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Rural Health Policy Resources

Selected recent or important resources focusing on Rural Health Policy.

Distribution of Disproportionate Share Hospital Payments to Rural and Critical Access Hospitals
Information concerning potential effects of Medicaid Disproportionate Share Hospital (DSH) payment on rural hospitals in 47 states. Features statistics on hospital Medicaid DSH payments by census region, with breakdowns by urban, rural, and Critical Access Hospitals.
Author(s): Erin M. Mobley, Fred Ullrich, Keith J. Mueller
Date: 11/2017
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Regulatory Overload: Assessing the Regulatory Burden On Health Systems, Hospitals And Post-Acute Care Providers
Discusses the level, impact, and opportunities to reduce regulatory burden on healthcare systems and offers recommendations for immediate relief. Assesses the impact across nine domains: quality reporting, new models of care/value-based payment, meaningful use of electronic health records, hospital conditions of participation, program integrity, fraud and abuse, privacy and security, post-acute care, and billing and coverage verification requirements. Page 21 discusses the disproportionate impact of fraud and abuse laws on rural providers.
Additional links: Executive Summary, Infographic: Federal Agencies with Regulatory or Oversight Authority Impacting Hospitals, Infographic: Regulatory Burden Overwhelming Providers, Diverting Clinicians from Patient Care
Date: 10/2017
Type: Document
Sponsoring organization: American Hospital Association
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State Innovation Models (SIM) Initiative Evaluation: Model Test Year Three Annual Report
Third annual report detailing the findings of CMS's State Innovation Models (SIM) Initiative, which tests the ability of the governments in six states - Arkansas, Maine, Massachusetts, Minnesota, Oregon, and Vermont - to accelerate health system transformation in the areas of delivery systems, payment models, information technology, workforce development, and more. Focuses on sharing cross-state progress and findings, state-specific findings and lessons learned, and lessons for policymakers. Additional emphasis is placed on monitoring healthcare experience, utilization, and expenditures in participating SIM states.
Date: 09/2017
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, RTI International
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State Innovation Models (SIM) Round 2: Model Design Final Report
Shares results from a federal evaluation of the Round 2 State Innovation Models (SIM) Initiative awards. Provides a summary and review of each awardees' final State Health System Innovations Plan (SHSIP). Includes several suggestions and recommendations for improving rural healthcare delivery, payment, and access.
Date: 08/2017
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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The Road to Value-based Care: Where are We?
Presentation slides by Keith Mueller for the NRHA Annual Meeting in San Diego, CA. Discusses the Rural Health Value Project, initiated in 2013, and how it has progressed in the years since. Includes examples of innovative approaches, models and strategies, and resources to support continued innovation, with specific examples provided to demonstrate Critical Access Hospital (CAH) value.
Date: 05/2017
Type: Presentation Slides
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Compendium of Unimplemented Recommendations: May 2017
Annual report identifying the top 25 unimplemented recommendations from the Office of Inspector General (OIG) that, in OIG's view, would have the most substantial positive impact on Health and Human Services (HHS) programs. Positive impact may refer to cost savings, program efficacy and efficiency, and/or quality improvement. Primary areas of interest in the May 2017 edition include: Critical Access Hospital (CAH) swing bed reimbursement rates, Medicare payment policies, combating prescription opioid abuse, and quality compliance in Indian Health Service (IHS) hospitals.
Date: 05/2017
Type: Document
Sponsoring organization: Office of Inspector General (HHS)
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How Could Repealing Key Provisions of the Affordable Care Act Affect Community Health Centers and their Patients?
Analyzes and estimates the potential effects of repealing certain provisions of the Affordable Care Act (ACA), focusing primarily on the implications for community health centers located in medically underserved communities. Examines how each of the following actions may affect health centers and primary healthcare access: ending the Health Centers Fund, ending health insurance subsidies, and ending expanded Medicaid coverage.
Author(s): Sara J. Rosenbaum, Jessica Sharac, Thao-Chi Tran, et al.
Date: 03/2017
Type: Document
Sponsoring organization: George Washington University Department of Health Policy and Management
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Social Determinants of Health
Policy brief informed by a September 2016 National Advisory Committee on Rural Health and Human Services meeting held in Albuquerque, New Mexico, with site visits to update the committee about factors that affect health outcomes. Identifies emerging payment models and financing strategies, and provides policy recommendations for addressing the social determinants of health in rural communities.
Date: 01/2017
Type: Document
Sponsoring organization: National Advisory Committee on Rural Health and Human Services
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Factsheet: Rural and Small Hospitals
Fact sheet and position statement from the American Hospital Association identifying key legislation and policy priorities for rural and small hospitals, with a particular focus on Critical Access Hospitals.
Date: 01/2017
Type: Document
Sponsoring organization: American Hospital Association
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Rural Relevance 2017: Assessing the State of Rural Healthcare in America
Examines the current state of rural healthcare and analyzes how potential policy changes may affect rural safety net providers. Major topics of discussion include sequestration, bad debt, Critical Access Hospital (CAH) reimbursement, prospective payment system (PPS) coding offset, value-based purchasing, and more. Free registration is required in order to access the study.
Author(s): Michael Topchik
Date: 2017
Type: Document
Sponsoring organizations: Chartis Center for Rural Health, iVantage Health Analytics
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2017 Legislative and Regulatory Agenda
Outlines the National Rural Health Association's legislative agenda as it relates to rural health policy issues.
Date: 2017
Type: Document
Sponsoring organization: National Rural Health Association
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Building on the History of the State Offices of Rural Health: Celebrating 25 Years of Service
Provides an overview of the history of the State Offices of Rural Health program and National Organization of State Offices of Rural Health. Highlights the work of the SORHs in Minnesota, South Carolina, and Oklahoma.
