HHS launches innovative payment model with new treatment and transport options to more appropriately and effectively meet beneficiaries’ emergency needs

Today, the Department of Health and Human Services announced a new payment model for emergency ambulance services that aims to allow Medicare Fee-For-Service beneficiaries to receive the most appropriate level of care at the right time and place with the potential for lower out-of-pocket costs.

The new model, the Emergency Triage, Treat and Transport (ET3) Model, will test two new ambulance payments, while continuing to pay for emergency transport for a Medicare beneficiary to a hospital emergency department or other destination covered under current regulations. The two new payments are:

• payment for treatment in place with a qualified health care practitioner, either on-the-scene or connected using telehealth
• payment for unscheduled, emergency transport of Medicare beneficiaries to alternative destinations (such as 24-hour care clinics) other than destinations covered under current regulations.

Additionally, the model will encourage development of medical triage lines for low-acuity 911 calls in regions where participating ambulance suppliers and providers operate. The ET3 Model will have a five-year performance period, with an anticipated start date in early 2020.

Applications will be accepted over multiple rounds, and ET3 Model participants will be encouraged to partner with other payers, including state Medicaid agencies. A Request for Applications is expected to be released in Summer 2019 to solicit Medicare-enrolled ambulance suppliers and providers. To implement the triage lines for low-acuity 911 calls, a Notice of Funding Opportunity is expected to be issued in the Fall of 2019 for a limited number of two-year cooperative agreements.

A press release on today’s announcement is available at: https://www.cms.gov/newsroom/press-releases/hhs-launches-innovative-payment-model-new-treatment-and-transport-options-more-appropriately-and. A fact sheet on the ET3 Model is attached and is available at: https://www.cms.gov/newsroom/fact-sheets/emergency-triage-treat-and-transport-et3-model. For more information on the ET3 Model, please visit: https://innovation.cms.gov/initiatives/et3/.