RI 2026 S2560: Insurance - Accident and Sickness Insurance Policies

Plain-English Summary

This legislation mandates that all individual and group health insurance plans, as well as Medicaid in Rhode Island, cover mental health and substance use disorder services provided by Emergency Medical Services (EMS). It authorizes EMS to bring licensed mental health professionals to the scene of a crisis for evaluation and treatment. Furthermore, it allows EMS to transport patients to emergency room diversion facilities or community-based behavioral health centers rather than solely to hospital emergency rooms. Insurance providers must reimburse these services and transports at rates comparable to traditional office visits or emergency department transports, effective January 1, 2027.

For younger readers

Sometimes people call an ambulance because they are having a very hard time with their feelings or mental health. This new law says that doctors who are experts in feelings and mental health are allowed to ride in the ambulance to help people right where they are. It also says the ambulance can take these people to special places that help with mental health, instead of just the big hospital emergency room. The law makes sure that health insurance companies pay for these rides and the help the doctors give.

Who & Where It Applies

Impacted groups

People with mental health disordersEmergency Medical Services (EMS) providersHealth insurance companiesMedicaid recipientsBehavioral health facilities

Impacted communities

All

Constitutional & Fiscal Check

None Likely

Estimated cost

Amount unknown

Estimated revenue

None

Bill Analysis

Both viewpoints

For Progressives

Expands the social safety net by ensuring Medicaid and private insurance cover on-site mental health crisis intervention, potentially reducing the criminalization of mental health episodes and police involvement.
Promotes harm reduction and community welfare by allowing EMS to transport patients to specialized behavioral health facilities rather than overcrowding emergency rooms, ensuring patients receive appropriate, specialized care.
Increases equity in healthcare access by mandating fair reimbursement rates for mental health services provided in the field, ensuring that providers can financially sustain these critical services for vulnerable populations.
Relies heavily on the private insurance market structure for implementation rather than establishing a fully public, universal mental health crisis response system.
Could potentially lead to increased insurance premiums if commercial insurers pass the mandated reimbursement costs down to consumers, which disproportionately affects lower-income policyholders.
While the bill allows transport to alternative facilities, it does not explicitly appropriate funds to build or expand these community-based behavioral health facilities, potentially leading to immediate capacity shortages.

For Conservatives

Increases system efficiency by diverting non-emergency mental health cases away from expensive hospital emergency rooms, potentially lowering overall healthcare system costs in the long run.
Allows police resources to remain focused on crime and law enforcement duties rather than responding to non-violent mental health crises and substance use issues.
Utilizes existing private and non-profit ambulance services and healthcare providers to deliver care rather than creating a massive new government agency to handle these services.
Imposes heavy government mandates on private insurance companies by dictating exactly what services must be covered and setting price floors for reimbursement, interfering with the free market.
Expands government bureaucracy by granting the Department of Health and the Insurance Commissioner broad, undefined authority to promulgate new rules and regulations to enforce the act.
Will likely result in higher insurance premiums for businesses and families as carriers are forced to absorb the costs of these new coverage mandates and reimbursement requirements.

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.