CMS Unveils New Value-Based Care, ACO Options for Rural Providers

A new rural health model recently unveiled by CMS will offer rural providers and their communities new funding opportunities to bolster value-based care through capitated payments and accountable care organization (ACO) participation.

According to yesterday’s announcement, the CHART Model aims to address rural health disparities by giving rural communities the financial resources needed to transform care delivery systems using innovative financial arrangements and operational and regulatory flexibilities.

The model is part of the President Trump’s Executive Order from last week on Improving Rural Health and Telehealth Access, as well as the President’s 2019 Medicare Executive Order and CMS’ Rethinking Rural Health initiative.

“The Trump Administration has placed an unprecedented priority on improving the health of the one in five Americans who live in rural areas,” CMS Administrator Seema Verma said in the announcement. “The CHART Model represents our next opportunity to make investments that will transform the rural health care system, allowing us to use every lever to support all Americans getting access to high-quality care where they live.”

Rural providers will have two opportunities to receive funding from CMS for value-based care efforts. The first being the CHART Model’s Community Transformation Track, which will give up to 15 rural communities a total of $75 million in seed money to lead organizations to implement care delivery reforms, reimburse providers capitated payments, and offer operational and regulatory flexibilities to establish a more sustainable rural healthcare system.

Lead organizations include but are not limited to state Medicaid agencies, state rural health offices, local public health departments, academic medical centers, and independent practice associations.

Telehealth expansions, such as allowing the beneficiary’s home to be an originating site, will be part of the flexibilities offered by the lead organizations in the Community Transformation Track, CMS stated.

Under the model’s track, rural outpatient departments and emergency rooms will also be paid as if they were classified as hospitals and participating hospitals will be able to waive cost-sharing for Medicare Part B services, as well as offer Medicare beneficiaries transportation and gift cards for chronic disease management, the federal agency noted.

Other benefit enhancements offered to participants include home visits after discharge from a hospital and for care management and a waiver of the 3-day inpatient stay prior to admission requirement for skilled nursing facility coverage.

Rural ACOs will also be able to get funding through the CHART Model’s ACO Transformation Track.

Under the track, CMS will provide upfront investments to up to 20 ACOs with the majority of its providers or suppliers in rural areas that participate. But the rural ACOs must participate in a two-sided financial risk arrangement in the Medicare Shared Savings Program (MSSP).

The ACOs will either receive a one-time payment of at least $200,000 plus $36 per beneficiary for a five-year agreement period in the MSSP or a prospective per beneficiary per month payment of at least $8 for up to 24 months.

The amount rural ACOs will receive upfront will hinge on the level of risk providers take on in the MSSP and the number of rural beneficiaries assigned to the ACO based on the MSSP’s patient attribution methodology. The maximum is 10,000 beneficiaries, according to model specifics.

Rural ACOs will also have access to operational and regulatory flexibilities through waivers available in the MSSP, CMS added.

According to the announcement, CMS will select rural communities for the Community Transformation Track in September, with the winners being announced in early 2021 and the model launching later that summer.

Rural ACOs will be able to submit a Request for Application in Spring 2021, with CMS selecting organizations to participate in the ACO Transformation Track starting in January 2021.

Already, healthcare stakeholders are praising the new rural health model, with the National Association of ACOs (NAACOS) calling the model a “needed and welcomed step for our health system’s move to value-based payment.”

Healthcare improvement company Premier Inc. also commended CMS on the CHART Model’s announcement.

“By requiring partnerships between health systems, state Medicaid agencies and other providers, the Community Transformation track will help break down the current care silos and enable coordination across the continuum to improve care,” Blair Childs, Premier’s senior vice president of public affairs, said in a statement. “Providers in rural areas will similarly benefit from capitated payments, which will ensure a predictable budget and a focus on innovative care to improve the health of their communities.”

Childs also stated that the ACO Transformation Track will “remove a major hurdle for rural providers wishing to transition to ACOs by providing critical up-front investment.”

But rural ACOs may still face issues with MSSP participation, NAACOS stated.

The program’s benchmarking methodology can disadvantage rural ACOs in a phenomenon known as the “rural glitch.” NAACOS advised CMS to address the flaw as another way to support rural providers.

The group also called for CMS to allow new ACOs to join the MSSP in 2021 even though the agency canceled a new 2021 MSSP ACO class as a result of the COVID-19 public health emergency. A new application cycle would provide rural ACOs with more opportunities to participate in value-based care.