In Rhode Island, the practice of medicine is going long distance. This year, the Rhode Island Telemedicine Coverage Act went into effect, requiring insurers to provide coverage for telemedicine services to the same extent that they cover in-person care. RI Gen. Laws § 27-81-4.
Telemedicine permits the delivery of health care services using real time, two-way electronic audiovisual communications – including both video conferencing and “store-and-forward” technology – to facilitate the assessment, diagnosis, treatment, and care management of a patient’s health care. § 27-81-3(12).
Telemedicine does not encompass the use of any of the following:
(1) audio-only telephone conversations;
(2) email messages;
(3) facsimile transmissions; or
(4) automated computer programs used to diagnose or treat ocular or refractive conditions.
Id. When medically appropriate, patients may receive health care services from the comfort of their own homes. § 27-81-3(9). Notably, the Act does not require that a health care provider be located a minimum distance away from its patient to deliver health care services via telemedicine. Therefore, the language of the Act suggests that a provider may deliver health care services via telemedicine to a patient who lives across the state, or even across the street.
Rhode Island providers, however, may not use telemedicine to deliver health care services across state borders. This limitation is subject to change if Rhode Island lawmakers choose to enter the Interstate Medical Licensure Compact (“IMLC”). The IMLC is an agreement between 24 states and one territory and the 31 medical and osteopathic boards within those jurisdictions. Under this agreement, licensed physicians who meet certain eligibility requirements can qualify to practice medicine across state lines within the IMLC. According to the IMLC, approximately 80% of all physicians satisfy these eligibility requirements.
Presently, Maine and New Hampshire are the only New England member states. Vermont is likely to become the third New England member state, having passed IMLC legislation in December 2017.
On February 15, 2017, Rhode Island lawmakers introduced legislation allowing for the state’s entry into the IMLC. On June 30, 2017, Rhode Island lawmakers established a special legislative commission to examine the advisability of Rhode Island joining the IMLC. That commission is expected to report its findings no later than January 1, 2019.
Similarly, Rhode Island nurses may not deliver health care services via telemedicine to patients across state borders. This was not always the case. For nearly a decade, Rhode Island was a member of the Nurse Licensure Compact (“NLC”), which permitted Rhode Island registered nurses and licensed/practical vocational nurses to use telemedicine to provide health care in 24 other states across the country. January 19, 2018, however, marked the implementation of the enhanced Nurse Licensure Compact (“eNLC”), which serves the same purpose as the preceding Compact. Presently, 30 states comprise the eNLC, with Maine and New Hampshire serving as New England’s sole representation. Despite the General Assembly’s introduction of legislation allowing Rhode Island’s entry into the eNLC at the beginning of this year, that bill was held for further study. As a result, to date, Rhode Island has not yet joined the eNLC and its nurses, therefore, can no longer deliver health care services via telemedicine to patients across state borders.
Notwithstanding these interstate limitations, Rhode Island providers who wish to utilize telemedicine within the Ocean State are encouraged to review the Rhode Island Department of Health Guidelines to ensure the delivery of quality health care from a distance.