2024 -- S 3127 SUBSTITUTE A AS AMENDED

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LC006205/SUB A

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2024

____________

A N   A C T

RELATING TO PUBLIC UTILITIES AND CARRIERS -- MOTOR PASSENGER CARRIERS

-- NON-EMERGENCY MEDICAL TRANSPORTATION

     Introduced By: Senators Britto, Ciccone, DiMario, Sosnowski, F. Lombardi, and Lawson

     Date Introduced: June 03, 2024

     Referred To: Senate Health & Human Services

     (Governor)

It is enacted by the General Assembly as follows:

     SECTION 1. Section 39-13-1 of the General Laws in Chapter 39-13 entitled "Motor

Passenger Carriers" is hereby amended to read as follows:

     39-13-1. Definitions.

     (a) “Coordinated paratransit services” means paratransit services coordinated by the

department of transportation, to be provided under a brokerage or other contractual model to

provide, promote, and coordinate new or existing paratransit operations to enable all state,

municipal, and private agencies access to appropriate paratransit services. For the purpose of this

chapter, non-emergency medical transportation as defined in § 39-14.3-1 shall not be considered to

be coordinated paratransit services.

     (b) “Jitney” means and includes any motor bus or other public-service motor vehicle

operated in whole or in part upon any street or highway in such manner as to afford a means of

transportation similar to that afforded by a street railway company, by indiscriminately receiving

or discharging passengers; or running on a regular route or over any portion thereof; or between

fixed termini.

     (c) “Paratransit services” means flexible transportation services provided on a demand-

responsive and advance-reservation basis, for any destination within the scope of a service program

provided by a state or municipal agency, the fee for which is determined pursuant to a contract

between the service provider and the state or municipal agency. Paratransit includes single or group

trips or trips made on a recurring basis such as for work, school, medical, nutrition, and sheltered

workshops.

     (d) “Public-service motor vehicle” shall include all motor vehicles as defined in § 31-1-3,

used for the transportation of passengers for hire.

     (e) “Transportation operator(s)” means an entity(ies) providing flexible transportation

services that are operated publicly or privately, and are distinct from conventional fixed-route,

fixed-schedule transit, and are generally operated with low-capacity vehicles that provide curb-to-

curb or door-to-door service that typically involves transportation of elderly, disabled, low-income,

or the otherwise transportation-dependent population.

     SECTION 2. Title 39 of the General Laws entitled "PUBLIC UTILITIES AND

CARRIERS" is hereby amended by adding thereto the following chapter:

CHAPTER 14.3

NON-EMERGENCY MEDICAL TRANSPORTATION

     39-14.3-1. Definitions.

     Terms used in this chapter shall be construed as follows, unless another meaning is

expressed or is clearly apparent from the language or context:

     (1) "Certificate" means a certificate of operating authority issued to a non-emergency

medical transportation service provider.

     (2) "Common carrier" means any person engaging in the business of providing for-hire

non-emergency medical transportation services as defined in this chapter.

     (3) "Division" means the division of public utilities and carriers.

     (4) "Driver" means any person operating a motor vehicle used to provide non-emergency

medical transportation services that the person owns or is operating with the expressed or implied

consent of the vehicle owner.

     (5) "EOHHS" means the Rhode Island executive office of health and human services.

     (6) "Non-emergency medical transportation" or "NEMT" means the transportation

program established to provide cost effective NEMT services for individuals eligible for medical

assistance under the Medicaid State Plan who need access to health care services and have no other

means of transportation. The program is inclusive of the Elderly Transportation Program (ETP)

and monthly bus pass distribution for the TANF ("RI Works") program. It is a key benefit of

Medicaid defined under 42 C.F.R. 457.1206 and is frequently coordinated by state agencies,

departments, and authorities, including the executive office of health and human services and the

RIde program administered by the Rhode Island public transit authority, and may be coordinated

by a third-party scheduler contracted by such state agency, department or authority. For the

LC006205/SUB A - Page 2 of 21

purposes of this chapter, the coordination of transportation by medical facilities when discharging

patients/clients shall not be deemed NEMT.

     (7) "Non-emergency medical vehicle" ("NEMT vehicle") means a vehicle operated under

the authority of a NEMT certificate holder in vehicles bearing "Public Service" registration plates

issued by the department of motor vehicles.

     (8) "Passenger" means an individual being transported by a certificated carrier in

conformance with the provisions of this chapter.

     (9) "Person" means and includes any individual, partnership, corporation, or other

association of individuals.

