Rural Health
Resources by Topic: Health insurance
The Implications of the No Surprises Act on Contract Dynamics, Negotiations, and Finances
Provides feedback from insurance and healthcare stakeholders regarding the No Surprises Act (NSA), with a focus on insurer-provider dynamics, insurer and provider staffing, contract negotiations, payment rates, and the handling of advanced explanation of benefits (AEOB) provisions. Provides 2024 interview feedback from 35 stakeholders regarding the NSA and includes reflections on its impact for rural and underserved communities.
Author(s): Petra W. Rasmussen, Erin Lindsey Duffy, Isha Yardi, et al.
Date: 12/2024
Sponsoring organization: RAND Corporation
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Provides feedback from insurance and healthcare stakeholders regarding the No Surprises Act (NSA), with a focus on insurer-provider dynamics, insurer and provider staffing, contract negotiations, payment rates, and the handling of advanced explanation of benefits (AEOB) provisions. Provides 2024 interview feedback from 35 stakeholders regarding the NSA and includes reflections on its impact for rural and underserved communities.
Author(s): Petra W. Rasmussen, Erin Lindsey Duffy, Isha Yardi, et al.
Date: 12/2024
Sponsoring organization: RAND Corporation
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Texas Medicaid Managed Care Provider Network Adequacy Report, 2024
Reports information and statistics on managed care organizations (MCOs) and their obligations to provide access to services for Medicaid members in Texas. Discusses MCO contractual obligations and performance related to geography throughout, with breakdowns by metro, micro, and rural area.
Date: 12/2024
Sponsoring organization: Texas Health and Human Services
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Reports information and statistics on managed care organizations (MCOs) and their obligations to provide access to services for Medicaid members in Texas. Discusses MCO contractual obligations and performance related to geography throughout, with breakdowns by metro, micro, and rural area.
Date: 12/2024
Sponsoring organization: Texas Health and Human Services
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Medicaid Behavioral Health Providers Delivering Most Behavioral Health Services via Telehealth Before and During the COVID-19 Pandemic Issue Brief
Examines the extent to which Medicaid behavioral health providers shifted their practices to mostly telebehavioral health services during the COVID-19 pandemic through December 2021. Explores differences between specialty and non-specialty behavioral health providers, providers serving enrollees with mental health conditions versus substance use disorders, and rural and urban providers.
Date: 12/2024
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Examines the extent to which Medicaid behavioral health providers shifted their practices to mostly telebehavioral health services during the COVID-19 pandemic through December 2021. Explores differences between specialty and non-specialty behavioral health providers, providers serving enrollees with mental health conditions versus substance use disorders, and rural and urban providers.
Date: 12/2024
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Medicare Could save Billions with Comparable Access for Enrollees If Critical Access Hospital Payments for Swing-Bed Services Were Similar to Those of the Fee-for-Service Prospective Payment System
Describes the use of swing beds for skilled nursing services at Critical Access Hospitals (CAHs) and average daily Medicare reimbursement for these services from 2015 through 2020. Examines data from a sample of 100 CAHs to determine whether Medicare enrollees would have had access to the same skilled nursing services provided by CAHs at alternative facilities within a 35-mile driving distance. Compares the average daily reimbursement for skilled nursing services at CAHs and alternative facilities, as well as the potential savings to Medicare if CAHs were reimbursed for skilled nursing services under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS).
Date: 12/2024
Sponsoring organization: Office of Inspector General (HHS)
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Describes the use of swing beds for skilled nursing services at Critical Access Hospitals (CAHs) and average daily Medicare reimbursement for these services from 2015 through 2020. Examines data from a sample of 100 CAHs to determine whether Medicare enrollees would have had access to the same skilled nursing services provided by CAHs at alternative facilities within a 35-mile driving distance. Compares the average daily reimbursement for skilled nursing services at CAHs and alternative facilities, as well as the potential savings to Medicare if CAHs were reimbursed for skilled nursing services under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS).
Date: 12/2024
Sponsoring organization: Office of Inspector General (HHS)
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Nevada Medicaid Cost Driver Analysis, 2024
Report analyzing 2016-2023 Medicaid data to determine drivers of healthcare costs in Nevada. Data analyzed by plan type, service category, geography, age, and sex.
Date: 12/2024
Sponsoring organization: Nevada Department of Health and Human Services
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Report analyzing 2016-2023 Medicaid data to determine drivers of healthcare costs in Nevada. Data analyzed by plan type, service category, geography, age, and sex.
Date: 12/2024
Sponsoring organization: Nevada Department of Health and Human Services
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December 2024 MedPAC Meeting Transcript
Transcript from the Medicare Payment Advisory Commission's (MedPAC) December 2024 meeting. Covers payment adequacy and updates for physician and other health professional services, hospital inpatient and outpatient services, Rural Emergency Hospitals (REHs), skilled nursing facility services, inpatient rehabilitation facility services, home health services, hospice services, and outpatient dialysis services.
