State Community Paramedicine Laws
To better address the health care needs of residents and reduce health spending, states are exploring strategies to implement community paramedicine and expand the roles of EMS professionals. Strategies include examining scope of practice, reimbursement for community paramedicine services and allowing alternative destinations for transport.
Scope of Practice
A practitioner’s scope of practice is the defined parameters of duties or services that a credentialed individual may provide, typically determined by state statutes or rules. Several federal agencies and organizations—such as the National Highway and Transportation Services Administration, the National Consensus Conference on Community Paramedicine and American College of Emergency Physicians—suggest that not every EMS professional action needs to be clearly defined in scope of practice. Community paramedicine is an expanded role for EMS professionals but aligns with their training and does not present new procedures or medications. Even so, at least 45 states have a statewide community paramedicine scope of practice defined in statute, rules or protocols.
State examples of community paramedicine scope of practice legislation include:
Arkansas (2015 Ark. Acts, Act 685) established a licensure program for community paramedics with a defined scope of practice. Community paramedics must complete two years full time as a paramedic, complete a community paramedic training program from an accredited college or university and meet certain clinical training requirements. Community paramedics may coordinate community services, monitor chronic disease, assess health status, conduct hospital discharge follow-up care, collect laboratory specimens and manage medication compliance.
Maine (Me. Rev. Stat. Ann. tit. 32 §84.4) allowed the board of emergency medical services to pilot 12 community paramedicine programs in 2012 to provide patient evaluation, advice and treatment to prevent or improve a medical condition within the scope of practice of the emergency medical services provider. Following the success of pilot programs to integrate and coordinate care for patients with chronic conditions who are at high risk for unnecessary emergency department visits or re-hospitalization, the program was made permanent in 2017 (HB 981).
To learn more about community paramedics’ scope of practice, visit NCSL’s Scope of Practice Policy Legislative Database.
There is increased interest from private and public payers in community paramedicine models as an opportunity to reduce costs, improve care quality and improve population health. States may provide reimbursement for community paramedicine services through pilot or grant funding, Medicaid reimbursement, commercial reimbursement or provider partnerships.
At least seven state Medicaid agencies—including Arizona, Georgia, Hawaii, Minnesota, Nevada, Oregon (during the COVID-19 emergency) and Wyoming—reimburse for community paramedicine services. At least 14 states provide reimbursement for EMS treatment of patients without transport to an emergency department.
As of 2022, at least 21 states required reimbursement across public or private payers for community paramedicine, and the number of community paramedicine programs across the country continues to grow.
Community paramedicine programs may help decrease demand on emergency department resources by triaging patients in the field and transporting the patient, with consent, to an alternative destination. At least seven states—Arizona, California, Delaware, Illinois, Louisiana, New Mexico and Ohio—allow patients to be transported by EMS services to alternate destinations, such as primary care clinics, general medical clinics, urgent care centers or other social or psychological services.
Concerns exist regarding the under-triage and transport of patients requiring emergency care to alternative destinations. Proponents suggest additional training—such as community paramedicine certification—and medical director supervision may ensure patients are accurately triaged and assessed for transport to primary care, urgent care or other social or psychological facilities.
Arizona’s Treat and Refer Recognition Program, created through a Medicaid state plan amendment in 2016, allows emergency care providers to determine the appropriate destination to transfer a patient, provides reimbursement for ambulatory services without transportation to a hospital or other health facility, and creates community paramedicine training for providers.
Louisiana (La. Rev. Stat. Ann. 40:1131(4)(a)) allows an ambulance provider to transport an individual to an alternative destination with the individual’s permission and only if their conditions does not meet the definition of an emergency medical condition.