What is ET3?

On June 11, 2019, CMS held a webinar to announce the Emergency Treat, Triage and Transport (ET3) payment model that’s aimed for participating EMS and non-transport ambulance services to partner with participants in the delivery of emergency care.  The purpose for the Emergency Treat, Triage and Transport payment model is to reduce the risk on emergency departments and transport the patients under the ET3 model to other destinations without the need for more complex care following a 911 call.

What are the benefits to participate in ET3?

Under the ET3 program, the Centers for Medicare and Medicaid Services Innovation Center (CMMI) will reimburse participating providers for payment for treatment rather than payment for transport.  The payment model is voluntary five-year performance aimed at increasing the flexibility and efficiency of pre-hospital systems. CMS has agreed to pay EMS when addressing emergency needs of Medicare patients during the services for the following:

• Transport a patient to a hospital emergency department or other approved destinations as covered under CMS reimbursement guidelines.
• Transport to an alternative destination such as urgent care, primary care physician’s office, rural health clinic or behavioral health facility.
• Provide treatment in place with a qualified health care practitioner, either by remaining on the scene to treat or taking treatment advice using remote connection using telehealth.
• EMS agencies that successfully implement a program of providing for transportation to ATDs and or treatment at the scene may be eligible for performance-based payment adjustments up to 5% starting in year 3 under the ET3 Model.
• Coding of ATD claims for transportation to alternative treatment destination will be submitted using ALS (A0427), BLS (A0429) and Loaded Mileage (A0425) HCPCS Codes.

How do I enroll?

The Request for Application (RFA) is the first of three steps which applicants will be considered to participate in regarding the ET3 Payment Model.   CMS will review the number of FFS ground transports during the first two RFAs based on the timelines below.

• Request for Application (RFA) Released – Spring 2019
• Application Submission (RFA) – Summer 2019
• Participants Selection Process – Fall 2019
• Performance Initiative – January 2020
• Performance End – December 2024

Additional applications will be contingent if you’re not selected during the initial application process.  The application will be contingent on availability of funding and evidence the ET3 payment model is working, but it’s not guaranteed.  Forty providers will be selected to a two-year cooperative agreement to be included in the model in one of three phases for a staggered ramp-up approach.  All phases of the program will end at the same time after five years, allowing for only those providers to participate in the beginning phase, to participate for the entire full five-year duration.

Licensed Ambulance Providers, dispatch centers operated by local governments that provides one or more 911 calls participating in the Medicare program will be eligible for the payment model.

Applicants must propose and implement a model in their state which at least 15,000 Medicare FFS transports occurred in 2017. Applicants with one or more counties and a minimum of 7,500 Medicare FFS transports which occurred in 2017, will receive preference during the application review.

References:  https://innovation.cms.gov/initiatives/et3/faq.html