Legislative Resources

This page is a resource for understanding the United States EMS Compact and how your state can join. Whether you are a legislator, legislative staffer, or executive-branch official, you will find the model bill, the joining process, recorded vote history, and answers to common questions below.

How does my state join the EMS Compact?

1. Pass the model legislation. Your state enacts the EMS Compact model legislation (REPLICA) without changes. This legislation functions as state law and as a binding contract between your state and all other participating states. See REPLICA Model Legislation for the bill text and background.

2. Designate a Compact Commissioner. Once enacted, the Governor or designee appoints your state's Compact Commissioner, typically the State EMS Director or a designee. The Commissioner serves as your state's voting member on the Interstate Commission for EMS Personnel Practice.

3. Integrate with the National EMS Coordinated Database (NEMSCD). Your state EMS agency partners with the Commission to securely submit and manage licensure data through the NEMSCD. The state does not pay a fee to join; limited technical integration may be required depending on existing systems.

4. Go live. After legislation, appointment, and integration are complete, your state becomes a fully operational participating state. EMS clinicians licensed in your state gain an immediate Privilege to Practice in all other participating states, and your state gains access to a qualified workforce of more than 480,000 EMS clinicians who can respond during emergencies, disasters, or staffing needs.

Legislative Support by the Numbers

Since 2015, the EMS Compact has received overwhelming bipartisan support in state legislatures. Across current member and enacting states, more than 3,600 legislators have voted on Compact legislation, with 73 "no" votes in Houses and 12 in Senates. That is an approval rate of nearly 98%. The table below shows recorded votes on EMS Compact legislation by chamber.

State	Year joined	Bill	House Yes	House No	Senate Yes	Senate No
Alabama	2017	HB 250	100	0	26	0
Alaska (3)	2026	HB 110	39	0	13	7
Arizona	2026	SB 1235	45	10	27	3
Arkansas	2025	HB 1253	99	1	34	0
Colorado	2015	HB 1015	65	0	34	0
Connecticut (4)	2026	HB 5514	142	4	35	0
Delaware	2017	SB 35	38	0	20	0
Georgia	2017	SB 109	191	9	54	1
Idaho	2016	SB 1281	63	4	34	0
Indiana	2020	SB 61	94	0	50	0
Iowa	2019	HF 694	96	0	50	0
Kansas	2016	SB 225	124	1	39	0
Louisiana	2020	SB 13	95	0	36	0
Mississippi	2017	SB 2828	120	0	51	0
Missouri (1)	2018	SB 870	131	13	32	0
Nebraska (2)	2018	LB 1034	n/a	n/a	49	0
Nevada	2023	AB 158	42	0	21	0
North Dakota	2019	HB 1337	89	3	46	0
Oklahoma	2023	HB 2422	87	0	45	0
Pennsylvania	2022	SB 861	172	28	37	0
South Carolina	2018	H 4486	98	0	43	0
South Dakota	2021	HB 1065	68	0	33	0
Tennessee	2016	HB 1888	93	0	31	0
Texas	2015	HB 2498	144	0	31	0
Utah	2016	HB 100	74	0	25	0
Virginia	2016	HB 222	91	0	40	0
West Virginia	2020	HB 4179	96	0	32	0
Wyoming	2017	HB 0112	59	0	28	1
Total			2,555	73	996	12

(1) Missouri: the vote occurred within a larger omnibus bill; recorded opposition was not specific to the EMS Compact language. (2) Nebraska: a unicameral legislature; the vote shown reflects final approval by the Nebraska Legislature. (3) Alaska: HB 110 is an omnibus healthcare licensing compacts bill that includes the EMS Compact provisions; the bill became law on June 22, 2026, and the EMS Compact provisions take effect September 20, 2026, so the Compact is not yet in force in Alaska. (4) Connecticut: HB 5514 was enacted in 2026 with activation conditioned on a regional partner state (Massachusetts, New York, or Rhode Island) enacting REPLICA, so the Compact is not yet in force in Connecticut.

To see which interstate compacts your state already uses, the Council of State Governments maintains a searchable database of active interstate compacts by state and topic.

Five Key Benefits

1. A reliable workforce for long- and short-term needs. Agencies gain access to more than 480,000 qualified EMS clinicians who meet common standards for education, testing, and background checks. This supports rural coverage, vacancy backfill, and large events without unnecessary red tape.

2. Advanced public protection and oversight. Your State EMS Office receives secure access to the NEMSCD and authority to track and share licensure history, receive timely notifications of disciplinary actions or investigations, conduct cross-border investigations, and issue subpoenas across state lines. These tools promote transparency and patient safety in ways no single state can achieve alone.

