On February 22, 2022, CMS announced that it had removed the Accountable Care Organization (ACO) transformation track from the Community Health Access and Rural Transformation (CHART) model. According to CMS, the CHART model is intended to help individuals in rural communities, including Medicare and Medicaid beneficiaries, by transforming their health care delivery systems by “taking advantage of innovative financial arrangements as well as operational and regulatory flexibilities.” “. The decision to remove the ACO Transformation Pathway comes nearly a year after CMS delayed a request for applications for the ACO Transformation Pathway in March 2021.
Specifically, one of the stated goals of the CHART model is to increase “the financial stability of rural health care providers through multiple new financing approaches, including the use of upfront investments and payments capitation that pays for quality and patient outcomes in relation to volume”.[.]To this end, the CHART model provided for two distinct tracks: the community transformation track and the ACO transformation track.
The Community Transformation Stream provides seed funding to state Medicaid agencies, local public health departments, independent practice associations, academic medical centers, and other organizations to provide coordinated care in rural areas.
Under the ACO Transformation Track, participating rural ACOs were to receive a one-time upfront payment equal to a minimum of $200,000 plus $36 per beneficiary to participate in the CHART model.
CMS says its decision to eliminate the ACO transformation track from the CHART model is part of its “broader efforts” to “advance health equity and increase the number of beneficiaries in responsible care relationships.”