2025 -- S 0701

========

LC001654

========

     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2025

____________

A N   A C T

RELATING TO BUSINESSES AND PROFESSIONS -- NURSES

     Introduced By: Senators Lauria, Valverde, Euer, Ujifusa, DiMario, Lawson, Pearson, and
Murray

     Date Introduced: March 07, 2025

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

     SECTION 1. Section 5-34-3 of the General Laws in Chapter 5-34 entitled "Nurses" is

hereby amended to read as follows:

     5-34-3. Definitions.

     As used in this chapter:

     (1) “Advanced practice registered nurse” (APRN) is the title given to an individual licensed

to practice advanced practice registered nursing within one of the following roles: certified nurse

practitioner (CNP), certified registered nurse anesthetist (CRNA) as defined in chapter 34.2 of this

title, or certified clinical nurse specialist (CNS), and who functions in a population focus. An APRN

may serve as a primary- or acute-care provider of record.

     (2) “Advanced practice registered nursing” means an independent and expanded scope of

nursing in a role and population focus approved by the board of nurse registration and nursing

education that includes the registered nurse scope of practice and may include, but is not limited

to, performing acts of advanced assessment, diagnosing, prescribing, and ordering. Each APRN is

accountable to patients, the nursing profession, and the board of nursing for complying with the

requirements of this chapter and the quality of advanced nursing care rendered; recognizing limits

of knowledge and experience; planning for the management of situations beyond the APRN’s

expertise; and for consulting with or referring patients to other healthcare providers as appropriate.

     (3) “Approval” means the process where the board of nursing evaluates and grants official

recognition to basic nursing education programs meeting established criteria and standards.

     (4) “Certified clinical nurse specialist” is an advanced practice registered nurse who

independently provides care to clients; facilitates attainment of health goals; and provides

innovation in nursing practice, based on clinical expertise, evidence-based decision-making, and

leadership skills. The clinical nurse specialist practices with individual clients and populations;

nurses, and other multidisciplinary team members; and organizations to effect systemwide changes

to improve programs of care. The practice may include prescriptive privileges.

     (5) “Certified nurse practitioner” is an advanced practice nurse utilizing independent

knowledge of physical assessment, diagnosis, and management of health care and illnesses. The

practice includes prescriptive privileges. Certified nurse practitioners are members of the healthcare

delivery system practicing in areas including, but not limited to: family practice, pediatrics, adult

health care, geriatrics, and women’s health care in primary, acute, long-term, and critical-care

settings in healthcare facilities and the community. Certified nurse practitioners may be recognized

as the primary-care provider or acute-care provider of record.

     (6) “Certified registered nurse anesthetist” is as defined in chapter 34.2 of this title (“Nurse

Anesthetist”).

     (7) “Department” means the department of health.

     (8) “Health” means optimum well-being.

     (9) “Health care” means those services provided to promote the optimum well-being of

individuals.

     (10) “Licensed” means the status of qualified individuals who have completed a designated

process by which the board of nursing grants permission to individuals accountable and/or

responsible for the practice of nursing and to engage in that practice, prohibiting all others from

legally doing so.

     (11) “Nursing” means the provision of services that are essential to the promotion,

maintenance, and restoration of health throughout the continuum of life. It provides care and

support of individuals and families during periods of wellness, illness, and injury, and incorporates

the appropriate healthcare plan of care prescribed by a licensed advanced practice registered nurse,

certified nurse midwife, licensed physician, dentist, or podiatrist. It is a distinct component of health

services. Nursing practice is based on specialized knowledge, judgment, and nursing skills acquired

through educational preparation in nursing and in the biological, physical, social, and behavioral

sciences.

     (12) “Population foci” means focus of the patient population. Population focus shall

include:

     (i) Family/Individual across the lifespan;

LC001654 - Page 2 of 13

     (ii) Adult-gerontology;

     (iii) Neonatal;

     (iv) Pediatrics;

     (v) Women’s health/gender-related; and

     (vi) Psychiatric/mental health.

