Rural Health
Resources by Topic: Reimbursement and payment models
Update to the Payment for Historically Excepted Tribal Federally Qualified Health Centers (FQHCs) for Calendar Year (CY) 2026
Provides an overview of updates to the historically excepted Tribal Federally Qualified Health Center (FQHC) Prospective Payment System (PPS) rate for calendar year 2026.
Date: 02/2026
Sponsoring organization: Centers for Medicare & Medicaid Services
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Provides an overview of updates to the historically excepted Tribal Federally Qualified Health Center (FQHC) Prospective Payment System (PPS) rate for calendar year 2026.
Date: 02/2026
Sponsoring organization: Centers for Medicare & Medicaid Services
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Shared Savings Program Fast Facts
Provides summary statistics on the Medicare Shared Savings Program as of January 1, 2026. Offers data on the number of Accountable Care Organizations (ACOs), assigned beneficiaries, total earned shared savings, and quality scores each year since 2012; the number and percent of ACOs in each track; and more. Includes information on ACO participants, including the number of Rural Health Clinics (RHCs) and Critical Access Hospitals (CAHs) participating in the program.
Date: 02/2026
Sponsoring organization: Centers for Medicare & Medicaid Services
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Provides summary statistics on the Medicare Shared Savings Program as of January 1, 2026. Offers data on the number of Accountable Care Organizations (ACOs), assigned beneficiaries, total earned shared savings, and quality scores each year since 2012; the number and percent of ACOs in each track; and more. Includes information on ACO participants, including the number of Rural Health Clinics (RHCs) and Critical Access Hospitals (CAHs) participating in the program.
Date: 02/2026
Sponsoring organization: Centers for Medicare & Medicaid Services
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Small Practices Guide: Getting Started with Electronic Clinical Quality Measure (CQM) Reporting
Provides an overview of electronic clinical quality measures (eCQMs) under the Merit-based Incentive Payment System (MIPS). Describes how small practices can report eCQMs, whether participating as an individual clinician, group, subgroup, or Alternative Payment Model (APM) Entity.
Date: 02/2026
Sponsoring organization: Centers for Medicare & Medicaid Services
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Provides an overview of electronic clinical quality measures (eCQMs) under the Merit-based Incentive Payment System (MIPS). Describes how small practices can report eCQMs, whether participating as an individual clinician, group, subgroup, or Alternative Payment Model (APM) Entity.
Date: 02/2026
Sponsoring organization: Centers for Medicare & Medicaid Services
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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.
Date: 02/2026
Sponsoring organization: Centers for Medicare & 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.
Date: 02/2026
Sponsoring organization: Centers for Medicare & Medicaid Services
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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: 02/2026
Sponsoring organization: Centers for Medicare & 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: 02/2026
Sponsoring organization: Centers for Medicare & Medicaid Services
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Purchased/Referred Care and Cancer: Overview and Options for Tribal Consideration
Describes the Purchased/Referred Care (PRC) program of the Indian Health Service (IHS) and discusses how it functions in the cancer care pathways for Oklahoma tribal communities. Offers recommendations to tribal leaders for working with and alongside the program to improve health outcomes while supporting self-determination. Recommendations discuss tribal governance, collaborations, service delivery models, care coordination, and engaging with federal policymakers.
Author(s): Grace Fox
Date: 01/2026
Sponsoring organization: Native Nations Center for Tribal Policy Research
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Describes the Purchased/Referred Care (PRC) program of the Indian Health Service (IHS) and discusses how it functions in the cancer care pathways for Oklahoma tribal communities. Offers recommendations to tribal leaders for working with and alongside the program to improve health outcomes while supporting self-determination. Recommendations discuss tribal governance, collaborations, service delivery models, care coordination, and engaging with federal policymakers.
Author(s): Grace Fox
Date: 01/2026
Sponsoring organization: Native Nations Center for Tribal Policy Research
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Encouraging Rural Participation in Population-Based Total Cost of Care (PB-TCOC) Models
Examines the financial constraints rural providers have in pivoting to value-based care and alternative payment models (APMs), including population-based total cost of care (PB-TCOC) models. Provides recommendations and supportive policies to increase rural participation in PB-TCOC models and discusses issues such as financial risk, use of benchmarks to meet spending goals, performance measurements, information technology and telehealth, and more.
Date: 01/2026
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Examines the financial constraints rural providers have in pivoting to value-based care and alternative payment models (APMs), including population-based total cost of care (PB-TCOC) models. Provides recommendations and supportive policies to increase rural participation in PB-TCOC models and discusses issues such as financial risk, use of benchmarks to meet spending goals, performance measurements, information technology and telehealth, and more.
Date: 01/2026
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Glossary of Value-Based Care Terms
Presents definitions of key terms related to value-based care and payment. Includes terminology regarding healthcare value, payment and incentive structures, care delivery, data and technology, and more.
Date: 01/2026
Sponsoring organization: Rural Health Value
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Presents definitions of key terms related to value-based care and payment. Includes terminology regarding healthcare value, payment and incentive structures, care delivery, data and technology, and more.
Date: 01/2026
Sponsoring organization: Rural Health Value
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Rural Hospital Bypass by Patients With Commercial Health Insurance
Results of a study examining rural hospital bypass rates among commercially insured patients, and hospital payments from patients who bypassed their nearest hospitals. Features statistics with breakdowns by clinical category and 4 levels of population density.
Author(s): Jessica Y. Chang, Caitlin E. Carroll
Citation: JAMA Network Open, 9(1), e2555017
Date: 01/2026
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Results of a study examining rural hospital bypass rates among commercially insured patients, and hospital payments from patients who bypassed their nearest hospitals. Features statistics with breakdowns by clinical category and 4 levels of population density.
Author(s): Jessica Y. Chang, Caitlin E. Carroll
Citation: JAMA Network Open, 9(1), e2555017
Date: 01/2026
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Advancing Medicaid Primary Care Population-Based Payment Models: Four Lessons for States
Discusses the impact of Medicaid policy, the Rural Health Transformation Program, and reimbursement models on primary healthcare. Discusses population-based payment (PC PBP) and value-based payment (VBP) models, sharing examples from Colorado meant to enhance payments to rural and small primary care practices.
Author(s): Kelsey Brykman
Date: 01/2026
Sponsoring organization: Center for Health Care Strategies
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Discusses the impact of Medicaid policy, the Rural Health Transformation Program, and reimbursement models on primary healthcare. Discusses population-based payment (PC PBP) and value-based payment (VBP) models, sharing examples from Colorado meant to enhance payments to rural and small primary care practices.
Author(s): Kelsey Brykman
Date: 01/2026
Sponsoring organization: Center for Health Care Strategies
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