Tag: Emergency Triage – Treat and Transport (ET3) Model

FirstWatch Webinar | ET3 Medical Triage Line NOFO Help

From FirstWatch Solutions

You’re invited to join us for a 30-minute webinar to help with your team’s submission for the

ET3 Notice Of Funding Opportunity (NOFO): Medical Triage Line

Tuesday, April 20th

9:00am PT / 12:00pm ET

ET3 submissions for Medical Triage Line are due May 11, 2021

FirstWatch & Priority Solutions have partnered to create ‘cut-n-paste’ text for your review / potential use designed for relevant sections of the ET3 NOFO directed at Low-Code (Emergency Communication Nurse System (ECNS) and long-time partner solution offered by FirstWatch (real-time views of ECNS, ProQA & CAD data, as well as Reporting requirements) for your review & consideration, as part of your submission.
Register Here for Webinar on April 20th

Register Now

Webinar Speakers

Rob Lawrence, MCMI

Rob has part-time roles as Director of Strategic Implementation for Pro EMS of Cambridge, Mass. and the Executive Director of the California Ambulance Association. Rob is also the Principal of Robert Lawrence Consulting. Rob served as the California COO with Paramedics Plus after nine years as the COO of the Richmond Ambulance Authority. Prior to that, he was the COO for Suffolk as part of the East of England Ambulance Service. He is a graduate of the UK’s Royal Military Academy Sandhurst, serving for 23 years as a Medical Support Officer. Rob is the Communications Committee Chair of the American Ambulance Association. Rob is an accomplished writer, broadcaster and international speaker and is a member of the EMS World Advisory Board.

Elaine Messerli-Kelly, BSN-RN

Elaine is a Subject Matter Expert specializing in nurse triage and programs aimed at navigating patients to appropriate care. Elaine and EMK Consultants have partnered with several agencies who are seeking innovative solutions to traditional care which will improve the health of their communities. She works with Priority Solutions and the International Academy of Emergency Dispatch as a Regional ECNS and ECN-Quality Instructor.

Dr. Conrad Fivaz

Dr. Fivaz chairs the Council of Standards for Emergency Nurse Triage within the International Academy of Emergency Dispatch, the body responsible for the clinical governance of the nurse triage protocols. He fulfills the role of Clinical Director for PSI. He is also a member of the IAED CBRN committee.

He held a position as associate editor of the peer-reviewed journal, Annals of Emergency Dispatch and Response and authored numerous original research papers. He co-authored the clinical triage protocols used in the ECNS system and implemented the system in many countries on 4 continents over a 20-year period.

He qualified as Family Physician in South Africa where his interest and experience in clinical triage medicine started when he worked as emergency physician in a busy tertiary University Hospital’s Emergency Department and flight doctor for the “Flight for Life” helicopter service while completing his Masters degree in Family Medicine. He worked as a Family Physician in the UK before relocating with his family to the US.

ET3 | Model Medical Triage Line Notice of Funding Opportunity

From CMS on March 12, 2021

Emergency Triage, Treat and Transport (ET3) Model Medical Triage Line – Notice of Funding Opportunity (NOFO) Available

 

Today, the Centers for Medicare & Medicaid (CMS) is releasing a Notice of Funding Opportunity (NOFO) for the Emergency Triage, Treat and Transport (ET3) Model. Through the NOFO, CMS will fund state and local governments, their designees, or other entities that operate or have authority over a Public Safety Answering Point (PSAP) to establish or expand Medical Triage Lines aimed at reducing inappropriate use of emergency ambulance services and increasing efficiency in Emergency Medical Services (EMS) systems.

The NOFO complements the ambulance payment component of the ET3 Model, which began implementation on January 1, 2021 and for which the final list of Participants was posted today. Applicants to the NOFO must share at least one ZIP Code with the ambulance providers and suppliers that are participants in the model. Under the ET3 Model, CMS provides greater flexibility to ambulance care teams to address emergency health care needs of Medicare Fee-for-Service (FFS) beneficiaries following a 911 call, by paying ambulances to transport beneficiaries to Alternative Destinations or to facilitate Treatment in Place with a Qualified Health Care Partner, either in-person or through telehealth.

