Rhode Island

Rhode Island has no DPC laws at present.  Please do not be confused by 230 RI Code of Rules 20 30 4.3 which does define “Direct Primary Care Expenses” in the context of an insurance contract but this has nothing to do with DPC practices or defining what is or is not insurance. Be sure to review the Rhode Island Insurance Code and the medical practice act (CHAPTER 5-37 Board of Medical Licensure and Discipline Index Of Sections)when planning your DPC practice. Physicians will want to review the regulations discussed by the Physician Licensing Section of the Rhode Island Department of Health. We have not been able to locate any specific statements regarding dispensing medications, but this Fee Splitting statement is available. Restrictive covenants (noncompete clauses) are not enforceable in Rhode Island.

Unfortunately transparent lab pricing is made difficult in Rhode Island. The language of RI Gen L § 23-16.2-5.1 (2020) favors hospitals and DPC practices serving employers while discriminating against DPC practices that serve individual patients that sign up one by one. Here is the language. Note the areas that I have placed in bold for emphasis.

Ҥ 23-16.2-5.1. Payment for services rendered by clinical laboratories - Commissions, rebates, and fees - Use of laboratory's name.

(a) It shall be unlawful for any purveyor of clinical laboratory services, directly or indirectly, through any person, firm, corporation, or association, or its officers or agents, to bill or receive payment, reimbursement, compensation, or fee from any person other than the recipient of the services, the recipient being the person upon whom the clinical services have been or will be rendered.

(b) The provisions of subsection (a) of this section shall be inapplicable to payment by:

(1) A legal relative of the recipient of the services;

(2) An insurance carrier designated by the recipient of the services;

(3) A hospital on behalf of an in-patient or out-patient of the hospital having been the recipient of the services;

(4) One purveyor to another purveyor for actual services rendered;

(5) An industrial firm only for its own employees;

(6) A trade union health facility only for its registered patients;

(7) Governmental agencies and/or their specified public or private agent, agency, or organization on behalf of the recipient of the services.

(c) A clinical laboratory shall not offer or give a commission, rebate or other fee, directly or indirectly, to any person as consideration for the referral of a specimen derived from a human body to a clinical laboratory for examination by the laboratory.

(d) A clinical laboratory shall not solicit or accept a commission, rebate, or other fee, directly or indirectly, from any person as consideration for the referral of a specimen derived from the human body to a clinical laboratory for examination by the laboratory.

(e) A clinical laboratory shall not lend the use of the name of a clinical laboratory or a licensed hospital or clinic, or any other employee of the laboratory or institution, to an unlicensed clinical laboratory.