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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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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Dashboard: Acute Behavioral Health Events Along the Birthing Journey in Arkansas
Provides data on acute behavioral health events, including mental health and substance abuse diagnoses, among Arkansas mothers, utilizing 2019-2022 Arkansas Healthcare Transparency Initiative (HTI) data. Features clinical, demographic, and payer data associated with patients and individual encounters, recurring encounters, and outpatient visits, and can be sorted by region and county.
Date: 10/2024
Type: Website
Sponsoring organization: Arkansas Center for Health Improvement
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Provides data on acute behavioral health events, including mental health and substance abuse diagnoses, among Arkansas mothers, utilizing 2019-2022 Arkansas Healthcare Transparency Initiative (HTI) data. Features clinical, demographic, and payer data associated with patients and individual encounters, recurring encounters, and outpatient visits, and can be sorted by region and county.
Date: 10/2024
Type: Website
Sponsoring organization: Arkansas Center for Health Improvement
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As Pandemic-Era Policies End, Medicaid Programs Focus on Enrollee Access and Reducing Health Disparities Amid Future Uncertainties: Results from an Annual Medicaid Budget Survey for State Fiscal Years 2024 and 2025
Examines changes taking place in Medicaid programs in the 50 states and the District of Columbia. Features sections on delivery systems, provider rates and taxes, benefits, and pharmacy and prescription drugs. Highlights challenges and priorities related to state workforce shortages, systems issues, emerging state budget pressures, and more.
Author(s): Elizabeth Hinton, Elizabeth Williams, Jada Raphael, et al.
Date: 10/2024
Type: Document
Sponsoring organization: KFF
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Examines changes taking place in Medicaid programs in the 50 states and the District of Columbia. Features sections on delivery systems, provider rates and taxes, benefits, and pharmacy and prescription drugs. Highlights challenges and priorities related to state workforce shortages, systems issues, emerging state budget pressures, and more.
Author(s): Elizabeth Hinton, Elizabeth Williams, Jada Raphael, et al.
Date: 10/2024
Type: Document
Sponsoring organization: KFF
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The Rural Emergency Hospital Model: Year Two Progress Report
Provides an overview of the Rural Emergency Hospital (REH) payment designation, including the growth in REHs through September 1, 2024, factors that contribute to a hospital seeking REH conversion, and the impacts of REH conversion. Outlines concerns identified by REH leaders, facilities considering converting to REH status, and other rural stakeholders related to the REH designation, as well as policy recommendations to address these concerns.
Author(s): Emma Sheffert, Julia Harris, Marilyn Werber Serafini
Date: 10/2024
Type: Document
Sponsoring organization: Bipartisan Policy Center
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Provides an overview of the Rural Emergency Hospital (REH) payment designation, including the growth in REHs through September 1, 2024, factors that contribute to a hospital seeking REH conversion, and the impacts of REH conversion. Outlines concerns identified by REH leaders, facilities considering converting to REH status, and other rural stakeholders related to the REH designation, as well as policy recommendations to address these concerns.
Author(s): Emma Sheffert, Julia Harris, Marilyn Werber Serafini
Date: 10/2024
Type: Document
Sponsoring organization: Bipartisan Policy Center
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Northern Maine Medical Center: A Rural Hospital Gaining Momentum in its Work Toward Quality Improvement
Profiles a prospective payment hospital in northern Maine that engaged in the 2022-2023 Rural Healthcare Provider Transition Project (RHPTP), focusing on financial sustainability, cost efficiency, and quality improvement. Highlights hospital accomplishments and improvements via participation of the project.
Date: 10/2024
Type: Document
Sponsoring organization: National Rural Health Resource Center
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Profiles a prospective payment hospital in northern Maine that engaged in the 2022-2023 Rural Healthcare Provider Transition Project (RHPTP), focusing on financial sustainability, cost efficiency, and quality improvement. Highlights hospital accomplishments and improvements via participation of the project.
Date: 10/2024
Type: Document
Sponsoring organization: National Rural Health Resource Center
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Health Care Workforce: Key Issues, Challenges, and the Path Forward
Provides an overview of the supply and distribution of physicians, nurses, direct care workers, behavioral health workers, and oral healthcare providers. Describes persistent challenges related to the healthcare workforce, including supply and distribution of healthcare workers, especially in rural communities; racial and ethnic diversity; burnout; compensation; and administrative burden. Identifies opportunities to address these challenges and efforts supported by the U.S. Department of Health and Human Services to address these issues.
