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Rural Health
Resources by Topic: Health insurance

Calendar Year (CY) 2015 Rural Health Clinic (RHC) and Federally Qualified Health Centers (FQHC) Updates: Payment Rate Increases for RHCs and FQHCs Billing Under the All-Inclusive Rate System (AIR), and Urban and Rural Designations for FQHCs Billing Under the AIR
Provides updates for RHCs and FQHCs that are submitting claims to Medicare Administrative Contractors (MACs) for services to Medicare beneficiaries.
Date: 12/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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How Payment Caps Can Reduce Hospital Prices and Spending: Lessons from the Oregon State Employee Plan
Report discusses how policy changes to state employee insurance plans effected healthcare costs in Oregon. Details Oregon's plan to place payment caps tied to Medicare reimbursement rates and exceptions for rural and critical access hospitals.
Author(s): Roslyn C. Murray, Christopher M. Whaley, Erin C. Fuse Brown, Andrew M. Ryan
Date: 07/2024
Type: Document
Sponsoring organization: Milbank Memorial Fund
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CY 2025 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Proposed Rule (CMS 1809-P)
Fact sheet providing an overview of the Centers for Medicare & Medicaid Services (CMS) proposed rule regarding updates and changes to the Medicare payments for hospital outpatient and Ambulatory Surgical Center (ASC) services for calendar year 2025. Summarizes provisions regarding changes to Intensive Outpatient Program (IOP) and partial hospital program rate setting; a proposal to include an add-on payment to the Medicare outpatient hospital all-inclusive rate (AIR) for certain high-cost drugs for people with Medicare who receive care at Indian Health Service (IHS) or tribal hospitals; updates to the Hospital Outpatient Quality Reporting (OQR), Ambulatory Surgical Center Quality Reporting (ASCQR), and Rural Emergency Hospital Quality Reporting (REHQR) Programs; a proposal for new Conditions of Participation (CoPs) for hospitals and Critical Access Hospitals (CAHs) for obstetrical services; Medicaid and CHIP continuous eligibility; Medicaid clinic services "four walls" exceptions; and more.
Date: 07/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Standing Technical Expert Panel for the Development, Evaluation, and Maintenance of Post-Acute Care (PAC) and Hospice Quality Reporting Program (QRP) Measurement Sets: Summary Report
Describes a December 15, 2023, Technical Expert Panel (TEP) regarding the development of additional cross-setting measures for the Post-Acute Care (PAC) and Hospice Quality Reporting Programs (QRPs), and filling measurement gaps with the Centers for Medicare & Medicaid Services (CMS) Universal Foundation measures. Summarizes TEP comments on adding measures to PAC and Hospice QRPs in four domains: 1) behavioral and mental health, 2) patient experience of care, 3) pain management, and 4) immunization. Covers panelists' discussions on the appropriateness of the existing measure set and potential new measures, setting-specific considerations, data sources, and other topics related to each domain. Includes rural references throughout.
Date: 07/2024
Type: Document
Sponsoring organizations: Abt Associates, Acumen, Centers for Medicare and Medicaid Services
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Calendar Year (CY) 2025 Medicare Physician Fee Schedule Proposed Rule
Fact sheet providing an overview of the Centers for Medicare & Medicaid Services (CMS) proposed rule regarding updates and changes to the Medicare payments under the Physician Fee Schedule (PFS) and other Medicare Part B issues for calendar year 2025. Summarizes provisions related to telehealth services; advanced primary care management services; behavioral health services; opioid treatment programs; dental and oral health services; Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Conditions for Coverage, care coordination services, telecommunication services, payment for vaccine costs, intensive outpatient program (IOP) services; and more.
Date: 07/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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The Uneven Impact of Medicaid Expansion on Rural and Urban Black, Latino/a, and White Mortality
Examines mortality rates and the corresponding impact of Medicaid expansion on Black, Latino/a, and White populations, broken down by rural versus urban location. Utilizes 2009-2019 data of Average Treatment Effect on the Treated (ATET) estimates to provide statistical breakdowns and graphic representation of how Medicaid expansion has impacted mortality rates for varying populations.
Author(s): J. Tom Mueller, Regina S. Baker, Matthew M. Brooks
Citation: Journal of Rural Health
Date: 07/2024
Type: Document
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Estimated Impacts of Multiple Payment Policies on Rural-Serving Home Health Agencies
Describes the estimated impact of three major Medicare home health payment policy changes - implementation of the Patient-Driven Groupings Model (PDGM), revisions to rural add-on payments, and the demonstration and nationwide expansion of the Home Health Value-Based Purchasing (HHVBP) model - on home health agency (HHA) reimbursement for Medicare beneficiaries. Compares the estimated impact of these payment policy changes by HHA rural-serving status, U. S. Census Division, profit status, quality rating, and episode volume.
Author(s): Tracy M. Mroz, Lisa A. Garberson, C. Holly A. Andrilla, Davis G. Patterson
Date: 07/2024
Type: Document
Sponsoring organization: WWAMI Rural Health Research Center
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Disruptors, Essential Services, and Reflections on a Career in Rural Health, with John Supplitt
An episode of the Exploring Rural Health podcast featuring John Supplitt, Senior Director of Rural Health Services for the American Hospital Association. Focuses on the importance of maintaining rural essential services, along with insights from Supplitt's long career in rural health.
Date: 07/2024
Type: Audio
Sponsoring organization: Rural Health Information Hub
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Telehealth Trends and Hypertension Management Among Rural and Medicaid Patients After COVID-19
This study examines trends in primary care utilization and hypertension management among adults who visited Dartmouth Health System in 2017-2018 and 2022. Compares changes in synchronous and asynchronous primary care utilization and effective control of elevated blood pressure by rurality and Medicaid enrollment before and during the COVID-19 pandemic through 2022.
Author(s): Matthew Mackwood, Oleksandra Pashchenko, Christopher Leggett, et al.
Citation: Telemedicine and e-Health, 30(6), e1677-e1688
Date: 06/2024
Type: Document
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Healthcare Spending among Diverse Populations with Alzheimer's Disease and Related Dementias: A Claims-Based Analysis
Examines healthcare spending and utilization among commercially insured Alzheimer's disease and related dementia (ADRD) patients. Explores the impact of race and ethnicity, poverty, and urban/rural status on annual spending among ADRD patients by analyzing data from the FAIR Health National Private Insurance Claims between January 2016 and December 2023, along with demographic and socioeconomic data from the U.S. Census American Community Survey. Includes data on the probability of ADRD patients using different care venues and the average and expected amounts allowed within each venue based on sociodemographic characteristics.
Date: 06/2024
Type: Document
Sponsoring organization: FAIR Health
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