Rural Health
Resources by Topic: Critical Access Hospitals
Clarity for Rural Emergency Hospitals and Changes for Critical Access Hospitals: CMS Finalizes Conditions of Participation and Payment and Enrollment Policies But Pauses Stark Law Flexibilities
Provides an overview of the Rural Emergency Hospitals (REHs) provisions of the Calendar Year 2023 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Final Rule. Discusses REH reimbursement, Conditions of Participation (CoPs), enrollment provisions, and Stark Law regulatory modifications to accommodate REHs. Highlights changes to the definition of "primary roads" related to Critical Access Hospital (CAH) CoPs.
Author(s): Emily Jane Cook, Caroline Reignley, Amber Arnold, Sandra M. DiVarco
Date: 11/2022
Sponsoring organization: McDermott Will & Emery
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Provides an overview of the Rural Emergency Hospitals (REHs) provisions of the Calendar Year 2023 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Final Rule. Discusses REH reimbursement, Conditions of Participation (CoPs), enrollment provisions, and Stark Law regulatory modifications to accommodate REHs. Highlights changes to the definition of "primary roads" related to Critical Access Hospital (CAH) CoPs.
Author(s): Emily Jane Cook, Caroline Reignley, Amber Arnold, Sandra M. DiVarco
Date: 11/2022
Sponsoring organization: McDermott Will & Emery
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2022 National Healthcare Quality and Disparities Report
Provides a comprehensive summary and data analysis of healthcare quality and access in the U.S. Addresses access to healthcare, patient safety, person-centered care, care coordination, effective treatment, healthy living, and care affordability. Includes a discussion of rural hospital closures and the impact on the distance required to access selected healthcare services.
Date: 11/2022
Sponsoring organization: Agency for Healthcare Research and Quality
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Provides a comprehensive summary and data analysis of healthcare quality and access in the U.S. Addresses access to healthcare, patient safety, person-centered care, care coordination, effective treatment, healthy living, and care affordability. Includes a discussion of rural hospital closures and the impact on the distance required to access selected healthcare services.
Date: 11/2022
Sponsoring organization: Agency for Healthcare Research and Quality
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Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Organ Acquisition; Rural Emergency Hospitals: Payment Policies, Conditions of Participation, Provider Enrollment, Physician Self-Referral; New Service Category for Hospital Outpatient Department Prior Authorization Process; Overall Hospital Quality Star Rating; COVID-19
Establishes the Rural Emergency Hospital (REH) provider type. Outlines REH payment policy, Conditions of Participation (CoPs), quality measures, and enrollment policy. Outlines changes to the Critical Access Hospitals (CAH) CoPs regarding location and distance requirements, patient's rights requirements, and flexibilities for CAHs that are part of a larger health system. Among other things, this rule also revises the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Medicare Ambulatory Surgical Center (ACS) payment system for calendar year 2023 and finalizes provisions included in the COVID-19 interim final rules.
Additional links: Fact Sheet
Date: 11/2022
Sponsoring organization: Centers for Medicare and Medicaid Services
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Establishes the Rural Emergency Hospital (REH) provider type. Outlines REH payment policy, Conditions of Participation (CoPs), quality measures, and enrollment policy. Outlines changes to the Critical Access Hospitals (CAH) CoPs regarding location and distance requirements, patient's rights requirements, and flexibilities for CAHs that are part of a larger health system. Among other things, this rule also revises the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Medicare Ambulatory Surgical Center (ACS) payment system for calendar year 2023 and finalizes provisions included in the COVID-19 interim final rules.
Additional links: Fact Sheet
Date: 11/2022
Sponsoring organization: Centers for Medicare and Medicaid Services
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Financial Characteristics of Critical Access Hospitals (CAHs) Participating in Accountable Care Organizations (ACO)
Examines Critical Access Hospital (CAH) participation in Medicare and non-Medicare Accountable Care Organizations (ACOs) in 2019. Compares the organizational and financial characteristics of CAHs across facilities that participate in ACOs and those that do not participate in an ACO. Includes data on profitability, liquidity, outpatient revenue, and Medicare payer mix.
Author(s): Angelina Budko, George Pink, Susie Gurzenda, Ann Howard, Kristin L. Reiter
Date: 11/2022
Sponsoring organization: Flex Monitoring Team
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Examines Critical Access Hospital (CAH) participation in Medicare and non-Medicare Accountable Care Organizations (ACOs) in 2019. Compares the organizational and financial characteristics of CAHs across facilities that participate in ACOs and those that do not participate in an ACO. Includes data on profitability, liquidity, outpatient revenue, and Medicare payer mix.
Author(s): Angelina Budko, George Pink, Susie Gurzenda, Ann Howard, Kristin L. Reiter
Date: 11/2022
Sponsoring organization: Flex Monitoring Team
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The Impact of Medicare Shared Savings Program Participation on Hospital Financial Performance: An Event-Study Analysis
Examines the effects of hospitals' participation in the Medicare Shared Savings Program (MSSP) on their financial performance. Compares within-hospital changes over time between MSSP and non-MSSP hospitals. Includes a comparison of the effects of MSSP participation between Critical Access Hospitals (CAHs) and non-CAHs.
