THE VALUED VOICE

Vol. 64, Issue 34
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Thursday, August 20, 2020

   

New CMS Payment Model Aims to Improve Rural Health Care

In conjunction with an August 3 Executive Order issued by President Donald Trump, the Centers for Medicare & Medicaid Services (CMS) announced a new payment model on August 11 with the goal of increasing access to and improving the quality and financial economics of rural health care. This new demonstration model, the Community Health Access and Rural Transformation (CHART) Model, aims to increase rural providers’ financial stability by providing up-front funding and predictable payments that are less dependent on service volume. The CHART model will also relax certain requirements via waiver to reduce regulatory burden and increase flexibilities for model participants. CHART has two tracks: The Community Transformation Track, and the Accountable Care Organization (ACO) Transformation Track. 

Under the guidance of a lead agency which will manage funding, recruit hospitals, engage with the state Medicaid agency and ensure compliance with CHART model requirements, participating rural hospitals in the Community Transformation Track will be involved in implementing a health care delivery redesign strategy. Model participants will benefit from regulatory flexibilities to support the redesign process, including cost sharing waivers for Part B services, transportation assistance for beneficiaries with transportation, waiver of the three-day inpatient stay requirement prior to admission to a Skilled Nursing Facility and the Critical Access Hospital 96-hour rule, telehealth expansion, post-discharge and care management home visits, and the waiver of certain Medicare hospital conditions of participation.  

Applications for the Community Transformation Track will be available in September, with implementation expected in the Summer of 2021. Up to 15 lead agencies will receive as much as $5 million to implement the redesign, and participating hospitals will receive a prospectively set capitated payment amount each year. 

The ACO Transformation Track will provide up-front funding for up to 20 rural-focused ACOs. Participating ACOs will be required to enroll in a two-sided level of the Medicare Shared Savings Program (MSSP) and will have access to all waivers and beneficiary incentive programs available in the MSSP program. ACOs will receive a one-time up-front payment of at least $200,000 plus $36 per beneficiary, and a prospective per-beneficiary, per-month (PBPM) payment of at least $8 for up to 24 months. The actual amount will be based on the level of risk assumed by the ACO. A request for application for the ACO Transformation Track will be available in spring 2021, with implementation expected in January 2022.

Contact WHA Vice President of Policy Development Laura Rose for more information on these programs. 

This story originally appeared in the August 20, 2020 edition of WHA Newsletter

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Thursday, August 20, 2020

New CMS Payment Model Aims to Improve Rural Health Care

In conjunction with an August 3 Executive Order issued by President Donald Trump, the Centers for Medicare & Medicaid Services (CMS) announced a new payment model on August 11 with the goal of increasing access to and improving the quality and financial economics of rural health care. This new demonstration model, the Community Health Access and Rural Transformation (CHART) Model, aims to increase rural providers’ financial stability by providing up-front funding and predictable payments that are less dependent on service volume. The CHART model will also relax certain requirements via waiver to reduce regulatory burden and increase flexibilities for model participants. CHART has two tracks: The Community Transformation Track, and the Accountable Care Organization (ACO) Transformation Track. 

Under the guidance of a lead agency which will manage funding, recruit hospitals, engage with the state Medicaid agency and ensure compliance with CHART model requirements, participating rural hospitals in the Community Transformation Track will be involved in implementing a health care delivery redesign strategy. Model participants will benefit from regulatory flexibilities to support the redesign process, including cost sharing waivers for Part B services, transportation assistance for beneficiaries with transportation, waiver of the three-day inpatient stay requirement prior to admission to a Skilled Nursing Facility and the Critical Access Hospital 96-hour rule, telehealth expansion, post-discharge and care management home visits, and the waiver of certain Medicare hospital conditions of participation.  

Applications for the Community Transformation Track will be available in September, with implementation expected in the Summer of 2021. Up to 15 lead agencies will receive as much as $5 million to implement the redesign, and participating hospitals will receive a prospectively set capitated payment amount each year. 

The ACO Transformation Track will provide up-front funding for up to 20 rural-focused ACOs. Participating ACOs will be required to enroll in a two-sided level of the Medicare Shared Savings Program (MSSP) and will have access to all waivers and beneficiary incentive programs available in the MSSP program. ACOs will receive a one-time up-front payment of at least $200,000 plus $36 per beneficiary, and a prospective per-beneficiary, per-month (PBPM) payment of at least $8 for up to 24 months. The actual amount will be based on the level of risk assumed by the ACO. A request for application for the ACO Transformation Track will be available in spring 2021, with implementation expected in January 2022.

Contact WHA Vice President of Policy Development Laura Rose for more information on these programs. 

This story originally appeared in the August 20, 2020 edition of WHA Newsletter