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Rural Healthcare Payment and Reimbursement – Resources

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

Shared Savings Program Fast Facts
Provides summary statistics on the Medicare Shared Savings Program as of January 1, 2024. Offers data on the number of Accountable Care Organizations (ACOs), assigned beneficiaries, total earned shared savings, and quality scores each year since 2012; the number and percent of ACOs in each track; and more. Includes information on ACO participants, including the number of Rural Health Clinics (RHCs) and Critical Access Hospitals (CAHs) participating in the program.
Date: 01/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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What States Can Learn from Maryland's Experience with Hospital Global Budgeting
Podcast episode exploring lessons learned from Maryland's hospital global budgeting model. Includes a discussion on small and rural hospitals' financial sustainability and their involvement in the model, as well as comparisons to the Pennsylvania Rural Health Model and the Vermont All-Payer Accountable Care Organization (ACO) Model.
Date: 01/2024
Type: Audio
Sponsoring organization: Mathematica
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January 2024 MedPAC Meeting Transcript
Transcript from the Medicare Payment Advisory Commission's (MedPAC) January 2024 meeting. Covers payment adequacy and updates for physician and other health professional services, hospital inpatient and outpatient services, outpatient dialysis services, hospice services, skilled nursing facility services, home health agency services, and inpatient rehabilitation facility services. Discusses status reports on ambulatory surgical centers, Medicare Part D, and the Medicare Advantage program, as well as policy options for standardized benefits in Medicare Advantage plans. Includes rural references and considerations throughout.
Date: 01/2024
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Evaluation of the Next Generation Accountable Care Organization (NGACO) Model: Final Report
Sixth and final evaluation report on the Next Generation Accountable Care Organization (NGACO) Model. Summarizes findings from across all six performance years (2016-2021) and explores how participating entities responded to the model and how they did or did not achieve model goals. Presents information on cumulative model-wide impacts on Medicare spending, utilization, and quality of care; variations in model outcomes by organization characteristics; spending patterns of beneficiaries served by NGACOs; population health strategies and pathways to reduced spending; lessons learned; and more. The appendices include data on community and beneficiary characteristics, including rurality.
Additional links: Findings at a Glance, Technical Appendices
Date: 01/2024
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, NORC at the University of Chicago
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Alternative Payment Models in the Quality Payment Program as of December 2023
A set of three tables that list brief information about Alternative Payment Models (APMs) that the Centers for Medicare and Medicaid Services (CMS) operates or has announced, as of December 2023. Identifies Advanced APMs, Merit Based Incentive Program (MIPs) APMs, and Other Payer Advanced APMs, which include Medicaid Other Payer Advanced APMs, Medicare Health Plan Payment Arrangements, and commercial payment arrangements.
Date: 12/2023
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Independent Evaluation of Comprehensive Primary Care Plus (CPC+): Final Annual Report
Reports on the Comprehensive Primary Care Plus (CPC+) model, a CMS primary care payment and delivery reform effort that ran from 2017-2021. Outlines key findings from the model, including CPC+ supports to practices, care delivery changes made by practices, impacts on outcomes for Medicare fee-for-service beneficiaries, and implications for primary care models. Describes the experiences of payers, practices, health IT vendors, and patients. Includes rural references throughout.
Additional links: Appendices to the Final Report, Volume 1, Appendices to the Final Report, Volume 2, Findings at a Glance
Date: 12/2023
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, Mathematica
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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: 12/2023
Type: Document
Sponsoring organization: Rural Health Value
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Uncompensated Care is Highest for Rural Hospitals, Particularly in Non-Expansion States
Analyzes uncompensated care and hospital operating expense data to explore trends over time, the role of Medicaid expansion, and the impact on rural hospitals. Includes state-by-state comparisons as well as rural and urban comparisons.
Author(s): Emmaline Keesee, Susie Gurzenda, Kristie Thompson, George H. Pink
Citation: Medical Care Research and Review, 81(2), 164-170
Date: 11/2023
Type: Document
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Final Rule for CY 2024 Physician Fee Schedule: Fact Sheet
Fact sheet covering Centers for Medicare & Medicaid Services (CMS) telehealth policy changes for 2024 as outlined in the final calendar year (CY) 2024 Physician Fee Schedule. Covers eligible services that can be delivered by telehealth, remote monitoring services, physician supervision, diabetes self-management training (DSMT), and more.
Date: 11/2023
Type: Document
Sponsoring organization: Center for Connected Health Policy: The National Telehealth Policy Resource Center
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Hospital Outpatient Prospective Payment System (OPPS): Remedy for the 340B-Acquired Drug Payment Policy for Calendar Years 2018-2022 Final Rule (CMS 1793-F)
Fact sheet providing an overview of the Centers for Medicare & Medicaid Services (CMS) final rule describing the agency's actions to remedy payment cuts to certain hospitals that participate in the 340B Drug Pricing Program from 2018-2022 that were declared unlawful by the Supreme Court's decision in American Hospital Association v. Becerra, 142 S. Ct. 1896 (2022). Details the one-time lump sum payments to affected 340B covered entities to what they would have been paid had the 340B payment cuts not been applied, as well as a 0.5% payment reduction on future non-drug item and service payments to maintain budget neutrality beginning in calendar year 2026.
Date: 11/2023
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Last Updated: 1/29/2024