COMMITTEE ON HEALTH, HOSPITALS AND 
HUMAN SERVICES 
 
12/7/2023-REPORTED OUT TO THE FLOOR 
10/04/2023-REPORTED OUT TO THE COMMITTEE ON RULES AND JUDICIARY 
 
 
BILL NO. 
35-0119 
 
Thirty-Fifth Legislature of the Virgin Islands 
 
 
 
August 22, 2023 
 
 
 
An Act amending title 19 Virgin Islands Code by adding a chapter 7A directing the Department 
of Health to develop and approve Mobile Integrated Healthcare Programs 
 
 
 
PROPOSED BY:  
 
Senators Marise C. James and Angel L. Bolques, Jr. 
Co-sponsors: Ray Fonseca, Novelle E. Francis, Jr. and  
Samuel Carriόn 
 
Be it enacted by the Legislature of the Virgin Islands: 
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SECTION 1.  Title 19 Virgin Islands Code is amended by adding a chapter 7A to read 
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as follows: 
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“Chapter 7A.  Mobile Integrated Healthcare Programs 
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§ 155.  Definitions 
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As used in this chapter: 
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(1) 
“Community paramedic" means an individual who: 
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(A) is licensed as a paramedic; 
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2 
 
(B) meets the requirements for additional licensure as a community paramedic 
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under this chapter that may be required by the Commissioner of the Department; 
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(C) works within a designated MIH program under medical control as part of a 
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community-based team of health and social services providers; and 
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(D) provides services to a patient who has been identified by the individual’s 
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treating physician as an individual for whom community paramedic services would 
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likely: 
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(i) 
prevent admission to or allow discharge from a nursing facility; 
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(ii) 
prevent readmission to a hospital or nursing home; or  
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(iii) prevent injury and illness. 
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(2) 
“Emergency department avoidance or ED avoidance” means a component of an 
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MIH program that, after primary ambulance response, assessment, and consultation with on-
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line medical direction, utilizes community paramedics with advanced training and nurse 
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practitioners to manage the patient as an MIH patient in accordance with this chapter and 
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Department guidelines. 
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(3) 
“Emergency medical services" or “EMS” means providing any of the following: 
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(A) emergency ambulance services or other services, including extrication and 
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rescue services, utilized in serving an individual’s need for immediate medical care to 
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prevent loss of life or aggravation of physiological or psychological illness or injury; or 
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(B) transportation services, acute care, chronic condition services, disease 
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management services, or other healthcare services provided as part of a MIH program.  
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(4) 
“Healthcare facility” means a licensed institution providing healthcare services or 
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a healthcare setting, including, but not limited to, hospitals and other licensed inpatient centers, 
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ambulatory, surgical or treatment centers, skilled nursing centers, residential treatment centers, 
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diagnostic, laboratory and imaging centers, and rehabilitation and other therapeutic health 
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settings.  
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(5) 
“Healthcare personnel” or “personnel” means an individual or individuals employed 
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by or affiliated with a healthcare provider, who provide direct patient care, to include, but is not 
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limited to, community paramedics, EMS personnel, nurses, nurse practitioners, physician 
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assistants, and social workers. 
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(6) 
“Healthcare provider” m e a n s a provider of medical, behavioral or health services, 
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or any other person or organization that is paid for healthcare services delivery in the normal 
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course of business, to include primary care providers, home care agencies, visiting nurse 
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associations, or other in-home services.  A visiting nurse association, also known as a visiting 
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nurse agency or home healthcare agency or association, means any of various organizations 
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that provide home healthcare and hospice services through a network of nurses, therapists, 
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social workers, and other healthcare associates for patients who are housebound, recovering 
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from an illness or injury, or are living with a disability or chronic condition. 
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(7) 
“Medical control” means the clinical oversight provided by a physician or existing 
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primary care provider to all components of the MIH program, including medical direction, 
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training, scope of practice, continuous quality assurance and improvement of healthcare delivery 
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and clinical protocols.  
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(8) 
“Medical direction” means the authorization for treatment provided by a physician 
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or existing primary care provider to healthcare personnel in accordance with clinical protocols, 
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whether on-line through direct communication, or telecommunication, or off-line through 
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standing orders. 
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(9) 
“Scope of practice” mean the procedures, actions, activities, and processes that 
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healthcare personnel are permitted to undertake in keeping with the terms of their professional 
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license and is limited to that which the law allows for the specific education, experience, and 
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demonstrated competency. 
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Ҥ 156.  Development and approval of mobile integrated healthcare programs 
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(a) 
Mobile Integrated Healthcare (“MIH”) means patient-centered care delivered in a 
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patient's home or in a mobile environment that focuses on improving patient outcomes by 
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integrating the larger spectrum of community healthcare and technology.  
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(b) 
MIH components include traditional emergency medical services (“EMS”) 
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response, community paramedics, physician assistants, nurse practitioners, community health 
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workers, social workers, mental health providers, 911 nurse triage lines, public safety, 
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telemedicine, and alternate destination or emergency room diversion. 
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(c) 
A Department-approved MIH program, including MIH programs with an emergency 
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department avoidance component, that utilizes healthcare personnel to deliver healthcare services 
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to patients in an out-of-hospital environment in coordination with healthcare facilities or 
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healthcare providers may provide healthcare services such as  chronic disease management, 
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dental care, behavioral health, maternal and infant health, preventative care, post-discharge follow-
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up visits, or transport or referral to facilities other than a hospital emergency department.   
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(d) 