Additional links: Assessing Payment Adequacy and Updating Payments: Hospital Inpatient and Outpatient Services; and Mandated Report on Rural Emergency Hospitals - Presentation Slides, Assessing Payment Adequacy and Updating Payments: Skilled Nursing Facility Services - Presentation Slides
Date: 12/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Transcript from the Medicare Payment Advisory Commission's (MedPAC) December 2024 meeting. Covers payment adequacy and updates for physician and other health professional services, hospital inpatient and outpatient services, Rural Emergency Hospitals (REHs), skilled nursing facility services, inpatient rehabilitation facility services, home health services, hospice services, and outpatient dialysis services.
Additional links: Assessing Payment Adequacy and Updating Payments: Hospital Inpatient and Outpatient Services; and Mandated Report on Rural Emergency Hospitals - Presentation Slides, Assessing Payment Adequacy and Updating Payments: Skilled Nursing Facility Services - Presentation Slides
Date: 12/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Estimating the Effects of the Medicare $2 Drug List on Part D Enrollees
Discusses the Medicare $2 Drug List (M2DL) Model, which would allow Medicare Part D enrollees to purchase monthly drugs for $2 or less. Provides projected financial impact of the model, such as out of pocket (OOP) costs for individual drugs as well as OOP changes for enrollees, with breakdowns by demographic variables, including urban, rural-micropolitan, rural-other, or unclassified location.
Date: 12/2024
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Discusses the Medicare $2 Drug List (M2DL) Model, which would allow Medicare Part D enrollees to purchase monthly drugs for $2 or less. Provides projected financial impact of the model, such as out of pocket (OOP) costs for individual drugs as well as OOP changes for enrollees, with breakdowns by demographic variables, including urban, rural-micropolitan, rural-other, or unclassified location.
Date: 12/2024
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Trends in Medicaid and CHIP Telehealth, 2019-2021 Part II: Medicaid and CHIP Telehealth Utilization Trends by Enrollee and Provider Rurality
Explores trends in the use of telehealth among Medicaid and Children's Health Insurance Program (CHIP) enrollees before and during the COVID-19 Public Health Emergency (PHE). Compares trends between rural and urban enrollees, enrollees that reside in primary care Health Professional Shortage Areas (HPSAs), and by providers' rural or urban location.
Author(s): Anupama Warrier, Amelia Whitman, Aiden Lee, et al.
Date: 12/2024
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Explores trends in the use of telehealth among Medicaid and Children's Health Insurance Program (CHIP) enrollees before and during the COVID-19 Public Health Emergency (PHE). Compares trends between rural and urban enrollees, enrollees that reside in primary care Health Professional Shortage Areas (HPSAs), and by providers' rural or urban location.
Author(s): Anupama Warrier, Amelia Whitman, Aiden Lee, et al.
Date: 12/2024
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Civil Rights and Disparities in Pediatric Healthcare Access for Racial and Ethnic Minority Families in Arizona
Reports on disparities in pediatric healthcare access and quality experienced by racial and ethnic minority families in Arizona. Discusses primary findings based on testimony heard by the Arizona Advisory Committee to the U.S. Commission on Civil Rights, and provides suggestions to address civil rights concerns related to pediatric healthcare. Includes findings related to insurance, foster youth, healthcare provider shortages, data collection, and bias, among other topics. Discusses rural and tribal health throughout.
Date: 12/2024
Sponsoring organization: U.S. Commission on Civil Rights
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Reports on disparities in pediatric healthcare access and quality experienced by racial and ethnic minority families in Arizona. Discusses primary findings based on testimony heard by the Arizona Advisory Committee to the U.S. Commission on Civil Rights, and provides suggestions to address civil rights concerns related to pediatric healthcare. Includes findings related to insurance, foster youth, healthcare provider shortages, data collection, and bias, among other topics. Discusses rural and tribal health throughout.
Date: 12/2024
Sponsoring organization: U.S. Commission on Civil Rights
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Hospital Margins Rebounded in 2023, But Rural Hospitals and Those With High Medicaid Shares Were Struggling More Than Others
Examines hospital margins for non-federal general short-term hospitals in the U.S. from 2018 through 2023, with a focus on operating margins. Analyzes RAND Hospital Data to explore the extent to which hospitals profited or lost money on patient care and other operating activities. Discusses differences in operating margins by hospital characteristics, including hospital ownership type, commercial share, size, rural or urban location, and Medicare rural payment designation.
Date: 12/2024
Sponsoring organization: KFF
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Examines hospital margins for non-federal general short-term hospitals in the U.S. from 2018 through 2023, with a focus on operating margins. Analyzes RAND Hospital Data to explore the extent to which hospitals profited or lost money on patient care and other operating activities. Discusses differences in operating margins by hospital characteristics, including hospital ownership type, commercial share, size, rural or urban location, and Medicare rural payment designation.
Date: 12/2024
Sponsoring organization: KFF
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