Rural Health
Resources by Topic: Medicare
Projecting the Impact of the $2,000 Part D Out-Of-Pocket Cap for Medicare Part D Enrollees with High Prescription Drug Spending
Examines the impact of the Medicare Part D $2,000 cap on out-of-pocket prescription drugs. Provides projected savings according to low-income subsidy (LIS) status, state, and demographic characteristics, including urban, rural-micropolitan, rural-other, or unclassified geographic location.
Date: 01/2025
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Examines the impact of the Medicare Part D $2,000 cap on out-of-pocket prescription drugs. Provides projected savings according to low-income subsidy (LIS) status, state, and demographic characteristics, including urban, rural-micropolitan, rural-other, or unclassified geographic location.
Date: 01/2025
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Behavioral Health Crisis Services Billed to Commercial Insurance, Medicaid, and Medicare
Examines the extent to which three specific crisis service billing codes are used by commercial payors, Medicaid, and Medicare in 2020 in the 11 states and District of Columbia that cover these services in their Medicaid fee-for-service plans. Compares the rate of crisis service claims by state, rurality, and provider type.
Author(s): Crystal Blyler, Amy Edmonds, Allison Wishon, et al.
Date: 01/2025
Sponsoring organizations: HHS Office of the Assistant Secretary for Planning and Evaluation, Mathematica
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Examines the extent to which three specific crisis service billing codes are used by commercial payors, Medicaid, and Medicare in 2020 in the 11 states and District of Columbia that cover these services in their Medicaid fee-for-service plans. Compares the rate of crisis service claims by state, rurality, and provider type.
Author(s): Crystal Blyler, Amy Edmonds, Allison Wishon, et al.
Date: 01/2025
Sponsoring organizations: HHS Office of the Assistant Secretary for Planning and Evaluation, Mathematica
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Emergency Triage, Treat, and Transport (ET3) Model: Final Evaluation Report
Presents quantitative and qualitative results from the evaluation of the Emergency Triage, Treat, and Transport (ET3) Model, a voluntary model that allowed ambulance care teams to use alternate models of emergency healthcare to improve quality and lower care costs. Describes the characteristics of ET3 participants, the extent to which ET3 interventions successfully prevented emergency department (ED) visits, and how average Medicare Parts A and B spending for patients that received ET3 interventions compared to patients who had low acuity ED visits. Discusses challenges and barriers to delivering ET3 interventions. Includes rural references throughout.
Additional links: Findings at a Glance, Technical Appendix
Date: 01/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Presents quantitative and qualitative results from the evaluation of the Emergency Triage, Treat, and Transport (ET3) Model, a voluntary model that allowed ambulance care teams to use alternate models of emergency healthcare to improve quality and lower care costs. Describes the characteristics of ET3 participants, the extent to which ET3 interventions successfully prevented emergency department (ED) visits, and how average Medicare Parts A and B spending for patients that received ET3 interventions compared to patients who had low acuity ED visits. Discusses challenges and barriers to delivering ET3 interventions. Includes rural references throughout.
Additional links: Findings at a Glance, Technical Appendix
Date: 01/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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A Summary of State Innovation Models (SIM) Evaluation Results Across 17 States (2013-2020)
Summarizes evaluation results of the State Innovation Models (SIM), which examined the ability of 17 state governments to implement and test innovative value-based payment (VBP) healthcare models across multiple payers between 2013 and 2020. Presents findings regarding the implementation and impact of 29 delivery and payment models, including patient-centered medical homes, accountable care organizations, behavioral health integration, and more. Covers state contracting and consensus building, practice transformation, pediatric care, behavioral healthcare, beneficiary and provider perspectives, and more. Includes a section on payment model designs tailored to unique state needs, including rural populations, as well as rural references throughout.
Additional links: A Summary of State Innovation Models (SIM): Focus on State-Led Transformation - Findings at a Glance, Executive Summary, Findings at a Glance
Date: 01/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Summarizes evaluation results of the State Innovation Models (SIM), which examined the ability of 17 state governments to implement and test innovative value-based payment (VBP) healthcare models across multiple payers between 2013 and 2020. Presents findings regarding the implementation and impact of 29 delivery and payment models, including patient-centered medical homes, accountable care organizations, behavioral health integration, and more. Covers state contracting and consensus building, practice transformation, pediatric care, behavioral healthcare, beneficiary and provider perspectives, and more. Includes a section on payment model designs tailored to unique state needs, including rural populations, as well as rural references throughout.
