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Rural Health
Resources by Topic: Reimbursement and payment models

Intergovernmental Advisory Committee to the Federal Communications Commission Advisory Recommendation No: 2019-2 in the Matter of State, Local Tribal, and Territorial Regulatory and Other Barriers and Incentives to Telemedicine
Examines the technical infrastructure necessary for effective telemedicine delivery in state, territorial, tribal, and local (rural and urban) areas. Discusses the regulatory barriers including legislation, licensing, reimbursement, malpractice insurance, and privacy that obstruct its development and utilization, and offers recommendations addressing these barriers. Appendix A presents case studies of broadband and telehealth development in several states and territories.
Date: 11/2019
Type: Document
Sponsoring organizations: Federal Communications Commission, Intergovernmental Advisory Committee to the Federal Communications Commission
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Rural Health Clinic Costs and Medicare Reimbursement
Policy brief exploring whether updates to the Medicare per-visit reimbursement cap have allowed Rural Health Clinics (RHCs) of various types and sizes to keep pace with increases in staffing and other costs. Features statistics including RHC mean Medicare adjusted cost per visit and RHC mean Medicare healthcare staff costs as of 2014, with breakdowns by 4 sizes of RHCs and private or publicly-owned status.
Author(s): John Gale, Zachariah T. Croll, Andrew F. Coburn
Date: 11/2019
Type: Document
Sponsoring organization: Maine Rural Health Research Center
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The Development of Telehealth Laws in the U.S. from 2008 to 2015: A Legal Landscape
Policy brief examining the scope and evolving nature of telehealth statutes and regulations in the 50 states and the District of Columbia. Explores the extent to which state laws regulate primary care delivery through use of telehealth. Features U.S. maps showing changes from 2008 to 2015 in terms of various types of telehealth-related laws, including those governing insurance coverage, and statistics with breakdowns by the top 25 and bottom 25 rural states.
Author(s): Cason D. Schmit, Alva O. Ferdinand, Timothy Callaghan, et al.
Date: 11/2019
Type: Document
Sponsoring organization: Southwest Rural Health Research Center
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Finalized CY 2020 Physician Fee Schedule
Fact sheet describing calendar year 2020 changes to Medicare's telehealth reimbursement policy as a part of the Physician Fee Schedule (PFS) final rule. Includes sections on opioid use disorder treatment services, care management services, chronic care remote physiologic monitoring services, and online digital evaluation service (E-visit).
Date: 11/2019
Type: Document
Sponsoring organization: Center for Connected Health Policy: The National Telehealth Policy Resource Center
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Delta Region Community Health Systems Development (DRCHSD) Program: Best Practice Concepts in Revenue Cycle Management Guide
Offers rural hospital executives and management teams best practice concepts in revenue cycle management by assisting them in identifying performance improvement within their hospitals and departments. Provides State Offices of Rural Health (SORH) directors and Flex Program coordinators a better understanding of the revenue cycle best practices to help them design educational training programs to support rural hospital administrators with performance improvement.
Author(s): BKD CPAs & Advisors
Date: 10/2019
Type: Document
Sponsoring organization: National Rural Health Resource Center
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Financial Incentives to Improve Community Health
Slides presented at the 2019 National Organization of State Offices of Rural Health (NOSORH) Annual Meeting discussing several federal initiatives as a result of the Affordable Care Act (ACA), including the Medicare Shared Savings Program and Accountable Care Organizations (ACOs), resulting in controlled costs, improved quality of care, and offering financial incentives. Identifies how State Offices of Rural Health can support health organizations to participate successfully in these initiatives.
Author(s): Keith Mueller
Date: 10/2019
Type: Presentation Slides
Sponsoring organization: National Organization of State Offices of Rural Health
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State Telehealth Laws & Reimbursement Policies
Summary of telehealth-related policies, laws, and regulations for the 50 states and the District of Columbia. Focuses on Medicaid fee-for-service policies and includes the most recent policy language in each state as of September 2019.
Additional links: Infographic, Interactive Map - Current State Laws & Reimbursement Policies, Interactive Map - Legislation and Regulation Tracking
Date: 10/2019
Type: Document
Sponsoring organization: Center for Connected Health Policy: The National Telehealth Policy Resource Center
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Qualifying Alternative Payment Model Participants (QPs) Methodology Fact Sheet: Medicare Option 2019 Performance Period
Explains the methods used by the Centers for Medicare & Medicaid Services (CMS) to determine if clinicians participating in the Medicare Advanced Alternative Payment Models (APMs), a track of the Quality Payment Program, are eligible as Qualifying Alternative Payment Model Participants (QPs), or partial QPs for the 2019 performance period. This includes eligible clinicians who receive payments for Medicare Part B services furnished at Method II Critical Access Hospitals (CAHs), Rural Health Clinics (RHCs), or Federally Qualified Health Centers (FQHCs).
Date: 10/2019
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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A View from the States: Key Medicaid Policy Changes: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2019 and 2020
Report examines changes taking place in Medicaid programs in the 50 states and the District of Columbia. Features sections on eligibility, delivery systems, benefits, long-term services and supports, and provider rates and taxes. Full report includes a section on rural payment adjustments.
Author(s): Kathleen Gifford, Eileen Ellis, Aimee Lashbrook, et al.
Date: 10/2019
Type: Document
Sponsoring organization: Kaiser Family Foundation
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Estimate of Federal Payment Reductions to Hospitals Following the ACA: 2010-2029: Estimates and Methodology
Estimates the reduction in Medicare hospital payments due to sequestration from 2010 to 2019, not including reductions enacted under the Affordable Care Act (ACA). Demonstrates how other legislative acts and regulatory changes by the Centers for Medicare and Medicaid Services (CMS) reduced federal payments to hospitals over the same period. Highlights how reductions in Medicare payments for bad debt impacted Critical Access Hospitals (CAHs).
Date: 10/2019
Type: Document
Sponsoring organizations: American Hospital Association, Federation of American Hospitals
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