216-RICR-40-05-1
216-RICR-40-05-1. Licensure and Discipline of Physicians (version Amendment, 11/23/2015 to 09/26/2017)
RULES AND REGULATIONS
FOR THE LICENSURE AND DISCIPLINE OF PHYSICIANS
[R5-37-MD/DO]
STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS
DEPARTMENT OF HEALTH
1967
AS AMENDED:
December 1967
December 2002
February 1975
April 2004
February 1976
October 2004
March 1977
January 2007 (re-filing in
accordance with the
provisions of § 42-35-4.1 of
the Rhode Island General
Laws, as amended)
December 1978
May 1982
July 1986
October 1988 (E)
October 2007
September 1990(E)
August 2008
January 1991 (E)
August 2009
August 1991
January 2012 (re-filing in
accordance with the
provisions of § 42-35-4.1 of
the Rhode Island General
Laws, as amended)
September 1991
November 1992
June 1997
September 1998
January 2012
January 2000
May 2012
January 2002 (re-filing in
accordance with the
provisions of § 42-35-4.1 of
the Rhode Island General
Laws, as amended)
September 2012
April 2014
September 2014
October 2015
INTRODUCTION
These amended Rules and Regulations for the Licensure and Discipline of Physicians (R5-
37-MD/DO) are promulgated pursuant to the authority conferred under Chapter 5-37 of the
General Laws of Rhode Island, as amended, and are established for the purpose of updating
prevailing standards governing the licensure and discipline of physicians in Rhode Island. These
specific amendments update standards and criteria for issuance of limited medical registrations1,
fees for medical records, closing of a medical practice, as well as general updating of regulatory
requirements for consistency with accepted medical practice.
The healing art of medicine has changed over the years and is a collaborative endeavor
involving many other health care professionals.
The Board of Medical Licensure and Discipline recognizes there are several other disciplines
that participate in the healing arts. The practice of medicine is not a provincial exercise that is
unique to physicians; rather there are many other licensed health care professionals who
participate in these healing arts. These Regulations are intended for the physician community
and to set clear boundaries for unlicensed persons or those similarly who lack qualifications.
Pursuant to the provisions of § 42-35-3(a)(3) and § 42-35.1-4 of the General Laws of Rhode
Island, as amended, the following were given consideration was given in arriving at the amended
regulations as to:
(1) Alternative approaches to the regulations;
(2) Duplication or overlap with other state regulations; and
(3) Significant economic impact on small business.
Based on the available information, no known alternative approach, duplication or overlap
was identified.
Upon promulgation of these amendments, these amended regulations shall supersede all
previous Rules and Regulations for the Licensure and Discipline of Physicians and Rules and
Regulations for Limited Medical Registration [R-5-37REG] promulgated by the Rhode Island
Department of Health and filed with the Secretary of State.
1 Prior to the September 2015 edition, these requirements were contained in the Rules and Regulations for
Limited Medical Registration [R-5-37REG], which have been repealed concurrent with the promulgation of
these amendments.
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TABLE OF CONTENTS
Page
PART I
Licensure Requirements / Physicians
1
1.0 Definitions
1
2.0 License Requirements
3
2.2 Practice of Medical Acupuncture
3
3.0 Qualifications
3
4.0 Application/Fee
6
5.0 Examination
7
6.0 Continuing Education
7
7.0 Issuance and Renewal of License
8
8.0 Refusal of License
11
9.0 Inactive List
11
10.0 Unprofessional Conduct
12
11.0 Services
12
11.2 Medical Records
12
12.0 Patient Disclosure
13
13.0 Collaborative Pharmacy Practice
14
PART II Violations / Sanctions / Severability
27
14.0 Practices and Procedures
27
15.0 Severability
27
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PART I
LICENSURE REQUIREMENTS FOR PHYSICIANS
Section 1.0
Definitions
Wherever used in these Regulations, the terms listed below shall be construed in the following
manner:
1.1
“Acupuncture” means the insertion of needles into the human body by piercing the skin of
the body, for the purpose of controlling and regulating the flow and balance of energy in
the body. For the purposes of these Regulations; “medical acupuncture” means
acupuncture as practiced by physicians licensed under the provisions of RIGL Chapter 5-
37.
1.2
"Act" refers to RIGL Chapter 5-37 entitled, "Board of Medical Licensure and Discipline."
1.3
“Attending physician” means a physician who has an active, full medical license.
1.4
"Board" refers to the Rhode Island Board of Medical Licensure and Discipline or any
committee or subcommittee thereof established under the provisions of § 5-37-1.1 of the
Act.
1.5
"Chief Administrative Officer" means the administrator of the Rhode Island Board of
Medical Licensure and Discipline.
1.6
"Collaborative pharmacy practice" is that practice of pharmacy whereby a pharmacist
with advanced training and experience relevant to the scope of collaborative practice
agrees to work in collaboration with one or more physicians for the purpose of drug
therapy management of patients, such management to be pursuant to a protocol or
protocols authorized by the physician(s) and subject to conditions and/or limitations as set
forth by the Department. A health care professional who has prescribing privileges and is
employed by a collaborating physician may be in such an agreement.
1.7
“Department” means the Rhode Island Department of Health.
1.8
"Director" refers to the Director, Rhode Island Department of Health.
1.9
“Doctor of Acupuncture” means a person who has been licensed under the provisions of
RIGL Chapter 5-37.2 to practice the art of healing known as acupuncture.
1.10 "Drug therapy management" means the review, in accordance with a collaborative
practice agreement, of drug therapy regimen(s) of patients by a pharmacist for the purpose
of rendering advice to one (1) or more physicians that are party to the agreement, or their
physician designees, regarding adjustment of the regimen. Decisions involving drug
therapy management shall be made in the best interests of the patient. In accordance with
a collaborative practice agreement, drug therapy management may include:
(a) Modifying and managing drug therapy;
(b) Collecting and reviewing patient histories;
(c) Obtaining and checking vital signs, including pulse, temperature, blood pressure, and
respiration; and
(d) Under the supervision of, or in direct consultation with a physician, ordering and
evaluating the results of laboratory tests directly related to drug therapy when
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performed in accordance with approved protocols applicable to the practice setting and
providing such evaluation does not include any diagnostic component.
1.11 "Foreign Medical Graduate" means a physician (individual) whose basic medical degree
or qualification was conferred by an allopathic medical school located outside the United
States, Canada and Puerto Rico.
1.12 “Intern, resident, or fellow” means a physician in training in an accredited postgraduate
training program.
1.13 "License" is synonymous with registration certificate.
1.14 “Medical record” means a record of a patient’s medical information and treatment history
maintained by physicians and other medical personnel, which includes, but is not limited
to, information related to medical diagnosis, immunizations, allergies, x-rays, copies of
laboratory reports, records of prescriptions, and other technical information used in
assessing the patient’s health condition, whether such information is maintained in a paper
or electronic format.
1.15 “Non-ablative treatment” means any laser/intense pulsed light treatment or other energy
source, chemical, or modality that is not expected or intended to remove, burn, or vaporize
tissue. This shall include treatments related to laser hair removal.
