Rural Healthcare Payment and Reimbursement – Resources
Selected recent or important resources focusing on Rural Healthcare Payment and Reimbursement.
Mandated Analysis of Home Health Service Utilization From January 2016 Through March 2022
Report evaluates the distribution of rural add-on payments for home health claims. Examines the results of the Centers for Medicare and Medicaid Services's new rural add-on methodology aimed at providing higher add-on percentages for "low population density" categories and explores the effect this methodology has had on "high utilization" categories. Makes comments and recommendations as to how this methodology can be adjusted.
Additional links: Report in Brief
Date: 12/2022
Sponsoring organization: Office of Inspector General (HHS)
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Report evaluates the distribution of rural add-on payments for home health claims. Examines the results of the Centers for Medicare and Medicaid Services's new rural add-on methodology aimed at providing higher add-on percentages for "low population density" categories and explores the effect this methodology has had on "high utilization" categories. Makes comments and recommendations as to how this methodology can be adjusted.
Additional links: Report in Brief
Date: 12/2022
Sponsoring organization: Office of Inspector General (HHS)
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Medicaid Population-Based Payment: The Current Landscape, Early Insights, and Considerations for Policymakers
Provides an overview of population-based payment (PBP) models and the Medicaid PBP landscape. Identifies promising strategies for designing and implementing PBPs in Medicaid and considerations for state and federal policymakers who want to support these programs. Highlights state PBP approaches, including the Pennsylvania Rural Health Model.
Author(s): Rob Houston, Anne Smithey, Kelsey Brykman
Date: 11/2022
Sponsoring organization: Center for Health Care Strategies
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Provides an overview of population-based payment (PBP) models and the Medicaid PBP landscape. Identifies promising strategies for designing and implementing PBPs in Medicaid and considerations for state and federal policymakers who want to support these programs. Highlights state PBP approaches, including the Pennsylvania Rural Health Model.
Author(s): Rob Houston, Anne Smithey, Kelsey Brykman
Date: 11/2022
Sponsoring organization: Center for Health Care Strategies
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CY 2023 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule (CMS 1772-FC) Rural Emergency Hospitals — New Medicare Provider Type
Provides an overview of Rural Emergency Hospitals, a Medicare provider type established by the Consolidated Appropriations Act, 2021. Details key policies outlined in the Calendar Year 2023 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Final Rule, including payment policies, conditions of participation, REH provider enrollment, and exceptions to the physician self-referral law.
Date: 11/2022
Sponsoring organization: Centers for Medicare and Medicaid Services
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Provides an overview of Rural Emergency Hospitals, a Medicare provider type established by the Consolidated Appropriations Act, 2021. Details key policies outlined in the Calendar Year 2023 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Final Rule, including payment policies, conditions of participation, REH provider enrollment, and exceptions to the physician self-referral law.
Date: 11/2022
Sponsoring organization: Centers for Medicare and Medicaid Services
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October 2022 MACPAC Meeting Transcript
Transcript from the Medicaid and CHIP Payment and Access Commission's (MACPAC) October 2022 meeting. Covers Medicaid race and ethnicity data collection and reporting, improving access to Medicaid coverage and care for adults leaving incarceration, the unwinding of the Public Health Emergency, streamlining the delivery of home- and community-based services, potential recommendations for structuring Disproportionate Share Hospital allotments during economic crises, and more. Includes rural references and considerations throughout.
Date: 10/2022
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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Transcript from the Medicaid and CHIP Payment and Access Commission's (MACPAC) October 2022 meeting. Covers Medicaid race and ethnicity data collection and reporting, improving access to Medicaid coverage and care for adults leaving incarceration, the unwinding of the Public Health Emergency, streamlining the delivery of home- and community-based services, potential recommendations for structuring Disproportionate Share Hospital allotments during economic crises, and more. Includes rural references and considerations throughout.
Date: 10/2022
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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Rural Health System Value-Based Care Innovators Roundtable: Strategies and Insights
Presents findings from interviews with five health systems that include a substantial proportion of rural hospitals and clinics and actively support the transition to value-based care. Covers organizational structure, governance and decision-making, operations, data and communication, contracts, and social determinants of health. Identifies common health system tensions and opportunities to implementing value-based care at rural facilities.
Date: 10/2022
Sponsoring organization: Rural Health Value
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Presents findings from interviews with five health systems that include a substantial proportion of rural hospitals and clinics and actively support the transition to value-based care. Covers organizational structure, governance and decision-making, operations, data and communication, contracts, and social determinants of health. Identifies common health system tensions and opportunities to implementing value-based care at rural facilities.
Date: 10/2022
Sponsoring organization: Rural Health Value
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Landscape of Area-Level Deprivation Measures and Other Approaches to Account for Social Risk and Social Determinants of Health in Health Care Payments
Examines social determinants of health (SDOH) at the community level and their impact on health-related social needs (HRSNs) of the individual. Discusses how policies related to federal payment systems can incentivize screening for HRSNs as well as referrals to appropriate social and behavioral services. Provides an environmental scan of what measures can be used to provide accountability for funding and policy efforts targeted at SDOH. Includes an appendix that defines and describes indices of social risk, such as the social vulnerability index (SVI) and area deprivation index (ADI), as well as payment models that include measures of social risk.