Additional links: A Summary of State Innovation Models (SIM): Focus on State-Led Transformation - Findings at a Glance, Executive Summary, Findings at a Glance
Date: 01/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Shared Savings Program Fast Facts
Provides summary statistics on the Medicare Shared Savings Program as of January 1, 2025. Offers data on the number of Accountable Care Organizations (ACOs), assigned beneficiaries, total earned shared savings, and quality scores each year since 2012; the number and percent of ACOs in each track; and more. Includes information on ACO participants, including the number of Rural Health Clinics (RHCs) and Critical Access Hospitals (CAHs) participating in the program.
Date: 01/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides summary statistics on the Medicare Shared Savings Program as of January 1, 2025. Offers data on the number of Accountable Care Organizations (ACOs), assigned beneficiaries, total earned shared savings, and quality scores each year since 2012; the number and percent of ACOs in each track; and more. Includes information on ACO participants, including the number of Rural Health Clinics (RHCs) and Critical Access Hospitals (CAHs) participating in the program.
Date: 01/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Evaluating Medicare Advantage Benchmark Setting Methodology on Rural Counties
Examines how the current Medicare Advantage benchmark setting process and methods impact rural and urban counties. Presents data on the Medicare fee-for-service spending quartiles by metropolitan and non-metropolitan counties and the effects of caps on benchmark payments by geography.
Author(s): Dan M. Shane, Edmer Lazaro, Fred Ullrich, Keith Mueller
Date: 01/2025
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Examines how the current Medicare Advantage benchmark setting process and methods impact rural and urban counties. Presents data on the Medicare fee-for-service spending quartiles by metropolitan and non-metropolitan counties and the effects of caps on benchmark payments by geography.
Author(s): Dan M. Shane, Edmer Lazaro, Fred Ullrich, Keith Mueller
Date: 01/2025
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Medicare Advantage Enrollment Update 2024
Reports on the percentage of rural Medicare beneficiaries enrolled in Medicare Advantage (MA) plans by metropolitan and nonmetropolitan location and plan type, from 2014-2024.
Author(s): Fred Ullrich, Keith Mueller
Date: 01/2025
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Reports on the percentage of rural Medicare beneficiaries enrolled in Medicare Advantage (MA) plans by metropolitan and nonmetropolitan location and plan type, from 2014-2024.
Author(s): Fred Ullrich, Keith Mueller
Date: 01/2025
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Merit-Based Incentive Payment System (MIPS): 2025 Reporting MIPS Quality Measures through Medicare Part B Claims Quick Start Guide for Small Practices
Provides details on how small practices can report quality measures through Medicare Part B claims measures. Highlights changes to these measures in 2025, score redistribution policies for small practices, and information for clinicians at Critical Access Hospitals.
Date: 01/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides details on how small practices can report quality measures through Medicare Part B claims measures. Highlights changes to these measures in 2025, score redistribution policies for small practices, and information for clinicians at Critical Access Hospitals.
Date: 01/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Merit-based Incentive Payment System (MIPS): 2025 MIPS Quick Start Guide for Small Practices
Provides an overview of the Merit-based Incentive Payment System (MIPS). Outlines 6 steps for small practices regarding participation in the 2025 performance year. Includes information on performance category redistribution policies for small practices.
Date: 01/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides an overview of the Merit-based Incentive Payment System (MIPS). Outlines 6 steps for small practices regarding participation in the 2025 performance year. Includes information on performance category redistribution policies for small practices.
Date: 01/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Telehealth FAQ Calendar Year 2025
Provides information on Medicare telehealth regulations and payment policy for calendar year 2025. Includes information on audio-only services, behavioral health services, direct supervision, and more.
Date: 2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides information on Medicare telehealth regulations and payment policy for calendar year 2025. Includes information on audio-only services, behavioral health services, direct supervision, and more.
Date: 2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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