2026 -- H 7485

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LC004515

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2026

____________

A N   A C T

RELATING TO HEALTH AND SAFETY -- EMERGENCY MEDICAL TRANSPORTATION

SERVICES

     Introduced By: Representatives Spears, McEntee, Cotter, Donovan, Azzinaro, Kennedy,
Casey, Slater, Kazarian, and Casimiro

     Date Introduced: February 04, 2026

     Referred To: House Health & Human Services

     It is enacted by the General Assembly as follows:

     SECTION 1. Chapter 23-4.1 of the General Laws entitled "Emergency Medical

Transportation Services" is hereby amended by adding thereto the following section:

     23-4.1-3.1. Mobile integrated healthcare community paramedicine program.

     (a) The department of health, in collaboration of the ambulance service coordinating

advisory board, shall administer a mobile integrated healthcare community paramedicine program

(the” program”), as defined in § 27-18-1.1, § 27-19-1, § 27-20-1, and § 27-41-2, 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 emergency medical services agencies as defined in chapters 18, 19, 20, and 41

of title 27, who apply for and receive approval from the department of health to provide such

services. The scope of the program shall address and incorporate ambulance services which are in-

network (“INN”) ground ambulance services, out-of-network (“OON”) ground ambulance

services, INN and OON community-based healthcare services, and INN and OON mobile

integrated health community paramedicine programs approved by the department of health.

     (b) Provided, an OON ground ambulance service participating in the program shall be

subject to all state and federal prohibitions on surprise medical billing for their services.

     SECTION 2. Sections 27-18-1.1 and 27-18-69 of the General Laws in Chapter 27-18

entitled "Accident and Sickness Insurance Policies" are hereby amended to read as follows:

     27-18-1.1. Definitions.

     As used in this chapter:

     (1) “Adverse benefit determination” means any of the following: a denial, reduction, or

termination of, or a failure to provide or make payment (in whole or in part) for, a benefit, including

any such denial, reduction, termination, or failure to provide or make payment that is based on a

determination of an individual’s eligibility to participate in a plan or to receive coverage under a

plan, and including, with respect to group health plans, a denial, reduction, or termination of, or a

failure to provide or make payment (in whole or in part) for, a benefit resulting from the application

of any utilization review, as well as a failure to cover an item or service for which benefits are

otherwise provided because it is determined to be experimental or investigational or not medically

necessary or appropriate. The term also includes a rescission of coverage determination.

     (2) “Affordable Care Act” means the federal Patient Protection and Affordable Care Act

of 2010, as amended by the federal Health Care and Education Reconciliation Act of 2010, and

federal regulations adopted thereunder.

     (3) "Ambulance" means any publicly or privately owned vehicle, designed, constructed,

equipped, and operated for emergency medical treatment and/or transportation of persons who are

sick or injured.

     (3)(4) “Commissioner” or “health insurance commissioner” means that individual

appointed pursuant to § 42-14.5-1.

     (5) "Emergency medical services" or "EMS agencies" 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 prevention care to mitigate loss of life or

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

established pursuant to the provisions of § 39-21.1-2.

     (6) "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)(7) “Essential health benefits” shall have the meaning set forth in section 1302(b) of the

federal Affordable Care Act [42 U.S.C. § 18022].

     (5)(8) “Grandfathered health plan” means any group health plan or health insurance

coverage subject to 42 U.S.C. § 18011.

     (9) "Ground ambulance services" means those services provided by an ambulance service

LC004515 - Page 2 of 22

licensed to operate in Rhode Island in accordance with § 23-4.1-6. The term excludes air and water

ambulance services and ambulance services provided outside of Rhode Island.

     (6)(10) “Group health insurance coverage” means, in connection with a group health plan,

health insurance coverage offered in connection with such plan.

     (7)(11) “Group health plan” means an employee welfare benefit plan, as defined in 29

U.S.C. § 1002(1), to the extent that the plan provides health benefits to employees or their

dependents directly or through insurance, reimbursement, or otherwise.

     (8)(12) “Health benefits” or “covered benefits” means coverage or benefits for the

diagnosis, cure, mitigation, treatment, or prevention of disease, or amounts paid for the purpose of

affecting any structure or function of the body including coverage or benefits for transportation

primarily for and essential thereto, and including medical services as defined in § 27-19-17.

     (9)(13) “Healthcare facility” means an institution providing healthcare services or a

healthcare setting, including, but not limited to, hospitals and other licensed inpatient centers,

ambulatory surgical or treatment centers, skilled nursing centers, residential treatment centers,

diagnostic, laboratory, and imaging centers, and rehabilitation and other therapeutic health settings.

     (10)(14) “Healthcare professional” means a physician or other healthcare practitioner

licensed, accredited, or certified to perform specified healthcare services consistent with state law.

     (11)(15) “Healthcare provider” or “provider” means a healthcare professional or a

healthcare facility.

     (12)(16) “Healthcare services” means services for the diagnosis, prevention, treatment,

cure, or relief of a health condition, illness, injury, or disease.

     (13)(17) “Health insurance carrier” means a person, firm, corporation, or other entity

subject to the jurisdiction of the commissioner under this chapter. Such term does not include a

group health plan.

