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Community Health Access and Rural Transformation (CHART) Model

In September 2021, South Dakota Medicaid was one of four organizations that was awarded up to $5 million from CMS over the course of a 7 year grant to implement the Community Health Access and Rural Transformation (CHART) Model. The Community Health Access and Rural Transformation (CHART) model community transformation track is a federal grant opportunity 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.

Benefits to Hospitals
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 will transition participating hospitals’ Medicare and Medicaid reimbursement methodologies to a bi-weekly capitated payment based on historical expenditures with adjustment factors. Medicare payments will be transitioned to this methodology in January 2023 and Medicaid payments will 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 and Stakeholders
Hospitals interested in participating in the opportunity and stakeholders interested in serving on the advisory council should contact South Dakota at

Additional Information