The Evolving Landscape of National Telehealth Policies during a Public Health Emergency: Responsiveness to Rural Needs

The coronavirus pandemic precipitated significant but temporary changes in telehealth policy and the use of telehealth services to ensure access to needed health services during a public health emergency (PHE). Extending the temporary policy changes will require statutory and regulatory action. This paper takes stock of current telehealth policies and assesses options for expanding the […]

Considerations for Defining Rural Places in Health Policies and Programs

The RUPRI Health Panel has released a new brief that identifies key questions to ask when creating, modifying, or using a definition. Rural definitions in statute and policy are used to direct resources to underserved peoples. But changes in population behavior and Census processes have led to concern about historic methods of defining rural. This […]

New Report from RUPRI Rural Health on Effects of the ACA on Coverage and Access to Care

A new policy brief from the RUPRI Center for Rural Health Policy & Analysis shows that access to health insurance coverage has changed significantly following changes in public and private insurance due to the Patient Protection and Affordable Care Act (PPACA). From 2013-2016, the PPACA led to an overall increase in coverage rates of nearly 13 and […]

Assessing the Unintended Consequences of Health Policy on Rural Populations and Places

The RUPRI Rural Health Panel, through the support of the Federal Office of Rural Health Policy (FORHP) in the Department of Health and Human Services, has released a new Policy Brief, Assessing the Unintended Consequences of Health Policy on Rural Populations and Places. The purpose of this paper is to illuminate the unintended consequences of health […]

Spread of Medicare Accountable Care Organizations in Rural

Accountable care organization (ACO) models are the most widely adopted value-based payment initiatives from the Centers for Medicare & Medicaid Services. The Shared Savings Program, started in 2011, is the most commonly adopted Medicare ACO model. This policy brief updates findings from previous RUPRI Center reports. It shows that there is continued growth in the […]

Primer on Rural Long-Term Services and Support

 Rural Long-Term Services and Supports: A Primer provides policymakers and other interested stakeholders a primer on rural long-term services and supports (LTSS): (1) the fundamentals of the rural LTSS system, (2) rural access to and use of LTSS, and (3) discussion of the opportunities within and limitations of current Federal and State LTSS policy for advancing […]

Footloose Jobs & Urbanization

Footloose Jobs & Urbanization: Recent History and Policy Considerations for Indiana This policy brief outlines the recent history of footloose and non-footloose jobs in Indiana, including regional changes in rural and urban employment. We also examine economic development policy and suggest future models for consideration. Written by Michael J. Hicks, PhD (Center for Business and […]

RUPRI Health Center releases report on the Changing Rural and Urban Enrollment in State Medicaid Programs

The RUPRI Center for Rural Health Policy Analysis has analyzed Medicaid enrollment in a new brief, Changing Rural and Urban Enrollment in State Medicaid Programs and found that growth was happened in most states, but was largest in expansion states and metropolitan areas generally had higher growth than micropolitan and rural areas. County-level data on Medicaid enrollment […]

RUPRI Health Center Releases Report on Rural Enrollment in Health Insurance Marketplaces

The RUPRI Center for Rural Health Policy Analysis has released a brief, 2016 Rural Enrollment in Health Insurance Marketplaces, by State. The data shows that about half of all states had higher enrollment growth in non-metropolitan areas than metropolitan areas. In this brief, cumulative county-level enrollment in Health Insurance Marketplaces (HIMs) through March 2016 is presented […]

Rural Medicare Advantage Market Dynamics and Quality: Historical Context and Current Implications

In this policy brief, we assess variation in Medicare’s star quality ratings of Medicare Advantage (MA) plans that are available to rural beneficiaries. Evidence from the recent Centers for Medicare & Medicaid Services (CMS) quality demonstration suggests that market dynamics, i.e., firms entering and exiting the MA marketplace, play a role in quality improvement. Therefore, […]

RUPRI Health Center Examines Rural Premium Trends in Health Insurance Marketplace

Health Insurance Marketplaces: Premium Trends in Rural Areas Since 2014, when the Health Insurance Marketplaces (HIMs) authorized by the Patient Protection and Affordable Care Act (ACA) were implemented, considerable premium changes have been observed in the marketplaces. This policy brief from the RUPRI Center for Rural Health Policy Analysis assesses the changes in average HIM […]

