Rural Health
Resources by Topic: Reimbursement and payment models
Report to Congress: Unified Payment for Medicare-Covered Post-Acute Care
Presents a prototype for a Unified Post-acute Care (PAC) prospective payment system (PPS) that would set payment for PAC services on the basis of the clinical characteristics of the patient rather than the type of provider. Details the structure of the prototype and the data used in the analyses to design and calibrate the PPS. Explores key considerations for unifying PAC payment, such as cost-sharing and value-based payment. Includes data on PAC provider characteristics, including facility size and rural status, as well as rural payment adjustments.
Additional links: Appendices
Author(s): Benjamin Silver, Anne Deutsch, Nicole Coomer, et al.
Date: 07/2022
Sponsoring organizations: Centers for Medicare and Medicaid Services, RTI International
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Presents a prototype for a Unified Post-acute Care (PAC) prospective payment system (PPS) that would set payment for PAC services on the basis of the clinical characteristics of the patient rather than the type of provider. Details the structure of the prototype and the data used in the analyses to design and calibrate the PPS. Explores key considerations for unifying PAC payment, such as cost-sharing and value-based payment. Includes data on PAC provider characteristics, including facility size and rural status, as well as rural payment adjustments.
Additional links: Appendices
Author(s): Benjamin Silver, Anne Deutsch, Nicole Coomer, et al.
Date: 07/2022
Sponsoring organizations: Centers for Medicare and Medicaid Services, RTI International
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Behavioral Health and Primary Care Integration in Rural Health Facilities: Policy Brief and Recommendations to the Secretary
Provides an overview of the prevalence of mental illness and substance use disorders in rural areas. Discusses the role of rural primary care providers in treating these conditions. Outlines federal programs and resources to support behavioral health and primary care integration. Offers policy recommendations related to access to care; workforce recruitment and retention; telehealth, technology, and broadband; and reimbursement and sustainable revenue.
Date: 06/2022
Sponsoring organization: National Advisory Committee on Rural Health and Human Services
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Provides an overview of the prevalence of mental illness and substance use disorders in rural areas. Discusses the role of rural primary care providers in treating these conditions. Outlines federal programs and resources to support behavioral health and primary care integration. Offers policy recommendations related to access to care; workforce recruitment and retention; telehealth, technology, and broadband; and reimbursement and sustainable revenue.
Date: 06/2022
Sponsoring organization: National Advisory Committee on Rural Health and Human Services
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The Pennsylvania Rural Health Model (PARHM): Second Annual Evaluation Report
Evaluates the second year of the Pennsylvania Rural Health Model (PARHM), an initiative designed to test if global budgets can help rural hospitals improve their financial viability, provide flexibility to meet locally defined community health needs, and reduce overall healthcare spending. Provides an overview of the model and describes the implementation experience of participating hospitals and payers. Presents a descriptive quantitative assessment of financial performance, spending and utilization, access to care, and quality of care outcomes during the second performance year.
Additional links: Appendix, Findings at a Glance
Date: 06/2022
Sponsoring organizations: Centers for Medicare and Medicaid Services, NORC at the University of Chicago
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Evaluates the second year of the Pennsylvania Rural Health Model (PARHM), an initiative designed to test if global budgets can help rural hospitals improve their financial viability, provide flexibility to meet locally defined community health needs, and reduce overall healthcare spending. Provides an overview of the model and describes the implementation experience of participating hospitals and payers. Presents a descriptive quantitative assessment of financial performance, spending and utilization, access to care, and quality of care outcomes during the second performance year.
Additional links: Appendix, Findings at a Glance
Date: 06/2022
Sponsoring organizations: Centers for Medicare and Medicaid Services, NORC at the University of Chicago
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MedPAC Comment on CMS's Proposed Rule on the Hospital Inpatient PPS and the Long-term Care Hospital PPS for FY 2023
Comments on a May 10, 2022, Federal Register proposed rule revising the hospital inpatient and long-term care hospital (LTCH) prospective payment systems (PPS). Discusses proposals on rate-setting in both the inpatient prospective payment systems (IPPS) and LTCH PPS, promoting stability in the IPPS and LTCH PPS, creating a permanent supplemental payment for Puerto Rico and Indian Health Service (IHS) hospitals, establishing a payment adjustment for domestic N95 respirators, adding new measures to the LTCH quality reporting program, and establishing overarching principles for measuring equity and health care quality disparities across CMS quality programs.
Date: 06/2022
Sponsoring organization: Medicare Payment Advisory Commission
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Comments on a May 10, 2022, Federal Register proposed rule revising the hospital inpatient and long-term care hospital (LTCH) prospective payment systems (PPS). Discusses proposals on rate-setting in both the inpatient prospective payment systems (IPPS) and LTCH PPS, promoting stability in the IPPS and LTCH PPS, creating a permanent supplemental payment for Puerto Rico and Indian Health Service (IHS) hospitals, establishing a payment adjustment for domestic N95 respirators, adding new measures to the LTCH quality reporting program, and establishing overarching principles for measuring equity and health care quality disparities across CMS quality programs.
