Rural Healthcare Payment and Reimbursement – Resources
Selected recent or important resources focusing on Rural Healthcare Payment and Reimbursement.
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
Sponsoring organizations: Centers for Medicare and Medicaid Services, NORC at the University of Chicago
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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
Sponsoring organizations: Centers for Medicare and Medicaid Services, NORC at the University of Chicago
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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
Sponsoring organizations: Centers for Medicare and Medicaid Services, U.S. Department of Health and Human Services
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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
Sponsoring organizations: Centers for Medicare and Medicaid Services, U.S. Department of Health and Human Services
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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
Sponsoring organizations: Primary Care Collaborative, Robert Graham Center, Simple Healthcare
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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
Sponsoring organizations: Primary Care Collaborative, Robert Graham Center, Simple Healthcare
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Federally Qualified Health Centers and Performance of Medicare Accountable Care Organizations
Explores the association between participation of Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) in Medicare Shared Savings Program Accountable Care Organizations (ACOs) with ACOs' beneficiary characteristics, utilization, expenditure, and quality. Features statistics including estimated changes in Medicare Shared Savings Program ACO-assigned beneficiaries, utilization, and expenditure, with breakdowns by FQHC and RHC visits and other types of visits.
Author(s): Kun Li, Yucheng Hou, Frank McStay, Jonathan Gonzalez-Smith, Robert S. Saunders
Citation: JAMA Network Open, 7(11), e2445536
Date: 11/2024
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Explores the association between participation of Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) in Medicare Shared Savings Program Accountable Care Organizations (ACOs) with ACOs' beneficiary characteristics, utilization, expenditure, and quality. Features statistics including estimated changes in Medicare Shared Savings Program ACO-assigned beneficiaries, utilization, and expenditure, with breakdowns by FQHC and RHC visits and other types of visits.
Author(s): Kun Li, Yucheng Hou, Frank McStay, Jonathan Gonzalez-Smith, Robert S. Saunders
Citation: JAMA Network Open, 7(11), e2445536
Date: 11/2024
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State Telehealth Laws and Reimbursement Policies Report, Fall 2024
Provides an overview of state telehealth policies as of early September 2024. Covers Medicaid reimbursement, private payer laws, and professional requirements.
Additional links: Executive Summary, Infographic, State Summary Chart
Date: 11/2024
Sponsoring organization: Center for Connected Health Policy: The National Telehealth Policy Resource Center
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Provides an overview of state telehealth policies as of early September 2024. Covers Medicaid reimbursement, private payer laws, and professional requirements.
Additional links: Executive Summary, Infographic, State Summary Chart
Date: 11/2024
Sponsoring organization: Center for Connected Health Policy: The National Telehealth Policy Resource Center
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Calendar Year (CY) 2025 Medicare Physician Fee Schedule Final Rule
Fact sheet providing an overview of the Centers for Medicare & Medicaid Services (CMS) final rule regarding updates and changes to the Medicare payments under the Physician Fee Schedule (PFS) and other Medicare Part B issues for calendar year 2025. Summarizes provisions related to telehealth services; advanced primary care management services; behavioral health services; opioid treatment programs; dental and oral health services; Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) care coordination services, telecommunication services, intensive outpatient program (IOP) services, and payment for vaccine costs; and more.
Date: 11/2024
Sponsoring organization: Centers for Medicare and Medicaid Services
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Fact sheet providing an overview of the Centers for Medicare & Medicaid Services (CMS) final rule regarding updates and changes to the Medicare payments under the Physician Fee Schedule (PFS) and other Medicare Part B issues for calendar year 2025. Summarizes provisions related to telehealth services; advanced primary care management services; behavioral health services; opioid treatment programs; dental and oral health services; Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) care coordination services, telecommunication services, intensive outpatient program (IOP) services, and payment for vaccine costs; and more.
