Information for Healthcare Providers

Monoclonal Antibody (MABS) Treatment

MABS treatments are available for outpatients with mild to moderate COVID-19 who are at high risk for progressing to severe disease and/or hospitalization. Specific referral criteria for each treatment facility follows.

Treatment Options

• Bamlanivimab and etesevimab EUA | EUA Provider Fact Sheet | EUA Patient Fact Sheet | Baseball Card (RIDOH no longer recommends the administration of bamlanivimab alone)

• Casirivimab and imdevimab (Regeneron) EUA | EUA Provider Fact Sheet | EUA Patient Fact Sheet | Baseball Card

Referrals

The Rhode Island Department of Health (RIDOH) recognizes that MABS, when administered to appropriate patients, are a safe and effective treatment for COVID-19. RIDOH therefore recommends MABS treatment be considered for any COVID-19 positive patient at the discretion of the attending physician and in accordance with the FDA EAU. Healthcare providers should evaluate any patient who is COVID-19 positive for the appropriate use of MABS, recognizing the risks and benefits of this treatment. RIDOH guidance

In addition to primary or specialty care provider evaluation and referral, COVID-positive patients who were tested at State testing sites can access same-day telehealth services at the following clinics to evaluate for referral for MABS treatment:

• Blackstone Valley Community Health Care 
• Ocean State Urgent Care 
• South County Express Care
• Thundermist Health Center

Find more information about these particular clinics.

TeleCARE by Brown Emergency Medicine is another option for patient evaluation and referral for MABS treatment.

For patients who do not have or have lost their health insurance, learn about other urgent care and health centers and accessing healthcare and support services.

Find all MABS treatment locations in Rhode Island.

Resources

• Videos of Rhode Island doctors promoting MABS
• combatcovid.hhs.gov
• PHE.gov web pages

Treatment Resources

• Current Treatments for the Coronavirus (COVID-19)
• CDC, Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease (COVID-19)
• IDSA, Infectious Diseases Society of America Guidelines on the Treatment and Management of Patients with COVID-19
• NIH, COVID-19 Treatment Guidelines

• RIDOH COVID-19 Response Data
• RIDOH COVID-19 Provider Briefings
• How You Can Help the Rhode Island COVID-19 Response
• CDC Information for Healthcare Professionals about COVID-19

The Rhode Island Department of Health (RIDOH) recommends COVID-19 testing for:

• People with symptoms of COVID-19
• People who may have been exposed to someone with COVID-19
• Certain asymptomatic populations.

Test Ordering Options

Outpatient healthcare providers can order COVID-19 tests for patients in the following ways:

• Use the online ordering system at schedulecovidtest.ri.gov to order a test for a patient who has symptoms or may have been exposed to someone with COVID-19. The ordering clinician may choose from a list of State-run testing sites located throughout Rhode Island. VIEW STEPS
• Refer patients to a local respiratory clinic for COVID-19 testing.
• Primary care providers and respiratory clinics performing in-office specimen collection and sending tests to a lab for processing should order tests according to the office’s or lab’s protocol.
• Additional testing options for pediatric patients are noted below.

RIDOH encourages facilities that have the capacity to conduct point-of-care testing to contact test kit manufacturers directly to place an order. RIDOH has a limited supply of BinaxNOW rapid antigen test kits that are available to some clinics. To see if your facility qualifies to receive some of these tests, email [email protected]. 

Health care workers who are not able to get tested through their employers can use the testing options above.

Connecticut and Massachusetts healthcare providers caring for Rhode Island residents can gain access to Rhode Island’s online ordering portal by emailing [email protected]. Rhode Island providers seeing Massachusetts patients can refer those patients to testing through a Respiratory Clinic or in their home state as needed.

All Rhode Islanders can also self-schedule a COVID-19 test on portal.ri.gov, regardless of whether they have symptoms or if they have been identified as a close contact of someone with COVID-19.

For more information about COVID-19 testing in Rhode Island, including an up-to-date list of testing sites and guidance about testing for different populations, visit health.ri.gov/covid/testing.

Pediatric Patient Testing

Providers may use the online ordering system at schedulecovidtest.ri.gov to schedule a COVID-19 test for a pediatric patient. The parent or caregiver may be asked to swab children younger than age 12 with coaching from the staff at the testing site.