     (10) "Public motor vehicle" and "PMV" and "public motor vehicle certificate of operating

authority" means the type of vehicle and operating certification process as defined in § 39-14.1-1.

     (11) "RIPTA" means the Rhode Island public transit authority.

     (12) "Special license" means a license, commonly referred to as a "hackney operator's

license," issued by the division of public utilities and carriers authorizing drivers to transport

passengers for compensation.

     (13) "Taxicab" means every motor vehicle identified as such in § 39-14-1.

     (14) "Third-party scheduler" means a vendor engaged by a state agency, department or

authority to schedule and coordinate transportation services for clients of the agency, department

or authority.

     (15) "Vehicle" means a motor vehicle used to provide non-emergency medical

transportation services as defined in this chapter.

     (16) "Vehicle markings" means markings required to be affixed to the outside of vehicles

identifying the vehicle as providing NEMT service.

     (17) "Wheelchair-accessible vehicle" means a vehicle designed and equipped to allow the

transportation of a passenger who uses a wheelchair without requiring that passenger to be removed

from the wheelchair.

     39-14.3-2. Powers of division.

     Every person owning or operating a motor vehicle engaged in providing non-emergency

medical transportation is declared a common carrier and subject to the jurisdiction of the division.

The division may prescribe any rules and regulations that it deems proper to ensure adequate,

economical, safe, and efficient service regulated under this chapter. Moreover, the executive office

of health and human services shall determine reasonable vehicle standards to ensure NEMT

vehicles are of satisfactory condition, age, and mileage to be used to transport NEMT passengers

in a safe, sanitary, and acceptable manner.

LC006205/SUB A - Page 3 of 21

     39-14.3-3. Certificate required for NEMT operations.

     (a) No person shall operate a vehicle in the provision of non-emergency medical

transportation in this state until the person shall have obtained an NEMT certificate of operating

authority from the division certifying that the applicant is fit, willing, and able to provide such

service to passengers. The certificate shall be issued only after submission to the division of a

written application for it, accompanied by a fee of one hundred twenty-five dollars ($125), and

after a public hearing has been conducted on the application. Certificates issued under this chapter

shall be renewed before the close of business on December 31 of each calendar year. The renewal

fee shall be one hundred dollars ($100) and shall be submitted with the renewal form. All revenues

received under this section shall be deposited as general revenues.

     (b) Notwithstanding the provisions of subsection (a) of this section, the division shall have

the authority to automatically grant such a certificate to any applicant who has previously held a

public motor vehicle certificate, issued under § 39-14.1-3 ("PMV certificate"), and has utilized that

certificate solely to provide non-emergency medical transportation prior to the establishment of

this chapter. In such instances, the division may administratively convert such a PMV certificate to

an NEMT certificate without the need for an additional application fee to be paid or an application

hearing to be held. The division shall establish a mechanism for all such certificate conversion

requests to be made no later than August 1, 2024. Nothing in this subsection shall be construed to

mean that such converted certificates are exempt from the annual renewal process listed in

subsection (a) of this section.

     (c) Non-emergency medical transportation services provided by RIPTA and by licensed

ambulance companies shall be exempt from this chapter.

     (d) Taxicab companies certificated and authorized by the division under chapter 14 of title

39 shall be permitted to provide non-emergency medical transportation services without the need

to apply for an NEMT certificate as required in subsection (a) of this section; provided, however,

that taxicabs shall not provide services beyond the authority conferred through its division-issued

certificate of public convenience and the requirements set forth in chapter 14 of title 39.

     (e) Transportation network companies authorized by the division under chapter 14.2 of title

39 shall be exempt from this chapter, provided, that non-emergency medical transportation

conducted by such companies shall be provided in accordance with policies established by EOHHS.

     (f) No for-hire transportation services authorized by the division under chapters 13 or 14.1

of title 39 shall be authorized to provide non-emergency medical transportation services, without

first having obtained an NEMT certificate as required in subsection (a) of this section.

     39-14.3-4. Hearing on application.

LC006205/SUB A - Page 4 of 21

     Upon receipt of an application for new authority, the division shall, within a reasonable

time, set the time and place for the required hearing. Notice of the hearing shall be given by first-

class mail to the applicant and shall be published on the division's agency website. Following the

hearing, the administrator of the division shall issue a decision granting or denying the application

as soon as practicable.

     39-14.3-5. Safety and sanitary condition of vehicles - Inspection and suitability.

