Rhode Island Issues Emergency Regulations on Off-Label Prescribing for COVID-19, and Guidance on Telehealth and Reciprocal Licensure
Rhode Island has issued important updates for health care providers related to COVID-19, available at https://health.ri.gov/diseases/ncov2019/for/providers/. Providers should be aware of these updates including, among others, the following described below.
On March 22, the Rhode Island Department of Health (RIDOH) issued emergency regulations governing off-label prescribing of FDA-approved medication for the purposes of treating COVID-19. The emergency regulations and requirements do not apply to licensed Rhode Island physicians who are board certified in the American Board of Medical Specialties of Infectious Disease and/or Critical Care.
Under the emergency regulation, a practitioner prescribing an FDA-approved medication for the off-label purpose of treating COVID-19 must meet the following requirements:
Indicate on the prescription the ICD-10 diagnosis code.
Indicate on the prescription a telephone number at which the dispensing authority (e.g., pharmacist) may reach the health care provider to address questions relative to dose and treatment.
Document in the patient’s medical record that the specific risks and benefits of the off-label treatment were discussed with the patient.
Document in the patient’s medical record the clinical rationale for the off-label prescribing, citing:
a. At least one peer-reviewed article that justifies the clinical decision for the off-label prescribing, in the event that the FDA publishes such guidance.
b. Applicable FDA guidance justifying the clinical decision for the off-label prescribing, in the event that the FDA publishes such guidance.
The regulations provide that practitioners may not prescribe any medication for COVID-19, unless treatment or prevention of COVID or similar infectious diseases is within the practitioner’s usual and customary scope of practice.
The emergency regulations are set forth at 216-RICR-20-20-6, under a new Part 6 titled Off Label Prescribing Of Medications For Covid-19.
As of March 18, 2020, out-of-state licensed professionals may obtain a temporary 90-day license from RIDOH so that they may temporarily practice in Rhode Island. See https://health.ri.gov/licenses/ for the list of licensed professionals who may obtain such temporary licenses, and for the application form.
Per Executive Order 20-06 issued on March 18, 2020, by Governor Gina M. Raimondo, Rhode Island insurance carriers must establish reasonable requirements for coverage for clinically appropriate, medically necessary telemedicine services delivered by in-network providers, including audio-only telephone conversations, at rates not lower than services delivered in person. In addition, the executive order suspended the patient location requirement for telemedicine, and provided that patients may receive telemedicine at any location. The order is in effect from the date issued until April 17, 2020.
Similarly, as of March 18, 2020, Rhode Island Medicaid will reimburse for clinically appropriate, medically necessary covered services, including behavioral health services to members via telehealth. This includes both fee-for-service and managed care. The RI Medicaid Guidance Memo sets out the fee-for-service billing codes eligible for telehealth services.