The NOFO is available at grants.gov under Opportunity Number CMS-2F2-21-001.

For more information, please see the ET3 Model’s webpage. Stay up to date on the latest ET3 Model news and updates by subscribing to the ET3 Model listserv or contact us at ET3Model@cms.hhs.gov.

FirstWatch | The Promise, Potential, and Possible Pitfalls of ET3

Firstwatch Webinar on January 22 at Noon ET | Powered by Prodigy EMS

The ET3 program starts in earnest on January 1, 2021. This program has been a long time in the making, which COVID only prolonged.

In this installment of Conversations That Matter, guest facilitator Rob Lawrence explores the path to going live with ET3 with Matt Zavadsky (MedStar Mobile Healthcare, Fort Worth, Texas) and Hanan Cohen (Empress EMS, New York). You’ll learn about what they hope to achieve with their ET3 programs, how they’re measuring quality and success, and the potential for program expansion. They’ll also share their views on whether the new administration in Washington might support continuation or expansion of Treatment in Place and other initiatives that have been implemented as a result of the pandemic.

Register

Guest Host – Rob Lawrence, MCMI

Rob has part-time roles as Director of Strategic Implementation for Pro EMS of Cambridge, Mass. and the Executive Director of the California Ambulance Association. Rob is also the Principal of Robert Lawrence Consulting. Rob served as the California COO with Paramedics Plus after nine years as the COO of the Richmond Ambulance Authority. Prior to that, he was the COO for Suffolk as part of the East of England Ambulance Service. He is a graduate of the UK’s Royal Military Academy Sandhurst, serving for 23 years as a Medical Support Officer. Rob is the Communications Committee Chair of the American Ambulance Association, a member of the EMS World Advisory Board, and an accomplished writer, broadcaster and international speaker.

Matt Zavadsky, MS-HSA, NREMT

Matt Zavadsky is the Chief Strategic Integration Officer at MedStar Mobile Healthcare. Matt has 41 years of EMS experience and has helped guide the implementation and financial sustainability of numerous innovative programs with healthcare partners. Matt is also the President of the National Association of EMTs and chairs their EMS 3.0 committee. He is the co-author of the book “Mobile Integrated Healthcare – Approach to Implementation” published by Jones & Bartlett Publishing. He has a Master’s Degree in Healthcare Administration, with a Graduate Certificate in Healthcare Data Management and is a member of the EMS World Advisory Board.

Hanan Cohen

Hanan is the Director of Business Development and Community Paramedicine at Empress EMS. He is a paramedic and community paramedic with 30 years experience in EMS and Hospital Administration. His major focus is on new program design to provide collaborative community health programs with hospitals in Westchester County, New York, and New York City. Through his efforts, Empress EMS launched community paramedic programs for two local hospitals in White Plains and the Bronx. These treat in place programs primarily focus on reducing readmission of high-risk patients with chronic disease to the hospital and preventing the use of the emergency room for non-emergency issues.
Register

ET3 Model Moves Forward Starting January 1, 2021

The Centers for Medicare & Medicaid Services (CMS) has announced that the first performance period for the Emergency Triage, Treat, and Transport (ET3) Model will begin on January 1, 2021. As we reported previously, CMS delayed the start of ET3 Model, consistent with its delaying or pausing other payment models, because of the COVID-19 public health emergency (PHE).

To start this effort, CMS has indicated that it will post a revised Participation Agreement (PA) to the ET3 Model Portal by mid-October 2020. Participants must upload signed PAs to the ET3 Model Portal by December 15, 2020. CMS will also post an Implementation Plan Template (IPT). Participants must submit their IPT CMS by November 15, 2020 to allow CMS to review and accept the IPT prior to beginning their participation in the Model.

