[Congressional Record Volume 171, Number 186 (Thursday, November 6, 2025)]
[Senate]
[Page S7964]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. COLLINS (for herself and Mr. Welch):
  S. 3145. A bill to amend title XI of the Social Security Act to 
require the Center for Medicare and Medicaid Innovation to test a 
comprehensive alternative response for emergencies model under the 
Medicare program; to the Committee on Finance.
  Ms. COLLINS. 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.

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