WASHINGTON — A new piece of legislation is aiming to modernize the way EMS is delivered — and sustained — across the country.
The Modernizing EMS Delivery and Sustainability (MEDS) Act, H.R. 3443, officially titled the When Minutes Count for Emergency Medical Patients Act, seeks to amend Title XI of the Social Security Act and create a payment model that better reflects the realities EMS agencies face on the ground.
The bipartisan legislation, backed by the National Association of EMS Physicians (NAEMSP), aims to tackle long-standing pain points for EMS providers while also directing the Medicare Payment Advisory Commission (MedPAC) to study how Medicare reimburses emergency medical services.
The MEDS Act focuses on three urgent issues impacting EMS care:
- Evaluating the role and value of EMS physician oversight
- Addressing shortages of critical medications and blood products
- Increasing transparency around hospital wall times
Dr. Douglas Kupas, president of NAEMSP, said the bill addresses foundational issues that affect the care delivered by EMTs and paramedics every day.
“There are many stressors on our EMS system that affect the patients treated by paramedics and EMTs,” Kupas said. “The quality and safety of care for these patients depends upon system oversight by an EMS physician, availability of essential life-saving medications, and efficient transfer of care to the emergency department. This bill is a crucial step toward strengthening EMS systems and improving outcomes for the communities they serve.”
A new Medicare payment model tailored for EMS needs
The MEDS Act would establish a new emergency services payment model by amending Section 1115A of the Social Security Act — the provision that authorizes the testing of innovative healthcare payment and delivery models.
Known as the “When Minutes Count for EMS Patients Model,” the initiative would provide supplemental Medicare payments to EMS agencies for maintaining a ready supply of lifesaving EMS medications and blood products used in prehospital care for emergency medical conditions.
These payments would help cover the costs of acquiring, storing, transporting (by ground or air), and administering critical items such as:
- Epinephrine
- Midazolam
- Calcium
- Saline and Lactated Ringers solutions
- Albuterol
- Dextrose
- Fentanyl
- Blood and plasma-based products
The model, as outlined in Section 2(h)(7)(A) of the bill, is designed to ensure that EMS agencies are equipped with essential interventions—even if they’re not used on every call—helping reduce disruptions caused by persistent supply shortages.
Reducing wall times, improving response times
The bill directly addresses one of EMS providers’ biggest operational challenges: wall time — the period crews are required to wait in an ER until a patient is formally transferred to hospital care. In some communities, this delay stretches over an hour, reducing EMS unit availability and response capacity.
The legislation mandates guidance under EMTALA (Emergency Medical Treatment and Labor Act) for hospitals to address excessive wall times. It also calls for a federal report evaluating the effectiveness of that guidance within a year of its release.
Evaluating EMS oversight and the workforce behind it
The MEDS Act also calls for a closer look at the foundation of EMS: medical direction and the workforce that carries it out.
Under Section 3 of the bill, the Medicare Payment Advisory Commission (MedPAC) would be tasked with evaluating how EMS medical directors impact patient care and whether current Medicare payments adequately support their role.
The review would include:
- Whether EMS agencies are being reimbursed enough to cover medical oversight responsibilities
- How new EMS delivery models — like treating patients in place or transporting to non-hospital facilities — might increase the need for physician supervision
- Whether Medicare should create separate payments for medical direction, and how that could be implemented
The bill also directs MedPAC to study the EMS workforce shortage, which has grown since 2020. As outlined in Section 3(a)(3), the commission would examine whether Medicare’s current reimbursement structure is enough to support recruitment and retention, and recommend changes to ensure a strong, sustainable EMS workforce for the future.
Defining EMS in federal law
The bill also proposes amending Section 1861 of the Social Security Act to add a formal definition of “emergency medical services” consistent with the Controlled Substances Act — an important move that could lay the foundation for more integrated support for EMS under Medicare and Medicaid.
NAEMSP is encouraging providers to contact their congressional representatives in support of H.R. 3443. The organization’s Legislative Action Center provides information and tools for outreach.
