Community Health Access and Rural Transformation (CHART) | CMS 2G2 21 001

Opportunity Information: Apply for CMS 2G2 21 001

The Community Health Access and Rural Transformation (CHART) Model is a voluntary rural health payment and delivery reform initiative run by the Center for Medicare and Medicaid Innovation (CMMI) within the Centers for Medicare and Medicaid Services (CMS). It is built around the idea that rural communities face a different set of constraints than urban and suburban systems, such as lower patient volume, tighter workforce capacity, longer travel distances, and greater financial fragility for small hospitals and clinics. CHART is meant to test whether pairing better-aligned financial incentives with more day-to-day operational flexibility and strong hands-on technical support helps rural providers redesign care in ways that improve access and outcomes while controlling Medicare and Medicaid spending. CMS will evaluate the model on core results such as total expenditures, access to care, quality of care, and health outcomes for rural residents. The opportunity also fits into CMS broader Rethinking Rural Health initiative, which focuses on creating payment approaches that keep high-quality care viable and affordable in rural America.

CHART includes two paths, but this specific Notice of Funding Opportunity (NOFO) covers only the Community Transformation Track. Under this track, selected awardees receive cooperative agreement funding along with a structured program framework to help them define their target community, assess local health and service needs, and then carry out a broad health care delivery system redesign. In practice, this means the award supports community-level planning and implementation work, including partnerships across local hospitals, clinicians, and other health and social service organizations, with an emphasis on changing how care is organized and delivered rather than only funding isolated programs.

A key feature of the Community Transformation Track is the Alternative Payment Model (APM) component for participating rural hospitals, which involves capitated payments. Capitation provides a predictable, stable revenue stream that is not as dependent on high volumes of inpatient or emergency department utilization. CMS is using this structure to encourage hospitals to shift away from relying on avoidable admissions and other high-cost utilization for financial survival, and toward strategies that reduce fixed costs, prevent unnecessary care, improve care coordination, and manage population health more proactively. Alongside the payment approach, CMS offers operational flexibilities designed to reduce regulatory burden and give hospitals room to prioritize high-value services and strengthen care management for their beneficiaries, which can be especially important in settings where staffing and resources are limited.

From an applicant standpoint, the NOFO is a discretionary funding opportunity administered by the U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services. The funding instrument is a cooperative agreement, meaning the federal government typically remains more involved than it would under a standard grant, often through ongoing collaboration, reporting, and technical assistance expectations. Eligible applicants are broad and include state, county, and local governments; special districts; independent school districts; public and private institutions of higher education; federally recognized tribal governments and other tribal organizations; public housing authorities; nonprofit organizations with or without 501(c)(3) status; for-profit organizations (including small businesses, and other for-profits that are not small businesses). The program is listed under CFDA 93.624 (Health-related assistance).

In terms of scale and timing, the opportunity was created on September 15, 2020, with an original application closing date of February 16, 2021. CMS anticipated making around 15 awards, with an award ceiling of up to $5,000,000 per awardee. Overall, the NOFO is aimed at selecting organizations capable of leading community-wide transformation efforts in rural areas, with the combination of upfront cooperative agreement support and a hospital payment approach designed to make long-term redesign financially feasible rather than forcing rural hospitals to depend on utilization-driven reimbursement.

• The Department of Health and Human Services, Centers for Medicare Medicaid Services in the health sector is offering a public funding opportunity titled "Community Health Access and Rural Transformation (CHART)" and is now available to receive applicants.
• Interested and eligible applicants and submit their applications by referencing the CFDA number(s): 93.624.
• This funding opportunity was created on Sep 15, 2020.
• Applicants must submit their applications by Feb 16, 2021 No Explanation. (Agency may still review applications by suitable applicants for the remaining/unused allocated funding in 2026.)
• Each selected applicant is eligible to receive up to $5,000,000.00 in funding.
• The number of recipients for this funding is limited to 15 candidate(s).
• Eligible applicants include: State governments, County governments, City or township governments, Special district governments, Independent school districts, Public and State controlled institutions of higher education, Native American tribal governments (Federally recognized), Public housing authorities/Indian housing authorities, Native American tribal organizations (other than Federally recognized tribal governments), Nonprofits having a 501(c)(3) status with the IRS, other than institutions of higher education, Nonprofits that do not have a 501(c)(3) status with the IRS, other than institutions of higher education, Private institutions of higher education, For profit organizations other than small businesses, Small businesses.

Apply for CMS 2G2 21 001

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