State Rural Hospital Flexibility Program

 

The Rural Hospital Flexibility Program (Flex) enables state designated entities to support critical access hospitals in quality improvement, quality reporting, performance improvement, and benchmarking; to assist facilities seeking designation as critical access hospitals; and to create a program to establish or expand the provision of rural emergency medical services. Flex Program objectives include quality, operational, financial, and population health improvement with the goal of supporting access to necessary health care services in rural communities. State Flex programs will act as resources and focal points for these activities within their respective states. The Rural Veterans Health Access Program provides funding to states to coordinate activities to provide rural veterans access to services for needed mental health care via the use of networks, electronic communication and telehealth networks. The program targets states with high percentages of veterans to the total population.

Active 93.241 Health Resources and Services Administration, Department of Health and Human Services B - Project Grants Fiscal Year 2021 Accomplishments for the Medicare Rural Hospital Flexibility Program: In 2020, 1282 Critical Access Hospitals (CAHs) participated in the Medicare Beneficiary Quality Improvement Program (MBQIP), to report on quality measures aligned with those collected by the Centers for Medicare and Medicaid Services. Quality measures quantify health care processes, outcomes, patient perceptions, and organizational structure and systems to guide decisions about improvements to health care services. MBQIP provides the opportunity for rural hospitals to evaluate their quality data and compare outcomes with that of hospitals with similar characteristics (such as small bed size, limited resources, and health services). 61.1% of CAHs reported improvement in core MBQIP measures and 35.2% of CAHs reported improvement in additional MBQIP measures. Grantee accomplishments for the Rural Veterans Health Access Program include: initiating Veteran’s Administration telehealth visits at community-based healthcare provider sites establishing a coalition to increases access to care for veterans in rural areas; and the creation of a new Project ECHO line specific for veteran-related health issues, that launched in 2020.
Fiscal Year 2022 Accomplishments for the Medicare Rural Hospital Flexibility Program: In 2021, 1353 Critical Access Hospitals (CAHs) participated in the Medicare Beneficiary Quality Improvement Program (MBQIP), to report on quality measures aligned with those collected by the Centers for Medicare and Medicaid Services. Quality measures quantify health care processes, outcomes, patient perceptions, and organizational structure and systems to guide decisions about improvements to health care services. MBQIP provides the opportunity for rural hospitals to evaluate their quality data and compare outcomes with that of hospitals with similar characteristics (such as small bed size, limited resources, and health services). 71% of CAHs reported improvement in core MBQIP measures and 55% of CAHs reported improvement in additional MBQIP measures. CAHs also participate in financial improvement initiatives through the Flex program, and 54% of CAHs reported improvement in targeted operations in 2021. Grantee accomplishments for the Rural Veterans Health Access Program include: creating programs that aims to build Veteran participation in healthcare and wellbeing activities by promoting connectedness and help seeking; and providing seed funding to organizations with Critical Access Hospitals. The Rural Veterans Health Access Program-Title XVIII, § 1820 (g) (6) of the Social Security Act (42 U.S.C. 1395i-4(g) (6)), as amended
The Rural Hospital Flexibility Program (Flex)-Title XVIII, §1820(g) (1) and (2) of the Social Security Act (42 U.S.C. 1395i-4), as amended Flex and Rural Veterans Recipients: Only states with certified Critical Access Hospitals are eligible for this Program. The Governor designates the eligible applicant from each state. All other states need to submit an application to the Regional Administrator of their CMS Regional Office that expresses the state's interest in developing a Medicare Rural Hospital Flexibility Program before they can apply for funds. States with at least one hospital located in a non-metropolitan statistical area or county that provide CMS with necessary assurances. Applicants should review the individual HRSA notice of funding opportunity issued under this assistance listing for any required proof or certifications which must be submitted prior to or simultaneous with submission of an application package. Preapplication coordination is not applicable. 2 CFR 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards applies to this program. HRSA requires all applicants to apply electronically through Grants.gov. All qualified applications will be forwarded to an objective review committee. Based on the advice of the objective review committee, the HRSA program official with delegated authority is responsible for final selection and funding decisions. Based on the advice of the objective review committee, the HRSA program official with delegated authority is responsible for final selection and funding decisions. Contact the headquarters or regional location, as appropriate for application deadlines From 120 to 180 days. Up to six months. Not applicable. Flex awards may be made for up to 5-year periods of performance. Subject to availability of funds, after initial awards, projects may be renewed non-competitively contingent upon submission and approval of an application, availability of appropriated funds, and recipient's satisfactory performance. The Rural Veterans Health Access Program awards on made for up to 3-year period of performance. The Rural Veterans Health Access Program awards on made for up to 3-year period of performance. Contact Headquarters for selection criteria. All funds awarded are to be expended solely for the purposes outlined in the approved projects. Administrative (indirect) expenses are limited to the lesser of 15 percent of the award or the state’s federally negotiated indirect rate for administering the award. Not applicable. In accordance with the provisions of 2 CFR 200, Subpart F - Audit Requirements, nonfederal entities that expend financial assistance of $750,000 or more in Federal awards will have a single or a program-specific audit conducted for that year. Non-Federal entities that expend less than $750,000 a year in Federal awards are exempt from Federal audit requirements for that year, except as noted in 2 CFR 200.503. Recipients are required to maintain grant accounting records for 3 years after the date they submit the Federal Financial Report (FFR). If any litigation, claim, negotiation, audit, or other action involving the award has been started before the expiration of the 3-year period, the records shall be retained until completion of the action and resolution of all issues which arise from it, or until the end of the regular 3-year period, whichever is later. Statutory formula is not applicable to this assistance listing.

Matching requirements are not applicable to this assistance listing.

MOE requirements are not applicable to this assistance listing. Awards are made annually. Funds are available to recipients on an as needed basis throughout the budget period and payments are made through the Payment Management System (PMS). Recipient drawdown funds, as necessary, from PMS, the centralized web based payment system for HHS awards None/Not specified. Laura Seifert, Program Coordinator
Federal Office of Rural Health Policy
Rockville, MD 20857 US
LSeifert@hrsa.gov
Phone: (301) 443-3343

Jessica Sanders, Program Coordinator
5600 Fishers Lane
Rockville, MD 20857 USA
jsanders@hrsa.gov
Phone: 301-443-0736 http://www.hrsa.gov/ruralhealth/ 75-0350-0-1-550 (Cooperative Agreements) FY 22$28,708,947.00; FY 23 est $30,156,755.00; FY 24 est $30,156,755.00; FY 21$28,509,826.00; FY 20$28,509,826.00; FY 19$28,509,826.00; - Medicare Rural Hospital Flexibility Program(Cooperative Agreements) FY 22$873,793.00; FY 23 est $892,084.00; FY 24 est $893,703.00; FY 21$810,659.00; FY 20$858,224.00; FY 19$813,659.00; - Rural Veterans Health Access Program Medicare Rural Hospital Flexibility Program $345,653 to $1,190,219; Average, $683,768 Rural Veterans Health Access Program: $293,706 to $299,999; Average $297,901. This program is subject to the provisions of 45 CFR Part 92 for state, local and tribal governments and 45 CFR Part 74 for institutions of higher education, hospitals, other nonprofit organizations and commercial organizations, as applicable. HRSA awards are subject to the requirements of the HHS Grants Policy Statement (HHS GPS) that are applicable based on recipient type and purpose of award. The HHS GPS is available at https://www.hrsa.gov/grants/hhsgrantspolicy.pdf. Not applicable.