Bill Summary – FastDemocracy

-- S 0576
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     LC001384
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                       S TATE             OF         RHODE               IS L A N D
                                         IN GENERAL ASSEMBLY
                                       JANUARY SESSION, A.D. 2023
                                             ____________
                                               A N     A CT
      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 at least three (3) people who meet the requirements of state laws and
  regulations where the services are being furnished. Also, at least two (2) of the staff members must
  be licensed, at a minimum, as an emergency medical technician by the state or local authority where
 the services are furnished and 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. 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 - Page 2 of 16
  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 - Page 3 of 16
          (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 at least three (3) people who meet the requirements of state laws and
 regulations where the services are being furnished. Also, at least two (2) of the staff members must
 be at a minimum, as an emergency medical technician by the state or local authority where the
 services are furnished and 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
                                          LC001384 - Page 4 of 16
  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. 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 - Page 5 of 16
  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 - Page 6 of 16
  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
  me