Rural Health
Resources by Topic: Reimbursement and payment models
A Global Equity Model (GEM) for the Advancement of Community Health and Health Equity
Provides an overview of existing and emerging payment systems and their roles in promoting community health and health equity. Proposes a global payment model for health systems' inpatient, emergency department (ED), and outpatient sites of care with community health and health equity as its organizing features. Includes information on the Pennsylvania Rural Health Model, the ACO REACH model, and other rural-relevant payment models.
Author(s): Anaeze C. Offodile II, Jason B. Gibbons, Samantha Murrell, Donna Kinzer, Joshua M. Sharfstein
Date: 11/2022
Type: Document
Sponsoring organization: National Academy of Medicine
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Provides an overview of existing and emerging payment systems and their roles in promoting community health and health equity. Proposes a global payment model for health systems' inpatient, emergency department (ED), and outpatient sites of care with community health and health equity as its organizing features. Includes information on the Pennsylvania Rural Health Model, the ACO REACH model, and other rural-relevant payment models.
Author(s): Anaeze C. Offodile II, Jason B. Gibbons, Samantha Murrell, Donna Kinzer, Joshua M. Sharfstein
Date: 11/2022
Type: Document
Sponsoring organization: National Academy of Medicine
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Person-Centered Innovation – An Update on the Implementation of the CMS Innovation Center's Strategy
Provides an update on the Centers for Medicare and Medicaid Services' (CMS) Innovation Center's progress in the implementation of the strategy refresh announced in 2021. Describes accomplishments from the first year of implementing the strategy refresh and outlines areas of focus for the upcoming year across the five strategic objectives: driving accountable care, advancing health equity, supporting innovation, addressing affordability, and partnering to achieve healthcare system transformation. Includes information on the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model and the Community Health Access and Rural Transformation (CHART) Model.
Additional links: Supplemental Document
Date: 11/2022
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides an update on the Centers for Medicare and Medicaid Services' (CMS) Innovation Center's progress in the implementation of the strategy refresh announced in 2021. Describes accomplishments from the first year of implementing the strategy refresh and outlines areas of focus for the upcoming year across the five strategic objectives: driving accountable care, advancing health equity, supporting innovation, addressing affordability, and partnering to achieve healthcare system transformation. Includes information on the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model and the Community Health Access and Rural Transformation (CHART) Model.
Additional links: Supplemental Document
Date: 11/2022
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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The Path to Coordinated Federal Leadership to Strengthen Primary Health Care
Discusses the potential of a Secretary's Council on Primary Care within the U.S. Department of Health and Human Services. Describes primary care's role in addressing policy challenges related to health equity, payment, workforce training, pandemic recovery and resilience, the opioid crisis, and mental health. Offers recommendations to include and strengthen high-quality primary care as part of a long-term vision of a high-value healthcare system. Includes rural references throughout.
Author(s): Robert L. Phillips Jr., Christopher Koller, Alice Hm Chen
Date: 11/2022
Type: Document
Sponsoring organization: Milbank Memorial Fund
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Discusses the potential of a Secretary's Council on Primary Care within the U.S. Department of Health and Human Services. Describes primary care's role in addressing policy challenges related to health equity, payment, workforce training, pandemic recovery and resilience, the opioid crisis, and mental health. Offers recommendations to include and strengthen high-quality primary care as part of a long-term vision of a high-value healthcare system. Includes rural references throughout.
Author(s): Robert L. Phillips Jr., Christopher Koller, Alice Hm Chen
Date: 11/2022
Type: Document
Sponsoring organization: Milbank Memorial Fund
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Rethinking Rurality: Using Hospital Referral Regions to Investigate Rural-Urban Health Outcomes
Examines the relationship between the proportion of rural population served in each of the 306 hospital referral regions (HRRs) and health outcomes, healthcare spending and utilization, and access to and quality of primary care. Explores whether mortality differences in HRRs are associated with differences in price-adjusted Medicare reimbursements, quality of primary care, and access to primary care.
Author(s): Lucy Skinner, Sandra Wong, Carrie Colla
Citation: BMC Health Services Research, 22(1), 1312
Date: 11/2022
Type: Document
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Examines the relationship between the proportion of rural population served in each of the 306 hospital referral regions (HRRs) and health outcomes, healthcare spending and utilization, and access to and quality of primary care. Explores whether mortality differences in HRRs are associated with differences in price-adjusted Medicare reimbursements, quality of primary care, and access to primary care.
Author(s): Lucy Skinner, Sandra Wong, Carrie Colla
Citation: BMC Health Services Research, 22(1), 1312
Date: 11/2022
Type: Document
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Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Organ Acquisition; Rural Emergency Hospitals: Payment Policies, Conditions of Participation, Provider Enrollment, Physician Self-Referral; New Service Category for Hospital Outpatient Department Prior Authorization Process; Overall Hospital Quality Star Rating; COVID-19
Establishes the Rural Emergency Hospital (REH) provider type. Outlines REH payment policy, Conditions of Participation (CoPs), quality measures, and enrollment policy. Outlines changes to the Critical Access Hospitals (CAH) CoPs regarding location and distance requirements, patient's rights requirements, and flexibilities for CAHs that are part of a larger health system. Among other things, this rule also revises the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Medicare Ambulatory Surgical Center (ACS) payment system for calendar year 2023 and finalizes provisions included in the COVID-19 interim final rules.
