Rural Health
Resources by Topic: Health insurance
January 2025 MedPAC Meeting Transcript
Transcript from the Medicare Payment Advisory Commission's (MedPAC) January 2025 meeting. Covers payment adequacy and updates for physician and other health professional services, hospital inpatient and outpatient services, skilled nursing facility services, home health agency services, inpatient rehabilitation facility services, outpatient dialysis services, and hospice services. Discusses status reports on Medicare Part D, ambulatory surgical centers, and the Medicare Advantage program, as well as policy options for modifying the cost-sharing liability for beneficiaries who receive care at Critical Access Hospitals. Includes rural references and considerations throughout.
Additional links: Reducing Beneficiary Cost-sharing for Outpatient Services at Critical Access Hospitals
Date: 01/2025
Sponsoring organization: Medicare Payment Advisory Commission
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Transcript from the Medicare Payment Advisory Commission's (MedPAC) January 2025 meeting. Covers payment adequacy and updates for physician and other health professional services, hospital inpatient and outpatient services, skilled nursing facility services, home health agency services, inpatient rehabilitation facility services, outpatient dialysis services, and hospice services. Discusses status reports on Medicare Part D, ambulatory surgical centers, and the Medicare Advantage program, as well as policy options for modifying the cost-sharing liability for beneficiaries who receive care at Critical Access Hospitals. Includes rural references and considerations throughout.
Additional links: Reducing Beneficiary Cost-sharing for Outpatient Services at Critical Access Hospitals
Date: 01/2025
Sponsoring organization: Medicare Payment Advisory Commission
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Medicaid Coverage in Metro and Small Town/Rural Counties, 2023
Presents county-level data for children, non-elderly adults, and seniors insured by Medicaid/CHIP. Utilizes 2023 American Community Survey (ACS) Public Use Microdata Sample (PUMS) data to provide insurance comparisons by county and by state.
Date: 01/2025
Sponsoring organization: Georgetown University Health Policy Institute
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Presents county-level data for children, non-elderly adults, and seniors insured by Medicaid/CHIP. Utilizes 2023 American Community Survey (ACS) Public Use Microdata Sample (PUMS) data to provide insurance comparisons by county and by state.
Date: 01/2025
Sponsoring organization: Georgetown University Health Policy Institute
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Evaluating Access to Psychosocial Services for the Medicaid-Insured Children in Georgia
Assesses mental health workforce supply and demand for psychosocial services for the Medicaid-insured children in Georgia, and examines the impact of policy interventions to increase availability of services for the Medicaid-insured population. Analyzes factors associated with unmet demand, including data on rurality, travel distance, and more.
Author(s): Yujia Xie, Pravara Harati, Janani Rajbhandari-Thapa, Nicoleta Serban
Citation: BMC Public Health, 25, 244
Date: 01/2025
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Assesses mental health workforce supply and demand for psychosocial services for the Medicaid-insured children in Georgia, and examines the impact of policy interventions to increase availability of services for the Medicaid-insured population. Analyzes factors associated with unmet demand, including data on rurality, travel distance, and more.
Author(s): Yujia Xie, Pravara Harati, Janani Rajbhandari-Thapa, Nicoleta Serban
Citation: BMC Public Health, 25, 244
Date: 01/2025
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Examining Differences in Rural and Urban Medicare FFS Beneficiaries' Emergency Department Use Before and During COVID-19
Results of a study describing changes from 2018-2022 in emergency department use among rural and urban Medicare Fee-for-Service (FFS) beneficiaries. Features statistics including patient demographics, primary diagnoses, and admission sources, with breakdowns by urban and rural areas.
Author(s): Alana Knudson, Craig D. Holden, Marilyn Klug, Tricia Stauffer, Shena Popat
Date: 01/2025
Sponsoring organization: ETSU/NORC Rural Health Research Center
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Results of a study describing changes from 2018-2022 in emergency department use among rural and urban Medicare Fee-for-Service (FFS) beneficiaries. Features statistics including patient demographics, primary diagnoses, and admission sources, with breakdowns by urban and rural areas.
Author(s): Alana Knudson, Craig D. Holden, Marilyn Klug, Tricia Stauffer, Shena Popat
Date: 01/2025
Sponsoring organization: ETSU/NORC Rural Health Research Center
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Impact of the Medicare Improvements for Patients And Providers Act on Mental Health Service Utilization And Spending among Older Adults
Examines the impact of the Medicare Improvements for Patients and Providers Act (MIPPA) on outpatient mental healthcare utilization. Utilizes 2008-2017 Medicare claims and administrative data to analyze MIPPA in a pre-implementation phase as well as 4 post-implementation phases. Includes data on mental healthcare outpatient visits by age group, race, dual eligibility status, substance use disorder, comorbidities, and urban, large rural, small rural, or isolated rural location.
Author(s): Matt Toth, Brent Gibbons, Abbie Levinson, et al.
Date: 01/2025
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Examines the impact of the Medicare Improvements for Patients and Providers Act (MIPPA) on outpatient mental healthcare utilization. Utilizes 2008-2017 Medicare claims and administrative data to analyze MIPPA in a pre-implementation phase as well as 4 post-implementation phases. Includes data on mental healthcare outpatient visits by age group, race, dual eligibility status, substance use disorder, comorbidities, and urban, large rural, small rural, or isolated rural location.
Author(s): Matt Toth, Brent Gibbons, Abbie Levinson, et al.
