2022 -- S 2476 SUBSTITUTE A AS AMENDED

========

LC004627/SUB A

========

     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2022

____________

A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

     

     Introduced By: Senators Miller, DiMario, Lawson, Valverde, and Cano

     Date Introduced: March 01, 2022

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

1

     SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness Insurance

2

Policies" is hereby amended by adding thereto the following sections:

3

     27-18-89. Emergency medical services transport to alternate facilities.

4

     (a) As used in this section, the following terms shall have the following meanings:

5

     (1) "Basic life support" or "BLS" means transportation by ground ambulance vehicle and

6

medically necessary supplies and services, plus the provision of BLS ambulance services. The

7

ambulance must be staffed by at least two (2) people who meet the requirements of state laws and

8

regulations where the services are being furnished. Also, at least one of the staff members must be

9

licensed, at a minimum, as an emergency medical technician by the state or local authority where

10

the services are furnished and be legally authorized to operate all lifesaving and life-sustaining

11

equipment on board the vehicle.

12

     (2) "Emergency medical services" or "EMS" means the practitioners, ambulance vehicles,

13

and ambulance service entities licensed in accordance with chapter 4.1 of title 23 to provide

14

emergency medical care, transportation, and preventive care to mitigate loss of life or exacerbation

15

of illness or injury, including, but not limited to, EMS responding to the 911 system established

16

under chapter 21.1 of title 39.

17

     (3) "Emergency medical services practitioner" means an individual who is licensed in

18

accordance with state laws and regulations to perform emergency medical care and preventive care

19

to mitigate loss of life or exacerbation of illness or injury, including emergency medical

 

1

technicians, advanced emergency medical technicians, advanced emergency medical technicians-

2

cardiac, and paramedics.

3

     (4) “Mobile integrated healthcare/community paramedicine” means the provision of

4

healthcare using patient-centered, mobile resources in the out-of-hospital environment with EMS

5

agency’s licensed paramedic and advanced emergency medical technician-cardiac practitioners

6

working in collaboration with physicians, nurses, mid-level practitioners, community health teams

7

and social, behavioral and substance use disorder specialists to address the unmet needs of

8

individuals experiencing intermittent health care issues. The mobile integrated

9

healthcare/community paramedicine program rules, regulations, standing orders, protocols, and

10

procedures shall be instituted by the department of health with the collaboration of the ambulance

11

service coordinating advisory board.

12

     (b) This section authorizes emergency medical services in the state participating in a mobile

13

integrated healthcare/community paramedicine program to divert non-emergency basic life service

14

calls from emergency departments. Emergency medical services practitioners shall assess

15

individuals who are in need of emergency medical services and apply the correct level of care

16

thereafter, which may include transport to an alternative facility deemed appropriate by the

17

emergency medical services practitioner. An alternative facility shall include, but not be limited to:

18

     (1) An individual’s primary care provider;

19

     (2) A community health clinic;

20

     (3) An urgent care facility;

21

     (4) An emergency room diversion facility, as defined in § 23-17.26-2; and

22

     (5) A community-based behavioral health facility designed to provide immediate

23

assistance to a person in crisis.

24

     (c) Emergency medical services shall be permitted to transport to the following facilities

25

designated by the director of the department of health:

26

     (1) Emergency room diversion facilities, as defined in § 23-17.26-2; and

27

     (2) Community-based behavioral health facilities designed to provide immediate assistance

28

to a person in crisis.

29

     (d) Commencing January 1, 2023, every individual or group health insurance contract, plan

30

or policy issued for delivery or renewed in this state that provides medical coverage that includes

31

coverage for emergency medical services shall provide coverage for transport to an alternative

32

location facility as identified in subsection (b) of this section and shall reimburse the EMS for such

33

services at the same rate as for a non-emergency basic life support transport to an emergency

34

department.

 

LC004627/SUB A - Page 2 of 14

1

     (e) If treatment at an alternative facility is deemed appropriate by the EMS practitioner, the

2

emergency medical service shall bill at the rate described in subsection (d) of this section, even if

3

an advanced life support assessment was provided.

