ET3 Program Comes to an Abrupt End

The photo shows the back of a yellow Fairfax County (VA) ambulance.
Photo/National Highway Safety Traffic Administration

The federal government is ending its Emergency Triage, Treat, and Transport (ET3) Model two years ahead of schedule, saying the number of “interventions” were lower than anticipated.

“Emergency Medical Services remain an area of focus for CMS, and we believe that the lessons learned from the ET3 Model can aid in the development of potential future initiatives,” Centers for Medicare & Medicaid Services wrote. “This decision does not affect Model Participants’ participation in the Model through December 31, 2023.”

When launched in January 2021, the ET3 program was heralded for its innovation in getting ambulance services reimbursed for alternative forms of patient care and transport. Previously, EMS providers were only reimbursed for transporting patients to hospitals.

The ET3 model made Medicare reimbursement available for certain non-transport ambulance services and ambulance transports to alternate destinations.

UPDATE: CMS sent JEMS a letter it sent out to providers about the upcoming ending of ET3. It is being re-published in full below.

Thank you for your continued efforts and commitment to the Emergency Triage, Treat, and Transport (ET3) Model.

After careful consideration, the Centers for Medicare & Medicaid Services (CMS) has decided to end the ET3 Model (the “Model”) early, on December 31, 2023, which is two years prior to the ET3 Model Participation Agreement’s (the “Agreement”) original Performance Period end date.

Article 19.3(b) of the Agreement provides that CMS may immediately or with advance notice terminate the Agreement by promptly notifying the Participant, in writing, of the effective date of the termination and the reason for such termination. CMS may terminate the Agreement if CMS determines in its sole discretion that CMS no longer has the funds to support the Model or that continuing the Model is no longer in the public interest.

CMS has determined that it is in the public interest to end the ET3 Model. CMS made this determination based on a number of factors, including the current number of interventions. Current and projected number of interventions are lower than the number anticipated when the Model was designed. This affects the cost of operating the Model relative to its expected benefits, the ability of CMS to conduct a robust quantitative evaluation of the Model’s impact, and the Model’s ability to achieve the estimated Medicare savings in the Model’s design. For these reasons, CMS has determined that it is not in the public interest to test the Model in Performance Year 4 (i.e., Calendar Year 2024) through Performance Year 5 (i.e., Calendar Year 2025) and has good cause to unilaterally amend the Agreement to modify its Performance Period.

As a result of this decision, CMS intends to release an amendment to the Agreement within 30 days of this notice to modify the Model performance period. Article 21.4 of the Agreement provides that CMS may unilaterally amend the Agreement or any Appendix thereto as specified in the Agreement, including its Appendices, or for good cause or as necessary to comply with applicable federal or State law, regulatory requirements, accreditation standards or licensing guidelines or rules.This decision does not affect Model Participants’ participation in the Model through December 31, 2023, the ability to bill for ET3 interventions with a date of service through December 31, 2023, or the ability to receive performance-based payments. In addition, this does not impact Participants’ ability to apply for any subsequent or future models. If you have any questions, please email ET3Model@cms.hhs.gov.

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