South Dakota Medicaid Seeks Hospital Participants for CHART Model

• Increase access to care for rural beneficiaries.
• Improve quality of care and health outcomes for beneficiaries.
• Increase the financial stability of rural providers.

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 would be transitioned to this methodology in January 2023 and Medicaid payments would 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 including:

• 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.