4

     (f) The office of the health insurance commissioner and/or the department of health may

5

promulgate such rules and regulations as are necessary and proper to effectuate the purpose and for

6

the efficient administration and enforcement of this section.

7

     27-18-90. Coverage of EMS mental health and substance use disorder treatment.

8

     (a) As used in this section, "emergency medical services" or "EMS" means the

9

practitioners, ambulance vehicles, and ambulance service entities licensed in accordance with

10

chapter 4.1 of title 23 to provide emergency medical care, transportation, and preventive care to

11

mitigate loss of life or exacerbation of illness or injury, including, but not limited to, EMS

12

responding to the 911 system established under chapter 21.1 of title 39.

13

     (b) Emergency medical services shall be permitted to allow licensed providers who treat

14

mental health disorders, including substance use disorders, to accompany EMS. Such providers

15

shall be permitted to treat EMS patients when medically necessary and appropriate. Such treatment

16

shall be permitted to occur in the community.

17

     (c) Commencing January 1, 2023, every individual or group health insurance contract, plan

18

or policy issued for delivery or renewed in this state that provides medical coverage that includes

19

coverage for emergency medical services, shall provide coverage for transportation and treatment

20

described in subsection (b) of this section and shall reimburse such services at a rate not lower than

21

the same service would have been had that service been delivered in a traditional office setting.

22

     (d) Treatment and coverage for mental health disorders, including substance use disorders,

23

as described in this section shall be provided in accordance with chapter 38.2 of title 27.

24

     (e) The office of the health insurance commissioner and/or the department of health may

25

promulgate such rules and regulations as are necessary and proper to effectuate the purpose and for

26

the efficient administration and enforcement of this section.

27

     SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service

28

Corporations" is hereby amended by adding thereto the following sections:

29

     27-19-81. Emergency medical services transport to alternate facilities.

30

     (a) As used in this section, the following terms shall have the following meaning:

31

     (1) "Basic life support" or "BLS" means transportation by ground ambulance vehicle and

32

medically necessary supplies and services, plus the provision of BLS ambulance services. The

33

ambulance must be staffed by at least two (2) people who meet the requirements of state laws and

34

regulations where the services are being furnished. Also, at least one of the staff members must be

 

LC004627/SUB A - Page 3 of 14

1

licensed, at a minimum, as an emergency medical technician by the state or local authority where

2

the services are furnished and be legally authorized to operate all lifesaving and life-sustaining

3

equipment on board the vehicle.

4

     (2) "Emergency medical services" or "EMS" means the practitioners, ambulance vehicles,

5

and ambulance service entities licensed in accordance with chapter 4.1 of title 23 to provide

6

emergency medical care, transportation, and preventive care to mitigate loss of life or exacerbation

7

of illness or injury, including, but not limited to, EMS responding to the 911 system established

8

under chapter 21.1 of title 39.

9

     (3) "Emergency medical services practitioner" means an individual who is licensed in

10

accordance with state laws and regulations to perform emergency medical care and preventive care

11

to mitigate loss of life or exacerbation of illness or injury, including emergency medical

12

technicians, advanced emergency medical technicians, advanced emergency medical technicians-

13

cardiac, and paramedics.

14

     (4) “Mobile integrated healthcare/community paramedicine” means the provision of

15

healthcare using patient-centered, mobile resources in the out-of-hospital environment with EMS

16

agency’s licensed paramedic and advanced emergency medical technician-cardiac practitioners

17

working in collaboration with physicians, nurses, mid-level practitioners, community health teams

18

and social, behavioral and substance use disorder specialists to address the unmet needs of

19

individuals experiencing intermittent health care issues. The mobile integrated

20

healthcare/community paramedicine program rules, regulations, standing orders, protocols, and

21

procedures shall be instituted by the department of health with the collaboration of the ambulance

22

service coordinating advisory board.

