Bill
HB 5772
HB 5772 would cap patient ground ambulance copays at $50 and require ambulance reimbursements to match Medicare rates starting January 1, 2026.
HB 5772 – Summary
Overview
HB 5772, introduced in the Rhode Island General Assembly for the 2025 session, would reform ambulance service cost-sharing and reimbursement across several types of health coverage. The bill seeks to cap patient copayments for ground ambulance services and to require reimbursement rates for ambulance services to align with Medicare rates. The act would take effect January 1, 2026, and overall coverage would be updated across multiple insurer types, plus Medicaid.
What the bill does
- Copayment cap for ground ambulance services
- For individual or group health insurance contracts delivered, issued for delivery, or renewed in Rhode Island on or after January 1, 2009, copayments for ground ambulance services may not exceed $50.
- Definitions
- “Ground ambulance services” means services provided by Rhode Island-licensed ambulance services (consistent with § 23-4.1-6). The term excludes air and water ambulances and services outside Rhode Island.
- Exemptions to the copayment cap
- The cap does not apply to certain coverage types, including hospital confinement indemnity, disability income, accident-only, long-term care, Medicare supplement, limited benefit health, specified disease indemnity, sickness or bodily injury or death by accident (or both), and other limited-benefit policies.
- Medicare-based reimbursement rates (effective January 1, 2026)
- For contracts issued for delivery or renewal on or after January 1, 2026, reimbursement rates for ambulance services must match Medicare reimbursement rates for the same services.
- Applies to:
- Individual and group health insurance contracts/plans/policies
- Nonprofit Hospital Service Corporations
- Nonprofit Medical Service Corporations
- Health Maintenance Organizations (HMOs)
- “Ambulance” is defined as any vehicle designed and equipped for emergency medical treatment/transport.
- Medicaid reimbursement
- Medicaid reimbursement rates for ambulance services shall be equal to Medicare rates for the same services (Section 40-8-33).
Affected entities and individuals
- Insurers and healthcare plans operating in Rhode Island, including:
- Individual and group health insurance contracts
- Nonprofit Hospital Service Corporations
- Nonprofit Medical Service Corporations
- Health Maintenance Organizations (HMOs)
- Rhode Island Medicaid program (state budget/Medicaid reimbursements)
- Ambulance providers licensed in Rhode Island (ground ambulance services)
Key provisions by section
- Sections 27-18-69, 27-19-60, 27-20-55, 27-41-73: Uniform copayment cap of $50 for ground ambulance services; 2026 Medicare-based reimbursement requirement; defines covered/excluded services; applies to contracts delivered/renewed after 2009.
- Section 40-8-33: Medicaid reimbursement rates for ambulance services set to Medicare rates.
- Section 6: Effective date – January 1, 2026.
Procedural and timeline notes
- Introduced: January 21, 2025 (and February 26, 2025 referral to House Finance)
- Status: As of April 30, 2025, the committee recommended the measure be held for further study
- Scheduled actions: Hearing/consideration noted for late April 2025
- Effective date: Hypothetically January 1, 2026, if enacted
Potential impacts
- Patients: Reduced out-of-pocket costs for ground ambulance copays (capped at $50) for many plans; clearer alignment with standardized Medicare rates.
- Insurers: Increased reimbursement obligations to Medicare rates starting in 2026; potential effects on premiums, plan design, and pricing.
- Ambulance providers: Potentially higher reimbursements (Medicare-level) for insured and Medicaid services, depending on payer mix.
- State Medicaid: Budgetary implications from Medicare-rate alignment.
Bottom line
HB 5772 would standardize ambulance cost-sharing and align reimbursement levels with Medicare rates across major Rhode Island health coverage types, with a clear copay cap and a 2026 effective date, while also updating Medicaid payments to Medicare-equivalent rates. The bill is currently under study in committee.
Compiled from official sources — confirm details with the bill’s official record.
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