     (14)(18) “Health plan” or “health benefit plan” means health insurance coverage and a

group health plan, including coverage provided through an association plan if it covers Rhode

Island residents. Except to the extent specifically provided by the federal Affordable Care Act, the

term “health plan” shall not include a group health plan to the extent state regulation of the health

plan is preempted under section 514 [29 U.S.C. § 1144] of the federal Employee Retirement Income

Security Act of 1974. The term also shall not include:

     (A)(i) Coverage only for accident, or disability income insurance, or any combination

thereof.

     (ii) Coverage issued as a supplement to liability insurance.

     (iii) Liability insurance, including general liability insurance and automobile liability

LC004515 - Page 3 of 22

insurance.

     (iv) Workers’ compensation or similar insurance.

     (v) Automobile medical payment insurance.

     (vi) Credit-only insurance.

     (vii) Coverage for on-site medical clinics.

     (viii) Other similar insurance coverage, specified in federal regulations issued pursuant to

Pub. L. No. 104-191, the federal Health Insurance Portability and Accountability Act of 1996

(“HIPAA”), under which benefits for medical care are secondary or incidental to other insurance

benefits.

     (B) The following benefits if they are provided under a separate policy, certificate, or

contract of insurance or are otherwise not an integral part of the plan:

     (i) Limited scope dental or vision benefits.

     (ii) Benefits for long-term care, nursing home care, home health care, community-based

care, or any combination thereof.

     (iii) Other excepted benefits specified in federal regulations issued pursuant to federal Pub.

L. No. 104-191 (“HIPAA”).

     (C) The following benefits if the benefits are provided under a separate policy, certificate,

or contract of insurance, there is no coordination between the provision of the benefits and any

exclusion of benefits under any group health plan maintained by the same plan sponsor, and the

benefits are paid with respect to an event without regard to whether benefits are provided with

respect to such an event under any group health plan maintained by the same plan sponsor:

     (i) Coverage only for a specified disease or illness.

     (ii) Hospital indemnity or other fixed indemnity insurance.

     (D) The following if offered as a separate policy, certificate, or contract of insurance:

     (i) Medicare supplement health insurance as defined under section 1882(g)(1) [42 U.S.C.

§ 1395ss] of the federal Social Security Act.

     (ii) Coverage supplemental to the coverage provided under chapter 55 of title 10, United

States Code (Civilian Health and Medical Program of the Uniformed Services (CHAMPUS)).

     (iii) Similar supplemental coverage provided to coverage under a group health plan.

     (19) "Mobile integrated healthcare community paramedicine program" 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

emergency medical service practitioners working in collaboration with physicians, nurses, mid-

level practitioners, community health teams and social, behavioral and substance use disorder

LC004515 - Page 4 of 22

specialists to address the unmet needs of individuals experiencing intermittent health care issues;

provided that, 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.

     (15)(20) “Office of the health insurance commissioner” means the agency established

under § 42-14.5-1.

     (16)(21) “Rescission” means a cancellation or discontinuance of coverage that has

retroactive effect for reasons unrelated to timely payment of required premiums or contribution to

costs of coverage.

     27-18-69. Licensed ambulance service.

     (a) No individual or group health insurance contract, plan, or policy delivered, issued for

delivery, or renewed in this state on or after January 1, 2009, shall provide for a copayment for

ground ambulance services in excess of fifty dollars ($50.00).

     (b) As used in this section, the term “ground ambulance services” shall mean those services

provided by an ambulance service licensed to operate in Rhode Island in accordance with § 23-4.1-

6. The term excludes air and water ambulance services and ambulance services provided outside

of Rhode Island.

     (c) This section Subsections (a) and (d) of this section shall not apply to insurance coverage

providing benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident

only; (4) Long-term care; (5) Medicare supplement; (6) Limited benefit health; (7) Specified

disease indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited

benefit policies.

     (d) Individual and group health insurance contracts, plans, and policies issued for delivery,

or renewed in this state on or after January 1, 2027, shall provide coverage and reimbursement for

ground ambulance services, as defined in § 27-18-1.1, equal to coverage and reimbursement rates

provided by Medicare for the same medical services, and shall reimburse the emergency medical

services provider staffed by emergency medical services practitioners, as defined in § 27-18-1.1, at

the level of care provided, regardless of whether the patient is transported, such coverage and

reimbursement shall be inclusive of the community-based healthcare services, to include mobile

integrated health community paramedicine programs approved by the department of health;

provided that, mobile integrated health community paramedicine programs services shall be

performed by emergency medical services staffed by emergency medical practitioners. If the

ground ambulance service provider participates in the carrier's network, the carrier shall cover and

reimburse the ambulance service provider at the ambulance service provider's rate for the level of

LC004515 - Page 5 of 22

care provided, regardless of whether the patient is transported. This coverage and reimbursement

shall also extend to ambulance services which are in-network (“INN”) ground ambulance services,

out-of-network (“OON”) ground ambulance services, INN and OON community-based healthcare

services, and INN and OON mobile integrated health community paramedicine programs approved

by the department of health.

     SECTION 3. Sections 27-19-1 and 27-19-60 of the General Laws in Chapter 27-19 entitled

"Nonprofit Hospital Service Corporations" are hereby amended to read as follows:

     27-19-1. Definitions.

