The Biden administration has removed an option for accountable care organizations to participate in a payment model intended to improve care coordination for rural providers.

The Centers for Medicare & Medicaid Services announced Tuesday that it removed the ACO transformation track from the CHART model, which is intended to help rural providers participate in value-based care. The decision comes as part of a larger strategic refresh to examine the center’s payment models.

CMS said in a notice Tuesday it is examining its models to advance health equity and increase the number of beneficiaries in an accountable care relationship, making a goal of having all Medicare beneficiaries in such a relationship by 2030.

Due to these broader efforts, the Center for Medicare and Medicaid Innovation removed the ACO transformation track, but the center did not further elaborate on why. 

CMS told Fierce Healthcare that eligible providers can still participate in the Medicare Shared Savings Program (MSSP).

"CMS will keep engaging with beneficiaries, providers, local communities and other stakeholders to expand the availability of accountable care models and programs to Medicare beneficiaries in rural and underserved areas," the agency said.

CMMI has said that part of its strategic refresh it will look to nix any duplicative payment models to ease burdens on providers.

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The CHART model was created in 2020 and aimed to help Medicare beneficiaries living in rural communities get access to healthcare services. The model aims to give providers up-front investments and capitated payments based on patient outcomes. It also provides waivers to help rural providers with key regulatory flexibility.

CHART had two models: a community transformation track available to hospitals and state organizations. The other model was the ACO transformation track that was removed.

CMS told Fierce Healthcare that a provider can still participate in both MSSP and the community transformation track.

CMMI hinted that the ACO track may have been in trouble back in March 2021 when the center delayed its application period.

The National Association for ACOs said that it was disappointed by the decision. The association has been concerned over a slide in ACO participation in recent years in part due to a push by CMMI to get ACOs to take on more financial risk.

“Despite today’s announcement, NAACOS remains optimistic that CMS will soon launch more options to encourage ACO participation,” the group said in a statement.

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It added that CMS has several ways to encourage more participation, including restarting the ACO Investment Model that offers pre-paid shared savings to participants.

ACOs agree to take on a certain level of financial risk and agree to meet spending and quality targets. An ACO that meets those benchmarks will get a share of any savings but must repay Medicare if they are off-target.

The investment model, which is no longer active, was intended to create more financial incentives for providers to become ACOs, a key concern among providers.

CMMI’s decision comes as Congress is trying to make it easier for rural providers to become ACOs. Last June, lawmakers introduced legislation to fix a glitch surrounding how ACO benchmarks are calculated.