Rural Health
Resources by Topic: Reimbursement and payment models
Health Care Provisions in the Families First Coronavirus Response Act, P.L. 116-127
Provides an overview of the healthcare-related provisions of the Families First Coronavirus Response Act, passed in response to the COVID-19 pandemic. Focuses on coverage of COVID-19 testing and related items for individuals covered by Medicare, Medicare Advantage, Medicaid, CHIP, TRICARE, Veterans healthcare, the IHS, and most private plans. Includes a discussion of changes to Medicare coverage of telehealth services.
Date: 04/2020
Sponsoring organization: Congressional Research Service
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Provides an overview of the healthcare-related provisions of the Families First Coronavirus Response Act, passed in response to the COVID-19 pandemic. Focuses on coverage of COVID-19 testing and related items for individuals covered by Medicare, Medicare Advantage, Medicaid, CHIP, TRICARE, Veterans healthcare, the IHS, and most private plans. Includes a discussion of changes to Medicare coverage of telehealth services.
Date: 04/2020
Sponsoring organization: Congressional Research Service
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Community Health Centers in a Time of Change: Results from an Annual Survey
Summarizes results from the Kaiser Family Foundation/Geiger Gibson 2019 Community Health Center Survey. Explores trends in patient health coverage, healthcare affordability, and health center revenue; social determinants of health; potential implications of Medicaid work requirements; participation in the Title X program; and other challenges facing health centers. Includes rural references throughout. Presents survey response data by urban and rural status in Appendix A.
Author(s): Jessica Sharac, Anne Markus, Jennifer Tolbert, Sara Rosenbaum
Date: 04/2020
Sponsoring organization: KFF
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Summarizes results from the Kaiser Family Foundation/Geiger Gibson 2019 Community Health Center Survey. Explores trends in patient health coverage, healthcare affordability, and health center revenue; social determinants of health; potential implications of Medicaid work requirements; participation in the Title X program; and other challenges facing health centers. Includes rural references throughout. Presents survey response data by urban and rural status in Appendix A.
Author(s): Jessica Sharac, Anne Markus, Jennifer Tolbert, Sara Rosenbaum
Date: 04/2020
Sponsoring organization: KFF
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Rural Hospital Participation in Medicare Accountable Care Organizations
Report explores the rates of rural hospital participation in Medicare Shared Savings Program (SSP) Accountable Care Organizations (ACOs). Details some of the factors that correspond to participation and compares rates by region and by rural status.
Date: 04/2020
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Report explores the rates of rural hospital participation in Medicare Shared Savings Program (SSP) Accountable Care Organizations (ACOs). Details some of the factors that correspond to participation and compares rates by region and by rural status.
Date: 04/2020
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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MedPAC Comment on CMS's Proposed Rule on Contract Year 2021 and 2022 Policy and Technical Changes to Medicare Advantage and Part D
Responds to a proposed rule to revise regulations for Medicare Advantage (MA) and the Medicare Prescription Drug Benefit program (Part D). Provides comments on CMS proposals regarding out-of-network telehealth benefits, updates to the quality rating models for MA and Part D plans, and changes to MA network adequacy standards. Discusses how changes to network adequacy standards would impact access to dialysis facilities for beneficiaries in micropolitan counties, rural counties, and counties with extreme access considerations (CEAC).
Date: 04/2020
Sponsoring organization: Medicare Payment Advisory Commission
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Responds to a proposed rule to revise regulations for Medicare Advantage (MA) and the Medicare Prescription Drug Benefit program (Part D). Provides comments on CMS proposals regarding out-of-network telehealth benefits, updates to the quality rating models for MA and Part D plans, and changes to MA network adequacy standards. Discusses how changes to network adequacy standards would impact access to dialysis facilities for beneficiaries in micropolitan counties, rural counties, and counties with extreme access considerations (CEAC).
Date: 04/2020
Sponsoring organization: Medicare Payment Advisory Commission
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CARES Act: Provisions to Help Rural Hospitals
Provides an overview of aspects of the Coronavirus Aid, Relief, and Economic Security (CARES) Act designed to support rural hospitals. Highlights provisions related to access to capital, Medicare payments, and telehealth, among others.
Date: 04/2020
Sponsoring organization: American Hospital Association
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Provides an overview of aspects of the Coronavirus Aid, Relief, and Economic Security (CARES) Act designed to support rural hospitals. Highlights provisions related to access to capital, Medicare payments, and telehealth, among others.
Date: 04/2020
Sponsoring organization: American Hospital Association
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Public Law 116-136: Coronavirus Aid, Relief, and Economic Security (CARES) Act
Text of the Coronavirus Aid, Relief, and Economic Security (CARES) Act, Public Law 116-136 (March 27, 2020). Outlines telehealth flexibilities to support providers and enhance access to care during the COVID-19 Public Health Emergency. Among other things, the CARES Act allows Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) to serve as distant sites to provide telehealth services to patients in their homes during the public health emergency (PHE); establishes the Paycheck Protection Program (PPP); extends the ability to order home health services to physician assistants, nurse practitioners, and certified nurse specialists; and provides additional funding to the Federal Communications Commission (FCC) to enable the provision of telehealth services.
