The model will encourage the development of medical triage lines for low-acuity 911 calls in regions where participating ambulance companies operate. The ET3 model will have a five-year performance period, starting in early 2020.

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New Payment Model for Ambulance
Services: ET3
The Department of Health and Human Services had launched a new payment model
for ambulance services that federal officials believe could lower out-of-pocket costs for
Medicare fee-for-service beneficiaries. The Emergency Triage, Treat and Transport
Model—ET3—allows ambulance companies to deliver on-the-scene or telehealth
services to Medicare FFS patients, and transport them to alternative care venues, such
as primary care doctors’ offices or urgent-care clinics. The model will encourage the
development of medical triage lines for low-acuity 911 calls in regions where
participating ambulance companies operate. The ET3 model will have a five-year
performance period, starting in early 2020.
Emergency Triage, Treat, and Transport (ET3) is a voluntary, five-year payment model
that will provide greater flexibility to ambulance care teams to address emergency
health care needs of Medicare beneficiaries following a 911 call. Under the ET3 model,
the Centers for Medicare & Medicaid Services (CMS) will pay participating ambulance

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suppliers and providers to
 Transport an individual to a hospital emergency department (ED) or other
destination covered under the regulations;
 Transport to an alternative destination (such as a primary care doctor’s office or an
urgent care clinic), or
 Provide treatment in place with a qualified health care practitioner, either on the
scene or connected using telehealth. ET3 model aims to improve quality and lower
costs by reducing avoidable transports to the ED and unnecessary hospitalizations
following those transports.
As per Centers for Medicare & Medicaid Services (CMS), the model is designed to prod
providers across the care continuum to more appropriately and inexpensively meet
beneficiaries’ care needs. Currently, Medicare primarily pays for unscheduled,
emergency ambulance services when beneficiaries are transported to a hospital ED.
This creates a financial incentive to transport all beneficiaries to the more-expensive ED,
even when a cheaper care option is more appropriate. The model will give providers
the option of treating Medicare FFS patients at the scene, or using telehealth, and to
transport them to less-costly care venues when appropriate.
 The ET3 model will include ambulance payments for treatment with a healthcare
provider, either on-the-scene or using telehealth.
 The model will also pay for unscheduled, emergency transport to hospital EDs, and
alternative destinations, such as urgent care clinics and primary care offices.
 Federal officials say the model will provide alternatives to transporting patients to
more-expensive hospital EDs.
Two New Payment Options
The ET3 model will expand to include two new ambulance payments:

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 Payment for treatment with a healthcare provider, either on-the-scene or using
telehealth;
 Payment for unscheduled, emergency transport of Medicare beneficiaries to
alternative destinations, such as 24-hour care clinics, other than destinations covered
under current regulations, including hospital EDs.
Currently, Medicare regulations only allow 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, and most often to a
hospital ED, even when a lower-acuity destination may more appropriately meet an
individual’s needs.
Providers and alternative care venues that partner with ambulance companies would
receive payment as usual under Medicare for services rendered. The model will be
phased in to maximize participation across the country, and CMS will encourage ET3
participants to partner with other payers, including state Medicaid agencies.
Reference:
Emergency Triage, Treat, and Transport (ET3) Model