The CARE Act of 2025 mandates a Medicare program test model for alternative emergency response services, allowing Medicare Part B payments for ground ambulance services that treat patients on-site without transport, aiming to improve access and efficiency in emergency care.
Mike Carey
Representative
OH-15
The CARE Act of 2025 mandates a Medicare program model that allows payment for ground ambulance services that respond to emergencies, even if transport to a hospital is not required. This model will run for five years and aims to improve access to emergency medical services by enabling on-scene treatment and telehealth options. The act requires a report analyzing the model's impact on patient outcomes, resource use, and regional variations in emergency service availability.
CARE Act Proposes Paying Ambulances for On-Scene Emergency Care, Even Without Hospital Transport
This bill, the CARE Act of 2025, directs Medicare to test a significant shift in how it pays for emergency responses. Within two years, the Center for Medicare and Medicaid Innovation must launch a five-year pilot program. Under this model, Medicare Part B would pay ground ambulance services for providing treatment during an emergency call, even if the patient isn't transported to a hospital.
Beyond the Ride: A New Approach to Emergency Calls
Currently, Medicare generally only pays for an ambulance trip if it results in transporting a patient. This bill changes that equation for the pilot program. If you call 911, paramedics arrive, provide necessary medical treatment on the spot, and determine you don't need a hospital visit, the ambulance service could still bill Medicare for the services rendered. This applies to emergency calls where treatment is given, but transport isn't required or doesn't happen. The idea is to potentially reduce unnecessary hospital trips and ensure ambulance crews are compensated for providing legitimate medical care at the scene. Additionally, if telehealth is used during the response (like consulting a doctor remotely), the location where the patient is being treated counts as a valid 'originating site' for billing purposes.
Dollars and Dispatch: The Payment Puzzle
The bill states that payment rates for these 'treat-without-transport' services should "generally align" with what Medicare would have paid if the patient had been transported (under section 1834(l) of the Social Security Act). That phrasing leaves some room for interpretation in how exactly the rates will be set. While this could incentivize providing appropriate care efficiently on-site, it also raises questions. Could it lead to more ambulance dispatches for minor issues simply to generate a bill? Ensuring the payment structure encourages the right care without inflating costs will be a key challenge.
Keeping Score: Evaluating the Impact
This isn't a permanent change yet; it's a five-year test. To figure out if it's working, the bill requires the Comptroller General (the head of the Government Accountability Office) to report back to Congress within four years. This report will dig into how the model affects Medicare beneficiaries' access to emergency care, patient outcomes (comparing those treated on-scene versus transported), overall healthcare resource use, and any regional differences. It will also identify best practices and challenges, ultimately providing recommendations on the future of such emergency medical service models. This evaluation will be crucial in determining if paying for treatment without transport actually improves care and is a sustainable approach for Medicare.