Author(s): Jenn Lukens
Location: Rural Monitor
Date: 11/2016
Type: Document
Sponsoring organization: Rural Health Information Hub
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State Innovation Models (SIM) Initiative Evaluation: Model Test Year Two Annual Report
Second annual report detailing the findings of CMS's State Innovation Models (SIM) Initiative, which tests the ability of the governments in six states - Arkansas, Maine, Massachusetts, Minnesota, Vermont, and Oregon - to accelerate health system transformation in the areas of delivery systems, payment models, information technology, workforce development, and more. Presents results from the second of three planned site visits to the states, including interviews, focus groups, and surveys. Connections made throughout to issues specifically affecting rural healthcare.
Date: 08/2016
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, RTI International
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Frontier Community Health Integration Project (FCHIP) Demonstration Fact Sheet
Provides an overview of the Frontier Community Health Integration Project (FCHIP) Demonstration, which will test new models of health care delivery in the most sparsely populated rural counties. Identifies the participating Critical Access Hospitals and the interventions they will address.
Date: 08/2016
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Families in Crisis: The Human Service Implications of Rural Opioid Misuse (Policy Brief)
Presents findings and policy recommendations from the National Advisory Committee on Rural Health and Human Services' 2016 meeting with rural residents, healthcare providers, and stakeholders regarding the impact and effects of opioid use disorders on rural families. Topics addressed include drug overdose and death, conflict with partners and children, emotional disturbance, adverse health risks, and related impacts on employment and economic sustainability.
Date: 07/2016
Type: Document
Sponsoring organization: National Advisory Committee on Rural Health and Human Services
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Medicare Access and CHIP Reauthorization Act of 2015: Ensuring Successful Implementation of Physician Payment Reforms
Recording of a July 13, 2016 U.S. Senate Finance Committee hearing regarding the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Andy Slavitt, Acting Administrator for the Centers for Medicare and Medicaid Services, discusses the input received from stakeholders and the resulting focus on patient first, physician driven, collaborative care. He also emphasizes the need to support small, rural practices and those in underserved areas to achieve success.
Date: 07/2016
Type: Video/Multimedia
Sponsoring organization: Senate Committee on Finance
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Compendium of Unimplemented Recommendations: April 2016
Annual report identifying the top 25 unimplemented recommendations from the Office of Inspector General (OIG) that, in OIG's view, would have the most substantial positive impact on Health and Human Services (HHS) programs. Positive impact may refer to cost savings, program efficacy and efficiency, and/or quality improvement. Primary area of interest in the April 2016 edition relates to coinsurance calculations for outpatient services received at Critical Access Hospitals (CAHs).
Date: 04/2016
Type: Document
Sponsoring organization: Office of Inspector General (HHS)
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Responsive Rural Health Delivery Systems
Policy brief discussing how rural healthcare delivery systems can address current challenges while transitioning to value-based care. Lays out recommendations for creating a high performance rural healthcare system based on five critical factors as defined by the Rural Policy Research Institute's Rural Health Panel: affordability, accessibility, community focused, high quality, and patient centered.
Author(s): Brandon Baumbach, Sue Deitz, Maria Poepsel
Date: 02/2016
Type: Document
Sponsoring organization: National Rural Health Association
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Delivery System Reform and Implications for Rural Communities
Policy brief discussing how rural healthcare providers can benefit from participation in Delivery System Reform (DSR) and continue to provide accessible, quality health services. Offers recommendations to the Secretary of Health and Human Services, such as requiring rural healthcare providers to participate in CMS quality programs, and having CMS incorporate rural-relevant quality measures that are appropriate for rural healthcare providers.
Date: 12/2015
Type: Document
Sponsoring organization: National Advisory Committee on Rural Health and Human Services
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Rural Medicare Advantage Plan Payment in 2015
Examines how changes to the Medicare Advantage (MA) payment policy formula, which were implemented as part of the Affordable Care Act (ACA), are impacting MA plans and beneficiaries in rural and urban areas.
Author(s): Leah Kemper, Abigail Barker, Timothy McBride, Keith Mueller
Date: 12/2015
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Rural Health Delivery System Reform
November 2015 webcast discussing changes in rural healthcare delivery and what rural facilities can do to make sure they keep up. Includes examples of what is working in rural areas. Moderated by Teryl Eisinger, Executive Director, National State Offices of Rural Health. Panel includes Tom Morris, Associate Administrator, Federal Office of Rural Health Policy(FORHP); Keith Mueller, Director, Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis; and Joshua Wynne, Dean of the University of North Dakota School of Medicine and Health Sciences. 60 minutes.
Additional links: Transcript
Date: 11/2015
Type: Video/Multimedia
Sponsoring organization: Rural Health Information Hub
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Mortality and Life Expectancy in Rural America: Connecting the Health and Human Service Safety Nets to Improve Health Outcomes Over the Life Course
Policy brief describing the driving forces behind rural health disparities in Appalachian Kentucky, and offering nationally relevant recommendations for addressing these challenges. Discusses rural and urban differences in life expectancy and mortality rates, and other significant factors including behavioral health, substance abuse, population health, trauma care, and transportation.
Date: 10/2015
Type: Document
Sponsoring organization: National Advisory Committee on Rural Health and Human Services
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Statement of James Macrae, Health Resources and Services Administration, on Rural Health before the U.S. Senate Health, Education, Labor and Pensions Committee
Testimony of the HRSA Acting Administrator at an October 29th, 2015, U.S. Senate HELP Committee hearing, Mental Health and Substance Use Disorders in America: Priorities, Challenges, and Opportunities. Identifies HRSA activities that address mental health and substance abuse issues, highlighting efforts focused on rural areas. A full video of the hearing is available, with Macrae's testimony beginning at 38:30.
