Public Health Law

Provider Scope of Practice

"Scope of practice" describes the procedures and actions that are lawfully permitted in a given profession, as well as places limits upon the profession's functions. To facilitate coverage expansions under health care reform, many believe revising state laws to allow certain professions to practice independently or increase the procedures they are able to provide is one way to increase primary care capacity. State health agencies are responsible for enforcing laws and regulations that protect health and ensure safety, including inspection or licensing of a variety of public health system partners, and in some states, are involved in oversight of professional licensure activities. Approximately one-quarter of health agencies are involved in overseeing professional licensure for nurses, physicians, physician assistants, dentists, and pharmacists. Over 50% of state health agencies report oversight of professional licensure for other occupations, including emergency medical technicians and paramedics, podiatrists, speech and language therapists, administrators of long-term care facilities, and radiology technicians.

Community Health Workers

Community Health Workers (CHWs) are public health workers who directly serve their community and have a deep understanding of the community's language and culture. CHWs link health services to the community and build health knowledge through support services, community education, and outreach. Several states established CHW certification requirements as early as 1999. In 2014, a new Medicaid rule allowed for reimbursement of preventive services provided by non-licensed providers, such as CHWs, upon recommendation from a licensed Medicaid provider. As of November 2014, several states have statutes or regulations regarding CHW certification.

Emergency Medical Services

ASTHO, in partnership with the Office of the Assistant Secretary for Preparedness and Response (ASPR), conducted a comprehensive assessment of various facets of community paramedicine as part of a larger examination of plausible approaches to increasing day to-day EMS services in communities without changing scope of professional practice parameters in the United States. The primary objective of this project was to conduct innovative and relevant legal and policy research to ascertain core issues that may impede ongoing and future activities of health professionals in routine community paramedicine activities.