Loyola University Chicago School of Law, JD 2022
The Centers for Medicare & Medicaid Services (“CMS”) Innovation Center (“CMMI”) recently announced a new model for health care providers in rural areas to receive payment from the federal government. The Community Health Access and Rural Transformation (“CHART”) initiative aims to improve rural health care while promoting the Trump Administration’s push to shift health care providers into a more expansive value-based payment model.
Why would CMS introduce the CHART model now?
Rural communities in the United States comprise of nearly 60 million people who face unique barriers in their access to quality health care services. A vast majority of Americans residing in rural areas are Medicare and Medicaid beneficiaries, yet many are unable to utilize their health care benefits for lack of transportation, shortages in health care services, and dated technology that hinders care-delivery innovations. CMS has stated that the current fee-for-service and volume-based payment models permeate the health care inequities in rural communities but remains focused on the transformation of rural health care delivery through the new CHART model.
Since 2010, over 130 rural hospitals have closed their doors, and this trend has led to a shortage of 20,000 rural health care workers, including primary care physicians. These circumstances have led to rural Americans with higher rates of preventable diseases, unintentional injuries, and worse health outcomes than Americans residing in urban and suburban communities. The CMS introduction of the CHART model attempts to remedy these inherent rural health care obstacles by empowering local communities to create solutions that are tailored to their specific needs.
How will the CHART model operate?
CMMI will be providing $75 million of seed funding from CMS to fifteen rural communities to submit their plans to transform their health care facilities ranging from rural health centers, ambulatory surgery clinics, rural inpatient facilities, freestanding clinics, and more. The selected rural communities will serve as Lead Organizations who are paid for their quality and outcomes of care rather than the volume of their care. The Lead Organizations must be contained within rural counties as classified by the Federal Office of Rural Health Policy and will be responsible for working closely with CHART model participants in the communities.
In return, CMS will offer flexibility in both regulatory and operational requirements in an effort to embolden rural hospitals to transform their care delivery system. CMS will also provide regular monthly payments to these hospitals in an effort to stabilize the CHART model throughout the trial period.
Additionally, twenty rural Accountable Care Organizations (“ACOs”) will have the ability to join in the CHART model. ACOs will be paid their shared savings upfront to encourage stable infrastructure and long-term expansion of the ACO in a given rural community.
What is the timeline for rural communities to apply for CHART funding?
Interested rural health care providers and hospital systems can find the notice of funding opportunity on the CMMI CHART website now or on the federal government grant website. Communities that wish to participate in the Transformation Track of the CHART Model must submit their Letters of Intent by January 28, 2022, and applications for the program will be due shortly thereafter on February 16, 2022.
The current public health emergency from COVID-19 has exacerbated health disparities in rural communities. Not only have rural health systems suffered for years under the volume-based payment model, but access to quality care during a pandemic has highlighted the need for swift and meaningful intervention from CMS. The complicated and outdated payment model has not benefited rural health care providers, but the introduction of the CHART model will be the necessary push into a value-based payment system that will enhance rural health care access and lessen disparate outcomes. Although the CHART model is not operational yet, compliance with program rules will be essential to the pilot program. Rural hospitals that receive the CMS funding will need to reinforce their internal monitoring and auditing functions to guarantee funding and CHART program functionality.