1.16 "Person" means any individual, partnership, firm corporation, (including, but not limited
to, associations, joint stock companies, limited liability companies, and insurance
companies), trust or estate, state or political subdivision or instrumentality of a state.
1.17 "Physician" means any person licensed to practice allopathic or osteopathic medicine
pursuant to the provisions of RIGL Chapter 5-37.
1.18 “Postgraduate training”, as used in these Regulations, means satisfactory training after
earning the medical degree at an accredited program, or its equivalent as determined by the
Board, including internship, residency and fellowship. Such training shall include one (1)
year of internship and one (1) or two (2) years of progressive residency or comparable
fellowship.
1.19 "Practice of Medicine", pursuant to § 5-37-1(1) of the Act, shall include the practice of
allopathic and osteopathic medicine. Any person shall be regarded as practicing medicine
within the meaning of the Act who holds himself or herself out as being able to diagnose,
treat, perform surgery, use a laser/intense pulsed light, or prescribe for any person for
disease, pain, injury, deformity or physical or mental condition or prescribe for any person
ill or alleged to be ill with disease, pain, injury, deformity or abnormal physical or mental
condition, or who shall either profess to heal, offer or undertake, by any means or method,
to diagnose, treat, perform surgery, or prescribe for any person for disease, pain, injury,
deformity or physical or mental condition. In addition, one who attaches the title M.D.,
physician, surgeon, D.O., osteopathic physician and surgeon, or any other similar word or
words or abbreviation to his or her name indicating that he or she is engaged in the
treatment or diagnosis of the diseases, injuries or conditions of persons shall be held to be
engaged in the practice of medicine. Non-ablative treatment is part of the practice of
medicine.
1.20 “RIGL” means the General Laws of Rhode Island, as amended.
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1.21 “These Regulations” mean all parts of the Rhode Island Rules and Regulations for the
Licensure and Discipline of Physicians [R5-37-MD/DO].
1.22 “Surgery” is performed for the purpose of structurally altering the human body by the
incision or destruction of tissues and is part of the practice of medicine. Surgery also is the
diagnostic or therapeutic treatment of conditions or disease processes by any instruments
causing localized alteration or transposition of human tissue which include lasers, ultra-
sound, ionizing radiation, scalpels, probes, and needles. The tissue can be cut, burned,
vaporized, frozen, sutured, probed, or manipulated by closed reductions for major
dislocations or fractures, or otherwise altered by mechanical, thermal, light-based,
electromagnetic, or chemical means. All of these surgical procedures are invasive,
including those that are performed with lasers, and the risks of any surgical procedure are
not eliminated by using a light knife or laser in place of a metal knife, or scalpel.
Section 2.0
License Requirements
2.1
No person, unless licensed to practice medicine in Rhode Island, shall practice allopathic
or osteopathic medicine or surgery or attempt to practice allopathic or osteopathic
medicine or surgery, or any of the branches of allopathic or osteopathic medicine or
surgery after having received therefore or with the intent of receiving therefore, either
directly or indirectly, any bonus, gift or compensation or who shall open an office with
intent to practice allopathic or osteopathic medicine or shall hold himself or herself out to
the public as a practitioner of allopathic or osteopathic medicine, whether by appending to
his or her name the title of doctor or any abbreviation thereof, or M.D., or D.O. or any
other title or designation implying a practitioner of allopathic or osteopathic medicine.
2.1.1 All physicians who are licensed to practice medicine in Rhode Island must obtain
and sustain medical malpractice coverage prior to seeing patients. Proof of
malpractice insurance shall be provided to the Board upon request. It is incumbent
upon the licensee to ensure that malpractice coverage does not lapse while engaged
in the practice of medicine.
Practice of Medical Acupuncture
2.2
Any physician licensed in Rhode Island under the provisions of the Act who seeks to
practice medical acupuncture as a therapy shall comply with the following:
2.2.1 Meet the requirements for licensure as a doctor of acupuncture set forth in the Rules
and Regulations for Licensing Doctors of Acupuncture and Acupuncture Assistants
promulgated by the Rhode Island Department of Health; or
2.2.2 Successfully complete a course offered to physicians that has been approved by the
American Board of Medical Acupuncture (ABMA).
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Visiting Physicians
2.3
Notwithstanding the provisions of § 2.1 of these Regulations, a physician who is licensed
to practice medicine in another state or states, but not in Rhode Island, and who is in good
standing in such state or states, may exercise the privilege to practice medicine for a patient
located in Rhode Island under the following circumstances only:
(a) 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.
(b) The physician is present in Rhode Island on a singular occasion as a member of an air
ambulance treatment team or organ harvesting team.
(c) The physician, whether or not physically present in Rhode Island, is being consulted on
a singular occasion by a physician licensed in Rhode Island, 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 Rhode Island provide consultation
to a patient in Rhode Island who does not have a physician patient relationship with
that physician unless that patient is in the physical presence of a physician licensed in
Rhode Island.
(d) The physician is present in Rhode Island for a period not to exceed seven (7) days as a
volunteer physician serving in a non-compensated role for a charitable function.
(e) The physician is present in Rhode Island while providing medical services to a sports
team incorporated in the United States or another country provided that:
(1) The physician has a written agreement with that sports team to provide care to team
members, coaching staff, and families traveling with the team for a specific
sporting event or preseason training camp occurring in Rhode Island.
(2) The physician may not provide care or consultation to any person residing in Rhode
Island other than those enumerated in § 2.3 of these Regulations or under the
conditions permitted in § 2.4 of these Regulations.
(3) The physician shall be permitted to provide care and consultation to those in § 2.3
of these Regulations for no longer than seven (7) consecutive days per sporting
event.
(4) The physician is not authorized to practice at a health care facility or clinic, acute
care facility, or urgent care center; but nothing in these Regulations shall prevent
the physician from accompanying a person enumerated in § 2.3 of these
Regulations to such a facility or from providing consultation to a physician licensed
in Rhode Island in regard to such person.
(5) If the physician is licensed in another country, he or she must obtain prior written
permission from the Director to be permitted to provide care and consultation to
those in § 2.3 of these Regulations.
2.4
If a physician licensed in Rhode Island obtains prior written permission from the Director,
the physician who is not licensed in Rhode Island but is practicing under §§ 2.3(c), (d) or
(e) of these Regulations may be permitted to extend his or her authorization to practice
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medicine for more than seven (7) consecutive days if the requesting physician shows good
cause for the extension, but for no more than a total of thirty (30) days in any one year.
2.5
A physician practicing under §§ 2.3(c) or (d) of these Regulations shall inform the Director
in writing of his or her intent to practice prior to, or as soon as practicable, but no later than
seven (7) days, after the consultation.
2.6
Any person who is found to have violated any provisions of § 5-37-16.2 of the Act or §§
2.3, 2.4 or 2.5 of these Regulations shall be subject to § 5-37-12 of the Act regarding the
unauthorized practice of medicine.
