2023 -- H 5904 SUBSTITUTE A AS AMENDED

========

LC002080/SUB A

========

     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2023

____________

A N   A C T

RELATING TO PUBLIC UTILITIES AND CARRIERS -- NON-EMERGENCY MEDICAL

TRANSPORTATION

     

     Introduced By: Representatives Serpa, and Azzinaro

     Date Introduced: March 01, 2023

     Referred To: House Judiciary

     (Division of Public Utilities and Carriers)

It is enacted by the General Assembly as follows:

1

     SECTION 1. Section 23-4.1-6 of the General Laws in Chapter 23-4.1 entitled "Emergency

2

Medical Transportation Services" is hereby amended to read as follows:

3

     23-4.1-6. Licensing of ambulances and ambulance service.

4

     (a) A person shall not engage in the business or service of the transportation of patients

5

upon any public way of the state unless that person holds a license by the director of health for

6

engaging in that business or service.

7

     (b) A person shall not operate an ambulance on public ways in this state if the ambulance

8

is not licensed by the director of health under this chapter.

9

     (c) The director of health shall not issue or renew a license for an ambulance under this

10

chapter unless the ambulance meets the minimum equipment standards established under this

11

chapter.

12

     (d) If a major emergency occurs and the licensed ambulances in the state are not sufficient

13

to meet the needs to transport the injured or sick persons, the licensing provisions of this section

14

do not apply during the period of the emergency.

15

     (e)(1) If an ambulance is owned by a nonresident and is licensed as a motor vehicle in

16

another state, it may be operated on the public ways of this state to transport patients who are picked

17

up out of state and brought to treatment centers in the state, without the ambulance, its owners, the

18

driver, the attendant, or the attendant drivers being licensed under this section.

 

1

     (2) Also exempted are:

2

     (i) Any motor vehicles or aircraft owned by or operated under the direct control of the

3

United States;

4

     (ii) Those hospital-based and owned vehicles and their attendants which are used solely for

5

the transportation of non-emergency patients to and from other institutions for the purpose of

6

therapy and/or other medical treatment and services of a non-emergency nature; and

7

     (iii) Those private ambulance and service companies and their attendants which are used

8

solely for the transportation of non-emergency patients; provided, however, that those private

9

ambulance and service companies annually attest to the ambulance service coordinating board the

10

fact that the ambulance or service companies are not engaged in the transportation of emergency

11

patients.

12

     (f) Any change of ownership of a licensed ambulance or of a business or service engaged

13

in the transportation of patients ends the license concerned. Upon a change of ownership, the

14

director of health shall issue a ninety (90) day temporary license upon the application of the new

15

owner for a current license.

16

     (g) All persons engaged in the business or service of the transportation of patients on any

17

public ways in the state, all person operating an ambulance for ambulance purposes on any public

18

way in the state, and all ambulances operated on public ways in this state shall conform to the

19

minimum standards set by regulations issued under the authority of this chapter.

20

     (h) If there is a hardship imposed on any applicant for a license because of an unusual

21

circumstance, the applicant may apply to the director for a temporary waiver of the licensing

22

provisions of this section for good cause shown. The director has the power to waive licensing

23

provisions for a period not to exceed ninety (90) days.

24

     (i) A person may not transport any patient by a stretcher, or in a supine position, in a vehicle

25

unless the person holds a license as an emergency medical services provider issued by the director

26

of health for engaging in that business or service. For the purposes of this section the definition of

27

a "person" means an individual, corporation, organization, government, governmental subdivision

28

or agency, business, trust, partnership, association, or any other legal entity, and an "emergency

29

medical provider" means the practitioners, ambulance vehicles, and ambulance services entities

30

licensed in accordance with chapter 4.1 of title 23 to provide emergency care, transportation, and

31

preventative care to mitigate loss of life, or exacerbation of illness and injury.

32

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

33

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

34

CHAPTER 14.3

 

LC002080/SUB A - Page 2 of 9

1

NON-EMERGENCY MEDICAL TRANSPORTATION

2

     39-14.3-1. Definitions.

3

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

4

expressed or is clearly apparent from the language or context:

5

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

6

medical transportation service provider.

7

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

8

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

9

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

10

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

11

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

12

consent of the vehicle owner.

13

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

14

     (6) “Gurney-transport vehicle” means a vehicle designed by the manufacturer to transport

15

non-ambulatory passengers on a gurney or stretcher.