Author(s): James Macrae
Date: 10/2015
Type: Document
Sponsoring organization: Senate Committee on Health, Education, Labor & Pensions
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State Actions to Promote and Restrain Commercial Accountable Care Organizations
Identifies actions state governments can take to promote the benefits of Accountable Care Organizations (ACOs) while mitigating potential risks. Discusses rural-specific concerns related to solvency and exclusivity provisions. Also examines state policy tools that regulate and support both providers and payers. Section 2 offers ACO policy guidance specific to California.
Author(s): Nicholas C. Petris Center on Health Care Markets and Consumer Welfare
Date: 10/2015
Type: Document
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NRHA Rural Proofing Tool
Policy paper describing the process of rural proofing in policy development, strategic planning, and implementation. This structured approach ensures that government policy and legislation recognizes the unique needs of healthcare in rural communities.
Author(s): David Schmitz, Elizabeth Johnsen
Date: 09/2015
Type: Document
Sponsoring organization: National Rural Health Association
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Delivery System Reform
Slides from a presentation by Jennifer Lundblad, President and CEO of Stratis Health, before the National Advisory Committee on Rural Health and Human Services (NACRHHS) concerning delivery system reform and its importance to rural facilities and providers.
Date: 09/2015
Type: Presentation Slides
Sponsoring organization: Stratis Health
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Performance Measurement for Rural Low-Volume Providers
Identifies challenges to measuring healthcare performance among low-volume rural providers, and presents recommendations to meet these challenges. Primary focus is on finding appropriate quality measures for use within Centers for Medicare and Medicaid Services' (CMS) pay-for-performance programs, and encouraging rural participation in CMS quality improvement initiatives.
Date: 09/2015
Type: Document
Sponsoring organization: National Quality Forum
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Pinch Hitting
Provides an overview of the role community paramedicine can play in meeting rural healthcare needs, with examples from several states. Highlights the pros and cons of this approach, describes how it is funded, and identifies states that have taken legislative action on the issue. Article begins on page number 22.
Author(s): Michelle Ancell
Location: State Legislatures, 22-25
Date: 09/2015
Type: Document
Sponsoring organization: National Conference of State Legislatures
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Converging Forces, Emerging Opportunities
Slides from a July 2015 NRHA Rural Quality Forum presentation addressing the transition from volume- to value-based care. Describes opportunities from this transition, including payment, care delivery, and governance redesign to improve quality outcomes in rural areas. Identifies resources and strategies rural healthcare systems can use to transition from volume to value.
Author(s): Jennifer P. Lundblad
Date: 07/2015
Type: Presentation Slides
Sponsoring organization: Stratis Health
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What Do the Medicare and Medicaid Programs Mean to Rural Health?
On the 50th anniversary of the Medicare and Medicaid programs, five rural health experts share their insights on the impact of these programs in rural America.
Author(s): Alan Morgan, Wayne Myers, Thomas Hoyer, Thomas Ricketts, Keith Mueller
Location: Rural Monitor
Date: 07/2015
Type: Document
Sponsoring organization: Rural Health Information Hub
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Statement by Daniel Derksen, Director of Arizona Center for Rural Health before Subcommittee on Health, Committee on Ways and Means, U.S. House of Representatives
Testimony from the Director of the Arizona Center for Rural Health presented at a July 28th, 2015 Ways and Means subcommittee hearing concerning rural healthcare disparities created by Medicare regulations. Highlights the importance of rural physician training programs and the need for graduate medical education reform, and discusses regulatory challenges for Critical Access Hospitals (CAHs) such as the 96-hour rule and the two-midnight rule.
Author(s): Daniel Derksen, Director of Arizona Center for Rural Health
Date: 07/2015
Type: Document
Sponsoring organization: House Ways and Means Committee, Subcommittee on Health
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Statement by Carrie Saia, CEO of Holton Community Hospital, Before Subcommittee on Health, Committee on Ways and Means, U.S. House of Representatives
Testimony from Carrie Saia, CEO of a 12-bed Critical Access Hospital (CAH) based in Holton, Kansas, before the House Ways and Means Subcommittee on Health concerning rural healthcare disparities created by Medicare regulations. Discusses burdens related to direct supervision of outpatient therapy services, and the 96-hour physician certification and average length of stay requirement for CAHs. Testimony was presented to the committee on July 28, 2015.
Author(s): Carrie Saia, Holton Community Hospital
Date: 07/2015
Type: Document
Sponsoring organization: House Ways and Means Committee, Subcommittee on Health
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Statement by Shannon Sorensen, CEO of Brown County Hospital, Before Subcommittee on Health, Committee on Ways and Means, U.S. House of Representatives
Testimony from the CEO of Brown County Hospital, a Critical Access Hospital located in north central Nebraska, presented at a July 28th, 2015 hearing before the House Ways and Means Subcommittee on Health concerning rural healthcare disparities created by Medicare regulations. Discusses the impact of regulation changes such as the 96-hour rule, the two-midnight rule, physician supervision requirements, electronic health records and meaningful use, and the Recovery Audit Contractors program.
Author(s): Shannon Sorensen, Brown County Hospital
Date: 07/2015
Type: Document
Sponsoring organization: House Ways and Means Committee, Subcommittee on Health
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Statement by Tim Joslin, Community Regional Medical Centers before Subcommittee on Health, Committee on Ways and Means, U.S. House of Representatives
Testimony from the CEO of Community Regional Medical Centers based in California presented at a July 28th, 2015 Ways and Means subcommittee hearing concerning rural healthcare disparities created by Medicare regulations. Provides a brief overview of the economic, social, and health challenges facing the rural San Joaquin Valley population. Discusses the role of graduate medical education in addressing physician shortages for the region.
