Rural Health
Resources by Topic: Reimbursement and payment models
National Rural Health Day Webinar: CMS Framework for Advancing Health Care
Recording of a November 15, 2022, webinar providing an overview of the Centers for Medicare & Medicaid (CMS) Framework for Advancing Health Care in Rural, Tribal and Geographically Isolated Communities. Discusses the CMS Framework for Health Equity and identifies other rural health resources, including other recent CMS rural health reports.
Additional links: Presentation Slides, Transcript
Date: 11/2022
Sponsoring organization: Centers for Medicare and Medicaid Services
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Recording of a November 15, 2022, webinar providing an overview of the Centers for Medicare & Medicaid (CMS) Framework for Advancing Health Care in Rural, Tribal and Geographically Isolated Communities. Discusses the CMS Framework for Health Equity and identifies other rural health resources, including other recent CMS rural health reports.
Additional links: Presentation Slides, Transcript
Date: 11/2022
Sponsoring organization: Centers for Medicare and Medicaid Services
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Clarity for Rural Emergency Hospitals and Changes for Critical Access Hospitals: CMS Finalizes Conditions of Participation and Payment and Enrollment Policies But Pauses Stark Law Flexibilities
Provides an overview of the Rural Emergency Hospitals (REHs) provisions of the Calendar Year 2023 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Final Rule. Discusses REH reimbursement, Conditions of Participation (CoPs), enrollment provisions, and Stark Law regulatory modifications to accommodate REHs. Highlights changes to the definition of "primary roads" related to Critical Access Hospital (CAH) CoPs.
Author(s): Emily Jane Cook, Caroline Reignley, Amber Arnold, Sandra M. DiVarco
Date: 11/2022
Sponsoring organization: McDermott Will & Emery
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Provides an overview of the Rural Emergency Hospitals (REHs) provisions of the Calendar Year 2023 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Final Rule. Discusses REH reimbursement, Conditions of Participation (CoPs), enrollment provisions, and Stark Law regulatory modifications to accommodate REHs. Highlights changes to the definition of "primary roads" related to Critical Access Hospital (CAH) CoPs.
Author(s): Emily Jane Cook, Caroline Reignley, Amber Arnold, Sandra M. DiVarco
Date: 11/2022
Sponsoring organization: McDermott Will & Emery
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Certified Community Behavioral Health Clinics Demonstration Program: Report to Congress, 2021
Provides an overview of the Certified Community Behavioral Health Clinic (CCBHC) demonstration. Offers a summary of the findings from the prior annual reports on the CCBHC demonstration, a comparison of cost and quality in the first two demonstration years, and the results of impact analyses. This is the fifth annual report to Congress on the CCBHC demonstration.
Date: 11/2022
Sponsoring organizations: HHS Office of the Assistant Secretary for Planning and Evaluation, Mathematica
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Provides an overview of the Certified Community Behavioral Health Clinic (CCBHC) demonstration. Offers a summary of the findings from the prior annual reports on the CCBHC demonstration, a comparison of cost and quality in the first two demonstration years, and the results of impact analyses. This is the fifth annual report to Congress on the CCBHC demonstration.
Date: 11/2022
Sponsoring organizations: HHS Office of the Assistant Secretary for Planning and Evaluation, Mathematica
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CMS Framework for Advancing Health Care in Rural, Tribal, and Geographically Isolated Communities
Report outlines the Centers for Medicare & Medicaid Services (CMS) plan for improving health equity and health outcomes across the U.S. for rural, tribal, and geographically isolated communities. Details a 6 priority framework emphasizing the application of a community-informed geographic lens; the collection and use of standardized data; support for healthcare professionals; the optimization of medical and communication technology; the expansion of access to comprehensive healthcare coverage, benefits, and services and supports; and innovation and value-based care. Highlights examples of activities CMS is undertaking in support of each priority and recent CMS efforts that align with each priority.
Date: 11/2022
Sponsoring organization: Centers for Medicare and Medicaid Services
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Report outlines the Centers for Medicare & Medicaid Services (CMS) plan for improving health equity and health outcomes across the U.S. for rural, tribal, and geographically isolated communities. Details a 6 priority framework emphasizing the application of a community-informed geographic lens; the collection and use of standardized data; support for healthcare professionals; the optimization of medical and communication technology; the expansion of access to comprehensive healthcare coverage, benefits, and services and supports; and innovation and value-based care. Highlights examples of activities CMS is undertaking in support of each priority and recent CMS efforts that align with each priority.
Date: 11/2022
Sponsoring organization: Centers for Medicare and Medicaid Services
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A Global Equity Model (GEM) for the Advancement of Community Health and Health Equity
Provides an overview of existing and emerging payment systems and their roles in promoting community health and health equity. Proposes a global payment model for health systems' inpatient, emergency department (ED), and outpatient sites of care with community health and health equity as its organizing features. Includes information on the Pennsylvania Rural Health Model, the ACO REACH model, and other rural-relevant payment models.
Author(s): Anaeze C. Offodile II, Jason B. Gibbons, Samantha Murrell, Donna Kinzer, Joshua M. Sharfstein
Date: 11/2022
Sponsoring organization: National Academy of Medicine
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Provides an overview of existing and emerging payment systems and their roles in promoting community health and health equity. Proposes a global payment model for health systems' inpatient, emergency department (ED), and outpatient sites of care with community health and health equity as its organizing features. Includes information on the Pennsylvania Rural Health Model, the ACO REACH model, and other rural-relevant payment models.
