Rural Health
Resources by Topic: Reimbursement and payment models
North Carolina Community Health Center Association - COVID-19 Resources
Provides information and resources for health centers in North Carolina related to COVID-19, including clinical guidance, reimbursement and billing, telehealth, and human resources.
Date: 04/2021
Type: Website
Sponsoring organization: North Carolina Community Health Center Association
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Provides information and resources for health centers in North Carolina related to COVID-19, including clinical guidance, reimbursement and billing, telehealth, and human resources.
Date: 04/2021
Type: Website
Sponsoring organization: North Carolina Community Health Center Association
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March 2021 MedPAC Meeting Transcript
Transcript from the Medicare Payment Advisory Commission's (MedPAC) March 2021 meeting. Features a discussion on rural Medicare beneficiaries' access to care. Also covers the skilled nursing facility value-based purchasing program and proposed replacement, streamlining CMS's portfolio of alternative payment models, balancing efficiency with equity in Medicare Advantage benchmark policy, and the relationship between clinician services and other Medicare services.
Date: 03/2021
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Transcript from the Medicare Payment Advisory Commission's (MedPAC) March 2021 meeting. Features a discussion on rural Medicare beneficiaries' access to care. Also covers the skilled nursing facility value-based purchasing program and proposed replacement, streamlining CMS's portfolio of alternative payment models, balancing efficiency with equity in Medicare Advantage benchmark policy, and the relationship between clinician services and other Medicare services.
Date: 03/2021
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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CMS Bundled Payments for Care Improvement Initiative Models 2-4: Year 7 Evaluation & Monitoring Annual Report
Seventh and final report describing findings from an evaluation of Models 2, 3, and 4 of the Bundled Payments for Care Improvement (BPCI) initiative, linking provider payments for an episode of care with the goal of decreasing cost of care while improving quality. Includes information specific to rural BPCI-participating hospitals, skilled nursing facilities, and home health agencies.
Additional links: Appendices, Findings at a Glance
Author(s): The Lewin Group, Abt Associates, GDIT, Telligen
Date: 03/2021
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Seventh and final report describing findings from an evaluation of Models 2, 3, and 4 of the Bundled Payments for Care Improvement (BPCI) initiative, linking provider payments for an episode of care with the goal of decreasing cost of care while improving quality. Includes information specific to rural BPCI-participating hospitals, skilled nursing facilities, and home health agencies.
Additional links: Appendices, Findings at a Glance
Author(s): The Lewin Group, Abt Associates, GDIT, Telligen
Date: 03/2021
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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CMS Bundled Payments for Care Improvement Advanced Model: Year 2 Evaluation Report
Second annual report of the Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model, which tests whether linking payments for a clinical episode of care can reduce Medicare expenditures while maintaining or improving quality of care. Covers the period from October 1, 2018, through January 1, 2020. Describes participants in the model; clinical episodes included; the reach of the model; and the impact of BPCI Advanced on episode payments, utilization, and quality of care. Includes information on rural hospital participation in the model.
Additional links: Appendices
Author(s): The Lewin Group, Abt Associates, GDIT, Telligen
Date: 03/2021
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Second annual report of the Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model, which tests whether linking payments for a clinical episode of care can reduce Medicare expenditures while maintaining or improving quality of care. Covers the period from October 1, 2018, through January 1, 2020. Describes participants in the model; clinical episodes included; the reach of the model; and the impact of BPCI Advanced on episode payments, utilization, and quality of care. Includes information on rural hospital participation in the model.
Additional links: Appendices
Author(s): The Lewin Group, Abt Associates, GDIT, Telligen
Date: 03/2021
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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State-Driven Initiatives to Support Moving to Value-Based Care in the Era of COVID-19
Describes four areas where state-driven strategies can facilitate and promote the adoption of value-based payment (VBP) models. Presents case examples throughout, including the Pennsylvania Rural Health Model. Discusses how additional federal actions could support transitions to VBP at the state level.
Author(s): Caroline Picher, Lauren Block, Mark Japinga, Hemi Tewarson
Date: 03/2021
Type: Document
Sponsoring organizations: Duke-Margolis Center for Health Policy, National Governors Association
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Describes four areas where state-driven strategies can facilitate and promote the adoption of value-based payment (VBP) models. Presents case examples throughout, including the Pennsylvania Rural Health Model. Discusses how additional federal actions could support transitions to VBP at the state level.