Author(s): Tim Joslin, Community Regional Medical Centers
Date: 07/2015
Type: Document
Sponsoring organization: House Ways and Means Committee, Subcommittee on Health
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Hospital Policy Issues: Statement by Mark Miller, Medicare Payment Advisory Commission before Subcommittee on Health, Committee on Ways and Means, U.S. House of Representatives
Testimony from the Medicare Payment Advisory Commission’s executive director presented at a July 22nd, 2015 Ways and Means subcommittee hearing concerning Medicare hospital payment issues, rural health issues, and beneficiary access to care. Discusses Medicare’s rural hospital payment adjustments, how they impact access to care, and principles to consider in evaluating rural add-on payments. Also discusses MedPAC recommendations related to graduate medical education (GME), including some related to rural training.
Author(s): Mark Miller, Medicare Payment Advisory Commission
Date: 07/2015
Type: Document
Sponsoring organization: House Ways and Means Committee, Subcommittee on Health
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Care Coordination in Rural Communities: Supporting the High Performance Rural Health System
Examines current care coordination programs and processes to see how they impact rural communities, and determine how well different approaches to care coordination are working. Also makes policy recommendations that support care coordination and help facilitate a high performance rural health system.
Author(s): Charles Alfero, Andrew Coburn, Jennifer Lundblad, et al.
Date: 06/2015
Type: Document
Sponsoring organization: Rural Policy Research Institute Rural Health Panel
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Statement by Thomas Morris, Federal Office of Rural Health Policy before Subcommittee on Labor, Health and Human Services, Education and Related Agencies, Committee on Appropriations, U.S. Senate
Testimony presented at a May 7, 2015 Labor-HHS Subcommittee hearing on rural health. Discusses the challenges of rural health delivery and the accomplishments of Health Resources and Services Administration (HRSA) and Federal Office of Rural Health Policy (FORHP) programs addressing rural health.
Author(s): Tom Morris, Federal Office of Rural Health Policy
Date: 05/2015
Type: Document
Sponsoring organization: Senate Committee on Appropriations
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Labor-HHS Subcommittee Hearing: Rural Health
Recording of a May 7, 2015, hearing before the U.S. Senate Appropriations Committee, Subcommittee on Labor, Health and Human Services, Education, and Related Agencies. Witnesses include Sean Cavanaugh from the Centers for Medicare and Medicaid Services (CMS), Tom Morris from the Federal Office of Rural Health Policy (FORHP), and other leaders working directly in rural healthcare facilities and programs.
Date: 05/2015
Type: Video/Multimedia
Sponsoring organization: Senate Committee on Appropriations
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A Critique of the Office of the Inspector General’s Report on Swing Beds in Critical Access Hospitals
Policy brief evaluating a March 2015 report from the Office of the Inspector General (OIG), U.S. Department of Health and Human Services, commenting on Medicare reimbursement policy for swing bed services in Critical Access Hospitals (CAHs). Evaluates the methods and data of the OIG report.
Author(s): Kristin Reiter, Mark Holmes
Date: 03/2015
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Medicare Could Have Saved Billions at Critical Access Hospitals If Swing-Bed Services Were Reimbursed Using the Skilled Nursing Facility Prospective Payment System Rates
Reports the Inspector General’s findings from a study of swing bed services and reimbursement at Critical Access Hospitals (CAHs). Concludes that swing bed usage has significantly increased in recent years and that there would be significant savings to the Medicare program if swing bed services were reimbursed at skilled nursing facility (SNF) prospective payment system (PPS) rates.
Date: 03/2015
Type: Document
Sponsoring organization: Office of Inspector General (HHS)
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Designing and Implementing the Rural Health System of the Future
Slide presentation by Keith Mueller, Rural Policy Research Institute, at the American Hospital Association Rural Health Care Leadership Conference. Discusses the changing face of rural healthcare and makes recommendations on how best to transition to a high performance rural health system.
Author(s): Keith Mueller
Date: 02/2015
Type: Presentation Slides
Sponsoring organization: Rural Policy Research Institute Rural Health Panel
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Telehealth Policy Trends and Considerations
Provides an overview of the field of telehealth and the potential questions that may arise when considering the creation of policy related to the subject. Focuses on three areas of interest for state policy makers: coverage and reimbursement, licensure, and safety and security. Includes a policy checklist and strategies being tested in several states.
Date: 2015
Type: Document
Sponsoring organization: National Conference of State Legislatures
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State Innovation Models (SIM) Initiative Evaluation: Model Test Base Year Annual Report
First annual report on 6 states - Arkansas, Maine, Massachusetts, Minnesota, Oregon, and Vermont - that received federal support in the first round of the State Innovation Model (SIM) initiative to design and implement health care innovation plans. Presents results of the first site visits to the states, including information from interviews and focus groups, and baseline data on care coordination, quality of care, healthcare utilization, and healthcare expenditures. Includes some discussion of issues specific to rural healthcare.
Date: 11/2014
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, RTI International
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Rural Implications of the Blueprints for State-Based Health Insurance Marketplaces
Presents different states’ approaches to the health insurance marketplaces including service areas and rating areas, network adequacy requirements, rural consumer outreach, rural representation on the Marketplace governing board, certification and oversight of Qualified Health Plans, and design of the Small Business Health Options Program.
Author(s): Andy Potter, Matt Nattinger, Keith J. Mueller
Date: 09/2014
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Access to Rural Health Care – A Literature Review and New Synthesis
Reviews relevant literature to help clarify the meaning of access in the context of rural healthcare. Focuses on four dimensions of access including people, place, provider, and payment, and notes that changes in one dimension affects the others. Recommends that policymakers address all dimensions of access throughout the policymaking process to ensure best outcomes.
