New Medicare Rule Pays Ambulances for Non-Transport Calls: What the 5-Year Test Means for You

The new Comprehensive Alternative Response for Emergencies Act of 2025 (CARE Act) is a big deal for emergency services, especially if you or someone you know relies on Medicare. Essentially, this bill mandates that the Center for Medicare and Medicaid Innovation (CMMI) must start testing a new payment model within two years that changes how ambulances get paid when they respond to a 911 call but don't end up taking anyone to the hospital.

The End of the 'Must Transport to Bill' Rule

Right now, ground ambulance companies generally only get paid by Medicare if they transport a patient to a facility. This creates a financial headache for providers when they respond to a call—say, for an elderly person who fell but isn't seriously injured—assess and treat the person on the scene, and then determine transport isn't necessary. Under the old rules, that service often went uncompensated. The CARE Model flips this script. It requires Medicare Part B payment for services provided by ambulance crews when they respond to an emergency, even if no transport occurs (Section 2). Think of it as Medicare finally agreeing to pay for 'treat-in-place' services.

How Much Will the Ambulance Get Paid?

This is where the fine print gets interesting. The bill states that the payment rates for these non-transport responses must “generally match” what the ambulance would have been paid if they had transported the patient under existing rules (Section 2). For providers, this is a huge win, stabilizing their revenue and ensuring they get paid for professional services rendered, regardless of whether a ride is needed. For the rest of us, it means better service availability, as ambulance companies can afford to keep responding to every call without losing money on the non-transport ones. For example, if a construction worker calls 911 after a minor fall, the responding EMTs can now treat a small injury and safely leave them at the site, getting paid for their time and expertise, rather than feeling pressure to transport just to get a billable event.

The Cost and the Catch

While this is great for ambulance services and potentially better for patients who don't want an unnecessary ride, there's a significant financial question mark for Medicare. The test is mandated to run for five years, and since Medicare will now be paying for a whole category of services that were previously uncompensated, the Medicare Trust Funds could see a substantial increase in expenditures. The bill’s language is also a little vague, requiring the payment to “generally match” transport rates, giving the Secretary of Health and Human Services a lot of discretion in setting the final price tag. If the volume of these non-transport calls is high, this new payment stream could add up quickly.

Telehealth and the Future of Emergency Care

Another modern twist in the CARE Model is its connection to telehealth. If the emergency response is combined with a telehealth service—say, the EMTs consult with a doctor via video link—the patient's location during that consultation counts as the “originating site” for payment. This is a technical but important detail that removes a key barrier to using telehealth in emergency situations. It means that the ambulance crew can use technology to get a rapid, high-level consult without having to physically move the patient, making the 'treat-in-place' model even safer and more effective. The entire five-year test will be closely watched, with the Comptroller General required to report back to Congress on how this model affects access, resource use, and patient outcomes compared to the old system.