Rural Health
Resources by Topic: Health insurance
Assisting Rural Consumers
Offers information and guidance for Navigators and certified application counselors helping rural healthcare consumers. Covers rural-relevant considerations and policy updates regarding Federally-facilitated and State-based Marketplaces, Medicaid/CHIP, and Medicare. Outlines tips for assisters to address barriers to care and conducting outreach in rural areas.
Date: 04/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Offers information and guidance for Navigators and certified application counselors helping rural healthcare consumers. Covers rural-relevant considerations and policy updates regarding Federally-facilitated and State-based Marketplaces, Medicaid/CHIP, and Medicare. Outlines tips for assisters to address barriers to care and conducting outreach in rural areas.
Date: 04/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Ways and Means Republican Members Share Commitment to Value-Based Health Care and Outline Priorities For Medicare Innovation Hub
An April 2025 letter from the U.S. House Committee on Ways and Means majority members regarding the Centers for Medicare & Medicaid Services (CMS) Innovation Center (CMMI). Offers considerations for new and existing models related to promoting value, improving care in rural and underserved communities, and incorporating public input.
Date: 04/2025
Sponsoring organization: House Ways and Means Committee
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An April 2025 letter from the U.S. House Committee on Ways and Means majority members regarding the Centers for Medicare & Medicaid Services (CMS) Innovation Center (CMMI). Offers considerations for new and existing models related to promoting value, improving care in rural and underserved communities, and incorporating public input.
Date: 04/2025
Sponsoring organization: House Ways and Means Committee
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Federal and State Reimbursement for Youth Behavioral Health Services
Report details Medicaid and Children's Health Insurance Program (CHIP) coverage of behavioral health services for rural people under 21 years of age. Breaks down reimbursement eligibility for behavioral health providers in all 50 states and discusses barriers to access in rural areas.
Date: 04/2025
Sponsoring organization: WWAMI Rural Health Research Center
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Report details Medicaid and Children's Health Insurance Program (CHIP) coverage of behavioral health services for rural people under 21 years of age. Breaks down reimbursement eligibility for behavioral health providers in all 50 states and discusses barriers to access in rural areas.
Date: 04/2025
Sponsoring organization: WWAMI Rural Health Research Center
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CMS Bundled Payments for Care Improvement Advanced Model: Sixth Annual Evaluation Report
Sixth annual report of the Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model, which tests whether linking payments for a clinical episode of care can reduce Medicare expenditures while maintaining or improving the quality of care. Examines the impact of BPCI Advanced on episode payments, utilization, and quality of care, as well as estimates of Medicare program savings in Model Year 5. Also explores the impact of the model on accountable care relationships, strengthening primary care, and care for patients eligible for both Medicare and Medicaid. Includes data on the percentage of BPCI Advanced episodes with and without ACO attribution by patient characteristics, including rural residents.
Additional links: Appendices, Executive Summary, Findings at a Glance, Transformation Spotlight
Author(s): The Lewin Group, Abt Associates, GDIT, Telligen
Date: 04/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Sixth annual report of the Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model, which tests whether linking payments for a clinical episode of care can reduce Medicare expenditures while maintaining or improving the quality of care. Examines the impact of BPCI Advanced on episode payments, utilization, and quality of care, as well as estimates of Medicare program savings in Model Year 5. Also explores the impact of the model on accountable care relationships, strengthening primary care, and care for patients eligible for both Medicare and Medicaid. Includes data on the percentage of BPCI Advanced episodes with and without ACO attribution by patient characteristics, including rural residents.
Additional links: Appendices, Executive Summary, Findings at a Glance, Transformation Spotlight
Author(s): The Lewin Group, Abt Associates, GDIT, Telligen
Date: 04/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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April 2025 MedPAC Meeting Transcript
Transcript from the Medicare Payment Advisory Commission's (MedPAC) April 2025 meeting. Covers physician fee schedule updates and improving the accuracy of relative payment rates; structural differences between the stand-alone prescription drug plan (PDP) and Medicare Advantage–Prescription Drug plan (MA–PD) markets; the utilization and delivery of Medicare Advantage supplemental benefits; the effect of Medicare Advantage on rural hospitals; paying for software technologies in Medicare; access to hospice and certain services under the hospice benefit for beneficiaries with end-stage renal disease and beneficiaries with cancer; and regulations, star ratings, and fee-for-service Medicare policies aimed at improving nursing home quality.