     (13) “Practical nursing” is practiced by licensed practical nurses (L.P.N.s). It is an integral

part of nursing based on a knowledge and skill level commensurate with education. It includes

promotion, maintenance, and restoration of health and utilizes standardized procedures leading to

predictable outcomes that are in accord with the professional nurse regimen under the direction of

a registered nurse. In situations where registered nurses are not employed, the licensed practical

nurse functions under the direction of a licensed physician, dentist, podiatrist, or other licensed

healthcare providers authorized by law to prescribe. Each L.P.N. is responsible for the nursing care

rendered.

     (14) “Professional nursing” is practiced by registered nurses (R.N.s). The practice of

professional nursing is a dynamic process of assessment of an individual’s health status;

identification of healthcare needs; determination of healthcare goals with the individual and/or

family participation; and the development of a plan of nursing care to achieve these goals. Nursing

actions, including teaching and counseling, are directed toward the promotion, maintenance, and

restoration of health and evaluation of the individual’s response to nursing actions and the medical

regimen of care. The professional nurse provides care and support of individuals and families

during periods of wellness and injury and incorporates, where appropriate, the medical plan of care

as prescribed by a licensed physician, dentist, podiatrist, or other licensed healthcare providers

authorized by law to prescribe. Each R.N. is directly accountable and responsible to the consumer

for the nursing care rendered.

     (15) “Psychiatric and mental health nurse clinical specialist” is a certified clinical nurse

specialist working in the population foci of psychiatric/mental health as an advanced practice nurse

utilizing independent knowledge in psychiatric mental-health assessment; diagnosis, health

promotion, psychotherapeutic modalities, and management of mental health and illnesses. The

practice may include prescription privileges within their scope of practice. The practice may also

include consultation and education.

     (16) “Telemedicine” has the meaning as provided in § 27-81-3.

     SECTION 2. Chapter 5-34 of the General Laws entitled "Nurses" is hereby amended by

adding thereto the following section:

     5-34-51. Telemedicine in the practice of medicine for advanced practice registered

LC001654 - Page 3 of 13

nurses.

     (a) Professionals licensed under this chapter who use telemedicine in the practice of

medicine shall be subject to the same standard of care that would apply to the provision of the same

medical care service or procedure in an in-person setting.

     (b) The board of nursing shall not sanction an APRN solely because the healthcare service

is provided through telemedicine and is not provided through in-person consultation or contact;

provided that, the healthcare service is necessary and medically and clinically appropriate to be

provided through telemedicine services.

     (c) When another state or territory seeks to sanction a Rhode Island licensed APRN for

providing services via telemedicine to a patient outside of Rhode Island in a state or territory in

which the APRN is not licensed, the board of nursing shall not sanction the APRN based on the

delivery of service via telemedicine; provided that, the following conditions are met:

     (1) The patient is an established patient or the APRN is covering a provider with the

established patient-provider relationship; and

     (2) The patient has been seen in person within the previous twenty-four (24) months by the

APRN or the provider for whom the APRN is providing coverage.

     (d) The state shall not require an APRN who uses telemedicine in the practice of medicine

to be licensed or registered in the state in accordance with state law when the following conditions

are met:

     (1) The APRN is licensed as an APRN or its equivalent in a state or territory of the United

States of America;

     (2) The license is in good standing and without restriction;

     (3) The APRN has professional liability insurance coverage for any care provided to a

person while the person is located in Rhode Island; and

     (4) There is an established patient-provider relationship and the patient has been seen in-

person within the previous twenty-four (24) months by the APRN; or

     (5) The patient has been referred to the APRN for purposes other than direct diagnosis or

treatment by an in-state provider who retains authority and responsibility for the patient’s care, and

the APRN makes all recommendations to the in-state provider after communicating with the

patient; or

     (6) The purpose of the telemedicine service is to initiate the evaluation and potential

treatment of a new patient who will be seen in person within the next three (3) months, and the

APRN does not directly diagnose or treat the patient until the patient is seen in person. The APRN

may make a request or recommendation to a Rhode Island licensed provider who has treated the

LC001654 - Page 4 of 13

patient in person, whether or not the Rhode Island provider referred the patient to the APRN;

however, the Rhode Island provider has no obligation to accept a request or recommendation from

an APRN who has not fully evaluated the patient.

