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


Additional Links

CHART Fact Sheet
Medicaid Participant Fact Sheet
Notice of Funding Opportunity (


Letter of Intent (Optional): Apr 13, 2021
Application Deadline: May 11, 2021

Sponsoring Organization

Centers for Medicare & Medicaid Services (CMS)


Offers funding to rural communities to create transformational change in healthcare delivery systems in order to address challenges and reduce disparities in the provision of healthcare services for rural populations. Aims to increase access to care, improve healthcare quality and outcomes, and enhance stability and sustainability in rural health systems.

The Community Health Access and Rural Transformation (CHART) Model Community Transformation Track includes three core program elements:

  1. Funding to establish partnerships and technical support - recipients must use funds to develop partnerships with community healthcare stakeholders, recruit participant hospitals, and procure technical support in order to develop and implement a health system transformation plan that is in line with community needs
  2. Operational flexibilities - recipients may leverage operational and regulatory flexibilities available through the CHART Model that are designed to help rural providers ease regulatory burden, emphasize high-value services, and support care management
  3. Value-based payment - the program establishes an alternative payment model (APM) that offers capitated payments to participant hospitals, creating a stable revenue stream to incentivize rural hospitals to lower fixed costs, reduce avoidable utilization, and improve care quality

Amount of Funding

Award ceiling: $5,000,000 per project
Project period: 7 years
Estimated number of awards: 15
Estimated total program funding: $75,000,000

Up to $2,000,000 is available in year 1 of the project period to support pre-implementation activities. Up to $500,000 per year is available in years 2-7.

Who Can Apply

Applications may be submitted by:

  • State governments
  • County governments
  • City or township governments
  • Special district governments
  • Faith-based organizations
  • For-profit organizations other than small businesses
  • Federally recognized Indian tribes or tribal organizations, as defined by the Indian Health Care Improvement Act
  • Tribal organizations other than federally recognized
  • Nonprofits with or without 501(c)(3) status, other than institutions of higher education
  • Private institutions of higher education, including academic medical centers
  • Public and State controlled institutions of higher education, including academic medical centers
  • Small businesses

Eligible organizations must also meet the following requirements to serve as a lead organization for their community and receive cooperative agreement funding.

  • A presence in the community one year prior to the publication of the CHART Community Transformation Track notice of funding opportunity on September 15, 2020
  • Expertise in rural health issues, such as specific diseases, health disparities, barriers to care, policy, and other key factors prevalent in the community
  • Experience through either direct management or a partnership in designing and implementing alternative payment models (APMs)
  • Received and successfully managed one or several health-related grant(s) or cooperative agreements of at least $500,000 over the last 3 years
  • Experience in each of the following areas:
    • Engaging and maintaining provider participation in APMs or Center for Medicare & Medicaid Innovation (CMMI) demonstration projects or models
    • Establishing, modifying, and maintaining agreements between healthcare providers
    • Conducting outreach, developing and managing relationships with diverse healthcare stakeholders

A lead organization will be responsible for defining the parameters of a rural community, for the purposes of the CHART model. In order to qualify as rural for this opportunity, a community must meet the following criteria:

  • Encompass a single county or census tract or a set of contiguous or noncontiguous counties or census tracts each of which is defined as rural according to the Federal Office of Rural Health Policy's list of eligible counties and census tracts
  • Include at least 10,000 Medicare Fee-for-Service (FFS) beneficiaries whose primary residence is within the community

Lead organizations are required to assemble an advisory council and recruit participant hospitals for the program. Additional eligibility requirements for advisory council members and participant hospitals can be found in the program guidance on

Geographic Coverage


What This Program Funds

Capacity Building • Operating Costs and Staffing

Application Process

Application instructions, requirements, and other information can be found in the funding announcement on

Application webinar recording and slides
CHART model office hour recording and slides
CHART model overview webinar recording and slides
CHART model payment policies webinar recording and slides
CHART sample payment calculation
Applicant frequently asked questions


For programmatic or technical questions:
Sally Caine Leathers

For grants management or budget questions:
Shamia Cunningham

Topics This Program Addresses

Community Planning and Coalition Building • Healthcare Facilities • Reimbursement and Payment Models