Limited Medical Registration Requirements for Interns, Residents or Fellows
2.7
Except for physicians licensed pursuant to RIGL Chapter 5-37, no person shall perform the
duties of an intern, resident or fellow in Rhode Island without holding a limited medical
registration certificate pursuant to § 5-37-16 of the Act.
2.7.1 Limited medical registration shall only be granted to individuals appointed as
intern, resident or, fellow in a hospital licensed in Rhode Island, or other institution
or clinic pursuant to § 5-37-16 of the Act for the purpose of obtaining training in a
medical program accredited by the Accreditation Council for Graduate Medical
Education, (ACGME), the American Osteopathic Association, (AOA), or other
accrediting body approved by the Board, or to a fellow for the purpose of teaching,
research and/or training in conjunction with a medical education program in a
medical school accredited by the Liaison Committee for Medical Education
(LCME) or by the Commission on Osteopathic College Accreditation (COCA).
2.8
A limited medical registration certificate (for postgraduate training) shall entitle the holder
thereof to practice medicine in the hospital or other institution designated on the certificate
of limited registration, or outside such hospital or other institution for the treatment under
the supervision of one of its medical staff who is a duly licensed physician [i.e. full
licensure], of persons accepted by it as patients, or in any hospital, institution, clinic or
program affiliated for training purposes with the hospital, institution or clinic designated
on such certificate, which affiliation is approved by the Department. In all cases the
practice of medicine under a limited medical registration shall be in accordance with
policies and procedures established by the hospital, institution or other clinic designated on
the certificate.
2.8.1 It shall be the responsibility of each hospital, clinic or other institution to submit,
on or before 1 April of each year to the Department for its approval, a list of
affiliated hospitals, institutions, clinics or programs providing training programs for
interns, residents or, fellows.
2.8.2 Any hospital, clinic or institution providing training programs for interns, residents,
or fellows, that are subject to statutory licensure in Rhode Island, shall hold a
current license.
2.9
Once a full license to practice medicine in the state of Rhode Island has been granted, all
concurrent limited medical registration privileges shall cease.
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2.10 (a) Physicians who are fully licensed in Rhode Island or in an alternate jurisdiction, and
who are entering or re-entering an accredited graduate medical education program
(training program) are eligible for limited medical registration (training license). The
limited medical registration shall be granted annually for the duration of training.
(b) If the physician chooses to practice outside of the accredited graduate medical
education program at any time during the period of training, a full medical license in
required.
2.11 A physician in training greater than five (5) years shall obtain a full, unrestricted license to
practice medicine in Rhode Island, unless the physician remains in an accredited training
program and has successfully passed all three (3) parts of the United States Medical
Licensing Examination (USMLE) or all three (3) levels of the Comprehensive Osteopathic
Medical Licensing Examination of the United States (COMLEX-USA).
Section 3.0
Qualifications
3.1
Allopathic Physicians:
3.1.1 Graduates of Schools Located in the U.S.A. and Puerto Rico: An applicant
seeking licensure to practice medicine in Rhode Island must:
(a) be of good moral character;
(b) have graduated from a medical school accredited by the Liaison Committee for
Medical Education (LCME);
(c) have satisfactorily completed two (2) years of progressive post graduate
training, internship and residency, in a program accredited by the Accreditation
Council for Graduate Medical Education;
(d) have satisfactorily passed an examination approved by the Board; and
(e) meet such other requirements as set forth by regulation or as may be established
by the Board.
3.1.2 Graduates of Schools Located in Canada: An applicant seeking licensure to
practice medicine in Rhode Island must:
(a) be of good moral character;
(b) have graduated from a medical school accredited by the Liaison Committee for
Medical Education (LCME);
(c) have satisfactorily completed two (2) years of progressive post graduate
training in a program accredited by the Accreditation Committee of the
Federation of the Medical Licensing Authority of Canada or the Royal College
of Physicians and Surgeons of Canada;
(d) have satisfactorily passed an examination approved by the Board; and
(e) meet such other requirements as set forth by regulation or as may be established
by the Board.
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3.1.3 Foreign Medical Graduates: An applicant seeking licensure to practice medicine
in Rhode Island who is a Foreign Medical Graduate must:
(a) be of good moral character;
(b) have graduated from a medical school located outside the United States which
is recognized by the World Health Organization and the Board;
(c) have received certification by the Education Commission for Foreign Medical
Graduates (ECFMG);
(d) applicants must have satisfactorily completed two (2) years of progressive
postgraduate training, internship and residency or a comparable fellowship in a
training program accredited by the Accreditation Council for Graduate Medical
Education (ACGME). The Board may grant up to twelve (12) months of credit
at the internship level to an applicant with a minimum of three (3) years of
progressive international postgraduate training when advanced standing is also
granted by the American Board of Medical Specialties.
(e) have satisfactorily passed an examination approved by the Board; and
(f) meet such other requirements as set forth by regulation or as may be established
by the Board.
3.1.4 Foreign Medical Graduates/United States Citizens (Fifth [5th] Pathway): An
applicant seeking licensure to practice medicine in Rhode Island and who is a
Foreign Medical Graduate and a United States citizen at the time of attendance at
said foreign school and who has completed all of the formal requirements of said
medical school except internship and/or social services must:
(a) be of good moral character;
(b) have successfully completed a course of study from a medical school located
outside the United States which is recognized by the World Health
Organization and the Board;
(c) have satisfactorily passed the Educational Commission for Foreign Medical
Graduates Examinations;
(d) have attained a score satisfactory to a medical school approved by the Liaison
Committee on Medical Education on a qualifying examination acceptable to the
State Board for Medicine;
(e) applicants shall have satisfactorily completed two (2) years of progressive
postgraduate training, internship and residency or fellowship in a training
program accredited by the Accreditation Council for Graduate Medical
Education.
(f) have satisfactorily passed an examination approved by the Board; and
(g) meet such other requirements as set forth by regulation or as may be established
by the Board.
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3.1.5 Waiver of Training Requirements - Allopathic Physicians.
(a) Notwithstanding the requirements of § 3.1.1(c) of these Regulations, all or
some of the postgraduate training requirement for graduates of schools located
in the U.S.A. and Puerto Rico may be waived, at the discretion of the Board, for
graduates who hold a full and unrestricted medical license in another state/
jurisdiction for at least five (5) years and are certified by an American Board of
Medical Specialty (ABMS) Board.
(b) Notwithstanding the requirements of § 3.1.2(c) of these Regulations, all or
some of the postgraduate training requirement for graduates of schools located
in Canada may be waived, at the discretion of the Board, for graduates who
hold a full and unrestricted medical license in another state/jurisdiction for at
least five (5) years and are certified by an ABMS Board.
(c) Notwithstanding the requirements of § 3.1.3(d) of these Regulations, all or
some of the postgraduate training requirement for foreign medical graduates
may be waived, at the discretion of the Board, for international graduates with
advanced international postgraduate training, who hold full and unrestricted
medical licensure in another state/jurisdiction, and five (5) years of clinical
practice experience in good standing in the alternate jurisdiction.
