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Medicare Rural Hospital Flexibility Program (Flex)


The Medicare Rural Hospital Flexibility Program (Flex) is a federal funding program designed to improve and sustain access to appropriate and quality health care services in rural areas. Established by the Balanced Budget Act (BBA) of 1997:

  • Supports the conversion and designation of small rural hospitals to Critical Access Hospital (CAH) status;
  • Assists in developing and maintaining quality health care network systems;
  • Strengthens and further integrates Emergency Medical Services (EMS) in rural areas; and
  • Facilitates the development of state specific model community-based collaborative systems in rural areas.

When the program began in 1999, the primary focus was on the (1) development of an initial State Rural Health Plan (SRHP) and (2) conversion of eligible health care facilities to CAH status. Since then, the program has shifted its focus to sustaining quality rural health care infrastructures wherein CAH facilities serves as the hub of an organization system of health care. Projects funded under the Flex program include those that center around:

  • Development and implementation of a SRHP;
  • Performance and quality improvement within the rural health care system;
  • Supporting CAH facilities;
  • Program evaluation;
  • Integration of EMS; and
  • Networking

The Virginia Department of Health has managed this program since 1999. Accomplishments have included:

  • Continuously increasing rural health partners;
  • Leveraging program funding to cost-effectively extend various Flex program services to include 7 CAH facilities and 17 other small rural hospital facilities;
  • Acquiring of $1.1 million in additional federal funds to pilot a health information technology project at one of Virginia’s CAH facilities;
  • Expand the use of technology, EMS and collaboration to improve healthcare in rural areas;
  • Provided over $100,000 to CAH facilities for health information technology upgrades.

Current Flex-funded projects:


Learn More

Federal Office of Rural Health Policy

Rural Health Resource Center

Technical Assistance and Services Center (TASC)

Flex Monitoring Team

Rural Assistance Center

National Rural Recruitment and Retention Network (3RNet)

Rural Hospital Flexibility Program Strategic Plan

Technical Assistance and Services Center for the FLEX Program

For more information about Virginia's State Office of Rural Health contact Theresa Taylor


Last Updated: 11-18-2013

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