On February 22, 2022, CMS announced that it has 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 through “leveraging innovative financial arrangements as well as operational and regulatory flexibilities.” The decision to remove the ACO transformation track comes nearly a year after CMS delayed a request for applications for the ACO transformation track in March 2021.

Specifically, one of the CHART Model’s stated objectives is to increase “financial stability for rural health care providers through multiple new funding approaches, including the use of up-front investments and predictable, capitated payments that pay for quality and patient outcomes over volume[.]” To that end, the CHART Model provided for two separate tracks: the Community Transformation Track and the ACO Transformation Track.
The Community Transformation Track offers upfront 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 asserts that its decision to eliminate the ACO Transformation Track from the CHART Model is part of its “broader efforts” to “to advance health equity and to increase the number of beneficiaries in accountable care relationships.”