This bill adds a new model to section 1115A of the Social Security Act and tasks agencies to analyze and report on Medicare payment and operational issues for emergency medical services. It focuses on supplemental payments to ambulance agencies to cover costs of specified life‑saving medications and blood products and requires studies and guidance intended to address drug shortages, EMS workforce pressures, and hospital handoff delays.
The measure aims to create targeted payments for ambulance providers that cover acquisition, storage, transport and data‑integration costs tied to maintaining immediate access to critical supplies, while directing MedPAC and HHS to evaluate medical direction, workforce shortages, quality assurance, and EMTALA 'wall time'.
At a Glance
What It Does
Amends section 1115A to create the 'When Minutes Count' model that pays participating ground and air ambulance agencies supplemental lump‑sum amounts (monthly or quarterly) to cover costs of specified EMS medications and blood products, including acquisition, storage, transport, and related administrative costs. The Secretary must select participants across all HHS regions, require data reporting tied to NEMSIS elements, and run the model for at least five years, with a one‑year post‑termination evaluation report to Congress.
Who It Affects
Ground and air ambulance providers that are emergency medical services agencies, EMS medical directors, EMS clinicians, hospitals receiving EMS patients (through wall‑time guidance), MedPAC, and Medicare and Medicaid programs that may see payment or quality‑measurement changes. Blood suppliers and logistics providers will also be affected by procurement and storage cost recovery mechanics.
Why It Matters
The bill creates an explicit federal payment pathway to reimburse EMS agencies for readiness costs that are not captured by current ambulance fee schedules, seeks to generate national data on outcomes and equity (including rural impacts), and could change incentives for pre‑hospital care, medical direction, and where patients are treated.
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What This Bill Actually Does
The core of the bill is a new Medicare demonstration—labeled the When Minutes Count model—inserted into the authority for testing alternative payment models. The model pays participating ambulance agencies extra money beyond standard Medicare ambulance payments to cover the real cost of keeping life‑saving drugs and blood products immediately available.
The law specifies that payments must account for acquisition (including a higher initial stock multiple), storage, transport (ground and air), administration, wastage, and the software/data integration needed to submit quality and outcome information.
Participation requires an application showing an agency can deliver the reporting data the Secretary needs to evaluate the model. The bill names particular discrete data elements (including several NEMSIS outcome fields) and asks agencies to provide quality and outcome information tied to emergency department and inpatient encounters.
The Secretary must pick at least one participant per HHS region and, where feasible, include different types of EMS agencies; payments go out as lump sums monthly or quarterly.The model must run at least five years and the Secretary must report to Congress within one year of the model’s end. That report must analyze whether supplemental payments increased use of medications and blood products, affected patient outcomes (including mortality and morbidity), and whether underserved and rural populations benefited.
The statute also defines the covered drugs (a narrow list including epinephrine, fentanyl, midazolam, and certain fluids) and 'blood products' so the payment and reporting mechanics are clear about what is reimbursable.Separately, the bill directs MedPAC to produce a multi‑part report within two years evaluating EMS medical directors’ roles and payment options (including whether medical direction should be paid separately), the EMS workforce shortage and its payment drivers, quality assurance mechanisms, and whether statutory definitions should change to formally recognize EMS agencies under other Medicare provider categories. Finally, HHS must issue guidance within one year on EMS 'wall time' under EMTALA and then report whether that guidance reduced handoff delays, with recommendations for Congress if not.
The Five Things You Need to Know
The model pays supplemental lump‑sum amounts (monthly or quarterly) in addition to existing Medicare payments and must run for at least five years.
The Secretary must select at least one eligible EMS agency in each HHS region and, where feasible, include multiple agency types (e.g.
municipal, private, volunteer).
Payment rates must cover acquisition (including at least double average acquisition in year one if needed), storage, transport, administration, wastage, and data/software integration costs for specified medications and blood products.
Applicants must provide discrete quality and outcome data—including ICD‑10 and specified NEMSIS disposition elements (eOutcome 0.1, 0.2, 10, and 13)—to support the Secretary’s evaluation.
MedPAC must issue a comprehensive report within two years on EMS medical director payment models, workforce shortages, quality assurance options, and whether Medicare statutes should formally define 'emergency medical services' or include EMS agencies as 'providers of services'.
Section-by-Section Breakdown
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Adds 'When Minutes Count' model authority
This provision inserts a new subsection (h) into section 1115A authorizing a CMS model that provides supplemental payments to ground and air ambulance agencies for maintaining specified life‑saving medications and blood products. It frames the model’s purpose narrowly—readiness and immediate administration in emergency medical conditions—and embeds definitions for eligible drugs, blood products, and eligible entities.
