CARE Act of 2025
- Bill Number
- S. 3145
- Origin Chamber
- Senate
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-11-06: Read twice and referred to the Committee on Finance. (Sponsor introductory remarks on measure: CR S7964)
- Last Updated
- 2026-04-30T11:03:20Z
AI-Generated Summary
Purpose of the Legislation
The CARE Act of 2025 aims to improve emergency medical services for Medicare beneficiaries by requiring the Center for Medicare and Medicaid Innovation (CMMI)—a part of the Centers for Medicare & Medicaid Services (CMS) that tests new ways to deliver and pay for healthcare—to test a new payment model. This model would cover ground ambulance responses to emergencies even if the patient does not need or receive a transport to a hospital, addressing gaps in current Medicare coverage where such "treat-in-place" services often go unpaid.
Key Provisions
- Model Implementation: CMMI must begin testing the "Comprehensive Alternative Response for Emergencies Model" (CARE Model) no later than 2 years after the bill's enactment. The model applies to Medicare Part B (which covers outpatient services like doctor visits and preventive care) and pays for emergency services provided by ground ambulance providers or their partners.
- Services must involve dispatching an ambulance in response to an emergency call (as defined by CMS).
- No transport to a medical facility is required for payment, but services must follow state and local licensing rules and protocols, which can include remote medical guidance via video calls (telehealth).
- Payment Structure:
- Payments for these services will generally match what Medicare would pay if a transport had occurred (based on existing ambulance fee schedules).
- For telehealth used alongside these services, the patient's location qualifies as an "originating site" (the place where the patient is when receiving remote care), allowing for additional facility fees.
- Duration and Oversight: The model runs for 5 years.
- Reporting Requirement: Four years after implementation, the Government Accountability Office (GAO, an independent agency that audits federal programs) must submit a report to Congress evaluating the model's effects. The report will cover:
- Access to emergency services for Medicare users, including health outcomes and resource use.
- Comparisons between CARE Model outcomes and traditional ambulance transports.
- Regional and demographic differences in 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 voluntary innovation models.
- Makes the CARE Model mandatory (CMMI "shall" test it), unlike most models where CMS has discretion to choose what to test.
- Exempts the CARE Model from certain CMS decision-making rules, ensuring it is prioritized and implemented without delay.
- Expands Medicare coverage for ambulance services beyond the current rule under Section 1834(l), which only pays for transports, not responses without transport. This introduces payment for "alternative responses" like on-scene treatment or triage.
Potential Impacts
- On Medicare Beneficiaries: Could enhance access to timely emergency care in rural or underserved areas, potentially improving health outcomes by allowing treatment without unnecessary hospital trips, reducing stress on patients.
- On Government Agencies: CMS/CMMI will need to develop and administer the model, including setting payment rates and monitoring compliance, which may require new administrative resources. The GAO report could inform future policy changes.
- On Healthcare Providers: Ground ambulance services may see increased reimbursements for non-transport responses, stabilizing finances and encouraging efficient use of resources, but could face challenges in meeting varying state protocols.
- Broader Effects: May reduce overall Medicare costs by avoiding costly transports and hospital admissions; no direct impact on international relations, as it focuses on domestic U.S. healthcare.
Main Stakeholders Affected
- Medicare Beneficiaries: Elderly and disabled individuals enrolled in Medicare Part B who rely on emergency services.
- Ground Ambulance Providers and Suppliers: EMS organizations, including private and public ambulance services, that respond to 911 calls.
- CMS and CMMI: Responsible for implementing and funding the model.
- State and Local Governments: Involved in licensing EMS and setting emergency protocols, which must align with the model.
- Congress and GAO: Oversight through reporting and potential future legislation.
- Telehealth Providers: Benefit from expanded originating site payments for remote consultations during emergencies.
Notable Legal, Constitutional, or Political Implications
- Legal: Strengthens Medicare's framework for innovation models by mandating a specific test, potentially setting a precedent for required pilots in other areas of healthcare. Ensures compliance with federal ambulance payment rules while incorporating state variations, avoiding federal overreach into local EMS standards.
- Constitutional: No apparent conflicts; aligns with Congress's authority under the Spending Clause to regulate federal programs like Medicare.
- Political: Bipartisan sponsorship (by Senators Collins (R) and Welch (D)) suggests broad support for improving emergency care. Could influence future debates on Medicare sustainability and rural healthcare access, with the GAO report providing data-driven insights to reduce partisanship in reforms.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (9)
Sen. Welch, Peter [D-VT], Sen. Klobuchar, Amy [D-MN], Sen. Cassidy, Bill [R-LA], Sen. Justice, James C. [R-WV], Sen. Whitehouse, Sheldon [D-RI], Sen. Kim, Andy [D-NJ], Sen. Capito, Shelley Moore [R-WV], Sen. Coons, Christopher A. [D-DE], Sen. Hyde-Smith, Cindy [R-MS]
Recent Actions
- 2025-11-06: Read twice and referred to the Committee on Finance. (Sponsor introductory remarks on measure: CR S7964)
- 2025-11-06: Introduced in Senate
Bill Versions
- Comprehensive Alternative Response for Emergencies Act of 2025 — issued 2025-11-06 — PDF (5 pages)