Rural Health
Resources by Topic: Reimbursement and payment models
Evaluation of the Accountable Care Organization Investment Model: AIM Impacts in the First Performance Year
Evaluation examining the first year performance of the 47 Accountable Care Organizations (ACOs) participating in the ACO Investment Model (AIM), which tests the use of prepaid shared savings to encourage new ACOs to form in rural and underserved areas (Test 1) and to encourage current Medicare Shared Savings Program ACOs to transition to arrangements with greater financial risk (Test 2). Describes provider characteristics, beneficiary characteristics, and impacts of the 41 Test 1 AIM ACOs. Includes data on rurality for both Test 1 and Test 2 AIM ACOs.
Additional links: Appendices, Findings At-A-Glance
Date: 08/2018
Type: Document
Sponsoring organizations: Abt Associates, Centers for Medicare and Medicaid Services
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Evaluation examining the first year performance of the 47 Accountable Care Organizations (ACOs) participating in the ACO Investment Model (AIM), which tests the use of prepaid shared savings to encourage new ACOs to form in rural and underserved areas (Test 1) and to encourage current Medicare Shared Savings Program ACOs to transition to arrangements with greater financial risk (Test 2). Describes provider characteristics, beneficiary characteristics, and impacts of the 41 Test 1 AIM ACOs. Includes data on rurality for both Test 1 and Test 2 AIM ACOs.
Additional links: Appendices, Findings At-A-Glance
Date: 08/2018
Type: Document
Sponsoring organizations: Abt Associates, Centers for Medicare and Medicaid Services
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MedPAC Comment on CMS's Proposed Rule on the CY 2019 Home Health PPS Update and 2020 Case Mix Refinements
Comment on a July 12, 2018, Federal Register proposed rule revising payments for home health services. Includes a section addressing a proposed rural add-on payment policy.
Date: 08/2018
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Comment on a July 12, 2018, Federal Register proposed rule revising payments for home health services. Includes a section addressing a proposed rural add-on payment policy.
Date: 08/2018
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Medicare Fee-for-Service: Information on the First Year of Nationwide Reduced Payment Rates for Durable Medical Equipment
Examines the effects of reduced payment rates for certain durable medical equipment (DME) in non-bid areas. Reports on changes in the number of suppliers, utilization of rate-adjusted items, and beneficiaries' access to rate-adjusted items. Includes information on changes in rural and non-rural non-bid areas.
Additional links: Full Report
Date: 08/2018
Type: Document
Sponsoring organization: Government Accountability Office
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Examines the effects of reduced payment rates for certain durable medical equipment (DME) in non-bid areas. Reports on changes in the number of suppliers, utilization of rate-adjusted items, and beneficiaries' access to rate-adjusted items. Includes information on changes in rural and non-rural non-bid areas.
Additional links: Full Report
Date: 08/2018
Type: Document
Sponsoring organization: Government Accountability Office
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Rural Hospitals and Medicaid Payment Policy
Describes how rural hospitals serve Medicaid beneficiaries and the process through which Medicaid programs pay rural hospitals. Features statistics from 2015 with breakdowns by urban hospitals, Critical Access Hospitals (CAHs), and other rural hospitals.
Date: 08/2018
Type: Document
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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Describes how rural hospitals serve Medicaid beneficiaries and the process through which Medicaid programs pay rural hospitals. Features statistics from 2015 with breakdowns by urban hospitals, Critical Access Hospitals (CAHs), and other rural hospitals.
Date: 08/2018
Type: Document
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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Building a Community Health Worker Program: The Key to Better Care, Better Outcomes, & Lower Costs
A toolkit offering information and strategies to help hospitals and healthcare systems design and implement a community health worker (CHW) program targeted to the communities they serve. Highlights evidence-based best practices, sustainable financing of CHW activities, engaging stakeholders, and suggests outcome measures. Provides a chapter of case studies on rural, urban, and suburban settings.
Author(s): Beth A. Brooks, Sheila Davis, Loraine Frank-Lightfoot, et al.
Date: 07/2018
Type: Document
Sponsoring organizations: American Hospital Association, CommunityHealth Works
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A toolkit offering information and strategies to help hospitals and healthcare systems design and implement a community health worker (CHW) program targeted to the communities they serve. Highlights evidence-based best practices, sustainable financing of CHW activities, engaging stakeholders, and suggests outcome measures. Provides a chapter of case studies on rural, urban, and suburban settings.
