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Understanding Interstate Compacts

While there are many tools and resources available related to Interstate Compacts in the United States, the 'Bench Book' developed by the Interstate Commission for Adult Offender Supervision (ICAOS) in 2005 and revised in 2020 is a established resource for judges, court personnel, lawyers, and legislators for questions on interstate compacts. Links to the ICAOS Bench Book are provided for your reference:

National Center for Interstate Compacts

The Council of State Governments operations the National Center for Interstate Compacts. The Council of State Governments believes interstate compacts provide the most effective means for achieving borderless practice for licensed practitioners and military spouses relieving the burdens of maintaining multiple state licenses.

Since January 2016, 170 separate pieces of licensure compact legislation have been passed by the states. To date, 42 states and territories have enacted occupational licensure compacts for nurses, physicians, physical therapists, emergency medical technicians, psychologists, speech therapists/audiologists, occupational therapists, and counselors. The map below shows the widespread use of interstate compacts among professions who offer multistate practice to their practitioners.

CSG Resources:

Development in Interstate Law

Explore the latest insights into interstate compact law with this in-depth review of 2022’s key judicial, legislative, and administrative developments, authored by Jeffrey B. Litwak and Marisa Fiat. This article highlights significant cases and legal interpretations, examines the impact of recent federal initiatives, and discusses evolving compact frameworks that shape critical areas such as transportation, environmental stewardship, and public safety. Whether you’re a policy professional or a legal scholar, this comprehensive overview offers valuable context on the complexities and ongoing advancements in interstate cooperation.

Developments in Interstate Compact Law and Practice 2022

Legislative Frequently Asked Questions

How much will the EMS Compact cost my state?

Answer: Currently, there are no fees associated with the EMS Compact. The Compact allows for the levy of a fee when it is determined that a fee is necessary. In December 2017, the National Registry of Emergency Medical submitted two proposals to the Commission, one to support the Coordinated Database and one to provide administrative support to the Commission. The support from the National Registry, a not-for-profit organization, has been significant in that it has alleviated any immediate need for funding through, a levy. In the first year of the Compact, associated costs have been those related to participation in the Commission. The Commission has conducted much of its regular business via conference call or through online meetings. The Commission has successfully scheduled those few meetings requiring travel in conjunction with other events to achieve economy of scale for participating states.

A “Funding Assistance Guide” was published by the National Association of State EMS Officials (NASEMSO) in 2016. This guide lists the various funding resources supporting state EMS offices budgets including in-state revenue streams. According to this guide EMS personnel licensure fees comprise 5% or less of their annual EMS office budgets.

Can the Commission pass rules and regulations that impact states without providing for public comment unless requested even though it will use public funds to operate?

Answer: No. REPLICA Section 12 “Rulemaking”, outlines in detail the public process utilized for public comment in writing, reviewing, and adopting rules. This section also outlines how a public hearing can be easily requested. The Commission is comprised of one voting representative from each of the member states who will participate in deliberations, decisions and rulemaking. Similar to many states’ current rulemaking processes, the Commission Rules Committee will draft and publish any proposed rule language for public comment.

Could the EMS Compact compromise the quality care of patient care and services to the communities in member states?

Answer: There is no evidence to support that The EMS Compact would compromise the quality of care for patients. The EMS Compact brings an umbrella over quality that has not previously existed between some states including:

The EMS Compact requires all Emergency Medical Technicians, (EMTs), Advanced EMTs (AEMT) and Paramedics working across state lines to have passed a common, standardized, and educationally sound ‘fitness test’ for EMS licensure and to meet the current educational and performance standards in their home state.
The EMS Compact requires all EMS personnel exercising the ‘privilege to practice’ in a remote state to function under a defined scope of practice and under the supervision of a physician medical director.
The EMS Compact increases safety for patients and EMS coworkers by ensuring that member states utilize Federal Bureau of Investigation (FBI) compliant background checks with biometric data*.
The EMS Compact reduces the potential for medical errors by authorizing EMS personnel to work under their home state scope of practice.
The EMS Compact member states’ EMS licensing authority will have access to a national, EMS personnel Coordinated Database. State EMS Officials will have the ability to rapidly share licensure history of personnel for the first time in our profession.

Furthermore, under Section 8. “Adverse Actions”, if an individual’s license in any home state is restricted or suspended, the individual shall not be eligible to practice in a remote state under the privilege to practice until the individual’s home state license is restored. This is based on home state laws and rules understanding that there are differences between states, including in the area of what constitutes a felony and, or a misdemeanor. Any member state may take adverse action against an individual’s privilege to practice in that state based on the factual findings of another member state, so long as each state follows its own procedures for imposing such adverse action.

* No later than five years after activation of the Compact, requires a criminal background check of all applicants for initial licensure, including the use of the results of fingerprint or other biometric data checks compliant with the requirements of the Federal Bureau of Investigation with the exception of federal employees who have suitability determination in accordance with US CFR §731.202 and submit documentation of such as promulgated in the rules of the Commission; (See Section 3, C., 4. of the Compact.)

As members of the Interstate Commission for EMS Personnel Practice are not elected officials does this lessen their accountability to the public?

Answer: Commissioners are public officials and are generally members of the executive branch of state government. As the Commission is a public body, Commissioners are accountable to the public. REPLICA clarifies that “the responsible official of the state EMS authority or his designee shall be the delegate to this compact for each member state.” Therefore, the Compact delegate is a public official and accountable to both their home state executive branch leadership, EMS community and the general public.

