Rural Healthcare Payment and Reimbursement – Resources
Selected recent or important resources focusing on Rural Healthcare Payment and Reimbursement.
State-Driven Initiatives to Support Moving to Value-Based Care in the Era of COVID-19
Describes four areas where state-driven strategies can facilitate and promote the adoption of value-based payment (VBP) models. Presents case examples throughout, including the Pennsylvania Rural Health Model. Discusses how additional federal actions could support transitions to VBP at the state level.
Author(s): Caroline Picher, Lauren Block, Mark Japinga, Hemi Tewarson
Date: 03/2021
Sponsoring organizations: Duke-Margolis Center for Health Policy, National Governors Association
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Describes four areas where state-driven strategies can facilitate and promote the adoption of value-based payment (VBP) models. Presents case examples throughout, including the Pennsylvania Rural Health Model. Discusses how additional federal actions could support transitions to VBP at the state level.
Author(s): Caroline Picher, Lauren Block, Mark Japinga, Hemi Tewarson
Date: 03/2021
Sponsoring organizations: Duke-Margolis Center for Health Policy, National Governors Association
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How to Design Value‐based Care Models for Rural Participant Success: A Summit Findings Report
Summarizes a July 2020 virtual summit of rural participants in value‐based care (VBC) models and programs. Details six themes on VBC model design, implementation, and operation that can influence rural organization participation in VBC models. Provides recommendations for VBC model designers to improve rural healthcare provider participation and success in VBC models.
Author(s): Keith Mueller, Clint MacKinney, Jennifer Lundblad, Karla Weng
Date: 12/2020
Sponsoring organization: Rural Health Value
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Summarizes a July 2020 virtual summit of rural participants in value‐based care (VBC) models and programs. Details six themes on VBC model design, implementation, and operation that can influence rural organization participation in VBC models. Provides recommendations for VBC model designers to improve rural healthcare provider participation and success in VBC models.
Author(s): Keith Mueller, Clint MacKinney, Jennifer Lundblad, Karla Weng
Date: 12/2020
Sponsoring organization: Rural Health Value
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Evaluation of the Accountable Care Organization Investment Model: Final Report
Examines the ACO Investment Model (AIM) over three performance years. AIM tested the use of prepaid shared savings to encourage new ACOs to form in rural and underserved areas and to encourage current Medicare Shared Savings Program ACOs to transition to arrangements with greater financial risk. Reports on AIM results related to ACO formation, risk-taking, and sustainability, including the impact of rurality. Also discusses impacts on healthcare costs, utilization, and quality of care.
Additional links: Appendices, CMS Perspective Report, Findings at a Glance
Date: 09/2020
Sponsoring organizations: Abt Associates, Centers for Medicare and Medicaid Services
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Examines the ACO Investment Model (AIM) over three performance years. AIM tested the use of prepaid shared savings to encourage new ACOs to form in rural and underserved areas and to encourage current Medicare Shared Savings Program ACOs to transition to arrangements with greater financial risk. Reports on AIM results related to ACO formation, risk-taking, and sustainability, including the impact of rurality. Also discusses impacts on healthcare costs, utilization, and quality of care.
Additional links: Appendices, CMS Perspective Report, Findings at a Glance
Date: 09/2020
Sponsoring organizations: Abt Associates, Centers for Medicare and Medicaid Services
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Evaluation of the Health Care Innovation Awards, Round 2: Final Report
Summarizes the final evaluation results of 38 Health Care Innovation Awards Round Two projects. Discusses program impacts on healthcare service use and costs, factors associated with positive impacts, and awardees' experiences sustaining programs and implementing payment models after the end of the awards. Offers overall findings and awardee-specific evaluation reports. Includes some information on results for projects serving rural areas.
Additional links: Findings at a Glance
Date: 09/2020
Sponsoring organizations: Centers for Medicare and Medicaid Services, Mathematica Policy Research
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Summarizes the final evaluation results of 38 Health Care Innovation Awards Round Two projects. Discusses program impacts on healthcare service use and costs, factors associated with positive impacts, and awardees' experiences sustaining programs and implementing payment models after the end of the awards. Offers overall findings and awardee-specific evaluation reports. Includes some information on results for projects serving rural areas.