16

     (7)(i) "Non-emergency medical transportation" or "NEMT" means and includes

17

transportation services offered to patients and health care consumers who face extraordinary

18

barriers getting to their medical appointments. It is a key benefit of Medicaid defined under 42

19

C.F.R. 457.1206 and is frequently coordinated by state agencies, departments, and authorities,

20

including the executive office of health and human services and the RIde program administered by

21

the Rhode Island public transit authority. NEMT is for people who are ambulatory curb-to curb and

22

door-to-door and provided in accordance with the following criteria:

23

     (A) Ambulatory curb-to curb transportation is for patients who are capable of meeting their

24

driver on the curb, getting in and out of the car and walking into their appointment unassisted; and

25

     (B) Ambulatory door-to-door transportation is for patients who need help getting from

26

their home or medical appointment to and from the car; and

27

     (C) Wheelchair patients requiring NEMT transportation shall be transported using

28

wheelchair-accessible public motor vehicles, as defined in this chapter.

29

     (ii) For the purposes of this chapter, the coordination of transportation by medical facilities

30

when discharging patients/clients shall not be deemed NEMT; and

31

     (iii) NEMT shall not be utilized for people who require a gurney transport vehicle.

32

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

33

conformance with the provisions of this chapter.

34

     (9) "PASS" means the passenger assistance safety and sensitivity driver certification

 

LC002080/SUB A - Page 3 of 9

1

training program devised and administered by the Community Transportation Association of

2

America.

3

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

4

association of individuals.

5

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

6

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

7

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

8

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

9

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

10

passengers for compensation.

11

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

12

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

13

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

14

or authority.

15

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

16

transportation services as defined in this chapter.

17

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

18

identifying the vehicle as providing NEMT service.

19

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

20

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

21

from the wheelchair.

22

     39-14.3-2. Powers of division.

23

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

24

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

25

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

26

economical, safe, and efficient service regulated under this chapter.

27

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

28

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

29

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

30

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

31

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

32

written application for it, accompanied by a fee of two hundred fifty dollars ($250), and after a

33

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

34

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

 

LC002080/SUB A - Page 4 of 9

1

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

2

received under this section shall be deposited as general revenues.

3

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

4

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

5

certificate, issued under § 39-14.1-1 ("PMV certificate"), and has utilized that certificate solely to

6

provide non-emergency medical transportation prior to the establishment of this chapter. In such

7

instances, the division may administratively convert such a PMV certificate to an NEMT certificate

8

without the need for an additional application fee to be paid or an application hearing to be held;

9

provided, however, that the applicant for such a conversion shall have satisfied any additional

10

licensing/certification requirements established by this chapter. The division shall establish a

11

mechanism for all certificate conversion requests to be made no later than four o'clock (4:00) p.m.

12

on August 1, 2023. Nothing in this subsection shall be construed to mean that such converted

13

certificates are exempt from the annual renewal process listed in subsection (a) of this section.

14

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

15

ambulance companies shall be exempt from this chapter.

16

     (d) Taxicab companies certificated and authorized by the division shall be permitted to

17

provide non-emergency medical transportation services without the need to apply for an NEMT

18

certificate as required in subsection (a) of this section; provided, however, that all taxicab drivers

19

shall adhere to the special licensing provisions of § 39-14.3-8.

20

     (e) No for-hire transportation services authorized by the division under chapters 13 or 14.2

21

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

22

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

23

     39-14.3-4. Hearing on application.

24

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

25

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

26

class mail to the applicant and shall be published in a newspaper of statewide distribution, and on

27

the division's agency website. Following the hearing, the administrator of the division shall issue a

28

decision granting or denying the application as soon as practicable.

29

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

30

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

31

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

32

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

33

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

34

A fee of twenty-five dollars ($25.00) shall be paid to the division of motor vehicles for each annual

 

LC002080/SUB A - Page 5 of 9

1

inspection. Moreover, the division of public utilities and carrier shall have additional responsibility,

2

under § 39-14.3-2, to ensure that the vehicles are of satisfactory condition, age, and mileage to be

3

used to transport NEMT passengers in a safe, sanitary, and acceptable manner.

4

     39-14.3-6. Registration and vehicle markings.

5

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

6

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

7

before being used to transport passengers, certificate holders shall, on an annual basis, register each

8

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

9

The fee for filing the initial registration shall be twenty dollars ($20.00). All subsequent annual

10

vehicle renewals shall be twenty dollars ($20.00) and shall be filed and the fee remitted with the

11

annual certificate renewal as outlined in § 39-l4.3-3(a).

12

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

13

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

14

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

15

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

16

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

17

for such vehicle markings.

18

     39-14.3-7. NEMT vehicles.

19

     (a) Vehicles used to transport passengers in non-emergency medical transportation shall

20

only be:

21

     (1) 4-door sedans;

22

     (2) Minivans;

23

     (3) Multi-passenger transport vans, or;

24

     (4) Wheelchair-accessible vehicles;

25

     (b) NEMT vehicles shall meet the same vehicle age/mileage standards as the division has

26

previously prescribed for taxicabs and limited public motor vehicles as defined in § 39-14-1.