     The division of motor vehicles shall have jurisdiction over the lighting, equipment, safety

and sanitary condition of all vehicles utilized to provide non-emergency medical transportation and

shall cause an inspection of it to be made before registering it, and from time to time thereafter, as

it shall deem necessary for the convenience, protection, and safety of passengers and of the public.

The division of motor vehicles shall establish a reasonable fee to be paid for each annual inspection.

Moreover, the executive office of health and human services shall ensure that the vehicles are of

satisfactory condition, age, and mileage to be used to transport NEMT passengers in a safe, sanitary,

and acceptable manner.

     39-14.3-6. Registration and vehicle markings.

     (a) Every vehicle engaged in non-emergency medical transportation shall be appropriately

registered with the division of motor vehicles to be operated on the roadways of the state. Moreover,

before being used to transport passengers, certificate holders shall register each vehicle with the

division on a form that lists vehicle year, make, model, and license plate number.

     (b) Every vehicle used to provide non-emergency medical transportation services shall bear

markings on the outside of the vehicle identifying it as authorized to provide such services. Such

markings shall make it clearly identifiable as an NEMT vehicle and shall list the NEMT certificate

number issued by the division. The division shall, in conjunction with EOHHS and all other state

agencies that contract for NEMT services on behalf of passengers, establish reasonable guidelines

for such vehicle markings.

     39-14.3-7. Drivers - General requirements.

     No person shall operate an NEMT vehicle for compensation upon the public highways

until the person shall have first obtained an operator's license as provided for in chapter 10 of title

31. Provided, further, no person shall operate an NEMT vehicle upon the highways until the person

shall have first obtained a special license from the division under any rules and regulations that the

division shall have established in accordance with § 3-14-20 and § 39-14.1-8. Nothing in this

section shall prohibit the executive office of health and human services from requiring additional

vetting and/or training of NEMT drivers.

     39-14.3-8. Proof of financial responsibility.

LC006205/SUB A - Page 5 of 21

     The owner of any NEMT vehicle operating under this chapter shall file with the division a

certificate of insurance issued by an insurance company authorized to transact business in this state,

showing that the owner has a policy insuring the NEMT certificate holder against liability for injury

to person and damage to property that may be caused by the operation of the NEMT vehicle, which

policy shall provide for the indemnity in the sum of not less than one million five hundred thousand

dollars ($1,500,000) for personal injury and indemnity of not less than one hundred thousand

dollars ($100,000) for damage to property. Such proof of financial responsibility shall be

resubmitted annually when the NEMT certificate is renewed in accordance with § 39-14.3-3 (a).

     39-14.3-9. Penalty for violations - General.

     (a) Any person, firm, or corporation, subject to the provisions of this chapter and/or any

rules and regulations promulgated under it, who shall knowingly or willfully cause to be done any

act prohibited by this chapter, or who shall be guilty of any violation of this chapter or the rules

and regulations shall be deemed guilty of a misdemeanor and shall, upon conviction, be subject to

a fine not to exceed one thousand dollars ($1,000) or imprisonment for a term not exceeding one

year, or both for each offense.

     (b) The administrator of the division may, in their discretion, in lieu of seeking criminal

sanctions, and/or in lieu of revoking or suspending the carrier's operating authority as conferred

under this chapter, impose upon its regulated common carriers an administrative civil penalty

("fine"). This fine shall not exceed one thousand dollars ($1,000) per violation under this chapter

or the division's rules and regulations promulgated under this chapter.

     SECTION 4. Chapter 27-18 of the General Laws entitled "Accident and Sickness Insurance

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

     27-18-95. Emergency medical services transport to alternate facilities.

     (a) As used in this section, the following terms shall have 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 staffed by individuals who meet the requirements of state laws and regulations

where the services are being furnished. Additionally, the number of emergency medical technicians

will be equal to the number established in regulations by the department of health to 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

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

LC006205/SUB A - Page 6 of 21

under chapter 21.1 of title 39.

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

accordance with state laws and regulations to perform emergency medical care and preventive 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 set and 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 calls from emergency departments within their service area as

provided by department of health regulations. Pursuant to an EMS agency’s approved plan,

emergency medical services practitioners shall assess individuals who are in need of emergency

medical services and apply the correct level of care thereafter, 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) A community health clinic;

     (2) An urgent care facility;

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

     (4) 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 shall administer 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

LC006205/SUB A - Page 7 of 21

department of health to provide such services.

     (e) Commencing January 1, 2025, every individual or group health insurance contract, plan

or policy issued for delivery or renewed in 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 treatment at an alternative facility is deemed appropriate by the EMS practitioner, the

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

an advanced life support assessment was provided.

