Rural Health
Resources by Topic: Reimbursement and payment models
CMS Bundled Payments for Care Improvement Advanced Model: Fourth Evaluation Report
Fourth annual report of the Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model, which tests whether linking payments for a clinical episode of care can reduce Medicare expenditures while maintaining or improving the quality of care. Explores the impact of BPCI Advanced on episode payments, utilization, and quality of care, as well as estimates of Medicare program savings in Model Year 3. Analyzes BPCI Advanced outcomes for beneficiaries from populations that have been historically underserved, including beneficiaries in rural areas and areas with a high Area Deprivation Index (ADI).
Additional links: Appendices, Findings at a Glance
Author(s): The Lewin Group, Abt Associates, GDIT, Telligen
Date: 03/2023
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
view details
Fourth annual report of the Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model, which tests whether linking payments for a clinical episode of care can reduce Medicare expenditures while maintaining or improving the quality of care. Explores the impact of BPCI Advanced on episode payments, utilization, and quality of care, as well as estimates of Medicare program savings in Model Year 3. Analyzes BPCI Advanced outcomes for beneficiaries from populations that have been historically underserved, including beneficiaries in rural areas and areas with a high Area Deprivation Index (ADI).
Additional links: Appendices, Findings at a Glance
Author(s): The Lewin Group, Abt Associates, GDIT, Telligen
Date: 03/2023
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
view details
Obstetric Readiness in Rural Communities Lacking Hospital Labor and Delivery Units
Policy brief discussing the current rural maternal healthcare workforce and their capacity to manage obstetric emergencies during pregnancy, labor, and delivery. Offers recommendations to promote obstetric readiness for emergency care in rural hospitals without obstetric units and support for community-based, emergency department-adjacent health workers.
Author(s): Eneka Lamb, Madeline Merwin, Quinyatta Mumford, et al.
Date: 02/2023
Type: Document
Sponsoring organization: National Rural Health Association
view details
Policy brief discussing the current rural maternal healthcare workforce and their capacity to manage obstetric emergencies during pregnancy, labor, and delivery. Offers recommendations to promote obstetric readiness for emergency care in rural hospitals without obstetric units and support for community-based, emergency department-adjacent health workers.
Author(s): Eneka Lamb, Madeline Merwin, Quinyatta Mumford, et al.
Date: 02/2023
Type: Document
Sponsoring organization: National Rural Health Association
view details
Modernizing Payment to Critical Access Hospitals: A Proposal for the Next Iteration of the Flex Program
Commentary briefly describing the history the Medicare Rural Hospital Flexibility Program (Flex) and Cost-Based Reimbursement (CBR) for Medicare. Outlines the challenges of CBR for Critical Access Hospitals (CAH) and proposes a new payment system.
Author(s): Clint MacKinney, Keith Mueller, Alva Ferdinand, et al.
Citation: Journal of Rural Health, 39(4), 716-718
Date: 02/2023
Type: Document
view details
Commentary briefly describing the history the Medicare Rural Hospital Flexibility Program (Flex) and Cost-Based Reimbursement (CBR) for Medicare. Outlines the challenges of CBR for Critical Access Hospitals (CAH) and proposes a new payment system.
Author(s): Clint MacKinney, Keith Mueller, Alva Ferdinand, et al.
Citation: Journal of Rural Health, 39(4), 716-718
Date: 02/2023
Type: Document
view details
Quality Improvement in Rural Health Care
Policy position paper regarding challenges rural providers face in participating in quality improvement initiatives. Offers policy recommendations on the establishment and support of rural-relevant quality measures.
Author(s): Michelle Mills, Roger Wells
Date: 02/2023
Type: Document
Sponsoring organization: National Rural Health Association
view details
Policy position paper regarding challenges rural providers face in participating in quality improvement initiatives. Offers policy recommendations on the establishment and support of rural-relevant quality measures.
Author(s): Michelle Mills, Roger Wells
Date: 02/2023
Type: Document
Sponsoring organization: National Rural Health Association
view details
Center for Medicare & Medicaid Innovation Initiatives to Address Rural Health and Health Disparities
Policy brief describing three national Center for Medicare & Medicaid Innovation (CMMI) value-based initiatives that allow providers to work toward health equity. Provides policy recommendations to design and refine programs to engage rural providers.
Author(s): Andrea Mitchell, Alyssa Meller, Hunter Nostrant
Date: 02/2023
Type: Document
Sponsoring organization: National Rural Health Association
view details
Policy brief describing three national Center for Medicare & Medicaid Innovation (CMMI) value-based initiatives that allow providers to work toward health equity. Provides policy recommendations to design and refine programs to engage rural providers.
