Medicare Mandates 5-Year Test of Ambulance Payment for Non-Transport Calls: The CARE Act Explained

Here’s a situation everyone dreads: You call 911 because a loved one is having a medical emergency, the ambulance shows up, but after the EMTs assess the situation, they determine the person can be treated right there or needs a different kind of help—not a high-speed trip to the ER. Under the current system, that ambulance crew often doesn’t get paid by Medicare unless they physically transport the patient. It’s a huge financial problem for emergency medical services (EMS) providers.

The Comprehensive Alternative Response for Emergencies Act of 2025 (CARE Act) is trying to fix that. It mandates that the Center for Medicare and Medicaid Innovation (CMMI) test a new payment model under Medicare Part B for five years. This CARE Model will pay ground ambulance services for responding to an emergency call and providing treatment, even if they don't transport the patient to the hospital. The Secretary of Health and Human Services must get this model up and running within two years of the bill’s enactment.

The 'No-Transport' Lifeline for Ambulance Crews

For the average person, this sounds like common sense. Why shouldn't an ambulance be paid for providing a professional medical service, regardless of whether a transport happens? This bill makes it explicit: Medicare will pay for these non-transport services as long as they are provided in response to an emergency call and follow local protocols. Critically, the bill states that the payment rate for these services must generally match what the ambulance would have been paid if they had transported the patient. This is a massive shift.

Think about the EMTs working in your town. They often spend time stabilizing a patient, consulting with doctors, and ensuring the situation is managed, only to walk away with zero Medicare reimbursement if the patient refuses transport or is treated on-scene. The CARE Act aims to stabilize the revenue stream for these providers, especially in rural areas where every call counts. It essentially recognizes that the value is in the medical response, not just the ride.

What’s the Catch? Paying for the 'Almost' Trip

While this model offers a clear benefit in improving ambulance service viability and encouraging on-scene treatment instead of unnecessary ER visits, there’s a real concern about the cost to the Medicare Trust Fund. By mandating that non-transport services be paid at the same rate as a full transport, the bill guarantees a significant new expenditure.

Since the definition of an “emergency medical call” can be subjective, there's a risk of over-utilization—ambulances responding to borderline calls just to generate a payable service fee. If the volume of these newly payable calls is high, the cost could balloon quickly. This trade-off is the core challenge of the CARE Model: better triage and appropriate care versus potentially higher overall program costs.

Telehealth Gets a Seat in the Ambulance

Another clever provision of the CARE Act involves telehealth. If a telehealth service (like a virtual consultation with an emergency physician) is provided during the on-scene treatment, the patient’s location (their home, their workplace, etc.) will be treated as an official “originating site” for Medicare payment purposes. This is a big deal because Medicare usually restricts where telehealth services can originate.

This integration encourages ambulance crews to use technology to get expert advice without forcing a transport. For someone living in a remote area, this could mean getting high-level specialist input right in their driveway, potentially saving them hours of travel and an expensive, unnecessary hospital stay.

The Scorecard: How We’ll Know if It Works

The CARE Model is a five-year experiment. To keep tabs on whether this is a smart use of taxpayer money, the bill requires the Comptroller General of the United States to deliver a comprehensive report to Congress after four years. This report is tasked with comparing patient outcomes under the CARE Model (on-scene treatment) versus traditional transport, analyzing the impact on resource use, and assessing how regional differences affect service availability.

This mandated review is crucial. It means that while Medicare is footing the bill for this five-year test run, we should get solid data on whether paying for the “almost” trip actually leads to better, more efficient care for Medicare beneficiaries. It’s an expensive gamble, but one that could fundamentally improve how emergency services operate in the U.S.