Rural Health
Resources by Topic: Reimbursement and payment models
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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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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MedPAC Data Book: Health Care Spending and the Medicare Program, 2025
Provides an overview of Medicare spending and highlights data on Medicare beneficiary demographics, dual-eligible beneficiaries, quality of care provided through the Medicare program, and other payer liability. Examines settings of care, including rural-specific provider sites, as they relate to spending, access to care, and profit margins. Compares rural and urban beneficiaries and providers throughout. Chart 6-2 addresses rural hospital closures and Rural Emergency Hospital conversions.
Date: 07/2025
Sponsoring organization: Medicare Payment Advisory Commission
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Provides an overview of Medicare spending and highlights data on Medicare beneficiary demographics, dual-eligible beneficiaries, quality of care provided through the Medicare program, and other payer liability. Examines settings of care, including rural-specific provider sites, as they relate to spending, access to care, and profit margins. Compares rural and urban beneficiaries and providers throughout. Chart 6-2 addresses rural hospital closures and Rural Emergency Hospital conversions.
Date: 07/2025
Sponsoring organization: Medicare Payment Advisory Commission
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2023 Quality Payment Program Experience Report
Reports on the clinician experience for those participating in the Quality Payment Program in 2023. Presents data on Merit-based Incentive Payment System (MIPS) eligibility and participation rates for clinicians in small practices and rural areas, mean and median final scores for 2023 and 2025 payment adjustments, and payment adjustment trends from 2021 through 2023.
Date: 06/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Reports on the clinician experience for those participating in the Quality Payment Program in 2023. Presents data on Merit-based Incentive Payment System (MIPS) eligibility and participation rates for clinicians in small practices and rural areas, mean and median final scores for 2023 and 2025 payment adjustments, and payment adjustment trends from 2021 through 2023.
Date: 06/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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RHPTP HELP Webinar: Medicare's NEW Advanced Primary Care Management Program
Webinar recording discusses the Advanced Primary Care Management (APCM) Program, an initiative to improve the delivery, coordination, and outcomes in primary care services. Explores the process of transitioning from fee-for-service to value-based care models and discusses how Medicare's program fits the APCM model.
Additional links: Webinar Slides
Author(s): Lindsay Corcoran, Amy Graham
Date: 06/2025
Sponsoring organization: National Rural Health Resource Center
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Webinar recording discusses the Advanced Primary Care Management (APCM) Program, an initiative to improve the delivery, coordination, and outcomes in primary care services. Explores the process of transitioning from fee-for-service to value-based care models and discusses how Medicare's program fits the APCM model.
Additional links: Webinar Slides
Author(s): Lindsay Corcoran, Amy Graham
Date: 06/2025
Sponsoring organization: National Rural Health Resource Center
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