Rural Health
Resources by Topic: Reimbursement and payment models
Development and Deployment of Community Health Workers in Delaware
A guide for establishing a Community Health Worker program in the state of Delaware. Includes information about certification requirements and reimbursement mechanisms, along with model programs from other states.
Date: 06/2017
Sponsoring organizations: Delaware Center for Health Innovation, Delaware Health and Social Services
view details
A guide for establishing a Community Health Worker program in the state of Delaware. Includes information about certification requirements and reimbursement mechanisms, along with model programs from other states.
Date: 06/2017
Sponsoring organizations: Delaware Center for Health Innovation, Delaware Health and Social Services
view details
Hospital Value-Based Purchasing: CMS Should Take Steps to Ensure Lower Quality Hospitals Do Not Qualify for Bonuses
Examines the scoring methodology used by the Hospital Value-Based Purchasing (HVBP) program, which measures quality and efficiency within multiple hospital types including small, rural, and safety-net hospitals. Addresses differences in how safety net, small rural, and small urban hospitals performed, how payment adjustments changed for them over time, and the impact of an efficiency score on payment adjustments. Supports revising the methodology to apply the standards more evenly.
Additional links: Full Report
Date: 06/2017
Sponsoring organization: Government Accountability Office
view details
Examines the scoring methodology used by the Hospital Value-Based Purchasing (HVBP) program, which measures quality and efficiency within multiple hospital types including small, rural, and safety-net hospitals. Addresses differences in how safety net, small rural, and small urban hospitals performed, how payment adjustments changed for them over time, and the impact of an efficiency score on payment adjustments. Supports revising the methodology to apply the standards more evenly.
Additional links: Full Report
Date: 06/2017
Sponsoring organization: Government Accountability Office
view details
MedPAC Report to the Congress: Medicare and the Health Care Delivery System, June 2017
Includes chapters on implementing a unified payment system for post-acute care, Part B drug payment policies, the redesign of the Merit-Based Incentive Payment System (MIPS) and other alternative payment models, drug and device manufacturer payments to physicians and teaching hospitals, stand-alone emergency departments, and skilled nursing facility use. Rural hospitals and rural patient populations are discussed throughout the report.
Date: 06/2017
Sponsoring organization: Medicare Payment Advisory Commission
view details
Includes chapters on implementing a unified payment system for post-acute care, Part B drug payment policies, the redesign of the Merit-Based Incentive Payment System (MIPS) and other alternative payment models, drug and device manufacturer payments to physicians and teaching hospitals, stand-alone emergency departments, and skilled nursing facility use. Rural hospitals and rural patient populations are discussed throughout the report.
Date: 06/2017
Sponsoring organization: Medicare Payment Advisory Commission
view details
Factors Affecting States' Ability to Respond to Federal Medicaid Cuts and Caps: Which States Are Most At Risk?
Examines 30 key factors that contribute to state-by-state differences in Medicaid per enrollee spending including rural population, and uses the factors to rank and identify which states are at greatest risk if federal Medicaid cuts or caps are enacted. Presents findings across five main areas: Medicaid policy, demographics, health status, available tax revenue and state budget choices, and healthcare markets.
Author(s): Robin Rudowitz, Allison Valentine, Petry Ubri, Julia Zur
Date: 06/2017
Sponsoring organization: KFF
view details
Examines 30 key factors that contribute to state-by-state differences in Medicaid per enrollee spending including rural population, and uses the factors to rank and identify which states are at greatest risk if federal Medicaid cuts or caps are enacted. Presents findings across five main areas: Medicaid policy, demographics, health status, available tax revenue and state budget choices, and healthcare markets.
Author(s): Robin Rudowitz, Allison Valentine, Petry Ubri, Julia Zur
Date: 06/2017
Sponsoring organization: KFF
view details
Federal Health Centers: An Overview
Explains the Federal Health Center program, with information relating to the statutory authority, program requirements, funding, location, patient populations, health outcomes, and more. Also discusses the Federally Qualified Health Center (FQHC) designation, and how this designation affects Medicare and Medicaid payment levels.
Date: 05/2017
Sponsoring organization: Congressional Research Service
view details
Explains the Federal Health Center program, with information relating to the statutory authority, program requirements, funding, location, patient populations, health outcomes, and more. Also discusses the Federally Qualified Health Center (FQHC) designation, and how this designation affects Medicare and Medicaid payment levels.