     As used in this chapter:

     (1) “Adverse benefit determination” means any of the following: a denial, reduction, or

termination of, or a failure to provide or make payment (in whole or in part) for, a benefit, including

any such denial, reduction, termination, or failure to provide or make payment that is based on a

determination of an individual’s eligibility to participate in a plan or to receive coverage under a

plan, and including, with respect to group health plans, a denial, reduction, or termination of, or a

failure to provide or make payment (in whole or in part) for, a benefit resulting from the application

of any utilization review, as well as a failure to cover an item or service for which benefits are

otherwise provided because it is determined to be experimental or investigational or not medically

necessary or appropriate. The term also includes a rescission of coverage determination.

     (2) “Affordable Care Act” means the federal Patient Protection and Affordable Care Act,

Pub. L. No. 111-148, 124 Stat. 119, as amended by the federal Health Care and Education

Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029, and federal regulations adopted

thereunder.

     (3) "Ambulance" means any publicly or privately owned vehicle, designed, constructed,

equipped, and operated for emergency medical treatment and/or transportation of persons who are

sick or injured.

     (3)(4) “Commissioner” or “health insurance commissioner” means that individual

appointed pursuant to § 42-14.5-1.

     (4)(5) “Contracting hospital” means an eligible hospital that has contracted with a nonprofit

hospital service corporation to render hospital care to subscribers to the nonprofit hospital service

plan operated by the corporation.

     (5)(6) “Eligible hospital” is one that is maintained either by the state or by any of its

political subdivisions or by a corporation organized for hospital purposes under the laws of this

state or of any other state or of the United States, that is designated as an eligible hospital by a

majority of the directors of the nonprofit hospital service corporation.

LC004515 - Page 6 of 22

     (7) "Emergency medical services" or "EMS agencies" 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 prevention care to mitigate loss of life or

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

established pursuant to the provisions of § 39-21.1-2.

     (8) "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.

     (6)(9) “Essential health benefits” shall have the meaning set forth in section 1302(b) of the

federal Patient Protection and Affordable Care Act [42 U.S.C. § 18022(b)].

     (7)(10) “Grandfathered health plan” means any group health plan or health insurance

coverage subject to 42 U.S.C. § 18011.

     (11) "Ground ambulances services" means those services provided by an ambulance

service licensed to operate in Rhode Island in accordance with § 23-4.1-6. The term excludes air

and water ambulance services and ambulance services provided outside of Rhode Island.

     (8)(12) “Group health insurance coverage” means, in connection with a group health plan,

health insurance coverage offered in connection with the plan.

     (9)(13) “Group health plan” means an employee welfare benefit plan, as defined in 29

U.S.C. § 1002(1), to the extent that the plan provides health benefits to employees or their

dependents directly or through insurance, reimbursement, or otherwise.

     (10)(14) “Health benefits” or “covered benefits” means coverage or benefits for the

diagnosis, cure, mitigation, treatment, or prevention of disease, or amounts paid for the purpose of

affecting any structure or function of the body including coverage or benefits for transportation

primarily for and essential thereto, and including medical services as defined in § 27-19-17.

     (11)(15) “Healthcare facility” means an institution providing healthcare services or a

healthcare setting, including but not limited to: hospitals and other licensed inpatient centers;

ambulatory surgical or treatment centers; skilled nursing centers; residential treatment centers;

diagnostic, laboratory, and imaging centers; and rehabilitation and other therapeutic health settings.

     (12)(16) “Healthcare professional” means a physician or other healthcare practitioner

licensed, accredited, or certified to perform specified healthcare services consistent with state law.

     (13)(17) “Healthcare provider” or “provider” means a healthcare professional or a

healthcare facility.

LC004515 - Page 7 of 22

     (14)(18) “Healthcare services” means services for the diagnosis, prevention, treatment,

cure, or relief of a health condition, illness, injury, or disease.

     (15)(19) “Health insurance carrier” means a person, firm, corporation, or other entity

subject to the jurisdiction of the commissioner under this chapter, and includes nonprofit hospital

service corporations. Such term does not include a group health plan. The use of this term shall not

be construed to subject a nonprofit hospital service corporation to the insurance laws of this state

other than as set forth in § 27-19-2.

     (16)(20) “Health plan” or “health benefit plan” means health insurance coverage and a

group health plan, including coverage provided through an association plan if it covers Rhode

Island residents. Except to the extent specifically provided by the federal Patient Protection and

Affordable Care Act, the term “health plan” shall not include a group health plan to the extent state

regulation of the health plan is preempted under section 514 of the federal Employee Retirement

Income Security Act of 1974 [29 U.S.C. § 1144]. The term also shall not include:

     (A)(i) Coverage only for accident, or disability income insurance, or any combination

thereof.

     (ii) Coverage issued as a supplement to liability insurance.

     (iii) Liability insurance, including general liability insurance and automobile liability

insurance.

     (iv) Workers’ compensation or similar insurance.

     (v) Automobile medical payment insurance.

     (vi) Credit-only insurance.

     (vii) Coverage for on-site medical clinics.

