CMS Delays CHART Model’s ACO Transformation Track

CMS has pushed back the application cycle by a year for a new rural-focused accountable care organization (ACO) model.

In an email sent yesterday, CMS said it has delayed the request for applications release date from spring 2021 to spring 2022 for the ACO Transformation Track of the upcoming Community Health Access and Rural Transformation (CHART) Model.

CMS had intended to select up to 20 rural-focused ACOs to receive advanced payments as part of joining the Medicare Shared Savings Program, in addition to awarding $75 million in upfront, seed funding to 15 rural communities via the Community Transformation Track.

The application cycle for the Community Transformation Track is still open, with a new deadline of May 11, 2021.

CMS did not indicate why it has decided to delay the CHART Model’s ACO Transformation Track.

“We will notify stakeholders of any updates via the CHART listserv, as information becomes available,” the agency stated in the email.

The CHART Model was announced in August 2020 under the Trump administration and aims to transform the rural healthcare system through new funding opportunities for rural communities as well as rural-focused ACOs.

Under the ACO Transformation Track, rural-focused ACOs will be able to receive a one-time upfront payment of at least $200,000 plus $36 per beneficiary to participate in a five-year agreement period of the Shared Savings Program through the CHART Model.

Rural-focused ACOs will also be eligible for a prospective per beneficiary per month (PBPM) payment equal to a minimum of $8 for up to two years.

Both the upfront payment and PBPM amount will vary based on the level of financial risk participating ACOs assume under the Shared Savings Program and the number of rural beneficiaries attributed to the organization, up to a maximum of 10,000 beneficiaries.

The ACO Transformation Track differs from the Community Transformation Track, which will award upfront funding to lead organizations, which will be state Medicaid agencies, academic medical centers, public health departments, and similar organizations that will coordinate care delivery transformations in their rural communities.

However, both CHART Model charts aim to increase financial stability for rural providers through alternative payment models that offer predictable revenue sources, such as capitated payments that also pay for quality and patient outcomes.

CMS also intends for the ACO Transformation Track’s advanced payments to help participating ACOs engage in value-based payment initiatives that improve patient outcomes and quality of care for rural beneficiaries.

The track was built on CMS’ previous ACO Investment Model, which successfully reduced spending while maintaining quality of care after providing upfront payments to participating ACOs for two years.

But leading ACO advocates are concerned that the ACO Transformation Track delay could be a problem for rural value-based care.

“Today’s announcement is a short-term setback but also provides an opportunity to work with CMS to grow participation in this type of accountable care investment model as well as population health-focused payment models,” the National Association of ACOs (NAACOS) president and CEO Clif Gaus, ScD, said in a statement yesterday.

NAACOS had previously applauded the ACO Transformation Track for providing the opportunity for rural healthcare providers to participate in a value-based care program. Although, the group argued that it would “help too few providers” and urged CMS to broaden participation.

“A new innovative CHART 2.0 option for ACOs in the Medicare Shared Savings Program would help foster the growth of new ACOs in underserved communities, improve beneficiary care and create savings for the Medicare program,” Gaus stated in yesterday’s statement.

About 57 million Americans live in rural communities, yet these individuals have worse health outcomes and higher rates of preventable diseases compared to residents of urban areas.

Rural providers are also disproportionally less involved in value-based payment models, according to NAACOS.