Rural Health
Resources by Topic: Reimbursement and payment models
Third Party Negotiated Hospital Pricing in Rural and Urban Hospitals within 12 U.S. States
Examines the gross and negotiated pricing for common services in rural and urban hospitals. Bases findings on samples from 12 states and focuses on costs of routine care, imaging, and childbirth.
Author(s): Lindsey R. Hammerslag, Aaron P. Smith, Jeffrey C. Talbert
Date: 11/2025
Sponsoring organization: Rural and Underserved Health Research Center
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Examines the gross and negotiated pricing for common services in rural and urban hospitals. Bases findings on samples from 12 states and focuses on costs of routine care, imaging, and childbirth.
Author(s): Lindsey R. Hammerslag, Aaron P. Smith, Jeffrey C. Talbert
Date: 11/2025
Sponsoring organization: Rural and Underserved Health Research Center
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Small Practices Guide: Getting Started with Merit-based Incentive Payment System (MIPS) Clinical Quality Measure (CQM) Reporting
Provides an overview of Merit-based Incentive Payment System (MIPS) clinical quality measures (MIPS CQMs). Describes how small practices can report MIPS CQMs, whether participating as an individual clinician, group, subgroup, or Alternative Payment Model (APM) Entity.
Date: 11/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides an overview of Merit-based Incentive Payment System (MIPS) clinical quality measures (MIPS CQMs). Describes how small practices can report MIPS CQMs, whether participating as an individual clinician, group, subgroup, or Alternative Payment Model (APM) Entity.
Date: 11/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Medicare Physician Fee-For-Service Payments: Adjusting for Variation in Geographic Practice Costs and Challenges for Hawaiʻi
Reports on policy approaches to Medicare reimbursement in Hawaii in order to address provider shortages and limited access to care associated with the state's geographic isolation and high cost of living. Discusses how Medicare policy impacts reimbursement and service availability in rural, remote, and frontier areas.
Author(s): Reinie Gerrits-Goh, John Desfor, Diana M.V. Shaw, et al.
Date: 11/2025
Sponsoring organization: University of Hawaiʻi Rural Health Research & Policy Center
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Reports on policy approaches to Medicare reimbursement in Hawaii in order to address provider shortages and limited access to care associated with the state's geographic isolation and high cost of living. Discusses how Medicare policy impacts reimbursement and service availability in rural, remote, and frontier areas.
Author(s): Reinie Gerrits-Goh, John Desfor, Diana M.V. Shaw, et al.
Date: 11/2025
Sponsoring organization: University of Hawaiʻi Rural Health Research & Policy Center
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A View of Medicaid Today and a Look Ahead: Balancing Access, Budgets and Upcoming Changes: Results from an Annual Medicaid Budget Survey for State Fiscal Years 2025 and 2026
Examines changes taking place in Medicaid programs in the 50 states and the District of Columbia. Features sections on delivery systems, provider rates and taxes, benefits, and pharmacy and prescription drugs. Highlights challenges and priorities related to implementing federal priorities, systems issues, state budget limitations, and more.
Author(s): Elizabeth Hinton, Elizabeth Williams, Jada Raphael, et al.
Date: 11/2025
Sponsoring organization: KFF
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Examines changes taking place in Medicaid programs in the 50 states and the District of Columbia. Features sections on delivery systems, provider rates and taxes, benefits, and pharmacy and prescription drugs. Highlights challenges and priorities related to implementing federal priorities, systems issues, state budget limitations, and more.
Author(s): Elizabeth Hinton, Elizabeth Williams, Jada Raphael, et al.
Date: 11/2025
Sponsoring organization: KFF
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Closing the Distance in Rural Primary Care: Evidence, Stories and Solutions
Explores the state of rural primary care in the United States. Describes recent federal legislation that may impact rural primary care, healthcare access, and health outcomes. Discusses trends in rural primary care, including comparisons between rural and urban primary care spending relative to all total spending, primary care workforce availability, and comprehensiveness of primary care. Presents five case studies highlighting rural primary care practices and practice models.
Date: 11/2025
Sponsoring organizations: Primary Care Collaborative, Robert Graham Center
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Explores the state of rural primary care in the United States. Describes recent federal legislation that may impact rural primary care, healthcare access, and health outcomes. Discusses trends in rural primary care, including comparisons between rural and urban primary care spending relative to all total spending, primary care workforce availability, and comprehensiveness of primary care. Presents five case studies highlighting rural primary care practices and practice models.
Date: 11/2025
Sponsoring organizations: Primary Care Collaborative, Robert Graham Center
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Final CY 2026 Medicare Physician Fee Schedule: Fact Sheet
Fact sheet covering the Centers for Medicare & Medicaid Services (CMS) telehealth policy changes for 2026 as outlined in the final calendar year (CY) 2026 Physician Fee Schedule. Covers the process for determining which services 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); and more.
Date: 11/2025
Sponsoring organization: Center for Connected Health Policy: The National Telehealth Policy Resource Center
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Fact sheet covering the Centers for Medicare & Medicaid Services (CMS) telehealth policy changes for 2026 as outlined in the final calendar year (CY) 2026 Physician Fee Schedule. Covers the process for determining which services 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); and more.
Date: 11/2025
Sponsoring organization: Center for Connected Health Policy: The National Telehealth Policy Resource Center
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Calendar Year (CY) 2026 Medicare Physician Fee Schedule Final Rule (CMS-1832-F)
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 2026. Summarizes provisions related to telehealth services; improving care for chronic illness and behavioral health needs; Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) care coordination services, services requiring direct supervision, and telecommunication services; and more.
Date: 10/2025
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 2026. Summarizes provisions related to telehealth services; improving care for chronic illness and behavioral health needs; Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) care coordination services, services requiring direct supervision, and telecommunication services; and more.
Date: 10/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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State Telehealth Laws and Reimbursement Policies Report, Fall 2025
Provides an overview of state telehealth policies as of early September 2025. Covers Medicaid reimbursement, private payer laws, and professional requirements.
Additional links: Executive Summary, Infographic, State Summary Chart
Date: 10/2025
Sponsoring organization: Center for Connected Health Policy: The National Telehealth Policy Resource Center
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Provides an overview of state telehealth policies as of early September 2025. Covers Medicaid reimbursement, private payer laws, and professional requirements.
Additional links: Executive Summary, Infographic, State Summary Chart
Date: 10/2025
Sponsoring organization: Center for Connected Health Policy: The National Telehealth Policy Resource Center
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Rural Transformation Program State Legislative Resources
Provides an overview of the Rural Health Transformation Program, including how states approached seeking public input for the application. Describes how states have successfully implemented policies related to the allowable uses of Rural Health Transformation Program funds.
Date: 10/2025
Sponsoring organization: National Conference of State Legislatures
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Provides an overview of the Rural Health Transformation Program, including how states approached seeking public input for the application. Describes how states have successfully implemented policies related to the allowable uses of Rural Health Transformation Program funds.
Date: 10/2025
Sponsoring organization: National Conference of State Legislatures
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Merit-Based Incentive Payment System (MIPS): 2024 Performance Year/2026 MIPS Payment Year - Payment Adjustment User Guide
Provides information on Merit-Based Incentive Payment System (MIPS) payment adjustments for calendar year 2026. Describes how 2024 MIPS scores relate to 2026 payment adjustments and how payment adjustments are applied. Offers answers to frequently asked questions.
Date: 10/2025
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 2026. Describes how 2024 MIPS scores relate to 2026 payment adjustments and how payment adjustments are applied. Offers answers to frequently asked questions.
Date: 10/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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