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Rural Health
Resources by Topic: Reimbursement and payment models

Merit-based Incentive Payment System (MIPS): 2023 MIPS Quick Start Guide for Small Practices (15 or Fewer Clinicians)
Provides an overview of the Merit-based Incentive Payment System (MIPS) and outlines 6 steps regarding participation in the 2023 performance year. Includes information on performance category redistribution policies for small practices.
Date: 12/2022
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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The Evolution of Hospital Designations and Payment in the U.S.: Implications for Rural Hospitals
Provides a history and overview of Medicare hospital payment polices as well as alternative payment models and their impact on rural facilities. Discusses the context in which rural hospitals serve patients, rural hospital payment provisions and designations, and current federal payment models that impact rural hospitals.
Author(s): Onyinye Oyeka, Clinton MacKinney, Keith J. Mueller
Date: 12/2022
Type: Document
Sponsoring organization: Rural Policy Research Institute Rural Health Panel
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Mandated Analysis of Home Health Service Utilization From January 2016 Through March 2022
Report evaluates the distribution of rural add-on payments for home health claims. Examines the results of the Centers for Medicare and Medicaid Services's new rural add-on methodology aimed at providing higher add-on percentages for "low population density" categories and explores the effect this methodology has had on "high utilization" categories. Makes comments and recommendations as to how this methodology can be adjusted.
Additional links: Report in Brief
Date: 12/2022
Type: Document
Sponsoring organization: Office of Inspector General (HHS)
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CMS Innovation Center: 2022 Report to Congress
Reports to Congress on payment and service delivery models and initiatives tested or announced by the Center for Medicare and Medicaid Innovation between October 2020 and September 2022. Includes summaries and updates on multiple rural-relevant models and initiatives, including Community Health Access and Rural Transformation (CHART) Model, the Pennsylvania Rural Health Model (PARHM), the Vermont All-Payer Accountable Care Organization Model, and more.
Date: 12/2022
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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RHC Regulatory Updates & Good Faith Estimate (GFE) Policy
Recording of a December 7, 2022, webinar providing an overview of telehealth payment rates for Rural Health Clinics (RHCs) and other regulatory updates and potential changes for 2023. Discusses price transparency in healthcare and good faith estimate requirements for RHCs. Includes links to good faith estimate resources. Part of the Rural Health Clinic Technical Assistance Series.
Additional links: Presentation Slides, Transcript
Date: 12/2022
Type: Document
Sponsoring organization: National Association of Rural Health Clinics
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30 Years Of 340B: Preserving The Health Care Safety Net
Discusses the development and purpose of the 340B Drug Pricing Program, and provides an overview of the program. Summarizes research on the impact of the 340B program on hospitals and lessons learned.
Author(s): Henry A. Waxman
Citation: Health Affairs Forefront
Date: 12/2022
Type: Document
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Preserve Telehealth Access Act of 2021: Telehealth Recommendations
Offers policy recommendations related to Maryland's Preserve Telehealth Access Act of 2021, including recommendations related to provider options to deliver care via telehealth, audio-visual and audio-only delivery, remote patient monitoring, hospice care services, inpatient care, patient privacy, and reimbursement levels.
Author(s): Randolph S. Sergent, Ben Steffen
Date: 12/2022
Type: Document
Sponsoring organization: Maryland Health Care Commission
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Evaluation of the Primary Care First Model: First Annual Report
Provides an overview of the Primary Care First (PCF) model, which aims to enhance primary care and move primary care practitioners toward value-based payment. Describes the first performance year of the PCF model for Cohort 1 practices. Explores advanced primary care attributes that Cohort 1 practices report they possessed at the start of PCF and the approaches these practices have taken or plan to take to change how they deliver advanced primary care. Presents findings on the 13 payers that are partnering with the Centers for Medicare & Medicaid Services (CMS) as payer partners, including why they chose to partner with CMS and efforts made to align their payments with CMS in the PCF model.
Additional links: Findings at a Glance
Date: 12/2022
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, Mathematica
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Evaluation of the Vermont All-Payer Accountable Care Organization Model: Second Evaluation Report
Evaluates the first three performance years of the Vermont All-Payer Accountable Care Organization Model (VTAPM), which aims to assess whether scaling an Accountable Care Organization (ACO) across all payers in the state can reduce program expenditures while preserving or improving care quality. Discusses the implementation of the model, provider engagement, efforts to address population health goals; characteristics of participating hospitals, practitioners, and beneficiaries; and the model's impacts on Medicare spending, utilization, and quality of care. Describes changes to the model's design in response to the COVID-19 public health emergency and how COVID-19 and a cyberattack impacted healthcare utilization. Includes information on hospital and provider participation in rural areas and limited participation by Critical Access Hospitals.
Additional links: Findings at a Glance, Technical Appendices
Date: 12/2022
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, NORC at the University of Chicago
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Federal Support for Financially Distressed Hospitals
Provides an overview of Medicare hospital payments and federal funding opportunities to assist financially distressed hospitals. Includes information on COVID-19 relief funding targeted to rural and safety net hospitals.
Date: 12/2022
Type: Document
Sponsoring organization: Congressional Research Service
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