Additional links: Findings at a Glance
Date: 09/2020
Sponsoring organizations: Centers for Medicare and Medicaid Services, Mathematica Policy Research
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The Impact of Medicare's Rural Add-on Payments on Supply of Home Health Agencies Serving Rural Counties
Examines how Medicare rural add-on payments affected the number of home health agencies serving rural counties between 2002-2017. Compares the population-adjusted number of home health agencies in urban, urban-adjacent non-urban-adjacent rural counties during periods with add-on payments and without add-on payments. Discusses implications for revised and future add-on payments to maintain or increase the supply of rural home health agencies.
Author(s): Tracy M. Mroz, Davis G. Patterson, Bianca K. Frogner
Citation: Health Affairs, 39(6), 949-957
Date: 06/2020
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Examines how Medicare rural add-on payments affected the number of home health agencies serving rural counties between 2002-2017. Compares the population-adjusted number of home health agencies in urban, urban-adjacent non-urban-adjacent rural counties during periods with add-on payments and without add-on payments. Discusses implications for revised and future add-on payments to maintain or increase the supply of rural home health agencies.
Author(s): Tracy M. Mroz, Davis G. Patterson, Bianca K. Frogner
Citation: Health Affairs, 39(6), 949-957
Date: 06/2020
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Medicaid: State Views on Program Administration Challenges
Describes four federal Medicaid policies that pose barriers to effective program administration. Highlights the requirement for states to pay Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) under the prospective payment system as a challenge for states. Identifies three issues for federal policymakers to consider when addressing these administrative challenges.
Additional links: Full Report
Date: 04/2020
Sponsoring organization: Government Accountability Office
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Describes four federal Medicaid policies that pose barriers to effective program administration. Highlights the requirement for states to pay Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) under the prospective payment system as a challenge for states. Identifies three issues for federal policymakers to consider when addressing these administrative challenges.
Additional links: Full Report
Date: 04/2020
Sponsoring organization: Government Accountability Office
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Second Report to Congress: Social Risk Factors and Performance in 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: Executive Summary
Date: 03/2020
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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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: Executive Summary
Date: 03/2020
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Estimate of Federal Payment Reductions to Hospitals Following the ACA: 2010-2029: Estimates and Methodology
Estimates the reduction in Medicare hospital payments due to sequestration from 2010 to 2029, not including reductions enacted under the Affordable Care Act (ACA). Demonstrates how other legislative acts and regulatory changes by the Centers for Medicare and Medicaid Services (CMS) reduced federal payments to hospitals over the same period. Highlights how reductions in Medicare payments for bad debt impacted Critical Access Hospitals (CAHs).
Date: 10/2019
Sponsoring organizations: American Hospital Association, Federation of American Hospitals
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Estimates the reduction in Medicare hospital payments due to sequestration from 2010 to 2029, not including reductions enacted under the Affordable Care Act (ACA). Demonstrates how other legislative acts and regulatory changes by the Centers for Medicare and Medicaid Services (CMS) reduced federal payments to hospitals over the same period. Highlights how reductions in Medicare payments for bad debt impacted Critical Access Hospitals (CAHs).
Date: 10/2019
Sponsoring organizations: American Hospital Association, Federation of American Hospitals
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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
Sponsoring organizations: Centers for Medicare and Medicaid Services, L&M Policy Research
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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
Sponsoring organizations: Centers for Medicare and Medicaid Services, L&M Policy Research
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Rural Health Value: Policy Documents and Demonstrations
Summaries of selected rural health demonstration programs and rural aspects of payment policies.
Sponsoring organization: Rural Health Value
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Summaries of selected rural health demonstration programs and rural aspects of payment policies.
Sponsoring organization: Rural Health Value
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Additional resources are available related to this guide. See the full list of resources by topic for:
- Accountable Care Organizations
- Care coordination
- Health insurance
- Healthcare business and finance
- Medicaid
- Medicare
- Policy
- Reimbursement and payment models
- Service delivery models
Last Updated: 1/21/2025