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REPLICA legislation continues to compromise EMS care

Seven states have enacted legislation that negatively affects EMS jobs and wages. Colorado, Idaho, Kansas, Tennessee, Texas, Utah, Virginia and Wyoming have all approved the Recognition of EMS Personnel Licensure Interstate CompAct (REPLICA) over the past year, which poses a serious threat to IAFF affiliates everywhere, compromises quality care and service to the communities they serve. States such as Michigan, Minnesota, Mississippi, Missouri, New Mexico, Oregon have seen initiatives underway.

However, several states have successfully prevented REPLICA from passing, including Louisiana, Nevada and Wisconsin.

The IAFF believes EMS services should be locally driven and that REPLICA reduces control over patient care. The legislation poses a threat to IAFF affiliates everywhere, compromising quality care and services to the communities. It would also negatively affect the wages of EMS workers and put their jobs in jeopardy.

REPLICA is also a threat because...

·         Even if a state’s fire department does not provide or support fire-based EMS, passage in another state may affect other states that do offer fire-based EMS ambulance services.

·         If the Trump administration decides that Medicaid should be under state control – it could mean that states get less assistance over the next several years.

The legislation allows ambulances to cross state lines to not only pick up patients, but also transport them to other states or back to the state of origin.

 

The National Association of State EMS Officials (NASAMSO) authored the legislation in response to the federal government’s request to improve response to federal law enforcement activities and to emergency incidents, such as wildland fires. The federal government aims to ease restrictions to make it easier for EMS personnel to provide services across state lines that involve high-level security response from the FBI, Department of Homeland Security and other law enforcement to emergencies. The IAFF understands the need to make access more convenient, but REPLICA in its current form makes government bigger and more bureaucratic. In addition, current legislation exceeds the scope and extends the legislation to include day-to-day EMS response, which could include non-emergency inter-facility work.

 

We believe this could allow private entities and rival organizations to position resources near state borders to access multiple communities and take work away from IAFF affiliates in their jurisdictions and inadvertently create a parity gap in wages for states that enter such agreements.

Although the IAFF was a stakeholder organization during the creation of this model legislation, it is evident that our position was not inserted. We have stated our opposition to the rest of the stakeholders and authors of the model legislation.

Here are some of our chief concerns:

  1. We believe that REPLICA is a threat to jobs and wages. Allowing EMS providers to cross state borders from states or regions that receive less pay negatively effects the market.
  2. By allowing EMS providers from other states to transport patients, there is the possibility that Medicaid money will be leaving your state to benefit other states.
  3. Although conceptually designed to benefit the individual and seeks to increase access to EMS care, it has nothing in place to enhance the safety of providers, such as mandating radio interoperability.
  4. REPLICA holds itself out as not having a fiscal impact. This is partially true because states do not experience a fiscal impact upfront. However, once 10 states sign on, the agreement goes into effect and state money must be contributed to support the commission.
  5. There is nothing in place that truly ensures quality.
  6. Business will make decisions based on the flexibility of the workforce. By using this legislation, a private for-profit business could build a base in a less costly state, license its ambulances in multiple states and use the lower-cost workforce to cross borders. This puts private industry in a good position to underbid existing services.
  7. REPLICA does not isolate movement of EMS personnel to the area around the state’s border. These resources can travel the entire state.
  8. REPLICA is different than the nurses agreement. Nurses travel from their home state to the state in which they work. They do not transport patients back and forth across state lines. REPLICA is interstate commerce.

We have offered compromises to the authors of the legislation, but they have not been accepted. Additionally, we are aware of a law that allows federal resources to enter the state to work without applying for reciprocity. In lieu of joining a compact that directly affects local EMS services, we encourage a model that allows local communities to keep their autonomy and the federal government to do what it needs to do without applying for reciprocity.

A potential solution is to look at states such as Indiana, which has adopted language to address the issue:

An agency or instrumentality of the United States and any paramedic, emergency medical technician, emergency medical technician-basic advanced, or ambulance of the agency or instrumentality of the United States does not include a person operating under a contract with the government of the United States. (Indiana Emergency)

 

In Louisiana and Washington, IAFF affiliates have adopted resolutions stating they will oppose REPLICA legislation until IAFF modifications are met.

 

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