Rural Health
Resources by Topic: Reimbursement and payment models
Improving Primary Care Valuation Processes to Inform the Physician Fee Schedule
Describes the current process and data inputs used by the Centers for Medicare & Medicaid Services (CMS) for primary care service valuation in the Medicare Physician Fee Schedule (PFS). Discusses promising approaches to update the PFS and the potential role of hybrid payments. Offers recommendations to CMS to improve the valuation process and accurately reflect the full scope of high-quality primary care.
Additional links: Read Online
Date: 2025
Sponsoring organization: Health and Medicine Division (HMD), National Academies of Sciences, Engineering, and Medicine
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Describes the current process and data inputs used by the Centers for Medicare & Medicaid Services (CMS) for primary care service valuation in the Medicare Physician Fee Schedule (PFS). Discusses promising approaches to update the PFS and the potential role of hybrid payments. Offers recommendations to CMS to improve the valuation process and accurately reflect the full scope of high-quality primary care.
Additional links: Read Online
Date: 2025
Sponsoring organization: Health and Medicine Division (HMD), National Academies of Sciences, Engineering, and Medicine
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Telehealth FAQ Calendar Year 2025
Provides information on Medicare telehealth regulations and payment policy for calendar year 2025. Includes information on audio-only services, behavioral health services, direct supervision, and more.
Date: 2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides information on Medicare telehealth regulations and payment policy for calendar year 2025. Includes information on audio-only services, behavioral health services, direct supervision, and more.
Date: 2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Bridging the Gap: A Policy Framework for Sustainable Community Paramedicine in Rural America
Policy brief regarding the need for a national policy for non-physician licensed healthcare providers to be reimbursed for community paramedicine services. Discusses the role of community paramedicine in expanding access to care in rural areas and describes four community paramedicine models. Offers policy recommendations related to recognizing, supporting, and reimbursing community paramedicine programs.
Author(s): Katie Gorndt, Kimberly Haverly, Tom Syverson
Date: 12/2024
Sponsoring organization: National Rural Health Association
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Policy brief regarding the need for a national policy for non-physician licensed healthcare providers to be reimbursed for community paramedicine services. Discusses the role of community paramedicine in expanding access to care in rural areas and describes four community paramedicine models. Offers policy recommendations related to recognizing, supporting, and reimbursing community paramedicine programs.
Author(s): Katie Gorndt, Kimberly Haverly, Tom Syverson
Date: 12/2024
Sponsoring organization: National Rural Health Association
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Texas Medicaid and CHIP Reference Guide: Fifteenth Edition
Reference guide for aspects of Texas's Medicaid and Children's Health Insurance Program (CHIP) programs, including caseload and costs, eligibility and enrollment, available services, program administration, and quality of care. Features information on rural-specific policies for reimbursement, time and distance standards, the Rural Access to Primary Care and Preventive Services Program, rural hospitals, Rural Health Clinics (RHCs), and Federally Qualified Health Centers (FQHCs).
Date: 12/2024
Sponsoring organization: Texas Health and Human Services
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Reference guide for aspects of Texas's Medicaid and Children's Health Insurance Program (CHIP) programs, including caseload and costs, eligibility and enrollment, available services, program administration, and quality of care. Features information on rural-specific policies for reimbursement, time and distance standards, the Rural Access to Primary Care and Preventive Services Program, rural hospitals, Rural Health Clinics (RHCs), and Federally Qualified Health Centers (FQHCs).
Date: 12/2024
Sponsoring organization: Texas Health and Human Services
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The Implications of the No Surprises Act on Contract Dynamics, Negotiations, and Finances
Provides feedback from insurance and healthcare stakeholders regarding the No Surprises Act (NSA), with a focus on insurer-provider dynamics, insurer and provider staffing, contract negotiations, payment rates, and the handling of advanced explanation of benefits (AEOB) provisions. Provides 2024 interview feedback from 35 stakeholders regarding the NSA and includes reflections on its impact for rural and underserved communities.
Author(s): Petra W. Rasmussen, Erin Lindsey Duffy, Isha Yardi, et al.
Date: 12/2024
Sponsoring organization: RAND Corporation
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Provides feedback from insurance and healthcare stakeholders regarding the No Surprises Act (NSA), with a focus on insurer-provider dynamics, insurer and provider staffing, contract negotiations, payment rates, and the handling of advanced explanation of benefits (AEOB) provisions. Provides 2024 interview feedback from 35 stakeholders regarding the NSA and includes reflections on its impact for rural and underserved communities.
Author(s): Petra W. Rasmussen, Erin Lindsey Duffy, Isha Yardi, et al.
Date: 12/2024
Sponsoring organization: RAND Corporation
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Medicare Could save Billions with Comparable Access for Enrollees If Critical Access Hospital Payments for Swing-Bed Services Were Similar to Those of the Fee-for-Service Prospective Payment System
Describes the use of swing beds for skilled nursing services at Critical Access Hospitals (CAHs) and average daily Medicare reimbursement for these services from 2015 through 2020. Examines data from a sample of 100 CAHs to determine whether Medicare enrollees would have had access to the same skilled nursing services provided by CAHs at alternative facilities within a 35-mile driving distance. Compares the average daily reimbursement for skilled nursing services at CAHs and alternative facilities, as well as the potential savings to Medicare if CAHs were reimbursed for skilled nursing services under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS).
