RIBIT · Rhode Island Bill Information Tracker

Authorizes emergency medical service agencies to transport individuals to alternative facilities for treatment and permits licensed providers for mental health disorders to treat patients within the community.

Changes since original draft

~~2023 – S 0576~~
2023 – S 0576 SUBSTITUTE A
========
~~LC001384~~
LC001384/SUB A
========
~~S TATE OF RHODE IS L AND~~
S TATE OF RHODE IS L AND
IN GENERAL ASSEMBLY
~~JANUARY SESSION, A.D. 2023~~
~~____________~~
~~A N A C T~~
JANUARY SESSION, A.D. 2023
____________
A N A C T
RELATING TO INSURANCE – ACCIDENT AND SICKNESS INSURANCE POLICIES
Introduced By: Senators Miller, Lawson, Lauria, DiMario, DiPalma, Valverde, and
Murray
Date Introduced: March 07, 2023
Referred To: Senate Health & Human Services
It is enacted by the GeneralAssembly as follows:
SECTION1. Chapter 27-18of the GeneralLaws entitled"Accident andSickness Insurance Policies" is hereby amended by adding thereto the following section:
27-18-91. Emergency medical services transport to alternate facilities.
(a) As used in this section, the following terms shallhave the following meanings:
(1) "Basic life support" or "BLS" means transportation by ground ambulance vehicle and medically necessary supplies and services, plus the provision of BLS ambulance services. The ambulance must be staffedbyatleast three (3) people who meetthe requirements of state laws and regulations where the services are beingfurnished. Also, atleasttwo (2) of the staff members must be licensed, ataminimum, asanemergencymedical technician bythe stateor local authority where the services are furnished and be legally authorized to operate all lifesaving and life-sustaining equipment on board the vehicle.
(1) "Basic life support" or "BLS" means transportation by ground ambulance vehicle and medically necessary supplies and services, plus the provision of BLS ambulance services. The ambulance must be staffedbyindividuals who meetthe requirements of state laws and regulations where the services are being furnished. Also, atleast one of the staff members must be licensed, at a minimum, as an emergencymedical technician by the state or local authority where the services are furnished and be legally authorized to operate all lifesaving and life-sustaining equipment on board the vehicle.
(2) "Emergency medical services"or "EMS" means the practitioners, ambulance vehicles, and ambulance service entities licensed in accordance with chapter 4.1 of title 23 to provide emergencymedicalcare,transportation, and preventive care to mitigate loss of life or exacerbation of illness or injury, including, but not limited to, EMS responding to the 911 system established under chapter 21.1 of title 39.
(3) "Emergency medical services practitioner" means an individual who is licensed in accordance withstate laws andregulations to performemergencymedicalcare andpreventive care to mitigate loss of life or exacerbation of illness or injury, including emergency medical technicians, advanced emergency medical technicians, advanced emergency medical technicians cardiac, and paramedics.
(4) "Mobile integrated healthcare community paramedicine" means the provision of healthcare using patient-centered,mobile resources in the out-of-hospital environment pursuant to an EMS agency's plan approved by the department of health utilizing licensed paramedic and advanced emergency medical technician-cardiac practitioners working in collaboration with physicians, nurses, mid-level practitioners, community health teams and social, behavioral and substance use disorder specialists to address the unmet needs of individuals experiencing intermittent health care issues.
(b) Only those emergency medical services (EMS) agencies who submit plans that meet the minimum requirements for participation setand approved by the department of health shall be eligible to participate in a mobile integrated healthcare/community paramedicine program.
(c) This section authorizes emergency medical services in the state that are approved by the department of health to participate in a mobile integrated healthcare/community paramedicine program to divert non-emergency basic life service calls from emergencydepartments. Pursuantto anEMS agency's approvedplan, emergencymedical services practitioners shall assess individuals whoarein needof emergencymedicalservices andapply the correctlevelof carethereafter,which may include transport to an alternative facility deemed appropriate by the emergency medical services practitioner. An alternative facility shall include, but not be limited to:
(1) An individual's primary care provider;
(2) A community health clinic;
(3) An urgent care facility;
(4) An emergency room diversion facility, as defined in § 23-17.26-2; and
(5) A community-based behavioral health facility designed to provide immediate assistance to a person in crisis.
(d) The department of health with the collaboration of the ambulance service coordinating advisory board shalladminister the mobile integrated healthcare/community paramedicine program and shall promulgate any rules, regulations, standing orders, protocols, and procedures necessary and proper for the efficient administration and enforcement of this section. The requirements of this section shall only apply to EMS agencies who apply for and receive approval from the department of health to provide such services.
