Rural Health
Resources by Topic: Reimbursement and payment models
FQHC and RHC Supplemental Payment Requirements and FQHC, RHC, and FBC Network Sufficiency under Medicaid and CHIP Managed Care
Provides state health officials with guidance on Federally-qualified Health Center (FQHC) and Rural Health Clinic (RHC) payment methodologies under both Medicaid and Children's Health Insurance Program (CHIP) managed care delivery systems. Also provides guidance on FQHC, RHC, and freestanding birth center (FBC) network sufficiency standards applicable to a Medicaid managed care delivery system.
Date: 04/2016
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides state health officials with guidance on Federally-qualified Health Center (FQHC) and Rural Health Clinic (RHC) payment methodologies under both Medicaid and Children's Health Insurance Program (CHIP) managed care delivery systems. Also provides guidance on FQHC, RHC, and freestanding birth center (FBC) network sufficiency standards applicable to a Medicaid managed care delivery system.
Date: 04/2016
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Improving Efficiency and Preserving Access to Emergency Care in Rural Areas
Slides that provide background on rural hospital payment policy and strategies to preserve access to emergency care in rural areas. Discusses existing payment models and benefits and drawbacks of different models.
Author(s): Jeff Stensland, Zach Gaumer
Date: 04/2016
Type: Presentation Slides
Sponsoring organization: Medicare Payment Advisory Commission
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Slides that provide background on rural hospital payment policy and strategies to preserve access to emergency care in rural areas. Discusses existing payment models and benefits and drawbacks of different models.
Author(s): Jeff Stensland, Zach Gaumer
Date: 04/2016
Type: Presentation Slides
Sponsoring organization: Medicare Payment Advisory Commission
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Effects of Community-Based Health Worker Interventions to Improve Chronic Disease Management and Care Among Vulnerable Populations: A Systematic Review
Reports on a review of 67 studies evaluating the effectiveness of community-based health workers (CBHWs) as an intervention model for chronic disease management and care among low-income, underserved, and racial and ethnic minority populations at risk for health disparities. Discusses the roles and tasks of CBHWs, the effectiveness of their intervention, their qualifications and training, and the reimbursement and sustainability of CBHWs.
Author(s): Kyounghae Kim, Janet S. Choi, Eunsuk Choi, et al.
Citation: American Journal of Public Health, 106(4), e3–e28
Date: 04/2016
Type: Document
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Reports on a review of 67 studies evaluating the effectiveness of community-based health workers (CBHWs) as an intervention model for chronic disease management and care among low-income, underserved, and racial and ethnic minority populations at risk for health disparities. Discusses the roles and tasks of CBHWs, the effectiveness of their intervention, their qualifications and training, and the reimbursement and sustainability of CBHWs.
Author(s): Kyounghae Kim, Janet S. Choi, Eunsuk Choi, et al.
Citation: American Journal of Public Health, 106(4), e3–e28
Date: 04/2016
Type: Document
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Dental Therapy Toolkit: Summary of Dental Therapy Regulatory and Payment Processes
Reviews the payment and regulatory processes for dental therapists in Minnesota. Covers the following aspects related to practicing dental therapy: education and examination requirements, supervision, clinical experiences, practice settings, scope of practice, and more. Offers guidance on payment and billing procedures for Minnesota's Medical Assistance program for care delivered by dental therapists.
Date: 03/2016
Type: Document
Sponsoring organization: Minnesota Department of Health - Office of Rural Health and Primary Care
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Reviews the payment and regulatory processes for dental therapists in Minnesota. Covers the following aspects related to practicing dental therapy: education and examination requirements, supervision, clinical experiences, practice settings, scope of practice, and more. Offers guidance on payment and billing procedures for Minnesota's Medical Assistance program for care delivered by dental therapists.
Date: 03/2016
Type: Document
Sponsoring organization: Minnesota Department of Health - Office of Rural Health and Primary Care
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MedPAC Report to the Congress: Medicare Payment Policy, 2016
Annual review of Medicare payment policies, with recommendations to Congress. Discussions of rural aspects of Medicare payment policies are included throughout the report. Focuses on payment adequacy, Medicare Advantage, and Medicare Part D.
