Rhode Island Code of Regulations
Title 216 - Department of health
Chapter 40 - Professional licensing and facility regulation
Subchapter 05 - Professional Licensing
Part 20 - Optometrists (216-RICR-40-05-20)
Section 216-RICR-40-05-20.4 - Licensure and Certification Requirements for Optometrists
Universal Citation: 216 RI Code of Rules 40 05 20.4
Current through September 18, 2024
20.4.1 Licensure and Certification Requirements
A. Any person practicing
or offering to practice optometry in this state must be licensed as an
optometrist in Rhode Island in accordance with R.I. Gen. Laws Chapter 5-35.1
and regulatory requirements of this Part.
1.
Furthermore, optometrists licensed in this state who desire to administer and
prescribe pharmaceutical agents in the treatment of ocular conditions of the
human eye and its appendages, without the use of surgery or other invasive
techniques, must be certified by the Board in accordance with the requirements
herein. Provided, however, that as of March 20, 1997, individuals who are
licensed and certified to prescribe certain topical therapeutic pharmaceutical
agents may continue to prescribe said medications in accordance with that
certification; and those individuals who hold diagnostic pharmaceutical
privileges as of March 20, 1997, may continue to exercise those
privileges.
B. Any
optometrist who utilizes latex gloves shall do so in accordance with the
provisions of the rules and regulations pertaining to the Use of Latex Gloves
by Health Care Workers, in Licensed Health Care Facilities, and by Other
Persons, Firms, or Corporations Licensed or Registered by the Department (Part
20-15-3 of this Title).
C. Pain
Assessment
1. All health care providers
licensed by this state to provide health care services and all health care
facilities licensed under R.I. Gen. Laws Chapter 23-17, shall assess patient
pain in accordance with the requirements of the "Rules and Regulations Related
to Pain Assessment."
20.4.2 Qualifications for Licensure and Certification Basic Licensure Requirements
A. In addition to the requirements of R.I.
Gen. Laws §
5-35.1-2, an applicant seeking
licensure to practice optometry in this state must:
1. Have successfully passed all sections of
the National Board of Examiners in Optometry (NBEO) examination;
2. Candidates seeking initial licensure in
Rhode Island must be certified in the use of therapeutic pharmaceuticals in
accordance with the requirements of R.I. Gen. Laws §
5-35.1-1(7), and
have successfully completed the educational and certification requirements
related to the amplification of privileges to treat anterior uveitis and
glaucoma of §20.4.2(B) of this Part.
B. Therapeutic Pharmaceutical Requirements
Related to Amplification of Privileges to Treat Anterior Uveitis and Glaucoma
1. All applicants for initial licensure or
any licensed applicant who seek certification to use all therapeutic
pharmaceuticals used in the treatment of conditions of the human eye and its
appendages including, but not limited to, the removal of superficial foreign
bodies from the eye and the treatment of the diseases of anterior uveitis and
glaucoma, without the use of surgery or other invasive techniques, shall have
successfully completed the National Board of Examiners in Optometry (NBEO)
examination in "The Treatment and Management of Ocular Disease" administered
after January 1, 1999.
C.
§20.4.2(C)(1) of this Part shall apply to optometrists who have graduated
from a college of optometry prior to January 1, 2007:
1. Upon successful completion of the written
National Board of Examiners in Optometry (NBEO) examination, in "The Treatment
and Management of Ocular Disease" administered after January 1, 1999, a duly
licensed optometrist may prescribe all such pharmaceuticals exclusive of those
used in the treatment of glaucoma. Prescriptive privileges for those
pharmaceuticals used in the treatment of glaucoma will commence upon completion
of §20.4.2(C)(1)(a) of this Part and acceptance of such by the Board.
a. Submit a completed form for each patient
providing evidence that the applicant has performed written consultations which
satisfy the following requirements:
(1) The
applicant has consulted with an ophthalmologist or optometrist with amplified
privileges to treat glaucoma, who is licensed in good standing, and who has
been treating glaucoma for no less than three (3) years regarding no less than
twenty (20) glaucoma-related patients and the ophthalmologist or optometrist
with amplified privileges to treat glaucoma, who is licensed in good standing,
and who has been treating glaucoma for no less than three (3) years has
provided written confirmation of this consultation.
