H.R. 3443 — When Minutes Count for Emergency Medical Patients Act

This section requires the Center for Medicare and Medicaid Innovation (CMI) to test the When Minutes Count for EMS Patients Model under Medicare (title XVIII). (As background, the CMI tests innovative payment and service delivery models to reduce Medicare and Medicaid expenditures while preserving or enhancing quality of care for beneficiaries.) The model provides supplemental payments—in addition to regular ambulance payments under section 1834(l)—to participating eligible entities (e.g., ground and air emergency medical services agencies) for specified life-sustaining EMS medications (epinephrine, lidocaine, calcium, 0.9 percent saline solution, lactated Ringers solution, albuterol, midazolam, and 10 percent dextrose solution) and blood products administered immediately by EMS professionals to individuals with emergency medical conditions. (1) The Secretary must select at least one eligible entity per HHS region and at least one of each type of EMS agency, with sufficient participants across all regions and geographic areas (rural, frontier, suburban, urban); (2) payments are lump-sum monthly or quarterly, calculated on total costs of maintaining sufficient supplies (at least double average first-year acquisition costs for medications), including acquisition, storage, transport, administration, wastage, and reporting software; (3) participants must submit applications with data on quality, outcomes, and emergency services (e.g., NEMSIS elements); (4) the model runs for at least five years; and (5) the Secretary must report to Congress within one year of termination, analyzing utilization increases, quality and outcomes impacts (including morbidity/mortality for Medicare/Medicaid patients), and benefits for underserved and rural communities.

This section directs the Medicare Payment Advisory Commission (MedPAC) to submit to Congress, not later than two years after the date of enactment, a report on payment for emergency medical services under Medicare (title XVIII of the Social Security Act). The report must evaluate (1) roles and responsibilities of EMS medical directors in overseeing ambulance services for Medicare beneficiaries, including whether Medicare payments to EMS agencies were sufficient in the prior year to reimburse medical directors, impacts of EMS modernization (i.e., treat-in-place or non-hospital transport options) on physician supervision needs, and recommended Medicare payment models (including separate payments for online and offline medical direction); (2) roles of EMS professionals, including shortages since 2020 and their effects on Medicare beneficiary access, payment impacts on recruitment and retention, modernization effects on staffing, and recommendations to ensure an adequate workforce; (3) quality assurance mechanisms for EMS (e.g., quality measures or conditions of participation), accounting for the unique EMS delivery model and service types; and (4) an analysis and recommendations on EMS payments generally. In conducting these evaluations, MedPAC must consider specified sources, including the supervision requirements for EMS under section 303(k) of the Controlled Substances Act.