National Registry of EMTs

Recognition of EMS Personnel Licensure Interstate CompAct

The Recognition of EMS Personnel Licensure Interstate CompAct (REPLCIA) is the nation's first and only multi-state compact for the Emergency Medical Services profession. REPLICA provides qualified EMS professionals licensed in a "Home State" a legal "Privilege To Practice" in "Remote States". Home States are simply a state where an EMT or Paramedic is licensed; Remote States are other states that have adopted the REPLICA legislation. The REPLICA Compact was activated on May 8, 2017 when Georgia signed the legislation into law. The compact administration is now working to implement the law.

REPLICA States

10 of the 10 Required States Have Signed REPLICA into Law!


REPLICA MEETS GOAL.
INTERSTATE COMPACT BECOMES OFFICIAL!

May 8, 2017 (Columbus, OH). With the 10th member state enactment, the Recognition of Emergency Medical Services Licensure Interstate Compact (REPLICA) has become official. Governor Nathan Deal of Georgia signed Senate Bill 109 on today activating the nation’s first EMS licensure compact. States that have passed REPLICA to date include: Colorado, Texas, Kansas, Virginia, Tennessee, Idaho, Utah, Mississippi, Wyoming and Georgia.

Released in 2014, REPLICA’s model legislation creates a formal pathway for the licensed individual to provide pre-hospital care across state lines under authorized circumstances. According to Keith Wages, president of the National Association of State EMS Officials (NASEMSO), “REPLICA represents a collective, nationwide effort to address the problems faced by responders when needing to cross state borders in the line of their duties.” Wages highlighted the compact’s abilities to “increase access to healthcare, reduce regulatory barriers for EMS responders, and place an umbrella of quality over cross border practice not previously seen in the EMS profession.” Wages also noted that the partnership with the National Registry of Emergency Medical Technicians (NREMT) has been essential during the advocacy and implementation phases. “We are grateful for their continued support and contributions.”

Through funding provided by the Department of Homeland Security (DHS), NASEMSO led 23 EMS, fire, law enforcement organizations and associations as well as key federal partners in the design and drafting of REPLICA. The National Registry of EMTs (NREMT) currently provides funding to finalize the development of the Commission.

The compact calls for establishment of an Interstate Commission with each state that has passed REPLICA holding a seat, as well as a national EMS personnel coordinated database. Member states will be able to rapidly share personnel licensure information, develop policy focused only on cross border EMS practice, and hold EMS personnel originating in other states accountable in an unprecedented way. The National Registry of EMT’s (NREMT) has committed to the development and hosting of the coordinated database.

Twelve national associations and organizations support REPLICA. Three states have REPLICA bills under consideration in their legislative sessions.

Colorado – Georgia - Idaho – Kansas - Mississippi - Tennessee - Texas - Utah – Virginia - Wyoming


Facts and Benefits

REPLICA is a formal pathway for the licensed individual to provide pre-hospital care across state lines under authorized circumstances. REPLICA increases access to EMS for patients, reduces regulatory barriers for EMS personnel and brings unprecedented accountability to the EMS profession.REPLICA is supported by 12 national associations and organizations.

Benefits for EMS Personnel

  • Obtain and maintain one EMS license, receive privileges to practice in REPLICA states while carrying out day-to-day duties, staffing large planned and unplanned events as authorized.
  • Creates an expedited pathway to licensure for members of the military separating from active duty and their spouses with unrestricted NREMT card.
  • Work under the scope of practice from your home REPLICA state.
  • Reduced time, paperwork and costs associated with maintaining multiple licenses just to do your job.

Participating in an Interstate Compact

  • Compacts are tested, flexible, and defensible ways in which to resolve conflicts and barriers presented by state borders.
  • Compact states share in the responsibilities of managing cross border activities instead of each state individually addressing the same issue in a different manner.
  • Commissions manage compacts, member states designate one public official responsible for EMS to participate, each state has one seat, one vote.
  • REPLICA is joining the ranks of other well-known Compacts including nursing, physician, driver’s licenses as well as emergency management.

