Rural Health
Resources by Topic: Medicare
Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care
Examines the current state of primary care in the United States, and describes an implementation plan to strengthen high-quality primary care. Discusses value-based care and reimbursement, access to care, primary care workforce recruitment and training, and the role of health information technology. Includes rural references throughout.
Additional links: Read Online
Author(s): Board on Health Care Services
Date: 2021
Sponsoring organization: Health and Medicine Division (HMD), National Academies of Sciences, Engineering, and Medicine
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Examines the current state of primary care in the United States, and describes an implementation plan to strengthen high-quality primary care. Discusses value-based care and reimbursement, access to care, primary care workforce recruitment and training, and the role of health information technology. Includes rural references throughout.
Additional links: Read Online
Author(s): Board on Health Care Services
Date: 2021
Sponsoring organization: Health and Medicine Division (HMD), National Academies of Sciences, Engineering, and Medicine
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Public Law 116–260: Consolidated Appropriations Act, 2021
Text of the Consolidated Appropriations Act, 2021, Public Law 116-260 (December 27, 2020). Section 125 establishes the Rural Emergency Hospital designation. Section 127 makes changes to direct graduate medical education (GME) and indirect GME payments to teaching hospitals that train residents in Rural Training Programs.
Date: 12/2020
Sponsoring organization: U.S. Congress
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Text of the Consolidated Appropriations Act, 2021, Public Law 116-260 (December 27, 2020). Section 125 establishes the Rural Emergency Hospital designation. Section 127 makes changes to direct graduate medical education (GME) and indirect GME payments to teaching hospitals that train residents in Rural Training Programs.
Date: 12/2020
Sponsoring organization: U.S. Congress
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December 2020 MedPAC Meeting Transcript
Transcript from the Medicare Payment Advisory Commission's (MedPAC) December 2020 meeting. Covers payment adequacy and updates for hospital inpatient and outpatient services and the mandated report on expanding the post-acute care transfer policy to hospice, ambulatory surgical center services, outpatient dialysis services, physician and other health professional services, hospice services, and a status report and benchmark policy option on the Medicare Advantage program. Includes rural references throughout.
Date: 12/2020
Sponsoring organization: Medicare Payment Advisory Commission
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Transcript from the Medicare Payment Advisory Commission's (MedPAC) December 2020 meeting. Covers payment adequacy and updates for hospital inpatient and outpatient services and the mandated report on expanding the post-acute care transfer policy to hospice, ambulatory surgical center services, outpatient dialysis services, physician and other health professional services, hospice services, and a status report and benchmark policy option on the Medicare Advantage program. Includes rural references throughout.
Date: 12/2020
Sponsoring organization: Medicare Payment Advisory Commission
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Rural Health Clinics Modernization Policy Explained
Recording of a webinar (updated December 31, 2020) providing an overview of statutory revisions to the Rural Health Clinic (RHC) payment methodology. Explains the impact of the changes on both capped and uncapped RHCs. Includes information on telehealth reimbursement for RHCs. Part of the Rural Health Clinic Technical Assistance Series.
Additional links: Presentation Slides
Author(s): Bill Finerfrock, Nathan Baugh
Date: 12/2020
Sponsoring organization: National Association of Rural Health Clinics
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Recording of a webinar (updated December 31, 2020) providing an overview of statutory revisions to the Rural Health Clinic (RHC) payment methodology. Explains the impact of the changes on both capped and uncapped RHCs. Includes information on telehealth reimbursement for RHCs. Part of the Rural Health Clinic Technical Assistance Series.
Additional links: Presentation Slides
Author(s): Bill Finerfrock, Nathan Baugh
Date: 12/2020
Sponsoring organization: National Association of Rural Health Clinics
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The Centers for Medicare & Medicaid Services Could Improve Its Wage Index Adjustment for Hospitals in Areas With the Lowest Wages
Analyzes characteristics of hospitals with area wage indexes (AWI) in the bottom quartile in 2020, including rurality, geography, Medicaid expansion status, and hourly wages. Provides an overview of the hospital wage index system and AWI, circularity, and the impact of these policies on prospective payment system (PPS) hospitals. Offers policy recommendations to the Centers for Medicare and Medicaid Services regarding future adjustments.
Date: 12/2020
Sponsoring organization: Office of Inspector General (HHS)
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Analyzes characteristics of hospitals with area wage indexes (AWI) in the bottom quartile in 2020, including rurality, geography, Medicaid expansion status, and hourly wages. Provides an overview of the hospital wage index system and AWI, circularity, and the impact of these policies on prospective payment system (PPS) hospitals. Offers policy recommendations to the Centers for Medicare and Medicaid Services regarding future adjustments.
Date: 12/2020
Sponsoring organization: Office of Inspector General (HHS)
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Medicare Fee-For-Service Beneficiaries with Opioid Use Disorder in 2018: Disparities in Prevalence by Beneficiary Characteristics
Examines the sociodemographic, Medicare eligibility, clinical, and geographic characteristics of Medicare beneficiaries with opioid use disorder (OUD). Identifies disparities in OUD prevalence among Medicare beneficiaries. Discusses opportunities to tailor policies and interventions to beneficiary groups with high OUD prevalence to ensure access to treatment.
