Rural Healthcare Payment and Reimbursement – Resources
Selected recent or important resources focusing on Rural Healthcare Payment and Reimbursement.
The Impact of Medicare's Rural Add-on Payments on Supply of Home Health Agencies Serving Rural Counties
Examines how Medicare rural add-on payments affected the number of home health agencies serving rural counties between 2002-2017. Compares the population-adjusted number of home health agencies in urban, urban-adjacent non-urban-adjacent rural counties during periods with add-on payments and without add-on payments. Discusses implications for revised and future add-on payments to maintain or increase the supply of rural home health agencies.
Author(s): Tracy M. Mroz, Davis G. Patterson, Bianca K. Frogner
Citation: Health Affairs, 39(6), 949-957
Date: 06/2020
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Examines how Medicare rural add-on payments affected the number of home health agencies serving rural counties between 2002-2017. Compares the population-adjusted number of home health agencies in urban, urban-adjacent non-urban-adjacent rural counties during periods with add-on payments and without add-on payments. Discusses implications for revised and future add-on payments to maintain or increase the supply of rural home health agencies.
Author(s): Tracy M. Mroz, Davis G. Patterson, Bianca K. Frogner
Citation: Health Affairs, 39(6), 949-957
Date: 06/2020
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Medicaid: State Views on Program Administration Challenges
Describes four federal Medicaid policies that pose barriers to effective program administration. Highlights the requirement for states to pay Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) under the prospective payment system as a challenge for states. Identifies three issues for federal policymakers to consider when addressing these administrative challenges.
Additional links: Full Report
Date: 04/2020
Sponsoring organization: Government Accountability Office
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Describes four federal Medicaid policies that pose barriers to effective program administration. Highlights the requirement for states to pay Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) under the prospective payment system as a challenge for states. Identifies three issues for federal policymakers to consider when addressing these administrative challenges.
Additional links: Full Report
Date: 04/2020
Sponsoring organization: Government Accountability Office
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Second Report to Congress: Social Risk Factors and Performance in Medicare's Value-Based Purchasing Programs
Analyzes the effect of individuals' social risk factors on quality measures, resource utilization, and other Medicare program measures using Medicare and non-Medicare data sources. Describes how Medicare value-based purchasing (VBP) programs impact providers who serve socially at-risk beneficiaries. Categorizes rurality as a social risk factor. Explores emerging trends among providers addressing social risk factors through cooperation with social services and community-based organizations. Offers policy recommendations for the U.S. Department of Health and Human Services to account for social risk factors in VBP programs and achieve better outcomes for those with social risk factors. Second of two reports required by the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. See the first report.
Additional links: Executive Summary
Date: 03/2020
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Analyzes the effect of individuals' social risk factors on quality measures, resource utilization, and other Medicare program measures using Medicare and non-Medicare data sources. Describes how Medicare value-based purchasing (VBP) programs impact providers who serve socially at-risk beneficiaries. Categorizes rurality as a social risk factor. Explores emerging trends among providers addressing social risk factors through cooperation with social services and community-based organizations. Offers policy recommendations for the U.S. Department of Health and Human Services to account for social risk factors in VBP programs and achieve better outcomes for those with social risk factors. Second of two reports required by the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. See the first report.
Additional links: Executive Summary
Date: 03/2020
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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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
Sponsoring organizations: American Hospital Association, Federation of American Hospitals
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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
Sponsoring organizations: American Hospital Association, Federation of American Hospitals
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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
Sponsoring organizations: Centers for Medicare and Medicaid Services, L&M Policy Research
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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
Sponsoring organizations: Centers for Medicare and Medicaid Services, L&M Policy Research
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Rural Health Value: Policy Documents and Demonstrations
Summaries of selected rural health demonstration programs and rural aspects of payment policies.
Sponsoring organization: Rural Health Value
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Summaries of selected rural health demonstration programs and rural aspects of payment policies.
Sponsoring organization: Rural Health Value
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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.
Sponsoring organization: Centers for Medicare and Medicaid Services
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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.
Sponsoring organization: Centers for Medicare and Medicaid Services
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ACO Primary Care Flex Model: Model Overview Factsheet
Describes the ACO Primary Care Flex Model from the CMS Innovation Center including purpose and goals, eligibility and participation criteria, payment overview, and application and timeline. Includes information for Federally Qualified Health Centers and Rural Health Clinics.
Sponsoring organization: Centers for Medicare and Medicaid Services
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Describes the ACO Primary Care Flex Model from the CMS Innovation Center including purpose and goals, eligibility and participation criteria, payment overview, and application and timeline. Includes information for Federally Qualified Health Centers and Rural Health Clinics.
Sponsoring organization: Centers for Medicare and Medicaid Services
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States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model
Provides information on the Centers for Medicare & Medicaid Services (CMS) Innovation Center's States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model, a voluntary state total cost of care model that will test state accountability for controlling overall growth in health expenditures while increasing investment in primary care and improving population health outcomes.
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides information on the Centers for Medicare & Medicaid Services (CMS) Innovation Center's States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model, a voluntary state total cost of care model that will test state accountability for controlling overall growth in health expenditures while increasing investment in primary care and improving population health outcomes.
Sponsoring organization: Centers for Medicare and Medicaid Services
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State Medicaid Links
Provides links to state Medicaid agency websites, including pages for state contacts, eligibility, and enrollment information.
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides links to state Medicaid agency websites, including pages for state contacts, eligibility, and enrollment information.
Sponsoring organization: Centers for Medicare and Medicaid Services
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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: 3/28/2025