This page has information about clinics that offer COVID-19 testing for children. Note that some locations have restrictions on the age groups that can be tested.

Parents can also schedule a COVID-19 test for a child enrolled in a K-12 public or private school by calling the K-12 test scheduling service at 844-857-1814. This program is reserved for K-12 students and staff members who are symptomatic or have been identified as a close contact of a positive case. Pre K students and staff must be part of a Pre K program that is associated with an elementary school to be eligible for this testing program. MORE INFORMATION

If a patient was scheduled for testing through schedulecovidtest.ri.gov, the ordering clinician will receive lab results directly from the commercial lab. Please communicate these results to your patient. Note: To ensure proper processing of test results, it is important that a provider’s National Provider Identifier (NPI) and fax number are correctly entered.

Anyone tested for COVID-19 in the State of Rhode Island can access an official record of their test result on portal.ri.gov/results. All test results reported to RIDOH are available at this site. This step-by-step guide explains how to use the online result portal.

If a patient was tested for COVID-19 at a community-based testing location, the patient may have to follow that clinic’s instructions for obtaining their test results.

RIDOH encourages coordination between primary care providers and respiratory clinics in providing and obtaining patient test results.

Positive Test Results

If a patient tests positive for COVID-19, inform them that they need to isolate immediately. Anyone who tests positive should also inform their close contacts to quarantine and possibly get tested. A representative from RIDOH will also contact the patient directly for follow up. MORE

Report any positive cases of COVID-19 to RIDOH within 24 hours, including reinfection and vaccination breakthrough cases. The ordering provider should direct anyone with a positive test result to isolate, whether from rapid antigen or PCR testing.

For reporting positive results from testing you have ordered and sent out through a laboratory system:

• Report positive results only. 
• Please include the patient’s name, DOB, testing date, and testing site. 
• For reinfection and vaccination breakthrough cases, include the initial infection date and/or the patient's vaccine product and injection dates.
• You may report by either of the following methods. We strongly encourage you to send by secure email if possible, as our fax machine can get backed up. For the time being, we do not recommend calling 401-222-8022 with positive results due to phone waiting times.  
  1. Email using secure email. Send the test result to [email protected] with the subject: LAB POSITIVE. Attach the result report to the email or copy and paste the report into the body of the email. 
  2. Fax to 401-222-2488. Include a cover letter (re: LAB POSITIVE). 

For reporting point-of-care and rapid test results performed at your site:

• Report all positive and negative results. 
• Email Chris Jenkins for information on how to send POC results: [email protected]  
• Do not send results to Christine Jenkins.  

It's no longer necessary to report Patients Under Investigation (PUIs). Do not use the PUI form to report positive results to RIDOH.

For reporting possible cases of Multi-Inflammatory Disease in Children (MIS-C), please call the RIDOH Center for Acute Infectious Disease Epidemiology at 401-222-2577 Monday-Friday 8:30 a.m-4:30 p.m. (401-276-8046 after-hours).

Patient Resources

• When do I need to Isolate or Quarantine for COVID-19? (web page)  Eng | Esp | Port
• Close Contact Quarantine Requirements (handout)  Eng | Esp | Port | Cape Verdean Creole
• Close Contact Quarantine FAQ (handout)   Eng | Esp | Port
• Close Contact Quarantine Calculator (Excel file)  Eng | Esp | Port
• RIDOH Letter Requests: Rhode Islanders who need to provide verification of their quarantine status, isolation status, or test results may request a letter by submitting this online form. Letters will be sent by email and are usually ready in 72 hours.  Instructions  Types of Letters  

Provider Resources

The following resources and tools help providers assess whether a staff member or patient who tests positive for COVID-19 may have exposed others in the practice. RIDOH encourages practices to use these tools to identify and inform staff and patients who are close contacts and should quarantine, and to instruct them to self-monitor for symptoms for 14 days from exposure.

• Quarantine and Isolation by Population
• COVID-19 Close Contact Determination in Patient Care Settings
• COVID-19 Isolation and Quarantine Calculator

Quarantine and Isolation Facilities

There is a quarantine and isolation facility for the homeless and others with unstable housing at the Wyndham Hotel at 1850 Post Road in Warwick. Please see this welcome letter for more information about the site.