Date: 12/2020
Sponsoring organization: Centers for Medicare and Medicaid Services
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Examines the sociodemographic, Medicare eligibility, clinical, and geographic characteristics of Medicare beneficiaries with opioid use disorder (OUD). Identifies disparities in OUD prevalence among Medicare beneficiaries. Discusses opportunities to tailor policies and interventions to beneficiary groups with high OUD prevalence to ensure access to treatment.
Date: 12/2020
Sponsoring organization: Centers for Medicare and Medicaid Services
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Telemedicine Utilization Report: Telehealth and Telemedicine During the COVID-19 Pandemic
Examines the use of telemedicine to deliver Medicaid-covered services in the state of Minnesota. Describes state and federal telehealth policy waivers and modifications that were temporarily implemented in response to the COVID-19 pandemic. Discusses telehealth use by and special considerations for rural populations.
Author(s): Neerja Singh, Julie Marquardt
Date: 12/2020
Sponsoring organization: Minnesota Department of Human Services
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Examines the use of telemedicine to deliver Medicaid-covered services in the state of Minnesota. Describes state and federal telehealth policy waivers and modifications that were temporarily implemented in response to the COVID-19 pandemic. Discusses telehealth use by and special considerations for rural populations.
Author(s): Neerja Singh, Julie Marquardt
Date: 12/2020
Sponsoring organization: Minnesota Department of Human Services
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Association of CMS-HCC Risk Scores with Health Care Utilization among Rural and Urban Medicare Beneficiaries
Research brief exploring healthcare utilization by rural and urban Medicare beneficiaries in order to better understand CMS Hierarchical Condition Categories (HCCs) and accurately apply the CMS-HCC risk score model. Analyzes 2014 CMS-HCC risk score data for different healthcare outcomes, including inpatient and outpatient ER visits, acute inpatient stays, and hospital readmissions, comparing rural and urban populations.
Author(s): Tyler Malone, Denise Kirk, Randy Randolph, Kristin Reiter
Date: 12/2020
Sponsoring organization: North Carolina Rural Health Research Program
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Research brief exploring healthcare utilization by rural and urban Medicare beneficiaries in order to better understand CMS Hierarchical Condition Categories (HCCs) and accurately apply the CMS-HCC risk score model. Analyzes 2014 CMS-HCC risk score data for different healthcare outcomes, including inpatient and outpatient ER visits, acute inpatient stays, and hospital readmissions, comparing rural and urban populations.
Author(s): Tyler Malone, Denise Kirk, Randy Randolph, Kristin Reiter
Date: 12/2020
Sponsoring organization: North Carolina Rural Health Research Program
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CMS Hierarchical Condition Category (HCC) 2014 Risk Scores Are Lower for Rural Medicare Beneficiaries than for Urban Beneficiaries
Research brief discussing the Hierarchical Condition Category (HCC) risk adjustment model developed by the Centers for Medicare and Medicaid Services (CMS), comparing data on metropolitan, micropolitan, and non-core regions. Presents data on beneficiary distribution, average risk scores, risk scores by race/ethnicity, and healthcare utilization using 2014 CMS Risk Score Files, which were the only data available.
Author(s): Tyler Malone, Denise Kirk, Randy Randolph, Kristin Reiter
Date: 12/2020
Sponsoring organization: North Carolina Rural Health Research Program
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Research brief discussing the Hierarchical Condition Category (HCC) risk adjustment model developed by the Centers for Medicare and Medicaid Services (CMS), comparing data on metropolitan, micropolitan, and non-core regions. Presents data on beneficiary distribution, average risk scores, risk scores by race/ethnicity, and healthcare utilization using 2014 CMS Risk Score Files, which were the only data available.
Author(s): Tyler Malone, Denise Kirk, Randy Randolph, Kristin Reiter
Date: 12/2020
Sponsoring organization: North Carolina Rural Health Research Program
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Costs of Emergency Department Visits in the United States, 2017
Examines the cost of emergency department (ED) visits in the United States. Includes data by location of patient's residence for large metropolitan, small metro, micropolitan, and rural areas. Topics covered include aggregate costs, average costs, number of ED visits, aggregate costs by age, aggregate costs by community-level income, and aggregate costs by primary expected payer.
Author(s): Brian J. Moore, Lan Liang
Date: 12/2020
Sponsoring organization: Agency for Healthcare Research and Quality
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Examines the cost of emergency department (ED) visits in the United States. Includes data by location of patient's residence for large metropolitan, small metro, micropolitan, and rural areas. Topics covered include aggregate costs, average costs, number of ED visits, aggregate costs by age, aggregate costs by community-level income, and aggregate costs by primary expected payer.
Author(s): Brian J. Moore, Lan Liang
Date: 12/2020
Sponsoring organization: Agency for Healthcare Research and Quality
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