The Centers for Medicare & Medicaid Services (CMS) Innovation Center has announced the Community Health Access and Rural Transformation (CHART) Model, which seeks to help rural providers by reimbursing upfront investments and offering predictable, capitated payments that pay for quality and patient outcomes.
CMS notes that the approximately 57 million Americans living in rural communities face limited transportation options, shortages of healthcare services, and an inability to fully benefit from technological and care-delivery innovations.
The CHART Model aims to:
• Increase financial stability for rural providers through the use of new ways of reimbursing providers that provide up-front investments and predictable, capitated payments that pay for quality and patient outcomes;
• Remove regulatory burden by providing waivers that increase operational and regulatory flexibility for rural providers; and
• Enhance beneficiaries’ access to healthcare services by ensuring rural providers remain financially sustainable for years to come and can offer additional services such as those that address social determinants of health including food and housing.
The CHART Model will test whether upfront investments, predictable capitated payments, and operational and regulatory flexibilities will enable rural providers to improve access to high-quality care while reducing health care costs.
CMS is providing funding for rural communities to build systems of care through a Community Transformation Track and is enabling providers to participate in value-based payment models where they are paid for quality and outcomes, instead of volume, through an Accountable Care Organizations (ACO) Transformation Track.
CMS will select up to 15 Lead Organizations for the Community Transformation Track. The 15 organizations will coordinate efforts across the community to ensure that access to care is maintained and that the needs of various stakeholders are understood and accounted for in the transformation plan. Lead Organizations are responsible for managing cooperative agreement funding, recruiting participant hospitals, engaging the state Medicaid agency, establishing relationships with other aligned payers, convening the Advisory Council, and ensuring compliance with model requirements.
Lead Organizations will receive cooperative agreements of up to $5 million. CMS will make up to $2 million available upon acceptance into the CHART Model with the rest of the funding available as communities progress through the model.
A CHART ACO will be able to receive a one-time upfront payment equal to a minimum of $200,000 plus $36 per beneficiary to participate in the 5-year agreement period in the Shared Savings Program. A CHART ACO will be able to receive a prospective per beneficiary per month (PBPM) payment equal to a minimum of $8 for up to 24 months.
The amount for the upfront payment and the PBPM will vary based on the level of risk that the CHART ACO accepts in the Shared Savings Program and the number of rural beneficiaries assigned to it based on the Shared Savings Program assignment methodology, up to a maximum of 10,000 beneficiaries.
In a statement, Clif Gaus, president and CEO of the National Association of ACOs, described the announcement as a “needed and welcomed step for our health system’s move to value-based payment.”
Gaus also noted that another way to support rural providers in ACOs would be for CMS to address a flaw in how CMS sets ACO spending targets (i.e., benchmarks) to ensure rural ACOs are not disadvantaged compared to other ACOs. Often referred to as the “rural glitch,” NAACOS has long called for CMS to fix its benchmarking methodology. In addition to providing new opportunities to rural providers, NAACOS calls on CMS to continue expanding the progress of ACOs by allowing new ACOs to join the Medicare Shared Savings Program (MSSP) in 2021. Earlier this year the agency canceled a new 2021 MSSP ACO class due to challenges with the ongoing COVID-19 pandemic.