Date: 10/2024
Type: Document
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Provides an overview of the supply and distribution of physicians, nurses, direct care workers, behavioral health workers, and oral healthcare providers. Describes persistent challenges related to the healthcare workforce, including supply and distribution of healthcare workers, especially in rural communities; racial and ethnic diversity; burnout; compensation; and administrative burden. Identifies opportunities to address these challenges and efforts supported by the U.S. Department of Health and Human Services to address these issues.
Date: 10/2024
Type: Document
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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The Impacts of New York's Balance Billing Regulation on Ground Ambulance Pricing
Examines the impact of surprise out-of-network (OON) billing regulations on New York emergency ground ambulances. Analyzes 2012-2019 commercial claims data and discusses the impacts of billing regulations on costs of care, with considerations related to transports from rural, super-rural, and urban locations.
Author(s): Wendy Y. Xu, Christopher Garmon, Sheldon M. Retchin, Yiting Li
Citation: Health Services Research
Date: 10/2024
Type: Document
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Examines the impact of surprise out-of-network (OON) billing regulations on New York emergency ground ambulances. Analyzes 2012-2019 commercial claims data and discusses the impacts of billing regulations on costs of care, with considerations related to transports from rural, super-rural, and urban locations.
Author(s): Wendy Y. Xu, Christopher Garmon, Sheldon M. Retchin, Yiting Li
Citation: Health Services Research
Date: 10/2024
Type: Document
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Demographic-Based Disparities in Outcomes for Adults with Central Line-Associated Bloodstream Infections in the United States: A National Inpatient Sample Database Study (2016–2020)
Analyzes cost, length of stay, and mortality for hospitalized adults with central line-associated bloodstream infections (CLABSI), utilizing 2016-2020 National Inpatient Sample (NIS) data. Provides data on differences in care conditions by race and ethnicity, region, and rural versus urban location and teaching versus non-teaching hospital status.
Author(s): Marie Dix, Troy Belleville, Anjali Mishra, et al.
Citation: Frontiers in Medicine, 11
Date: 10/2024
Type: Document
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Analyzes cost, length of stay, and mortality for hospitalized adults with central line-associated bloodstream infections (CLABSI), utilizing 2016-2020 National Inpatient Sample (NIS) data. Provides data on differences in care conditions by race and ethnicity, region, and rural versus urban location and teaching versus non-teaching hospital status.
Author(s): Marie Dix, Troy Belleville, Anjali Mishra, et al.
Citation: Frontiers in Medicine, 11
Date: 10/2024
Type: Document
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What to Know About Medicare Coverage of Telehealth
Discusses telehealth use by Medicare patients before, during, and after declaration of the COVID-19 public health emergency. Notes temporary telehealth provisions set to expire December 31, 2024, telehealth provisions made permanent, and trends in use since 2020. Includes rural and urban comparisons of telehealth use since 2020. Discusses payment models for Medicare and Medicare Advantage, current policies related to telehealth, fraud, and the cost of coverage through Medicare.
Author(s): Alex Cottrill, Juliette Cubanski, Tricia Neuman
Date: 10/2024
Type: Document
Sponsoring organization: KFF
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Discusses telehealth use by Medicare patients before, during, and after declaration of the COVID-19 public health emergency. Notes temporary telehealth provisions set to expire December 31, 2024, telehealth provisions made permanent, and trends in use since 2020. Includes rural and urban comparisons of telehealth use since 2020. Discusses payment models for Medicare and Medicare Advantage, current policies related to telehealth, fraud, and the cost of coverage through Medicare.
Author(s): Alex Cottrill, Juliette Cubanski, Tricia Neuman
Date: 10/2024
Type: Document
Sponsoring organization: KFF
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Merit-Based Incentive Payment System (MIPS): 2025 MIPS Payment Year (2023 Performance Year) - Payment Adjustment User Guide
Provides information on Merit-Based Incentive Payment System (MIPS) payment adjustments for calendar year 2025. Describes how 2023 MIPS scores relate to 2025 payment adjustments and how payment adjustments are applied. Offers answers to frequently asked questions.
Date: 10/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides information on Merit-Based Incentive Payment System (MIPS) payment adjustments for calendar year 2025. Describes how 2023 MIPS scores relate to 2025 payment adjustments and how payment adjustments are applied. Offers answers to frequently asked questions.
Date: 10/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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