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Rural Health
Resources by Topic: Reimbursement and payment models

Calendar Year (CY) 2015 Rural Health Clinic (RHC) and Federally Qualified Health Centers (FQHC) Updates: Payment Rate Increases for RHCs and FQHCs Billing Under the All-Inclusive Rate System (AIR), and Urban and Rural Designations for FQHCs Billing Under the AIR
Provides updates for RHCs and FQHCs that are submitting claims to Medicare Administrative Contractors (MACs) for services to Medicare beneficiaries.
Date: 12/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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CY 2025 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Proposed Rule (CMS 1809-P)
Fact sheet providing an overview of the Centers for Medicare & Medicaid Services (CMS) proposed rule regarding updates and changes to the Medicare payments for hospital outpatient and Ambulatory Surgical Center (ASC) services for calendar year 2025. Summarizes provisions regarding changes to Intensive Outpatient Program (IOP) and partial hospital program rate setting; a proposal to include an add-on payment to the Medicare outpatient hospital all-inclusive rate (AIR) for certain high-cost drugs for people with Medicare who receive care at Indian Health Service (IHS) or tribal hospitals; updates to the Hospital Outpatient Quality Reporting (OQR), Ambulatory Surgical Center Quality Reporting (ASCQR), and Rural Emergency Hospital Quality Reporting (REHQR) Programs; a proposal for new Conditions of Participation (CoPs) for hospitals and Critical Access Hospitals (CAHs) for obstetrical services; Medicaid and CHIP continuous eligibility; Medicaid clinic services "four walls" exceptions; and more.
Date: 07/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Calendar Year (CY) 2025 Medicare Physician Fee Schedule Proposed Rule
Fact sheet providing an overview of the Centers for Medicare & Medicaid Services (CMS) proposed rule regarding updates and changes to the Medicare payments under the Physician Fee Schedule (PFS) and other Medicare Part B issues for calendar year 2025. Summarizes provisions related to telehealth services; advanced primary care management services; behavioral health services; opioid treatment programs; dental and oral health services; Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Conditions for Coverage, care coordination services, telecommunication services, payment for vaccine costs, intensive outpatient program (IOP) services; and more.
Date: 07/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Estimated Impacts of Multiple Payment Policies on Rural-Serving Home Health Agencies
Describes the estimated impact of three major Medicare home health payment policy changes - implementation of the Patient-Driven Groupings Model (PDGM), revisions to rural add-on payments, and the demonstration and nationwide expansion of the Home Health Value-Based Purchasing (HHVBP) model - on home health agency (HHA) reimbursement for Medicare beneficiaries. Compares the estimated impact of these payment policy changes by HHA rural-serving status, U. S. Census Division, profit status, quality rating, and episode volume.
Author(s): Tracy M. Mroz, Lisa A. Garberson, C. Holly A. Andrilla, Davis G. Patterson
Date: 07/2024
Type: Document
Sponsoring organization: WWAMI Rural Health Research Center
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Disruptors, Essential Services, and Reflections on a Career in Rural Health, with John Supplitt
An episode of the Exploring Rural Health podcast featuring John Supplitt, Senior Director of Rural Health Services for the American Hospital Association. Focuses on the importance of maintaining rural essential services, along with insights from Supplitt's long career in rural health.
Date: 07/2024
Type: Audio
Sponsoring organization: Rural Health Information Hub
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Evaluation of the Vermont All-Payer Accountable Care Organization Model: 2018-2022 - Fourth Evaluation Report
Evaluates the first five performance years of the Vermont All-Payer Accountable Care Organization Model (VTAPM), which aims to assess whether scaling an Accountable Care Organization (ACO) across all payers in the state can reduce program expenditures while preserving or improving care quality. Discusses the implementation of the model, provider engagement, efforts to address population health goals; characteristics of participating hospitals, practitioners, and beneficiaries; and the model's impacts on Medicare spending, utilization, and quality of care. Includes analyses of Medicare ACO subgroups and Medicaid spending, utilization, and quality of care trends. Outlines challenges and lessons learned.
Additional links: Findings at a Glance, Technical Appendices
Date: 06/2024
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, NORC at the University of Chicago
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Health Subcommittee Hearing on Improving Value-Based Care for Patients and Providers
Recording of a June 26, 2024, House Committee on Ways and Means Subcommittee on Health hearing on the challenges and opportunities associated with delivering better health outcomes and Medicare savings through value-based care. Features testimony from Sarah Chouinard, Chief Medical Officer of Main Street Health, regarding value-based care delivery in rural areas.
Additional links: Sarah Chouinard, Main Street Health - Testimony
Date: 06/2024
Type: Video/Multimedia
Sponsoring organization: House Ways and Means Committee, Subcommittee on Health
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2018‐23 Profitability of Rural and Urban Hospitals by Medicare Payment Designation
Examines the profitability of rural and urban hospitals according to special Medicare payment designations, including: Critical Access Hospitals (CAHs), Prospective Payment System (PPS) hospitals, Medicare Dependent Hospitals (MDHs), Sole Community Hospitals (SCHs), Rural Referral Centers (RRCs), and Essential Access Community Hospitals (EAC). Utilizes 2018-2023 data to analyze hospital profitability by rural versus urban status and facility/payment type.
Author(s): Sruthi Malavika Srinivasan, Kristie Thompson, George Pink
Date: 06/2024
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Is Rural Emergency Hospital the BEST Option for You?
Recording of a June 6, 2024, webinar regarding the Rural Emergency Hospital (REH) designation and conversion process. Features a discussion with three rural hospital leaders who consulted with the REH Technical Assistance Center when considering conversion. Transcript is available in the video description.
Date: 06/2024
Type: Video/Multimedia
Sponsoring organization: Rural Health Redesign Center
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Five Things to Know About Medicare Site-Neutral Payment Reforms
Discusses site-neutral payment reforms that seek to align Medicare payments with outpatient services in different settings. Examines benefits and drawbacks of the policy and discusses how the policy would impact rural hospitals.
Author(s): Zachary Levinson, Tricia Neuman, Scott Hulver
Date: 06/2024
Type: Document
Sponsoring organization: KFF
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