Emergency Triage, Treat, and Transport (ET3) Model


The Center for Medicare and Medicaid Innovation (CMMI) is releasing a Notice of Funding Opportunity announcement for the ET3 model ? a new, voluntary, five-year payment model designed to allow Medicare Fee-for-Service (FFS) beneficiaries access to the most appropriate emergency care at the right time and place. This announcement will present the funding opportunity for entities in control of their region?s 911 line. The intervention for this funding will be to establish or expand on a medical triage line integrated with the region?s 911 line, with the goal of diverting unnecessary emergency department transports and hospital admissions from the emergency department/hospital to more appropriate care in the community. In locations where ambulance suppliers and providers have already been accepted into the model, state and local governments will have the option to apply for this cooperative agreement aimed at triaging and prioritizing 911 calls so transport services are better utilized.

General information about this opportunity
Last Known Status
Program Number
Federal Agency/Office
Centers For Medicare and Medicaid Services, Department of Health and Human Services
Type(s) of Assistance Offered
A - Formula Grants
Program Accomplishments
Not applicable.
Section 1115A of the Social Security Act (the “Act”) authorizes the Innovation Center to test innovative payment and service delivery models to reduce Medicare, Medicaid, and CHIP expenditures while preserving or enhancing the quality of beneficiaries’ care. The ET3 model would be tested under this authority., Title Social Security Act, Section 1115A
Who is eligible to apply/benefit from this assistance?
Applicant Eligibility
Applicants eligible to apply to this NOFO must have authority over the 911 system in the same geographic area as an ET3 model participant (i.e., an ambulance provider or supplier in the ET3 model). .
Beneficiary Eligibility
Applicants eligible to apply to this NOFO must have authority over the 911 system in the same geographic area as an ET3 model participant (i.e., an ambulance provider or supplier in the ET3 model). Therefore, as long as an applicant meets this requirement, there is no restriction on who can apply.
The applicant must register in the System for Award Management (SAM) database in order to be able to submit the application. The applicant must provide an Employer Identification Number (EIN), otherwise known as a Taxpayer Identification Number (TIN), to apply. All applicants must have a Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS) number.
What is the process for applying and being award this assistance?
Pre-Application Procedure
Preapplication coordination is not applicable.
Application Procedure
2 CFR 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards applies to this program. Each entity that applies for the ET3 model must respond to the Program Requirements set forth in the NOFO. The awardee will be responsible for determining the budget allocations for staff time and infrastructure costs consistent with the terms of the cooperative agreement, and demonstrate how the applicant will utilize funds in model implementation as part of their application. The application procedure is as follows: Application materials will be available for download at http://www.grants.gov. Please note that HHS requires applications for all announcements to be submitted electronically through http://www.grants.gov. For assistance with http://www.grants.gov, contact support@grants.gov or 1-800-518-4726. At Grants.gov, applicants will be able to download a copy of the application packet, complete it off-line, and then upload and submit the application via the Grants.gov website. Specific instructions for applications submitted via http://www.grants.gov: You may access the electronic application for this project at http://www.grants.gov. You must search the downloadable application page by the CFDA number. At the http://www.grants.gov website, you will find information about submitting an application electronically through the site, including the hours of operation. HHS strongly recommends that you do not wait until the application due date to begin the application process through http://www.grants.gov because of the time needed to complete the required registration steps. The applicant must be registered in the System for Award Management (SAM) database in order to be able to submit the application. Applicants are encouraged to register early, and must have their DUNS and EIN/TIN numbers in order to do so. Authorized Organizational Representative: The Authorized Organizational Representative (AOR) who will officially submit an application on behalf of the organization must register with grants.gov for a username and password. AORs must complete a profile with Grants.gov using their organization's DUNS Number to obtain their username and password at http://grants.gov/applicants/get_registered.jsp. AORs must wait one business day after successful registration in SAM before entering their profiles in Grants.gov. Applicants should complete this process as soon as possible after successful registration in SAM to ensure this step is completed in time to apply before application deadlines. When an AOR registers with Grants.gov to submit applications on behalf of an organization, that organization's E-Biz POC will receive an email notification. The email address provided in the profile will be the email used to send the notification from Grants.gov to the E-Biz POC with the AOR copied on the correspondence. The E-Biz POC must then login to Grants.gov (using the organization's DUNS number for the username and the special password called "M-PIN") and approve the AOR, thereby providing permission to submit applications. Any files uploaded or attached to the Grants.gov application must be PDF file format and must contain a valid file format extension in the filename. Even though Grants.gov allows applicants to attach any file formats as part of their application, CMS restricts this practice and only accepts PDF file formats. Any file submitted as part of the Grants.gov application that is not in a PDF file format, or contains password protection, will not be accepted for processing and will be excluded from the application during the review process. In addition, the use of compressed file formats such as ZIP, RAR, or Adobe Portfolio will not be accepted. The application must be submitted in a file format that can easily be copied and read by reviewers. It is recommended that scanned copies not be submitted through Grants.gov unless the applicant confirms the clarity of the documents. Pages cannot be reduced in size, resulting in multiple pages on a single sheet, to avoid exceeding the page limitation. All documents that do not conform to the above specifications will be excluded from the application materials during the review process. After you electronically submit your application, you will receive an acknowledgement from http://www.grants.gov that contains a Grants.gov tracking number. HHS will retrieve your application package from Grants.gov. Please note, applicants may incur a time delay before they receive acknowledgement that the application has been accepted by the Grants.gov system. Applicants should not wait until the