(2) Up to ten (10) of these glaucoma-related
patients may have been diagnosed as glaucoma-related up to one (1) year prior
to completion of the requirements in §20.4.2(C)(1) of this Part. All
twenty (20) glaucoma- related patients shall be followed for a minimum of one
(1) year or until the patient is stabilized (i.e., symptoms controlled, vision
loss arrested, medication changes not required) whichever is longer;
and
(3) For each glaucoma-related
patient, the applicant shall develop, in consultation with the ophthalmologist
or optometrist with amplified privileges to treat glaucoma, who is licensed in
good standing, and who has been treating glaucoma for no less than three (3)
years the following:
(AA) A confirmatory
evaluation and diagnosis by the ophthalmologist or optometrist with amplified
privileges to treat glaucoma, who is licensed in good standing, and who has
been treating glaucoma for no less than three (3) years;
(BB) A written plan for diagnostic workup for
each patient. This workup shall be in accordance with the prevailing community
standard of care; and
(CC) A
treatment plan for each patient which shall take into account the assessment of
the optic nerve, the level of the intraocular pressure, and stability of the
clinical course.
(4) The
methodology of consultation required in §§20.4.2(C)(1)(a) ((1)) and
((2)) of this Part shall be left to the professional discretion of the
ophthalmologist or optometrist with amplified privileges to treat glaucoma, who
is licensed in good standing, and who has been treating glaucoma for no less
than three (3) years and the applicant; provided, however, the applicant may
submit to the Board of Examiners in Optometry the completed form once the
patient has reached the agreed upon treatment plan (including target pressure
and compliance with medications).
20.4.3 Application for License, Certification and Fees Licensure Application
A. Application for licensure shall be made on
forms provided by the Department, which shall be completed and submitted to the
Department. Such application shall be accompanied by the following documents:
1. If by endorsement, a statement from the
board of examiners in optometry in each state in which the applicant has held
or holds licensure to be submitted to the board of this state attesting to the
licensure status of the applicant during the time period the applicant held
licensure in said state;
2.
Supporting certified transcripts of education credentials as required in
§20.4.2(A) of this Part.
3.
Such documentation must consist of original statements and/or photocopies
bearing the signature of the dean or registrar and the imprint of the school
seal;
4. The results of the written
National Board Examination submitted directly to the Board by the National
Board;
5. The application fee as
set forth in the Fee Structure for Licensing, Laboratory and Administrative
Services Provided by the Department of Health (Part 10-05-2 of this Title);
and
6. Such other information as
the Board and/or Department may deem necessary.
20.4.4 Examinations
A. Examinations for Licensure
1. Applicants for licensure to practice
optometry shall be required to successfully complete all parts and all sections
of the National Board Examination of the National Board of Examiners in
Optometry (NBEO) in order to test the applicant's knowledge and skills to
practice optometry in this state pursuant to the statutory and regulatory
requirements of this Part.
B. Licensure by Endorsement
1. A license to practice optometry may be
issued without examination to an applicant who has been duly licensed by
examination as an optometrist under the laws of another state or jurisdiction
provided:
a. The applicant meets the
qualifications to practice optometry in this state in accordance with
§20.4.2 of this Part;
b. That
such state accords a like privilege to holders of licenses issued in this state
and the applicant has not failed to pass the exam required in this state;
and
c. The applicant submits the
license application form with supporting certified documentation of credentials
and application fee as set forth in the Fee Structure for Licensing, Laboratory
and Administrative Services Provided by the Department of Health (Part 10-05-2
of this Title).
20.4.5 Issuance and Renewal of License and Fee
A. Upon completion of the
aforementioned requirements, the Director may issue a license to those
applicants found to have satisfactorily met all the requirements of this Part.
Said license and/or certification shall expire annually on the 31st day of
January, unless sooner suspended or revoked.
B. Every person licensed who intends to
practice optometry during the ensuing year shall file a renewal application
duly executed together with the renewal fee for licensure as set forth in the
Fee Structure for Licensing, Laboratory and Administrative Services Provided by
the Department of Health (Part 10-05-2 of this Title) on or before the 31st day
of January in each year.
C. Upon
receipt of a renewal application accompanied by evidence of completion of the
prescribed continuing education program requirements as set forth in
§20.4.6 of this Part, including payment of fee, the accuracy of the
application shall be verified and license shall be granted effective February 1
of that year.
D. In case of neglect
or refusal to pay, the Department may revoke or suspend such license provided,
however, that no license shall be so suspended or revoked without first giving
sixty (60) days notice in each such case of neglect or refusal and within such
period any such optometrist shall have the right to receive a renewal of such
license on payment of the renewal fee, together with an added penalty as set
forth in the Fee Structure for Licensing, Laboratory and Administrative
Services Provided by the Department of Health (Part 10-05-2 of this
Title).
