Rural Health
Resources by Topic: Reimbursement and payment models
Hospital Outpatient Prospective Payment System (OPPS): Remedy for the 340B-Acquired Drug Payment Policy for Calendar Years 2018-2022 Final Rule (CMS 1793-F)
Fact sheet providing an overview of the Centers for Medicare & Medicaid Services (CMS) final rule describing the agency's actions to remedy payment cuts to certain hospitals that participate in the 340B Drug Pricing Program from 2018-2022 that were declared unlawful by the Supreme Court's decision in American Hospital Association v. Becerra, 142 S. Ct. 1896 (2022). Details the one-time lump sum payments to affected 340B covered entities to what they would have been paid had the 340B payment cuts not been applied, as well as a 0.5% payment reduction on future non-drug item and service payments to maintain budget neutrality beginning in calendar year 2026.
Date: 11/2023
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 describing the agency's actions to remedy payment cuts to certain hospitals that participate in the 340B Drug Pricing Program from 2018-2022 that were declared unlawful by the Supreme Court's decision in American Hospital Association v. Becerra, 142 S. Ct. 1896 (2022). Details the one-time lump sum payments to affected 340B covered entities to what they would have been paid had the 340B payment cuts not been applied, as well as a 0.5% payment reduction on future non-drug item and service payments to maintain budget neutrality beginning in calendar year 2026.
Date: 11/2023
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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CY 2024 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule (CMS 1786-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 2024. Summarizes provisions regarding changes to the community mental health centers (CMHC) Conditions of Participation (CoPs); payment for intensive outpatient program (IOP) services; payment methodology for Indian Health Service (IHS) and tribal facilities that convert to Rural Emergency Hospital (REH) status; the Hospital Outpatient Quality Reporting (OQR), Ambulatory Surgical Center Quality Reporting (ASCQR), and Rural Emergency Hospital Quality Reporting (REHQR) Programs; and more.
Date: 11/2023
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 2024. Summarizes provisions regarding changes to the community mental health centers (CMHC) Conditions of Participation (CoPs); payment for intensive outpatient program (IOP) services; payment methodology for Indian Health Service (IHS) and tribal facilities that convert to Rural Emergency Hospital (REH) status; the Hospital Outpatient Quality Reporting (OQR), Ambulatory Surgical Center Quality Reporting (ASCQR), and Rural Emergency Hospital Quality Reporting (REHQR) Programs; and more.
Date: 11/2023
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Calendar Year (CY) 2024 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 2024. Summarizes provisions related to paying separately for Community Health Integration, Social Determinants of Health (SDOH) Risk Assessment, and Principal Illness Navigation services; telehealth services; mental health visits furnished by Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs); including marriage and family therapists and mental health counselors as eligible for payment at RHCs and FQHCs; and more.
Date: 11/2023
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 2024. Summarizes provisions related to paying separately for Community Health Integration, Social Determinants of Health (SDOH) Risk Assessment, and Principal Illness Navigation services; telehealth services; mental health visits furnished by Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs); including marriage and family therapists and mental health counselors as eligible for payment at RHCs and FQHCs; and more.
Date: 11/2023
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Medicare Learning Network: Rural Emergency Hospitals
Details the regulatory requirements for providers to become a Rural Emergency Hospital (REH). Provides information on REH billing for Medicare services, Medicare payments for REH services, and the additional monthly facility payment.
Date: 11/2023
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Details the regulatory requirements for providers to become a Rural Emergency Hospital (REH). Provides information on REH billing for Medicare services, Medicare payments for REH services, and the additional monthly facility payment.
Date: 11/2023
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Rural Hospital Experiences in the Colorado Hospital Transformation Program
Provides an overview of the Colorado Hospital Transformation Program (CO HTP), a 5-year program that ties Medicaid supplemental payments to hospitals' ability to meet performance targets through September 2026. Describes the experiences of three Critical Access Hospitals (CAHs) and explores how CO HTP impacts rural hospitals. Covers planning and community engagement, quality of care, and healthcare costs.
Date: 10/2023
Type: Document
Sponsoring organization: Rural Health Value
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Provides an overview of the Colorado Hospital Transformation Program (CO HTP), a 5-year program that ties Medicaid supplemental payments to hospitals' ability to meet performance targets through September 2026. Describes the experiences of three Critical Access Hospitals (CAHs) and explores how CO HTP impacts rural hospitals. Covers planning and community engagement, quality of care, and healthcare costs.
