The regulation amends section 464.0123 of the Florida Statutes to authorize certain advanced practice registered nurses, specifically psychiatric mental health advanced practice nurses, to engage in autonomous practice to provide mental health services. This change expands the scope of autonomous practice for these nurses, allowing them to deliver mental health services independently, as defined by board rule. The authorization is effective starting July 1, 2026, and is contingent upon nurses being registered under this section and certified as psychiatric mental health advanced practice nurses. Definitions of "autonomous practice" and "mental health services" are noted as necessary for understanding the scope of this change.

The bill establishes a new prohibition in South Dakota law that bars requiring COVID-19 vaccination as a condition for employment, enrollment, or receipt of a benefit or service. It applies broadly to employers, educational institutions, state agencies, political subdivisions, and other persons, and includes an explicit “notwithstanding any other provision of law” clause.

A violation of the new prohibition is classified as a Class 2 misdemeanor, creating criminal penalty exposure for covered entities or individuals who impose COVID-19 vaccination requirements under the specified circumstances.

It creates this new rule by adding a new section to chapter 34-22; no other statutory changes are shown in the provided text.

AT A GLANCE

This bill authorizes the governor to enter New York into two emergency management assistance compacts, and it deems the legislature’s ratification complete upon the governor’s certification to specified officials.

FULL SUMMARY

The bill changes New York’s Executive Law provisions governing disaster emergency response assistance by (1) revising the language in Executive Law § 29-b(1) to use gender-neutral references for the governor and to clarify that non-state resource providers are treated as state agents when authorized and deployed under applicable compacts, and (2) adding two new sections, §§ 29-k and 29-l, that authorize New York, through the governor, to enter and have the legislature deem the state’s entry ratified for two specific emergency management assistance compacts.

First, Executive Law § 29-b(1) is revised to direct that the governor may direct the state disaster preparedness commission (at the governor’s discretion) to conduct emergency exercises or drills using commission personnel and resources, with disaster emergency response personnel operating under the chair of the commission and holding the same powers and immunities as in civil defense drills. The same subdivision is also revised to reflect that, when legally designated state officials authorize and deploy non-state resource providers to a “compact member jurisdiction,” the providers are deemed agents of the state for purposes of the deployment and are entitled to the rights and benefits for state resource providers under the compact, subject to the requesting state’s terms and conditions, while also prohibiting them from soliciting or offering assistance across compact member jurisdictions.

Second, the bill adds Executive Law § 29-k, establishing a mechanism for New York to enter the Northern Emergency Management Assistance Compact (referencing P.L. 112-282, ratified by Congress on January 14, 2013). It provides that the compact is deemed ratified by the legislature upon the governor’s certification to the temporary president of the senate, the speaker of the assembly, and the secretary of state that New York has entered into the compact.

Third, the bill adds Executive Law § 29-l, establishing a mechanism for New York to enter an International Emergency Management Assistance Compact defined by an emergency management assistance memorandum of understanding among specified New England states and Eastern Canadian provinces, authorized under a U.S.-Canada emergency planning and management agreement. Like § 29-k, it provides that the compact is deemed ratified by the legislature upon the governor’s certification to the same three officials that New York has entered into the compact.

The act takes effect immediately.

AT A GLANCE

This bill requires the Department of Emergency Management to assess feasibility of a prevention and mitigation program for imminent emergencies without a gubernatorial declaration and report findings by November 1, 2026.

FULL SUMMARY

The bill establishes a statutory definition of “state of preparedness” as a Governor-declared condition under which the threat or danger of a credible emergency or disaster is sufficiently severe and extensive to justify Commonwealth disaster-preparedness assistance to supplement local and relief-organization preparedness and to prevent or lessen anticipated damage, loss, hardship, or suffering.

It directs the Department of Emergency Management to assess the feasibility and impact of creating a program that prioritizes prevention and mitigation of damage, loss, hardship, or suffering caused by the anticipated effects of an imminent emergency that requires a gubernatorial declaration of a “state of preparedness,” or that is an emergency not warranting a gubernatorial declaration of a state of emergency. The assessment must include: (1) criteria for deciding when the Department should respond even without a gubernatorial declaration of a state of emergency; (2) procedures for procurement, maintenance, and replenishment of materials, equipment, and supplies (in needed quantities and locations) to ensure readiness and protect life, property, and economic well-being before and during such emergencies; (3) the feasibility of seeking reimbursement from persons causing or contributing to the emergency or disaster for Department expenses related to protection, relief, and recovery; and (4) cost estimates covering personnel, administrative, and equipment expenses for the Department and, where applicable, other state agencies, political subdivisions, or other entities responding to emergencies not warranting a gubernatorial declaration of a state of emergency.

The bill requires the Department to submit a report containing its findings and recommendations to the Governor and specified legislative committee chairs no later than November 1, 2026.

AT A GLANCE

This bill requires the Virginia Department of Emergency Management to assess and recommend criteria, readiness procurement, reimbursement feasibility, and estimated response costs for imminent emergencies not warranting a gubernatorial emergency declaration.

FULL SUMMARY

The bill directs the Virginia Department of Emergency Management to assess whether it should develop a program that prioritizes prevention and mitigation of damage, loss, hardship, or suffering from an imminent emergency that (a) would trigger a gubernatorial “state of preparedness” declaration or (b) would not warrant a gubernatorial declaration of a state of emergency.

It defines “state of preparedness” as the Governor’s judgment that a credible emergency or disaster is of sufficient severity and magnitude to warrant Commonwealth disaster-preparedness assistance to supplement localities’ and relief organizations’ efforts and to pre-position available resources to prevent or alleviate threatened or caused damage, loss, hardship, or suffering.

In conducting the assessment, the Department must evaluate and develop recommendations on (1) criteria for determining when an emergency warrants Department response when no gubernatorial declaration of a state of emergency is warranted; (2) procedures for procurement, maintenance, and replenishment of materials, equipment, and supplies (including quantities and locations) to ensure readiness and to protect life, property, and the Commonwealth’s economic well-being prior to and during a state of preparedness declaration or in emergencies not warranting a state of emergency; (3) the feasibility of seeking reimbursement from persons causing or contributing to an emergency or disaster for Department protection, relief, and recovery expenses; and (4) cost estimates, including personnel, administrative, and equipment expenses, that the Department (and possibly other state agencies, political subdivisions, or other entities) would incur when responding to an emergency not warranting a gubernatorial declaration of a state of emergency.

The Department must submit a report with findings and recommendations to the Governor and the specified legislative committees by November 1, 2026.

AT A GLANCE

This bill requires Florida hospitals operating emergency departments to develop, implement, and annually train evidence-based pediatric emergency care policies, and to designate a pediatric emergency care coordinator to ensure compliance.

FULL SUMMARY

The bill establishes new pediatric patient protection requirements for Florida hospitals that operate emergency departments by creating new subsections in s. 395.1012 (Patient safety). It requires each such hospital to develop and implement evidence-based policies and procedures for pediatric emergency care covering, at minimum, triage, measuring and recording vital signs, weighing and recording weights in kilograms, calculating medication dosages, and using pediatric instruments. It also requires at least annual training on these policies and procedures, including instruction on the use of pediatric instruments (as applicable to the hospital’s licensure type) using clinical simulation and conducting at least annual emergency department drills that simulate emergency situations.

The bill also requires each hospital emergency department to designate a “pediatric emergency care coordinator” (a physician, physician assistant, nurse, or paramedic with specified Florida licensure categories). The coordinator must be responsible for implementing and ensuring fidelity to the pediatric emergency care policies and procedures adopted under the new requirements. In addition, the bill authorizes, under specified conditions, hospitals with an emergency department to conduct the National Pediatric Readiness Project’s Open Assessment during years when the National Pediatric Readiness Assessment is not conducted.

The bill requires rulemaking related to pediatric readiness and emergency management planning by amending s. 395.1055. It directs the agency to adopt rules that establish minimum standards for pediatric patient care in hospital emergency departments, in consultation with the Florida Emergency Medical Services for Children State Partnership Program, including (at minimum) the availability and immediate access to pediatric-specific equipment and supplies. It also amends the existing comprehensive emergency management plan rule requirements to ensure pediatric and neonatal patient needs are addressed in plan components and that plan review and approval procedures include specified agencies and volunteer organizations, with the local emergency management agency completing review within 60 days.

Finally, the bill amends s. 408.05 (Florida Center for Health Information and Transparency) by adding a new function requiring the agency to collect and publish overall assessment scores from the National Pediatric Readiness Assessments submitted by hospitals. Specifically, the agency must collect overall assessment scores from the Florida EMS for Children State Partnership Program by December 31, 2026, and each subsequent December 31 during years in which the National Pediatric Readiness Assessment is conducted; publish each hospital’s overall score by April 1, 2027, and each subsequent April 1 when applicable (including a comparison to the national average score when available); and collect and publish no more than one overall score per hospital per year for assessments conducted under the relevant statutory subsections, with comparison to the hospital’s most recently published score. The act takes effect July 1, 2026.

AT A GLANCE

This bill expands Minnesota’s hospital construction moratorium exceptions by authorizing specified hospital bed additions and bed relocations, including up to 85 beds in Ramsey County, only if public interest review conditions are satisfied.

FULL SUMMARY

The bill provides an exception to Minnesota’s hospital construction moratorium (Minn. Stat. § 144.551, subd. 1) by expanding the list of hospital construction or modification projects that may be commenced despite the restriction.

Specifically, the bill adds a new clause to allow (1) a project to add up to 85 licensed beds in an existing safety net, level I trauma center hospital in Ramsey County, designated under Minn. Stat. § 383A.91, subd. 5. It also revises the statutory list of permitted projects by updating the moratorium exception text for multiple existing clauses, and adds detailed conditions for at least the following permitted projects: (2) a project to add 22 licensed beds at a Minnesota freestanding children’s hospital in St. Paul (part of an independent pediatric health system with freestanding inpatient hospitals in Minneapolis and St. Paul) for pediatric inpatient behavioral health services, with an option to proceed before completion of the public interest review if a plan is submitted by a 2022 deadline and timelines in § 144.552 are followed; (3) a project for a 144-bed psychiatric hospital on the former Bethesda Hospital site in Saint Paul, if found in the public interest after the § 144.552 review, requiring the commissioner of health to monitor the hospital (including case mix and payer mix, transfers, and diversions) and requiring the hospital to have an intake and assessment area, accommodate walk-up/ambulance/law-enforcement transfers and transfers from other facilities for acute mental health needs, comply with § 144.551, subd. 1a(b), and annually submit de-identified data in the commissioner-defined format and manner.

The bill further expands permitted bed-relocation authority with specified conditions for (4) relocation of up to 26 licensed long-term acute care hospital beds from an existing long-term care hospital in Hennepin County (with a licensed capacity prior to relocation of 92 beds) into dedicated space on the campus of an existing safety net, level I trauma center hospital in Ramsey County designated under § 383A.91, subd. 5, conditioned on a public interest finding under § 144.552 and continued use of the relocated beds as long-term acute care beds after relocation.

Overall, the operative change is a broadened set of named, geographically and capacity-limited hospital construction/expansion/relocation projects that are exempt from the moratorium, with additional administrative criteria and public interest/review-related conditions attached to particular Ramsey County, Hennepin County relocation, and specific psychiatric/children’s hospital bed-addition projects.

AT A GLANCE

This bill requires the Massachusetts Attorney General, in conjunction with the DCRA state administering agency, to annually acquire and study emergency medical care data for persons in custody and issue uniform reports.

FULL SUMMARY

The bill establishes a Massachusetts study and annual reporting process focused on how emergency medical care is delivered to persons held in custody (including individuals under arrest, en route to incarceration, or incarcerated in correctional agencies such as jails and prisons). It defines relevant terms including “custody,” “correctional agency,” “correctional officer,” “law enforcement officer,” and “emergency medical condition,” where the latter is framed in terms of symptoms whose absence of prompt medical attention could reasonably be expected to cause serious jeopardy, impairment, or dysfunction.

The bill directs the state agency administering the federal Death in Custody Reporting Act (DCRA)—identified as the Research and Policy Analysis Division / Statistical Analysis Center within the Office of Grants and Research of the Executive Office of Public Safety and Security—to submit, not later than 365 days after enactment, information about delivery of emergency medical care to persons in custody to the Massachusetts Attorney General. The reporting is to be developed in consultation with specified law enforcement and corrections stakeholders (including municipal police departments, college/university law enforcement agencies, county correctional facilities, state prisons, state agencies with arrest powers/lock-up facilities, and Emergency Medical Services).

The bill requires the Massachusetts Attorney General, in conjunction with the DCRA state administering agency, to annually acquire, collect, classify, and study delivery of emergency medical care and to report details “in a uniform manner” regarding when and how emergency medical care is summoned and provided. The annual report is required to include: the frequency, nature, and timing of care (including emergency department admissions and hospitalizations, with limited data on causes for admission); EMS activations (including primary impression); and information about medical care provided to a person prior to a death in custody, including other relevant clinical data if available. It also requires a psychiatric-crisis section addressing whether a 3-digit crisis report was made prior to law enforcement contact and whether EMS, hospitalization, or other medical care was provided, including a uniform summary of critical incident responses and medical care where some medical personnel data is not integrated into an electronic medical record.

Overall, the bill requires the data to culminate in a yearly report summarizing the nature/primary impression of medical needs, the prevalence of such emergencies, and whether care was provided in a timely manner.

The document outlines amendments to regulations concerning the use of health care kiosks in emergency departments of hospitals. These changes primarily impact hospitals, particularly those with emergency services, as they will need to modify their kiosk operations.

Under the new regulations, hospitals are prohibited from using health care kiosks to assess a patient's medical condition, prioritize injuries or illnesses, or triage patients. However, kiosks can still be utilized for the entry of personal identifying and billing information, replacing traditional paper forms.

The amendments are set to take effect on January 1, 2027. The intent of these regulations is to ensure that patient assessment and triage are conducted under the direct supervision of medical professionals, while still allowing for some administrative efficiencies through the use of kiosks.

AT A GLANCE

This bill requires covered law enforcement and correction-related officers and entities to request and provide emergency medical services when a person in their direct custody or audio/visual contact is experiencing an emergency medical condition.

FULL SUMMARY

The bill establishes the “Medical Civil Rights Act” by revising Civil Rights Law section 28 to require emergency medical services when a person experiences an emergency medical condition or is medically unstable while in direct audio/visual contact with, or under the custody or control of specified law enforcement or correction-related officers and entities.

Section 28 is restructured from prior “medical attention for persons under arrest” language to broader coverage tied to “direct contact” and “custody or control.” It grants any such person the right to emergency medical services (including when the condition is manifested or reasonably observed). Officers and covered entities are given a duty to provide attention to emergency medical needs and to immediately request emergency medical services once communicated to them that the person is experiencing an emergency medical condition or is medically unstable, or once they reasonably observe that status.

The bill modifies limitations and civil liability: (1) officers are not required to request emergency medical services if they make a reasonable determination the person is not experiencing an emergency medical condition (or is not medically unstable) and know the person was seen by a medical professional within the prior 24 hours and released after a non-emergency determination; (2) if emergency medical treatment was not provided and the person suffers serious physical injury or significant exacerbation, the person has a cause of action against the officer/representative/entity; and in such civil actions, the court must award reasonable attorneys’ fees to a successful plaintiff (replacing discretionary “may” language). It also keeps the rule that covered officers must immediately allow medical personnel to commence treatment in simultaneous law enforcement and medical involvement situations when the person has communicated that they are in an emergency state or reasonably appears to be so.

The bill retains and defines key terms in section 28—“emergency medical condition,” “medically unstable,” and covered categories such as “police officer,” “peace officer,” “correctional officer,” “law enforcement representative,” and “medical personnel”—and provides an immediate effective date.

AT A GLANCE

This bill requires hospitals and affiliated urgent care/health facilities to provide rape emergency contraception options orally and, upon request, immediately supply the complete regimen and perform STI screening and treatment.

FULL SUMMARY

The bill creates a new “Compassionate Assistance for Rape Emergencies (CARE) Act” by adding a new section (191.713) that sets the standard of care for hospitals and affiliated urgent care/health facilities providing emergency care to sexual assault victims. It requires oral notice of emergency contraception options, immediate provision of the complete emergency contraception regimen upon request, and sexually transmitted infection screening and treatment. The bill directs the Department of Health and Senior Services to promulgate implementing rules, and includes a nonseverability clause tying rulemaking to Missouri’s rule-approval framework.

The bill replaces existing forensic-examination requirements in section 197.135 and the reimbursement/evidence framework in section 595.220 by repealing sections 197.135 and 595.220 and enacting the three new sections: 191.713 (CARE Act), 197.135 (forensic exam/telehealth and provider requirements), and 595.220 (public safety payment, reimbursement rules, evidence procedures, electronic tracking, and retention). In the enacted 197.135, hospitals must (from the later of Jan. 1, 2023 or six months after establishment of the statewide telehealth network under 192.2520) perform forensic examinations using evidentiary collection kits upon victim/guardian request and consent for victims at least 14; it keeps the minor-handling structure by referencing subsection 2 of 595.220, requires referral of victims under 14 to SAFE CARE providers (and allows referral for ages 14–17), and permits hospitals to still perform exams for under-14 victims by request/consent subject to 595.220 and public safety rules. It also requires provider training at least equivalent to statewide telehealth network training, allows telehealth guidance if the provider is not a SANE or similarly trained clinician, permits limited waivers for technological hardship (up to one year at a time), mandates a waiver if the statewide telehealth network ceases and the hospital cannot comply without it, and exempts “specialty hospitals” (as designated by the department) if they have a transfer policy to an appropriate emergency-department hospital.

In the enacted 595.220, the Department of Public Safety must make payments to appropriate medical providers for reasonable forensic-exam and medical-treatment charges if the victim or guardian consents in writing and if the examination/treatment report is on a form approved by the attorney general with the advice of DPS; DPS must establish maximum reimbursement rates reflecting reasonable costs. The section retains that minors may consent (without disaffirmance by reason of minority and without parent/guardian consent), requires written notice to a parent/guardian that an exam occurred, and sets evidence-collection/chain-of-custody procedures including electronic notification of kits, law-enforcement timelines to take possession and provide to a laboratory, and a 30-year law-enforcement secure period if the offense has not been adjudicated. It also provides for evidentiary kits to be developed and distributed (subject to appropriation) by the Highway Patrol and eligible crime labs, billed so that DPS pays eligible forensic exam and covered medical treatment costs (including emergency contraception) and prohibits charging the victim for the forensic exam; it keeps direction that other medical treatment can be pursued through the crime victims’ compensation fund. The bill specifies DPS establishes rules on reimbursement for children under 14 (including emergency vs. nonemergency definitions/conditions and provider qualifications for nonemergency exams) and that reimbursement is provided regardless of findings.

Finally, 595.220 expands administrative and technical requirements: it requires the attorney general to establish protocols and an electronic platform implementing electronic evidence tracking for kits and components from exam through testing and disposition (with unique alphanumeric identifiers, machine-readable linkages, credentialed access for status checks and updates, and victim/designee tracking via a secured web-based system requiring registration). It mandates participation of all entities with custody or handling responsibilities, requires DPS (with AG advice and assistance from the Department of Health and Senior Services) to maintain a central repository for “unreported” evidentiary collection kits in temperature-controlled storage with retention for five years (and, for minors, five years after the victim turns 18), declares records in the system confidential and not subject to disclosure under Missouri’s public records law, and requires rules to implement the section with nonseverability tied to rule-approval provisions.

AT A GLANCE

This bill requires hospitals and nursing facilities to adopt workplace violence incident reporting systems, retain incident records for at least two years, and prohibit retaliation for reporting or seeking assistance.

FULL SUMMARY

The bill amends and reenacts Va. Code § 32.1-127 to broaden and update the Board’s hospital/nursing home regulation requirements, primarily adding new operational protocols, patient-access rules, testing and safety requirements, and fee/administrative adjustments. It also adds a detailed workplace violence reporting and retention framework for hospitals.

Among the substantive new/updated regulatory mandates, the bill requires: (1) emergency department physician staffing rules with an exception for certain co-located/psychiatric-only arrangements (with specific agreements, clinical oversight, trained staff, and annual reporting to specified legislative and behavioral health entities by November 1); (2) hospital organ-donation protocols including agreements with an organ procurement organization (and tissue/eye bank agreements), family notification procedures, and training requirements for donor-family approach; (3) obstetric and postpartum discharge planning protocols (including protocols for pregnant women in labor and written discharge plans for substance-abusing postpartum women with mandated referrals and CSB discharge plan management); (4) additional hospital inpatient psychiatric refusal/admission communication requirements (direct communication with referring physicians and toxicology review by a clinical toxicologist/poison control specialist when admission suitability is questioned); (5) life-sustaining treatment “medical and ethical appropriateness” decision procedures (second opinion, interdisciplinary review, written explanation, patient/agent participation rights, and written notice for legal remedies); and (6) new or expanded emergency department requirements, including security plans based on risk assessments (with a waiver option) and urine drug screening that must include fentanyl testing.

The bill also adds several compliance and operational requirements affecting access, safety, and continuity of care: hospitals must adopt air medical transportation notice protocols for non-emergent transfers; hospitals must inform patients expected to need outpatient physical therapy to select a provider before discharge; nursing homes/certified nursing facilities must implement substantiated visitation protocols during COVID-19 public health emergencies (including minimum visit frequency, conditions for in-person/virtual visits, technology-failure steps, and website/communication requirements); and hospitals/nursing homes/certified nursing facilities must implement protocols for visits by clergy, allowing appropriate frequency/duration limits and virtual options subject to federal/state guidance. Further, facilities must establish policies governing the permissible access and use of an “intelligent personal assistant” during inpatient services (with HIPAA-aligned health-information protections), hospitals performing planned surgical procedures likely to generate surgical smoke must use smoke evacuation systems, and hospitals must ensure parent/guardian access to minors’ health records via secure websites where not legally barred.

Finally, the bill establishes a hospital workplace violence incident reporting system and related anti-retaliation protections. Hospitals must: (i) document/track/analyze voluntarily reported workplace violence incidents for improvement purposes; (ii) keep records for at least two years including specified minimum data elements (incident timing, description, perpetrator type, location, incident type taxonomy, responses/consequences, and reporter identity); (iii) prohibit discrimination/retaliation for reporting or seeking assistance in incidents; (iv) provide quarterly internal reports to the hospital’s chief medical officer and chief nursing officer; and (v) send annual aggregated reports to the Department, removing personally identifiable information. The bill also adds a fee-setting directive for the issuance/renewal/change of hospital or nursing home licenses to support licensure and inspection costs while limiting how often fees may change (no more frequently than annually) and restricting fee changes to cases where program expenses differ by more than 10% from annual costs.

The bill establishes new Louisiana licensure requirements for hospitals that provide emergency services by creating R.S. 40:2115.34. It changes the criteria for issuing or renewing a hospital license starting January 1, 2027 by requiring specific minimum inpatient and emergency department bed counts and by requiring full compliance with federal EMTALA. It also contains enumerated exemptions that would exempt certain hospitals from these requirements.

The Illinois Police Training Act has been amended to introduce new training requirements for law enforcement officers focused on the identification and interaction with individuals with epilepsy. The Illinois Law Enforcement Training Standards Board is responsible for developing or approving a course that adheres to best practice guidelines from the Centers for Disease Control and Prevention. This training must be implemented within two years of the effective date of the amendment.

All law enforcement officers are now required to complete this training every three years to ensure they are equipped to effectively engage with individuals who have epilepsy. The amendments highlight the necessity of consulting with the Department of Public Health and the Department of Human Services to keep the training curriculum relevant and effective.

These changes are expected to affect various sectors, including law enforcement training, public health, and disability services, as they will need to adjust to the new training requirements. This may involve the development of new educational materials and programs to support the implementation of the training.

While the specific financial implications are not detailed, the introduction of these training programs may lead to costs associated with curriculum development, instructor training, and ongoing education for law enforcement personnel.

AT A GLANCE

This bill requires health insurers in Illinois to issue prior authorization determinations within 5 days for standard requests and 24 hours for urgent services, with noncompliance deemed as authorization.

FULL SUMMARY

HB4709 establishes the “Standardized Prior Authorization Act,” which sets statewide requirements governing when and how health insurance issuers (and their contracted private review agents) conduct prior authorization for covered health care services and related utilization review decisions. The Act applies to specified health insurance coverage delivered/issued in Illinois for individuals enrolled under the Illinois Public Aid Code (Article V) or the Children’s Health Insurance Program, and to health insurance coverage issued in Illinois after the effective date. It also requires that issuer prior authorization materials and clinical review criteria be transparent, publicly accessible, and provided in plain language at the point of care.

Operationally, issuers must (1) maintain a complete list of services subject to prior authorization and (2) conspicuously post current prior authorization requirements, written clinical review criteria, and service-specific information on their websites/online portals (with limits on unreasonable access restrictions). Clinical review criteria must align with nationally accepted standards (and are subject to development/update requirements, including annual evaluation). The Act prohibits denying claims for failure to obtain prior authorization when the requirement was not in effect or not publicly disclosed, and restricts issuers from treating certain supplies or routinely used components as “incidental” to deny services. Issuers must also provide advance written notice (generally 60 days) of new or amended prior authorization requirements/restrictions, with limited exceptions (e.g., fraud/abuse, availability/scarcity, FDA-authorized clinical trials, or removal of requirements).

The bill requires standardized electronic prior authorization transaction processes and specific decision timelines: standard prior authorization determinations must be made no later than 5 calendar days after obtaining all necessary information (subject to longer federal minimum timeframes where applicable), and expedited prior authorization for urgent services must be completed within 24 hours after receipt of all needed information (subject to longer federal minimum timeframes). For certain clinical laboratory tests, issuers must accept requests within specified windows tied to specimen collection and timely claims. When issuers issue adverse determinations, they must provide reasons (including evidence-based criteria and missing documentation), appeal rights and instructions, and additional appeal-supporting documentation. Appeals must be reviewed by appropriately qualified physicians under specified credentialing/training/conflict-of-interest rules. Prior authorization approvals generally must be honored for specified durations (generally the lesser of 12 months or the treatment length determined by the provider), with an extension-by-agreement option, and there are protections for continuity of prior authorizations from prior issuers for at least the initial 90 days of new plan coverage. Issuers are also restricted from revoking/further limiting valid prior approvals except under enumerated circumstances (e.g., fraud/abuse, unavailability, safety alerts/public health emergencies, standards changes by recognized accreditation/societies, or required legal changes).

Crucially, the Act establishes enforcement consequences and ongoing oversight: failure to meet deadlines/requirements results in automatic deemed authorization for services subject to review. The Department of Insurance (and private review agents/issuers) face authority to issue cease-and-desist orders and require plans of correction, with administrative fines up to $2,000 per violation for failure to submit or comply with correction plans and/or repeated violations, and complaints may be filed with the Department (with the Act explicitly stating no private right of action). The bill also requires issuer reporting to the Department starting June 1, 2028 and annually thereafter with de-identified aggregated trend data about prior authorization approvals/denials, appeal outcomes, electronic submission rates, denied services, denial reasons, and timing metrics. In addition, the Act grants rulemaking authority to the Department. The bill repeals the Prior Authorization Reform Act and makes conforming changes to the Illinois Insurance Code and Illinois Public Aid Code. Effective January 1, 2027.

AT A GLANCE

This bill requires every Illinois licensed hospital providing general medical and surgical services to staff its emergency department at all times with a licensed physician specializing in emergency medicine, excluding long-term acute care and rehabilitation hospitals.

FULL SUMMARY

HB4314 changes Section 1 of the Illinois Hospital Emergency Service Act by requiring staffing of hospital emergency departments. Specifically, every hospital licensed by the Illinois Department of Public Health that provides general medical and surgical services must have at least one licensed physician who specializes in emergency medicine staffing the emergency department at all times. The requirement applies to licensed hospitals except for long-term acute care hospitals and rehabilitation hospitals identified in Section 1.3 of the Act.

The bill revises the statutory language within the same Section 1(a) to state the “licensed physician who specializes in emergency medicine” must be staffing the emergency department continuously (“at all times”). It also retains Section 1’s existing framework that emergency services must be provided to any applicant presenting at the hospital or brought by ambulance or specialized EMS vehicle when an injury or acute medical condition is liable to cause death or severe injury or serious illness, and that hospitals must furnish emergency services consistent with EMTALA procedures.

No other operative changes appear in the text beyond this emergency-medicine staffing requirement within Section 1(a). The bill includes statements that the amendments to Section 1 are declarative of existing law and that nothing in the Section alters existing legal statuses and rights.

The act takes effect upon becoming law.

AT A GLANCE

This bill requires the Illinois Department of Public Health to issue an annual Freestanding Emergency Center license to facilities that meet the act’s criteria, and it permits expanded (a-25) location and hospital-emergency-department marketing allowances.

FULL SUMMARY

HB5239 changes Illinois’ Emergency Medical Services (EMS) Systems Act by revising the Freestanding Emergency Center (FEC) licensing provision (210 ILCS 50/32.5). It requires the Department of Public Health to issue an annual FEC license to a facility that meets the enumerated FEC criteria, while adding two specific allowances that affect where FECs may be located and how they may market themselves.

First, for FECs licensed under the “(a-25)” pathway, the bill allows the FEC to be located in a municipality with a population greater than 50,000 inhabitants (previously limited to 50,000 or fewer under the base subsection (a) criteria), and it removes the applicability of Illinois Health Facilities Planning Act requirements that otherwise apply to conversion to an FEC if the Department of Healthcare and Family Services has approved the conversion as a project under that subsection. Second, under the same “(a-25)” licensing pathway, the bill allows an FEC—if operated as provider-based under 42 CFR 413.65—to describe itself or hold itself out to the general public as a hospital emergency department in its advertising and marketing activities.

The bill retains the Department’s general licensing/oversight authorities in subsection (b): annual inspection of initial applicants and licensed FECs, issuance or annual relicensure for those meeting requirements, suspension/revocation/refusal to issue or renew for noncompliance after notice and a hearing opportunity, and the ability to issue an emergency suspension order when continued operation poses an immediate and serious danger to public health, safety, or welfare. It also preserves the Department’s authority to adopt rules necessary to implement the FEC licensing requirements.

AT A GLANCE

This bill requires law enforcement and correctional officers to immediately request emergency medical services for individuals in their custody or direct audio/visual contact when they report or reasonably appear medically unstable or experiencing an emergency medical condition.

FULL SUMMARY

The bill establishes new statutory “medical civil rights” protections in Massachusetts by adding Section 33½ to Chapter 276.

It defines key terms for the new protections, including “emergency medical condition” (a condition—physical, behavioral, related to substance use disorder, or mental—manifesting with sufficiently severe symptoms that a prudent layperson would expect that absence of prompt medical attention would likely result in serious jeopardy, serious impairment to body function, or serious dysfunction of an organ), “medically unstable” (an unstable medical or mental health status reasonably understood by a prudent layperson to lead to an emergency medical condition), and related actor categories such as “law enforcement agency,” “law enforcement officer,” “correctional officer,” “correctional agency,” and “medical personnel.”

The bill creates an operative right for any person experiencing an emergency medical condition or who is medically unstable while in direct audio/visual contact with, or in the custody/control of, a law enforcement or correctional officer, requiring that person to be provided emergency medical services.