23

     (b) This section authorizes emergency medical services in the state participating in a mobile

24

integrated healthcare/community paramedicine program to divert non-emergency basic life service

25

calls from emergency departments. Emergency medical services practitioners shall assess

26

individuals who are in need of emergency medical services and apply the correct level of care

27

thereafter, which may include transport to an alternative facility deemed appropriate by the

28

emergency medical services practitioner. An alternative facility shall include, but not be limited to:

29

     (1) An individual’s primary care provider;

30

     (2) A community health clinic;

31

     (3) An urgent care facility;

32

     (4) An emergency room diversion facility, as defined in § 23-17.26-2; and

33

     (5) A community-based behavioral health facility designed to provide immediate

34

assistance to a person in crisis.

 

LC004627/SUB A - Page 4 of 14

1

     (c) Emergency medical services shall be permitted to transport to the following facilities

2

designated by the director of RIDOH:

3

     (i) emergency room diversion facilities, as defined in § 23-17.26-2; and

4

     (ii) community-based behavioral health facilities designed to provide immediate assistance

5

to a person in crisis.

6

     (d) Commencing January 1, 2023, every individual or group health insurance contract, plan

7

or policy issued for delivery or renewed in this state that provides medical coverage that includes

8

coverage for emergency medical services shall provide coverage for transport to an alternative

9

location facility as identified in subsection (b) of this section and shall reimburse the EMS for such

10

services at the same rate as for a non-emergency basic life support transport to an emergency

11

department.

12

     (e) If treatment at an alternative facility is deemed appropriate by the EMS practitioner, the

13

emergency medical service shall bill at the rate described in subsection (d) of this section even if

14

an advanced life support assessment was provided.

15

     (f) The office of the health insurance commissioner and/or Rhode Island department of

16

health may promulgate such rules and regulations as are necessary and proper to effectuate the

17

purpose and for the efficient administration and enforcement of this section.

18

     27-19-82. Coverage of EMS mental health and substance use disorder treatment.

19

     (a) As used in this section, "emergency medical services" or "EMS" means the

20

practitioners, ambulance vehicles, and ambulance service entities licensed in accordance with

21

chapter 4.1 of title 23 to provide emergency medical care, transportation, and preventive care to

22

mitigate loss of life or exacerbation of illness or injury, including, but not limited to, EMS

23

responding to the 911 system established under chapter 21.1 of title 39.

24

     (b) Emergency medical services shall be permitted to allow licensed providers who treat

25

mental health disorders, including substance use disorders, to accompany EMS. Such providers

26

shall be permitted to treat EMS patients when medically necessary and appropriate. Such treatment

27

shall be permitted to occur in the community.

28

     (c) Commencing January 1, 2023, every individual or group health insurance contract, plan

29

or policy issued for delivery or renewed in this state that provides medical coverage that includes

30

coverage for emergency medical services, shall provide coverage for transportation and treatment

31

described in subsection (b) of this section and shall reimburse such services at a rate not lower than

32

the same service would have been had that service been delivered in a traditional office setting.

33

     (d) Treatment and coverage for mental health disorders, including substance use disorders,

34

as described in this section shall be provided in accordance with chapter 38.2 of title 27.

 

LC004627/SUB A - Page 5 of 14

1

     (e) The office of the health insurance commissioner and/or Rhode Island department of

2

health may promulgate such rules and regulations as are necessary and proper to effectuate the

3

purpose and for the efficient administration and enforcement of this section.

4

     SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service

5

Corporations" is hereby amended by adding thereto the following sections:

6

     27-20-77. Emergency medical services transport to alternate facilities.

7

     (a) As used in this section, the following terms shall have the following meaning:

8

     (1) "Basic life support" or "BLS" means transportation by ground ambulance vehicle and

9

medically necessary supplies and services, plus the provision of BLS ambulance services. The

10

ambulance must be staffed by at least two (2) people who meet the requirements of state laws and

11

regulations where the services are being furnished. Also, at least one of the staff members must be

12

licensed, at a minimum, as an emergency medical technician by the state or local authority where

13

the services are furnished and be legally authorized to operate all lifesaving and life-sustaining

14

equipment on board the vehicle.

