Rural Healthcare Payment and Reimbursement – Resources
Selected recent or important resources focusing on Rural Healthcare Payment and Reimbursement.
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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MedPAC Report to the Congress: Medicare and the Health Care Delivery System, June 2023
Evaluates Medicare payment issues and provides recommendations to the U.S. Congress. Chapter 7 presents a report on the use, payment, and quality of telehealth services that Medicare pays for separately under the physician fee schedule (PFS). Also includes chapters on the cost of drugs covered under Medicare Part B, postsale rebates for prescription drugs in Medicare Part D, standardized benefits in Medicare Advantage plans, future directions for Medicare Advantage payment policy, disparities in outcomes for beneficiaries with different social risks, Medicare behavioral health services, the alignment of fee-for-service payment rates across ambulatory settings, and the evaluation of a post-acute care prospective payment system prototype.
Date: 06/2023
Sponsoring organization: Medicare Payment Advisory Commission
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Evaluates Medicare payment issues and provides recommendations to the U.S. Congress. Chapter 7 presents a report on the use, payment, and quality of telehealth services that Medicare pays for separately under the physician fee schedule (PFS). Also includes chapters on the cost of drugs covered under Medicare Part B, postsale rebates for prescription drugs in Medicare Part D, standardized benefits in Medicare Advantage plans, future directions for Medicare Advantage payment policy, disparities in outcomes for beneficiaries with different social risks, Medicare behavioral health services, the alignment of fee-for-service payment rates across ambulatory settings, and the evaluation of a post-acute care prospective payment system prototype.
Date: 06/2023
Sponsoring organization: Medicare Payment Advisory Commission
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Closed, Converted, Merged, and New Hospitals with Medicare Rural Designations: January 2018-November 2022
Provides an overview of four Medicare rural hospital designations - Critical Access Hospital, Low-Volume Hospital, Medicare Dependent Hospital, and Sole Community Hospital - and factors related to financial distress that these designations are intended to address. Explores the number of rural-designated hospitals that have closed, merged, converted, or opened between January 2018-November 2022 and compares the number of rural-designated hospitals with the number of non-designated hospitals. Outlines considerations for Congress regarding policy options for rural hospitals and access to healthcare services in rural areas.
Date: 04/2023
Sponsoring organization: Congressional Research Service
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Provides an overview of four Medicare rural hospital designations - Critical Access Hospital, Low-Volume Hospital, Medicare Dependent Hospital, and Sole Community Hospital - and factors related to financial distress that these designations are intended to address. Explores the number of rural-designated hospitals that have closed, merged, converted, or opened between January 2018-November 2022 and compares the number of rural-designated hospitals with the number of non-designated hospitals. Outlines considerations for Congress regarding policy options for rural hospitals and access to healthcare services in rural areas.
Date: 04/2023
Sponsoring organization: Congressional Research Service
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April 2023 MedPAC Meeting Transcript
Transcript from the Medicare Payment Advisory Commission's (MedPAC) April 2023 meeting. Covers high prices of drugs covered under Medicare Part B, draft recommendations for reforming Medicare's wage index systems, aligning fee-for-service payment rates across ambulatory settings, leveraging Medicare policies to address social determinants of health, assessing post-sale rebates for prescription drugs in Medicare Part D, and assessing the need for Medicare safety net payments for skilled nursing facilities and home health agencies. Features discussions on draft reports regarding a prototype design for a post-acute care prospective payment system, telehealth in Medicare, and behavioral health in Medicare. Includes rural references throughout.
Date: 04/2023
Sponsoring organization: Medicare Payment Advisory Commission
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Transcript from the Medicare Payment Advisory Commission's (MedPAC) April 2023 meeting. Covers high prices of drugs covered under Medicare Part B, draft recommendations for reforming Medicare's wage index systems, aligning fee-for-service payment rates across ambulatory settings, leveraging Medicare policies to address social determinants of health, assessing post-sale rebates for prescription drugs in Medicare Part D, and assessing the need for Medicare safety net payments for skilled nursing facilities and home health agencies. Features discussions on draft reports regarding a prototype design for a post-acute care prospective payment system, telehealth in Medicare, and behavioral health in Medicare. Includes rural references throughout.
Date: 04/2023
Sponsoring organization: Medicare Payment Advisory Commission
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Optimizing Population-Based Total Cost of Care (PB-TCOC) Models in the Context of Alternative Payment Models (APMs) and Physician-Focused Payment Models (PFPMs)
Report from the Physician-Focused Payment Model Technical Advisory Committee (PTAC) summarizing findings on population-based total cost of care (PB-TCOC) payment models and the role these models can play in optimizing health care delivery and value-based transformation in the context of alternative payment models (APMs) and physician-focused payment models (PFPMs). Provides an overview of key issues relating to PB-TCOC models and value-based care transformation. Identifies areas where additional research is needed and some potential next steps. Includes rural references throughout.
Date: 03/2023
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Report from the Physician-Focused Payment Model Technical Advisory Committee (PTAC) summarizing findings on population-based total cost of care (PB-TCOC) payment models and the role these models can play in optimizing health care delivery and value-based transformation in the context of alternative payment models (APMs) and physician-focused payment models (PFPMs). Provides an overview of key issues relating to PB-TCOC models and value-based care transformation. Identifies areas where additional research is needed and some potential next steps. Includes rural references throughout.
Date: 03/2023
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Financial Risk Acceptance among Rural Health Care Providers Participating in the Quality Payment Program
Summarizes nonmetropolitan and metropolitan providers' participation in different Quality Payment Program tracks and subdivisions, and evaluates provider and patient-panel characteristics associated with financial risk acceptance. Features statistics on risk acceptance with breakdowns by specialty type and metropolitan status, and patient panel characteristics by risk type.
Author(s): Xi Zhu, Mina Shrestha, Fred Ullrich, Keith Mueller
Date: 03/2023
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Summarizes nonmetropolitan and metropolitan providers' participation in different Quality Payment Program tracks and subdivisions, and evaluates provider and patient-panel characteristics associated with financial risk acceptance. Features statistics on risk acceptance with breakdowns by specialty type and metropolitan status, and patient panel characteristics by risk type.
Author(s): Xi Zhu, Mina Shrestha, Fred Ullrich, Keith Mueller
Date: 03/2023
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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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: 8/29/2025