     (e) In all cases, the Rhode Island board of nursing shall have jurisdiction in evaluating

whether an APRN has conformed to the standards of care and conduct applicable to a Rhode Island

licensed provider when telemedicine service is provided to a patient while the patient is located

within the state.

     (f) In all cases, an APRN who delivers telemedicine service to a patient who is located in

the state during the rendition of those services shall be subject to the jurisdiction of the state and its

courts.

     SECTION 3. Section 5-37-1 of the General Laws in Chapter 5-37 entitled "Board of

Medical Licensure and Discipline" is hereby amended to read as follows:

     5-37-1. Definitions.

     As used in this chapter:

     (1) “Board” means the Rhode Island board of medical licensure and discipline or any

committee or subcommittee thereof.

     (2) “Chief administrative officer” means the administrator of the Rhode Island board of

medical licensure and discipline.

     (3) “Department” means the Rhode Island department of health.

     (4) “Director” means the director of the Rhode Island department of health.

     (5) “Healthcare facility” means any institutional health-service provider licensed pursuant

to the provisions of chapter 17 of title 23.

     (6) “Health-maintenance organization” means a public or private organization licensed

pursuant to the provisions of chapter 17 of title 23 or chapter 41 of title 27.

     (7) “Limited registrant” means a person holding a limited-registration certificate pursuant

to the provisions of this chapter.

     (8) “Medical malpractice” or “malpractice” means any tort, or breach of contract, based on

health care or professional services rendered or that should have been rendered, by a physician,

dentist, hospital, clinic, health-maintenance organization, or professional service corporation

providing healthcare services and organized under chapter 5.1 of title 7, to a patient or the rendering

of medically unnecessary services except at the informed request of the patient.

     (9) “Medical-practice group” means a single legal entity formed primarily for the purpose

of being a physician group practice in any organizational form recognized by the state in which the

group practice achieves its legal status, including, but not limited to, a partnership, professional

LC001654 - Page 5 of 13

corporation, limited-liability company, limited-liability partnership, foundation, not-for-profit

corporation, faculty practice plan, or similar association.

     (10) “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.

     (11) “Nonprofit medical-services corporation” or “nonprofit hospital-service corporation”

means any corporation organized pursuant to chapter 19 or chapter 20 of title 27 for the purpose of

establishing, maintaining, and operating a nonprofit medical-service plan.

     (12)(i) “Peer-review board” means any committee of a state or local professional

association or society including a hospital association, or a committee of any licensed healthcare

facility, or the medical staff thereof, or any committee of a medical-care foundation or health-

maintenance organization, or any committee of a professional-service corporation or nonprofit

corporation employing twenty (20) or more practicing professionals, organized for the purpose of

furnishing medical service, or any staff committee or consultant of a hospital-service or medical-

service corporation, the function of which, or one of the functions of which, is to evaluate and

improve the quality of health care rendered by providers of healthcare services or to determine that

healthcare services rendered were professionally indicated or were performed in compliance with

the applicable standard of care or that the cost of health care rendered was considered reasonable

by the providers of professional healthcare services in the area and shall include a committee

functioning as a utilization-review committee under the provisions of 42 U.S.C. § 1395 et seq.

(Medicare law) or as a professional-standards review organization or statewide professional-

standards review council under the provisions of 42 U.S.C. § 1301 et seq. (professional-standards

review organizations) or a similar committee or a committee of similar purpose, to evaluate or

review the diagnosis or treatment of the performance or rendition of medical or hospital services

that are performed under public medical programs of either state or federal design.

     (ii) “Peer-review board” also means the board of trustees or board of directors of a state or

local professional association or society, a licensed healthcare facility, a medical-care foundation,

a health-maintenance organization, and a hospital-service or medical-service corporation only

when such board of trustees or board of directors is reviewing the proceedings, records, or

recommendations of a peer-review board of the above enumerated organizations.

