Rural Health
Resources by Topic: Reimbursement and payment models
Impact of the Medicare Disproportionate Share Hospital Payment Cap on Rural and Urban Hospitals
Describes the number and location of hospitals that qualify for Medicare Disproportionate Share Hospital (DSH) payments and meet the criteria for a 12% payment cap. Examines how the payment cap and lost revenue impacts urban and rural hospitals. Presents options to modify DSH payments to ease the financial strain on rural hospitals.
Author(s): Paula Weigel, Fred Ullrich, Keith J. Mueller
Date: 12/2019
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Describes the number and location of hospitals that qualify for Medicare Disproportionate Share Hospital (DSH) payments and meet the criteria for a 12% payment cap. Examines how the payment cap and lost revenue impacts urban and rural hospitals. Presents options to modify DSH payments to ease the financial strain on rural hospitals.
Author(s): Paula Weigel, Fred Ullrich, Keith J. Mueller
Date: 12/2019
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Care Management Services in Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs): Frequently Asked Questions
Provides general information about chronic care management services, specific program requirements, detailed descriptions of billing, claims processing, and payment rules, and requirements for people who are considered part of a care management team for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs).
Date: 12/2019
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides general information about chronic care management services, specific program requirements, detailed descriptions of billing, claims processing, and payment rules, and requirements for people who are considered part of a care management team for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs).
Date: 12/2019
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Evaluation of the Maryland All-Payer Model: Volume I - Final Report
Evaluation of the All-Payer Model operating under an agreement with the Centers for Medicare & Medicaid Services (CMS) for hospitals in rural and urban settings implemented in Maryland in 2014. This model shifted the state's hospital payment structure to an annual, global hospital budget that includes both inpatient and outpatient hospital services. Report covers 4.5 years of implementation, and compares outcomes by rural and urban residency.
Author(s): Susan Haber, Heather Beil, Marisa Morrison, et al.
Date: 11/2019
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Evaluation of the All-Payer Model operating under an agreement with the Centers for Medicare & Medicaid Services (CMS) for hospitals in rural and urban settings implemented in Maryland in 2014. This model shifted the state's hospital payment structure to an annual, global hospital budget that includes both inpatient and outpatient hospital services. Report covers 4.5 years of implementation, and compares outcomes by rural and urban residency.
Author(s): Susan Haber, Heather Beil, Marisa Morrison, et al.
Date: 11/2019
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Intergovernmental Advisory Committee to the Federal Communications Commission Advisory Recommendation No: 2019-2 in the Matter of State, Local Tribal, and Territorial Regulatory and Other Barriers and Incentives to Telemedicine
Examines the technical infrastructure necessary for effective telemedicine delivery in state, territorial, tribal, and local (rural and urban) areas. Discusses the regulatory barriers including legislation, licensing, reimbursement, malpractice insurance, and privacy that obstruct its development and utilization, and offers recommendations addressing these barriers. Appendix A presents case studies of broadband and telehealth development in several states and territories.
Date: 11/2019
Type: Document
Sponsoring organizations: Federal Communications Commission, Intergovernmental Advisory Committee to the Federal Communications Commission
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Examines the technical infrastructure necessary for effective telemedicine delivery in state, territorial, tribal, and local (rural and urban) areas. Discusses the regulatory barriers including legislation, licensing, reimbursement, malpractice insurance, and privacy that obstruct its development and utilization, and offers recommendations addressing these barriers. Appendix A presents case studies of broadband and telehealth development in several states and territories.
Date: 11/2019
Type: Document
Sponsoring organizations: Federal Communications Commission, Intergovernmental Advisory Committee to the Federal Communications Commission
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Rural Health Clinic Costs and Medicare Reimbursement
Policy brief exploring whether updates to the Medicare per-visit reimbursement cap have allowed Rural Health Clinics (RHCs) of various types and sizes to keep pace with increases in staffing and other costs. Features statistics including RHC mean Medicare adjusted cost per visit and RHC mean Medicare healthcare staff costs as of 2014, with breakdowns by 4 sizes of RHCs and private or publicly-owned status.
Author(s): John Gale, Zachariah T. Croll, Andrew F. Coburn
Date: 11/2019
Type: Document
Sponsoring organization: Maine Rural Health Research Center
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Policy brief exploring whether updates to the Medicare per-visit reimbursement cap have allowed Rural Health Clinics (RHCs) of various types and sizes to keep pace with increases in staffing and other costs. Features statistics including RHC mean Medicare adjusted cost per visit and RHC mean Medicare healthcare staff costs as of 2014, with breakdowns by 4 sizes of RHCs and private or publicly-owned status.
Author(s): John Gale, Zachariah T. Croll, Andrew F. Coburn
Date: 11/2019
Type: Document
Sponsoring organization: Maine Rural Health Research Center
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The Development of Telehealth Laws in the U.S. from 2008 to 2015: A Legal Landscape
Policy brief examining the scope and evolving nature of telehealth statutes and regulations in the 50 states and the District of Columbia. Explores the extent to which state laws regulate primary care delivery through use of telehealth. Features U.S. maps showing changes from 2008 to 2015 in terms of various types of telehealth-related laws, including those governing insurance coverage, and statistics with breakdowns by the top 25 and bottom 25 rural states.
