,i  #aaith ,,congress  #ast ,session    
,h4 ,r4 #cddc  ,,in ,,the ,,house ,,of  
,,representatives  ,may #ae1 #bjbe ,mr4 
,hudson 7for himself and ,mrs4 ,dingell7
 introduced the following bill2 which   
was referred to the ,committee on       
,energy and ,commerce1 and in addition  
to the ,committee on ,ways and ,means1  
for a period to be subsequently         
determined by the ,speaker1 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 model1 and to
 direct the ,medicare ,payment ,advisory
 ,commission to carry out a study and   
report with respect to ,medicare payment
 for emergency medical services4  #a4   
,short title ,this ,act may be cited as 
the ,when ,minutes ,count for ,emergency
 ,medical ,patients ,act4  #b4 ,,cmi    
emergency services payment model        
,section #aaae;,a of the ,social        
,security ,act 7#db ,u4,s4,c4 #acae;a7  

is amended--  7#a7 in subsection        
7b77#b7-- 7,a7 in subparagraph 7,a71 in 
the third sentence1 by inserting 1 and  
shall include the model described in    
subparagraph 7,b77xxviii7 before the    
period at the end2 and  7,b7 in         
subparagraph 7,b71 by adding at the end 
the following new clause3  7xxviii7 ,the
 ,when ,minutes ,count for ,,ems        
,patients ,model described in subsection
 7h74  2 and  7#b7 by adding at the end 
the following new subsection3  7h7 ,when
 ,minutes ,count for ,,ems ,patients    
,model  7#a7 ,in general ,for purposes  
of subsection 7b77#b77;,b77xxviii71 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 7#db      
,u4,s4,c4 #acie et seq47 for specified  
life-sustaining ,,ems medications and   
blood products that require immediate   
administration by ,,ems professionals to

 individuals with emergency medical     
conditions 7as defined in section       
#ahfg7;e774  7#b7 ,application and      
selection of eligible entities  7,a7    
,application  7i7 ,in general ,to be    
eligible to participate in the model    
described in paragraph 7#a71 an eligible
 entity shall submit to the ,secretary  
an application in such form1 at such    
time1 and containing such information as
 the ,secretary may determine           
appropriate1 which shall include at     
least the information described in      
clause 7ii74  7ii7 ,information         
described ,for purposes of clause 7i71  
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 7#e71          
including--  7,i7 data that encompasses 
quality of care and the outcomes of     

individuals receiving emergency medical 
services 7as defined in                 
#cjc7k77#ac77;,c7 of the ,controlled    
,substances ,act72 and  7,,ii7 discrete 
data elements associated with emergency 
department and inpatient services1      
including ,,icd-#aj and ,national       
,emergency ,medical ,services           
,information ,system 7,,nemsis7         
dispositions 7,,nemsis #c4e elements3   
e,outcome #j4a1 e,outcome #j4b1         
e,outcome #aj1 and e,outcome #ac74  7,b7
 ,selection ,the ,secretary1 in         
approving applications under this       
subparagraph-- 7i7 shall select not less
 than #a eligible entity in each ,,hhs  
region 7as determined by the            
,secretary72 and  7ii7 to the extent    
feasible1 shall select at least #a of   
each type of emergency medical services 
agency 7as such term is defined for     
purposes of section #cjc7k77#ac77;,d7 of
 the ,controlled ,substances ,act74     
7#c7 ,supplemental payment adjustments  
,the ,secretary shall set payment rates 

for services furnished under the model  
described in paragraph 7#a7 and shall   
make such payments in addition to any   
payments that eligible entities         
participating in the model receive for  
such services under section #ahcd of    
this title4 ,such payment rates shall-- 
7,a7 be calculated based on the total   
costs of-- 7i7 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 7which    
shall constitute at least double the    
amount of average actual acquisition for
 such medications in the first year of  
the model1 as determined necessary by   
the ,secretary to ensure such sufficient
 supply72  7ii7 blood products          
7calculated separately for each type of 
product used in the provision of        
emergency medical services1 taking into 
account the cost of the acquisition1    
storage1 maintenance1 transport by      

ground and air1 and administration of   
blood products2 and administrative costs
 associated with blood and blood product
 usage and storage1 including wastage2  
7iii7 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  
7which shall not be based on the actual 
administration of such medications and  
blood products to ,medicare             
beneficiaries72 and  7iv7 maintaining   
software and data integration necessary 
for the reporting requirements described
 in paragraph 7#b77;,a72 and  7,b7 be   
paid to participants as a lump sum on a 
monthly or quarterly basis4  7#d7 ,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 7as   
determined by the ,secretary7 and in    
varying types of geographic areas       
7including rural1 frontier1 suburban and

 urban7 to assess and evaluate the      
reporting components required in the    
report under paragraph 7#e74  7#e7      
,report ,not later than #a year after   
the termination of the model under this 
subsection1 the ,secretary shall submit 
to ,congress a report that includes an  
analysis of the following3  7,a7        
,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 
shortage4  7,b7 ,the impact of providing
 such specified medications and blood   
products on the quality of care         
provided1 and patient outcomes including
 ,medicare and ,medicaid patient        
morbidity and mortality4  7,c7 ,whether 
such increased utilization of specified 
medications and blood products improved 
the quality of care and saved lives for 
traditionally underserved demographics  
and rural communities4  7#f7 ,duration  

