Rural Health
Resources by Topic: Reimbursement and payment models
Care Management Services in Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs): Frequently Asked Questions
Provides general information about chronic care management services, specific program requirements, detailed descriptions of billing, claims processing, and payment rules, and requirements for people who are considered part of a care management team for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs).
Date: 12/2019
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides general information about chronic care management services, specific program requirements, detailed descriptions of billing, claims processing, and payment rules, and requirements for people who are considered part of a care management team for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs).
Date: 12/2019
Sponsoring organization: Centers for Medicare and Medicaid Services
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Evaluation of the Maryland All-Payer Model: Volume I - Final Report
Evaluation of the All-Payer Model operating under an agreement with the Centers for Medicare & Medicaid Services (CMS) for hospitals in rural and urban settings implemented in Maryland in 2014. This model shifted the state's hospital payment structure to an annual, global hospital budget that includes both inpatient and outpatient hospital services. Report covers 4.5 years of implementation, and compares outcomes by rural and urban residency.
Author(s): Susan Haber, Heather Beil, Marisa Morrison, et al.
Date: 11/2019
Sponsoring organization: Centers for Medicare and Medicaid Services
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Evaluation of the All-Payer Model operating under an agreement with the Centers for Medicare & Medicaid Services (CMS) for hospitals in rural and urban settings implemented in Maryland in 2014. This model shifted the state's hospital payment structure to an annual, global hospital budget that includes both inpatient and outpatient hospital services. Report covers 4.5 years of implementation, and compares outcomes by rural and urban residency.
Author(s): Susan Haber, Heather Beil, Marisa Morrison, et al.
Date: 11/2019
Sponsoring organization: Centers for Medicare and Medicaid Services
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Intergovernmental Advisory Committee to the Federal Communications Commission Advisory Recommendation No: 2019-2 in the Matter of State, Local Tribal, and Territorial Regulatory and Other Barriers and Incentives to Telemedicine
Examines the technical infrastructure necessary for effective telemedicine delivery in state, territorial, tribal, and local (rural and urban) areas. Discusses the regulatory barriers including legislation, licensing, reimbursement, malpractice insurance, and privacy that obstruct its development and utilization, and offers recommendations addressing these barriers. Appendix A presents case studies of broadband and telehealth development in several states and territories.
Date: 11/2019
Sponsoring organizations: Federal Communications Commission, Intergovernmental Advisory Committee to the Federal Communications Commission
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Examines the technical infrastructure necessary for effective telemedicine delivery in state, territorial, tribal, and local (rural and urban) areas. Discusses the regulatory barriers including legislation, licensing, reimbursement, malpractice insurance, and privacy that obstruct its development and utilization, and offers recommendations addressing these barriers. Appendix A presents case studies of broadband and telehealth development in several states and territories.
Date: 11/2019
Sponsoring organizations: Federal Communications Commission, Intergovernmental Advisory Committee to the Federal Communications Commission
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Rural Health Clinic Costs and Medicare Reimbursement
Policy brief exploring whether updates to the Medicare per-visit reimbursement cap have allowed Rural Health Clinics (RHCs) of various types and sizes to keep pace with increases in staffing and other costs. Features statistics including RHC mean Medicare adjusted cost per visit and RHC mean Medicare healthcare staff costs as of 2014, with breakdowns by 4 sizes of RHCs and private or publicly-owned status.
Author(s): John Gale, Zachariah T. Croll, Andrew F. Coburn
Date: 11/2019
Sponsoring organization: Maine Rural Health Research Center
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Policy brief exploring whether updates to the Medicare per-visit reimbursement cap have allowed Rural Health Clinics (RHCs) of various types and sizes to keep pace with increases in staffing and other costs. Features statistics including RHC mean Medicare adjusted cost per visit and RHC mean Medicare healthcare staff costs as of 2014, with breakdowns by 4 sizes of RHCs and private or publicly-owned status.
Author(s): John Gale, Zachariah T. Croll, Andrew F. Coburn
Date: 11/2019
Sponsoring organization: Maine Rural Health Research Center
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Urban and Rural Hospitalizations in Mississippi: Overview and Trend Analyses, 2014-2018
Results of a rural health surveillance system established by the Mississippi State Department of Health to monitor and report on the health status of rural residents and the capacity of the local healthcare systems serving this population. Features county-level maps and statistics from 2014-2018 on inpatient care, numbers of hospitals, hospital beds, percent of hospitalizations, and payment models, with breakdowns by metropolitan, micropolitan, and rural areas.
