Rural Health
Resources by Topic: Reimbursement and payment models
Calendar Year (CY) 2015 Rural Health Clinic (RHC) and Federally Qualified Health Centers (FQHC) Updates: Payment Rate Increases for RHCs and FQHCs Billing Under the All-Inclusive Rate System (AIR), and Urban and Rural Designations for FQHCs Billing Under the AIR
Provides updates for RHCs and FQHCs that are submitting claims to Medicare Administrative Contractors (MACs) for services to Medicare beneficiaries.
Date: 12/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides updates for RHCs and FQHCs that are submitting claims to Medicare Administrative Contractors (MACs) for services to Medicare beneficiaries.
Date: 12/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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January 2025 Annual Rural Emergency Hospital (REH) Monthly Facility Payment Amount
Presents the monthly Rural Emergency Hospital (REH) monthly facility payment amount for Calendar Year 2025.
Date: 11/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Presents the monthly Rural Emergency Hospital (REH) monthly facility payment amount for Calendar Year 2025.
Date: 11/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Advancing Health Equity in Rural, Tribal, and Geographically Isolated Communities: FY2024 Year in Review
Summarizes Centers for Medicare & Medicaid Services (CMS) activities in fiscal year 2024 to advance health equity for people living in rural, tribal, and geographically isolated communities. Covers six priority focus areas: applying a community-informed geographic lens; increasing the collection and use of standardized data; strengthening and supporting healthcare professionals; optimizing medical and communication technology; expanding access to comprehensive healthcare coverage, benefits, and services and supports; and driving innovation and value-based care.
Date: 11/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Summarizes Centers for Medicare & Medicaid Services (CMS) activities in fiscal year 2024 to advance health equity for people living in rural, tribal, and geographically isolated communities. Covers six priority focus areas: applying a community-informed geographic lens; increasing the collection and use of standardized data; strengthening and supporting healthcare professionals; optimizing medical and communication technology; expanding access to comprehensive healthcare coverage, benefits, and services and supports; and driving innovation and value-based care.
Date: 11/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Calendar Year (CY) 2025 Medicare Physician Fee Schedule Final Rule
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 2025. Summarizes provisions related to telehealth services; advanced primary care management services; behavioral health services; opioid treatment programs; dental and oral health services; Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) care coordination services, telecommunication services, intensive outpatient program (IOP) services, and payment for vaccine costs; and more.
Date: 11/2024
Type: Document
Sponsoring organization: Centers for Medicare and 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 2025. Summarizes provisions related to telehealth services; advanced primary care management services; behavioral health services; opioid treatment programs; dental and oral health services; Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) care coordination services, telecommunication services, intensive outpatient program (IOP) services, and payment for vaccine costs; and more.
Date: 11/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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CY 2025 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule (CMS 1809-FC)
Fact sheet providing an overview of the Centers for Medicare & Medicaid Services (CMS) final rule regarding updates and changes to the Medicare payments for hospital outpatient and Ambulatory Surgical Center (ASC) services for calendar year 2025. Summarizes provisions regarding changes to Intensive Outpatient Program (IOP) and partial hospital program rate setting; incorporating an add-on payment to the Medicare outpatient hospital all-inclusive rate (AIR) for certain high-cost drugs for people with Medicare who receive care at Indian Health Service (IHS) or tribal hospitals; updates to the Hospital Outpatient Quality Reporting (OQR), Ambulatory Surgical Center Quality Reporting (ASCQR), and Rural Emergency Hospital Quality Reporting (REHQR) Programs; a new Conditions of Participation (CoPs) for hospitals and Critical Access Hospitals (CAHs) for obstetrical services; Medicaid and CHIP continuous eligibility; Medicaid clinic services "four walls" exceptions; and more.
Date: 11/2024
Type: Document
Sponsoring organization: Centers for Medicare and 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 for hospital outpatient and Ambulatory Surgical Center (ASC) services for calendar year 2025. Summarizes provisions regarding changes to Intensive Outpatient Program (IOP) and partial hospital program rate setting; incorporating an add-on payment to the Medicare outpatient hospital all-inclusive rate (AIR) for certain high-cost drugs for people with Medicare who receive care at Indian Health Service (IHS) or tribal hospitals; updates to the Hospital Outpatient Quality Reporting (OQR), Ambulatory Surgical Center Quality Reporting (ASCQR), and Rural Emergency Hospital Quality Reporting (REHQR) Programs; a new Conditions of Participation (CoPs) for hospitals and Critical Access Hospitals (CAHs) for obstetrical services; Medicaid and CHIP continuous eligibility; Medicaid clinic services "four walls" exceptions; and more.
