I 
119TH CONGRESS 
1ST SESSION H. R. 2538 
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. 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 1, 2025 
Mr. CAREY (for himself, Mr. DOGGETT, Mrs. MILLER of West Virginia, and 
Mr. RYAN) introduced the following bill; which was referred to the Com-
mittee 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 
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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Comprehensive Alter-
native Response for Emergencies Act of 2025’’ or the 
‘‘CARE Act of 2025’’. 
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SEC. 2. REQUIRING THE CENTER FOR MEDICARE AND MED-
ICAID INNOVATION TO TEST A COMPREHEN-
SIVE ALTERNATIVE RESPONSE FOR EMER-
GENCIES MODEL UNDER THE MEDICARE 
PROGRAM. 
(a) IN GENERAL.—Section 1115A of the Social Secu-
rity Act (42 U.S.C. 1315a) is amended— 
(1) in subsection (b)— 
(A) in paragraph (2)(A), in the third sen-
tence, by inserting ‘‘, and, beginning not later 
than the date that is 2 years after the date of 
the enactment of the CARE Act of 2025, shall 
include the Comprehensive Alternative Re-
sponse for Emergencies Model described in sub-
section (h)’’ before the period at the end; and 
(B) in paragraphs (3)(B), by striking ‘‘The 
Secretary’’ and inserting ‘‘Except in the case of 
the model described in subsection (h), the Sec-
retary’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(h) COMPREHENSIVE ALTERNATIVE RESPONSE FOR 
EMERGENCIES MODEL.— 
‘‘(1) IN GENERAL.—For purposes of subsection 
(b)(2)(A), the Comprehensive Alternative Response 
for Emergencies Model described in this subsection 
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is a model under which payment is made under part 
B of title XVIII for treatment services furnished to 
an individual enrolled under such part by a provider 
or supplier of ground ambulance services (as de-
scribed in section 1834(l)), or by an entity under ar-
rangement with such a provider, when such serv-
ices— 
‘‘(A) include the dispatch of a ground am-
bulance vehicle but do not include a cor-
responding transport payable under such sec-
tion; 
‘‘(B) are so furnished in response to an 
emergency medical call (as specified by the Sec-
retary) made with respect to such individual; 
and 
‘‘(C) are so furnished in accordance with 
State and local licensure requirements and pro-
tocols (which may include online medical direc-
tion through the use of audiovisual tele-
communications technology). 
‘‘(2) PAYMENT.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
set payment rates for services furnished under 
the model described in paragraph (1) in a man-
ner that generally aligns such payments with 
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the payments that would have been made for 
such services had such services resulted in a 
transport payable under section 1834(l). 
‘‘(B) ORIGINATING SITE FEE.—In the case 
of a telehealth service payable under section 
1834(m) that is furnished in conjunction with 
treatment services furnished under the model 
described in paragraph (1), the site where the 
individual receiving such telehealth service is lo-
cated shall be treated as an originating site that 
is described in paragraph (4)(C)(ii)(V) of such 
section for purposes of applying paragraph 
(2)(B) of such section. 
‘‘(3) DURATION.—The model described in para-
graph (1) shall be carried out for a period of 5 
years.’’. 
(b) REPORT.—Not later than 4 years after the date 
on which the Comprehensive Alternative Response for 
Emergencies Model (as described in section 1115A(h) of 
the Social Security Act, as added by subsection (a)) is im-
plemented, the Comptroller General of the United States 
shall submit to the Committee on Ways and Means of the 
House of Representatives and the Committee on Finance 
of the Senate a report that, taking into account stake-
holder input and to the extent data is available— 
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