     (g) The office of the health insurance commissioner may promulgate such rules and

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

and enforcement of this section.

     27-18-96. Coverage of emergency medical services mental health and 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 treat mental health disorders, including substance use disorders, to accompany EMS.

Such providers shall be permitted to evaluate and treat EMS patients when medically necessary

and appropriate. Such evaluation and treatment shall be 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 to provide immediate assistance

to a person in crisis.

     (d) Commencing January 1, 2025, every individual or group health insurance contract, plan

or policy issued for delivery or renewed in 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 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.

     (e) Commencing January 1, 2025, every individual or group health insurance contract, plan

LC006205/SUB A - Page 8 of 21

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

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

in subsection (c) of this section and shall reimburse such services at a rate not lower than the same

rate as for basic life support transport to an emergency department.

     (f) Treatment and 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 as are necessary and proper to effectuate the purpose and for the efficient administration

and enforcement of this section.

     SECTION 5. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service

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

     27-19-87. Emergency medical services transport to alternate facilities.

     (a) As used in this section, the following terms shall have 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 staffed by individuals who meet the requirements of state laws and regulations

where the services are being furnished. Additionally, the number of emergency medical technicians

will be equal to the number established in regulations by the department of health to 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

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.

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

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

LC006205/SUB A - Page 9 of 21

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 set and 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 calls from emergency departments within their service area as

provided by department of health regulations. Pursuant to an EMS agency’s approved plan,

emergency medical services practitioners shall assess individuals who are in need of emergency

medical services and apply the correct level of care thereafter, 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) A community health clinic;

     (2) An urgent care facility;

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

     (4) 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 shall administer 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 January 1, 2025, every individual or group health insurance contract, plan

or policy issued for delivery or renewed in 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 treatment at an alternative facility is deemed appropriate by the EMS practitioner, the

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

LC006205/SUB A - Page 10 of 21

an advanced life support assessment was provided.

     (g) The office of the health insurance commissioner may promulgate such rules and

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

and enforcement of this section.

     27-19-88. Coverage of emergency medical services mental health and 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 treat mental health disorders, including substance use disorders, to accompany EMS.

Such providers shall be permitted to evaluate and treat EMS patients when medically necessary

and appropriate. Such evaluation and treatment shall be 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 to provide immediate assistance

to a person in crisis.

     (d) Commencing January 1, 2025, every individual or group health insurance contract, plan

or policy issued for delivery or renewed in 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 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.

     (e) Commencing January 1, 2025, every individual or group health insurance contract, plan

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

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

in subsection (c) of this section and shall reimburse such services at a rate not lower than the same

rate as for basic life support transport to an emergency department.

     (f) Treatment and 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

LC006205/SUB A - Page 11 of 21

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

and enforcement of this section.

     SECTION 6. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service

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

     27-20-83. Emergency medical services transport to alternate facilities.

     (a) As used in this section, the following terms shall have 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 staffed by individuals who meet the requirements of state laws and regulations

where the services are being furnished. Additionally, the number of emergency medical technicians

will be equal to the number established in regulations by the department of health to 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

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.

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

accordance with state laws and regulations to perform emergency medical care and preventive 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 set and approved by the department of health shall be

eligible to participate in a mobile integrated healthcare/community paramedicine program.

LC006205/SUB A - Page 12 of 21

     (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 calls from emergency departments within their service area as

provided by department of health regulations. Pursuant to an EMS agency’s approved plan,

emergency medical services practitioners shall assess individuals who are in need of emergency

medical services and apply the correct level of care thereafter, 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) A community health clinic;

     (2) An urgent care facility;

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

     (4) 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 shall administer 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 January 1, 2025, every individual or group health insurance contract, plan

or policy issued for delivery or renewed in 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 treatment at an alternative facility is deemed appropriate by the EMS practitioner, the

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

an advanced life support assessment was provided.

     (g) The office of the health insurance commissioner may promulgate such rules and

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

and enforcement of this section.

     27-20-84. Coverage of emergency medical services mental health and 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

LC006205/SUB A - Page 13 of 21

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 treat mental health disorders, including substance use disorders, to accompany EMS.

Such providers shall be permitted to evaluate and treat EMS patients when medically necessary

and appropriate. Such evaluation and treatment shall be 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 to provide immediate assistance

to a person in crisis.

     (d) Commencing January 1, 2025, every individual or group health insurance contract, plan

or policy issued for delivery or renewed in 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 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.