It further requires that, except for a specified exception, a law enforcement or correctional officer must immediately request emergency medical services for an individual under the officer’s custody/control or in direct audio/visual contact when the person communicates that they are (A) experiencing an emergency medical condition or (B) medically unstable, or when the officer reasonably observes those same conditions. The bill limits this obligation by exempting an officer who makes a reasonable determination that the person is not experiencing those conditions and who knows the person was evaluated by a medical professional within the prior 24 hours and released after a determination that the person was not experiencing an emergency medical condition or was not medically unstable. In situations where medical personnel and law enforcement/correctional officers are simultaneously involved, it requires the officer to immediately allow medical personnel to commence treatment for the affected person when the relevant condition is communicated or reasonably observed.

AT A GLANCE

This bill repeals Minnesota’s hospital construction moratorium framework in Minnesota Statutes section 144.551, while keeping in force any exemption conditions previously granted under that section.

FULL SUMMARY

The bill repeals Minnesota’s hospital construction moratorium provisions in Minnesota Statutes, section 144.551, including its related subdivisions defining the moratorium and its exemption framework, while preserving whatever conditions were already imposed when an exemption was previously granted under section 144.551. It also updates related licensing and inspection provisions and makes conforming changes to ensure the moratorium framework is no longer operative.

Specifically, the bill provides that any condition on which a hospital construction moratorium exemption was granted under section 144.551 remains in effect (continuing effect for existing exemptions). It then repeals section 144.551, subdivisions 1, 1a, 2, 3, and 4, and also repeals additional sections connected to the moratorium process: Minnesota Statutes 2024, sections 144.552, 144.553, and 376.08, subdivision 3.

For conforming changes, the bill amends Minnesota Statutes, section 62J.17, subdivision 3 to adjust how the moratorium concept is referenced, clarifying that the section does not supersede or limit the applicability of sections 144.551 or 144A.071, and it includes language excluding from its scope “major spending commitments” made by nursing homes or intermediate care facilities related to long-term care.

The bill also amends Minnesota Statutes, section 144.55: subdivision 4 (routine inspections/presumption) is modified to remove some references that hinge on hospital construction moratorium exceptions (while still directing the commissioner to conduct inspections related to whether a hospital construction/addition/remodeling project complies with standards and to inspect conditions tied to prior exceptions), and subdivision 6 is amended to (1) prevent license renewal for certain boarding care beds (more than four beds in a resident room), and (2) prohibit renewal of hospital beds issued under a hospital construction moratorium exception if the commissioner determines the hospital or hospital corporate system is not satisfying the conditions for the exception.

Beginning in the 2026-27 school year, Wisconsin schools and charter schools will be required to implement a cardiac emergency response plan (CERP) for emergencies occurring on school property and during athletic events. The CERP must include essential components such as a designated response team, a plan for activation, distribution of the plan, and guidelines for the placement and maintenance of automated external defibrillators (AEDs).

For athletic events, the CERP will ensure that coaches and athletic trainers are equipped to handle sudden cardiac arrest incidents, which includes requirements for AED accessibility and CPR certification for coaches.

To support the implementation of these plans, the Office of School Safety in the Department of Justice may provide grants to schools, with amounts varying based on the grade levels offered. The maximum grant amounts are $8,000 for high schools, $4,000 for schools serving grades 6 to 8, and $2,000 for schools with grades K-5.

This legislation aims to improve safety measures in educational environments and may influence related industries, including emergency medical services, CPR and AED training providers, and AED manufacturers.

AT A GLANCE

This bill requires law enforcement and correctional officers to immediately request emergency medical services when they hear or reasonably observe a person who is experiencing an emergency medical condition or is medically unstable, with limited exceptions.

FULL SUMMARY

The bill establishes new “medical civil rights” protections in Massachusetts law by adding a new section, Chapter 276, Section 33 ½, defining key terms including “emergency medical condition” (with severity thresholds tied to what a prudent layperson would expect from absence of prompt care), “medically unstable” (defined by an unstable medical or mental health status that a prudent layperson would reasonably understand could lead to an emergency medical condition), and covered personnel (including law enforcement agencies/officers, correctional officers/agencies, and medical personnel).

It grants any person who is experiencing an emergency medical condition or is medically unstable while in direct audio or visual contact with, or in the custody/control of, a law enforcement or correctional officer the right to be provided with emergency medical services.

It further requires that—subject to a limited exception—law enforcement or correctional officers must immediately request emergency medical services when the person has communicated that they are experiencing an emergency medical condition or are medically unstable, or when such conditions have been reasonably observed by the officer.

The bill creates an exception to the immediate-request obligation: an officer is not required to request emergency services if the officer makes a reasonable determination that the person is not experiencing an emergency medical condition or is not medically unstable, and the officer knows the person was seen by a medical professional within the prior 24 hours and released after a determination that the person was not experiencing an emergency medical condition or was not medically unstable. In addition, when medical personnel and officers are simultaneously involved, the officer must immediately allow medical personnel to commence treatment for the affected person upon communication or reasonable observation of an emergency medical condition or medical instability.

AT A GLANCE

This bill requires each Utah hospital emergency department to implement evidence-based pediatric care policies, train staff annually, and conduct pediatric readiness assessments with results submitted to the Bureau of Emergency Medical Services by December 31.

FULL SUMMARY

The bill establishes new state requirements for hospital emergency departments regarding pediatric emergency readiness and care standards. A new Utah Code section (53-2d-704) defines key terms, including “emergency department,” “pediatric emergency care coordinator,” and “pediatric readiness assessment” (linked to the National Pediatric Readiness Assessment developed by the National Pediatric Readiness Project).

Emergency departments must: (1) develop and implement evidence-based pediatric patient care policies and procedures addressing pediatric triage protocols, vital-sign measurement/recording, pediatric weight measurement/recording in kilograms, pediatric medication dose calculation, pediatric-specific equipment use, and age-appropriate care protocols; (2) provide annual staff training on these policies/procedures, including hands-on pediatric equipment simulation tied to staff licensure/role; and (3) conduct pediatric emergency drill exercises at least every six months. Each emergency department must designate a pediatric emergency care coordinator who is a physician, physician assistant, or registered/advan ce practice registered nurse meeting specified licensure requirements, with responsibilities including implementing the pediatric policies/procedures, ensuring compliance with pediatric care standards, and coordinating pediatric emergency care training.

Each emergency department must conduct a pediatric readiness assessment according to the National Pediatric Readiness Project’s timelines and submit the assessment results to the Bureau of Emergency Medical Services by December 31 of the assessment year. General acute hospital emergency departments may voluntarily conduct the Project’s “Open Assessment” in years when the required assessment is not conducted. The bureau must collect overall assessment scores, may publish aggregate scores, and must adopt rules establishing minimum pediatric patient care standards for emergency departments, including requirements related to pediatric equipment/supplies access, staff training, quality assurance, and reporting of assessment results.

The bill appropriates $278,000 in fiscal year 2027 (a General Fund reallocation) to the Department of Public Safety for “Emergency Medical Services” / pediatric readiness, with legislative intent that the department provide a direct award grant to the Utah Pediatric Trauma Network for pediatric readiness. The bill takes effect on May 6, 2026.

Beginning in the 2026-27 school year, Wisconsin schools and charter schools will be required to implement a cardiac emergency response plan (CERP) for emergencies occurring on school property and during school-sponsored athletic events. This plan must include the establishment of a cardiac emergency response team, procedures for activating the team during a cardiac arrest, and coordination with local emergency medical services.

For athletic events, the CERP will ensure that automated external defibrillators (AEDs) are clearly marked and accessible, and that athletic coaches are certified in CPR and AED usage. Ongoing training for school personnel in first aid, CPR, and AED use will also be mandated.

To support the implementation of these requirements, the Office of School Safety in the Department of Justice may provide grants starting in the 2026-27 school year. Grant amounts will vary based on the grade levels offered by the schools, with a maximum of $8,000 for high schools, $4,000 for schools serving grades 6 to 8, and $2,000 for schools serving grades K-5.

The legislation will impact educational institutions, emergency medical services, and training organizations that provide CPR and AED certification. While schools may incur costs related to training, equipment procurement, and compliance, the availability of grants may help offset some of these expenses.

AT A GLANCE

This bill exempts specified identifying and location information of current emergency department physicians, their spouses, and under-26 children from Florida public-records disclosure and requires custodial agencies to keep it confidential if they receive a notarized written request.

FULL SUMMARY

The bill creates a new public-records exemption in Florida’s public records law (s. 119.071(5)(l)) for specified personal identifying and location information relating to “current emergency department physicians,” defined as physicians licensed under ch. 458 or 459 whose duties are performed in a hospital emergency department licensed under ch. 395. Specifically exempt from disclosure are: (1) the home addresses, personal telephone numbers, and dates of birth of current emergency department physicians; (2) the names, home addresses, personal telephone numbers, dates of birth, and places of employment of the spouses and children under age 26 of such physicians; and (3) the names and locations of schools and day care facilities attended by such under-26 children.

The exemption is expressly retroactive: it applies to the exempt information “held by an agency before, on, or after July 1, 2026.” For agencies that are custodians of the exempt information but are not the employer of the emergency department physician, the custodian must maintain the exempt status only if the individual (physician or qualifying spouse/child) requests maintenance of the exemption and submits a written, notarized request to the custodial agency. The request must state under oath the statutory basis for the request and confirm eligibility; the individual has a duty to withdraw the request if the exemption no longer applies. If the custodian receives a qualifying request, the agency must maintain the exempt status until the qualifying conditions cease to apply to the exempt individual.

The exemption is subject to Florida’s Open Government Sunset Review Act (s. 119.15) and will stand repealed on October 2, 2031 unless reenacted. The bill also includes a legislative “public necessity” statement explaining that release of the specified physician and family information could expose emergency department physicians (and qualifying family members) to physical or emotional harm or stalking, and that the potential harm outweighs any public benefit.

The act takes effect July 1, 2026.

AT A GLANCE

This bill requires each hospital emergency department to develop, implement, and train on evidence-based pediatric emergency care policies and procedures, and designate a pediatric emergency care coordinator.

FULL SUMMARY

The bill establishes additional pediatric patient safety requirements for hospitals with emergency departments and creates statewide requirements for pediatric readiness planning, rulemaking, and public reporting of pediatric readiness assessment results.

For hospitals, it requires (starting in new subsections of s. 395.1012) each hospital emergency department to (1) develop and implement evidence-based pediatric emergency care policies and procedures reflecting specified minimum elements (triage; measuring/recording vital signs; weighing/recording weights in kilograms; calculating medication dosages; and use of pediatric instruments), (2) conduct annual training on those policies, including pediatric instrument use using clinical simulation and at least annual emergency drills that simulate emergency situations. It also requires each hospital emergency department to designate a “pediatric emergency care coordinator” who must be a physician or physician assistant licensed under specified chapters, a nurse licensed under specified chapters, or a paramedic licensed under specified chapters, and to ensure adherence to the required pediatric policies and procedures; additionally, it requires the emergency department to conduct the National Pediatric Readiness Assessment under National Pediatric Readiness Project timelines. Separately, hospitals are authorized to conduct the National Pediatric Readiness Project’s “Open Assessment” during years in which the main National Pediatric Readiness Assessment is not conducted.

The bill changes agency rulemaking and comprehensive emergency management plan standards. It requires the Agency for Health Care Administration (AHCA), in consultation with the Florida Emergency Medical Services for Children State Partnership Program, to adopt rules establishing minimum standards for pediatric patient care in hospital emergency departments, including (at minimum) the availability of and immediate access to pediatric-specific equipment and supplies (added as a new rulemaking subsection in s. 395.1055). It also revises s. 395.1055’s comprehensive emergency management plan requirements by specifying that such plans must include additional plan components addressing responding to family inquiries and pediatric and neonatal patient needs, and it retains annual preparation and update and local emergency management agency review/approval.

Finally, the bill amends s. 408.05 to expand AHCA’s health information transparency duties by adding a requirement to collect the overall assessment score of National Pediatric Readiness Assessments from the Florida Emergency Medical Services for Children State Partnership Program by specified deadlines, and to publish overall assessment scores by hospital emergency department by specified future dates. It requires publishing a comparison to the national average score when available, and it limits collection and publication to no more than one overall assessment score per hospital per year, including a comparison to the hospital’s most recently published score. The bill takes effect July 1, 2026.

AT A GLANCE

This bill requires freestanding hospital emergency facilities to offer patients or legal representatives the opportunity to choose the receiving acute care hospital for medically necessary transfers.

FULL SUMMARY

The bill establishes a new statutory subdivision in RSA 151 governing transfer practices for patients receiving emergency medical care at freestanding hospital emergency facilities (FHEFs). It requires FHEFs to give patients (or legal representatives) the opportunity to choose the receiving acute care hospital when a medically necessary transfer is required and the receiving hospital can meet the patient’s needs, and it prohibits FHEFs from directing transfers exclusively to the parent/affiliated hospital except when required by federal law. It also requires documentation of the patient’s transfer choice in the medical record and directs that, if the patient cannot choose, the FHEF must arrange transfer to the closest appropriate receiving hospital able to address the patient’s needs.

The bill also establishes prohibited practices for FHEFs and their owners/operators: they may not condition treatment or discharge on transfer to an affiliated/parent hospital based on insurance or lack of insurance; they may not engage in steering, coercion, or misleading communications intended to limit transfer choice; and they may not execute EMS provider policies/contracts that require or encourage exclusive transfers to an affiliated/parent hospital.

The bill requires the Department of Health and Human Services commissioner to issue interim rules under RSA 541-A:19 to implement these provisions and to adopt final rules by June 30, 2027. It provides for enforcement through referral of a pattern of violations to the Department of Justice, treating such violations as an unfair or deceptive act or practice under RSA 358-A:2, with rights and remedies under RSA 358-A available for enforcement.

The act takes effect upon passage.

AT A GLANCE

This bill establishes an emergency medicine study committee in Arizona to review and assess emergency medical services delivery and capacity and to report findings by December 31, 2026 and annually thereafter.

FULL SUMMARY

The bill establishes an “emergency medicine study committee” to review and assess the state of emergency medical services and emergency medicine delivery in Arizona, including barriers and sustainability.

It creates a committee with specified membership: three House members appointed by the Speaker (no more than two from the same political party, with the Speaker designating a chairperson); three Senate members appointed by the President of the Senate (no more than two from the same political party); the Director of the Arizona Department of Health Services (or designee); two emergency department operators (appointed by the Speaker and separated by county population threshold of under 500,000 vs. 500,000 or more); three licensed physicians (appointed by the President of the Senate and allocated across emergency medicine in under-500,000 and 500,000+ counties, plus a medical director for an emergency medical services agency); one emergency-medicine registered nurse or nurse practitioner appointed by the Speaker; and two pre-hospital emergency medical services providers (one appointed by the Speaker for under-500,000 counties and one appointed by the President of the Senate for 500,000+ counties).

The committee’s duties include: (1) reviewing the delivery of the emergency medical services system and obstacles to its delivery and sustainability; (2) analyzing emergency medicine capacity, including rural/urban adequacy and factors affecting EMS delivery; (3) reviewing how uncompensated care affects the financial viability of emergency medicine practice; (4) identifying factors affecting the stability of entities delivering emergency medicine; and (5) soliciting input from patients, health care providers, and stakeholders regarding service delivery and financial viability. The committee may hold public hearings, conduct fact-finding tours, request data from the Department of Health Services, and take testimony. The Legislature and the Department of Health Services must provide staff and support. Members receive no compensation but may be reimbursed for expenses under Arizona law.

The committee must submit reports on or before December 31, 2026 and annually thereafter to the Governor, the President of the Senate, and the Speaker of the House, and provide a copy to the Secretary of State. The committee is repealed from and after June 30, 2029 (sunset of the committee’s existence and operations).

AT A GLANCE

This bill establishes a statewide air medical services program within Hawaii’s Department of Health and requires it to oversee statewide governance, coordination, quality improvement, and disaster readiness.

FULL SUMMARY

The bill establishes a statewide air medical services program within the Hawaii Department of Health’s Emergency Medical Services and Injury Prevention System Branch to provide governance, coordination, oversight, quality improvement, and disaster readiness for Hawaii’s emergency aeromedical and interfacility air medical transport services.

To staff the program, the bill requires creation of three permanent positions exempt from chapter 76: (1) a physician “state air medical director” to provide statewide clinical and medical oversight; (2) a “state air medical program manager” to administer the program, develop policy, plan the system, coordinate with agencies, and integrate air medical services with emergency medical services, trauma systems, and healthcare facilities; and (3) an “air medical coordinator” to handle operational coordination, data oversight, compliance monitoring, performance improvement, and coordination with licensed air medical providers, county EMS agencies, hospitals, and emergency management partners. It also requires that these positions be permanent and recurring, not contingent on temporary programs, pilot projects, or time-limited funding.

The program is authorized to provide clinical governance; develop and implement statewide policies, procedures, and clinical protocols consistent with nationally recognized standards; coordinate air medical transport across counties to improve timeliness, health equity, and access; oversee licensed providers’ participation in data-based quality improvement; support statewide disaster preparedness/response/recovery for multi-island and mass-casualty incidents; and coordinate with a broad set of EMS and acute care/response partners (including county EMS agencies, hospitals, trauma and stroke centers, acute care facilities, and emergency management agencies). As a condition of licensure, all air medical providers must cooperate with and participate in statewide coordination, data reporting, and quality improvement activities as required by the department; the bill also allows the program to coordinate with the state EMS advisory committee and to establish advisory or quality improvement committees.

The bill requires the Department of Health to establish and assess annual air medical ambulance licensure and accreditation fees, set to be reasonable, non-refundable, and sufficient to cover specified program costs (administration/oversight, licensure/accreditation verification and enforcement, statewide coordination and quality improvement, data collection/reporting, and coordination with emergency management and disaster-preparedness partners). Fees collected must be deposited into the existing Emergency Medical Services Special Fund (HRS §321-234) and used solely to administer and support the statewide air medical services program, staff, and emergency management coordination functions. It also amends HRS §321-234(b) to add that fees remitted under the new air-medical program section are used solely for those purposes, while keeping the annual $3,500,000 county EMS system distribution structure intact and maintaining the prohibition on using the remainder to supplant pre–July 1, 2004 EMS funding. The act takes effect July 1, 3000.

AT A GLANCE

This bill requires the Department of Public Health to issue an annual freestanding emergency center license to qualifying facilities and permits eligible FECs to be located in municipalities over 50,000.

FULL SUMMARY

SB4049 changes the Emergency Medical Services Systems Act (210 ILCS 50/32.5) by adding licensing flexibilities for freestanding emergency centers (FECs) and expanding permissible public-facing marketing language under specified conditions.

The Department of Public Health must issue an annual FEC license to a facility that meets the enumerated FEC requirements in subsection (a), but adds an exception allowing the FEC to be located in a municipality with a population greater than 50,000 (instead of being restricted to 50,000 or fewer for the general rule). Separately, if the facility operates as a provider-based entity under 42 CFR 413.65, it may describe itself or hold itself out to the general public as a “hospital emergency department” in its advertising and marketing activities. A new cross-reference exception is also created by allowing the FEC location/marketing carve-out to apply when the facility otherwise complies with the FEC requirements.

In addition, the bill retains or adjusts multiple existing “notwithstanding any other provision” pathways for issuing annual FEC licenses in specific circumstances (e.g., certain facilities tied to earlier permit/letter-of-intent timelines, counties lacking a licensed general acute care hospital, and facilities converting from a hospital’s inpatient services). For the conversion-based pathway, the bill expressly conditions the municipality-location exception and states that the FEC is not subject to specified Illinois Health Facilities Planning Act requirements applicable to conversion to an FEC if the Department of Healthcare and Family Services has approved the conversion.

The bill does not change the Department’s core enforcement framework: the Department must continue to inspect initial applicants and licensed FECs annually, issue or relicense FECs that satisfy licensure requirements, and may suspend, revoke, refuse to issue, or refuse to renew licenses after notice and an opportunity for a hearing when standards are not met; it also must continue to support emergency suspension orders where continued operation poses an immediate and serious danger, and it authorizes the Department to adopt rules needed to implement the section.

AT A GLANCE

This bill requires Mississippi hospital emergency departments to screen and provide stabilizing treatment for emergency medical conditions requested for evaluation, and prohibits delays or denials for specified non-medical reasons.

FULL SUMMARY

The bill establishes new requirements for hospital emergency departments to screen and treat individuals who request emergency evaluation, sets duties regarding stabilization and transfer, prohibits delays/denials for specified non-medical reasons, and creates enforcement mechanisms (state civil actions and a private right of action) plus whistleblower/provider protections and obligations for hospitals with specialized facilities to accept transfers when they have capacity.

It also defines key terms (“emergency medical condition,” “hospital,” “emergency medical services,” and “stabilize/stabilizing treatment”) broadly, including pregnancy-related emergencies and medical stabilization standards tied to preventing material deterioration during discharge/transfer. For pregnant patients, it specifies that the definition of emergency medical condition includes a listed set of conditions and circumstances involving inadequate time for safe transfer or threats to patient safety.

The bill further establishes: (1) a duty of care to provide stabilizing treatment when an emergency medical condition is identified; (2) that emergency medical services and stabilizing treatment cannot be delayed or denied for inability to pay, lack of insurance/public benefits, citizenship/immigration status, pregnancy outcome/status, or staff/hospital personal, institutional, or religious beliefs/policies; (3) a limitation that hospitals may not condition medically necessary pregnancy termination on consent of anyone other than the patient or the patient’s legal representative; and (4) strict conditions on when an unstabilized patient may be transferred after appropriate screening, including obligations to minimize risks, ensure receiving capacity and qualified personnel, provide required medical records, use qualified transport and medically appropriate life support, obtain written request after being informed of transfer risks, and require a physician certification weighing expected benefits against increased transfer risks.

For enforcement and remedies, it authorizes the Attorney General and the State Department of Health to investigate and bring civil actions against violating hospitals/providers, with remedies including injunctive relief, civil penalties up to $50,000 per violation, and corrective action orders, license suspension, and Medicaid exclusion for repeat/gross violations. It creates a private cause of action for individuals harmed by violations for compensatory and punitive damages, equitable relief, and reasonable attorney’s fees/costs, and it removes certain liability shields by stating hospitals/providers are not immune based on religious/moral objections and cannot claim immunity under federal conscience protection laws when such objections lead to denial of stabilizing emergency care. It additionally prohibits hospitals from penalizing providers who stabilize patients consistent with medical standards of care and protects hospital employees from retaliation for reporting violations, and requires hospitals with specialized facilities (e.g., trauma, NICU, maternal-fetal medicine) to accept appropriate transfers if capacity exists. The bill takes effect and applies to hospitals/providers operating in Mississippi on and after July 1, 2026.

The bill would add two new hospital requirements to West Virginia’s hospital code: (1) mandatory development of protocols for “trauma informed care” for patients who have experienced miscarriage, abuse, neglect, or other stressful events, including staff training/continuing education and creation of patient resource/assistance materials; and (2) a specific “Butterfly Protocol” for miscarriage patients requiring a discreet visual symbol on a patient’s chart or electronic medical record to alert staff and staff training on the symbol’s meaning and on trauma-informed responses for patients whose records include it.

AT A GLANCE

This bill authorizes public school employees and agents, including health assistants, to administer or assist with specified emergency medications for eligible students if parents provide written authorization and required medical orders each school year.

FULL SUMMARY

The bill establishes a statutory framework for public school employees and agents—including school health assistants—who volunteer to administer specified emergency medications and to assist with diabetes-related tasks, with separate rules from student self-administration. It permits volunteer administration of: epinephrine for anaphylaxis; glucagon in diabetes emergencies; seizure rescue medication for students with epilepsy or other seizure disorders; and asthma rescue inhalers (inhalers for asthma or other chronic lung diseases). It also permits insulin administration/assistance via the student’s insulin delivery system and blood glucose monitoring/assistance.

For emergency medication or diabetes assistance tied to a specific student, the student’s parent/guardian must provide (1) a written request and authorization, (2) written medical orders from an authorized prescriber (physician, APRN, PA, or other practitioner with prescriptive authority), and (3) the prescribed medication supply and any necessary devices/equipment. The permission is effective for the school year and must be renewed each subsequent school year upon fulfilling section requirements. The bill allows secure but accessible storage of student medication/supplies by the public school. Volunteers must receive instruction on proper administration from a licensed physician/PA/RN/APRN or other qualified licensed healthcare professional; for insulin/blood glucose monitoring instruction, the bill also specifies a certified diabetes educator as a qualified professional.

The bill expands and updates liability protections for public schools, personnel/agents, and medical providers acting in good faith in accordance with the section. It requires the department/public school to inform the parent/guardian in writing that compliance may not incur liability from injuries arising from compliance, requires a signed parent/guardian acknowledgment including indemnification/hold harmless, and grants immunity from civil or criminal liability except for gross negligence, willful and wanton misconduct, or intentional misconduct. It also defines key terms used in the emergency-medication framework, including “bronchodilators,” “epinephrine,” “glucagon,” “inhaler,” and “seizure rescue medication,” in a way that expressly covers multiple FDA-approved delivery forms/devices.

Separately, the bill amends the student self-administration statute (HRS §302A-1164) to revise the scope and terminology of what students may self-administer and what is permitted for school volunteering. It updates the “inhaler” concept and clarifies the permitted medication categories (asthma, anaphylaxis, diabetes, and other potentially life-threatening illnesses) and adjusts the volunteering-related medication categories to align with the broader emergency-medication and diabetes-assistance framework. The bill also updates the definition and permissions related to student carrying of self-administered medication and devices, and it amends the immunity clause to maintain the gross-negligence/willful-and-wanton/intentional-misconduct exception. The bill’s effective date is upon approval.

The bill establishes a new statutory requirement for Missouri hospitals that operate emergency departments. It requires each such hospital to keep at least one physician physically on site and on duty who is responsible for the emergency department at all times the emergency department is open.

The operative change is the addition of a new section in Chapter 197 of the Revised Statutes of Missouri, designated as section 197.062, containing the staffing-at-all-times requirement described above. No other provisions, definitions, enforcement mechanisms, penalties, or effective date are included in the provided text.

AT A GLANCE

This bill requires the Department of Health to establish and oversee a statewide time-sensitive emergencies data repository by January 1, 2031, and require quarterly provider reporting thereafter.

FULL SUMMARY

The bill establishes statewide, data-driven continuous quality improvement for time-sensitive emergencies (including cardiac, stroke, and trauma). It creates a “single statewide time-sensitive emergencies data repository” to collect and analyze incidence, severity, and causes of these events, defines required datasets and reporting, and requires the Department of Health (the department) to perform oversight, validation, technical assistance, and performance reporting.

It amends RCW 70.168.090 and RCW 70.168.150. For RCW 70.168.090, the bill shifts from a trauma-only registry to (i) maintaining the trauma registry until the time-sensitive emergencies data repository is established by January 1, 2031, and then (ii) establishing the time-sensitive emergencies repository by January 1, 2031. It also expands required hospital/provider submissions to quarterly reporting beginning January 1, 2031 for trauma, cardiac events, and stroke events; requires a repository data validation and continuous data quality improvement process; adds department obligations for system performance oversight, quarterly system performance/quality reporting, feedback to ambulance/aid services and hospitals, and using data to develop standards and interventions.

For RCW 70.168.150, the bill updates the cardiac and stroke system participation framework by aligning hospital data submission with the new repository starting January 1, 2031 (while retaining requirements for participating hospitals to engage in quality improvement and participate in national/state/local data collection systems, including consensus stroke measures). It also adds department funding-supported and public education provisions related to heart attack/stroke symptoms and 911 use, plus clarifies program confidentiality and—by amended language—includes authority to contract with a single entity through competitive procurement to develop and administer the statewide repository.

Overall, the core new establishment is the statewide time-sensitive emergencies data repository (with datasets for trauma, cardiac events, and stroke events; quarterly submissions by specified providers; data validation and continuous quality improvement; quarterly aggregate reporting and public posting of data), alongside expanded department oversight duties and updated cardiac/stroke program data-reporting requirements beginning in 2031.

AT A GLANCE

This bill requires the State Board of Medical Examiners to ensure physicians’ biennial CME credits for renewal include one communication-and-treatment credit for deaf or hard-of-hearing persons.

FULL SUMMARY

The bill requires the State Board of Medical Examiners to ensure that each physician’s biennial continuing medical education (CME) credits for renewal include one credit earned through educational programs or topics focused on communication with and treatment of persons who are deaf or hard of hearing. The CME training content must meet the requirements of the specific training program standard established in existing law (referenced as subsection b. of section 1 of P.L.2021, c.79), and the new CME requirement is governed by the existing CME enforcement/administrative provisions referenced in section 10 of P.L.2001, c.307.

The Division of Deaf and Hard of Hearing in the Department of Human Services must create a dedicated training and outreach unit. That unit is tasked with developing and administering a training program on communication with and treatment of persons who are deaf or hard of hearing for individuals who work in the emergency department of a general hospital licensed under P.L.1971, c.136.

In consultation with the Division, each emergency department of a licensed general hospital must develop and implement a training protocol covering proper communication and treatment for emergency-department employees who may interact with deaf or hard-of-hearing individuals as part of their jobs.

The act takes effect 90 days after enactment.

AT A GLANCE

This bill prohibits licensed general hospitals from advertising or holding themselves out as providing level-one or level-two pediatric emergency department services unless they meet specified pediatric staffing, leadership, facilities, and consultation requirements.

FULL SUMMARY

The bill establishes statutory requirements governing when licensed general hospitals may advertise or hold themselves out as providing level-one or level-two pediatric emergency department services. It also requires the Department of Health (DOH) to compile pediatric emergency department registry data submitted by hospitals and include hospital-specific pediatric emergency care data in the New Jersey Hospital Performance Report.

For level-one pediatric emergency departments, a general hospital may not market the service unless it maintains (1) a separate, designated pediatric emergency department exclusively for pediatric patients; (2) a director who is a board-certified pediatric emergency medicine physician who cannot direct any other pediatric emergency department; (3) a nurse with day-to-day managerial responsibility who is a certified pediatric emergency nurse and cannot have a managerial role at any other pediatric emergency department; (4) 24-hour staffing by specified qualified physicians (including board-certified pediatric emergency physicians, or other enumerated alternatives); (5) staff in specified pediatric subspecialties (e.g., pediatric anesthesiology, cardiology, hematology/oncology, infectious diseases, nephrology, neurology, orthopedics, pulmonology, radiology, and surgery); (6) formal consultative relationships with additional enumerated physician subspecialists available for consultation within one hour; and (7) separate pediatric inpatient and pediatric intensive care units in the hospital.

For level-two pediatric emergency departments, a hospital may not advertise or otherwise hold itself out as providing the service unless it meets parallel requirements on pediatric leadership and nursing (including the same director and nurse-management restrictions), maintains designated pediatric patient space, and has (either) separate pediatric inpatient/pediatric intensive care capability or a formal transfer agreement with a level-one pediatric emergency provider. Level-two also requires formal consultative relationships with a specified set of pediatric subspecialists available for one-hour consultations, and it defines “pediatric” as patients from the 29th day after birth through (but not including) the 18th birthday.

The bill requires DOH to compile annually the pediatric emergency medicine registry data submitted by each general hospital (under existing N.J.A.C. requirements) and include hospital-specific data elements—selected by DOH as most relevant—in the annual New Jersey Hospital Performance Report. The Commissioner of Health must adopt rules under the Administrative Procedure Act as necessary to implement the act, and the act takes effect on the first day of the sixth month after enactment, with the commissioner allowed to take anticipatory administrative action before then.

