Rural Healthcare Payment and Reimbursement – Resources

Evaluation of the Maryland All-Payer Model: Volume I - Final Report
Evaluation of the All-Payer Model operating under an agreement with the Centers for Medicare & Medicaid Services (CMS) for hospitals in rural and urban settings implemented in Maryland in 2014. This model shifted the state's hospital payment structure to an annual, global hospital budget that includes both inpatient and outpatient hospital services. Report covers 4.5 years of implementation, and compares outcomes by rural and urban residency.
Author(s): Susan Haber, Heather Beil, Marisa Morrison, et al.
Date: 11/2019
Type: Document
Sponsoring organization: Centers for Medicare and Medicaid Services
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Estimate of Federal Payment Reductions to Hospitals Following the ACA: 2010-2029: Estimates and Methodology
Estimates the reduction in Medicare hospital payments due to sequestration from 2010 to 2029, not including reductions enacted under the Affordable Care Act (ACA). Demonstrates how other legislative acts and regulatory changes by the Centers for Medicare and Medicaid Services (CMS) reduced federal payments to hospitals over the same period. Highlights how reductions in Medicare payments for bad debt impacted Critical Access Hospitals (CAHs).
Date: 10/2019
Type: Document
Sponsoring organizations: American Hospital Association, Federation of American Hospitals
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States' Medicaid Fee-for-Service Nursing Facility Payment Policies
Spreadsheet outlining each state's Medicaid fee-for-service (FFS) nursing facility payment policy. Lists how each state sets the payment rate and any adjustments and supplemental payments. Includes information on rural/urban aspects of setting or adjustment to the payment in each state.
Date: 10/2019
Type: Document
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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Toward a High Performing Rural Health Care System: Key Issues and Recommendations from Rural Health Care System Innovators
Summarizes key themes and recommendations from a meeting of rural health leaders regarding innovations in rural healthcare financing and service delivery to inform state and national policy discussions. Offers recommendations, examples, and discussion on 3 areas: financing rural health system innovation, creating an infrastructure to support rural health innovation, and promoting governance models that support innovation.
Author(s): Keith J. Mueller, Charlie Alfero, Andrew F. Coburn, et al.
Date: 05/2019
Type: Document
Sponsoring organization: Rural Policy Research Institute Rural Health Panel
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Medicare: Voluntary and Mandatory Episode-Based Payment Models and Their Participants
Reviews tests of 6 episode-based Medicare payment models. Describes the characteristics of providers that participated in these models, including rural or urban location, addresses factors affecting their decision to participate, and compares the advantages of mandatory versus voluntary participation.
Additional links: Full Report
Date: 12/2018
Type: Document
Sponsoring organization: Government Accountability Office
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Significant Vulnerabilities Exist in the Hospital Wage Index System for Medicare Payments
Reports on 41 examinations of wage data of individual acute care hospitals from 2004 to 2017 to describe significant vulnerabilities observed in the wage index system for Medicare payments. Includes discussion on the rural floor wage index and the effects it has on wage index accuracy. Offers recommendations to reform the hospital wage index system.
Date: 11/2018
Type: Document
Sponsoring organization: Office of Inspector General (HHS)
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Innovation Center State-Based Initiatives: A Systematic Review of Lessons Learned
A synthesis of findings from 47 evaluation reports covering 12 Center for Medicare & Medicaid Innovation models with a state component. Includes information on the impact of models for rural areas and identifies barriers and challenges faced in rural areas.
Date: 08/2018
Type: Document
Sponsoring organizations: Centers for Medicare and Medicaid Services, L&M Policy Research
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The Medicaid Fee-for-Service Provider Payment Process
Outlines Medicaid's fee-for-services (FFS) provider payment process. Details the claims-based submission payment process, as well as additional non-claims-based payment processes. Includes information targeted to Rural Health Clinics and Federally Qualified Health Centers throughout.
Date: 07/2018
Type: Document
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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Medicaid Payment Policy for Federally Qualified Health Centers
Describes the role of Federally Qualified Health Centers (FQHCs) in Medicaid, and highlights current policy issues related to Medicaid FQHC payment. Also discusses the Medicaid FQHC prospective payment system (PPS), alternative payment methodologies, how FQHCs participate in managed care networks, and states' desire for increased flexibility in setting FQHC payment rates.
Date: 12/2017
Type: Document
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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ACO Primary Care Flex Model
Provides information on the Centers for Medicare & Medicaid Services (CMS) Innovation Center's ACO Primary Care Flex Model, which will test how prospective payments and increased funding for primary care in accountable care organizations (ACOs) impact health outcomes, quality, and costs of care. Aims to increase the number of low-revenue ACOs participating in the Medicare Shared Savings Program (SSP), including ACOs serving rural and underserved populations.
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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