CMS plans to provide additional guidance, including:  an Orientation Overview fact sheet, Billing and Payment fact sheets, Model Participation During the PHE fact sheet, a Who’s Who fact sheet, and an ET3 Model Portal User Guide. These documents will be available to participants through the ET3 Model Portal during the next several weeks.

The re-engagement on the ET3 Model prior to the end of the PHE is something that the American Ambulance Association (AAA) has supported in discussions with CMS. While it does not address some of the gaps in reimbursement and treatment that our members are seeing nationwide, for those who are participating in the model, it will be an enormous benefit.

The AAA also continues to work with CMS to identify new models that will allow other ground ambulance providers and suppliers to participate in innovative models, even though there were not able to meet the ET3 participation requirements.

CMS Announces Delay to ET3 Start Date

On April 8, 2020, the Centers for Medicare and Medicaid Services (CMS) announced that it will be delaying the start of the Emergency Triage, Treat and Transport (ET3) Model until Fall 2020.  The ET3 Model was previously set to start on May 1, 2020.  CMS cited the national response to the COVID-19 pandemic as the reason for this delay.

In its delay notice, CMS also reminded the EMS industry that it has issued a number of temporary regulatory waivers and new rules that are designed to give health care providers and suppliers maximum flexibility to respond to the current national emergency.  This includes a number of flexibilities offered specifically to the ambulance industry.

CMMI Delays ET3 Pilot Program Until Fall

The Centers for Medicare and Medicaid Innovation (CMMI) has announced the delay of the start of the ET3 Model Pilot Program. CMMI has delayed the program until the fall of this year. The program was set to begin on May 1. In its notice, CMMI also referenced the interim final rule providing waivers for transport to alternative destinations and other regulatory flexibility previously reported by the AAA.

ET3 Model Timeline Delay and Important Updates

ET3 Model Stakeholders,

Thank you for your engagement to date related to the ET3 Model. The Centers for Medicare & Medicaid Services (CMS) is seeking to support the community of organizations that are responding to the public health emergency stemming from the Novel Coronavirus Disease (COVID-19). As CMS and ET3 Model selected applicants work to respond to needs due to COVID-19, CMS has decided to delay the start of the ET3 Model from May 1, 2020 until Fall 2020.

CMS appreciates your continued support and enthusiasm for the innovations available under the ET3 Model, and as such, we will continue to communicate information and updates about the Model through this listserv.

Important Updates Regarding CMS Flexibilities to Fight COVID-19

In addition, we want to inform ET3 Model stakeholders that CMS recently announced in a press release an Interim Final Rule with Comment Period (IFC) that provides temporary regulatory waivers and new rules to equip the American healthcare system with maximum flexibility to respond to the 2019 COVID-19 pandemic. The IFC and all of CMS’s Coronavirus Waivers & Flexibilities can be found here.

The flexibilities offered specifically to ambulances during the Public Health Emergency (PHE) for the COVID-19 pandemic can be found at this link: Ambulances (PDF). This includes temporarily expanding the list of allowable destinations for ground ambulance transports during the COVID-19 PHE to include any destination that is equipped to treat the condition of the patient in a manner consistent with state and local Emergency Medical Services (EMS) protocols in use where the services are being furnished. These destinations may include, but are not limited to: any location that is an alternative site determined to be part of a hospital, CAH or SNF, community mental health centers, federally qualified health centers (FQHCs), rural health clinics (RHCs), physician’s offices, urgent care facilities, ambulatory surgical centers (ASCs), any location furnishing dialysis services outside of the ESRD facility when an ESRD facility is not available, and the beneficiary’s home. Home may be an appropriate destination for a COVID-19 patient who is discharged from the hospital to home to be under quarantine. There must be a medically necessary ground ambulance transport of a patient in order for an ambulance service to be covered.

These actions, and earlier CMS actions in response to COVID-19, are part of the ongoing White House Coronavirus Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19, visit www.coronavirus.gov. For a complete and updated list of CMS actions, and other information specific to CMS, please visit the Current Emergencies website.

