Rural Health
Resources by Topic: Medicare
Rural Beneficiary Access to Medicare Advantage-Part D Plans
Policy brief updating RUPRI's analysis of Medicare Advantage-Part D plans (MA-PDs) including enhanced benefit plan availability and differences in characteristics across metropolitan, micropolitan, and noncore areas. Features statistics including number of MA-PDs and stand-alone prescription drug plans (PDPs), average monthly premium costs, and availability in metropolitan, micropolitan, and noncore areas from 2008-2023.
Author(s): Edmer Lazaro, Dan M. Shane, Fred Ullrich, Keith Mueller
Date: 08/2025
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Policy brief updating RUPRI's analysis of Medicare Advantage-Part D plans (MA-PDs) including enhanced benefit plan availability and differences in characteristics across metropolitan, micropolitan, and noncore areas. Features statistics including number of MA-PDs and stand-alone prescription drug plans (PDPs), average monthly premium costs, and availability in metropolitan, micropolitan, and noncore areas from 2008-2023.
Author(s): Edmer Lazaro, Dan M. Shane, Fred Ullrich, Keith Mueller
Date: 08/2025
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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End-Stage Renal Disease Treatment Choices (ETC) Model: Third Annual Evaluation Report, Calendar Years 2021-2023
Evaluation of the End-Stage Renal Disease Treatment Choices (ETC) Model, incorporating analyses of home dialysis use, waitlisting for a kidney transplant, living donor and deceased donor transplantation, utilization of services, Medicare payments, and quality of care. Features results from interviews and surveys involving model participants and beneficiaries, and examines impacts of the first three years of the ETC Model, 2021-2023. Explores if the impacts of the ETC Model differed by patient subgroup, including rural residence.
Additional links: Appendices, Executive Summary, Findings at a Glance
Date: 08/2025
Sponsoring organizations: Centers for Medicare and Medicaid Services, The Lewin Group
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Evaluation of the End-Stage Renal Disease Treatment Choices (ETC) Model, incorporating analyses of home dialysis use, waitlisting for a kidney transplant, living donor and deceased donor transplantation, utilization of services, Medicare payments, and quality of care. Features results from interviews and surveys involving model participants and beneficiaries, and examines impacts of the first three years of the ETC Model, 2021-2023. Explores if the impacts of the ETC Model differed by patient subgroup, including rural residence.
Additional links: Appendices, Executive Summary, Findings at a Glance
Date: 08/2025
Sponsoring organizations: Centers for Medicare and Medicaid Services, The Lewin Group
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FY 2026 Medicare Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) and Quality Reporting (IPFQR) Updates Final Rule (CMS-1831-F)
Fact sheet providing an overview of the Centers for Medicare & Medicaid Services (CMS) fiscal year 2026 inpatient psychiatric facility (IPF) prospective payment system (PPS) final rule. Covers annual updates to the prospective payment rates, outlier threshold, and wage index. Also describes changes to facility-level adjustment factors for teaching status and rural location.
Date: 08/2025
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) fiscal year 2026 inpatient psychiatric facility (IPF) prospective payment system (PPS) final rule. Covers annual updates to the prospective payment rates, outlier threshold, and wage index. Also describes changes to facility-level adjustment factors for teaching status and rural location.
Date: 08/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Merit-Based Incentive Payment System (MIPS): Traditional MIPS Scoring Guide for the 2025 Performance Year
Provides details on how scores are calculated for the Merit-Based Incentive Payment System (MIPS), one of two tracks under the Medicare Quality Payment Program. Explains the four performance categories that affect Medicare Physician Fee Schedule payments: quality, cost, improvement activities, and promoting interoperability. Includes information for small practices.
Date: 08/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides details on how scores are calculated for the Merit-Based Incentive Payment System (MIPS), one of two tracks under the Medicare Quality Payment Program. Explains the four performance categories that affect Medicare Physician Fee Schedule payments: quality, cost, improvement activities, and promoting interoperability. Includes information for small practices.
Date: 08/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Merit-Based Incentive Payment System (MIPS): 2025 Merit-Based Incentive Payment (MIPS) Value Pathways (MVPs) Implementation Guide
Provides an overview of the Merit-based Incentive Payment System (MIPS) Value Pathways (MVPs), a voluntary reporting option that can be used to meet MIPS reporting requirements for the 2025 performance year. Describes subgroup reporting, reporting requirements, scoring, performance feedback and public reporting, and how to register to report an MVP. Includes information on considerations and exceptions for small practices and clinicians in a rural or Health Professional Shortage Area.
Date: 08/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides an overview of the Merit-based Incentive Payment System (MIPS) Value Pathways (MVPs), a voluntary reporting option that can be used to meet MIPS reporting requirements for the 2025 performance year. Describes subgroup reporting, reporting requirements, scoring, performance feedback and public reporting, and how to register to report an MVP. Includes information on considerations and exceptions for small practices and clinicians in a rural or Health Professional Shortage Area.
Date: 08/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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AHEAD CMS-Designed Medicare FFS HGB Calculator Tool for Acute Care Hospitals Demonstration
Provides an overview and demonstration of the CMS-Designed Medicare Fee-for-Service Hospital Global Budget (HGB) Calculator Tool, which aims to support fee-for-service acute care hospitals in understanding the HGB financial methodology for the AHEAD Model. Discusses how an AHEAD Medicare Fee-for-Service Hospital Global Budget is constructed.