The Virgin Islands Department of Health (“Department””) shall develop and approve 
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mobile integrated healthcare programs consistent with its role as the territorial lead agency for 
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healthcare-related services.  In so doing, the Department shall consider the following: 
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(1) 
the type of healthcare that can be provided under the program; 
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(2) 
the training, educational, and certification requirements for community 
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paramedics and other healthcare personnel in providing services under the program;  
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(3) 
the degree of oversight, reporting, and enforcement needed for the program; 
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(4) 
 relevant standards and criteria developed or adopted by nationally recognized 
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agencies or organizations; and  
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(5) 
the recommendations of interested stakeholders. 
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(e) 
The Department, pursuant to its mandate under 3 V.I.C. § 418(a) and its 
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responsibility under 3 V.I.C. § 418(a)(11), and its licensing and certification authority under 
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chapter 15 of this title, shall establish or approve MIH programs that meet the following criteria: 
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(1) 
provide pre-hospital and post-hospital services as a coordinated continuum 
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of care that fully supports the patient's medical needs; 
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(2) 
address gaps in service delivery and prevent unnecessary hospitalizations, or 
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other harmful and wasteful resource delivery; 
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(3) 
focus on partnerships through contracts or otherwise between healthcare 
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providers and healthcare facilities, as defined in this chapter, respectively, that promote 
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coordination and utilization of existing personnel and resources without duplication of 
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services; 
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(4) 
adhere to clinical standards and protocols adopted by the Department to 
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ensure that MIH healthcare providers employed by healthcare facilities provide 
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healthcare services or treatment within their scope of practice; 
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(5) 
dispatch only those community paramedics or other healthcare providers 
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employed by a healthcare facility who have received appropriate training and 
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demonstrate competency in the MIH clinical protocols; 
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(6) 
meet appropriate standards related to capacity, location, personnel, and 
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equipment; 
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(7) 
provide access to qualified medical control and medical direction; 
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(8) 
provide a secure and effective medical communication subsystem linkage for 
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online medical direction; 
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(9) 
have an activated 911 system to ensure that if an MIH program patient 
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experiences a medical emergency during an MIH visit there will be a rapid response by 
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emergency services; 
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(10) ensure compliance with all territorial and federal privacy requirements 
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regarding patient medical records and other individually identified patient health 
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information; and 
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(11) ensure that healthcare providers operating MIH programs collect and 
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maintain data of mobile integrated health services, including statistics on mortality and 
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morbidity; the information needed to review access, availability, quality, cost, and third-
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party reimbursement for the services; and coordinate and perform the data collection in 
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conjunction with other data-collection activities. 
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(f) 
In addition, the Department shall examine how 911 triage assessment tools may be 
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incorporated into MIH, with the objective of enhancing the efficiency and effectiveness of MIH 
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programs. 
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§ 157.  Mobile Integrated Healthcare Revolving Fund 
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(a) 
There is established a separate and distinct fund within the Treasury of the 
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Government of the Virgin Islands, the Mobile Integrated Healthcare Revolving Fund (“the 
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Fund”).  The Fund is established to fund the development, implementation, and services of the 
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mobile integrated healthcare program within the Department of Health.  The Commissioner of 
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Finance shall maintain and provide for the administration of the Fund. 
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(b) 
The Fund consists of all sums appropriated to it from time to time by the Legislature 
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of the Virgin Islands, federal monies, public and private grants, donations, gifts, and bequests 
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of all money made to the Fund. 
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(c) 
The Commissioner of Finance shall disburse monies deposited into the Fund upon 
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warrant of the Commissioner of Health.  Monies in the Fund must be used solely for the benefit 
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of the mobile integrated healthcare program, including administrative expenses, personnel 
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expenses, equipment costs, and all reasonable direct and indirect costs required to implement 
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and support the program. 
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(d) 
The Commissioner of Finance shall maintain a record of all monies deposited into 
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and disbursed from the Fund and shall report the status of the Fund annually to the Governor, 
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the Legislature, and the Commissioner of Health, 
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SECTION 2.  Not later than 120 days after the effective date of this act, the 
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Commissioner of the Virgin Islands Department of Health shall adopt regulations to implement 
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and administer mobile integrated healthcare programs, licensing and certification, medical 
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protocols and guidelines, Health Insurance Portability and Accountability Act of 1996 
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compliance, reimbursement and billing, quality assurance and performance metrics, and 
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collaborative agreements. 
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BILL SUMMARY 
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This bill mandates that the Virgin Islands Department of Health establish mobile 
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integrated healthcare programs and provides the criteria that must be considered in establishing 
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various models of the MIH program.  It also defines important terms in the chapter.  The bill 
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establishes the Mobile Integrated Healthcare Revolving Fund and requires the monies in that 
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Fund to be used solely for the Department of Health’s mobile integrated healthcare program. 
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Finally, the bill mandates that the Commissioner of Health promulgate regulations to 
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administer the chapter. 
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BR23-0253/August 2, 2023/SLR 
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