E. Retirement from practice
for a period not exceeding five (5) years shall not deprive the holder of a
license of the right to renew such license upon payment of all annual renewal
fees remaining unpaid, and a further fee as set forth in the Fee Structure for
Licensing, Laboratory and Administrative Services Provided by the Department of
Health (Part 10-05-2 of this Title).
20.4.6 Continuing Education
A. For Re-Licensure for those Optometrists
with Amplified Therapeutic Privileges:
1.
Every optometrist licensed to practice optometry with amplified therapeutic
privileges in this state under the provisions of the Act and this Part shall on
or before the 31st day of January of every year attest to the Board that he/she
possesses satisfactory evidence of having completed in the preceding calendar
year, no less than twenty (20) hours of continuing education in optometry or
other related health field, in course(s) that shall include ten (10) or more
hours of approved courses in pharmacology for the treatment and management of
ocular conditions of the eye offered, sponsored, or administered by any of the
following organizations:
a. American
Optometric Association and its affiliated associations;
b. Schools/colleges of optometry;
c. Any course approved by the Council on
Optometric Practitioners Education (COPE);
d. American Academy of Ophthalmology -
Category I;
e. All courses that
meet the requirements of eligibility for Category I of the American Optometric
Association Optometric Recognition Award;
f. American Academy of Optometry;
g. Accreditation Council for Pharmacy
Education (ACPE);
h. Accreditation
Council for Continuing Medical Education (ACCME).
B. For Re-Licensure for those
Optometrists without Amplified Therapeutic Privileges:
1. Optometrists licensed to practice
optometry without therapeutic privileges must show evidence of sixteen (16)
hours of continuing education in optometry or other related health fields in
the calendar year preceding the most recent license renewal.
2. The Board may waive the continuing
education requirement in specific circumstances for due cause such as hardship
or for any sufficient reason, if satisfactory evidence is submitted to the
Board to that effect.
3.
Optometrists initially licensed after the February 1st renewal date shall be
exempt from the continuing education requirements stated in this Part until the
date of the next renewal cycle (i.e., January 31st of the next year).
4. It shall be the sole responsibility of the
individual optometrist to obtain documentation from the recognized sponsoring
or co-sponsoring organizations, agencies or other, of his or her participation
in the learning experience and the number of dated credits earned. Furthermore,
it shall be the sole responsibility of the individual to safeguard the
documents for review by the Board, if required. These documents shall be
retained by each licensee for no less than two (2) years and are subject to
random audit by the Department.
20.4.7 Practice of Optometry
A. Pursuant to §20.4.2(B)(1) of this
Part, optometrists with amplified privileges, as defined in this Part, may:
1. Remove superficial foreign bodies from the
conjunctiva, lid and cornea without surgery or other invasive techniques;
and
2. Administer and prescribe
pharmaceutical agents as provided in this Part for the treatment of ocular
conditions of the human eye and its appendages without surgery or other
invasive techniques, and in accordance with the prevailing standards of
practice as those of duly licensed physicians providing similar
services.
3. Treatment of glaucoma
shall exclude treatment of infantile and congenital glaucoma. Treatment of
acute angle closure glaucoma shall be limited to initiation of immediate
emergency care.
B. Scope
of Medications
1. Optometrists Without
Amplified Therapeutic Privileges
a.
Medications which may be used by certified optometrists qualified to administer
and prescribe topical therapeutic pharmaceutical agents in the treatment of
conditions of the human eye and its appendages but not holding amplified
privileges in accordance with §20.4.2(B)(1) of this Part, include topical
medication (mast cell inhibitors or stabilizers), lubricants, decongestants,
mucolytics, antibiotics, and steroids with a clinical potency not exceeding
1/4% methyl-prednisolone or equivalent.
2. Optometrists with Amplified Therapeutic
Privileges
a. Optometrists authorized by the
Board as having amplified privileges, in accordance with §20.4.2(B)(1) of
this Part, may utilize all pharmaceutical agents in the treatment of conditions
of the human eye and its appendages, including anterior uveitis and glaucoma,
without surgery or other invasive techniques, and in accordance with the
requirements of this Part.
