H.R. 2538

119th CONGRESS 1st Session

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 · Sponsor: Mr. Carey

Table of contents

• H.R. 2538
  • SEC. 1. Short title
  • SEC. 2. Requiring the Center for Medicare and Medicaid Innovation to test a comprehensive alternative response for emergencies model under the Medicare program

SEC. 1. Short title

• This Act may be cited as the or the .

SEC. 2. Requiring the Center for Medicare and Medicaid Innovation to test a comprehensive alternative response for emergencies model under the Medicare program

• (a) In general
  • Section 1115A of the Social Security Act () is amended— 42 U.S.C. 1315a
    • in subsection (b)—
      • in paragraph (2)(A), in the third sentence, by inserting before the period at the end; and
      • in paragraphs (3)(B), by striking The Secretaryand inserting Except in the case of the model described in subsection (h), the Secretary; and
      • (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 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 described in section 1834(l)), or by an entity under arrangement with such a provider, when such services—
            • include the dispatch of a ground ambulance vehicle but do not include a corresponding transport payable under such section;
            • are so furnished in response to an emergency medical call (as specified by the Secretary) made with respect to such individual; and
            • are so furnished in accordance with State and local licensure requirements and protocols (which may include online medical direction through the use of audiovisual telecommunications technology).
        • (2) Payment
          • (A) In general
            • The Secretary shall set payment rates for services furnished under the model described in paragraph (1) in a manner that generally aligns such payments with 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 located 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 paragraph (1) shall be carried out for a period of 5 years.
    • by adding at the end the following new subsection:
• (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 implemented, 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 stakeholder input and to the extent data is available—
    • analyzes various aspects of Medicare beneficiaries’ access to emergency medical services, including an evaluation of the impact of such model on beneficiary outcomes and resource utilization;
    • compares beneficiary outcomes under such model with beneficiary outcomes using traditional emergency transportation;
    • assesses the impact of regional variations and demographics on the availability of emergency medical services;
    • identifies best practices and potential challenges in implementing such model; and
    • includes recommendations for improving emergency medical services.