Rural Health
Resources by Topic: Medicare
Medicare Advantage Enrollees Have Access to About Half of the Physicians Available to Traditional Medicare Beneficiaries
Explores how provider networks vary across Medicare Advantage plans and when compared to traditional Medicare. Examines the share of physicians available to Medicare Advantage enrollees as a share of physicians available to traditional Medicare beneficiaries by analyzing Medicare Advantage provider directories for 2022. Includes information on the availability of physicians to Medicare Advantage enrollees and traditional Medicare beneficiaries in rural counties.
Author(s): Matthew Rae, Jeannie Fuglesten Biniek, Tricia Neuman, Karen Pollitz
Date: 10/2025
Sponsoring organization: KFF
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Explores how provider networks vary across Medicare Advantage plans and when compared to traditional Medicare. Examines the share of physicians available to Medicare Advantage enrollees as a share of physicians available to traditional Medicare beneficiaries by analyzing Medicare Advantage provider directories for 2022. Includes information on the availability of physicians to Medicare Advantage enrollees and traditional Medicare beneficiaries in rural counties.
Author(s): Matthew Rae, Jeannie Fuglesten Biniek, Tricia Neuman, Karen Pollitz
Date: 10/2025
Sponsoring organization: KFF
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Calendar Year (CY) 2026 Medicare Physician Fee Schedule Final Rule (CMS-1832-F)
Fact sheet providing an overview of the Centers for Medicare & Medicaid Services (CMS) final rule regarding updates and changes to the Medicare payments under the Physician Fee Schedule (PFS) and other Medicare Part B issues for calendar year 2026. Summarizes provisions related to telehealth services; improving care for chronic illness and behavioral health needs; Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) care coordination services, services requiring direct supervision, and telecommunication services; and more.
Date: 10/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Fact sheet providing an overview of the Centers for Medicare & Medicaid Services (CMS) final rule regarding updates and changes to the Medicare payments under the Physician Fee Schedule (PFS) and other Medicare Part B issues for calendar year 2026. Summarizes provisions related to telehealth services; improving care for chronic illness and behavioral health needs; Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) care coordination services, services requiring direct supervision, and telecommunication services; and more.
Date: 10/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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State Telehealth Laws and Reimbursement Policies Report, Fall 2025
Provides an overview of state telehealth policies as of early September 2025. Covers Medicaid reimbursement, private payer laws, and professional requirements.
Additional links: Executive Summary, Infographic, State Summary Chart
Date: 10/2025
Sponsoring organization: Center for Connected Health Policy: The National Telehealth Policy Resource Center
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Provides an overview of state telehealth policies as of early September 2025. Covers Medicaid reimbursement, private payer laws, and professional requirements.
Additional links: Executive Summary, Infographic, State Summary Chart
Date: 10/2025
Sponsoring organization: Center for Connected Health Policy: The National Telehealth Policy Resource Center
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Merit-Based Incentive Payment System (MIPS): 2024 Performance Year/2026 MIPS Payment Year - Payment Adjustment User Guide
Provides information on Merit-Based Incentive Payment System (MIPS) payment adjustments for calendar year 2026. Describes how 2024 MIPS scores relate to 2026 payment adjustments and how payment adjustments are applied. Offers answers to frequently asked questions.
Date: 10/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides information on Merit-Based Incentive Payment System (MIPS) payment adjustments for calendar year 2026. Describes how 2024 MIPS scores relate to 2026 payment adjustments and how payment adjustments are applied. Offers answers to frequently asked questions.
Date: 10/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Medicare Waiver Expiration & Telehealth FAQs
Provides answers to frequently asked questions regarding the expiration of Medicare telehealth waivers on September 30, 2025. Covers in-person visit requirements, billing procedures, and the applicability of policies across different care settings, including Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs).
Additional links: Chart: Telehealth Medicare Post-September 30, 2025
Date: 10/2025
Sponsoring organization: Center for Connected Health Policy: The National Telehealth Policy Resource Center
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Provides answers to frequently asked questions regarding the expiration of Medicare telehealth waivers on September 30, 2025. Covers in-person visit requirements, billing procedures, and the applicability of policies across different care settings, including Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs).
Additional links: Chart: Telehealth Medicare Post-September 30, 2025
Date: 10/2025
Sponsoring organization: Center for Connected Health Policy: The National Telehealth Policy Resource Center
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Investing in Primary Care: The Nurse Practitioner Will See You Now
Describes opportunities to support advancement of preparation and growth for nurse practitioners (NPs) to meet the population's primary care needs. Explores the importance of NPs in rural and underserved communities, and Health Professional Shortage Areas.
Author(s): Jessica McCann, Margaret Flinter
Date: 10/2025
Sponsoring organization: Milbank Memorial Fund
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Describes opportunities to support advancement of preparation and growth for nurse practitioners (NPs) to meet the population's primary care needs. Explores the importance of NPs in rural and underserved communities, and Health Professional Shortage Areas.
