Rural Health
Resources by Topic: Reimbursement and payment models
A Summary of State Innovation Models (SIM) Evaluation Results Across 17 States (2013-2020)
Summarizes evaluation results of the State Innovation Models (SIM), which examined the ability of 17 state governments to implement and test innovative value-based payment (VBP) healthcare models across multiple payers between 2013 and 2020. Presents findings regarding the implementation and impact of 29 delivery and payment models, including patient-centered medical homes, accountable care organizations, behavioral health integration, and more. Covers state contracting and consensus building, practice transformation, pediatric care, behavioral healthcare, beneficiary and provider perspectives, and more. Includes a section on payment model designs tailored to unique state needs, including rural populations, as well as rural references throughout.
Additional links: A Summary of State Innovation Models (SIM): Focus on State-Led Transformation - Findings at a Glance, Executive Summary, Findings at a Glance
Date: 01/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Summarizes evaluation results of the State Innovation Models (SIM), which examined the ability of 17 state governments to implement and test innovative value-based payment (VBP) healthcare models across multiple payers between 2013 and 2020. Presents findings regarding the implementation and impact of 29 delivery and payment models, including patient-centered medical homes, accountable care organizations, behavioral health integration, and more. Covers state contracting and consensus building, practice transformation, pediatric care, behavioral healthcare, beneficiary and provider perspectives, and more. Includes a section on payment model designs tailored to unique state needs, including rural populations, as well as rural references throughout.
Additional links: A Summary of State Innovation Models (SIM): Focus on State-Led Transformation - Findings at a Glance, Executive Summary, Findings at a Glance
Date: 01/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Shared Savings Program Fast Facts
Provides summary statistics on the Medicare Shared Savings Program as of January 1, 2025. Offers data on the number of Accountable Care Organizations (ACOs), assigned beneficiaries, total earned shared savings, and quality scores each year since 2012; the number and percent of ACOs in each track; and more. Includes information on ACO participants, including the number of Rural Health Clinics (RHCs) and Critical Access Hospitals (CAHs) participating in the program.
Date: 01/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides summary statistics on the Medicare Shared Savings Program as of January 1, 2025. Offers data on the number of Accountable Care Organizations (ACOs), assigned beneficiaries, total earned shared savings, and quality scores each year since 2012; the number and percent of ACOs in each track; and more. Includes information on ACO participants, including the number of Rural Health Clinics (RHCs) and Critical Access Hospitals (CAHs) participating in the program.
Date: 01/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Maximizing the Value of Remote Patient Monitoring
Provides a brief description of the remote patient monitoring landscape. Discusses four areas policymakers could focus on to improve the effectiveness and accessibility of remote patient monitoring.
Author(s): Maya Sandalow, Julia Harris
Date: 01/2025
Sponsoring organization: Bipartisan Policy Center
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Provides a brief description of the remote patient monitoring landscape. Discusses four areas policymakers could focus on to improve the effectiveness and accessibility of remote patient monitoring.
Author(s): Maya Sandalow, Julia Harris
Date: 01/2025
Sponsoring organization: Bipartisan Policy Center
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Community Health Center Patients, Financing, and Services
Describes health center patient characteristics, services, patient experiences, and financing changes between 2019 and 2023. Presents data on health centers in rural communities throughout.
Author(s): Akash Pillai, Bradley Corallo, Jennifer Tolbert
Date: 01/2025
Sponsoring organization: KFF
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Describes health center patient characteristics, services, patient experiences, and financing changes between 2019 and 2023. Presents data on health centers in rural communities throughout.
Author(s): Akash Pillai, Bradley Corallo, Jennifer Tolbert
Date: 01/2025
Sponsoring organization: KFF
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Medical Debt and Its Impact on Rural Patients and Providers, with Carrie Henning-Smith
An episode of the Exploring Rural Health podcast featuring Carrie Henning-Smith, Co-Director of the University of Minnesota Rural Health Research Center. Focuses on the prevalence of and difficulties caused by medical debt for both rural patients and providers.
Date: 01/2025
Sponsoring organization: Rural Health Information Hub
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An episode of the Exploring Rural Health podcast featuring Carrie Henning-Smith, Co-Director of the University of Minnesota Rural Health Research Center. Focuses on the prevalence of and difficulties caused by medical debt for both rural patients and providers.
