Rural Health
Resources by Topic: Medicare
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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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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Evaluation of the Rural Community Hospital Demonstration: CCA Extension Final Report (Covering 2016-2021)
Provides an overview of the Rural Community Hospital Demonstration (RCHD), focusing on the 26 hospitals that participated during the extension period authorized by the 21st Century Cures Act (2016-2021). Describes the characteristics of active RCHD participants before they joined the demonstration, the Medicare payments received under the program, and the impact of the RCHD on hospital financial measures.
Additional links: Appendices, At-A-Glance, Executive Summary
Date: 09/2025
Sponsoring organizations: American Institutes for Research, Centers for Medicare and Medicaid Services
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Provides an overview of the Rural Community Hospital Demonstration (RCHD), focusing on the 26 hospitals that participated during the extension period authorized by the 21st Century Cures Act (2016-2021). Describes the characteristics of active RCHD participants before they joined the demonstration, the Medicare payments received under the program, and the impact of the RCHD on hospital financial measures.
Additional links: Appendices, At-A-Glance, Executive Summary
Date: 09/2025
Sponsoring organizations: American Institutes for Research, Centers for Medicare and Medicaid Services
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Nursing Homes Failed to Report 43 Percent of Falls With Major Injury and Hospitalization among Their Medicare-Enrolled Residents
Explores the extent to which falls with major injury that resulted in hospitalization among Medicare-enrolled nursing home residents were accurately reported by nursing homes in Minimum Data Set (MDS) assessments between July 2022 and June 2023. Compares the nursing home and patient characteristics associated with higher rates of unreported falls, including nursing home size, ownership structure, rurality, and overall star rating.
Additional links: Report Highlights
Date: 09/2025
Sponsoring organization: Office of Inspector General (HHS)
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Explores the extent to which falls with major injury that resulted in hospitalization among Medicare-enrolled nursing home residents were accurately reported by nursing homes in Minimum Data Set (MDS) assessments between July 2022 and June 2023. Compares the nursing home and patient characteristics associated with higher rates of unreported falls, including nursing home size, ownership structure, rurality, and overall star rating.
Additional links: Report Highlights
Date: 09/2025
Sponsoring organization: Office of Inspector General (HHS)
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MedPAC Comment on CMS's Proposed Rule on CY 2026 Revisions to Payment Policies Under the Physician Fee Schedule and Other Changes to Part B for Payment Policies
Comment on a July 16, 2025, Federal Register proposed rule revising the physician fee schedule to improve payment systems for physicians and other Medicare Part B revisions. Includes a discussion of a proposal to allow Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) to provide and bill for medical visits via telehealth and be paid at Physician Fee Schedule (PFS)-equivalent rates through December 2026.
Date: 09/2025
Sponsoring organization: Medicare Payment Advisory Commission
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Comment on a July 16, 2025, Federal Register proposed rule revising the physician fee schedule to improve payment systems for physicians and other Medicare Part B revisions. Includes a discussion of a proposal to allow Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) to provide and bill for medical visits via telehealth and be paid at Physician Fee Schedule (PFS)-equivalent rates through December 2026.
Date: 09/2025
Sponsoring organization: Medicare Payment Advisory Commission
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September 2025 MedPAC Meeting Transcript
Transcript from the Medicare Payment Advisory Commission's (MedPAC) September 2024 meeting. Covers Medicare payment operations and improving payment accuracy, a discussion with the Comptroller General of the United States regarding the Government Accountability Office's work related to improper payments in the Medicare program and opportunities to improve program sustainability, Medicare's overall financial situation, access to hospice and services under the Medicare hospice benefit for beneficiaries with end-stage renal disease or cancer, and the relationship between changes in Medicare Advantage enrollment and hospital finances.
Date: 09/2025
Sponsoring organization: Medicare Payment Advisory Commission
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Transcript from the Medicare Payment Advisory Commission's (MedPAC) September 2024 meeting. Covers Medicare payment operations and improving payment accuracy, a discussion with the Comptroller General of the United States regarding the Government Accountability Office's work related to improper payments in the Medicare program and opportunities to improve program sustainability, Medicare's overall financial situation, access to hospice and services under the Medicare hospice benefit for beneficiaries with end-stage renal disease or cancer, and the relationship between changes in Medicare Advantage enrollment and hospital finances.
Date: 09/2025
Sponsoring organization: Medicare Payment Advisory Commission
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