Rural Healthcare Payment and Reimbursement – Resources

Factors Affecting the Development of Medicaid Hospital Payment Policies: Findings from Structured Interviews in Five States
Study examining Medicaid hospital payment policies with a focus on factors affecting payment mix and structure, the impact of state policies and financing methods, how states target hospital services or types such as rural hospitals, barriers to and drivers of change to payment methods, and more. Focuses on 5 states that made or are making significant hospital policy changes: Arizona, Louisiana, Michigan, Mississippi, and Virginia. Appendix B includes state profiles.
Author(s): Thomas Marks, Kathy Gifford, Steven Perlin, Melisa Byrd, Timothy Beger
Date: 10/2018
Type: Document
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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Innovation Center State-Based Initiatives: A Systematic Review of Lessons Learned
A synthesis of findings from 47 evaluation reports covering 12 Center for Medicare & Medicaid Innovation models with a state component. Includes information on the impact of models for rural areas and identifies barriers and challenges faced in rural areas.
Date: 08/2018
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, L&M Policy Research
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The Medicaid Fee-for-Service Provider Payment Process
Outlines Medicaid's fee-for-services (FFS) provider payment process. Details the claims-based submission payment process, as well as additional non-claims-based payment processes. Includes information targeted to Rural Health Clinics and Federally Qualified Health Centers throughout.
Date: 07/2018
Type: Document
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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Medicaid Payment Policy for Federally Qualified Health Centers
Describes the role of Federally Qualified Health Centers (FQHCs) in Medicaid, and highlights current policy issues related to Medicaid FQHC payment. Also discusses the Medicaid FQHC prospective payment system (PPS), alternative payment methodologies, how FQHCs participate in managed care networks, and states' desire for increased flexibility in setting FQHC payment rates.
Date: 12/2017
Type: Document
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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ACO Primary Care Flex Model
Provides information on the Centers for Medicare & Medicaid Services (CMS) Innovation Center's ACO Primary Care Flex Model, which will test how prospective payments and increased funding for primary care in accountable care organizations (ACOs) impact health outcomes, quality, and costs of care. Aims to increase the number of low-revenue ACOs participating in the Medicare Shared Savings Program (SSP), including ACOs serving rural and underserved populations.
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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ACO Primary Care Flex Model: Model Overview Factsheet
Describes the ACO Primary Care Flex Model from the CMS Innovation Center including purpose and goals, eligibility and participation criteria, payment overview, and application and timeline. Includes information for Federally Qualified Health Centers and Rural Health Clinics.
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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CMS Cross Cutting Initiative: Rural Health
A fact sheet that provides examples of how the Centers for Medicare & Medicaid Services (CMS) is working to eliminate disparities in rural healthcare access related to workforce shortages, facility closures, and infrastructure issues. Discusses innovative healthcare payment models from 2023 that address barriers to value-based care in rural healthcare delivery.
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model
Provides information on the Centers for Medicare & Medicaid Services (CMS) Innovation Center's States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model, a voluntary state total cost of care model that will test state accountability for controlling overall growth in health expenditures while increasing investment in primary care and improving population health outcomes.
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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State Medicaid Links
Provides links to state Medicaid agency websites, including pages for state contacts, eligibility, and enrollment information.
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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Medicare Shared Savings Program
Provides an overview of the Medicare Shared Savings Program. Offers links to program resources, including application information, program data, and program statutes and regulations.
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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