93.624: Community Health Access and Rural Transformation (CHART) Model

93.624

Active

Centers for Medicare and Medicaid Services (CMS) [HHS]

Aug. 18, 2022

Aug. 18, 2022

The Community Health Access and Rural Transformation (CHART) Model is a voluntary payment Model. CHART will test whether aligned financial incentives across payers and robust technical support enable rural providers to transform care on a broad scale and increase uptake of Alternative Payment Models (APMs) in ways that improve access to high quality care and reduce Medicare and Medicaid costs. CHART will equip Award Recipients with funding and a framework to assess their Community’s health needs, create a care delivery and redesign strategy, and select an Alternative Payment Model (APM) to offer providers in their area. Communities’ participation in CHART will begin with a year-plus pre-implementation period, during which they will develop a care delivery redesign strategy and recruit participants. Following the pre-implementation period, Award Recipients will have 6 performance years (PYs) SIM The State Innovation Model (SIM) is based on the premise that state innovation with broad stakeholder input and engagement will align delivery system transformation across multiple payers and populations to provide better care at lower costs. SIM is focused on public and private sector collaboration to transform the state’s delivery system. SIM provides financial and technical support to states to test the ability of state governments to use their regulatory and policy levers to accelerate health transformation efforts. In Round 1, CMS partnered with 6 Model Test states to implement state-wide health transformation strategies and 19 Model Design states to develop and refine State Healthcare Innovation Plans (SHIPs) to guide future implementation efforts. In Round 2, CMS partnered with an additional 11 Model Test states to implement their SHIPs and 17 states, 3 territories, and the District of Columbia to develop and/or refine their SHIPs. All of the Design states from both rounds of SIM have completed their project period 2 of the 6 Round 1 Test states have completed their tests and the other 4 are in their final year. The 11 Round 2 Test states are currently in the active testing phase. There are no current opportunities for additional rounds of SIM.

A - Formula Grants

CHART Lead Organizations can only receive up to one CHART cooperative agreement. CHART award recipient are regional or state entities that are responsible for accomplishing CHART’s three core program components: (1) establishing robust technical support and regional partnerships, (2) implementing care delivery redesign, and (3) implementing value-based payment reform. Specifically, Lead Organizations will carry out the following key program activities: (1) convene an Advisory Council, (2) create a Transformation Plan, and (3) implement the APM. Entities must meet the following criteria to be a CHART awardee: 1. Have a documented presence in the Community or the state as of one year prior to the release of the Notice of Funding Opportunity (NOFO) for which they are applying 2. Have demonstrated expertise in rural health issues, rural healthcare delivery, and healthcare payment models 3. Have received grant funding of at least $500,000 total over the last three years Examples of potential awardees include but are not limited to State Medicaid Agencies (SMAs), State Offices of Rural Health (SORHs), local public health departments, Independent Practice Associations (IPAs), and Academic Medical Centers (AMCs). SIM CMS invites the 50 state Governor’s Offices, United States Territories Governors’ Offices (American Samoa, Guam, Northern Mariana Islands, Puerto Rico, and the Virgin islands), and the Mayor’s Office of the District of Columbia to apply. • Only one application from a Governor per state is permitted for either a Model Design or a Model Test award (assuming the state applied and was not selected for funding under the first round of Model Test awards). • A state cannot receive multiple Round 2 Model Design or Model Test awards. • A state cannot receive both a Round 2 Model Design award and a Round 2 Model Test award. • Each application must include a letter from the Governor (or the Mayor, if from the District of Columbia) officially endorsing the application for a Model Design award or for a Model Test award. • States currently engaged in a Model Test award with CMS are NOT eligible to apply for funding under Round 2. A state may propose that an outside organization focused on quality and state delivery system transformation, such as a non-profit affiliated with the State Department of Health or a public-private partnership supported by the Governor’s Office, receive and administer funds through a Model Design or Model Test award. The Governor’s Office must submit such requests in writing to CMS with its Letter of Intent and include a justification for the request and an attestation that the state will actively participate in all activities described in its proposal. Approval of such requests will be at the sole discretion of CMS. Only one such request supported by the Governor will be allowed per state. A state pursuing this approach will still be expected to address all of the required areas described in this FOA. Eligibility Threshold Criteria: • All applicants must have submitted a required letter of intent to the programmatic point of contact in Section VI. Agency Contacts by June 6, 2014. If a letter of intent has not been submitted by the required due date, any subsequent application submitted by the entity will be ineligible. See Section IV.2.A, Letter of Intent to Apply, for more information. • Application deadline: Applications not received by the application deadline (TBD) through www.grants.gov will not be reviewed. • Application requirements: Applications will be considered for funding only if the application meets the requirements outlined in Section III, Eligibility Information and Section IV, Application and Submission Information. • Page limits: Model Test applications shall not be more than 55 pages in length. Model Design applications shall not be more than 27 pages in length. Both types of applications must be limited to the page maximums, sequence of sections, and section content specified in Section IV.2 Content and Form of Application Submission, parts C & D. • In addition, applications should include attestations of support from key stakeholders. The letters of support will not be included in the page limits for applications. The letters should attest to stakeholders’ active engagement in the model and must contain specific information about how the stakeholders will contribute to the SIM process. • The standard forms, project abstract, Governor’s endorsement, and curriculum vitae are also not included in these page limits. States are strongly encouraged to review the criteria information provided in Section V of the FOA, Application Review Information, to help ensure that the proposal adequately addresses all the criteria that will be used in evaluating applications and determining appropriate funding levels for each award.

CHART Each CHART Community must meet the following criteria: 1. Be a set of contiguous or non-contiguous counties or census tracts classified as rural, as defined by the Federal Office of Rural Health Policy’s list of eligible counties and census tracts used for its grant programs 2. Must contain a minimum of 10,000 Medicare FFS beneficiaries SIM The emphasis is on targeting Medicare, Medicaid, and CHIP populations. Proposals will describe the target populations, geographic areas, or communities that will be the focus of service delivery and payment model testing, the current quality and beneficiary experience outcomes including current health population status, and the specific improvement targets expected from the model.

https://sam.gov/fal/73b67bd6d9ee406da811b338c907cbb6/view