Rural Home Health Services – Resources
Selected recent or important resources focusing on Rural Home Health Services.
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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Who Will Care for Rural Older Adults? Measuring the Direct Care Workforce in Rural Areas
Policy brief examining existing disparities in the supply of home health aides and nursing assistants in rural areas compared to urban areas. Features statistics on the ratio of home health aides and nursing assistants relative to the population of adults age 65 and above, with breakdowns by urban and rural areas and by census region.
Author(s): Janette Dill, Carrie Henning-Smith, Rongxuan Zhu, Elizabeth Vomacka
Date: 11/2022
Sponsoring organization: University of Minnesota Rural Health Research Center
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Policy brief examining existing disparities in the supply of home health aides and nursing assistants in rural areas compared to urban areas. Features statistics on the ratio of home health aides and nursing assistants relative to the population of adults age 65 and above, with breakdowns by urban and rural areas and by census region.
Author(s): Janette Dill, Carrie Henning-Smith, Rongxuan Zhu, Elizabeth Vomacka
Date: 11/2022
Sponsoring organization: University of Minnesota Rural Health Research Center
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Patterns of Health Care Use among Rural-Urban Medicare Beneficiaries Age 85 and Older, 2010-2017
Policy brief examining how rural and urban Medicare beneficiaries age 85+ differ in terms of their socioeconomic and health characteristics that may inform healthcare use. Features statistics on trends in healthcare use, including inpatient and emergency department care, outpatient and prescription services, specialists and dentists, and home health and durable medical equipment, with breakdowns by urban and rural location.
Author(s): Yvonne Jonk, Heidi O'Connor, Amanda Burgess, Carly Milkowski
Date: 11/2022
Sponsoring organization: Maine Rural Health Research Center
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Policy brief examining how rural and urban Medicare beneficiaries age 85+ differ in terms of their socioeconomic and health characteristics that may inform healthcare use. Features statistics on trends in healthcare use, including inpatient and emergency department care, outpatient and prescription services, specialists and dentists, and home health and durable medical equipment, with breakdowns by urban and rural location.
Author(s): Yvonne Jonk, Heidi O'Connor, Amanda Burgess, Carly Milkowski
Date: 11/2022
Sponsoring organization: Maine Rural Health Research Center
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Rural and Urban Differences in Care Provided by Home Health Agencies in the United States: A Review of the Literature
Explores the differences in care outcomes for rural and urban home health agencies (HHAs). Discusses some of the barriers faced by rural HHAs, such as overcoming long distances, increased costs, and workforce limitations, among others.
Author(s): Denise D. Quigley, Ashley M. Chastain, Jung A. Kang, et al.
Citation: The Journal of Post-Acute and Long-Term Care Medicine, 23(10), 1653.e1-1653.e13
Date: 10/2022
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Explores the differences in care outcomes for rural and urban home health agencies (HHAs). Discusses some of the barriers faced by rural HHAs, such as overcoming long distances, increased costs, and workforce limitations, among others.
Author(s): Denise D. Quigley, Ashley M. Chastain, Jung A. Kang, et al.
Citation: The Journal of Post-Acute and Long-Term Care Medicine, 23(10), 1653.e1-1653.e13
Date: 10/2022
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Home Health Agencies Used Multiple Strategies to Respond to the COVID-19 Pandemic, Although Some Challenges Persist
Presents results of a survey of home health agencies (HHAs) conducted between September through December 2021 to explore the challenges they faced during the COVID-19 pandemic. Discusses challenges related to staffing, infection control, the use of telehealth, and the adequacy of emergency preparedness plans, as well as challenges specific to rural HHAs. Provides recommendations for how the Centers for Medicare & Medicaid Services (CMS) can help HHAs prepare for and respond to current and future infectious disease outbreaks and changes to the home health care landscape.
Date: 10/2022
Sponsoring organization: Office of Inspector General (HHS)
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Presents results of a survey of home health agencies (HHAs) conducted between September through December 2021 to explore the challenges they faced during the COVID-19 pandemic. Discusses challenges related to staffing, infection control, the use of telehealth, and the adequacy of emergency preparedness plans, as well as challenges specific to rural HHAs. Provides recommendations for how the Centers for Medicare & Medicaid Services (CMS) can help HHAs prepare for and respond to current and future infectious disease outbreaks and changes to the home health care landscape.
Date: 10/2022
Sponsoring organization: Office of Inspector General (HHS)
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Report to Congress: Unified Payment for Medicare-Covered Post-Acute Care
Presents a prototype for a Unified Post-acute Care (PAC) prospective payment system (PPS) that would set payment for PAC services on the basis of the clinical characteristics of the patient rather than the type of provider. Details the structure of the prototype and the data used in the analyses to design and calibrate the PPS. Explores key considerations for unifying PAC payment, such as cost-sharing and value-based payment. Includes data on PAC provider characteristics, including facility size and rural status, as well as rural payment adjustments.