15

     (2) "Emergency medical services" or "EMS" means the practitioners, ambulance vehicles,

16

and ambulance service entities licensed in accordance with chapter 4.1 of title 23 to provide

17

emergency medical care, transportation, and preventive care to mitigate loss of life or exacerbation

18

of illness or injury including, but not limited to, EMS responding to the 911 system established

19

under chapter 21.1 of title 39.

20

     (3) "Emergency medical services practitioner" means an individual who is licensed in

21

accordance with state laws and regulations to perform emergency medical care and preventive care

22

to mitigate loss of life or exacerbation of illness or injury, including emergency medical

23

technicians, advanced emergency medical technicians, advanced emergency medical technicians-

24

cardiac, and paramedics.

25

     (4) “Mobile integrated healthcare/community paramedicine” means the provision of

26

healthcare using patient-centered, mobile resources in the out-of-hospital environment with EMS

27

agency’s licensed paramedic and advanced emergency medical technician-cardiac practitioners

28

working in collaboration with physicians, nurses, mid-level practitioners, community health teams

29

and social, behavioral and substance use disorder specialists to address the unmet needs of

30

individuals experiencing intermittent health care issues. The mobile integrated

31

healthcare/community paramedicine program rules, regulations, standing orders, protocols, and

32

procedures shall be instituted by the department of health with the collaboration of the ambulance

33

service coordinating advisory board.

34

     (b) This section authorizes emergency medical services in the state participating in a mobile

 

LC004627/SUB A - Page 6 of 14

1

integrated healthcare/community paramedicine program to divert non-emergency basic life service

2

calls from emergency departments. Emergency medical services practitioners shall assess

3

individuals who are in need of emergency medical services and apply the correct level of care

4

thereafter, which may include transport to an alternative facility deemed appropriate by the

5

emergency medical services practitioner. An alternative facility shall include, but not be limited to:

6

     (1) An individual’s primary care provider;

7

     (2) A community health clinic;

8

     (3) An urgent care facility;

9

     (4) An emergency room diversion facility, as defined in § 23-17.26-2; and

10

     (5) A community-based behavioral health facility designed to provide immediate

11

assistance to a person in crisis.

12

     (c) Emergency medical services shall be permitted to transport to the following facilities

13

designated by the director of RIDOH:

14

     (i) emergency room diversion facilities, as defined in § 23-17.26-2; and

15

     (ii) community-based behavioral health facilities designed to provide immediate assistance

16

to a person in crisis.

17

     (d) Commencing January 1, 2023, every individual or group health insurance contract, plan

18

or policy issued for delivery or renewed in this state that provides medical coverage that includes

19

coverage for emergency medical services shall provide coverage for transport to an alternative

20

location facility as identified in subsection (b) of this section and shall reimburse the EMS for such

21

services at the same rate as for a non-emergency basic life support transport to an emergency

22

department.

23

     (e) If treatment at an alternative facility is deemed appropriate by the EMS practitioner, the

24

emergency medical service shall bill at the rate described in subsection (c) of this section, even if

25

an advanced life support assessment was provided.

26

     (f) The office of the health insurance commissioner and/or Rhode Island department of

27

health may promulgate such rules and regulations as are necessary and proper to effectuate the

28

purpose and for the efficient administration and enforcement of this section.

29

     27-20-78. Coverage of EMS mental health and substance use disorder treatment.

30

     (a) As used in this section, "emergency medical services" or "EMS" means the

31

practitioners, ambulance vehicles, and ambulance service entities licensed in accordance with

32

chapter 4.1 of title 23 to provide emergency medical care, transportation, and preventive care to

33

mitigate loss of life or exacerbation of illness or injury, including, but not limited to, EMS

34

responding to the 911 system established under chapter 21.1 of title 39.

 

LC004627/SUB A - Page 7 of 14

1

     (b) Emergency medical services shall be permitted to allow licensed providers who treat

2

mental health disorders, including substance use disorders, to accompany EMS. Such providers

3

shall be permitted to treat EMS patients when medically necessary and appropriate. Such treatment

4

shall be permitted to occur in the community.

5

     (c) Commencing January 1, 2023, every individual or group health insurance contract, plan

6

or policy issued for delivery or renewed in this state that provides medical coverage that includes

7

coverage for emergency medical services, shall provide coverage for transportation and treatment

8

described in subsection (b) of this section and shall reimburse such services at a rate not lower than

9

the same service would have been had that service been delivered in a traditional office setting.