(e)Commencing January1, 2024, everyindividual or group health insurance contract,plan or policy issued for delivery or renewedin this state that provides medical coverage that includes coverage for emergency medical services shall provide coverage for transport to an alternative
LC001384 - Page 2of 16 location facility as identified in subsection (c) of this section and shall reimburse the EMS for such services at the same rate as for a basic life support transport to an emergency department.
LC001384/SUB A - Page 2of 16 location facility as identified in subsection (c) of this section and shall reimburse the EMS for such services at the same rate as for a basic life support transport to an emergency department.
(f) If treatmentatan alternative facility is deemedappropriate by the EMS practitioner, the emergencymedical service shall bill at the rate described in subsection (e) of this section, evenif an advanced life support assessment was provided.
(g) The office of the health insurance commissioner may promulgate such rules and regulations asarenecessaryandproper to effectuatethepurpose andfor the efficient administration and enforcement of this section.
27-18-92.Coverage ofemergencymedicalservices mentalhealthand substance use disorder treatment.
(a) As used in this section, "emergency medical services" or "EMS" means the practitioners, ambulance vehicles, and ambulance service entities licensed in accordance with chapter 4.1 of title 23 to provide emergency medical care,transportation, and preventive care to mitigate loss of life or exacerbation of illness or injury, including, but not limited to, EMS responding to the 911 system established under chapter 21.1 of title 39.
(b) Emergency medical services shall be permitted to allow licensed providers who evaluate and treatmentalhealth disorders, including substance use disorders, to accompanyEMS. Such providers shall be permitted to evaluate and treat EMS patients when medically necessary and appropriate. Such evaluation and treatment shallbe permitted to occur in the community.
(b) Emergency medical services shall be permitted to allow licensed providers who evaluate and treat mentalhealth disorders, including substance use disorders, to accompanyEMS. Such providers shall be permitted to evaluate and treat EMS patients when medically necessary and appropriate. Such evaluation and treatment shallbe permitted to occur in the community.
(c) Emergency medical services shall be permitted to transport to the following facilities designated by the director of the department of health:
(1) Emergency room diversion facilities, as defined in § 23-17.26-2; and
(2) Community-based behavioral health facilities designed toprovide immediate assistance to a person in crisis.
(d) Commencing January1, 2024, everyindividual or group health insurance contract,plan or policy issued for delivery or renewedin this state that provides medical coverage that includes coverage for emergency medical services, shall provide coverage for evaluation and treatment described in subsection (b) of this section andshall reimburse such services ata rate notlower than the same service would have been had that service been delivered in a traditionaloffice setting.
(e)Commencing January1, 2024, everyindividual or group health insurance contract,plan or policy issued for delivery or renewedin this state that provides medical coverage that includes coverage for emergencymedical services, shall provide coverage for transportation and described in subsection (c) of this section and shall reimburse suchservices at a rate not lower than the same rate as for basic life support transport to an emergency department.
~~LC001384 - Page 3of 16~~
LC001384/SUB A - Page 3of 16
(f) Treatmentand coverage for mental health disorders, including substance use disorders, as described in this section shall be provided in accordance with chapter 38.2 of title 27.
(g) The department of health with the collaboration of the ambulance service coordinating advisory board shall promulgate any rules, regulations, standing orders, protocols, and procedures necessary and proper for the efficient administration and enforcement of this section.
(h) The office of the health insurance commissioner may promulgate such rules and regulations asarenecessaryandproper to effectuatethepurpose andfor the efficient administration and enforcement of this section.
SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service Corporations" is hereby amended by adding thereto the following sections:
27-19-83. Emergency medical services transport to alternate facilities.
(a) As used in this section, the following terms shallhave the following meaning:
(1) "Basic life support" or "BLS" means transportation by ground ambulance vehicle and medically necessary supplies and services, plus the provision of BLS ambulance services. The ambulance must be staffedbyatleast three (3) people who meetthe requirements of state laws and regulations where the services are beingfurnished. Also, atleasttwo (2) of the staff members must be at a minimum, as an emergency medical technician by the state or local authority where the services are furnished and be legally authorized to operate all lifesaving and life-sustaining equipment on board the vehicle.
(1) "Basic life support" or "BLS" means transportation by ground ambulance vehicle and medically necessary supplies and services, plus the provision of BLS ambulance services. The ambulance must be staffedbyindividuals who meetthe requirements of state laws and regulations where the services are being furnished. Also, at least one of the staff members must be at a minimum, as an emergencymedical technician by the state or local authority where the services are furnished and be legally authorized to operate all lifesaving and life-sustaining equipment on board the vehicle.
