Rural Health
Resources by Topic: Reimbursement and payment models
Evaluation of the Vermont All-Payer Accountable Care Organization Model: Second Evaluation Report
Evaluates the first three performance years of the Vermont All-Payer Accountable Care Organization Model (VTAPM), which aims to assess whether scaling an Accountable Care Organization (ACO) across all payers in the state can reduce program expenditures while preserving or improving care quality. Discusses the implementation of the model, provider engagement, efforts to address population health goals; characteristics of participating hospitals, practitioners, and beneficiaries; and the model's impacts on Medicare spending, utilization, and quality of care. Describes changes to the model's design in response to the COVID-19 public health emergency and how COVID-19 and a cyberattack impacted healthcare utilization. Includes information on hospital and provider participation in rural areas and limited participation by Critical Access Hospitals.
Additional links: Findings at a Glance, Technical Appendices
Date: 12/2022
Sponsoring organizations: Centers for Medicare and Medicaid Services, NORC at the University of Chicago
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Evaluates the first three performance years of the Vermont All-Payer Accountable Care Organization Model (VTAPM), which aims to assess whether scaling an Accountable Care Organization (ACO) across all payers in the state can reduce program expenditures while preserving or improving care quality. Discusses the implementation of the model, provider engagement, efforts to address population health goals; characteristics of participating hospitals, practitioners, and beneficiaries; and the model's impacts on Medicare spending, utilization, and quality of care. Describes changes to the model's design in response to the COVID-19 public health emergency and how COVID-19 and a cyberattack impacted healthcare utilization. Includes information on hospital and provider participation in rural areas and limited participation by Critical Access Hospitals.
Additional links: Findings at a Glance, Technical Appendices
Date: 12/2022
Sponsoring organizations: Centers for Medicare and Medicaid Services, NORC at the University of Chicago
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Federal Support for Financially Distressed Hospitals
Provides an overview of Medicare hospital payments and federal funding opportunities to assist financially distressed hospitals. Includes information on COVID-19 relief funding targeted to rural and safety net hospitals.
Date: 12/2022
Sponsoring organization: Congressional Research Service
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Provides an overview of Medicare hospital payments and federal funding opportunities to assist financially distressed hospitals. Includes information on COVID-19 relief funding targeted to rural and safety net hospitals.
Date: 12/2022
Sponsoring organization: Congressional Research Service
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Rural Health Clinic All-Inclusive Rate: CY 2023 Update
Provides an overview of Rural Health Clinic (RHC) payment limits and cost report data requirements for calendar year 2023.
Date: 11/2022
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides an overview of Rural Health Clinic (RHC) payment limits and cost report data requirements for calendar year 2023.
Date: 11/2022
Sponsoring organization: Centers for Medicare and Medicaid Services
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New Mexico Primary Care Alternative Payment Model Provider Readiness Assessment
Examines facilitators and barriers related to primary care stakeholders' readiness to implement an alternative payment model (APM) in New Mexico. Analyzes 2022 survey and focus group data from providers to gain feedback from Federally Qualified Health Centers (FQHCs), small- and medium-sized practices, hospitals, and interprofessional teams. Discusses issues such as care delivery, health information technology (HIT), financial and organizational readiness, and more, with information specific to small and rural facilities.
Date: 11/2022
Sponsoring organizations: Health Management Associates, New Mexico Human Services Department
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Examines facilitators and barriers related to primary care stakeholders' readiness to implement an alternative payment model (APM) in New Mexico. Analyzes 2022 survey and focus group data from providers to gain feedback from Federally Qualified Health Centers (FQHCs), small- and medium-sized practices, hospitals, and interprofessional teams. Discusses issues such as care delivery, health information technology (HIT), financial and organizational readiness, and more, with information specific to small and rural facilities.
Date: 11/2022
Sponsoring organizations: Health Management Associates, New Mexico Human Services Department
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Access to Emergency Medical Services in Rural Communities: Policy Brief and Recommendations to the Secretary
Provides an overview of issues related to the provision of emergency medical services (EMS) in rural areas. Discusses rural EMS access, financing, and workforce challenges, as well as promising telehealth innovations. Outlines federal programs and resources that support EMS programs. Offers policy recommendations related to access to EMS, workforce, and reimbursement.
Date: 11/2022
Sponsoring organization: National Advisory Committee on Rural Health and Human Services
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Provides an overview of issues related to the provision of emergency medical services (EMS) in rural areas. Discusses rural EMS access, financing, and workforce challenges, as well as promising telehealth innovations. Outlines federal programs and resources that support EMS programs. Offers policy recommendations related to access to EMS, workforce, and reimbursement.
Date: 11/2022
Sponsoring organization: National Advisory Committee on Rural Health and Human Services
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Medicaid Population-Based Payment: The Current Landscape, Early Insights, and Considerations for Policymakers
Provides an overview of population-based payment (PBP) models and the Medicaid PBP landscape. Identifies promising strategies for designing and implementing PBPs in Medicaid and considerations for state and federal policymakers who want to support these programs. Highlights state PBP approaches, including the Pennsylvania Rural Health Model.
