Rural Health
Resources by Topic: Reimbursement and payment models
December 2025 MedPAC Meeting Transcript
Transcript from the Medicare Payment Advisory Commission's (MedPAC) December 2025 meeting. Covers payment adequacy and updates for physician and other health professional services, hospital inpatient and outpatient services, Rural Emergency Hospitals (REHs), post-acute care, skilled nursing facility services, inpatient rehabilitation facility services, home health services, hospice services, and outpatient dialysis services. Includes discussions on improving Medicare payment approaches and mandated reports on the impact of recent changes to the home health prospective payment system and an assessment of the Medicare ground ambulance data collection system.
Additional links: Assessing Payment Adequacy and Updating Payments: Hospital Inpatient and Outpatient Services; Mandated Report on Rural Emergency Hospitals; And Update on Site-neutral Payments - Presentation Slides, Mandated Report: Assessment of the Medicare Ground Ambulance Data Collection System - Presentation Slides
Date: 12/2025
Sponsoring organization: Medicare Payment Advisory Commission
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Transcript from the Medicare Payment Advisory Commission's (MedPAC) December 2025 meeting. Covers payment adequacy and updates for physician and other health professional services, hospital inpatient and outpatient services, Rural Emergency Hospitals (REHs), post-acute care, skilled nursing facility services, inpatient rehabilitation facility services, home health services, hospice services, and outpatient dialysis services. Includes discussions on improving Medicare payment approaches and mandated reports on the impact of recent changes to the home health prospective payment system and an assessment of the Medicare ground ambulance data collection system.
Additional links: Assessing Payment Adequacy and Updating Payments: Hospital Inpatient and Outpatient Services; Mandated Report on Rural Emergency Hospitals; And Update on Site-neutral Payments - Presentation Slides, Mandated Report: Assessment of the Medicare Ground Ambulance Data Collection System - Presentation Slides
Date: 12/2025
Sponsoring organization: Medicare Payment Advisory Commission
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Merit-Based Incentive Payment System (MIPS): Traditional MIPS Scoring Guide for the 2025 Performance Year
Provides details on how scores are calculated for the Merit-Based Incentive Payment System (MIPS), one of two tracks under the Medicare Quality Payment Program. Explains the four performance categories that affect Medicare Physician Fee Schedule payments: quality, cost, improvement activities, and promoting interoperability. Includes information for small practices.
Date: 12/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides details on how scores are calculated for the Merit-Based Incentive Payment System (MIPS), one of two tracks under the Medicare Quality Payment Program. Explains the four performance categories that affect Medicare Physician Fee Schedule payments: quality, cost, improvement activities, and promoting interoperability. Includes information for small practices.
Date: 12/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Merit-Based Incentive Payment System (MIPS): 2025 Merit-Based Incentive Payment (MIPS) Value Pathways (MVPs) Implementation Guide
Provides an overview of the Merit-based Incentive Payment System (MIPS) Value Pathways (MVPs), a voluntary reporting option that can be used to meet MIPS reporting requirements for the 2025 performance year. Describes subgroup reporting, reporting requirements, scoring, performance feedback and public reporting, and how to register to report an MVP. Includes information on considerations and exceptions for small practices and clinicians in a rural or Health Professional Shortage Area.
Date: 12/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides an overview of the Merit-based Incentive Payment System (MIPS) Value Pathways (MVPs), a voluntary reporting option that can be used to meet MIPS reporting requirements for the 2025 performance year. Describes subgroup reporting, reporting requirements, scoring, performance feedback and public reporting, and how to register to report an MVP. Includes information on considerations and exceptions for small practices and clinicians in a rural or Health Professional Shortage Area.
Date: 12/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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What to Ask (About) a Hospital
Describes payment and financial considerations for hospitals as it relates to the hospital's organizational structure, type of care provided, location, patient population, training programs, and alternative payment models. Discusses rural considerations throughout with a close analysis in Section 6: How a Hospital's Location Matters.
Author(s): Christine H. Monahan, Kennah Watts, Julia Burleson, Rachel Swindle, Ariel Winter
Date: 11/2025
Sponsoring organizations: Blood Cancer United, Georgetown University's Center on Health Insurance Reforms (CHIR)
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Describes payment and financial considerations for hospitals as it relates to the hospital's organizational structure, type of care provided, location, patient population, training programs, and alternative payment models. Discusses rural considerations throughout with a close analysis in Section 6: How a Hospital's Location Matters.
Author(s): Christine H. Monahan, Kennah Watts, Julia Burleson, Rachel Swindle, Ariel Winter
Date: 11/2025
Sponsoring organizations: Blood Cancer United, Georgetown University's Center on Health Insurance Reforms (CHIR)
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Telehealth FAQ Calendar Year 2026
Provides information on Medicare telehealth regulations and payment policy for calendar year 2026. Includes information on audio-only services, behavioral health services, direct supervision, and more. Highlights changes that take effect on January 31, 2026 under current law.
Date: 11/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides information on Medicare telehealth regulations and payment policy for calendar year 2026. Includes information on audio-only services, behavioral health services, direct supervision, and more. Highlights changes that take effect on January 31, 2026 under current law.
Date: 11/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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Calendar Year 2026 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Final Rule (CMS-1834-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 2026. Summarizes provisions regarding changes to hospital price transparency; Intensive Outpatient Program (IOP) and partial hospital program rate setting; updates to the Hospital Outpatient Quality Reporting (OQR), Ambulatory Surgical Center Quality Reporting (ASCQR), and Rural Emergency Hospital Quality Reporting (REHQR) Programs; hospital quality start ratings; and more.
Date: 11/2025
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 for hospital outpatient and Ambulatory Surgical Center (ASC) services for calendar year 2026. Summarizes provisions regarding changes to hospital price transparency; Intensive Outpatient Program (IOP) and partial hospital program rate setting; updates to the Hospital Outpatient Quality Reporting (OQR), Ambulatory Surgical Center Quality Reporting (ASCQR), and Rural Emergency Hospital Quality Reporting (REHQR) Programs; hospital quality start ratings; and more.
Date: 11/2025
Sponsoring organization: Centers for Medicare and Medicaid Services
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RHCs and CAHs Participating in the Medicare Shared Savings Program (MSSP): Characteristics of the Providers and Communities
Describes the characteristics of Rural Health Clinics (RHCs) and Critical Access Hospitals (CAHs) currently participating in the Medicare Shared Savings Program (MSSP) in 2023. Compares CAH and RHC characteristics by MSSP participation, ownership status, and free-standing versus provider-based RHC status.
Author(s): Edmer Lazaro, Dan Shane, Fred Ullrich, Keith Mueller
Date: 11/2025
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Describes the characteristics of Rural Health Clinics (RHCs) and Critical Access Hospitals (CAHs) currently participating in the Medicare Shared Savings Program (MSSP) in 2023. Compares CAH and RHC characteristics by MSSP participation, ownership status, and free-standing versus provider-based RHC status.
Author(s): Edmer Lazaro, Dan Shane, Fred Ullrich, Keith Mueller
Date: 11/2025
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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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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