The facility accepts referrals for people who:

• Have tested positive but do not have a safe place to isolate.
• Have been exposed to someone with COVID-19 and ordered to quarantine but do not have a safe place to quarantine.
  • COVID-19 testing is offered every Wednesday for quarantining residents.

The intake form can be filled out by the patient or someone completing it on their behalf, such as a social worker, physician, or case manager. For patients unable to fill out the form who do not have someone to help them, staff will perform the intake with them by phone at 401-250-8987.

• The intake form is HIPAA secure. It is deposited directly into the Microsoft Teams software being used by the facility to coordinate care. Once the form has been submitted, a nurse will review the referral and follow up with the referring person within three hours. 

Intakes and new admissions take place from 8 a.m. – 5 p.m. daily. Voicemails left on the intake hotline after hours will be returned the next day.

Find resources to help healthcare providers prepare to receive, administer, and recommend COVID-19 vaccines here.

The Centers for Disease Control and Prevention (CDC) now recommends reporting of MIS-C and MIS-A. Clinical criteria for each condition follows. Report cases to Rhode Island’s Center for Acute Infectious Disease Epidemiology by calling 401-222-2577 Monday through Friday from 8:30 a.m. to 4:30 p.m. If after hours, please call RIDOH’s answering service at 401-276-8046 to connect with the medical staff on call.

Multi-System Inflammatory Syndrome in Children (MIS-C)

MIS-C is a condition associated with infection from COVID-19. Clinical criteria for MIS-C diagnosis include:

• Younger than age 21 and
• Fever, laboratory evidence of inflammation, severe illness requiring hospitalization, multisystem organ involvement and
• No alternative plausible diagnosis and
• Positive for current or recent COVID-19 infection by RT-PCR, serology, or antigen test or exposure to a suspected or confirmed COVID-19 case within the four weeks before symptoms started

Click here for clinical information from Hasbro Children's Hospital and additional resources on MIS-C.

Multi-System Inflammatory Syndrome in Adults (MIS-A)

MIS-A is a condition similar to MIS-C, but in adults. For the MIS-A case definition, providers can use either the same definition for MIS-C or the definition used in the Morbidity and Mortality Weekly Report (MMWR) series.

The MIS-A case definition used in the report includes the following five criteria:

• Severe illness requiring hospitalization in a person age 21 or older and
• Positive test result for current or previous COVID-19 infection (nucleic acid, antigen, or antibody) during admission or in the previous 12 weeks and
• Severe dysfunction of one or more extrapulmonary organ systems (e.g., hypotension or shock, cardiac dysfunction, arterial or venous thrombosis or thromboembolism, or acute liver injury) and
• Laboratory evidence of severe inflammation (e.g., elevated CRP, ferritin, D-dimer, or interleukin-6) and
• Absence of severe respiratory illness (to exclude patients in which inflammation and organ dysfunction might be attributable simply to tissue hypoxia)

Long COVID

Long COVID, also known as "long haul" COVID, has been described as subacute and chronic multi-system post-infectious sequelae of acute COVID-19 infection. It is distinct from MIS-C and MIS-A.

Referrals

For specialty care of patients with Long COVID, primary care providers can refer their patients to the Infectious Disease and Immunology Clinic at Lifespan.

• Fax referrals to the Infectious Diseases and Immunology Center at 401-793-7401
• Send referrals within Lifespan through LifeChart as "Referral to Infectious Diseases"

OHIC Resources

• Rhode Island Office of the Health Insurance Commissioner (OHIC) COVID-19 Information
• Guidance regarding Coverage for COVID-19 PCR and Antigen Testing
• Reinstatement of Temporary Emergency Measures Regarding Benefit Determination Review and Network Plans and Health Care Accessibility and Quality Assurance

TeleMedicine

Effective March 18, 2020, the Governor signed an executive order directing health insurers to follow previously announced instructions to cover visits conducted over the phone and online during this crisis. This order for an expansion of Telemedicine coverage will apply to primary and specialty care, as well as mental and behavioral health care. Insurance plans are updating policies to coincide with the Executive Order and this Telemedicine Insurer Grid reflects compliance with the current order. RIDOH is grateful to the volunteers who compiled it.

Please note: This grid is not an official RIDOH document, but a compilation by volunteers designed to be a helpful reference. For official payer policy contact the specific payer.