Author(s): Joshua Breslau, Laurie Martin, Justin Timbie, Nabeel Qureshi, Deborah Zajdman
Date: 09/2022
Sponsoring organizations: HHS Office of the Assistant Secretary for Planning and Evaluation, RAND Corporation
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Examines social determinants of health (SDOH) at the community level and their impact on health-related social needs (HRSNs) of the individual. Discusses how policies related to federal payment systems can incentivize screening for HRSNs as well as referrals to appropriate social and behavioral services. Provides an environmental scan of what measures can be used to provide accountability for funding and policy efforts targeted at SDOH. Includes an appendix that defines and describes indices of social risk, such as the social vulnerability index (SVI) and area deprivation index (ADI), as well as payment models that include measures of social risk.
Author(s): Joshua Breslau, Laurie Martin, Justin Timbie, Nabeel Qureshi, Deborah Zajdman
Date: 09/2022
Sponsoring organizations: HHS Office of the Assistant Secretary for Planning and Evaluation, RAND Corporation
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Health Panel Comment Letter – Medicare Advantage Program
Offers comments in response to the Centers for Medicare & Medicaid Services (CMS) Request for Information on various aspects of the Medicare Advantage (MA) program. Presents a rural perspective on the MA program and discusses health equity in the MA program, expanding access to care, and value-based contracting. Includes data on the proportion of MA plans offering supplemental benefits in noncore, micropolitan, and metropolitan counties in 2020.
Date: 08/2022
Sponsoring organization: Rural Policy Research Institute Rural Health Panel
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Offers comments in response to the Centers for Medicare & Medicaid Services (CMS) Request for Information on various aspects of the Medicare Advantage (MA) program. Presents a rural perspective on the MA program and discusses health equity in the MA program, expanding access to care, and value-based contracting. Includes data on the proportion of MA plans offering supplemental benefits in noncore, micropolitan, and metropolitan counties in 2020.
Date: 08/2022
Sponsoring organization: Rural Policy Research Institute Rural Health Panel
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Synthesis of Evaluation Results across 21 Medicare Models, 2012-2020
Summarizes results from evaluations of 21 Centers for Medicare & Medicaid (CMS) Innovation Center models. Examines measures related to gross and net Medicare spending, utilization, and quality of care. Identifies themes among models with similar participant types and interventions used. Offers considerations for acute or specialty care and targeted populations models and prevention and population management models.
Additional links: Findings at a Glance, Synthesis of Evaluation Results Across 21 Medicare Models Slides, Transcript, Webinar Recording
Date: 07/2022
Sponsoring organization: Centers for Medicare and Medicaid Services
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Summarizes results from evaluations of 21 Centers for Medicare & Medicaid (CMS) Innovation Center models. Examines measures related to gross and net Medicare spending, utilization, and quality of care. Identifies themes among models with similar participant types and interventions used. Offers considerations for acute or specialty care and targeted populations models and prevention and population management models.
Additional links: Findings at a Glance, Synthesis of Evaluation Results Across 21 Medicare Models Slides, Transcript, Webinar Recording
Date: 07/2022
Sponsoring organization: Centers for Medicare and Medicaid Services
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Report to Congress: Unified Payment for Medicare-Covered Post-Acute Care
Presents a prototype for a Unified Post-acute Care (PAC) prospective payment system (PPS) that would set payment for PAC services on the basis of the clinical characteristics of the patient rather than the type of provider. Details the structure of the prototype and the data used in the analyses to design and calibrate the PPS. Explores key considerations for unifying PAC payment, such as cost-sharing and value-based payment. Includes data on PAC provider characteristics, including facility size and rural status, as well as rural payment adjustments.
Additional links: Appendices
Author(s): Benjamin Silver, Anne Deutsch, Nicole Coomer, et al.
Date: 07/2022
Sponsoring organizations: Centers for Medicare and Medicaid Services, RTI International
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Presents a prototype for a Unified Post-acute Care (PAC) prospective payment system (PPS) that would set payment for PAC services on the basis of the clinical characteristics of the patient rather than the type of provider. Details the structure of the prototype and the data used in the analyses to design and calibrate the PPS. Explores key considerations for unifying PAC payment, such as cost-sharing and value-based payment. Includes data on PAC provider characteristics, including facility size and rural status, as well as rural payment adjustments.
Additional links: Appendices
Author(s): Benjamin Silver, Anne Deutsch, Nicole Coomer, et al.
Date: 07/2022
Sponsoring organizations: Centers for Medicare and Medicaid Services, RTI International
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State Innovation Model Testing Awards from the Centers for Medicare & Medicaid Services Innovation Center: Highlighting Rural Focus
Summarizes the activities and accomplishments of rural-specific State Innovation Models (SIM) in 11 states: Arkansas, Colorado, Idaho, Iowa, Maine, Michigan, Minnesota, New York, Ohio, Oregon, and Vermont. Describes the SIM initiative, which began in 2012 to support states committed to designing and testing strategies for payment model and delivery system reform.
Date: 06/2022
Sponsoring organization: Rural Health Value
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Summarizes the activities and accomplishments of rural-specific State Innovation Models (SIM) in 11 states: Arkansas, Colorado, Idaho, Iowa, Maine, Michigan, Minnesota, New York, Ohio, Oregon, and Vermont. Describes the SIM initiative, which began in 2012 to support states committed to designing and testing strategies for payment model and delivery system reform.
Date: 06/2022
Sponsoring organization: Rural Health Value
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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: 12/19/2024