CARE Act of 2025

Mr. President, I rise today with my colleague from Vermont, Senator Welch, to introduce the Comprehensive Alternative Response to Emergencies Act, or the CARE Act. Our bipartisan legislation would require the Centers for Medicare and Medicaid Services to test a 5 year treatment-in-place model for Medicare. This model, also known as TIP, is the practice of treating patients in their homes or where a medical emergency occurs. The pilot program in our bill would reimburse EMS for the care they administer to seniors in emergencies outside of the hospital, such as for minor medical incidents. This program would expand access to health services for seniors, especially in rural communities, while reducing unnecessary emergency room visits and expenses.

Emergency room doctors throughout Maine often tell me about the frequent backlogs and long wait times that patients experience in waiting rooms. One way to address this problem is to reduce the number of nonessential emergency room visits. By creating a pathway to reimburse EMS for treating certain patients at home, the CARE Act will help decrease the number of emergency room visits and lengthy wait times.

When EMS arrives after a 9-1-1 call, they usually transport patients to the emergency department immediately. Many patients, however, may not need emergency services from a hospital and could be better served by receiving treatment ``in place.'' EMS is capable of providing a host of interventions, such as treating hypoglycemia for a patient with a diabetic emergency or responding to routine, chronic seizures.

Most insurance plans, including Medicare, do not reimburse emergency medical services unless the patient is transported to the hospital. The current payment model can thus incentivize transportation to the hospital even when a less expensive level of care is appropriate.

The CARE Act will also help support EMS providers' long-term financial viability. According to the Maine Ambulance Association, approximately 35 percent of EMS calls conclude without transport. Without reimbursement, EMS providers must absorb the costs of these calls, further challenging the sustainability of their operations. The treatment-in-place pilot program proposed by our legislation offers a solution to this financial burden by reimbursing EMS for this kind of care.

This model also saves Medicare money. When CMS implemented a trial version of TIP during the COVID-19 pandemic, the program demonstrated more than $500 net savings to Medicare per patient encounter.

This commonsense bill builds on the past success of TIP. TIP increases communities at a time when EMS is facing historic staffing and financial challenges, by removing the need for time-consuming transport. The reimbursement of a TIP encounter is only a fraction of the cost of ambulance transport and a hospital emergency department visit.

Reducing unnecessary emergency room visits, lowering costs, and easing the strain on our hospital and EMS workforce will help improve care overall. The CARE Act presents an opportunity to further test the TIP model and improve patient care, while supporting the brave first responders who save countless lives in our communities. Our bill is supported by the

American Ambulance Association, the Maine Ambulance Association, the National Association of Emergency Medical Technicians, the National Rural Healthcare Association, the National EMS Quality Alliance, and many other local EMS organizations around the country. I urge all my colleagues to support this legislation.

Mr. President, I rise today with my colleague from Vermont, Senator Welch, to introduce the Comprehensive Alternative Response to Emergencies Act, or the CARE Act. Our bipartisan legislation would require the Centers for Medicare and Medicaid Services to test a 5 year treatment-in-place model for Medicare. This model, also known as TIP, is the practice of treating patients in their homes or where a medical emergency occurs. The pilot program in our bill would reimburse EMS for the care they administer to seniors in emergencies outside of the hospital, such as for minor medical incidents. This program would expand access to health services for seniors, especially in rural communities, while reducing unnecessary emergency room visits and expenses.

Emergency room doctors throughout Maine often tell me about the frequent backlogs and long wait times that patients experience in waiting rooms. One way to address this problem is to reduce the number of nonessential emergency room visits. By creating a pathway to reimburse EMS for treating certain patients at home, the CARE Act will help decrease the number of emergency room visits and lengthy wait times.

When EMS arrives after a 9-1-1 call, they usually transport patients to the emergency department immediately. Many patients, however, may not need emergency services from a hospital and could be better served by receiving treatment ``in place.'' EMS is capable of providing a host of interventions, such as treating hypoglycemia for a patient with a diabetic emergency or responding to routine, chronic seizures.

Most insurance plans, including Medicare, do not reimburse emergency medical services unless the patient is transported to the hospital. The current payment model can thus incentivize transportation to the hospital even when a less expensive level of care is appropriate.

The CARE Act will also help support EMS providers' long-term financial viability. According to the Maine Ambulance Association, approximately 35 percent of EMS calls conclude without transport. Without reimbursement, EMS providers must absorb the costs of these calls, further challenging the sustainability of their operations. The treatment-in-place pilot program proposed by our legislation offers a solution to this financial burden by reimbursing EMS for this kind of care.

This model also saves Medicare money. When CMS implemented a trial version of TIP during the COVID-19 pandemic, the program demonstrated more than $500 net savings to Medicare per patient encounter.

This commonsense bill builds on the past success of TIP. TIP increases communities at a time when EMS is facing historic staffing and financial challenges, by removing the need for time-consuming transport. The reimbursement of a TIP encounter is only a fraction of the cost of ambulance transport and a hospital emergency department visit.

Reducing unnecessary emergency room visits, lowering costs, and easing the strain on our hospital and EMS workforce will help improve care overall. The CARE Act presents an opportunity to further test the TIP model and improve patient care, while supporting the brave first responders who save countless lives in our communities. Our bill is supported by the

American Ambulance Association, the Maine Ambulance Association, the National Association of Emergency Medical Technicians, the National Rural Healthcare Association, the National EMS Quality Alliance, and many other local EMS organizations around the country. I urge all my colleagues to support this legislation.