Rhode Island Guidance Affecting Nursing Service Agencies and Agencies Using Service Agency Staff

By Patrick N. Sampson on February 12, 2026

The Rhode Island Department of Health (“RIDOH”) recently issued Guidance regarding Nursing Service Agencies (the “Guidance”) clarifying statutory and regulatory requirements for Nursing Service Agencies (“NSAs”).[1] The Guidance sets forth several requirements for NSAs, including:

1. Central Office Requirements

Effective January 1, 2026, NSAs are required to maintain a physical office in a commercial space in Rhode Island with regular posted hours. As of January 1, 2026, a registered agent will no longer be accepted as a substitute for a central office as set forth in 216-RICR-40-10-10 (the “NSA Regulations”).  The office space should be appropriately staffed, and the NSA must have someone available within two hours should RIDOH conduct a survey when the office is closed.

NSAs are also required to ensure that the central office location complies with NSA Regulations, including:

• Ensuring the NSA license is posted in a conspicuous place on the premises;
• Permitting RIDOH to conduct inspections and investigations at the office location;
• Maintaining personnel files and records of each employee that are available at all times for inspection; and
• Ensuring sufficient space to store policies, procedures, training logs, and other administrative material.

2. Licensure Exemptions

RIDOH confirmed certain exemptions for licensure for NSAs pursuant R.I. Gen. Laws § 23-17.7.1-15 for NSAs that:

• Limit the provision of temporary staff to one or more hospitals; and
• Achieve and maintain certification from the Joint Commission.

NSAs who qualify for the exemption are still required to register with RIDOH and provide the name of the hospital to whom staff is provided. Exempted NSAs are prohibited from providing staff to facilities other than the specific hospitals RIDOH has approved.  

3. Platform-Based Staffing Models

In the Guidance, RIDOH specifically addresses digital, platform-based staffing models like digital apps scheduling nurses with shifts, clarifying that under Rhode Island law, a NSA shall be considered an employer and those individuals a NSA provides on a temporary basis shall be considered employees of the NSA, not independent contractors. Accordingly, RIDOH warns that digital platforms are performing nearly all the requirements of a NSA with independent contractors rather than employees and are therefore required to maintain NSA licensure to operate in Rhode Island. Platforms operating in Rhode Island without appropriate licensure could be subject to penalties or enforcement action. Likewise, facilities using unlicensed NSAs could also be subject to enforcement action.

4. Home Care Providers, Home Nursing Care Providers, Hospice and Hospitals using NSA Staff.

The Guidance also prohibits NSAs from providing staff to home nursing care providers, home care providers and hospice providers in Rhode Island. Likewise, NSAs are prohibited from providing staff to hospitals unless the NSA has received an approved exemption from RIDOH as discussed above.

NSAs found staffing home nursing care providers, home care providers, hospice providers, and certain hospitals will be subject to penalties enforced by RIDOH.

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[1]               A full copy of the Guidance can be found here: Nursing Service Agency Guidance Document.