Author(s): Jessica McCann, Margaret Flinter
Date: 10/2025
Sponsoring organization: Milbank Memorial Fund
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Many Medicare Advantage and Medicaid Managed Care Plans Have Limited Behavioral Health Provider Networks and Inactive Providers
Examines the availability of behavioral health providers in selected Medicare Advantage (MA) and Medicaid managed care networks in 2023. Analyzes provider network lists and MA and Medicaid encounter data for four MA and two Medicaid managed care plans from 10 selected urban and rural counties across five states. Describes the proportion of the behavioral health workforce in each county included in the plans' networks. Discusses the extent to which managed care plans had inactive providers in their network and why these providers did not deliver services to enrollees. Includes data on the percentage of inactive providers in rural and urban counties. Offers recommendations to monitor and improve the accuracy of provider networks.
Additional links: Report Highlights
Date: 10/2025
Sponsoring organization: Office of Inspector General (HHS)
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Examines the availability of behavioral health providers in selected Medicare Advantage (MA) and Medicaid managed care networks in 2023. Analyzes provider network lists and MA and Medicaid encounter data for four MA and two Medicaid managed care plans from 10 selected urban and rural counties across five states. Describes the proportion of the behavioral health workforce in each county included in the plans' networks. Discusses the extent to which managed care plans had inactive providers in their network and why these providers did not deliver services to enrollees. Includes data on the percentage of inactive providers in rural and urban counties. Offers recommendations to monitor and improve the accuracy of provider networks.
Additional links: Report Highlights
Date: 10/2025
Sponsoring organization: Office of Inspector General (HHS)
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Transforming Rural Health Care Through Medicaid Innovation: Tip Sheet Series
Informational tip sheets discussing the use of Medicaid innovations to assist states in creating their Rural Health Transformation (RHT) Program applications. Covers issues such as behavioral health, school-based services, integrated care access, community health workers, community paramedicine, specialty care, and healthcare technology. Provides examples, strategies, Medicaid policy information, and resources.
Additional links: Improving Access to Integrated Care for Dually Eligible Individuals in Rural Areas, Leveraging Community Health Workers to Address Rural Health Care Needs, Leveraging Community Paramedicine to Address Rural Health Needs, Leveraging Peers and Lay Counselors to Address Behavioral Health Care Workforce Shortages in Rural Areas, Using Project ECHO to Deliver Specialty Care in Rural Areas, Using School-Based Services to Improve Access to Preventive Health Care for Children in Rural Areas, Using Tech-Enabled Solutions to Improve Care Quality and Access in Rural Areas
Author(s): Molly Knowles, Nancy Archibald, Karla Silverman, Lauren Scannelli Jacobs
Date: 10/2025
Sponsoring organization: Center for Health Care Strategies
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Informational tip sheets discussing the use of Medicaid innovations to assist states in creating their Rural Health Transformation (RHT) Program applications. Covers issues such as behavioral health, school-based services, integrated care access, community health workers, community paramedicine, specialty care, and healthcare technology. Provides examples, strategies, Medicaid policy information, and resources.
Additional links: Improving Access to Integrated Care for Dually Eligible Individuals in Rural Areas, Leveraging Community Health Workers to Address Rural Health Care Needs, Leveraging Community Paramedicine to Address Rural Health Needs, Leveraging Peers and Lay Counselors to Address Behavioral Health Care Workforce Shortages in Rural Areas, Using Project ECHO to Deliver Specialty Care in Rural Areas, Using School-Based Services to Improve Access to Preventive Health Care for Children in Rural Areas, Using Tech-Enabled Solutions to Improve Care Quality and Access in Rural Areas
Author(s): Molly Knowles, Nancy Archibald, Karla Silverman, Lauren Scannelli Jacobs
Date: 10/2025
Sponsoring organization: Center for Health Care Strategies
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Rural Emergency Hospital (REH) Model Frequently Asked Questions
Provides answers to frequently asked questions regarding the Rural Emergency Hospital (REH) designation. Covers general information, Conditions of Participation, and REH payment policies.
Date: 10/2025
Sponsoring organizations: Mathematica, Rural Health Redesign Center
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Provides answers to frequently asked questions regarding the Rural Emergency Hospital (REH) designation. Covers general information, Conditions of Participation, and REH payment policies.
Date: 10/2025
Sponsoring organizations: Mathematica, Rural Health Redesign Center
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Unfairness Toward Rural Beneficiaries in Medicare's Hierarchical Conditions Categories Score
Evaluates the Centers for Medicare & Medicaid Services (CMS) Hierarchical Condition Category (HCC) to determine its usefulness in accurately predicting risk for rural and urban patients. Assesses rural and urban risk by mortality rates and compares findings with HCC's measure of spending to identify risk. Discusses implications of findings related to reimbursement rates, healthcare access, social determinants of health, and Medicare Advantage enrollment. Offers potential solutions to address study findings.
Author(s): Ravi B. Parikh, Kristin A. Linn, Junning Liang, et al
Citation: Health Affairs Scholar, 3(9)
Date: 09/2025
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Evaluates the Centers for Medicare & Medicaid Services (CMS) Hierarchical Condition Category (HCC) to determine its usefulness in accurately predicting risk for rural and urban patients. Assesses rural and urban risk by mortality rates and compares findings with HCC's measure of spending to identify risk. Discusses implications of findings related to reimbursement rates, healthcare access, social determinants of health, and Medicare Advantage enrollment. Offers potential solutions to address study findings.
Author(s): Ravi B. Parikh, Kristin A. Linn, Junning Liang, et al
Citation: Health Affairs Scholar, 3(9)
Date: 09/2025
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