Date: 06/2022
Sponsoring organization: Medicare Payment Advisory Commission
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MedPAC Report to the Congress: Medicare and the Health Care Delivery System, June 2022
Evaluates Medicare payment issues and provides recommendations to the U.S. Congress. Chapter 2 presents a report on access to care for beneficiaries in Medically Underserved Areas (MUAs), who are dually eligible for Medicare and Medicaid, or have multiple chronic conditions. Also includes chapters on alternative payment models, safety net providers, the cost of drugs covered under Medicare Part B, the accuracy of Medicare Advantage payments, the alignment of fee-for-service payment rates across ambulatory settings, and segmentation in the stand-alone Part D plan market.
Date: 06/2022
Sponsoring organization: Medicare Payment Advisory Commission
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Evaluates Medicare payment issues and provides recommendations to the U.S. Congress. Chapter 2 presents a report on access to care for beneficiaries in Medically Underserved Areas (MUAs), who are dually eligible for Medicare and Medicaid, or have multiple chronic conditions. Also includes chapters on alternative payment models, safety net providers, the cost of drugs covered under Medicare Part B, the accuracy of Medicare Advantage payments, the alignment of fee-for-service payment rates across ambulatory settings, and segmentation in the stand-alone Part D plan market.
Date: 06/2022
Sponsoring organization: Medicare Payment Advisory Commission
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State Innovation Model Testing Awards from the Centers for Medicare & Medicaid Services Innovation Center: Highlighting Rural Focus
Summarizes the activities and accomplishments of rural-specific State Innovation Models (SIM) in 11 states: Arkansas, Colorado, Idaho, Iowa, Maine, Michigan, Minnesota, New York, Ohio, Oregon, and Vermont. Describes the SIM initiative, which began in 2012 to support states committed to designing and testing strategies for payment model and delivery system reform.
Date: 06/2022
Sponsoring organization: Rural Health Value
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Summarizes the activities and accomplishments of rural-specific State Innovation Models (SIM) in 11 states: Arkansas, Colorado, Idaho, Iowa, Maine, Michigan, Minnesota, New York, Ohio, Oregon, and Vermont. Describes the SIM initiative, which began in 2012 to support states committed to designing and testing strategies for payment model and delivery system reform.
Date: 06/2022
Sponsoring organization: Rural Health Value
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Convergence of Service Providers and Managers' Perspectives on Strengths, Gaps, and Priorities for Rural Health System Redesign: A Whole-Systems Qualitative Study in Washington County, Maine
Presents themes from interviews with 46 direct healthcare service providers between September - November 2020 in Washington County, Maine. Explores existing clinical service strengths, local and state gaps in services and the impact of those gaps on quality and safety, and priorities and strategies for sustaining or restoring essential healthcare services.
Author(s): Rebecca L. West, Judy Margo, Jeff Brown, Amy Dowley, Susan Haas
Citation: Journal of Primary Care & Community Health, 13
Date: 05/2022
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Presents themes from interviews with 46 direct healthcare service providers between September - November 2020 in Washington County, Maine. Explores existing clinical service strengths, local and state gaps in services and the impact of those gaps on quality and safety, and priorities and strategies for sustaining or restoring essential healthcare services.
Author(s): Rebecca L. West, Judy Margo, Jeff Brown, Amy Dowley, Susan Haas
Citation: Journal of Primary Care & Community Health, 13
Date: 05/2022
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MedPAC Comment on CMS's Proposed Rule on the Inpatient Rehabilitation Facility PPS for FY 2023
Comments on an April 6, 2022, Federal Register proposed rule addressing updates to the prospective payment system for inpatient rehabilitation facilities (IRFs) for fiscal year 2023. Includes comments on the IRF teaching and rural payment adjustments.
Date: 05/2022
Sponsoring organization: Medicare Payment Advisory Commission
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Comments on an April 6, 2022, Federal Register proposed rule addressing updates to the prospective payment system for inpatient rehabilitation facilities (IRFs) for fiscal year 2023. Includes comments on the IRF teaching and rural payment adjustments.
Date: 05/2022
Sponsoring organization: Medicare Payment Advisory Commission
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MedPAC Comment on CMS's Proposed Rule on the Inpatient Psychiatric Facility PPS for FY 2023
Comment on an April 4, 2022, Federal Register proposed rule revising the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) for fiscal year 2023. Includes a discussion of rural and Disproportionate Share Hospital (DSH) IPF PPS payment adjustments.
Date: 05/2022
Sponsoring organization: Medicare Payment Advisory Commission
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Comment on an April 4, 2022, Federal Register proposed rule revising the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) for fiscal year 2023. Includes a discussion of rural and Disproportionate Share Hospital (DSH) IPF PPS payment adjustments.
Date: 05/2022
Sponsoring organization: Medicare Payment Advisory Commission
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Let's Get a Good Deal on Health Care
Explains the challenges rural hospitals face with current payment systems and the potential that value-based payment holds for meeting rural communities' needs.
Author(s): A. Clinton MacKinney
Citation: Rural Monitor
Date: 05/2022
Sponsoring organization: Rural Health Information Hub
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Explains the challenges rural hospitals face with current payment systems and the potential that value-based payment holds for meeting rural communities' needs.
Author(s): A. Clinton MacKinney
Citation: Rural Monitor
Date: 05/2022
Sponsoring organization: Rural Health Information Hub
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