10

     (d) Treatment and coverage for mental health disorders, including substance use disorders,

11

as described in this section shall be provided in accordance with chapter 38.2 of title 27.

12

     (e) The office of the health insurance commissioner and/or Rhode Island department of

13

health may promulgate such rules and regulations as are necessary and proper to effectuate the

14

purpose and for the efficient administration and enforcement of this section.

15

     SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance

16

Organizations" is hereby amended by adding thereto the following sections:

17

     27-41-94. Emergency medical services transport to alternate facilities.

18

     (a) As used in this section, the following terms shall have the following meaning:

19

     (1) "Basic life support" or "BLS" means transportation by ground ambulance vehicle and

20

medically necessary supplies and services, plus the provision of BLS ambulance services. The

21

ambulance must be staffed by at least two (2) people who meet the requirements of state laws and

22

regulations where the services are being furnished. Also, at least one of the staff members must be

23

licensed, at a minimum, as an emergency medical technician by the state or local authority where

24

the services are furnished and be legally authorized to operate all lifesaving and life-sustaining

25

equipment on board the vehicle.

26

     (2) "Emergency medical services" or "EMS" means the practitioners, ambulance vehicles,

27

and ambulance service entities licensed in accordance with chapter 4.1 of title 23 to provide

28

emergency medical care, transportation, and preventive care to mitigate loss of life or exacerbation

29

of illness or injury, including, but not limited to, EMS responding to the 911 system established

30

under chapter 21.1 of title 39.

31

     (3) "Emergency medical services practitioner" means an individual who is licensed in

32

accordance with state laws and regulations to perform emergency medical care and preventive care

33

to mitigate loss of life or exacerbation of illness or injury, including emergency medical

34

technicians, advanced emergency medical technicians, advanced emergency medical technicians-

 

LC004627/SUB A - Page 8 of 14

1

cardiac, and paramedics.

2

     (4) “Mobile integrated healthcare/community paramedicine” means the provision of

3

healthcare using patient-centered, mobile resources in the out-of-hospital environment with EMS

4

agency’s licensed paramedic and advanced emergency medical technician-cardiac practitioners

5

working in collaboration with physicians, nurses, mid-level practitioners, community health teams

6

and social, behavioral and substance use disorder specialists to address the unmet needs of

7

individuals experiencing intermittent health care issues. The mobile integrated

8

healthcare/community paramedicine program rules, regulations, standing orders, protocols, and

9

procedures shall be instituted by the department of health with the collaboration of the ambulance

10

service coordinating advisory board.

11

     (b) This section authorizes emergency medical services in the state participating in a mobile

12

integrated healthcare/community paramedicine program to divert non-emergency basic life service

13

calls from emergency departments. Emergency medical services practitioners shall assess

14

individuals who are in need of emergency medical services and apply the correct level of care

15

thereafter, which may include transport to an alternative facility deemed appropriate by the

16

emergency medical services practitioner. An alternative facility shall include, but not be limited to:

17

     (1) An individual’s primary care provider;

18

     (2) A community health clinic;

19

     (3) An urgent care facility;

20

     (4) An emergency room diversion facility, as defined in § 23-17.26-2; and

21

     (5) A community-based behavioral health facility designed to provide immediate

22

assistance to a person in crisis.

23

     (c) Emergency medical services shall be permitted to transport to the following facilities

24

designated by the director of RIDOH:

25

     (i) Emergency room diversion facilities, as defined in § 23-17.26-2; and

26

     (ii) Community-based behavioral health facilities designed to provide immediate

27

assistance to a person in crisis.

28

     (d) Commencing January 1, 2023, every individual or group health insurance contract, plan

29

or policy issued for delivery or renewed in this state that provides medical coverage that includes

30

coverage for emergency medical services shall provide coverage for transport to an alternative

31

location facility as identified in subsection (b) of this section and shall reimburse the EMS for such

32

services at the same rate as for a non-emergency basic life support transport to an emergency

33

department.

