2023 -- S 0576 SUBSTITUTE A

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LC001384/SUB A/3

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2023

____________

A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

     Introduced By: Senators Miller, Lawson, Lauria, DiMario, DiPalma, Valverde, and
Murray

     Date Introduced: March 07, 2023

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

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

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

     27-18-91. Emergency medical services transport to alternate facilities.

     (a) As used in this section, the following terms 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

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 basic life service 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) An individual’s primary care provider;

     (2) A community health clinic;

     (3) An urgent care facility;

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

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

assistance to a person in crisis.

     (d) The department of health with the collaboration of the ambulance service coordinating

advisory board 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

department of health to provide such services.

     (e) Commencing January 1, 2024, 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

LC001384/SUB A/3 - Page 2 of 15

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.

     27-18-92. 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, 2024, 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, 2024, 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.

LC001384/SUB A/3 - Page 3 of 15

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

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

     27-19-83. Emergency medical services transport to alternate facilities.

     (a) As used in this section, the following terms 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

LC001384/SUB A/3 - Page 4 of 15

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 basic life service 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) An individual’s primary care provider;

     (2) A community health clinic;

     (3) An urgent care facility;

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

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

assistance to a person in crisis.

     (d) The department of health with the collaboration of the ambulance service coordinating

advisory board 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, 2024, 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

LC001384/SUB A/3 - Page 5 of 15

and enforcement of this section.

     27-19-84. 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

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, 2024, 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, 2024, 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

LC001384/SUB A/3 - Page 6 of 15

and enforcement of this section.

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

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

     27-20-79. Emergency medical services transport to alternate facilities.

     (a) As used in this section, the following terms 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.

     (c) This section authorizes emergency medical services in the state who are approved by

the department of health to participate in a mobile integrated healthcare/community paramedicine

program to divert non-emergency basic life service calls from emergency departments within their

LC001384/SUB A/3 - Page 7 of 15

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) An individual’s primary care provider;

     (2) A community health clinic;

     (3) An urgent care facility;

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

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

assistance to a person in crisis.

     (d) The department of health with the collaboration of the ambulance service coordinating

advisory board 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, 2024, 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.

     27-20-80. 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

LC001384/SUB A/3 - Page 8 of 15

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, 2024, 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, 2024, 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 4. Chapter 27-41 of the General Laws entitled "Health Maintenance

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

     27-41-96. Emergency medical services transport to alternate facilities.

     (a) As used in this section, the following terms 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

LC001384/SUB A/3 - Page 9 of 15

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 basic life service 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) An individual’s primary care provider;

     (2) A community health clinic;

LC001384/SUB A/3 - Page 10 of 15

     (3) An urgent care facility;

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

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

assistance to a person in crisis.

     (d) The department of health with the collaboration of the ambulance service coordinating

advisory board 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, 2024, 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.

     27-41-97. 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:

LC001384/SUB A/3 - Page 11 of 15

     (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, 2024, 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, 2024, 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 5. Chapter 42-7.2 of the General Laws entitled "Office of Health and Human

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

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

     (a) As used in this section, the following terms 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

LC001384/SUB A/3 - Page 12 of 15

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 basic life service 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) An individual’s primary care provider;

     (2) A community health clinic;

     (3) An urgent care facility;

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

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

assistance to a person in crisis.

     (d) The department of health with the collaboration of the ambulance service coordinating

advisory board shall administer the mobile integrated healthcare/community paramedicine program

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

LC001384/SUB A/3 - Page 13 of 15

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

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the services described in this section.

     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 INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

***

     This act would authorize emergency medical service agencies approved by the department

of health to participate in a mobile integrated healthcare/community paramedicine program,

allowing the agencies to transport individuals to alternative facilities such as an individual’s

primary care provider, community health clinic, urgent care facility, emergency room diversion

facility, or a community-based behavioral health facility, based on the individual’s need of

emergency medical services. This act would further permit licensed providers to accompany

emergency medical services and treat patients within the community for mental health disorders,

including substance use disorders. This act would further require the health insurance contract, plan

or policy to provide coverage for transport to an alternative location facility and treatment by a

licensed provider for mental health disorders and substance use disorders within the community.

     This act would take effect upon passage.

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