S-3145-119
Read twice and referred to the Committee on Finance. (Sponsor introductory remarks on measure: CR S7964)
Sponsored by Susan Collins (R-ME)
What it does
This bill would require the Center for Medicare and Medicaid Innovation (CMMI) to launch and test a 5-year payment model under Medicare Part B. The model would allow Medicare to pay ground ambulance providers for treating patients on-scene — including via telehealth — even when no hospital transport occurs. Currently, Medicare generally only pays ambulance providers when a patient is physically transported. The bill also requires the Government Accountability Office (GAO) to submit a report to Congress within 4 years of implementation, evaluating patient outcomes, resource use, regional variations, and best practices.
Who benefits
Medicare beneficiaries who call 911 but do not need hospital transport — they would receive on-scene treatment covered by Medicare rather than facing potential out-of-pocket costs. Ground ambulance providers and emergency medical services (EMS) agencies, who would receive Medicare reimbursement for treat-and-release calls they currently perform without payment. Telehealth companies and remote physicians providing online medical direction during on-scene care. Rural communities where ambulance services are financially strained and treat-without-transport calls are common. Hospitals that may see reduced low-acuity emergency department visits.
Who is hurt
Medicare's trust fund, which would bear new costs for services previously uncompensated — though the model may generate offsetting savings if hospital transports are avoided. Competing urgent care or telehealth-only providers who may lose patients to on-scene EMS telehealth services. Taxpayers broadly, if the pilot model expands costs without demonstrated savings. Patients in states with restrictive EMS licensure protocols may have uneven access to the model's benefits, depending on how state and local rules interact with the federal pilot.
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 on-scene treatment is medically appropriate and less costly. They contend that treat-and-release models have shown promise in state-level pilots and that unnecessary ambulance transports cost Medicare significantly more than on-scene care. Supporters also argue the bill reduces patient harm by avoiding unnecessary hospital visits, which carry risks of infection and complications, while giving EMS agencies a sustainable revenue model for services they already provide.
Opponents argue
Opponents argue that paying ambulance providers for non-transport calls could create a new financial incentive to under-triage patients — leaving individuals on-scene who actually need hospital care — raising patient safety concerns. They contend that without robust outcome data, a mandatory 5-year pilot may lock Medicare into a payment model before its risks are fully understood, and that the bill's requirement that CMMI "shall" implement the model removes the agency's normal discretion to evaluate feasibility before launch. Critics may also question whether payment rates aligned with transport reimbursement are appropriate for services of a fundamentally different scope.