Author(s): Huang Huang, Fred Ullrich, A. Clinton MacKinney, Keith Mueller
Citation: Health Services Research, 2022
Date: 10/2022
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Examines the effects of hospitals' participation in the Medicare Shared Savings Program (MSSP) on their financial performance. Compares within-hospital changes over time between MSSP and non-MSSP hospitals. Includes a comparison of the effects of MSSP participation between Critical Access Hospitals (CAHs) and non-CAHs.
Author(s): Huang Huang, Fred Ullrich, A. Clinton MacKinney, Keith Mueller
Citation: Health Services Research, 2022
Date: 10/2022
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Assessment of Strategies Used in US Hospitals to Address Social Needs During the COVID-19 Pandemic
Presents findings on efforts to address social determinants of health (SDOH) by rural hospitals, Critical Access Hospitals (CAHs), and safety-net hospitals according to 2020 American Hospital Association survey data. Discusses rates of social needs among patient populations served by rural and urban hospitals and rates of SDOH screening and community partnerships.
Author(s): Jose F. Figueroa, Ciara Duggan, Cristina Toledo-Cornell, et al.
Citation: JAMA Health Forum, 3(10), e223764
Date: 10/2022
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Presents findings on efforts to address social determinants of health (SDOH) by rural hospitals, Critical Access Hospitals (CAHs), and safety-net hospitals according to 2020 American Hospital Association survey data. Discusses rates of social needs among patient populations served by rural and urban hospitals and rates of SDOH screening and community partnerships.
Author(s): Jose F. Figueroa, Ciara Duggan, Cristina Toledo-Cornell, et al.
Citation: JAMA Health Forum, 3(10), e223764
Date: 10/2022
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Safety Assurance Factors for EHR Resilience (SAFER) Guides Requirements
Infographic displaying the differences in the Safety Assurance Factors for EHR Resilience (SAFER) Guide requirements for hospitals and Critical Access Hospitals (CAHs) participating in the Medicare Promoting Interoperability Program and eligible clinicians participating in the Merit-based Incentive Payment System (MIPS) Promoting Interoperability performance category for eligible clinicians.
Date: 10/2022
Sponsoring organization: Centers for Medicare and Medicaid Services
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Infographic displaying the differences in the Safety Assurance Factors for EHR Resilience (SAFER) Guide requirements for hospitals and Critical Access Hospitals (CAHs) participating in the Medicare Promoting Interoperability Program and eligible clinicians participating in the Merit-based Incentive Payment System (MIPS) Promoting Interoperability performance category for eligible clinicians.
Date: 10/2022
Sponsoring organization: Centers for Medicare and Medicaid Services
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Using Z Codes to Improve Health Equity in Rural Indiana
Describes how Cameron Memorial Community Hospital, a Critical Access Hospital in Indiana, used ICD-10-CM Z codes to detect and address patients' social needs as part of its health equity strategy.
Date: 10/2022
Sponsoring organization: American Hospital Association
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Describes how Cameron Memorial Community Hospital, a Critical Access Hospital in Indiana, used ICD-10-CM Z codes to detect and address patients' social needs as part of its health equity strategy.
Date: 10/2022
Sponsoring organization: American Hospital Association
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Medicare Part B Overpaid and Beneficiaries Incurred Cost-Share Overcharges of Over $1 Million for the Same Professional Services
Results of an audit of Medicare Part B claims to determine whether Part B payments to Critical Access Hospitals (CAHs) for professional services and payments made to healthcare practitioners for the same services complied with federal requirements. Includes recommendations from the Office of Inspector General (OIG), and the response from the Centers for Medicare & Medicaid Services (CMS).
Additional links: Report in Brief
Date: 09/2022
Sponsoring organization: Office of Inspector General (HHS)
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Results of an audit of Medicare Part B claims to determine whether Part B payments to Critical Access Hospitals (CAHs) for professional services and payments made to healthcare practitioners for the same services complied with federal requirements. Includes recommendations from the Office of Inspector General (OIG), and the response from the Centers for Medicare & Medicaid Services (CMS).
Additional links: Report in Brief
Date: 09/2022
Sponsoring organization: Office of Inspector General (HHS)
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State Flex Program Staff Sustainability Guide and Toolkit
A guide for state Flex Programs to help recruit good Flex Program staff, train them successfully, retain staff longer, and plan an orderly process of finding and training new staff before the outgoing staff leave. Presents a Staff Sustainability Cycle, a process for improving the retention of high-performing Flex Program staff, and outlines specific strategies and practical tools for addressing each component of the cycle.
Date: 08/2022
Sponsoring organization: National Rural Health Resource Center
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A guide for state Flex Programs to help recruit good Flex Program staff, train them successfully, retain staff longer, and plan an orderly process of finding and training new staff before the outgoing staff leave. Presents a Staff Sustainability Cycle, a process for improving the retention of high-performing Flex Program staff, and outlines specific strategies and practical tools for addressing each component of the cycle.
Date: 08/2022
Sponsoring organization: National Rural Health Resource Center
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