Skip to main content

Rural Health
Resources by Topic: Reimbursement and payment models

Medicaid and CHIP in the Commonwealth of the Northern Mariana Islands
Summarizes key requirements and design features of Medicaid and the State Children's Health Insurance Program (CHIP) in the Northern Mariana Islands. Features statistics on program costs from fiscal years 2011-2019, with breakdowns by federal spending and Northern Mariana Islands spending.
Date: 04/2020
Type: Document
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
view details
Surviving COVID-19 as a Rural Health Clinic: New Federal Policies & Programs to Help Keep Your Clinic Open
Webinar recording providing an in-depth presentation on the federal initiatives supporting Rural Health Clinics (RHCs) during the COVID-19 pandemic given by the National Association of Rural Health Clinics' Bill Finerfrock, Executive Director and Nathan Baugh, Director of Government Relations.
Additional links: Webinar Slides
Date: 04/2020
Type: Presentation Slides
Sponsoring organization: National Association of Rural Health Clinics
view details
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
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
view details
Crosswalk: CMS Interim Final Rule & Published CMS Guidances
Provides an overview of key provisions in the March 2020 Centers for Medicare and Medicaid Services' interim final rule on telehealth policy and related, previously issued guidance in response to the COVID-19 pandemic. Covers coding issues and expansion of telehealth in Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs), among other topics.
Date: 04/2020
Type: Document
Sponsoring organization: Center for Connected Health Policy: The National Telehealth Policy Resource Center
view details
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
Type: Document
Sponsoring organization: American Hospital Association
view details
Telehealth Coverage Policies in the Time of COVID-19
Summary of telehealth services that are covered by various public and private payers related to COVID-19. Includes information on state and federal actions. Updated with new information and new policies as the situation develops.
Additional links: COVID-19 Related State Actions
Date: 04/2020
Type: Website
Sponsoring organization: Center for Connected Health Policy: The National Telehealth Policy Resource Center
view details
Merit-Based Incentive Payment System (MIPS) 101 Guide: 2019 Performance Year
Provides an overview of the Merit-based Incentive Payment System (MIPS) track for clinicians participating in Medicare, one of two options under the Quality Payment Program. Details the 4 performance categories that are weighted as part of MIPS scoring: quality, cost, improvement activities, and promoting interoperability. Addresses calculation of the low-volume threshold exclusion, opt-in options, and the impact of special statuses such as rural practice.
Date: 04/2020
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
view details
Second Report to Congress on Social Risk and 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: Full Report
Date: 03/2020
Type: Document
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
view details
Interim Evaluation of California's Public Hospital Redesign and Incentives in Mediā€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
Type: Document
Sponsoring organizations: California Department of Health Care Services, UCLA Center for Health Policy Research
view details
Medicaid State Plan Fee-for-Service Payments for Services Delivered Via Telehealth
Explains state policy options for paying Medicaid providers that use telehealth to deliver services, with the goal of increasing access to care in response to the COVID-19 pandemic.
Date: 03/2020
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
view details