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Rural Health
Resources by Topic: Reimbursement and payment models

Rural Emergency Hospital (REH) Model Summary
Provides an overview of the Rural Emergency Hospital (REH) model, a Medicare provider type established by the Consolidated Appropriations Act, 2021. Describes key features of the REH model and the REH payment methodology. Identifies considerations that must be addressed by the Centers for Medicare and Medicaid Services (CMS) and state Medicaid programs, as well as areas that will require technical assistance.
Date: 04/2021
Type: Document
Sponsoring organization: National Rural Health Association
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Merit-Based Incentive Payment System (MIPS): Participating in the Improvement Activities Performance Category in the 2021 Performance Year - Traditional MIPS
Provides details on how to participate in the performance improvement part of the Merit-based Incentive Payment System (MIPS), one of two payment options under the Medicare Quality Payment Program. Identifies differences for small practices and clinicians located in a rural or Health Professional Shortage Area.
Date: 04/2021
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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States Work to Support Rural Hospitals Despite Pandemic Challenges
Blog post highlighting state-level policies to address and prevent rural hospital closures. Discusses proposals in state legislatures regarding alternative payment methodologies and funding, service delivery models, and the recruitment and retention of a rural healthcare workforce.
Author(s): Beth Giambrone
Date: 04/2021
Type: Document
Sponsoring organization: Association of State and Territorial Health Officials
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CMS: Current Emergencies: Coronavirus Disease 2019
Guidance from CMS for healthcare facilities and labs related to COVID-19. Includes clinical and technical guidance on infection control and prevention for specific types of facilities, information on billing and coding, coverage for services related to COVID-19, and other topics.
Date: 04/2021
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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Respond to Coronavirus (COVID-19)
Clinical management, patient education, and preparedness resources to help family physicians respond to COVID-19. Includes information on vaccination, payment, and telehealth.
Date: 04/2021
Type: Website
Sponsoring organization: American Academy of Family Physicians
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CMS Bundled Payments for Care Improvement Initiative Models 2­-4: Year 7 Evaluation & Monitoring Annual Report
Seventh and final report describing findings from an evaluation of Models 2, 3, and 4 of the Bundled Payments for Care Improvement (BPCI) initiative, linking provider payments for an episode of care with the goal of decreasing cost of care while improving quality. Includes information specific to rural BPCI-participating hospitals, skilled nursing facilities, and home health agencies.
Additional links: Appendices, Findings at a Glance
Author(s): The Lewin Group, Abt Associates, GDIT, Telligen
Date: 03/2021
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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CMS Bundled Payments for Care Improvement Advanced Model: Year 2 Evaluation Report
Second annual report of the Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model, which tests whether linking payments for a clinical episode of care can reduce Medicare expenditures while maintaining or improving quality of care. Covers the period from October 1, 2018, through January 1, 2020. Describes participants in the model; clinical episodes included; the reach of the model; and the impact of BPCI Advanced on episode payments, utilization, and quality of care. Includes information on rural hospital participation in the model.
Additional links: Appendices
Author(s): The Lewin Group, Abt Associates, GDIT, Telligen
Date: 03/2021
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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State-Driven Initiatives to Support Moving to Value-Based Care in the Era of COVID-19
Describes four areas where state-driven strategies can facilitate and promote the adoption of value-based payment (VBP) models. Presents case examples throughout, including the Pennsylvania Rural Health Model. Discusses how additional federal actions could support transitions to VBP at the state level.
Author(s): Caroline Picher, Lauren Block, Mark Japinga, Hemi Tewarson
Date: 03/2021
Type: Document
Sponsoring organizations: Duke-Margolis Center for Health Policy, National Governors Association
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Tackling America's Mental Health and Addiction Crisis Through Primary Care Integration
Explores how primary and behavioral healthcare integration can overcome the unmet needs for mental health and substance use services. Discusses barriers to integrated care delivery. Offers policy recommendations to improve the integration of primary and behavioral healthcare services through enhanced payments, training, and technical assistance, and improving access to behavioral health providers for consultation and referral.
Additional links: Infographic
Date: 03/2021
Type: Document
Sponsoring organization: Bipartisan Policy Center
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Telehealth Reimbursement Guide for California
Provides an overview of telehealth and explains telehealth reimbursement criteria for Medicare, Medi-Cal, and other insurance programs in California. Includes specific information for Rural Health Clinics and Federally Qualified Health Centers.
Date: 03/2021
Type: Document
Sponsoring organization: California Telehealth Resource Center
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