Rural Health
Resources by Topic: Reimbursement and payment models
AHEAD CMS-Designed Medicare FFS Hospital Global Budget Calculator Tool for Critical Access Hospital
Provides an overview and demonstration of the CMS-Designed Medicare Fee-for-Service Hospital Global Budget (HGB) Calculator Tool for Critical Access Hospitals, which aims to support eligible CAHs in understanding the key elements of the AHEAD Medicare Fee-for-Service (FFS) HGB methodology. Discusses key differences in the hospital global budget construction and methodology for Critical Access Hospitals and fee-for-service hospitals.
Additional links: AHEAD Model CMS-Designed Medicare FFS Critical Access Hospital Global Budget Calculator Tool, AHEAD Model: CMS-Designed Medicare Hospital Global Budget Critical Access Hospital Calculator Tool At-A-Glance
Date: 07/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides an overview and demonstration of the CMS-Designed Medicare Fee-for-Service Hospital Global Budget (HGB) Calculator Tool for Critical Access Hospitals, which aims to support eligible CAHs in understanding the key elements of the AHEAD Medicare Fee-for-Service (FFS) HGB methodology. Discusses key differences in the hospital global budget construction and methodology for Critical Access Hospitals and fee-for-service hospitals.
Additional links: AHEAD Model CMS-Designed Medicare FFS Critical Access Hospital Global Budget Calculator Tool, AHEAD Model: CMS-Designed Medicare Hospital Global Budget Critical Access Hospital Calculator Tool At-A-Glance
Date: 07/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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FY 2026 Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) Final Rule — CMS-1833-F
Fact sheet providing an overview of the Centers for Medicare & Medicaid Services (CMS) fiscal year 2026 hospital inpatient prospective payment system (IPPS) and long-term care hospital prospective payment system (LTCH PPS) final rule. Includes information about the Medicare Promoting Interoperability Program and the discontinuation of the low-wage index hospital policy for FY 2026 and subsequent years.
Date: 07/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Fact sheet providing an overview of the Centers for Medicare & Medicaid Services (CMS) fiscal year 2026 hospital inpatient prospective payment system (IPPS) and long-term care hospital prospective payment system (LTCH PPS) final rule. Includes information about the Medicare Promoting Interoperability Program and the discontinuation of the low-wage index hospital policy for FY 2026 and subsequent years.
Date: 07/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Merit-Based Incentive Payment System (MIPS): 2025 MIPS Group Participation Guide - Traditional MIPS and MVPs
Provides an overview of traditional Merit-based Incentive Payment System (MIPS) and MIPS Value Pathways (MVP) group participation options for the 2025 performance year. Discusses eligibility; special status designations; the quality, cost, and promoting interoperability performance categories; scoring and payment adjustments; and more. Includes information on group reporting requirements and considerations for small practices and clinicians in a rural or Health Professional Shortage Area.
Date: 07/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides an overview of traditional Merit-based Incentive Payment System (MIPS) and MIPS Value Pathways (MVP) group participation options for the 2025 performance year. Discusses eligibility; special status designations; the quality, cost, and promoting interoperability performance categories; scoring and payment adjustments; and more. Includes information on group reporting requirements and considerations for small practices and clinicians in a rural or Health Professional Shortage Area.
Date: 07/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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MedPAC Data Book: Health Care Spending and the Medicare Program, 2025
Provides an overview of Medicare spending and highlights data on Medicare beneficiary demographics, dual-eligible beneficiaries, quality of care provided through the Medicare program, and other payer liability. Examines settings of care, including rural-specific provider sites, as they relate to spending, access to care, and profit margins. Compares rural and urban beneficiaries and providers throughout. Chart 6-2 addresses rural hospital closures and Rural Emergency Hospital conversions.
Date: 07/2025
Sponsoring organization: Medicare Payment Advisory Commission
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Provides an overview of Medicare spending and highlights data on Medicare beneficiary demographics, dual-eligible beneficiaries, quality of care provided through the Medicare program, and other payer liability. Examines settings of care, including rural-specific provider sites, as they relate to spending, access to care, and profit margins. Compares rural and urban beneficiaries and providers throughout. Chart 6-2 addresses rural hospital closures and Rural Emergency Hospital conversions.
Date: 07/2025
Sponsoring organization: Medicare Payment Advisory Commission
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Transforming School-Based Telehealth through Rural Partnerships
Webinar recording discusses how Eastern Oklahoma Medical Center implemented a school-based telemedicine program to improve access to care in rural and low-income Oklahoma communities. Details challenges and lessons learned related to billing and policy development, communication with parents, and partnerships with rural school nurses and administrators. Transcript available below the video description.
Additional links: Presentation Slides
Author(s): Tiffany Griffis
Date: 06/2025
Sponsoring organization: Heartland Telehealth Resource Center
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Webinar recording discusses how Eastern Oklahoma Medical Center implemented a school-based telemedicine program to improve access to care in rural and low-income Oklahoma communities. Details challenges and lessons learned related to billing and policy development, communication with parents, and partnerships with rural school nurses and administrators. Transcript available below the video description.
