Community Health Access and Rural Transformation (CHART) Model

South Dakota Medicaid is seeking hospitals and Medicaid stakeholders interested in participating in the Community Health Access and Rural Transformation (CHART) model community transformation track. South Dakota Medicaid intends to apply as a lead organization for the CHART grant funding opportunity which CMS will award to up to 15 organizations nationally. CMS will notify organizations if they are selected for the opportunity in July 2021. By indicating your interest in participating, you will help strengthen South Dakota Medicaid’s application.

For purposes of the opportunity, participating hospitals must be in a rural area, which may be any South Dakota county besides Minnehaha, Lincoln, Pennington, or Meade. The CHART Model is intended to:

• Increase access to care for rural beneficiaries.
• Improve quality of care and health outcomes for beneficiaries.
• Increase the financial stability of rural providers.

Hospitals interested in participating in the CHART model and stakeholders interested in serving on the CHART advisory council should contact South Dakota Medicaid Director, William Snyder by March 1, 2021, at William.Snyder@state.sd.us.

Benefits to Hospitals
The CHART model will transition participating hospitals’ Medicare and Medicaid reimbursement methodologies to a bi-weekly capitated payment based on historical expenditures with adjustment factors. Medicare payments would be transitioned to this methodology in January 2023 and Medicaid payments would be transitioned to an aligned methodology in January 2024. The capitated payments will provide financially predictable, stable revenue with the opportunity to generate and keep savings. The payment methodology will also provide flexibility to innovate care, focus on quality, and drive population health.
Participating hospitals may also receive Medicare operational and regulatory flexibilities, which may include, but are not limited to, the following:

• Waiver of cost sharing for Part B services.
• Waiver of certain Medicare hospital conditions of participation.
• Waiver of requirements for a 3-day inpatient stay prior to admission to a Skilled Nursing Facility.
• Waiver of the Critical Access Hospital requirements that a physician must certify that a patient is expected to be discharged or transferred within 96 hours of being admitted.
• Medicare telehealth expansion (continued post-COVID-19) including allowing a beneficiary’s home to be considered an originating site for certain services and allowing providers to engage in telehealth services with non-established patients.
• Allowing care management home visits proactively and prior to potential hospitalization and waiver of the homebound requirement for receiving these services.

Interested Hospitals
Interested hospitals should contact South Dakota Medicaid Director William Snyder by March 1, 2021, at William.Snyder@state.sd.us to express interest or discuss the opportunity. Interested hospitals may be asked to sign a non-binding letter of intent to participate in the CHART model. If South Dakota is awarded a CHART grant, there will be a pre-implementation period from August 1, 2021 – December 31, 2022. During the pre-implementation period, hospitals can learn more about the opportunity and CMS will calculate the Medicare capitated payment amount for each hospital. Hospitals will be provided the opportunity to evaluate the capitated payment amount and determine if they wish to participate in the CHART model.

Interested Stakeholders
South Dakota Medicaid is also seeking stakeholders to serve on the CHART advisory council. If South Dakota is awarded a CHART grant, the advisory council will assist with implementing the CHART model and monitoring progress. The advisory council may include, but is not limited to, the following:

• Participating hospitals.
• Medicaid and/or Medicare beneficiaries or unpaid caregivers.
• Primary care providers, FQHCs, RHCs, or physician group practices.
• Substance use disorder treatment and/or mental health services health care providers.
• Rural health organizations.
• Advocacy groups.
• Long-term care facilities, home health providers, or hospice providers.
• Indian Health Services, tribal health providers, or federally recognized tribe or tribal organizations.

Stakeholders interested in serving on the CHART advisory council should contact South Dakota Medicaid Director, William Snyder by March 1, 2021 at William.Snyder@state.sd.us.

Sample Letters of Intent

• Participating Hospital Sample Letter of Intent
• Advisory Council Sample Letter of Intent

Additional Information

• CMS CHART Website
• CHART Model Frequently Asked Questions
• Notice of Funding Opportunity