EMS Personnel Eligibility

  • Must be 18 years of age and have met state licensure requirements at the EMT, AEMT or Paramedic level in a REPLICA Home State.
  • Be practicing in good standing in their home state with an unrestricted license and under the supervision of an EMS Medical Director.

State EMS Office – EMS System Eligibility

  • Utilize the NREMT exam at the EMT and Paramedic levels for initial licensure
  • Utilize FBI compliant background check with biometric data (e.g. fingerprints) within 5 years of Compact activation.
  • Have a process to receive, investigate, and resolve complaints; and share information with other Compact states as necessary.
  • Enact the model REPLICA legislation
  • REPLICA is supported by 11 national EMS-Fire ground and air medical associations.

Multi-State
Privilege To Practice

REPLICA extends a multi-state privilege to practice to qualified EMS personnel.

Public Service

REPLICA enhances the way EMS is able to serve the public. REPLICA allows EMS personnel to better serve the public across state lines. (Note: REPLICA applies to individual EMS professionals, not EMS agencies.)

Public Protection

REPLICA provides a mechanism for State EMS Offices to share licensure information, communicate, and coordinate.

Veteran Recognition

REPLICA recognizes the service of veterans and their spouses. REPLICA provides a mechanism for our nation's veterans to receive priority processing of EMS licensure paperwork.
Why is an EMS Compact Needed?

Since the 1970's, states have had the authority to license emergency medical services personnel. Although the federal government frequently provides resources and assistance to aid states in the development of licensing protocols, EMS licenses are issued by individual states and are based on individual state regulations. The license issued to emergency services personnel by a state is based on a determination of the individual’s fitness to practice: individuals must meet or exceed the minimum requirements established by that state’s laws and regulations. These requirements vary by state, but often include:

  • Completing a state approved or nationally accredited training program;
  • Obtaining a passing score on a national certification examination;
  • Passing a criminal history background check;
  • Being credentialed by a licensed ambulance service or other emergency agency; and
  • Having a medical director who is responsible for verifying the competency of the provider on a periodic basis.

The EMS industry has undergone much change since the 1970s. It is becoming increasingly more common for EMS personnel to cross state lines to provide services in non-declared states of emergency. This increased level of interstate movement and cooperation has placed a renewed emphasis on how EMS personnel are licensed to ensure that they are not being accused of practicing medicine in a state in which they are not technically licensed. As a result, there is an increasing need for a universal means of assuring a legal, accountable and geographically consistent method of licensing emergency services personnel.

In addition to the need for a licensing standard, EMS personnel frequently encounter the need to work across state lines. While there have been limited efforts to address this problem, prior to "REPLICA" a more permanent and wide-reaching solution had not been found. REPLICA solves this growing problem through the formation of an interstate compact, which would allow member states to self-regulate the existing system for licensing EMS personnel.

The benefits of being a REPLICA state

With REPLICA, EMS personnel will be able to respond across state borders within the provision of their duties on a short term, intermittent basis on a privilege to practice under approved circumstances. REPLICA does not apply to EMS agencies. Member states act as one as it relates to personnel regulatory matters under the well-known practice of interstate compacts. REPLICA promotes compliance with the laws governing EMS personnel practice in each member state, home and remote, and gives states the ability to hold providers accountable from both. Benefits of REPLICA include:

  • REPLICA extends the privilege to practice under authorized circumstances and on a limited basis to EMS Providers.
  • REPLICA enables the ready exchange of information between states through a Coordinated Database regarding EMS personnel licensure, adverse actions, and significant investigatory information.
  • REPLICA promotes the highest level of public protection to patients and to EMS personnel in your state’s EMS System. State EMS Offices will now know who is coming into their state.
  • REPLICA provides a unique opportunity to support members of the military and their spouses with a clear and timely pathway by which to become licensed.

EMS personnel covered by REPLICA includes those responding to calls for assistance across state lines as part of their duty, covering large scale planned events such as staffing concerts, races or large scale unplanned events where federal agencies are dispatched to support details, for example, wildland firefighting teams. Today, in many states, these EMS Providers have no legal standing or protection when practicing. REPLICA will solve this problem.

