Rural Health
Resources by Topic: Legislation and regulations
Medicare Part D Enrollees Reaching the Out-of-Pocket Limit by June 2024
Examines the number of Medicare Part D enrollees who reached the catastrophic Inflation Reduction Act (IRA) out-of-pocket prescription drug spending cap by June 2024. Provides demographic information on enrollees who reach the catastrophic phase and the related savings, including breakdowns for state and metropolitan, micropolitan, or rural/unknown location.
Author(s): Kenneth Finegold, Kristen L. King, Bisma A. Sayed, Rachael Zuckerman
Date: 10/2024
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Examines the number of Medicare Part D enrollees who reached the catastrophic Inflation Reduction Act (IRA) out-of-pocket prescription drug spending cap by June 2024. Provides demographic information on enrollees who reach the catastrophic phase and the related savings, including breakdowns for state and metropolitan, micropolitan, or rural/unknown location.
Author(s): Kenneth Finegold, Kristen L. King, Bisma A. Sayed, Rachael Zuckerman
Date: 10/2024
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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The Impacts of New York's Balance Billing Regulation on Ground Ambulance Pricing
Examines the impact of surprise out-of-network (OON) billing regulations on New York emergency ground ambulances. Analyzes 2012-2019 commercial claims data and discusses the impacts of billing regulations on costs of care, with considerations related to transports from rural, super-rural, and urban locations.
Author(s): Wendy Y. Xu, Christopher Garmon, Sheldon M. Retchin, Yiting Li
Citation: Health Services Research
Date: 10/2024
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Examines the impact of surprise out-of-network (OON) billing regulations on New York emergency ground ambulances. Analyzes 2012-2019 commercial claims data and discusses the impacts of billing regulations on costs of care, with considerations related to transports from rural, super-rural, and urban locations.
Author(s): Wendy Y. Xu, Christopher Garmon, Sheldon M. Retchin, Yiting Li
Citation: Health Services Research
Date: 10/2024
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What to Know About Medicare Coverage of Telehealth
Discusses telehealth use by Medicare patients before, during, and after declaration of the COVID-19 public health emergency. Notes temporary telehealth provisions set to expire December 31, 2024, telehealth provisions made permanent, and trends in use since 2020. Includes rural and urban comparisons of telehealth use since 2020. Discusses payment models for Medicare and Medicare Advantage, current policies related to telehealth, fraud, and the cost of coverage through Medicare.
Author(s): Alex Cottrill, Juliette Cubanski, Tricia Neuman
Date: 10/2024
Sponsoring organization: KFF
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Discusses telehealth use by Medicare patients before, during, and after declaration of the COVID-19 public health emergency. Notes temporary telehealth provisions set to expire December 31, 2024, telehealth provisions made permanent, and trends in use since 2020. Includes rural and urban comparisons of telehealth use since 2020. Discusses payment models for Medicare and Medicare Advantage, current policies related to telehealth, fraud, and the cost of coverage through Medicare.
Author(s): Alex Cottrill, Juliette Cubanski, Tricia Neuman
Date: 10/2024
Sponsoring organization: KFF
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Health Care Transparency: CMS Needs More Information on Hospital Pricing Data Completeness and Accuracy
Provides an overview of the Centers for Medicare & Medicaid Services (CMS) hospital price transparency requirements before and after 2024 updates to the requirements. Describes users' experiences with hospital pricing data before the 2024 updates. Examines CMS's enforcement of hospital price transparency requirements and offers recommendations to CMS regarding the sufficiency and accuracy of the data reported. Table 3 compares CMS enforcement actions by hospitals' rural or urban designation between 2021 and 2023.
