Bill would test a treatment-in-place Medicare reimbursement model for EMS providers, helping patients avoid unnecessary hospital visits
WASHINGTON, D.C. – U.S. Senators Peter Welch (D-Vt.), a member of the Senate Finance Committee, and Susan Collins (R-Maine) introduced the Comprehensive Alternative Response to Emergencies (CARE) Act, bipartisan legislation that would require the Centers for Medicare and Medicaid Services (CMS) to test a five-year “treatment-in-place” model in which Medicare reimburses Emergency Medical Service (EMS) providers when they treat a patient outside of the hospital, such as for minor medical incidents, rather than transporting them to a hospital for care.
“Vermont’s EMS providers are on the frontlines of medical emergencies. It’s only common sense that our government should pay EMS providers for their vital services, regardless of whether a person needs an ambulance to the hospital. But right now, EMS providers aren’t getting reimbursed for their work—we need to fix that,” said Senator Welch. “I’m proud to work with Senator Collins on this bipartisan legislation to ensure that EMS providers can better help communities across rural America.”
“Having access to high-quality emergency medical services is essential for individuals in rural communities across Maine and the nation, yet in many areas these providers face serious staffing and financial challenges,” said Senator Collins. “This bipartisan bill would expand the treatment-in-place model for EMS services, reducing unnecessary emergency room visits, lowering costs, and easing the strain on our state’s hospital and EMS workforces.”
Inflationary pressures, coupled with the increasing volume of services that are ineligible for reimbursement, pose a serious threat to EMS providers, particularly those serving rural and older communities. These challenges are forcing EMS providers to curtail service and, in some areas, shut down services entirely. In recent years, several EMS providers in rural Vermont have closed their doors due to mounting expenses, leaving local residents with fewer options for emergency services.
The CARE Act would build on the success of a temporary treatment-in-place model implemented during the COVID-19 pandemic, which demonstrated savings of more than $500 to Medicare per patient encounter. In recent years, about 22% of EMS calls conclude without transport to a hospital, leaving providers to absorb those costs. By reimbursing EMS for care delivered in place, this legislation would strengthen local emergency response and better ensure that more patients receive appropriate, timely care.
The CARE Act is endorsed by the American Ambulance Association; Congressional Fire Service Institute; International Association of Firefighters; International Association of Fire Chiefs; National Association of Emergency Medical Technicians (NAEMT); National Association of Towns and Townships; National Rural Health Association; and the Vermont Ambulance Association.
“An immense thank you to Senator Welch for introducing with Senator Collins the CARE Act (S. 3145), which recognizes that Vermont ambulance service organizations and our paramedics and EMTs provide vital prehospital medical care and that reimbursement should not be based solely on also transporting a Vermonter to a medical facility,” said Drew Hazelton, President, Vermont Ambulance Association.
“We extend our heartfelt thanks to Senators Collins and Welch for their leadership in introducing the CARE Act. By acknowledging that ambulance service organizations provide critical prehospital medical care, not just transportation, this legislation helps ensure that our nation’s EMTs and paramedics are properly recognized and services are reimbursed for this care delivered every single day in communities across America,” said Jamie Pafford-Gresham, President, American Ambulance Association.
“The IAFC supports the bipartisan Comprehensive Alternative Response for Emergencies (CARE) Act,” said Fire Chief Trisha L. Wolford, President and Board Chair, International Association of Fire Chiefs. “Fire-based EMS agencies across the nation are on the front lines of our healthcare system, providing critical care every day while facing the challenges of overburdened emergency departments and increasing demand on EMS. The CARE Act represents a significant step toward recognizing and supporting fire and EMS departments in their lifesaving work, while enhancing patient outcomes and alleviating the burden on overcrowded emergency departments. We commend Senator Collins and Senator Welch for their leadership in advancing this initiative with a common-sense approach to modernizing emergency medical care.”
“NAEMT advocates to provide patients with the right care, in the right place, at the right time, and in the most cost-effective manner. We are grateful for Senators Collins and Welch for introducing the Comprehensive Alternative Response for Emergencies (CARE) Act. This legislation will assess the benefits of TIP to reduce overall Medicare costs, promote patient outcomes, and allow patients the freedom to receive care on their own terms. TIP provides strong benefits to struggling EMS agencies and crowded emergency departments (ED). By allowing patients to more appropriately receive care on-scene in lieu of transportation to a hospital, CMS can lessen the burden placed on EMS providers struggling with workforce shortages as well as decompress overcrowded hospitals and ED,” said Chief Chris Way, President, the National Association of Emergency Medical Technicians (NAEMT).
Learn more about the CARE Act.
Read and download the full text of the bill.
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