Introduction: Maine DHHS encourages eligible Maine hospitals1 and rural communities2 to consider the opportunity to participate in the Community Transformation Track of the CMS Innovation Center’s Community Health Access and Rural Transformation (CHART) model.  Eligible hospitals and/or rural communities that meet the requirements for participation as outlined by CMS and have a vision for participation that is consistent with the Maine Framework for CHART participation3 are encouraged to indicate their interest by completing the following statement of interest by Friday, Oct 23, 2020. 

Interested eligible hospitals and/or rural communities that complete this statement will be invited to participate in a web-based discussion with Maine DHHS staff within 1-2 weeks after the submission deadline to further explore their interest, vision and capacity. Based on indications of interest and discussions with interested hospitals/communities, Maine DHHS aims to make a final selection for a Maine application to the CHART model by mid-November 2020.
 
If you have questions about completing this statement and/or the CMS CHART initiative, please contact Dr. Lisa Letourneau at lisa.letourneau@maine.gov, or tel. 207.415.4043 
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NOTE: More information on the CMS CHART model is available on the CMS CHART webpage.  The full CMS CHART Notice of Funding Opportunity (NOFO) is also available for review on Grants.gov.

 1CMS defines eligible Participant Hospitals as follows:
Participant Hospitals must be an acute care hospital or Critical Access Hospital that either:
  (1) Is physically located within the Community [see below] and receives at least 20% of its Medicare FFS revenue from Eligible Hospital Services provided to residents of the Community; OR
  (2) Is physically located inside or outside of the Community and is responsible for at least 20% of Medicare expenditures for Eligible Hospital Services provided to residents of the Community.

 2CMS requires that eligible applicant Communities meet the following criteria:
  (1) Encompass either (a) a single county or census tract or (b) a set of contiguous or noncontiguous counties or census tracts. Each county or census tract must be 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.
  (2) At the time of application submission, include a minimum of 10,000 Medicare Fee For Service (FFS) beneficiaries whose primary residence is within the Community.

Note: CMS classifies rural counties and census tracts using the Federal Office of Rural Health Policy’s (FORHP) list of eligible counties and census tracts, as outlined in HRSA List of Rural Counties or identified in searchable database (by county or zip code) using HRSA Rural Health Grants Eligibility Analyzer.
 
3See Maine Framework for CHART participation

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* 1. Statement of Interest: Please note that that either eligible hospitals and/or interested organizations from rural communities may complete this statement of interest.  Completing this statement does not constitute a commitment to pursue an application for participation in the CHART model.

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* 2. Hospital(s): (select all that apply)

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* 3. Rural Community (please list rural county(s) and/or rural census tracts):

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* 4. Name & role of individual completing this assessment:

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* 5. Estimated total population size of rural Community: (Note: census data on Maine county and municipality population size available at Maine Census Data Center).

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* 6. Estimated number of Medicare FFS beneficiaries within the Community: (Note: CMS data on Medicare FFS enrollees available on CMS website)

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* 7. Potential community partners (please list names of potential partner organizations: (Note that partner participation agreements/commitments are not required or expected at this time)

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* 8. As noted above, Maine DHHS aims to select one rural Community and one or more eligible hospitals by mid-November to partner in the development of a Maine application for the CHART Transformation Track model.  Selected communities/hospital(s) will be asked to partner with Maine DHHS to develop an application for submission to CMS by February 12, 2021.  By checking the box below, you are indicating your intention to commit to this expectation:

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