Rural Health
Resources by Topic: Reimbursement and payment models
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
Type: Document
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
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Rural Emergency Hospital (REH) Model Frequently Asked Questions
Provides answers to frequently asked questions regarding the Rural Emergency Hospital (REH) designation. Covers general information, Conditions of Participation, and REH payment policies.
Date: 08/2024
Type: Document
Sponsoring organizations: Mathematica, Rural Health Redesign Center
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Provides answers to frequently asked questions regarding the Rural Emergency Hospital (REH) designation. Covers general information, Conditions of Participation, and REH payment policies.
Date: 08/2024
Type: Document
Sponsoring organizations: Mathematica, Rural Health Redesign Center
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An REH Conversion Story: Harper County Hospital
Profiles Oklahoma's Harper County Hospital and its transition from a Critical Access Hospital (CAH) to a Rural Emergency Hospital (REH). Summarizes an interview with Kevin O'Brien, Chief Executive Officer (CEO) of Harper County Hospital, regarding the experience of converting to REH status. Covers the hospital's financial position before conversion, including limitations to being a county-owned hospital; the exploration of the REH designation; and the financial and operational impacts of the REH designation, including services added by the hospital after the conversion.
Date: 07/2024
Type: Document
Sponsoring organization: Rural Health Redesign Center
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Profiles Oklahoma's Harper County Hospital and its transition from a Critical Access Hospital (CAH) to a Rural Emergency Hospital (REH). Summarizes an interview with Kevin O'Brien, Chief Executive Officer (CEO) of Harper County Hospital, regarding the experience of converting to REH status. Covers the hospital's financial position before conversion, including limitations to being a county-owned hospital; the exploration of the REH designation; and the financial and operational impacts of the REH designation, including services added by the hospital after the conversion.
Date: 07/2024
Type: Document
Sponsoring organization: Rural Health Redesign Center
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An REH Conversion Story: Mercy Hospital
Profiles Mercy Hospital, in Moundridge, Kansas, and its transition from a prospective payment system (PPS) hospital to a Rural Emergency Hospital (REH). Summarizes an interview with Aaron Herbel, Chief Executive Officer (CEO) of Mercy Hospital, regarding the experience of converting to REH status. Covers the conversion timeline, the involvement of hospital and community stakeholders, and the opening of a walk-in clinic that coincided with the REH conversion.
Author(s): Hope Burch, Tracey Dorff, Anna Anna, Janice Walters
Date: 07/2024
Type: Document
Sponsoring organization: Rural Health Redesign Center
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Profiles Mercy Hospital, in Moundridge, Kansas, and its transition from a prospective payment system (PPS) hospital to a Rural Emergency Hospital (REH). Summarizes an interview with Aaron Herbel, Chief Executive Officer (CEO) of Mercy Hospital, regarding the experience of converting to REH status. Covers the conversion timeline, the involvement of hospital and community stakeholders, and the opening of a walk-in clinic that coincided with the REH conversion.
Author(s): Hope Burch, Tracey Dorff, Anna Anna, Janice Walters
Date: 07/2024
Type: Document
Sponsoring organization: Rural Health Redesign Center
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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
Type: Document
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
Type: Document
Sponsoring organizations: HHS Office of the Assistant Secretary for Planning and Evaluation, Mathematica, RAND Corporation
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Rural Community Health Worker Programs: Proving Value and Finding Sustainability
Features four rural healthcare organizations describing the impact of their community health worker (CHW) programs and strategies for sustaining them. Discusses CHW roles, activities, reimbursement options, and more.
Author(s): Kay Miller Temple
Citation: Rural Monitor
Date: 07/2024
Type: Document
Sponsoring organization: Rural Health Information Hub
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Features four rural healthcare organizations describing the impact of their community health worker (CHW) programs and strategies for sustaining them. Discusses CHW roles, activities, reimbursement options, and more.
Author(s): Kay Miller Temple
Citation: Rural Monitor
Date: 07/2024
Type: Document
Sponsoring organization: Rural Health Information Hub
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The Low-Volume Hospital Adjustment Before and During COVID-19
Describes characteristics of rural low-volume hospitals (LVHs) between April 2018 and March 2022. Compares the characteristics and profitability of rural LVHs with other rural prospective payment system (PPS) hospitals before and during the COVID-19 pandemic. Presents data on LVH profitability margins with and without the LVH payment adjustment.
Author(s): Emmaline Keesee, Susie Gurzenda, Kristie Thompson, George Pink
Date: 07/2024
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Describes characteristics of rural low-volume hospitals (LVHs) between April 2018 and March 2022. Compares the characteristics and profitability of rural LVHs with other rural prospective payment system (PPS) hospitals before and during the COVID-19 pandemic. Presents data on LVH profitability margins with and without the LVH payment adjustment.
Author(s): Emmaline Keesee, Susie Gurzenda, Kristie Thompson, George Pink
Date: 07/2024
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Why Primary Care Practitioners Aren't Joining Value-Based Payment Models: Reasons and Potential Solutions
Explores reasons why primary care providers do not participate in value-based payment models. Presents findings from focus group and key informant interviews with primary care providers and primary care member organizations. Covers financial, workforce, and administrative burden-related challenges, and outlines potential solutions. Includes a discussion of financial challenges small and rural independent practices face in participating in value-based payment models.
Author(s): Ann S. O'Malley, Rumin Sarwar, Cindy Alvarez, Eugene C. Rich
Date: 07/2024
Type: Document
Sponsoring organization: Commonwealth Fund
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Explores reasons why primary care providers do not participate in value-based payment models. Presents findings from focus group and key informant interviews with primary care providers and primary care member organizations. Covers financial, workforce, and administrative burden-related challenges, and outlines potential solutions. Includes a discussion of financial challenges small and rural independent practices face in participating in value-based payment models.
Author(s): Ann S. O'Malley, Rumin Sarwar, Cindy Alvarez, Eugene C. Rich
Date: 07/2024
Type: Document
Sponsoring organization: Commonwealth Fund
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Proposed CY 2025 Medicare Physician Fee Schedule: Fact Sheet
Fact sheet covering proposed Centers for Medicare & Medicaid Services (CMS) telehealth policy changes for 2025 as outlined in the calendar year (CY) 2025 Physician Fee Schedule proposed rule. Covers proposals related to audio-only telehealth; eligible services that can be delivered by telehealth; frequency limitations for inpatient visits, nursing facilities, and critical care consults; direct supervision through the use of live video; payment to Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs); opioid treatment programs; and more.
Date: 07/2024
Type: Document
Sponsoring organization: Center for Connected Health Policy: The National Telehealth Policy Resource Center
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Fact sheet covering proposed Centers for Medicare & Medicaid Services (CMS) telehealth policy changes for 2025 as outlined in the calendar year (CY) 2025 Physician Fee Schedule proposed rule. Covers proposals related to audio-only telehealth; eligible services that can be delivered by telehealth; frequency limitations for inpatient visits, nursing facilities, and critical care consults; direct supervision through the use of live video; payment to Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs); opioid treatment programs; and more.
Date: 07/2024
Type: Document
Sponsoring organization: Center for Connected Health Policy: The National Telehealth Policy Resource Center
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MedPAC Data Book: Health Care Spending and the Medicare Program, 2024
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.
Date: 07/2024
Type: Document
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.
Date: 07/2024
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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