     (13) “Person” means any individual, partnership, firm, corporation, association, trust or

estate, state or political subdivision, or instrumentality of a state.

LC001654 - Page 6 of 13

     (14) “Physician” means a person with a license to practice allopathic or osteopathic

medicine in this state under the provisions of this chapter.

     (15) “Practice of medicine” includes the practice of allopathic and osteopathic medicine.

Any person is regarded as practicing medicine within the meaning of this chapter who holds himself

or herself out as being able to diagnose, treat, operate, or prescribe for any person ill or alleged to

be ill with disease, pain, injury, deformity, or abnormal physical or mental condition, or who either

professes to heal, offer, or undertake, by any means or method, to diagnose, treat, operate, 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.

     (16) “Telemedicine” has the meaning as provided in § 27-81-3.

     SECTION 4. Chapter 5-37 of the General Laws entitled "Board of Medical Licensure and

Discipline" is hereby amended by adding thereto the following section:

     5-37-34. Telemedicine in the practice of medicine for physicians.

     (a) Professionals licensed under this chapter who use telemedicine in the practice of

medicine shall be subject to the same standard of care that would apply to the provision of the same

medical care service or procedure in an in-person setting.

     (b) The board of medical licensure and discipline shall not sanction a physician solely

because the healthcare service is provided through telemedicine and is not provided through in-

person consultation or contact; provided that, the healthcare service is necessary and medically and

clinically appropriate to be provided through telemedicine services.

     (c) When another state or territory seeks to sanction a Rhode Island licensed physician for

providing services via telemedicine to a patient outside of Rhode Island in a state or territory in

which the physician is not licensed, the board of medical licensure and discipline shall not sanction

the physician based on the delivery of service via telemedicine; provided that, the following

conditions are met:

     (1) The patient is an established patient or the physician is covering a provider with the

established patient-provider relationship; and

     (2) The patient has been seen in person within the previous twenty-four (24) months by the

Rhode Island licensed physician or the provider for whom the physician is providing coverage.

     (d) The state shall not require a physician who uses telemedicine in the practice of medicine

to be licensed or registered in the state in accordance with state law when the following conditions

LC001654 - Page 7 of 13

are met:

     (1) The physician is licensed as an osteopathic or allopathic physician in a state or territory

of the United States of America;

     (2) The license is in good standing and without restriction;

     (3) The physician has professional liability insurance coverage for any care provided to a

person while the person is located in Rhode Island; and

     (4) There is an established patient-provider relationship and the patient has been seen in

person within the previous twenty-four (24) months by the physician; or

     (5) The patient has been referred to the physician for purposes other than direct diagnosis

or treatment by an in-state provider who retains authority and responsibility for the patient’s care,

and the physician makes all recommendations to the in-state provider after communicating with

the patient; or

     (6) The purpose of the telemedicine service is to initiate the evaluation and potential

treatment of a new patient who will be seen in person within the next three (3) months, and the

physician does not directly diagnose or treat the patient until the patient is seen in person. The

physician may make a request or recommendation to a Rhode Island licensed provider who has

treated the patient in-person, whether or not the Rhode Island provider referred the patient to the

physician; however, the Rhode Island provider has no obligation to accept a request or

recommendation from a physician who has not fully evaluated the patient.

     (e) In all cases, the Rhode Island board of medical licensure and discipline shall have

jurisdiction in evaluating whether a physician has conformed to the standards of care and conduct

applicable to a Rhode Island licensed physician when telemedicine service is provided to a patient

while the patient is located within the state.

     (f) In all cases, a physician who delivers telemedicine service to a patient who is located in

the state during the rendition of those services shall be subject to the jurisdiction of the state and its

courts.

     SECTION 5. Section 5-54-2 of the General Laws in Chapter 5-54 entitled "Physician

Assistants" is hereby amended to read as follows:

     5-54-2. Definitions.

     As used in this chapter, the following words have the following meanings:

     (1) “Administrator” means the administrator, division of professional regulation.

     (2) “Approved program” means a program for the education and training of physician

assistants formally approved by the American Medical Association’s (A.M.A.’s) Committee on

Allied Health, Education and Accreditation, its successor, the Commission on Accreditation of

LC001654 - Page 8 of 13

Allied Health Education Programs (CAAHEP) or its successor.