Author(s): A. Clinton MacKinney, Andrew Coburn, Jennifer Lundblad, et al.
Date: 08/2014
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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State Innovation Models (SIM) Initiative Evaluation: Model Design and Model Pre-Test Evaluation Report
Reports on the experiences of 19 states that received federal support to work on state health care innovation plans focused on developing innovative healthcare delivery and payment models. Discusses rural concerns in these states, as well as strategies to address rural healthcare needs. Some topics addressed include patient-centered medical homes, accountable care organizations, workforce, broadband access, electronic health record adoption, and telehealth.
Date: 07/2014
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, RTI International
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Keeping Rural Communities Healthy
Recognizes that keeping rural communities healthy is vital to the U.S. economy. Provides an overview of characteristics of rural populations, rural health statistics, barriers to healthcare in rural areas, economic implications of rural healthcare, and relevant policy actions to keep rural America healthy.
Author(s): U.S. Congress Joint Economic Committee Democratic Staff
Date: 07/2014
Type: Document
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How Does Medicaid Expansion Affect Insurance Coverage of Rural Populations?
Examines how states’ decisions on Medicaid expansion are impacting rural areas in the United States. Uses population estimates, current status of state expansion, and state-level insurance estimates to answer two primary questions: how is Medicaid expansion affecting rural populations, and how would it differ if every state were to expand Medicaid?
Author(s): Kristie Thompson, Brystana Kaufman, Mark Holmes
Date: 07/2014
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Preventing Rural Workforce by Design
Argues that the lack of primary care physicians in rural America could have been and can still be avoided. Policies aimed to attract recent graduates into primary healthcare, rather than specialty healthcare, can help to address disparities between rural and urban healthcare.
Author(s): Robert Bowman, Michael Halasy
Location: Rural and Remote Health, 14, 2852
Date: 06/2014
Type: Document
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MedPAC Report to the Congress: Medicare Payment Policy, 2014
Annual review of Medicare payment policies, with recommendations to Congress. Discussions of rural aspects of Medicare payment policies are included throughout the report.
Date: 03/2014
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Realizing Rural Care Coordination: Considerations and Action Steps for State Policy-Makers
This brief draws from health initiatives undertaken in Alabama, Colorado, Montana, New Mexico, North Carolina, and Vermont to identify common policy considerations and action steps for coordinating care in rural areas.
Author(s): Michael Stanek, Carrie Hanlon, Tess Shiras
Date: 03/2014
Type: Document
Sponsoring organization: Robert Wood Johnson Foundation
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Socioeconomic Policy Is Health Policy
Argues that medical care is not the only factor in improving people's health in rural areas while drawing on international studies.
Author(s): Wayne Myers
Location: Rural Monitor, 2014(Winter)
Date: 02/2014
Type: Document
Sponsoring organization: Rural Health Information Hub
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Evaluation of the Medicare Frontier Extended Stay Clinic Demonstration: Report to Congress
Reports on the results of a Medicare Frontier Extended Stay Clinic (FESC) demonstration project that used an enhanced clinic model in frontier areas to address the needs of seriously ill or injured patients who could not be transferred to a hospital or needed monitoring and observation for a limited period of time. Includes an overview of the demonstration and key findings from the project.
Date: 2014
Type: Document
Sponsoring organization: U.S. Department of Health and Human Services
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Improving Rural Health: State Policy Options
Discusses strategies that states have used to improve healthcare in rural communities. Covers workforce pipeline initiatives, long-term care services, behavioral health, emergency medical services, wellness and prevention, rural health clinics, school-based health centers, telehealth, recruitment and retention of healthcare professionals, loan repayment programs, and community health workers.
Author(s): Kristine Goodwin, Laura Tobler
Date: 11/2013
Type: Document
Sponsoring organization: National Conference of State Legislatures
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Accountable Care Organizations in Rural America
Reports that Medicare Accountable Care Organizations (ACOs) operate in 16.7% of non-metropolitan counties.
Additional links: National and Regional Maps
Author(s): A. Clinton MacKinney, Thomas Vaughn, Xi Zhu, Keith J. Mueller, Fred Ullrich
Date: 07/2013
Type: Document
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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HHS Regulatory and Policy Changes Focus on Supporting Rural Health Care
Summaries of regulatory and policy actions in 2012 to assist rural hospitals, clinics, and clinicians who play a key role in ensuring access to high-quality health services in Rural America.
Date: 03/2013
Type: Document
Sponsoring organization: Health Resources and Services Administration
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The Future of Rural Health
Describes the current status of the rural health system and the opportunities for change with the passage of the Affordable Care Act. Discusses core concepts of providing primary care such as mental health and oral health, new models of care, workforce, technology and system integration.
Author(s): Charlie Alfero, Tommy Barnhart, Darrold Bertsch
Date: 02/2013
Type: Document
Sponsoring organization: National Rural Health Association
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Streamlining Telemedicine Licensure to Improve Rural America
Provides information and statistics to support advocacy efforts for telemedicine cross-state licensure to improve health care access in rural America.
Author(s): Jarod Giger, Mary DeVany
Date: 02/2013
Type: Document
Sponsoring organization: National Rural Health Association
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Recruitment and Training of Racial/Ethnic Health Professionals in Rural America
Provides information and statistics on the need for recruitment and training programs targeted specifically for racial and ethnic minority health professionals in rural America.
Author(s): Ann Chester, Angeline Bushy, Esther Forti, Kas Kasten, Sherron McKendall.