RUPRI Health Center Examines Beneficiary Assignment Updates in Medicare ACOs

Medicare Accountable Care Organizations: Beneficiary Assignment Update  This brief updates Brief No. 2014-3 and explains changes in the Centers for Medicare & Medicaid Services (CMS) Accountable Care Organization (ACO) regulations issued in June 2015 pertaining to beneficiary assignment for Medicare Shared Savings Program ACOs. Overall, the regulatory changes are intended to (1) encourage ACOs to […]

Medicaid Payment and Delivery System Reform: Challenges and Opportunities for Rural Health Systems

Medicaid has grown significantly in its importance to rural health systems and communities; a higher proportion (22 percent) of rural residents was enrolled in Medicaid than Medicare (20 percent) in 2014. At the same time, the use of payment and delivery innovations has grown significantly, but varies across the U.S. As a result of expansions […]

RUPRI Center for Rural Health Policy Analysis reviews Rural Medicare Advantage Plan Payment in 2015

Payment to Medicare Advantage (MA) plans was fundamentally altered by the Patient Protection and Affordable Care Act of 2010 (ACA).  This brief finds that while plans operating in both rural and urban areas have experienced a reduction in MA payment, the reduction in rural payment overall has been less significant.  In addition, MA plans have […]

Policy Brief: Medicare Value-Based Payment Reform

Medicare Value-Based Payment Reform: Priorities for Transforming Rural Health Systems View Policy Brief | Related: View Full Report In January 2015, Department of Health and Human Services (HHS) Secretary Burwell announced new goals and timelines for moving Medicare reimbursement from fee-for-service to value-based payment. These payment changes are driving delivery system reforms by making healthcare […]

New RUPRI Policy Brief released: Micropolitan America – for the Future of Rural Regional Innovation

Over one-half of the population of nonmetropolitan statistical areas of the United States live in a subset of nonmetropolitan geographies classified as Micropolitan areas. Over 27 million people live in these larger rural places, which are often anchor communities serving as regional hubs for commerce, employment and services. However, these areas are largely unexplored and […]

The RUPRI Center has a new policy brief titled, Developmental Strategies and Challenges for Rural Accountable Care Organizations

This Policy Brief shares insights into initial strategic decisions and challenges of four Accountable Care Organizations (ACOs) with a rural presence, one from each census region (West, Midwest, Northeast, and South). Semi-structured on-site interviews were conducted with ACO leaders and key stakeholder group representatives (e.g., board members, physicians). The four ACOs were formed as a […]

Redesigning Medicare: Considerations for Rural Beneficiaries and Health Systems

View report The enactment of the Balanced Budget Act of 1997 (BBA) dramatically changed the context for discussions of Medicare policy. Two major pathways for discussion were identified: Appropriate and equitable payment for services, either through traditional fee-for service (FFS) Medicare payments or through Medicare+Choice monthly premiums; and Appropriate and necessary changes to the program […]

The Area Wage Index of the Medicare Inpatient Hospital Prospective Payment System

The Area Wage Index of the Medicare Inpatient Hospital Prospective Payment System: Perspectives, Policies, and Choices View Policy Paper This policy paper discusses the positions of various rural health advocates on the wage index and recording the actions taken by Congress and the Health Care Financing Administration (HCFA) to improve the wage index.Finally, it outlines […]

Improving Prescription Drug Coverage for Rural Medicare Beneficiaries: Key Rural Considerations and Objectives For Legislative Proposals

View Policy Paper This Policy Paper combines the work from current projects of the Maine Rural Health Research Center (MRHRC) and the Rural Health Panel of the Rural Policy Research Institute (RUPRI) to provide a statement of specific rural considerations and objectives for any proposal that would add a prescription drug benefit to the Medicare […]

Calculating and Using the Area Wage Index of the Medicare Inpatient Hospital Prospective Payment System

View policy brief This policy brief explains how the area wage index is calculated and used, and identifies the major unresolved issues related to its calculation and use. This report was written by Anthony Wellever (Delta Rural Health Consulting and Research) in collaboration with RUPRI Health Panel Members: Andrew Coburn, Charles Fluharty, J. Patrick Hart, […]