RI 2026 H8134: Insurance - Accident and Sickness Insurance Policies

Plain-English Summary

This legislation mandates that health insurance policies and Medicaid in Rhode Island provide coverage for emergency medical services (EMS) related to mental health and substance use disorders. It authorizes licensed mental health professionals to accompany EMS teams to evaluate and treat patients on-site in the community. Furthermore, it permits EMS to transport patients to emergency room diversion facilities or community-based behavioral health centers instead of solely to hospital emergency rooms. The bill sets reimbursement requirements for these services and transports, ensuring they are paid at rates comparable to traditional office visits or emergency department transports.

For younger readers

Sometimes people have a very hard time with their feelings or need help with a mental health problem fast. Usually, ambulances only take people to the hospital. This new rule allows special doctors who know about feelings to ride with the ambulance to help people right where they are. If the person needs to go to a safe place, the ambulance can take them to a special center for help instead of a busy hospital. It also makes sure insurance companies pay for this help.

Who & Where It Applies

Impacted groups

People with mental health disordersEMS providers and ambulance servicesHealth insurance companiesMedicaid recipientsCommunity-based behavioral health facilities

Impacted communities

All

Constitutional & Fiscal Check

None Likely

Estimated cost

Amount unknown

Estimated revenue

None

Bill Analysis

Both viewpoints

For Progressives

Expands access to critical mental health and substance use treatment for vulnerable populations, including Medicaid recipients, ensuring care is available during crises without requiring hospitalization.
Promotes a systemic reform in crisis response by integrating behavioral health specialists into EMS, moving away from police-centric or purely medical responses to mental health emergencies.
Encourages community-based care and de-escalation by allowing treatment on-site or transport to diversion facilities, preventing the trauma and stigma often associated with involuntary emergency room admissions.
Relies heavily on the private insurance market structure to deliver care, which may not fully address systemic inequities faced by the uninsured or underinsured populations not covered by the specified plans.
While it mandates reimbursement, it does not explicitly fund the creation of new community-based behavioral health facilities, potentially leading to bottlenecks if existing facilities are full.
The delay in insurance coverage mandates until January 1, 2027, postpones the full benefits of the legislation, leaving gaps in coverage for those currently in need of these services.

For Conservatives

Potentially reduces the financial strain on expensive hospital emergency rooms by diverting non-emergency mental health cases to more appropriate, lower-cost community facilities.
Utilizes existing private healthcare providers and infrastructure to deliver services rather than creating a new, large-scale government agency to manage crisis response.
Focuses on treating patients efficiently on-site or at specialized centers, which could free up traditional EMS resources and police to handle other public safety emergencies.
Imposes strict government mandates on private insurance companies regarding what they must cover and how much they must pay, interfering with the free market principles of the insurance industry.
Increases state spending by mandating these coverages and reimbursement rates for Medicaid, which will ultimately be funded by taxpayers.
Expands the regulatory authority of the Department of Health and the Office of the Health Insurance Commissioner to promulgate new rules and regulations, increasing bureaucracy.

Votes

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Full Bill Text

Changes to existing Rhode Island law · 158 additions

SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness Insurance Policies" is hereby amended by adding thereto the following section: 27-18-96. Coverage of emergency medical services mental health and substance use disorder treatment.

(a) As used in this section, "emergency medical services" or "EMS" means the practitioners, ambulance vehicles, and ambulance service entities licensed in accordance with chapter 4.1 of title 23 to provide emergency medical care, transportation, and preventive care to mitigate loss of life or exacerbation of illness or injury, including, but not limited to, EMS responding to the 911 system established under chapter 21.1 of title 39.

(b) Emergency medical services shall be permitted to allow licensed providers who evaluate and treat mental health disorders, including substance use disorders, to accompany EMS. Such providers shall be permitted to evaluate and treat EMS patients when medically necessary and appropriate. Such evaluation and treatment shall be permitted to occur in the community.

(c) Emergency medical services shall be permitted to transport to the following facilities designated by the director of the department of health:

(1) Emergency room diversion facilities, as defined in § 23-17.26-2; and

(2) Community-based behavioral health facilities designed to provide immediate assistance to a person in crisis.

(d) Commencing January 1, 2027, 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, 2027, 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 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 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service Corporations" is hereby amended by adding thereto the following section: 27-19-88. Coverage of emergency medical services mental health and substance use disorder treatment.