Rural Healthcare Payment and Reimbursement – Resources
Selected recent or important resources focusing on Rural Healthcare Payment and Reimbursement.
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
Sponsoring organizations: Centers for Medicare and Medicaid Services, Mathematica
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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
Sponsoring organizations: Centers for Medicare and Medicaid Services, Mathematica
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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
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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
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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
Sponsoring organization: Centers for Medicare and Medicaid Services
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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
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
Sponsoring organization: Rural Policy Research Institute Rural Health Panel
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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
Sponsoring organization: Rural Policy Research Institute Rural Health Panel
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Medicare: Performance-Based and Geographic Adjustments to Physician Payments
Statement to the U.S. House of Representatives Committee on Energy and Commerce, Subcommittee on Health, summarizing the Government Accountability Organization's (GAO) 2021 reports on the Quality Payment Program and the two tracks it established to incentivize Medicare providers and its 2022 report on geographic adjustments to physician payments. Includes information on the participation of providers in rural and underserved areas in Advanced Alternative Payment Models (APMs) and the challenges these providers face in transitioning to APMs.
Additional links: Full Report
Date: 10/2023
Sponsoring organization: Government Accountability Office
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Statement to the U.S. House of Representatives Committee on Energy and Commerce, Subcommittee on Health, summarizing the Government Accountability Organization's (GAO) 2021 reports on the Quality Payment Program and the two tracks it established to incentivize Medicare providers and its 2022 report on geographic adjustments to physician payments. Includes information on the participation of providers in rural and underserved areas in Advanced Alternative Payment Models (APMs) and the challenges these providers face in transitioning to APMs.
Additional links: Full Report
Date: 10/2023
Sponsoring organization: Government Accountability Office
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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
Sponsoring organizations: HHS Office of the Assistant Secretary for Planning and Evaluation, NORC at the University of Chicago
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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
Sponsoring organizations: HHS Office of the Assistant Secretary for Planning and Evaluation, NORC at the University of Chicago
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Distributional Analysis of Variation in Medicare Advantage Participation Within and Between Metropolitan, Micropolitan, and Noncore Counties
Policy brief identifying penetration rates, number of plans, and enrollment patterns and trends in Medicare Advantage participation in metropolitan and nonmetropolitan counties from 2017-2022. Features statistics with breakdowns by year and metropolitan, micropolitan, and noncore areas.
Author(s): Dan Shane, Ufuoma Ejughemre, Fred Ullrich, Keith Mueller
Date: 08/2023
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Policy brief identifying penetration rates, number of plans, and enrollment patterns and trends in Medicare Advantage participation in metropolitan and nonmetropolitan counties from 2017-2022. Features statistics with breakdowns by year and metropolitan, micropolitan, and noncore areas.
Author(s): Dan Shane, Ufuoma Ejughemre, Fred Ullrich, Keith Mueller
Date: 08/2023
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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COVID-19 Impact on Dental Service Delivery, Financing, Regulation, and Education Systems: An Environmental Scan
Describes the immediate and longer-term impacts of the COVID-19 pandemic on dental care delivery, regulation, education, and finance. Mentions rural throughout.
Author(s): Margaret Langelier, Aubri Kottek, Theekshana Fernando, et al.
Date: 07/2023
Sponsoring organization: Oral Health Workforce Research Center
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Describes the immediate and longer-term impacts of the COVID-19 pandemic on dental care delivery, regulation, education, and finance. Mentions rural throughout.
Author(s): Margaret Langelier, Aubri Kottek, Theekshana Fernando, et al.
Date: 07/2023
Sponsoring organization: Oral Health Workforce Research Center
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A Rural Accountable Care Organization's Journey
Profiles South East Rural Physicians Alliance Accountable Care Organization (SERPA‐ACO), a physician‐led ACO consisting of 16 Nebraska clinics - 13 of which are rural. Describes various value-based payment models SERPA-ACO clinics participated in and activities the clinics use to succeed in these models. Includes recommendations for primary care clinics considering joining an ACO.
Date: 06/2023
Sponsoring organization: Rural Health Value
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Profiles South East Rural Physicians Alliance Accountable Care Organization (SERPA‐ACO), a physician‐led ACO consisting of 16 Nebraska clinics - 13 of which are rural. Describes various value-based payment models SERPA-ACO clinics participated in and activities the clinics use to succeed in these models. Includes recommendations for primary care clinics considering joining an ACO.
Date: 06/2023
Sponsoring organization: Rural Health Value
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Updated Simulation of a Prospective Payment System for Post-Acute Care
Updates a potential unified post-acute care (PAC) prospective payment system (PPS) and estimates the impact of a PAC PPS on providers and Medicare beneficiaries. Presents data comparing the estimated costs payments to actual payments by rurality and region.
Author(s): Doug Wissoker, Bowen Garrett
Date: 06/2023
Sponsoring organizations: Medicare Payment Advisory Commission, Urban Institute
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Updates a potential unified post-acute care (PAC) prospective payment system (PPS) and estimates the impact of a PAC PPS on providers and Medicare beneficiaries. Presents data comparing the estimated costs payments to actual payments by rurality and region.
Author(s): Doug Wissoker, Bowen Garrett
Date: 06/2023
Sponsoring organizations: Medicare Payment Advisory Commission, Urban Institute
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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: 11/4/2025