3.2
Osteopathic Physicians:
3.2.1 Graduates of Schools of Osteopathic Medicine, An applicant seeking licensure to
practice Osteopathic Medicine in Rhode Island must:
(a) be of good moral character;
(b) have graduated from an osteopathic medical school located in the United States
that is accredited by the American Osteopathic Association;
(c) have satisfactorily completed two (2) years of progressive post graduate
training, internship and residency in a program approved by the American
Osteopathic Association or the Accreditation Council for Graduate Medical
Education:
(d) have satisfactorily passed an examination approved by the Board; and
(e) meet such other requirements as set forth by regulations or as may be
established by the Board.
3.2.2 Waiver of Training Requirements - Osteopathic Physicians. Notwithstanding
the requirements of § 3.2.1 of these Regulations, all or some of the postgraduate
training requirement for graduates of schools of osteopathic medicine may be
waived, at the discretion of the Board, for graduates who hold a full and
unrestricted license to practice osteopathic medicine in another state/jurisdiction for
at least five (5) years and are certified by the AOA or an ABMS Board.
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Licensure By Endorsement
3.3
The Board may grant expedited full and unrestricted licensure to applicants with a verified
full and unrestricted licensure in another state with administrative approval from the Chief
Administrative Officer provided that the candidate shall: (1) have no formal disciplinary
actions or active or pending investigations; past, pending, public or confidential restrictions
or sanctions, by the board of medicine, licensing authority, medical society, professional
society, hospital, medical school or institution staff sanctions in any state, country or
jurisdiction. A disciplinary action includes, but is not limited to, the refusal to issue or
renew a license to practice medicine by any aforementioned entity. (2) hold unrestricted
licenses in every jurisdiction that the candidate holds a license, (3) meet minimum
requirements for a license in the state of Rhode Island, (4) have submitted a completed
application, in the English language or accompanied by a certified translation thereof into
English for reciprocal licensure. Such licenses shall be considered provisional until
ratified at a meeting of the full Board. Willful violation of the provisions of this section by
a licensing candidate shall be grounds for immediate license suspension.
3.4
Volunteer Physicians
3.4.1 Licensure. The Board may grant a license to practice medicine in Rhode Island as
a volunteer physician to an individual who meets all of the following requirements:
(a) Be otherwise qualified for licensure as a physician pursuant to these
Regulations.
(b) Be retired from the active practice of medicine and whose only clinical
activities will be volunteering in clinics and other facilities that provide medical
care to underinsured or uninsured patients.
(c) Receive no monetary or in-kind compensation for any clinical services
provided as a physician.
(d) Submit documentation to the Board from an IRS-approved 501(c)(3)
organization, or other similar entity, providing care for underinsured or
uninsured patients, attesting to the physician's status as a volunteer physician
and the absence of compensation (monetary or in-kind).
(1) Separate documentation shall be provided for each organization where the
applicant intends to provide services as a volunteer physician.
(e) Submit documentation to the Board that malpractice insurance will be provided,
either by the organization or by the applicant.
3.4.2 Issuance and Renewal.
(a) Fees. There shall be no licensure fee for a volunteer physician license.
(b) Upon completion of the requirements contained in § 3.4.1 of these Regulations,
the Director may issue a volunteer physician license in accordance § 7.0 of
these Regulations.
(c) A volunteer physician license may be renewed in accordance § 7.2 of these
Regulations.
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3.4.3 Continuing Education. A volunteer physician shall be required to complete
continuing medical education in accordance with § 6.0 of these Regulations.
3.4.4 Restrictions and Limitations. Physicians who have academic and/or
administrative jobs, and who wish to volunteer, are not eligible for a volunteer
physician license.
3.4.5 Conversion to Full/Unrestricted License. A physician with a volunteer license
who wishes to resume active practice may convert the license to full/unrestricted
license by paying the initial licensure fee as set forth in the Rules and Regulations
Pertaining to the Fee Structure for Licensing, Laboratory and Administrative
Services Provided by the Department of Health.
Academic Faculty
3.5
Pursuant to § 5-37-16.1 of the Act, notwithstanding any other provisions of the Act, a
physician of noteworthy and recognized professional attainment who is clearly an
outstanding physician and who has been offered by the dean of an accredited medical
school in Rhode Island a full-time academic appointment at senior rank, may, at the
Board’s sole discretion, be granted limited registration while serving on the academic staff
of the medical school.
3.5.1 Such limited registration shall enable said physician(s) to engage in the practice of
medicine to the extent that such practice is incidental to a necessary part of his or
her academic appointment and then only in the hospital or hospitals and out-patient
clinics connected with the medical school through formal academic affiliation.
Except to the extent authorized by the Act and these Regulations, the academic
physician with limited registration shall not engage in the practice of medicine or
receive compensation therefor, unless he or she is issued a license to practice
medicine in accordance with the provisions of § 5-37-2 of the Act.
Section 4.0 Application for License & Fees
4.1
Application for licensure shall be made on forms provided by the Board which shall be
completed, including the physician's signature, notarized and a recent identification
photograph of the applicant, head and shoulder front view, approximately 2 x 3 inches in
size submitted to the Board.
4.2
Such application shall be accompanied by the following documents and fee (non-
refundable and non-returnable):
(a) [DELETED].
(b) the applicant must submit a self-query of the National Practitioner Data Bank.
(c) each license application, except from an applicant who qualifies for a license by
endorsement pursuant to § 3.3 of these Regulations, must also include a completed
Federation Credentials Verification Form (FCVS) from the Federation of State Medical
Boards of the United States, Inc.
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(d) a statement from the Board of Examiners in Allopathic or Osteopathic Medicine in
each state in which the applicant has held or holds licensure to be submitted to the
Board of this state attesting the licensure status of the applicant during the time period
applicant held licensure in said state;
(e) the application examination fee, as set forth in the Rules and Regulations Pertaining to
the Fee Structure for Licensing, Laboratory and Administrative Services Provided by
the Department of Health;
(f) such other information as may be deemed necessary and appropriate by the Board.
4.3
The Board, at its discretion, reserves the right to require any or all applicants to appear
before the Board for an interview.
4.4
An applicant shall not be eligible for licensure by endorsement if the Board finds that the
applicant has engaged in any conduct prohibited by these Regulations.
Interns, Residents or, Fellows
4.5
An application for limited medical registration as an intern, resident or fellow be made on
forms provided by the Board, shall be submitted through the hospital, institution, clinical
facility, or medical practice, and shall be accompanied by the following documents and fee
(non-refundable and non-returnable):
(a) Being eighteen (18) years of age or older;
(b) Good moral character;
(c) Successful graduation and completion of no less than two (2) years of study in a
medical school accredited by the LCME or COCA and having power to grant degrees
in medicine or osteopathic medicine;
(d) Appointment as an intern, resident or fellow in an accredited training program pursuant
to § 2.7 of these Regulations; and
(e) The application fee, as set forth in the Rules and Regulations Pertaining to the Fee
Structure for Licensing, Laboratory and Administrative Services Provided by the
Department of Health;
(f) Such other information as may be deemed necessary by the Board.
