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Rural Health
Resources by Topic: Reimbursement and payment models

Merit-based Incentive Payment System (MIPS): 2024 What's New for Small Practices
Summarizes new elements of the Merit-based Incentive Payment System (MIPS) for small practices - a group of 15 or fewer clinicians billing under a practice's Taxpayer Identification Number (TIN) - during the 2024 performance year. Discusses changes to performance category requirements and flexibilities, new MIPS Value Pathways (MVPs), and performance threshold and payment adjustments. Includes information on performance category redistribution policies for small practices.
Date: 05/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Forces of Change: 2023 Survey Results
Presents results from a 2023 survey of 532 local health departments (LHDs). Provides data on LHD staffing and budgets, billing practices, community health workers, programs and partnerships focused on social determinants of health and violence prevention, data modernization, and outbreak analytics. Includes comparisons of small, medium, and large LHDs.
Author(s): Margaret C. Cunningham, Krishna Patel, Chloe Garofalini, Kellie Hall, Timothy C. McCall
Date: 04/2024
Type: Document
Sponsoring organization: National Association of County and City Health Officials
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April 2024 MedPAC Meeting Transcript
Transcript from the Medicare Payment Advisory Commission's (MedPAC) April 2024 meeting. Covers telehealth in Medicare, alternative approaches to lowering Medicare payments for select conditions in inpatient rehabilitation facilities, approaches for updating the Medicare physician fee schedule, initial findings from an analysis of Medicare Part B payment rates and 340B ceiling prices, and more. Includes discussion of telehealth in rural areas and data on telehealth use in Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) between 2020 and 2022.
Additional links: Telehealth in Medicare: Status Report - Presentation Slides
Date: 04/2024
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Survey Emphasizes Scale and Significance of the RHC Program
Summarizes results of a 2024 national survey of 930 Rural Health Clinics. Presents data on the average payer mix, use and attitude toward telehealth services, Medicare Advantage (MA) contract structures, and MA reimbursement relative to traditional Medicare reimbursement, and more.
Additional links: NARHC 2024 Policy Survey Results
Date: 04/2024
Type: Document
Sponsoring organization: National Association of Rural Health Clinics
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Quality in Motion: Acting on the CMS National Quality Strategy
Provides an overview of the Centers for Medicare & Medicaid Services (CMS) 2022 National Quality Strategy (NQS). Describes actions CMS has taken to meet the eight NQS goals across four priority areas: outcomes and alignment, equity and engagement, safety and resiliency, and interoperability and scientific achievement. Includes rural references throughout.
Date: 04/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Creating a Sustainable Future for Value-Based Care: A Playbook of Voluntary Best Practices for VBC Payment Arrangements
Describes themes that emerged from workgroup meetings regarding the implementation of value-based care (VBC) models, with a focus on total cost of care arrangements. Outlines voluntary best practices and domains within VBC payment arrangements for health plans, facilities, clinicians, and VBC entities to consider during the design, implementation, and evaluation of VBC participation. Includes rural information and considerations throughout.
Date: 04/2024
Type: Document
Sponsoring organizations: AHIP, American Medical Association, National Association of ACOs
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Medicare Accountable Care Organizations: Past Performance and Future Directions
Summarizes research findings about Medicare accountable care organizations (ACOs) from recent peer-reviewed journals, official evaluations of Medicare ACOs, and research organization reports. Describes characteristics of certain ACOs associated with greater savings and factors that limit ACOs' ability to achieve net budgetary savings for the Medicare program. Identifies policy approaches that could increase savings for Medicare through ACOs and the Medicare Shared Savings Program. Includes a brief discussion of challenges facing ACOs in rural and underserved areas.
Date: 04/2024
Type: Document
Sponsoring organization: Congressional Budget Office
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What Would Shifting To A Single-Dose HPV Vaccine Mean For Health And Access?
Discusses the potential impact of single-dose human papilloma virus (HPV) vaccines on health disparities for rural residents, lower socioeconomic status patients, men, and sexual and gender minorities. Discusses relief of cost barriers for health systems and vaccine shortages.
Author(s): Matthew Najarian, Amanda F. Petrik
Citation: Health Affairs Forefront
Date: 04/2024
Type: Document
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Evaluation of the Maryland Total Cost of Care Model: Progress Report
Provides an overview of the Maryland Total Cost of Care Model and evaluates the first four years of the program, 2019-2022. Explores the effects of the model on Medicare spending; service use, including preventable hospital use; and healthcare quality measures. Estimates the potential impact of switching Maryland to the Medicare prospective payment system (PPS) on Medicare spending and service use, including implications for rural and safety net hospitals.
Additional links: Appendices, Findings at a Glance, Transformation Spotlight
Date: 04/2024
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, Mathematica
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Medicare Payment for Rural or Geographically Isolated Hospitals
Displays data on Medicare payment adjustments for Sole Community Hospitals, Medicare-Dependent Hospitals, Low-Volume Hospitals, and Critical Access Hospitals. Includes information on the number of qualifying hospitals by state and eligibility criteria.
Date: 04/2024
Type: Document
Sponsoring organization: Congressional Research Service
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