Medicare Rural Hospital Flexibility

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The Rural Hospital Flexibility Program (Flex) provides funding to state governments to spur quality and performance improvement activities; stabilize rural hospital finance; and integrate emergency medical services (EMS) into their health care systems. Only States with Critical Access Hospitals (CAH) or potential CAHs are eligible for the Flex program. Flex funding encourages the development of cooperative systems of care in rural areas -- joining together CAHs, EMS providers, clinics, and health practitioners to increase efficiencies and quality of care. The Flex program requires States to develop rural health plans, and funds their efforts to implement community-level outreach and technical assistance to advance the following goals: Improve quality of care and performance management Improve and integrate EMS Develop and implement rural health networks Support existing CAHs and eligible hospitals Designate CAHs in the State Although focused on small, rural hospitals, the Flex program operates on the National, State, community, and facility levels to cover a broad range of fundamental health service issues and "modernization" goals. State use Flex resouces for performance management activities, training programs, needs assessments, and network building. Efforts have included the use of a balanced scorecard approach, forming relationships with state Quality Improvement Organizations (QIOs), developing quality improvement-related networks, and participating in national quality improvement and reporting efforts.

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