Date: 01/2025
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Postpartum Health Care Use in Medicaid During the COVID-19 Public Health Emergency: Implications for Extending Postpartum Coverage
Examines the impact of Medicaid continuous enrollment during the COVID-19 public health emergency (PHE) on postpartum healthcare utilization. Utilizes 2018-2023 claims data from the Centers for Medicare and Medicaid Services (CMS) Transformed Medicaid Statistical Information System (T-MSIS) to analyze a pre-PHE versus PHE cohort of women. Includes healthcare utilization data with breakdowns according to age, race/ethnicity, eligibility group (Medicaid or other form), rural versus urban location, maternity care desert status, severe maternal morbidity and/or chronic health condition, postpartum month, and state.
Author(s): Amelia Whitman, Anupama Warrier, Sarah Gordon, et al.
Date: 01/2025
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Examines the impact of Medicaid continuous enrollment during the COVID-19 public health emergency (PHE) on postpartum healthcare utilization. Utilizes 2018-2023 claims data from the Centers for Medicare and Medicaid Services (CMS) Transformed Medicaid Statistical Information System (T-MSIS) to analyze a pre-PHE versus PHE cohort of women. Includes healthcare utilization data with breakdowns according to age, race/ethnicity, eligibility group (Medicaid or other form), rural versus urban location, maternity care desert status, severe maternal morbidity and/or chronic health condition, postpartum month, and state.
Author(s): Amelia Whitman, Anupama Warrier, Sarah Gordon, et al.
Date: 01/2025
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Projecting the Impact of the $2,000 Part D Out-Of-Pocket Cap for Medicare Part D Enrollees with High Prescription Drug Spending
Examines the impact of the Medicare Part D $2,000 cap on out-of-pocket prescription drugs. Provides projected savings according to low-income subsidy (LIS) status, state, and demographic characteristics, including urban, rural-micropolitan, rural-other, or unclassified geographic location.
Date: 01/2025
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Examines the impact of the Medicare Part D $2,000 cap on out-of-pocket prescription drugs. Provides projected savings according to low-income subsidy (LIS) status, state, and demographic characteristics, including urban, rural-micropolitan, rural-other, or unclassified geographic location.
Date: 01/2025
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Behavioral Health Crisis Services Billed to Commercial Insurance, Medicaid, and Medicare
Examines the extent to which three specific crisis service billing codes are used by commercial payors, Medicaid, and Medicare in 2020 in the 11 states and District of Columbia that cover these services in their Medicaid fee-for-service plans. Compares the rate of crisis service claims by state, rurality, and provider type.
Author(s): Crystal Blyler, Amy Edmonds, Allison Wishon, et al.
Date: 01/2025
Sponsoring organizations: HHS Office of the Assistant Secretary for Planning and Evaluation, Mathematica
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Examines the extent to which three specific crisis service billing codes are used by commercial payors, Medicaid, and Medicare in 2020 in the 11 states and District of Columbia that cover these services in their Medicaid fee-for-service plans. Compares the rate of crisis service claims by state, rurality, and provider type.
Author(s): Crystal Blyler, Amy Edmonds, Allison Wishon, et al.
Date: 01/2025
Sponsoring organizations: HHS Office of the Assistant Secretary for Planning and Evaluation, Mathematica
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Emergency Triage, Treat, and Transport (ET3) Model: Final Evaluation Report
Presents quantitative and qualitative results from the evaluation of the Emergency Triage, Treat, and Transport (ET3) Model, a voluntary model that allowed ambulance care teams to use alternate models of emergency healthcare to improve quality and lower care costs. Describes the characteristics of ET3 participants, the extent to which ET3 interventions successfully prevented emergency department (ED) visits, and how average Medicare Parts A and B spending for patients that received ET3 interventions compared to patients who had low acuity ED visits. Discusses challenges and barriers to delivering ET3 interventions. Includes rural references throughout.
Additional links: Findings at a Glance, Technical Appendix
Date: 01/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Presents quantitative and qualitative results from the evaluation of the Emergency Triage, Treat, and Transport (ET3) Model, a voluntary model that allowed ambulance care teams to use alternate models of emergency healthcare to improve quality and lower care costs. Describes the characteristics of ET3 participants, the extent to which ET3 interventions successfully prevented emergency department (ED) visits, and how average Medicare Parts A and B spending for patients that received ET3 interventions compared to patients who had low acuity ED visits. Discusses challenges and barriers to delivering ET3 interventions. Includes rural references throughout.
Additional links: Findings at a Glance, Technical Appendix
Date: 01/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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A Summary of State Innovation Models (SIM) Evaluation Results Across 17 States (2013-2020)
Summarizes evaluation results of the State Innovation Models (SIM), which examined the ability of 17 state governments to implement and test innovative value-based payment (VBP) healthcare models across multiple payers between 2013 and 2020. Presents findings regarding the implementation and impact of 29 delivery and payment models, including patient-centered medical homes, accountable care organizations, behavioral health integration, and more. Covers state contracting and consensus building, practice transformation, pediatric care, behavioral healthcare, beneficiary and provider perspectives, and more. Includes a section on payment model designs tailored to unique state needs, including rural populations, as well as rural references throughout.
Additional links: A Summary of State Innovation Models (SIM): Focus on State-Led Transformation - Findings at a Glance, Executive Summary, Findings at a Glance
Date: 01/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Summarizes evaluation results of the State Innovation Models (SIM), which examined the ability of 17 state governments to implement and test innovative value-based payment (VBP) healthcare models across multiple payers between 2013 and 2020. Presents findings regarding the implementation and impact of 29 delivery and payment models, including patient-centered medical homes, accountable care organizations, behavioral health integration, and more. Covers state contracting and consensus building, practice transformation, pediatric care, behavioral healthcare, beneficiary and provider perspectives, and more. Includes a section on payment model designs tailored to unique state needs, including rural populations, as well as rural references throughout.
Additional links: A Summary of State Innovation Models (SIM): Focus on State-Led Transformation - Findings at a Glance, Executive Summary, Findings at a Glance
Date: 01/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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