Date: 11/2024
Sponsoring organization: Centers for Medicare and Medicaid Services
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Final CY 2025 Medicare Physician Fee Schedule: Fact Sheet
Fact sheet covering Centers for Medicare & Medicaid Services (CMS) telehealth policy changes for 2025 as outlined in the final calendar year (CY) 2025 Physician Fee Schedule. Covers audio-only telehealth; eligible services that can be delivered by telehealth; frequency limitations for inpatient visits, nursing facilities, and critical care consults; direct supervision through the use of live video; payment to Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs); opioid treatment programs; and more.
Date: 11/2024
Sponsoring organization: Center for Connected Health Policy: The National Telehealth Policy Resource Center
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Fact sheet covering Centers for Medicare & Medicaid Services (CMS) telehealth policy changes for 2025 as outlined in the final calendar year (CY) 2025 Physician Fee Schedule. Covers audio-only telehealth; eligible services that can be delivered by telehealth; frequency limitations for inpatient visits, nursing facilities, and critical care consults; direct supervision through the use of live video; payment to Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs); opioid treatment programs; and more.
Date: 11/2024
Sponsoring organization: Center for Connected Health Policy: The National Telehealth Policy Resource Center
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Re-Imagining Rural Health: Themes, Concepts, and Next Steps from the CMS Innovation Center "Hackathon" Series
Summarizes themes that emerged from Centers for Medicare & Medicaid Services (CMS) Innovation Center's August 2024 Rural Health Hackathons, which aimed to inform potential payment and service delivery model development and to identify innovative solutions to address the access, care delivery, and workforce needs of rural, Tribal, frontier, and geographically isolated areas communities. Describes lessons learned from previous Innovation Center models focused on rural health and how these lessons were applied during the development of new models. Outlines potential areas for the Innovation Center to explore to advance health in rural, Tribal, frontier, and geographically isolated areas.
Date: 11/2024
Sponsoring organization: Centers for Medicare and Medicaid Services
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Summarizes themes that emerged from Centers for Medicare & Medicaid Services (CMS) Innovation Center's August 2024 Rural Health Hackathons, which aimed to inform potential payment and service delivery model development and to identify innovative solutions to address the access, care delivery, and workforce needs of rural, Tribal, frontier, and geographically isolated areas communities. Describes lessons learned from previous Innovation Center models focused on rural health and how these lessons were applied during the development of new models. Outlines potential areas for the Innovation Center to explore to advance health in rural, Tribal, frontier, and geographically isolated areas.
Date: 11/2024
Sponsoring organization: Centers for Medicare and Medicaid Services
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Rural Value-Based Care – The Payer Perspective
Summarizes discussions on rural value-based care (VBC) contracting during a July 2024 summit of leaders from national and regional healthcare payer organizations. Describes challenges facing payer organizations that serve rural beneficiaries, including engaging rural healthcare organizations in VBC; solutions to rural-specific challenges; and recommendations for rural healthcare organizations.
Date: 11/2024
Sponsoring organization: Rural Health Value
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Summarizes discussions on rural value-based care (VBC) contracting during a July 2024 summit of leaders from national and regional healthcare payer organizations. Describes challenges facing payer organizations that serve rural beneficiaries, including engaging rural healthcare organizations in VBC; solutions to rural-specific challenges; and recommendations for rural healthcare organizations.
Date: 11/2024
Sponsoring organization: Rural Health Value
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Merit-Based Incentive Payment System (MIPS): 2025 MIPS Payment Year (2023 Performance Year) - Payment Adjustment User Guide
Provides information on Merit-Based Incentive Payment System (MIPS) payment adjustments for calendar year 2025. Describes how 2023 MIPS scores relate to 2025 payment adjustments and how payment adjustments are applied. Offers answers to frequently asked questions.
Date: 10/2024
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides information on Merit-Based Incentive Payment System (MIPS) payment adjustments for calendar year 2025. Describes how 2023 MIPS scores relate to 2025 payment adjustments and how payment adjustments are applied. Offers answers to frequently asked questions.
Date: 10/2024
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: 12/26/2024