3. Professional mobility for a modern workforce. EMS aligns with the mobility already used by other professions. Clinicians can hold a single state license and practice across state lines, improving flexibility, reducing burnout, and supporting retention.

4. Readiness without delay. Beyond long-term workforce support, the Compact enables immediate mutual aid during disasters, mass gatherings, or major incidents. Clinicians can cross state lines and begin work without waiting for emergency declarations or temporary waivers.

5. A state voice in national EMS policy. Each participating state appoints a voting Commissioner to the Commission, the governmental body that administers the Compact. Your state's EMS leadership helps shape national solutions while protecting local interests.

Links and Bookmarks for Legislators

• REPLICA model legislation and how states join
• Key terms and definitions
• Participating states and current status
• Compact history and origins
• The Commission and governance
• Privilege to Practice for EMS personnel
• Employers and EMS agencies
• Facts and benefits

Legislative Frequently Asked Questions

How much will the EMS Compact cost my state? There are no fees charged by the Commission to states or to EMS clinicians. The Commission has statutory authority, like other compact commissions, to levy assessments, but it has never imposed them. A multi-year grant from the National Registry of EMTs currently supports Commission operations and the NEMSCD, avoiding state assessments.

Can the Commission pass rules without public comment? No. REPLICA Section 12, "Rulemaking," requires a public process that includes notice, written comment, and the ability to request a hearing. Each participating state is represented by a voting Commissioner who participates in deliberations and rulemaking.

Does the EMS Compact compromise quality of care? No. The Compact raises baseline protections by requiring common entry standards (education and examination), FBI-compliant background checks for initial licensure, medical direction, and coordinated data sharing. Under Section 8, if a Home State license is restricted or suspended, the Privilege to Practice is not valid in other states until restored. Any participating state may act on a clinician's Privilege to Practice based on another state's factual findings, using its own due process.

Are Commissioners accountable to the public? Yes. Commissioners are public officials, typically executive-branch leaders responsible for EMS. The Commission is a public body subject to open-meeting requirements, and Commissioners are accountable to their state leadership and the public.

Does the Compact expand immunity for Commissioners? No. Commissioners have the same immunity they hold in their state roles; REPLICA extends that existing immunity to their Commission duties, it does not expand it.

Does the Compact make government more bureaucratic? No. Compacts reduce duplication by creating uniform rules for cross-border issues that no single state can resolve alone. They preserve state sovereignty while enabling shared solutions.

Can the Commission affect state rights over time through rulemaking? No. The Commission may adopt rules only to administer the Compact's interstate functions, through a public process. States retain full authority over the licenses they issue.

Can a participating state withdraw from the EMS Compact? Yes. A state may withdraw by a statute repealing the agreement, as outlined in Section 14 of the model legislation. Obligations for reporting before the effective date of withdrawal remain in place.

Understanding Interstate Compacts

The "Bench Book" developed by the Interstate Commission for Adult Offender Supervision is a widely used resource on compact law for judges, court personnel, lawyers, and legislators. Selected chapters cover who must comply with an interstate compact, the nature of interstate compacts, delegation of state authority to an interstate commission, the congressional consent requirement, and state law conflicts with an interstate compact.

The Council of State Governments operates the National Center for Interstate Compacts. Since January 2016, states have enacted more than 250 pieces of licensure-compact legislation, and all fifty states and several territories now participate in one or more occupational licensure compacts. See the National Center for Interstate Compacts for more.

Endorsements

The EMS Compact reflects a multi-year national collaboration and is supported by many organizations. The Council of State Governments passed a formal resolution supporting REPLICA on August 13, 2014. The National Registry of Emergency Medical Technicians issued a statement of support in August 2016, and the National EMS Advisory Council issued a final advisory supporting activation of REPLICA in every state and territory on September 8, 2016. The International Association of EMS Chiefs stated its support on October 29, 2017, noting the Compact directly benefits the boots-on-the-ground provider and the patients they treat, and the National Volunteer Fire Council expressed support on September 25, 2014.

Supporting national associations and organizations include the American Ambulance Association, the Association of Air Medical Services, the Association of Critical Care Transport, the Council of State Governments, the International Association of EMS Chiefs, the International Association of Fire Chiefs, the National Association of EMS Educators, the National Association of EMS Physicians, the National Association of Emergency Medical Technicians, the National Association of State EMS Officials, the National Registry of Emergency Medical Technicians, and the National Volunteer Fire Council.

This page is for informational purposes and does not constitute legal advice.