I 
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 subse-
quently 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 Representa-
tives 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’’. 
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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 sen-
tence, 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 sub-
section (h).’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(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 administra-
tion by EMS professionals to individuals with emer-
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gency medical conditions (as defined in section 
1867(e)). 
‘‘(2) APPLICATION AND SELECTION OF ELIGI-
BLE ENTITIES.— 
‘‘(A) APPLICATION.— 
‘‘(i) IN GENERAL.—To be eligible to 
participate in the model described in para-
graph (1), an eligible entity shall submit to 
the Secretary an application in such form, 
at such time, and containing such informa-
tion as the Secretary may determine ap-
propriate, which shall include at least the 
information described in clause (ii). 
‘‘(ii) INFORMATION DESCRIBED.—For 
purposes of clause (i), the information de-
scribed 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 Sec-
retary to be able to perform the analysis 
required for the report required under 
paragraph (5), including— 
‘‘(I) data that encompasses qual-
ity of care and the outcomes of indi-
viduals receiving emergency medical 
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services (as defined in 303(k)(13)(C) 
of the Controlled Substances Act); 
and 
‘‘(II) discrete data elements asso-
ciated 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 ap-
proving 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 med-
ical services agency (as such term is de-
fined 
for 
purposes 
of 
section 
303(k)(13)(D) of the Controlled Sub-
stances Act). 
‘‘(3) 
SUPPLEMENTAL
PAYMENT
ADJUST-
MENTS.—The Secretary shall set payment rates for 
services furnished under the model described in 
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paragraph (1) and shall make such payments in ad-
dition to any payments that eligible entities partici-
pating 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 short-
ages (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 sepa-
rately for each type of product used in the 
provision of emergency medical services, 
taking into account the cost of the acquisi-
tion, storage, maintenance, transport by 
ground and air, and administration of 
blood products; and administrative costs 
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associated with blood and blood product 
usage and storage, including wastage; 
‘‘(iii) maintaining a sufficient supply 
to serve all patients requiring the adminis-
tration of specified EMS medications and 
blood products in the eligible entity’s pri-
mary service area (which shall not be 
based on the actual administration of such 
medications and blood products to Medi-
care beneficiaries); and 
‘‘(iv) maintaining software and data 
integration necessary for the reporting re-
quirements 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). 
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‘‘(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 in-
cludes an analysis of the following: 
‘‘(A) Whether supplemental payments for 
ground and air ambulance services under the 
model under this subsection increased the utili-
zation of blood and blood products and lessened 
the adverse effects of the specified medications 
in shortage. 
‘‘(B) The impact of providing such speci-
fied medications and blood products on the 
quality of care provided, and patient outcomes 
including Medicare and Medicaid patient mor-
bidity and mortality. 
‘‘(C) Whether such increased utilization of 
specified medications and blood products im-
proved the quality of care and saved lives for 
traditionally underserved demographics and 
rural communities. 
‘‘(6) DURATION.—The model described in para-
graph (1) shall be carried out for a period of not 
less than 5 years. 
‘‘(7) DEFINITIONS.—In this subsection: 
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‘‘(A) SPECIFIED LIFE-SAVING EMS MEDI-
CATION.—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 Cos-
metic 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 de-
rived from human blood, including whole blood 
and other blood components for transfusion, 
and plasma-derived medicinal products. 
‘‘(C) ELIGIBLE ENTITY.—The term ‘eligi-
ble entity’ means an emergency medical services 
agency (as defined in section 303(k)(13)(D) of 
the Controlled Substances Act).’’. 
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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 re-
ferred 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 de-
scribed in paragraph (5). 
(2) EMS MEDICAL DIRECTOR EVALUATION.— 
(A) IN GENERAL.—For purposes of para-
graph (1)(A), the evaluation described in this 
subsection is, with respect to EMS medical di-
rectors and the 1-year period preceding the date 
of the enactment of the When Minutes Count 
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for Emergency Medical Patients Act, an evalua-
tion of the key roles and responsibilities of phy-
sician 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 direc-
tors 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 ambu-
lance 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 appro-
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priate 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 med-
ical 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 pro-
vided to Medicare beneficiaries and 
how such separate payment could be 
implemented. 
(B) SOURCES OF INFORMATION.—In con-
ducting the evaluation under subparagraph (A), 
MedPAC shall consider the following sources of 
information with respect to the role of EMS 
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medical directors in the provision of emergency 
medical services: 
(i) The official position statement 
with respect to EMS medical director com-
pensation of the National Association of 
EMS Physicians. 
(ii) The Health Resources and Serv-
ices Administration Guide for Preparing 
Medical Directors. 
(iii) The National Highway Traffic 
Safety Administration Guide for Preparing 
Medical Directors. 
(iv) The United States Fire Adminis-
tration 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 Emer-
gency Physicians policy statement entitled 
‘‘Physician Medical Direction of Emer-
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gency Medical Services Education Pro-
grams’’. 
(viii) Any other relevant information. 
(3) EMERGENCY MEDICAL SERVICES PROFES-
SIONAL EVALUATION.—For purposes of paragraph 
(1)(B), the evaluation described in this subsection is, 
with respect to emergency medical services profes-
sionals 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 med-
ical services professionals who provide care and 
treatment to Medicare beneficiaries, and shall in-
clude 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 pay-
ment 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. 
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(C) An analysis of how modernization of 
EMS services described in paragraph (2)(A) 
may impact the staffing of professionals to pro-
vide such services. 
(D) Recommendations on any changes that 
should be made to ensure a sufficient and capa-
ble EMS professional workforce to provide the 
highest quality of care and transport for Medi-
care beneficiaries with emergency medical con-
ditions. 
(E) Any other relevant information on the 
current and potential future role of such profes-
sionals in the provision of emergency medical 
services, community paramedicine, and mobile 
integrated health care services. 
(4) 
QUALITY
ASSURANCE
RECOMMENDA-
TIONS.—For purposes of paragraph (1)(C), the rec-
ommendations described in this subsection are rec-
ommendations 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 
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forming such recommendations, MedPAC shall take 
into consideration— 
(A) the uniqueness of the emergency med-
ical 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
DEFINI-
TION ANALYSIS AND RECOMMENDATION.—For pur-
poses of paragraph (1)(D), the analysis and rec-
ommendation 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 Sub-
stances 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 
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emergency medical services agency. Such rec-
ommendation shall include— 
(i) an evaluation of any changes to 
payment under title XVIII of such Act 
that would result from such an amend-
ment; 
(ii) an evaluation of any other poten-
tial benefits or obligations under titles 
XVIII and XIX of such Act that would re-
sult 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 depart-
ment, 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 para-
graph (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 recommenda-
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tions for legislation that the Secretary believes Con-
gress should consider enacting to eliminate wall 
time. 
(c) DEFINITIONS.—In this section, the following defi-
nitions 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 Sub-
stances 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 PROFES-
SIONAL.—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 
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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’’. 
Æ 
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