119-hr3443

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3443 Introduced in House

    (IH) ]

<DOC>

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''.
 <all>