Rural Health
Resources by Topic: Reimbursement and payment models
CY 2025 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule (CMS 1809-FC)
Fact sheet providing an overview of the Centers for Medicare & Medicaid Services (CMS) final rule regarding updates and changes to the Medicare payments for hospital outpatient and Ambulatory Surgical Center (ASC) services for calendar year 2025. Summarizes provisions regarding changes to Intensive Outpatient Program (IOP) and partial hospital program rate setting; incorporating an add-on payment to the Medicare outpatient hospital all-inclusive rate (AIR) for certain high-cost drugs for people with Medicare who receive care at Indian Health Service (IHS) or tribal hospitals; updates to the Hospital Outpatient Quality Reporting (OQR), Ambulatory Surgical Center Quality Reporting (ASCQR), and Rural Emergency Hospital Quality Reporting (REHQR) Programs; a new Conditions of Participation (CoPs) for hospitals and Critical Access Hospitals (CAHs) for obstetrical services; Medicaid and CHIP continuous eligibility; Medicaid clinic services "four walls" exceptions; and more.
Date: 11/2024
Sponsoring organization: Centers for Medicare and Medicaid Services
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Fact sheet providing an overview of the Centers for Medicare & Medicaid Services (CMS) final rule regarding updates and changes to the Medicare payments for hospital outpatient and Ambulatory Surgical Center (ASC) services for calendar year 2025. Summarizes provisions regarding changes to Intensive Outpatient Program (IOP) and partial hospital program rate setting; incorporating an add-on payment to the Medicare outpatient hospital all-inclusive rate (AIR) for certain high-cost drugs for people with Medicare who receive care at Indian Health Service (IHS) or tribal hospitals; updates to the Hospital Outpatient Quality Reporting (OQR), Ambulatory Surgical Center Quality Reporting (ASCQR), and Rural Emergency Hospital Quality Reporting (REHQR) Programs; a new Conditions of Participation (CoPs) for hospitals and Critical Access Hospitals (CAHs) for obstetrical services; Medicaid and CHIP continuous eligibility; Medicaid clinic services "four walls" exceptions; and more.
Date: 11/2024
Sponsoring organization: Centers for Medicare and Medicaid Services
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Final CY 2025 Medicare Physician Fee Schedule: Fact Sheet
Fact sheet covering Centers for Medicare & Medicaid Services (CMS) telehealth policy changes for 2025 as outlined in the final calendar year (CY) 2025 Physician Fee Schedule. Covers audio-only telehealth; eligible services that can be delivered by telehealth; frequency limitations for inpatient visits, nursing facilities, and critical care consults; direct supervision through the use of live video; payment to Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs); opioid treatment programs; and more.
Date: 11/2024
Sponsoring organization: Center for Connected Health Policy: The National Telehealth Policy Resource Center
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Fact sheet covering Centers for Medicare & Medicaid Services (CMS) telehealth policy changes for 2025 as outlined in the final calendar year (CY) 2025 Physician Fee Schedule. Covers audio-only telehealth; eligible services that can be delivered by telehealth; frequency limitations for inpatient visits, nursing facilities, and critical care consults; direct supervision through the use of live video; payment to Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs); opioid treatment programs; and more.
Date: 11/2024
Sponsoring organization: Center for Connected Health Policy: The National Telehealth Policy Resource Center
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Re-Imagining Rural Health: Themes, Concepts, and Next Steps from the CMS Innovation Center "Hackathon" Series
Summarizes themes that emerged from Centers for Medicare & Medicaid Services (CMS) Innovation Center's August 2024 Rural Health Hackathons, which aimed to inform potential payment and service delivery model development and to identify innovative solutions to address the access, care delivery, and workforce needs of rural, Tribal, frontier, and geographically isolated areas communities. Describes lessons learned from previous Innovation Center models focused on rural health and how these lessons were applied during the development of new models. Outlines potential areas for the Innovation Center to explore to advance health in rural, Tribal, frontier, and geographically isolated areas.
Date: 11/2024
Sponsoring organization: Centers for Medicare and Medicaid Services
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Summarizes themes that emerged from Centers for Medicare & Medicaid Services (CMS) Innovation Center's August 2024 Rural Health Hackathons, which aimed to inform potential payment and service delivery model development and to identify innovative solutions to address the access, care delivery, and workforce needs of rural, Tribal, frontier, and geographically isolated areas communities. Describes lessons learned from previous Innovation Center models focused on rural health and how these lessons were applied during the development of new models. Outlines potential areas for the Innovation Center to explore to advance health in rural, Tribal, frontier, and geographically isolated areas.
Date: 11/2024
Sponsoring organization: Centers for Medicare and Medicaid Services
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Rural Value-Based Care – The Payer Perspective
Summarizes discussions on rural value-based care (VBC) contracting during a July 2024 summit of leaders from national and regional healthcare payer organizations. Describes challenges facing payer organizations that serve rural beneficiaries, including engaging rural healthcare organizations in VBC; solutions to rural-specific challenges; and recommendations for rural healthcare organizations.
Date: 11/2024
Sponsoring organization: Rural Health Value
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Summarizes discussions on rural value-based care (VBC) contracting during a July 2024 summit of leaders from national and regional healthcare payer organizations. Describes challenges facing payer organizations that serve rural beneficiaries, including engaging rural healthcare organizations in VBC; solutions to rural-specific challenges; and recommendations for rural healthcare organizations.
