Rural Healthcare Payment and Reimbursement – Resources
Selected recent or important resources focusing on Rural Healthcare Payment and Reimbursement.
Rural Hospitals Must Keep up with Innovation to Remain Viable
Describes changes to the healthcare market environment, including technology, telehealth, services offered by retailers and large corporations, and declining patient volume. Outlines priorities for Critical Access Hospitals to remain viable, including the transition to population-based payment. Details a transition framework to guide hospitals as they move to a population-based payment system and navigate a changing environment.
Date: 01/2023
Sponsoring organization: Stroudwater Associates
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Describes changes to the healthcare market environment, including technology, telehealth, services offered by retailers and large corporations, and declining patient volume. Outlines priorities for Critical Access Hospitals to remain viable, including the transition to population-based payment. Details a transition framework to guide hospitals as they move to a population-based payment system and navigate a changing environment.
Date: 01/2023
Sponsoring organization: Stroudwater Associates
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Evaluation of the Rural Community Hospital Demonstration: Interim Report Two (Covering 2016-2018)
Provides an overview of the Rural Community Hospital Demonstration (RCHD). Describes the characteristics of RCHD participants as of fiscal year 2018, the Medicare payments received under the program, and the impact of the RCHD on hospital financial measures. Examines whether hospitals that continued to participate in the RCHD under the 21st Century Cures Act (CCA) extension experienced additional changes to their financial condition, as well as the impact of the program on hospitals that joined the demonstration for the first time under the CCA extension.
Additional links: Findings at a Glance
Date: 12/2022
Sponsoring organizations: American Institutes for Research, Centers for Medicare and Medicaid Services
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Provides an overview of the Rural Community Hospital Demonstration (RCHD). Describes the characteristics of RCHD participants as of fiscal year 2018, the Medicare payments received under the program, and the impact of the RCHD on hospital financial measures. Examines whether hospitals that continued to participate in the RCHD under the 21st Century Cures Act (CCA) extension experienced additional changes to their financial condition, as well as the impact of the program on hospitals that joined the demonstration for the first time under the CCA extension.
Additional links: Findings at a Glance
Date: 12/2022
Sponsoring organizations: American Institutes for Research, Centers for Medicare and Medicaid Services
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The Evolution of Hospital Designations and Payment in the U.S.: Implications for Rural Hospitals
Provides a history and overview of Medicare hospital payment polices as well as alternative payment models and their impact on rural facilities. Discusses the context in which rural hospitals serve patients, rural hospital payment provisions and designations, and current federal payment models that impact rural hospitals.
Author(s): Onyinye Oyeka, Clinton MacKinney, Keith J. Mueller
Date: 12/2022
Sponsoring organization: Rural Policy Research Institute Rural Health Panel
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Provides a history and overview of Medicare hospital payment polices as well as alternative payment models and their impact on rural facilities. Discusses the context in which rural hospitals serve patients, rural hospital payment provisions and designations, and current federal payment models that impact rural hospitals.
Author(s): Onyinye Oyeka, Clinton MacKinney, Keith J. Mueller
Date: 12/2022
Sponsoring organization: Rural Policy Research Institute Rural Health Panel
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Mandated Analysis of Home Health Service Utilization From January 2016 Through March 2022
Report evaluates the distribution of rural add-on payments for home health claims. Examines the results of the Centers for Medicare and Medicaid Services's new rural add-on methodology aimed at providing higher add-on percentages for "low population density" categories and explores the effect this methodology has had on "high utilization" categories. Makes comments and recommendations as to how this methodology can be adjusted.
Additional links: Report in Brief
Date: 12/2022
Sponsoring organization: Office of Inspector General (HHS)
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Report evaluates the distribution of rural add-on payments for home health claims. Examines the results of the Centers for Medicare and Medicaid Services's new rural add-on methodology aimed at providing higher add-on percentages for "low population density" categories and explores the effect this methodology has had on "high utilization" categories. Makes comments and recommendations as to how this methodology can be adjusted.
Additional links: Report in Brief
Date: 12/2022
Sponsoring organization: Office of Inspector General (HHS)
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Medicaid Population-Based Payment: The Current Landscape, Early Insights, and Considerations for Policymakers
Provides an overview of population-based payment (PBP) models and the Medicaid PBP landscape. Identifies promising strategies for designing and implementing PBPs in Medicaid and considerations for state and federal policymakers who want to support these programs. Highlights state PBP approaches, including the Pennsylvania Rural Health Model.
Author(s): Rob Houston, Anne Smithey, Kelsey Brykman
Date: 11/2022
Sponsoring organization: Center for Health Care Strategies
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Provides an overview of population-based payment (PBP) models and the Medicaid PBP landscape. Identifies promising strategies for designing and implementing PBPs in Medicaid and considerations for state and federal policymakers who want to support these programs. Highlights state PBP approaches, including the Pennsylvania Rural Health Model.