application deadline to apply because notification by Grants.gov that the application is incomplete may not be received until close to or after the application deadline, eliminating the opportunity to correct errors and resubmit the application. Applications submitted after the deadline, as a result of errors on the part of the applicant, will not be reviewed. After HHS retrieves your application package from Grants.gov, a return receipt will be emailed to the applicant contact. This will be in addition to the validation number provided by Grants.gov. Applications cannot be accepted through any email address. Full applications can only be accepted through http://www.grants.gov. Full applications cannot be received via paper mail, courier, or delivery service. All grant applications must be submitted electronically and be received through http://www.grants.gov by 3:00 pm Eastern Daylight Time on the applicable due date. Applications not successfully submitted to Grants.gov by the due date and time will not be eligible for review. All applications will receive an automatic time stamp upon submission and applicants will receive an email reply acknowledging the application's receipt. Please be aware of the following: 1) Search for the application package in Grants.gov by entering the CFDA number. This number is shown on the cover page of this announcement. 2) If you experience technical challenges while submitting your application electronically, please contact Grants.gov Support directly at: www.grants.gov/customersupport or (800) 518-4726. Customer Support is available to address questions 24 hours a day, 7 days a week (except on Federal holidays). 3) Upon contacting Grants.gov, obtain a tracking number as proof of contact. The tracking number is helpful if there are technical issues that cannot be resolved. To be considered timely, applications must be received by the published deadline date. However, a general extension of a published application deadline that affects all State applicants or only those in a defined geographical area may be authorized by circumstances that affect the public at large, such as natural disasters (e.g., floods or hurricanes) or disruptions of electronic (e.g., application receipt services) or other services, such as a prolonged blackout. This statement does not apply to an individual entity having internet service problems. In order for there to be any consideration there must be an effect on the public at large. Grants.gov complies with Section 508 of the Rehabilitation Act of 1973. If an individual uses assistive technology and is unable to access any material on the site including forms contained with an application package, they can email the Grants.gov contact center at support@grants.gov or call 1-800-518-4726.
Award Procedure
1. Successful applicants will receive a Notice of Award (NoA) signed and dated by the CMS Grants Management Officer that will set forth the amount of the award and other pertinent information. The award will also include standard Terms and Conditions. Applicant should be aware that special requirements could apply to cooperative agreement awards based on the particular circumstances of the effort to be supported and/or deficiencies identified by the review panel. 2. Award funds will be distributed through the Payment Management System.
Contact the headquarters or regional location, as appropriate for application deadlines
Approval/Disapproval Decision Time
Approximately 6 months
Not Applicable. CMS reserves the right to approve or deny any or all proposals for funding. The Innovation Center's authorizing statute at 1115A(d)(2) of the Social Security Act states that there is no administrative or judicial review of the selection of organizations, sites, or participants to test models.
Not applicable.
How are proposals selected?
Applications will be forwarded to a review panel. The review panel will evaluate the proposals based on how well they address the evaluation criteria outlined in the NOFO. Successful applicants will receive a Notice of Award (NoA) signed and dated by the CMS Grants Management Officer that will set forth the amount of the award and other pertinent information. The award will also include standard Terms and Conditions. Applicants should be aware that special requirements could apply to cooperative agreement awards based on the particular circumstances of the effort to be supported and/or deficiencies identified by the review panel.
How may assistance be used?
CMS intends for Awardees to use model funding for staff time and infrastructure costs incurred due to activities that are required to design, implement and operate a 911 triage line for the ET3 model. Below we list examples of potentially allowable expenses for model funding (assuming there is no supplanting of other federal, state, or local program funding): • Staff training on triage line and ET3 model activities; • Triage line staff salaries; • Hardware and software required to establish a triage line; • Contractual costs related to establishing a triage line; • Participation in CMS evaluation activities, including data collection and reporting
What are the requirements after being awarded this opportunity?
Performance Reports: Awardees are required report of their progress on a set of program milestones that cover operational aspects of model implementation as well as performance on specific measures of beneficiary impact. These milestones are detailed in the NOFO. These reports will be submitted as part of the quarterly and annual progress reports.
Awardees must comply with audit requirements outlined in HHS regulation 45 CFR Part 75
Awardees are required to maintain a record of all identifiable source data used to generate the values reported for program monitoring and milestones and must make this data available to CMS for program monitoring, auditing, and evaluation purposes upon request.
Other Assistance Considerations
Formula and Matching Requirements
Statutory formula is not applicable to this assistance listing.

Matching requirements are not applicable to this assistance listing.

MOE requirements are not applicable to this assistance listing.
Length and Time Phasing of Assistance
ET3 Model funding awarded through cooperative agreements will be available on an annual basis for up to two years, pending continued compliance with terms of the award and availability of funds. This line of funding for the ET3 model will start in FY2020 and end in FY2021. Cooperative agreement
Who do I contact about this opportunity?
Regional or Local Office
None. The ET3 model is being developed and will be managed by the CMS Innovation Center. See below for Contact Information.
Headquarters Office
Alexis Lilly
7500 Security Blvd
Baltimore, MD 21244 USA
Phone: 410-786-3501
Website Address
Financial Information
Account Identification
(Formula Grants (Cooperative Agreements)) FY 18 FY 19 FY 20 est $17,000,000.00; -
Range and Average of Financial Assistance
The ET3 Model will award up to $34 Million in cooperative agreement funds across up to 40 awardees during the two-year performance period.
Regulations, Guidelines and Literature
Published information pertinent to the ET3 model is available at https://innovation.cms.gov/initiatives/et3/
Examples of Funded Projects
Not applicable.


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