4.6
Furthermore, each applicant from an accredited training program or its equivalent shall
have the application for limited medical registration signed by:
(a) The administrator/chief executive officer of the hospital, clinic, or other institution that
has granted the appointment as an intern, resident or fellow; and
(b) The program director attesting to the provisions of § 4.5(c) of these Regulations.
4.7
Applicants from foreign medical schools shall present evidence of valid certification by the
Educational Commission for Foreign Medical Graduates (ECFMG) including the
provisions of § 4.6(a) of these Regulations.
12
(a) This requirement may be waived at the discretion of the Board for candidates approved
by the Board who are participating in a short-term [less than six (6) month duration]
postgraduate experience as part of a formal program administered by the director of an
ACGME or AOA accredited residency or fellowship.
Academic Faculty
4.8
Application for limited registration for "academic faculty" shall be made on forms
provided by the Department which shall be completed, notarized and submitted to the
Board at least thirty (30) days prior to the scheduled date of Board meeting.
4.9
Such application shall be accompanied by the following documents and fee (non-
refundable and non-returnable):
(a) (i) For U.S. citizens: a certified copy of birth certificate;
(ii) For foreign medical physicians: if a certified copy of birth certificate cannot be
obtained, immigration papers or resident alien card or such other birth verifying
papers acceptable to the Board;
(b) One (1) recent photograph of the applicant, head and shoulder front view
approximately 2 x 3 inches in size;
(c) A statement from the board of examiners in medicine in each state in which the
applicant holds or has held a license confirming the applicant to be or have been in
good standing. Such statement shall be submitted to the Board;
(d) A certified copy of medical diploma;
(e) A complete curriculum vitae;
(f) A written statement from the dean of the medical school attesting that an offer has been
made to the individual for a full-time senior level academic appointment, including the
recommendation that the applicant is a person of professional rank (i.e., associate or
full professor) whose knowledge and special training will benefit the medical school;
and
(g) The application fee, as set forth in the Rules and Regulations Pertaining to the Fee
Structure for Licensing, Laboratory and Administrative Services Provided by the
Department of Health;
4.10 All documents not written in the English language shall be accompanied by certified
translations.
Section 5.0
Examination
5.1
By Examination for Allopathic & Osteopathic Physicians:
Applicants shall be required to pass such examination as the Board deems necessary to
test the applicant's knowledge and skills to practice medicine in Rhode Island pursuant to
the Act and these Regulations.
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5.1.1 For written examinations, the Board requires applicants to successfully pass the
following:
(1) The National Board of Allopathic or Osteopathic Medical Examination
(NBME) or (NBOME); or
(2) The United States Medical Licensing Examination (USMLE);
(3) The Comprehensive Osteopathic Medical Licensing Examination of the
United States (COMLEX-USA)
(4) The Licentiate Medical Council of Canada (LMCC);
(5) Or any combination of examinations acceptable to the Board and as
recommended by the United States Medical Licensing Examination;
(6) The passing score for each section of the above examinations must be 75 or
more (The Board does not accept averaging of the separate components.)
(7) Applicants for licensure in Rhode Island must pass each section of the
required examination by the third (3rd) attempt. In the event of a third (3rd)
failure, opportunity for re-examination(s) shall be subject to the applicant’s
completion of additional requirements as recommended by the Board on a
case by case basis.
Section 6.0
Continuing Education
6.1
Every physician licensed to practice allopathic or osteopathic medicine in Rhode Island
under the provisions of the Act and these Regulations, shall on or before the first (1st) day
of June of every even-numbered year, on a biennial basis, earn a minimum of forty (40)
hours of AMA PRA Category 1 Credit™/AOA Category 1a continuing medical
education credits and shall document this to the Board.
6.1.1 A physician’s participation in an American Board of Medical Specialty’s (ABMS)
Maintenance of Certification program will be considered equivalent to meeting
CME requirement.
6.1.2 A physician’s participation in the AOA’s Osteopathic Continuous Certification
(OCC) program will be considered equivalent to meeting CME requirement.
6.2
The application shall include evidence satisfactory to the Board of completion of a
prescribed program of continuing medical education established by the appropriate
medical or osteopathic society. Participation by duly appointed members of the Board in
regular Board meetings and investigating committee meetings shall be considered
acceptable on an hours served basis in lieu of AMA PRA Category 1 Credit™/AOA
Category 1a continuing medical education hours.
6.2.1 Said continuing medical education shall include a minimum of two (2) hours from
a list of topics related to current public health needs, which list shall be developed
by the Director in consultation with and as approved by the appropriate medical
or osteopathic society. The list shall be available to physicians as of 1 July of
each even-numbered year.
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6.3
The Board, may extend for only one (1) six (6) month period such educational
requirements pursuant to the provisions of § 5-37-2.1 of the Act.
6.4
It shall be the sole responsibility of the individual physician to obtain documentation
from the approved sponsoring or co-sponsoring organizations, agencies or other, of his or
her participation in a learning experience and the number of dated credits earned.
6.4.1 Those documents must be safeguarded, for a period of three (3) years, by the
physician for review by the Board if required. Only a summary list of those
documents, not the documents themselves, shall be submitted with the application
for renewal of the certification.
6.5
Licensure renewal shall be denied to any applicant who fails to provide satisfactory
evidence of continuing medical education as required by these Regulations.
Section 7.0
Issuance and Renewal of License and Fee
7.1
Upon completion of the aforementioned requirements and upon submission of the initial
licensure fee as set forth in the Rules and Regulations Pertaining to the Fee Structure for
Licensing, Laboratory and Administrative Services Provided by the Department of
Health, the Director may issue a license to those applicants found to have satisfactorily
met all the requirements of these Regulations. Said license unless sooner suspended or
revoked shall expire biennially on the first (1st) day of July of the next even-numbered
year.
7.2
(a) Every physician licensed during the current year who intends to practice allopathic or
osteopathic medicine during the ensuing two (2) years shall file with the Board,
before the first (1st) day of July of each even-numbered year, a renewal application,
on such forms as the Chief Administrative Officer deems appropriate, and duly
executed together with the renewal fee as set forth in the Rules and Regulations
Pertaining to the Fee Structure for Licensing, Laboratory and Administrative
Services Provided by the Department of Health on or before the first (1st) day of July
in each even-numbered year. Payment shall be postmarked on or before July 1.
(b) Notwithstanding the provisions of § 7.2(a) of these Regulations, a physician shall be
eligible for a reduced renewal fee, as set forth in the Rules and Regulations
Pertaining to the Fee Structure for Licensing, Laboratory and Administrative
Services Provided by the Department of Health, if the physician complies with the
following requirements:
(1) Successful completion of the Physician Professional Education Program for the
current renewal cycle, as established by the Director; and
(2) (i)
For the renewal period ending 30 June 2014, documentation of successful
completion of the Physician Professional Education Program for the current
renewal cycle is filed with the Board before 1 May 2014;
(ii) For renewal periods ending 30 June 2016 and later, documentation of
successful completion of the Physician Professional Education Program for
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the current renewal cycle is filed with the Board before the first (1st) day of
April of each even-numbered year; and
(3) Payment is received on or before the first (1st) day of July of each even-numbered
year.