(2) "Emergency medical services"or "EMS" means the practitioners, ambulance vehicles, and ambulance service entities licensed in accordance with chapter 4.1 of title 23 to provide emergencymedicalcare,transportation, and preventive care to mitigate loss of life or exacerbation of illness or injury, including, but not limited to, EMS responding to the 911 system established under chapter 21.1 of title 39.
(3) "Emergency medical services practitioner" means an individual who is licensed in accordance withstate laws andregulations to performemergencymedicalcare andpreventive care to mitigate loss of life or exacerbation of illness or injury, including emergency medical technicians, advancedemergency medical technicians, advancedemergency medical technicians- cardiac, and paramedics.
(4) "Mobile integrated healthcare/community paramedicine" means the provision of healthcare using patient-centered,mobile resources in the out-of-hospital environment pursuant to an EMS agency's plan approved by the department of health utilizing licensed paramedic and advanced emergency medical technician-cardiac practitioners working in collaboration with physicians, nurses, mid-level practitioners, community health teams and social, behavioral and
~~LC001384 - Page 4of 16 substance use disorder specialists to address the unmet needs of individuals experiencing intermittent health care issues.~~
LC001384/SUB A - Page 4of 16 substance use disorder specialists to address the unmet needs of individuals experiencing intermittent health care issues.
(b) Only those emergency medical services (EMS) agencies who submit plans that meet the minimum requirements for participation setand approved by the department of health shall be eligible to participate in a mobile integrated healthcare/community paramedicine program.
(c) This section authorizes emergency medical services in the state who are approved by the department of health to participate in a mobile integrated healthcare/community paramedicine program to divert non-emergency basic life service calls from emergencydepartments. Pursuantto anEMS agency's approvedplan, emergencymedical services practitioners shall assess individuals whoarein needof emergencymedicalservices andapply the correctlevelof carethereafter,which may include transport to an alternative facility deemed appropriate by the emergency medical services practitioner. An alternative facility shall include, but not be limited to:
(1) An individual's primary care provider;
(2) A community health clinic;
(3) An urgent care facility;
(4) An emergency room diversion facility, as defined in § 23-17.26-2; and
(5) A community-based behavioral health facility designed to provide immediate assistance to a person in crisis.
(d) The department of health with the collaboration of the ambulance service coordinating advisory board shalladminister the mobile integrated healthcare/community paramedicine program and shall promulgate any rules, regulations, standing orders, protocols, and procedures necessary and proper for the efficient administration and enforcement of this section. The requirements of this section shall only apply to EMS agencies that apply for and receive approval from the department of health to provide such services.
(e)Commencing January1, 2024, everyindividual or group health insurance contract,plan or policy issued for delivery or renewedin this state that provides medical coverage that includes coverage for emergency medical services shall provide coverage for transport to an alternative location facility as identified in subsection (c) of this section and shall reimburse the EMS for such services at the same rate as for a basic life support transport to an emergency department.
(f) If treatmentatan alternative facility is deemedappropriate by the EMS practitioner, the emergencymedical service shall bill at the rate described in subsection (e) of this section, evenif an advanced life support assessment was provided.
(g) The office of the health insurance commissioner may promulgate such rules and regulations asarenecessaryandproper to effectuatethepurpose andfor the efficient administration
~~LC001384 - Page 5of 16 and enforcement of this section.~~
LC001384/SUB A - Page 5of 16 and enforcement of this section.
27-19-84.Coverage ofemergencymedicalservices mentalhealthand substance use disorder treatment.
(a) As used in this section, "emergency medical services" or "EMS" means the practitioners, ambulance vehicles, and ambulance service entities licensed in accordance with chapter 4.1 of title 23 to provide emergency medical care,transportation, and preventive care to mitigate loss of life or exacerbation of illness or injury, including, but not limited to, EMS responding to the 911 system established under chapter 21.1 of title 39.
(b) Emergency medical services shall be permitted to allow licensed providers who evaluate and treatmentalhealth disorders, including substance use disorders, to accompanyEMS. Such providers shall be permitted to evaluate and treat EMS patients when medically necessary and appropriate. Such evaluation and treatment shallbe permitted to occur in the community.
(c) Emergency medical services shall be permitted to transport to the following facilities designated by the director of the department of health:
(1) Emergency room diversion facilities, as defined in § 23-17.26-2; and
(2) Community-based behavioral health facilities designed toprovide immediate assistance to a person in crisis.
(d) Commencing January1, 2024, everyindividual or group health insurance contract,plan or policy issued for delivery or renewedin this state that provides medical coverage that includes coverage for emergency medical services, shall provide coverage for evaluation and treatment described in subsection (b) of this section andshall reimburse such services ata rate notlower than the same service would have been had that service been delivered in a traditionaloffice setting.
