Texas Medicaid Approved ET3 Model as a Covered Benefit

ET3 Reimbursement-Texas Medicaid Approved

A new Medicaid benefit changes the emergency services landscape in Texas. Here’s why it matters.

The Emergency Triage, Treat, and Transport (ET3) model, which started in 2019, pays EMS agencies for treatment and transports beyond the emergency room – such as in place or to alternate destinations. Previously, emergency service agencies received payment only for transports to the hospital emergency department or nursing home/skilled living facilities. Often, those places are not the best option when calls are not an emergency. And the old payment model provided an incentive to continue that drop-off – despite what’s best for the patient.

The ET3 model became a covered benefit of Texas-based Medicaid-approved service providers beginning September 1, 2022. This is an important milestone as the emergency services industry continues to focus on providing the best care for the community. ET3 allows these enrolled ambulance providers the flexibility to offer care at the right time and the right place. It not only can save money and improve the quality of care but also allow the emergency department to focus on true emergencies when others are transported elsewhere.

Currently, this reimbursement is only available through Texas Medicaid. To bill for these services, an emergency services provider must be enrolled as an ambulance provider in Texas Medicaid, respond to a call by an emergency response system, and determine the client’s needs are not an emergency but do require medical attention.

There is a challenge to the new payment model and benefit, however. Emergency service agencies do not know upfront whether a patient is covered under insurance, Medicaid, or another option. They will always do what’s right for the patient, but they may not get reimbursed in the process.

We are hopeful this change is only the beginning – and more payment models are shifted — as the emergency landscape continues to transition in Texas. We do know our industry will always do what’s best for the patient, whether payment is provided or not.

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