7.3
Upon receipt of a renewal application and payment of fee, a license renewal, subject to
the terms of the Act and these Regulations, shall be issued, effective for two (2) years,
unless sooner suspended or revoked.
7.4
The licenses (registration certificates) of all allopathic or osteopathic physicians whose
renewals, accompanied by the prescribed fee, are not filed on or before the first (1st) day
of July shall be automatically lapsed. The Board may in its discretion and upon the
payment by the physician of the current licensure (registration) fee, plus an additional
fee, as set forth in the Rules and Regulations Pertaining to the Fee Structure for
Licensing, Laboratory and Administrative Services Provided by the Department of
Health reinstate any license (certificate) lapsed under the provisions of § 5-37-10 of the
Act and § 7.4 of these Regulations.
7.5
Every person to whom a license to practice medicine in Rhode Island has been granted by
the duly constituted licensing authority in Rhode Island and who intends to engage in the
practice of medicine during the ensuing two years, shall register his or her license by
filing with the Board such application duly executed together with such registration form
and fee as established by the Director.
7.6
[DELETED]
7.7
Each physician licensed in Rhode Island shall be required to provide pertinent
information to be included in an individual physician profile that shall be compiled by the
Board and made available to the public, as described in § 5-37-9.2 of the Act. This
information will be collected through a questionnaire provided by the Board and
completed by each licensed physician.
7.7.1 Through this questionnaire, each Rhode Island licensed physician shall provide
the following information to the Board for inclusion in the profile:
(a) Name(s) of medical school(s) and date(s) of graduation;
(b) Graduate medical education;
(c) A description of any final disciplinary actions by licensing boards in other
states within the most recent ten (10) years;
(d) A description of any criminal convictions for felonies within the most recent
ten (10) years. For the purpose of this subsection, a person shall be deemed to
be convicted of a crime if he or she pleaded guilty or if he or she was found or
adjudged guilty by a court of competent jurisdiction; or has been convicted of
a felony by the entry of a plea of nolo contendere;
(e) A description of revocation or restriction of hospital privileges for reasons
related to competence or quality of patient care that have been taken by the
16
hospital’s governing body or any other official of the hospital after procedural
due process has been afforded, or the resignation from or non-renewal of
medical staff membership or the restriction of privileges at a hospital during
the course of an investigation. Only cases which have occurred within the
most recent ten (10) years shall be disclosed to the public; and,
(f) All medical malpractice court judgments and all medical malpractice
arbitration awards in which payment was awarded to a complaining party
since September 1, 1988 in any state in which the physician was licensed
since September 1, 1988 or during the most recent ten (10) years, and all
settlements of malpractice claims in which payment was made to a
complaining party since September 1, 1988 or within the most recent ten (10)
years in any state in which the physician was licensed since September 1,
1988 or within the most recent ten (10) years.
7.7.2 In order to update for the profile the information initially supplied to the Board by
the physician at initial application for licensure, each physician shall provide the
following information through the questionnaire:
(a) Specialty board certification;
(b) Number of years in practice in any state;
(c) Name(s) of the hospital(s) where the physician has privileges in any state;
(d) The location of the physician’s primary practice setting; and,
(e) [DELETED].
7.7.3 [DELETED].
7.8
A limited medical registration certificate as an intern, resident or fellow shall be valid for
a period of not more than one (1) year from the date of issuance and may be renewed
annually for not more than four (4) consecutive years by the Department, except as
provided in § 2.11 of these Regulations.
7.9
A limited registration certificate for academic faculty shall be valid for a period of not
more than one (1) year, expiring on the 30th day of June following its initial effective date
and may be renewed for not more than five (5) consecutive years by the Board, provided
however, such registration shall automatically expire when the holder's relationship with
the medical school is terminated or substantially changes. The holder shall reapply for
limited registration in accordance with the requirements of §§ 4.8, 4.9 and 4.10 of these
Regulations if the relationship with the medical school substantially changes. After the
fifth consecutive renewal, a physician may reapply for limited registration in accordance
with the provisions of §§ 4.8, 4.9 and 4.10 of these Regulations.
Section 8.0
Refusal of License
8.1
The director at the direction of the Board, after due notice and hearing, in accordance
with the procedures set forth in §§ 5-37-5.2 to 5-37-6.2 of the Act, may refuse to grant
the original license to any physician and/or applicant who:
17
(a) is not of good moral character;
(b) does not meet the requirements for licensure set forth in the Act, regulations
established by the Board, and/or regulations promulgated by the director who has
violated any laws involving moral turpitude or affecting the ability of any physician
and/or applicant to practice medicine; or
(c) has been found guilty in another state of conduct which if committed in Rhode Island
would constitute unprofessional conduct, as defined in § 5-37-5.1 of the Act and these
Regulations.
(d) has been denied medical licensure in another state.
Said Director shall serve a copy of his or her decision or ruling upon any person whose
original certificate has been refused.
Section 9.0
Inactive List
9.1
A physician licensed to practice allopathic or osteopathic medicine who does not intend
to engage in the practice of medicine during any year, may upon written request to the
Board have his or her name transferred to an inactive list and shall not be required to
register biennially or pay any fee as long as he or she remains inactive. During said
period of inactive status, the physician may not practice medicine, as defined in § 1.19 of
these Regulations.
9.1.1
Any physician whose name has been included in the inactive list pursuant to § 9.1
of these Regulations shall be restored to active status by the Director upon the
filing of a written request accompanied by the registration form and fee as set
forth in the Rules and Regulations Pertaining to the Fee Structure for Licensing,
Laboratory and Administrative Services Provided by the Department of Health.
Furthermore, at the discretion of the Board, the applicant may be required to
appear before the Board for an interview.
Section 10.0 Unprofessional Conduct
10.1
The Director is authorized to deny or revoke any license to practice allopathic or
osteopathic medicine or otherwise discipline a licensee upon finding by the Board that
the person is guilty of unprofessional conduct which shall include, but not be limited to
those items, or combination thereof, listed in § 5-37-5.1 of the Act.
10.2
Licenses that have been revoked by the Director shall not be eligible for consideration for
re-instatement for a period of five (5) years. Re-instatement of revoked licenses shall be
at the discretion of the Board.
10.3
Pursuant to § 5-37-16 and § 5-37-16.1 of the Act, the Director is authorized to revoke the
limited registration certificate of any intern, resident or fellow, or academic faculty
physician, who violates any of the provisions of § 5-37-16 and § 5-37-16.1 of the Act
and/or these Regulations.
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10.4
Physician Self-treatment or Treatment of Immediate Family Members. A physician
is not authorized to prescribe a controlled substance to one self or an immediate family
member under any circumstances.