(e)Commencing January1, 2024, everyindividual or group health insurance contract,plan or policy issued for delivery or renewedin this state that provides medical coverage that includes coverage for emergencymedical services, shall provide coverage for transportation and described in subsection (c) of this section and shall reimburse suchservices at a rate not lower than the same rate as for basic life support transport to an emergency department.
(f) Treatmentand coverage for mental health disorders, including substance use disorders, as described in this section shall be provided in accordance with chapter 38.2 of title 27.
(g) The department of health with the collaboration of the ambulance service coordinating advisory board shall promulgate any rules, regulations, standing orders, protocols, and procedures necessary and proper for the efficient administration and enforcement of this section.
(h) The office of the health insurance commissioner may promulgate such rules and regulations asarenecessaryandproper to effectuatethepurpose andfor the efficient administration
~~LC001384 - Page 6of 16 and enforcement of this section.~~
LC001384/SUB A - Page 6of 16 and enforcement of this section.
SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service Corporations" is hereby amended by adding thereto the following sections:
27-20-79. Emergency medical services transport to alternate facilities.
(a) As used in this section, the following terms shallhave the following meaning:
(1) "Basic life support" or "BLS" means transportation by ground ambulance vehicle and medically necessary supplies and services, plus the provision of BLS ambulance services. The ambulance must be staffedbyatleast three (3) people who meetthe requirements of state laws and regulations where the services are beingfurnished. Also, atleasttwo (2) of the staff members must be at a minimum, as an emergency medical technician by the state or local authority where the services are furnished and be legally authorized to operate all lifesaving and life-sustaining equipment on board the vehicle.
(1) "Basic life support" or "BLS" means transportation by ground ambulance vehicle and medically necessary supplies and services, plus the provision of BLS ambulance services. The ambulance must be staffedbyindividuals who meetthe requirements of state laws and regulations where the services are being furnished. Also, at least one of the staff members must be at a minimum, as an emergencymedical technician by the state or local authority where the services are furnished and be legally authorized to operate all lifesaving and life-sustaining equipment on board the vehicle.
(2) "Emergency medical services"or "EMS" means the practitioners, ambulance vehicles, and ambulance service entities licensed in accordance with chapter 4.1 of title 23 to provide emergencymedicalcare,transportation, and preventive care to mitigate loss of life or exacerbation of illness or injury, including, but not limited to, EMS responding to the 911 system established under chapter 21.1 of title 39.
(3) "Emergency medical services practitioner" means an individual who is licensed in accordance withstate laws andregulations to performemergencymedicalcare andpreventive care to mitigate loss of life or exacerbation of illness or injury, including emergency medical technicians, advancedemergency medical technicians, advancedemergency medical technicians- cardiac, and paramedics.
(4) "Mobile integrated healthcare/community paramedicine" means the provision of healthcare using patient-centered,mobile resources in the out-of-hospital environment pursuant to an EMS agency's plan approved by the department of health utilizing licensed paramedic and advanced emergency medical technician-cardiac practitioners working in collaboration with physicians, nurses, mid-level practitioners, community health teams and social, behavioral and substance use disorder specialists to address the unmet needs of individuals experiencing intermittent health care issues.
(b) Only those emergency medical services (EMS) agencies who submit plans that meet the minimum requirements for participation setand approved by the department of health shall be eligible to participate in a mobile integrated healthcare/community paramedicine program.
(c) This section authorizes emergency medical services in the state who are approved by the department of health to participate in a mobile integrated healthcare/community paramedicine
LC001384 - Page 7of 16 program to divert non-emergency basic life service calls from emergencydepartments. Pursuantto anEMS agency's approvedplan, emergencymedical services practitioners shall assess individuals whoarein needof emergencymedicalservices andapply the correctlevelof carethereafter,which may include transport to an alternative facility deemed appropriate by the emergency medical services practitioner. An alternative facility shall include, but not be limited to:
LC001384/SUB A - Page 7of 16 program to divert non-emergency basic life service calls from emergencydepartments. Pursuantto anEMS agency's approvedplan, emergencymedical services practitioners shall assess individuals whoarein needof emergencymedicalservices andapply the correctlevelof carethereafter,which may include transport to an alternative facility deemed appropriate by the emergency medical services practitioner. An alternative facility shall include, but not be limited to:
(1) An individual's primary care provider;
(2) A community health clinic;
(3) An urgent care facility;
(4) An emergency room diversion facility, as defined in § 23-17.26-2; and
(5) A community-based behavioral health facility designed to provide immediate assistance to a person in crisis.
