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Rural Healthcare Payment and Reimbursement – Resources

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

Calendar Year (CY) 2024 Medicare Physician Fee Schedule Final Rule
Fact sheet providing an overview of the Centers for Medicare & Medicaid Services (CMS) final rule regarding updates and changes to the Medicare payments under the Physician Fee Schedule (PFS) and other Medicare Part B issues for calendar year 2024. Summarizes provisions related to paying separately for Community Health Integration, Social Determinants of Health (SDOH) Risk Assessment, and Principal Illness Navigation services; telehealth services; mental health visits furnished by Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs), including marriage and family therapists and mental health counselors as eligible for payment at RHCs and FQHCs; and more.
Date: 11/2023
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Health Panel Comment Letter – Encouraging Rural Participation in Population-Based Total Cost of Care Models
Offers comments in response to the Physician-Focused Payment Model Technical Advisory Committee (PTAC) Request for Information regarding rural participation in population-based total cost of care models. Covers considerations for determining the most relevant definition of rural, barriers that impact rural providers' participation in alternative payment models (APMs), service delivery models and resources that are effective in encouraging value-based care (VBC) transformation in rural areas, and more.
Date: 10/2023
Type: Document
Sponsoring organization: Rural Policy Research Institute Rural Health Panel
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State Telehealth Laws and Reimbursement Policies Report, Fall 2023
Provides an overview of state telehealth policies as of early September 2023. Covers Medicaid reimbursement, private payer laws, and professional requirements.
Additional links: Executive Summary, Infographic, State Summary Chart
Date: 10/2023
Type: Document
Sponsoring organization: Center for Connected Health Policy: The National Telehealth Policy Resource Center
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MedPAC Payment Basics
Series of briefs providing an of Medicare payment systems. Covers payments systems including Accountable Care Organizations (ACO), Critical Access Hospitals (CAH), Federally Qualified Health Centers and Rural Health Clinics, hospital acute inpatient services, and more.
Date: 10/2023
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Environmental Scan on Encouraging Rural Participation in Population-Based TCOC Models
Presents results of an environmental scan regarding population-based total cost of care (PB-TCOC) payment models and encouraging rural participation in these models. Describes challenges affecting rural patients and providers; opportunities for alternative payment models (APMs) and PB-TCOC models to address challenges in rural areas; trends in rural providers' participation in APMs; driving care delivery transformation in rural providers, including models that include or target rural participants in their model designs; leveraging financial incentives to improve rural health care; adoption and use of health information technology, including telehealth and data analytics among rural providers; and the measurement of rural providers' performance in APMs.
Date: 09/2023
Type: Document
Sponsoring organizations: HHS Office of the Assistant Secretary for Planning and Evaluation, NORC at the University of Chicago
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Sustaining Essential Rural Health Services Through Changes in Payment and Related Public Policies
Presentation slides that discuss payment policies and models, Medicare and Medicaid, Accountable Care Organizations (ACOs), commercial plans, value-based care, and more, with data and maps illustrating impacts in specific areas.
Author(s): Keith J. Mueller
Date: 09/2023
Type: Presentation Slides
Sponsoring organizations: Iowa Department of Health Management and Policy, Rural Policy Research Institute
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The Pennsylvania Rural Health Model (PARHM): Third Annual Evaluation Report
Evaluates the third performance year of the Pennsylvania Rural Health Model (PARHM), an initiative designed to test if global budgets can help rural hospitals improve their financial viability, provide flexibility to meet locally defined community health needs, and reduce overall healthcare spending. Provides an overview of the model and describes the implementation experience of participating hospitals and payers. Presents a descriptive quantitative assessment of financial performance, spending and utilization, access to care, and quality of care outcomes from 2016, the model's baseline, through 2021. Includes three case studies discussing three themes: the recruitment and retention of system-affiliated hospitals, engagement and coordination with community organizations and providers, and exploring service line changes.
Additional links: Appendix, Findings at a Glance
Date: 09/2023
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, NORC at the University of Chicago
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Health Panel Comment Letter - 2024 Physician Fee Schedule and Medicare Part B Proposed Rule
Comments offered in response to a July 13, 2023, Federal Register proposed rule revising the Medicare Physician Fee Schedule. Includes discussions on telehealth services, services addressing health-related social needs, advancing access to behavioral health services, Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs), and the Medicare Shared Savings Program.
Date: 09/2023
Type: Document
Sponsoring organization: Rural Policy Research Institute Rural Health Panel
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MedPAC Comment on CMS's Proposed Rule on the Outpatient Prospective Payment System for FY 2024
Comment on the July 31, 2023, Federal Register proposed rule revising the physician fee schedule to improve Medicare Hospital Outpatient Prospective Payment System (OPPS) and Medicare Ambulatory Surgical Center (ACS) payments for calendar year 2024. Includes discussions on extending the use of the hospital market basket to update ASC payment rates, a proposed quality measure for emergency department visits in Rural Emergency Hospitals (REHs), and more.
Date: 09/2023
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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MedPAC Comment on CMS's Proposed Rule on the Physician Prospective Payment System for FY 2024
Comment on the August 7, 2023, Federal Register proposed rule revising the physician fee schedule to improve payment systems for physicians and other Medicare Part B revisions. Includes discussions on payment rates for Medicare telehealth services; the Medicare Shared Savings Program, including regional adjustments; incorporating Medicare Advantage data into public reporting; and more.
Date: 09/2023
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Last Updated: 2/16/2024