Rhode Island
LLC
Website link to register:
https://sos.ri.gov/divisions/business-portal
Naming conventions
Certain terms like “University” or “Academy” require additional approval. Must include “Limited Liability Company,” “LLC,” or “L.L.C.” PLLCs must use “Professional LLC.”
Licensing Requirements
Submit proof of licensure from the Rhode Island Board of Medical Licensure and Discipline. Proof of malpractice insurance required. Facility permits from the Rhode Island Department of Health may apply.
Required documentation for medical practices
Articles of Organization, Lab Testing Permits, Professional Licenses, Malpractice Insurance
Filing Fee: $150
Annual/Biennial Fee: $50
Additional Notes: Annual report due by LLC anniversary date.
Medicaid
Program Name: Rhode Island Medicaid
Official Website: https://eohhs.ri.gov/consumer/health-care
Legislation: Rhode Island does not have specific DPC legislation; practices operate under general healthcare and insurance laws.
Private Contracting
Permitted; DPC practices should ensure compliance with state insurance regulations to avoid being classified as insurers.
Restrictions
No explicit restrictions for DPC providers; compliance with federal and state regulations is necessary.
Medicaid Program
Rhode Island Medicaid provides health coverage to eligible low-income residents through RIte Care and other programs.
Notification Requirements
Notification strongly recommended for Medicaid patient clarity.
Provider Enrollment Requirements
Providers must enroll with Rhode Island Medicaid to serve beneficiaries directly or offer reimbursable services.
Enrollment Options
No "Ordering and Referring Only" status available.
Ordering, Referrals, and Testing
Non-enrolled providers may face challenges with Medicaid recognition for orders and referrals.
Designated PCP Restrictions
DPC physicians cannot act as Medicaid-designated PCPs.
Billing and Reimbursement
DPC practices typically do not bill Medicaid for services covered under private agreements.
Managed Care Plan Exemptions
Not specified.
Billing Clarity
Cannot bill Medicaid patients for covered services unless explicitly outlined.
CMS Guidance
CMS encourages streamlined enrollment for non-billing providers.
Opportunities for Collaboration
Opportunities may exist to collaborate with Medicaid Managed Care Organizations (MCOs) or state programs aimed at primary care expansion.
State-Specific Notes
Collaboration opportunities exist with Rhode Island Medicaid Managed Care Organizations for primary care expansion.
Dispensing Medication
Board of Pharmacy Official Link: https://health.ri.gov/licenses/detail.php?id=262
State Licensing
Physicians must register with the Rhode Island Department of Health for dispensing controlled substances.
Scope of Practice
Direct dispensing of medications is allowed within a physician’s scope of practice.
Inventory Management
Accurate inventory logs and secure storage are mandatory for all medications.
Record-Keeping
Records must comply with Rhode Island state and federal HIPAA regulations.
Dispensing Standards
Labels must meet Rhode Island Board of Pharmacy standards, including prescribing physician, patient name, and dosage.
Controlled Substances
DEA registration and reporting to Rhode Island’s PDMP are mandatory for controlled substances.
Billing and Reimbursement
Billing practices must adhere to Rhode Island-specific and federal anti-kickback statutes.
Federal Compliance
Compliance with FDA, DEA, and OSHA standards is mandatory for dispensing.
State Pharmacy Laws
Physicians must adhere to Rhode Island pharmacy board regulations for controlled substances dispensing.
Patient Consent
Patient consent must be obtained prior to dispensing medications.
Insurance and Liability
Liability insurance must explicitly cover risks associated with dispensing practices.
Training Requirements
Continuing education for controlled substances dispensing is encouraged in Rhode Island.
Audits and Inspections
Inspections are conducted by the Rhode Island Board of Pharmacy to ensure compliance, with penalties for violations.