(d) The department of health with the collaboration of the ambulance service coordinating advisory board shalladminister the mobile integrated healthcare/community paramedicine program and shall promulgate any rules, regulations, standing orders, protocols, and procedures necessary and proper for the efficient administration and enforcement of this section. The requirements of this section shall only apply to EMS agencies that apply for and receive approval from the department of health to provide such services.
(e)Commencing January1, 2024, everyindividual or group health insurance contract,plan or policy issued for delivery or renewedin this state that provides medical coverage that includes coverage for emergency medical services shall provide coverage for transport to an alternative location facility as identified in subsection (c) of this section and shall reimburse the EMS for such services at the same rate as for a basic life support transport to an emergency department.
(f) If treatmentatan alternative facility is deemedappropriate by the EMS practitioner, the emergencymedical service shall bill at the rate described in subsection (e) of this section, evenif an advanced life support assessment was provided.
(g) The office of the health insurance commissioner may promulgate such rules and regulations asarenecessaryandproper to effectuatethepurpose andfor the efficient administration and enforcement of this section.
27-20-80.Coverage ofemergencymedicalservices mentalhealthand substance use disorder treatment.
(a) As used in this section, "emergency medical services" or "EMS" means the practitioners, ambulance vehicles, and ambulance service entities licensed in accordance with chapter 4.1 of title 23 to provide emergency medical care,transportation, and preventive care to mitigate loss of life or exacerbation of illness or injury, including, but not limited to, EMS
~~LC001384 - Page 8of 16 responding to the 911 system established under chapter 21.1 of title 39.~~
LC001384/SUB A - Page 8of 16 responding to the 911 system established under chapter 21.1 of title 39.
(b) Emergency medical services shall be permitted to allow licensed providers who evaluate and treatmentalhealth disorders, including substance use disorders, to accompanyEMS. Such providers shall be permitted to evaluate and treat EMS patients when medically necessary and appropriate. Such evaluation and treatment shallbe permitted to occur in the community.
(c) Emergency medical services shall be permitted to transport to the following facilities designated by the director of the department of health:
(1) Emergency room diversion facilities, as defined in § 23-17.26-2; and
(2) Community-based behavioral health facilities designed toprovide immediate assistance to a person in crisis.
(d) Commencing January1, 2024, everyindividual or group health insurance contract,plan or policy issued for delivery or renewedin this state that provides medical coverage that includes coverage for emergency medical services, shall provide coverage for evaluation and treatment described in subsection (b) of this section andshall reimburse such services ata rate notlower than the same service would have been had that service been delivered in a traditionaloffice setting.
(e)Commencing January1, 2024, everyindividual or group health insurance contract,plan or policy issued for delivery or renewedin this state that provides medical coverage that includes coverage for emergencymedical services, shall provide coverage for transportation and described in subsection (c) of this section and shall reimburse suchservices at a rate not lower than the same rate as for basic life support transport to an emergency department.
(f) Treatmentand coverage for mental health disorders, including substance use disorders, as described in this section shall be provided in accordance with chapter 38.2 of title 27.
(g) The department of health with the collaboration of the ambulance service coordinating advisory board shall promulgate any rules, regulations, standing orders, protocols, and procedures necessary and proper for the efficient administration and enforcement of this section.
(h) The office of the health insurance commissioner may promulgate such rules and regulations asarenecessaryandproper to effectuatethepurpose andfor the efficient administration and enforcement of this section.
SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance Organizations" is hereby amended by adding thereto the following sections:
27-41-96. Emergency medical services transport to alternate facilities.
(a) As used in this section, the following terms shallhave the following meaning:
(1) "Basic life support" or "BLS" means transportation by ground ambulance vehicle and medically necessary supplies and services, plus the provision of BLS ambulance services. The
LC001384 - Page 9of 16 ambulance must be staffedbyatleast three (3) people who meetthe requirements of state laws and regulations where the services are beingfurnished. Also, atleasttwo (2) of the staff members must be at a minimum, as an emergency medical technician by the state or local authority where the services are furnished and be legally authorized to operate all lifesaving and life-sustaining equipment on board the vehicle.
LC001384/SUB A - Page 9of 16 ambulance must be staffedbyindividuals who meetthe requirements of state laws and regulations where the services are being furnished. Also, at least one of the staff members must be at a minimum, as an emergencymedical technician by the state or local authority where the services are furnished and be legally authorized to operate all lifesaving and life-sustaining equipment on board the vehicle.