Author(s): Beth A. Brooks, Sheila Davis, Loraine Frank-Lightfoot, et al.
Date: 07/2018
Type: Document
Sponsoring organizations: American Hospital Association, CommunityHealth Works
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2018 Rural Hospital and Clinic Financial Summit Report: Key Financial Success Indicators and Strategies
Identifies the indicators of financial success for hospitals and clinics, provides strategies to transition into value-based payment models, and includes success stories from Summit participants and resources necessary for hospitals and clinics. Includes a table showing Critical Access Hospital financial indicators medians for 2016.
Date: 07/2018
Type: Document
Sponsoring organization: National Rural Health Resource Center
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Identifies the indicators of financial success for hospitals and clinics, provides strategies to transition into value-based payment models, and includes success stories from Summit participants and resources necessary for hospitals and clinics. Includes a table showing Critical Access Hospital financial indicators medians for 2016.
Date: 07/2018
Type: Document
Sponsoring organization: National Rural Health Resource Center
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The Medicaid Fee-for-Service Provider Payment Process
Outlines Medicaid's fee-for-services (FFS) provider payment process. Details the claims-based submission payment process, as well as additional non-claims-based payment processes. Includes information targeted to Rural Health Clinics and Federally Qualified Health Centers throughout.
Date: 07/2018
Type: Document
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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Outlines Medicaid's fee-for-services (FFS) provider payment process. Details the claims-based submission payment process, as well as additional non-claims-based payment processes. Includes information targeted to Rural Health Clinics and Federally Qualified Health Centers throughout.
Date: 07/2018
Type: Document
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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Rural Health Clinic Participation in the Merit-Based Incentive System and Other Quality Reporting Initiatives: Challenges and Opportunities
Reports on past and current RHC quality reporting initiatives in relation to the Merit-Based Incentive Payment System (MIPS). Explores options for RHCs to voluntarily participate in MIPS and covers challenges for RHCs participating in quality reporting.
Author(s): John A. Gale, Zachariah Croll, Andrew F. Coburn
Date: 07/2018
Type: Document
Sponsoring organization: Maine Rural Health Research Center
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Reports on past and current RHC quality reporting initiatives in relation to the Merit-Based Incentive Payment System (MIPS). Explores options for RHCs to voluntarily participate in MIPS and covers challenges for RHCs participating in quality reporting.
Author(s): John A. Gale, Zachariah Croll, Andrew F. Coburn
Date: 07/2018
Type: Document
Sponsoring organization: Maine Rural Health Research Center
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Average Beneficiary CMS Hierarchical Condition Category (HCC) Risk Scores for Rural and Urban Providers
Findings brief investigating potential differences in urban and rural CMS-HCC risk scores at the provider's patient panel level. Features statistics from the 2015 Medicare Physician and Other Supplier Public Use File to compare patient panel CMS-HCC risk scores with breakdowns by urban and rural providers across provider specialties, census divisions, and Merit-Based Incentive Payment System (MIPS) participation requirements.
Author(s): Abby F. Hoffman, Kristin L. Reiter, Randy K. Randolph
Date: 07/2018
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Findings brief investigating potential differences in urban and rural CMS-HCC risk scores at the provider's patient panel level. Features statistics from the 2015 Medicare Physician and Other Supplier Public Use File to compare patient panel CMS-HCC risk scores with breakdowns by urban and rural providers across provider specialties, census divisions, and Merit-Based Incentive Payment System (MIPS) participation requirements.
Author(s): Abby F. Hoffman, Kristin L. Reiter, Randy K. Randolph
Date: 07/2018
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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MedPAC Comment on CMS's Interim Final Rule on Durable Medical Equipment Fee Schedule Adjustments
Describes Medicare's method of setting payment rates for durable medical equipment, prosthetics, orthotics, and supplies, and explains the reinstitution of 50/50 blended payment rates for rural and non-contiguous areas from June 1, 2018 to December 31, 2018.
Author(s): Francis J. Crosson
Date: 07/2018
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Describes Medicare's method of setting payment rates for durable medical equipment, prosthetics, orthotics, and supplies, and explains the reinstitution of 50/50 blended payment rates for rural and non-contiguous areas from June 1, 2018 to December 31, 2018.
Author(s): Francis J. Crosson
Date: 07/2018
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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