C. Scheduled Medications
1. Every optometrist licensed to practice
optometry with amplified therapeutic privileges in this state may prescribe
oral pharmaceutical agents, including oral steroids and narcotic and
non-narcotic analgesics, within the scope of the optometrist's practice, and in
accordance with the following:
a. A
prescription for oral nonsteroidal anti-inflammatories shall not exceed one
seven-day supply;
b. A prescription
for oral steroids shall not exceed one seven-day supply;
c. A prescription for any controlled
substance listed in schedules III-V of R.I. Gen. Laws Chapter 21-28, shall not
exceed one seventy-two (72) hour supply.
d. Licensed optometrists may prescribe
schedule II hydrocodone-containing medications provided that the prescription
does not exceed one seventy-two (72) hour supply.
e. No optometrist shall deliver any
medication by injection.
f. In
order to prescribe any controlled substance listed in R.I. Gen. Laws Chapter
21-28, a licensed optometrist must:
(1) Obtain
a state registration for prescribing controlled substances by completing the
application for registration.
(2)
Obtain a federal registration for controlled substances by completing
application form DEA-224, or its successor form, and submitting it with its
specified filing fee.
(3) The
Director will determine whether issuance of a registration is consistent with
the public interest, and may refuse registration where the issuance of said
registration would be inconsistent with the public interest, according to the
provisions of R.I. Gen. Laws Chapter 21-28.
D. Minimum/Initial Examination of
New Patients
1. Pursuant to R.I. Gen. Laws
§
5-35.1-16, every person practicing
optometry shall perform an examination of the patient that is in accordance
with the prevailing community standard of care, and record same in the
patient's medical record.
E. Minimum Equipment for Optometric Practice
1. At any location where an optometrist
practices his or her profession, an optometrist shall have any equipment that a
reasonable and prudent person practicing optometry would have available in
order to meet the needs of his/her patients.
F. Spectacle or Eyeglass Prescriptions
1. A spectacle prescription shall contain all
of the information necessary for the accurate fabrication, fitting and
dispensing of the spectacles (eyeglasses). All spectacle prescriptions shall be
in accordance with the requirements of the Federal Trade Commission's
"Ophthalmic Practice Rules" incorporated in §
20.2(A) of
this Part.
2. A contact lens
prescription shall contain all of the information necessary for the accurate
fitting and dispensing of the contact lens. All such prescriptions shall be in
accordance with the requirements of the Federal Trade Commission's "Contact
Lens Rule" incorporated in §
20.2(B) of
this Part.
G. Electronic
Prescribing Standards
1. Optometrists shall
be required to adhere to electronic prescribing standards within thirty (30)
months of receiving prescriptive authority as defined in R.I. Gen. Laws §
5-35.1-12(a), and
§20.4.7 of this Part.
2.
Electronic prescribing standards shall include the following:
a. Technological devices for the transmission
or communication of prescriptions between optometrists and pharmacists may be
used in accordance with the following requirements:
(1) The transmission of prescriptions for
controlled substances shall be in compliance with the provisions of R.I. Gen.
Laws Chapters 21-28 ("Uniform Controlled Substances Act") and 5-37.3
("Confidentiality of Health Care Communications and Information Act"), and all
other applicable federal and state laws;
(AA)
In compliance with federal requirements, the transmission of prescriptions for
controlled substances by technological devices shall consist of a copy of the
original prescription that has been signed by the optometrist.
(BB) In compliance with federal requirements,
an electronic signature by the optometrist for controlled substance
prescriptions is prohibited.
(2) Unless otherwise prohibited by law,
prescriptions may be transmitted by electronic means or facsimile from the
optometrist to the dispensing pharmacy. The facsimile copy of the prescription
may serve as the hard copy of the prescription in accordance with the
provisions of R.I. Gen. Laws Chapter 21-28.
(3) In addition to all other information
required to be included on a prescription, an electronically transmitted
prescription and facsimile prescriptions shall include the date of
transmission, and the identity of the receiving pharmacy.
(4) The patient shall have the right to
choose the manner in which his/her prescription is transmitted to the
pharmacy.
(5) The patient shall
have the right to choose the pharmacy to which his/her prescription is
transferred.
(6) Technological
devices shall not be used to circumvent documentation, verification, or any
provisions of R.I. Gen. Laws Chapter 5-19.1. Neither shall they be used to
commit any other action that may be deemed unprofessional conduct.
20.4.8 Denial, Suspension or Revocation of License and/or Certification
The Director may deny, suspend or revoke a license in accordance with the provisions of R.I. Gen. Laws § 5-35.1-18.
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