Recognition of EMS Personnel Licensure Interstate CompAct
The Recognition of EMS Personnel Licensure Interstate CompAct will be activated after the tenth state signs the REPLCIA legislation in to law. REPLICA brings many importance enhancements to the EMS profession. Once actived, qualified EMS professionals licensed in a "Home State" will have the 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.
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.
Privilege To Practice
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.
Dia Gainor, the Executive Director of NASEMSO explains REPLICA in this audio podcast.
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.
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.
The Department of Homeland Security, Office of Health Affairs (DHS/OHA) initially funded the project to develop the REPLICA legislation.
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.
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.
- American Ambulance Association
- American College of Emergency Physicians
- Association of Air Medical Services
- Association of Critical Care Transport
- Bureau of Land Management (US Department of Interior)
- EMS Labor Alliance
- Federal Bureau of Investigation (US Department of Justice)
- Federation of State Medical Boards
- Forest Service (US Department of Agriculture)
- International Association of EMS Chiefs
- International Association of Fire Chiefs
- International Association of Fire Fighters
- International Association of Flight & Critical Care Paramedics
- International Paramedic
- National Association of EMS Educators
- National Association of EMS Physicians
- National Association of EMTs
- National Association of State EMS Officials
- National EMS Management Association
- National Governors Association
- National Park Service (US Department of Interior)
- National Registry of EMTs
- National Volunteer Fire Council
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.
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.
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.
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.
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.
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.
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.
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.
Once it is activated by 10 states, and unless the compact is repealed by all but one state, it will remain active in perpetuity.
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.
Ten states must adopt the EMS Compact for it to be operational. Currently, seven states have passed the legislation required to join the Recognition of EMS Personnel Licensure CompAct.
- NEMSAC: Looks to help implement REPLICA
- NEMSAC: REPLICA Advisory Notice (September 2016)
- Anytime, Anywhere (News Letter Journal, Weston County, WY, Oct. 13, 2016)
- NREMT Supports National Interstate Compact (August 2016)
- NHTSA - EMS Update (June/July 2016)
- JEMS – EMS Insider (Sept. 9, 2015)
- Oregon NAEMSP Support Letter (April 2015)
- IAFC News - REPLICAting Success Across the United States (Feb. 9, 2015)
- EMS World Article (Jan 2015)
- EMS World – Practicing in Multiple States could soon be a lot easier (Dec. 5, 2014)
- National Volunteer Fire Council "I encourage volunteer fire, EMS, and rescue personnel to work to have REPLICA is adopted in their states" (Sept 2014)
- CSG: Recognizing EMS Personnel Across State Lines (June 2014)
- Quick Take – One Multi-State EMS License Pitched (Nov. 12, 2014)