Author(s): Caroline Picher, Lauren Block, Mark Japinga, Hemi Tewarson
Date: 03/2021
Type: Document
Sponsoring organizations: Duke-Margolis Center for Health Policy, National Governors Association
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Tackling America's Mental Health and Addiction Crisis Through Primary Care Integration
Explores how primary and behavioral healthcare integration can overcome the unmet needs for mental health and substance use services. Discusses barriers to integrated care delivery. Offers policy recommendations to improve the integration of primary and behavioral healthcare services through enhanced payments, training, and technical assistance, and improving access to behavioral health providers for consultation and referral.
Additional links: Infographic
Date: 03/2021
Type: Document
Sponsoring organization: Bipartisan Policy Center
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Explores how primary and behavioral healthcare integration can overcome the unmet needs for mental health and substance use services. Discusses barriers to integrated care delivery. Offers policy recommendations to improve the integration of primary and behavioral healthcare services through enhanced payments, training, and technical assistance, and improving access to behavioral health providers for consultation and referral.
Additional links: Infographic
Date: 03/2021
Type: Document
Sponsoring organization: Bipartisan Policy Center
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Update to Rural Health Clinic (RHC) Payment Limits
Provides an overview of the updates to Rural Health Clinic (RHC) payment limits per visit beginning April 1, 2021, through 2028.
Date: 03/2021
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides an overview of the updates to Rural Health Clinic (RHC) payment limits per visit beginning April 1, 2021, through 2028.
Date: 03/2021
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Which Hospitals Could Be Financially Affected by a Public Option?
Describes the potential impacts of a public option health insurance plan on hospital finances, including rural hospitals. Analyzes hospital discharge data to identify hospitals that had a greater share of total charges paid by private insurance across 25 states. Presents data by hospital and patient characteristics.
Author(s): Anuj Gangopadhyaya, Claire O'Brien
Date: 03/2021
Type: Document
Sponsoring organization: Urban Institute
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Describes the potential impacts of a public option health insurance plan on hospital finances, including rural hospitals. Analyzes hospital discharge data to identify hospitals that had a greater share of total charges paid by private insurance across 25 states. Presents data by hospital and patient characteristics.
Author(s): Anuj Gangopadhyaya, Claire O'Brien
Date: 03/2021
Type: Document
Sponsoring organization: Urban Institute
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MedPAC Report to the Congress: Medicare Payment Policy, 2021
Annual review of Medicare payment policies, with recommendations to Congress. Includes discussion on Medicare payment policies directly affecting rural providers and beneficiaries. Addresses payment adequacy for healthcare facilities and services, improving Medicare payment for post-acute care, Medicare Advantage, Medicare Part D, and the impact of healthcare provider consolidation. Contains information on the effects of the COVID-19 pandemic on Medicare beneficiary healthcare access, mortality, and service use. Presents an option for Medicare's coverage of telehealth beyond the public health emergency.
Date: 03/2021
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Annual review of Medicare payment policies, with recommendations to Congress. Includes discussion on Medicare payment policies directly affecting rural providers and beneficiaries. Addresses payment adequacy for healthcare facilities and services, improving Medicare payment for post-acute care, Medicare Advantage, Medicare Part D, and the impact of healthcare provider consolidation. Contains information on the effects of the COVID-19 pandemic on Medicare beneficiary healthcare access, mortality, and service use. Presents an option for Medicare's coverage of telehealth beyond the public health emergency.
Date: 03/2021
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Report to Congress on Medicaid and CHIP, March 2021
Reports on five aspects of Medicaid: 1) improving Medicaid's responsiveness during economic downturns; 2) addressing concerns about high rates of maternal morbidity and mortality; 3) reexamining Medicaid's estate recovery policies; 4) integrating care for people who are dually eligible for Medicaid and Medicare; and 5) improving hospital payment policy for the nation's safety-net hospitals. Chapter 5 examines the relationship between disproportionate share hospital (DSH) allotments to states and the number of uninsured individuals, the amounts and sources of hospitals' uncompensated care costs, and the amounts and sources of hospitals' uncompensated care costs. Table 5-1 details DSH spending for urban and rural hospitals and for Critical Access Hospitals.
Date: 03/2021
Type: Document
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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Reports on five aspects of Medicaid: 1) improving Medicaid's responsiveness during economic downturns; 2) addressing concerns about high rates of maternal morbidity and mortality; 3) reexamining Medicaid's estate recovery policies; 4) integrating care for people who are dually eligible for Medicaid and Medicare; and 5) improving hospital payment policy for the nation's safety-net hospitals. Chapter 5 examines the relationship between disproportionate share hospital (DSH) allotments to states and the number of uninsured individuals, the amounts and sources of hospitals' uncompensated care costs, and the amounts and sources of hospitals' uncompensated care costs. Table 5-1 details DSH spending for urban and rural hospitals and for Critical Access Hospitals.
Date: 03/2021
Type: Document
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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