Latest Updates: Application Window Closes Soon for ET3

ESO Staff

Ambulance suppliers and providers still have a short window of time left to apply for the first round of participation in the Emergency Triage, Treat, and Transport (ET3) program, sponsored by the Centers for Medicare and Medicaid Services (CMS). Medicare-enrolled ambulance providers have until September 19, 2019 to submit a Request for Applications (RFA) via the online portal; those selected will take part in an experimental 5-year program aimed at giving ambulance companies more flexibility and options in treatment choices, complete with new payment model.

Organizers theorize that by allowing ambulance companies more options – such as transporting a patient to a lower-acuity destination or providing onsite telehealth services rather than transport – will not only offer more effective treatment for Medicare patients, but will actually save millions of dollars.

More Options for Better Treatment, Lower Costs

According to the U.S. Departments of Health and Human Services and Transportation, Medicare could save $560 million per year by transporting individuals to doctors’ offices rather than a hospital ED. Currently, Medicare only pays for emergency ground ambulance services when beneficiaries are transported to a limited number of covered destinations. This creates an incentive for ambulances to transport to high-acuity locations like Emergency Departments, even when a lower-acuity option would suffice.

Under the new ET3 payment model, ambulance companies will receive payment for two additional treatment options when appropriate:

  • Transport to an alternative destination (such as a primary care doctor’s office or an urgent care clinic)
  • On-scene “treatment in place” with a qualified health care practitioner, either in-person of via approved telehealth technology

ET3 organizers hypothesize that these new options will not only lower the costs charged to Medicare, but also reduce already overwhelmed EDs and actually improve care for patients by allowing more appropriate treatment options.

Expectations for Participants

Participating ambulance companies will be expected to align with their local resources to meet the requirements of the ET3 program, including creating partnerships with Medicare-enrolled, lower-acuity facilities and health care providers. Similarly, treatment-in-place health care practitioners must be Medicare-enrolled qualified and able to furnish services, either in-person on the scene or via telehealth technology. Each ET3 participant must ensure that at least one of the non-ED options is available at all times.

It’s important to note that agencies do not have to offer the treatment-in-place option; the minimum requirement is to establish alternative transport locations. However, if an ambulance agency does choose to offer on-scene treatment options, it must employ the appropriate teleheatlh technology (for example, a minimum of audio and video connectivity, as opposed to telephone-only communications). Additionally, a patient who is eligible for the new intervention options may still choose to be transported to a Medicare-covered destination (like the ED) and these transports will still be covered as usual by state regulations.

Participants will also be expected to regularly report on requested metrics, and the CMS will regularly be monitoring additional statistics to ensure no negative outcomes are inadvertently created by the new model. Additionally, participants will be expected to participate in “learning communities” and activities, such as webinars, interviews, and in-person meetings, to ensure feedback is being received and best practices shared.

Participating ambulance companies that demonstrate a high quality of care based on performance metrics may be eligible for a performance-based payment increases after three years of participation in the program.


The RFA application portal is open from August 5, 2019 through September 19, 2019.

More information is also available at the CMS ET3 website, or in the ET3 FAQ page.


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