CMS Announces a Model for Rural Health Care Access and Transformation

On September 16, 2020, the CMS Innovation Center announced the Community Health Access and Rural Transformation (CHART) Model.

As part of that rural transformation, including transforming a system built on fee-for-service and volume to one based on value, CMS is testing the CHART Model.

Through the Model, CMS is directly providing a pool of $75 million in upfront seed funding, with 15 rural communities applying for up to $5 million to develop local transformation plans. With this upfront seed funding, CMS is also providing regulatory and operational flexibility for updated service delivery models as well as changing how participating hospitals in these communities are paid, from a system based on volume to stable, monthly payments. In addition to supporting these 15 rural communities, CMS is also looking for 20 rural accountable care organizations (ACOs) to participate in the model, paying shared savings up front so that ACOs have infrastructure funding to be successful in moving toward achieving better outcomes. Taken together, these are substantial and tangible actions to support health care in our rural communities.

Specifically, the CHART Model will:

• Increase financial stability for rural health care providers through multiple new funding approaches, including the use of up-front investments and predictable, capitated payments that pay for quality and patient outcomes over volume
• Provide the necessary operational and regulatory flexibilities to allow health care providers and CMS to test the Model in their local communities and successfully transform themselves
• Support local rural communities’ transformation efforts through direct engagement with CMS, which will offer real-time technical expertise and other learning when needed to foster success

If successful, beneficiaries’ access to health care services should be improved, rural provider’s financial sustainability should increase for years to come, and communities can align with payers and other stakeholders to address both their health care service delivery ecosystem and the necessary social support structures, such as food and housing, to deliver improved health. Ultimately, the CHART Model aims to improve quality and health while reducing Medicare and Medicaid expenditures in rural communities over the long term.

CMS is providing funding, regulatory and operational flexibilities, and technical assistance for rural communities to transform their systems of care through a Community Transformation Track. Further, CMS is enabling providers to participate in value-based payment models in which they are paid for quality and outcomes, instead of volume, through an ACO Transformation Track.

CMS anticipates the Notice of Funding Opportunity for the Community Transformation Track will be available in September on the Model website. The Request for Application for the ACO Transformation Track will be available in early 2021 on the CHART Model website.

See also the full text of this excerpted CMS Fact Sheet.