Thank you again for your interest in the Model and for your efforts to improve the quality of care in the EMS industry.

If you have any questions about this update, please contact the ET3 Model team at ET3Model@cms.hhs.gov.

Follow CMS and the CMS Innovation Center on Twitter at @CMSGov and @CMSinnovates.

Centers for Medicare & Medicaid Services (CMS) has sent this Emergency Triage, Treat, and Transport (ET3) Model Update. To contact Centers for Medicare & Medicaid Services (CMS) go to our contact us page.

Member Advisory: CMMI Releases Initial List of ET3 Participants

The Centers for Medicare and Medicaid Services (CMMI) has released its initial list of applicants selected to participate in the ET3 pilot program. CMMI notes that the list is not final as it still needs to execute participation agreements with the applicants. CMMI will issue a final list once it completes the process.

Applicants from 36 states and the District of Columbia were selected to participate in the program. Approximately 200 applicants were approved with instances in which the same ambulance service organization submitted applications for multiple counties as well as more than one organization submitting an application for the same county. CMMI has sent notifications to each of the applicants letting them know to expect a follow up email with the partnership agreement, program guidance and additional details.

The ET3 program is a five-year voluntary pilot program designed to test the potential benefit to the Medicare program and patients of ambulance service providers and suppliers furnishing treatment in place as well as transport to alternative destinations. For more information about the ET3 program, please go the ET3 website.

CMS Open Door Forum & Member Q&A – November 7th

The Centers for Medicare and Medicaid Services has scheduled its next Ambulance Open Door Forum for Thursday, November 7 from 2:00-3:30 PM Eastern. If you plan to attend, please dial in at least 15 minutes before the call.

CMS Ambulance Open Door Forum

November 7 | 2:00 PM ET
Participant Dial-In Number:  1-888-455-1397
Conference ID #: 4676500

Questions?

Have more questions? The AAA is here to help! Following the ODF the AAA will be publishing a follow up blog post going over any updates and important announcements.

AAA Follow Up Q&A

November 7 | 4:00 PM ET
1-800-250-2600
Pin: 82802314#
Speakers: AAA Senior Vice President of Government Affairs, Tristan North; AAA Healthcare Lobbyist, Kathy Lester, Esq.

CMS Open Door Forum & Member Q&A – August 28

The Centers for Medicare and Medicaid Services has scheduled its next Ambulance Open Door Forum for Wednesday, August 28 at 2:00 PM Eastern. If you plan to attend, please dial in at least 15 minutes before the call.

CMS Ambulance Open Door Forum

August 28 | 2:00 PM ET
Participant Dial-In Number:  1-888-455-1397
Conference ID #: 6609831

Questions?

Have more questions? The AAA is here to help! Following the ODF the AAA will be publishing a follow up blog post going over any updates and important announcements.

AAA Follow Up Q&A

August 28 | 3:00 PM ET
1-800-250-2600
Pin: 82802314#
Speakers: AAA Senior Vice President of Government Affairs, Tristan North; AAA Healthcare Lobbyist, Kathy Lester, Esq.; AAA Medicare Regulatory Committee Chair, Krista Cuthbert; and AAA Payment Reform Committee Chair, Asbel Montes.

ET3 Model Application Portal Now Open

Emergency Triage, Treatment and Transport (ET3) Model Application Portal is Now Open!

On August 5, 2019, the Center for Medicare and Medicaid Innovation (CMMI) announced that it had opened its Request for Application (RFA) Online Portal. The Online Portal can be found on the ET3 Model website. The Online Portal can also be accessed directly by clicking here.

As a reminder, CMMI will be hosting a webinar about the Online Portal on Thursday, August 8, 2019.  This webinar will take place from 12:00 p.m. to 1:30 p.m. EDT. If you are interested in participating in this webinar, you can register by clicking here.

