Rural Health
Resources by Topic: Medicare
Medicare Physician Fee-For-Service Payments: Adjusting for Variation in Geographic Practice Costs and Challenges for Hawaiʻi
Reports on policy approaches to Medicare reimbursement in Hawaii in order to address provider shortages and limited access to care associated with the state's geographic isolation and high cost of living. Discusses how Medicare policy impacts reimbursement and service availability in rural, remote, and frontier areas.
Author(s): Reinie Gerrits-Goh, John Desfor, Diana M.V. Shaw, et al.
Date: 11/2025
Sponsoring organization: University of Hawaiʻi Rural Health Research & Policy Center
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Reports on policy approaches to Medicare reimbursement in Hawaii in order to address provider shortages and limited access to care associated with the state's geographic isolation and high cost of living. Discusses how Medicare policy impacts reimbursement and service availability in rural, remote, and frontier areas.
Author(s): Reinie Gerrits-Goh, John Desfor, Diana M.V. Shaw, et al.
Date: 11/2025
Sponsoring organization: University of Hawaiʻi Rural Health Research & Policy Center
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Paying Family Caregivers: Self-direction in Medicaid Personal Care
Compares characteristics of dually eligible older adults receiving caregiving through either self-direction and non-self-direction, including personal demographics, health conditions, healthcare utilization, and rurality. Discusses rural findings in light of workforce shortages in rural communities. Includes analysis of Medicaid data from 6 states with reliable self-direction data as well as analysis of characteristics for 41 states and Washington, D.C.
Author(s): Yiqing Kuang, Katherine E.M. Miller
Citation: Health Affairs Scholar, 3(11)
Date: 11/2025
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Compares characteristics of dually eligible older adults receiving caregiving through either self-direction and non-self-direction, including personal demographics, health conditions, healthcare utilization, and rurality. Discusses rural findings in light of workforce shortages in rural communities. Includes analysis of Medicaid data from 6 states with reliable self-direction data as well as analysis of characteristics for 41 states and Washington, D.C.
Author(s): Yiqing Kuang, Katherine E.M. Miller
Citation: Health Affairs Scholar, 3(11)
Date: 11/2025
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Final CY 2026 Medicare Physician Fee Schedule: Fact Sheet
Fact sheet covering the Centers for Medicare & Medicaid Services (CMS) telehealth policy changes for 2026 as outlined in the final calendar year (CY) 2026 Physician Fee Schedule. Covers the process for determining which services can be delivered by telehealth; frequency limitations for inpatient visits, nursing facilities, and critical care consults; direct supervision through the use of live video; payment to Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs); and more.
Date: 11/2025
Sponsoring organization: Center for Connected Health Policy: The National Telehealth Policy Resource Center
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Fact sheet covering the Centers for Medicare & Medicaid Services (CMS) telehealth policy changes for 2026 as outlined in the final calendar year (CY) 2026 Physician Fee Schedule. Covers the process for determining which services can be delivered by telehealth; frequency limitations for inpatient visits, nursing facilities, and critical care consults; direct supervision through the use of live video; payment to Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs); and more.
Date: 11/2025
Sponsoring organization: Center for Connected Health Policy: The National Telehealth Policy Resource Center
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Report to the Secretary of Health and Human Services: Reducing Barriers to Participation in Population-Based Total Cost of Care (PB-TCOC) Models and Supporting Primary and Specialty Care Transformation
Summarizes findings from the Physician-Focused Payment Model Technical Advisory Committee's (PTAC) review of information on reducing barriers to participation in alternative payment models (APMs). Discusses key issues relating to reducing barriers to participation in APMs and value-based care transformation, areas where additional research is needed, and potential next steps.
Date: 10/2025
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Summarizes findings from the Physician-Focused Payment Model Technical Advisory Committee's (PTAC) review of information on reducing barriers to participation in alternative payment models (APMs). Discusses key issues relating to reducing barriers to participation in APMs and value-based care transformation, areas where additional research is needed, and potential next steps.
Date: 10/2025
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Medicare Advantage Enrollees Have Access to About Half of the Physicians Available to Traditional Medicare Beneficiaries
Explores how provider networks vary across Medicare Advantage plans and when compared to traditional Medicare. Examines the share of physicians available to Medicare Advantage enrollees as a share of physicians available to traditional Medicare beneficiaries by analyzing Medicare Advantage provider directories for 2022. Includes information on the availability of physicians to Medicare Advantage enrollees and traditional Medicare beneficiaries in rural counties.
Author(s): Matthew Rae, Jeannie Fuglesten Biniek, Tricia Neuman, Karen Pollitz
Date: 10/2025
Sponsoring organization: KFF
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Explores how provider networks vary across Medicare Advantage plans and when compared to traditional Medicare. Examines the share of physicians available to Medicare Advantage enrollees as a share of physicians available to traditional Medicare beneficiaries by analyzing Medicare Advantage provider directories for 2022. Includes information on the availability of physicians to Medicare Advantage enrollees and traditional Medicare beneficiaries in rural counties.
Author(s): Matthew Rae, Jeannie Fuglesten Biniek, Tricia Neuman, Karen Pollitz
Date: 10/2025
Sponsoring organization: KFF
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Calendar Year (CY) 2026 Medicare Physician Fee Schedule Final Rule (CMS-1832-F)
Fact sheet providing an overview of the Centers for Medicare & Medicaid Services (CMS) final rule regarding updates and changes to the Medicare payments under the Physician Fee Schedule (PFS) and other Medicare Part B issues for calendar year 2026. Summarizes provisions related to telehealth services; improving care for chronic illness and behavioral health needs; Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) care coordination services, services requiring direct supervision, and telecommunication services; and more.
