MEMSA is excited to work with the Montana state legislature to address the EMS crisis in Montana. We believe one of the primary challenges facing Montana EMS is lack of proper funding, which contributes to ongoing staffing issues and ability to obtain quality equipment and supplies. We maintain that legislative intervention in our reimbursement model with different payors such as state Medicaid and commercial insurance payors would have a positive effect on ambulance service health and viability. As always MEMSA is grateful to both the paid and volunteer ECPs who provide coverage for their communities in our state. If you would like to attend the next meeting, it will be held at the capital, room #137 (also available by Zoom), on Tuesday, January 13^th, 2026 at 8:00 am. If you have not attended a legislative session before, please review the proper etiquette which can be found here.

The Senate Bill 518 ("SB 518"), enacted by the Montana Legislature in 2025, transfers the regulation and licensing of “emergency care providers” (ECPs: EMR, EMT, AEMT, Paramedic) from the Montana Board of Medical Examiners to the Montana Department of Labor & Industry (DLI).

The effective date for this change is January 1, 2026.

Licensing rules, license renewal procedures, complaint handling, disciplinary oversight, and administrative rules will now fall under DLI jurisdiction, rather than the Board of Medical Examiners.

For training courses, rule-making, and oversight, references to the “Board” are being updated to reflect DLI oversight in proposed rule notices.

What this means for you:

Expect updated licensure applications, renewal procedures, rule references and supervisory communications from DLI rather than the Board of Medical Examiners.

Ensure your agency/organization updates internal compliance systems (licensing tracking, credentialing, continuing education) to reflect DLI oversight effective 1/1/2026.

If your service or medical director submits revisions to scope or protocols, follow the new DLI processes (rather than prior Board-processes) as they come online.

If you have an existing ECP license, the license number will automatically be updated on January 1^st, 2026, to reflect this change, which will only impact the first three letters of your license number. ECP licenses will change as follows:

• MED-EMT-LIC-XXXX to ECP-EMT-LIC-XXXX

• MED-AEMT-LIC-XXXX to ECP-AEMT-LIC-XXXX

• MED-EMR-LIC-XXXX to ECP-EMR-LIC-XXXX

• MED-PARA-LIC-XXXX to ECP-PARA-LIC-XXXX

Adoption of National Model Clinical Guidelines & National EMS Scope of Practice Model 2019: Including Change Notices 1.0 and 2.0

Montana has developed a new regulatory document, the “Montana Emergency Care Provider (ECP) Scope of Practice Document,” which is intended to define the regulatory scope of practice for EMS providers across all license levels, effective 9/1/2025.

The National Association of State EMS Officials (NASEMSO) “National Model EMS Clinical Guidelines, Version 3.0 (March 2022)” are now adopted for use in Montana.

The Scope of Practice document is regulatory (i.e., defines “may do / may not do” for each level of licensure). The NASEMSO Model Clinical Guidelines are practice guidance (i.e., evidence‐ and consensus‐based recommendations that agencies can adopt/modify).

The Montana scope document explicitly states that licensed ECPs and their medical directors must operate within:

the regulatory Scope of Practice document,

their agency’s approved protocols,

and the NASEMSO Model Clinical Guidelines (as adopted).

Documentation on curricula/practice guidelines notes that pre-hospital treatment protocol documents previously issued (e.g., “Montana ECP Practice Guidelines”, Inter‐Facility Transfer guidance) continue only until 8/31/2025, after which the new scope and model guidelines apply.

What this means for you:

Your license level (EMR, EMT, AEMT, Paramedic) and any endorsements must be evaluated in light of the new Montana Scope of Practice document. Confirm that your training, credentialing and endorsements align with the new regulatory document.

The NASEMSO Model EMS Clinical Guidelines can be used by your agency to craft or revise protocols—but your agency’s protocols must still reflect the regulatory Scope of Practice document and any limitations your medical director imposes.

If you have previously practiced under older Montana protocols, check whether your agency has initiated protocol revisions to align with the new framework.

Medical directors should review their oversight, training and protocols to ensure they are aligned with the Scope of Practice document, the NASEMSO guidelines, and now with DLI rulemaking oversight.


Agency-Level Protocol Development & Local Variation

With the adoption of the national model guidelines and the new regulatory scope, individual EMS agencies in Montana are now authorized to write or revise their own pre-hospital protocols (offline medical direction, standing orders, local algorithms) based on this dual framework.

MEMSA will provide a space on our website for agencies to share their protocols for others to adopt.

Local protocols must not exceed the regulatory scope of practice (i.e., providers must not be asked to perform procedures or administer medications outside their licensure/endorsement as defined in the Scope of Practice document).

Agencies should ensure their protocols are consistent with the NASEMSO Model Clinical Guidelines (or justify a local variation), and approved by their designated medical director.

What this means for you on the ground:

If you respond for more than one agency, check each agency’s protocol set for version date, licensure level applicability, and whether it references the new scope/model guidelines.

Make sure your training, certifications, endorsements and continuing education are up to date so you’re credentialed to follow the agency protocol version.

Medical directors should ensure that any protocol changes receive clear rollout.

Agencies should archive earlier protocol versions (for legal/QA purposes) and document transition to the new framework.
For individual providers: Ask your medical director or agency leadership how your agency is transitioning protocols.

For medical directors: Lead a review of your agency’s protocol set, ensure protocol revisions are underway or completed, align training, endorsements, QA processes, and documentation with the new framework. Ensure your agency is aware of the governance change to DLI.

For agency leadership: Update policy manuals, provider credentialing files, mutual aid agreements (if needed), and training records to reflect the new documents, protocol transition dates, and ensure clarity of provider level vs. allowable interventions.

For QA/PI staff: Track provider performance during the transition, ensure documentation of when new protocols took effect, maintain archived copies of prior protocols, and monitor for any scope of practice issues during the shift.

Communication: Inform all crew members about the changes—especially that although local protocols may vary, all must fall within the regulatory scope and be approved via your medical director. Reinforce that the NASEMSO Model guidelines serve as “best practice” resources but not every agency must adopt them verbatim—they must adopt something consistent with the Montana regulatory scope.

Links to Key Resources

MT-ECP-Scope-of-Practice-Document.pdf

National EMS Scope of Practice Model 2019: Including Change Notices 1.0 and 2.0

National Model Clinical Guidelines

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