CMS Announces 184 Participants For ET3 Model, New Funding

March 16, 2021 - CMS has shared the final list of 184 public and private ambulance providers and suppliers selected to participate in the agency’s Emergency Triage, Treat, and Transport (ET3) Model, an alternative payment model that encourages greater care flexibility following a 911 call.

ET3 Model participants span 36 states and include Medicare-enrolled ambulance service suppliers and hospital-owned ambulance providers.

Additionally, the model includes local governments, their designees, or other entities that operate or have authority over one or more 911 dispatches in geographic areas where ambulance suppliers and providers have been selected to participate in the model.

As part of the ET3 Model, CMS also recently issued a Notice of Funding Opportunity worth up to $34 million over two years for local and state governments to expand emergency and non-emergency medical triage services.

The funding will go to governments where model participants are located and will help the model redirect 911 callers with non-emergency conditions to more appropriate alternative sources of care, such as urgent care centers, physician offices, and even food banks and other community resources.

While part of the ET3 Model, the special funding opportunity can help local governments and providers to “identify creative ways to triage the surging number of patients suffering from COVID-19,” CMS stated in the announcement.

The funding will go to up to 40 entities, with funding amounts varying based on the area’s needs and the population it serves.

The federal agency launched the ET3 Model on Jan. 1, 2021, to test whether two new ambulance payments can ensure Medicare beneficiaries receive quality care “at the right place at the right time,” including non-emergency department settings when appropriate.

The new ambulance payments break from traditional Medicare policy, which has only paid for emergency ground ambulance services when beneficiaries are transported to certain types of facilities, including the hospital emergency department, skilled nursing facility, or dialysis center.

This policy has created an incentive for ambulance providers to transport all beneficiaries requiring immediate care to the hospital even if an alternative care site is more appropriate, CMS said.

CMS intends for the ET3 Model to incentivize ambulance providers to consider other—oftentimes cheaper—sites of care, including urgent care clinics and primary care physician offices, as long as the destinations are covered under current Medicare requirements.

The voluntary, five-year alternative payment model also requires participating ambulance providers and suppliers to collaborate with a qualified healthcare practitioner to deliver emergency treatment in place, including both on-the-scene and through telehealth.

Participating ambulance providers and suppliers are paid by Medicare based on the level of service provided— Basic Life Support (BLS-E) or emergency Advance Life Support, Level 1 (ALS1-E) rate—plus mileage and quality adjustments.

The qualified healthcare practitioner is also paid the current Medicare rate if the practitioner can treat the beneficiary in place.

CMS had previously selected applicants to participate in the ET3 Model but had to delay the 2020 start of the model’s first performance period because of the COVID-19 pandemic.

During the public health emergency, CMS had also temporarily expanded the qualifying locations ambulance providers and suppliers could take patients. ET3 Model participants will be able to continue to access this regulatory flexibility while participating in the model, the agency stated.

CMS intends for the ET3 Model to improve quality of care and reduce healthcare costs by decreasing avoidable transports to the emergency department and unnecessary hospitalizations. The model aligns with the agency’s push to implement value-based care models.