WASHINGTON, D.C. – Today, U.S. Reps. Mike Carey (R-Ohio-15), Lloyd Doggett (D-Texas-35), and Carol Miller (R-W.Va.-01), and Pat Ryan (D-N.Y.-18), all members of the House Ways and Means Committee, led the reintroduction of their bipartisan Comprehensive Alternative Response for Emergencies (CARE) Act. The bill would allow seniors on Medicare to receive at-home emergency medical services to treat minor medical incidents by creating a model that reimburses Emergency Medical Service (EMS) providers delivering treatment in place and not just reimburse when Medicare patients are transported to the hospital.
“For some patients, an emergency room visit may not be necessary and can place additional burdens on our first responders and health care providers in the hospital,” Rep. Carey said. “For many, including seniors on Medicare, treatment in place is more viable, saves time and money, and increases the availability of first responders. These options also save seniors a trip to the emergency room that can result in long wait times, increased costs, and potentially life-threatening complications. I urge my colleagues to join me and pass this bill.”
“Preventing a costly emergency room trip by treating patients immediately at home is sometimes both the best way to help the patient and the taxpayer,” said Rep. Doggett. “Our legislation to establish a Medicare pilot program is designed to show the effectiveness of fair pay to first responders for such services. Thereby, we hope to encourage a permanent payment system for treatment in place.”
Emergency Medical Services (EMS) providers are at the frontline of delivering care and transportation in rural America. In West Virginia, many patients live hours from a hospital and must consistently rely on EMS for treatment. Our EMS personnel are equipped to provide care to patients that may not be in a dire medical situation, rather than spend precious time and resources on transporting non-emergency patients to a hospital emergency department. This commonsense legislation builds upon the Treatment-in-Place Model to provide timely care to our rural patients and empower EMS providers, and I will continue to work to improve access to quality health care for patients in West Virginia and across the U.S.” Rep. Miller said.
“Our grandparents, neighbors, and friends are safer and healthier because of the dedicated care paramedics and EMTs provide to our community,” Rep. Ryan said. “They deserve to be compensated – no matter where they administer care. That’s why I’m proud to co-lead the Comprehensive Alternative Response for Emergencies Act to ensure that our highly trained first responders are fully supported in continuing to save lives and serve our seniors. I will keep fighting for the resources that our first responders need and deserve.”
“Treatment In Place (TIP) could save Medicare between $1.2 and $1.5 billion annually. In addition to the savings, TIP could be a solution to help EMS workforce and resiliency. The goal of all healthcare should be to provide patients with the right care, at the right time, and in the right place which should also be the most cost-effective manner. NAEMT applauds Congressman Carey and Congressman Doggett for their leadership in introducing the Comprehensive Alternative Response for Emergencies (CARE) Act to recognize EMS for the tireless work they do 24/7/365 and update the antiquated payment model for EMS. Right now, Medicare currently does NOT reimburse EMS practitioners for TIP. EMS is ONLY reimbursed for care when a patient is transported to a hospital ER. Passage of this measure will shorten task times for EMS agencies struggling with workforce shortages, help decompress overcrowded hospitals and emergency departments, meet patients’ needs without long waits at the hospital, and save the government money!” Chief Christopher Way, President of National Association of Emergency Medical Technicians (NAEMT), said.
“We greatly appreciate Congressmen Carey and Doggett introducing the Comprehensive Alternative Response for Emergencies Act which will start the process toward reimbursement of the vital 9-1-1 emergency ground ambulance services provided to Medicare patients regardless of whether the patient is transported to a medical facility. Paramedics and EMTs are highly-trained medical professionals providing care under medical protocols and often arrive on the scene with an ambulance and either told by the patient not to be transported or additional medical care at a facility is not required. This important legislation will help correct long-standing policy and properly view ambulance services as health care instead of just medical transportation,” Jamie Pafford-Gresham, AAA President, said.
BACKGROUND:
Adults aged 65 and older account for nearly 20% of all ER visits. This population contributes to the backlog in waiting rooms, even when they might not have an issue requiring inpatient treatment. In a 2021 study, patients who received at-home care had a lower risk for readmission by 26% and a lower risk for long-term care admission as compared to patients who received in-hospital treatment.
In 2019, the Centers for Medicare and Medicaid Services (CMS) announced the Emergency Triage, Treat, and Transport (ET3) Model, which was originally set to run from 2020 to the end of 2023. However, due to the COVID-19 pandemic, the model’s start was delayed until June 2021, and unfortunately, due to related challenges, CMMI ultimately ended the model 2 years early. This has not only harmed EMS providers, but also beneficiaries’ access to appropriate care.
The CARE Act would create a five-year pilot payment program to test a treatment-in-place model under Medicare. This legislation will ensure Medicare collects comprehensive data to inform future reimbursement decisions for EMS services and treatment-in-place. Medicare beneficiaries make up about 40% of all patients treated by EMS, and between 12.9-16.2% of Medicare-covered 911 transports involve medical conditions that do not require a hospital ER visit. Ensuring EMS providers receive appropriate payment for the most effective and efficient care can improve quality outcomes for beneficiaries and reduce Medicare spending on unnecessary, expensive hospital care.
The bill has received support from: American Ambulance Association, International Association of Fire Fighters, and the National Association of Emergency Medical Technicians.
Full text of the bill can be found here.
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