Additional links: Exploring the Effect of Medicare Advantage on Rural Hospitals
Date: 04/2025
Sponsoring organization: Medicare Payment Advisory Commission
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Transcript from the Medicare Payment Advisory Commission's (MedPAC) April 2025 meeting. Covers physician fee schedule updates and improving the accuracy of relative payment rates; structural differences between the stand-alone prescription drug plan (PDP) and Medicare Advantage–Prescription Drug plan (MA–PD) markets; the utilization and delivery of Medicare Advantage supplemental benefits; the effect of Medicare Advantage on rural hospitals; paying for software technologies in Medicare; access to hospice and certain services under the hospice benefit for beneficiaries with end-stage renal disease and beneficiaries with cancer; and regulations, star ratings, and fee-for-service Medicare policies aimed at improving nursing home quality.
Additional links: Exploring the Effect of Medicare Advantage on Rural Hospitals
Date: 04/2025
Sponsoring organization: Medicare Payment Advisory Commission
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Are HHC Scores a Reliable Health Status Indicator Across Rural and Urban Areas?
Examines differences in Centers for Medicare & Medicaid Services Hierarchical Condition Category (HCC) risk scores between rural and urban Medicare Fee-for-Service (FFS) beneficiaries and analyzes which factors drive observed differences. Features statistics with breakdowns by urban, large rural, small rural, and isolated rural areas for 4 chronic conditions in 2019-2020.
Author(s): Craig D. Holden, Alana Knudson, Marilyn Klug, Samantha Augenbraun, Shena Popat
Date: 04/2025
Sponsoring organization: ETSU/NORC Rural Health Research Center
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Examines differences in Centers for Medicare & Medicaid Services Hierarchical Condition Category (HCC) risk scores between rural and urban Medicare Fee-for-Service (FFS) beneficiaries and analyzes which factors drive observed differences. Features statistics with breakdowns by urban, large rural, small rural, and isolated rural areas for 4 chronic conditions in 2019-2020.
Author(s): Craig D. Holden, Alana Knudson, Marilyn Klug, Samantha Augenbraun, Shena Popat
Date: 04/2025
Sponsoring organization: ETSU/NORC Rural Health Research Center
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Small Practice After-Action Review: 2023 Performance Year Final Score
Tool for small practices interested in examining their 2023 Merit-based Incentive Payment System (MIPS) final score to identify opportunities to improve performance in 2025.
Additional links: Video: Small Practice Action Planning Tool for MIPS
Date: 04/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Tool for small practices interested in examining their 2023 Merit-based Incentive Payment System (MIPS) final score to identify opportunities to improve performance in 2025.
Additional links: Video: Small Practice Action Planning Tool for MIPS
Date: 04/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Merit-based Incentive Payment System (MIPS) 2025 Small Practice Eligibility and Participation Frequently Asked Questions
Provides answers to frequently asked questions regarding small practice participation and eligibility for the Merit-based Incentive Payment System (MIPS) for the 2025 performance year. Covers individual and group eligibility, the low-volume threshold, changes to group composition during the performance year, and more.
Date: 04/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides answers to frequently asked questions regarding small practice participation and eligibility for the Merit-based Incentive Payment System (MIPS) for the 2025 performance year. Covers individual and group eligibility, the low-volume threshold, changes to group composition during the performance year, and more.
Date: 04/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Merit-Based Incentive Payment System (MIPS): 2025 Reporting MIPS Quality Measures through Medicare Part B Claims Quick Start Guide for Small Practices
Provides details on how small practices can report quality measures through Medicare Part B claims measures. Highlights changes to these measures in 2025, score redistribution policies for small practices, and information for clinicians at Critical Access Hospitals.
Date: 04/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides details on how small practices can report quality measures through Medicare Part B claims measures. Highlights changes to these measures in 2025, score redistribution policies for small practices, and information for clinicians at Critical Access Hospitals.
Date: 04/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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The Relationship Between Food and Housing Insecurity and Healthcare Use among Virginia Medicaid Expansion Members: Considering the Neighborhood Context
Examines how rurality and residential segregation impact food and housing insecurity in Medicaid expansion members in Virginia. Analyzes 14,735 individuals in 2019 for food and housing security, with demographic breakdowns by sex, race/ethnicity, age, health status, healthcare usage, income, and urban, suburban, or rural location.
Author(s): Hannah Shadowen, Sarah J. Marks, Olufemi Obembe, et al.
Citation: Health Services Research, 60(S2)
Date: 04/2025
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Examines how rurality and residential segregation impact food and housing insecurity in Medicaid expansion members in Virginia. Analyzes 14,735 individuals in 2019 for food and housing security, with demographic breakdowns by sex, race/ethnicity, age, health status, healthcare usage, income, and urban, suburban, or rural location.
Author(s): Hannah Shadowen, Sarah J. Marks, Olufemi Obembe, et al.
Citation: Health Services Research, 60(S2)
Date: 04/2025
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