Rhode Island

Last updated 05/15/2024

Consent Requirements

An agreement should be employed documenting patient informed consent for the use of patient-physician e-mail and other text based communications. The agreement should be discussed with the patient to ensure his/her understanding of the guidelines. The agreement should include the following terms:

• Types of transmissions that will be permitted
• Circumstances when alternate forms of communication or office visits should be utilized
• Security measures, such as encryption of data, password protected screen savers and data files, or utilization of other reliable authentication techniques, as well as potential risks to privacy
• 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 May 2024).

An agreement should be employed documenting patient informed consent for the use of patient-physician e-mail and other text based communications. The agreement should be discussed with the patient to ensure his/her understanding of the guidelines.  See guidelines for requirements.

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

Last updated 05/15/2024

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 May 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 individuals 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 May 2024).

Last updated 05/15/2024

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 May 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, (Accessed May 2024).

“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 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: Code of RI Rules, 216-40-05-1 (Accessed May 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 May 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 the American Speech-Language-Hearing Association (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 May 2024).

Last updated 05/15/2024

Licensure Compacts

Member of Psychology Interjurisdictional Compact.

SOURCE: PSYPACT Compact. (Accessed May 2024).

Member of the Interstate Medical Licensure Compact.

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

Nurse Licensing Compact

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

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

Last updated 05/15/2024

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 May 2024).

Virtual Assessment Mechanisms for Eye Exams

Last updated 05/15/2024

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 May 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 May 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 May 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 May 2024).

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 May 2024).

Last updated 05/15/2024

Professional Board Standards

Professionals licensed under this chapter 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 May 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 May 2024).

Speech Language Pathologists

Telepractice requirements for speech language pathologists are contained in statute.

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

See Misc. section for virtual eye assessment requirements.