,the model described in paragraph 7#a7  
shall be carried out for a period of not
 less than #e years4  7#g7 ,definitions 
,in this subsection3 7,a7 ,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 #cef7;a77#a7 of the ,food1 ,drug
 and ,cosmetic ,act3  7i7 ,epinephrine4 
7ii7 ,lidocaine4  7iii7 ,calcium4  7iv7 
#j4i percent saline solution4  7v7      
,lactated ,ringers solution4  7vi7      
,albuterol4  7vii7 ,midazolam4  7viii7  
#aj percent dextrose solution4  7ix7    
,fentanyl4  7,b7 ,blood product ,the    
term blood product means any therapeutic
 substance derived from human blood1    
including whole blood and other blood   
components for transfusion1 and         
plasma-derived medicinal products4  7,c7
 ,eligible entity ,the term eligible    
entity means an emergency medical       
services agency 7as defined in section  
#cjc7k77#ac77;,d7 of the ,controlled    

,substances ,act74  4  #c4 ,med,p,a,c   
report2 ,,emtala guidance  7a7          
,med,p,a,c report  7#a7 ,in general ,not
 later than #b years after the date of  
the enactment of this ,act1 the         
,medicare ,payment ,advisory ,commission
 7in this section referred to as        
,med,p,a,c7 shall submit to ,congress a 
report on payment for emergency medical 
services under title ,,xviii of the     
,social ,security ,act 7#db ,u4,s4,c4   
#acie et seq474 ,such report shall      
include--  7,a7 with respect to ,,ems   
medical directors1 the evaluation       
described in paragraph 7#b72  7,b7 with 
respect to emergency medical services   
professionals1 the evaluation described 
in paragraph 7#c72  7,c7 with respect to
 quality assurance1 the recommendations 
described in paragraph 7#d72 and  7,d7  
with respect to emergency medical       
services1 the analysis and              
recommendation described in paragraph   
7#e74  7#b7 ,,ems medical director      
evaluation  7,a7 ,in general ,for       

purposes of paragraph 7#a77;,a71 the    
evaluation described in this subsection 
is1 with respect to ,,ems medical       
directors and the #a-year period        
preceding the date of the enactment of  
the ,when ,minutes ,count for ,emergency
 ,medical ,patients ,act1 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 information3 7i7 ,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 7,b74  7ii7 

,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  
7#db ,u4,s4,c4 #acie et seq47 to treat a
 patient in place and not transport the 
patient to a hospital1 or to transport  
the patient to an appropriate clinical  
setting that is not a hospital1 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 hospital4  7iii7 
,recommendations as to potential models 
of payment under title ,,xviii of the   
,social ,security ,act for services     
furnished by ,,ems medical directors1   
including--  7,i7 any recommended       
difference in payment for online and    
offline medical direction2 and  7,,ii7  
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 implemented4  7,b7     
,sources of information ,in conducting  
the evaluation under subparagraph 7,a71 
,med,p,a,c shall consider the following 
sources of information with respect to  
the role of ,,ems medical directors in  
the provision of emergency medical      
services3 7i7 ,the official position    
statement with respect to ,,ems medical 
director compensation of the ,national  
,association of ,,ems ,physicians4  7ii7
 ,the ,health ,resources and ,services  
,administration ,guide for ,preparing   
,medical ,directors4  7iii7 ,the        
,national ,highway ,traffic ,safety     
,administration ,guide for ,preparing   
,medical ,directors4  7iv7 ,the ,united 
,states ,fire ,administration ,handbook 
for ,medical ,directors4  7v7 ,the      
supervision requirements under section  
#cjc7k7 of the ,controlled ,substances  
,act4  7vi7 ,the ,medicare ,ground      

,ambulance ,data ,collection ,system    
established under section #ahcd7l77#ag7 
of the ,social ,security ,act 7#db      
,u4,s4,c4 #aciem7l77#ag774  7vii7 ,the  
,american ,college of ,emergency        
,physicians policy statement entitled   
,physician ,medical ,direction of       
,emergency ,medical ,services ,education
 ,programs4  7viii7 ,any other relevant 
information4  7#c7 ,emergency medical   
services professional evaluation ,for   
purposes of paragraph 7#a77;,b71 the    
evaluation described in this subsection 
is1 with respect to emergency medical   
services professionals and the #a-year  
period preceding the date of the        
enactment of the ,when ,minutes ,count  
for ,emergency ,medical ,patients ,act1 
an evaluation of the key roles and      
responsibilities of emergency medical   
services professionals who provide care 
and treatment to ,medicare              
beneficiaries1 and shall include the    
following information3  7,a7 ,an        
analysis of the shortage of ,,ems       

