EMS Licensure Compact Gaining Traction in State Legislation

A recent trend among states is the introduction of legislation to adopt interstate licensure compacts.  Interstate licensure compacts allow special licensure or exceptions to state licensing requirements for specific health care providers to practice across state lines in other states that have adopted the same compact as long as certain requirements are met. Current compacts include the Physical Therapy Compact, Nurse Licensure Compact, Interstate Medical Licensure Compact and the Psychology Interjurisdictional Compact.  One such compact that has received less attention, but has been gaining traction lately is the Recognition of EMS Personnel Licensure Interstate CompAct (REPLICA). REPLICA is a multi-state compact that allows emergency medical services (EMS) personnel in REPLICA member states to respond to calls and transport patients across state lines and provide emergency services before returning to their home state without having to apply for a separate license in another REPLICA member state. It is not considered a separate license, but rather is an extension of a privilege for EMS personnel to practice on a short-term, intermittent basis under certain circumstances including:

  • Response areas that cross state lines
  • Staffing for large scale responses that are not at the level of a governor’s declaration of a disaster
  • Staffing for large scale planned special events such as concerts or sporting events

Like other interstate licensure compacts, it could potentially allow EMS personnel, including emergency medical technicians (EMTs), advanced emergency medical technicians (AEMTs) and paramedics, to connect remotely to less qualified medical staff or even directly to patients across state lines under the right circumstances. REPLICA allows participating EMS personnel to provide services within the scope of practice authorized within their home state unless otherwise modified by an appropriate authority. This may encourage the adoption of telehealth-enabled EMS across bordering states in the compact.  Other requirements for REPLICA member states include that the state utilize the National Registry of Emergency Medical Technicians (NREMT) exam for initial licensure, that the EMS personnel be under the supervision of a physician medical director in their home state, and that a criminal background check of all applicants be conducted for initial licensure, compliant with the requirements of the Federal Bureau of Investigations.

Sixteen states have adopted REPLICA into law, including Alabama, Colorado, Delaware, Georgia, Idaho, Kansas, Nebraska, New Hampshire, Missouri, Mississippi, South Carolina, Tennessee, Texas, Utah, Virginia, and Wyoming. An additional nine states have filed bills proposing to adopt REPLICA, most recently with North Dakota HB 1337, Indiana SB 510, Iowa HF 694, and West Virginia SB 432. Each state in the compact is represented in the Interstate Commission for EMS Personnel Practice Members, which has authority over cross-border activities enabled by REPLICA. Although REPLICA became active on May 8, 2017, it will not be fully operational until the Commission concludes developing the necessary rules and policies.

Additionally, Health and Human Services (HHS) has also announced the Emergency Triage, Treat and Transport model (ET3), which will begin in early 2020. The voluntary payment model will reimburse EMS personnel for transporting a Medicare patient to a site other than an emergency room or for the delivery of treatment on the scene or via telehealth. The model aims to ensure Medicare beneficiaries receive the most appropriate care and to provide more efficient, broader access to emergency care. This model may encourage more states to adopt REPLICA and encourage development of the rules and policies to begin operation.

For more information on REPLICA, visit the compact website, or to learn more about the ET3 payment model, visit the CMS Innovation Center.