Press release

CMS Selects Applicants for Participation in Innovative Payment Model with New Emergency Treatment and Transport Options

Five-Year voluntary model will test payments with the potential to more appropriately and effectively meet beneficiaries’ emergency transport needs

Today, the Centers for Medicare & Medicaid Services (CMS) is announcing the selection of 205 applicants to participate in the Emergency Triage, Treat, and Transport (ET3) Model, a payment model that aims to allow beneficiaries to access the most appropriate emergency services at the right time and place. The voluntary, five-year payment model will provide greater flexibility to ambulance care teams to address emergency health care needs of Medicare Fee-for-Service beneficiaries following a 911 call. Today’s applicant selections are part of CMS’s strategic initiative to advance innovative payment structures to move our health care system to one that incentivizes value by rewarding quality, performance, and innovation. Announced by CMS in early 2019, the ET3 Model creates a new set of incentives for emergency transport and care, ensuring patients get convenient, appropriate treatment by Medicare-enrolled providers and suppliers.

“Most beneficiaries who call 911 with a medical emergency are transported to a hospital emergency department, even when a lower-acuity destination may be more appropriate,” said CMS Administrator Seema Verma. “The participants in our ET3 Model will be able to deliver care to patients at the right time and place. We congratulate the applicants selected to participate in the Model, and we look forward to working with them on testing new payments for emergency transport to improve patient care.”

Currently, Medicare only pays for emergency ground ambulance services when beneficiaries are transported to specific types of facilities, most often a hospital emergency department (ED), creating an incentive to transport all beneficiaries to the hospital even when an alternative treatment option may be more appropriate. To counter this incentive, CMS will test two new ambulance payments, while continuing to pay for emergency transport of a Medicare beneficiary to a hospital ED or other destination covered under current Medicare requirements. Under the ET3 Model, Medicare will pay participating ambulance suppliers and providers to:

• Transport a beneficiary to an alternative destination (such as a primary care doctor’s office or an urgent care clinic), or
• Initiate and facilitate treatment in place by a qualified health care practitioner, either in-person on the scene or via telehealth.

Upon arriving on the scene of a 911 call, participating ambulance suppliers and providers may triage Medicare beneficiaries to one of these Model’s interventions. This requires the participating ambulance suppliers and providers to partner with alternative destinations (such as primary care doctors’ offices or urgent-care clinics) and with qualified health care practitioners to deliver treatment in place (either on-the-scene or through telehealth). In doing so, the Model aims to engage health care providers across the care continuum to more appropriately and effectively meet beneficiaries’ needs. Importantly, a beneficiary treated by a Model participant can always choose to be brought to an ED if he or she prefers.

Applicants selected to participate in the ET3 Model are Medicare-enrolled ambulance service suppliers or ambulance providers in 36 states and the District of Columbia that plan to implement, at minimum, the ET3 Model’s alternative destination intervention.

As another component of the Model, CMS intends to issue a Notice of Funding Opportunity (NOFO) for up to 40 two-year cooperative agreements, available to state and local governments, or their designees that operate or have authority over a Primary or Secondary Public Safety Answering Point (PSAP) that receives 911 calls in geographic regions where ambulance suppliers and providers are participating. The NOFO will fund the implementation of a medical triage line integrated with the PSAP in an eligible region. The Model will test whether these two components will work synergistically to improve quality and lower costs by reducing avoidable transports to the ED and unnecessary hospitalizations following those transports.

With respect to the ambulance services component of the ET3 Model, CMS will share the final list of ET3 Model Participants who have agreed to participate in the Model this spring, and begin paying for transport to alternative destinations and treatment in place at that time. CMS is notifying the applicants of their selection in order for them to have ample time to establish the partnerships needed to implement these two interventions in the ET3 Model. With respect to participation in the triage line component of the ET3 Model, CMS intends to issue the medical triage line NOFO this spring with applications due this summer. In the fall, CMS plans to issue the cooperative agreement awards and a two-year period of performance will begin.

For more information or for a list of the ET3 Model selected applicants, please visit https://innovation.cms.gov/initiatives/et3/.

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