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CMS selects 205 applicants for new Emergency Triage, Treat and Transport Model

Ambulance care teams will have greater flexibility to address the emergency needs of Medicare fee-for-service beneficiaries following a 911 call.

Susan Morse, Managing Editor

The Centers for Medicare and Medicaid Services has announced the selection of 205 applicants to participate in the new Emergency Triage, Treat and Transport Model.

A final list of ET3 Model participants will be made available after the applicants sign a participation agreement.

The model will reimburse emergency services for Medicare fee-for-service beneficiaries when treatment is provided at a facility other than an emergency department. Ambulance care teams will have greater flexibility to address emergency needs following a 911 call.

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Currently, 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.

CMS will test two new ambulance payments, while continuing to pay for emergency transport of a Medicare beneficiary to a hospital ED or other destination covered under current Medicare requirements.

The first is for transport to a primary care office or an urgent care clinic; the second allows qualified healthcare practitioners, either in-person or by telehealth, to initiate and facilitate treatment.


The ET3 voluntary, five-year payment model allows for a greater range of treatment options and the most appropriate level of emergency care.

The emergency room is the most expensive facility in which to receive care. The model may have lower costs for both Medicare and the patient.

A patient may always choose to be brought to the ER, CMS said.

Under the new model, upon arriving on the scene of a 911 call, ambulance providers may triage Medicare beneficiaries to one of the model's intervention sites. This requires partnering with alternative destinations, such as primary care  offices or urgent-care clinics and with qualified healthcare practitioners to deliver treatment in place, either on-the-scene or through telehealth.

Applicants selected to participate in the ET3 Model are Medicare-enrolled ambulance service suppliers or ambulance providers in 36 states and the District of Columbia that plan to implement, at minimum, the ET3 Model's alternative destination intervention.

As another component of the model, CMS intends to issue a Notice of Funding Opportunity for up to 40, two-year cooperative agreements, available to state and local governments that operate or have authority over a Primary or Secondary Public Safety Answering Point (PSAP) that receives 911 calls.

The opportunity will fund the implementation of a medical triage line integrated with the PSAP in an eligible region. The model will test whether these two components will work synergistically to improve quality and lower costs by reducing avoidable transports to the ER and unnecessary hospitalizations following those transports.

CMS intends to issue the medical triage line Notice of Funding Opportunity this spring, with applications due this summer.


The model is part of CMS's strategic initiative to advance innovative payment structures in value-based care, rewarding quality, performance and innovation.

Announced by CMS in early 2019, the ET3 Model creates a new set of incentives for emergency transport and care, ensuring patients get convenient, appropriate treatment.


"Most beneficiaries who call 911 with a medical emergency are transported to a hospital emergency department, even when a lower-acuity destination may be more appropriate," said CMS Administrator Seema Verma. 

Twitter: @SusanJMorse
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