The Centers for Medicare & Medicaid Services (CMS) plans to test a new voluntary emergency ambulance service innovation model that seeks promote “the most appropriate level of care at the right time and place.” In announcing the model, CMS noted that because Medicare regulations now only allow payment for emergency ground ambulance services for transportation to hospitals, critical access hospitals, skilled nursing facilities, and dialysis centers, most Medicare beneficiaries with a medical emergency who call 911 are transported to hospital emergency departments (ED), even if a lower-acuity destination would meet the individual’s needs.

Under the new CMS “Emergency Triage, Treat and Transport” (ET3) model, following a 911 call, participating ambulance suppliers and providers would either: (1) transport the individual to a hospital ED or other facility covered under current regulations; (2) transport the individual to an alternative destination (e.g., primary care physician or urgent care clinic); or (3) provide treatment in place, with a qualified health care practitioner either on the scene or connected via telehealth. Participating ambulance suppliers and providers could earn up to a 5% payment adjustment in later years of the five-year model based on achievement on key quality measures. CMS anticipates releasing a request for applications this summer and starting the model in early 2020.