Date: 03/2016
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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Annual review of Medicare payment policies, with recommendations to Congress. Discussions of rural aspects of Medicare payment policies are included throughout the report. Focuses on payment adequacy, Medicare Advantage, and Medicare Part D.
Date: 03/2016
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
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2012-14 Profitability of Urban and Rural Hospitals by Medicare Payment Classification
Compares the total margin and operating margin of rural and urban hospitals using 2012-2014 profitability data. Analysis divides rural hospitals by the size of the prospective payment system and by the Medicare payment classification – Critical Access Hospitals (CAHs), Medicare dependent hospitals, sole community hospitals, and rural referral centers.
Author(s): Sharita R. Thomas, G. Mark Holmes, George H. Pink
Date: 03/2016
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Compares the total margin and operating margin of rural and urban hospitals using 2012-2014 profitability data. Analysis divides rural hospitals by the size of the prospective payment system and by the Medicare payment classification – Critical Access Hospitals (CAHs), Medicare dependent hospitals, sole community hospitals, and rural referral centers.
Author(s): Sharita R. Thomas, G. Mark Holmes, George H. Pink
Date: 03/2016
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
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Rural ACO Leaders Speak: What Have Been the Biggest Challenges and the Biggest Advantages to Creating Your ACO?
Five rural Accountable Care Organization (ACO) leaders discuss the biggest challenges and advantages they've experienced in building an ACO.
Author(s): Zachary Toliver
Citation: Rural Monitor
Date: 03/2016
Type: Document
Sponsoring organization: Rural Health Information Hub
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Five rural Accountable Care Organization (ACO) leaders discuss the biggest challenges and advantages they've experienced in building an ACO.
Author(s): Zachary Toliver
Citation: Rural Monitor
Date: 03/2016
Type: Document
Sponsoring organization: Rural Health Information Hub
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Access to Rural Home Health Services: Views from the Field
Describes current issues affecting access to rural home health services, with an emphasis on Medicare-reimbursed programs. Based on published research, gray literature, and telephone interviews with 40 key informants from 19 states between May 2014 and March 2015. Discusses challenges and barriers to access as well as possible solutions.
Author(s): Susan M. Skillman, Davis G. Patterson, Cynthia Coulthard, Tracy M. Mroz
Date: 02/2016
Type: Document
Sponsoring organization: WWAMI Rural Health Research Center
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Describes current issues affecting access to rural home health services, with an emphasis on Medicare-reimbursed programs. Based on published research, gray literature, and telephone interviews with 40 key informants from 19 states between May 2014 and March 2015. Discusses challenges and barriers to access as well as possible solutions.
Author(s): Susan M. Skillman, Davis G. Patterson, Cynthia Coulthard, Tracy M. Mroz
Date: 02/2016
Type: Document
Sponsoring organization: WWAMI Rural Health Research Center
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Report to Congress on Medicaid Disproportionate Share Hospital Payments
First annual report on Medicaid Disproportionate Share Hospital (DSH) payments, which provide support to safety-net hospitals to help offset uncompensated care costs for Medicaid and uninsured patients. Discusses Medicaid policy, current and future DSH allotments, and data needs. Table B-3 projects FY2018 DSH payments under different scenarios, with data for urban and rural hospitals and for Critical Access Hospitals.
Date: 02/2016
Type: Document
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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First annual report on Medicaid Disproportionate Share Hospital (DSH) payments, which provide support to safety-net hospitals to help offset uncompensated care costs for Medicaid and uninsured patients. Discusses Medicaid policy, current and future DSH allotments, and data needs. Table B-3 projects FY2018 DSH payments under different scenarios, with data for urban and rural hospitals and for Critical Access Hospitals.
Date: 02/2016
Type: Document
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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Community Health Workers: Roles and Opportunities in Health Care Delivery System Reform
Identifies and discusses health services research on the utilization and integration of Community Health Workers (CHWs) into healthcare service delivery. Includes an analysis regarding the various CHW models, employment data, training and credentialing, and challenges associated with the development of this occupation.
Author(s): John E. Snyder
Date: 01/2016
Type: Document
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Identifies and discusses health services research on the utilization and integration of Community Health Workers (CHWs) into healthcare service delivery. Includes an analysis regarding the various CHW models, employment data, training and credentialing, and challenges associated with the development of this occupation.
Author(s): John E. Snyder
Date: 01/2016
Type: Document
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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