Rural Health
Resources by Topic: Reimbursement and payment models
The Pennsylvania Rural Health Model (PARHM): Fourth Annual Evaluation Report
Evaluates the fourth performance year of the Pennsylvania Rural Health Model (PARHM), an initiative designed to test if global budgets can help rural hospitals improve their financial viability, provide flexibility to meet locally defined community health needs, and reduce overall healthcare spending. Provides an overview of the model and describes the implementation experience of participating hospitals and payers. Presents a descriptive quantitative assessment of financial performance, spending and utilization, access to care, and quality of care outcomes from 2016, the model's baseline, through 2022. Includes three case studies discussing three themes: experiences with global budget reconciliation, behavioral health transformation, and interactions and alignment between PARHM and other value-based care programs.
Additional links: Appendix, Findings at a Glance
Date: 12/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Evaluates the fourth performance year of the Pennsylvania Rural Health Model (PARHM), an initiative designed to test if global budgets can help rural hospitals improve their financial viability, provide flexibility to meet locally defined community health needs, and reduce overall healthcare spending. Provides an overview of the model and describes the implementation experience of participating hospitals and payers. Presents a descriptive quantitative assessment of financial performance, spending and utilization, access to care, and quality of care outcomes from 2016, the model's baseline, through 2022. Includes three case studies discussing three themes: experiences with global budget reconciliation, behavioral health transformation, and interactions and alignment between PARHM and other value-based care programs.
Additional links: Appendix, Findings at a Glance
Date: 12/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Rural-Urban Medicaid and CHIP Enrollee Comparisons Using the 2019 T-MSIS Analytic File
Compares urban and rural residents enrolled in fee-for-service or managed care Medicaid, using data from the 2019 Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF). Features demographics and statistics on Medicaid enrollment, with breakdowns by levels of rurality.
Author(s): Kristie Thompson, Hannah Friedman, Lily Wang, Mark Holmes
Date: 12/2024
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Compares urban and rural residents enrolled in fee-for-service or managed care Medicaid, using data from the 2019 Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF). Features demographics and statistics on Medicaid enrollment, with breakdowns by levels of rurality.
Author(s): Kristie Thompson, Hannah Friedman, Lily Wang, Mark Holmes
Date: 12/2024
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Hospital Margins Rebounded in 2023, But Rural Hospitals and Those With High Medicaid Shares Were Struggling More Than Others
Examines hospital margins for non-federal general short-term hospitals in the U.S. from 2018 through 2023, with a focus on operating margins. Analyzes RAND Hospital Data to explore the extent to which hospitals profited or lost money on patient care and other operating activities. Discusses differences in operating margins by hospital characteristics, including hospital ownership type, commercial share, size, rural or urban location, and Medicare rural payment designation.
Date: 12/2024
Type: Document
Sponsoring organization: KFF
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Examines hospital margins for non-federal general short-term hospitals in the U.S. from 2018 through 2023, with a focus on operating margins. Analyzes RAND Hospital Data to explore the extent to which hospitals profited or lost money on patient care and other operating activities. Discusses differences in operating margins by hospital characteristics, including hospital ownership type, commercial share, size, rural or urban location, and Medicare rural payment designation.
Date: 12/2024
Type: Document
Sponsoring organization: KFF
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OHA Director 2024 Statewide Listening Tour
Outlines planned priorities following a 2024 listening tour by the Oregon Health Authority Director in the areas of public health, Medicaid, policy and analytics, and behavioral health. Discusses capturing rural and urban health disparities, alternative payment models for healthcare providers, and rural healthcare facility closures.
Date: 12/2024
Type: Document
Sponsoring organization: Oregon Health Authority
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Outlines planned priorities following a 2024 listening tour by the Oregon Health Authority Director in the areas of public health, Medicaid, policy and analytics, and behavioral health. Discusses capturing rural and urban health disparities, alternative payment models for healthcare providers, and rural healthcare facility closures.
Date: 12/2024
Type: Document
Sponsoring organization: Oregon Health Authority
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Center for Medicare and Medicaid Innovation: 2024 Report to Congress
Reports to Congress on payment and service delivery models and initiatives tested or announced by the Center for Medicare and Medicaid Innovation between October 2022 and September 2024. Includes summaries and updates on multiple rural-relevant models and initiatives, including the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model, the Transforming Maternal Health Model, the Pennsylvania Rural Health Model (PARHM), the Vermont All-Payer Accountable Care Organization Model, and more.