34

     (e) If treatment at an alternative facility is deemed appropriate by the EMS practitioner, the

 

LC004627/SUB A - Page 9 of 14

1

emergency medical service shall bill at the rate as described in subsection (d) of this section, even

2

if an advanced life support assessment was provided.

3

     (f) The office of the health insurance commissioner and/or Rhode Island department of

4

health may promulgate such rules and regulations as are necessary and proper to effectuate the

5

purpose and for the efficient administration and enforcement of this section.

6

     27-41-95. Coverage of EMS mental health and substance use disorder treatment.

7

     (a) As used in this section, "emergency medical services" or "EMS" means the

8

practitioners, ambulance vehicles, and ambulance service entities licensed in accordance with

9

chapter 4.1 of title 23 to provide emergency medical care, transportation, and preventive care to

10

mitigate loss of life or exacerbation of illness or injury, including, but not limited to, EMS

11

responding to the 911 system established under chapter 21.1 of title 39.

12

     (b) Emergency medical services shall be permitted to allow licensed providers who treat

13

mental health disorders, including substance use disorders, to accompany EMS. Such providers

14

shall be permitted to treat EMS patients when medically necessary and appropriate. Such treatment

15

shall be permitted to occur in the community.

16

     (c) Commencing January 1, 2023, every individual or group health insurance contract, plan

17

or policy issued for delivery or renewed in this state that provides medical coverage that includes

18

coverage for emergency medical services, shall provide coverage for transportation and treatment

19

described in subsection (b) of this section and shall reimburse such services at a rate not lower than

20

the same service would have been had that service been delivered in a traditional office setting.

21

     (d) Treatment and coverage for mental health disorders, including substance use disorders,

22

as described in this section shall be provided in accordance with chapter 38.2 of title 27.

23

     (e) The office of the health insurance commissioner and/or Rhode Island department of

24

health may promulgate such rules and regulations as are necessary and proper to effectuate the

25

purpose and for the efficient administration and enforcement of this section.

26

     SECTION 5. Chapter 42-7.2 of the General Laws entitled "Office of Health and Human

27

Services" is hereby amended by adding thereto the following sections:

28

     42-7.2-21. Emergency medical services transport to alternate facilities.

29

     (a) As used in this section, the following terms shall have the following meaning:

30

     (1) "Basic life support" or "BLS" means transportation by ground ambulance vehicle and

31

medically necessary supplies and services, plus the provision of BLS ambulance services. The

32

ambulance must be staffed by at least two (2) people who meet the requirements of state laws and

33

regulations where the services are being furnished. Also, at least one of the staff members must be

34

licensed, at a minimum, as an emergency medical technician by the state or local authority where

 

LC004627/SUB A - Page 10 of 14

1

the services are furnished and be legally authorized to operate all lifesaving and life-sustaining

2

equipment on board the vehicle.

3

     (2) "Emergency medical services" or "EMS" means the practitioners, ambulance vehicles,

4

and ambulance service entities licensed in accordance with chapter 4.1 of title 23 to provide

5

emergency medical care, transportation, and preventive care to mitigate loss of life or exacerbation

6

of illness or injury, including, but not limited to, EMS responding to the 911 system established

7

under chapter 21.1 of title 39.

8

     (3) "Emergency medical services practitioner" means an individual who is licensed in

9

accordance with state laws and regulations to perform emergency medical care and preventive care

10

to mitigate loss of life or exacerbation of illness or injury, including emergency medical

11

technicians, advanced emergency medical technicians, advanced emergency medical technicians-

12

cardiac, and paramedics.

13

     (4) “Mobile integrated healthcare/community paramedicine” means the provision of

14

healthcare using patient-centered, mobile resources in the out-of-hospital environment with EMS

15

agency’s licensed paramedic and advanced emergency medical technician-cardiac practitioners

16

working in collaboration with physicians, nurses, mid-level practitioners, community health teams

17

and social, behavioral and substance use disorder specialists to address the unmet needs of

18

individuals experiencing intermittent health care issues. The mobile integrated

19

healthcare/community paramedicine program rules, regulations, standing orders, protocols, and

20

procedures shall be instituted by the department of health with the collaboration of the ambulance

21

service coordinating advisory board.