     (viii) Other similar insurance coverage, specified in federal regulations issued pursuant to

the federal Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191, 110

Stat. 1936 (“HIPAA”), under which benefits for medical care are secondary or incidental to other

insurance benefits.

     (B) The following benefits if they are provided under a separate policy, certificate, or

contract of insurance or are otherwise not an integral part of the plan:

     (i) Limited scope dental or vision benefits.

     (ii) Benefits for long-term care, nursing home care, home health care, community-based

care, or any combination thereof.

     (iii) Other excepted benefits specified in federal regulations issued pursuant to the federal

Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191, 110 Stat. 1936

(“HIPAA”).

LC004515 - Page 8 of 22

     (C) The following benefits if the benefits are provided under a separate policy, certificate,

or contract of insurance, there is no coordination between the provision of the benefits and any

exclusion of benefits under any group health plan maintained by the same plan sponsor, and the

benefits are paid with respect to an event without regard to whether benefits are provided with

respect to such an event under any group health plan maintained by the same plan sponsor:

     (i) Coverage only for a specified disease or illness.

     (ii) Hospital indemnity or other fixed indemnity insurance.

     (D) The following if offered as a separate policy, certificate, or contract of insurance:

     (i) Medicare supplement health insurance as defined under section 1882(g)(1) of the federal

Social Security Act [42 U.S.C. § 1395ss].

     (ii) Coverage supplemental to the coverage provided under chapter 55 of title 10, United

States Code (Civilian Health and Medical Program of the Uniformed Services (CHAMPUS)).

     (iii) Similar supplemental coverage provided to coverage under a group health plan.

     (21) "Mobile integrated healthcare community paramedicine program" 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

emergency medical service 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;

provided that, 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.

     (17)(22) “Nonprofit hospital service corporation” means any corporation organized

pursuant to this chapter for the purpose of establishing, maintaining, and operating a nonprofit

hospital service plan.

     (18)(23) “Nonprofit hospital service plan” means a plan by which specified hospital care

is to be provided to subscribers to the plan by a contracting hospital.

     (19)(24) “Office of the health insurance commissioner” means the agency established

under § 42-14.5-1.

     (20)(25) “Rescission” means a cancellation or discontinuance of coverage that has

retroactive effect for reasons unrelated to timely payment of required premiums or contribution to

costs of coverage.

     (21)(26) “Subscribers” mean those persons, whether or not residents of this state, who have

contracted with a nonprofit hospital service corporation for hospital care pursuant to a nonprofit

LC004515 - Page 9 of 22

hospital service plan operated by the corporation.

     27-19-60. Licensed ambulance service.

     (a) No individual or group health insurance contract, plan, or policy delivered, issued for

delivery, or renewed in this state on or after January 1, 2009, shall provide for a copayment for

ground ambulance services in excess of fifty dollars ($50.00).

     (b) As used in this section, the term “ground ambulance services” shall mean those services

provided by an ambulance service licensed to operate in Rhode Island in accordance with § 23-4.1-

6. The term excludes air and water ambulance services and ambulance services provided outside

of Rhode Island.

     (c) This section Subsections (a) and (d) of this section shall not apply to insurance coverage

providing benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident

only; (4) Long-term care; (5) Medicare supplement; (6) Limited benefit health; (7) Specified

disease indemnity; (8) Sickness or bodily injury or death by accident, or both; and (9) Other limited

benefit policies.

     (d) Individual and group health insurance contracts, plans, and policies issued for delivery,

or renewed in this state on or after January 1, 2027, shall provide coverage and reimbursement for

ground ambulance services, as defined in § 27-19-1, equal to coverage and reimbursement rates

provided by Medicare for the same medical services, and shall reimburse the emergency medical

services provider staffed by emergency medical services practitioners, as defined in § 27-19-1, at

the level of care provided, regardless of whether the patient is transported, such coverage and

reimbursement shall be inclusive of the community-based healthcare services, to include mobile

integrated health community paramedicine programs approved by the department of health;

provided that, mobile integrated health community paramedicine programs services shall be

performed by emergency medical services staffed by emergency medical practitioners. If the

ground ambulance service provider participates in the carrier's network, the carrier shall cover and

reimburse the ambulance service provider at the ambulance service provider's rate for the level of

care provided, regardless of whether the patient is transported.

     This coverage and reimbursement shall also extend to ambulance services which are in-

network (“INN”) ground ambulance services, out-of-network (“OON”) ground ambulance

services, INN and OON community-based healthcare services, and INN and OON mobile

integrated health community paramedicine programs approved by the department of health.

     SECTION 4. Sections 27-20-1 and 27-20-55 of the General Laws in Chapter 27-20 entitled

"Nonprofit Medical Service Corporations" are hereby amended to read as follows:

     27-20-1. Definitions.

LC004515 - Page 10 of 22

     As used in this chapter:

     (1) “Adverse benefit determination” means any of the following: a denial, reduction, or

termination of, or a failure to provide or make payment (in whole or in part) for, a benefit, including

any such denial, reduction, termination, or failure to provide or make payment that is based on a

determination of an individual’s eligibility to participate in a plan or to receive coverage under a

plan, and including, with respect to group health plans, a denial, reduction, or termination of, or a

failure to provide or make payment (in whole or in part) for, a benefit resulting from the application

of any utilization review, as well as a failure to cover an item or service for which benefits are

otherwise provided because it is determined to be experimental or investigational or not medically

necessary or appropriate. The term also includes a rescission of coverage determination.