Date: 12/2024
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, U.S. Department of Health and Human Services
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Reports to Congress on payment and service delivery models and initiatives tested or announced by the Center for Medicare and Medicaid Innovation between October 2022 and September 2024. Includes summaries and updates on multiple rural-relevant models and initiatives, including the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model, the Transforming Maternal Health Model, the Pennsylvania Rural Health Model (PARHM), the Vermont All-Payer Accountable Care Organization Model, and more.
Date: 12/2024
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, U.S. Department of Health and Human Services
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Texas Value-Based Payment and Quality Improvement Advisory Committee Recommendations to the 89th Texas Legislature
Identifies trends and provides policy recommendations related to value based care and quality improvement in Texas. Discusses rural healthcare access and workforce throughout and highlights key reports focusing on rural health.
Date: 12/2024
Type: Document
Sponsoring organization: Texas Health and Human Services
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Identifies trends and provides policy recommendations related to value based care and quality improvement in Texas. Discusses rural healthcare access and workforce throughout and highlights key reports focusing on rural health.
Date: 12/2024
Type: Document
Sponsoring organization: Texas Health and Human Services
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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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Dashboard: Arkansas Healthcare Expenditures
Interactive dashboard providing data on medical, pharmacy, and dental expenditures in Arkansas, utilizing the Arkansas Healthcare Transparency Initiative's All-Payer Claims Database for the years 2021-2023. Allows sorting by year, type of coverage, and type of service for individuals, total expenditures, or average annualized expenditures. Breaks down data at the county level by sex, age, payer type, and race/ethnicity.
Date: 11/2024
Type: Website
Sponsoring organization: Arkansas Center for Health Improvement
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Interactive dashboard providing data on medical, pharmacy, and dental expenditures in Arkansas, utilizing the Arkansas Healthcare Transparency Initiative's All-Payer Claims Database for the years 2021-2023. Allows sorting by year, type of coverage, and type of service for individuals, total expenditures, or average annualized expenditures. Breaks down data at the county level by sex, age, payer type, and race/ethnicity.
Date: 11/2024
Type: Website
Sponsoring organization: Arkansas Center for Health Improvement
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Strengthening Independent Primary Care Practice in California: Understanding Small Practice Perspectives
Examines business and financial factors influencing independent primary care practice in California through interviews with physicians in California's Riverside, San Bernardino, and Humboldt counties and other healthcare leaders and subject matter experts. Identifies common concerns and provides recommendations related to healthcare economics, reimbursement, and policy. Discusses topics related to rural practice, including the Rural Health Clinic designation.
Author(s): Jill M. Yegian
Date: 11/2024
Type: Document
Sponsoring organization: California Health Care Foundation
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Examines business and financial factors influencing independent primary care practice in California through interviews with physicians in California's Riverside, San Bernardino, and Humboldt counties and other healthcare leaders and subject matter experts. Identifies common concerns and provides recommendations related to healthcare economics, reimbursement, and policy. Discusses topics related to rural practice, including the Rural Health Clinic designation.
Author(s): Jill M. Yegian
Date: 11/2024
Type: Document
Sponsoring organization: California Health Care Foundation
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RHC Regulatory Changes in 2025 - Medicare Physician Fee Schedule Updates You Need to Know!
Recording of a November 18, 2024, webinar providing an overview of telehealth payment rates for Rural Health Clinics (RHCs) and other regulatory updates and potential changes for 2025. Covers Medicare vaccine reimbursement changes, the elimination of productivity standards, lab requirement changes, intensive outpatient program (IOP) services, telehealth regulations, and more. Part of the Rural Health Clinic Technical Assistance Series.
Additional links: Presentation Slides
Date: 11/2024
Type: Video/Multimedia
Sponsoring organization: National Association of Rural Health Clinics
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Recording of a November 18, 2024, webinar providing an overview of telehealth payment rates for Rural Health Clinics (RHCs) and other regulatory updates and potential changes for 2025. Covers Medicare vaccine reimbursement changes, the elimination of productivity standards, lab requirement changes, intensive outpatient program (IOP) services, telehealth regulations, and more. Part of the Rural Health Clinic Technical Assistance Series.
Additional links: Presentation Slides
Date: 11/2024
Type: Video/Multimedia
Sponsoring organization: National Association of Rural Health Clinics
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