22

     (b) This section authorizes emergency medical services in the state participating in a mobile

23

integrated healthcare/community paramedicine program to divert non-emergency basic life service

24

calls from emergency departments. Emergency medical services practitioners shall assess

25

individuals who are in need of emergency medical services and apply the correct level of care

26

thereafter, which may include transport to an alternative facility deemed appropriate by the

27

emergency medical services practitioner. An alternative facility shall include, but not be limited to:

28

     (1) An individual’s primary care provider;

29

     (2) A community health clinic;

30

     (3) An urgent care facility;

31

     (4) An emergency room diversion facility, as defined in § 23-17.26-2; and

32

     (5) A community-based behavioral health facility designed to provide immediate

33

assistance to a person in crisis.

34

     (c) Emergency medical services shall be permitted to transport to the following facilities

 

LC004627/SUB A - Page 11 of 14

1

designated by the director of the department of health:

2

     (1) Emergency room diversion facilities, as defined in § 23-17.26-2; and

3

     (2) Community-based behavioral health facilities designed to provide immediate assistance

4

to a person in crisis.

5

     (d) Rhode Island Medicaid and its contracted managed care entities shall provide coverage

6

for transport to an alternative facility as identified in subsection (b) of this section and shall

7

reimburse the EMS for such services at the same rate as for a non-emergency basic life support

8

transport to an emergency department.

9

     (e) If treatment at an alternative facility is deemed appropriate by the EMS practitioner, the

10

emergency medical service shall bill at the rate described in subsection (d) of this section even if

11

an advanced life support assessment was provided.

12

     (f) The executive office of health and human services shall set the reimbursement rates for

13

the services described in this section. The department of health in collaboration with the ambulance

14

service coordinating advisory board shall promulgate such rules, regulations, standing orders, and

15

protocols as are necessary and proper to effectuate the purpose and for the efficient administration

16

and enforcement of this chapter.

17

     42-7.2-22. Coverage of EMS mental health and substance use disorder treatment.

18

     (a) As used in this section, "emergency medical services" or "EMS" means the

19

practitioners, ambulance vehicles, and ambulance service entities licensed in accordance with

20

chapter 4.1 of title 23 to provide emergency medical care, transportation, and preventive care to

21

mitigate loss of life or exacerbation of illness or injury, including, but not limited to, EMS

22

responding to the 911 system established under chapter 21.1 of title 39.

23

     (b) Emergency medical services shall be permitted to allow licensed providers who treat

24

mental health disorders, including substance use disorders, to accompany EMS. Such providers

25

shall be permitted to treat EMS patients when medically necessary and appropriate. Such treatment

26

shall be permitted to occur in the community.

27

     (c) Rhode Island Medicaid and its contracted managed care entities shall provide coverage

28

for transportation and treatment described in subsection (b) of this section and shall reimburse such

29

services at a rate not lower than the same service would have been had that service been delivered

30

in a traditional office setting.

31

     (d) The executive office of health and human services shall set the reimbursement rates for

32

the services described in this section. The department of health in collaboration with the ambulance

33

service coordinating advisory board shall promulgate such rules, regulations, standing orders, and

34

protocols as are necessary and proper to effectuate the purpose and for the efficient administration

 

LC004627/SUB A - Page 12 of 14

1

and enforcement of this chapter.

2

     SECTION 6. This act shall take effect upon passage.

========

LC004627/SUB A

========

 

LC004627/SUB A - Page 13 of 14

EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

***

1

     This act would require health insurers, nonprofit hospital service corporations, nonprofit

2

medical service corporations, health maintenance organizations and Rhode Island Medicaid, to

3

issue or renew policies that provide coverage for emergency medical services transport to alternate

4

facilities and coverage of emergency medical services, mental health and substance use disorder

5

treatment, on or after January 1, 2023.

6

     This act would take effect upon passage.

========

LC004627/SUB A

========

 

LC004627/SUB A - Page 14 of 14