Date: 10/2023
Type: Document
Sponsoring organization: Rural Health Value
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Health Panel Comment Letter – Encouraging Rural Participation in Population-Based Total Cost of Care Models
Offers comments in response to the Physician-Focused Payment Model Technical Advisory Committee (PTAC) Request for Information regarding rural participation in population-based total cost of care models. Covers considerations for determining the most relevant definition of rural, barriers that impact rural providers' participation in alternative payment models (APMs), service delivery models and resources that are effective in encouraging value-based care (VBC) transformation in rural areas, and more.
Date: 10/2023
Type: Document
Sponsoring organization: Rural Policy Research Institute Rural Health Panel
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Offers comments in response to the Physician-Focused Payment Model Technical Advisory Committee (PTAC) Request for Information regarding rural participation in population-based total cost of care models. Covers considerations for determining the most relevant definition of rural, barriers that impact rural providers' participation in alternative payment models (APMs), service delivery models and resources that are effective in encouraging value-based care (VBC) transformation in rural areas, and more.
Date: 10/2023
Type: Document
Sponsoring organization: Rural Policy Research Institute Rural Health Panel
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State Telehealth Laws and Reimbursement Policies Report, Fall 2023
Provides an overview of state telehealth policies as of early September 2023. Covers Medicaid reimbursement, private payer laws, and professional requirements.
Additional links: Executive Summary, Infographic, State Summary Chart
Date: 10/2023
Type: Document
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 2023. Covers Medicaid reimbursement, private payer laws, and professional requirements.
Additional links: Executive Summary, Infographic, State Summary Chart
Date: 10/2023
Type: Document
Sponsoring organization: Center for Connected Health Policy: The National Telehealth Policy Resource Center
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Provision of Hospice Services by Critical Access Hospitals: Strengths and Challenges
Describes the characteristics of Critical Access Hospitals (CAHs) that report providing hospice services by analyzing data from the 2021 American Hospital Association (AHA) annual survey. Presents findings from qualitative interviews with seven CAHs who report providing hospice care, including how CAHs provide hospice services, the advantages CAHs may have when providing end-of-life care, and what CAH-specific barriers exist in providing such care.
Author(s): Robert Barclay, Megan Lahr, Hannah MacDougall, Abigail Wenninger
Date: 10/2023
Type: Document
Sponsoring organization: Flex Monitoring Team
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Describes the characteristics of Critical Access Hospitals (CAHs) that report providing hospice services by analyzing data from the 2021 American Hospital Association (AHA) annual survey. Presents findings from qualitative interviews with seven CAHs who report providing hospice care, including how CAHs provide hospice services, the advantages CAHs may have when providing end-of-life care, and what CAH-specific barriers exist in providing such care.
Author(s): Robert Barclay, Megan Lahr, Hannah MacDougall, Abigail Wenninger
Date: 10/2023
Type: Document
Sponsoring organization: Flex Monitoring Team
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Medicare: Performance-Based and Geographic Adjustments to Physician Payments
Statement to the U.S. House of Representatives Committee on Energy and Commerce, Subcommittee on Health, summarizing the Government Accountability Organization's (GAO) 2021 reports on the Quality Payment Program and the two tracks it established to incentivize Medicare providers and its 2022 report on geographic adjustments to physician payments. Includes information on the participation of providers in rural and underserved areas in Advanced Alternative Payment Models (APMs) and the challenges these providers face in transitioning to APMs.
Additional links: Full Report
Date: 10/2023
Type: Document
Sponsoring organization: Government Accountability Office
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Statement to the U.S. House of Representatives Committee on Energy and Commerce, Subcommittee on Health, summarizing the Government Accountability Organization's (GAO) 2021 reports on the Quality Payment Program and the two tracks it established to incentivize Medicare providers and its 2022 report on geographic adjustments to physician payments. Includes information on the participation of providers in rural and underserved areas in Advanced Alternative Payment Models (APMs) and the challenges these providers face in transitioning to APMs.
Additional links: Full Report
Date: 10/2023
Type: Document
Sponsoring organization: Government Accountability Office
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MedPAC Payment Basics
Series of briefs providing an of Medicare payment systems. Covers payments systems including Accountable Care Organizations (ACO), Critical Access Hospitals (CAH), Federally Qualified Health Centers and Rural Health Clinics, hospital acute inpatient services, and more.
Date: 10/2023
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Series of briefs providing an of Medicare payment systems. Covers payments systems including Accountable Care Organizations (ACO), Critical Access Hospitals (CAH), Federally Qualified Health Centers and Rural Health Clinics, hospital acute inpatient services, and more.
Date: 10/2023
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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