The final list of ambulance providers selected to participate in the Centers for Medicare and Medicaid Services' Emergency Triage, Treat and Transport (ET3) Model was officially released on Friday.
CMS picked 184 public and private ambulance providers and suppliers representing 36 states to participate in the new payment model. At the start of the new year, CMS launched the treat and transport interventions of the ET3 Model with the selected participants.
The model reimburses emergency services for Medicare fee-for-service beneficiaries when treatment is provided at a facility other than an emergency department.
It tests two new payment options – one for transportation to a primary care office, urgent care clinic or community mental health center and one for qualified healthcare practitioners, either in person or by telehealth – to initiate and facilitate treatment.
The voluntary, five-year payment model requires participating ambulance providers to collaborate with alternative destinations, such as primary care offices, urgent care clinics and qualified healthcare practitioners.
CMS will continue to pay for emergency transport of a Medicare beneficiary to a hospital emergency department or other destination covered under current Medicare requirements.
As another aspect of the model, CMS issued a Notice of Funding Opportunity worth up to $34 million to local and state governments to expand their emergency and nonemergency medical triage services in locations with ET3 Model participants.
It plans to offer 40 two-year cooperative agreements, which will vary based on the needs of the populations that applicants serve. Individual awards will not exceed $1.175 million, CMS said.
WHY THIS MATTERS
Historically, Medicare only pays for emergency ground ambulance services when beneficiaries are transported to specific types of facilities, most often a hospital emergency department. This creates an incentive to transport all beneficiaries to the hospital even when an alternative treatment option may be more appropriate, CMS said.
The ET3 Model aims to ensure that Medicare beneficiaries receive the most appropriate level of care for their needs while increasing efficiency in emergency medical service systems. It also seeks to lower costs by reducing avoidable visits to the ED, which is the most expensive arena for care.
THE LARGER TREND
The model is part of CMS's strategic initiative to advance innovative payment structures in value-based care, rewarding quality, performance and innovation.
It was originally announced early in 2019, and at the time had an anticipated start date for early 2020. In February, before the public health emergency began, CMS announced it had selected 205 applicants to participate in the model.
During the PHE, CMS expanded the range of locations where patients can be transported by ambulance.
Model participants are eligible to transport beneficiaries to covered destinations under the ambulance flexibilities and bill Medicare as usual, according to CMS.
Once the PHE ends, participants will still be required to implement the ET3 transport to an alternative destination intervention consistent with model requirements and may transport only to alternative destination partners.
Email the writer: email@example.com