     (2) “Affordable Care Act” means the federal Patient Protection and Affordable Care Act,

as amended by the federal Health Care and Education Reconciliation Act of 2010, and federal

regulations adopted thereunder.

     (3) "Ambulance" means any publicly or privately owned vehicle, designed, constructed,

equipped, and operated for emergency medical treatment and/or transportation of persons who are

sick or injured.

     (3)(4) “Certified registered nurse practitioners” is an expanded role utilizing independent

knowledge of physical assessment and management of health care and illnesses. The practice

includes collaboration with other licensed healthcare professionals including, but not limited to,

physicians, pharmacists, podiatrists, dentists, and nurses.

     (4)(5) “Commissioner” or “health insurance commissioner” means that individual

appointed pursuant to § 42-14.5-1.

     (5)(6) “Counselor in mental health” means a person who has been licensed pursuant to § 

5-63.2-9.

     (7) "Emergency medical services" or "EMS agencies" 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 prevention care to mitigate loss of life or

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

established pursuant to the provisions of § 39-21.1-2.

     (8) "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.

LC004515 - Page 11 of 22

     (6)(9) “Essential health benefits” shall have the meaning set forth in section 1302(b) of the

federal Affordable Care Act [42 U.S.C. § 18022(b)].

     (7)(10) “Grandfathered health plan” means any group health plan or health insurance

coverage subject to 42 U.S.C. § 18011.

     (11) "Ground ambulances services" means those services provided by an ambulance

service licensed to operate in Rhode Island in accordance with § 23-4.1-6. The term excludes air

and water ambulance services and ambulance services provided outside of Rhode Island.

     (8)(12) “Group health insurance coverage” means, in connection with a group health plan,

health insurance coverage offered in connection with such plan.

     (9)(13) “Group health plan” means an employee welfare benefit plan as defined in 29

U.S.C. § 1002(1) to the extent that the plan provides health benefits to employees or their

dependents directly or through insurance, reimbursement, or otherwise.

     (10)(14) “Health benefits” or “covered benefits” means coverage or benefits for the

diagnosis, cure, mitigation, treatment, or prevention of disease, or amounts paid for the purpose of

affecting any structure or function of the body including coverage or benefits for transportation

primarily for and essential thereto, and including medical services as defined in § 27-19-17.

     (11)(15) “Healthcare facility” means an institution providing healthcare services or a

healthcare setting, including but not limited to: hospitals and other licensed inpatient centers;

ambulatory surgical or treatment centers; skilled nursing centers; residential treatment centers;

diagnostic, laboratory, and imaging centers; and rehabilitation and other therapeutic health settings.

     (12)(16)“Healthcare professional” means a physician or other healthcare practitioner

licensed, accredited, or certified to perform specified healthcare services consistent with state law.

     (13)(17) “Healthcare provider” or “provider” means a healthcare professional or a

healthcare facility.

     (14)(18) “Healthcare services” means services for the diagnosis, prevention, treatment,

cure, or relief of a health condition, illness, injury, or disease.

     (15)(19) “Health insurance carrier” means a person, firm, corporation, or other entity

subject to the jurisdiction of the commissioner under this chapter, and includes a nonprofit medical

service corporation. Such term does not include a group health plan.

     (16)(20) “Health plan” or “health benefit plan” means health insurance coverage and a

group health plan, including coverage provided through an association plan if it covers Rhode

Island residents. Except to the extent specifically provided by the federal Affordable Care Act, the

term “health plan” shall not include a group health plan to the extent state regulation of the health

plan is preempted under section 514 of the federal Employee Retirement Income Security Act of

LC004515 - Page 12 of 22

1974 [29 U.S.C. § 1144]. The term also shall not include:

     (A)(i) Coverage only for accident, or disability income insurance, or any combination

thereof;

     (ii) Coverage issued as a supplement to liability insurance;

     (iii) Liability insurance, including general liability insurance and automobile liability

insurance;

     (iv) Workers’ compensation or similar insurance;

     (v) Automobile medical payment insurance;

     (vi) Credit-only insurance;

     (vii) Coverage for on-site medical clinics; and

     (viii) Other similar insurance coverage, specified in federal regulations issued pursuant to

federal Pub. L. No. 104-191, the federal Health Insurance Portability and Accountability Act of

1996 (“HIPAA”), under which benefits for medical care are secondary or incidental to other

insurance benefits.

     (B) The following benefits if they are provided under a separate policy, certificate, or

contract of insurance or are otherwise not an integral part of the plan:

     (i) Limited scope dental or vision benefits;

     (ii) Benefits for long-term care, nursing home care, home health care, community-based

care, or any combination thereof; and

     (iii) Other excepted benefits specified in federal regulations issued pursuant to federal Pub.