The document outlines amendments to Washington state laws concerning the dispensing and delivery of medications from hospitals and healthcare entities. A significant change allows hospitals to permit practitioners to prescribe limited amounts of prepackaged emergency medications to patients being discharged from emergency departments when community or outpatient pharmacy services are unavailable. This provision is particularly relevant for medications related to opioid overdose reversal, treatment for opioid use disorder, and human immunodeficiency virus postexposure prophylaxis.

The amendments establish specific conditions under which medications can be dispensed, including the lack of access to pharmacy services within a 15-mile radius and patients' inability to reach local pharmacies. Hospitals are required to develop policies regarding the types of emergency medications that can be prepackaged and distributed, ensuring that these medications are prepared under the supervision of licensed pharmacists.

Training for practitioners and nurses involved in dispensing these medications is mandated, and a valid prescription must be maintained in patient records prior to distribution. Additionally, a maximum of a 48-hour supply of emergency medication can be dispensed, with certain exceptions.

The amendments reinforce the requirement for healthcare entities to be licensed to purchase, administer, dispense, and deliver legend drugs and controlled substances, with oversight by pharmacists. These changes are expected to impact the healthcare industry, particularly hospitals and pharmacies, as well as the pharmaceutical sector involved in the production and distribution of emergency medications.

While specific monetary impacts are not detailed, the changes may lead to increased operational costs for hospitals related to policy development, training, and compliance with new regulations. Pharmacies may also experience financial implications due to alterations in medication dispensing practices.

The document outlines amendments to New York's public health law concerning hospital-sponsored off-campus emergency departments. Key changes include the establishment of operational standards for these emergency departments, which are required to generally operate 24 hours a day, seven days a week, with the possibility of part-time operation under specific local circumstances.

These amendments aim to align the staffing, training, and patient care standards of off-campus emergency departments with those of general hospital-based emergency departments. This alignment is expected to enhance the quality of emergency medical services provided to the community.

The act is set to take effect immediately upon passage, with no specific monetary impacts detailed in the text. Overall, these changes will significantly influence the healthcare industry, particularly hospitals and emergency medical services.

The document outlines amendments to New York's public health law that focus on the responsibilities of hospital and emergency room physicians in treating patients for controlled substance overdoses. A key change is the requirement for physicians to notify the patient's prescriber about the treatment, which aims to enhance communication and improve patient care management.

Additionally, emergency room and hospital practitioners are mandated to consult the prescription monitoring program registry when treating patients for overdoses. This requirement is designed to provide a comprehensive view of the patient's controlled substance history, facilitating better-informed treatment decisions.

The healthcare industry, particularly hospitals and emergency medical services, will be directly impacted by these amendments. Pharmaceutical companies and prescribers managing patients with substance use disorders may also feel the effects of these changes.

While specific monetary impacts are not detailed, the new requirements for consultations and notifications may lead to increased administrative costs for healthcare providers. However, improved management of overdoses could potentially reduce costs associated with emergency care and long-term treatment for substance use disorders.

AT A GLANCE

This bill requires the Department of Education, with the Department of Health, to develop protocols for Hawaii public schools to maintain and administer stock short-acting bronchodilators for student asthma emergencies.

FULL SUMMARY

The bill establishes a framework allowing Hawaii public schools to maintain and use a standing “stock supply” of short-acting bronchodilators for student asthma episodes (actual or perceived), and authorizes trained school personnel and department staff to volunteer to administer specified emergency medications.

To implement the stock-supply approach, the bill adds two new sections to HRS Chapter 302A. New section 302A-A permits a school to maintain stock bronchodilators administered by a school health assistant or other authorized volunteer to students as needed. It requires the Department of Education (with the Department of Health) to develop protocols covering stock bronchodilator/spacer maintenance and location, staff training under the bill’s cross-referenced requirements, administration parameters, and immediate and longer-term follow-up (including making an emergency 911 call). For schools intending to maintain stock, the bill requires (1) following the department protocol, (2) ensuring each bronchodilator is prescribed by a prescriber with prescriptive authority and dispensed by a licensed pharmacist/pharmacy/manufacturer, and allowing refill of used/expired prescriptions by an authorized prescriber; and (3) allowing purchase or acceptance of donated/transferred short-acting bronchodilators/components only if they are new, unexpired, manufacturer-sealed, not recalled, unadulterated, and compliant with FDA regulations. Schools also must restrict administration of stock bronchodilators to specifically trained school health assistants and authorized agents, and must inform parents/guardians about potential use of the bronchodilator (protocols available on request).

The added framework modifies the emergency-volunteer medication section by adding stock bronchodilator administration permissions and training requirements. Under new section 302A-B, school employees/agents who volunteer may administer epinephrine, glucagon, seizure rescue medication, inhalers, and stock bronchodilators in emergency situations, subject to section-specific requirements. For stock bronchodilators administered under 302A-A, the bill requires annual parent/guardian notice, administration to follow the department protocol (including indications, standard dosing, disposition, and aftercare), and volunteer training content addressing asthma exacerbation causes, recognition of asthma attack signs/symptoms, indications for bronchodilator administration, administration technique (including inhalers/spacers), and the need for immediate access to a certified emergency responder. The bill also clarifies that stock-bronchodilator administration by authorized volunteers does not imply diagnosis or constitute the practice of medicine, nursing, or other licensed professional activity. Liability protections are extended: except in cases of gross negligence, willful and wanton misconduct, or intentional misconduct, persons acting in accordance with these provisions (including training providers and prescribing/pharmacy professionals) are immune from civil or criminal liability.

Beyond adding stock-bronchodilator provisions, the bill amends HRS 302A-1164 (student self-administration/self-testing provisions) to expand the permitted student self-management scope and related documentation. It updates the section’s title and operative text to include self-administration of asthma medication (along with anaphylaxis medication and diabetes-related activities), and it clarifies the student’s ability to perform blood glucose monitoring. It also updates parent/guardian authorization and physician certification requirements for student self-management of diabetes (including permission for the student to possess supplies/equipment on the person) and for students with asthma/anaphylaxis/diabetes or other potentially life-threatening illnesses to confirm the student is capable of and instructed in proper self-administration or self-monitoring. The bill further amends HRS 328-16 by updating prescription labeling and prescription communication requirements: it adds that the prescription label may identify the school/institution as the prescriber recipient for a bronchodilator prescribed under the new 302A-A stock provision (replacing the prior person/owner-animal focus for this category), and it similarly updates prescription communications to require inclusion of the school/institution name/address when applicable.

AT A GLANCE

This bill authorizes Hawaii public schools to maintain a stock supply of bronchodilators for asthma episodes, if the Department of Education protocol is followed and parents provide written acknowledgment.

FULL SUMMARY

The bill creates two new Hawaii Revised Statutes sections in Chapter 302A, Part III, Subpart F, establishing a framework for schools to maintain and use a stock supply of bronchodilators for students experiencing actual or perceived asthma episodes. A school may maintain such a stock supply to be administered by school health assistants or authorized school volunteers. The Department of Education (with the Department of Health) must develop and make available a protocol covering: (1) storage and location of stock bronchodilators and spacers; (2) training requirements for school personnel/agents; (3) parameters for administration; and (4) immediate and long-term follow-up contingencies, including any “911” communication. Schools intending to keep the stock supply must follow the department protocol, ensure bronchodilators are prescribed with the school designated as the patient, and limit administration to trained school health assistants and authorized employees/agents; schools also must inform parents/guardians each year about potential use. The new sections also define “bronchodilator,” expand the relevant concept of “school,” and define “stock bronchodilators.”

The bill further adds/clarifies procedures for emergency medication administration by volunteers and indemnity/immune-from-liability rules. Under the revised permitted-volunteer framework, school employees and agents may volunteer to administer certain emergency medications (including inhaler/stock bronchodilators) and to assist with diabetes-related tasks, subject to parent/guardian written authorization and written medical orders for student-specific emergency medication, and specified authorization/certification requirements for insulin and blood glucose monitoring. For bronchodilators drawn from a stock supply, the bill requires the department or school to provide written notice that the department/school and its personnel will not incur liability from compliance, and it requires a parent/guardian signed statement acknowledging no-liability and indemnification obligations. It also contains a general civil/criminal immunity provision for schools/persons (including trained health professionals and prescribers/dispensers) acting in accordance with the section, except in cases of gross negligence, willful and wanton misconduct, or intentional misconduct.

The bill amends Section 302A-1164 to align student self-management permissions and diabetes/medication authorization language with the new volunteer/stock-bronchodilator structure. Changes include: (1) streamlining the listed permissions to focus on self-administration of medication and student blood glucose monitoring; (2) modifying the parent/guardian authorization and physician certification requirements to emphasize that the student may perform blood glucose checks, administer insulin via the student’s delivery system, and manage diabetes during school-related activities (and that the student may possess necessary supplies/equipment, if applicable); and (3) revising the immunity clause cross-references so immunity applies to persons acting in accordance with the amended section’s requirements.

Finally, the bill amends Section 328-16 (prescription dispensing/labeling and communications) to permit bronchodilator prescriptions to include the name of the school or institution where the bronchodilator is prescribed under the new stock-supply section, and adjusts prescription communication requirements to reflect that school/institution labeling. It also directs the revisor of statutes to substitute appropriate section numbers for lettered designations for the new sections, and provides that the Act takes effect upon approval (no other effective date is stated).

The document discusses an amendment to Michigan legislation that offers legal protection to individuals who voluntarily administer bleeding control measures during emergency situations. This protection is designed for those who act without a legal obligation to intervene, ensuring they are shielded from civil liability for any damages that may arise from their actions, except in cases of gross negligence or willful misconduct.

The amendment aims to promote bystander intervention in emergencies, which could significantly benefit various sectors, including emergency medical services, sports organizations, and public health initiatives. By encouraging individuals to assist in critical situations, the legislation seeks to enhance community safety and response efforts.

The changes outlined in the document will come into effect contingent upon the enactment of the proposed legislation, although specific implementation dates are not mentioned.

The document outlines upcoming changes to health insurance regulations in California, focusing on essential health benefits. These new regulations are set to take effect on January 1, 2027, pending approval from the United States Department of Health and Human Services for a new benchmark plan.

The changes will primarily impact the health insurance industry, particularly insurers offering individual and small group health insurance policies. Additionally, sectors related to healthcare services, such as fertility services and durable medical equipment providers, will also be affected.

Under the new benchmark plan, health insurers will be required to cover additional benefits, which may result in increased costs. Key new coverage mandates include comprehensive fertility services, durable medical equipment like mobility and communication devices, and pediatric vision and oral care benefits.

Insurers will need to ensure compliance with the updated essential health benefits requirements, which may necessitate adjustments to their offerings and pricing structures. Overall, these changes aim to enhance health coverage for Californians, particularly in reproductive health and pediatric care, while imposing new obligations on health insurers.

The 69th Legislature of Montana has introduced significant amendments to laws governing emergency care providers and workers' compensation coverage. A key change involves transferring the licensing oversight of emergency care providers from the Board of Medical Examiners to the Department of Labor and Industry. This shift aims to streamline regulatory processes and enhance the oversight of emergency care services, potentially impacting various healthcare and emergency service businesses that will need to adapt to new licensing regulations.

The amendments also clarify the roles and responsibilities of emergency care providers, medical assistants, and physicians, emphasizing the importance of licensure and the scope of practice. The board is empowered to establish rules for competency and educational requirements, as well as to create a medical assistance program for licensees facing substance use or mental health challenges. Additionally, annual reporting on complaints related to physician practices in medical marijuana certification is mandated.

Changes to workers' compensation coverage are also outlined, affecting public schools, community colleges, nonprofit organizations, and agricultural businesses. The amendments specify compensation benefits for community service workers and provide guidelines for coverage options for volunteers and self-employed individuals. These changes are expected to influence various sectors, particularly in education and community service.

Furthermore, the amendments address the regulation of emergency medical services, including the establishment of minimum licensing standards and operational procedures. The expanded definitions related to opioid antagonist administration and eligible recipients aim to enhance harm reduction efforts and improve emergency response capabilities.

Overall, these legislative changes are designed to improve the structure and oversight of emergency care services and workers' compensation in Montana, potentially leading to increased compliance costs and operational adjustments for affected businesses.

AT A GLANCE

This bill requires authorized facilities, stations, and ambulance services to arrange immediate transport of newborns to the nearest medical facility and notify DHS when the child is left and medically ready for discharge.

FULL SUMMARY

The bill revises Georgia’s “Safe Place for Newborns Act of 2002 Eliza Jane Warner Act” (Title 19, Chapter 10A) to expand authorized safe-haven options, add operational requirements for handling newborns left in safe places, and add specifications and limitations for newborn safety devices.

It clarifies and updates key definitions for “ambulance service,” “medical facility,” “newborn safety device,” “police station,” and “public safety vehicle.” It also revises the prosecution shield for mothers who leave a newborn: a mother is not prosecuted for certain enumerated offenses based on the act of leaving the newborn if the newborn is no more than 45 days old, and the newborn is left in (1) the physical custody of an on-duty staff member/employee of an authorized facility/station/public safety vehicle/ambulance service with an additional 30-day age limit, provided the mother shows identity proof (if willing) and provides name/address (if willing), or (2) a newborn safety device; it further shields individuals acting at the mother’s direction for acts that would be protected if performed by the mother.

The bill adds or strengthens operational duties and oversight: the Department of Human Services (DHS) must investigate and report to the General Assembly regarding children left with authorized entities or in a newborn safety device, including whether a dedicated toll-free information line is desirable and cost-effective. It requires DHS reimbursement for “all reasonable medical and other reasonable costs” associated with the newborn prior to DHS taking custody, and it imposes timing/transport obligations on medical facilities/fire stations/police stations: the accepting entity must arrange immediate transport to the nearest medical facility and notify DHS when the child is left and when medically ready for discharge; DHS must take physical custody within six hours of receiving the “medically ready” notification and promptly bring the child before juvenile court as required by specified law. It also provides civil and criminal liability protections for covered facilities and personnel for failure to discharge duties, while preserving liability for negligent treatment after custody.

DHS must develop standards for signage informing the public that the location is authorized to accept newborns under the chapter, including rulemaking for sign size/type and placement. The bill authorizes facilities/stations (including ambulance services) to install newborn safety devices only if the device is in a conspicuous, visible area and the location is staffed 24/7 by an emergency medical services provider. It requires installed devices to include (1) a security camera recording access to the device and (2) a dual alarm system: one alarm must connect to the facility/station and be tested at least monthly; the second alarm must monitor the device interior and be checked at least twice daily to confirm proper functioning; and the dual alarm system must dispatch the nearest ambulance service to retrieve a newborn if all staff are off-site or otherwise unavailable. Finally, it prohibits the expenditure of state funds for the acquisition or operation of newborn safety devices and repeals conflicting laws.

AT A GLANCE

This act requires the Alaska Department of Education and Early Development to adopt statewide hands-only CPR curricula for required grade levels based on current national emergency cardiovascular care guidelines.

FULL SUMMARY

The act requires the Alaska Department of Education and Early Development to adopt statewide curricula to instruct public school students on hands-only cardiopulmonary resuscitation (CPR). The department must determine which grade levels are required to receive the instruction and must adopt curricula appropriate for each required grade level; CPR curricula must be based on current national, evidence-based emergency cardiovascular care guidelines. A person holding a current CPR instructor certificate, a license/certificate to provide emergency medical services under AS 18.08.082, or a current teacher certificate under AS 14.20 may present the curriculum. Public schools providing instruction for the adopted grade levels must offer the instruction if practicable.

The act also modifies the existing statewide health education encouragement statute by changing the listed health education topics: it removes CPR from the parenthetical list of example topics for kindergarten through grade 12 health education (leaving the general requirement to include “physical health and personal safety” and other specified topics).

In the emergency medical services (EMS) framework, the act amends the department’s administration duties to clarify that its planning and training/education responsibilities apply to “care for major emergencies” (in addition to trauma care), while retaining the trauma-center designation process based on an applicable national evaluation system. It further expands the definition of “major emergency” in EMS law to include a heart attack or stroke. Finally, it provides an effective date: Sections 1 and 2 take effect July 1, 2027.

AT A GLANCE

This bill requires each Illinois EMS System to maintain a Department-approved “Just Culture” policy for evaluating human error and service failures, and it governs subsequent discipline and licensing procedures for Resource Hospitals.

FULL SUMMARY

The bill amends the Illinois Emergency Medical Services (EMS) Systems Act by revising EMS definitions and changing how Resource Hospitals run EMS System participation, discipline, and personnel licensing.

Key definition changes in Section 3.5 include updating the meaning of “Digital license” to cover a Department-issued secure electronic record that is accessible through Department or Department-approved platforms and readily verifiable by Resource Hospitals and vehicle service providers; the bill also adds/clarifies definitions related to EMS personnel terminology such as “Physical license” and keeps/aligns other defined terms used across the Act (e.g., “Clinical observation,” “Just Culture,” and “Trauma”).

For Resource Hospitals’ duties (Section 3.35), the bill requires that each EMS System maintain a Department-approved policy regarding “Just Culture” for evaluating/responding to human error and certain failures to perform emergency and nonemergency medical services. It also incorporates or reinforces System Program Plan obligations and the EMS Medical Director’s role in issuing System discipline, plus detailed operational requirements regarding staffing, education, dispatcher prearrival instructions, protocol development, and transport monitoring.

The bill significantly refines EMS System participation suspensions and due process (Section 3.40), including: (1) clearer Department review and investigation steps after an EMS Medical Director issues a suspension order; (2) hearing rights before a local System review board (with board composition and roster requirements); (3) additional pathways for review by the State EMS Disciplinary Review Board; and (4) procedures for immediate suspension, including short internal timelines for providing orders/responses and the Director’s review of whether the suspension should be stayed or continue during proceedings. The bill further updates the State EMS Disciplinary Review Board’s structure and procedures (Section 3.45), and revises EMS personnel licensure levels and licensing administration (Section 3.50), including Department authority over education/training and testing, relicensure cycles (notably with specified continuing-education hours), issuance of physical vs digital licenses, and Department authority to suspend/revoke/refuse licenses after hearing. It also adds provisions for: (a) fee waivers for certain small-population volunteer/guard/trooper scenarios; (b) limited circumstances allowing a non-EMS personnel to operate an EMS vehicle under specified conditions, including possible retroactive waivers; (c) a rule that Department drug-use testing provisions do not apply where they conflict or duplicate a collective bargaining agreement drug-testing requirement for covered persons; and (d) electronic license-renewal notice procedures when an applicant provides an email address.

AT A GLANCE

This bill requires health insurance issuers to cover and limit insured out-of-pocket costs for emergency and urgent ground ambulance services from nonparticipating providers for policies issued or renewed on or after January 1, 2027.

FULL SUMMARY

SB3517 establishes changes to the Illinois Insurance Code’s provisions governing billing and cost sharing for services furnished by nonparticipating providers and nonparticipating emergency/ambulance facilities. The bill amends Section 356z.3a (Billing; emergency services; nonparticipating providers) and also amends the Health Maintenance Organization Act Section 4-15 to align HMO payment rules for ground ambulance services with the updated Insurance Code approach.

Key changes in Insurance Code Section 356z.3a include: (1) new coverage and cost-sharing protections for ground ambulance services by nonparticipating ground ambulance service providers beginning with policies issued/renewed on or after January 1, 2027, requiring coverage for both emergency and urgent ground ambulance service; (2) for covered emergency ground ambulance services or urgent ground ambulance services from a nonparticipating ground ambulance service provider on/after January 1, 2027, the health insurance issuer must ensure the insured’s out-of-pocket costs are no greater than if a participating provider had furnished the services, with cost sharing applied as though care had been received from a participating ground ambulance provider; (3) a defined payment mechanism for reimbursement to nonparticipating ground ambulance providers after a provider submits a bill and after subtracting the insured’s cost sharing (including local-government jurisdiction rate rules for providers subject to local jurisdiction, and otherwise a rate framework tied to the lesser of negotiated rate, 85% of billed charges, or an average gross charge rate filed for the date of service); (4) an annual filing requirement beginning October 1, 2026 for nonparticipating ground ambulance service providers to file average gross charge rates (and required information) with the Department of Public Health for specified base charge and loaded mileage charge categories, and publication of submitted rate information by the Department of Public Health by January 1, 2027 and annually thereafter.

The amended Section 356z.3a also clarifies/extends the issuer/provider payment dispute process for bills assigned to nonparticipating providers: the issuer must provide a written explanation of benefits with proposed reimbursement and applicable cost-sharing amounts; if disputes are not resolved within required timelines, either party may initiate binding arbitration with the Department of Insurance, using a panel/selection process for approved arbitrators/entities, and requiring a written decision within 45 days after a request is filed. The bill contains additional technical provisions on when certain arbitration-related Code sections apply during pendency of decisions, caps/limits on interest accrual timing, and states that nothing changes the Managed Care Reform Act’s “prudent layperson” emergency-services rule. It further provides that certain services are exempt from the Section (e.g., air ambulance, excepted benefits, and short-term limited-duration insurance), restricts home rule units from regulating ground ambulance payments inconsistently with the Section, and adds a neonatal intensive care exception requiring out-of-pocket cost parity with participating providers when the nonparticipating neonatal intensive care is billed as emergency services.

Finally, the bill amends Health Maintenance Organization Act Section 4-15 to require HMOs to pay charges for emergency transportation by ambulance to enrolled individuals under the plan promptly, consistent with the Insurance Code’s ground ambulance payment protections, and to require ambulance providers who accept HMO payment not to seek additional payment from the enrollee.

AT A GLANCE

This bill extends until January 1, 2037 the Maddy EMS program’s county $2-for-$10 additional penalty authority and related pediatric trauma funding and administration-reimbursement limits.

FULL SUMMARY

The bill extends the availability dates for specified emergency medical services (EMS) funding provisions within California’s Maddy EMS program framework. It updates Government Code Section 76000.5 to keep an elective county penalty (a $2 added penalty for every $10, or part of $10, in certain criminal fines/penalties/forfeitures) and related use rules in effect until January 1, 2037. It also updates Health and Safety Code Section 1797.98a to keep the pediatric trauma funding requirement and related EMS fund administration reimbursement limits in effect until January 1, 2037.

On Government Code Section 76000.5, the bill amends the operative expiration of the $2-for-$10 additional penalty authority: county boards of supervisors may continue to levy the additional penalty for covered court-imposed criminal fines, penalties, and forfeitures, with the same exclusions (e.g., restitution fines; certain other penalties; specified parking offenses; and the state surcharge). It also continues the requirement that increased penalties not offset or reduce funding from other sources, and requires deposit of amounts into the Maddy EMS Fund; the section’s “remain in effect” date is changed to January 1, 2037.

On Health and Safety Code Section 1797.98a, the bill amends operative dating for (1) the requirement that 15% of money deposited into the Maddy EMS Fund under Section 76000.5 be used for pediatric trauma centers, including support that may be used for reimbursement (physicians/surgeons and hospitals for uninsured emergency-care patients up to stabilization) and for expanding pediatric trauma services/equipment, and for a fallback use to improve pediatric trauma and emergency service access and coordination (with preference for children’s-specialty hospitals and pediatric emergency physicians); and (2) the requirement that costs of administering money deposited pursuant to Section 76000.5 be reimbursed from collected funds at an amount not exceeding actual administrative costs or 10% of money collected (whichever is lower). Both related subdivisions are retained through January 1, 2037 and are the only substantive changes signaled in the text provided.

AT A GLANCE

This bill requires each regional EMS council to annually file with the department and relevant board, on or before May 30, a regional EMS services and support plan consistent with the statewide EMS plan.

FULL SUMMARY

The bill requires clearer communication between regional emergency medical services (EMS) councils and the Massachusetts Department responsible for EMS oversight by adding explicit communication guidelines to the regional councils’ required planning process.

It amends Massachusetts General Laws ch. 111C to (1) expand a regional EMS plan requirement to include guidelines for clear and streamlined communication between regional councils and the department; (2) require that a specified process for regional council input expressly includes communication to the regional councils (in addition to “input from”); and (3) add a new requirement that each regional EMS council prepare and annually file with the department and the relevant board, on or before May 30, a regional EMS services and support plan describing planned efforts to meet and advance the council’s roles and responsibilities, while remaining consistent with the statewide EMS plan. The bill also updates a department-contractor amendment provision to allow (subject to appropriation and existing contractual guidelines) amendments to regional EMS council contracts to reflect submitted regional EMS plans, and it ties regional council annual submitted plans into the scope of provisions in the EMS contracting/administrative framework.

The bill also changes EMS quality/compliance oversight procedures by replacing the existing section on the department’s procedures for making, transmitting, investigating, and adjudicating public complaints about certified/licensed/designated/approved persons, including requirements to publish a description of procedures (and forms/materials) online, investigate all complaints received as appropriate, refer complaints to other entities when appropriate, and notify complainants (where known) of actions taken or findings and reasons when an investigation is not required.

Additionally, it directs the EMS department (in consultation with regional councils) to study and recommend potential permanent funding sources and mechanisms to support the EMS office, regional councils, and central medical emergency direction centers, and to issue a report to the legislative clerks and budget committees by December 1, 2025. Finally, it creates an emergency medical services peer licensure advisory committee within ch. 111C, composed of specified department/office representatives plus six commissioner-appointed members drawn from multiple EMS/fire and paramedic stakeholder groups; it requires at least two annual meetings to advise on the complaint resolution process and disciplinary actions, with members serving three-year terms (maximum three terms) without compensation.

AT A GLANCE

This bill requires the Office of Emergency Services to submit quarterly Legislature reports on Next Generation 911’s development, implementation, spending, challenges, and chosen solutions through completion and legacy 911 decommissioning.

FULL SUMMARY

SB 985 requires the Office of Emergency Services, in developing California’s Next Generation 911 system, to provide the Legislature with quarterly reporting focused on development, implementation, and spending.

The bill amends Government Code Section 53121 to add detailed quarterly report requirements: each report must cover statewide progress toward and major challenges to development and implementation of Next Generation 911, including technological, operational, and legal/contractual challenges (and other challenges identified by the office). Reports must also include proposed solutions to challenges, potential costs of those solutions, effects on and changes to the implementation timeline and expected completion dates, and progress made in implementing chosen solutions.

Quarterly reports must incorporate recommendations from the State 911 Advisory Board and explain any actions taken in response, including justification if the office makes decisions that contradict those recommendations (including how the office justifies the contradiction). The bill also directs the office to submit copies of each quarterly report to specified legislative budget committee leadership and the relevant subcommittees, and sets a schedule tying submissions to defined dates throughout each year.

Finally, SB 985 requires continued quarterly reporting through full Next Generation 911 implementation and decommissioning of the legacy 911 system, notwithstanding Section 10231.5, so reporting does not end until both conditions are met.

The bill makes a targeted change to the District of Columbia Policemen and Firemen’s Retirement and Disability Act’s mandatory-retirement rule for certain first responders. It removes the Metropolitan Police Department and Fire and Emergency Medical Services mandatory retirement age requirement by revising Section 12(h)(2) of the Act so that it no longer applies to those D.C. agencies.

Under the revised Section 12(h)(2), the provision applies to specified federal law-enforcement members (United States Secret Service Uniformed Division or United States Park Police, or the United States Secret Service Division) once they have reached age 60; retirement at that point is left to the discretion of the head of the member’s department, and the member remains entitled to an annuity computed under the relevant subsection.

The Council adopts a fiscal impact statement by reference to the committee report. The act takes effect following approval by the Mayor; in the event of a veto, it takes effect after the Council overrides the veto and completes a 30-day congressional review period under the District’s Home Rule Act.

AT A GLANCE

This bill establishes the Emergency Medical Services Personnel Licensure Interstate Compact in Arizona, requiring member states to recognize the compact privilege to practice under defined eligibility and due-process limits.

FULL SUMMARY

The bill establishes the Emergency Medical Services Personnel Licensure Interstate Compact in Arizona by adding a new Arizona statute section (A.R.S. § 36-2259) that sets out the compact’s purpose, definitions, “home state” licensure rules, and the “compact privilege to practice” for EMTs, AEMTs, and paramedics across member states, including required eligibility conditions (e.g., age, valid unrestricted license, practice under a medical director’s supervision) and the scope-of-practice framework. It also requires member states to recognize the compact privilege, allows remote states to restrict/suspend/revoke the privilege subject to due process, and requires notification to the home state and the compact’s administrative body when adverse actions occur.

The bill further creates and governs an interstate commission (the “Interstate Commission for EMS Personnel Practice”) as a joint public agency with powers to promulgate binding uniform rules, maintain a coordinated licensure/adverse-action database, collect information from member states, and oversee compliance. It specifies reporting and data-sharing obligations (including submission of adverse actions, significant investigatory information, and indicators that privileges are restricted/suspended/revoked), establishes rulemaking and public-comment procedures (including emergency rules and challenge provisions), and includes oversight/enforcement mechanisms such as default/termination processes, dispute resolution, and litigation enforcement.

On the Arizona side, the bill amends A.R.S. § 36-2202 (director duties/qualification standards) by adding a requirement tied to the compact: beginning on the effective date of the amendment (or FBI approval), a person applying for initial EMT certification under the EMS Personnel Licensure Interstate Compact must possess a valid fingerprint clearance card under Title 41, Chapter 12, Article 3.1. It also amends A.R.S. § 36-2220 (records/confidentiality) to clarify that investigatory materials relating to emergency medical care technicians are confidential but includes an explicit exemption allowing the department to submit information in compliance with the compact as required by A.R.S. § 36-2259, and amends A.R.S. § 36-2245 (ambulance investigations/complaints) by adjusting procedural timelines/wording around when the department must act after receiving complaints and records, and around notice of nonsubstantive vs. substantive determinations.

Finally, the bill amends fingerprinting statutes (A.R.S. § 41-619.51 definitions; § 41-1758 definitions; and § 41-1758.01 duties) by adding/including A.R.S. § 36-2202 among the enumerated fingerprint-triggering sections and requiring the fingerprinting division to conduct checks and issue fingerprint clearance cards for persons seeking those EMS licenses, along with related administrative duties for notices and clearance-card issuance/denial/suspension processes.

AT A GLANCE

This bill establishes a statewide POLST framework in Pennsylvania law that makes POLST a legally actionable medical order across care settings, with eligibility limited to life-limiting and irreversible conditions.

FULL SUMMARY

The bill amends Pennsylvania’s advance health care directive/OOH-DNR framework in Title 20 to extend applicability to (i) out-of-hospital nonresuscitation orders and (ii) Pennsylvania Orders for Life-Sustaining Treatment (POLST). It adds/updates definitions used in the health care directives chapter (e.g., “Health care provider,” “Medical command physician,” “Order,” and OOH-DNR-related terms), adjusts cross-references so provisions align with the updated structure, and updates criminal-penalty language to cover falsification or interference with OOH-DNR orders/bracelets/necklaces and POLST.

