HR-2538-119
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.
Sponsored by Mike Carey (R-OH)
What it does
This bill would require the Center for Medicare and Medicaid Innovation (CMMI) to launch and test a five-year payment model under Medicare Part B. Under the model, ground ambulance providers would be reimbursed for treating patients on-scene during a medical emergency — even when no transport to a hospital occurs. Currently, Medicare generally only pays ambulance providers when they transport a patient. The bill also directs the Government Accountability Office (GAO) to report to Congress within four years on patient outcomes, resource use, regional access differences, and best practices under the model.
Who benefits
Medicare Part B enrollees (approximately 67 million people) who experience medical emergencies that can be resolved on-scene without a hospital trip, potentially avoiding unnecessary transports and associated costs. Ground ambulance service providers and suppliers who would receive Medicare reimbursement for treat-and-release or treat-in-place services they currently perform without payment. Rural and underserved communities where hospital access is limited and on-scene stabilization may be the most practical option. Telehealth providers who would be eligible for originating site fees when delivering remote medical direction during these calls. Emergency medical systems broadly, which may reduce unnecessary emergency department visits.
Who is hurt
Hospitals and emergency departments that may see reduced patient volume — and associated revenue — if more patients are treated on-scene rather than transported. Medicare's trust fund, which would bear new payment obligations for services not previously reimbursed, potentially increasing program costs. Ambulance providers in states with restrictive licensure or protocols may be unable to participate, creating geographic inequities in access to the model. Patients in areas with lower-quality EMS systems may receive on-scene care of variable quality if oversight is insufficient. Taxpayers who fund Medicare if the model does not produce offsetting savings from reduced transports.
Supporters argue
Supporters argue that the current Medicare payment structure creates a perverse incentive: ambulance providers are only paid when they transport patients, even when transport is medically unnecessary. This drives up costs for Medicare and exposes patients to the risks and expenses of unnecessary emergency department visits. They contend that mobile integrated healthcare and community paramedicine programs have demonstrated in multiple state-level pilots that on-scene treatment can safely resolve a significant share of emergency calls, reducing hospitalizations and improving patient experience. Requiring CMMI to test this model — with a mandatory GAO evaluation — is a measured, evidence-based approach to modernizing emergency care payment.
Opponents argue
Opponents argue that paying ambulance providers for treat-and-release services without transport creates a new financial incentive that could be exploited — providers may be tempted to bill for on-scene services in cases where transport would have been medically appropriate, potentially compromising patient safety. They contend that CMMI already has broad discretionary authority to test such models and that mandating a specific model by statute bypasses the agency's clinical and actuarial vetting process. Critics may also raise concerns that payment rates "generally aligned" with transport rates could overpay for lower-acuity on-scene services, adding net costs to Medicare without demonstrated savings.