WITH THE HELP FROM GD

Summary

The Rhode Island Medical Assistance Program reimburses for some live-video services and provides no reimbursement for store-and-forward or remote patient monitoring.

 

Live Video

Policy

Rhode Island Medicaid’s fee schedule lists several telehealth service CPT codes related to follow-up and inpatient telehealth consultations under procedure/professional services.

Source: RI Department of Health. Medicaid Fee Schedule Rates. (Accessed Feb. 2019).
Eligible Services / Specialties

Reimbursement is available for initial inpatient telehealth consultation and follow-up inpatient telehealth consultation.

Source: RI Department of Health. Medicaid Fee Schedule Rates. (Accessed Feb. 2019).

Private Payer Laws

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.

 

Source: RI General Law, Sec. 27-81-4(a). (Accessed Mar. 2019).
Definitions

“Telemedicine” means the delivery of clinical health care services by means of real-time two-way electronic audiovisual communications, including the application of secure video conferencing or store-and-forward technology to provide or support health care delivery, which facilitate the assessment, diagnosis, treatment, and care management of a patient’s health care while such patient is at an originating site and the health care provider is at a distant site, consistent with applicable federal laws and regulations. Telemedicine does not include an audio-only telephone conversation, 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(12). (Accessed Mar. 2019).

Parity

Payment Parity

No explicit payment parity.

 

Service Parity

A health insurer shall not exclude a health care service for coverage solely because the health care service is provided through telemedicine and is not provided through in-person consultation or contact, subject to the terms and conditions of a telemedicine agreement between the insurer and provider

 

Professional Regulation /
Health & Safety

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 Mar. 2019).
Online Prescribing

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 Mar. 2019).
Consent

An informed consent agreement should be employed for the use of patient-physician email and other text-based communications.
The agreement should include:
• Types of transmissions that will be permitted
• Circumstances when alternate forms of communication or office visits should be utilized
• Security measures
• Hold harmless clause for information lost due to technical failures
• Requirement for express patient consent to forward patient-identifiable information to a third party
• A statement noting that the patient’s failure to comply with the agreement may result in termination of the e-mail relationship

 

Source: RI Department of Health. Telemedicine. (Accessed Mar. 2019).
Cross-State Licensing

RI allows physicians who have a license in good standing in another state to consult with RI licensed physicians 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 Mar. 2019).
Miscellaneous

Telemedicine does not include an audio-only telephone conversation, email message or facsimile transmission between the provider and patient.

Source: RI General Law, Sec. 27-81-3(12). (Accessed Mar. 2019).

 

See Department of Health Policy for Department of Health Telemedicine Guidelines for other requirements on RI providers.

Source: RI Department of Health. Telemedicine. (Accessed Mar. 2019).

Contact us to discuss your telehealth initiatives in Rhode Island


[recaptcha]

*Required