Rural Health
Resources by Topic: Medicare
A Summary of State Innovation Models (SIM) Evaluation Results Across 17 States (2013-2020)
Summarizes evaluation results of the State Innovation Models (SIM), which examined the ability of 17 state governments to implement and test innovative value-based payment (VBP) healthcare models across multiple payers between 2013 and 2020. Presents findings regarding the implementation and impact of 29 delivery and payment models, including patient-centered medical homes, accountable care organizations, behavioral health integration, and more. Covers state contracting and consensus building, practice transformation, pediatric care, behavioral healthcare, beneficiary and provider perspectives, and more. Includes a section on payment model designs tailored to unique state needs, including rural populations, as well as rural references throughout.
Additional links: A Summary of State Innovation Models (SIM): Focus on State-Led Transformation - Findings at a Glance, Executive Summary, Findings at a Glance
Date: 01/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Summarizes evaluation results of the State Innovation Models (SIM), which examined the ability of 17 state governments to implement and test innovative value-based payment (VBP) healthcare models across multiple payers between 2013 and 2020. Presents findings regarding the implementation and impact of 29 delivery and payment models, including patient-centered medical homes, accountable care organizations, behavioral health integration, and more. Covers state contracting and consensus building, practice transformation, pediatric care, behavioral healthcare, beneficiary and provider perspectives, and more. Includes a section on payment model designs tailored to unique state needs, including rural populations, as well as rural references throughout.
Additional links: A Summary of State Innovation Models (SIM): Focus on State-Led Transformation - Findings at a Glance, Executive Summary, Findings at a Glance
Date: 01/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Shared Savings Program Fast Facts
Provides summary statistics on the Medicare Shared Savings Program as of January 1, 2025. Offers data on the number of Accountable Care Organizations (ACOs), assigned beneficiaries, total earned shared savings, and quality scores each year since 2012; the number and percent of ACOs in each track; and more. Includes information on ACO participants, including the number of Rural Health Clinics (RHCs) and Critical Access Hospitals (CAHs) participating in the program.
Date: 01/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides summary statistics on the Medicare Shared Savings Program as of January 1, 2025. Offers data on the number of Accountable Care Organizations (ACOs), assigned beneficiaries, total earned shared savings, and quality scores each year since 2012; the number and percent of ACOs in each track; and more. Includes information on ACO participants, including the number of Rural Health Clinics (RHCs) and Critical Access Hospitals (CAHs) participating in the program.
Date: 01/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Evaluating Medicare Advantage Benchmark Setting Methodology on Rural Counties
Examines how the current Medicare Advantage benchmark setting process and methods impact rural and urban counties. Presents data on the Medicare fee-for-service spending quartiles by metropolitan and non-metropolitan counties and the effects of caps on benchmark payments by geography.
Author(s): Dan M. Shane, Edmer Lazaro, Fred Ullrich, Keith Mueller
Date: 01/2025
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Examines how the current Medicare Advantage benchmark setting process and methods impact rural and urban counties. Presents data on the Medicare fee-for-service spending quartiles by metropolitan and non-metropolitan counties and the effects of caps on benchmark payments by geography.
Author(s): Dan M. Shane, Edmer Lazaro, Fred Ullrich, Keith Mueller
Date: 01/2025
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Medicare Advantage Enrollment Update 2024
Reports on the percentage of rural Medicare beneficiaries enrolled in Medicare Advantage (MA) plans by metropolitan and nonmetropolitan location and plan type, from 2014-2024.
Author(s): Fred Ullrich, Keith Mueller
Date: 01/2025
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Reports on the percentage of rural Medicare beneficiaries enrolled in Medicare Advantage (MA) plans by metropolitan and nonmetropolitan location and plan type, from 2014-2024.
Author(s): Fred Ullrich, Keith Mueller
Date: 01/2025
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Merit-based Incentive Payment System (MIPS): 2025 MIPS Quick Start Guide for Small Practices
Provides an overview of the Merit-based Incentive Payment System (MIPS). Outlines 6 steps for small practices regarding participation in the 2025 performance year. Includes information on performance category redistribution policies for small practices.
Date: 01/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides an overview of the Merit-based Incentive Payment System (MIPS). Outlines 6 steps for small practices regarding participation in the 2025 performance year. Includes information on performance category redistribution policies for small practices.