CMMI Releases Preview of ET3 RFA

On May 22, 2019, the Center for Medicare and Medicaid Innovation (CMMI) released a preview of the Request for Applications (RFAs). This documentation will be used by ambulance providers and suppliers to apply for inclusion as “Participants” in the Emergency Triage, Treat, and Transport (ET3) pilot program.

Webinar: Learn More About the RFA

June 13, 2019 | 2:00 PM Eastern
Speakers: Brian Werfel, Kathy Lester, Rebecca Williamson, Asbel Montes
$99 for Members | $198 for Non-Members

Register Now

Relevant Background

On February 14, 2019, CMMI announced the creation of a new 5-year pilot program designed to give participating EMS agencies greater flexibility to address the needs of Medicare beneficiaries following a 911 call. The ET3 model would create a new payment model under which participating EMS agencies will be eligible for Medicare reimbursement for: (1) transportation to alternative treatment destinations and (2) treatment at the scene. At the time, CMMI indicated that it anticipated starting the ET3 model in early 2020. To that end, CMMI anticipated soliciting Requests for Participation in the Summer of 2019.

Participation in this pilot program is voluntary. Regardless of whether an ambulance provider or supplier participates in the pilot program, payment for ambulance transportation currently covered under the Medicare Ambulance Fee Schedule will not be affected.

The RFA provides a good deal of additional information regarding the proposed operation of the ET3 Model. These additional details are summarized below.

Eligibility Criteria/Application Process

To be eligible to participate, you must be a Medicare-enrolled ambulance provider or supplier.  In addition, CMMI is limiting eligibility to ambulance providers and suppliers that are located in a state or state in which at least 15,000 Medicare FFS emergency ambulances took place in calendar year 2017.  Note: based on this restriction, ambulance providers and suppliers in the State of Alaska would not be eligible for participation in the ET3 Model.

Medical Necessity Requirement

CMMI previously indicated that the existing medical necessity requirements would apply to ambulance transportation to alternative treatment destinations. In the RFA, CMMI reiterated this requirement. As a result, EMS agencies will only be eligible for reimbursement for transportation to alternative treatment destinations to the extent the beneficiary’s condition is such that safe transport by other means is contraindicated.

CMMI indicated that beneficiaries that do not meet the medical necessity requirements for ambulance transportation may still meet the medical necessity requirements for a Medicare-covered item or service furnished by a qualified health care practitioner, and, therefore, may allow an EMS agency to receive payment for treatment at the scene under the ET3 Model.

Payments under the ET3 Model

The ET3 Model provides for a number of new payment streams.  The two payment streams being made available to participating EMS agencies are: (1) payment for transportation of Medicare beneficiaries to alternative treatment destinations and (2) payment for treatment of the Medicare beneficiary at the scene, where such care was rendered by a qualified health care practitioner either at the scene or via telehealth.

Payment for Transportation to Alternative Treatment Destinations

When the ET3 Model was first announced, CMS indicated that the reimbursement to EMS agencies for providing transportation to alternative treatment destinations would be based on the corresponding BLS “base rate” in the area. However, in the RFA, CMMI indicates that the payment for transportation to an alternative treatment destination will now be made at either the applicable BLS emergency or ALS emergency base rate.  In order to qualify for payment at the applicable ALS emergency rate, the EMS agency must meet Medicare’s definition of “Advanced Life Support” (i.e., the provision of valid ALS intervention and/or the provision of a qualifying ALS assessment).  The payment for this base rate would include the current adjustments for transports provided in urban, rural, or super-rural areas.

The EMS agency would also be eligible for payment for all loaded mileage, at the applicable Medicare mileage rate. This payment would include all current adjustments, including the “bonus” paid for the first 17 rural miles.

Note: CMMI indicated that it would be creating an exception to general Medicare requirement that patients be transported to the nearest appropriate facility. Based on the language in the RFA, it appears clear that CMMI would cover all of the mileage to an alternative treatment destination, even where transportation to the nearest hospital ED would have been shorter.