     (3) “Approved program for continuing medical education” means a program for continuing

education approved by the American Academy of Physician Assistants (AAPA) or the

Accreditation Council for Continuing Medical Education of the American Medical Association

(AMA), or the American Academy of Family Physicians (AAPFP) or the American Osteopathic

Association Committee on Continuing Medical Education (AOACCME) or any other board-

approved program.

     (4) “Board” means the board of licensure of physician assistants.

     (5) “Collaboration” means the physician assistant shall, as indicated by the patient’s

condition, the education, competencies, and experience of the physician assistant, and the standards

of care, consult with or refer to an appropriate physician or other healthcare professional. The

degree of collaboration shall be determined by the practice and includes decisions made by a

physician employer, physician group practice, and the credentialing and privileging systems of a

licensed hospital, health center, or ambulatory care center. A physician must be accessible at all

times for consultation by the physician assistant.

     (6) “Director” means the director of the department of health.

     (7) “Division” means the division of professional regulation, department of health.

     (8) [Deleted by P.L. 2013, ch. 320, § 1 and P.L. 2013, ch. 420, § 1.]

     (9) “Physician” means a person licensed under the provisions of chapter 29 or 37 of this

title.

     (10) “Physician assistant” or “PA” means a person who is qualified by academic and

practical training to provide medical and surgical services in collaboration with physicians.

     (11) “Telemedicine” has the meaning as provided in § 27-81-3.

     (11)(12) “Unprofessional conduct” includes, but is not limited to, the following items or

any combination and may be defined by regulations established by the board with prior approval

of the director:

     (i) Fraudulent or deceptive procuring or use of a license;

     (ii) Representation of himself or herself as a physician;

     (iii) Conviction of a felony; conviction of a crime arising out of the practice of medicine.

All advertising of medical business that is intended or has a tendency to deceive the public;

     (iv) Abandonment of a patient;

     (v) Dependence upon a controlled substance, habitual drunkenness, or rendering

professional services to a patient while intoxicated or incapacitated by the use of drugs;

     (vi) Promotion of the sale of drugs, devices, appliances, or goods or services provided for

LC001654 - Page 9 of 13

a patient in a manner that exploits the patient for the financial gain of the physician assistant;

     (vii) Immoral conduct of a physician assistant in the practice of medicine;

     (viii) Willfully making and filing false reports or records;

     (ix) Willful omission to file or record or willfully impeding or obstructing a filing or

recording, or inducing another person to omit to file or record medical or other reports as required

by law;

     (x) Agreeing with clinical or bioanalytical laboratories to accept payments from these

laboratories for individual tests or test series for patients;

     (xi) Practicing with an unlicensed physician or physician assistant or aiding or abetting

these unlicensed persons in the practice of medicine;

     (xii) Offering, undertaking, or agreeing to cure or treat a disease by a secret method,

procedure, treatment, or medicine;

     (xiii) Professional or mental incompetence;

     (xiv) Surrender, revocation, suspension, limitation of privilege based on quality of care

provided, or any other disciplinary action against a license or authorization to practice in another

state or jurisdiction; or surrender, revocation, suspension, or any other disciplinary action relating

to membership on any medical staff or in any medical professional association, or society while

under disciplinary investigation by any of those authorities or bodies for acts or conduct similar to

acts or conduct that would constitute grounds for action as stated in this chapter;

     (xv) Any adverse judgment, settlement, or award arising from a medical liability claim

related to acts or conduct that would constitute grounds for action as stated in this chapter;

     (xvi) Failure to furnish the board, the administrator, investigator, or representatives,

information legally requested by the board;

     (xvii) Violation of any provisions of this chapter or the rules and regulations promulgated

by the director or an action, stipulation, or agreement of the board;

     (xviii) Cheating or attempting to subvert the certifying examination;

     (xix) Violating any state or federal law or regulation relating to controlled substances;

     (xx) Medical malpractice;

     (xxi) Sexual contact between a physician assistant and patient during the existence of the

physician assistant/patient relationship;

     (xxii) Providing services to a person who is making a claim as a result of a personal injury,

who charges or collects from the person any amount in excess of the reimbursement to the physician

assistant by the insurer as a condition of providing or continuing to provide services or treatment.