professionals since #bjbj and the impact
 of such shortage on access by ,medicare
 beneficiaries to emergency medical     
services1 including causes and potential
 solutions4  7,b7 ,an analysis of the   
extent to which payment under title     
,,xviii of the ,social ,security ,act   
impacts such shortage1 and whether ,,ems
 agencies require additional payment    
under such title ,,xviii to attract and 
retain capable ,,ems professionals4     
7,c7 ,an analysis of how modernization  
of ,,ems services described in paragraph
 7#b77;,a7 may impact the staffing of   
professionals to provide such services4 
7,d7 ,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 conditions4  7,e7 ,any
 other relevant information on the      
current and potential future role of    
such professionals in the provision of  

emergency medical services1 community   
paramedicine1 and mobile integrated     
health care services4  7#d7 ,quality    
assurance recommendations ,for purposes 
of paragraph 7#a77;,c71 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 beneficiaries1   
such as the use of quality measures or  
conditions of participation under title 
,,xviii of the ,social ,security ,act   
7#db ,u4,s4,c4 #acie et seq474 ,in      
forming such recommendations1 ,med,p,a,c
 shall take into consideration--  7,a7  
the uniqueness of the emergency medical 
services delivery model2 and  7,b7      
different types of emergency medical    
services agencies1 as described in      
section #cjc7k77#ac77;,d7 of the        
,controlled ,substances ,act 7#ba       
,u4,s4,c4 #hbc7k77#ac77;,d774  7#e7     
,emergency medical services definition  

analysis and recommendation ,for        
purposes of paragraph 7#a77;,d71 the    
analysis and recommendation described in
 this subsection are the following3 7,a7
 ,an analysis of the consequences of    
amending section #ahfa of the ,social   
,security ,act 7#db ,u4,s4,c4 #aciex7 to
 add a definition of the term emergency 
medical services that is consistent with
 the definition of such term in section 
#cjc7k77#ac77;,c7 of the ,controlled    
,substances ,act 7#ba ,u4,s4,c4         
#hbc7k77#ac77;,c774  7,b7 ,a            
recommendation as to whether the term   
provider of services under section      
#ahfa7u7 of the ,social ,security ,act  
7#db ,u4,s4,c4 #aciex7u77 should be     
amended to include an emergency medical 
services agency4 ,such recommendation   
shall include-- 7i7 an evaluation of any
 changes to payment under title ,,xviii 
of such ,act that would result from such
 an amendment2  7ii7 an evaluation of   
any other potential benefits or         
obligations under titles ,,xviii and    

,,xix of such ,act that would result    
from such an amendment2 and  7iii7 any  
other relevant information4  7b7        
,,emtala guidance and report  7#a7      
,guidance ,not later than #a year after 
the date of enactment of this ,act1 the 
,secretary of ,health and ,human        
,services shall issue guidance to       
hospitals that have a hospital emergency
 department1 regarding the obligation of
 such hospitals to address wall time    
pursuant to section #ahfg of the ,social
 ,security ,act 7#db ,u4,s4,c4          
#acie;dd74  7#b7 ,report ,not later than
 #a year after the date on which the    
guidance is issued under paragraph 7#a71
 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 year1 and any recommendations for  
legislation that the ,secretary believes
 ,congress should consider enacting to  
eliminate wall time4  7c7 ,definitions  
,in this section1 the following         

definitions apply3 7#a7 ,emergency      
medical services ,the term emergency    
medical services--  7,a7 has the meaning
 given such term in section             
#cjc7k77#ac77;,c7 of the ,controlled    
,substances ,act 7#ba ,u4,s4,c4         
#hbc7k77#ac77;,c772 and  7,b7 includes  
ambulance services 7whether ground or   
air7 covered under section #ahcd7l7 of  
the ,social ,security ,act 7#db         
,u4,s4,c4 #aciem7l774  7#b7 ,emergency  
medical services agency ,the term       
emergency medical services agency has   
the meaning given such term in section  
#cjc7k77#ac77;,d7 of the ,controlled    
,substances ,act 7#ba ,u4,s4,c4         
#hbc7k77#ac77;,d774  7#c7 ,emergency    
medical services professional ,the term 
emergency medical services professional 
has the meaning given such term in      
section #cjc7k77#ac77;,e7 of the        
,controlled ,substances ,act 7#ba       
,u4,s4,c4 #hbc7k77#ac77;,e774  7#d7     
,,ems medical director ,the term ,,ems  
medical director has the meaning given  

the term medical director in section    
#cjc7k77#ac77;,h7 of the ,controlled    
,substances ,act 7#ba ,u4,s4,c4         
#hbc7k77#ac77;,h774  7#e7 ,medicare     
beneficiary ,the term ,medicare         
beneficiary means an individual entitled
 to benefits under part ,a of title     
,,xviii of the ,social ,security ,act   
7#db ,u4,s4,c4 #acie et seq47 or        
enrolled under part ,b of such title4   
7#f7 ,wall time ,the term wall time     
means the amount of time beyond #cj     
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    
department4  7#g7 ,specified drug ,the  
term specified drug has the meaning     
given the term specified life-saving    
,,ems medication in section             
#aaae;,a7h77#g7 of the ,social ,security
 ,act1 as added by section #b of the    
,when ,minutes ,count for ,emergency    
,medical ,patients ,act4