Author(s): Andrea Mitchell, Alyssa Meller, Hunter Nostrant
Date: 02/2023
Type: Document
Sponsoring organization: National Rural Health Association
view details
Small Practice After Action Review: 2021 Performance Year Final Score
Tool for small practices interested in examining their 2021 Merit-based Incentive Payment System (MIPS) final score to identify opportunities to improve performance in 2023.
Date: 02/2023
Type: Tool
Sponsoring organization: Centers for Medicare and Medicaid Services
view details
Tool for small practices interested in examining their 2021 Merit-based Incentive Payment System (MIPS) final score to identify opportunities to improve performance in 2023.
Date: 02/2023
Type: Tool
Sponsoring organization: Centers for Medicare and Medicaid Services
view details
FQHC & RHC CMS Policy Manual Updates
Highlights policy changes in the 2022 and 2023 Final Physician Fee Schedules, but not included in the FQHC/RHC CMS Policy Manual, regarding mental health face-to-face and telehealth encounters, and care management services. Details when permanent policies take effect. Discusses the current CMS modified definition of a mental health visit. Provides clarification on the Medicare allowance for general care management services including chronic care, chronic pain, and behavioral health integration.
Date: 02/2023
Type: Document
Sponsoring organization: Center for Connected Health Policy: The National Telehealth Policy Resource Center
view details
Highlights policy changes in the 2022 and 2023 Final Physician Fee Schedules, but not included in the FQHC/RHC CMS Policy Manual, regarding mental health face-to-face and telehealth encounters, and care management services. Details when permanent policies take effect. Discusses the current CMS modified definition of a mental health visit. Provides clarification on the Medicare allowance for general care management services including chronic care, chronic pain, and behavioral health integration.
Date: 02/2023
Type: Document
Sponsoring organization: Center for Connected Health Policy: The National Telehealth Policy Resource Center
view details
The Approaching End of the COVID-19 Public Health Emergency and Its Implications for RHCs
Outlines Rural Health Clinic (RHC)-specific waivers implemented in response to the COVID-19 pandemic and will end at the conclusion of the public health emergency (PHE). Highlights how other policies will be impacted by the end of the PHE, including telehealth flexibilities; Medicaid redetermination; the commercialization of COVID-19 vaccines, treatments, and tests; and Emergency Use Authorizations.
Date: 02/2023
Type: Document
Sponsoring organization: National Association of Rural Health Clinics
view details
Outlines Rural Health Clinic (RHC)-specific waivers implemented in response to the COVID-19 pandemic and will end at the conclusion of the public health emergency (PHE). Highlights how other policies will be impacted by the end of the PHE, including telehealth flexibilities; Medicaid redetermination; the commercialization of COVID-19 vaccines, treatments, and tests; and Emergency Use Authorizations.
Date: 02/2023
Type: Document
Sponsoring organization: National Association of Rural Health Clinics
view details
Rural Hospitals Face Renewed Financial Challenges, Especially in States That Have Not Expanded Medicaid
Provides an overview of rural hospital finances before the COVID-19 pandemic and compares operating margins in hospitals in states that expanded Medicaid with those that did not expand Medicaid. Describes financial trends during pandemic. Highlights selected policy initiatives intended to support rural hospitals or restructure the rural healthcare delivery system.
Author(s): Zachary Levinson, Jamie Godwin, Scott Hulver
Date: 02/2023
Type: Document
Sponsoring organization: KFF
view details
Provides an overview of rural hospital finances before the COVID-19 pandemic and compares operating margins in hospitals in states that expanded Medicaid with those that did not expand Medicaid. Describes financial trends during pandemic. Highlights selected policy initiatives intended to support rural hospitals or restructure the rural healthcare delivery system.
Author(s): Zachary Levinson, Jamie Godwin, Scott Hulver
Date: 02/2023
Type: Document
Sponsoring organization: KFF
view details
Federal Telehealth Flexibilities in Private Health Insurance During the COVID-19 Public Health Emergency: In Brief
Provides an overview of how private health insurance plans cover telehealth services, as well as federal flexibilities that encouraged private health insurance plans to promote telehealth services during the COVID-19 pandemic. Summarizes the two main types of laws at the state level addressing telehealth coverage in private health insurance. Outlines considerations for telehealth coverage after the end of the COVID-19 public health emergency.
Date: 02/2023
Type: Document
Sponsoring organization: Congressional Research Service
view details
Provides an overview of how private health insurance plans cover telehealth services, as well as federal flexibilities that encouraged private health insurance plans to promote telehealth services during the COVID-19 pandemic. Summarizes the two main types of laws at the state level addressing telehealth coverage in private health insurance. Outlines considerations for telehealth coverage after the end of the COVID-19 public health emergency.
Date: 02/2023
Type: Document
Sponsoring organization: Congressional Research Service
view details