Based on the language in the RFA, it appears that claims for transportation to alternative treatment destinations will be submitted using the normal ambulance HCPCS codes (i.e., A0427 for an ALS emergency and A0429 for a BLS emergency).

Payment for Treatment at the Scene

When the EMS agency facilitates in-person treatment by a qualified health care practitioner (QHP), the EMS agency will be paid an amount equivalent to the BLS emergency or ALS emergency base rate.  In order to qualify for payment at the applicable ALS emergency rate, the EMS agency must provide medically necessary supplies and services and either a qualifying ALS assessment or the provision of at least one ALS intervention. When the EMS agency facilitates treatment in pace via telehealth, the EMS agency will be paid a modified “telehealth originating site facility fee” equivalent to the applicable BLS emergency or ALS emergency base rate.

Claims submitted for treatment at the scene, whether by the QHP in person or via telehealth, will be submitted using a model-specific code (yet to be announced).

Performance-Based Payment Adjustment for EMS Agencies

EMS agencies that provide transportation to alternative treatment destinations and/or treatment at the scene may be eligible for performance-based payment adjustments of up to 5%, based upon meeting certain performance and reporting metrics. These adjustments will become available no earlier than Year 3 of the ET3 Model, and are not guaranteed.  Performance-based payment adjustments would be based on performance during the previous year (e.g., if the EMS agency meets the performance criteria in Year 3, it would see an increase in Year 4). These performance-based payment adjustments apply only to payments under the ET3 Model, i.e., they do not apply to Medicare payments made under the current Medicare Ambulance Fee Schedule.

Payment for Non-Participant Partners

When an EMS agency transports a patient to an alternative treatment destination, that facility will bill Medicare for the services it renders to the beneficiary using its normal claims submission procedures.

Payment for Qualified Health Care Practitioners

A QHP that partners with an EMS agency to provide treatment at the scene will bill Medicare using the applicable HCPCS code for the services it furnished under existing Medicare FFS rules.  When that service is furnished via telehealth, the QHP must submit a claim to Medicare for telehealth services furnished from the distant site.  QHPs that provide services to Medicare beneficiaries during non-business hours (defined as being from 8:00 p.m. to 8:00 a.m. local time) will be eligible for a 15% increase in the payment rates normally applicable to their in-person or telehealth services.

Notice of Funding Opportunity for 911 Dispatch Centers

Separate from the RFA process, CMMI expects to allocate funding to governmental entities and their designees that operate 911 dispatch centers.  The purpose of this funding is to support the successful implementation of medical triage lines integrated into the local 911 system.  These Notice of Funding Opportunity (NOFOs) will be released following the first round of Participant selection (i.e., likely in the Fall/Winter of 2019).

Application Timelines

The RFA is the first of up to three potential RFAs that will be used to select EMS agencies to participate in the ET3 Model as “Participants.” CMMI is indicating that it hopes to select enough EMS agencies to participate to capture up to 30% of the existing volume of Medicare FFS emergency ground ambulance transports. Additional RFAs will be considered based on available funding and evidence that the ET3 Model is working as intended.

CMMI is not currently accepting applications. Round 1 applications will be accepted via an application portal that will be opened at a later date. Information on the applicable process, including the date the application portal will be opened will be posted on the ET3 Model website: https://innovation.cms.gov/initiatives/et3

Application Submission Process

If you elect to apply for participation in the ET3 Model, you will be required to identify a “region” in which you propose to implement the model. CMMI indicates that this region should be a county or equivalent entity, or multiple counties or equivalent entities.

In selecting Participants, CMMI indicated that it will give preference to applicants who propose a region that includes at least one county (or county-equivalent) where at least 7,500 Medicare FFS emergency ground ambulance transports occurred in 2017. CMMI provided a list of the number of Medicare FFS emergency ground ambulance transports that occurred in each county (organized by state)  That list can be obtained by clicking here.

