Rural Health
Resources by Topic: Reimbursement and payment models
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
Sponsoring organization: National Association of Rural Health Clinics
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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
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
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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
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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
Sponsoring organization: Maryland Health Care Commission
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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
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
Sponsoring organizations: Centers for Medicare and Medicaid Services, Mathematica
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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
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
Sponsoring organizations: Centers for Medicare and Medicaid Services, NORC at the University of Chicago
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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
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
Sponsoring organization: Congressional Research Service
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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
Sponsoring organization: Congressional Research Service
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Rural Health Clinic All-Inclusive Rate: CY 2023 Update
Provides an overview of Rural Health Clinic (RHC) payment limits and cost report data requirements for calendar year 2023.
Date: 11/2022
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides an overview of Rural Health Clinic (RHC) payment limits and cost report data requirements for calendar year 2023.
Date: 11/2022
Sponsoring organization: Centers for Medicare and Medicaid Services
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New Mexico Primary Care Alternative Payment Model Provider Readiness Assessment
Examines facilitators and barriers related to primary care stakeholders' readiness to implement an alternative payment model (APM) in New Mexico. Analyzes 2022 survey and focus group data from providers to gain feedback from Federally Qualified Health Centers (FQHCs), small- and medium-sized practices, hospitals, and interprofessional teams. Discusses issues such as care delivery, health information technology (HIT), financial and organizational readiness, and more, with information specific to small and rural facilities.
Date: 11/2022
Sponsoring organizations: Health Management Associates, New Mexico Human Services Department
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Examines facilitators and barriers related to primary care stakeholders' readiness to implement an alternative payment model (APM) in New Mexico. Analyzes 2022 survey and focus group data from providers to gain feedback from Federally Qualified Health Centers (FQHCs), small- and medium-sized practices, hospitals, and interprofessional teams. Discusses issues such as care delivery, health information technology (HIT), financial and organizational readiness, and more, with information specific to small and rural facilities.
Date: 11/2022
Sponsoring organizations: Health Management Associates, New Mexico Human Services Department
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Access to Emergency Medical Services in Rural Communities: Policy Brief and Recommendations to the Secretary
Provides an overview of issues related to the provision of emergency medical services (EMS) in rural areas. Discusses rural EMS access, financing, and workforce challenges, as well as promising telehealth innovations. Outlines federal programs and resources that support EMS programs. Offers policy recommendations related to access to EMS, workforce, and reimbursement.
Date: 11/2022
Sponsoring organization: National Advisory Committee on Rural Health and Human Services
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Provides an overview of issues related to the provision of emergency medical services (EMS) in rural areas. Discusses rural EMS access, financing, and workforce challenges, as well as promising telehealth innovations. Outlines federal programs and resources that support EMS programs. Offers policy recommendations related to access to EMS, workforce, and reimbursement.
Date: 11/2022
Sponsoring organization: National Advisory Committee on Rural Health and Human Services
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Medicaid Population-Based Payment: The Current Landscape, Early Insights, and Considerations for Policymakers
Provides an overview of population-based payment (PBP) models and the Medicaid PBP landscape. Identifies promising strategies for designing and implementing PBPs in Medicaid and considerations for state and federal policymakers who want to support these programs. Highlights state PBP approaches, including the Pennsylvania Rural Health Model.
Author(s): Rob Houston, Anne Smithey, Kelsey Brykman
Date: 11/2022
Sponsoring organization: Center for Health Care Strategies
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Provides an overview of population-based payment (PBP) models and the Medicaid PBP landscape. Identifies promising strategies for designing and implementing PBPs in Medicaid and considerations for state and federal policymakers who want to support these programs. Highlights state PBP approaches, including the Pennsylvania Rural Health Model.
Author(s): Rob Houston, Anne Smithey, Kelsey Brykman
Date: 11/2022
Sponsoring organization: Center for Health Care Strategies
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