Evaluating CMMI’s Latest Opportunity for Rural Payment & Delivery Transformation

In August 2020, CMMI announced its latest rural initiative, the Community Health Access and Rural Transformation (CHART) model, a voluntary opportunity for rural communities to test care
transformation supported by value-based payment reform. The CHART model includes two participation tracks, the Community Transformation Track and the ACO Transformation Track, which will offer upfront investments, predictable capitated payments, and operational and regulatory flexibilities to enable value transformation for rural communities and rural ACOs, respectively.
On September 15, 2020, CMS posted the Notice of Funding Opportunity (NOFO) for the CHART model’s Community Transformation Track (CTT), which is modeled after the hospital global budget payment systems in Maryland and rural Pennsylvania and is the focus of this brief. The CHART model offers states and their rural providers an attractive opportunity to restructure payments to enable broader facility transformation. While the CTT will not be appropriate for every rural community, for some, it could be the mechanism for meaningful reform and longer-term financial sustainability. This paper summarizes the key new information published in the NOFO, along with strategic considerations for prospective applicants and a timeline for decisionmakers evaluating the model.

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