HHS Testing New Ambulance Payments

Health and Human Services https://www.hhs.gov within their Center for Medicare and Medicaid Innovation (CMMI) https://innovation.cms.gov/initiatives/et3 tests innovative payment and service delivery models to lower costs and improve quality of care.

Currently, Medicare primarily pays for unscheduled emergency ground ambulance services when beneficiaries are transported to a hospital emergency department This has created an incentive to transport all beneficiaries to the hospital even when an alternative treatment option may be more appropriate.

To counter this incentive, the new model, “Emergency Triage, Treat, and Transport (ET3) will test two new ambulance payments, while still continuing to pay for emergency transport for a Medicare beneficiary to a hospital emergency room or another destination covered under current regulations.

The new ET3 model will make it possible for participating ambulance suppliers and providers to partner with qualified healthcare practitioners to deliver treatment in place either on the scene or through telehealth.

Also it will possible to treat patients along alternative destination sites such as primary care doctors’ offices or urgent care clinics to provide care for Medicare beneficiaries following a medical emergency where emergency care has been accessed through 911 services.

The ET3 model will have a five year performance period with an anticipated start date in early 2020. To ensure access to model interventions across individuals in a region, CMS will encourage ET3 model participants to partner with other payers and to include state Medicaid agencies.

CMS anticipates issuing a Notice of Funding Opportunity (NOFO) for a limited number of two year cooperative agreements. The NOFO will be available to local governments or other entities that operate or have authority over one or more 911 dispatches in geographic locations where ambulance suppliers and providers have been selected to participate.

For more information, go to https://innovation.cms.gov/initiatives/et3

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