Date: 11/2024
Sponsoring organization: Rural Health Value
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Texas Rural Hospital Grant Program Report
Reports on the establishment, functions, and achievements of the Rural Hospital Grant Program in Texas during the 2024 and 2025 state fiscal years. Provides an overview of program funding and awards, and details grant programs supporting hospital stabilization, maternal care, and Alternative Payment Model readiness.
Date: 11/2024
Sponsoring organization: Texas Health and Human Services
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Reports on the establishment, functions, and achievements of the Rural Hospital Grant Program in Texas during the 2024 and 2025 state fiscal years. Provides an overview of program funding and awards, and details grant programs supporting hospital stabilization, maternal care, and Alternative Payment Model readiness.
Date: 11/2024
Sponsoring organization: Texas Health and Human Services
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Impacts of Telehealth on Rural Health Care Access
Policy brief highlighting the significance and effectiveness of telehealth. Includes analysis of current telehealth policies for Medicaid, Medicare, and private payors, and examines COVID-19 impacts on telehealth. Offers policy recommendations to enhance adoption and efficacy of telehealth services, particularly in rural areas.
Date: 11/2024
Sponsoring organization: National Rural Health Association
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Policy brief highlighting the significance and effectiveness of telehealth. Includes analysis of current telehealth policies for Medicaid, Medicare, and private payors, and examines COVID-19 impacts on telehealth. Offers policy recommendations to enhance adoption and efficacy of telehealth services, particularly in rural areas.
Date: 11/2024
Sponsoring organization: National Rural Health Association
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Growing the Rural Physician Workforce: Decades of Federal Funding Impacts Rural Graduate Medical Education
A historical review of graduate medical education funding and its relationship to the supply of rural physicians. Highlights recent federal funding and policies aimed at addressing the geographic maldistribution of physicians.
Author(s): Kay Miller Temple
Citation: Rural Monitor
Date: 11/2024
Sponsoring organization: Rural Health Information Hub
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A historical review of graduate medical education funding and its relationship to the supply of rural physicians. Highlights recent federal funding and policies aimed at addressing the geographic maldistribution of physicians.
Author(s): Kay Miller Temple
Citation: Rural Monitor
Date: 11/2024
Sponsoring organization: Rural Health Information Hub
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Texas Rural Hospital Services Strategic Plan Progress Report, 2024
Reports on the progress, strategies, and milestones of the Texas Rural Hospital Services Strategic Plan. Discusses strategies to support rural hospitals, covering policies and initiatives related to Medicaid reimbursements, hospital revenue opportunities, challenges providing care to patients covered by Medicare and other payers, use of state funds for hospital stabilization, and infrastructure development. Provides a map of rural hospitals, Critical Access Hospitals, and Rural Emergency Hospitals in Texas.
Date: 11/2024
Sponsoring organization: Texas Health and Human Services
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Reports on the progress, strategies, and milestones of the Texas Rural Hospital Services Strategic Plan. Discusses strategies to support rural hospitals, covering policies and initiatives related to Medicaid reimbursements, hospital revenue opportunities, challenges providing care to patients covered by Medicare and other payers, use of state funds for hospital stabilization, and infrastructure development. Provides a map of rural hospitals, Critical Access Hospitals, and Rural Emergency Hospitals in Texas.
Date: 11/2024
Sponsoring organization: Texas Health and Human Services
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Medicare Learning Network: Rural Emergency Hospitals
Details the regulatory requirements for providers to become a Rural Emergency Hospital (REH). Provides information on REH billing for Medicare services, Medicare payments for REH services, and the additional monthly facility payment.
Date: 11/2024
Sponsoring organization: Centers for Medicare and Medicaid Services
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Details the regulatory requirements for providers to become a Rural Emergency Hospital (REH). Provides information on REH billing for Medicare services, Medicare payments for REH services, and the additional monthly facility payment.
Date: 11/2024
Sponsoring organization: Centers for Medicare and Medicaid Services
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October 2024 MedPAC Meeting Transcript
Transcript from the Medicare Payment Advisory Commission's (MedPAC) October 2024 meeting. Covers an analysis of Medicare beneficiaries in nursing homes, findings from MedPAC's annual beneficiary and provider focus groups, supplemental benefits in Medicare Advantage, a work plan for a mandated final report on the impact of recent changes to the home health prospective payment system, and initial estimates of home health care use among Medicare Advantage enrollees. Includes rural references throughout.
Additional links: Medicare Beneficiaries in Nursing Homes - Presentation Slides
Date: 10/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Transcript from the Medicare Payment Advisory Commission's (MedPAC) October 2024 meeting. Covers an analysis of Medicare beneficiaries in nursing homes, findings from MedPAC's annual beneficiary and provider focus groups, supplemental benefits in Medicare Advantage, a work plan for a mandated final report on the impact of recent changes to the home health prospective payment system, and initial estimates of home health care use among Medicare Advantage enrollees. Includes rural references throughout.
Additional links: Medicare Beneficiaries in Nursing Homes - Presentation Slides
Date: 10/2024
Sponsoring organization: Medicare Payment Advisory Commission
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