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Rural Health Information Hub

Rural Health
Resources by Topic: Reimbursement and payment models

Federal Support for Financially Distressed Hospitals
Provides an overview of Medicare hospital payments and federal funding opportunities to assist financially distressed hospitals. Includes information on COVID-19 relief funding targeted to rural and safety net hospitals.
Date: 12/2022
Type: Document
Sponsoring organization: Congressional Research Service
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Clarity for Rural Emergency Hospitals and Changes for Critical Access Hospitals: CMS Finalizes Conditions of Participation and Payment and Enrollment Policies But Pauses Stark Law Flexibilities
Provides an overview of the Rural Emergency Hospitals (REHs) provisions of the Calendar Year 2023 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Final Rule. Discusses REH reimbursement, Conditions of Participation (CoPs), enrollment provisions, and Stark Law regulatory modifications to accommodate REHs. Highlights changes to the definition of "primary roads" related to Critical Access Hospital (CAH) CoPs.
Author(s): Emily Jane Cook, Caroline Reignley, Amber Arnold, Sandra M. DiVarco
Date: 11/2022
Type: Document
Sponsoring organization: McDermott Will & Emery
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Certified Community Behavioral Health Clinics Demonstration Program: Report to Congress, 2021
Provides an overview of the Certified Community Behavioral Health Clinic (CCBHC) demonstration. Offers a summary of the findings from the prior annual reports on the CCBHC demonstration, a comparison of cost and quality in the first two demonstration years, and the results of impact analyses. This is the fifth annual report to Congress on the CCBHC demonstration.
Date: 11/2022
Type: Document
Sponsoring organizations: HHS Office of the Assistant Secretary for Planning and Evaluation, Mathematica
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Medicare Shared Savings Program: Rule Changes and Implications for Rural Health Care Organizations
Summarizes changes to the Centers for Medicare & Medicaid Services (CMS) Medicare Shared Savings Program (SSP) that take effect in January 2023 for current participants, and in January 2024 for organizations applying for a January 1, 2024 start. Discusses the potential impact of these changes on rural health and participation considerations.
Date: 11/2022
Type: Document
Sponsoring organization: Rural Health Value
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Merit-Based Incentive Payment System (MIPS): 2023 Merit-Based Incentive Payment (MIPS) Value Pathways (MVPs) Implementation Guide
Provides an overview of the Merit-based Incentive Payment System (MIPS) Value Pathways (MVPs), a new voluntary reporting option that can be used to meet MIPS reporting requirements beginning with the 2023 performance year. Describes subgroup reporting, reporting requirements, scoring, performance feedback and public reporting, and how to register to report an MVP. Includes information on considerations and exceptions for small practices and clinicians in a rural or Health Professional Shortage Area.
Date: 11/2022
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Dental Therapy Resource Guide
Describes the role of dental therapists in expanding access to dental health care in rural and underserved communities. Outlines the status of state laws and regulations regarding dental therapy education and practice as of August 2021. Compares the scope of practice of dental therapists to other dental care providers.
Date: 11/2022
Type: Document
Sponsoring organization: National Association of Community Health Centers
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CMS Framework for Advancing Health Care in Rural, Tribal, and Geographically Isolated Communities
Report outlines the Centers for Medicare & Medicaid Services (CMS) plan for improving health equity and health outcomes across the U.S. for rural, tribal, and geographically isolated communities. Details a 6 priority framework emphasizing the application of a community-informed geographic lens; the collection and use of standardized data; support for healthcare professionals; the optimization of medical and communication technology; the expansion of access to comprehensive healthcare coverage, benefits, and services and supports; and innovation and value-based care. Highlights examples of activities CMS is undertaking in support of each priority and recent CMS efforts that align with each priority.
Date: 11/2022
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Advancing Rural Health Equity: Fiscal Year 2022 Year in Review
Summarizes Centers for Medicare & Medicaid Services (CMS) activities in fiscal year 2022 to advance health equity for people living in rural, tribal, and geographically isolated communities. Covers 10 priority focus areas: Medicaid and the Children's Health Insurance Program (CHIP), Medicare, Marketplace, the rural health workforce, payment and delivery system models and demonstrations, long-term services and supports, maternal health, mental health and substance use disorders, quality, and COVID-19.
Date: 11/2022
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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A Global Equity Model (GEM) for the Advancement of Community Health and Health Equity
Provides an overview of existing and emerging payment systems and their roles in promoting community health and health equity. Proposes a global payment model for health systems' inpatient, emergency department (ED), and outpatient sites of care with community health and health equity as its organizing features. Includes information on the Pennsylvania Rural Health Model, the ACO REACH model, and other rural-relevant payment models.
Author(s): Anaeze C. Offodile II, Jason B. Gibbons, Samantha Murrell, Donna Kinzer, Joshua M. Sharfstein
Date: 11/2022
Type: Document
Sponsoring organization: National Academy of Medicine
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Person-Centered Innovation – An Update on the Implementation of the CMS Innovation Center's Strategy
Provides an update on the Centers for Medicare and Medicaid Services' (CMS) Innovation Center's progress in the implementation of the strategy refresh announced in 2021. Describes accomplishments from the first year of implementing the strategy refresh and outlines areas of focus for the upcoming year across the five strategic objectives: driving accountable care, advancing health equity, supporting innovation, addressing affordability, and partnering to achieve healthcare system transformation. Includes information on the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model and the Community Health Access and Rural Transformation (CHART) Model.
Additional links: Supplemental Document
Date: 11/2022
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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