Date: 03/2020
Sponsoring organization: U.S. Congress
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Text of the Coronavirus Aid, Relief, and Economic Security (CARES) Act, Public Law 116-136 (March 27, 2020). Outlines telehealth flexibilities to support providers and enhance access to care during the COVID-19 Public Health Emergency. Among other things, the CARES Act allows Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) to serve as distant sites to provide telehealth services to patients in their homes during the public health emergency (PHE); establishes the Paycheck Protection Program (PPP); extends the ability to order home health services to physician assistants, nurse practitioners, and certified nurse specialists; and provides additional funding to the Federal Communications Commission (FCC) to enable the provision of telehealth services.
Date: 03/2020
Sponsoring organization: U.S. Congress
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Second Report to Congress: Social Risk Factors and Performance in Medicare's Value-Based Purchasing Programs
Analyzes the effect of individuals' social risk factors on quality measures, resource utilization, and other Medicare program measures using Medicare and non-Medicare data sources. Describes how Medicare value-based purchasing (VBP) programs impact providers who serve socially at-risk beneficiaries. Categorizes rurality as a social risk factor. Explores emerging trends among providers addressing social risk factors through cooperation with social services and community-based organizations. Offers policy recommendations for the U.S. Department of Health and Human Services to account for social risk factors in VBP programs and achieve better outcomes for those with social risk factors. Second of two reports required by the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. See the first report.
Additional links: Executive Summary
Date: 03/2020
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Analyzes the effect of individuals' social risk factors on quality measures, resource utilization, and other Medicare program measures using Medicare and non-Medicare data sources. Describes how Medicare value-based purchasing (VBP) programs impact providers who serve socially at-risk beneficiaries. Categorizes rurality as a social risk factor. Explores emerging trends among providers addressing social risk factors through cooperation with social services and community-based organizations. Offers policy recommendations for the U.S. Department of Health and Human Services to account for social risk factors in VBP programs and achieve better outcomes for those with social risk factors. Second of two reports required by the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. See the first report.
Additional links: Executive Summary
Date: 03/2020
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Interim Evaluation of California's Public Hospital Redesign and Incentives in Medi‐Cal (PRIME) Program
Reports on California's Public Hospital Redesign and Incentives in Medi-Cal Program (PRIME), approved by the Centers for Medicare and Medicaid Services (CMS) to modify Medicaid programs and implement innovative delivery reforms. PRIME uses evidence-based quality improvement methods that require hospitals to establish performance baselines, institute targets for improvement, and evaluate the success of quality improvement interventions on an ongoing basis. The analysis of the program included 52 designated public hospitals and district/municipal hospitals, with 17 of the latter being Critical Access Hospitals (CAHs).
Author(s): Nadereh Pourat, Xiao Chen, Ana E. Martinez, et al.
Date: 03/2020
Sponsoring organizations: California Department of Health Care Services, UCLA Center for Health Policy Research
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Reports on California's Public Hospital Redesign and Incentives in Medi-Cal Program (PRIME), approved by the Centers for Medicare and Medicaid Services (CMS) to modify Medicaid programs and implement innovative delivery reforms. PRIME uses evidence-based quality improvement methods that require hospitals to establish performance baselines, institute targets for improvement, and evaluate the success of quality improvement interventions on an ongoing basis. The analysis of the program included 52 designated public hospitals and district/municipal hospitals, with 17 of the latter being Critical Access Hospitals (CAHs).
Author(s): Nadereh Pourat, Xiao Chen, Ana E. Martinez, et al.
Date: 03/2020
Sponsoring organizations: California Department of Health Care Services, UCLA Center for Health Policy Research
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MedPAC Report to the Congress: Medicare Payment Policy, 2020
Annual review of Medicare payment policies, with recommendations to Congress. Includes discussion on Medicare payment policies directly affecting rural providers and beneficiaries. Addresses payment adequacy for healthcare facilities and services, improving Medicare payment for post-acute care, Medicare Advantage, Medicare Part D, and the impact of healthcare provider consolidation.
Date: 03/2020
Sponsoring organization: Medicare Payment Advisory Commission
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Annual review of Medicare payment policies, with recommendations to Congress. Includes discussion on Medicare payment policies directly affecting rural providers and beneficiaries. Addresses payment adequacy for healthcare facilities and services, improving Medicare payment for post-acute care, Medicare Advantage, Medicare Part D, and the impact of healthcare provider consolidation.
Date: 03/2020
Sponsoring organization: Medicare Payment Advisory Commission
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Report to Congress on Medicaid and CHIP, March 2020
Reports on three aspects of Medicaid: improving the structure of Disproportionate Share Hospital (DSH) payments, state reporting on the quality of care for individuals covered by Medicaid or the State Children's Health Insurance Program (CHIP), and the timeliness and quality of Medicaid demonstration evaluations. Chapter 1 examines the relationship between DSH allotments to states and the number of uninsured individuals, the amounts and sources of hospitals' uncompensated care costs, and the amounts and sources of hospitals' uncompensated care costs. Table 1-1 details DSH spending for urban and rural hospitals and for Critical Access Hospitals.
Date: 03/2020
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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Reports on three aspects of Medicaid: improving the structure of Disproportionate Share Hospital (DSH) payments, state reporting on the quality of care for individuals covered by Medicaid or the State Children's Health Insurance Program (CHIP), and the timeliness and quality of Medicaid demonstration evaluations. Chapter 1 examines the relationship between DSH allotments to states and the number of uninsured individuals, the amounts and sources of hospitals' uncompensated care costs, and the amounts and sources of hospitals' uncompensated care costs. Table 1-1 details DSH spending for urban and rural hospitals and for Critical Access Hospitals.
Date: 03/2020
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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