Date: 10/2019
Sponsoring organization: Mississippi State Department of Health
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Results of a rural health surveillance system established by the Mississippi State Department of Health to monitor and report on the health status of rural residents and the capacity of the local healthcare systems serving this population. Features county-level maps and statistics from 2014-2018 on inpatient care, numbers of hospitals, hospital beds, percent of hospitalizations, and payment models, with breakdowns by metropolitan, micropolitan, and rural areas.
Date: 10/2019
Sponsoring organization: Mississippi State Department of Health
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Estimate of Federal Payment Reductions to Hospitals Following the ACA: 2010-2029: Estimates and Methodology
Estimates the reduction in Medicare hospital payments due to sequestration from 2010 to 2029, not including reductions enacted under the Affordable Care Act (ACA). Demonstrates how other legislative acts and regulatory changes by the Centers for Medicare and Medicaid Services (CMS) reduced federal payments to hospitals over the same period. Highlights how reductions in Medicare payments for bad debt impacted Critical Access Hospitals (CAHs).
Date: 10/2019
Sponsoring organizations: American Hospital Association, Federation of American Hospitals
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Estimates the reduction in Medicare hospital payments due to sequestration from 2010 to 2029, not including reductions enacted under the Affordable Care Act (ACA). Demonstrates how other legislative acts and regulatory changes by the Centers for Medicare and Medicaid Services (CMS) reduced federal payments to hospitals over the same period. Highlights how reductions in Medicare payments for bad debt impacted Critical Access Hospitals (CAHs).
Date: 10/2019
Sponsoring organizations: American Hospital Association, Federation of American Hospitals
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States' Medicaid Fee-for-Service Nursing Facility Payment Policies
Spreadsheet outlining each state's Medicaid fee-for-service (FFS) nursing facility payment policy. Lists how each state sets the payment rate and any adjustments and supplemental payments. Includes information on rural/urban aspects of setting or adjustment to the payment in each state.
Date: 10/2019
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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Spreadsheet outlining each state's Medicaid fee-for-service (FFS) nursing facility payment policy. Lists how each state sets the payment rate and any adjustments and supplemental payments. Includes information on rural/urban aspects of setting or adjustment to the payment in each state.
Date: 10/2019
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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Financial Alignment Initiative South Carolina Healthy Connections Prime: First Evaluation Report
Evaluation of the first year of the South Carolina Healthy Connections Prime demonstration to integrate care for the state's Medicare-Medicaid beneficiaries. Discusses access and other challenges for rural enrollees and how the program has worked to address rural needs.
Date: 09/2019
Sponsoring organizations: Centers for Medicare and Medicaid Services, RTI International
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Evaluation of the first year of the South Carolina Healthy Connections Prime demonstration to integrate care for the state's Medicare-Medicaid beneficiaries. Discusses access and other challenges for rural enrollees and how the program has worked to address rural needs.
Date: 09/2019
Sponsoring organizations: Centers for Medicare and Medicaid Services, RTI International
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Serving Rural America: Health Insurance Providers at Work
Offers 5 case studies to showcase the ways in which health insurance providers are working to ensure access to high quality healthcare in rural areas. Examples feature 8 insurance providers in Maryland, Pennsylvania, California, and Oregon sharing different approaches to healthcare delivery, financing, and community engagement.
Date: 09/2019
Sponsoring organization: AHIP
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Offers 5 case studies to showcase the ways in which health insurance providers are working to ensure access to high quality healthcare in rural areas. Examples feature 8 insurance providers in Maryland, Pennsylvania, California, and Oregon sharing different approaches to healthcare delivery, financing, and community engagement.
Date: 09/2019
Sponsoring organization: AHIP
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Evaluation of the Accountable Care Organization Investment Model: AIM Implementation and Impacts over Two Performance Years
Evaluation examining the first two years of 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). Reports on AIM ACO composition, including rurality. Appendices include detailed information on each AIM ACO.
Additional links: Appendices, Findings at a Glance
Date: 09/2019
Sponsoring organizations: Abt Associates, Centers for Medicare and Medicaid Services
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Evaluation examining the first two years of 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). Reports on AIM ACO composition, including rurality. Appendices include detailed information on each AIM ACO.
Additional links: Appendices, Findings at a Glance
Date: 09/2019
Sponsoring organizations: Abt Associates, Centers for Medicare and Medicaid Services
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