The Comprehensive Alternative Response for Emergencies Act of 2025 (CARE Act) would require the Center for Medicare and Medicaid Innovation (CMMI) to test a new model under Medicare that pays for emergency services delivered by ground ambulance teams when an emergency call is answered but no transport is billed under current law. The model allows on-site evaluation and treatment, potentially with telehealth, and pays under Medicare Part B rather than the traditional 1834(l) transport payment.
The demonstration runs for five years and includes a federal evaluation by the Comptroller General to assess access, outcomes, and implementation challenges, with recommendations to improve emergency medical services.
In short, the bill would move a portion of emergency-response payments from transport-focused billing to on-scene care under a formal demonstration, using telehealth as a pathway for remote medical direction and treatment where appropriate. The GAO evaluation would help determine whether this model improves access and efficiency without compromising care quality, and whether it should influence future Medicare policy.
At a Glance
What It Does
The bill amends 1115A to authorize a five-year model in which payment under Part B covers treatment services furnished in response to an emergency call, when a ground ambulance is dispatched but no transport is billed under 1834(l). Telehealth direction may be used, and licensure standards are respected.
Who It Affects
Medicare beneficiaries during EMS encounters, ground ambulance providers, telehealth providers, state and local EMS agencies, and CMS/CMMI as the sponsor of the demonstration.
Why It Matters
It tests a new approach to emergency care that could improve access and on-scene treatment while potentially reducing unnecessary transports, creating data to inform Medicare’s future coverage decisions.
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What This Bill Actually Does
The CARE Act shifts a portion of emergency medical payments toward on-scene care rather than transport. Section 2 adds a new CARE Model to the Center for Medicare and Medicaid Innovation’s authority under Section 1115A, authorizing payment for emergency services delivered during an ambulance dispatch when no corresponding transport is billed under traditional Medicare rules.
The model explicitly allows treatment that is provided on-site or via telehealth, subject to state licensure and protocols. The payments under this model would be aligned with the levels that would have been paid if a transport had occurred, but would be delivered under Part B rather than as an 1834(l) ambulance transport payment.
A telehealth component is integrated, with the originating site and other telehealth payment considerations addressed to ensure proper reimbursement when telehealth accompanies on-site treatment. The model is designed for a five-year duration to gather performance data on access, beneficiary outcomes, and resource use, while also examining regional variation and implementation challenges.After implementation, the Comptroller General must report within four years to the Ways and Means Committee (House) and the Finance Committee (Senate).
The report should analyze beneficiary access to EMS, compare outcomes with traditional EMS transport, assess regional variations, identify best practices and challenges, and offer recommendations for improving emergency medical services. This exhibit is meant to generate evidence to guide future Medicare policy on emergency response and on-site care.
The Five Things You Need to Know
The CARE model adds a new subsection (h) to Section 1115A to authorize a five-year test.
Payments under the model are set to roughly align with what would be paid for a transport under 1834(l).
Treatment services may be provided on-site or via telehealth, and must comply with state licensure and protocols.
If telehealth is used with the model, the patient’s location can qualify as an originating site for telehealth payments.
A Comptroller General evaluation is due within four years after implementation to assess access, outcomes, and implementation challenges.
Section-by-Section Breakdown
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Short title
This section designates the act as the Comprehensive Alternative Response for Emergencies Act of 2025, the CARE Act of 2025.
CARE Model authorization and scope
Section 2 adds a new subsection (h) to Section 1115A of the Social Security Act to authorize a Comprehensive Alternative Response for Emergencies Model. The model describes payment for emergency services furnished by ground ambulance providers or affiliations when dispatched in response to an emergency call, but with no transport billed under 1834(l). It permits on-scene treatment and telehealth-directed care, subject to licensure requirements and protocols, and sets the duration of the model at five years. Payment rates will generally align with payments for the hypothetical transport that would have occurred.
GAO Comptroller General reporting
Not later than four years after the CARE model is implemented, the Comptroller General must submit a report to the Ways and Means Committee (House) and the Finance Committee (Senate). The report analyzes beneficiary access to emergency services, compares outcomes with traditional EMS transport, assesses regional variations and demographics, identifies best practices and challenges, and offers recommendations to improve emergency medical services.
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Who Benefits
- Medicare beneficiaries who receive emergency care on scene or via telehealth, potentially with faster access and on-site treatment
Who Bears the Cost
- Medicare program, which must fund Part B payments under the CARE model; ambulance providers who invest in telehealth and new workflows; state and local EMS agencies for licensure and implementation costs; telehealth platforms and care teams supporting on-site treatment; hospitals that may see changes in transport volumes and EDloads
Key Issues
The Core Tension
The central dilemma is balancing the potential improvement in access and on-site care against the risk of increased costs and variability in care quality when telehealth and on-scene treatment replace traditional ambulance transport.
The CARE Act introduces a novel reimbursement approach that shifts some emergency-response payments from ambulance transports to on-site treatment and telehealth. While this could improve access and reduce unnecessary transports in some cases, it raises questions about cost, quality control, and equity.
Implementation will require robust data collection, consistent licensure and protocol adherence across states, and careful monitoring of telehealth-enabled care to prevent under-triage or overbilling. The model’s success will hinge on clear clinical guidelines and reliable data to compare outcomes with traditional EMS transport.
Key tensions include balancing patient safety and timely access to care with the cost and administrative burden of a larger telehealth-enabled EMS workflow, and ensuring that regional differences in EMS capacity do not undermine equity of access.
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