Author(s): Rob Houston, Anne Smithey, Kelsey Brykman
Date: 11/2022
Sponsoring organization: Center for Health Care Strategies
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A Global Equity Model (GEM) for the Advancement of Community Health and Health Equity
Provides an overview of existing and emerging payment systems and their roles in promoting community health and health equity. Proposes a global payment model for health systems' inpatient, emergency department (ED), and outpatient sites of care with community health and health equity as its organizing features. Includes information on the Pennsylvania Rural Health Model, the ACO REACH model, and other rural-relevant payment models.
Author(s): Anaeze C. Offodile II, Jason B. Gibbons, Samantha Murrell, Donna Kinzer, Joshua M. Sharfstein
Date: 11/2022
Sponsoring organization: National Academy of Medicine
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Provides an overview of existing and emerging payment systems and their roles in promoting community health and health equity. Proposes a global payment model for health systems' inpatient, emergency department (ED), and outpatient sites of care with community health and health equity as its organizing features. Includes information on the Pennsylvania Rural Health Model, the ACO REACH model, and other rural-relevant payment models.
Author(s): Anaeze C. Offodile II, Jason B. Gibbons, Samantha Murrell, Donna Kinzer, Joshua M. Sharfstein
Date: 11/2022
Sponsoring organization: National Academy of Medicine
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CY 2023 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule (CMS 1772-FC) Rural Emergency Hospitals — New Medicare Provider Type
Provides an overview of Rural Emergency Hospitals, a Medicare provider type established by the Consolidated Appropriations Act, 2021. Details key policies outlined in the Calendar Year 2023 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Final Rule, including payment policies, conditions of participation, REH provider enrollment, and exceptions to the physician self-referral law.
Date: 11/2022
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides an overview of Rural Emergency Hospitals, a Medicare provider type established by the Consolidated Appropriations Act, 2021. Details key policies outlined in the Calendar Year 2023 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Final Rule, including payment policies, conditions of participation, REH provider enrollment, and exceptions to the physician self-referral law.
Date: 11/2022
Sponsoring organization: Centers for Medicare and Medicaid Services
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October 2022 MACPAC Meeting Transcript
Transcript from the Medicaid and CHIP Payment and Access Commission's (MACPAC) October 2022 meeting. Covers Medicaid race and ethnicity data collection and reporting, improving access to Medicaid coverage and care for adults leaving incarceration, the unwinding of the Public Health Emergency, streamlining the delivery of home- and community-based services, potential recommendations for structuring Disproportionate Share Hospital allotments during economic crises, and more. Includes rural references and considerations throughout.
Date: 10/2022
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) October 2022 meeting. Covers Medicaid race and ethnicity data collection and reporting, improving access to Medicaid coverage and care for adults leaving incarceration, the unwinding of the Public Health Emergency, streamlining the delivery of home- and community-based services, potential recommendations for structuring Disproportionate Share Hospital allotments during economic crises, and more. Includes rural references and considerations throughout.
Date: 10/2022
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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Rural Health System Value-Based Care Innovators Roundtable: Strategies and Insights
Presents findings from interviews with five health systems that include a substantial proportion of rural hospitals and clinics and actively support the transition to value-based care. Covers organizational structure, governance and decision-making, operations, data and communication, contracts, and social determinants of health. Identifies common health system tensions and opportunities to implementing value-based care at rural facilities.
Date: 10/2022
Sponsoring organization: Rural Health Value
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Presents findings from interviews with five health systems that include a substantial proportion of rural hospitals and clinics and actively support the transition to value-based care. Covers organizational structure, governance and decision-making, operations, data and communication, contracts, and social determinants of health. Identifies common health system tensions and opportunities to implementing value-based care at rural facilities.
Date: 10/2022
Sponsoring organization: Rural Health Value
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Landscape of Area-Level Deprivation Measures and Other Approaches to Account for Social Risk and Social Determinants of Health in Health Care Payments
Examines social determinants of health (SDOH) at the community level and their impact on health-related social needs (HRSNs) of the individual. Discusses how policies related to federal payment systems can incentivize screening for HRSNs as well as referrals to appropriate social and behavioral services. Provides an environmental scan of what measures can be used to provide accountability for funding and policy efforts targeted at SDOH. Includes an appendix that defines and describes indices of social risk, such as the social vulnerability index (SVI) and area deprivation index (ADI), as well as payment models that include measures of social risk.
Author(s): Joshua Breslau, Laurie Martin, Justin Timbie, Nabeel Qureshi, Deborah Zajdman
Date: 09/2022
Sponsoring organizations: HHS Office of the Assistant Secretary for Planning and Evaluation, RAND Corporation
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Examines social determinants of health (SDOH) at the community level and their impact on health-related social needs (HRSNs) of the individual. Discusses how policies related to federal payment systems can incentivize screening for HRSNs as well as referrals to appropriate social and behavioral services. Provides an environmental scan of what measures can be used to provide accountability for funding and policy efforts targeted at SDOH. Includes an appendix that defines and describes indices of social risk, such as the social vulnerability index (SVI) and area deprivation index (ADI), as well as payment models that include measures of social risk.
Author(s): Joshua Breslau, Laurie Martin, Justin Timbie, Nabeel Qureshi, Deborah Zajdman
Date: 09/2022
Sponsoring organizations: HHS Office of the Assistant Secretary for Planning and Evaluation, RAND Corporation
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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: 1/24/2025