Today, the Centers for Medicare & Medicaid Services announced the final list of participants approved to take part in CMS’ Emergency Triage, Treat, and Transport (ET3) Model, a payment model that aims to provide greater flexibility to ambulance care teams to address emergency health care needs of Medicare Fee-for-Service beneficiaries following a 911 call. The list of final participants include 184 public and private ambulance providers and suppliers representing 36 states. CMS is also issuing a Notice of Funding Opportunity (NOFO) of up to $34 million over two years for local and state governments to expand emergency and non-emergency medical triage services in locations of model participants.
Historically, Medicare only pays for emergency ground ambulance services when beneficiaries are transported to specific types of facilities, most often a hospital emergency department, creating an incentive to transport all beneficiaries to the hospital even when an alternative treatment option may be more appropriate. CMS will test two new ambulance payments, while continuing to pay for emergency transport of a Medicare beneficiary to a hospital emergency department or other destination covered under current Medicare requirements. The ET3 Model seeks to ensure Medicare beneficiaries have access to quality care at the right place at the right time by furthering innovative payment structures to move America’s health care system to one that incentivizes value by rewarding quality, performance and innovation.
On Jan. 1, 2021, CMS launched the treat and transport interventions of the ET3 Model with the selected participants. The voluntary, five-year payment model requires the participating ambulance suppliers and providers collaborate with alternative destinations, such as primary care doctors’ offices or urgent-care clinics, and with qualified health care practitioners to deliver treatment in place, which can be on-the-scene or through telehealth.
The $34 million in funding through the NOFO can be awarded to local and state government or their designees, which operate or have authority over 911 operations, also known as a Primary or Secondary Public Safety Answering Point (PSAP). To qualify, such operations must receive 911 calls in geographic regions where Medicare-enrolled ambulance suppliers and providers are participating in the ET3 Model. Through a competitive process, CMS will award up to 40 two-year cooperative agreements. Award amounts will vary based on the needs demonstrated and population served by each applicant, with individual awards not to exceed $1.175 million.
The ET3 Model NOFO is designed to support the establishment or expansion of medical triage lines integrated with PSAPs, typically 911 operations. This component of the ET3 Model helps redirect 911 callers with non-emergency conditions to more appropriate and alternative sources of care rather than dispatching an ambulance, which is particularly needed as Emergency Medical Services (EMS) systems try to identify creative ways to triage the surging number of patients suffering from COVID-19. These care alternatives could include urgent care centers, primary care centers or the caller’s usual source of care. In addition, callers may be triaged to community resources, such as mental health and substance abuse services, state and local health agencies, and food banks.
Announced by CMS in early 2019, the ET3 Model aims to encourage appropriate use of services to meet health care needs effectively and increase efficiency in EMS systems. The ET3 Model seeks to engage health care providers across the care continuum to more appropriately and effectively meet beneficiaries’ needs. By triaging these type of 911 calls, CMS seeks to provide appropriate care, reduce inappropriate use of emergency ambulance services, and increase efficiency in EMS systems. The model will test whether these two components, the integrated medical triage line and ambulance payment model, will work in synergy together following a 911 call to improve quality of care and lower costs by reducing avoidable transports to the emergency department and unnecessary hospitalizations.