Rural Healthcare Payment and Reimbursement – Resources
Selected recent or important resources focusing on Rural Healthcare Payment and Reimbursement.
April 2025 MedPAC Meeting Transcript
Transcript from the Medicare Payment Advisory Commission's (MedPAC) April 2025 meeting. Covers physician fee schedule updates and improving the accuracy of relative payment rates; structural differences between the stand-alone prescription drug plan (PDP) and Medicare Advantage–Prescription Drug plan (MA–PD) markets; the utilization and delivery of Medicare Advantage supplemental benefits; the effect of Medicare Advantage on rural hospitals; paying for software technologies in Medicare; access to hospice and certain services under the hospice benefit for beneficiaries with end-stage renal disease and beneficiaries with cancer; and regulations, star ratings, and fee-for-service Medicare policies aimed at improving nursing home quality.
Additional links: Exploring the Effect of Medicare Advantage on Rural Hospitals
Date: 04/2025
Sponsoring organization: Medicare Payment Advisory Commission
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Transcript from the Medicare Payment Advisory Commission's (MedPAC) April 2025 meeting. Covers physician fee schedule updates and improving the accuracy of relative payment rates; structural differences between the stand-alone prescription drug plan (PDP) and Medicare Advantage–Prescription Drug plan (MA–PD) markets; the utilization and delivery of Medicare Advantage supplemental benefits; the effect of Medicare Advantage on rural hospitals; paying for software technologies in Medicare; access to hospice and certain services under the hospice benefit for beneficiaries with end-stage renal disease and beneficiaries with cancer; and regulations, star ratings, and fee-for-service Medicare policies aimed at improving nursing home quality.
Additional links: Exploring the Effect of Medicare Advantage on Rural Hospitals
Date: 04/2025
Sponsoring organization: Medicare Payment Advisory Commission
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Most People in the Most Rural Counties Get Medicare Coverage from Traditional Medicare
Examines the percentage of eligible Medicare beneficiaries with traditional Medicare versus Medicare Advantage at the county level. Compares type of Medicare coverage by rural non-adjacent, rural adjacent, and urban county classification.
Author(s): Jeannie Fuglesten Biniek, Meredith Freed, Nolan Sroczynski, Tricia Neuman
Date: 04/2025
Sponsoring organization: KFF
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Examines the percentage of eligible Medicare beneficiaries with traditional Medicare versus Medicare Advantage at the county level. Compares type of Medicare coverage by rural non-adjacent, rural adjacent, and urban county classification.
Author(s): Jeannie Fuglesten Biniek, Meredith Freed, Nolan Sroczynski, Tricia Neuman
Date: 04/2025
Sponsoring organization: KFF
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Are HHC Scores a Reliable Health Status Indicator Across Rural and Urban Areas?
Examines differences in Centers for Medicare & Medicaid Services Hierarchical Condition Category (HCC) risk scores between rural and urban Medicare Fee-for-Service (FFS) beneficiaries and analyzes which factors drive observed differences. Features statistics with breakdowns by urban, large rural, small rural, and isolated rural areas for 4 chronic conditions in 2019-2020.
Author(s): Craig D. Holden, Alana Knudson, Marilyn Klug, Samantha Augenbraun, Shena Popat
Date: 04/2025
Sponsoring organization: ETSU/NORC Rural Health Research Center
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Examines differences in Centers for Medicare & Medicaid Services Hierarchical Condition Category (HCC) risk scores between rural and urban Medicare Fee-for-Service (FFS) beneficiaries and analyzes which factors drive observed differences. Features statistics with breakdowns by urban, large rural, small rural, and isolated rural areas for 4 chronic conditions in 2019-2020.
Author(s): Craig D. Holden, Alana Knudson, Marilyn Klug, Samantha Augenbraun, Shena Popat
Date: 04/2025
Sponsoring organization: ETSU/NORC Rural Health Research Center
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Advancing Value-Based Payment Policies Relevant to Rural Areas – Continued Challenges and New Opportunities
Discusses lessons from the recent public health emergency, rising health care costs, improved quality measurement, and innovative technologies on the transition from volume-based payment to value-based payment. Outlines potential policy opportunities for the Centers for Medicare & Medicaid Services (CMS) Innovation Center model design and CMS program inclusion to expand rural-appropriate opportunities to participate in the transition to value-based care. Builds on the 2020 publication How to Design Value‐based Care Models for Rural Participant Success: A Summit Findings Report.
Date: 04/2025
Sponsoring organization: Rural Health Value
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Discusses lessons from the recent public health emergency, rising health care costs, improved quality measurement, and innovative technologies on the transition from volume-based payment to value-based payment. Outlines potential policy opportunities for the Centers for Medicare & Medicaid Services (CMS) Innovation Center model design and CMS program inclusion to expand rural-appropriate opportunities to participate in the transition to value-based care. Builds on the 2020 publication How to Design Value‐based Care Models for Rural Participant Success: A Summit Findings Report.
Date: 04/2025
Sponsoring organization: Rural Health Value
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MedPAC Report to the Congress: Medicare Payment Policy, 2025
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.