10.5
Discharging a Patient from a Practice. Periodically, a physician/practice may need to
terminate the physician-patient relationship. This shall be done via written notice, which
shall be documented in the medical record. The physician/practice must be available to
the patient for thirty (30) days for medication refills, urgent or emergent conditions. A
physician does not have to refill controlled substances if there is a suspicion of diversion.
10.6
Closing a Medical Practice.
(a) In the event of a planned voluntary closure of a medical practice, the physician shall,
at least ninety (90) days before closing his or her practice, give public notice as to the
disposition of patients' medical records in a media venue with, at a minimum,
statewide influence, and shall notify the Rhode Island Medical Society and the Board
of the location of the records. The public notice shall include the date of the
physician's retirement, and where and how patients may obtain their records both
prior to and after closure of the physician's practice.
(b) The heirs or estate of a deceased physician who had been practicing at the time of his
or her death shall, within ninety (90) days of the physician's death, give public notice
as to the disposition of patients' medical records in a media venue with a statewide
circulation, and shall notify the Rhode Island Medical Society and the Board of the
location of the records.
(c) Any physician closing his or her practice, or the heirs or estate of a deceased
physician who had been practicing at the time of his or her death, shall store the
physician's patient records in a location and manner so that the records are maintained
and accessible to patients.
(d) Any person or corporation or other legal entity receiving medical records of any
retired physician or deceased physician who had been practicing at the time of his or
her death, shall comply with and be subject to the provisions of RIGL Chapter 37.3,
the Confidentiality of Health Care Information Act, and shall be subject to the rules
and regulations promulgated in accordance with RIGL § 23-1-48 and with the
provisions of RIGL § 5-37-22(c) and (d), even though this person, corporation, or
other legal entity is not a physician.
Section 11.0 Mammography and Medical Records
Mammography
11.1 (a) All aspects of mammography services shall be performed in accordance with the
Mammography Quality Standards Reauthorization Act of 1998, Public Law 105-248,
and 21 C.F.R. Part 900.
(b) Pursuant to RIGL §23-4.9-1, each facility that takes a mammography x-ray of any
individual within Rhode Island shall keep and maintain that mammography x-ray for
the life of the individual. However, any mammography x-ray may be destroyed if the
19
individual has had no contact with the mammographic imaging facility for a period
exceeding fifteen (15) years.
Medical Records
11.2
Medical records and medical bills may be requested by the patient or the patient’s
personal representative. All medical record requests to physicians shall be made in
writing through a properly executed Authorization for Release of Health Care
Information.
(a) (1) Reimbursement to the physician for providing a patient a copy of their medical
record, regardless of format, shall not exceed seventy-five cents ($0.75) per page
for the first fifty (50) pages. After fifty (50) pages, the fee shall not exceed fifty
cents ($0.50) per page. If a medical record is greater than two hundred and
twenty-five (225) pages, the total charge will not exceed one hundred and twenty
dollars ($125). If a health record is transferred electronically (e.g., USB, CD or
other electronic means), the fee shall be consistent with the number of pages
transferred and, if there are greater than two hundred and twenty-five (225) pages,
shall not exceed one hundred twenty-five dollars ($125.00). An additional charge
to reflect actual cost of postage or electronic transfer is permissible.
(2) [DELETED]
(3) A special handling fee of an additional twenty dollars ($20.00) may be charged if
the records must be delivered to the patient or authorized representative within
forty-eight (48) hours of the request.
(4) Fees shall be adjusted for inflation on an annual basis by the Board using United
States Bureau of Labor Statistics calculator, adjusting rates to the most recent
completed year. The increase will be effective on 1 October 2016, and on the 1st
day of October in each succeeding year.
(5) Family Discount. Reimbursement to the physician for providing a family a copy
of their respective medical records shall not exceed seventy-five cents ($0.75) per
page for the first fifty (50) pages. After fifty (50) pages, the fee shall not exceed
fifty cents ($0.50) per page. At no time can the cost per record exceed twenty-
five dollars ($ 25) each, if properly executed Authorization for Release of Health
Care Information requests are presented at the same time. An additional charge to
reflect actual cost of postage or electronic transfer is permissible.
(b) The physician may not require prior payment of charges for medical services as a
condition for obtaining a copy of the medical record. The physician may not require
prepayment of charges for duplicating or retrieving records as a condition prior to
fulfilling the patient's request for the medical record if the request is for the purpose
of continuity of care. Copying of X-rays or other documents not reproducible by
photocopy shall be at the physician's actual cost plus reasonable fees for clerical
service not to exceed twenty-five dollars ($25.00). Charges shall not be made if the
record is requested for immunization records required for school admission or by the
applicant or beneficiary or individual representing an applicant or beneficiary for the
purposes of supporting a claim or appeal under the provision of the Social Security
20
Act or any federal or state needs-based benefit program such as Medical Assistance,
RIte Care, Temporary Disability Insurance and Unemployment compensation.
(c) No fees shall be charged to an applicant for benefits in connection with a Civil Court
Certification Proceeding or a claim under the Worker’s Compensation Act RIGL §
28-29-38 as reflected in RIGL § 23-17-19.1(16).
(d) Requested records must be provided within thirty (30) days of the receipt of the
written request or signed authorization for records. Requests for medical records
made by authorized third parties (e.g., attorneys representing the patient, attorneys
not representing the patient, a patient's estate on behalf of the patient, or insurance
companies) submitting a properly executed Authorization for Release of Information
shall be billed at two dollars and fifty cents ($2.50) per page for the first ten (10)
pages, then seventy-five cents ($0.75) per page for the next fifty (50) pages, then fifty
cents ($0.50) per page. An additional charge to reflect actual cost of postage is
permissible.
(e) Should instances arise relating to the retrieval and copying of medical records which
are not specifically covered by these Regulations, a fee structure consistent with that
described above shall apply.
(f) No fees shall be charged when a medical record is being sent from one provider to the
next in the context of a consultation.
11.3
Medical Records shall be stored by physicians or their authorized agents for a period of at
least seven (7) years unless otherwise required by law or regulation.
11.4
Medical Records shall be legible and contain the identity of the physician or physician
extender and supervising physician by name and professional title who is responsible for
rendering, ordering, supervising or billing each diagnostic or treatment procedure. The
records must contain sufficient information to justify the course of treatment, including,
but not limited to: active problem and mediation lists; patient histories; examination
results; test results; records of drugs prescribed, dispensed, or administered; and reports
of consultations and hospitalizations.
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Section 12.0 Patient Disclosure
12.1
In accordance with § 5-37-22 of the Act, physicians shall comply with the following
provisions:
12.1.1 Any physician who is not a participant in a medical insurance plan shall post a
notice, in a conspicuous place in his or her medical offices where it can be read by
his or her patients, which shall read, in substance, as follows: "To my patients: I
do not participate in a medical insurance plan. You should know that you will be
responsible for the payment of my medical fees."
Any physician who fails to post such a notice shall not be entitled to charge his or
her patients any amount, for medical fees, in excess of that allowed had the
physician participated in such a medical insurance plan.
