Scope of Practice
States are responsible for setting the scope of practice, or the tasks a health professional is allowed to perform under their licensure or certification, within the state. The scope of practice for community paramedics may vary from state to state, depending on the licensure or certification process required.
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 regulations. The National EMS Scope of Practice Model, developed in 2007 and most recently revised in 2019, provides a national standard for emergency medical responder, EMT, advanced EMT and paramedic education, certification, licensure and credentialing. All 50 states, Washington D.C. and the U.S. territories have adopted the model as their foundation for state regulatory requirements for EMS clinicians.
States that define community paramedicine scope of practice may do so in statute, or they may delegate the authority to an agency, department or licensing board. Hawaii authorized the department of health to develop guidelines for community paramedicine; explore and develop partnerships with public and private health care entities, insurers and community organizations; and employ telehealth to enhance access and the patient experience in 2019.
North Dakota outlines the services that community paramedic may provide, which must be reimbursed under the state Medicaid program, including health assessments, chronic disease monitoring and education, immunizations and vaccinations, follow-up care, medication management and other activities within the EMS clinician's scope of practice.
In addition to the education and training, licensure and certification and scope of practice requirements by states, coverage for community paramedicine services by both public and private payers affect how and where these services are utilized.