Date: 02/2013
Type: Document
Sponsoring organization: National Rural Health Association
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Rural America's Oral Health Care Needs
Policy brief that provides an overview of Rural America's oral health care needs and lists recommendations for consideration for improving oral health in rural America.
Date: 02/2013
Type: Document
Sponsoring organization: National Rural Health Association
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State Health Insurance Exchanges: Assessing Rural Implications of Statutes
A study of state-based exchange programs established as a result of the Affordable Care Act (ACA) and how those exchanges affected rural marketplaces. Focuses on market function, governance, enrollment, access standards, and certifying Qualified Health Plans (QHPs).
Author(s): Anthony R. Eves, Keith Mueller
Date: 02/2013
Type: Document
Sponsoring organization: Rural Policy Research Institute
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Elder Health in Rural America
An overview and analysis of the current status of rural communities and rural elder health, including policy, and practice. Suggests recommendations for future policy based on a systems approach which incorporates sustainability, best practice, quality, efficiency, and effectiveness.
Author(s): Rebecca M. Hartman, Florence M. Weierbach
Date: 02/2013
Type: Document
Sponsoring organization: National Rural Health Association
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Rural Women's Health
Policy paper providing information and statistics on the state of women's health in rural America and how legislation and national trends can affect women's health.
Author(s): Kevin J. Bennett, John E. Lopes Jr., Kathleen Spencer, Saskia van Hecke
Date: 01/2013
Type: Document
Sponsoring organization: National Rural Health Association
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North Carolina Rural Health Research and Policy Analysis Cartographic Archive
A list of maps in PDF that define rural and characterize rural America. Thematic maps cover demographics, frontier counties, health status, critical access hospitals, rural hospitals, skilled nursing facilities, and health workforce supply.
Date: 2013
Type: Map/Mapping System
Sponsoring organization: North Carolina Rural Health Research Program
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Understanding and Addressing Barriers to Implementation of Environmental and Policy Interventions to Support Physical Activity and Healthy Eating in Rural Communities
Identifies policies being used in rural communities to promote wellness, physical activity, and healthy eating to combat obesity. Discusses barriers to implementation of these policies and strategies to overcome the barriers.
Author(s): Ellen K. Barnidge, Catherine Radvanyi, Kathleen Duggan, et al.
Location: Journal of Rural Health, 29(1), 97-105
Date: 09/2012
Type: Document
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Professional Liability Reform
A policy brief discussing the current and future impact of malpractice insurance rates have on rural communities. Discusses ways to decrease medical liability costs rural health care providers.
Date: 09/2012
Type: Document
Sponsoring organization: National Rural Health Association
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Dynamics of Sustainability: A Primer for Rural Health Organizations
Provides information and case studies on sustainability for rural organizations that are starting new programs.
Date: 02/2012
Type: Document
Sponsoring organization: Health Resources and Services Administration
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Electronic Health Record Implementation and Meaningful Use Adoption in Rural Hospitals and Physician Clinics
Provides background information that led to the adoption of legislation regarding the advancement of electronic health records (EHR) and of meaningful use. Offers recommendations that support legislation for the development of EHR adoption and implementation timelines to reduce the disparities between urban and rural facilities.
Author(s): Michelle Reisinger, Deborah Herzberg
Date: 01/2012
Type: Document
Sponsoring organization: National Rural Health Association
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Public Reporting of Quality by Critical Access Hospitals: The Key Issues
Policy paper reviews the progress made in rural hospital public reporting of quality from 2005-2012 with an increased emphasis and use of data for measuring performance and maintaining payment. Describes the current challenges Critical Access Hospitals (CAH) face when participating in quality reporting.
Date: 01/2012
Type: Document
Sponsoring organization: National Rural Health Association
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Evidence-based Falls Prevention in Critical Access Hospitals
Policy brief identifying and assessing evidence-based patient safety and quality improvement interventions appropriate for use by state Flex Programs and CAHs.
Author(s): Karen B. Pearson, Andrew F. Coburn,
Date: 12/2011
Type: Document
Sponsoring organization: Flex Monitoring Team
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Negotiated Rulemaking Committee on the Designation of Medically Underserved Populations and Health Professional Shortage Areas: Final Report to the Secretary
Contains recommendations and documentation of the Negotiated Rulemaking (NRM) Committee to influence methodologies used to determine Medically Underserved Populations (MUPs) and Health Professional Shortage Areas (HPSAs).
Additional links: Appendices and Addenda, Attachments
Date: 10/2011
Type: Document
Sponsoring organization: Health Resources and Services Administration
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The Rural Implications of Key Primary Care Provisions in the Affordable Care Act
White paper highlighting specific Affordable Care Act (ACA) provisions regarding challenges in training and placement of primary care providers in communities of need. Provides recommendations for program and policy changes that would address concerns in rural communities.
Date: 09/2011
Type: Document
Sponsoring organization: National Advisory Committee on Rural Health and Human Services
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Emergency Medical Treatment and Active Labor Act (EMTALA) and Telehealth in Critical Access Hospitals
Policy paper examining the difficulties Critical Access Hospitals (CAHs) experience when delivering required emergency services and care due to EMTALA regulations and potential policies that could reduce the impact of EMTALA regulations.
Date: 05/2011
Type: Document
Sponsoring organization: National Rural Health Association
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The Country Doctor
Thematic issue focused on ethical concerns physicians face in a rural setting, including issues related to patient privacy, overlapping roles for rural physicians, and other topics.
Location: AMA Journal of Ethics, 13(5)
Date: 05/2011
Type: Document
Sponsoring organization: American Medical Association
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Rural Health Preparedness
Policy brief discussing the nation's critical needs for maintaining an adequate rural healthcare system and public health infrastructure that can effectively respond to both natural and manmade disasters.