Date: 01/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Telehealth FAQ Calendar Year 2025
Provides information on Medicare telehealth regulations and payment policy for calendar year 2025. Includes information on audio-only services, behavioral health services, direct supervision, and more.
Date: 2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides information on Medicare telehealth regulations and payment policy for calendar year 2025. Includes information on audio-only services, behavioral health services, direct supervision, and more.
Date: 2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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CMS Office of Minority Health: Health Equity Data Book
Provides data on disparities in participation in Centers for Medicare & Medicaid Services (CMS) programs, including data on demographics of covered individuals, chronic conditions, behavioral health conditions, and social determinants of health. Contains rural data for select programs.
Date: 12/2024
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides data on disparities in participation in Centers for Medicare & Medicaid Services (CMS) programs, including data on demographics of covered individuals, chronic conditions, behavioral health conditions, and social determinants of health. Contains rural data for select programs.
Date: 12/2024
Sponsoring organization: Centers for Medicare and Medicaid Services
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Medicare Could save Billions with Comparable Access for Enrollees If Critical Access Hospital Payments for Swing-Bed Services Were Similar to Those of the Fee-for-Service Prospective Payment System
Describes the use of swing beds for skilled nursing services at Critical Access Hospitals (CAHs) and average daily Medicare reimbursement for these services from 2015 through 2020. Examines data from a sample of 100 CAHs to determine whether Medicare enrollees would have had access to the same skilled nursing services provided by CAHs at alternative facilities within a 35-mile driving distance. Compares the average daily reimbursement for skilled nursing services at CAHs and alternative facilities, as well as the potential savings to Medicare if CAHs were reimbursed for skilled nursing services under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS).
Date: 12/2024
Sponsoring organization: Office of Inspector General (HHS)
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Describes the use of swing beds for skilled nursing services at Critical Access Hospitals (CAHs) and average daily Medicare reimbursement for these services from 2015 through 2020. Examines data from a sample of 100 CAHs to determine whether Medicare enrollees would have had access to the same skilled nursing services provided by CAHs at alternative facilities within a 35-mile driving distance. Compares the average daily reimbursement for skilled nursing services at CAHs and alternative facilities, as well as the potential savings to Medicare if CAHs were reimbursed for skilled nursing services under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS).
Date: 12/2024
Sponsoring organization: Office of Inspector General (HHS)
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December 2024 MedPAC Meeting Transcript
Transcript from the Medicare Payment Advisory Commission's (MedPAC) December 2024 meeting. Covers payment adequacy and updates for physician and other health professional services, hospital inpatient and outpatient services, Rural Emergency Hospitals (REHs), skilled nursing facility services, inpatient rehabilitation facility services, home health services, hospice services, and outpatient dialysis services.
Additional links: Assessing Payment Adequacy and Updating Payments: Hospital Inpatient and Outpatient Services; and Mandated Report on Rural Emergency Hospitals - Presentation Slides, Assessing Payment Adequacy and Updating Payments: Skilled Nursing Facility Services - Presentation Slides
Date: 12/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Transcript from the Medicare Payment Advisory Commission's (MedPAC) December 2024 meeting. Covers payment adequacy and updates for physician and other health professional services, hospital inpatient and outpatient services, Rural Emergency Hospitals (REHs), skilled nursing facility services, inpatient rehabilitation facility services, home health services, hospice services, and outpatient dialysis services.
Additional links: Assessing Payment Adequacy and Updating Payments: Hospital Inpatient and Outpatient Services; and Mandated Report on Rural Emergency Hospitals - Presentation Slides, Assessing Payment Adequacy and Updating Payments: Skilled Nursing Facility Services - Presentation Slides
Date: 12/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Estimating the Effects of the Medicare $2 Drug List on Part D Enrollees
Discusses the Medicare $2 Drug List (M2DL) Model, which would allow Medicare Part D enrollees to purchase monthly drugs for $2 or less. Provides projected financial impact of the model, such as out of pocket (OOP) costs for individual drugs as well as OOP changes for enrollees, with breakdowns by demographic variables, including urban, rural-micropolitan, rural-other, or unclassified location.
Date: 12/2024
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Discusses the Medicare $2 Drug List (M2DL) Model, which would allow Medicare Part D enrollees to purchase monthly drugs for $2 or less. Provides projected financial impact of the model, such as out of pocket (OOP) costs for individual drugs as well as OOP changes for enrollees, with breakdowns by demographic variables, including urban, rural-micropolitan, rural-other, or unclassified location.
Date: 12/2024
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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