What Are Interstate Compacts?
Interstate Compacts

Compacts, which are governed by the tenets of contract law, provide states an enforceable, sustainable and durable tool capable of ensuring permanent change without federal intervention. With more than 215 interstate compacts in existence today and each state belonging to an average of 25 compacts, there is considerable legal and historical precedence for the development and use of the tool.

Perhaps more importantly, several compacts that deal specifically with licensing and emergency management issues already exist. Compacts such as the Driver’s License Compact and the Nurse Licensure Compact provide precedence for member states to honor licenses issued in another member state. Numerous compacts deal with emergency management and preparedness, including the Emergency Management Assistance Compact and the existing regional forest fire compacts. An emergency medical services personnel compact would allow the member states to preserve state sovereignty through collective control and self-regulation.

Replica Explained

Dia Gainor, the Executive Director of NASEMSO explains REPLICA in this audio podcast.

Sue Prentis, the REPLICA Advocate, provides an update about the status of the Recognition of EMS Personnel Licensure Interstate Compact .


Compacts by State

The Council of State Governments, National Center for Interstate Compacts, has an interactive map showing the details of every interstate compact membership.

Frequently Asked Questions

Who created REPLICA?

Under the terms of a contract with the US Department of Homeland Security Office of Health Affairs, the National Association of State Emergency Medical Services Officials (NASEMSO) proposed to demonstrate, at a national level, that systematic development and design of an interstate compact will facilitate a robust and capable method of offering an immediate, legal privilege to practice for individuals properly licensed in their states of origin under circumstances specified in the compact. Ultimately, the Project Team sought to solve the problem associated with day-to-day emergency deployment of EMS personnel across state boundaries. The project resulted in the creation of a piece of legislation for states’ use that parallels that which has made it possible for interstate recognition of nursing licenses and state drivers’ licenses by multiple (“member”) states under terms and conditions outlined in the compact. In short, member states agree to honor licenses so long as the license is issued in another member state in a manner consistent with the compact terms, and share each other’s authority related to the license and resulting privilege to practice.

Who funded this project?

The Department of Homeland Security, Office of Health Affairs (DHS/OHA) initially funded the project to develop the REPLICA legislation.

How was the compact developed?

This project started in October 2012 and the final deliverable was submitted to DHA/OHA in April of 2014. The project timeline included two phases:

1. National Advisory Panel

The National Advisory Panel (NAP) was formed and tasked with examining the current landscape of challenges facing state licensure of EMS personnel and to present a set of solution-oriented recommendations for inclusion in a new interstate compact. The NAP developed a set of formal recommendations to guide the development of the interstate compact, to include the high-level provisions that should be included in the compact. The NAP attended two 2-day meetings held during January and March 2013.

2. Drafting Team

The Drafting Team was charged with taking the theory-based NAP recommendations and making them operational via draft legislation. The expert Drafting Team met four times (June, August, October, and December 2013) to develop a draft interstate compact based on the recommendations of the NAP and their own expertise.

Subject Matter Expert Guidance

The Council of State Governments’ National Center for Interstate Compacts provided extensive instruction, input and expertise about the development and content of REPLICA. This allowed the EMS compact to draw from the “best of the best” legal and operational principles across the over 200 active compacts in use by state today.

What organizations were part of the National Advisory Panel?


What are the requirements an individual EMT must meet to enjoy the privilege to practice in a remote state?

An individual must:

  • Be at least 18 years old; and
  • Have a current unrestricted license issued by a member state as an EMT, AEMT or Paramedic, or a state recognized and licensed level with a scope of practice and authority between EMT & Paramedic; and
  • Practice under the supervision of a medical director.

What conditions must a state follow to be eligible to join the compact?