     (e) Commencing January 1, 2025, every individual or group health insurance contract, plan

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

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

in subsection (c) of this section and shall reimburse such services at a rate not lower than the same

rate as for basic life support transport to an emergency department.

     (f) Treatment and 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 as are necessary and proper to effectuate the purpose and for the efficient administration

and enforcement of this section.

     SECTION 7. Chapter 27-41 of the General Laws entitled "Health Maintenance

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

     27-41-100. Emergency medical services transport to alternate facilities.

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

LC006205/SUB A - Page 14 of 21

     (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 staffed by individuals who meet the requirements of state laws and regulations

where the services are being furnished. Additionally, the number of emergency medical technicians

will be equal to the number established in regulations by the department of health to 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

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.

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

accordance with state laws and regulations to perform emergency medical care and preventive 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 set and 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 calls from emergency departments within their service area as

provided by department of health regulations. Pursuant to an EMS agency’s approved plan,

emergency medical services practitioners shall assess individuals who are in need of emergency

medical services and apply the correct level of care thereafter, 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:

LC006205/SUB A - Page 15 of 21

     (1) A community health clinic;

     (2) An urgent care facility;

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

     (4) 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 shall administer 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 January 1, 2025, every individual or group health insurance contract, plan

or policy issued for delivery or renewed in 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 treatment at an alternative facility is deemed appropriate by the EMS practitioner, the

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

an advanced life support assessment was provided.

     (g) The office of the health insurance commissioner may promulgate such rules and

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

and enforcement of this section.

     27-41-101. Coverage of emergency medical services mental health and 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 treat mental health disorders, including substance use disorders, to accompany EMS.

Such providers shall be permitted to evaluate and treat EMS patients when medically necessary

and appropriate. Such evaluation and treatment shall be permitted to occur in the community.

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

LC006205/SUB A - Page 16 of 21

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 to provide immediate assistance

to a person in crisis.

     (d) Commencing January 1, 2025, every individual or group health insurance contract, plan

or policy issued for delivery or renewed in 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 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.

     (e) Commencing January 1, 2025, every individual or group health insurance contract, plan

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

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

in subsection (c) of this section and shall reimburse such services at a rate not lower than the same

rate as for basic life support transport to an emergency department.

     (f) Treatment and 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 as are necessary and proper to effectuate the purpose and for the efficient administration

and enforcement of this section.

     SECTION 8. 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 shall have 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 staffed by individuals who meet the requirements of state laws and regulations

where the services are being furnished. Additionally, the number of emergency medical technicians

will be equal to the number established in regulations by the department of health to 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

LC006205/SUB A - Page 17 of 21

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.

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

accordance with state laws and regulations to perform emergency medical care and preventive 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 set and 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 calls from emergency departments within their service area as

provided by department of health regulations. Pursuant to an EMS agency’s approved plan,

emergency medical services practitioners shall assess individuals who are in need of emergency

medical services and apply the correct level of care thereafter, 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) A community health clinic;

     (2) An urgent care facility;

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

     (4) 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 shall administer the mobile integrated healthcare/community paramedicine program

and shall promulgate any rules, regulations, standing orders, protocols, and procedures necessary

LC006205/SUB A - Page 18 of 21

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 and its contracted managed care entities shall provide 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 treatment at an alternative facility is deemed appropriate by the EMS practitioner, the

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

an advanced life support assessment was provided.

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

the services described in this section.

     42-7.2-22. Coverage for emergency medical services mental health and substance 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 treat mental health disorders, including substance use disorders, to accompany EMS.

Such providers shall be permitted to evaluate and treat EMS patients when medically necessary

and appropriate. Such evaluation and treatment shall be 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 to provide immediate assistance

to a person in crisis.

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

for transportation, evaluation, and treatment described in 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 set the reimbursement rates for

LC006205/SUB A - Page 19 of 21

the services described in this section.

     SECTION 9. This act shall take effect on August 1, 2024.

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LC006205/SUB A

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LC006205/SUB A - Page 20 of 21

EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO PUBLIC UTILITIES AND CARRIERS -- MOTOR PASSENGER CARRIERS

-- NON-EMERGENCY MEDICAL TRANSPORTATION

***

     This act would establish a safe and reasonable regulatory framework for companies and

drivers providing non-emergency medical transportation services to a population of vulnerable

passengers through coordination with the state's health and human service agencies.

     This act would take effect on August 1, 2024.

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LC006205/SUB A

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LC006205/SUB A - Page 21 of 21