Additional links: AHEAD Model CMS-Designed Medicare FFS Acute Care Hospital Global Budget Calculator Tool, AHEAD Model: CMS-Designed Medicare Hospital Global Budget Acute Care Hospital Calculator Tool At-A-Glance
Date: 07/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides an overview and demonstration of the CMS-Designed Medicare Fee-for-Service Hospital Global Budget (HGB) Calculator Tool, which aims to support fee-for-service acute care hospitals in understanding the HGB financial methodology for the AHEAD Model. Discusses how an AHEAD Medicare Fee-for-Service Hospital Global Budget is constructed.
Additional links: AHEAD Model CMS-Designed Medicare FFS Acute Care Hospital Global Budget Calculator Tool, AHEAD Model: CMS-Designed Medicare Hospital Global Budget Acute Care Hospital Calculator Tool At-A-Glance
Date: 07/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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AHEAD CMS-Designed Medicare FFS Hospital Global Budget Calculator Tool for Critical Access Hospital
Provides an overview and demonstration of the CMS-Designed Medicare Fee-for-Service Hospital Global Budget (HGB) Calculator Tool for Critical Access Hospitals, which aims to support eligible CAHs in understanding the key elements of the AHEAD Medicare Fee-for-Service (FFS) HGB methodology. Discusses key differences in the hospital global budget construction and methodology for critical access hospitals and fee-for-service hospitals.
Additional links: AHEAD Model CMS-Designed Medicare FFS Critical Access Hospital Global Budget Calculator Tool, AHEAD Model: CMS-Designed Medicare Hospital Global Budget Critical Access Hospital Calculator Tool At-A-Glance
Date: 07/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides an overview and demonstration of the CMS-Designed Medicare Fee-for-Service Hospital Global Budget (HGB) Calculator Tool for Critical Access Hospitals, which aims to support eligible CAHs in understanding the key elements of the AHEAD Medicare Fee-for-Service (FFS) HGB methodology. Discusses key differences in the hospital global budget construction and methodology for critical access hospitals and fee-for-service hospitals.
Additional links: AHEAD Model CMS-Designed Medicare FFS Critical Access Hospital Global Budget Calculator Tool, AHEAD Model: CMS-Designed Medicare Hospital Global Budget Critical Access Hospital Calculator Tool At-A-Glance
Date: 07/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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FY 2026 Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) Final Rule — CMS-1833-F
Fact sheet providing an overview of the Centers for Medicare & Medicaid Services (CMS) fiscal year 2026 hospital inpatient prospective payment system (IPPS) and long-term care hospital prospective payment system (LTCH PPS) final rule. Includes information about the Medicare Promoting Interoperability Program and the discontinuation of the low-wage index hospital policy for FY 2026 and subsequent years.
Date: 07/2025
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) fiscal year 2026 hospital inpatient prospective payment system (IPPS) and long-term care hospital prospective payment system (LTCH PPS) final rule. Includes information about the Medicare Promoting Interoperability Program and the discontinuation of the low-wage index hospital policy for FY 2026 and subsequent years.
Date: 07/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Proposed CY 2026 Medicare Physician Fee Schedule: Fact Sheet
Fact sheet covering Centers for Medicare & Medicaid Services (CMS) telehealth policy changes for 2026 as outlined in the final calendar year (CY) 2026 Physician Fee Schedule. Covers the process for determining which services can be delivered by telehealth; frequency limitations for inpatient visits, nursing facilities, and critical care consults; direct supervision through the use of live video; payment to Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs); and more.
Date: 07/2025
Sponsoring organization: Center for Connected Health Policy: The National Telehealth Policy Resource Center
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Fact sheet covering Centers for Medicare & Medicaid Services (CMS) telehealth policy changes for 2026 as outlined in the final calendar year (CY) 2026 Physician Fee Schedule. Covers the process for determining which services can be delivered by telehealth; frequency limitations for inpatient visits, nursing facilities, and critical care consults; direct supervision through the use of live video; payment to Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs); and more.
Date: 07/2025
Sponsoring organization: Center for Connected Health Policy: The National Telehealth Policy Resource Center
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Merit-Based Incentive Payment System (MIPS): 2025 MIPS Group Participation Guide - Traditional MIPS and MVPs
Provides an overview of traditional Merit-based Incentive Payment System (MIPS) and MIPS Value Pathways (MVP) group participation options for the 2025 performance year. Discusses eligibility; special status designations; the quality, cost, and promoting interoperability performance categories; scoring and payment adjustments; and more. Includes information on group reporting requirements and considerations for small practices and clinicians in a rural or Health Professional Shortage Area.
Date: 07/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides an overview of traditional Merit-based Incentive Payment System (MIPS) and MIPS Value Pathways (MVP) group participation options for the 2025 performance year. Discusses eligibility; special status designations; the quality, cost, and promoting interoperability performance categories; scoring and payment adjustments; and more. Includes information on group reporting requirements and considerations for small practices and clinicians in a rural or Health Professional Shortage Area.
Date: 07/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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