Author(s): Cason D. Schmit, Alva O. Ferdinand, Timothy Callaghan, et al.
Date: 11/2019
Type: Document
Sponsoring organization: Southwest Rural Health Research Center
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Policy brief examining the scope and evolving nature of telehealth statutes and regulations in the 50 states and the District of Columbia. Explores the extent to which state laws regulate primary care delivery through use of telehealth. Features U.S. maps showing changes from 2008 to 2015 in terms of various types of telehealth-related laws, including those governing insurance coverage, and statistics with breakdowns by the top 25 and bottom 25 rural states.
Author(s): Cason D. Schmit, Alva O. Ferdinand, Timothy Callaghan, et al.
Date: 11/2019
Type: Document
Sponsoring organization: Southwest Rural Health Research Center
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Urban and Rural Hospitalizations in Mississippi: Overview and Trend Analyses, 2014-2018
Results of a rural health surveillance system established by the Mississippi State Department of Health to monitor and report on the health status of rural residents and the capacity of the local healthcare systems serving this population. Features county-level maps and statistics from 2014-2018 on inpatient care, numbers of hospitals, hospital beds, percent of hospitalizations, and payment models, with breakdowns by metropolitan, micropolitan, and rural areas.
Date: 10/2019
Type: Document
Sponsoring organization: Mississippi State Department of Health
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Results of a rural health surveillance system established by the Mississippi State Department of Health to monitor and report on the health status of rural residents and the capacity of the local healthcare systems serving this population. Features county-level maps and statistics from 2014-2018 on inpatient care, numbers of hospitals, hospital beds, percent of hospitalizations, and payment models, with breakdowns by metropolitan, micropolitan, and rural areas.
Date: 10/2019
Type: Document
Sponsoring organization: Mississippi State Department of Health
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Financial Incentives to Improve Community Health
Slides presented at the 2019 National Organization of State Offices of Rural Health (NOSORH) Annual Meeting discussing several federal initiatives as a result of the Affordable Care Act (ACA), including the Medicare Shared Savings Program and Accountable Care Organizations (ACOs), resulting in controlled costs, improved quality of care, and offering financial incentives. Identifies how State Offices of Rural Health can support health organizations to participate successfully in these initiatives.
Author(s): Keith Mueller
Date: 10/2019
Type: Presentation Slides
Sponsoring organization: National Organization of State Offices of Rural Health
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Slides presented at the 2019 National Organization of State Offices of Rural Health (NOSORH) Annual Meeting discussing several federal initiatives as a result of the Affordable Care Act (ACA), including the Medicare Shared Savings Program and Accountable Care Organizations (ACOs), resulting in controlled costs, improved quality of care, and offering financial incentives. Identifies how State Offices of Rural Health can support health organizations to participate successfully in these initiatives.
Author(s): Keith Mueller
Date: 10/2019
Type: Presentation Slides
Sponsoring organization: National Organization of State Offices of Rural Health
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Estimate of Federal Payment Reductions to Hospitals Following the ACA: 2010-2029: Estimates and Methodology
Estimates the reduction in Medicare hospital payments due to sequestration from 2010 to 2029, not including reductions enacted under the Affordable Care Act (ACA). Demonstrates how other legislative acts and regulatory changes by the Centers for Medicare and Medicaid Services (CMS) reduced federal payments to hospitals over the same period. Highlights how reductions in Medicare payments for bad debt impacted Critical Access Hospitals (CAHs).
Date: 10/2019
Type: Document
Sponsoring organizations: American Hospital Association, Federation of American Hospitals
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Estimates the reduction in Medicare hospital payments due to sequestration from 2010 to 2029, not including reductions enacted under the Affordable Care Act (ACA). Demonstrates how other legislative acts and regulatory changes by the Centers for Medicare and Medicaid Services (CMS) reduced federal payments to hospitals over the same period. Highlights how reductions in Medicare payments for bad debt impacted Critical Access Hospitals (CAHs).
Date: 10/2019
Type: Document
Sponsoring organizations: American Hospital Association, Federation of American Hospitals
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States' Medicaid Fee-for-Service Nursing Facility Payment Policies
Spreadsheet outlining each state's Medicaid fee-for-service (FFS) nursing facility payment policy. Lists how each state sets the payment rate and any adjustments and supplemental payments. Includes information on rural/urban aspects of setting or adjustment to the payment in each state.
Date: 10/2019
Type: Document
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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Spreadsheet outlining each state's Medicaid fee-for-service (FFS) nursing facility payment policy. Lists how each state sets the payment rate and any adjustments and supplemental payments. Includes information on rural/urban aspects of setting or adjustment to the payment in each state.
Date: 10/2019
Type: Document
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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