The bill changes EMS-related rules for OOH-DNR/bracelets/necklaces by (1) clarifying that EMS personnel must comply with authorized medical command physician instructions to withhold or discontinue resuscitation even if an OOH-DNR device/order is absent, (2) setting EMS authorization and required actions when an OOH-DNR order/bracelet/necklace is presented or discovered after CPR begins, and (3) providing good-faith protections and recognition procedures for out-of-state OOH-DNR forms consistent with Pennsylvania law. It also repeals an existing statutory section requiring an advisory committee related to standardized treatment-order forms (repeal of former §5488), and it adds a “discontinuance” rule barring execution of new OOH-DNR orders on/after the date the Department adopts an initial POLST form, while continuing applicability/recognition for previously executed OOH-DNR orders.

Separately, the bill creates a new POLST subchapter in Title 20 (added Chapter 54 Subchapter F, §§5491–5498.18). This new subchapter establishes a statewide legal framework for POLST as immediately actionable medical orders across care settings, including: definitions; restrictions/prohibitions on POLST use (including eligibility tied to a “life-limiting and irreversible condition,” and a “stable chronic condition” limitation); a voluntary consent requirement that bars insurers/coverage entities from conditioning insurance on POLST completion or using POLST status to alter coverage/reimbursement except as the POLST directs valid treatment limits; creation of a POLST Advisory Committee (appointment authority, composition, and roles); department duties to adopt/update the standard POLST form and education materials and make them publicly available; POLST form requirements (including outcome-neutral medical order options, notice statements, identification/signature provisions, and a formal public comment/publication process for adoption/updates); rules for validity and portability; operational “team care” mechanisms; copy effectiveness; signature options (including marks and electronic signatures where authorized); standards for surrogate decision makers; revocation; transfer and review requirements when patients move between facilities; compliance and good-faith liability protections for providers/transferers; EMS integration rules requiring compliance with a POLST do-not-resuscitate order and listing what EMS must do when POLST DNR is known or discovered; immunity for compliance/noncompliance in specified good-faith circumstances; and priority rules when a POLST conflicts with an advance health care directive (later-executed controls to the extent of conflict).

The bill further provides continuity and transition rules for POLST forms (including recognition of POLSTs executed under prior forms; effect of PLSWC-form POLSTs; and ability for health care providers to comply with substantial equivalents executed in another jurisdiction, subject to conditions such as consultation and conformity to Pennsylvania legal standards). It also requires the Department, in consultation with the committee and the Pennsylvania eHealth Partnership Authority, to study feasibility and cost of an Internet-based POLST registry and report results/status to relevant legislative committees at least every 180 days until final results. Effective dates are set so that the additions (including §5496 and the overall remainder of the act) take effect immediately for the specified provision(s), with the remainder of the act taking effect after 90 days.

AT A GLANCE

This bill authorizes the State Department of Public Health to issue Del Puerto Health Care District a time-limited special permit, with specified licensure waivers, to operate one rural emergency stabilization unit.

FULL SUMMARY

AB 2282 creates a new Health and Safety Code Section 1251.7 that authorizes, on a time-limited basis, the State Department of Public Health (department) to issue a special permit to Del Puerto Health Care District to operate one rural emergency stabilization center care unit located outside and noncontiguous to a general acute care hospital, with specified waivers of certain general acute care hospital licensure requirements.

The rural emergency stabilization center care unit would be authorized only if multiple conditions are met: compliance with the new section and relevant emergency-department health and safety requirements determined by the department; the district maintains written transport and transfer agreements; and operation does not abrogate applicable collective bargaining agreements. As an operational condition, the district must enter into and maintain written transport and transfer agreements with every general acute care hospital within a 30-mile radius that maintains a licensed emergency department (agreements must cover transfer acceptance when clinically appropriate and subject to capacity, transfer timeframes, communication protocols, and ambulance coordination). The permit/waiver authorization is also limited to allowing the waiver of licensure requirements tied to inpatient beds, inpatient nursing units, or other services that cannot be provided at the rural unit.

The bill sets substantive operating requirements for the rural emergency stabilization center care unit: it must provide 24-hour emergency medical screening, stabilization, and triage for all patients regardless of insurance status or ability to pay; meet nurse-to-patient staffing requirements equivalent to those for a basic emergency department (by reference to regulations under Section 1276.4); maintain at least one physician with emergency medicine training and sufficient additional medical/nursing/ancillary staff; provide or contract for basic laboratory and radiology services as determined feasible; adopt written policies and procedures for triage, transfer, and coordination with the local emergency medical services agency (including criteria for when patients must be taken directly to a general acute care hospital emergency department); and operate without diminishing employee rights under applicable collective bargaining agreements.

The bill restricts the rural unit from maintaining licensed inpatient beds or admitting patients as inpatients, generally requiring transfer or discharge within 24 hours of registration (with an exception for emergency circumstances necessary to stabilize for safe transfer), and requires reporting to the department if a patient remains longer than 24 hours. It also requires the district to apply for the special permit, submit information needed to evaluate compliance, allow department inspection, and requires the unit to submit utilization and outcomes data (and to the Department of Health Care Access and Information if required). The special permit has an initial two-year term, renewable in two-year increments up to a cumulative 10 years, with extensions tied to the progress of a “hospital project” involving construction milestones, certificate of occupancy, and licensing as a general acute care hospital. The permit and any licensure waiver become inoperative for new patient registrations once the hospital project begins providing emergency department services to the public, and the district must wind down the rural unit no later than one year after that first public emergency department service date; the Section is then repealed on January 1 of the following year. The bill includes legislative findings declaring that a special statute is necessary for Del Puerto Health Care District and outlines the basis for that necessity.

AT A GLANCE

This bill authorizes the governor to enter New York into two emergency management assistance compacts, and it deems the legislature’s ratification complete upon the governor’s certification to specified officials.

FULL SUMMARY

The bill changes New York’s Executive Law provisions governing disaster emergency response assistance by (1) revising the language in Executive Law § 29-b(1) to use gender-neutral references for the governor and to clarify that non-state resource providers are treated as state agents when authorized and deployed under applicable compacts, and (2) adding two new sections, §§ 29-k and 29-l, that authorize New York, through the governor, to enter and have the legislature deem the state’s entry ratified for two specific emergency management assistance compacts.

First, Executive Law § 29-b(1) is revised to direct that the governor may direct the state disaster preparedness commission (at the governor’s discretion) to conduct emergency exercises or drills using commission personnel and resources, with disaster emergency response personnel operating under the chair of the commission and holding the same powers and immunities as in civil defense drills. The same subdivision is also revised to reflect that, when legally designated state officials authorize and deploy non-state resource providers to a “compact member jurisdiction,” the providers are deemed agents of the state for purposes of the deployment and are entitled to the rights and benefits for state resource providers under the compact, subject to the requesting state’s terms and conditions, while also prohibiting them from soliciting or offering assistance across compact member jurisdictions.

Second, the bill adds Executive Law § 29-k, establishing a mechanism for New York to enter the Northern Emergency Management Assistance Compact (referencing P.L. 112-282, ratified by Congress on January 14, 2013). It provides that the compact is deemed ratified by the legislature upon the governor’s certification to the temporary president of the senate, the speaker of the assembly, and the secretary of state that New York has entered into the compact.

Third, the bill adds Executive Law § 29-l, establishing a mechanism for New York to enter an International Emergency Management Assistance Compact defined by an emergency management assistance memorandum of understanding among specified New England states and Eastern Canadian provinces, authorized under a U.S.-Canada emergency planning and management agreement. Like § 29-k, it provides that the compact is deemed ratified by the legislature upon the governor’s certification to the same three officials that New York has entered into the compact.

The act takes effect immediately.

AT A GLANCE

This bill requires the Hawaii Emergency Medical Services Advisory Committee to include three specified nonvoting ex officio members and to replace the Adjutant General with the Emergency Management Agency administrator by July 1, 2026.

FULL SUMMARY

The bill establishes a change in membership for the Hawaii Emergency Medical Services Advisory Committee by revising the statute governing its composition (HRS § 321-225(b)). It requires the committee to include three nonvoting ex officio members—specifically the Director of Transportation, the Administrator of the Hawaii Emergency Management Agency (or designated representative), and the Administrator of the State Health Planning and Development Agency (or designated representative).

It also removes the Adjutant General as an ex officio, nonvoting member and replaces that role with the Administrator of the Hawaii Emergency Management Agency. All other committee membership categories and appointment structure remain the same, including seventeen voting members appointed by the Governor representing all counties: physicians experienced in emergency medical services (with specified emergency medicine and pediatric board-eligible/certified requirements), health care consumers with no connection to the State health care system, allied health professionals related to emergency medical services, and mobile intensive care technicians or emergency medical technicians engaged in pre-hospital emergency medical service.

The bill retains the existing operational rules for the committee: members serve without compensation but are reimbursed for necessary expenses (including travel), the chairperson is elected by the committee members, a majority constitutes a quorum, and a majority vote of members present at a meeting with a quorum is required to validate committee action.

The revised committee-composition provisions take effect on July 1, 2026.

AT A GLANCE

This bill establishes Hawaii’s time-sensitive emergency medical systems of care and revises EMS governance, dispatch, air-medical, and quality requirements to require integrated statewide emergency medical services under Department oversight.

FULL SUMMARY

The bill establishes a “time-sensitive emergency medical systems of care” model for Hawaii by revising multiple definitions and statewide EMS governance and operational provisions to require integrated, coordinated statewide systems (including emergency medical services for children, trauma, and critical care) and to modernize air-medical, dispatch, and data/quality components.

It changes who can perform and under what supervision certain basic life support activities by allowing state-approved basic life support personnel to use fully automatic external defibrillators, initiate IV lines, place tourniquets, and perform manual external defibrillation under the direction and personal supervision of a state-licensed clinician (replacing the prior “mobile intensive care technician” reference). It also amends the legal framework governing EMS levels and contracts so that county-established EMS levels apply unless the Department of Health determines otherwise in consultation with the Hawaii emergency medical systems of care advisory council, and it strengthens/clarifies the Department’s statewide oversight and contracting role for emergency medical ambulance services and other system components.

The bill renames and restructures the statewide advisory body: the “state emergency medical services advisory committee” is replaced with the “Hawaii emergency medical systems of care advisory council.” It increases council membership to 23 members (including 4 nonvoting ex-officio members and 19 county-representative members) and specifies categories of members (physicians, consumers, allied health professionals, EMS personnel, and trauma/acute care clinicians). The council’s duties are updated to emphasize ongoing monitoring/evaluation, seeking public input, advising on a master plan for medicom, the “911” system, and other components, and advising the Department on implementation of the statewide system.

Operationally, it amends Department duties to make multiple statewide functions explicit, including: maintaining statewide communications interoperability; overseeing development and implementation of a statewide “911” dispatch system; establishing standards and training/quality assurance for dispatchers with a certification deadline for existing dispatchers (July 1, 2026) and continuing thereafter; establishing a program for early defibrillation; and establishing and maintaining emergency medical services for children statewide. It also updates community paramedicine/mobilized integrated health care provisions to allow licensed providers approved by the Department to conduct specified telehealth-based real-time/asynchronous/remote patient monitoring (with rulemaking authority). For air-medical services, it revises the statewide air-medical services system to require data submission to the Department, use medicom center as an intermediary for arranging emergency transport (including bariatric patient transport, as referenced), plan/coordinate system activities, base emergency helicopter triage protocols on national air-medical triage/transport guidelines, and uses an emergency air-medical quality improvement committee (analyzing department-established performance measures) to recommend system standards and resources.

The law updates how Connecticut Medicaid reimburses ambulance services.

It repeals and replaces the existing text of Conn. Gen. Stat. § 17b-273, effective July 1, 2026. The bill requires the Commissioner of Social Services, beginning on and after July 1, 2026, to revise the reimbursement mileage methodology used for out-of-district ambulance services.

Specifically, for ambulance services reimbursed under the state medical assistance program, the Commissioner must base the out-of-district mileage calculation on the distance traveled with the patient onboard from the point of patient pickup to the destination, rounded to the nearest one-tenth of a mile. Ambulance providers may document such mileage using any reasonable and verifiable method, including GPS data, navigation/dispatch computer systems, or commercially available mapping/routing programs.

The Commissioner must also require ambulance service providers to maintain mileage documentation as part of the patient care record, including a trip report that lists the patient’s name and the street address of both the pickup point and the destination.

AT A GLANCE

This bill requires PSAPs to comply with Community Emergency Services and Support Act protocols by July 1, 2027, and requires the Office of the Statewide 9-1-1 Administrator to monitor that compliance.

FULL SUMMARY

The bill amends the Illinois State Police Law and the Illinois Police Training Act and expands and coordinates Illinois’ emergency mental health and 9-1-1 systems. It also changes the Emergency Telephone System Act by adding new compliance and monitoring requirements linked to the Community Emergency Services and Support Act, and it amends the Community Emergency Services and Support Act by adding/expanding definitions, coordination duties, state goals/prohibitions, governance, PSAP implementation timelines, reporting, and oversight.

In Illinois State Police training for academy and in-service and cadet basic training, it requires (among other items) expanded specialized training areas and delivery standards—most notably: victim-centered, trauma-informed investigation training for homicide investigators; specialized instruction for officer-involved criminal sexual assault investigations (including evidentiary and report-writing standards, instructor qualification requirements, and State Police rulemaking for training standards); written policies and specialized training for officer-involved death investigations; and structured cadet training modules covering (at minimum) autism/developmental and physical disability interaction, cell-phone medical information access and use, constitutional law/civil and human rights, crime-victim communication and victims’ rights explanations, crisis intervention/mental health specialty certification (40+ hours), elder abuse, electronic control devices, epinephrine auto-injector administration consistent with the Illinois State Police Act, evidence collection and legal evidence rules, firearms restraining orders and firearms training requirements, hate crimes recognition/reporting, high-risk traffic stops and high-speed chase alternatives, human trafficking detection/investigation, juvenile law processing, mandated reporting, officer wellness/suicide prevention, officer-worn body camera training, opioid antagonist administration, and de-escalation and use-of-force training. It also requires minimum hours and content for certain use-of-force trainings and sets repeated in-service cadences (annual, every 3 years, every 5 years) with specified minimum topics.

For governance and compliance in emergency mental/behavioral health response, the bill adds to the Emergency Telephone System Act: PSAPs must comply with Community Emergency Services and Support Act protocols beginning July 1, 2027, and the Office of the Statewide 9-1-1 Administrator must monitor PSAP compliance, with DHS consultation and adoption of implementation rules including required data elements, reporting formats, and a provider data reporting mechanism. It further amends the Community Emergency Services and Support Act to expand coordination requirements among 9-1-1 PSAPs/emergency services and mobile mental/behavioral health services, including state goals (e.g., divert from hospitalization/incarceration when possible, allow on-site care when appropriate, recommend community referrals with attention to barriers, coordinate transportation to the least restrictive setting) and state prohibitions (not dispatching law enforcement for mental/behavioral care except for specified criminal threat/injury scenarios; limits on law enforcement accompaniment during equivalent emergencies; and restrictions on using law enforcement for transportation between behavioral health providers). The bill also requires mobile mental health relief provider training components (de-escalation; community knowledge; stigma/sensitive language; neurodivergent/developmental disability recognition and stabilization techniques; involuntary commitment process training and bias protections; restrictive-care referral guidelines; regional best practices), requires data reporting for monitoring/quality improvement, sets PSAP staff training expectations, and adds statewide/advisory committee and regional committee provisions emphasizing lived experience/advocacy representation and protocol design and review.

Finally, the bill establishes an implementation schedule and oversight: PSAP coordination with mobile mental/behavioral health services must begin once specified conditions are met (and not later than July 1, 2027), with staged activities requiring pilot testing of revised protocols by June 30, 2025; evaluation/revisions and implementation at pilot sites by June 30, 2026; and full implementation by all remaining PSAPs by June 30, 2027. It also requires periodic reporting by DHS/Division of Mental Health to the General Assembly on implementation progress (on or before July 1, 2026, twice every year 2023-era timing is referenced, and quarterly thereafter until statewide full implementation), and it creates/clarifies ongoing oversight of PSAP compliance via the Statewide 9-1-1 Administrator in accordance with the new monitoring sections.

AT A GLANCE

This bill defines “public works employee” and limits those employees to being treated as “first responders” only when the governor declares an emergency under R.S. 29:721 et seq.

FULL SUMMARY

The bill expands Louisiana’s statutory definition of “first responder” to include public works employees, and it creates a new statutory definition for “public works employee.” It amends R.S. 23:1017.1(6) to specify that “first responder” includes public works employees (as defined in R.S. 29:723) among other listed categories.

It enacts R.S. 29:723(21), defining “public works employee” as an employee of a municipal or parish public works department responsible for maintaining and improving municipal or parish infrastructure. The bill limits when public works employees are treated as “first responders”: they are considered first responders only in instances involving emergencies declared by the governor under R.S. 29:721 et seq. It also authorizes that the term “first responder” may be displayed on the uniform of a public works employee.

It amends R.S. 29:739(C) (Intrastate Mutual Aid Compact—Definitions) to clarify that the definition of “first responder” in that section includes public works personnel and “public works employees” that provide immediate support services during prevention, response, and recovery operations consistent with Homeland Security Presidential Directive 8.

The act is cited as the “Shelby LaSalle Act.” The Louisiana State Law Institute is directed to renumber the definitions in R.S. 29:723 to ensure they are in alphabetical order. The bill becomes effective upon the governor’s signature, or if not signed, upon expiration of the time for bills to become law without signature; if vetoed and later approved by the legislature, it becomes effective the day following approval.

AT A GLANCE

This bill requires Missouri ambulance districts, after they are declared organized, to elect six directors either from six population-equal election districts or at large, with terms set by the elected seat.

FULL SUMMARY

The bill restructures Missouri law governing ambulance districts by repealing specified existing sections and enacting replacement provisions on: (1) how organized districts are divided into election districts or otherwise manage director elections; (2) director candidate qualifications; (3) the ability to abolish or establish election subdistricts under certain conditions; (4) rules for filling director vacancies and appointment timing; and (5) procedures for annexation, consolidation, and related voting/tax limitations. It also establishes a new state program for critical incident stress management within the Department of Public Safety, with accompanying participation/check-in requirements and confidentiality and funding provisions.

For ambulance districts, the replacement election/director rules require that after a district is declared organized, the county commission either divides the district into six election districts as equal in population as possible or provides for election of six directors at large from within the district (with board election mechanics tied to the next regularly scheduled election after the organizing order). Director terms are set by which election district (or at-large slot) a director is elected from: directors from districts 1 and 4 serve one-year terms; districts 2 and 5 serve two-year terms; and districts 3 and 6 serve three-year terms, after which all directors serve three-year terms. The bill removes an older population-based special carve-out and replaces at-large sequencing language, and adds a specific transition rule: a director holding office as of August 28, 2026 continues as an at-large director for the remainder of the existing term. It also modifies candidate eligibility by retaining the U.S. citizenship, district residency for two years, and minimum age requirements, while removing the prior requirement that the candidate be a “qualified voter of the election district.”

The bill also changes subdistrict governance and vacancy/appointment processes. It permits an ambulance district, by ordinance with a two-thirds board vote following a public hearing, to abolish the boundaries of existing election subdistricts if the board cannot find a qualified candidate for each subdistrict director position; abolished subdistricts may be eliminated and directors elected at large, with current directors serving as at-large directors for the remainder of their terms. It also allows districts, by two-thirds board vote ordinance, to establish election subdistricts with contiguous, compact, nearly equal population areas and requires board members to be residents of the subdistrict they represent. Vacancy-filling changes include shortening and clarifying the county commission timeline: if the board cannot agree on filling vacancies, the county commission must fill vacancies by appointment of qualified persons within thirty calendar days upon receipt of a written request of a majority of remaining board members or the ambulance service administrator (rather than the prior “within sixty days”/different trigger language).

For annexation and consolidation, the bill adjusts the election/order and consolidation workflow. Annexation approval triggers a county commission order declaring annexation within thirty days of certification of election results. For consolidation, the bill adds/clarifies an explicit consolidation plan content and process: consolidation petitions/resolutions must include a consolidation plan outlining legal description and tax levy of the proposed consolidated district, lists of property/assets and outstanding bonds/debts and current tax levies for each district, designation of who maintains ambulance service (with a presumption that the largest operating-budget district assumes responsibility), the proposed number of board members and initial directors drawn from existing boards (at least one from each district), and a consolidation timeline not exceeding 180 days (modifiable for good cause). It also adds notice/objection procedures: districts must post and publish notice of intent (including newspaper publication once per week for two consecutive weeks) and hold a joint public hearing within set timing; objections may be filed within thirty days after the public hearing by a specified voter-signature threshold (five percent of votes cast for governor in the district in the most recent gubernatorial election), after which county commissions submit the question to voters if eligibility thresholds are met. If consolidation is approved by a majority, commissioners order consolidation pursuant to the plan and appoint directors specified in the plan; the bill also imposes tax limitations tied to the ballot and requires that consolidated districts not impose property or sales taxes exceeding the lowest existing rates among consolidating districts without additional voter approval language.

Separately, the bill establishes the “Critical Incident Stress Management Program” in the Department of Public Safety (Section 590.192). The program must provide services to peace officers and first responders dealing with stress and potential psychological trauma from critical incidents or emotionally difficult events, including consultation, risk assessment, education, intervention, and crisis intervention. It requires all peace officers and first responders to meet with a program service provider once every three to five years for a mental health check-in OR to participate in a department-established behavioral health/mental health program meeting the same requirements (with the provider required to notify the officer’s/first responder’s commanding officer or director/supervisor upon completion). It creates confidentiality/protective privileges for information disclosed during services, limiting admissibility/use in criminal, administrative, or civil proceedings unless harm-prevention necessity, written consent, or mandatory reporting disclosure applies.

Finally, the bill creates a dedicated “988 Public Safety Fund” in the state treasury funded by general assembly appropriations. The fund’s money may be used solely by the Department of Public Safety for the critical incident stress management services described in the program (and any investment interest/earnings must be credited to the fund). The bill also includes rulesmaking authorities and nonseverability language tied to compliance with rulemaking review requirements, plus a provision that remaining funds do not revert to the general revenue fund at biennium end.

AT A GLANCE

This bill requires New Jersey’s Department of Health, through the Office of Emergency Medical Services, to develop, maintain, review, and publish a comprehensive Statewide EMS Plan.

FULL SUMMARY

The bill requires New Jersey’s Department of Health (DOH), specifically the Office of Emergency Medical Services, to develop and maintain a comprehensive Statewide Emergency Medical Services (EMS) Plan to support a comprehensive, coordinated EMS system across the State.

The Office must create the plan with short- and long-term goals and objectives, may incorporate regional EMS plans, and—if regional plans are used—requires they be jointly developed by county boards of health in each region (in consultation with local boards of health as needed) and approved by the Office to become part of the Statewide plan. The Office must review and update the Statewide plan triennially and make changes as necessary to improve effectiveness and efficiency, and must publish the plan on the department’s Internet website.

In developing and updating the plan, the Office must, at minimum: inventory EMS resources; assess the current effectiveness of the EMS system; determine needed changes to improve access by region and population; develop EMS performance metrics, a schedule to achieve them, monitoring/evaluation methods, and cost estimates; and work with medical organizations, hospitals, and other public and private agencies to develop approaches to obtain grant or other funding to support EMS programs.

The plan must include specified operational and program components, including: improving delivery outcomes and reducing time to definitive treatment; increasing access to high-quality EMS statewide; promoting continuing improvement across transportation modes, communications, hospital emergency departments and other facilities, provider training/service delivery, and consumer education; ensuring system and scene-to-in-hospital performance improvement; expanding EMS education and training with emphasis on underserved regions; maintaining trauma center/stroke center/specialty center designation using a national evaluation system; maintaining a comprehensive patient care data collection and performance improvement system incorporating data reported under P.L.2017, c.116 (C.26:2K-67); maintaining processes for specialty-center designation/verification data and reports with limits on treating certain records as government records under specified public-records laws; establishing crisis intervention and peer support services with specified accreditation standards (including clinical leadership qualifications and at least five years of relevant experience); coordinating EMS-for-Children and the State trauma medical director to revise related plans/protocols to conform to the Statewide plan; supporting health/medical emergency response teams for mass casualty/disaster situations; improving EMS dispatching (including training and accrediting 911 dispatch centers and establishing/maintaining public safety answering points); and identifying/broadcasting best practices for managing providers and improving response times.

The bill takes effect 180 days after enactment.

AT A GLANCE

This bill establishes a 2026–2027 targeted inflationary increase of 2.7% effective April 1, 2026, for eligible reimbursable costs and contracts under specified OMH and related programs.

FULL SUMMARY

The bill enacts the major components necessary to implement the 2026–2027 New York State health and mental hygiene budget, structured into Parts A through BB, with each Part specifying its own effective date (and a general effective date rule in the act’s opening provisions).

Across Parts A through BB, the bill principally extends or updates numerous existing health/Medicaid and related program provisions (often by changing expiration dates), and it also revises substantive rules in several policy areas. Key changes include: extending Department of Health Medicaid expenditure assessment and various pool-related assessment/distribution authorities for later dates (notably into 2027–2029 in multiple places); extending effectiveness of multiple previously enacted provider payment/reimbursement and pool provisions tied to statewide funding mechanisms; and extending and adjusting certain behavioral health “government rate” structures.

Several Parts implement targeted financial adjustments and program funding: Part P establishes a “2026–2027 targeted inflationary increase” (2.7%) effective April 1, 2026, to be applied to eligible reimbursable costs/contract amounts for enumerated OMH/OPWDD/OASAS/OTDA/OCFS/SOFA programs, with conditions restricting other new targeted inflation or cost-of-living adjustments and requiring local providers/units to certify that funds support recruitment/retention of specified support/direct care/clinical/non-executive staff before executive-level compensation increases. Other Parts adjust or extend hospital/long-term care reimbursement mechanisms and pool allocations, including specified statewide funding caps/amounts and timeframes.

The bill also makes targeted substantive regulatory-policy revisions beyond expiration/extensions. These include: Part G revising automated external defibrillator (AED) public access defibrillation provider requirements—changing definitions (e.g., AED device description to focus on charging and delivering defibrillation), replacing prior collaborative-agreement language with department-authorized operation via regulation, adding/expanding training, registration, maintenance/testing, usage reporting routing (including to EMS or public safety answering point), de-identified reporting to the department, and post/signage requirements; Part R changing terminology and oversight for substance-related and addictive disorder services parity within the insurance law (including parity reporting, coverage protections, utilization review standards, and insurer/provider directory requirements); Part F/BB making technical and program-extension changes (including defined funding/account and administrative dispute-resolution timing/structure for emergency services/surprise bills); and Parts M and O adjusting Medicaid/insurance rules for certain eligibility/covered services and fee/rate increase mechanisms for specific program categories and timeframes.

AT A GLANCE

This bill requires New York 3D printer sellers and deliverers to equip their printers with blocking technology and authorizes the Attorney General to license qualifying entities to enforce related restrictions.

FULL SUMMARY

The bill makes multiple changes across New York law as components of the 2026–2027 state budget bill, including: (1) extending the effectiveness of certain Guard recruitment/retention incentives (Part A) and adjusting related expiration timelines; (2) extending the suspension period for certain tax law deposits into the State Emergency Services Revolving Loan Fund funded through the public safety communications surcharge (Part B); (3) expanding New York’s three-dimensional (3D) printing and firearm-related restrictions by adding new penal definitions and offenses relating to 3D-printed guns and “pistol converters,” creating firearm-prevention technology requirements for 3D printers through new Executive Law and General Business Law provisions, and setting rulemaking, working-group, and enforcement mechanisms (Parts C); and (4) creating a comprehensive drone regulatory regime (new Penal Law Article 280 plus related Executive Law authority for drone mitigation, registry, and enforcement policies) (Part D).

On firearm/3D printing technology, the bill defines key terms in Penal Law for 3D printing and firearm manufacturing code, strengthens prohibitions on manufacturing/selling/transporting “convertible pistols” and related devices, and adds new requirements that 3D printers sold or delivered in New York be equipped with “blocking technology.” The bill also authorizes a working group and directs a state division to promulgate performance-standard rules for blocking technology and to create/maintain a library of firearms blueprint and illegal parts files, with safeguards against misuse; it prohibits misuse or publication of library contents. The bill establishes civil and enforcement pathways, including injunctive relief, civil penalties for gun industry members found to have violated the 3D printer restrictions, and a limited licensing/authorization process via the Attorney General for certain entities holding both state gunsmith licensing and a federal firearms license (Parts C and Subparts therein).

On drones, the bill establishes Penal Law Article 280 (“Offenses Relating to Unlawful Use of a Drone”) defining “drone,” “nefarious manner,” and “prohibited space,” creating a class A misdemeanor for unlawful drone operation (including operation in prohibited space without express prior approval). It provides exceptions for certain toy/recreational drones and for drones operated for specified lawful/commercial/educational/public-safety purposes subject to risk thresholds. It also amends the Executive Law to authorize police/peace officers to use mitigation measures against credible threats posed by drones, emphasizes least-destructive measures, restricts use of kinetic measures to when non-kinetic measures fail or would reasonably be expected to fail, requires training and reporting, and requires rulemaking and establishment of a “New York state blue list” of vetted vendors for compliant drone mitigation technology (Part D).

Beyond drones and 3D printing, the bill includes several other major policy changes: it increases and refines workers’ compensation administration by extending dedicated workers’ compensation fraud unit funding and adding expanded annual reporting requirements, modifies and modernizes the authorized-provider framework for workers’ compensation medical care (including “authorized provider” terminology and provider compliance obligations), and repeals specified workers’ compensation provider authorization subdivisions while adding an exclusion list mechanism and adding new enforcement tools and penalties (Parts W and X). It amends criminal procedure regarding temporary orders of protection (Part H), reforms the insurance law by prohibiting use of certain factors (employment, education, homeownership, zip code) for private passenger auto rate setting and replaces a flexible-rating framework (Parts JJ and II), creates new ethics-and-lobbying training and late-fee authority (Part U), adds “critical incident paid leave” obligations for State Police members (Part AA), updates procurement thresholds in state finance/economic development/education law to higher discretionary levels (Part Y), extends alcohol licensing-related provisions and modifies liquor wholesaler fee prohibitions on retailers (Parts O and P/C), creates “Local Cops, Local Crimes Act” restrictions on municipal immigration enforcement arrangements and related immigration detention facility approvals (Part LL), enacts a “New York state Bivens act” providing a state damages action for deprivation of federal constitutional rights by government officials under color of law (Part KK/Bivens Subpart), adds “Sensitive Location Protection Act” protections limiting immigration enforcement access at sensitive locations absent specific legal process (Part E), and adds a law-enforcement face-coverings law requiring visible identification for interaction with the public while restricting mask use (Part F). The bill also modifies Orange County industrial development agency oversight by extending/expanding monitor authority and compliance procedures, including conflict-of-interest controls, document-sharing timelines, and enhanced review powers (Part MM). Several provisions specify targeted effective dates and expiration/repeal dates within Parts A–OO; for example, the Guard incentive expiration is extended to September 1, 2031 (Part A), and multiple other parts use delayed effect, sunset/repeal, or Part-specific effective dates where explicitly stated.

AT A GLANCE

This bill requires municipal fire departments to notify the Department of Emergency Services and Public Protection within ten business days after appointing a new or interim fire chief, using a commissioner-prescribed form.