12.1.2 Every physician shall disclose to patients eligible for Medicare, in advance of
treatment, whether such physician accepts assignment under Medicare
reimbursement as payment in full for medical services and/or treatment in the
physician's office. Such disclosure shall be given by posting in each physician's
office in a conspicuous place a summary of the physician's Medicare
reimbursement policy. Any physician who fails to make the disclosure as
required by these Regulations herein shall not be allowed to charge the patient in
excess of the Medicare assignment amount for the medical procedure performed.
12.1.3 When a patient requests in writing that his or her medical records be transferred to
another physician, the original physician shall promptly honor such request. The
physician shall be reimbursed for reasonable expenses (as defined in § 11.2 of
these Regulations) incurred in connection with copying such medical records.
12.1.4 Every physician shall, upon written request of any patient (or his or her authorized
representative as defined in RIGL § 5-37.3-3(1)) who has received health care
services from such provider, at the option of the physician either permit such
patient (or his or her authorized representative) to examine and copy the patient's
confidential health care information or provide such patient (or his or her
authorized representative) a summary of such information. If the physician
decides to provide a summary and the patient is not satisfied with a summary,
then the patient may request and the physician shall provide a copy of the entire
record. At the time of such examination, copying or provision of summary
information, the physician shall be reimbursed for reasonable expenses (as
defined above) in connection with copying such information. If in the
professional judgment of the physician, it would be injurious to the mental or
physical health of the patient to disclose certain confidential health care
information to the patient, the physician is not required to disclose or provide a
summary of such information to the patient, but shall upon written request of the
patient (or his or her authorized representative) disclose such information to
another physician designated by the patients.
12.1.5 Every physician who has ownership interest in health facilities, or laboratories,
including any health care facility licensed pursuant to RIGL Chapter 23-17, any
residential care/assisted living facility licensed pursuant to RIGL Chapter 23-17.4,
22
and any adult day care program licensed pursuant to RIGL Chapter 23-1-52, or
any equipment not on the physician's premises shall, in writing, make full patient
disclosure of his or her ownership interest in the facility or therapy prior to
utilization. The written notice shall state that the patient has free choice either to
use the physician's proprietary facility or therapy or may seek the needed medical
services elsewhere.
12.1.6 A physician who practices medical acupuncture as a therapy shall provide full
written disclosure to his/her patient receiving medical acupuncture that the
physician’s qualifications to practice medical acupuncture are not equivalent to
those of doctors of acupuncture licensed in accordance with RIGL Chapter 5-
37.2. Further, a physician integrating medical acupuncture into his/her medical
practice shall disclose to the patient the type of pathway (i.e., pain management,
primary care) in which the physician was trained.
Section 13.0 Collaborative Pharmacy Practice
13.1
A physician may engage in a collaborative pharmacy practice with a Rhode Island
licensed pharmacist pursuant to a collaborative practice agreement, provided that the
physician has completed a residency training program, is eligible for certification, or is
certified by a member board of the American Board of Medical Specialties or the Bureau
of Osteopathic Specialists in the area(s) of medicine included in the practice agreement,
and provided that the pharmacist is qualified pursuant to rules and regulations of the
Rhode Island Board of Pharmacy.
13.2
Any physician engaging in a collaborative pharmacy practice shall execute a written
agreement with a pharmacist which shall include, but is not limited to, the following:
13.2.1 Identification, qualifications, and signatures of the parties to the agreement, the
date of signing of the agreement and the term of the agreement. An initial
agreement shall be valid for a period not to exceed two (2) years.
13.2.2 A termination clause specifying the responsibilities of each party for records
confidentiality and continuity of care, a requirement for written notice and a
minimum termination notice period.
13.2.3 The procedures for obtaining informed consent from each patient involved in
services pursuant to the agreement.
13.2.4 The role(s) of any health care professional with prescriptive privileges employed
by or collaborating with the physician.
13.2.5 The quality assurance procedures of the collaboration.
13.2.6 Proof of liability insurance for all parties to the agreement.
13.2.7 The scope of conditions or diseases to be managed and the practice protocols for
management shall be specified as set forth in § 13.6 of these Regulations.
23
13.3
All services provided pursuant to a collaborative practice agreement shall be consistent
with said agreement and shall be performed in a setting that ensures patient privacy and
confidentiality.
13.4
A patient shall be fully informed of the collaborative nature of drug therapy management
for his/her medical conditions.
13.5
A patient may decline to participate in a collaborative pharmacy practice and may
withdraw at any time without terminating the physician-patient relationship.
13.6
A separate practice protocol shall be written for each disease or condition to be managed
in the collaborative pharmacy practice. The protocol(s) shall be appended to the
collaborative practice agreement, and may be revised from time to time by mutual
agreement of the parties without affecting the term of the agreement. Practice protocols
shall provide, at a minimum:
13.6.1 A description of the type of disease or condition, the drugs or drug categories
involved, and the drug therapy management decisions the pharmacist is
authorized to engage in.
13.6.2 The procedures, decision criteria and/or plan the physician and pharmacist will
follow in providing drug therapy management.
13.6.3 The documentation requirements for the physician and pharmacist.
13.6.4 The reporting and consultation requirements for the physician and pharmacist.
13.6.5 The communication required when a pharmacist decision is over-ridden by the
physician.
13.6.6 A provision for review of the outcomes of treatment for patients managed
pursuant to the protocol.
13.6.7 The date(s) adopted and/or amended.
13.7
Collaborative pharmacy practice protocols shall only be used for conditions or diseases
with generally accepted standards of care. The scope of the collaborative practice shall
not include research, clinical or investigational trials.
13.8
Each signatory of a collaborative pharmacy practice agreement shall keep a copy of the
agreement with appendices on file at his/her primary place of practice.
13.9
Each patient receiving care pursuant to a collaborative pharmacy practice agreement shall
have an authorized prescriber's order in the primary medical record and on file with the
pharmacist authorizing the implementation of drug therapy management.
13.10 A file of completed, signed patient consent forms authorizing release of medical
information among the health professionals in the collaborative pharmacy practice shall
be maintained at the physician practice site and on file with the pharmacist.
24
13.11 The physician establishing a collaborative practice shall notify the board in writing within
thirty (30) days of the effective date of the collaborative practice. The notice shall be
submitted on a prescribed form and shall include, at a minimum the principals in the
collaborative and the drug therapies to be managed. The Department may request
additional information as required to determine compliance with these Regulations.
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PART II
PRACTICES AND PROCEDURES/SEVERABILITY
Section 14.0 Rules Governing Practices and Procedures
14.1
All hearings and reviews required under the provisions of the Act and these Regulations
shall be held in accordance with the provisions of the Rules and Regulations Pertaining
to Practices and Procedures Before the Rhode Island Department of Health [R42-35-
PP].
Section 15.0 Severability
15.1
If any provision of these Regulations or the application to any facility or circumstances
shall not effect the provisions or application of these regulations which can be given
effect, and to this end the provisions of these Regulations are declared to be severable.
Physicians_Final_October2015
Monday, October 19, 2015