Rural Health
Resources by Topic: Reimbursement and payment models
Environmental Scan on Identifying a Pathway Toward Maximizing Participation in Population-Based Total Cost of Care (PB-TCOC) Models
Presents results of an environmental scan on the identification of a pathway toward maximizing participation in population-based total cost of care (PB-TCOC) models. Describes the Center for Medicare & Medicaid Services's (CMS's) goal of having all Medicare beneficiaries with Parts A and B in accountable care relationships by 2030. Discusses challenges and technical issues related to maximizing participation in PB-TCOC models, including organizational structure, payment, and risk adjustment. Summarizes relevant features of CMS Innovation Center (CMMI) models identified in previous Physician-Focused Payment Model Technical Advisory Committee (PTAC) proposals. Includes rural references and considerations throughout.
Date: 09/2024
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Presents results of an environmental scan on the identification of a pathway toward maximizing participation in population-based total cost of care (PB-TCOC) models. Describes the Center for Medicare & Medicaid Services's (CMS's) goal of having all Medicare beneficiaries with Parts A and B in accountable care relationships by 2030. Discusses challenges and technical issues related to maximizing participation in PB-TCOC models, including organizational structure, payment, and risk adjustment. Summarizes relevant features of CMS Innovation Center (CMMI) models identified in previous Physician-Focused Payment Model Technical Advisory Committee (PTAC) proposals. Includes rural references and considerations throughout.
Date: 09/2024
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Rural Emergency Hospitals Fact Sheet
Provides a brief overview of the Rural Emergency Hospital (REH) provider designation. Outlines REH payment, services, eligibility requirements, and how to apply for REH designation.
Date: 09/2024
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides a brief overview of the Rural Emergency Hospital (REH) provider designation. Outlines REH payment, services, eligibility requirements, and how to apply for REH designation.
Date: 09/2024
Sponsoring organization: Centers for Medicare and Medicaid Services
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Financial Performance of Rural and Urban Hospitals in the Medicare Shared Savings Program
Presents financial performance trends of hospitals that participated in Medicare's Shared Savings Program (SSP) from 2011-2018. Compares trends in 6 financial outcomes between SSP and non-SSP hospitals, and differences in these trends among rural and urban hospitals.
Author(s): Huang Huang, Xi Zhu, Fred Ullrich, A. Clinton MacKinney, Keith Mueller
Date: 09/2024
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Presents financial performance trends of hospitals that participated in Medicare's Shared Savings Program (SSP) from 2011-2018. Compares trends in 6 financial outcomes between SSP and non-SSP hospitals, and differences in these trends among rural and urban hospitals.
Author(s): Huang Huang, Xi Zhu, Fred Ullrich, A. Clinton MacKinney, Keith Mueller
Date: 09/2024
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Evaluating the Effectiveness of a Patient-Centered, Nonphysician Led Self-Monitoring Blood Pressure Program in a Rural Federally Qualified Health Center
Evaluated the effectiveness of a self-monitoring blood pressure program (SMBP) involving a nonphysician team for 205 patients with recent hypertension diagnoses in a rural Washington Federally Qualified Health Center (FQHC). Discusses facilitators and barriers to implementation including COVID-19, telehealth, community health workers, working with limited English proficiency populations, reimbursement, and collaborations.
Author(s): Magali Sanchez, KeliAnne Hara-Hubbard, Bárbara Baquero
Citation: Journal of Public Health Management and Practice, 30, S3167-S174
Date: 09/2024
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Evaluated the effectiveness of a self-monitoring blood pressure program (SMBP) involving a nonphysician team for 205 patients with recent hypertension diagnoses in a rural Washington Federally Qualified Health Center (FQHC). Discusses facilitators and barriers to implementation including COVID-19, telehealth, community health workers, working with limited English proficiency populations, reimbursement, and collaborations.
Author(s): Magali Sanchez, KeliAnne Hara-Hubbard, Bárbara Baquero
Citation: Journal of Public Health Management and Practice, 30, S3167-S174
Date: 09/2024
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Medicare Billing for Telehealth Encounters: An Introductory Guide on Fee-for-Service
Presents an overview of how to bill fee-for-service Medicare and Medicaid for telehealth encounters. Includes information on originating and distant sites, virtual healthcare, and coding telehealth services. Lists types of practice sites, including Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs), and implications for billing telehealth services. Provides contact information for Regional Telehealth Research Centers (RTRC).
Date: 09/2024
Sponsoring organization: Center for Connected Health Policy: The National Telehealth Policy Resource Center
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Presents an overview of how to bill fee-for-service Medicare and Medicaid for telehealth encounters. Includes information on originating and distant sites, virtual healthcare, and coding telehealth services. Lists types of practice sites, including Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs), and implications for billing telehealth services. Provides contact information for Regional Telehealth Research Centers (RTRC).
