CARE Act of 2025
- Sponsor
- Rep. Carey, Mike [R-OH-15]
- Committees
- Ways and Means Committee (primary)
- Last action
- Apr 1, 2025
Bottom line
The CARE Act of 2025 aims to improve emergency medical service efficiency and patient outcomes by allowing Medicare to pay for non-transport ambulance responses and associated telehealth services, potentially reducing unnecessary hospitalizations.
What it actually does
The bill mandates the Center for Medicare and Medicaid Innovation (CMMI) to establish a new 5-year model, the Comprehensive Alternative Response for Emergencies (CARE) Model, under Medicare Part B. This model will allow ground ambulance service providers to receive payment for emergency medical calls that involve dispatching an ambulance but do not result in patient transport, provided services are furnished according to state and local protocols. It also treats the patient's location as an originating site for telehealth services furnished in conjunction with these emergency responses.
Proponents argue
Proponents argue that the bill addresses a critical gap in Medicare coverage, where ambulance services are currently only reimbursed if a patient is transported. This model would enable paramedics and EMTs to provide appropriate on-scene care, including telehealth consultations, without requiring transport, thereby reducing unnecessary emergency department visits and improving patient care in place. It acknowledges the significant resources expended on non-transport calls.
Opponents contend
Opponents might raise concerns about potential for over-utilization of ambulance services if non-transport calls are reimbursed, leading to increased Medicare costs. There could also be questions about the oversight and quality control of services provided without transport, and whether sufficient safeguards are in place to prevent fraud or abuse in a new payment model.
The bill is concise and can be read quickly, allowing ample time for stakeholders to understand its core provisions.
Section 2(a)(1)(A) and (2) amending Section 1115A(b)(2)(A) and adding Section 1115A(h) of the Social Security Act
Establishment of Comprehensive Alternative Response for Emergencies (CARE) Model
This provision requires the Center for Medicare and Medicaid Innovation (CMMI) to implement the CARE Model within two years of the bill's enactment. This model will allow Medicare Part B to pay ground ambulance service providers for emergency responses where an ambulance is dispatched, but the patient is not transported to a hospital, provided services are rendered according to state and local protocols, including potential telehealth use.
Supporters argue
Supporters argue this provision is crucial for modernizing emergency medical services, allowing providers to deliver appropriate care in the field without the financial pressure to transport patients unnecessarily. This can lead to better patient outcomes and more efficient use of healthcare resources.
Critics contend
Critics might express concern that mandating a specific model limits CMMI's flexibility to innovate and test other approaches. They may also worry about the financial implications of a new, potentially broad payment stream without sufficient data on its long-term cost-effectiveness.
Tradeoffs
The tension lies between ensuring appropriate reimbursement for valuable on-scene care and managing potential increases in Medicare spending due to a new payment category.
Section 2(a)(2) adding Section 1115A(h)(2)(A) of the Social Security Act
Alignment of Payment Rates for Non-Transport Services
This provision directs the Secretary of Health and Human Services to set payment rates for services under the CARE Model. These rates are to generally align with payments that would have been made if the services had resulted in a transport payable under existing Medicare law (Section 1834(l)). This ensures that providers are compensated fairly for their emergency response efforts, regardless of whether transport occurs.
Section 2(a)(2) adding Section 1115A(h)(2)(B) of the Social Security Act
Telehealth Originating Site Designation
This provision specifies that when a telehealth service, payable under Medicare Part B (Section 1834(m)), is provided in conjunction with CARE Model services, the location where the Medicare beneficiary is receiving the telehealth service will be considered an "originating site." This allows for an originating site facility fee to be paid, facilitating the use of telehealth in emergency response scenarios.
Section 2(a)(2) adding Section 1115A(h)(3) of the Social Security Act
Five-Year Model Duration
The CARE Model is mandated to be carried out for a period of five years. This duration provides sufficient time to collect data, evaluate the model's effectiveness, and assess its impact on beneficiary outcomes and resource utilization before making decisions about permanent implementation.
Section 2(b)
GAO Report on CARE Model Impact
This section requires the Comptroller General of the United States (GAO) to submit a report to Congress within four years of the CARE Model's implementation. The report will analyze various aspects of Medicare beneficiaries' access to emergency medical services, compare outcomes under the model with traditional transport, assess regional variations, identify best practices and challenges, and provide recommendations for improving emergency medical services.