Date: 04/2011
Type: Document
Sponsoring organization: National Rural Health Association
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Deleterious Impact on Rural Multiracial and Multicultural Populations Related to the Devolution of Welfare Programs
Policy brief demonstrates that devolution of U.S. welfare programs has disproportionately harmed rural communities with their unique economic and social conditions.
Date: 04/2011
Type: Document
Sponsoring organization: National Rural Health Association
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Place-based Policies and Public Health: The Road to Healthy Rural People and Places
Identifies how the Patient Protection and Affordable Care Act of 2010 (ACA) can influence the determinants of health and contribute to the prosperity, equity, sustainability, and livability of rural places.
Author(s): Keith J. Mueller, A. Clinton MacKinney, Mario Gutierrez, Jocelyn Richgels
Date: 03/2011
Type: Document
Sponsoring organization: Rural Policy Research Institute
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Public Health Nursing: Strengthening the Core of Rural Public Health
Policy paper discussing major concerns regarding the current and future shortage of public health nurses in rural areas and factors contributing to the shortage including an aging workforce, salaries, lack of qualified applicants, and ineffective recruitment and retention.
Date: 01/2011
Type: Document
Sponsoring organization: National Rural Health Association
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Training Physicians for Rural Practice: Capitalizing on Local Expertise to Strengthen Rural Primary Care
Reports that medical residents who train in rural settings are more likely to practice in a rural area. Rural Training Track (RTT) programs play an important role in increasing rural practice placements, thus reducing primary care shortages. Describes the new Rural Training Track Technical Assistance (RTT-TA) program.
Author(s): Davis G. Patterson, Randall Longenecker, David Schmitz, Susan M. Skillman, Mark P. Doescher
Date: 01/2011
Type: Document
Sponsoring organization: WWAMI Rural Health Research Center
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Telehealth Reimbursement
Policy paper discussing reimbursement challenges that prevent the widespread adoption of telehealth.
Date: 05/2010
Type: Document
Sponsoring organization: National Rural Health Association
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The 2010 Report to the Secretary: Rural Health and Human Services Issues
Report to the Secretary of the U.S. Department of Health and Human Services on issues related to rural America. Topics include home and community based care for rural seniors, rural primary care workforce, and rural health care provider integration.
Date: 05/2010
Type: Document
Sponsoring organization: National Advisory Committee on Rural Health and Human Services
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A Rural Perspective/Commentary Regarding "Expanding Health Care Coverage to All Americans" (Full Report)
Provides commentary from the Rural Health Panel on proposed options for expanding health care coverage that have a special, significant meaning for rural areas.
Author(s): Keith J. Mueller, Andrew F. Coburn, A. Clinton MacKinney, Timothy D. McBride, Rebecca T. Slifkin
Date: 06/2009
Type: Document
Sponsoring organization: Rural Policy Research Institute Rural Health Panel
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A Rural Perspective/Commentary Regarding "Transforming the Health Care Delivery System: Proposals to Improve Patient Care and Reduce Health Care Costs" (Full Report)
Outlines the potential impact on rural America of the proposed policy reform options from the Senate Finance Committee in this full report of the RUPRI Health Panel.
Author(s): Keith J. Mueller, Andrew F. Coburn, A. Clinton MacKinney, Timothy D. McBride, Rebecca T. Slifkin
Date: 05/2009
Type: Document
Sponsoring organization: Rural Policy Research Institute
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Rural Health Care: Innovations in Policy and Practice
Discusses strategies being used to improve healthcare access in rural areas. Includes a section discussing philanthropic activities related to rural health.
Date: 03/2009
Type: Document
Sponsoring organization: Grantmakers in Health
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The Top 10 Rural Issues for Health Care Reform
Examines the health care issues and challenges facing rural America including: increased heath care costs, large numbers of uninsured and underinsured, and an overextended health care infrastructure.
Author(s): Jon M. Bailey
Date: 03/2009
Type: Document
Sponsoring organization: Center for Rural Affairs
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CMS Value-Based Purchasing Program and Critical Access Hospitals
Addresses the implications of value-based purchasing (VBP) for the cost-based reimbursement that CAHs receive. Describes the Rural Health Panel's recommendations for action.
Additional links: Summary of Recommendations
Author(s): Andrew F. Coburn, A. Clinton MacKinney, Timothy D. McBride, et al.
Date: 01/2009
Type: Document
Sponsoring organization: Rural Policy Research Institute Rural Health Panel
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CMS: Rural Health
Provides information about the Centers for Medicare and Medicaid Services' (CMS) rural health initiatives, including the CMS Rural Health Council. Also provides links to rural-specific resources, publications, and reports.
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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National Governors Association Center for Best Practices Health Division
Provides information, research, policy analysis, technical assistance, and resource development for governors and their staff on a wide range health-related policy issues.
Type: Website
Sponsoring organization: National Governors Association
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Highlights from the History of Rural Health
Video series highlighting key moments and developments in recent rural health history in the United States. Provides first-person accounts of the issues and how solutions came to be.
Type: Video/Multimedia
Sponsoring organization: Rural Health Information Hub
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Scope of Practice Policy
Website designed to provide state policymakers with information on scope of practice topics related to nurse practitioners, physician assistants, dental hygienists, and dental therapists. Includes interactive state policy maps and a legislation database.
Type: Database, Website
Sponsoring organizations: Association of State and Territorial Health Officials, National Conference of State Legislatures
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Health Update from The National Advisory Committee on Rural Health and Human Services
A February 2015 webinar discussing three briefs from the National Advisory Committee on Rural Health and Human Services (NACRHHS). The first two briefs focus on the Affordable Care Act, with discussion on rural enrollment and pricing of the 2014 Health Insurance Marketplace plans and premiums. The third brief focuses on rural hospice. Presented by Committee Chair Ronnie Musgrove and several other NACRHHS members. 53 minutes.