Additional links: Fact Sheet
Date: 11/2022
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Establishes the Rural Emergency Hospital (REH) provider type. Outlines REH payment policy, Conditions of Participation (CoPs), quality measures, and enrollment policy. Outlines changes to the Critical Access Hospitals (CAH) CoPs regarding location and distance requirements, patient's rights requirements, and flexibilities for CAHs that are part of a larger health system. Among other things, this rule also revises the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Medicare Ambulatory Surgical Center (ACS) payment system for calendar year 2023 and finalizes provisions included in the COVID-19 interim final rules.
Additional links: Fact Sheet
Date: 11/2022
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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CY 2023 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule (CMS 1772-FC) Rural Emergency Hospitals — New Medicare Provider Type
Provides an overview of Rural Emergency Hospitals, a Medicare provider type established by the Consolidated Appropriations Act, 2021. Details key policies outlined in the Calendar Year 2023 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Final Rule, including payment policies, conditions of participation, REH provider enrollment, and exceptions to the physician self-referral law.
Date: 11/2022
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides an overview of Rural Emergency Hospitals, a Medicare provider type established by the Consolidated Appropriations Act, 2021. Details key policies outlined in the Calendar Year 2023 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Final Rule, including payment policies, conditions of participation, REH provider enrollment, and exceptions to the physician self-referral law.
Date: 11/2022
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Financial Characteristics of Critical Access Hospitals (CAHs) Participating in Accountable Care Organizations (ACO)
Examines Critical Access Hospital (CAH) participation in Medicare and non-Medicare Accountable Care Organizations (ACOs) in 2019. Compares the organizational and financial characteristics of CAHs across facilities that participate in ACOs and those that do not participate in an ACO. Includes data on profitability, liquidity, outpatient revenue, and Medicare payer mix.
Author(s): Angelina Budko, George Pink, Susie Gurzenda, Ann Howard, Kristin L. Reiter
Date: 11/2022
Type: Document
Sponsoring organization: Flex Monitoring Team
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Examines Critical Access Hospital (CAH) participation in Medicare and non-Medicare Accountable Care Organizations (ACOs) in 2019. Compares the organizational and financial characteristics of CAHs across facilities that participate in ACOs and those that do not participate in an ACO. Includes data on profitability, liquidity, outpatient revenue, and Medicare payer mix.
Author(s): Angelina Budko, George Pink, Susie Gurzenda, Ann Howard, Kristin L. Reiter
Date: 11/2022
Type: Document
Sponsoring organization: Flex Monitoring Team
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Rural Hospital Services Strategic Plan Progress Report
Reports on the progress, strategies, and milestones of the Rural Hospital Services Strategic Plan, as required by the Texas Legislature. Discusses the status of strategies related to Medicaid reimbursements, rural hospital revenue opportunities, and challenges providing care to patients covered by Medicare and other payers. Outlines future strategic and operational goals to support rural hospitals and offers a map of hospitals affected by new rural definitions.
Date: 11/2022
Type: Document
Sponsoring organization: Texas Health and Human Services
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Reports on the progress, strategies, and milestones of the Rural Hospital Services Strategic Plan, as required by the Texas Legislature. Discusses the status of strategies related to Medicaid reimbursements, rural hospital revenue opportunities, and challenges providing care to patients covered by Medicare and other payers. Outlines future strategic and operational goals to support rural hospitals and offers a map of hospitals affected by new rural definitions.
Date: 11/2022
Type: Document
Sponsoring organization: Texas Health and Human Services
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Virtual Communication Services in Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs)
Provides information for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) regarding billing and payment for virtual communication services as established in the 2019 Physician Fee Schedule Final Rule.
Date: 11/2022
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides information for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) regarding billing and payment for virtual communication services as established in the 2019 Physician Fee Schedule Final Rule.
Date: 11/2022
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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October 2022 MACPAC Meeting Transcript
Transcript from the Medicaid and CHIP Payment and Access Commission's (MACPAC) October 2022 meeting. Covers Medicaid race and ethnicity data collection and reporting, improving access to Medicaid coverage and care for adults leaving incarceration, the unwinding of the Public Health Emergency, streamlining the delivery of home- and community-based services, potential recommendations for structuring Disproportionate Share Hospital allotments during economic crises, and more. Includes rural references and considerations throughout.
Date: 10/2022
Type: Document
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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Transcript from the Medicaid and CHIP Payment and Access Commission's (MACPAC) October 2022 meeting. Covers Medicaid race and ethnicity data collection and reporting, improving access to Medicaid coverage and care for adults leaving incarceration, the unwinding of the Public Health Emergency, streamlining the delivery of home- and community-based services, potential recommendations for structuring Disproportionate Share Hospital allotments during economic crises, and more. Includes rural references and considerations throughout.
Date: 10/2022
Type: Document
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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