Rural Health
Resources by Topic: Medicare
Environmental Scan on Reducing Barriers to Participation in Population-Based Total Cost of Care (PB-TCOC) Models and Supporting Primary and Specialty Care Transformation
Presents results of an environmental scan on reducing barriers to participation in population-based total cost of care (PB-TCOC) models and supporting primary and specialty care transformation. Discusses identifying pathways for maximizing participation of different kinds of organizations in PB-TCOC models; an assessment of and approaches to reducing organization-level barriers; approaches to support primary and specialty care transformation; an assessment of factors that influence the ability of PB-TCOC models to be competitive; and a summary of relevant features in previously submitted Physician-Focused Payment Model Technical Advisory Committee (PTAC) proposals. Includes rural references throughout.
Date: 05/2025
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Presents results of an environmental scan on reducing barriers to participation in population-based total cost of care (PB-TCOC) models and supporting primary and specialty care transformation. Discusses identifying pathways for maximizing participation of different kinds of organizations in PB-TCOC models; an assessment of and approaches to reducing organization-level barriers; approaches to support primary and specialty care transformation; an assessment of factors that influence the ability of PB-TCOC models to be competitive; and a summary of relevant features in previously submitted Physician-Focused Payment Model Technical Advisory Committee (PTAC) proposals. Includes rural references throughout.
Date: 05/2025
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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CMS Innovation Center Strategic Direction
Describes the vision and strategic objectives for the Center for Medicare and Medicaid Innovation (CMS Innovation Center). Strategic objectives include promoting evidence-based prevention, empowering people to achieve their health goals, and driving choice and competition.
Additional links: Frequently Asked Questions, White Paper: The CMS Innovation Center's Strategy to Make America Healthy Again
Date: 05/2025
Sponsoring organization: Centers for Medicare & Medicaid Services
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Describes the vision and strategic objectives for the Center for Medicare and Medicaid Innovation (CMS Innovation Center). Strategic objectives include promoting evidence-based prevention, empowering people to achieve their health goals, and driving choice and competition.
Additional links: Frequently Asked Questions, White Paper: The CMS Innovation Center's Strategy to Make America Healthy Again
Date: 05/2025
Sponsoring organization: Centers for Medicare & Medicaid Services
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Evaluation of the Primary Care First Model: Third Annual Report
Provides an overview of the Primary Care First (PCF) model, which aims to enhance primary care and move primary care practitioners toward value-based payment. Describes the PCF model implementation experiences for Cohort 1 and Cohort 2 practices through 2023. Explores the characteristics of practices and payers that continued to participate in the PCF model compared to those who left. Examines the role that the PCF Model's incentives and supports played in the strategies and practices adopted to improve care delivery and how the trajectory of these strategies and activities practices have transformed over time. Estimates the impact of the PCF Model on Medicare fee-for-service (FFS) expenditures and service use, including acute hospitalizations. Estimates the impacts of the model on a set of seven leading indicators to provide an early assessment of whether care delivery changes are resulting in meaningful early outcome changes.
Additional links: Executive Summary, Findings at a Glance
Date: 05/2025
Sponsoring organizations: Centers for Medicare & Medicaid Services, Mathematica
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Provides an overview of the Primary Care First (PCF) model, which aims to enhance primary care and move primary care practitioners toward value-based payment. Describes the PCF model implementation experiences for Cohort 1 and Cohort 2 practices through 2023. Explores the characteristics of practices and payers that continued to participate in the PCF model compared to those who left. Examines the role that the PCF Model's incentives and supports played in the strategies and practices adopted to improve care delivery and how the trajectory of these strategies and activities practices have transformed over time. Estimates the impact of the PCF Model on Medicare fee-for-service (FFS) expenditures and service use, including acute hospitalizations. Estimates the impacts of the model on a set of seven leading indicators to provide an early assessment of whether care delivery changes are resulting in meaningful early outcome changes.
Additional links: Executive Summary, Findings at a Glance
Date: 05/2025
Sponsoring organizations: Centers for Medicare & Medicaid Services, Mathematica
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Merit-based Incentive Payment System (MIPS): 2025 MIPS Promoting Interoperability Performance Category Hardship Exception Application Guide
Provides guidance on how clinicians can apply for a MIPS hardship exception. Highlights guidance for having your MIPS Promoting Interoperability performance category reweighted to 0% in cases of insufficient internet connectivity, decertified electronic health record technology, or other circumstances out of the clinicians' control.
Date: 05/2025
Sponsoring organization: Centers for Medicare & Medicaid Services
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Provides guidance on how clinicians can apply for a MIPS hardship exception. Highlights guidance for having your MIPS Promoting Interoperability performance category reweighted to 0% in cases of insufficient internet connectivity, decertified electronic health record technology, or other circumstances out of the clinicians' control.
Date: 05/2025
Sponsoring organization: Centers for Medicare & Medicaid Services
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Medicare Shared Savings Program: Rule Changes and Implications for Rural Health Care Organizations
Summarizes changes to the Centers for Medicare & Medicaid Services (CMS) Medicare Shared Savings Program (SSP) that take effect in January 2023 for current participants, and in January 2024 for organizations applying for a January 1, 2024 start. Discusses the potential impact of these changes on rural health and participation considerations.