Additional links: Audio Recording, Presentation Slides, Transcript
Type: Audio
Sponsoring organization: Rural Health Information Hub
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Health Resources and Services Administration Strategic Plan, FY 2016 - FY 2018
Identifies five Health Resources and Services Administration (HRSA) goals to address healthcare access and service delivery issues. Includes information on HRSA's work related to rural health.
Type: Document
Sponsoring organization: Health Resources and Services Administration
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Frontier Extended Stay Clinics (FESC) Demonstration
An overview of a completed CMS demonstration that looked at an enhanced clinic model in frontier areas to address the needs of seriously ill or injured patients who cannot be transferred to a hospital, or who need monitoring and observation for a limited period of time.
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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Frontier Community Health Integration Project Demonstration (FCHIP)
An overview of a CMS demonstration to develop and test new models for the delivery of healthcare services in frontier areas through improving access to, and better integration of, the delivery of healthcare to Medicare beneficiaries.
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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State Innovation Models (SIM)
An overview of a CMS initiative that supports statewide healthcare system transformation. Aims to create multi-payer models that raise community health status and reduce long term health risks for beneficiaries. Statewide approaches include rural areas, although few include a particular rural focus.
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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Health Care Innovation Awards (HCIA)
Overview of a CMS demonstration to test a wide range of innovative projects to deliver better health, improved care, and lower costs via Medicare, Medicaid and the Children’s Health Insurance Program (CHIP), particularly for beneficiaries with the highest healthcare needs. Includes projects that serve rural populations.
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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Rural Community Hospital Demonstration
An overview of a CMS demonstration project which provides cost-based reimbursement for small rural hospitals too large to be Critical Access Hospitals. Examines the community benefits and financial impact for participating hospitals.
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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CMS Innovation Center
Supports the development, testing and sharing of innovative healthcare payment and service delivery models. Includes data, reports, webinars and forums for sharing knowledge among healthcare innovators, data researchers and policy analysts.
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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Sustainability Planning Tools
Collection of resources to help consider long-term program sustainability plans that address community needs and engage partners and stakeholders in the process.
Type: Website
Sponsoring organization: Georgia Health Policy Center
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Daily Yonder
Tracks policy and publishes news and special reports on these issues facing small communities - health, employment, broadband access, education, and economic development.
Type: Journal/Newsletter
Sponsoring organization: Center for Rural Strategies
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PubMed Search: Health Policy and Rural Health
Searches PubMed's collection of journal article citations on the topics of health policy and rural health.
Type: Literature Search
Sponsoring organization: National Library of Medicine
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Rural Health Voices
This blog, sponsored by the National Rural Health Association (NRHA), offers news and opinion postings related to health care in rural America.
Type: Website
Sponsoring organization: National Rural Health Association
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National Rural Health Association Today
Electronic newsletter providing updates from the National Rural Health Association on government affairs, funding and educational opportunities as well as national news that impacts rural health.
Type: Journal/Newsletter
Sponsoring organization: National Rural Health Association
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NRHA Fighting for Rural
Information concerning the current National Rural Health Association's advocacy efforts to support rural health.
Type: Website
Sponsoring organization: National Rural Health Association
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Code of Federal Regulations: Title 42 Public Health
Provides access to Code of Federal Regulations' health-related provisions, including Medicare and Medicare.
Type: Website
Sponsoring organization: U.S. National Archives and Records Administration
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Rural Health Policy
Provides information and resources from the Federal Office of Rural Health Policy related to FORHP's rural health policy work.
Type: Website
Sponsoring organization: Federal Office of Rural Health Policy
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NRHA Policy Documents
A listing of the policy and position papers adopted by the NRHA Rural Health Congress (a broad representation of association members) in order for the association to advocate for rural health at the national level.
Type: Website
Sponsoring organization: National Rural Health Association
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Compendium of Recommendations by the National Advisory Committee on Rural Health
A list of recommendations, arranged by broad subject area or year, made by the National Advisory Committee on Rural Health and Human Services in its reports to the Secretary of the U.S. Department of Health and Human Services.
Type: Document
Sponsoring organization: National Advisory Committee on Rural Health and Human Services
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Rural Health Research Centers and Analysis Initiatives
Identifies currently and previously funded Federal Office of Rural Health Policy rural health research centers and rural health policy analysis initiatives.
Type: Website
Sponsoring organization: Rural Health Research Gateway
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AHA: Rural Health Care
Information on American Hospital Association (AHA) advocacy activities related to rural hospitals. Includes news and resources.
Type: Website
Sponsoring organization: American Hospital Association
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KHN Morning Briefing
Daily news stories on a variety of health policy issues, compiled by Kaiser Health News.
Type: Website
Sponsoring organization: Kaiser Family Foundation
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Journal of Rural Health
Quarterly, peer-reviewed publication of the National Rural Health Association. Includes original research on rural health topics, case studies, articles on rural policy issues, and more. Subscription required.
Type: Journal/Newsletter
Sponsoring organization: National Rural Health Association
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Rural Roads
Quarterly magazine of the National Rural Health Association featuring articles to engage and educate those working to improve healthcare in rural America.
Type: Journal/Newsletter
Sponsoring organization: National Rural Health Association
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State Health Facts
Contains state-level data on demographics, health status, healthcare costs and access, healthcare providers, and more. Individual state profiles and 50-state comparisons.
Type: Database
Sponsoring organization: Kaiser Family Foundation
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Additional resources are available related to this guide. See the full list of resources by topic for:


Last Updated: 12/14/2017