(2) "Emergency medical services"or "EMS" means the practitioners, ambulance vehicles, and ambulance service entities licensed in accordance with chapter 4.1 of title 23 to provide emergencymedicalcare,transportation, and preventive care to mitigate loss of life or exacerbation of illness or injury, including, but not limited to, EMS responding to the 911 system established under chapter 21.1 of title 39.
(3) "Emergency medical services practitioner" means an individual who is licensed in accordance withstate laws andregulations to performemergencymedicalcare andpreventive care to mitigate loss of life or exacerbation of illness or injury, including emergency medical technicians, advancedemergency medical technicians, advancedemergency medical technicians- cardiac, and paramedics.
(4) "Mobile integrated healthcare/community paramedicine" means the provision of healthcare using patient-centered,mobile resources in the out-of-hospital environment pursuant to an EMS agency's plan approved by the department of health utilizing licensed paramedic and advanced emergency medical technician-cardiac practitioners working in collaboration with physicians, nurses, mid-level practitioners, community health teams and social, behavioral and substance use disorder specialists to address the unmet needs of individuals experiencing intermittent health care issues.
(b) Only those emergency medical services (EMS) agencies who submit plans that meet the minimum requirements for participation setand approved by the department of health shall be eligible to participate in a mobile integrated healthcare/community paramedicine program.
(c) This section authorizes emergency medical services in the state who are approved by the department of health to participate in a mobile integrated healthcare/community paramedicine program to divert non-emergency basic life service calls from emergencydepartments. Pursuantto anEMS agency's approvedplan, emergencymedical services practitioners shall assess individuals whoarein needof emergencymedicalservices andapply the correctlevelof carethereafter,which may include transport to an alternative facility deemed appropriate by the emergency medical services practitioner. An alternative facility shall include, but not be limited to:
(c) This section authorizes emergency medical services in the state who are approved by the department of health to participate in a mobile integrated healthcare/community paramedicine program to divert non-emergency basic life service calls from emergencydepartments. Pursuantto anEMS agency's approvedplan, emergencymedical services practitioners shall assess individuals whoarein needof emergencymedicalservices and apply the correctlevelof carethereafter,which may include transport to an alternative facility deemed appropriate by the emergency medical services practitioner. An alternative facility shall include, but not be limited to:
(1) An individual's primary care provider;
(2) A community health clinic;
LC001384/SUB A - Page 10of 16
(3) An urgent care facility;
(4) An emergency room diversion facility, as defined in § 23-17.26-2; and
(5) A community-based behavioral health facility designed to provide immediate assistance to a person in crisis.
(d) The department of health with the collaboration of the ambulance service coordinating advisory board shalladminister the mobile integrated healthcare/community paramedicine program and shall promulgate any rules, regulations, standing orders, protocols, and procedures necessary and proper for the efficient administration and enforcement of this section. The requirements of this section shall only apply to EMS agencies that apply for and receive approval from the department of health to provide such services.
(e)Commencing January1, 2024, everyindividual or group health insurance contract,plan or policy issued for delivery or renewedin this state that provides medical coverage that includes coverage for emergency medical services shall provide coverage for transport to an alternative location facility as identified in subsection (c) of this section and shall reimburse the EMS for such services at the same rate as for a basic life support transport to an emergency department.
(f) If treatmentatan alternative facility is deemedappropriate by the EMS practitioner, the emergencymedical service shall bill at the rate described in subsection (e) of this section, evenif an advanced life support assessment was provided.
(g) The office of the health insurance commissioner may promulgate such rules and regulations asarenecessaryandproper to effectuatethepurpose andfor the efficient administration and enforcement of this section.
27-41-97.Coverage ofemergencymedicalservices mentalhealthand substance use disorder treatment.
(a) As used in this section, "emergency medical services" or "EMS" means the practitioners, ambulance vehicles, and ambulance service entities licensed in accordance with chapter 4.1 of title 23 to provide emergency medical care,transportation, and preventive care to mitigate loss of life or exacerbation of illness or injury, including, but not limited to, EMS responding to the 911 system established under chapter 21.1 of title 39.
(b) Emergency medical services shall be permitted to allow licensed providers who evaluate and treatmentalhealth disorders, including substance use disorders, to accompanyEMS. Such providers shall be permitted to evaluate and treat EMS patients when medically necessary and appropriate. Such evaluation and treatment shallbe permitted to occur in the community.
(c) Emergency medical services shall be permitted to transport to the following facilities designated by the director of the department of health:
LC001384/SUB A - Page 11of 16
(1) Emergency room diversion facilities, as defined in § 23-17.26-2; and
(2) Community-based behavioral health facilities designed toprovide immediate assistance to a person in crisis.