Are members of the Interstate Commission for EMS Personnel Practice granted more immunity through the Compact?

Answer: No. Members of the Commission have the same level of immunity that applies in their state position. REPLICA legislation extends this immunity to their role as a Compact delegate but does not expand the immunity.

The qualified immunity doctrine protects government officials from liability for civil damages “insofar as their conduct does not violate clearly established statutory or constitutional rights of which a reasonable person would have known.”

Does REPLICA in its current form make government bigger and more bureaucratic?

Answer: Interstate Compacts have long been seen as a way to lessen, not increase, the burdens of government regulations while upholding common standards and public protections. Compact member states share in the responsibilities of managing cross-border activities instead of each state individually addressing the same issue in a different manner. Interstate Compacts address issues of concern to the federal government between its member states instead of inviting the federal government to intervene.

Could the Commission over time be able to pass rules and impact state rights?

Answer: No, the Commission can write rules only related to the Compact operations and does so through a public process, including public comment, and the availability of public hearings.

REPLICA states that it will “enhance the states’ ability to protect the public’s health and safety, especially patient safety. Are there controls over the quality of providers, service or agency, and measures that a providing agency is licensed or regulated in a remote state?

Answer: Yes, REPLICA brings member states under an umbrella of accountability and quality controls not previously seen in our profession. These include the sharing of a common standard for testing and an FBI compliant background check at the time of initial licensure, access to a Coordinated Database which includes licensure history on personnel from member states, requiring that personnel have medical direction in their home states and allowing for the utilization of home state protocols

The Commission is a “body politic,” a group of people that is politically organized under a single government authority. What is the single government authority for this agency to be organized under?

Answer: Interstate compacts are empowered under the United States Constitution (Article 1, Section 10, Clause 3). A compacts commission is the government authority which is informed by the collective authority of the member states and is charged with the promulgation of rules. Upon activation, REPLICA will join over 200 other governmental commissions or administrations of interstate compacts already in place, organized and provided the same authority to their compact. The Interstate Commission for EMS Personnel Practice will be comprised of one representative from each member state’s authority responsible for EMS, with one vote.

By instituting an immunity clause for unelected officials is there a way to ensure quality controls or the manner in which commissioners can be held accountable?

Answer: Commissioners will be state employees who already have immunity due to their governmental employment. As such, they are and will be held accountable for their work on the Commission by the state leadership that appointed them to the Commission.

Can a member state withdraw from the EMS Compact?

Answer: Withdrawal from the Compact is permitted pursuant to Section 14 of the Model Legislation. A state may withdraw by enacting a statute specifically repealing the agreement. Withdrawal shall not affect the continuing requirement of the withdrawing state's EMS authority to comply with the investigative and adverse action reporting requirements of this act prior to the effective date of withdrawal.

Endorsements

The EMS Compact is the result of a multi-year, nation-wide, collaborative process. As a result, the EMS Compact is strongly supported by many national organizations and associations.

The Council of State Government - Resolution of Support

The Council of State Government (CSG) was the first to pass a formal resolution of support of REPLICA. CSG is the only organization that serves all three branches of government and hosts the enhance of ideas and perspectives that support the development of public policy as well as leadership of state government.

“NOW, THEREFORE BE IT RESOLVED, that The Council of State Governments supports the establishment of the Recognition of EMS Personnel Licensure Compact (REPLICA) and encourages its member jurisdictions to consider the new interstate agreement as an innovative policy solution to the challenge of interstate EMS personnel emergency and life-saving operations.“ - August 13, 2014

International Association of EMS Chiefs – Statement of Support

"The International Association of EMS Chiefs is pleased to support the efforts of REPLICA. As a stakeholder since the inception of this project as we recognize the need for a systematic way for EMS providers to cross jurisdictional boundaries in the course of their daily operations and in the times of disasters. REPLICA meets this need without the confusion and complications that often accompanies interstate patient care. This compact directly benefits the boot on the ground provider and the patients they treat." - October 29, 2017

National Registry of Emergency Medical Technicians – Statement of Support

“The National Registry is excited to announce a commitment to support the Recognition of EMS Personnel Licensure Interstate Compact project. Every day, EMS practitioners cross state lines while caring for patients, responding to disasters, or performing other work duties. ” - August 2016

National EMS Advisory Council – Final Advisory on REPLICA

“Activation of REPLICA in every State and Territory is in line with the NEMSAC core values of being visionary, strategic, and diligent. Having REPLICA activated nationwide is visionary because it promotes a seamless and integrated workforce across the continuum of emergency care. “ - September 8, 2016

Read the National EMS Advisory Council's Final Advisory statement.

National Volunteer Fire Council

“The adoption of the compact will make it easier for EMS personnel in different states to cooperate in the delivery of services. I encourage volunteer fire, EMS, and rescue personnel to work to have REPLICA is adopted in their states.” NVFC - September 25, 2014

Supporting National Associations and Organizations

American Ambulance Association
Association of Air Medical Services
Association of Critical Care Transport
Council Of State Governments
International Association of EMS Chiefs
International Association of Fire Chiefs
National Association of EMS Educators
National Association of EMS Physicians
National Association of Emergency Medical Technicians
National Association of State EMS Officials
National EMS Management Association
National Registry of Emergency Medical Technicians
National Volunteer Fire Council