Additional links: Full Report
Date: 10/2024
Sponsoring organization: Government Accountability Office
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Provides an overview of the Centers for Medicare & Medicaid Services (CMS) hospital price transparency requirements before and after 2024 updates to the requirements. Describes users' experiences with hospital pricing data before the 2024 updates. Examines CMS's enforcement of hospital price transparency requirements and offers recommendations to CMS regarding the sufficiency and accuracy of the data reported. Table 3 compares CMS enforcement actions by hospitals' rural or urban designation between 2021 and 2023.
Additional links: Full Report
Date: 10/2024
Sponsoring organization: Government Accountability Office
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Medicare Payment Basics: Federally Qualified Health Center and Rural Health Clinic Payment Systems
Presents an overview of Medicare payments for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs). Details how the all-inclusive rate (AIR) is calculated for RHCs and how the national statutory payment limit applies to provider-based RHCs enrolled in Medicare before December 31, 2020, and whether they part of a hospital with fewer than 50 beds. Includes information on special payment rules for certain services provided by FQHCs and RHCs.
Date: 10/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Presents an overview of Medicare payments for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs). Details how the all-inclusive rate (AIR) is calculated for RHCs and how the national statutory payment limit applies to provider-based RHCs enrolled in Medicare before December 31, 2020, and whether they part of a hospital with fewer than 50 beds. Includes information on special payment rules for certain services provided by FQHCs and RHCs.
Date: 10/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Medicare Payment Basics: Skilled Nursing Facility Services Payment System
Overview of Medicare payments for skilled nursing and rehabilitation services. Describes what constitutes a skilled nursing facility and how small, rural hospitals and Critical Access Hospitals (CAHs) may be used to provide these services with CMS approval. Compares Medicare daily base rates for urban and rural skilled nursing facilities.
Date: 10/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Overview of Medicare payments for skilled nursing and rehabilitation services. Describes what constitutes a skilled nursing facility and how small, rural hospitals and Critical Access Hospitals (CAHs) may be used to provide these services with CMS approval. Compares Medicare daily base rates for urban and rural skilled nursing facilities.
Date: 10/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Medicare Payment Basics: Physician and Other Health Professional Payment System
Overview of Medicare payments for physician services conducted in a variety of settings including physicians' offices, hospitals, ambulatory surgical centers, skilled nursing facilities and other post-acute care settings, hospices, outpatient dialysis facilities, clinical laboratories, and beneficiaries' homes.
Date: 10/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Overview of Medicare payments for physician services conducted in a variety of settings including physicians' offices, hospitals, ambulatory surgical centers, skilled nursing facilities and other post-acute care settings, hospices, outpatient dialysis facilities, clinical laboratories, and beneficiaries' homes.
Date: 10/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Medicare Payment Basics: Part D Payment System
Overview of the Medicare Part D prescription drug benefit, including subsidy amounts, payments to plans, how enrollee premiums are calculated, and benefit and payment updates.
Date: 10/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Overview of the Medicare Part D prescription drug benefit, including subsidy amounts, payments to plans, how enrollee premiums are calculated, and benefit and payment updates.
Date: 10/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Medicare Payment Basics: Outpatient Hospital Services Payment System
Outlines Medicare's payments for outpatient hospital services, including considerations for rural sole community hospitals.
Date: 10/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Outlines Medicare's payments for outpatient hospital services, including considerations for rural sole community hospitals.
Date: 10/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Medicare Payment Basics: Outpatient Dialysis Services Payment System
Overview of Medicare payment methods for outpatient dialysis services of beneficiaries with end-stage renal disease (ESRD). Describes the base payment rate for freestanding and hospital-based facilities and identifies facility-level adjustments, including facilities located in rural areas.
Date: 10/2024
Sponsoring organization: Medicare Payment Advisory Commission
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Overview of Medicare payment methods for outpatient dialysis services of beneficiaries with end-stage renal disease (ESRD). Describes the base payment rate for freestanding and hospital-based facilities and identifies facility-level adjustments, including facilities located in rural areas.
Date: 10/2024
Sponsoring organization: Medicare Payment Advisory Commission
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