6 Colo. Code Regs. § 1015-3-2-18
Current through Register Vol. 47, No. 11, June 10, 2024
Section 6 CCR 1015-3-2-18 - Community Paramedic18.1 In addition to the medical acts within the scope of practice of a Paramedic contained within Appendices A, B, C, and D, a P-CP may perform the out-of-hospital medical services contained within this section and Appendix G, under the authorization of a CIHCS Agency medical director while providing community integrated health care services. A P-CP may also provide those medical acts that are out-of-hospital medical services contained in this Section, Appendix G, and Section 19 under the authorization of a clinical medical director and under the medical supervision of a medical supervisor. 18.1.1 A waiver cannot be granted to expand the out-of-hospital medical services that a P-CP may perform in a CIHCS setting.18.1.2 It is understood that these out-of-hospital medical services may not be addressed in the National EMS Education Standards for Paramedics. As such, it is the joint responsibility of the applicable medical director and P-CPs performing these services to obtain appropriate additional training needed to safely and effectively utilize and monitor these interventions in the out-of-hospital and clinical setting environments.18.2 A CIHCS Agency or clinical medical director may limit the scope of a P-CP. A P-CP may decline to provide out-of-hospital medical services to any individual that requires a level of care outside of their defined scope of practice or that the P-CP believes is beyond their capabilities.18.3 The duties of a CIHCS Agency medical director responsible for supervision and authorization of a P-CP, in addition to those located at 6 CCR 1011-3, Section 5.2, shall include: 18.3.1 Be actively involved in the provision of community integrated health care services in the community served by the CIHCS Agency. Involvement does not require that a physician have such experience prior to becoming a medical director but does require such involvement during the time that he or she acts as a CIHCS medical director. Active involvement in the community could include, by way of example and not limitation, those inherent, reasonable, and appropriate responsibilities of a medical director to interact and as needed collaborate with the community served by the CIHCS Agency, the hospital community, the public safety agencies, home care, hospice, and the medical community. Active involvement should include other aspects of liaison oversight and communication normally expected in the supervision of CIHCS providers.18.3.2 Be actively involved on a regular basis with the P-CP being supervised. Involvement does not require that a physician have such experience prior to becoming a medical director, but it does require such involvement during the time that he or she acts as a medical director. Involvement could include, by way of example and not limitation, involvement in continuing education, audits, and protocol development. Passive or negligible involvement with the CIHCS Agency and supervised P-CP does not meet this requirement.18.3.3 In conjunction with the CIHCS Agency administrator, develop and implement a quality management policy for the CIHCS Agency and P-CP that includes consumer chart reviews in order to determine that appropriate assessments, referrals, documentation, and communication are occurring between the consumer's care providers, P-CPs, and the consumer.18.3.4 Ensure that all issued protocols are appropriate for the skill level of each authorized P-CP to whom the performance of medical acts is delegated and are compliant with accepted standards of medical practice.18.3.5 Develop, implement, and annually review protocols, guidelines, and standing orders regarding medical supervision, consultation requirements, and follow up care by other medical professionals. CIHCS Agency medical directors will ensure that P-CPs have adequate clinical knowledge of, and are competent in, out-of-hospital medical services performed on behalf of the CIHCS Agency. These duties and operations may be delegated to other physicians or other qualified health care professionals designated by the medical director. However, the CIHCS Agency medical director shall retain ultimate authority and responsibility for the monitoring and supervision, for establishing protocols and standing orders and for the competency of the performance of authorized medical acts of P-CP providers.18.3.6 Oversee the ongoing training and education programs for P-CP personnel for the provision of out-of-hospital medical services. Ensure the competence of the P-CP under his or her supervision in all skills, procedures, and medications authorized.18.3.7 Notify the Department within fourteen business days of the cessation of duties as the CIHCS Agency's medical director;18.3.8 In collaboration with the CIHCS Agency administrator, designate through policy when the CIHCS Agency medical director is unavailable, a backup for medical direction in accordance with the requirements of 6 CCR 1011-3, Section 5.2.18.3.9 Ensure that medical direction is available at all appropriate times as determined by the CIHCS Agency policy.18.3.10 Provide evaluation, treatment, and transportation guidelines and protocols for non-urgent CIHCS Agency consumers.18.3.11 In conjunction with the CIHCS consumer's care provider, if applicable, develop, monitor, and evaluate consumer service plans.18.3.12 In conjunction with the CIHCS consumer's care provider(s), if applicable, and the P-CP, develop and implement a discharge summary as part of each consumer's service plan.18.3.13 Physicians acting as medical directors for a Community Integrated Health Care Service agency pursuant to Section 25-3.5-1303(1)(a), C.R.S. that are responsible for the supervision and authorization of a P-CP shall have training and experience in the acts and skills for which they are providing supervision and authorization.18.4 A clinical medical director's responsibilities for authorizing a P-CP in a clinical setting shall include those located in Section 19.3 of these rules.37 CR 12, June 25, 2014, effective 5/21/201437 CR 12, June 25, 2014, effective 7/15/201437 CR 22, November 25, 2014, effective 12/15/201438 CR 24, December 25, 2015, effective 1/14/201640 CR 10, May 25, 2017, effective 7/1/201740 CR 20, October 25, 2017, effective 1/1/201840 CR 21, November 10, 2017, effective 1/1/201841 CR 23, December 10, 2018, effective 1/14/201943 CR 22, November 25, 2020, effective 1/1/202144 CR 23, December 10, 2021, effective 12/30/202145 CR 10, May 25, 2022, effective 6/14/2022