Applicants will be required to participate in the transportation to alternative treatment destination (ATD) portion of the program. Applicants will have the option – – but not be required – – to propose the creation of a program to provide treatment at the scene in conjunction with QHPs.  Note: CMMI indicated that applicants that elect to implement the treatment at the scene intervention will earn additional points towards their overall application score.

In order to implement the ATD portion, you will be required to partner with alternative destination sites (e.g., Urgent Care Centers), which must be enrolled in Medicare or employ or contract with Medicare-enrolled practitioners, and which must be able to accept and treat Medicare FFS beneficiaries.  If you elect to implement the treatment at the scene portion, you must also partner with QHPs to provide treatment at the scene. These contractual partners are referred to in the RFA as “Non-Participant Partners” (NPPs). To qualify, you must contract with NPPs that can ensure the availability of services for ET3 Model beneficiaries on a 24 hours per day, 7 days a week basis. CMMI will have the right to accept or reject a proposed Non-Participant Partner.

Applicants will also be required to describe their strategy for engaging other payers in their proposed service area, or explain how they can successfully implement the model for Medicare FFS beneficiaries only.

Accountability and Performance Metrics/Ongoing Educational Commitments

Participants in the ET3 will be required to report certain metrics to CMMI and its contractors. You will also be required to participate in what CMMI is calling a “Learning System.”  This is a structured approach to sharing, integrating, and actively applying quality improvement concepts, tactics, and lessons designed to improve the likelihood of success of the model. At a minimum, this will include consistent participation in monthly ET3 Model learning activities, and participation in at least one in-person event, with the location to be determined by CMMI at a later date.

The above is a brief summary of the new information available regarding the ET3 Model. It is not intended to be a complete discussion of all of the requirements for participation. AAA Members are strongly encouraged to read the RFA for themselves to determine whether they want to participate in the ET3 Model.

CMS Releases ET3 Request for Applications (RFA)

Just minutes ago, the Centers for Medicare & Medicaid Services (CMS) announced the release of the Request for Applications (RFA) for the Emergency Triage, Treat, and Transport (ET3) Model. The RFA can be found here.

CMS is not accepting applications at this time but has released the RFA so that those ambulance services thinking about submitting an application can review it. In the notice, CMS also shared some FAQs on ET3.

The AAA team is currently reviewing the RFA and will be sending out a notice with additional details shortly.

Summary of March 28, 2019 Ambulance ODF

The Centers for Medicare and Medicaid Services (CMS) held its latest Open Door Forum on Wednesday, March 28, 2019.  As with past Open Door Forums, CMS started the call with the following announcements:

  1. Ambulance Cost Data Collection – CMS reminded the industry that the Bipartisan Budget Act of 2018, enacted on February 9, 2018, requires CMS to create a new cost data collection system by December 31, 2019.
  2. Emergency Triage, Treat, and Transport Model – A representative from the Innovation Center within CMS provided an overview of the “Emergency Triage, Treat, and Transport Model” or “ET3.” This is a 5-year pilot program intended to provide ambulance providers with greater flexibility to handle low-acuity 911 calls, by providing Medicare payment for: (a) ambulance transportation to alternative treatment destinations and (b) treatment at the scene. The CMS representative indicated that CMS is in possession of data that suggests that 16% of emergency ambulance transports to a hospital emergency department could have been resolved by transporting the patient to an alternative treatment site, e.g., an urgent care center. CMS estimates that had all of these patients elected to receive care in the lower-acuity setting, it would have saved the Medicare Program approximately $560 million each year. With respect to the operation of the model itself, CMS essentially repeated the information that had been previously provided on its webinars. You can view the AAA Member Advisory on the ET3 Model by clicking here.
  3. Ambulance Inflation Factor – CMS reiterated that the 2019 Ambulance Inflation Factor is 2.3%.

