The term “community paramedicine” (CP) is sometimes used interchangeably with “mobile integrated health care” (MIH), but the definitions of these terms are not necessarily congruent.

MIH is usually used as an umbrella term that refers to multiple types of services provided by emergency medical services (EMS) agencies that go beyond responding to 911 calls and transporting people to an emergency department (ED). Some MIH services are provided by paramedics, and some are provided by other types of health professionals, such as nurse practitioners and registered nurses.

CP usually refers to MIH services provided by paramedics that are beyond traditional EMS services. In some cases, CP only connotes services provided by paramedics outside of response to 911 calls, such as providing home visits to people recently discharged from a hospital or providing case management services to frequent users of EMS services. In other cases, CP also encompasses alternate destination services under which paramedics who respond to 911 calls transport people who meet eligibility criteria to destinations other than an ED, such as a sobering center or a mental health crisis center.

Ultimately, both terms speak to the objectives of reducing ED overuse, avoiding duplication of health care services, and meeting the health care needs of vulnerable and underserved communities in more pragmatic and cost-effective ways.

Although CP and MIH projects exist in varying forms across states, with some dating back to as early as 2002, legislative efforts to recognize and regulate community paramedicine have largely taken place within the last 10 years.

Twenty-three states have passed laws that regulate community paramedicine, establish CP pilot programs, or authorize EMS personnel to provide nonemergency care. Most states with statutory recognition of community paramedicine do not treat community paramedics as a separate licensed EMS occupation. Rather, eligible EMS professionals become CP professionals by completing further training and, depending on the state, receiving certification, approval, or endorsement. Most of these enabling statutes contain criteria for training and continuing education. Curricula may vary depending on the specific EMS agency that a prospective CP professional wants to work for, based on local needs. In addition to community paramedics, some states also recognize “community emergency medical technicians” and “community emergency medical responders” as members of the CP workforce.

California has not passed legislation regulating community paramedicine. However, since 2014, California has operated a statewide pilot project on community paramedicine under the auspices of the Office of Statewide Health Planning and Development (OSHPD)’s Health Workforce Pilot Projects (HWPP) Program. Established under Sections 128125–128195 of the California Health and Safety Code and Title 22, Division 7, Chapter 6 of the California Code of Regulations, the HWPP was founded in 1972 and waives scope-of-practice laws to test and evaluate new and innovative models of care. HWPP #173 is sponsored by the California Emergency Medical Services Authority and currently includes 15 active CP pilot projects across the state.

Below is a summary of different types of state legislation passed that address community paramedicine. See the full issue brief (PDF) for a table with details on legislation passed by 17 states to regulate community paramedicine and similar programs. Use the interactive map for a quick overview of the legislative environment in each state.

General Oversight

• Seventeen states have passed laws authorizing and regulating CP or similar programs.
• Six states have passed legislation establishing statewide CP projects and/or working groups to review the feasibility of community paramedicine.
• Six states have ongoing statewide CP pilot projects made possible through existing statutes. Instead of passing additional legislation or establishing explicit authority in state law, these states’ existing laws governing EMS may grant EMS agencies broad authority, or allow local EMS agencies great latitude in determining the scope of services that EMS providers may provide in their respective service areas. Authority to conduct pilot projects may be time-limited. For example, in California, Health Workforce Pilot Projects are intended to support proof-of-concept studies that can inform debates about proposals to change laws and regulations that govern the health professionals’ practice.
• Alaska does not have a statewide CP project and has not passed legislation authorizing and regulating community paramedicine. However, its Community Health Aides/Practitioners (CHA/Ps) program, which serves indigenous tribal communities, contains similarities to community paramedicine. As frontline health care workers, CHA/Ps provide culturally relevant emergency, acute, chronic, and preventive care to their communities, as well as assessing and referring community members to appropriate health care resources. CHA/Ps are trained in emergency medical skills required of all three EMT levels in the state. They are required to enroll in Alaska’s Medicaid program; however, not all of the services they provide are covered by Medicaid.

Medicaid and Commercial Insurance Reimbursement

• In three states, only the Medicaid program reimburses CP services.
• In 12 states, only commercial health plans reimburse CP services.
• In four states, both the Medicaid program and commercial health plans reimburse CP services.
• In 14 states, Medicaid programs reimburse for treatment without transport on 911 calls.

Professions Included in Statutes

• Seven states’ laws include only paramedics. The other 10 include other emergency medical professions, such as EMTs (basic, intermediate,
  or advanced), emergency medical responders, or other licensed emergency care providers.

Types of Services

• Nine states’ laws contain specific language outlining the types of services that CP programs or professionals can provide, such as health assessments, chronic disease management, hospital discharge follow-up care, and medication compliance.
• The remaining eight states have “general authority” laws, with language stating that CP providers may provide whatever services are within their scope of practice as long as such services are authorized by a physician or EMS medical director, or are part of a patient’s care plan.
• In three states — Iowa, Ohio, and Washington — the passed legislation does not specifically contain the words “community paramedicine,” “mobile integrated health care,” or other similar language. Instead, the legislation authorizes EMS personnel to provide care in nonemergency situations, such as performing medical services within their scope of practice or providing community assistance referrals and education services.

Community Paramedicine Education and Licensing/Certification

• Twelve states require formal recognition after training, which varies across states and can be licensure, certification, approval, or endorsement.
  • Two states do not require recognition and require only completion of an approved training program.
• Twelve states require prospective CP or MIH personnel to complete additional training. Training requirements vary by state, ranging from state-accredited programs to programs set by individual local EMS bureaus.
  • Five states require CP personnel to obtain training from an accredited college/university or educational institution.
  • Three states are currently developing CP education regulations.

Presently, only one-third of states have enacted MIH-CP legislation. At the same time, community paramedicine is also being piloted in smaller-scale efforts across individual EMS agencies in additional states. There is great variation across states in terms of CP providers’ scope of practice, educational requirements, and Medicaid and commercial insurance reimbursement. This variation makes it difficult for policymakers in other states to determine which elements to include in CP legislation.

Further research is needed to assess the consequence of variation in statutory requirements on the diffusion of CP services within states. As California continues its CP pilot projects, policymakers should look toward the demonstrated benefits of these projects as a guide to expanding community paramedicine statewide through legislative action.