Significant Vulnerabilities Exist in the Hospital Wage Index System for Medicare Payments
Reports on 41 examinations of wage data of individual acute care hospitals from 2004 to 2017 to describe significant vulnerabilities observed in the wage index system for Medicare payments. Includes discussion on the rural floor wage index and the effects it has on wage index accuracy. Offers recommendations to reform the hospital wage index system.
Date: 11/2018
Type: Document
Sponsoring organization: Office of Inspector General (HHS)
view details

Factors Affecting the Development of Medicaid Hospital Payment Policies: Findings from Structured Interviews in Five States
Study examining Medicaid hospital payment policies with a focus on factors affecting payment mix and structure, the impact of state policies and financing methods, how states target hospital services or types such as rural hospitals, barriers to and drivers of change to payment methods, and more. Focuses on five states that made or are making significant hospital policy changes: Arizona, Louisiana, Michigan, Mississippi, and Virginia. Appendix B includes state profiles.
Author(s): Thomas Marks, Kathy Gifford, Steven Perlin, Melisa Byrd, Timothy Beger
Date: 10/2018
Type: Document
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
view details

Innovation Center State-Based Initiatives: A Systematic Review of Lessons Learned
A synthesis of findings from 47 evaluation reports covering 12 Center for Medicare & Medicaid Innovation models with a state component. Includes information on the impact of models for rural areas and identifies barriers and challenges faced in rural areas.
Date: 08/2018
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, L&M Policy Research
view details

Rural Health Insurance Market Challenges
Policy brief examining challenges affecting rural health insurance markets with a focus on Medicare Advantage, Medicare Part D, Medicaid Managed Care, and the Health Insurance Marketplace. Provides recommendations related to health insurance availability, network development and adequacy, and consumer and provider engagement.
Date: 08/2018
Type: Document
Sponsoring organization: National Advisory Committee on Rural Health and Human Services
view details

Rural Hospitals and Medicaid Payment Policy
Describes how rural hospitals serve Medicaid beneficiaries and the process through which Medicaid programs pay rural hospitals. Features statistics from 2015 with breakdowns by urban hospitals, Critical Access Hospitals (CAHs), and other rural hospitals.
Date: 08/2018
Type: Document
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
view details

The Medicaid Fee-for-Service Provider Payment Process
Outlines Medicaid's fee-for-services (FFS) provider payment process. Details the claims-based submission payment process, as well as additional non-claims-based payment processes. Includes information targeted to Rural Health Clinics and Federally Qualified Health Centers throughout.
Date: 07/2018
Type: Document
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
view details

Toward Hospital Global Budgeting: State Considerations
Overview of hospital global budgeting, using case studies from Maryland, Pennsylvania, and Vermont. Explores ways in which global budgets can offer some financial stability for rural hospitals.
Author(s): Robert Murray
Date: 05/2018
Type: Document
Sponsoring organization: State Health & Value Strategies
view details

Medicaid Payment Policy for Federally Qualified Health Centers
Describes the role of Federally Qualified Health Centers (FQHCs) in Medicaid, and highlights current policy issues related to Medicaid FQHC payment. Also discusses the Medicaid FQHC prospective payment system (PPS), alternative payment methodologies, how FQHCs participate in managed care networks, and states' desire for increased flexibility in setting FQHC payment rates.
Date: 12/2017
Type: Document
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
view details

Medicare Value-Based Payment Models: Participation Challenges and Available Assistance for Small and Rural Practices
Identifies challenges faced by small and rural physician practices when participating in Medicare's new value-based payment models, and groups them into five key areas: financial resources and risk management, health IT and data, population health management care delivery, quality and efficiency performance measurement and reporting, and effects of model participation and managing compliance with requirements. Also identifies two types of organizations, partner and non-partner, along with the services they provide, that can help small and rural practices overcome these challenges.
Additional links: Full Report
Date: 12/2016
Type: Document
Sponsoring organization: Government Accountability Office
view details

Medicaid Outpatient Payment Policy
Provides an overview of Medicaid payment policies for outpatient hospital services. Attached Excel sheet includes details for each state, including adjustments for rural geography and for Critical Access Hospitals.
Additional links: State Medicaid Payment Policies for Outpatient Hospital Services
Date: 07/2016
Type: Document
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
view details