Date: 09/2024
Sponsoring organization: Center for Connected Health Policy: The National Telehealth Policy Resource Center
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MedPAC Comment on CMS's Proposed Rule on the Payment System for End-Stage Renal Disease for CY 2025
Comments on a July 5, 2024, Federal Register proposed rule related to Medicare payment policies for end-stage renal disease (ESRD). Includes comments addressing modifications to the outlier policy, updates to the low-volume payment adjustment (LVPA), and updates to the wage index methodology.
Date: 08/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Comments on a July 5, 2024, Federal Register proposed rule related to Medicare payment policies for end-stage renal disease (ESRD). Includes comments addressing modifications to the outlier policy, updates to the low-volume payment adjustment (LVPA), and updates to the wage index methodology.
Date: 08/2024
Sponsoring organization: Medicare Payment Advisory Commission
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MedPAC Comment on CMS's Proposed Rule on the Home Health Prospective Payment System for CY 2025
Comments on a July 3, 2024, Federal Register proposed rule related to Medicare payment policies for home health agencies. Includes comments regarding permanent and temporary budget-neutrality adjustments, the plan of care development and scope of services home health patients receive, and the proposed adoption of the core-based statistical area (CBSA) delineations for the home health wage index.
Date: 08/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Comments on a July 3, 2024, Federal Register proposed rule related to Medicare payment policies for home health agencies. Includes comments regarding permanent and temporary budget-neutrality adjustments, the plan of care development and scope of services home health patients receive, and the proposed adoption of the core-based statistical area (CBSA) delineations for the home health wage index.
Date: 08/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Advancing Health Equity through Primary Care Policy: Priorities and Recommendations for California
Provides policy recommendations to improve access to primary care and improve health equity in California, summarizing perspectives and conclusions from policy, primary care, and health equity experts who participated in the 2023 Summit on Primary Care Policy to Advance Health Equity. Covers topics including engagement with community organizations, workforce development, access to care, data sharing, payment, and accountability. Discusses people who live in rural areas and other underserved populations throughout.
Author(s): Diane Rittenhouse, Rebeckah Muratore, Alexandra Ament, Deliya Wesley, Katie Morrison Lee
Date: 08/2024
Sponsoring organization: California Health Care Foundation
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Provides policy recommendations to improve access to primary care and improve health equity in California, summarizing perspectives and conclusions from policy, primary care, and health equity experts who participated in the 2023 Summit on Primary Care Policy to Advance Health Equity. Covers topics including engagement with community organizations, workforce development, access to care, data sharing, payment, and accountability. Discusses people who live in rural areas and other underserved populations throughout.
Author(s): Diane Rittenhouse, Rebeckah Muratore, Alexandra Ament, Deliya Wesley, Katie Morrison Lee
Date: 08/2024
Sponsoring organization: California Health Care Foundation
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FY 2025 Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) Final Rule – CMS-1808-F
Fact sheet providing an overview of the Centers for Medicare & Medicaid Services (CMS) fiscal year 2025 hospital inpatient prospective payment system (IPPS) and long-term care hospital prospective payment system (LTCH PPS) final rule. Includes information about the extension of the low-wage index hospital policy, a separate IPPS payment for small and independent hospitals to establish and maintain a buffer stock of essential medicines, the distribution of graduate medical education (GME) residency slots, updates to quality reporting programs, and more.
Date: 08/2024
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 2025 hospital inpatient prospective payment system (IPPS) and long-term care hospital prospective payment system (LTCH PPS) final rule. Includes information about the extension of the low-wage index hospital policy, a separate IPPS payment for small and independent hospitals to establish and maintain a buffer stock of essential medicines, the distribution of graduate medical education (GME) residency slots, updates to quality reporting programs, and more.
Date: 08/2024
Sponsoring organization: Centers for Medicare and Medicaid Services
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Certified Community Behavioral Health Clinics Demonstration Program: Report to Congress, 2023
Provides an overview of the Certified Community Behavioral Health Clinic (CCBHC) demonstration. Describes changes in the quality of care during the first four years of the demonstration for states with available quality measures, as well as quality bonus payments states made to CCBHCs based on quality measure performance. Builds on findings on demonstration implementation, quality improvement, and costs outlined in previous evaluation reports, focusing on data collected since spring 2022.
Date: 07/2024
Sponsoring organizations: HHS Office of the Assistant Secretary for Planning and Evaluation, Mathematica, RAND Corporation
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Provides an overview of the Certified Community Behavioral Health Clinic (CCBHC) demonstration. Describes changes in the quality of care during the first four years of the demonstration for states with available quality measures, as well as quality bonus payments states made to CCBHCs based on quality measure performance. Builds on findings on demonstration implementation, quality improvement, and costs outlined in previous evaluation reports, focusing on data collected since spring 2022.
Date: 07/2024
Sponsoring organizations: HHS Office of the Assistant Secretary for Planning and Evaluation, Mathematica, RAND Corporation
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