Date: 01/2025
Sponsoring organization: Rural Health Information Hub
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Merit-based Incentive Payment System (MIPS): 2025 MIPS Quick Start Guide for Small Practices
Provides an overview of the Merit-based Incentive Payment System (MIPS). Outlines 6 steps for small practices regarding participation in the 2025 performance year. Includes information on performance category redistribution policies for small practices.
Date: 01/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides an overview of the Merit-based Incentive Payment System (MIPS). Outlines 6 steps for small practices regarding participation in the 2025 performance year. Includes information on performance category redistribution policies for small practices.
Date: 01/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Telehealth FAQ Calendar Year 2025
Provides information on Medicare telehealth regulations and payment policy for calendar year 2025. Includes information on audio-only services, behavioral health services, direct supervision, and more.
Date: 2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides information on Medicare telehealth regulations and payment policy for calendar year 2025. Includes information on audio-only services, behavioral health services, direct supervision, and more.
Date: 2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Texas Medicaid and CHIP Reference Guide: Fifteenth Edition
Reference guide for aspects of Texas's Medicaid and Children's Health Insurance Program (CHIP) programs, including caseload and costs, eligibility and enrollment, available services, program administration, and quality of care. Features information on rural-specific policies for reimbursement, time and distance standards, the Rural Access to Primary Care and Preventive Services Program, rural hospitals, Rural Health Clinics (RHCs), and Federally Qualified Health Centers (FQHCs).
Date: 12/2024
Sponsoring organization: Texas Health and Human Services
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Reference guide for aspects of Texas's Medicaid and Children's Health Insurance Program (CHIP) programs, including caseload and costs, eligibility and enrollment, available services, program administration, and quality of care. Features information on rural-specific policies for reimbursement, time and distance standards, the Rural Access to Primary Care and Preventive Services Program, rural hospitals, Rural Health Clinics (RHCs), and Federally Qualified Health Centers (FQHCs).
Date: 12/2024
Sponsoring organization: Texas Health and Human Services
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The Implications of the No Surprises Act on Contract Dynamics, Negotiations, and Finances
Provides feedback from insurance and healthcare stakeholders regarding the No Surprises Act (NSA), with a focus on insurer-provider dynamics, insurer and provider staffing, contract negotiations, payment rates, and the handling of advanced explanation of benefits (AEOB) provisions. Provides 2024 interview feedback from 35 stakeholders regarding the NSA and includes reflections on its impact for rural and underserved communities.
Author(s): Petra W. Rasmussen, Erin Lindsey Duffy, Isha Yardi, et al.
Date: 12/2024
Sponsoring organization: RAND Corporation
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Provides feedback from insurance and healthcare stakeholders regarding the No Surprises Act (NSA), with a focus on insurer-provider dynamics, insurer and provider staffing, contract negotiations, payment rates, and the handling of advanced explanation of benefits (AEOB) provisions. Provides 2024 interview feedback from 35 stakeholders regarding the NSA and includes reflections on its impact for rural and underserved communities.
Author(s): Petra W. Rasmussen, Erin Lindsey Duffy, Isha Yardi, et al.
Date: 12/2024
Sponsoring organization: RAND Corporation
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Medicare Could save Billions with Comparable Access for Enrollees If Critical Access Hospital Payments for Swing-Bed Services Were Similar to Those of the Fee-for-Service Prospective Payment System
Describes the use of swing beds for skilled nursing services at Critical Access Hospitals (CAHs) and average daily Medicare reimbursement for these services from 2015 through 2020. Examines data from a sample of 100 CAHs to determine whether Medicare enrollees would have had access to the same skilled nursing services provided by CAHs at alternative facilities within a 35-mile driving distance. Compares the average daily reimbursement for skilled nursing services at CAHs and alternative facilities, as well as the potential savings to Medicare if CAHs were reimbursed for skilled nursing services under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS).
Date: 12/2024
Sponsoring organization: Office of Inspector General (HHS)
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Describes the use of swing beds for skilled nursing services at Critical Access Hospitals (CAHs) and average daily Medicare reimbursement for these services from 2015 through 2020. Examines data from a sample of 100 CAHs to determine whether Medicare enrollees would have had access to the same skilled nursing services provided by CAHs at alternative facilities within a 35-mile driving distance. Compares the average daily reimbursement for skilled nursing services at CAHs and alternative facilities, as well as the potential savings to Medicare if CAHs were reimbursed for skilled nursing services under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS).
Date: 12/2024
Sponsoring organization: Office of Inspector General (HHS)
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