CMS announces Medicare reimbursement for certain non-transport treatment

By News Staff

WASHINGTON — A new payment model was announced Thursday that will make Medicare reimbursement available for certain non-transport ambulance services and ambulance transports to alternate destinations. 

Officials from the Centers for Medicare and Medicaid Services, the U.S. Department of Health and Human Services announced the Emergency Triage, Treat and Transport (ET3) Model at a DC Fire & EMS station.

“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,” said HHS Secretary Alex Azar. “Today’s announcement shows that we can radically rethink the incentives around care delivery even in one of the trickiest parts of our system. 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.”

The ET3 Model will make it possible for participating EMS agencies to partner with qualified healthcare practitioners and providers to deliver treatment in place (on-scene or via telehealth) and with alternative destination sites (such as primary care doctors’ offices or urgent-care clinics)

HHS officials note that ET3 Model is designed to engage healthcare providers across the care continuum to more effectively meet beneficiaries' needs.

The Model, which will have a five-year performance period, will also encourage medical triage lines for low acuity 911 calls. 

Officials have released the following details on ET3: 

• CMS is anticipating a start date of early 2020
• The Model will apply only to agencies that respond to 911 calls
•  Ambulance agencies currently enrolled as Medicare providers can apply to participate beginning this summer
•  This is a voluntary program — reimbursement under the standard ambulance fee schedule won't change for now
• Participating EMS agencies will need to track designated quality metrics

Currently, Medicare primarily pays for unscheduled, emergency ground ambulance services when beneficiaries are transported to a hospital emergency department. This often creates an incentive to transport patients to the hospital, even when an alternative treatment option may be more appropriate.

CMS plans to release a Request for Applications this summer to solicit Medicare-enrolled ambulance suppliers and providers. 

This fall, CMS will issue a Notice of Funding Opportunity to implement the triage lines for low-acuity 911 calls in limited two-year cooperative agreements.