Additional links: Appendices
Author(s): Benjamin Silver, Anne Deutsch, Nicole Coomer, et al.
Date: 07/2022
Sponsoring organizations: Centers for Medicare and Medicaid Services, RTI International
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Presents a prototype for a Unified Post-acute Care (PAC) prospective payment system (PPS) that would set payment for PAC services on the basis of the clinical characteristics of the patient rather than the type of provider. Details the structure of the prototype and the data used in the analyses to design and calibrate the PPS. Explores key considerations for unifying PAC payment, such as cost-sharing and value-based payment. Includes data on PAC provider characteristics, including facility size and rural status, as well as rural payment adjustments.
Additional links: Appendices
Author(s): Benjamin Silver, Anne Deutsch, Nicole Coomer, et al.
Date: 07/2022
Sponsoring organizations: Centers for Medicare and Medicaid Services, RTI International
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Quality of Home Health Agencies Serving Rural Medicare Beneficiaries
Describes a study examining the quality of home health agencies (HHAs) that serve rural beneficiaries, based on ratings from the Centers for Medicare and Medicaid Services star rating system. Features statistics including characteristics of HHAs, patient care ratings, and patient experience ratings in 2018 by rural-serving status.
Date: 02/2022
Sponsoring organization: WWAMI Rural Health Research Center
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Describes a study examining the quality of home health agencies (HHAs) that serve rural beneficiaries, based on ratings from the Centers for Medicare and Medicaid Services star rating system. Features statistics including characteristics of HHAs, patient care ratings, and patient experience ratings in 2018 by rural-serving status.
Date: 02/2022
Sponsoring organization: WWAMI Rural Health Research Center
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Post-Acute Care Trajectories for Rural Medicare Beneficiaries: Planned versus Actual Hospital Discharges to Skilled Nursing Facilities and Home Health Agencies
Examines care transitions among rural fee-for-service Medicare beneficiaries following discharge from an acute care hospital. Compares planned and actual discharges to home health agencies and skilled nursing facilities. Discusses implications of these findings on rural healthcare policy and practice.
Author(s): Tracy M. Mroz, Lisa A. Garberson, C. Holly A. Andrilla, et al.
Date: 03/2021
Sponsoring organization: WWAMI Rural Health Research Center
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Examines care transitions among rural fee-for-service Medicare beneficiaries following discharge from an acute care hospital. Compares planned and actual discharges to home health agencies and skilled nursing facilities. Discusses implications of these findings on rural healthcare policy and practice.
Author(s): Tracy M. Mroz, Lisa A. Garberson, C. Holly A. Andrilla, et al.
Date: 03/2021
Sponsoring organization: WWAMI Rural Health Research Center
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Left Behind Again: Rural Home Health Services in a Medicaid Pediatric Accountable Care Organization
Examines differences in pediatric home healthcare utilization among rural and urban children in a Medicaid pediatric Accountable Care Organization (ACO) in Ohio. Analyzes overall differences in healthcare use and annual trends in home health use by rurality and Medicaid eligibility group. Discusses how these findings could inform state policies and future research.
Author(s): Rose Y. Hardy, Gilbert C. Liu, Kimberly J. Conkol, Sean P. Gleeson, Kelly J. Kelleher
Citation: Journal of Rural Health
Date: 2021
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Examines differences in pediatric home healthcare utilization among rural and urban children in a Medicaid pediatric Accountable Care Organization (ACO) in Ohio. Analyzes overall differences in healthcare use and annual trends in home health use by rurality and Medicaid eligibility group. Discusses how these findings could inform state policies and future research.
Author(s): Rose Y. Hardy, Gilbert C. Liu, Kimberly J. Conkol, Sean P. Gleeson, Kelly J. Kelleher
Citation: Journal of Rural Health
Date: 2021
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The Impact of Medicare's Rural Add-on Payments on Supply of Home Health Agencies Serving Rural Counties
Examines how Medicare rural add-on payments affected the number of home health agencies serving rural counties between 2002-2017. Compares the population-adjusted number of home health agencies in urban, urban-adjacent non-urban-adjacent rural counties during periods with add-on payments and without add-on payments. Discusses implications for revised and future add-on payments to maintain or increase the supply of rural home health agencies.
Author(s): Tracy M. Mroz, Davis G. Patterson, Bianca K. Frogner
Citation: Health Affairs, 39(6), 949-957
Date: 06/2020
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Examines how Medicare rural add-on payments affected the number of home health agencies serving rural counties between 2002-2017. Compares the population-adjusted number of home health agencies in urban, urban-adjacent non-urban-adjacent rural counties during periods with add-on payments and without add-on payments. Discusses implications for revised and future add-on payments to maintain or increase the supply of rural home health agencies.
Author(s): Tracy M. Mroz, Davis G. Patterson, Bianca K. Frogner
Citation: Health Affairs, 39(6), 949-957
Date: 06/2020
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Last Updated: 10/17/2025