Scope of Practice Laws Affecting Team-Based Heart Disease Care in Rural America: Policy Challenges and Opportunities

Heart disease is the leading cause of death in the United States with a disproportionate impact in rural America, and health worker shortages contribute to these disparities. Team-based heart disease care models can help mitigate health worker shortages, but lack of role clarity and restrictive scope of practice laws can be a barrier to their implementation.

To better understand the intersection of licensed scope of practice laws with rural heart disease care, we performed a legal epidemiology analysis to identify and describe licensed scope of practice laws for 9 health worker cadres in 13 state and federal jurisdictions for 8 heart disease services.

We found substantial ambiguity, variation, and some important gaps, which may undermine the predictability of regulatory and reimbursement environments and hinder implementation of innovative team-based care models.

Three policy opportunities to address the identified gaps include: (1) linking licensed scope of practice definitions to the scope of accredited training curricula, (2) shifting away from collaborative practice agreements to define licensed scope of practice, and (3) prohibiting insurance plans from conditioning reimbursement based solely on provider cadre.