CARE Act of 2025
- Bill Number
- H.R. 2538
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-04-01: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- Last Updated
- 2026-05-22T08:08:40Z
AI-Generated Summary
Purpose
The Comprehensive Alternative Response for Emergencies Act of 2025 (CARE Act of 2025) aims to improve Medicare coverage for emergency medical services by requiring the Center for Medicare and Medicaid Innovation (CMMI)—a part of the Department of Health and Human Services (HHS)—to test a new payment model. This model would reimburse ground ambulance providers for responding to emergencies and providing treatment on-site, even if no patient transport occurs, addressing gaps in current Medicare rules that only pay for transports.
Key Provisions
- Mandated Model Testing: CMMI must implement the Comprehensive Alternative Response for Emergencies Model under Medicare Part B (which covers outpatient services) within 2 years of the bill's enactment. The model runs for 5 years.
- Eligible Services: Payments apply to treatment services provided by ground ambulance providers, suppliers (as defined under Medicare rules for ambulance services), or entities working with them. Services qualify if:
- They involve dispatching an ambulance vehicle in response to an emergency call (as defined by HHS).
- No transport leading to a payable claim occurs.
- They follow state and local licensing rules and protocols, which can include remote medical guidance via video and audio telehealth technology.
- Payment Structure:
- Rates are set to generally match what Medicare would pay if a transport had happened.
- For telehealth services linked to these treatments, the patient's location qualifies as an "originating site" (the place where the patient is during a telehealth visit), allowing for an additional facility fee under existing Medicare telehealth rules.
- Reporting Requirement: Four years after implementation, the Government Accountability Office (GAO)—an independent agency that audits federal programs—must submit a report to key congressional committees (House Ways and Means and Senate Finance). The report will evaluate:
- Beneficiaries' access to emergency services, including model impacts on health outcomes and resource use.
- Comparisons of outcomes under the model versus traditional transport-based services.
- Effects of regional differences and demographics on service availability.
- Best practices, challenges, and recommendations for improving emergency care.
Significant Changes to Existing Law
- Amends Section 1115A of the Social Security Act, which authorizes CMMI to test innovative payment and service delivery models to reduce costs and improve care (usually at the Secretary of HHS's discretion).
- Makes this specific model mandatory, unlike most CMMI tests which are optional.
- Exempts the model from certain CMMI budget neutrality rules (requiring tests to not increase overall Medicare spending), allowing more flexibility.
- Introduces Medicare payments for non-transport emergency responses, expanding beyond current rules that limit ambulance reimbursements to actual patient transports.
Potential Impacts
- On Government Agencies: CMMI and HHS will need to develop and oversee the model, including setting payment rates and monitoring compliance, potentially increasing administrative workload. The GAO report could inform future policy adjustments.
- On Citizens (Medicare Beneficiaries): Could enhance access to timely emergency care in rural or underserved areas where transport isn't always needed, potentially leading to better health outcomes and reduced unnecessary hospital visits. Rural or low-mobility seniors may benefit most.
- On Providers: Ground ambulance services gain a new revenue source for "treat-and-release" responses, which could improve financial stability and encourage more efficient emergency responses.
- On International Relations: No direct impacts, as this is a domestic Medicare program focused on U.S. healthcare delivery.
Main Stakeholders Affected
- Medicare Beneficiaries: Primarily older adults and people with disabilities enrolled in Medicare, especially those in areas with limited emergency access.
- Ground Ambulance Providers and Suppliers: Emergency medical teams and organizations that respond to 911 calls, who stand to gain from expanded reimbursements.
- HHS and CMMI: Responsible for implementing and evaluating the model.
- Congressional Committees: House Ways and Means and Senate Finance, which receive the GAO report and oversee Medicare policy.
- State and Local Governments: Involved through licensure and protocols for emergency services.
Notable Legal, Constitutional, or Political Implications
- Legal: Strengthens CMMI's role in healthcare innovation by mandating a test model, potentially setting a precedent for required expansions in Medicare coverage. Ensures compliance with state protocols, avoiding federal overreach into local emergency systems.
- Constitutional: No major issues; aligns with Congress's authority under the Spending Clause to regulate federal programs like Medicare.
- Political: Introduced bipartisansely (by Republicans and Democrats), signaling broad support for addressing emergency care gaps post-pandemic. Could influence future debates on Medicare sustainability and rural healthcare, but the 5-year test limits long-term commitments without further legislation.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (45)
Rep. Doggett, Lloyd [D-TX-37], Rep. Miller, Carol D. [R-WV-1], Rep. Ryan, Patrick [D-NY-18], Rep. Westerman, Bruce [R-AR-4], Rep. Davis, Donald G. [D-NC-1], Rep. Sewell, Terri A. [D-AL-7], Rep. Pettersen, Brittany [D-CO-7], Rep. Dingell, Debbie [D-MI-6], Rep. Mann, Tracey [R-KS-1], Rep. Stansbury, Melanie A. [D-NM-1], Rep. Graves, Sam [R-MO-6], Del. Norton, Eleanor Holmes [D-DC-At Large], Rep. Thompson, Glenn [R-PA-15], Rep. Smucker, Lloyd [R-PA-11], Rep. Bacon, Don [R-NE-2], Rep. Vasquez, Gabe [D-NM-2], Rep. Kelly, Mike [R-PA-16], Rep. Adams, Alma S. [D-NC-12], Rep. Tenney, Claudia [R-NY-24], Rep. Costa, Jim [D-CA-21], Rep. Tonko, Paul [D-NY-20], Rep. Bynum, Janelle S. [D-OR-5], Rep. Gottheimer, Josh [D-NJ-5], Rep. Norcross, Donald [D-NJ-1], Rep. Vindman, Eugene Simon [D-VA-7], Rep. Harder, Josh [D-CA-9], Rep. Smith, Adrian [R-NE-3], Rep. De La Cruz, Monica [R-TX-15], Rep. Morelle, Joseph D. [D-NY-25], Rep. McClain Delaney, April [D-MD-6], Rep. Neguse, Joe [D-CO-2], Rep. Wilson, Joe [R-SC-2], Rep. Goodlander, Maggie [D-NH-2], Rep. Pfluger, August [R-TX-11], Rep. Ross, Deborah K. [D-NC-2], Rep. Suozzi, Thomas R. [D-NY-3], Rep. Mrvan, Frank J. [D-IN-1], Rep. Crawford, Eric A. "Rick" [R-AR-1], Rep. Newhouse, Dan [R-WA-4], Rep. Salinas, Andrea [D-OR-6], Rep. Shreve, Jefferson [R-IN-6], Rep. Crow, Jason [D-CO-6], Rep. Crank, Jeff [R-CO-5], Rep. Pingree, Chellie [D-ME-1], Rep. Mejia, Analilia [D-NJ-11]
Recent Actions
- 2025-04-01: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-04-01: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-04-01: Introduced in House
- 2025-04-01: Introduced in House
Bill Versions
- Comprehensive Alternative Response for Emergencies Act of 2025 — issued 2025-04-01 — PDF (5 pages)