CHART Model Community Transformation Track in Texas

Status of the CHART Model in Texas

The Community Health Access and Rural Transformation (CHART) Model is a 7-year federal funding opportunity for eligible rural hospitals to voluntarily participate to test health care transformation supported by payment reform through implementation of alternative payment models (APMS) in Medicare and Medicaid. The deadline for hospitals to sign a Participation Agreement to join Performance Period 1 (Calendar Year 2023) of the CHART Model was Nov. 1, 2022. Unfortunately, no Texas rural hospitals opted to join the Model for this year. HHSC surveyed potential Participant Hospitals on factors considered in the hospitals decision-making and is communicating these results with the Centers for Medicare & Medicaid Services (CMS) for consideration. HHSC and CMS are evaluating next steps for the Model and hospital recruitment for Performance Period 2 (Calendar Year 2024).

HHSC began recruitment of potential Participant Hospitals for the CHART Model on Oct. 1, 2021. HHSC’s robust recruitment efforts consisted of sending multiple notices and emails to stakeholders on CHART Model updates, responding to stakeholder inquiries regarding the CHART Model, presenting and attending at Texas Organization of Rural and Community Hospitals (TORCH) conferences, hosting one-on-one meetings with potential Participation Hospital meetings, facilitating topic-focused meetings with potential Participant Hospitals including a Financial Readiness Panel and Q&A session with the CMS, distributed key information regarding the CHART Model such as an estimated and final Medicare Capitated Payment Amount to potential Participant Hospitals, and consistently posting new information and materials on the HHSC CHART Model website.

If you are interested in receiving additional information about the CHART Model in Texas, please sign up for email updates.

If you are interested in additional information about HHSC’s recruitment efforts for the CHART Model in 2022, please review the HHSC CHART Model Pre-Implementation Resources.

CHART Model Funding Tracks

The CHART Model is a funding opportunity from CMS. The CHART Model is a voluntary opportunity for rural communities to test health care transformation supported by payment reform.

  • The Community Transformation Track – Provides award recipients with cooperative agreement funding and a programmatic framework to assess the needs of their Community and implement health care delivery system redesign. This track builds on the lessons from the Maryland Total Cost of Care Model and Pennsylvania Rural Health Model.
  • The Accountable Care Organization (ACO) Transformation Track (Removed by CMS) – Provides upfront payments to rural ACOs that join the Medicare Shared Savings Program. This track builds on lessons learned from the ACO Investment Model. CMS has announced the removal of the ACO Transformation Track from the CHART model; therefore, the ACO request for applications will not be released as previously communicated. Please visit the CMS website for more information.

CHART Model Community Transformation Track

The CHART Community Transformation Track will provide rural hospitals with three ways to transform their local health care system:

  1. Regular lump sum payments based on a hospital’s Medicare fee-for-service income (a.k.a. capitated payment amount)

    CMS will replace Medicare fee-for-service claims reimbursement for Participant Hospitals with regular, lump sum payments also called a “capitated payment amount (CPA)” throughout the duration of the CHART Model. The CHART Model CPA will be calculated by CMS, not HHSC. The benefit of this payment change to hospitals is that the CPA payment provides stability and predictability, as well as the freedom to invest in new service lines and utilize regulatory flexibilities offered by the CHART Model initiative. For example, hospitals may have had to focus on providing higher-reimbursing specialty services over essential primary care and improving behavioral health capacity or maintaining inpatient beds to meet Medicare conditions of participation, even when it may not be what is needed in the community.
  2. Cooperative Agreement Funding

    As the CHART Model Lead Organization for Texas, HHSC will disperse up to $2.7 million in cooperative agreement funding to participant hospitals. Participating hospitals will use the funding to establish partnerships and technical support to address one or more health challenges in the Texas CHART application to establish a telemedicine project that fits the needs of the hospital's county, and to address health disparities and selected social determinants of health.
  3. Operational Flexibilities

    CMS will make available certain operational flexibilities to expand Lead Organizations’ ability to implement health care delivery system redesign and promote participating hospitals’ capacity to manage their patients’ care. Lead Organizations, like HHSC, will be responsible for requesting operational flexibilities in their Transformation Plans in consultation with Participant Hospitals.

    These flexibilities will be provided through a combination of the Model Design Flexibilities listed in the notice of funding opportunity and through CMMI’s authority under section 1115A(d)(1) of the Act to waive certain Medicare and Medicaid requirements, solely as may be necessary to test the Model. CMMI may waive such requirements of Titles XI and XVIII and of sections 1902(a)(1), 1902(a)(13), 1903(m)(2)(A)(iii), and provisions of section 1934 that were added to section 1115A(d)(1) by the PACE Innovation Act as may be necessary solely for purposes of carrying out section 1115A with respect to testing models described in section 1115A(b).

CHART Model Award

As the Lead Organization, HHSC will receive up to $5 million in cooperative agreement funding. HHSC’s goal is to use much of the cooperative agreement funding to:

  • Provide technical assistance to hospitals related to transformation
  • Allow hospitals to purchase telemedicine equipment, training, software and hire additional staff, if needed, to implement transformation goals

If successful, residents of participating rural communities should see improvement in access to health care services, financial stability of providers and an alignment of payers and other stakeholders to address both the communities’ needs and social support structures, such as food and housing, to ensure improved health. Ultimately, the CHART Model’s purpose is to bring improved financial stability to participant rural hospitals through capitated arrangements and provide strategies to address health challenges through telemedicine. Through the CHART Model, health care providers, as well as public and private payers, can collectively invest in increasing access to care, promoting quality and improving the health outcomes of residents within their Community.

The estimated project period is Oct. 1, 2021 through Dec. 31, 2028.

If you are interested in receiving additional information about the CHART Model in Texas, sign up for email updates.

HHSC’s CHART Model application and supplementary materials are included below. It is recommended to view the CHART Model application requirements on pages 51 – 59 of the CHART Model Notice of Funding Opportunity before viewing HHSC’s application. These pages show the information HHSC was required to include in its application.

The following additional resource materials prepared by HHSC in advance of HHSC’s CHART Model application provide more detail on HHSC’s planned approach for implementing the CHART Model in Texas.

CHART Model Advisory Council

Recognizing that stakeholder engagement is key to effective reform, the CHART Model requires an Advisory Council to be established. It is a multi-stakeholder group that will advise HHSC, the state’s Lead Organization, about certain deliverables and topics related to the CHART Model. The Council will meet quarterly, and its purpose will be to provide critical feedback in the development and implementation of Texas’ CHART Model Transformation Plan and assist with collaboration efforts with Participant Hospitals and other key stakeholders. Other activities the Advisory Council may contribute to are: recruiting hospitals and Aligned Payers, developing APM ideas, identifying technical assistance needs of participating hospitals related to their telemedicine projects and Community health challenges, and monitoring the progress of the Model. Summaries from Council meetings will be posted after each meeting.

CHART Model and Rural Health Care Resources