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Rural Health
Resources by Topic: Reimbursement and payment models

Medicaid Payment Policy for Federally Qualified Health Centers
Describes the role of Federally Qualified Health Centers (FQHCs) in Medicaid, and highlights current policy issues related to Medicaid FQHC payment. Also discusses the Medicaid FQHC prospective payment system (PPS), alternative payment methodologies, how FQHCs participate in managed care networks, and states' desire for increased flexibility in setting FQHC payment rates.
Date: 12/2017
Type: Document
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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Rural-Urban Enrollment in Part D Prescription Drug Plans: June 2017 Update
Updates prior policy briefs and shows state-to-state variation in stand-alone prescription drug plans and Medicare Advantage with Prescription Drug plans. Features statistics with breakdowns by rural and urban enrollment in 2008 and 2017.
Author(s): Paula Weigel, Fred Ullrich, Keith Mueller
Date: 12/2017
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Distribution of Disproportionate Share Hospital Payments to Rural and Critical Access Hospitals
Information concerning potential effects of Medicaid Disproportionate Share Hospital (DSH) payment on rural hospitals in 47 states. Features statistics on hospital Medicaid DSH payments by census region, with breakdowns by urban, rural, and Critical Access Hospitals.
Author(s): Erin M. Mobley, Fred Ullrich, Keith J. Mueller
Date: 11/2017
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Telehealth Services Proposed for Medicare Part B Reimbursements, 2018: Fact Sheet
Identifies the five conditions that a telehealth service must meet in order to be covered by Medicare Part B, provides an overview of how telehealth services get added to Medicare's reimbursable list, and outlines proposed services that may be added for calendar year 2018.
Date: 11/2017
Type: Document
Sponsoring organization: Congressional Research Service
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State Telehealth Laws and Reimbursement Policies
Provides a summary of telehealth-related laws and reimbursement policies for all 50 states and the District of Columbia, using policy language available in each state as of October 2017. The primary focus of the report is on Medicaid coverage for telehealth services but also includes references to state policies that require private insurer payment for the service. Interactive map allows results to be narrowed by state.
Additional links: 50 State Scan of Telehealth Reimbursement Laws and Medicaid Policies Factsheet, Interactive Map, State Telehealth Laws and Medicaid Program Policies Infographic
Date: 11/2017
Type: Document
Sponsoring organization: Center for Connected Health Policy (National Telehealth Policy Resource Center)
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Differences in Community Characteristics of Sole Community Hospitals
Findings brief presenting a snapshot of Sole Community Hospitals (SCHs) and their communities in 2015, and identifying trends in characteristics of selected SCHs and their communities from 2006 through 2015. Features statistics including breakdowns by large rural, small rural, and isolated rural location.
Author(s): Sharita R. Thomas, Mark Holmes, George H. Pink
Date: 11/2017
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Global Budgets for Safety-Net Hospitals
Discusses the purpose and basic structure of the all-payer global budget system within the context of safety-net hospitals. Describes how global budgeting may be used to improve safety-net hospitals' finances by capturing the savings of wellness and prevention strategies.
Author(s): Joshua M. Sharfstein, Sule Gerovich, David Chin
Location: JAMA
Date: 10/2017
Type: Document
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Improving Healthcare Value in Rural America
Identifies and explains the challenges facing rural communities as they work to improve healthcare value. Discusses the distinct differences between urban and rural value initiatives, highlights promising strategies for achieving rural value, and makes the case for using customized approaches rather than one-size-fits-all models.
Date: 10/2017
Type: Document
Sponsoring organization: Healthcare Value Hub
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Medicaid Payment and Delivery System Reform: Early Insights from 10 Medicaid Expansion States
Examines the evolution of payment and delivery system reform in ten states that expanded Medicaid coverage through the Affordable Care Act (ACA). States were chosen to provide diversity in size, location, urban/rural mix, and population demographics. Findings are based on a review of states' managed care policies and contracting documents, supplemented by interviews with senior Medicaid officials.
Author(s): Sara Rosenbaum, Sara Schmucker, Sara Rothenberg, Rachel Gunsalus, J. Zoƫ Beckerman
Date: 10/2017
Type: Document
Sponsoring organization: Commonwealth Fund
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Medicare Payment Basics: Outpatient Dialysis Services Payment System
Provides an overview of how Medicare pays for the outpatient dialysis services of beneficiaries with end-stage renal disease (ESRD). Includes information about the facility-level rural adjustment.
Date: 10/2017
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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