On February 14, 2019, the Center for Medicare and Medicaid Innovation (CMMI) announced the Emergency Triage, Treat, and Transport (ET3) Model that aims to transform the ambulance system.  Medicare-enrolled ambulance service suppliers and hospital-owned ambulance providers will participate in the model.   CMMI believes this model will improve quality and lower costs by reducing hospitalizations and avoidable transports.

Currently, Medicare provides payment for emergency ground ambulance services when a beneficiary is transported to a hospital, critical access hospital, skilled nursing facility, and dialysis center.  As a result, CMS believes that Medicare beneficiaries that call 911 are often taken to one of these facilities, even in circumstances where lower acuity care would be appropriate. The ET3 model would offer flexibility to ambulance providers after receiving a 911 call for lower acuity calls.  Participating ambulance suppliers and providers would be permitted to:

(1) transport an individual to a hospital emergency department or other destination covered under the regulations;

(2) transport an individual to an alternative destination (primary care doctor or urgent care clinic); or

(3) provide treatment in place with a qualified health care practitioner, either on the scene or connected using telehealth. 

CMMI believes that this model “will allow the beneficiaries to access the most appropriate emergency services at the right time and place” and will “encourage local governments, their designees, or other entities that operate or have authority over one or more 911 dispatches to promote successful model implementation by establishing a new medical triage line for low-acuity 911 calls.” 

The ET3 model is anticipated to begin in January 2020 and will have a five-year performance period.  CMMI anticipates releasing the Request for Applications later this year.   The performance period for all participants will end at the same time and therefore only applicants selected through the initial Request for Applications will be able to participate for the full five years. 

CMMI also plans to issue a Notice of Funding Opportunity in the fall of 2019 for up to 40 two-year cooperative agreements that would be available to local governments, their designees, or other entities that operate one or more 911 dispatches where ambulance suppliers and providers are participating in the ET3 Model.

A fact sheet is available here.