Following the announcements, CMS moved into a Question & Answer period. The majority of the questions related to the ET3 pilot program. As is typical, many questions were not answered on the call; instead, CMS asked the individual to submit their question in writing. However, the following questions were answered on the call:

  1. Payment Rates under ET3 – CMS was asked whether the BLS base rate payment would be the BLS emergency base rate. It was not clear that the CMS representative fully understood the question, although she indicated that it would.
  2. Eligibility for Government Agencies – CMS was asked whether governmental agencies that operate 911 centers would submit applications to participate as part of the RFA process in the Summer of 2019. CMS responded that governmental agencies that operate 911 centers would not submit RFAs, but would rather wait for the Notice of Funding Opportunity (NOFO), which will be issued after the ambulance providers and suppliers are selected for participation (expected to be the late Fall/Winter of 2019). CMS further confirmed that if the governmental agency also operated its own ambulance service that it would be eligible to apply for both aspects of the ET3 Model.
  3. Limit on Ambulance Providers – CMS was asked whether it would cap the number of ambulance providers and suppliers selected to participate in the program. CMS responded that, at the present time, it has no intent to cap the number of participating ambulance providers and suppliers at any specific number.
  4. Return Transports from Alternative Treatment Destinations – CMS was asked whether the model would provide for ambulance payment for the return transport after a patient was transported to an alternative treatment site. CMS indicated that the model does not provide for payment for the return transport.
  5. Definition of “Telehealth” – CMS confirmed that the model will use the same definition of “telehealth” used in other areas of the Medicare Program. CMS further confirmed that telehealth encounters require both audio and video connections.
  6. Approval of Alternative Treatment Sites – CMS confirmed that state and local regulatory agencies would have final approval over acceptable alternative treatment sites.
  7. Qualified Health Care Practitioner – CMS confirmed that a “qualified health care practitioner” would be an individually enrolled Medicare practitioner, which includes physicians and nurse practitioners. In some instances, it can also include physician’s assistants. CMS confirmed that the definition would not include registered nurses or advance scope paramedics.
  8. NOFO Funding – CMS indicated that, at the present time, it is not prepared to release additional details on the nature or size of the funding opportunities available to governmental agencies and their designees that operate or have authority over 911 centers.
  9. Medicare Advantage and Other Payers – CMS confirmed that the ET3 Model applies only to Medicare beneficiaries enrolled in FFS Medicare. It does not apply to Medicare Advantage enrollees, Medicaid recipients, etc.

Questions? Email Brian at bwerfel@aol.com

UPDATED: CMS Open Door Forum – Thursday, March 28

The Centers for Medicare and Medicaid Services has scheduled its next Ambulance Open Door Forum for Thursday, March 28 at 2:00 PM Eastern. If you plan to attend, please dial in at least 15 minutes before the call.

CMS Ambulance Open Door Forum

March 28 | 2:00 PM ET
Participant Dial-In Number:  1-800-837-1935
Conference ID #: 6695896

Questions?

Have more questions? The AAA is here to help! Following the ODF the AAA will be publishing a follow up blog post going over any updates and important announcements.

CMS ET3 Model Webinar & Follow Up AAA Member Q&A Call – Wednesday, Feb. 27

The Centers for Medicare and Medicaid Services has scheduled a webinar on the new Emergency Triage, Treat, and Transport (ET3) Model announced on February 14, 2019.

The webinar will be held on Wednesday, February 27th at 1:00 PM EasternRegistration is open.

CMS ET3 Model Webinar

February 27 | 1:00 PM ET

Questions?

Have more questions? The AAA is here to help! Following the ET3 Webinar, the AAA will host a Q&A conference call open to all members.

AAA Follow Up Q&A

February 27 | 3:00 PM ET
1-800-250-2600
Pin: 73556603#
Speakers: AAA Senior Vice President of Government Affairs, Tristan North; AAA Healthcare Lobbyist, Kathy Lester, Esq.; AAA Medicare Regulatory Committee Chair, Rebecca Williamson; AAA Payment Reform Committee Chair, Asbel Montes.