Author(s): Rob Houston, Anne Smithey, Kelsey Brykman
Date: 11/2022
Sponsoring organization: Center for Health Care Strategies
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Provides an overview of population-based payment (PBP) models and the Medicaid PBP landscape. Identifies promising strategies for designing and implementing PBPs in Medicaid and considerations for state and federal policymakers who want to support these programs. Highlights state PBP approaches, including the Pennsylvania Rural Health Model.
Author(s): Rob Houston, Anne Smithey, Kelsey Brykman
Date: 11/2022
Sponsoring organization: Center for Health Care Strategies
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National Rural Health Day Webinar: CMS Framework for Advancing Health Care
Recording of a November 15, 2022, webinar providing an overview of the Centers for Medicare & Medicaid (CMS) Framework for Advancing Health Care in Rural, Tribal and Geographically Isolated Communities. Discusses the CMS Framework for Health Equity and identifies other rural health resources, including other recent CMS rural health reports.
Additional links: Presentation Slides, Transcript
Date: 11/2022
Sponsoring organization: Centers for Medicare and Medicaid Services
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Recording of a November 15, 2022, webinar providing an overview of the Centers for Medicare & Medicaid (CMS) Framework for Advancing Health Care in Rural, Tribal and Geographically Isolated Communities. Discusses the CMS Framework for Health Equity and identifies other rural health resources, including other recent CMS rural health reports.
Additional links: Presentation Slides, Transcript
Date: 11/2022
Sponsoring organization: Centers for Medicare and Medicaid Services
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Clarity for Rural Emergency Hospitals and Changes for Critical Access Hospitals: CMS Finalizes Conditions of Participation and Payment and Enrollment Policies But Pauses Stark Law Flexibilities
Provides an overview of the Rural Emergency Hospitals (REHs) provisions of the Calendar Year 2023 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Final Rule. Discusses REH reimbursement, Conditions of Participation (CoPs), enrollment provisions, and Stark Law regulatory modifications to accommodate REHs. Highlights changes to the definition of "primary roads" related to Critical Access Hospital (CAH) CoPs.
Author(s): Emily Jane Cook, Caroline Reignley, Amber Arnold, Sandra M. DiVarco
Date: 11/2022
Sponsoring organization: McDermott Will & Emery
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Provides an overview of the Rural Emergency Hospitals (REHs) provisions of the Calendar Year 2023 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Final Rule. Discusses REH reimbursement, Conditions of Participation (CoPs), enrollment provisions, and Stark Law regulatory modifications to accommodate REHs. Highlights changes to the definition of "primary roads" related to Critical Access Hospital (CAH) CoPs.
Author(s): Emily Jane Cook, Caroline Reignley, Amber Arnold, Sandra M. DiVarco
Date: 11/2022
Sponsoring organization: McDermott Will & Emery
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Certified Community Behavioral Health Clinics Demonstration Program: Report to Congress, 2021
Provides an overview of the Certified Community Behavioral Health Clinic (CCBHC) demonstration. Offers a summary of the findings from the prior annual reports on the CCBHC demonstration, a comparison of cost and quality in the first two demonstration years, and the results of impact analyses. This is the fifth annual report to Congress on the CCBHC demonstration.
Date: 11/2022
Sponsoring organizations: HHS Office of the Assistant Secretary for Planning and Evaluation, Mathematica
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Provides an overview of the Certified Community Behavioral Health Clinic (CCBHC) demonstration. Offers a summary of the findings from the prior annual reports on the CCBHC demonstration, a comparison of cost and quality in the first two demonstration years, and the results of impact analyses. This is the fifth annual report to Congress on the CCBHC demonstration.
Date: 11/2022
Sponsoring organizations: HHS Office of the Assistant Secretary for Planning and Evaluation, Mathematica
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CMS Framework for Advancing Health Care in Rural, Tribal, and Geographically Isolated Communities
Report outlines the Centers for Medicare & Medicaid Services (CMS) plan for improving health equity and health outcomes across the U.S. for rural, tribal, and geographically isolated communities. Details a 6 priority framework emphasizing the application of a community-informed geographic lens; the collection and use of standardized data; support for healthcare professionals; the optimization of medical and communication technology; the expansion of access to comprehensive healthcare coverage, benefits, and services and supports; and innovation and value-based care. Highlights examples of activities CMS is undertaking in support of each priority and recent CMS efforts that align with each priority.
Date: 11/2022
Sponsoring organization: Centers for Medicare and Medicaid Services
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Report outlines the Centers for Medicare & Medicaid Services (CMS) plan for improving health equity and health outcomes across the U.S. for rural, tribal, and geographically isolated communities. Details a 6 priority framework emphasizing the application of a community-informed geographic lens; the collection and use of standardized data; support for healthcare professionals; the optimization of medical and communication technology; the expansion of access to comprehensive healthcare coverage, benefits, and services and supports; and innovation and value-based care. Highlights examples of activities CMS is undertaking in support of each priority and recent CMS efforts that align with each priority.
Date: 11/2022
Sponsoring organization: Centers for Medicare and Medicaid Services
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