Date: 12/2024
Sponsoring organization: Office of Inspector General (HHS)
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Describes the use of swing beds for skilled nursing services at Critical Access Hospitals (CAHs) and average daily Medicare reimbursement for these services from 2015 through 2020. Examines data from a sample of 100 CAHs to determine whether Medicare enrollees would have had access to the same skilled nursing services provided by CAHs at alternative facilities within a 35-mile driving distance. Compares the average daily reimbursement for skilled nursing services at CAHs and alternative facilities, as well as the potential savings to Medicare if CAHs were reimbursed for skilled nursing services under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS).
Date: 12/2024
Sponsoring organization: Office of Inspector General (HHS)
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Suicide Care in Kentucky Hospitals
Provides an overview of suicide-related visits in Kentucky hospitals and emergency departments, recent changes, and patient demographics. Features statistics including percentages of suicide-related visits in 2017-2023 in rural and urban Kentucky hospitals, and a county-level map showing locations of psychiatric hospitals.
Date: 12/2024
Sponsoring organization: Kentucky Hospital Association
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Provides an overview of suicide-related visits in Kentucky hospitals and emergency departments, recent changes, and patient demographics. Features statistics including percentages of suicide-related visits in 2017-2023 in rural and urban Kentucky hospitals, and a county-level map showing locations of psychiatric hospitals.
Date: 12/2024
Sponsoring organization: Kentucky Hospital Association
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December 2024 MedPAC Meeting Transcript
Transcript from the Medicare Payment Advisory Commission's (MedPAC) December 2024 meeting. Covers payment adequacy and updates for physician and other health professional services, hospital inpatient and outpatient services, Rural Emergency Hospitals (REHs), skilled nursing facility services, inpatient rehabilitation facility services, home health services, hospice services, and outpatient dialysis services.
Additional links: Assessing Payment Adequacy and Updating Payments: Hospital Inpatient and Outpatient Services; and Mandated Report on Rural Emergency Hospitals - Presentation Slides, Assessing Payment Adequacy and Updating Payments: Skilled Nursing Facility Services - Presentation Slides
Date: 12/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Transcript from the Medicare Payment Advisory Commission's (MedPAC) December 2024 meeting. Covers payment adequacy and updates for physician and other health professional services, hospital inpatient and outpatient services, Rural Emergency Hospitals (REHs), skilled nursing facility services, inpatient rehabilitation facility services, home health services, hospice services, and outpatient dialysis services.
Additional links: Assessing Payment Adequacy and Updating Payments: Hospital Inpatient and Outpatient Services; and Mandated Report on Rural Emergency Hospitals - Presentation Slides, Assessing Payment Adequacy and Updating Payments: Skilled Nursing Facility Services - Presentation Slides
Date: 12/2024
Sponsoring organization: Medicare Payment Advisory Commission
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The Pennsylvania Rural Health Model (PARHM): Fourth Annual Evaluation Report
Evaluates the fourth performance year of the Pennsylvania Rural Health Model (PARHM), an initiative designed to test if global budgets can help rural hospitals improve their financial viability, provide flexibility to meet locally defined community health needs, and reduce overall healthcare spending. Provides an overview of the model and describes the implementation experience of participating hospitals and payers. Presents a descriptive quantitative assessment of financial performance, spending and utilization, access to care, and quality of care outcomes from 2016, the model's baseline, through 2022. Includes three case studies discussing three themes: experiences with global budget reconciliation, behavioral health transformation, and interactions and alignment between PARHM and other value-based care programs.
Additional links: Appendix, Findings at a Glance
Date: 12/2024
Sponsoring organizations: Centers for Medicare and Medicaid Services, NORC at the University of Chicago
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Evaluates the fourth performance year of the Pennsylvania Rural Health Model (PARHM), an initiative designed to test if global budgets can help rural hospitals improve their financial viability, provide flexibility to meet locally defined community health needs, and reduce overall healthcare spending. Provides an overview of the model and describes the implementation experience of participating hospitals and payers. Presents a descriptive quantitative assessment of financial performance, spending and utilization, access to care, and quality of care outcomes from 2016, the model's baseline, through 2022. Includes three case studies discussing three themes: experiences with global budget reconciliation, behavioral health transformation, and interactions and alignment between PARHM and other value-based care programs.
Additional links: Appendix, Findings at a Glance
Date: 12/2024
Sponsoring organizations: Centers for Medicare and Medicaid Services, NORC at the University of Chicago
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Rural-Urban Medicaid and CHIP Enrollee Comparisons Using the 2019 T-MSIS Analytic File
Compares urban and rural residents enrolled in fee-for-service or managed care Medicaid, using data from the 2019 Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF). Features demographics and statistics on Medicaid enrollment, with breakdowns by levels of rurality.
Author(s): Kristie Thompson, Hannah Friedman, Lily Wang, Mark Holmes
Date: 12/2024
Sponsoring organization: North Carolina Rural Health Research Program
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Compares urban and rural residents enrolled in fee-for-service or managed care Medicaid, using data from the 2019 Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF). Features demographics and statistics on Medicaid enrollment, with breakdowns by levels of rurality.
Author(s): Kristie Thompson, Hannah Friedman, Lily Wang, Mark Holmes
Date: 12/2024
Sponsoring organization: North Carolina Rural Health Research Program
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