L. No. 104-191 (“HIPAA”).

     (C) The following benefits if the benefits are provided under a separate policy, certificate,

or contract of insurance; there is no coordination between the provision of the benefits and any

exclusion of benefits under any group health plan maintained by the same plan sponsor; and the

benefits are paid with respect to an event without regard to whether benefits are provided with

respect to such an event under any group health plan maintained by the same plan sponsor:

     (i) Coverage only for a specified disease or illness; and

     (ii) Hospital indemnity or other fixed indemnity insurance.

     (D) The following if offered as a separate policy, certificate, or contract of insurance:

     (i) Medicare supplement health insurance as defined under section 1882(g)(1) of the federal

Social Security Act [42 U.S.C. § 1395ss];

     (ii) Coverage supplemental to the coverage provided under chapter 55 of title 10, United

States Code (Civilian Health and Medical Program of the Uniformed Services (CHAMPUS)).

     (iii) Similar supplemental coverage provided to coverage under a group health plan.

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     (17)(21) “Licensed midwife” means any midwife licensed under § 23-13-9.

     (18)(22) “Medical services” means those professional services rendered by persons duly

licensed under the laws of this state to practice medicine, surgery, chiropractic, podiatry, and other

professional services rendered by a licensed midwife, certified registered nurse practitioners, and

psychiatric and mental health nurse clinical specialists, and appliances, drugs, medicines, supplies,

and nursing care necessary in connection with the services, or the expense indemnity for the

services, appliances, drugs, medicines, supplies, and care, as may be specified in any nonprofit

medical service plan. Medical service shall not be construed to include hospital services.

     (23) "Mobile integrated healthcare community paramedicine program" 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

emergency medical service 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;

provided that, 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.

     (19)(24) “Nonprofit medical service corporation” means any corporation organized

pursuant hereto for the purpose of establishing, maintaining, and operating a nonprofit medical

service plan.

     (20)(25) “Nonprofit medical service plan” means a plan by which specified medical service

is provided to subscribers to the plan by a nonprofit medical service corporation.

     (21) “Office of the health insurance commissioner” means the agency established under § 

42-14.5-1.

     (22)(26) “Psychiatric and mental health nurse clinical specialist” is an expanded role

utilizing independent knowledge and management of mental health and illnesses. The practice

includes collaboration with other licensed healthcare professionals, including, but not limited to:

psychiatrists, psychologists, physicians, pharmacists, and nurses.

     (23)(27) “Rescission” means a cancellation or discontinuance of coverage that has

retroactive effect for reasons unrelated to timely payment of required premiums or contribution to

costs of coverage.

     (24)(28) “Subscribers” means those persons or groups of persons who contract with a

nonprofit medical service corporation for medical service pursuant to a nonprofit medical service

plan.

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     (25)(29) “Therapist in marriage and family practice” means a person who has been licensed

pursuant to § 5-63.2-10.

     27-20-55. Licensed ambulance service.

     (a) No individual or group health insurance contract, plan, or policy delivered, issued for

delivery, or renewed in this state on or after January 1, 2009, shall provide for a copayment for

ground ambulance services in excess of fifty dollars ($50.00).

     (b) As used in this section, the term “ground ambulance services” shall mean those services

provided by an ambulance service licensed to operate in Rhode Island in accordance with § 23-4.1-

6. The term excludes air and water ambulance services and ambulance services provided outside

of Rhode Island.

     (c) This section Subsections (a) and (d) of this section shall not apply to insurance coverage

providing benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident

only; (4) Long-term care; (5) Medicare supplement; (6) Limited benefit health; (7) Specified

disease indemnity; (8) Sickness or bodily injury or death by accident, or both; and (9) Other limited

benefit policies.

     (d) Individual and group health insurance contracts, plans, and policies issued for delivery,

or renewed in this state on or after January 1, 2027, shall provide coverage and reimbursement for

ground ambulance services, as defined in § 27-20-1, equal to coverage and reimbursement rates

provided by Medicare for the same medical services, and shall reimburse the emergency medical

services provider staffed by emergency medical services practitioners, as defined in § 27-20-1, at

the level of care provided, regardless of whether the patient is transported, such coverage and

reimbursement shall be inclusive of the community-based healthcare services, to include mobile

integrated health community paramedicine programs approved by the department of health;

provided that, mobile integrated health community paramedicine programs services shall be

performed by emergency medical services staffed by emergency medical practitioners. If the

ground ambulance service provider participates in the carrier's network, the carrier shall cover and

reimburse the ambulance service provider at the ambulance service provider's rate for the level of

care provided, regardless of whether the patient is transported.

     This coverage and reimbursement shall also extend to ambulance services which are in-

network (“INN”) ground ambulance services, out-of-network (“OON”) ground ambulance

services, INN and OON community-based healthcare services, and INN and OON mobile

integrated health community paramedicine programs approved by the department of health.

     SECTION 5. Sections 27-41-2 and 27-41-73 of the General Laws in Chapter 27-41 entitled

"Health Maintenance Organizations" are hereby amended to read as follows:

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     27-41-2. Definitions.

     As used in this chapter:

     (1) “Adverse benefit determination” means any of the following: a denial, reduction, or

termination of, or a failure to provide or make payment (in whole or in part) for, a benefit, including

any such denial, reduction, termination, or failure to provide or make payment that is based on a

determination of an individual’s eligibility to participate in a plan or to receive coverage under a

plan, and including, with respect to group health plans, a denial, reduction, or termination of, or a

failure to provide or make payment (in whole or in part) for, a benefit resulting from the application

of any utilization review, as well as a failure to cover an item or service for which benefits are

otherwise provided because it is determined to be experimental or investigational or not medically

necessary or appropriate. The term also includes a rescission of coverage determination.

