Rural Health
Resources by Topic: Reimbursement and payment models
Report to Congress on Medicaid and CHIP, March 2019
Reports on three aspects of Medicaid: improving the structure of Disproportionate Share Hospital (DSH) payment reductions, oversight of upper payment limits for supplemental payments to hospitals, and Disproportionate Share Hospital (DSH) payments to states. Chapter 3 includes the annual report on DSH payments, which provide support to safety-net hospitals to help offset uncompensated care costs for Medicaid and uninsured patients. Table 3-1 identifies DSH spending for urban and rural hospitals and for Critical Access Hospitals.
Date: 03/2019
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) payment reductions, oversight of upper payment limits for supplemental payments to hospitals, and Disproportionate Share Hospital (DSH) payments to states. Chapter 3 includes the annual report on DSH payments, which provide support to safety-net hospitals to help offset uncompensated care costs for Medicaid and uninsured patients. Table 3-1 identifies DSH spending for urban and rural hospitals and for Critical Access Hospitals.
Date: 03/2019
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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2019 Telehealth Reimbursement
Provides an overview of Medicare reimbursement for telehealth services and discusses factors, policies, and legislation affecting reimbursement including: geographic and originating site restrictions; provider restrictions; service restrictions; payment for remote communication technology; chronic care management and remote monitoring; Medicare Advantage; Accountable Care Organizations, bundled care, and telehealth. Covers Medicaid and private payer telehealth reimbursement policies.
Date: 02/2019
Sponsoring organization: Center for Connected Health Policy: The National Telehealth Policy Resource Center
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Provides an overview of Medicare reimbursement for telehealth services and discusses factors, policies, and legislation affecting reimbursement including: geographic and originating site restrictions; provider restrictions; service restrictions; payment for remote communication technology; chronic care management and remote monitoring; Medicare Advantage; Accountable Care Organizations, bundled care, and telehealth. Covers Medicaid and private payer telehealth reimbursement policies.
Date: 02/2019
Sponsoring organization: Center for Connected Health Policy: The National Telehealth Policy Resource Center
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Rural Report: Challenges Facing Rural Communities and the Roadmap to Ensure Local Access to High-Quality, Affordable Care
Reports on continuing, current, and emerging challenges for rural hospitals working to provide access to healthcare services in rural communities. Includes discussion on policy recommendations to improve access and covers new models of care, reimbursement policies, regulatory requirements, telehealth, workforce issues, and prescription drug costs.
Additional links: Executive Summary, Infographic
Date: 02/2019
Sponsoring organization: American Hospital Association
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Reports on continuing, current, and emerging challenges for rural hospitals working to provide access to healthcare services in rural communities. Includes discussion on policy recommendations to improve access and covers new models of care, reimbursement policies, regulatory requirements, telehealth, workforce issues, and prescription drug costs.
Additional links: Executive Summary, Infographic
Date: 02/2019
Sponsoring organization: American Hospital Association
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Technical Assistance for Hospitals Applying to the Pennsylvania Rural Health Model — A CMMI-Sponsored Rural Hospital Global Budget Model
Describes the experiences of the Rural Health Value program in coaching hospitals in Pennsylvania that were interested in participating in a global budget model. Explains a process to quickly develop a plan focused on community health rather than exclusively on clinical services, to facilitate the transition from volume to value.
Date: 2019
Sponsoring organization: Rural Health Value
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Describes the experiences of the Rural Health Value program in coaching hospitals in Pennsylvania that were interested in participating in a global budget model. Explains a process to quickly develop a plan focused on community health rather than exclusively on clinical services, to facilitate the transition from volume to value.
Date: 2019
Sponsoring organization: Rural Health Value
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State Innovation Models (SIM) Round 2: Model Test Annual Report Three
Third annual report on the Round 2 State Innovation Models (SIM) program across eleven participating states - Colorado, Connecticut, Delaware, Idaho, Iowa, Michigan, New York, Ohio, Rhode Island, Tennessee, and Washington. Addresses the adoption of delivery models and payment reforms related to value-based payment (VBP) and alternative payment models (APMs). Offers an update and lessons learned on strategies to support healthcare delivery transformation related to behavioral health integration, data for improving health care quality and performance, health information technology, care coordination, and workforce development. Describes states' population health activities. Includes discussion of rural issues throughout the report.
