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Trump Administration Announces Program to Boost Rural Health Care

August 11, 2020

Today the Trump Administration announced the Community Health Access and Rural Transformation (CHART) Model. CHART advances efforts to create new ways to finance rural health care, as announced in President Trump’s recent Executive Order. Today’s announcement further builds on recent actions by the Centers for Medicare & Medicaid Services (CMS) to address health care delivery in rural America, including the expansion of telehealth and reducing the minimum required level of supervision for hospital outpatient therapeutic services provided by critical access hospitals.

CHART aims to:

  • Increase financial stability for rural health care providers
  • Remove regulatory and operational burdens
  • Enhance and sustain access to health care services in rural communities

CHART will provide new funding opportunities to achieve these goals. Leveraging value-based payment methodologies, the CHART model offers two options for participants:

  • Community Transformation Track—Fifteen rural communities will receive up to $75 million to reform the way they deliver care, provide predictable capitated payments, and pursue operational and regulatory flexibilities, such as expanding telehealth and waiving some Medicare hospital conditions of participation. Model participants will be selected during September and will begin participating in the model during the summer of 2021
  • Accountable Care Organization (ACO) Transformation Track—Twenty rural ACOs will be selected to participate in a two-sided risk arrangement as part of the Medicare Shared Savings Program (MSSP). Upfront investments and use of all the waivers available in the MSSP program are intended to assist rural health care providers in increasing quality and outcomes for rural beneficiaries. Requests for applications are expected to be released during the spring of 2021 with the model beginning during January 2022

During 2019, Pennsylvania launched the Rural Health Model, a global budget payment system, with five participating rural hospitals. During 2020, an additional eight hospitals joined the model. Similar to the goals set by the Trump Administration, the Pennsylvania model aims to ensure access to high quality, affordable health care for rural residents and create financial stability for hospitals operating within these communities. While differing slightly from the Community Transformation Track, which offers upfront funding, the Pennsylvania model is similar to this track in that it encourages utilizing predictable payments and offers the opportunity to pursue operational and regulatory flexibilities. 

For more information, contact Kate Slatt, HAP’s vice president, innovative payment and care delivery.



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