Medicare tests ambulance-only emergency response—without safeguards for patient care

What it does

This bill directs Medicare to test a new emergency response model where ground ambulances can be dispatched and provide treatment without necessarily transporting the patient to a hospital, with payment rates aligned to traditional transport rates. The model runs for 5 years, and Congress will receive a report comparing outcomes to traditional emergency services.

Why we flagged it

The bill's core function is to authorize a 5-year pilot program testing alternative emergency response models within Medicare, specifically allowing ground ambulance dispatch and treatment without transport. This is a regulatory innovation test, not a broad policy overhaul.

What the text implies

• The bill does not specify what happens if a patient treated under the model later requires transport or hospitalization—liability, payment responsibility, and continuity of care are undefined.
• Payment rates are set to 'generally align' with transport rates, but the bill contains no mechanism to prevent ambulance providers from using this model to reduce costs while maintaining revenue, potentially incentivizing dispatch-only responses even when transport is medically appropriate.
• The model permits 'online medical direction through audiovisual telecommunications'—a lower standard than in-person evaluation—but the bill does not define competency standards, liability, or malpractice coverage for remote providers.
• The 5-year pilot is limited to Medicare beneficiaries, but results may be extrapolated to Medicaid and private insurance, affecting a much broader population without explicit legislative authorization.
• The Comptroller General report is due 4 years after implementation, meaning results arrive after the pilot is nearly complete, limiting Congress's ability to course-correct mid-program.

Who it affects

The model may improve access to emergency care in underserved areas and reduce unnecessary hospital transports, potentially lowering costs and improving outcomes for some beneficiaries. However, the bill lacks safeguards ensuring beneficiaries receive appropriate follow-up care or that payment rates don't incentivize under-treatment, creating risk of harm to vulnerable Medicare patients.

Who stands to gain

• ground ambulance service providers
• ambulance companies
• telehealth technology vendors
• Medicare Advantage insurers (if model reduces transport costs)

Named in the bill

Centers for Medicare & Medicaid Services (CMS), Center for Medicare and Medicaid Innovation (CMMI), Medicare Part B, Section 1115A of the Social Security Act, Section 1834 (ambulance services), Comptroller General of the US, House Committee on Ways and Means, Senate Committee on Finance

Where it stands

48 cosponsors: 29 Democrats, 19 Republicans.

• Apr 1, 2025 — Introduced · Congress.gov: “Introduced in House”
• Apr 1, 2025 — Referred to House Committee on Ways and Means and House Committee on Energy and Commerce · Congress.gov: “Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a…”

Dates and quoted wording are Congress.gov's action record; the timeline shows status changes, not every procedural step.

Money around this bill

8 lobbying clients named this bill on 14 disclosure filings across 3 quarters, Dec 2025 to Jun 2026. Those filings disclosed $1,402,304 in lobbying spend. A filing names 18 bills on average, so that figure is what each filing reported, not a share belonging to this bill.

More lobbying clients named this bill than 88% of bills with at least one filing.

Mike Carey, the sponsor, reported $1,809,017 in PAC receipts in the 2026 cycle.

• American Ambulance Association — $650,000 on 2 filings
• International Association of Fire Fighters — $380,304 on 2 filings
• American Ambulance Association — $140,000 on 2 filings
• International Association of Fire Chiefs — $70,000 on 2 filings
• National Association of Emergency Medical Technicians (naemt) — $62,000 on 2 filings

Lobbying Disclosure Act filings through Jul 22, 2026. A filing shows who paid to lobby on a bill it names, not what changed.