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CMS delays ACO Track of the Community Health Access and Rural Transformation Model 

CHART was set up to test whether upfront investments, capitated payments and regulatory flexibilities improve care while reducing costs.

Susan Morse, Managing Editor

(Photo by Martin Barraud\Getty Images)(Photo by Martin Barraud\Getty Images)

The Centers for Medicare and Medicaid Services is delaying the ACO Track of the Community Health Access and Rural Transformation Model, to the disappointment of the National Association of ACOs.

CMS gave no reason for the delay from this spring to spring 2022.

The delay applies only to the ACO Transformation Track of the CHART Model, and not to the Community Transformation Track. 

Clif Gaus, president and CEO of the National Association of ACOs, called the delay for ACOs a short-term setback.

"We look forward to working with the CMS Innovation Center to expand the eligibility and scale of a new ACO loan program for rural and small ACOs," Gaus said. "CHART's precursor, the ACO Investment Model, was one of the most successful Innovation Center models, creating a path toward alternative payment model participation for providers who would otherwise struggle to get there."


The CHART Model aims to address rural healthcare delivery disparities through financial arrangements and operational and regulatory flexibilities. It will test whether upfront investments, capitated payments and operational and regulatory flexibilities improve access to rural care while reducing costs.

CMS said it would select up to 20 rural-focused ACOs to receive advance payments as part of joining the Medicare Shared Savings Program. 

A CHART ACO would 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. It would also be able to receive a prospective per beneficiary per month payment equal to a minimum of $8 for up to 24 months.

The amount of the upfront payment and the per-beneficiary, per-month payment would vary based on the level of risk that the CHART ACO accepted in the Shared Savings Program and the number of rural beneficiaries, up to a maximum of 10,000.

NAACOS expressed support for CHART, but in October 2020 told CMS it would help too few providers, and urged the agency to allow for broader participation.

On Tuesday Gaus suggested a new innovative CHART 2.0 option for ACOs already in the Medicare Shared Savings Program. 


CMS announced the new value-based model in August 2020, saying healthcare challenges in rural Americans result in worse health outcomes and higher rates of preventable diseases than those living in urban areas. Approximately 57 million Americans, about one in five, live in a rural community. 

Challenges may include limited transportation options, a shortage of healthcare services, and an inability to fully benefit from technological and care-delivery innovations. 

Hospitals are also challenged, since the percentage with negative operating margins runs between 44% and 52%.

Many rural hospitals also have difficulty recruiting and retaining medical professionals.

For these and other reasons, rural providers have been slow to adopt national value-based payment models.

Twitter: @SusanJMorse
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