Application and selection requirements
Participating agencies must apply with evidence that they can supply the data the Secretary needs for evaluation. The statute requires the Secretary to select at least one applicant per HHS region and to include different EMS agency types where feasible, which creates a built‑in representativeness requirement but leaves precise selection criteria and caps to agency regulation.
How supplemental payments are calculated and paid
The Secretary must calculate payments to reflect total costs: an initial buffer in drug inventory (expressly at least double average acquisition if needed), separate per‑product blood costs (acquisition, storage, transport, administration), administrative costs including wastage, and data/integration expenses. Payments must be delivered as lump sums monthly or quarterly rather than per‑use fees, shifting the model toward readiness reimbursement rather than utilization‑based billing.
Reporting, evaluation, and model duration
The model must run for not less than five years. The Secretary must report to Congress within one year after the model ends on utilization, quality outcomes (including morbidity and mortality), equity impacts for underserved and rural communities, and whether increased supplies reduced harms from medication shortages. Those evaluation requirements drive the data obligations on participants and determine whether the model’s payments are deemed successful.
MedPAC study requirements
MedPAC must deliver a multi‑component report within two years covering EMS medical director roles and payment options (including separate payments for medical direction and online vs offline supervision), workforce shortages and payment drivers, quality assurance recommendations (quality measures or conditions of participation), and an analysis of whether Medicare statutes should formally define EMS or include EMS agencies as 'providers of services.' MedPAC must draw on multiple external guidance documents and data sources when forming recommendations.
EMTALA 'wall time' guidance and follow‑up report
HHS must issue guidance to hospitals with emergency departments about wall time under EMTALA within one year, and then report whether the guidance reduced wall‑time incidences one year later, with legislative recommendations if needed. The provision signals congressional concern about EMS to ED handoff delays and puts operational pressure on hospitals to address throughput.
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Explore Healthcare in Codify Search →Who Benefits and Who Bears the Cost
Every bill creates winners and losers. Here's who stands to gain and who bears the cost.
Who Benefits
- Participating ambulance agencies: they receive targeted readiness payments to cover acquisition, storage, transport, administration, and data systems for specified medications and blood products, reducing uncompensated readiness costs under current fee schedules.
- Medicare beneficiaries needing immediate pre‑hospital interventions: by funding readiness, the model aims to increase the probability that an EMS crew will have needed medications or blood on hand when minutes matter.
- Rural and underserved communities: because the statute requires geographic representation and assesses rural impacts, agencies serving these areas may gain disproportionate benefit if the model demonstrates improved outcomes where supply and transport constraints are greatest.
Who Bears the Cost
- Medicare program and taxpayers: supplemental lump‑sum payments increase federal outlays relative to current ambulance payment policy, at least during the model period and potentially beyond if recommendations expand coverage.
- Participating EMS agencies (administrative burden): agencies must meet data and reporting requirements, maintain inventory accounting and software integrations, and may incur upfront costs before receiving lump‑sum payments.
- HHS and CMS (implementation burden): the agencies must establish selection criteria, payment formulas, monitoring and audit processes, and handle the required reports and guidance, potentially without dedicated appropriations or staffing increases.
Key Issues
The Core Tension
The bill seeks to ensure immediate patient access to life‑saving supplies by paying EMS readiness costs—but doing so risks enlarging federal payments and creating incentives to stockpile or game eligibility, while imposing data and compliance burdens that may exclude the smallest, most resource‑limited EMS agencies from participation.
Designing payments around readiness (stockpiles, storage, transport and data systems) confronts measurement and incentive problems. The statute specifies an initial inventory multiple and enumerates many cost categories, but it leaves the concrete payment formula, audit rules, and eligibility thresholds to the Secretary.
That creates a risk that payments are set too high (encouraging stockpiling and excessive federal spending) or too low (leaving small and rural agencies unable to participate). The lump‑sum payment approach reduces per‑incident administrative billing but raises questions about how to adjust for changing market prices, product expiration and wastage, and how to reconcile payments with state Medicaid and private payer policies.
Data and evaluation pose implementation challenges. The bill names specific NEMSIS elements and ICD‑10 links, but many EMS agencies—especially volunteer or smaller rural services—lack mature electronic reporting and interoperability.
CMS will need robust technical specifications and likely transition timelines; otherwise the sample could skew toward larger, well‑resourced providers. The inclusion of substances such as fentanyl and midazolam in the 'specified' list also intersects with Controlled Substances Act supervision and diversion‑control obligations, complicating procurement, storage and transport rules and potentially increasing administrative compliance costs.
Finally, the EMTALA 'wall time' guidance and HHS follow‑up report place a compliance spotlight on hospitals without directly addressing underlying ED capacity constraints. If CMS recommends tougher expectations without corresponding payment or capacity investments, hospitals could face difficult operational and legal tradeoffs when ambulances arrive with patients who cannot be immediately transferred to clinical staff.
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