     (2) “Affordable Care Act” means the federal Patient Protection and Affordable Care Act,

Pub. L. No. 111-148, 124 Stat. 119, as amended by the Health Care and Education Reconciliation

Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029, and federal regulations adopted thereunder.

     (3) "Ambulance" means any publicly or privately owned vehicle, designed, constructed,

equipped, and operated for emergency medical treatment and/or transportation of persons who are

sick or injured.

     (3)(4) “Commissioner” or “health insurance commissioner” means that individual

appointed pursuant to § 42-14.5-1.

     (4)(5) “Covered health services” means the services that a health maintenance organization

contracts with enrollees and enrolled groups to provide or make available to an enrolled participant.

     (5)(6) “Director” means the director of the department of business regulation or his or her

duly appointed agents.

     (7) "Emergency medical services" or "EMS agencies" 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 prevention care to mitigate loss of life or

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

established pursuant to the provisions of § 39-21.1-2.

     (8) "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.

     (6)(9) “Employee” means any person who has entered into the employment of or works

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under a contract of service or apprenticeship with any employer. It shall not include a person who

has been employed for less than thirty (30) days by his or her employer, nor shall it include a person

who works less than an average of thirty (30) hours per week. For the purposes of this chapter, the

term “employee” means a person employed by an “employer” as defined in subsection (7) of this

section. Except as otherwise provided in this chapter, the terms “employee” and “employer” are to

be defined according to the rules and regulations of the department of labor and training.

     (7)(10) “Employer” means any person, partnership, association, trust, estate, or

corporation, whether foreign or domestic, or the legal representative, trustee in bankruptcy,

receiver, or trustee of a receiver, or the legal representative of a deceased person, including the state

of Rhode Island and each city and town in the state, that has in its employ one or more individuals

during any calendar year. For the purposes of this section, the term “employer” refers only to an

employer with persons employed within the state of Rhode Island.

     (8)(11) “Enrollee” means an individual who has been enrolled in a health maintenance

organization.

     (9)(12) “Essential health benefits” shall have the meaning set forth in section 1302(b) of

the Patient Protection and Affordable Care Act [42 U.S.C. § 18022(b)].

     (10)(13) “Evidence of coverage” means any certificate, agreement, or contract issued to an

enrollee setting out the coverage to which the enrollee is entitled.

     (11)(14) “Grandfathered health plan” means any group health plan or health insurance

coverage subject to 42 U.S.C. § 18011.

     (15) "Ground ambulances services" means those services provided by an ambulance

service licensed to operate in Rhode Island in accordance with § 23-4.1-6. The term excludes air

and water ambulance services and ambulance services provided outside of Rhode Island.

     (12)(16) “Group health insurance coverage” means, in connection with a group health plan,

health insurance coverage offered in connection with that plan.

     (13)(17) “Group health plan” means an employee welfare benefit plan as defined in 29

U.S.C. § 1002(1), to the extent that the plan provides health benefits to employees or their

dependents directly or through insurance, reimbursement, or otherwise.

     (14)(18) “Health benefits” or “covered benefits” means coverage or benefits for the

diagnosis, cure, mitigation, treatment, or prevention of disease, or amounts paid for the purpose of

affecting any structure or function of the body including coverage or benefits for transportation

primarily for and essential thereto, and including medical services as defined in § 27-19-17.

     (15)(19) “Healthcare facility” means an institution providing healthcare services or a

healthcare setting, including, but not limited, to hospitals and other licensed inpatient centers,

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ambulatory surgical or treatment centers, skilled nursing centers, residential treatment centers,

diagnostic, laboratory and imaging centers, and rehabilitation and other therapeutic health settings.

     (16)(20) “Healthcare professional” means a physician or other healthcare practitioner

licensed, accredited, or certified to perform specified healthcare services consistent with state law.

     (17)(21) “Healthcare provider” or “provider” means a healthcare professional or a

healthcare facility.

     (18)(22) “Healthcare services” means any services included in the furnishing to any

individual of medical, podiatric, or dental care, or hospitalization, or incident to the furnishing of

that care or hospitalization, and the furnishing to any person of any and all other services for the

purpose of preventing, alleviating, curing, or healing human illness, injury, or physical disability.

     (19)(23) “Health insurance carrier” means a person, firm, corporation, or other entity

subject to the jurisdiction of the commissioner under this chapter, and includes a health

maintenance organization. Such term does not include a group health plan.