Date: 05/2025
Sponsoring organization: Rural Health Value
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Summarizes changes to the Centers for Medicare & Medicaid Services (CMS) Medicare Shared Savings Program (SSP) that take effect in January 2023 for current participants, and in January 2024 for organizations applying for a January 1, 2024 start. Discusses the potential impact of these changes on rural health and participation considerations.
Date: 05/2025
Sponsoring organization: Rural Health Value
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Medicare Beneficiary Receipt of Methadone by Drive Time to Opioid Treatment Programs
Examines availability of methadone at opioid treatment programs for Medicare beneficiaries who have been diagnosed with an opioid use disorder. Utilizes data from 640,706 Medicare beneficiaries and analyzes their respective drive time to a treatment facility as well as receipt of methadone treatment. Includes U.S. map showing locations of opioid treatment programs and rural versus urban comparisons of patient drive times.
Author(s): Jonathan Cantor, Helin G. Hernandez, Aaron Kofner, et al.
Citation: JAMA Network Open, 8(4), e253099
Date: 04/2025
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Examines availability of methadone at opioid treatment programs for Medicare beneficiaries who have been diagnosed with an opioid use disorder. Utilizes data from 640,706 Medicare beneficiaries and analyzes their respective drive time to a treatment facility as well as receipt of methadone treatment. Includes U.S. map showing locations of opioid treatment programs and rural versus urban comparisons of patient drive times.
Author(s): Jonathan Cantor, Helin G. Hernandez, Aaron Kofner, et al.
Citation: JAMA Network Open, 8(4), e253099
Date: 04/2025
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Most People in the Most Rural Counties Get Medicare Coverage from Traditional Medicare
Examines the percentage of eligible Medicare beneficiaries with traditional Medicare versus Medicare Advantage at the county level in 2024. Compares type of Medicare coverage by rural non-adjacent, rural adjacent, and urban county classification.
Author(s): Jeannie Fuglesten Biniek, Meredith Freed, Nolan Sroczynski, Tricia Neuman
Date: 04/2025
Sponsoring organization: KFF
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Examines the percentage of eligible Medicare beneficiaries with traditional Medicare versus Medicare Advantage at the county level in 2024. Compares type of Medicare coverage by rural non-adjacent, rural adjacent, and urban county classification.
Author(s): Jeannie Fuglesten Biniek, Meredith Freed, Nolan Sroczynski, Tricia Neuman
Date: 04/2025
Sponsoring organization: KFF
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10 Things to Know About Rural Hospitals
Presents information and data on rural hospitals and rural hospital finances. Compares insurance coverage of discharges and births, margins, and the impact of Medicaid expansion by hospitals' rural and urban location. Includes information on rural hospital closures and Medicare special payment designations for rural hospitals. Discusses the potential impacts of recent federal spending proposals on rural hospitals.
Author(s): Scott Hulver, Zachary Levinson, Jamie Godwin, Tricia Neuman
Date: 04/2025
Sponsoring organization: KFF
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Presents information and data on rural hospitals and rural hospital finances. Compares insurance coverage of discharges and births, margins, and the impact of Medicaid expansion by hospitals' rural and urban location. Includes information on rural hospital closures and Medicare special payment designations for rural hospitals. Discusses the potential impacts of recent federal spending proposals on rural hospitals.
Author(s): Scott Hulver, Zachary Levinson, Jamie Godwin, Tricia Neuman
Date: 04/2025
Sponsoring organization: KFF
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Stand-Alone Drug Plans Cover a Larger Share of Medicare Part D Enrollees Living in the Most Rural Areas Than Medicare Advantage Plans
Examines Medicare Part D enrollment in stand-alone Medicare prescription drug plans and Medicare Advantage drug plans in 2025. Presents data by urban, rural adjacent, and rural non-adjacent status nationally and by state.
Author(s): Juliette Cubanski, Tricia Neuman, Anthony Damico
Date: 04/2025
Sponsoring organization: KFF
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Examines Medicare Part D enrollment in stand-alone Medicare prescription drug plans and Medicare Advantage drug plans in 2025. Presents data by urban, rural adjacent, and rural non-adjacent status nationally and by state.
Author(s): Juliette Cubanski, Tricia Neuman, Anthony Damico
Date: 04/2025
Sponsoring organization: KFF
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Sustaining Rural Hospital Access: Adjustments to Medicare Rural Hospital Designations
Describes the history of Medicare rural hospital designations. Discusses how traditional Medicare, Medicare Advantage, and Medicaid impact hospital finances. Outlines policy recommendations to the Secretary of Health and Human Services (HHS) and Congress regarding rural hospitals designations, payment adjustments, Medicare Advantage, and rural ambulance and emergency services.
Author(s): Emma Sheffert, Maya Sandalow
Date: 04/2025
Sponsoring organization: Bipartisan Policy Center
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Describes the history of Medicare rural hospital designations. Discusses how traditional Medicare, Medicare Advantage, and Medicaid impact hospital finances. Outlines policy recommendations to the Secretary of Health and Human Services (HHS) and Congress regarding rural hospitals designations, payment adjustments, Medicare Advantage, and rural ambulance and emergency services.
Author(s): Emma Sheffert, Maya Sandalow
Date: 04/2025
Sponsoring organization: Bipartisan Policy Center
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