Date: 11/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Final CY 2025 Medicare Physician Fee Schedule: Fact Sheet
Fact sheet covering Centers for Medicare & Medicaid Services (CMS) telehealth policy changes for 2025 as outlined in the final calendar year (CY) 2025 Physician Fee Schedule. Covers audio-only telehealth; eligible services that 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); opioid treatment programs; and more.
Date: 11/2024
Type: Document
Sponsoring organization: Center for Connected Health Policy: The National Telehealth Policy Resource Center
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Fact sheet covering Centers for Medicare & Medicaid Services (CMS) telehealth policy changes for 2025 as outlined in the final calendar year (CY) 2025 Physician Fee Schedule. Covers audio-only telehealth; eligible services that 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); opioid treatment programs; and more.
Date: 11/2024
Type: Document
Sponsoring organization: Center for Connected Health Policy: The National Telehealth Policy Resource Center
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Re-Imagining Rural Health: Themes, Concepts, and Next Steps from the CMS Innovation Center "Hackathon" Series
Summarizes themes that emerged from Centers for Medicare & Medicaid Services (CMS) Innovation Center's August 2024 Rural Health Hackathons, which aimed to inform potential payment and service delivery model development and to identify innovative solutions to address the access, care delivery, and workforce needs of rural, Tribal, frontier, and geographically isolated areas communities Describes lessons learned from previous Innovation Center models focused on rural health and how these lessons were applied during the development of new models. Outlines potential areas for the Innovation Center to explore to advance health in rural, Tribal, frontier, and geographically isolated areas.
Date: 11/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Summarizes themes that emerged from Centers for Medicare & Medicaid Services (CMS) Innovation Center's August 2024 Rural Health Hackathons, which aimed to inform potential payment and service delivery model development and to identify innovative solutions to address the access, care delivery, and workforce needs of rural, Tribal, frontier, and geographically isolated areas communities Describes lessons learned from previous Innovation Center models focused on rural health and how these lessons were applied during the development of new models. Outlines potential areas for the Innovation Center to explore to advance health in rural, Tribal, frontier, and geographically isolated areas.
Date: 11/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Rural Value-Based Care – The Payer Perspective
Summarizes discussions on rural value-based care (VBC) contracting during a July 2024 summit of leaders from national and regional healthcare payer organizations. Describes challenges facing payer organizations that serve rural beneficiaries, including engaging rural healthcare organizations in VBC; solutions to rural-specific challenges; and recommendations for rural healthcare organizations.
Date: 11/2024
Type: Document
Sponsoring organization: Rural Health Value
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Summarizes discussions on rural value-based care (VBC) contracting during a July 2024 summit of leaders from national and regional healthcare payer organizations. Describes challenges facing payer organizations that serve rural beneficiaries, including engaging rural healthcare organizations in VBC; solutions to rural-specific challenges; and recommendations for rural healthcare organizations.
Date: 11/2024
Type: Document
Sponsoring organization: Rural Health Value
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Catalog of Value-Based Initiatives for Rural Providers
Summarizes rural-relevant, value-based programs currently or recently implemented by the U.S. Department of Health and Human Services (HHS), including the Centers for Medicare & Medicaid Services (CMS) and the CMS Innovation Center. Designed to help rural healthcare leaders identify HHS value-based programs that are suitable for rural participation. Contains descriptions of each demonstration and provides direct links to the corresponding agency web page.
Date: 11/2024
Type: Document
Sponsoring organization: Rural Health Value
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Summarizes rural-relevant, value-based programs currently or recently implemented by the U.S. Department of Health and Human Services (HHS), including the Centers for Medicare & Medicaid Services (CMS) and the CMS Innovation Center. Designed to help rural healthcare leaders identify HHS value-based programs that are suitable for rural participation. Contains descriptions of each demonstration and provides direct links to the corresponding agency web page.
Date: 11/2024
Type: Document
Sponsoring organization: Rural Health Value
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Texas Rural Hospital Grant Program Report
Reports on the establishment, functions, and achievements of the Rural Hospital Grant Program in Texas during the 2024-2025 state fiscal years. Provides an overview of program funding and awards, and details grant programs supporting hospital stabilization, maternal care, and Alternative Payment Model readiness.
Date: 11/2024
Type: Document
Sponsoring organization: Texas Health and Human Services
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Reports on the establishment, functions, and achievements of the Rural Hospital Grant Program in Texas during the 2024-2025 state fiscal years. Provides an overview of program funding and awards, and details grant programs supporting hospital stabilization, maternal care, and Alternative Payment Model readiness.
Date: 11/2024
Type: Document
Sponsoring organization: Texas Health and Human Services
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