Additional links: Findings at a Glance
Date: 2019
Sponsoring organizations: Centers for Medicare and Medicaid Services, RTI International
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Third annual report on the Round 2 State Innovation Models (SIM) program across eleven participating states - Colorado, Connecticut, Delaware, Idaho, Iowa, Michigan, New York, Ohio, Rhode Island, Tennessee, and Washington. Addresses the adoption of delivery models and payment reforms related to value-based payment (VBP) and alternative payment models (APMs). Offers an update and lessons learned on strategies to support healthcare delivery transformation related to behavioral health integration, data for improving health care quality and performance, health information technology, care coordination, and workforce development. Describes states' population health activities. Includes discussion of rural issues throughout the report.
Additional links: Findings at a Glance
Date: 2019
Sponsoring organizations: Centers for Medicare and Medicaid Services, RTI International
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Perspectives of Physicians in Small Rural Practices on the Medicare Quality Payment Program
Provides feedback from small, rural practices on the implementation of Medicare's Quality Payment Program (QPP), which includes the Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). Identifies challenges rural physicians face and offers recommendations to help more small practices participate in the program.
Author(s): Peter Mendel, Christine Buttorff, Peggy G. Chen, et al.
Date: 2019
Sponsoring organizations: HHS Office of the Assistant Secretary for Planning and Evaluation, RAND Corporation
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Provides feedback from small, rural practices on the implementation of Medicare's Quality Payment Program (QPP), which includes the Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). Identifies challenges rural physicians face and offers recommendations to help more small practices participate in the program.
Author(s): Peter Mendel, Christine Buttorff, Peggy G. Chen, et al.
Date: 2019
Sponsoring organizations: HHS Office of the Assistant Secretary for Planning and Evaluation, RAND Corporation
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State Innovation Models (SIM) Initiative Evaluation: Model Test Year Five Annual Report
Fifth annual report on Round 1 of the CMS State Innovation Models (SIM) Initiative, which tests the ability of the governments in six states - Arkansas, Maine, Massachusetts, Minnesota, Oregon, and Vermont - to move providers to value-based payment models (VPMs). Presents the final summary findings for SIM Round 1. Includes information specific to rural areas.
Additional links: Appendices, Findings at a Glance
Date: 12/2018
Sponsoring organizations: Centers for Medicare and Medicaid Services, RTI International
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Fifth annual report on Round 1 of the CMS State Innovation Models (SIM) Initiative, which tests the ability of the governments in six states - Arkansas, Maine, Massachusetts, Minnesota, Oregon, and Vermont - to move providers to value-based payment models (VPMs). Presents the final summary findings for SIM Round 1. Includes information specific to rural areas.
Additional links: Appendices, Findings at a Glance
Date: 12/2018
Sponsoring organizations: Centers for Medicare and Medicaid Services, RTI International
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Medicare: Voluntary and Mandatory Episode-Based Payment Models and Their Participants
Reviews tests of 6 episode-based Medicare payment models. Describes the characteristics of providers that participated in these models, including rural or urban location, addresses factors affecting their decision to participate, and compares the advantages of mandatory versus voluntary participation.
Additional links: Full Report
Date: 12/2018
Sponsoring organization: Government Accountability Office
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Reviews tests of 6 episode-based Medicare payment models. Describes the characteristics of providers that participated in these models, including rural or urban location, addresses factors affecting their decision to participate, and compares the advantages of mandatory versus voluntary participation.
Additional links: Full Report
Date: 12/2018
Sponsoring organization: Government Accountability Office
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Medicare Fee-for-Service: Information on the Second Year of Nationwide Reduced Payment Rates for Durable Medical Equipment
Analyzes 2017 Medicare claims data to describe changes in the number of beneficiaries receiving and suppliers furnishing Medicare beneficiaries with rate-adjusted versus non-adjusted items in non-bid areas. Includes information on changes in rural and non-rural non-bid areas.
Additional links: Full Report
Date: 12/2018
Sponsoring organization: Government Accountability Office
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Analyzes 2017 Medicare claims data to describe changes in the number of beneficiaries receiving and suppliers furnishing Medicare beneficiaries with rate-adjusted versus non-adjusted items in non-bid areas. Includes information on changes in rural and non-rural non-bid areas.
Additional links: Full Report
Date: 12/2018
Sponsoring organization: Government Accountability Office
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Using Telehealth to Support Opioid Use Disorder Treatment
Provides an issue brief on how telehealth can increase access to medication-assisted treatment (MAT) for opioid use disorder (OUD). Addresses how telehealth is used, implemented, and reimbursed, highlighting the implications for MAT.
Date: 11/2018
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Provides an issue brief on how telehealth can increase access to medication-assisted treatment (MAT) for opioid use disorder (OUD). Addresses how telehealth is used, implemented, and reimbursed, highlighting the implications for MAT.
Date: 11/2018
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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