Based on feedback received from Model stakeholders, as well as a lack of hospital participation, the CHART Model ended early on September 30, 2023. CMS believes that the lessons learned from the CHART Model will continue to aid in the development of a potential future rural health care model at the CMS Innovation Center. Supporting rural health remains a key priority, and CMS is actively examining additional ways to expand access to high-quality health care and address the unique needs and challenges in rural areas.

Through the Community Health Access and Rural Transformation (CHART) Model, CMS aimed to continue addressing disparities by providing a way for rural communities to transform their health care delivery systems by leveraging innovative financial arrangements as well as operational and regulatory flexibilities.


The approximately 57 million Americans living in rural communities, including millions of Medicare and Medicaid beneficiaries, face unique challenges when seeking healthcare services, such as limited transportation options, shortages of health care services, and an inability to fully benefit from technological and care-delivery innovations. These challenges result in rural Americans facing worse health outcomes and higher rates of preventable diseases than those living in urban areas.

Model Details

CMS provided funding for rural communities to build systems of care through a Community Transformation Track.

The Model aimed to:

  • Increase financial stability for rural providers through the use of new ways of reimbursing providers that provide up-front investments and predictable, capitated payments that pay for quality and patient outcomes;
  • Remove regulatory burden by providing waivers that increase operational and regulatory flexibility for rural providers; and
  • Enhance beneficiaries’ access to health care services by ensuring rural providers remain financially sustainable for years to come and can offer additional services such as those that address social determinants of health including food and housing.

To achieve these goals, the CHART Model would have tested whether upfront investments, predictable capitated payments, and operational and regulatory flexibilities would enable rural health care providers to improve access to high quality care while reducing health care costs.

Community Transformation Track

In the fall of 2021, CMS awarded cooperative agreement funding to four entities under the CHART Community Transformation Track: University of Alabama Birmingham, State of South Dakota Department of Social Services, Texas Health and Human Services Commission, and Washington State Healthcare Authority. The awarded entities would have served as Lead Organizations in the respective states of Alabama, South Dakota, Texas, and Washington. The Lead Organizations in each of these states would have used the award funds to develop and implement a health care redesign strategy for their defined community over the course of the model.

A Lead Organization would have been a single entity that represented a rural Community, comprised of either (a) a single county or census tract or (b) a set of contiguous or non-contiguous counties or census tracts. Each county or census tract must have been 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. 

Lead Organizations would have been responsible for working closely with key model participants (e.g., including Participant Hospitals and the state Medicaid agency) and drive health care delivery system redesign by leading the development and implementation of Transformation Plans with their community partners. The Transformation Plan was a detailed description that outlines the community’s plan to implement health care delivery redesign strategy.

Lead Organizations and their community partners would have received upfront cooperative agreement funding, financial flexibilities through a predictable capitated payment amount (CPA) for Participant Hospitals in a community, and operational and regulatory flexibilities.

The four Lead Organizations were critical to the success of the Model because they would have coordinated efforts across the community to ensure that access to care was maintained and that the needs of various stakeholders were understood and accounted for in the transformation plan. Lead Organizations were responsible for managing cooperative agreement funding, recruiting Participant Hospitals, engaging the state Medicaid agency, establishing relationships with other aligned payers, convening the Advisory Council, and ensuring compliance with Model requirements. Ultimately, the Lead Organization would have overseen the execution and coordination of a Transformation Plan that outlined the health care delivery redesign strategy for the Community.

ACO Transformation Track (Removed)

CMS announced in March 2021 a one-year delay in releasing the Request for Applications for the Accountable Care Organization (ACO) Transformation Track. CMS is developing an Agency-wide vision and strategy for accountable care, including opportunities to increase ACO adoption in rural areas. As part of this effort, CMS is examining lessons learned from the Innovation Center’s ACO Investment Model (AIM) to inform future ACO policies, to advance health equity and to increase the number of beneficiaries in accountable care relationships. Given broader efforts underway, the CMS Innovation Center has removed the ACO Transformation Track from the CHART Model as of February 2022.



Community Transformation Track

CMS announced the Community Transformation Track Notice of Funding Opportunity (NOFO) in September 2020 and the application period closed on May 11, 2021.

Additional Information


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