Rural Health
Resources by Topic: Reimbursement and payment models
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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Comparing Utilization of Home Health Care Between Traditional Medicare and Medicare Advantage Beneficiaries by Rural-Urban Status
Policy report describing differences in utilization of home health care between beneficiaries enrolled in Traditional Medicare (TM) and Medicare Advantage (MA), and by rural or urban status. Examines differences in use of home health overall, provision of specific services, including physical and occupational therapy, and receipt of care from home health agencies by enrollment in TM and MA. Features statistics with breakdowns by urban, large rural, small rural, and isolated rural areas.
Date: 09/2025
Sponsoring organization: WWAMI Rural Health Research Center
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Policy report describing differences in utilization of home health care between beneficiaries enrolled in Traditional Medicare (TM) and Medicare Advantage (MA), and by rural or urban status. Examines differences in use of home health overall, provision of specific services, including physical and occupational therapy, and receipt of care from home health agencies by enrollment in TM and MA. Features statistics with breakdowns by urban, large rural, small rural, and isolated rural areas.
Date: 09/2025
Sponsoring organization: WWAMI Rural Health Research Center
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Comparison of Care in Hospital Outpatient Departments and Independent Physician Offices: Updated Findings for 2019-2024
Examines differences in Medicare payments for services at an independent physician's office (IPO) or a hospital outpatient department (HOPD). Utilizes 2019-2024 data to analyze characteristics of Medicare patients seen in HOPDs and IPOs, including rural versus urban location.
Date: 09/2025
Sponsoring organization: American Hospital Association
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Examines differences in Medicare payments for services at an independent physician's office (IPO) or a hospital outpatient department (HOPD). Utilizes 2019-2024 data to analyze characteristics of Medicare patients seen in HOPDs and IPOs, including rural versus urban location.
Date: 09/2025
Sponsoring organization: American Hospital Association
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Implementing High-Quality Primary Care: A Policy Menu for States
Presents policy strategies utilized by states to strengthen primary care across five priority areas. Strategies cover primary care reimbursement; addressing individual, community, and market-level barriers to care; expanding and supporting the primary care workforce; and supporting practice transformation. Includes rural references throughout.
Date: 09/2025
Sponsoring organizations: Milbank Memorial Fund, National Academy for State Health Policy
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Presents policy strategies utilized by states to strengthen primary care across five priority areas. Strategies cover primary care reimbursement; addressing individual, community, and market-level barriers to care; expanding and supporting the primary care workforce; and supporting practice transformation. Includes rural references throughout.
Date: 09/2025
Sponsoring organizations: Milbank Memorial Fund, National Academy for State Health Policy
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Expiring Health Provisions of the 119th Congress
Outlines the healthcare-related funding and governmental authorities that will expire during the 119th Congress, calendars year 2025-2026, if not extended through congressional action. Highlights similar provisions that expired during the 118th Congress (2023-2024). Includes rural references throughout.
Date: 09/2025
Sponsoring organization: Congressional Research Service
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Outlines the healthcare-related funding and governmental authorities that will expire during the 119th Congress, calendars year 2025-2026, if not extended through congressional action. Highlights similar provisions that expired during the 118th Congress (2023-2024). Includes rural references throughout.
Date: 09/2025
Sponsoring organization: Congressional Research Service
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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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Health Provisions in P.L. 119-21, the FY2025 Reconciliation Law
Provides an overview of the healthcare-related provisions of the July 2025 reconciliation law (Public Law 119-21). Offers detailed summaries of provisions that impact Medicaid, the State Children's Health Insurance Program (CHIP), Medicare, private health insurance, and rural health providers. Discusses the Rural Health Transformation Program.
Date: 08/2025
Sponsoring organization: Congressional Research Service
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Provides an overview of the healthcare-related provisions of the July 2025 reconciliation law (Public Law 119-21). Offers detailed summaries of provisions that impact Medicaid, the State Children's Health Insurance Program (CHIP), Medicare, private health insurance, and rural health providers. Discusses the Rural Health Transformation Program.
Date: 08/2025
Sponsoring organization: Congressional Research Service
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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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