FULL SUMMARY

The bill establishes several new or revised requirements for Connecticut’s public safety system, centered on (1) reporting/oversight related to fire chiefs, (2) updates to evidentiary rules governing chemical test results in certain criminal prosecutions, (3) DNA collection compliance and reporting tied to “lawfully owed DNA,” (4) firearms, pyrotechnics, security officer, and bail-bond permitting/licensing rules, and (5) civil preparedness planning that incorporates “targeted violence and terrorism prevention.” It also creates/adjusts governance and operational provisions for state police and other departmental functions, including expanding elements of civil preparedness planning and reauthorizing a police training center.

Key statutory changes begin with a new requirement effective October 1, 2026: municipal fire departments (as defined) must notify the Department of Emergency Services and Public Protection within ten business days after appointing a new or interim fire chief, using a commissioner-prescribed form (and the commissioner may adopt implementing regulations). The bill then replaces evidentiary admissibility provisions (effective October 1, 2026) in multiple statutes governing chemical tests for alcohol/drugs, changing conditions for admissibility by updating timing requirements and the types of qualified personnel/devices/equipment, and preserving rebuttable presumptions about blood alcohol ratios when additional-test conditions are met.

For DNA compliance, the bill replaces the framework governing DNA collection from certain offenders (effective October 1, 2026), adjusting timing requirements for when DNA samples must be taken and when referrals for criminal proceedings occur upon refusal. It also creates a new study by the Commissioner of Emergency Services and Public Protection on “lawfully owed DNA,” including an audit of current practices, a census of individuals owed but not collected, barriers/timelines/coordination, agency responsibilities, and recommendations for tracking/reporting; the commissioner must submit findings and recommendations to legislative committees by July 1, 2027. For risk protection orders (effective October 1, 2026), it revises court hearing procedure and state burden at hearings, clarifies termination/remedies and notice to the Department of Mental Health and Addiction Services, changes firearm/ammunition handling and transfer/destruction timelines (including extending the period before destruction from one year to two years after the relevant hearing), and requires removal/cancellation of associated NICS records upon termination.

The bill also makes targeted regulatory and licensing revisions: it updates supervised fireworks/pyrotechnics permitting and competency certificate provisions (effective October 1, 2026), including fees, renewal intervals, non-transferability, and commissioner suspension/revocation authority; it expands security officer licensing requirements by requiring pre-licensure training and licensing processes, authorizing limited work while a license application is pending under specified conditions, clarifying instructor approval requirements and violations penalties, and adding restrictions on where pending applicants may work. For professional bondsmen/bail enforcement agents, it creates and revises a special permit regime (effective October 1, 2026) allowing carriage of firearms/electronic defense weapons only after approved training, imposes a permit fee/renewal structure, requires annual safety refresher completion, and conditions permit validity on the status of underlying state firearm permits. In civil preparedness, effective July 1, 2026, it adds a statutory definition of “targeted violence,” requires civil preparedness planning to include targeted violence and terrorism prevention (for plans prepared on/after July 1, 2027), updates town/city emergency plan submission and approval workflows, adds shoreline LNG-related emergency planning, and authorizes local plan content options including livestock/pet evacuation and targeted violence/terrorism prevention provisions. Finally, it establishes a police training center through the Department of Emergency Services and Public Protection, located at an institution within the Connecticut State Colleges and Universities, and requires a memorandum of understanding by January 1, 2027.

The bill changes Florida’s inmate welfare trust fund rules for contractor-operated correctional facilities by (1) requiring that “maintenance and repair deduction fees” from contractor-operated correctional facilities be deposited in the Contractor-Operated Institutions Inmate Welfare Trust Fund, and (2) specifying that trust fund money may be used only for inmate reintegration programs and environmental health upgrades (including fixed capital outlay for repair and maintenance that improves environmental conditions), and only as expended pursuant to legislative appropriation. It also reenacts the trust fund statute in § 944.72(1) to incorporate the related change in the § 945.215 reference, and sets an effective date of July 1, 2026.

AT A GLANCE

This bill authorizes Louisiana Medicaid to reimburse ambulance providers for treatment-in-place services—assessment and treatment on scene without transport—when providers follow medical direction and established protocols.

FULL SUMMARY

The bill establishes a new Louisiana statute, R.S. 40:1132, creating a Medicaid “treatment-in-place services” framework for ambulance providers responding to 911 calls where the patient is assessed/treated on scene without being transported.

It defines key terms including “911 call,” “ambulance provider” (excluding air ambulance providers), “beneficiary” (Medicaid-eligible recipient), “medical assistance program” (Louisiana’s Medicaid program), “qualified medical practitioner” (licensed physician, nurse practitioner, or physician’s assistant), and “treatment-in-place service” (an encounter with assessment/treatment on scene without transport).

Under the new program, ambulance providers may initiate and facilitate treatment-in-place on site to Medicaid beneficiaries without transport, and may use audio/video telecommunication for real-time communication with a qualified medical practitioner. However, audio/video telecommunication with the qualified practitioner is not required for reimbursement. Treatment-in-place services must be provided in accordance with the ambulance provider’s medical direction and established protocols, and any EMS practitioner assessment/services must be consistent with the practitioner’s scope of practice. Medicaid coverage is required for these services, paid at the associated basic life support, emergency base rate, or advanced life support, Level 1 emergency base rate on the Medicaid fee schedule, depending on the level of response and services rendered.

The bill requires the Louisiana Department of Health to promulgate rules and regulations necessary to implement these provisions.

AT A GLANCE

This bill requires courts to reclassify domestic-violence offenses as higher-degree felonies or life felonies when the defendant has a prior domestic violence conviction at the time of the offense.

FULL SUMMARY

The bill creates new domestic-violence penalty enhancement rules and electronic monitoring pilot programs, and modifies Florida’s domestic violence injunction and verification/notification framework. It adds definitions for “military protective order,” creates a new statutory framework for enhanced penalties for domestic violence offenses with prior domestic violence convictions, establishes electronic monitoring pilot programs in specific jurisdictions (Pinellas County for misdemeanor domestic violence/injunction violations and the Sixth Judicial Circuit for felony domestic violence/injunction violations), and updates procedures and systems involving domestic violence injunction petitions, statewide verification of injunctions, law enforcement notification for violations of military protective orders, and relocation assistance amounts.

For enhanced penalties, the bill adds “conviction” and “military protective order” definitions and creates new section 741.2801. It requires reclassifying the penalty for a domestic violence crime committed by a person who has a prior domestic violence conviction at the time of the offense, shifting misdemeanor and felony levels up through life felony. It also provides that, for sentencing under chapter 921 and incentive gain-time eligibility under chapter 944, the reclassified offense is ranked without regard to the penalty enhancement in the new section; a specific exception is provided (the enhancement does not apply to a conviction for felony battery under s. 784.03(2)).

The bill creates two electronic monitoring pilot programs. Section 741.2905 establishes a Pinellas County pilot from July 1, 2026 to June 30, 2028 for qualifying persons at least 18 years old found guilty of/pleading to misdemeanor domestic violence, and/or violations of domestic violence injunctions, and/or violations of sexual/dating violence injunctions, when a no-contact order is entered as a probation condition; the court may order electronic monitoring, and must order it if clear and convincing evidence shows the defendant poses a threat of violence/physical harm (considering prior injunction violations for specified categories). The Pinellas pilot requires the sheriff (with consultation with specified officials) to design and implement the program, administer supervision for all court orders, conduct required participant meetings, impose costs on the monitored person (with discretionary reductions/waivers), prohibit substituting electronic monitoring for other mandatory probation conditions, and establish a petition procedure to remove an order upon establishing permanent residence in another state; the sheriff must submit evaluation reports to the Legislature by specified dates, and orders must terminate by June 30, 2028. Section 741.2906 creates a parallel pilot in the Sixth Judicial Circuit from July 1, 2026 to June 30, 2028 for qualifying felony domestic violence and injunction violations, administered by the Department of Corrections (including required participant meetings, costs under s. 948.09, limits on substituting monitoring for other mandatory probation conditions, and a department procedure for petitioning to remove monitoring); the Department of Corrections must also deliver evaluation reports on specified dates, and monitoring orders terminate by the pilot’s repeal date. Both pilot sections are repealed July 1, 2028.

Finally, the bill amends Florida’s domestic violence injunction statutes and related reporting/systems. It revises the petition information (including the required petition form and the factors a judge considers when determining reasonable cause of imminent danger), expands statewide verification system creation within the Department of Law Enforcement for domestic, dating, sexual, and repeat violence injunctions, and amends criminal penalties for injunction violations: a person with “one or more prior convictions” for domestic violence or injunction/foreign protection order violations who later violates an injunction/foreign protection order against the same victim commits a third-degree felony. It also adds a law enforcement notification duty: if an officer has probable cause to believe a person violated subsection (4) and determines a military protective order was entered in NCIC and the officer has probable cause of further violation, the officer or employing agency must notify the issuing agency. Additionally, it amends relocation assistance for victims of domestic violence by changing the maximum award amounts (one-time payment and lifetime maximum) and sets an effective date of July 1, 2026.

AT A GLANCE

This bill requires the POST Commission to set minimum basic peace-officer training at at least 600 hours for licensure, with specified additional domestic-violence, anti–racial profiling, and crisis-response content.

FULL SUMMARY

The bill repeals Missouri statutory sections 590.040 and 590.050 and replaces them with updated requirements governing (1) basic peace-officer training hours and (2) continuing education requirements, and it enacts a new section (590.275) establishing a statewide mental-health-related emergency response “co-response” framework.

It requires the POST Commission to set minimum basic training for licensure as a peace officer at no less than 600 hours (with specific exceptions), while also mandating additional basic-training content: at least 30 hours on investigating and managing domestic and family violence for every peace officer (with curriculum developed in consultation with specified health and victim-services stakeholders), at least 6 hours on prohibitions against racial profiling for officers first licensed on/after August 28, 2027 (including 2 hours each on racial profiling, implicit bias, and de-escalation), and at least 6 hours on behavior-health crisis response for officers first licensed on/after August 28, 2028. It also changes continuing education by requiring peace officers to complete, within a three-year reporting period, (a) 3 hours of training on prohibiting racial profiling for those who make traffic stops, and (b) 3 hours on behavior-health crisis response for those who provide emergency response; it also retains the director’s authority to license continuing education providers, and reimbursement limitations tied to commissioned/employed law enforcement personnel.

The new section 590.275 defines “behavioral health professional,” “co-response,” “law enforcement agency,” and “peace officer,” and requires (except where an immediate, significant risk of violence is indicated) that co-response teams (a behavioral health professional plus a peace officer) respond to “mental-health related” emergency dispatch calls, with a procedure allowing law enforcement to initially stage/secure the scene and then dispatch the team if the incident remains mental-health-related. It authorizes use of mobile crisis teams staffed by behavioral health professionals without law enforcement presence as primary responders for lower-acuity calls. It directs the Missouri 911 service board (with the Department of Mental Health and local dispatchers) to develop uniform dispatch triage protocols and requires dispatchers to receive at least 8 hours of training in crisis identification and safe triage.

To support implementation, the bill requires peace officers providing emergency response to complete at least 40 hours of standardized behavioral-health crisis training within 12 months of assignment, with annual refresher training and specified curriculum topics (recognition/decompensation, suicide-risk indicators and referral, verbal de-escalation/noncoercive communication, trauma-informed and culturally competent approaches, legal framework for involuntary transport and patient rights, and scenario-based/joint training). It creates the “Behavioral Health Co-Responder Grant Fund” in the state treasury (dedicated, nonreverting), funded by appropriations and gifts/grants, to support hiring/certifying behavioral health professionals, training/joint simulation, data systems, rural/underserved startup stipends, startup grants for jurisdictions unable to staff full teams immediately, and regional co-response hubs. It requires law enforcement agencies to collect standardized data on mental-health-related dispatches (including presence/absence of a behavioral health professional and incident outcomes such as diversion, transport, arrest, use of force, injuries, and demographics), mandates a statewide report by the Department of Public Safety to the General Assembly no later than January 1, 2028 and annually thereafter, and requires the General Assembly to contract for an independent evaluation no later than January 1, 2030. It allows the Department of Public Safety (consulting with the Department of Mental Health) to promulgate rules, with a nonseverability clause tied to rule review under Chapter 536 and invalidation of rules after August 28, 2026 if chapter 536 powers are held unconstitutional.

AT A GLANCE

This bill establishes a Class C misdemeanor offense for any person who knowingly and willfully violates an oral warning and approaches or remains within 25 feet of a first responder while intending to impede, threaten, or harass.

FULL SUMMARY

The bill establishes a new Missouri criminal offense, “impeding, threatening, or harassing a first responder,” by adding section 575.356 to Chapter 575 of the Revised Statutes of Missouri.

Under the new section, a person commits the offense if, after receiving an oral warning not to approach a first responder from an individual the person knows or reasonably should know is a first responder (while the first responder is engaged in the lawful performance of duties), the person knowingly and willfully violates the warning and approaches or remains within 25 feet of the first responder. The prohibited conduct must be done with the intent to: (1) impede or interfere with the first responder’s ability to perform duties; (2) threaten the first responder with physical harm; or (3) harass the first responder.

The offense is classified as a Class C misdemeanor. The section also defines key terms: “first responder” includes specified law enforcement officers, parole or probation officers, firefighters, and emergency medical care providers; “emergency medical care provider” includes enumerated medical personnel and certain hospital employees/agents/volunteers authorized to perform duties associated with hospital emergency department care or security; and “harass” requires willful conduct that is directed at a first responder, intentionally causes substantial emotional distress, and serves no legitimate purpose.

The proposed legislation introduces a new section to the Revised Statutes of Missouri that establishes the offense of impeding, threatening, or harassing first responders. This offense occurs when an individual knowingly approaches or remains within fifty feet of a first responder after receiving a warning, with the intent to interfere with their duties or cause them harm.

The legislation aims to provide legal protections for first responders, including law enforcement officers, firefighters, and emergency medical care providers, against harassment and interference while they perform their essential duties. By addressing these behaviors, the bill seeks to enhance the safety and effectiveness of emergency services and public safety operations.

While the legislation does not outline specific monetary impacts or implementation dates, it is expected to influence industries related to emergency services and law enforcement by reinforcing the importance of protecting first responders in their line of work.

The document outlines significant changes to the regulation of community paramedic services in Missouri. These changes include the repeal of an existing section and the introduction of new provisions that establish eligibility criteria for certification and define community paramedic services.

The new regulations will impact various business industries, including emergency medical services, healthcare institutions, and insurance companies, as they will need to adapt to the updated framework governing community paramedic services. Ambulance services are now required to have a memorandum of understanding when providing services outside their designated areas, which may lead to increased operational costs and administrative burdens.

Community paramedic services must be delivered by licensed paramedics certified by the department, and these services will need to be documented in patient care plans approved by a medical director. Additionally, the department will set regulations for recognizing community paramedic service entities that meet specific standards, which may involve costs related to compliance and training.

The changes emphasize the importance of coordination between ambulance services and emergency medical response agencies to prevent service duplication and ensure effective patient care. Overall, these regulatory updates aim to enhance the quality and efficiency of community paramedic services in Missouri.

AT A GLANCE

This bill requires 9-1-1 PSAPs to follow Community Emergency Services and Support Act protocols to identify and route certain behavioral or mental health crisis calls to appropriate behavioral health responders by June 30, 2027.

FULL SUMMARY

The bill amends Illinois’ Crisis and Emergency Response framework to require 9-1-1 public safety answering points (PSAPs) to follow Community Emergency Services and Support Act protocols to identify and route certain behavioral/mental health crisis calls to an appropriate behavioral health response. It also amends the Emergency Telephone System Act to mandate, beginning July 1, 2027, that all PSAPs comply with those Act protocols/processes for identifying behavioral and mental health-related emergencies that do not require a law-enforcement response, including transferring such calls to the statewide behavioral health crisis system when appropriate.

It further strengthens coordination, training, monitoring, and data/reporting for the behavioral health crisis response system. The Community Emergency Services and Support Act is revised to (among other things) align terminology with the Department of Human Services (replacing references to a Division of Mental Health), expand operational requirements for PSAP screening and emergency medical dispatch protocol use when appropriate, require training for PSAP telecommunicators and 9-8-8 crisis counselors/mobile mental health relief providers, and require PSAPs/9-8-8/mobile providers to provide required data to support evaluation, quality improvement, and compliance monitoring. The Emergency Telephone System Act is supplemented with new sections requiring the Statewide 9-1-1 Administrator (a) to monitor PSAP compliance, (b) to consult with the Department of Human Services/behavioral health entities for required data elements and reporting formats, and (c) to adopt rules to implement compliance monitoring.

The bill also amends Illinois Police Law (Civil Administrative Code) and the Illinois Police Training Act to expand and codify training content related to mental health crisis response. Illinois State Police specialized training is updated to require Crisis Intervention Team (CIT) training programs to include community response options under the Community Emergency Services and Support Act. The Illinois Police Training Act changes include explicitly requiring CIT training curricula to cover identifying mental illness, de-escalation, connecting individuals in crisis to treatment, and incorporating community response options under the Act; the Board must also develop/approve standard curricula for certified programs and therapy dog team certification. Additionally, Illinois State Police cadet and officer training requirements are broadened to include “crisis intervention team and mental health awareness,” with an overview of the Community Emergency Services and Support Act, and includes other in-service/cadet training items for mental health and related crisis topics.

Operational governance changes in the Community Emergency Services and Support Act include revised state/prohibited behaviors for when law enforcement may or may not be dispatched for mental/behavioral health care, requirements for mobile mental health relief provider training (including training elements such as de-escalation, community supports, stigma/respectful language, neurodivergent/developmental disability stabilization/connection to services, and the involuntary commitment process), guidance and protocols for inter-agency coordination, and specific system requirements for regional advisory committees and subregional committees. These committees must design and maintain local protocols enabling 9-8-8 coordination with 9-1-1, set maximum response times for 9-8-8 in-person response by type of mental/behavioral health emergency, review capacities/resources for planning and collaboration, and develop plans to support local communities in creating additional mobile mental health relief provider services to expand immediate coverage. The bill provides for Act reports and PSAP compliance oversight, authorizes rulemaking by the Department, and includes a phased implementation timeline for revising and implementing PSAP coordination protocols (with final statewide implementation required by June 30, 2027).

AT A GLANCE

This bill makes it unlawful, after a verbal warning, to knowingly and willfully violate directives not to approach first responders or emergency medical care providers in lawful performance of duty.

FULL SUMMARY

The bill establishes the “Helping Alleviate Lawful Obstruction (HALO) Act” by creating a new South Carolina criminal prohibition aimed at preventing interference with first responders and hospital emergency medical care providers after a verbal warning.

It adds Section 16-3-1092 to Article 11, Chapter 3, Title 16 of the South Carolina Code. The new section defines “Emergency medical care provider” to include registered nurses, physicians, physician assistants, medical directors, and hospital volunteers providing or assisting with medical care in a hospital emergency department (and defines “First Responder” to include law enforcement officers, firefighters, emergency medical technicians, certified EMS workers, and paramedics). After a person receives a verbal warning not to approach from someone the person knows or reasonably should know is a first responder engaged in lawful performance of a legal duty, it becomes unlawful to knowingly and willfully violate the warning with intent to (1) impede or interfere with the first responder’s duty—including obstructing movement, distracting from administering medical care to another, or effectuating a lawful arrest—or (2) offer or attempt to cause physical harm or injury with apparent present ability under circumstances reasonably creating fear of imminent harm or injury.

The new section also allows the first responder, while performing a legal duty, to direct a person to stand a reasonable distance away, capped at 25 feet. For emergency medical care providers, it criminalizes—after a verbal warning not to approach from a person who knows or reasonably should know is an emergency medical care provider providing emergency medical care in the hospital emergency department—approaching or remaining at a distance that would not allow safe, unencumbered treatment of the patient (as determined by the hospital emergency department), with intent to (1) impede or interfere with the provider’s duty (including obstructing movement or distracting from administering care) or (2) offer or attempt to cause physical harm or injury with apparent present ability under circumstances reasonably creating fear of imminent peril.

Violations of Section 16-3-1092 are classified as a misdemeanor, punishable by a fine of up to $500 and imprisonment of up to 30 days. The act takes effect upon approval by the Governor.

AT A GLANCE

This bill requires the newly created Virginia Home Care Council to establish and maintain a central registry of individual providers and operate as the limited public employer for collective bargaining.

FULL SUMMARY

The bill creates a new collective bargaining framework for public employees, establishes a Virginia Home Care Council as a “public employer” for limited bargaining purposes regarding individual home care providers, and sets a strike/termination rule tied to prohibited concerted work stoppages.

Effective July 1, 2027, a Virginia Home Care Council is created within the scope described in Title 32.1 to promote stability of the individual provider workforce. The Council has five members (one permanent member from the relevant Department; two Governor-appointed participant/participant-representative representatives; two Governor-appointed nonprofit representatives). It is required to create and maintain a central registry of individual providers, create a system for participants to identify providers, serve as the public employer for purposes of collective bargaining with individual providers under the new Title 40.1 article, and—if no exclusive bargaining representative exists—provide an employee-organization seeking certification specified private contact information for each provider on file within set timelines, while allowing providers to opt out of disclosure of personal/home contact information. The bill also requires orientation/training for newly hired individual providers (developed in consultation), operates as a communications and data hub for the individual provider workforce, and may enter contracts and employ staff to implement these duties. Individual providers are treated as public employees only for the limited purpose of effectuating the collective bargaining article: the Council is the bargaining “public employer” solely for bargaining scope within its control; providers are not classified as Commonwealth employees for retirement/health benefits and the Commonwealth is not liable for their acts or omissions.

The bill adds a comprehensive new Article 2.2 in Chapter 4 of Title 40.1 establishing definitions, the Public Employee Relations Board, bargaining unit determination, certification/decertification elections, collective bargaining duties, prohibited conduct, board procedures, duty to negotiate in good faith, impasse resolution (mediation and advisory arbitration), and grievance and arbitration/judicial review processes. A Public Employee Relations Board is established within the Department, composed of five members with employer representation, employee-organization representation, and a public chair; initial Governor appointments must occur by October 1, 2026 (subject to General Assembly confirmation), with staggered initial terms. The Board must administer the article, conduct hearings, issue subpoenas, and adopt regulations and rules; it can also issue cease-and-desist and other affirmative remedies for violations. Collective bargaining is structured around “exclusive bargaining representatives,” with bargaining unit determinations by the Board, secret ballot elections, and rules limiting petitions during the term of an agreement (generally one-year bar after certification and decertification timing tied to contract duration).

The bill repeals prior collective bargaining provisions (including repeal effective July 1, 2028 of §§ 32.1-331.04 and 40.1-54.3, and repeal effective January 1, 2030 of Article 2.1 in Chapter 4 of Title 40.1). It amends the prior strike consequence statute (§ 40.1-55) so that employees of Commonwealth/localities/agencies, and individual providers, who strike or willfully refuse duties in concert with two or more others to obstruct/impede/suspend operations are deemed to have terminated employment and become ineligible for public employment for 12 months. For local governments, the new collective bargaining article does not apply until January 1, 2030 (with limited exceptions). The bill includes special procedures for firefighters and emergency medical services providers via a statutory arbitration board process, prohibits public employers from lockouts, and creates rules on funding implementations for agreements (governing body requests for non-state agencies; Governor/Government Assembly requests for state agencies). It also directs regulatory development by the Department of Labor and Industry (by July 1, 2028) and subsequent Board adoption/transfer of those regulations, includes evaluation and phase-in reporting by the Board (findings/recommendations due September 1, 2027), and sets additional higher-education assessment/evaluation duties tied to the enactment’s effective operations.

AT A GLANCE

This bill caps annual prescription-drug cost-sharing for each covered person at $2,000 for health benefit plans entered into, renewed, or amended on or after October 1, 2026.

FULL SUMMARY

The bill establishes multiple state requirements intended to reduce healthcare costs and improve patient protections in North Carolina. It caps patient prescription-drug cost-sharing, limits certain forms of out-of-network charging in non-emergency situations, expands and recasts medical price transparency obligations for hospitals/ambulatory surgical facilities, strengthens hospital/ambulatory surgical facility collections practices tied to charity care eligibility, and adds new “good-faith estimate” and billing limits for shoppable services. It also directs specified state agencies to implement or communicate rulemaking and federal-marketplace updates, and appropriates funds to the Department of Insurance and the Department of Health and Human Services to implement and enforce key Parts of the act.

Prescription drug affordability: the bill adds a new statutory section requiring that for any health benefit plan, annual prescription-drug cost-sharing (including copayments, deductibles, and other out-of-pocket prescription drug expenses) may not exceed $2,000 per covered person. This applies to insurance contracts entered into, renewed, or amended on or after October 1, 2026.

Surprise billing and emergency protection: it changes G.S. 58-3-182 to include a nonemergency in-network payment rule at the facility level—nonemergency care furnished at a facility in the plan’s provider network must be charged at in-network rates, and the plan may not impose out-of-network cost-sharing while the facility is part of the network. It also modifies G.S. 58-3-200(d) by tightening the conditions under which insurers can use out-of-network benefit levels, requiring that contracting providers able to meet the insured’s needs are reasonably available without unreasonable delay, with insurer determination upon notice/request based on the insured’s location and specific medical needs. Separately, starting in 2027 calendar year, emergency ground ambulance services must be treated as part of the essential health benefit package under a referenced federal regulation; the Commissioner of the Department of Insurance must communicate this change to CMS and to all insurers on the federally facilitated marketplace in North Carolina.

Medical debt prevention, price transparency, penalties, and patient right to estimates: the bill creates a new Chapter 131E Article 11C (“Fair Billing and Collections Practices for Hospitals and Ambulatory Surgical Facilities”) and recodes G.S. 131E-91 into G.S. 131E-214.50 within that Article. It prohibits hospitals and ambulatory surgical facilities from referring a patient’s unpaid bill to collections before making an informed decision (based on a screening) that the patient is not eligible for the facility’s charity care/financial assistance, and it bars reporting unpaid bills to credit reporting agencies until the bill is at least 180 days past due. For price transparency, it amends G.S. 131E-214.13 to keep and refine hospital/ambulatory surgical facility quarterly reporting on the most frequently reported inpatient DRGs and adds quarterly reporting on total costs for the 20 most common surgical and 20 most common imaging procedures in outpatient settings, including specified charge components and HIPAA-based limits. It adds statutory requirements for rulemaking, establishes a mandate for the Commission to define at least 10 quality measures, requires providing certain reported information to patients in writing within three business days upon request, and adds an administrative civil penalty regime for noncompliant hospitals/ambulatory surgical facilities (with daily penalties capped at $2,000 and a floor tied to the CEO’s annual salary). Finally, the bill adds a new patient right to a good-faith estimate (G.S. 131E-214.52) for “shoppable services,” defining terms (including “shoppable service” as a non-urgent service schedulable in advance and requiring at least 300 such services in total) and requiring that upon request the facility provide an itemized, plain-language estimate at least three business days before scheduling, including relevant DRG/CPT/HCPCS codes. It also caps the final bill for the shoppable service at no more than 5% above the provided good-faith estimate, and directs the Department to adopt implementing rules. Appropriations include $2.5 million recurring (effective July 1, 2026) to the Department of Insurance for Parts I and II and $2.5 million recurring (effective July 1, 2026) to DHHS for Parts III and IV; most Parts have delayed applicability tied to rule effectiveness (notably January 1, 2027 for the shoppable estimate provisions and related patient-right rules).

The bill requires the Commissioner of Administrative Services, in consultation with the Commissioner of Emergency Services and Public Protection and the Labor Commissioner, to conduct a statewide study on whether the state should establish “essential worker” and/or “first responder” job classifications.

The study must: (1) assess the effect, if any, that such classifications would have on jobs that would fall within them, including potential impacts on employee benefits and applicable job requirements; (2) develop definitions for the classifications; and (3) determine whether telecommunicators (as defined in Conn. Gen. Stat. § 28-30) and employees of public works departments (as defined in Conn. Gen. Stat. § 31-57s) should be classified as essential workers or first responders.

By no later than January 1, 2027, the Commissioner of Administrative Services must submit a report on the study’s results to the joint standing committee of the General Assembly having cognizance of matters relating to public safety and security. The bill takes effect “from passage.”

Fiscal impact materials indicate no state or municipal fiscal impact.

AT A GLANCE

This bill prioritizes reimbursement funding for initial EMT certification, EMT recertification classes, and advisory-council continuing education, and it requires volunteer EMTs to meet at least 12 service calls per year (or 150 duty hours) for good-standing.

FULL SUMMARY

The bill amends the statutory scheme for distributing reimbursements from New Jersey’s “Emergency Medical Technician Training Fund” by changing eligibility and related definitions tied to being a “volunteer emergency medical technician.” It modifies section 4 of P.L.1992, c.143 (C.26:2K-57), including the categories of training/retraining that receive reimbursement priority and the performance threshold required for maintaining “volunteer in good standing” status during the initial three-year certification period.

With respect to reimbursement priority, the bill replaces the prior ordering that separately referenced “initial emergency medical technician certification and … refresher recertification classes” with an order prioritizing (1) initial EMT certification, (2) EMT recertification classes (including a consolidated reference to “emergency medical technician … recertification classes,” rather than a separate “refresher” term), and (3) select continuing education classes recommended by the advisory council.

For “volunteer EMT” good-standing requirements, the bill changes the minimum service threshold during the initial three-year certification period from “at least one service call per month” to “at least 12 service calls per year,” while also preserving the alternative threshold of “150 duty hours per year.” It also revises definitions used in the reimbursement framework: (a) it expands “Public or private institution of higher education” to include institutions located “in the United States” (rather than limited to New Jersey), and (b) it clarifies the meaning of “volunteer emergency medical technician” by defining an EMT who provides basic life support without receiving compensation in the form of hourly wage or salary provided for or in connection with basic life support services, and it specifies that a length-of-service award under a length-of-service award program is not treated as financial remuneration.

The bill provides that it takes effect immediately.

AT A GLANCE

This bill amends the District of Columbia’s Policemen and Firemen’s Retirement and Disability Act to allow covered federal public safety personnel to be retired at age 60 only at the department head’s discretion.

FULL SUMMARY

The bill temporarily changes the District of Columbia’s Policemen and Firemen’s Retirement and Disability Act by modifying the retirement trigger language in Section 12(h)(2) related to members of the United States Secret Service Uniformed Division and the United States Park Police force (and the United States Secret Service Division). It alters the statutory age-based retirement provision from one that previously mandated retirement at a specified age to language that instead places retirement at that age within the head of the department’s discretion.

Specifically, the amended Section 12(h)(2) provides that, upon reaching age 60, covered federal public safety personnel subject to the section shall be retired from the service only “in the discretion of the head of the member’s department,” while still providing that such retirees are entitled to receive an annuity computed under paragraph (1) of the applicable subsection. The bill is expressly framed as a “temporary” amendment intended to remove mandatory retirement age requirements for first responders.

The Council adopts a fiscal impact statement by referencing the Budget Director’s fiscal impact statement as required under the General Legislative Procedures Act.

The act takes effect after Mayor approval (or Council override of a veto) and a 30-day congressional review period, and it expires after 225 days from the date it takes effect.

AT A GLANCE

This bill requires covered Hawaii first-responder employing agencies to make at least one hour of dementia-specific training available at no cost and begin offering it by July 1, 2027.

