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Rural Health Information Hub

Rural Health
Resources by Topic: Care coordination

Maternal Opioid Misuse (MOM) Model
Overview of a CMS initiative focused on the care of pregnant and postpartum Medicaid beneficiaries with opioid use disorder (OUD) through state-driven transformation of the delivery system. Supports coordination of clinical care and integration of other services critical for health, well-being, and recovery.
Sponsoring organization: Centers for Medicare and Medicaid Services
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Care Management Medicare Reimbursement Strategies for Rural Providers
Information for rural healthcare providers on Medicare billing codes for services to keep beneficiaries healthy and better coordinate services to support beneficiaries at home. Addresses Annual Wellness Visits, Chronic Care Management, Transitional Care Management, Principal Care Management, and more.
Sponsoring organizations: NORC Walsh Center for Rural Health Analysis, Rural Health Information Hub
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Integrated Care Resource Center
Helps states learn about best practices for delivering coordinated healthcare to high-need, high-cost Medicaid beneficiaries. The resource center is a joint technical assistance project of the Centers for Medicare & Medicaid Services (CMS) Medicare-Medicaid Coordination Office and the Center for Medicaid, CHIP, and Survey & Certification (CMCS).
Sponsoring organization: Centers for Medicare and Medicaid Services
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