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Rural Healthcare Payment and Reimbursement – Resources

Selected recent or important resources focusing on Rural Healthcare Payment and Reimbursement.

Environmental Scan on Developing and Implementing Performance Measures for Population-Based Total Cost of Care (PB-TCOC) Models
Presents results of an environmental scan regarding the development and implementation of population-based total cost of care (PB-TCOC) payment models. Describes types of performance measures used in value-based payment models and pay-for-reporting programs, data sources used for constructing performance measures, features of PB-TCOC models, challenges in developing and implementing performance measures and opportunities for Alternative Payment Models (APMs) and PB-TCOC models to address these challenges, trends in existing performance measures across several Center for Medicare and Medicaid Innovation (CMMI) models and Medicare value-based care programs, and more. Includes rural references and considerations throughout.
Date: 03/2024
Type: Document
Sponsoring organizations: HHS Office of the Assistant Secretary for Planning and Evaluation, NORC at the University of Chicago
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March 2024 MedPAC Meeting Transcript
Transcript from the Medicare Payment Advisory Commission's (MedPAC) March 2024 meeting. Covers proposed approaches and research topics related to evaluating rural hospital and clinician payment policies, an assessment of the completeness of Medicare Advantage (MA) encounter data and other sources of information about MA enrollees' healthcare utilization, a preliminary analysis of MA quality, the Acute Hospital Care at Home program, and Medicare inpatient psychiatric service trends and issues.
Additional links: Rural Hospital and Clinician Payment Policy: A Workplan for 2024–2025 - Presentation Slides
Date: 03/2024
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Report to Congress on Medicaid and CHIP, March 2024
Reports on three aspects of Medicaid of interest to Congress: 1) improving the Medicaid beneficiary experience through Medical Care Advisory Committees (MCACs) and federal government actions to aid states, 2) increasing the transparency and improving the monitoring of the denials and appeals process in Medicaid managed care, and 3) reviewing hospital payment policy for the nation's safety-net hospitals. Chapter 3 examines the relationship between disproportionate share hospital (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 3-1 details DSH spending for urban and rural hospitals and for Critical Access Hospitals.
Date: 03/2024
Type: Document
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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MedPAC Report to the Congress: Medicare Payment Policy, 2024
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 Medicare fee-for-service payment systems, Medicare Advantage (MA), and Medicare Part D. Includes two mandated reports on special needs plans for beneficiaries dually eligible for Medicare and Medicaid and the Rural Emergency Hospital (REH) designation.
Date: 03/2024
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Use of In-Network Insurance Benefits Is Critical for Improving Retention in Telehealth-Based Buprenorphine Treatment
Evaluated 3,842 patients in an opioid use disorder (OUD) telehealth company to identify associations in insurance status and treatment program retention. Patient characteristic data includes breakdown by urbanicity, age, gender, race and ethnicity, buprenorphine status, and more.
Author(s): Arthur Robin Williams, Christopher Row, Lexie Minarik, et al.
Citation: Health Affairs Scholar, 2(3)
Date: 03/2024
Type: Document
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Catalog of Value-Based Initiatives for Rural Providers
Summarizes rural-relevant, value-based programs currently or recently implemented by the U.S. Department of Health and Human Services (HHS), including the Centers for Medicare and Medicaid Services (CMS) and the CMS Innovation Center. Designed to help rural healthcare leaders identify HHS value-based programs that are suitable for rural participation. Contains descriptions of each demonstration and provides direct links to the corresponding agency web page.
Date: 03/2024
Type: Document
Sponsoring organization: Rural Health Value
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Value-Based Care Assessment Tool
Online tool that assesses 80 different value-based care capacities in eight categories and creates a value-based care readiness report that can be used to support strategic planning. Tool is designed to be used by your healthcare organization's senior leadership team.
Date: 02/2024
Type: Tool
Sponsoring organization: Rural Health Value
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AHIP Value-Based Care Workgroup
Presentation slides from a January 23, 2024, presentation to the AHIP Value-Based Care Workgroup. Provides an overview of rural healthcare. Discusses rural-relevant engagement and rural value-based care and payment model design considerations. Highlights examples of rural providers successfully participating in value-based payment programs, including Medicare Shared Savings Programs and Accountable Care Organizations (ACOs).
Date: 01/2024
Type: Presentation Slides
Sponsoring organization: Rural Health Value
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States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model
Recording of a January 29, 2024, webinar regarding the Centers for Medicare & Medicaid Services' States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model. Discusses the AHEAD Model's timeline, key elements, opportunities, and requirements from a rural perspective. Identifies potential implications for rural hospital and primary care participation.
Additional links: Presentation Slides
Author(s): Clint MacKinney
Date: 01/2024
Type: Document
Sponsoring organization: Rural Health Value
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The Effects of Medicare Advantage on Rural Hospitals With St. Bernards Healthcare
Podcast episode featuring a discussion with Chris Barber, president and CEO of St. Bernards Healthcare, which serves communities in Arkansas and Missouri. Describes how certain Medicare Advantage plan practices can create problems for rural hospitals, health systems, and patients.
Date: 01/2024
Type: Audio
Sponsoring organization: American Hospital Association
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Last Updated: 3/27/2024