     (20)(24) “Health maintenance organization” means a single public or private organization

that:

     (i) Provides or makes available to enrolled participants healthcare services, including at

least the following basic healthcare services: usual physician services, hospitalization, laboratory,

x-ray, emergency, and preventive services, and out-of-area coverage, and the services of licensed

midwives;

     (ii) Is compensated, except for copayments, for the provision of the basic healthcare

services listed in subsection (20)(i) of this section to enrolled participants on a predetermined

periodic rate basis;

     (iii)(A) Provides physicians’ services primarily:

     (I) Directly through physicians who are either employees or partners of the organization;

or

     (II) Through arrangements with individual physicians or one or more groups of physicians

organized on a group practice or individual practice basis;

     (B) “Health maintenance organization” does not include prepaid plans offered by entities

regulated under chapter 1, 2, 19, or 20 of this title that do not meet the criteria above and do not

purport to be health maintenance organizations; and

     (iv) Provides the services of licensed midwives primarily:

     (A) Directly through licensed midwives who are either employees or partners of the

organization; or

     (B) Through arrangements with individual licensed midwives or one or more groups of

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licensed midwives organized on a group practice or individual practice basis.

     (21)(25) “Licensed midwife” means any midwife licensed pursuant to § 23-13-9.

     (22)(26) “Material modification” means only systemic changes to the information filed

under § 27-41-3.

     (27) "Mobile integrated healthcare community paramedicine program" 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

emergency medical service 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;

provided that, 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.

     (23)(28) “Net worth,” for the purposes of this chapter, means the excess of total admitted

assets over total liabilities.

     (24)(29) “Office of the health insurance commissioner” means the agency established

under § 42-14.5-1.

     (25)(30) “Physician” includes a podiatrist as defined in chapter 29 of title 5.

     (26)(31) “Private organization” means a legal corporation with a policy-making and

governing body.

     (27)(32) “Provider” means any physician, hospital, licensed midwife, or other person who

or that is licensed or authorized in this state to furnish healthcare services.

     (28)(33) “Public organization” means an instrumentality of government.

     (29)(34) “Rescission” means a cancellation or discontinuance of coverage that has

retroactive effect for reasons unrelated to timely payment of required premiums or contribution to

costs of coverage.

     (30)(35) “Risk-based capital (‘RBC’) instructions” means the risk-based capital report

including risk-based capital instructions adopted by the National Association of Insurance

Commissioners (“NAIC”), as these risk-based capital instructions are amended by the NAIC in

accordance with the procedures adopted by the NAIC.

     (31)(36) “Total adjusted capital” means the sum of:

     (i) A health maintenance organization’s statutory capital and surplus (i.e., net worth) as

determined in accordance with the statutory accounting applicable to the annual financial

statements required to be filed under § 27-41-9; and

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     (ii) Any other items, if any, that the RBC instructions provide.

     (32) “Uncovered expenditures” means the costs of healthcare services that are covered by

a health maintenance organization, but that are not guaranteed, insured, or assumed by a person or

organization other than the health maintenance organization. Expenditures to a provider who or

that agrees not to bill enrollees under any circumstances are excluded from this definition.

     27-41-73. Licensed ambulance service.

     (a) No individual or group health insurance contract, plan, or policy delivered, issued for

delivery, or renewed in this state on or after January 1, 2009, shall provide for a copayment for

ground ambulance services in excess of fifty dollars ($50.00).

     (b) As used in this section, the term “ground ambulance services” shall mean those services

provided by an ambulance service licensed to operate in Rhode Island in accordance with § 23-4.1-

6. The term excludes air and water ambulance services and ambulance services provided outside

of Rhode Island.

     (c) This section Subsections (a) and (d) of this section shall not apply to insurance coverage

providing benefits for: (1) Hospital confinement indemnity; (2) Disability income; (3) Accident

only; (4) Long-term care; (5) Medicare supplement; (6) Limited benefit health; (7) Specified

disease indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited

benefit policies.

     (d) Individual and group health insurance contracts, plans, and policies issued for delivery,

or renewed in this state on or after January 1, 2027, shall provide coverage and reimbursement for

ground ambulance services, as defined in § 27-41-2, equal to coverage and reimbursement rates

provided by Medicare for the same medical services, and shall reimburse the emergency medical

services provider staffed by emergency medical services practitioners, as defined in § 27-41-2, at

the level of care provided, regardless of whether the patient is transported, such coverage and

reimbursement shall be inclusive of the community-based healthcare services, to include mobile

integrated health community paramedicine programs approved by the department of health;

provided that, mobile integrated health community paramedicine programs services shall be

performed by emergency medical services staffed by emergency medical practitioners. If the

ground ambulance service provider participates in the carrier's network, the carrier shall cover and

reimburse the ambulance service provider at the ambulance service provider's rate for the level of

care provided, regardless of whether the patient is transported.

     This coverage and reimbursement shall also extend to ambulance services which are in-

network (“INN”) ground ambulance services, out-of-network (“OON”) ground ambulance

services, INN and OON community-based healthcare services, and INN and OON mobile

LC004515 - Page 20 of 22

integrated health community paramedicine programs approved by the department of health.

     SECTION 6. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO HEALTH AND SAFETY -- EMERGENCY MEDICAL TRANSPORTATION

SERVICES

***

     This act would provide coverage and increase individual and group insurance rates of

reimbursement for ambulance services, and would require health insurers to provide coverage for

emergency medical service providers administering mobile integrated healthcare community

paramedicine. This act would also direct the department of health, in collaboration of the

ambulance service coordinating advisory board, to administer a mobile integrated healthcare

community paramedicine program.

     This act would take effect upon passage.

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