Date: 03/2025
Sponsoring organization: Medicare Payment Advisory Commission
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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.
Date: 03/2025
Sponsoring organization: Medicare Payment Advisory Commission
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March 2025 MedPAC Meeting Transcript
Transcript from the Medicare Payment Advisory Commission's (MedPAC) March 2025 meeting. Covers research and proposals related to reforming physician fee schedule updates and improving the accuracy of relative payment rates, reducing beneficiary cost-sharing for outpatient services at Critical Access Hospitals, Medicare insurance agents, Medigap, payment for ground ambulance services, home healthcare use among Medicare Advantage enrollees, and institutional special needs plans. Includes rural references and considerations throughout.
Additional links: Mandated Report: Payment for Ground Ambulance Services, Reducing Beneficiary Cost-Sharing for Outpatient Services at Critical Access Hospitals
Date: 03/2025
Sponsoring organization: Medicare Payment Advisory Commission
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Transcript from the Medicare Payment Advisory Commission's (MedPAC) March 2025 meeting. Covers research and proposals related to reforming physician fee schedule updates and improving the accuracy of relative payment rates, reducing beneficiary cost-sharing for outpatient services at Critical Access Hospitals, Medicare insurance agents, Medigap, payment for ground ambulance services, home healthcare use among Medicare Advantage enrollees, and institutional special needs plans. Includes rural references and considerations throughout.
Additional links: Mandated Report: Payment for Ground Ambulance Services, Reducing Beneficiary Cost-Sharing for Outpatient Services at Critical Access Hospitals
Date: 03/2025
Sponsoring organization: Medicare Payment Advisory Commission
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February 2025 MACPAC Meeting Transcript
Transcript from the Medicaid and CHIP Payment and Access Commission's (MACPAC) February 2025 meeting. Covers transitions of care for children and youth with special healthcare needs (CYSHCN), hospital non-disproportionate share hospital supplemental payments and directed payment targeting, improving access to medications for opioid use disorder, healthcare access for children in foster care, and more. Includes rural references throughout.
Additional links: Hospital Non-DSH Supplemental Payment and Directed Payment Targeting Analyses
Date: 02/2025
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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Transcript from the Medicaid and CHIP Payment and Access Commission's (MACPAC) February 2025 meeting. Covers transitions of care for children and youth with special healthcare needs (CYSHCN), hospital non-disproportionate share hospital supplemental payments and directed payment targeting, improving access to medications for opioid use disorder, healthcare access for children in foster care, and more. Includes rural references throughout.
Additional links: Hospital Non-DSH Supplemental Payment and Directed Payment Targeting Analyses
Date: 02/2025
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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The Growing Impact of Medicare Advantage on Rural Hospitals Across America
Examines the impact of Medicare Advantage (MA) on rural hospitals. Discusses payment and reimbursement, healthcare access, hospital finance and patient data, hospital case examples, and more.
Date: 02/2025
Sponsoring organization: American Hospital Association
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Examines the impact of Medicare Advantage (MA) on rural hospitals. Discusses payment and reimbursement, healthcare access, hospital finance and patient data, hospital case examples, and more.
Date: 02/2025
Sponsoring organization: American Hospital Association
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Medicare Advantage Penetration and the Financial Distress of Rural Hospitals
Examines county-level Medicare Advantage (MA) penetration rates and the financial impact on rural hospitals. Utilizes 2014-2020 American Hospital Association data to analyze Medicare and non-Medicare inpatient days paid by the plans, with data breakdowns according to patient demographics, rural versus urban location, timing of inpatient stay, and more.
Author(s): Guido Cataife, Siying Liu
Citation: Health Economics Review, 15, 9
Date: 02/2025
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Examines county-level Medicare Advantage (MA) penetration rates and the financial impact on rural hospitals. Utilizes 2014-2020 American Hospital Association data to analyze Medicare and non-Medicare inpatient days paid by the plans, with data breakdowns according to patient demographics, rural versus urban location, timing of inpatient stay, and more.
Author(s): Guido Cataife, Siying Liu
Citation: Health Economics Review, 15, 9
Date: 02/2025
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Association of a State-Wide Alternative Payment Model for Rural Hospitals with Bypass for Elective Surgeries
Examines the impact of the payment model, Pennsylvania Rural Health Model (PARHM), on rural hospital bypass for elective surgeries. Utilizes 2016-2022 all-payer visit-level inpatient discharge data to measure 175,138 surgeries in Pennsylvania, with data on risk level of elective surgery, hospital type, payer type, and more.
Author(s): Donald S. Bourne, Zhaojun Sun, Bruce L. Jacobs, et al.
Citation: Health Services Research
Date: 01/2025
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Examines the impact of the payment model, Pennsylvania Rural Health Model (PARHM), on rural hospital bypass for elective surgeries. Utilizes 2016-2022 all-payer visit-level inpatient discharge data to measure 175,138 surgeries in Pennsylvania, with data on risk level of elective surgery, hospital type, payer type, and more.
Author(s): Donald S. Bourne, Zhaojun Sun, Bruce L. Jacobs, et al.
Citation: Health Services Research
Date: 01/2025
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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: 4/16/2025