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Resources by Topic: Reimbursement and payment models

Improving Access to Primary Care for Underserved Populations: A Review of Findings from Five Case Studies and Recommendations
Summarizes and synthesizes the findings from a series of five case studies that explored the impact of policy initiatives that aim to improve access to primary care. Covers increasing the availability of primary care providers, improving underserved communities' access to outpatient clinics, removing structural barriers to care, making primary care affordable, and improving comfort and communication between providers and patients. Presents recommendations for federal and state policymakers, primary care practices, medical schools, and other relevant stakeholders. Includes rural examples and considerations throughout.
Additional links: Executive Summary
Author(s): Maanasa Kona, Jalisa Clark, Emma Walsh-Alker
Date: 11/2023
Type: Document
Sponsoring organizations: Center on Health Insurance Reforms, Milbank Memorial Fund, National Institute for Health Care Reform
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Examining Alignment of Community Health Teams' Preferences for Health, Equity, and Spending with State All-payer Waiver Priorities: A Discrete Choice Experiment
Provides an overview of the Vermont All-Payer Model (VAPM) and regional community health teams (CHTs). Analyzes the results of a survey of all 13 Vermont CHTs to describe how VAPM and CHTs interact and how VAPM impacts the priorities and design of community-based CHTs. Examines how community-based CHTs make trade-offs made between health, health equity, and healthcare spending.
Author(s): Eline M. van den Broek-Altenburg, Jamie S. Benson, Adam J. Atherly
Citation: Health Services Research, 59(Suppl.1), e14257
Date: 11/2023
Type: Document
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The Future of Rural Hospitals and Health Systems
Podcast episode featuring a discussion with Joanne Conroy, M.D., Dartmouth Health president and CEO and the American Hospital Association Board of Trustees' chair-elect. Explores the future of rural hospitals and health systems and possible solutions to providing quality, cost-efficient care in rural communities.
Date: 11/2023
Type: Document
Sponsoring organization: American Hospital Association
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Amid Unwinding of Pandemic-Era Policies, Medicaid Programs Continue to Focus on Delivery Systems, Benefits, and Reimbursement Rates: Results from an Annual Medicaid Budget Survey for State Fiscal Years 2023 and 2024
Examines changes taking place in Medicaid programs in the 50 states and the District of Columbia. Features sections on delivery systems, provider rates and taxes, benefits, pharmacy and prescription drugs, and telehealth. Highlights challenges posed by the unwinding of COVID-19 Public Health Emergency (PHE), as well as other challenges and priorities.
Author(s): Elizabeth Hinton, Elizabeth Williams, Jada Raphael, et al.
Date: 11/2023
Type: Document
Sponsoring organization: KFF
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HHS is Taking Action to Strengthen Primary Care
Describes the importance of primary care to improving access to healthcare, the health and well-being of individuals and communities, and health equity. Discusses challenges facing primary care and outlines actions taken by the U.S. Department of Health and Human Services (HHS) to address these challenges. Covers primary care payment, workforce, access, health information technology, and research and practice improvement support.
Date: 11/2023
Type: Document
Sponsoring organization: U.S. Department of Health and Human Services
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The U.S. Department of Health and Human Services Is Taking Action to Strengthen Primary Care
Commentary describing challenges facing primary care in the United States and actions the U.S. Department of Health and Human Services (HHS) is taking to address these challenges and strengthen primary care.
Author(s): Rachel Levine, R. Burciaga Valdez, Chiquita Brooks-LaSure, et al.
Date: 11/2023
Type: Document
Sponsoring organization: National Academy of Medicine
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Hospital Outpatient Prospective Payment System (OPPS): Remedy for the 340B-Acquired Drug Payment Policy for Calendar Years 2018-2022 Final Rule (CMS 1793-F)
Fact sheet providing an overview of the Centers for Medicare & Medicaid Services (CMS) final rule describing the agency's actions to remedy payment cuts to certain hospitals that participate in the 340B Drug Pricing Program from 2018-2022 that were declared unlawful by the Supreme Court's decision in American Hospital Association v. Becerra, 142 S. Ct. 1896 (2022). Details the one-time lump sum payments to affected 340B covered entities to what they would have been paid had the 340B payment cuts not been applied, as well as a 0.5% payment reduction on future non-drug item and service payments to maintain budget neutrality beginning in calendar year 2026.
Date: 11/2023
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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CY 2024 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule (CMS 1786-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 2024. Summarizes provisions regarding changes to the community mental health centers (CMHC) Conditions of Participation (CoPs); payment for intensive outpatient program (IOP) services; payment methodology for Indian Health Service (IHS) and tribal facilities that convert to Rural Emergency Hospital (REH) status; the Hospital Outpatient Quality Reporting (OQR), Ambulatory Surgical Center Quality Reporting (ASCQR), and Rural Emergency Hospital Quality Reporting (REHQR) Programs; and more.
Date: 11/2023
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Calendar Year (CY) 2024 Medicare Physician Fee Schedule Final Rule
Fact sheet providing an overview of the Centers for Medicare & Medicaid Services (CMS) final rule regarding updates and changes to the Medicare payments under the Physician Fee Schedule (PFS) and other Medicare Part B issues for calendar year 2024. Summarizes provisions related to paying separately for Community Health Integration, Social Determinants of Health (SDOH) Risk Assessment, and Principal Illness Navigation services; telehealth services; mental health visits furnished by Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs); including marriage and family therapists and mental health counselors as eligible for payment at RHCs and FQHCs; and more.
Date: 11/2023
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid 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: 11/2023
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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