Additional links: Presentation Slides
Author(s): Tiffany Griffis
Date: 06/2025
Sponsoring organization: Heartland Telehealth Resource Center
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Association of a State-Wide Alternative Payment Model for Rural Hospitals with Bypass for Elective Surgeries
Examines the impact of the payment model, Pennsylvania Rural Health Model (PARHM), on rural hospital bypass for elective surgeries. Utilizes 2016-2022 all-payer visit-level inpatient discharge data to measure 175,138 surgeries in Pennsylvania, with data on risk level of elective surgery, hospital type, payer type, and more.
Author(s): Donald S. Bourne, Zhaojun Sun, Bruce L. Jacobs, et al.
Citation: Health Services Research, 60(3), e14442
Date: 06/2025
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Examines the impact of the payment model, Pennsylvania Rural Health Model (PARHM), on rural hospital bypass for elective surgeries. Utilizes 2016-2022 all-payer visit-level inpatient discharge data to measure 175,138 surgeries in Pennsylvania, with data on risk level of elective surgery, hospital type, payer type, and more.
Author(s): Donald S. Bourne, Zhaojun Sun, Bruce L. Jacobs, et al.
Citation: Health Services Research, 60(3), e14442
Date: 06/2025
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Payment Source Shift for Surgical Care Among Veterans Enrolled in Medicare Advantage Plans
Examines the likelihood of veterans enrolled in Medicare Advantage (MA) plans to shift payments for inpatient surgical care from MA to the Veterans Health Administration (VHA). Analyzes 54,754 inpatient surgeries of VHA enrollees to observe payment trends, with data broken down by demographics, insurance characteristics, region, and rurality.
Author(s): Winta T. Mehtsun, Yanlei Ma, Ellen Latsko, et al.
Citation: JAMA Health Forum, 6(6)
Date: 06/2025
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Examines the likelihood of veterans enrolled in Medicare Advantage (MA) plans to shift payments for inpatient surgical care from MA to the Veterans Health Administration (VHA). Analyzes 54,754 inpatient surgeries of VHA enrollees to observe payment trends, with data broken down by demographics, insurance characteristics, region, and rurality.
Author(s): Winta T. Mehtsun, Yanlei Ma, Ellen Latsko, et al.
Citation: JAMA Health Forum, 6(6)
Date: 06/2025
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2023 Quality Payment Program Experience Report
Reports on the clinician experience for those participating in the Quality Payment Program in 2023. Presents data on Merit-based Incentive Payment System (MIPS) eligibility and participation rates for clinicians in small practices and rural areas, mean and median final scores for 2023 and 2025 payment adjustments, and payment adjustment trends from 2021 through 2023.
Date: 06/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Reports on the clinician experience for those participating in the Quality Payment Program in 2023. Presents data on Merit-based Incentive Payment System (MIPS) eligibility and participation rates for clinicians in small practices and rural areas, mean and median final scores for 2023 and 2025 payment adjustments, and payment adjustment trends from 2021 through 2023.
Date: 06/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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RHPTP HELP Webinar: Medicare's NEW Advanced Primary Care Management Program
Webinar recording discusses the Advanced Primary Care Management (APCM) Program, an initiative to improve the delivery, coordination, and outcomes in primary care services. Explores the process of transitioning from fee-for-service to value-based care models and discusses how Medicare's program fits the APCM model.
Additional links: Webinar Slides
Author(s): Lindsay Corcoran, Amy Graham
Date: 06/2025
Sponsoring organization: National Rural Health Resource Center
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Webinar recording discusses the Advanced Primary Care Management (APCM) Program, an initiative to improve the delivery, coordination, and outcomes in primary care services. Explores the process of transitioning from fee-for-service to value-based care models and discusses how Medicare's program fits the APCM model.
Additional links: Webinar Slides
Author(s): Lindsay Corcoran, Amy Graham
Date: 06/2025
Sponsoring organization: National Rural Health Resource Center
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MedPAC Report to the Congress: Medicare and the Health Care Delivery System, June 2025
Evaluates Medicare payment issues and provides recommendations to the U.S. Congress. Covers proposed reforms to the physician fee schedule updates and the accuracy of relative payment rates; supplemental benefits in Medicare Advantage; home healthcare use among Medicare Advantage enrollees; Part D prescription drug plans for beneficiaries in fee-for-service Medicare and Medicare Advantage; Medicare beneficiaries in nursing homes; the inclusion of rural providers in current Medicare fee-for-service quality reporting programs; and recommendations related to reducing beneficiary cost sharing for outpatient services at Critical Access Hospitals. Includes rural references throughout.
Additional links: Executive Summary
Date: 06/2025
Sponsoring organization: Medicare Payment Advisory Commission
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Evaluates Medicare payment issues and provides recommendations to the U.S. Congress. Covers proposed reforms to the physician fee schedule updates and the accuracy of relative payment rates; supplemental benefits in Medicare Advantage; home healthcare use among Medicare Advantage enrollees; Part D prescription drug plans for beneficiaries in fee-for-service Medicare and Medicare Advantage; Medicare beneficiaries in nursing homes; the inclusion of rural providers in current Medicare fee-for-service quality reporting programs; and recommendations related to reducing beneficiary cost sharing for outpatient services at Critical Access Hospitals. Includes rural references throughout.
Additional links: Executive Summary
Date: 06/2025
Sponsoring organization: Medicare Payment Advisory Commission
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