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Rhode Island Telehealth State Laws & Reimbursement Policies

Medicaid Telehealth Reimbursement

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.

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Definitions

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.

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Eligible Services/Specialties
Reimbursement is available for initial inpatient telehealth consultation and follow-up inpatient telehealth consultation.

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Eligible Providers
Eligible Sites
Geographic Limits
Facility/Transmission Fee

Store-and-Forward

Policy
Eligible Services/Specialties
Geographic Limits
Transmission Fee

Remote Patient Monitoring

Policy
Conditions
Provider Limitations
Other Restrictions

Email/Phone/Fax

Consent

Out of State Providers

Miscellaneous

Private Payer Laws

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.

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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.

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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.

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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.

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Consent

Informed consent should be employed for the use of patient-physician email and other text-based communications. Click to see what the informed consent agreement should include.

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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.

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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.

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Miscellaneous

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

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