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Rural Health
Resources by Topic: Reimbursement and payment models

Merit-Based Incentive Payment System (MIPS): 2023 Opt-in and Voluntary Reporting Election Process Guide
Discusses the eligibility of clinicians, groups, and Alternative Payment Model (APM) participants that exceed some low-volume threshold criteria to opt-in to the Merit-Based Incentive Payment System (MIPS) and the APM Performance Pathway (APP) for the 2023 performance period. Compares opting in and voluntarily reporting MIPS data and provides an overview of the election process.
Date: 03/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Maternal Health in Rural America
White paper describing factors contributing to rural maternal health disparities, including financial barriers to providing obstetric services at rural hospitals, maternal health workforce shortages, access to care, and quality of care. Outlines policy considerations to increase access to maternal health services in rural areas.
Author(s): Hailey Waldman, Alexandra Zimmerman
Date: 02/2024
Type: Document
Sponsoring organization: National Rural Health Association
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Hearing on Examining Chronic Drug Shortages in the United States
Congressional hearing in the U.S. House of Representatives Ways & Means Committee discussing pharmaceutical drug shortages. Discusses cancer care, healthcare quality, the 340B program, supply and demand, reimbursement, and other policy measures. Witnesses include Dr. Stephen Schleicher discussing rural concerns. Captions available in video player.
Additional links: Dr. Stephen Schleicher Testimony
Date: 02/2024
Type: Video/Multimedia
Sponsoring organization: House Ways and Means Committee
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Evaluation of the Primary Care First Model: Second Annual Report
Provides an overview of the Primary Care First (PCF) model, which aims to enhance primary care and move primary care practitioners toward value-based payment. Describes the PCF model implementation experiences for Cohort 1 and Cohort 2 practices. Explores the preliminary impact of the PCF Model on acute hospitalizations and Medicare Part A and B expenditures relative to a comparison group. Estimates the impacts of the model on a set of seven leading indicators to provide an early assessment of whether care delivery changes are resulting in meaningful early outcome changes. Highlights implications from this report for the Primary Care First model and future models.
Additional links: Findings at a Glance
Date: 02/2024
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, Mathematica
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Policy and Research Update: Financial Models for Rural Hospitals
Slides presented at the 2024 American Hospital Association's Rural Health Care Leadership conference that discuss healthcare payment policies, value-based care, alternative payment models, Medicare Advantage, and more. Provides discussion on how rural hospitals are are adapting to financial models, statistics on insurance adoption, and related resources.
Author(s): Christina Campos, Kristen Dillon, Keith Mueller, George Pink
Date: 02/2024
Type: Presentation Slides
Sponsoring organizations: Iowa College of Public Health, Rural Policy Research Institute
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2024 Stability of the Rural Health Safety Net: State and National Data Tables
Provides links to national and state data tables showing the financial impact of federal policies such as sequestration and bad debt reimbursement on rural hospital revenues, jobs, and gross domestic product. Presented at the February 2024 National Rural Health Association Policy Institute.
Date: 02/2024
Type: Website
Sponsoring organization: Chartis Center for Rural Health
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Lessons Learned from Efforts to Support Vulnerable Critical Access and Other Rural Hospitals
Provides an overview of state and federal programs, demonstrations, and models designed to support Critical Access Hospitals (CAHs) and other rural hospitals. Describes challenges facing CAHs and rural hospitals, including chronic workforce shortages, high operating and staffing costs, inadequate reimbursement, operational and regulatory issues, and the diverse demographics of rural communities. Discusses lessons learned, the new for a new rural hospital model, and next steps.
Author(s): John Gale, Celia Jewell, Karen Pearson
Date: 02/2024
Type: Document
Sponsoring organization: Flex Monitoring Team
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Unrelenting Pressure Pushes Rural Safety Net Crisis Into Uncharted Territory
Examines financial and operational metrics for rural hospitals. Discusses the growth of Medicare Advantage (MA) enrollment in rural communities between 2019 and 2023, the impact of MA on rural hospital reimbursement, how the Rural Emergency Hospital (REH) designation can provide a path forward for some rural facilities, and the discontinuation of obstetrics and chemotherapy services at rural hospitals since 2011. Includes the percentage of rural hospitals in each state vulnerable to closure and nine factors significantly associated with rural hospital vulnerability.
Date: 02/2024
Type: Document
Sponsoring organization: Chartis Center for Rural Health
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Chartis Center for Rural Health Research & Resources for the 2024 National Rural Health Association's Rural Health Policy Institute Conference
Offers research and analysis of the stability of the rural healthcare safety net. Includes Unrelenting Pressure Pushes Rural Safety Net Crisis into Uncharted Territory, Rural America's OB Deserts Widen in Fallout From Pandemic, and presentation slides on this report from the 2024 National Rural Health Association Policy Institute. Provides links to national and state data tables showing the financial impact of federal policies on rural hospitals.
Date: 02/2024
Type: Website
Sponsoring organization: Chartis Center for Rural Health
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State Medicaid & CHIP Telehealth Toolkit
Toolkit to support state policymakers in expanding the use of telehealth to deliver Medicaid and Children's Health Insurance Program (CHIP) services. Provides information on telehealth flexibilities under Medicaid and CHIP; billing best practices; strategies for telehealth in value-based care; best practices from states during the COVID-19 public health emergency; strategies to promote the delivery of accessible and culturally competent care via telehealth; evaluation strategies to understand how telehealth affects quality, outcomes, and cost, and more. Offers state policy and operational considerations; information about common telehealth modalities; frequently asked questions for states to consider as they explore whether to expand the use of telehealth; Medicaid managed care and fee-for-service state checklists; and other planning tools. Includes information about using telehealth to deliver services to medically underserved and rural communities, American Indian and Alaska Native individuals, individuals with disabilities, older adults, and other specific populations.
Date: 02/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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