A home state’s license authorizes an individual to practice in a remote state under the privilege to practice only if the home state:

  • Currently requires the use of the National Registry of Emergency Medical Technicians (NREMT) examination as a condition of issuing initial licenses at the EMT and paramedic levels;
  • Has a mechanism in place for receiving and investigating complaints about individuals;
  • Notifies the Commission, in compliance with the terms herein, of any adverse action or significant investigatory information regarding an individual;
  • No later than five years after activation of the Compact, requires a criminal history check of all applicants for initial licensure with the exception of federal employees who have suitability determination in accordance with US CFR §731.202; and
  • Complies with the rules of the Commission.

Explain the 5-year timeframe; how does that apply to my home state?

For the first ten states that enact REPLICA as law they will have five years from date when the 10th state enacts the legislation to comply with the criminal history check requirements of the compact. Additional states will have exactly 5 years from that date to begin conducting criminal history checks. So for example, if the 10th state enacts REPLICA on July 1, 2016, all other states that enact REPLICA following that must begin conducting them by July 1, 2021.


If a state allows 16-year-olds to be EMTs to practice is the state still eligible to join the compact?

Yes, that state can still sign on to the EMS compact, but providers who are not yet 18 would not be eligible for immediate legal recognition under the terms of the agreement.


What are the conditions of practice in a remote state?

An individual may practice in a remote state under the terms of the compact under in following circumstances:

  • The individual originates a patient transport in their home state and transports the patient to a remote state
  • The individual originates in the home state and enters a remote state to pick up a patient and provide care and transports the patient to the home state
  • The individual originates in the home state and enters a remote state to provide patient care and/or transport within that remote state
  • The individual enters a remote state to pick up a patient and provide care and transport to a third member state

What happens when an individual can operate outside the national scope of practice in their home state, but the remote state doesn’t allow for the additional scope?

The compact allows for individuals to function within the scope of practice authorized by the home state unless and until modified by an appropriate authority in the remote state as may be defined in the rules of the commission.


When a remote state sanctions someone, can that individual still practice in their home state?

Only a Home State can take action against an individual’s license. A remote state can only act against a provider’s privilege to practice. The home state will immediately learn about the action and will be tasked with determining what action is taken against a provider’s license.


Will this compact give EMS providers automatic reciprocity?

The compact definitions distinguish between immediate legal recognition under short-term and intermittent conditions that is intended to “cover” an individual without any notification to or paperwork being filed with the destination state EMS office. Reciprocity is a scenario where an individual with a license in one state seeks to gain a license issued by a second state.


Does this relieve an EMS agency from being licensed in a state in which they do business?

No. The compact does not relax or eliminate requirements for state licensure of EMS agencies with which the EMS personnel are affiliated; the power for agency regulation will remain in the hands of the individual states.


Does this compact create new state law, or do we need to go back and create state law to match the elements of the compact?

This is a new piece of state law, and will supersede current law. Due process still prevails. Some states may need to add language re: and individuals practicing under the privilege to practice; some states may not need to do anything but pass REPLICA as written.


Is there a fee to join the compact?

No fees can be imposed on individuals by the REPLICA administration. While many modern administrative compacts are funded almost exclusively through state dues, the unique nature of this compact allows commission activities to be funded through fees paid by licensed practitioners who are utilizing the compact. Under the terms of the compact the annual assessment shall be determined based upon a formula established by the Commission. This financing structure was developed to ensure that individual state dollars would not be required to fund compact business and also to ensure that practitioners who do not use the compact are not responsible for helping to finance it.

The compact language also allows the commission to seek contributions, grants and other forms of funding from outside sources in an effort to reduce costs incurred by individual practitioners.


What is the anticipated lifespan of REPLICA?

Once it is activated by 10 states, and unless the compact is repealed by all but one state, it will remain active in perpetuity.


What will be the minimum numbers of states required to sign on to activate the compact?

10 states


How does the compact affect agencies with personnel with other medical licenses, such as nurses?

REPLICA does not cover other health care professionals such as respiratory therapists, nurses, or physicians.


What is the relationship between the EMS Licensure Compact and Emergency Management Assistance Compact?

The EMS Licensure Compact is intended to supplement EMAC. In the event of a gubernatorial declared state of emergency the Emergency Management Assistance Compact shall apply and supersede the terms of this Compact.