     SECTION 6. Chapter 5-37 of the General Laws entitled "Board of Medical Licensure and

LC001654 - Page 10 of 13

Discipline " is hereby amended by adding thereto the following section:

     5-54-29. Telemedicine in the practice of medicine for physician assistants.

     (a) Professionals licensed under this chapter who use telemedicine in the practice of

medicine shall be subject to the same standard of care that would apply to the provision of the same

medical care service or procedure in an in-person setting.

     (b) The board of medical licensure and discipline shall not sanction a physician solely

because the healthcare service is provided through telemedicine and is not provided through in-

person consultation or contact; provided that, the healthcare service is necessary and medically and

clinically appropriate to be provided through telemedicine services.

     (c) When another state or territory seeks to sanction a Rhode Island licensed physician for

providing services via telemedicine to a patient outside of Rhode Island in a state or territory in

which the physician is not licensed, the board of medical licensure and discipline shall not sanction

the physician based on the delivery of service via telemedicine; provided that, the following

conditions are met:

     (1) The patient is an established patient or the physician is covering a provider with the

established patient-provider relationship; and

     (2) The patient has been seen in person within the previous twenty-four (24) months by the

Rhode Island licensed physician or the provider for whom the physician is providing coverage.

     (d) The state shall not require a physician who uses telemedicine in the practice of medicine

to be licensed or registered in the state in accordance with state law when the following conditions

are met:

     (1) The physician is licensed as an osteopathic or allopathic physician in a state or territory

of the United States of America;

     (2) The license is in good standing and without restriction;

     (3) The physician has professional liability insurance coverage for any care provided to a

person while the person is located in Rhode Island; and

     (4) There is an established patient-provider relationship and the patient has been seen in-

person within the previous twenty-four (24) months by the physician; or

     (5) The patient has been referred to the physician for purposes other than direct diagnosis

or treatment by an in-state provider who retains authority and responsibility for the patient’s care,

and the physician makes all recommendations to the in-state provider after communicating with

the patient; or

     (6) The purpose of the telemedicine service is to initiate the evaluation and potential

treatment of a new patient who will be seen in person within the next three (3) months, and the

LC001654 - Page 11 of 13

physician does not directly diagnose or treat the patient until the patient is seen in person. The

physician may make a request or recommendation to a Rhode Island licensed provider who has

treated the patient in person, whether or not the Rhode Island provider referred the patient to the

physician; however, the Rhode Island provider has no obligation to accept a request or

recommendation from a physician who has not fully evaluated the patient.

     (e) In all cases, the Rhode Island board of medical licensure and discipline shall have

jurisdiction in evaluating whether a physician has conformed to the standards of care and conduct

applicable to a Rhode Island licensed physician when telemedicine service is provided to a patient

while the patient is located within the state.

     (f) In all cases, a physician who delivers telemedicine service to a patient who is located in

the state during the rendition of those services shall be subject to the jurisdiction of the state and its

courts.

     SECTION 7. This act shall take effect upon passage.

========

LC001654

========

LC001654 - Page 12 of 13

EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO BUSINESSES AND PROFESSIONS -- NURSES

***

     This act would permit advanced practice registered nurses (APRN), physicians, and

physician assistants to provide services to patients located in Rhode Island via telemedicine when

those services are necessary and medically and clinically appropriate. This act would also allow

APRNs, physicians, and physician assistants who are licensed in other states or U.S. territories who

have appropriate professional liability insurance coverage and who are licensed and in good

standing in those jurisdictions to provide telemedicine services to patients who are in Rhode Island

when those services are rendered. Further, this act would bring providers who render telemedicine

services to patients who are in the state when the services are rendered under the jurisdiction of the

state and its courts.

     This act would take effect upon passage.

========

LC001654

========

LC001654 - Page 13 of 13