Rural Healthcare Payment and Reimbursement – Resources
Selected recent or important resources focusing on Rural Healthcare Payment and Reimbursement.
January 2025 MedPAC Meeting Transcript
Transcript from the Medicare Payment Advisory Commission's (MedPAC) January 2025 meeting. Covers payment adequacy and updates for physician and other health professional services, hospital inpatient and outpatient services, skilled nursing facility services, home health agency services, inpatient rehabilitation facility services, outpatient dialysis services, and hospice services. Discusses status reports on Medicare Part D, ambulatory surgical centers, and the Medicare Advantage program, as well as policy options for modifying the cost-sharing liability for beneficiaries who receive care at Critical Acess Hospitals. Includes rural references and considerations throughout.
Additional links: Reducing Beneficiary Cost-sharing for Outpatient Services at Critical Access Hospitals
Date: 01/2025
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
view details
Transcript from the Medicare Payment Advisory Commission's (MedPAC) January 2025 meeting. Covers payment adequacy and updates for physician and other health professional services, hospital inpatient and outpatient services, skilled nursing facility services, home health agency services, inpatient rehabilitation facility services, outpatient dialysis services, and hospice services. Discusses status reports on Medicare Part D, ambulatory surgical centers, and the Medicare Advantage program, as well as policy options for modifying the cost-sharing liability for beneficiaries who receive care at Critical Acess Hospitals. Includes rural references and considerations throughout.
Additional links: Reducing Beneficiary Cost-sharing for Outpatient Services at Critical Access Hospitals
Date: 01/2025
Type: Document
Sponsoring organization: Medicare Payment Advisory Commission
view details
A Summary of State Innovation Models (SIM) Evaluation Results Across 17 States (2013-2020)
Summarizes evaluation results of the State Innovation Models (SIM), which examined the ability of 17 state governments to implement and test innovative value-based payment (VBP) healthcare models across multiple payers between 2013 and 2020. Presents findings regarding the implementation and impact of 29 delivery and payment models, including patient-centered medical homes, accountable care organizations, behavioral health integration, and more. Covers state contracting and consensus building, practice transformation, pediatric care, behavioral healthcare, beneficiary and provider perspectives, and more. Includes a section on payment model designs tailored to unique state needs, including rural populations, as well as rural references throughout.
Additional links: A Summary of State Innovation Models (SIM): Focus on State-Led Transformation - Findings at a Glance, Executive Summary, Findings at a Glance
Date: 01/2025
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
view details
Summarizes evaluation results of the State Innovation Models (SIM), which examined the ability of 17 state governments to implement and test innovative value-based payment (VBP) healthcare models across multiple payers between 2013 and 2020. Presents findings regarding the implementation and impact of 29 delivery and payment models, including patient-centered medical homes, accountable care organizations, behavioral health integration, and more. Covers state contracting and consensus building, practice transformation, pediatric care, behavioral healthcare, beneficiary and provider perspectives, and more. Includes a section on payment model designs tailored to unique state needs, including rural populations, as well as rural references throughout.
Additional links: A Summary of State Innovation Models (SIM): Focus on State-Led Transformation - Findings at a Glance, Executive Summary, Findings at a Glance
Date: 01/2025
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
view details
Shared Savings Program Fast Facts
Provides summary statistics on the Medicare Shared Savings Program as of January 1, 2025. 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: 01/2025
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
view details
Provides summary statistics on the Medicare Shared Savings Program as of January 1, 2025. 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: 01/2025
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
view details
Merit-based Incentive Payment System (MIPS): 2025 MIPS Quick Start Guide for Small Practices
Provides an overview of the Merit-based Incentive Payment System (MIPS). Outlines 6 steps for small practices regarding participation in the 2025 performance year. Includes information on performance category redistribution policies for small practices.
Date: 01/2025
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
view details
Provides an overview of the Merit-based Incentive Payment System (MIPS). Outlines 6 steps for small practices regarding participation in the 2025 performance year. Includes information on performance category redistribution policies for small practices.
Date: 01/2025
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
view details
CMS Office of Minority Health: Health Equity Data Book
Provides data on disparities in participation in Centers for Medicare & Medicaid Services (CMS) programs, including data on demographics of covered individuals, chronic conditions, behavioral health conditions, and social determinants of health. Contains rural data for select programs.
Date: 12/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
view details
Provides data on disparities in participation in Centers for Medicare & Medicaid Services (CMS) programs, including data on demographics of covered individuals, chronic conditions, behavioral health conditions, and social determinants of health. Contains rural data for select programs.
Date: 12/2024
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
view details
Medicare Could save Billions with Comparable Access for Enrollees If Critical Access Hospital Payments for Swing-Bed Services Were Similar to Those of the Fee-for-Service Prospective Payment System
Describes the use of swing beds for skilled nursing services at Critical Access Hospitals (CAHs) and average daily Medicare reimbursement for these services from 2015 through 2020. Examines data from a sample of 100 CAHs to determine whether Medicare enrollees would have had access to the same skilled nursing services provided by CAHs at alternative facilities within a 35-mile driving distance. Compares the average daily reimbursement for skilled nursing services at CAHs and alternative facilities, as well as the potential savings to Medicare if CAHs were reimbursed for skilled nursing services under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS).
