[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3443 Introduced in House (IH)]
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119th CONGRESS
1st Session
H. R. 3443
To amend title XI of the Social Security Act to create a model, and to
direct the Medicare Payment Advisory Commission to carry out a study
and report with respect to Medicare payment for emergency medical
services.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 15, 2025
Mr. Hudson (for himself and Mrs. Dingell) introduced the following
bill; which was referred to the Committee on Energy and Commerce, and
in addition to the Committee on Ways and Means, for a period to be
subsequently determined by the Speaker, in each case for consideration
of such provisions as fall within the jurisdiction of the committee
concerned
_______________________________________________________________________
A BILL
To amend title XI of the Social Security Act to create a model, and to
direct the Medicare Payment Advisory Commission to carry out a study
and report with respect to Medicare payment for emergency medical
services.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``When Minutes Count for Emergency
Medical Patients Act''.
SEC. 2. CMI EMERGENCY SERVICES PAYMENT MODEL.
Section 1115A of the Social Security Act (42 U.S.C. 1315a) is
amended--
(1) in subsection (b)(2)--
(A) in subparagraph (A), in the third sentence, by
inserting ``, and shall include the model described in
subparagraph (B)(xxviii)'' before the period at the
end; and
(B) in subparagraph (B), by adding at the end the
following new clause:
``(xxviii) The When Minutes Count for EMS
Patients Model described in subsection (h).'';
and
(2) by adding at the end the following new subsection:
``(h) When Minutes Count for EMS Patients Model .--
``(1) In general.--For purposes of subsection
(b)(2)(B)(xxviii), the When Minutes Count for EMS Patients
Model described in this subsection is a model that provides
supplemental payment for ground and air ambulance services
under title XVIII of the Social Security Act (42 U.S.C. 1395 et
seq.) for specified life-sustaining EMS medications and blood
products that require immediate administration by EMS
professionals to individuals with emergency medical conditions
(as defined in section 1867(e)).
``(2) Application and selection of eligible entities.--
``(A) Application.--
``(i) In general.--To be eligible to
participate in the model described in paragraph
(1), an eligible entity shall submit to the
Secretary an application in such form, at such
time, and containing such information as the
Secretary may determine appropriate, which
shall include at least the information
described in clause (ii).
``(ii) Information described.--For purposes
of clause (i), the information described in
this clause is such information as the
Secretary determines necessary to demonstrate
that the eligible entity will be able to
provide sufficient data for the Secretary to be
able to perform the analysis required for the
report required under paragraph (5),
including--
``(I) data that encompasses quality
of care and the outcomes of individuals
receiving emergency medical services
(as defined in 303(k)(13)(C) of the
Controlled Substances Act); and
``(II) discrete data elements
associated with emergency department
and inpatient services, including ICD-
10 and National Emergency Medical
Services Information System (NEMSIS)
dispositions (NEMSIS 3.5 elements:
eOutcome 0.1, eOutcome 0.2, eOutcome
10, and eOutcome 13).
``(B) Selection.--The Secretary, in approving
applications under this subparagraph--
``(i) shall select not less than 1 eligible
entity in each HHS region (as determined by the
Secretary); and
``(ii) to the extent feasible, shall select
at least 1 of each type of emergency medical
services agency (as such term is defined for
purposes of section 303(k)(13)(D) of the
Controlled Substances Act).
``(3) Supplemental payment adjustments.--The Secretary
shall set payment rates for services furnished under the model
described in paragraph (1) and shall make such payments in
addition to any payments that eligible entities participating
in the model receive for such services under section 1834 of
this title. Such payment rates shall--
``(A) be calculated based on the total costs of--
``(i) maintaining a sufficient supply of
specified EMS medications to minimize EMS
medical directors having to routinely change
protocols for administration of such
medications due to their persistent shortages
(which shall constitute at least double the
amount of average actual acquisition for such
medications in the first year of the model, as
determined necessary by the Secretary to ensure
such sufficient supply);
``(ii) blood products (calculated
separately for each type of product used in the
provision of emergency medical services, taking
into account the cost of the acquisition,
storage, maintenance, transport by ground and
air, and administration of blood products; and
administrative costs associated with blood and
blood product usage and storage, including
wastage;
``(iii) maintaining a sufficient supply to
serve all patients requiring the administration
of specified EMS medications and blood products
in the eligible entity's primary service area
(which shall not be based on the actual
administration of such medications and blood
products to Medicare beneficiaries); and
``(iv) maintaining software and data
integration necessary for the reporting
requirements described in paragraph (2)(A); and
``(B) be paid to participants as a lump sum on a
monthly or quarterly basis.
``(4) Scope of model.--The Secretary shall implement the
model in a manner that will provide for a sufficient number of
participants in all HHS regions (as determined by the
Secretary) and in varying types of geographic areas (including
rural, frontier, suburban and urban) to assess and evaluate the
reporting components required in the report under paragraph
(5).