(d) Commencing January1, 2024, everyindividual or group health insurance contract,plan or policy issued for delivery or renewedin this state that provides medical coverage that includes coverage for emergency medical services, shall provide coverage for evaluation and treatment described in subsection (b) of this section andshall reimburse such services ata rate notlower than the same service would have been had that service been delivered in a traditionaloffice setting.
(e)Commencing January1, 2024, everyindividual or group health insurance contract,plan or policy issued for delivery or renewedin this state that provides medical coverage that includes coverage for emergencymedical services, shall provide coverage for transportation and described in subsection (c) of this section and shall reimburse suchservices at a rate not lower than the same rate as for basic life support transport to an emergency department.
(f) Treatmentand coverage for mental health disorders, including substance use disorders, as described in this section shall be provided in accordance with chapter 38.2 of title 27.
(g) The department of health with the collaboration of the ambulance service coordinating advisory board shall promulgate any rules, regulations, standing orders, protocols, and procedures necessary and proper for the efficient administration and enforcement of this section.
(h) The office of the health insurance commissioner may promulgate such rules and regulations asarenecessaryandproper to effectuatethepurpose andfor the efficient administration and enforcement of this section.
SECTION 5. Chapter 42-7.2 of the General Laws entitled "Office of Health and Human Services"is hereby amended by adding thereto the following sections:
42-7.2-21. Emergency medical services transport to alternate facilities.
(a) As used in this section, the following terms shallhave the following meaning:
(1) "Basic life support" or "BLS" means transportation by ground ambulance vehicle and medically necessary supplies and services, plus the provision of BLS ambulance services. The ambulance must be staffedbyatleast three (3) people who meetthe requirements of state laws and regulations where the services are beingfurnished. Also, atleasttwo (2) of the staff members must be licensed, ataminimum, asanemergencymedical technician bythe stateor local authority where the services are furnished and be legally authorized to operate all lifesaving and life-sustaining equipment on board the vehicle.
(2) "Emergency medical services"or "EMS" means the practitioners, ambulance vehicles, and ambulance service entities licensed in accordance with chapter 4.1 of title 23 to provide emergencymedicalcare,transportation, and preventive care to mitigate loss of life or exacerbation of illness or injury, including, but not limited to, EMS responding to the 911 system established under chapter 21.1 of title 39.
(1) "Basic life support" or "BLS" means transportation by ground ambulance vehicle and medically necessary supplies and services, plus the provision of BLS ambulance services. The ambulance must be staffedbyindividuals who meetthe requirements of state laws and regulations where the services are being furnished. Also, atleast one of the staff members must be licensed, at a minimum, as an emergencymedical technician by the state or local authority where the services are furnished and be legally authorized to operate all lifesaving and life-sustaining equipment on board the vehicle.
(2) "Emergency medical services"or "EMS" means the practitioners, ambulance vehicles, and ambulance service entities licensed in accordance with chapter 4.1 of title 23 to provide
LC001384/SUB A - Page 12of 16 emergencymedicalcare,transportation, and preventive care to mitigate loss of life or exacerbation of illness or injury, including, but not limited to, EMS responding to the 911 system established under chapter 21.1 of title 39.
(3) "Emergency medical services practitioner" means an individual who is licensed in accordance withstate laws andregulations to performemergencymedicalcare andpreventive care to mitigate loss of life or exacerbation of illness or injury, including emergency medical technicians, advancedemergency medical technicians, advancedemergency medical technicians- cardiac, and paramedics.
(4) "Mobile integrated healthcare community paramedicine" means the provision of healthcare using patient-centered,mobile resources in the out-of-hospital environment pursuant to an EMS agency's plan approved by the department of health utilizing licensed paramedic and advanced emergency medical technician-cardiac practitioners working in collaboration with physicians, nurses, mid-level practitioners, community health teams and social, behavioral and substance use disorder specialists to address the unmet needs of individuals experiencing intermittent health care issues.
(b) Only those emergency medical services (EMS) agencies who submit plans that meet the minimum requirements for participation setand approved by the department of health shall be eligible to participate in a mobile integrated healthcare/community paramedicine program.
(c) This section authorizes emergency medical services in the state that are approved by the department of health to participate in a mobile integrated healthcare/community paramedicine program to divert non-emergency basic life service calls from emergencydepartments. Pursuantto anEMS agency's approvedplan, emergencymedical services practitioners shall assess individuals whoarein needof emergencymedicalservices andapply the correctlevelof carethereafter,which may include transport to an alternative facility deemed appropriate by the emergency medical services practitioner. An alternative facility shall include, but not be limited to:
(1) An individual's primary care provider;
(2) A community health clinic;
(3) An urgent care facility;
(4) An emergency room diversion facility, as defined in § 23-17.26-2; and
(5) A community-based behavioral health facility designed to provide immediate assistance to a person in crisis.