27

     39-14.3-8. Drivers - General requirements.

28

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

29

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

30

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

31

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

32

division shall require.

33

     (b) In addition to the licensing requirements of the division referenced in subsection (a) of

34

this section, no such special license shall be issued or renewed until the license applicant shall have

 

LC002080/SUB A - Page 6 of 9

1

presented to the division a valid certification demonstrating that the applicant has successfully

2

completed PASS driver safety and sensitivity training.

3

     (c) The special license shall contain a recent photograph of the license holder, the licensee's

4

name, the license number and the license expiration date. The license shall be posted in the front

5

of the NEMT vehicle at all times while the license holder is operating the vehicle, in a conspicuous

6

place to afford the passenger the ability to see the photo and listed information.

7

     39-14.3-9. Drivers - Training requirements for operating accessible vehicles.

8

     No person shall operate wheelchair-accessible vehicle, as defined in § 39-14.3-1, for

9

compensation in non-emergency medical transportation of passengers without first having satisfied

10

the licensing requirements established in § 39-14.3-8. Moreover, any operator of such an

11

"accessible" vehicle shall also present to the division valid certification that the applicant has

12

successfully completed supplementary PASS training in loading, securing, transporting, and

13

unloading wheelchair-bound passengers. Upon presentation of such certification, division

14

personnel shall append the special license required in § 39-14.3-8 to authorize the holder thereof to

15

operate a wheelchair-accessible NEMT for the purpose of transporting such non-ambulatory

16

passengers.

17

     It shall be unlawful both for any driver to operate, and for any certificate holder to allow

18

any driver in its employ to operate, a wheelchair-accessible NEMT vehicle without the driver

19

holding a valid annotated special license issued by the division confirming the driver has been

20

sufficiently trained in transporting non-ambulatory passengers.

21

     39-14.3-10. Proof of financial responsibility.

22

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

23

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

24

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

25

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

26

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

27

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

28

dollars ($100,000) for damage to property.

29

     39-14.3-11. Penalty for violations - General.

30

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

31

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

32

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

33

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

34

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

 

LC002080/SUB A - Page 7 of 9

1

year, or both for each offense.

2

     (b) The administrator may, in his or her discretion, in lieu of seeking criminal sanctions,

3

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

4

chapter, impose upon its regulated common carriers an administrative civil penalty ("fine"). This

5

fine shall not exceed one thousand dollars ($1,000) per violation under this chapter or the division's

6

rules and regulations promulgated under this chapter.

7

     39-14.3-12. Penalty for failure to comply with training requirements for operation of

8

accessible vehicles.

9

     (a) Any driver who operates a wheelchair-accessible vehicle without having successfully

10

completed the additional training requirements mandated by § 39-14.3-9 or without having in the

11

driver's possession the special license required by § 39-14.3-8 may be imprisoned for a term not to

12

exceed two (2) years and fined not more than ten thousand dollars ($10,000). If any driver shall

13

cause death or serious injury to any person while operating an NEMT vehicle in violation of § 39-

14

14.3-8 or 39-14.3-9, the driver may be imprisoned for a term not to exceed five (5) years and fined

15

not more than fifty thousand dollars ($50,000).

16

     (b) Every person involved in providing NEMT services, including any person holding an

17

NEMT certificate of operating authority issued under this chapter by the division, or managing or

18

operating a NEMT service provider, who shall aid, assist, abet, counsel, hire, command, or procure

19

another to drive a wheelchair-accessible vehicle to transport passengers in violation of § 39-14.3-8

20

or § 39-14.3-9, may be imprisoned for a term not to exceed four (4) years and fined not more than

21

twenty thousand dollars ($20,000), except that if a death or serious injury occurs during the

22

violative transportation, the term of imprisonment shall not exceed ten (10) years and the fine shall

23

not exceed one hundred thousand dollars ($100,000).

24

     SECTION 3. This act shall take effect upon passage on January 1, 2024.

========

LC002080/SUB A

========

 

LC002080/SUB A - Page 8 of 9

EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO PUBLIC UTILITIES AND CARRIERS -- NON-EMERGENCY MEDICAL

TRANSPORTATION

***

1

     This act would require any person who transports a patient by a stretcher or in a supine

2

position in a vehicle be licensed as an emergency medical service provider through the director of

3

health and would establish a safe and reasonable regulatory framework for companies and drivers

4

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

5

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

6

     This act would take effect upon passage on January 1, 2024.

========

LC002080/SUB A

========

 

LC002080/SUB A - Page 9 of 9