``(5) Report.--Not later than 1 year after the termination
of the model under this subsection, the Secretary shall submit
to Congress a report that includes an analysis of the
following:
``(A) Whether supplemental payments for ground and
air ambulance services under the model under this
subsection increased the utilization of blood and blood
products and lessened the adverse effects of the
specified medications in shortage.
``(B) The impact of providing such specified
medications and blood products on the quality of care
provided, and patient outcomes including Medicare and
Medicaid patient morbidity and mortality.
``(C) Whether such increased utilization of
specified medications and blood products improved the
quality of care and saved lives for traditionally
underserved demographics and rural communities.
``(6) Duration.--The model described in paragraph (1) shall
be carried out for a period of not less than 5 years.
``(7) Definitions.--In this subsection:
``(A) Specified life-saving ems medication.--The
term `specified life-saving EMS medication' means the
following drugs that have the meaning given the term
`life-saving' in section 356(a)(1) of the Food, Drug
and Cosmetic Act:
``(i) Epinephrine.
``(ii) Lidocaine.
``(iii) Calcium.
``(iv) 0.9 percent saline solution.
``(v) Lactated Ringers solution.
``(vi) Albuterol.
``(vii) Midazolam.
``(viii) 10 percent dextrose solution.
``(ix) Fentanyl.
``(B) Blood product.--The term `blood product'
means any therapeutic substance derived from human
blood, including whole blood and other blood components
for transfusion, and plasma-derived medicinal products.
``(C) Eligible entity.--The term `eligible entity'
means an emergency medical services agency (as defined
in section 303(k)(13)(D) of the Controlled Substances
Act).''.
SEC. 3. MEDPAC REPORT; EMTALA GUIDANCE.
(a) MedPAC Report.--
(1) In general.--Not later than 2 years after the date of
the enactment of this Act, the Medicare Payment Advisory
Commission (in this section referred to as ``MedPAC'') shall
submit to Congress a report on payment for emergency medical
services under title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.). Such report shall include--
(A) with respect to EMS medical directors, the
evaluation described in paragraph (2);
(B) with respect to emergency medical services
professionals, the evaluation described in paragraph
(3);
(C) with respect to quality assurance, the
recommendations described in paragraph (4); and
(D) with respect to emergency medical services, the
analysis and recommendation described in paragraph (5).
(2) EMS medical director evaluation.--
(A) In general.--For purposes of paragraph (1)(A),
the evaluation described in this subsection is, with
respect to EMS medical directors and the 1-year period
preceding the date of the enactment of the When Minutes
Count for Emergency Medical Patients Act, an evaluation
of the key roles and responsibilities of physician
medical directors in ensuring the highest quality of
emergency medical services furnished to a Medicare
beneficiary and shall include the following
information:
(i) An analysis of the extent to which
payment under title XVIII of the Social
Security Act to emergency medical services
agencies as providers or suppliers of ground
and air ambulance services during such period
was sufficient to enable such agencies to
reimburse EMS medical directors for the roles
and responsibilities of medical direction and
oversight services identified by the sources of
information in subparagraph (B).
(ii) Consider how modernization of EMS
services that allows an emergency medical
services agency that is an ambulance provider
or supplier under title XVIII of the Social
Security (42 U.S.C. 1395 et seq.) to treat a
patient in place and not transport the patient
to a hospital, or to transport the patient to
an appropriate clinical setting that is not a
hospital, may increase the necessity and
intensity of physician supervision to ensure
patient safety and quality of care of patients
with emergency medical conditions not being
transported to a hospital.
(iii) Recommendations as to potential
models of payment under title XVIII of the
Social Security Act for services furnished by
EMS medical directors, including--
(I) any recommended difference in
payment for online and offline medical
direction; and
(II) recommendations as to whether
separate payment under such title XVIII
for medical direction and oversight
would be justified to ensure high
quality of emergency care provided to
Medicare beneficiaries and how such
separate payment could be implemented.
(B) Sources of information.--In conducting the
evaluation under subparagraph (A), MedPAC shall
consider the following sources of information with
respect to the role of EMS medical directors in the
provision of emergency medical services:
(i) The official position statement with
respect to EMS medical director compensation of
the National Association of EMS Physicians.
(ii) The Health Resources and Services
Administration Guide for Preparing Medical
Directors.
(iii) The National Highway Traffic Safety
Administration Guide for Preparing Medical
Directors.
(iv) The United States Fire Administration
Handbook for Medical Directors.
(v) The supervision requirements under
section 303(k) of the Controlled Substances
Act.
(vi) The Medicare Ground Ambulance Data
Collection System established under section
1834(l)(17) of the Social Security Act (42
U.S.C. 1395m(l)(17)).
(vii) The American College of Emergency
Physicians policy statement entitled
``Physician Medical Direction of Emergency
Medical Services Education Programs''.
(viii) Any other relevant information.
