CHART Model Community Transformation Track in Texas

Roadmap to Chart Model Participation

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

The interest form is now closed for rural hospitals to identify their interest in possible participation in the CHART Model. 

If your hospital submitted a Letter of Intent and/or interest form, you should:
Prepare to assist HHSC staff as needed from May 1 to July 5, 2022 by providing information for the Transformation Plan. 

Continue discussions with your hospital leadership board/team about how your hospital will comply with the CHART Model Community Transformation Track requirements. (e.g., telemedicine project, social determinants of health).

Attend optional web-based meetings hosted periodically by HHSC about CHART Model participation. Each meeting focuses in detail about a different CHART Model requirement.

Prepare your hospital leadership to decide by July 1, 2022 whether to continue to prepare to participate in the CHART Model Community Transformation Track. (Hospitals will not have to sign a participation agreement with the Centers for Medicare and Medicaid Services (CMS) until October (November 1, 2022).) 

Review and complete identified steps in the CHART Model Participation Checklist, including reviewing important resources and documents, such as the CHART Model Participation Community Track Financial Specifications,  and Operational Flexibilities Exercise.

  • Notify HHSC (HHSC_CHART@hhsc.state.tx.us) immediately if your hospital reaches a decision NOT to participate in the CHART Model Community Transformation Track.

Detailed Information for Participating in the CHART Model

Because the CHART Model is multifaceted with many benefits and requirements for entities that choose to participate, we have consolidated the information below to assist entities in their decision.  The timelines provide an overview of the pre-implementation period as well as deadlines and key dates that occur during it. For easy reference, it is provided as a table and a graphic timeline.

Participant Hospitals and Aligned Payers each have benefits and requirements unique to them. CMS and HHSC both have created the following resources to facilitate discussions and decision-making about participating in the CHART Model Community Transformation Track and its impact on a community.

Payment Information

Implementation, Quality Reporting and Operational Flexibilities

Hospital Decision-making Resources

Hospital Exercises to Prepare for Participation

CHART Model Funding Tracks

The CHART Model is a funding opportunity from the Centers for Medicare and Medicaid Services (CMS). The CHART Model is a voluntary opportunity for rural communities to test health care transformation supported by payment reform.

There are two tracks for which Lead Organizations can apply for funding:

  • 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 web site 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:

  • 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.

  • 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.

  • 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 October 1, 2021 through December 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 references 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 Alternative Payment Model 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.

HHSC is working with the CHART Model Advisory Council to develop the Transformation Plan that will serve as an overview of the healthcare delivery redesign strategy for the CHART Model in Texas. The draft is due to CMS on May 18, 2022 and the final Transformation Plan due to CMS on July 29, 2022. The templates (including a Word document and Excel workbook) are included for reference below.

CHART Model and Rural Health Care Resources