(d) The department of health with the collaboration of the ambulance service coordinating advisory board shalladminister the mobile integrated healthcare/community paramedicine program and shall promulgate any rules, regulations, standing orders, protocols, and procedures necessary and proper for the efficient administration and enforcement of this section. The requirements of this chapter shall only apply to EMS agencies who apply for and receive approval from the department of health to provide such services.
(d) The department of health with the collaboration of the ambulance service coordinating advisory board shalladminister the mobile integrated healthcare/community paramedicine program and shall promulgate any rules, regulations, standing orders, protocols, and procedures necessary
LC001384/SUB A - Page 13of 16 and proper for the efficient administration and enforcement of this section. The requirements of this chapter shall only apply to EMS agencies who apply for and receive approval from the department of health to provide such services.
(e) Rhode Island Medicaid andits contractedmanagedcare entities shallprovide coverage for transport to an alternative facility as identified in subsection (c) of this section and shall reimburse the EMS for such services at the same rate as for a basic life support transport to an emergency department.
(f) If treatmentatan alternative facility is deemedappropriate by the EMS practitioner, the emergencymedical service shall bill at the rate described in subsection (e) of this section, evenif an advanced life support assessment was provided.
(g) The executive office of health and human services shall setthe reimbursement rates for the services described in this section.
42-7.2-22. Coverage foremergencymedicalservices mentalhealthandsubstance use disorder.
(a) As used in this section, "emergency medical services" or "EMS" means the practitioners, ambulance vehicles, and ambulance service entities licensed in accordance with chapter 4.1 of title 23 to provide emergency medical care,transportation, and preventive care to mitigate loss of life or exacerbation of illness or injury, including, but not limited to, EMS responding to the 911 system established under chapter 21.1 of title 39.
(b) Emergency medical services shall be permitted to allow licensed providers who evaluate and treatmentalhealth disorders, including substance use disorders, to accompanyEMS. Such providers shall be permitted to evaluate and treat EMS patients when medically necessary and appropriate. Such evaluation and treatment shallbe permitted to occur in the community.
(c) Emergency medical services shall be permitted to transport to the following facilities designated by the director of the department of health:
(1) Emergency room diversion facilities, as defined in § 23-17.26-2; and
(2) Community-based behavioral health facilities designed toprovide immediate assistance to a person in crisis.
(d) Rhode Island Medicaid and its contractedmanagedcare entities shallprovide coverage for transportation, evaluation, and treatmentdescribedin subsections (c) and(d) of this section and shall reimburse such services at a rate not lower than the same service would have been had that service been delivered in a traditional office setting or for basic life support transport to an emergency department.
~~(e) The executive office of health and human services shall setthe reimbursement rates for the services described in this section.~~
~~SECTION 6. This act shalltake effect upon passage. ======== LC001384 ========~~
(e) The executive office of health and human services shall setthe reimbursement rates for
LC001384/SUB A - Page 14of 16 the services described in this section.
SECTION 6. This act shalltake effect upon passage. ======== LC001384/SUB A ========
LC001384/SUB A - Page 15of 16
EXPLANATION
~~BY THE LEGISLATIVE COUNCIL~~
BY THE LEGISLATIVE COUNCIL
OF
~~A N A C T~~
A N A C T
RELATING TO INSURANCE – ACCIDENT AND SICKNESS INSURANCE POLICIES
***
This actwould authorize emergencymedical service agencies approved by the department of health to participate in a mobile integrated healthcare/community paramedicine program, allowing the agencies to transport individuals to alternative facilities such as an individual's primary care provider, community health clinic, urgent care facility, emergency room diversion facility, or a community-based behavioral health facility, based on the individual's need of emergency medical services. This act would further permit licensed providers to accompany emergency medical services and treatpatients within the community for mental health disorders, including substance usedisorders. This actwould furtherrequire the health insurance contract,plan or policy to provide coverage for transport to an alternative location facility and treatment by a licensed provider for mental health disorders and substance use disorders within the community.
This act would take effect upon passage.
========
~~LC001384~~
~~========~~
LC001384/SUB A
========
LC001384/SUB A - Page 16of 16

Votes

RIBIT does not have any votes for this legislation yet.
(Vote tracking on RIBIT is still a work-in-progress, so make sure to check the official RI website, too!)

Senate Bill #576 (2023)

AN ACT RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

Changes since original draft

Votes