(3) Emergency medical services professional evaluation.--
For purposes of paragraph (1)(B), the evaluation described in
this subsection is, with respect to emergency medical services
professionals and the 1-year period preceding the date of the
enactment of the When Minutes Count for Emergency Medical
Patients Act, an evaluation of the key roles and
responsibilities of emergency medical services professionals
who provide care and treatment to Medicare beneficiaries, and
shall include the following information:
(A) An analysis of the shortage of EMS
professionals since 2020 and the impact of such
shortage on access by Medicare beneficiaries to
emergency medical services, including causes and
potential solutions.
(B) An analysis of the extent to which payment
under title XVIII of the Social Security Act impacts
such shortage, and whether EMS agencies require
additional payment under such title XVIII to attract
and retain capable EMS professionals.
(C) An analysis of how modernization of EMS
services described in paragraph (2)(A) may impact the
staffing of professionals to provide such services.
(D) Recommendations on any changes that should be
made to ensure a sufficient and capable EMS
professional workforce to provide the highest quality
of care and transport for Medicare beneficiaries with
emergency medical conditions.
(E) Any other relevant information on the current
and potential future role of such professionals in the
provision of emergency medical services, community
paramedicine, and mobile integrated health care
services.
(4) Quality assurance recommendations.--For purposes of
paragraph (1)(C), the recommendations described in this
subsection are recommendations with respect to mechanisms that
may be used by Congress to ensure the highest quality of
emergency medical services furnished to Medicare beneficiaries,
such as the use of quality measures or conditions of
participation under title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.). In forming such recommendations, MedPAC
shall take into consideration--
(A) the uniqueness of the emergency medical
services delivery model; and
(B) different types of emergency medical services
agencies, as described in section 303(k)(13)(D) of the
Controlled Substances Act (21 U.S.C. 823(k)(13)(D)).
(5) Emergency medical services definition analysis and
recommendation.--For purposes of paragraph (1)(D), the analysis
and recommendation described in this subsection are the
following:
(A) An analysis of the consequences of amending
section 1861 of the Social Security Act (42 U.S.C.
1395x) to add a definition of the term ``emergency
medical services'' that is consistent with the
definition of such term in section 303(k)(13)(C) of the
Controlled Substances Act (21 U.S.C. 823(k)(13)(C)).
(B) A recommendation as to whether the term
``provider of services'' under section 1861(u) of the
Social Security Act (42 U.S.C. 1395x(u)) should be
amended to include an emergency medical services
agency. Such recommendation shall include--
(i) an evaluation of any changes to payment
under title XVIII of such Act that would result
from such an amendment;
(ii) an evaluation of any other potential
benefits or obligations under titles XVIII and
XIX of such Act that would result from such an
amendment; and
(iii) any other relevant information.
(b) EMTALA Guidance and Report.--
(1) Guidance.--Not later than 1 year after the date of
enactment of this Act, the Secretary of Health and Human
Services shall issue guidance to hospitals that have a hospital
emergency department, regarding the obligation of such
hospitals to address wall time pursuant to section 1867 of the
Social Security Act (42 U.S.C. 1395dd).
(2) Report.--Not later than 1 year after the date on which
the guidance is issued under paragraph (1), the Secretary shall
submit a report to Congress that includes an evaluation of
whether such guidance has decreased the incidences of wall time
during the such year, and any recommendations for legislation
that the Secretary believes Congress should consider enacting
to eliminate wall time.
(c) Definitions.--In this section, the following definitions apply:
(1) Emergency medical services.--The term ``emergency
medical services''--
(A) has the meaning given such term in section
303(k)(13)(C) of the Controlled Substances Act (21
U.S.C. 823(k)(13)(C)); and
(B) includes ambulance services (whether ground or
air) covered under section 1834(l) of the Social
Security Act (42 U.S.C. 1395m(l)).
(2) Emergency medical services agency.--The term
``emergency medical services agency'' has the meaning given
such term in section 303(k)(13)(D) of the Controlled Substances
Act (21 U.S.C. 823(k)(13)(D)).
(3) Emergency medical services professional.--The term
``emergency medical services professional'' has the meaning
given such term in section 303(k)(13)(E) of the Controlled
Substances Act (21 U.S.C. 823(k)(13)(E)).
(4) EMS medical director.--The term ``EMS medical
director'' has the meaning given the term ``medical director''
in section 303(k)(13)(H) of the Controlled Substances Act (21
U.S.C. 823(k)(13)(H)).
(5) Medicare beneficiary.--The term ``Medicare
beneficiary'' means an individual entitled to benefits under
part A of title XVIII of the Social Security Act (42 U.S.C.
1395 et seq.) or enrolled under part B of such title.
(6) Wall time.--The term ``wall time'' means the amount of
time beyond 30 minutes of patient hand off from EMS
professionals to hospital clinical personnel able to provide
care to the patient at a hospital emergency department or
freestanding emergency department.
(7) Specified drug.--The term ``specified drug'' has the
meaning given the term ``specified life-saving EMS medication''
in section 1115A(h)(7) of the Social Security Act, as added by
section 2 of the ``When Minutes Count for Emergency Medical
Patients Act''.
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