FULL SUMMARY

The bill establishes a statewide dementia-specific training program for first responders in Hawaii, focused on Alzheimer’s disease and related dementias. It requires designated state and county officials to make at least one hour of dementia-specific training available at no cost to covered personnel and to begin offering the training by July 1, 2027; it also authorizes annual completion of at least one hour of such training for all covered personnel. The training obligation is structured through multiple Hawaii Revised Statutes sections covering (1) agency personnel within the Hawaii Department of Human Services (via Chapter 127A), (2) county and state fire fire first responders (Chapter 132), (3) law enforcement officers (Chapter 139), (4) emergency medical services personnel and first responder personnel (Chapter 321), while also requiring a statewide curriculum review/recommendation process by the Executive Office on Aging (Chapter 349) to ensure consistency and best-practice alignment.

The bill directs the Executive Office on Aging to review and recommend a list of dementia-specific training curricula for first-responder employing agencies to ensure statewide consistency, expressly requiring that recommended curricula address recognition of and response to persons with Alzheimer’s and related dementias. It specifies that the Executive Office on Aging must seek low- to no-cost training options, identify whether each has an associated fee, and that all recommended curricula include at least one hour of instruction time. The curricula may include strategies for recognizing key signs; assessing cognition; interacting effectively (including during disaster response); identifying and intervening in situations involving risk of abuse or neglect; and best practices to ensure safe return.

The bill also adds substantive liability-protection language for personnel and departments: dementia-specific training provided under the new sections must not create or impose civil or criminal liability upon the covered personnel, agencies, or departments. Definitions are set for “dementia-specific training” as training curricula recommended by the Executive Office on Aging for first responder training under the new curriculum-review statute, and (for the fire provision) it defines “fire first responder” as first responder personnel employed by state and county fire protection agencies and departments.

The bill repeals Section 321-229.2, which previously authorized/allowed employers of first responder personnel to obtain dementia training that may be funded by private contributions from relevant non-profit organizations, and allowed coordination and use of existing training resources. The repeal replaces the prior private-contribution approach with the new statewide curriculum list and no-cost training availability mandates and expands/clarifies coverage across different first-responder categories (agency personnel, fire first responders, law enforcement officers, and EMS/first responder personnel), with a uniform curriculum-content framework and a July 1, 2027 start requirement.

AT A GLANCE

This bill requires MaineCare and emergency medical services insurers to reimburse ambulance services for emergency transport, on-scene treatment without transport, approved community paramedicine, and clinically appropriate alternate-destination transport.

FULL SUMMARY

The bill establishes expanded reimbursement obligations for ambulance/EMS services under (1) MaineCare (the Department of Health and Human Services) and (2) certain coverage provided by insurance carriers for emergency medical services, to cover not only emergency transport to a hospital but also on-scene treatment, community paramedicine services, and transport to clinically appropriate alternate destinations.

For MaineCare, the bill enacts a new statutory provision directing the department to provide reimbursement for ambulance services that include: (A) emergency transport to a hospital; (B) treatment provided on the scene in response to an emergency call, regardless of whether transport occurs; (C) care provided by an EMS provider through community paramedicine as defined in the EMS statute, limited to approved community paramedicine services; and (D) transport to an alternate destination—defined as a facility other than a hospital emergency department that is clinically appropriate for the patient’s condition (including examples such as urgent care centers, federally qualified health centers, primary care practices, behavioral health crisis centers, and substance use treatment facilities), as permitted by the Department of Defense, Veterans and Emergency Management and Maine Emergency Medical Services.

For insurance carriers, the bill further provides that carriers providing coverage for emergency medical services must reimburse for ambulance services using the same expanded categories (emergency transport, on-scene treatment regardless of transport, community paramedicine services through approved programs, and alternate destination transport with the same definition and facility examples). It also removes (repeals) a prior “first blocked paragraph” in an existing carrier reimbursement section, then creates a new “Required reimbursement for ambulance services” subsection containing the expanded reimbursement categories.

The bill requires rulemaking to implement the new reimbursement standards: the Department of Health and Human Services, in consultation with the Department of Defense, Veterans and Emergency Management and Maine Emergency Medical Services, must adopt rules establishing clinical and documentation standards for on-scene treatment, community paramedicine care, and alternate destination transport; establishing billing and coding procedures; and establishing quality assurance and patient safety requirements. Rules adopted under these provisions are designated as routine technical rules.

This legislative document introduces changes to the reimbursement policies for ambulance services and nontransporting emergency medical services in Maine, primarily affecting the healthcare and emergency medical services industries. The adjustments aim to ensure fair reimbursement practices and enhance the sustainability of emergency medical services in the state.

For in-network providers, reimbursement will be set at the provider's rate or 200% of the Medicare rate, whichever is lower. Out-of-network providers will receive reimbursement at their rate or 180% of the Medicare rate, also whichever is lower. Additionally, providers in rural or super rural areas may qualify for extra reimbursement based on Medicare criteria, while those with charges below 200% of the Medicare rate are limited to a maximum annual increase of 5%.

The changes regarding reimbursement rates for nontransporting emergency medical service providers will take effect on October 1, 2025. Meanwhile, provisions related to prior authorization for ground ambulance services and nontransporting emergency medical services will be effective immediately upon enactment.

The resolution designates the week of May 17 through May 23, 2026, as “Emergency Medical Services Week” in Pennsylvania. It calls attention to the importance of emergency medical services, including the lifesaving care provided by emergency responders and related out-of-hospital providers, and recognizes the specialized training and continuing education undertaken by those teams.

AT A GLANCE

This bill requires insurers to pay out-of-network emergency ambulance providers directly and promptly at the covered rate, notwithstanding policy limits on assigning benefits, and bars providers from charging insureds beyond required cost-sharing.

FULL SUMMARY

The bill creates new patient-protection rules for emergency ambulance services by adding a new Section 31 to Massachusetts General Laws chapter 176O (“Protection from Surprise Billing for Emergency Ambulance Services”). It defines covered terms (including “ambulance service provider,” “emergency ambulance service,” and related insurance concepts) and directs that, for emergency ambulance services provided by an out-of-network provider, a carrier must pay the ambulance provider directly and promptly at the covered rate, even if the insured’s policy purports to prohibit assignment of benefits. The bill also provides that a provider may sue a nonpaying carrier under chapter 176D for failure to make required payments.

The bill sets payment rates and municipal reporting requirements. It requires emergency ambulance payments to be at rates established by the municipality where the insured was transported, with those municipal rates subject to specified considerations (e.g., operational model and cost, payer mix, or adoption through public processes). Municipalities must annually report established ambulance rates to the Center for Health Information and Analysis, with the rates treated as public records and published annually. If no municipal rate exists, the minimum allowable reimbursement is either (i) 325% of the then-current CMS-published Medicare rate for the same service in the same geographic area or (ii) the provider’s billed charges, whichever is less. A provider receiving payment under these provisions is deemed paid in full and generally barred from further billing the insured, except that carrier cost-sharing may not exceed $100.

The bill adds provisions for uninsured/self-pay patients through a new Section 26 in chapter 111C (“Limitation on Emergency Ambulance Charges for Uninsured Persons”). It prohibits a ground ambulance provider from charging an uninsured or self-pay patient more than the current CMS-published rate for the same service in the same geographic area. It also prohibits the use of wage garnishments, liens on primary residences, reporting adverse information to consumer credit reporting agencies, or commencing civil actions to collect unpaid emergency ambulance bills, including by a debt buyer or assignee.

Finally, it requires information sharing by adding a new Section 53I to chapter 111: licensed hospitals and nursing homes must share a mutual patient’s insurance and demographic information with ambulance service providers upon request by the ambulance provider.

AT A GLANCE

This bill establishes a Class D misdemeanor offense for persons who, after an oral warning, knowingly approach or remain within 25 feet of a first responder performing lawful duties with intent to impede, threaten physical harm, or harass.

FULL SUMMARY

The bill creates a new criminal offense in Missouri for impeding, threatening, or harassing a “first responder.” Under the new section (RSMo § 575.356), a person commits the offense when they (after receiving an oral warning not to approach) knowingly and willfully violate the warning and approach or remain within 25 feet of the first responder while the first responder is engaged in the lawful performance of duties, with intent to: (1) impede or interfere with the first responder’s duties, (2) threaten the first responder with physical harm, or (3) harass the first responder.

The offense is classified as a Class D misdemeanor. The section also defines key terms: “first responder” includes law enforcement officers (per § 556.061), parole or probation officers, firefighters (per § 87.120), and emergency medical care providers; “emergency medical care provider” includes ambulance drivers, EMTs, paramedics, registered nurses, physicians, medical directors, and certain hospital personnel/agents/volunteers authorized to perform duties associated with emergency department care or related security; and “harass” is defined as willfully engaging in a course of conduct directed at a first responder that intentionally causes substantial emotional distress and serves no legitimate purpose.

Operationally, the bill establishes criminal liability tied to: (a) a prerequisite oral warning, (b) the offender’s knowledge that the warned individual is a first responder performing lawful duties, (c) proximity (within 25 feet) after the warning, and (d) a specific intent to impede, threaten physical harm, or harass as defined.

AT A GLANCE

This bill prohibits a person from knowingly approaching or remaining within a fifteen-foot safety buffer zone around covered officials while they perform official duties, and from persisting after a verbal warning with intent to impede, threaten, or harass.

FULL SUMMARY

The bill creates a new offense in the New York Penal Law by adding Section 240.80, “Interference with a New York state, New York city and local municipal emergency first responder, a judge of any court of law of this state, or a state, county or municipal prosecutor; safety buffer zone.” It prohibits a person from (1) knowingly approaching or remaining within a fifteen-foot safety buffer zone surrounding covered public officials while they are performing official duties, (2) after receiving a verbal warning to remain outside the buffer zone, knowingly and willfully failing to comply and remaining within or approaching the zone with intent to impede, threaten, harass, or otherwise interfere with the performance of their duties.

The provision defines “first responder” / “New York state, New York city, or local municipal first responder” to include specified categories engaged in lawful performance of official duties (police officer, peace officer, firefighter, emergency medical technician, paramedic, or other emergency medical services provider). It defines “safety buffer zone” as an area within fifteen feet of a covered first responder, judge, or state/county/municipal prosecutor engaged in lawful performance of their duties.

The bill includes explicit exceptions: it does not prohibit or restrict lawful recording/photographing/observing of covered officials so long as the activity occurs outside the fifteen-foot buffer zone and does not otherwise interfere with official duties; it also does not apply to someone seeking emergency assistance, providing aid, or complying with lawful instructions. Interference under Section 240.80 is classified as a Class B misdemeanor.

The bill takes effect on the ninetieth day after it becomes law.

AT A GLANCE

This bill allows an emergency medical services training and education institute to elect proprietary-school governance, and updates the EMS Board’s licensing authority and governance procedures for EMS training institutes.

FULL SUMMARY

The bill makes several changes to Kentucky’s medical services law, primarily in the areas of (1) proprietary education governance and definitions for purposes related to EMS training institutions, (2) the Kentucky Board of Emergency Medical Services’ structure and EMS training/education provisions, (3) the EMS Education Grant Program, and (4) the certificate-of-need (CON) process rules applicable to health facilities and certain services, plus (5) it creates a legislative task force to study overlapping fire and emergency ambulance district jurisdictions.

It amends KRS 165A.310 and adds an option in KRS 165A.340 allowing an “emergency medical services training and education institute” (as later defined in EMS statutes) to elect to be governed as a proprietary school; it also adjusts the definition of “emergency medical services training and education institute” in KRS 311A.010 to remove the prior broader reference to “educational institution” terminology and clarifies it is organizations licensed by the EMS Board whose sole program is EMS training (excluding licensed ambulance services that train their own employees/volunteers). KRS 311A.020 is revised to adjust the Office/administrative responsibilities list and renumber some responsibilities. The bill also updates KRS 311A.030 and KRS 311A.015: it refines EMS training and education institute licensing language (including the EMS Board’s authority to regulate these institutes), and substantially revises the composition, meeting frequency, quorum/procedures, attendance-based resignation rule, and reporting obligations of the EMS Board.

It amends the EMS Education Grant Program in KRS 311A.024 by explicitly describing three program components—student tuition support, agency support, and EMS training program (or educational institution) support—using updated phrasing to reference “training program” operators/entities eligible for support. The bill specifies that tuition support is paid to the EMS training program/institute or other operator where the person is enrolled; agency support reimburses Class I ground ambulance providers for wages paid to employees seeking initial paramedic certification (with board-set limits); and the training-program support component funds both existing and start-up EMS training programs (or institutes) certified or seeking certification, subject to grant ceilings, applicant priority criteria, time limits for commencing classes/programs, and detailed eligible-cost rules (including equipment/simulation and directly related personnel/services) while excluding items such as real property/building work, certain personnel costs (e.g., educator training travel/meals and compensation-package perquisites), lobbying, and uniforms/clothing. It also amends KRS 311A.025 to include “emergency medical services training program” among the certification/licensure levels (with related terminology adjustments) and updates KRS 311A.070 and KRS 311A.130 to align with the training-program/institution terminology—while preserving requirements that providers keep records and share responsibility for in-service training.

The bill amends CON law (KRS 216B.061) by clarifying the prohibited CON-triggering actions and terminology (including changing “Alter” to “Increase” a geographical area/location designated on a CON/license, and maintaining requirements against ex parte contact, and against obligating expenditures beyond authorized amounts without administrative escalation). It also revises cross-cutting educational definitions in KRS 164.945 (excluding EMS training/education institutes from the “college” definition used in that chapter), and updates KRS 311A.070’s cross-referenced notice provisions using the updated EMS training program/institution terminology. Finally, it establishes a Chapter 75 Fire District and Chapter 108 Emergency Ambulance Service District Task Force to study overlapping jurisdiction and taxing issues, sets membership rules, requires monthly meetings during the 2026 interim, and mandates findings/recommendations to the Legislative Research Commission by December 1, 2026; it also repeals KRS 311A.120 (Educational course and continuing education—Administrative regulations).

AT A GLANCE

This bill creates the Oregon Disaster Recovery Authority as a Governor-controlled advisory group that coordinates initial crisis services and recovery aligned with FEMA emergency support functions when the Governor declares a state of emergency.

FULL SUMMARY

The bill establishes a Statewide Regional Training Office within the Department of Public Safety Standards and Training, supervised by a Statewide Regional Training Officer appointed by the department director. It also directs implementation of new statewide emergency support coordination roles by requiring the State Resilience Officer to identify state agencies responsible for FEMA-defined emergency support functions and requiring each such agency to designate an “Emergency Management Responsible Officer” as the primary liaison with Oregon’s emergency management authorities.

The bill modifies the State Resilience Officer framework by amending ORS 401.913. It revises the office’s duties to add facilitation of policy standardization among state agencies, prioritization of investments to improve resilience posture, and regular reporting on agencies’ resilience policy compliance, preparedness of organizational continuity of governance procedures, and emergency readiness (with reports sent to the Governor, legislative committees, and/or public safety advisory boards/commissions as applicable). It also clarifies governance leadership: the Governor appoints the State Resilience Officer (subject to Senate confirmation), while the legislative and judicial branches each select individuals to monitor hazard safety and resilience planning effectiveness.

The bill creates the Oregon Disaster Recovery Authority as a Governor-controlled advisory group that can be activated when the Governor declares a state of emergency under ORS 401.165. When activated, the authority coordinates initial crisis services, recovery and mitigation efforts aligned with FEMA emergency support functions, and coordination of emergency funding/aid to local governments and private entities. The bill authorizes the Governor to hire time-limited additional state personnel during activation, establishes a dedicated Oregon Disaster Recovery Authority Fund for compensation of those personnel, and directs state agencies to assist the authority.

It amends emergency management and resilience infrastructure requirements by expanding Oregon Department of Emergency Management duties under ORS 401.114 to include oversight of collaboration and coordination for emergency stockpile plans and emergency preparedness programs, ensuring supplies/equipment are staged for emergencies, and developing/maintaining an inventory plan for sustainable procurement/rotation/management of preparedness assets. It also amends ORS 409.760 by revising definitions and expanding grant support language for Resilience Hubs and Resilience Networks, including removal of specified bracketed “support and technical assistance” wording and adding authority for grants/equipment/technical assistance/contracted services and other support for creating or sustaining hubs and networks.

Beyond these amendments, the bill authorizes (1) overnight training activities at facilities used for emergency preparedness/response/recovery that receive state funding; (2) counties to waive certain civil penalties imposed by the Oregon Health Authority or local health authorities when the underlying violation occurred during a declared state of emergency; and (3) a study by the Department of the State Fire Marshal on health coverage disparities between paid and volunteer firefighters, with a report due to legislative interim committees by September 15, 2027, and repeal of the study provision on January 2, 2028. It also requires the Oregon Department of Emergency Management to obtain fingerprints for specified department employees and contractors/subcontractors for state or nationwide criminal records checks.

Finally, the bill creates two new emergency assistance grant programs within ORS chapter 401: the Oregon Public Assistance Grant Program for infrastructure/public-health/safety/property protection work performed before/during/after emergencies, to be activated by the Governor under stated findings and department recommendations, with a dedicated Oregon Public Assistance Grant Program Account that limits coordination/distribution costs to no more than 10% of account moneys. It also creates the Oregon Individual Assistance Grant Program to provide grants addressing critical emergency-related needs of qualified individuals (including temporary rental assistance, hazard mitigation assistance, repair/replacement of owner-occupied primary residences, assistance with immediate needs, essential personal property assistance, and other serious needs not covered by insurance), including governance for eligibility and plan integration into the statewide emergency management plan. Dedicated accounts are established for both programs, and moneys can be continuously appropriated for program administration and assistance delivery.

AT A GLANCE

This bill requires the Secretary of Public Safety and Homeland Security to convene an emergency management work group and submit its findings and recommendations to specified legislative committees by October 1, 2026.

FULL SUMMARY

The bill directs the Secretary of Public Safety and Homeland Security to convene a work group to evaluate existing emergency management needs in Virginia.

The work group must include representatives from the Department of Emergency Management, the Department of Planning and Budget, the Virginia Emergency Management Association, the Virginia Association of Counties, the Virginia Municipal League, and any other stakeholders the Secretary selects. The work group is tasked with assessing sustainability of current funding for emergency management needs and reviewing alternative funding models used in other states.

In conducting its evaluation, the work group may hire an outside consultant and must analyze: local capability assessment for readiness reports; recent after-action reports from declared emergency events; historical trends in federal homeland security and emergency management funding; anticipated or announced federal funding changes; gaps in current funding; how other states fund emergency management services; and best practices from other states.

The Secretary must submit a report of the work group’s findings and recommendations to the Chairs of the House Committee on Appropriations, the House Committee on General Laws, the Senate Committee on Finance and Appropriations, and the Senate Committee on General Laws and Technology no later than October 1, 2026.

AT A GLANCE

This bill requires ambulance and air-ambulance services to install and maintain electronic global positioning monitoring devices starting January 1, 2024, subject to waivers.

FULL SUMMARY

The bill makes multiple changes to Arizona’s emergency medical services (EMS) and related statutory protections, with a focus on expanding terminology and operational requirements for air ambulances and air-ambulance attendants. It amends several EMS statutes governing emergency declarations and health-professional immunity (Title 12/13), EMS licensing/registration and prohibited acts (Title 36), medical control standards and council membership/operations (Title 36), administrative/complaint and enforcement procedures and civil penalties (Title 36), epinephrine administration/immunity for first responders (Title 36), and insurance/financial responsibility and rulemaking requirements for air ambulance services. It also amends Medicaid-related covered transportation benefits to explicitly include “air ambulance” alongside other transportation categories.

Key substantive changes include: (1) adding and defining “AIR AMBULANCE,” “AIR AMBULANCE SERVICE,” and “AIR AMBULANCE ATTENDANT” across EMS-related definitions and operative provisions, and treating air-ambulance personnel as “ambulance” counterparts for many regulatory and immunity purposes; (2) revising EMS health-professional/health-care-institution immunity by expanding who is included (including air-ambulance attendants) and clarifying presumptions and burden shifting in certain circumstances; (3) expanding ambulance director/rulemaking duties so that standards and procedures explicitly cover “AIR AMBULANCE SERVICES,” including staffing/attendant requirements and inspection/regulation frameworks; and (4) adjusting EMS council membership to add/clarify representation for ambulance service corporations and air-ambulance service corporations, while also extending/reaffirming an overall delayed repeal of the council after January 1, 2028.

The bill also changes operational and regulatory requirements for ambulance/air-ambulance services: it establishes/updates director authority to regulate services and set rates/charges consistent with EMS quality and response-time policy, adds requirement(s) that ambulance services install and maintain electronic global positioning monitoring devices beginning January 1, 2024 (subject to waivers), and adds triage/referral protocol language directing patient routing to “the most appropriate provider of medical services” and health-care institution based on condition (including patient choice and local protocols). It further updates investigation and enforcement procedures for complaints (including timelines for informal complaint processing, escalation to formal proceedings, hearing mechanics, civil penalty limits, confidentiality, and a specific applicability clause stating that the complaint/investigation provisions apply to air ambulances/air ambulance services to the extent complaints relate to air-medical services and do not conflict with federal air-carrier regulation).

A standalone repeal is included: Section 12 repeals Arizona Revised Statutes § 36-2212 (certificate of registration to operate an ambulance or air ambulance; termination on change in ownership; fees) as amended by Laws 2025, ch. 212, § 2—while other sections continue to regulate air-ambulance registration/operation through remaining statutory provisions. Finally, the bill makes targeted updates to health-plan/Medicaid contractor transportation coverage so that nonemergency transportation rules address “stretcher vans AND AIR AMBULANCE and ambulance transportation,” including when prior authorization is required (e.g., not required for medically necessary air-ambulance/ambulance transportation initiated by dialing 911).

AT A GLANCE

This bill extends permanently EMT provider quarterly assessment and Medicaid enhancement payments by removing the prior end date and requiring Alabama’s Department and Medicaid Agency to impose, report, and pay them each quarter.

FULL SUMMARY

SB144 makes the emergency medical transport (EMT) provider assessment and related Medicaid enhancement payments extend permanently by changing the end date in existing law (previously set through fiscal quarter beginning July 1, 2028, and now made ongoing). It amends Alabama Code Sections 40-26B-91, 40-26B-94, and 40-26B-95 to remove the sunset-style termination and to keep imposing, reporting, and paying the EMT assessment/enhancement on an ongoing quarterly basis.

Under amended §40-26B-91, EMT providers continue to be assessed each quarter based on the number of emergency medical transports they rendered in the prior quarter, with a quarterly assessment rate set by the department in consultation with the Alabama Medicaid Agency (maximum 5.3 percent, subject to existing statutory constraints). The department may adjust the rate each quarter to reduce surplus assessments, and any surplus from a prior quarter can be used to reduce the next rate; the assessment remains in addition to other taxes and assessments.

Under amended §40-26B-94, EMT providers must file a quarterly statement under penalty of perjury within the statutory deadline after each quarter’s close (showing transports, gross receipts, and other information the department requires after consultation and rule adoption). The duty to maintain records for at least three years and to make them available for department examination is retained, along with existing confidentiality rules that generally allow sharing with the Alabama Medicaid Agency as needed to administer the Medicaid program and the assessment.

Under amended §40-26B-95, the Alabama Medicaid Agency continues to pay an EMT enhancement each quarter to EMT providers (subject to federal approval exceptions already referenced in the statute). The enhancement formula is retained: it is calculated for each provider using the number of transports reimbursed by Medicaid as the primary payor in the preceding quarter multiplied by a quarterly “transport enhancement rate,” with total enhancements capped by the statutory “assessment pool”; the Medicaid Agency sets that rate based on the difference between the Medicaid rate and the average rate paid by commercial insurers. The act becomes effective October 1, 2026.

AT A GLANCE

This bill requires the 911 Board to establish, using best practices, a statewide 911 readiness measurement system and to report performance-audit findings with remediation plans to the Attorney General within 60 days.

FULL SUMMARY

HB268 adds new Section 11-98-4.3 to the Code of Alabama 1975 to create a statewide system for measuring 911 readiness performance of local communication districts (including public safety answering points). The bill defines “readiness” as a district’s capability to expedite answering, receiving, and transferring 911 calls and texts to efficiently dispatch the appropriate emergency service provider to the correct location where property or life may be in jeopardy.

It requires the 911 Board to establish a best-practices-based measurement system (using nationally recognized associations’ best practices as examples) using data related to districts’ 911 answering, receiving, transferring, and dispatching functions, including voice, texts, photos, and videos. The 911 Board may collect specified readiness-related data for each district, including 911 call volume, time to answer calls, time to process calls under Section 11-98-11, answered vs. unanswered calls, dropped calls, and the number of calls reporting a crime. Compliance may be funded through an advisory-service mechanism referenced in Section 11-98-5.2(b)(7)b. or from outside funding received by the 911 Board.

The bill authorizes the Attorney General—upon a complaint regarding a local communication district’s performance—to refer the matter to the 911 Board for a performance audit. The audit may include interviewing knowledgeable individuals (including district board members, PSAP director, public safety telecommunicators, heads of local emergency service providers, first responders, and complainant residents) and conducting on-site inspections and real-time monitoring of PSAP operations and equipment/technical functionality. Within 60 days of commencing an audit (or by audit completion), the 911 Board must submit a formal written report to the Attorney General evaluating readiness and identifying specific operational deficiencies; if deficiencies are confirmed, the report must include a remediation plan with measures to reach an acceptable readiness level, including training requirements, hiring additional telecommunicators, technology upgrades (hardware/software), and amendment of PSAP operating protocols, scripts, and recordkeeping. The audit report must be made public and may be posted on either the Attorney General’s or the 911 Board’s website.

Pursuant to the performance audit, the 911 Board is authorized to supervise implementation of the remediation plan in the audited district, and the 911 Board must adopt rules under the Alabama Administrative Procedure Act to implement the new system. The act becomes effective October 1, 2026.

The bill establishes that certain assaults targeting current or former public officials constitute assault in the second degree under Alabama law. It does so by revising the definition of second-degree assault in Section 13A-6-21(a), adding an additional subsection that covers intentional physical injury to a current or former local, state, or federal public official during, or as a result of, the performance of the official’s duty.

Penalties are also specified for the revised offense structure: assault in the second degree is designated as a Class C felony. The bill also includes nonsubstantive technical revisions to update the existing code language to current style and formatting.

The bill provides that the updated assault-in-the-second-degree provisions become effective October 1, 2026.

AT A GLANCE

This bill requires the Oregon Health Authority to calculate Medicaid supplemental EMS reimbursements for eligible local government, state agency, and federally recognized tribe providers based on qualifying federal financial participation, capped at actual uncompensated costs.

FULL SUMMARY

The bill establishes and revises Oregon’s Medicaid supplemental reimbursement framework for emergency medical services (EMS) provided by providers owned or operated by local governments, state agencies, or federally recognized Indian tribes. It amends ORS 413.234 to clarify eligibility and payment mechanics for Medicaid supplemental reimbursement tied to federal financial participation, including documentation requirements, limits tied to providers’ actual costs, and conditions preventing payment when federal approval is revoked or when required provider/CCO agreements are not in place. It also adds immediate emergency authority and effective timing by declaring an emergency and making the act effective upon passage.

ORS 413.234 is changed to (1) define Medicaid supplemental reimbursement based on an amount equal to the authority’s federal financial participation for the provider’s qualifying EMS costs, but capped so it may not exceed the provider’s actual costs less amounts the provider is eligible to receive from other public and private sources; (2) require EMS providers to make documentation/data/certifications available to the Oregon Health Authority necessary to establish federal financial participation eligibility and calculate the supplemental amount due; (3) require the authority to modify its calculation/payment method as needed to ensure EMS expenditures qualify for federal financial participation, while still prohibiting supplemental payments where the provider has not entered into the required agreement with the authority or contract with a coordinated care organization (CCO); and (4) impose conditions on implementation—no General Fund moneys may be used except to certify eligibility for federal financial participation, and providers must enter into and comply with an agreement to reimburse the authority for administrative costs of administering the section. The bill also requires reporting to Legislative Assembly health committees at the next session when CMS approves the section and later revokes or signals intent to revoke or refuse renewal.

ORS 413.235 is changed by replacing the prior concept of an “intergovernmental transfer program” with a broader “funding mechanism” to transfer funds between EMS providers and the authority to pay EMS costs for members of a CCO. The authority must pay any resulting federal financial participation to the authority for use in paying costs to the CCO, and the CCO must increase EMS reimbursement to the provider by an amount specified by the authority. The increased reimbursement must be at least actuarially equivalent to the Medicaid supplemental reimbursement paid under ORS 413.234. General Fund restrictions and provider reimbursement of the authority’s administration costs are retained in substance, but the prior “agree to pay a fee” language is replaced with a requirement that providers enter into and comply with an agreement to reimburse administrative costs; the authority may set any fee up to 20% of the EMS cost and may allow up to 120% of that fee to be counted as operating cost for providers. The bill also retains EMS providers’ documentation obligation for qualifying federal financial participation and requires the authority to return funds or exclude an expenditure if it does not qualify.

Finally, the bill adds coordination/implementation requirements: participation by coordinated care organizations and EMS providers in the funding mechanism must be voluntary, and the authority must consult with EMS providers during development, implementation, and operation of the mechanism. It declares an emergency and provides that the act takes effect on passage.

AT A GLANCE

This bill establishes an Emergency Medical Services Program Fund in the State Treasury, continuously appropriates it to the Oregon Health Authority, and authorizes the authority to fund EMS workforce and local provision projects.

FULL SUMMARY

The bill establishes the “Emergency Medical Services Program Fund” in the State Treasury as a separate fund from the General Fund, specifies its revenue sources (appropriations to the Oregon Health Authority, related federal funds, and settlement monies, gifts, grants, contributions, and donations), provides that interest credits to the fund, and makes the fund continuously appropriated to the authority for implementing new workforce/education/investment programming described in the bill. It authorizes (but does not require) the Oregon Health Authority to establish emergency medical services workforce development, training, and innovation programming, and—based on advice from the Emergency Medical Services Advisory Board—to provide funding to local governments, health care providers, and emergency medical services agencies to support emergency medical services provision.

It revises Oregon’s emergency medical services system governance by changing and updating multiple statutory provisions (ORS 682.500 through 682.533 and related 2024-law sections). Key changes include: removing the explicit requirement that the EMS program administer “state reimbursement systems” (ORS 682.500); expanding the scope of advisory/coordination activities in ORS 682.503 to include “long term and senior care” alongside stroke, cardiac, trauma, pediatric, and behavioral health; and modifying the membership structure/requirements of the Emergency Medical Services Advisory Board (ORS 682.506) and the EMS advisory board’s permanent committees/subcommittee structure (including replacing/adjusting pediatric and long-term/senior care committee references). It also updates committee functions and objectives to incorporate an explicit “long term and senior care” lens in relevant provisions (ORS 682.509, 682.515, 682.518, 682.521, 682.524, 682.527, and 682.533), and adjusts pediatric committee composition by removing certain non-core member categories while adding ex officio nonvoting representation from the EMS Program and statewide pediatric EMS committee leadership experience.

The bill restructures emergency medical services classification and designation rules. It keeps the overall framework that emergency medical services centers may be categorized/designated using nationally recognized classification standards, but updates the participating committees whose advice informs the Oregon Health Authority on what classification standards to recommend (ORS 682.527 and ORS 682.527-related cross-references). It also maintains the data-system/registry expectations tied to obtaining designations while updating references to committee participation and removing earlier timeline language shown as changed in the bill (the “not later than”/timeline extension language is replaced with “in accordance with the standard adopted,” without the prior tiered large-facility vs. rural-facility timeline detail). The bill further expands EMS data system provisions by adding or maintaining requirements that the data system support quality improvement and broader planning uses, specifies reporting categories and procedures (ORS 682.533), and clarifies patient demographic data may be requested.

