Rural Health
Resources by Topic: Medicare
The Rural Emergency Hospital Model: Year Two Progress Report
Provides an overview of the Rural Emergency Hospital (REH) payment designation, including the growth in REHs through September 1, 2024, factors that contribute to a hospital seeking REH conversion, and the impacts of REH conversion. Outlines concerns identified by REH leaders, facilities considering converting to REH status, and other rural stakeholders related to the REH designation, as well as policy recommendations to address these concerns.
Author(s): Emma Sheffert, Julia Harris, Marilyn Werber Serafini
Date: 10/2024
Type: Document
Sponsoring organization: Bipartisan Policy Center
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Provides an overview of the Rural Emergency Hospital (REH) payment designation, including the growth in REHs through September 1, 2024, factors that contribute to a hospital seeking REH conversion, and the impacts of REH conversion. Outlines concerns identified by REH leaders, facilities considering converting to REH status, and other rural stakeholders related to the REH designation, as well as policy recommendations to address these concerns.
Author(s): Emma Sheffert, Julia Harris, Marilyn Werber Serafini
Date: 10/2024
Type: Document
Sponsoring organization: Bipartisan Policy Center
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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
Type: Document
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
Type: Document
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Nationwide Availability of and Enrollment in Medicare and Medicaid Dual-Eligible Special Needs Plans With Exclusively Aligned Enrollment
Explores the availability and enrollment of dual-eligible special needs plans (D-SNPs) with exclusively aligned enrollment, in which the beneficiary can receive Medicare and Medicaid benefits through the same plan or affiliated plans within the same organization. Analyzes 2021-2022 beneficiary data and examines D-SNP plan availability and enrollment according to beneficiary demographics, health status, rurality, and more.
Author(s): Kenton J. Johnston, Michelle Hendricks, Megha Dabas, et al.
Citation: JAMA Health Forum, 5(10)
Date: 10/2024
Type: Document
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Explores the availability and enrollment of dual-eligible special needs plans (D-SNPs) with exclusively aligned enrollment, in which the beneficiary can receive Medicare and Medicaid benefits through the same plan or affiliated plans within the same organization. Analyzes 2021-2022 beneficiary data and examines D-SNP plan availability and enrollment according to beneficiary demographics, health status, rurality, and more.
Author(s): Kenton J. Johnston, Michelle Hendricks, Megha Dabas, et al.
Citation: JAMA Health Forum, 5(10)
Date: 10/2024
Type: Document
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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
Type: Document
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
Type: Document
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
Type: Document
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
Type: Document
Sponsoring organization: Government Accountability Office
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Merit-Based Incentive Payment System (MIPS): 2025 MIPS Payment Year (2023 Performance Year) - Payment Adjustment User Guide
Provides information on Merit-Based Incentive Payment System (MIPS) payment adjustments for calendar year 2025. Describes how 2023 MIPS scores relate to 2025 payment adjustments and how payment adjustments are applied. Offers answers to frequently asked questions.
Date: 10/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides information on Merit-Based Incentive Payment System (MIPS) payment adjustments for calendar year 2025. Describes how 2023 MIPS scores relate to 2025 payment adjustments and how payment adjustments are applied. Offers answers to frequently asked questions.
Date: 10/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Merit-Based Incentive Payment System (MIPS): 2024 Reporting Options Comparison Resource
Provides an overview of the similarities and differences among the three Merit-Based Incentive Payment System (MIPS) reporting options: Traditional MIPS, MIPS Value Pathways (MVP), and Alternative Payment Model (APM) Performance Pathway (APP). Designed to help providers understand which reporting options may be best for their practice. Includes information on reporting flexibilities and scoring for small and rural practices.
Additional links: 2024 Merit-Based Incentive Payment System (MIPS) At-A-Glance Reporting Options for Small Practices
Date: 10/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides an overview of the similarities and differences among the three Merit-Based Incentive Payment System (MIPS) reporting options: Traditional MIPS, MIPS Value Pathways (MVP), and Alternative Payment Model (APM) Performance Pathway (APP). Designed to help providers understand which reporting options may be best for their practice. Includes information on reporting flexibilities and scoring for small and rural practices.
Additional links: 2024 Merit-Based Incentive Payment System (MIPS) At-A-Glance Reporting Options for Small Practices
Date: 10/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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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
Type: Document
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
Type: Document
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
Type: Document
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
Type: Document
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
Type: Document
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
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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