CMMI Pilot Program for Treatment at Scene and Alternative Destinations

Earlier this afternoon, CMS announced the creation of a new pilot program that will permit Medicare reimbursement for: (1) ambulance transportation to alternative destinations (other than a hospital) and (2) treatment without transportation.

The 5-year pilot program, which is being operated by the CMS Innovation Center, is being called the “Emergency Triage, Treatment and Transportation Model” or “ET3” for short.  Participation in the program is voluntary, and whether or not an ambulance provider or supplier elects to participate will not impact their Medicare reimbursement for transports under the current Medicare Ambulance Fee Schedule.  

The basic outlines of the program are set forth below:

1.  CMS anticipates a program start date in early 2020.

2.  Participation will be limited to ambulance providers and suppliers that respond to 911 calls.

3.  Qualifying ambulance providers and suppliers that are currently enrolled in the Medicare program will be able to apply for participation starting in the summer of 2019.  

4.  To participate, ambulance providers and suppliers will be required to partner with qualified health care practitioners (i.e., physicians and physician-clinics);

5.  Participating providers and suppliers will be required to track designated quality measures.  

6.  Participating providers and suppliers will also be encouraged to develop triage procedures for low acuity 911 calls in their geographic response areas. 

Participants in the program will be eligible for Medicare payment for transportation to alternative destinations such as urgent care clinics and primary care physicians.  At this point, it is not known what CMS would pay for these services.  It is also unclear how these services should be coded.  It is anticipated that CMS will be providing additional details in the near future.  

We are including a link to the CMMI webpage on the program.  This webpage provides additional details on the operation of the program.  It also includes a link to a fact sheet and the CMMI Press Release.  That webpage can be found at: https://innovation.cms.gov/initiatives/et3/.    

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