Finally, the bill makes targeted EMS licensing/education rule updates and sets implementation timing. It amends ORS 682.017 to require EMS rules to include ambulance patient encounter data reporting to the EMS data system, and clarifies the lowest EMS provider licensure level must be an “emergency medical responder” and the rule requirements around ambulance operation/coordination and two-way communications. It amends ORS 682.204 to strengthen licensing/title restrictions (including clarifying ambulance operation requires at least one provider licensed above emergency medical responder), while adding explicit exemptions for students providing care under supervision as part of approved EMS courses, including allowing students to use the title/initials for the license level in training. It amends ORS 682.208 to require the authority to adopt rules establishing minimum educational requirements (replacing a prior “schedule of rules” phrasing) and sets the bill’s effective date as the 91st day after sine die adjournment; most program-governance and fund-related EMS statutory amendments become operative January 1, 2027, while the ambulance/data/education/producer-related amendments also become operative January 1, 2027, and the bill provides mechanisms to allow pre-implementation actions before that operative date.

AT A GLANCE

This bill reduces the State Emergency Medical Services Advisory Board’s membership from 28 to 24 members and reallocates the Governor’s appointments and staggered initial terms among specified appointing entities.

FULL SUMMARY

The bill amends and reenacts Virginia Code § 32.1-111.4:1, changing the structure and appointment composition rules of the State Emergency Medical Services Advisory Board and related membership provisions.

The Advisory Board remains a state-level body in the executive branch that advises on administration of the statewide emergency medical services (EMS) system and EMS vehicles, and reviews and recommends changes to the Statewide EMS Plan. The bill reduces the Board’s total membership from 28 to 24 members and adjusts the allocation of seats among specified appointing entities. It also changes several appointment-term counts (substantially affecting the staggered term distribution).

Specifically, it revises the Governor’s appointments composition: it changes the number of seats allocated to regional emergency medical services councils (from 11 representatives to 7 regional councils listed as “each of the 11 seven regional emergency medical services councils,” reflecting a structural adjustment in the statutory enumeration), and it revises the number of seats from the Virginia Association of Volunteer Rescue Squads, Inc. (from two representatives to the revised statutory count shown as “two”). The bill also revises staggered appointment allocations (the number of members for each of the two-, three-, and four-year initial terms) from the prior “nine …/ nine …/ 10 …” pattern to “eight”-based counts (shown as “nine eight,” “nine eight,” and “10 eight”), while keeping the general approach of staggered terms.

Beyond membership counts, it retains core governance and duties: members are not eligible for compensation (but the Department funds reimbursement of expenses); the chairman is elected from the Board for a one-year term; the Board meets at least four times annually; and the Board’s duties include advising on administration, reviewing and recommending on the Statewide EMS Plan and revisions, and reviewing scheduled reports on the statewide EMS system (including the Financial Assistance and Review Committee, Rescue Squad Assistance Fund, regional councils, and EMS vehicles). It also continues the requirement that the Advisory Board establish an Executive Committee and that the Office of Emergency Medical Services provide staff support.

AT A GLANCE

This bill requires insurers to reimburse in-network licensed emergency medical service providers for emergency ground transport at a minimum rate of 200% of the Medicare Ambulance Fee Schedule rate starting October 1, 2026.

FULL SUMMARY

The bill establishes statewide requirements governing health insurer reimbursement and billing rules for emergency ground ambulance services provided by licensed emergency medical service providers, including “emergency ground transport” and “treat in place” scenarios. It defines key terms (e.g., clean claims, covered services, in-network vs. out-of-network, treat in place, and cost-sharing amount) and requires insurers to contract with any willing EMS provider for covered services in the insurer’s provider network under comparable terms for in-network providers that meet legal licensing requirements.

Beginning October 1, 2026, insurers must reimburse in-network EMS providers for emergency ground transport at a minimum rate of 200% of the Medicare Ambulance Fee Schedule rate (as published by CMS). Beginning January 1, 2027, the minimum in-network reimbursement for treat in place (basic life support) is also 200% of the Medicare Ambulance Fee Schedule rate in effect on January 1, 2027, and a treat in place reimbursement claim is prohibited for the same event if the provider submitted an emergency ground transport claim. Beginning January 1, 2027, out-of-network reimbursement for covered services is set at 180% of the Medicare Ambulance Fee Schedule rate; the treat-in-place-specific minimum does not apply to out-of-network providers. The Medicare Ambulance Fee Schedule rate for this law is fixed to the rate applicable to ZIP code 35462 (including base and mileage components), and the reimbursement rate must be applied uniformly statewide.

The bill also provides that insurer payment under the reimbursement rules is “payment in full” for covered services and restricts billing/collections by EMS providers (including agents/contractors/assignees). Except for the enrollee’s in-network cost-sharing amount, EMS providers may not bill or seek collection of any other amount from the enrollee, regardless of in-network or out-of-network status. Insurers must certify the enrollee’s in-network cost-sharing amount to an out-of-network provider upon request. For claims timing, insurers generally must remit payment within 30 days of a clean electronic claim or within 45 days of a clean written claim; for non-clean claims, insurers must send a written receipt within 30 days stating either denial reasons or the additional information needed. The bill limits insurer demands for extra data elements beyond standard Alabama claim formats and provides an internal dispute process with escalation to an independent dispute resolution contractor if unresolved.

Starting in 2027, and each year thereafter, EMS providers must submit annual operational and financial reporting to the Alabama Department of Public Health, including vehicle counts, staffing, total ground ambulance transports, average response time to a definitive care facility, Alabama gross income and net profit, dividends (if ownership shares are public), parent-entity remittances for 2027 (before/after reimbursement changes), and—per a separate insurer reporting requirement—2027 monthly/quarterly amounts paid or reimbursed to providers. Health insurers must report to the department in 2027 (for each of the three years preceding January 1, 2027) the number and value of denied claims, denial percentages, out-of-pocket charges on approved claims, and total paid amounts (including comparisons to total health-service claims), and must continue annual reporting from 2028 onward with the same categories; insurers’ financial reporting to the department is confidential and not public. The bill requires rules by the Department of Public Health for implementation.

It requires a study by the Alabama Association of Ambulance Services, contracting with an accredited business school to evaluate the impacts of Sections 1 through 4, with a cost cap not to exceed $50,000 and costs borne by the three largest insurers by enrollment that offer individual marketplace plans; the study must include cross-state measures and recommendations balancing access and cost burden, and must be submitted by December 1, 2028. Sections 1 through 5 are repealed on June 1, 2029. Finally, the bill amends Alabama Code §§ 10A-20-6.16 and 27-21A-23 to incorporate references to “Sections 1 through 5” (while listing other incorporated insurance-law-related chapters) and becomes effective October 1, 2026.

AT A GLANCE

This bill authorizes Virginia counties and cities to establish local or regional suicide fatality review teams to review suspected suicide deaths and impose confidentiality, with Class 3 misdemeanor penalties for violations.

FULL SUMMARY

The bill creates authorization for Virginia counties/cities (and combinations thereof) to establish local or regional suicide fatality review teams, defines their purpose and permissible scope, and establishes detailed confidentiality and liability/immunity rules, including criminal penalties for confidentiality violations and penalties for violating confidentiality requirements. It also adds a new statutory section, creates an express FOIA exclusion, and links team meeting closure to existing closed-meeting provisions.

Operationally, the new section authorizes teams to conduct contemporaneous reviews of local suicide deaths, including suicide deaths of military service members and veterans; promote coordination among agencies investigating suicide deaths and providing services to surviving family members; develop understanding of causes/incidence; develop prevention plans and recommend changes to represented agencies; and advise the Department and other state agencies on law/policy/practice changes to prevent suicide deaths. Teams may review deaths of persons residing in Virginia whose death was or is suspected to be due to suicide, must adopt rules/procedures, and may share information only if agencies honor confidentiality via sworn statements; review of a death must be delayed until connected criminal investigations are completed or the Commonwealth consents earlier.

The bill imposes confidentiality across all information and records obtained or created for fatality reviews: such materials are excluded from the Virginia Freedom of Information Act, may be used only for the team’s proper purpose, are not subject to subpoena/discovery/admissibility solely because they were presented to the team, and participants are not required to testify about what transpired. After the review, records concerning the victim and family must be returned to the originating agency or destroyed; the team may publish only statistical or other non-identifying findings. It requires portions of meetings where individual cases are discussed to be closed, and requires sworn confidentiality statements from team members and those attending/presenting in closed meetings. Violations of confidentiality are punishable as a Class 3 misdemeanor, and the section provides civil liability immunity for team members/agents/employees (except gross negligence or willful misconduct) and similarly for entities/persons furnishing information to the teams (also excluding gross negligence or willful misconduct).

In parallel with creating the new suicide fatality review teams section, the bill amends existing public-record and closed-meeting rules to incorporate suicide fatality review team confidentiality: (1) it updates the mandatory-disclosure exclusions for public records to add suicide fatality review team materials that are confidential under the new § 32.1-283.9, and (2) it adds local/regional suicide fatality review teams to the list of permitted closed-meeting topics, ensuring confidentiality of individual cases discussed by such teams. The FOIA exclusion is also made explicit within the new suicide review statute.

AT A GLANCE

This bill requires Maine’s EMS Board to license community paramedicine clinicians and services and to adopt rules governing training, qualifications, medical director designation, and background-check compliance.

FULL SUMMARY

The bill establishes a new statutory framework within Maine’s Emergency Medical Services licensing law for “community paramedicine” and creates distinct licensure categories and rulemaking authority for (1) community paramedicine clinicians and (2) community paramedicine services.

Key changes include: (a) revising the existing EMS community paramedicine exemption in 22 MRSA §2147(15) to reflect updated terminology and to require the EMS Board’s rules for authorized community paramedicine services to include Maine Background Check Center Act compliance, mandatory reporter training, licensing standards alignment, and coordination with home health agencies; (b) updating the general EMS licensing prohibition in 32 MRSA §82(1) to include community paramedicine clinicians and services as activities that may not be operated without EMS Board licensure; (c) adding new statutory definitions in 32 MRSA §83 for “community paramedicine,” “community paramedicine clinician,” “community paramedicine service,” and “emergency medical services instructor.”

The bill also removes an existing community paramedicine licensing/authorization mechanism by repealing 32 MRSA §84(4) (which was repealed and replaced previously), and replaces it with new, standalone licensing provisions enacted as 32 MRSA §85-C (community paramedicine clinicians) and 32 MRSA §85-D (community paramedicine services). Those new provisions require board licensing; set minimum rulemaking requirements including training and qualifications; require identification of medical director(s) for services; prohibit the Board from limiting medical director eligibility only to licensed physicians (while allowing volunteer and dual-capacity service); require background check compliance; and require standards covering general requirements, professional/paraprofessional qualifications, treatment/service coordination, organizational structure/lines of authority, and records. The bill further specifies that initial rules under these clinician and service sections are major substantive rules, while subsequent amendments are routine technical rules.

It also contains a related change in 24-A MRSA §4303-F(1) to the first blocked paragraph, specifying that carriers may require prior authorization before an ambulance service provider delivers covered services through community paramedicine, while addressing when a carrier is not required to reimburse at the subsection’s reimbursement rates for community paramedicine services delivered in accordance with the (updated) community paramedicine provisions.

AT A GLANCE

This bill requires carriers to pay emergency ambulance providers not in their networks directly and promptly at required emergency rates, notwithstanding assignment-of-benefits prohibitions, and grants providers a right of action for nonpayment.

FULL SUMMARY

The bill establishes new state rules to protect patients from “surprise billing” for emergency ambulance services by adding a new Section 30 to Chapter 176O. It defines “emergency ambulance service” as ground ambulance medical or transport services furnished by an ambulance service provider in situations requiring an immediate response to assess and/or treat an emergency medical condition (with the emergency determination not based solely on retrospective analysis of the later level of care or final discharge). It also defines “ambulance service provider” (with an exception for nonprofit corporations licensed to operate critical care ambulance services that perform both ground and air transports) and sets standards for insurer/“carrier” payments and patient billing outcomes.

Under the new Section 30, when an insured receives emergency ambulance services from a provider not in the carrier network, the carrier must pay the provider directly and promptly at the emergency ambulance service rates. Payment must be made notwithstanding any insurance policy or contract prohibition on assignment of benefits, and an insured’s direct payment obligations do not eliminate the carrier’s obligation to pay the provider. The provider is given a right of action under Chapter 176D if the carrier fails to make the required payment.

Payment amounts are tied primarily to municipally established ambulance rates for the transport location, requiring municipalities to set rates using specified considerations (including operational/cost model, payer mix, and/or public process requirements). Municipalities must report their established ambulance rates annually to the Center for Health Information and Analysis, which must publish the rates. If there is no municipally established rate meeting the requirements, the minimum allowable reimbursement under a health benefit plan is set at either (i) 325% of the then-current CMS-published ambulance rate for the same service and geographic area, or (ii) the ambulance provider’s billed charges—whichever is less. Providers paid under these standards are deemed paid in full (no further billing to the insured) except for carrier-permitted cost-sharing capped at $100, and carriers must treat cost-sharing for emergency ambulance services as if provided by an in-network provider for purposes of in-network deductibles/out-of-pocket maximums.

The bill also adds two additional protections outside Chapter 176O: (1) it adds a new Chapter 111C Section 26 limiting what ground ambulance providers may charge uninsured/self-pay emergency patients to no more than the current CMS-published rate for the same service and geographic area, and prohibiting certain aggressive collection practices (wage garnishments, liens on primary residences, adverse credit reporting, and commencing civil actions) to collect unpaid emergency ambulance bills; and (2) it adds a new Chapter 111 Section 53I requiring hospitals or nursing homes to share patient insurance and demographic information with ambulance service providers upon request when the provider treated a mutual patient.

The document outlines new provisions in Missouri law regarding the notification of infectious disease exposure for health care facilities and first responders. These changes mandate that health care facilities inform health care workers and law enforcement officers of potential exposure to specific infectious diseases within 48 hours of becoming aware of such exposure.

The infectious diseases that require mandatory notification include COVID-19, HIV, Hepatitis B and C, and tuberculosis. Additionally, first responders who have transported individuals to health care facilities are permitted to request information on whether those individuals tested positive for any of the specified infectious diseases during their treatment.

The primary goal of these changes is to enhance the safety and health of workers in the health care and law enforcement sectors by ensuring timely communication regarding potential exposures. These requirements complement existing laws that protect health care workers.

The document does not provide a specific date for the implementation of these changes or any direct financial impacts on businesses or industries.

AT A GLANCE

This bill requires the Emergency Medical Services Funding Task Force within the Legislative Research Council’s Executive Board to deliver a report to the executive board by November 1, 2026.

FULL SUMMARY

The bill establishes an “Emergency Medical Services Funding Task Force” within the framework of the Executive Board of the Legislative Research Council (Section 1). The task force is directed to (1) examine mechanisms to fund counties and municipalities for emergency medical services as an essential service, (2) examine ambulance service payment policies, including reimbursement standards for out-of-network emergency medical services, (3) seek stakeholder input, (4) deliver to the executive board by no later than November 1, 2026 a report with findings and recommendations for legislative proposals related to emergency medical services funding in South Dakota, and (5) review planned expenditures of the Rural Health Transformation program and evaluate opportunities to incorporate those funds into emergency medical services funding strategies. The task force may meet no more than five times during the 2026 interim and is dissolved when it delivers its report to the executive board (Section 1).

The bill also specifies the task force’s composition (Section 2): the chairs of the House and Senate health and human services committees; the chairs of the House and Senate taxation committees; four House members (one of whom must be from the minority party) appointed by the Executive Board of the Legislative Research Council; and three Senate members (one of whom must be from the minority party) appointed by the executive board. If a committee chair is unable to serve, the Executive Board may appoint another member of the committee to serve in the chair’s place (Section 2).

The document discusses amendments to the Illinois Emergency Management Agency Act, focusing on funding for the Mutual Aid Box Alarm System (MABAS) and the Illinois Law Enforcement Alarm System (ILEAS). Starting July 1, 2026, the Illinois Emergency Management Agency and Office of Homeland Security (IEMA-OHS) will evaluate the funding needed to support emergency responders in coordinating personnel and equipment during all-hazard emergencies.

By January 1, 2027, IEMA-OHS is tasked with establishing a formula for distributing the determined funding to MABAS and ILEAS. This aims to ensure that both systems receive adequate financial support for their operations.

Beginning July 1, 2028, if appropriations for IEMA-OHS to grant to MABAS and ILEAS are found to be insufficient, the Act will provide for a continuing appropriation to cover necessary funding. This funding may be adjusted based on federal grants received.

The amendments are expected to impact industries related to emergency services, public safety, and local government agencies involved in disaster response and management. Overall, the provisions reflect a commitment to enhancing emergency preparedness and response efforts through adequate funding.

AT A GLANCE

This bill requires the Department to reimburse Medicaid ambulance service providers at the highest assessment-allowed reimbursement rate starting July 1, 2026, and limits charges to authorized base-rate and mileage-rate amounts.

FULL SUMMARY

The bill changes Utah’s ambulance provider payment framework, focusing on Medicaid fee-for-service reimbursement adjustments, definitions and allowable charges for base rate and mileage rate, and how the Bureau of Emergency Medical Services sets and can adjust ambulance base rates.

Beginning July 1, 2026, the Medicaid ambulance service provider adjustment under Utah Code § 26B-3-804 is changed so that the Department pays a reimbursement rate equal to the highest reimbursement rate allowed by the assessment (rather than reimbursing “up to” the Emergency Medical Services Ambulance Rates). For commercial health benefit plans and employers/workers’ compensation carriers, the bill amends §§ 31A-22-627.1 and 34A-2-407.1 by removing prior references to a separate “medication maximum cost” allowable expense concept and instead requiring that claims correctly charged under the governing section be accepted as allowable expenses for amounts equal to the “base rate” (and mileage rules where applicable). It also retains the requirement that payments be made directly to the provider, including out-of-network providers, and retains the rules prohibiting ambulance providers from charging in excess of authorized mileage and base-rate amounts.

The core rate-setting statute, § 53-2d-503, is revised to incorporate medication costs into the base rate. The bill defines “base rate” to include the cost of medication (and also includes an adjusted rate published by the bureau in rule), and it clarifies that the “balance bill” exception permitting billing an individual for the base-rate plus mileage-rate “does not include” certain billing and ties the allowable billing outcome to whether the plan/insurer allows the total of the base rate and mileage rate. The bill also adjusts the annual rate-setting process: beginning July 1, 2027, the bureau must publish an adjusted base rate in rule for each transport type on or before July 1 each year, using the medical care consumer price index to adjust the currently operative base rate, and the bureau may not adjust the base rate more than once each calendar year.

The bill repeals sunset dates that would have terminated key ambulance payment provisions: it removes the repeal of the ground ambulance reimbursement section (§ 31A-22-627.1) and the ground ambulance transport/maximum rate provision (§ 34A-2-407.1 and § 53-2d-503) that were previously scheduled for July 1, 2027. The bill also includes a repeal-date amendment in the general repeal schedules (Title 63I, 34/34A, and 53 repeals) to reflect these changes, and takes effect July 1, 2026.

AT A GLANCE

This bill requires Massachusetts’ Department of Mental Health to collect data on all chapter 123 section 12 applications and issue a July 31 annual public report without personally identifiable information.

FULL SUMMARY

The bill establishes a new statutory definition of “Community Alternative” in Massachusetts General Laws chapter 123, section 1. The definition covers voluntary, community-based treatment, services, or supports that function as alternatives to hospitalization, including specified crisis services (including mobile crisis intervention and community crisis stabilization), MassHealth Behavioral Health Urgent Care, children’s behavioral health services, technologically supported behavioral health services (including the behavioral health helpline/988), peer respite/peer-run programs, and other services, supports, or settings designated by the department.

The bill changes the involuntary hospitalization process under chapter 123, section 12 by replacing the prior subsection (a). Before a person may be restrained or authorization for restraint may be sought and before an application for hospitalization is made, the authorized decision-maker must determine whether there is an appropriate community alternative for the person. If an appropriate community alternative exists and the person consents, the applicant must arrange transport (by ambulance or otherwise) to the community alternative (as applicable). The bill also preserves the ability to proceed to a 3-day hospitalization application when there is no appropriate community alternative or when an appropriate community alternative exists but the person does not consent, with eligibility for who may determine this spanning licensed clinicians (including physicians, advanced practice registered nurses, qualified psychologists, and licensed independent clinical social workers) and, in emergency situations when a clinician is not available, police officers under specified conditions.

The bill requires additional operational reporting and public information by the Department. After subsection (e), new subsections (f) and (g) mandate that the Department collect data on all applications filed under the section, including counts and non-identifying characteristics (age, gender identity, race, ethnicity, insurance status, and diagnosis), and issue an annual (by July 31) report to the House and Senate Committees on Ways and Means, the Joint Committee on Public Health, and the Joint Committee on Mental Health, Substance Use and Recovery, without including personally identifiable information. The bill further requires the Department, in consultation with the Secretary of Health and Human Services, to maintain and daily update a public-facing website listing each community alternative’s availability and capacity, including name, location, telephone number and website, accepted payment types (if any), and descriptions of programs and services.

AT A GLANCE

This bill limits CRA and incentive district real property tax exemptions so exempt improvements are not exempt from qualifying fire or emergency medical services levy taxes.

FULL SUMMARY

The bill modifies Ohio tax exemption law for real property improvements/structures located in Community Reinvestment Areas (CRAs) and incentive districts so that “qualifying” fire and emergency medical services levy taxes are no longer reduced by these exemptions. It does so by amending five Revised Code sections that govern CRA exemptions (3735.67) and incentive/district exemption programs for municipal corporations, townships, and counties (5709.40, 5709.41, 5709.73, and 5709.78).

For CRA property exemptions under section 3735.67, the bill adds a new limitation for agreements/residential exemptions approved on or after the bill’s effective date: the exempted property is not exempt from specified levy taxes—(1) taxes levied by joint fire, fire and ambulance, joint ambulance, or joint emergency medical services districts; (2) certain township taxes under specified Revised Code provisions; and (3) township fire district taxes—subject to an exception where the same township board of trustees adopted the CRA resolution authorizing the exemption.

For the various incentive district/public-purpose tax exemption provisions (sections 5709.40, 5709.41, 5709.73, and 5709.78), the bill introduces/clarifies a parallel restriction that improvements/exempted parcels are not exempt from a qualifying fire or emergency medical services tax. It also adds a definition tie-in: “qualifying fire or emergency medical services tax” is defined to include specific levies, including joint fire/ambulance/EMS district levies; specified township levies; and township fire district levies. In each program context, the exemption for improvements funded under the incentive/public infrastructure exemption framework is barred from reducing those qualifying fire/EMS levy taxes.

Separately, the bill contains a technical repeal: it repeals the “existing sections” 3735.67, 5709.40, 5709.41, 5709.73, and 5709.78 after amending them, and it specifies that the changes to sections 5709.40, 5709.41, 5709.73, and 5709.78 apply to exemptions authorized in ordinances or resolutions adopted on or after the bill’s effective date (per Section 3).

The bill establishes that all Public Safety Dispatchers and Public Safety Telecommunicators employed by a public safety agency must receive the same internal benefits as “First Responders.” It defines “Public Safety Dispatchers or Public Safety Telecommunicators” as individuals whose primary responsibility is to receive, process, transmit, or dispatch emergency and nonemergency calls for law enforcement, fire, emergency medical, and other public safety services via telephone, radio, or other communication device, including promotion- and supervision-level personnel performing these functions.

The bill further directs that no change be made to telecommunicators’ compensation and pension benefits, notwithstanding any contrary general or special law or rules/regulations. As written, the operative requirement is limited to internal benefits parity with first responders and explicitly preserves existing pay and pension terms.

No other substantive provisions are included in the provided text beyond the single operative paragraph and its definitional and carve-out language.

AT A GLANCE

This act authorizes an ambulance to staff an interfacility specialty care transport with a registered nurse instead of an EMT, only when specified presence, competency, and medical-direction and coordination conditions are met.

FULL SUMMARY

The law creates new requirements for staffing ambulance personnel for “interfacility specialty care transports,” while also updating definitions and general ambulance staffing provisions.

It establishes a new section stating legislative findings and intent to ensure minimum standards and training for emergency medical personnel and services, and to improve timely and safe specialty-care transfers when workforce limits otherwise inhibit transport.

It changes RCW 18.73.030 by revising/adding definitions relevant to ambulance and specialty care transports (including defining “interfacility transport” and “specialty care transport,” and aligning the ambulance chapter’s terminology for emergency medical services personnel and patient transport).

It amends RCW 18.73.150’s ambulance staffing rules by adding a specific pathway permitting a registered nurse to serve as sufficient personnel for an interfacility specialty care transport without an EMT certification, subject to conditions regarding the presence of an EMT within the ambulance, nurse competencies, absence of a responding paramedic, lack of an ER-available RN with EMT certification at the sending hospital, adherence to physician medical direction, and (additionally) requirements that the nurse follows the registered nurse scope of practice and that the sending hospital coordinates to confirm the nurse’s familiarity with the ambulance’s equipment and supplies before participating.

The amendments take effect June 11, 2026.

AT A GLANCE

This bill requires the Emergency Medical Services’ Board to submit an annual report by January 1 to two legislative joint standing committees with recommendations for changes to the EMS chapter and related provisions.

FULL SUMMARY

The bill makes several changes to Maine’s Emergency Medical Services (EMS) statutory framework by restructuring the Emergency Medical Services’ Board and adjusting related governance and reporting requirements. It alters the Board’s membership composition by changing the number of additional Board members and clarifying the types of nonregional representatives included, including licensed medical and EMS personnel categories (e.g., emergency physician; emergency professional nurse; emergency medical dispatch representative; for-profit ambulance representative; nontransporting EMS representative; not-for-profit ambulance representative; hospitals; fire chief and statewide fire chief association representative; municipal EMS provider; pediatrics representative), and specifies that certain ambulance/EMS-category representatives must be licensed EMS persons.

It also adds/clarifies Board operational rules: the Board elects its own chair for a 2-year term; permits internal rules including possible termination of membership for irregular attendance; sets procedures for filling partial-term vacancies based on whether the original appointing authority was the Governor or a regional council; continues removal-for-cause by the Governor; and allows the Board to have a common seal and establish subcommittees. The bill increases the minimum meeting conditions by amending the requirement that the Board meet at least quarterly and clarifies that members are compensated under Title 5, chapter 379 when meeting.

The bill creates a new annual reporting obligation: by January 1 each year, the Board must submit a report to two legislative joint standing committees (those responsible for EMS matters and EMS personnel licensing matters) with recommendations for changes to the EMS chapter and related provisions. It also revises provisions governing the regional councils by changing the nominating language used in selecting Board members (substituting appointment-related wording for prior nomination wording) and adding a required function for regional councils: regularly advising the region’s Board representative on issues, concerns, and policies affecting the region.

For transition, the bill provides that any Board member serving on the effective date continues serving until the expiration of that member’s term, notwithstanding the normal statutory provisions referenced in the transition clause.

The proposed legislation seeks to amend Wisconsin's Medical Assistance program, focusing on reimbursement for emergency services. Starting January 1, 2027, the Department of Health Services (DHS) will increase the maximum reimbursement rate for non-transport ambulance services to align with the rate for basic life support emergency transport services. This adjustment is anticipated to enhance revenue for ambulance service providers from non-transport services.

Additionally, the Emergency Medical Services Board, in collaboration with DHS and the Technical College System Board, will be mandated to submit an annual report to the legislature. This report will address changes in the scope of practice for emergency medical responders and services practitioners, which may affect training requirements in the state.

The legislation also revises eligibility criteria for municipalities in the expenditure restraint incentive program. It excludes certain expenditures related to joint fire departments or emergency medical services districts from local levy limits, which could influence municipal budgeting and funding for emergency services.

Overall, the legislation aims to improve the financial sustainability of emergency medical services and ensure appropriate compensation for non-transport services while keeping the legislature informed about relevant developments in the field.

AT A GLANCE

This bill authorizes licensed paramedics in a county with a population of 100,000 or less to administer buprenorphine in the field only after giving an opioid antagonist and completing DOH-approved training.

FULL SUMMARY

The bill establishes a two-year phased pilot program in which licensed paramedics may administer buprenorphine in the field after administering an opioid antagonist to patients with suspected opioid overdose, but only in a county with a population of 100,000 or less. It directs the Department of Health (DOH) to create and implement the program, including training for paramedics, and to report pilot outcomes to the Legislature.

It changes Hawaii Revised Statutes §329E-3 by adding new authority effective July 1, 2026 for paramedics (in the specified small-population county) to administer buprenorphine following an opioid antagonist, subject to conditions: the paramedic must have DOH-approved training in opioid withdrawal assessment and buprenorphine administration; the patient must be alert, have regained decision-making capacity, and meet protocol-defined clinical criteria for field initiation; a same-day or next-day referral must be made to a DOH-authorized designated treatment provider; and documentation of the administration, withdrawal assessment, and referral must be submitted to DOH for program evaluation.

The bill also requires DOH to adopt rules under HRS chapter 91 covering clinical and operational protocols for field buprenorphine administration by paramedics, and requiring DOH to designate and maintain a list of treatment centers/providers able to accept referred patients within 24 to 48 hours, and ensure coordination between emergency medical services, emergency departments, and substance use disorder treatment programs. DOH is further required to implement the pilot (and may expand statewide as additional treatment resources become available) and to submit a legislative report no later than 20 months after the pilot start date evaluating: number of patients treated, withdrawal symptom outcomes, rates of engagement with follow-up treatment, operational challenges/recommendations for expansion, and any proposed legislation.

The bill appropriates general funds for DOH to implement the pilot program for fiscal year 2026–2027. It takes effect upon approval, with the funding effective July 1, 2026, and it sunsets the program by repealing sections 2 and 3 on June 30, 2028 (reenacting §329E-3 in the form it existed the day before the act’s effective date).

The proposed legislation in Wisconsin introduces significant changes to the coverage and reimbursement of emergency ambulance services under health insurance policies. It mandates that defined network plans, preferred provider plans, and self-insured governmental plans must cover emergency ambulance services provided by non-participating ambulance service providers. The reimbursement rates are prioritized, starting with a mutually agreed-upon rate, followed by a rate set or approved by a local governmental entity, and finally a rate of 350% of the Medicare program’s published rate or the rate billed by the provider, whichever is lower.

Additionally, the legislation imposes limitations on cost-sharing for enrollees. Ambulance service providers reimbursed at the applicable rate cannot charge enrollees more than their cost-sharing responsibilities, such as copayments or deductibles. Health plans are also prohibited from imposing higher cost-sharing amounts than would apply if the ambulance service provider were a participating provider.

The legislation requires health insurance policies and self-insured governmental health plans to process claims for covered emergency ambulance services within 30 days. They must either remit payment directly to the ambulance service provider or notify them of any claim defects. Furthermore, payment for ambulance transportation is mandated if the claim includes a medical necessity certification statement signed by an individual meeting federal criteria.