Date: 12/2024
Type: Document
Sponsoring organization: Office of Inspector General (HHS)
view details
Describes the use of swing beds for skilled nursing services at Critical Access Hospitals (CAHs) and average daily Medicare reimbursement for these services from 2015 through 2020. Examines data from a sample of 100 CAHs to determine whether Medicare enrollees would have had access to the same skilled nursing services provided by CAHs at alternative facilities within a 35-mile driving distance. Compares the average daily reimbursement for skilled nursing services at CAHs and alternative facilities, as well as the potential savings to Medicare if CAHs were reimbursed for skilled nursing services under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS).
Date: 12/2024
Type: Document
Sponsoring organization: Office of Inspector General (HHS)
view details
The Pennsylvania Rural Health Model (PARHM): Fourth Annual Evaluation Report
Evaluates the fourth performance year of the Pennsylvania Rural Health Model (PARHM), an initiative designed to test if global budgets can help rural hospitals improve their financial viability, provide flexibility to meet locally defined community health needs, and reduce overall healthcare spending. Provides an overview of the model and describes the implementation experience of participating hospitals and payers. Presents a descriptive quantitative assessment of financial performance, spending and utilization, access to care, and quality of care outcomes from 2016, the model's baseline, through 2022. Includes three case studies discussing three themes: experiences with global budget reconciliation, behavioral health transformation, and interactions and alignment between PARHM and other value-based care programs.
Additional links: Appendix, Findings at a Glance
Date: 12/2024
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, NORC at the University of Chicago
view details
Evaluates the fourth performance year of the Pennsylvania Rural Health Model (PARHM), an initiative designed to test if global budgets can help rural hospitals improve their financial viability, provide flexibility to meet locally defined community health needs, and reduce overall healthcare spending. Provides an overview of the model and describes the implementation experience of participating hospitals and payers. Presents a descriptive quantitative assessment of financial performance, spending and utilization, access to care, and quality of care outcomes from 2016, the model's baseline, through 2022. Includes three case studies discussing three themes: experiences with global budget reconciliation, behavioral health transformation, and interactions and alignment between PARHM and other value-based care programs.
Additional links: Appendix, Findings at a Glance
Date: 12/2024
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, NORC at the University of Chicago
view details
Rural-Urban Medicaid and CHIP Enrollee Comparisons Using the 2019 T-MSIS Analytic File
Compares urban and rural residents enrolled in fee-for-service or managed care Medicaid, using data from the 2019 Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF). Features demographics and statistics on Medicaid enrollment, with breakdowns by levels of rurality.
Author(s): Kristie Thompson, Hannah Friedman, Lily Wang, Mark Holmes
Date: 12/2024
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
view details
Compares urban and rural residents enrolled in fee-for-service or managed care Medicaid, using data from the 2019 Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF). Features demographics and statistics on Medicaid enrollment, with breakdowns by levels of rurality.
Author(s): Kristie Thompson, Hannah Friedman, Lily Wang, Mark Holmes
Date: 12/2024
Type: Document
Sponsoring organization: North Carolina Rural Health Research Program
view details
Center for Medicare and Medicaid Innovation: 2024 Report to Congress
Reports to Congress on payment and service delivery models and initiatives tested or announced by the Center for Medicare and Medicaid Innovation between October 2022 and September 2024. Includes summaries and updates on multiple rural-relevant models and initiatives, including the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model, the Transforming Maternal Health Model, the Pennsylvania Rural Health Model (PARHM), the Vermont All-Payer Accountable Care Organization Model, and more.
Date: 12/2024
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, U.S. Department of Health and Human Services
view details
Reports to Congress on payment and service delivery models and initiatives tested or announced by the Center for Medicare and Medicaid Innovation between October 2022 and September 2024. Includes summaries and updates on multiple rural-relevant models and initiatives, including the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model, the Transforming Maternal Health Model, the Pennsylvania Rural Health Model (PARHM), the Vermont All-Payer Accountable Care Organization Model, and more.
Date: 12/2024
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, U.S. Department of Health and Human Services
view details
Primary Care Collaborative 2024 Evidence Report: An Evaluation of Primary Care in Medicare Accountable Care Organizations
Examines the role of primary care in Accountable Care Organizations (ACOs) in the Medicare Shared Savings Program (MSSP), and includes 3 case studies of MSSP ACOs that are primary care centric. Explores how the performance of ACOs may be affected by serving beneficiaries with high economic and social need. Mentions rural throughout.
Author(s): Ann Greiner, David Muhlestein, Ann Kempski, Melissa K. Fillippi, Alison N. Huffstetler
Date: 11/2024
Type: Document
Sponsoring organizations: Primary Care Collaborative, Robert Graham Center, Simple Healthcare
view details
Examines the role of primary care in Accountable Care Organizations (ACOs) in the Medicare Shared Savings Program (MSSP), and includes 3 case studies of MSSP ACOs that are primary care centric. Explores how the performance of ACOs may be affected by serving beneficiaries with high economic and social need. Mentions rural throughout.
Author(s): Ann Greiner, David Muhlestein, Ann Kempski, Melissa K. Fillippi, Alison N. Huffstetler
Date: 11/2024
Type: Document
Sponsoring organizations: Primary Care Collaborative, Robert Graham Center, Simple Healthcare
view details
Additional resources are available related to this guide. See the full list of resources by topic for:
- Accountable Care Organizations
- Care coordination
- Health insurance
- Healthcare business and finance
- Medicaid
- Medicare
- Policy
- Reimbursement and payment models
- Service delivery models
Last Updated: 1/21/2025