Emergency, Triage, Treat and Transport Model to Begin in January

Situation Report | September 21, 2020

The federal Emergency Triage, Treat, and Transport (ET3) model is slated to begin January 1, 2021 following a delay announced in the spring due to the COVID-19 public health emergency.

Under ET3, the U.S. Centers for Medicare and Medicaid Services (CMS) will pay participating ambulance suppliers and providers to: 1) transport an individual to a hospital emergency department (ED) or other destination covered under the regulations; 2) transport to an alternative destination (such as a primary care doctor’s office or an urgent care clinic); or 3) provide treatment in place with a qualified health care practitioner, either on the scene or connected using telehealth.

Medicare regulations have historically only allowed payment for emergency ground ambulance services when individuals are transported to hospitals, critical access hospitals, skilled nursing facilities, and dialysis centers. Most beneficiaries who call 911 with a medical emergency are therefore transported to one of these facilities, in some cases unnecessarily.

Under this model, any individual who calls 911 and is connected to a dispatch system that has incorporated a medical triage line under the model would be screened for eligibility for medical triage services prior to ambulance initiation. Upon arriving on scene, participating ambulance suppliers and providers may triage Medicare fee-for-service (FFS) beneficiaries to one of the model’s interventions upon ambulance dispatch following a 911 call.

The CMS Innovation Center closed the Request for Applications (RFA) process in October 2019 and had announced the selected applicants in February 2020 just before the public health emergency stalled the program.

A five-year performance period will now begin on January 1, 2021 with CMS expecting to release a Notice of Funding Opportunity (NOFO) early in 2021.

More information is at https://innovation.cms.gov/initiatives/et3/.