These changes are expected to have a significant impact on the healthcare and insurance industries, particularly affecting ambulance service providers and health insurance companies. The legislation aims to standardize reimbursement practices for emergency ambulance services and protect enrollees from excessive costs. Further information regarding the fiscal impact of this proposal will be included in an appendix to the bill.

AT A GLANCE

This bill allows Wisconsin income tax filers to subtract up to $2,000 for eligible stipends paid to volunteer emergency responders after December 31, 2026.

FULL SUMMARY

The bill creates a Wisconsin income tax subtraction (for taxable years beginning after December 31, 2026) of up to $2,000 for stipends paid to volunteer “emergency responders,” where the stipend is based on calls/shifts worked, time on call, or a similar metric, and is paid by a local governmental unit or a qualified contracting entity. It defines “emergency responder” to include emergency medical responders, emergency medical services practitioners (including EMTs and paramedics), and firefighters, and limits the subtraction to the lesser of $2,000 or the amount of the stipend included in federal adjusted gross income.

It adds statutory protections for ambulance staffing: if a licensed physician, physician assistant, or registered nurse is staffing an ambulance or an emergency medical responder department, the Department of Health Services may not limit that provider to practicing only within a lower scope of practice than the scope permitted by the individual’s own license (Section 2). It also creates a matching rural services flexibility by allowing a rural emergency medical responder department to upgrade the service level of its operation to the highest level of license of any responding emergency medical responder or EMS practitioner staffing the transport ambulance, consistent with the earlier rural ambulance upgrade concept; if a rural emergency medical responder department member performs above the transporting ambulance service level (but within the member’s own licensed scope), the member must accompany the patient to the hospital.

The bill shifts and formalizes EMS licensing standards in statute. It renumbers the EMS practitioner/certificate reciprocity provisions (Section 6) and replaces the department’s reciprocity application requirements with narrower eligibility rules for certain applicants who hold current national registry EMT certification at or above the level sought, barring DHS from requiring specified out-of-state documentation and education verification steps for those applicants. It also creates a new statutory section governing license/certificate expiration, late renewal, and reinstatement for EMS practitioners and responders (effective as specified), replacing DHS’s administrative framework with statute-based deadlines and requirements: late renewal is permitted up to 12 months after expiration with a late fee and subsequent credentialing; reinstatement is tiered for expirations of over 12 months/under 3 years, 3/under 6 years, and 6 years or more, adding specific refresher/continuing education quantities and, for very long lapses, a requirement to successfully complete initial training and examination within the 24 months immediately preceding the reinstatement application.

No operative text beyond the above is included in the parsed sections, and the bill sets effective dates specifying that the staffing provisions and the new late renewal/reinstatement rules take effect on the first day of the third month after publication while other provisions take effect the day after publication.

AT A GLANCE

This bill requires the Department of Health Services to award community EMS grants to six municipal EMS programs, prioritizing rural, suburban, and urban providers, and prohibits awarding grants to programs already employing a community paramedic or practitioner.

FULL SUMMARY

The bill modifies Wisconsin’s statutory funding structure for two health-related grant efforts administered by the Department of Health Services (DHS): community emergency medical services (EMS) grants and statewide falls prevention awareness and initiatives. It sets up and funds a community EMS grants pilot as a continuing appropriation under s. 20.435 (1) (ck), including grant amount, eligibility limits, a preference by geography (rural/suburban/urban), a reporting requirement, and a time limit for awarding grants.

For the community EMS grants pilot, DHS must award grants to 6 municipal emergency medical services programs—defined as county/city/village/town EMS programs or combinations—so they can provide community EMS under s. 256.215 (2) and hire a full-time community paramedic or full-time community EMS practitioner. DHS must prioritize awarding the 6 grants to 2 rural, 2 suburban, and 2 urban municipal EMS programs. The appropriation provides $600,000, and if funds remain after awarding the initial 6 grants, DHS may award a seventh grant. DHS is barred from awarding a grant to any program that already employs a community paramedic or community EMS practitioner at the time of application. DHS also may not award grants under the pilot after the last day of the 12th month beginning after the act’s effective date. Within one year after receiving a grant, each recipient must submit a report to DHS and the legislature’s standing committees under s. 13.172 (3) detailing grant effectiveness, including estimated cost savings and estimated number of individuals served by the hired practitioner.

The bill also directs DHS to award a $200,000 grant in each of fiscal years 2025-26 and 2026-27 to the Wisconsin Institute for Healthy Aging for statewide falls prevention awareness and initiatives, appropriating the same amounts for that purpose. It makes related fiscal changes by increasing the relevant DHS appropriation line(s) to provide the additional $200,000 in each fiscal year to support this falls prevention grant.

Implementation details include repeal timing: the creation/replacement of the community EMS grant statutory provision is paired with a repeal of s. 20.435 (1) (ck) effective July 1, 2027, indicating the community EMS grants pilot authority ends then.

The proposed legislation introduces an exemption to local levy limits specifically for costs associated with regional emergency medical services. This exemption is available to municipalities that participate in joint emergency medical services districts or intergovernmental agreements, allowing them to better fund these essential services.

Under the new provisions, amounts levied for regional emergency medical services will not count towards existing levy limits, provided certain conditions are met. These conditions include a cap on the increase in levies, which cannot exceed the percentage change in the U.S. consumer price index plus 5%, and confirmation of a regional service area by the political subdivision.

Furthermore, expenditures qualifying for this exemption will not impact eligibility for the expenditure restraint incentive program, which requires budget increases to remain below a specified threshold.

Overall, the legislation aims to enhance financial flexibility for municipalities in funding emergency medical services, ensuring that they can adequately respond to the needs of their communities.

The proposed legislation in Wisconsin mandates that first responders receive training in the use of epinephrine delivery systems, essential for treating severe allergic reactions such as anaphylaxis. This training will cover recognizing symptoms, proper storage and administration of epinephrine, and emergency follow-up procedures.

The sectors affected by this requirement include emergency medical services, law enforcement, firefighting, and correctional facilities, all of which employ first responders who must comply with the new training standards.

The Department of Health Services (DHS) is responsible for identifying organizations that provide the necessary training, which can be offered online or in person. Additionally, DHS may supply epinephrine delivery systems to trained first responders or their employers, funded through a designated appropriation.

While the bill was introduced on March 11, 2025, it does not specify an implementation date. Further fiscal estimates related to the bill's implementation will be included in an appendix.

The proposed legislation introduces significant amendments to health insurance coverage and reimbursement for emergency ambulance services. It mandates that defined network plans, preferred provider plans, and self-insured governmental plans must cover emergency ambulance services provided by non-participating ambulance service providers. The reimbursement rates are prioritized, with the highest being a mutually agreed rate, followed by a rate set or approved by local governmental entities, and finally a rate of 350% of the Medicare program’s published rate or the rate billed by the ambulance service provider, whichever is lower.

To protect consumers, the legislation imposes cost-sharing limitations, ensuring that ambulance service providers reimbursed at the applicable rate cannot charge enrollees beyond their cost-sharing responsibilities. Health plans are also prohibited from imposing higher cost-sharing amounts than would apply if the ambulance service provider were a participating provider. Additionally, ambulance service providers receiving reimbursement under this legislation are restricted from billing enrollees for any amounts beyond copayments, coinsurance, or deductibles.

The legislation requires health insurance policies and self-insured governmental health plans to process claims for covered emergency ambulance services within 30 days. They must either remit payment directly to the ambulance service provider or notify them of any claim defects within the same timeframe. Furthermore, payment for ambulance transportation is contingent upon the inclusion of a medical necessity certification statement signed by an authorized individual.

Overall, these changes are expected to significantly impact the health insurance industry, ambulance service providers, and local governmental entities involved in setting reimbursement rates, while also aiming to enhance consumer protection against excessive out-of-pocket costs.

AT A GLANCE

This bill requires ambulance services to file quarterly call and response-time reports and disclose redacted data online, subjecting repeated late or missing reports to up to $500 civil penalties.

FULL SUMMARY

The bill establishes new quarterly reporting and public disclosure requirements for ambulance services regarding call types, response time milestones, certain refusal of mutual aid, complaint details, and medication/other patient injuries; it requires the Department to redact personally identifying information and post the data (as redacted) on its website, and it creates a notice-to-comply and civil-penalty process (up to $500) for repeated quarterly reporting failures. It also requires the Department to create an online certificate of necessity application tracking portal and a public dashboard showing ambulance response-time performance by call type and the percentage of calls requiring advanced life support.

The bill adds an electronic global positioning system (GPS) requirement for vehicles used for patient transport, effective January 1, 2024, to record on-scene arrival times for response-time measurement, with a waiver process for areas lacking sufficient GPS coverage (waivers expire April 1 of each year and may be renewed). It further expands the Department’s operational planning and oversight tools by requiring the Department to publicly make response-time data available (including through filings compliant with HIPAA) and by adding specific response-time consideration factors tied to hospital diversion, delayed emergency department admission, and ambulance availability in the affected area when reviewing response-time compliance.

For certificates of necessity, the bill adds a director prohibition on requiring applicants to purchase equipment/ambulances/other vehicles before approving a certificate of necessity if the applicant can demonstrate the ability to provide all services required under the certificate. It also updates procedural timelines and limits in the certificate of necessity appeal/administrative hearing process, including an explicit 7-day intervention window after hearing notice, a cap of five consecutive business days for a certificate of necessity appeal hearing unless an administrative law judge finds extraordinary need (with up to five additional days), and changes to the director’s review/accept/reject/modify steps and related service of decisions.

Finally, the bill adds a new civil penalty provision: the director must assess a $1,500 civil penalty on an ambulance service if the service is not complying with the certificate of necessity’s requirements, while preserving the holder’s ability to appeal and request a hearing. It also adjusts renewal terms by directing that decisions for certificate-of-necessity renewal must be based on current data and restates renewal/“show cause” timing mechanics tied to director-ordered hearings, while adding a service-area population-change trigger requiring the Department to review whether response-time adjustments are needed when population changes by 10% or more under specified census/estimate benchmarks.

AT A GLANCE

This bill establishes a Massachusetts EMS Implementation Commission, with appointments and its first meeting due by July 1, 2026, and requires it to hold public hearings and convene at least quarterly.

FULL SUMMARY

The bill establishes a special commission to study and guide implementation of emergency medical services (EMS) as an essential service in Massachusetts. It declares the act an emergency law to enable immediate implementation.

The commission consists of the Secretary of Health and Human Services (or designee) as chair; the Director of the Massachusetts Office of Emergency Medical Services (or designee); specified legislative appointees representing urban and rural EMS agencies; six Governor-appointed members (including representatives from regional EMS councils, public health experts with EMS experience, a hospital-based EMS provider, and a person with lived experience as an EMS recipient); and additional Governor-directed or association-directed representatives including the Massachusetts Municipal Association, the Fire Chiefs’ Association of Massachusetts, the Massachusetts EMS professionals (with at least one EMT and one paramedic appointed through the Office of EMS), and the Massachusetts Ambulance Association. Appointments and the first meeting must occur no later than July 1, 2026, and the commission must convene at least quarterly.

The commission must hold at least two public hearings and is required to: assess statewide EMS coverage, funding, and workforce capacity; identify and address disparities in EMS availability and response times in underserved communities; develop recommendations for sustainable funding models (including possible uses of Fair Share Amendment revenue, federal grants, public-private partnerships, and other funding streams); propose strategies for regionalization and shared services in collaboration with existing regional EMS councils; recommend approaches to EMS workforce shortages (including recruitment, training, and retention incentives for EMS personnel and instructors); and develop a framework for statewide EMS performance metrics and accountability standards.

The Massachusetts Office of Emergency Medical Services must provide administrative and technical support and may receive requests from the commission for data, reports, and information from state agencies, regional EMS councils, and municipal governments as needed. The commission must submit a final report with study results, recommendations, and any proposed standards and legislation to the Secretary of Health and Human Services, the joint committee on public health, the House and Senate Ways and Means committees, and the clerks of the House and Senate no later than 15 months after the act’s effective date; the commission may release a draft for public comment before filing the final report.

AT A GLANCE

This bill authorizes EMTs and other first responders to restrain overdose or imminent-threat patients using minimum necessary force under department regulations, while requiring ambulance transport and mandated written documentation.

FULL SUMMARY

The bill permits emergency medical technicians (EMTs) to restrain a patient who presents an immediate or serious threat of bodily harm to themselves or others, subject to department regulations and guidelines. It requires that, upon an EMT’s request, a law enforcement official assist with the restraint; the restraint must be the minimum necessary and must be documented in the EMT’s written report.

The bill adds a new operating framework for opioid antagonist use in apparent drug overdoses. If law enforcement officials, firefighters, or EMS personnel administer an opioid antagonist (as defined in the state controlled substances chapter) to a person suffering from an apparent overdose, the person must be transported by ambulance to a hospital, with or without consent, for monitoring, observation, and possible treatment until a treating physician determines the overdose is reversed and the person is not in imminent danger. It also authorizes restraint during transport under the same restraint provisions, and—if a law enforcement officer reasonably believes safety requires it—authorizes limited searches of the person and immediate surroundings to discover and seize dangerous weapons.

The bill updates liability protections. It amends the existing immunity for EMS personnel and related first-aid rendering, transportation, and overdose transport under the new section 18A, providing that EMS personnel acting in good faith are not personally liable for acts or omissions (except gross negligence or willful or wanton misconduct) and are not liable to a hospital for expenses in connection with emergency admissions, including admissions tied to monitoring, observation, or treating a person transported under section 18A.

Finally, it broadens general emergency-care immunity in Massachusetts. It amends the emergency-care liability statute to cover any person who, in good faith and without compensation, attempts to render emergency care—including administration of an opioid antagonist as defined in chapter 94C—and provides that liability is excluded except for gross negligence or willful or wanton misconduct.

AT A GLANCE

This bill establishes a three-year Massachusetts EMS treatment-in-place pilot requiring the Department of Public Health, with the EMS system advisory board, to design, test, and evaluate treat-in-place models.

FULL SUMMARY

The bill establishes a 3-year Massachusetts emergency medical services (EMS) “treatment-in-place” (TIP) pilot program, requiring the Department of Public Health (DPH), in collaboration with the EMS system advisory board, to design, test, evaluate, and advance treat-in-place models. It defines key terms (including “emergent medical condition,” “non-emergent medical condition,” “EMS providers,” and “treat-in-place”) to govern which situations TIP can be used for and who is eligible to participate.

Under the pilot, EMS providers may deliver care at the scene and/or via telehealth without transporting patients to an emergency department when the situation involves non-emergent conditions. The bill directs DPH to develop and test alternative payment models that reimburse treat-in-place services instead of paying only for emergency department transport, and to collaborate with the Centers for Medicare and Medicaid Services (CMS) to align reimbursement structures with existing federal programs. Participating providers must receive financial incentives, must collect specified performance data, and the program must prioritize providers serving high shares of Medicare/Medicaid beneficiaries and/or communities with limited access to emergency departments.

The bill requires participating EMS providers to collect data on patient outcomes, cost savings, patient satisfaction, and other metrics determined by DPH, and it requires DPH to prepare an annual report. The annual report must evaluate program effectiveness in improving access to EMS care, analyze cost savings and financial sustainability, incorporate provider-collected data, and include recommendations for expansion; the report is due by December 31 each year to the governor, specified public health/health care financing committee chairs, and legislative clerks. The bill also authorizes DPH (subject to appropriation) to allocate funding necessary to implement and evaluate the pilot.

It does not identify any specific existing statute or regulation being struck, inserted into, or revised in the provided text; instead, it creates a new EMS TIP pilot program and associated requirements and reporting obligations.

AT A GLANCE

This bill applies Florida’s workers’ compensation mental or nervous injury special provisions to 911 public safety telecommunicators for employment-related accidents and injuries, by expressly including them in s. 112.1815.

FULL SUMMARY

The bill establishes that the workers’ compensation “special provisions” in s. 112.1815, Florida Statutes, apply to 911 public safety telecommunicators in the same way the provisions apply to firefighters, paramedics/emergency medical technicians, and law enforcement officers, specifically for employment-related accidents and injuries involving mental or nervous injuries.

It changes s. 112.1815 by (1) adding/defining “911 public safety telecommunicator” within the section to have the same meaning as in s. 401.465(1); and (2) updating the operative benefit-determination provisions for first responders to expressly include 911 public safety telecommunicators. The bill incorporates these mental/nervous injury rules for telecommunicators: toxic-substance exposure is compensable only upon a preponderance of evidence linking the specific substance and exposure levels to the injury/disease; adverse results from smallpox vaccination are deemed injuries by accident arising out of work; and compensable mental or nervous injuries must be shown by clear and convincing evidence when they occur as a manifestation of a compensable injury. For mental or nervous injuries arising out of employment without accompanying physical injury, only medical benefits under s. 440.13 are payable unless a physical injury accompanies the mental/nervous injury for indemnity under s. 440.15.

The bill also specifies limitations on benefits that affect 911 public safety telecommunicators, providing that benefits for a 911 public safety telecommunicator are not subject to any limitation on temporary benefits under s. 440.093. It further clarifies that the “important state interest” declaration is part of the bill’s findings.

The act takes effect July 1, 2026.

AT A GLANCE

This bill requires each Florida county executive board to unanimously select by January 1, 2027 the entity operating its unified 911 emergency communications center, with sheriff designation if missed.

FULL SUMMARY

The bill revises Florida’s emergency communications statutory framework by (1) changing the applicability/definitions in s. 365.172, and (2) creating a new, county-based unified 911 requirements section in s. 365.1725.

In s. 365.172, the bill updates definitions used throughout the emergency communications statutes, including definitions for “Authorized expenditures” and technical terms used for 911/communications services and systems (e.g., E911/NG911, PSAP, and related terminology).

It then creates s. 365.1725, establishing legislative intent to create a unified 911 emergency answering and dispatch system within each county (or region) as a single point of contact, maximizing efficiency and interoperability, and prohibiting transferring emergency calls outside the unified system before dispatch (except where the emergency occurs outside the operator’s jurisdiction). The new section requires each county to convene an executive board meeting by August 1, 2026 to discuss creating a unified system; by January 1, 2027 the executive board must unanimously select the entity that will operate the emergency communications center (which may be the county, sheriff, municipality, special district, or another entity created via interlocal agreement); by February 1, 2027 the chair must certify compliance actions; and by March 1, 2027 the Office must report to state leadership identifying any county that has not designated an entity.

The bill requires that, by January 1, 2029, each county and every public safety agency within the county (including municipalities, special districts, airports, universities, state colleges, and school boards) provide 911, emergency call, and dispatch services from the emergency communications center operated by the designated entity. If a county has not met the January 1, 2029 deadline within 180 days of the required action date, the sheriff is deemed the designated entity, and all existing 911 operations must be integrated under the sheriff with mandatory participation by every public safety agency. The sheriff-as-designated-operator scenario specifies that operating expenditures may not be included in the sheriff’s budget under s. 30.49 and must instead be included in the county budget under ch. 129. The bill also imposes operational requirements on the operating entity: maintain headquarters in one location for the primary PSAP (while allowing offices/answering points elsewhere as needed); allow alternate PSAP/center reception only when the primary PSAP is unable to receive calls; require interoperability with all other emergency communications centers and proactive cybersecurity standards (including adoption of NIST-related “Optimal PSAP” guidance); and require vendors of CAD and interoperable radio communications systems (to the extent possible) to provide built-in integration capability with different PSAP CAD systems and radio systems used by Florida emergency communications centers, prohibiting additional licensing or integration fees for enabling integration of such systems. The bill also ensures certain voluntary or regional interlocal arrangements are allowed (e.g., Florida Highway Patrol or Fish and Wildlife Conservation Commission may voluntarily integrate via memorandum/agreement; and two or more counties may form a regional center via interlocal agreements), provided applicable requirements are met. The bill takes effect upon becoming law.

AT A GLANCE

This bill requires the Department of Health to appoint an EMS compact state delegate and authorizes the commission to govern home-state licensing and remote-state privilege to practice under the Interstate Compact.

FULL SUMMARY

The bill (“Big Beautiful Healthcare Frontier Act”) makes a wide set of statutory changes in Florida’s health and human services programs and creates or implements multiple interstate licensure compacts, including an Emergency Medical Services (EMS) Personnel Licensure Interstate Compact, a Physician Assistant Licensure Compact, and a Social Work Licensure Interstate Compact, while also adjusting Medicaid/Food Assistance program rules and various professional regulation provisions.

It requires Florida’s Department of Health to appoint a state delegate for the EMS compact (added s. 401.466) and establishes the compact’s operative framework, including: (1) home-state licensure as the basis for “privilege to practice” in remote member states; (2) eligibility conditions for exercising the privilege (e.g., age, current unrestricted home-state license, medical director supervision, and compliance with member-state rules); (3) remote-state authority to restrict/suspend/revoke the privilege with notice/reporting back to the home state and the interstate commission; (4) adverse-action exclusivity for home state, with reporting to the commission; (5) conditions under which EMS personnel may practice in remote states (specific patient-transport scenarios and other rule-defined conditions); (6) a coordinated data and reporting system; (7) commission governance (delegates, rules, bylaws, meetings, immunities/indemnities, venue for legal proceedings, and enforcement/default/termination processes); and (8) implementation/withdrawal/amendment mechanics.

It also creates an EMS-related disciplinary enforcement pathway in existing Florida statutes: s. 401.411 is amended to add new licensure discipline authorization and adds a new subsection addressing the Department of Health’s authority over EMS personnel privilege to practice under the new compact; s. 401.25 is amended to (a) exempt certain EMS personnel licensed in other states who practice under the compact within scope from Florida’s licensure requirements and (b) require appointment of the EMS compact delegate. Further, it adds/updates oversight/reporting ties to the coordinated licensure database by updating other regulatory provisions so that significant investigatory information for EMS personnel subject to multiple compacts is reported to the relevant coordinated system.

Beyond EMS, the bill (1) enacts the Physician Assistant Licensure Compact (added s. 456.66) with analogous concepts of compact privileges, remote-state authority, adverse actions, joint investigations, data system reporting, commission governance, and rulemaking; and it updates Florida’s physician assistant statutes accordingly, including joint delegation appointment by the Board of Medicine and the Board of Osteopathic Medicine and an exemption from Florida licensure requirements for compact-practicing physician assistants. (2) It creates the Social Work Licensure Interstate Compact (added s. 491.022) and updates related social work statutes, including appointment of the Social Work compact delegate and changes to exemptions and licensure-by-endorsement pathways for social workers practicing under the compact. (3) It amends a variety of other Florida regulatory provisions: it updates a healthcare-practitioner notice-of-referral requirement (s. 456.0575), changes physician assistant supervision numerical limits, expands dental hygienist authority to prescribe/dispense specified agents and administer local anesthesia under defined conditions, and revises dentist delegation/expanded-function rules and reporting of dental adverse incidents. Finally, it makes major Medicaid and food assistance changes: it revises Florida Kidcare alien eligibility (effective Oct. 1, 2026), adds eligibility-related administrative duties for address updates and address data sourcing for Medicaid, adjusts Medicaid retroactive payment timing and prohibited-entity payment rules, creates food assistance eligibility and a required “food assistance payment accuracy improvement plan” with specified error-rate reduction and reporting deadlines, modifies SNAP work participation requirements, and updates health insurance deductible/out-of-pocket maximum crediting for nonpreferred providers under specified conditions (s. 627.6471). The bill generally takes effect July 1, 2026, except for the Kidcare eligibility change effective Oct. 1, 2026.

AT A GLANCE

This bill exempts specified portions of meetings of three named interstate licensure compact commissions, and the resulting recordings, minutes, and records, from Florida open-meetings and public-records requirements.

FULL SUMMARY

The bill creates three new Florida statutory exemptions from state public meetings and public records requirements for specified portions of meetings held by three interstate licensure compact commissions (EMS Personnel, Physician Assistant, and Social Work). It also creates parallel exemptions for recordings, minutes, and records generated during those exempt meeting portions.

For each compact commission, the bill exempts from Florida’s public meetings statute and constitutional open-government requirement any meeting or portion of a meeting at which matters specifically exempted from disclosure by federal or state law are discussed. It further exempts from public records disclosure the recordings, minutes, and records generated during such exempt meeting portions.

The bill also exempts from public records disclosure certain personal identifying information held by Florida departments/boards for persons covered by the compacts: for EMS personnel, physician assistants, and social workers, the exemption covers information other than the individual’s name, licensure status, or licensure number obtained from the relevant coordinated/data system. The exemption applies unless the state that originally reported the information to the data system authorizes disclosure by law, in which case disclosure is limited to what the reporting state’s law authorizes.

Each exemption is subject to the Open Government Sunset Review Act and is scheduled to stand repealed on October 2, 2031 unless reenacted. The bill includes findings of public necessity tying the exemptions to requirements for confidential/sensitive discussions under the interstate compacts and to the need to avoid negating the public meetings exemption through release of recordings/minutes/records. The act takes effect on the same date HB 693 (or similar legislation) takes effect if adopted in the same legislative session or an extension and becomes law.

AT A GLANCE

This bill requires insurers to cover and reimburse participating ground ambulance services, including approved mobile integrated healthcare community paramedicine, at Medicare rates and the providers’ level of care in contracts renewed on or after January 1, 2027.

FULL SUMMARY

The bill establishes a state-administered “mobile integrated healthcare community paramedicine program” within Rhode Island’s emergency medical services framework. The Department of Health, in collaboration with the ambulance service coordinating advisory board, must administer the program and promulgate rules, regulations, standing orders, protocols, and procedures necessary for its administration and enforcement. Participation is limited to emergency medical services agencies that apply for and receive department approval, and the program’s scope must incorporate both in-network (INN) and out-of-network (OON) ground ambulance services, community-based healthcare services, and mobile integrated healthcare community paramedicine services approved by the department.

For OON ground ambulance services participating in the program, the bill requires compliance with state and federal prohibitions on surprise medical billing. It also defines “mobile integrated healthcare community paramedicine program” across multiple insurance and managed-care chapters, using language that ties the program to patient-centered, mobile out-of-hospital healthcare delivered under an EMS agency plan approved by the Department of Health and carried out by licensed EMS practitioners working in collaboration with additional clinical and community resources.

The bill increases or standardizes insurance coverage and reimbursement requirements for ground ambulance services beginning with policies renewed on or after January 1, 2027. For individual and group health insurance contracts (and parallel requirements in nonprofit hospital service corporation, nonprofit medical service corporation, and health maintenance organization chapters), insurers must provide coverage and reimbursement for ground ambulance services at rates equal to Medicare for the same medical services, must reimburse EMS providers at the “level of care provided,” and must ensure coverage and reimbursement include community-based healthcare services, including approved mobile integrated health community paramedicine programs (with the condition that such paramedicine program services are performed by EMS-staffed emergency medical practitioners). These coverage/reimbursement requirements extend to INN ground ambulance services, OON ground ambulance services, INN and OON community-based healthcare services, and INN and OON mobile integrated paramedicine programs approved by the Department of Health.

The bill takes effect upon passage. (Effective change date for the new insurance reimbursement obligation is explicitly tied to contracts/policies issued for delivery or renewed in the state on or after January 1, 2027.)

AT A GLANCE

This bill requires the Department of Health to establish and maintain statewide “emergency medical systems of care,” modernizing coordination, training, data evaluation, 911 oversight, and air-medical standards.

FULL SUMMARY

The bill establishes a comprehensive, time-sensitive “emergency medical systems of care” model in place of the prior “state emergency medical services system” framework, expanding coverage to include emergency medical services (EMS), EMS for children, and trauma and critical care services. It directs modernization of statewide coordination and integration to support timely, evidence-based response across islands and for time-sensitive emergencies, and it updates multiple statutory provisions to use the “systems of care” terminology and structure.

Key statutory changes include: (1) updating the definitions and governance framework in HRS chapter 321 (Sections 321-221 and 321-222) to define and organize “emergency medical systems of care,” adjust terms such as “state system,” “statewide,” and related air-medical terminology, and revise the composition and functions of the Hawaii emergency medical systems of care advisory council (replacing the prior advisory “committee” concept); (2) requiring the Department of Health to establish and maintain statewide “systems of care” (Section 321-223), including contracting and ensuring consistency of county/ambulance services with the part; and (3) revising the Department’s duties (Section 321-224) to include statewide EMS development, statewide training/curricula approval, data evaluation, mass-casualty/disaster resource coordination, interoperability communications, oversight of development/implementation of a statewide “911” dispatch system, public information/education, early defibrillation programming, statewide EMS-for-children services, and statewide standards for EMS course instructor qualifications and training-facility requirements.

The bill also modifies county-level implementation and evaluation provisions (Section 321-228) so the Department determines EMS levels for each county “in consultation with” the advisory council and may contract for EMS components (including emergency air-medical services) consistent with the statewide system; it updates technical assistance and data/evaluation functions (Section 321-230) to cover statewide EMS systems of care data across multiple emergency categories, authorizes/maintains a trauma registry, and expands the Department’s air-medical system requirements to include data collection/analysis to measure efficiency and effectiveness across each phase, monitoring of statewide air-medical flights and associated outcomes, coordination/assistance to public and private entities involved, and continued quality-improvement committee work using department-established air-medical performance measures. Finally, it aligns grant-consultation requirements (Section 321-231) by requiring Department consultation with the advisory council when preparing grant applications for the state system or components.

Effective date is upon approval (Section 11).

AT A GLANCE

This bill prohibits covered enrollees from being balance-billed by out-of-network providers for emergency services, specified nonemergency services at in-network facilities, and EMS-vehicle transportation, limiting cost-sharing to in-network amounts.

FULL SUMMARY

The bill amends Virginia’s health insurance balance billing statute and definitions to expand and clarify protections for covered enrollees receiving services from out-of-network providers.

It amends § 38.2-3438 (definitions) by adding/clarifying definitions relevant to emergency and balance billing, including: “Emergency medical services vehicle” (a permitted EMS vehicle equipped and operated to provide emergency medical care/transport), and expanded description of “Emergency services” for both hospital emergency departments and behavioral health crisis service providers, consistent with the definition of “emergency medical condition.” It also adds or clarifies “Offer to pay” / “payment notification” terminology tied to adjudicated and carrier-determined amounts for certain out-of-network services.

It amends § 38.2-3445.01 (balance billing for certain services; prohibited) by expressly prohibiting out-of-network balance billing for: emergency services; nonemergency surgical or ancillary services provided at an in-network facility; and transportation provided by an emergency medical services vehicle. The enrollee’s permitted cost-sharing is limited to the applicable in-network cost-sharing amount as determined using the carrier’s median in-network contracted rate (or a different method if no median in-network rate exists). The carrier and provider must ensure the enrollee incurs no greater cost and must not attempt to collect more than the amount determined under the statute.

The bill adds operational details for cost-sharing and payment disputes: it requires the carrier to treat the determined out-of-network cost-sharing as in-network cost-sharing, apply it toward the in-network maximum out-of-pocket, and imposes a $100 cap on cost-sharing for out-of-network services covered under the EMS-vehicle clause; it requires refunds of any enrollee overpayment within 30 business days plus interest at the legal rate; it requires commercially reasonable payment amounts based on similar services/area and establishes timelines and a negotiation/arbitration pathway under § 38.2-3445.02 if parties cannot agree. It also requires the carrier to make payments directly to providers and to make electronic/other verification methods available for eligibility and benefits information.