The Centers for Medicare & Medicaid Services (CMS) has announced a new Innovation Center model intended to improve rural health by leveraging innovative financial arrangements, and providing operational and regulatory flexibilities.
Under the Community Health Access and Rural Transformation (CHART) model, CMS will test whether upfront investments, predictable capitated payments, and operational and regulatory flexibilities will enable rural health care providers to improve access to high-quality care while reducing health care costs.
The CHART model includes two tracks — the Community Transformation Track and the Accountable Care Organization (ACO) Transformation Track. The Community Transformation Track will require “lead organizations” to partner with rural hospitals and providers, state Medicaid agencies, and other payers to manage delivery system reforms under the model. Lead organizations can include but are not limited to state Medicaid agencies, state offices of rural health, local public health departments, independent practice associations, and academic medical centers. CMS will select up to 15 lead organizations, which will receive up to $5 million in cooperative funding — up to $2 million of which is available upon acceptance into the CHART model.
Hospital participants will receive capitated payments and waivers for several Medicare requirements, including waivers of the three-day inpatient stay prior to skilled-nursing facility admission, cost sharing for Part B services and other beneficiary benefit enhancements, as well as expanded use of telehealth services. CMS anticipates the Notice of Funding Opportunity for the Community Transformation Track will be available in September on the model website, and participants will be announced in spring 2021.
Under the ACO Transformation Track, CMS will select up to 20 rural-focused ACOs to receive advanced payments as part of joining the Medicare Shared Savings Program. CMS will offer CHART ACOs advanced shared-savings payments comprised of two components:
- 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 five-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. CMS anticipates the request for application for the ACO Transformation Track will be available in early 2021.