Date: 10/2025
Sponsoring organization: Centers for Medicare & Medicaid Services
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Fact sheet providing an overview of the Centers for Medicare & Medicaid Services (CMS) final rule regarding updates and changes to the Medicare payments under the Physician Fee Schedule (PFS) and other Medicare Part B issues for calendar year 2026. Summarizes provisions related to telehealth services; improving care for chronic illness and behavioral health needs; Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) care coordination services, services requiring direct supervision, and telecommunication services; and more.
Date: 10/2025
Sponsoring organization: Centers for Medicare & Medicaid Services
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State Telehealth Laws and Reimbursement Policies Report, Fall 2025
Provides an overview of state telehealth policies as of early September 2025. Covers Medicaid reimbursement, private payer laws, and professional requirements.
Additional links: Executive Summary, Infographic, State Summary Chart
Date: 10/2025
Sponsoring organization: Center for Connected Health Policy: The National Telehealth Policy Resource Center
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Provides an overview of state telehealth policies as of early September 2025. Covers Medicaid reimbursement, private payer laws, and professional requirements.
Additional links: Executive Summary, Infographic, State Summary Chart
Date: 10/2025
Sponsoring organization: Center for Connected Health Policy: The National Telehealth Policy Resource Center
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Merit-Based Incentive Payment System (MIPS): 2024 Performance Year/2026 MIPS Payment Year - Payment Adjustment User Guide
Provides information on Merit-Based Incentive Payment System (MIPS) payment adjustments for calendar year 2026. Describes how 2024 MIPS scores relate to 2026 payment adjustments and how payment adjustments are applied. Offers answers to frequently asked questions.
Date: 10/2025
Sponsoring organization: Centers for Medicare & Medicaid Services
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Provides information on Merit-Based Incentive Payment System (MIPS) payment adjustments for calendar year 2026. Describes how 2024 MIPS scores relate to 2026 payment adjustments and how payment adjustments are applied. Offers answers to frequently asked questions.
Date: 10/2025
Sponsoring organization: Centers for Medicare & Medicaid Services
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Transforming Rural Health Care Through Medicaid Innovation: Tip Sheet Series
Informational tip sheets discussing the use of Medicaid innovations to assist states in creating their Rural Health Transformation (RHT) Program applications. Covers issues such as behavioral health, school-based services, integrated care access, community health workers, community paramedicine, specialty care, and healthcare technology. Provides examples, strategies, Medicaid policy information, and resources.
Additional links: Improving Access to Integrated Care for Dually Eligible Individuals in Rural Areas, Leveraging Community Health Workers to Address Rural Health Care Needs, Leveraging Community Paramedicine to Address Rural Health Needs, Leveraging Peers and Lay Counselors to Address Behavioral Health Care Workforce Shortages in Rural Areas, Using Project ECHO to Deliver Specialty Care in Rural Areas, Using School-Based Services to Improve Access to Preventive Health Care for Children in Rural Areas, Using Tech-Enabled Solutions to Improve Care Quality and Access in Rural Areas
Author(s): Molly Knowles, Nancy Archibald, Karla Silverman, Lauren Scannelli Jacobs
Date: 10/2025
Sponsoring organization: Center for Health Care Strategies
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Informational tip sheets discussing the use of Medicaid innovations to assist states in creating their Rural Health Transformation (RHT) Program applications. Covers issues such as behavioral health, school-based services, integrated care access, community health workers, community paramedicine, specialty care, and healthcare technology. Provides examples, strategies, Medicaid policy information, and resources.
Additional links: Improving Access to Integrated Care for Dually Eligible Individuals in Rural Areas, Leveraging Community Health Workers to Address Rural Health Care Needs, Leveraging Community Paramedicine to Address Rural Health Needs, Leveraging Peers and Lay Counselors to Address Behavioral Health Care Workforce Shortages in Rural Areas, Using Project ECHO to Deliver Specialty Care in Rural Areas, Using School-Based Services to Improve Access to Preventive Health Care for Children in Rural Areas, Using Tech-Enabled Solutions to Improve Care Quality and Access in Rural Areas
Author(s): Molly Knowles, Nancy Archibald, Karla Silverman, Lauren Scannelli Jacobs
Date: 10/2025
Sponsoring organization: Center for Health Care Strategies
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Many Medicare Advantage and Medicaid Managed Care Plans Have Limited Behavioral Health Provider Networks and Inactive Providers
Examines the availability of behavioral health providers in selected Medicare Advantage (MA) and Medicaid managed care networks in 2023. Analyzes provider network lists and MA and Medicaid encounter data for four MA and two Medicaid managed care plans from 10 selected urban and rural counties across five states. Describes the proportion of the behavioral health workforce in each county included in the plans' networks. Discusses the extent to which managed care plans had inactive providers in their network and why these providers did not deliver services to enrollees. Includes data on the percentage of inactive providers in rural and urban counties. Offers recommendations to monitor and improve the accuracy of provider networks.
Additional links: Report Highlights
Date: 10/2025
Sponsoring organization: Office of Inspector General (HHS)
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Examines the availability of behavioral health providers in selected Medicare Advantage (MA) and Medicaid managed care networks in 2023. Analyzes provider network lists and MA and Medicaid encounter data for four MA and two Medicaid managed care plans from 10 selected urban and rural counties across five states. Describes the proportion of the behavioral health workforce in each county included in the plans' networks. Discusses the extent to which managed care plans had inactive providers in their network and why these providers did not deliver services to enrollees. Includes data on the percentage of inactive providers in rural and urban counties. Offers recommendations to monitor and improve the accuracy of provider networks.
Additional links: Report Highlights
Date: 10/2025
Sponsoring organization: Office of Inspector General (HHS)
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