Date: 05/2017
Sponsoring organization: Congressional Research Service
view details
Public and Individual Health Insurance Trends in Rural Minnesota: Enrollment During Implementation of the Affordable Care Act
Report focuses on rural Minnesotans' enrollment in non-employer provided insurance coverage as impacted by the Affordable Care Act (ACA) since 2010. Includes a discussion of Medical Assistance and MinnesotaCare increases as well as the individual market. Data and statistics by county type (entirely rural, small town/rural mix, urban/small town/rural, entirely urban) also provided.
Date: 04/2017
Sponsoring organization: Minnesota Department of Health - Office of Rural Health and Primary Care
view details
Report focuses on rural Minnesotans' enrollment in non-employer provided insurance coverage as impacted by the Affordable Care Act (ACA) since 2010. Includes a discussion of Medical Assistance and MinnesotaCare increases as well as the individual market. Data and statistics by county type (entirely rural, small town/rural mix, urban/small town/rural, entirely urban) also provided.
Date: 04/2017
Sponsoring organization: Minnesota Department of Health - Office of Rural Health and Primary Care
view details
Finance in Rural and Urban Hospitals
Summary of the impact of the Affordable Care Act (ACA) on the insurance coverage rates and reimbursement methods in rural hospitals in Minnesota. Includes a discussion of public and private insurance programs, uncompensated care, and operating margins. Includes data and statistic comparisons for Critical Access Hospitals (CAHs), other rural hospitals, and urban hospitals.
Date: 04/2017
Sponsoring organization: Minnesota Department of Health - Office of Rural Health and Primary Care
view details
Summary of the impact of the Affordable Care Act (ACA) on the insurance coverage rates and reimbursement methods in rural hospitals in Minnesota. Includes a discussion of public and private insurance programs, uncompensated care, and operating margins. Includes data and statistic comparisons for Critical Access Hospitals (CAHs), other rural hospitals, and urban hospitals.
Date: 04/2017
Sponsoring organization: Minnesota Department of Health - Office of Rural Health and Primary Care
view details
Report to Congress on Medicaid and CHIP, March 2017
Reports on three aspects of Medicaid: Disproportionate Share Hospital (DSH) payments to states and providers, access to Medicaid, and children's coverage under CHIP. Chapter 2 includes the second annual report on DSH payments, which provide support to safety-net hospitals to help offset uncompensated care costs for Medicaid and uninsured patients. Table 2-1 identifies DSH spending for urban and rural hospitals and for Critical Access Hospitals. Chapter 3 examines state policies for distributing DSH payments to hospitals, including which states target rural or Critical Access Hospitals.
Date: 03/2017
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
view details
Reports on three aspects of Medicaid: Disproportionate Share Hospital (DSH) payments to states and providers, access to Medicaid, and children's coverage under CHIP. Chapter 2 includes the second annual report on DSH payments, which provide support to safety-net hospitals to help offset uncompensated care costs for Medicaid and uninsured patients. Table 2-1 identifies DSH spending for urban and rural hospitals and for Critical Access Hospitals. Chapter 3 examines state policies for distributing DSH payments to hospitals, including which states target rural or Critical Access Hospitals.
Date: 03/2017
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
view details
Global Budget Process as an Alternative Payment Model
Analyzes the all-payer hospital rate-setting system of McCready Health in rural Maryland. Discusses the Total Patient Revenue (TPR) system and corresponding essential functions such as rate setting, strategic planning, and care coordination.
Date: 03/2017
Sponsoring organization: Rural Health Value
view details
Analyzes the all-payer hospital rate-setting system of McCready Health in rural Maryland. Discusses the Total Patient Revenue (TPR) system and corresponding essential functions such as rate setting, strategic planning, and care coordination.
Date: 03/2017
Sponsoring organization: Rural Health Value
view details
MedPAC Report to the Congress: Medicare Payment Policy, 2017
Provides an annual review of Medicare payment policies, with recommendations to Congress. Includes discussions on Medicare payment policies that directly affect rural providers and beneficiaries. Analyses payment adequacy for home health, skilled nursing, long-term care hospitals, hospice, ambulatory surgical centers, and rehabilitation facilities.
Date: 03/2017
Sponsoring organization: Medicare Payment Advisory Commission
view details
Provides an annual review of Medicare payment policies, with recommendations to Congress. Includes discussions on Medicare payment policies that directly affect rural providers and beneficiaries. Analyses payment adequacy for home health, skilled nursing, long-term care hospitals, hospice, ambulatory surgical centers, and rehabilitation facilities.
Date: 03/2017
Sponsoring organization: Medicare Payment Advisory Commission
view details