Ambulance Suppliers: CMS Launches ET3 - A New Triage Model for EMS

27 February 2019 Health Care Law Today Blog
Authors: Pamela L. Johnston

On February 27, 2019, CMS will hold its first webinar to provide an overview on its new Emergency Triage, Treat, and Transport (ET3) Model for suppliers of emergency medicine services (EMS) and ambulance suppliers.

On February 14, 2019, CMS’ Innovation Center announced ET3’s upcoming availability, which emphasizes the need for EMS suppliers to partner with other health care providers in order to triage and treat patients more effectively. For the first time, the Medicare program will reimburse EMS suppliers for treating patients in-place and transporting emergency patients to alternative destinations like urgent care centers or physician practices rather than emergency departments.

This new approach is destined to change the way patients interact with emergency service providers in this country. According to Alex Azar, Secretary of HHS, in a recent press release, this “model will create a new set of incentives for emergency transport and care, ensuring patients get convenient, appropriate treatment in whatever setting makes sense for them. A value-based healthcare system will help deliver each patient the right care, at the right price, in the right setting, from the right provider.” (February 14, 2019).

The new ET3 model will allow participating ambulance suppliers and other health care providers to work together to deliver treatment in-place (either on-the-scene or through telehealth) and with alternative destination sites (such as primary care doctors’ offices or urgent-care clinics) to provide care for Medicare beneficiaries following a medical emergency for which they have accessed 911 services. Additionally, the model will encourage development of telephonic triage centers for low-acuity 911 calls in regions where participating ambulance suppliers and providers operate. The ET3 model will run for five years and start in 2020.

While continuing to pay for 911 transports under the current system, the ET3 model will test two new ambulance payments circumstances:

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

Qualified health care practitioners or alternative destination sites that partner with participating ambulance suppliers would receive payment as usual under Medicare for any services rendered.

The model will use a phased approach in regions across the country. CMS wants the EMS participants in the ET3 Model to partner with participants in the delivery of emergency care such as cities, counties, doctors, telemedicine centers, and urgent care facilities.

CMS will release its Request for Applications in Summer 2019 to solicit Medicare-enrolled ambulance suppliers and providers. In Fall 2019, to implement the triage lines for low-acuity 911 calls, CMS will release a Notice of Funding Opportunity for a limited number of two-year cooperative agreements, available to local governments, their designees, or other entities that operate or have authority over one or more 911 dispatches in geographic locations where ambulance suppliers and providers have been selected to participate. More information can be found here.

For more information on Foley’s experience with Ambulance and EMS suppliers, visit Foley’s Health Care Industry Team.

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