Author(s): Anaeze C. Offodile II, Jason B. Gibbons, Samantha Murrell, Donna Kinzer, Joshua M. Sharfstein
Date: 11/2022
Sponsoring organization: National Academy of Medicine
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Person-Centered Innovation – An Update on the Implementation of the CMS Innovation Center's Strategy
Provides an update on the Centers for Medicare and Medicaid Services' (CMS) Innovation Center's progress in the implementation of the strategy refresh announced in 2021. Describes accomplishments from the first year of implementing the strategy refresh and outlines areas of focus for the upcoming year across the five strategic objectives: driving accountable care, advancing health equity, supporting innovation, addressing affordability, and partnering to achieve healthcare system transformation. Includes information on the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model and the Community Health Access and Rural Transformation (CHART) Model.
Additional links: Supplemental Document
Date: 11/2022
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides an update on the Centers for Medicare and Medicaid Services' (CMS) Innovation Center's progress in the implementation of the strategy refresh announced in 2021. Describes accomplishments from the first year of implementing the strategy refresh and outlines areas of focus for the upcoming year across the five strategic objectives: driving accountable care, advancing health equity, supporting innovation, addressing affordability, and partnering to achieve healthcare system transformation. Includes information on the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model and the Community Health Access and Rural Transformation (CHART) Model.
Additional links: Supplemental Document
Date: 11/2022
Sponsoring organization: Centers for Medicare and Medicaid Services
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The Path to Coordinated Federal Leadership to Strengthen Primary Health Care
Discusses the potential of a Secretary's Council on Primary Care within the U.S. Department of Health and Human Services. Describes primary care's role in addressing policy challenges related to health equity, payment, workforce training, pandemic recovery and resilience, the opioid crisis, and mental health. Offers recommendations to include and strengthen high-quality primary care as part of a long-term vision of a high-value healthcare system. Includes rural references throughout.
Author(s): Robert L. Phillips Jr., Christopher Koller, Alice Hm Chen
Date: 11/2022
Sponsoring organization: Milbank Memorial Fund
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Discusses the potential of a Secretary's Council on Primary Care within the U.S. Department of Health and Human Services. Describes primary care's role in addressing policy challenges related to health equity, payment, workforce training, pandemic recovery and resilience, the opioid crisis, and mental health. Offers recommendations to include and strengthen high-quality primary care as part of a long-term vision of a high-value healthcare system. Includes rural references throughout.
Author(s): Robert L. Phillips Jr., Christopher Koller, Alice Hm Chen
Date: 11/2022
Sponsoring organization: Milbank Memorial Fund
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Rethinking Rurality: Using Hospital Referral Regions to Investigate Rural-Urban Health Outcomes
Examines the relationship between the proportion of rural population served in each of the 306 hospital referral regions (HRRs) and health outcomes, healthcare spending and utilization, and access to and quality of primary care. Explores whether mortality differences in HRRs are associated with differences in price-adjusted Medicare reimbursements, quality of primary care, and access to primary care.
Author(s): Lucy Skinner, Sandra Wong, Carrie Colla
Citation: BMC Health Services Research, 22(1), 1312
Date: 11/2022
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Examines the relationship between the proportion of rural population served in each of the 306 hospital referral regions (HRRs) and health outcomes, healthcare spending and utilization, and access to and quality of primary care. Explores whether mortality differences in HRRs are associated with differences in price-adjusted Medicare reimbursements, quality of primary care, and access to primary care.
Author(s): Lucy Skinner, Sandra Wong, Carrie Colla
Citation: BMC Health Services Research, 22(1), 1312
Date: 11/2022
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Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Organ Acquisition; Rural Emergency Hospitals: Payment Policies, Conditions of Participation, Provider Enrollment, Physician Self-Referral; New Service Category for Hospital Outpatient Department Prior Authorization Process; Overall Hospital Quality Star Rating; COVID-19
Establishes the Rural Emergency Hospital (REH) provider type. Outlines REH payment policy, Conditions of Participation (CoPs), quality measures, and enrollment policy. Outlines changes to the Critical Access Hospitals (CAH) CoPs regarding location and distance requirements, patient's rights requirements, and flexibilities for CAHs that are part of a larger health system. Among other things, this rule also revises the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Medicare Ambulatory Surgical Center (ACS) payment system for calendar year 2023 and finalizes provisions included in the COVID-19 interim final rules.
Additional links: Fact Sheet
Date: 11/2022
Sponsoring organization: Centers for Medicare and Medicaid Services
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Establishes the Rural Emergency Hospital (REH) provider type. Outlines REH payment policy, Conditions of Participation (CoPs), quality measures, and enrollment policy. Outlines changes to the Critical Access Hospitals (CAH) CoPs regarding location and distance requirements, patient's rights requirements, and flexibilities for CAHs that are part of a larger health system. Among other things, this rule also revises the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Medicare Ambulatory Surgical Center (ACS) payment system for calendar year 2023 and finalizes provisions included in the COVID-19 interim final rules.
Additional links: Fact Sheet
Date: 11/2022
Sponsoring organization: Centers for Medicare and Medicaid Services
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CY 2023 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule (CMS 1772-FC) Rural Emergency Hospitals — New Medicare Provider Type
Provides an overview of Rural Emergency Hospitals, a Medicare provider type established by the Consolidated Appropriations Act, 2021. Details key policies outlined in the Calendar Year 2023 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Final Rule, including payment policies, conditions of participation, REH provider enrollment, and exceptions to the physician self-referral law.
Date: 11/2022
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides an overview of Rural Emergency Hospitals, a Medicare provider type established by the Consolidated Appropriations Act, 2021. Details key policies outlined in the Calendar Year 2023 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Final Rule, including payment policies, conditions of participation, REH provider enrollment, and exceptions to the physician self-referral law.
Date: 11/2022
Sponsoring organization: Centers for Medicare and Medicaid Services
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