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.
HRSA Federal Office of Rural Health Policy Introduction:
The Flex Program supports Critical Access Hospitals (CAHs) to promote quality and performance improvement including:
- Stabilizing finances;
- Integrating emergency medical services into health care systems;
- Incorporating population health; and
- Fostering innovative models of health care.
Under the Flex Program, the Medicare Beneficiary Quality Improvement Project seeks to improve the quality of care provided in CAHs by voluntarily reporting measures not required by CMS. States coordinate technical assistance based on the needs of hospitals in their state.
The Virginia FLEX Program
The Virginia FLEX Program exists to assist Virginia Critical Access Hospitals (CAHs) in moving toward a value-based payment model that provides high quality and appropriate care to all. The goal of the Virginia Flex program is to partner with Critical Access Hospitals to improve the quality of care, financial and operational performance, and population health needs of their communities.
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.
Recent FLEX-funded projects:
- Congregational Health Assessments
- Incentives for small rural hospitals to participate in a statewide assessment of the ability of emergency departments to treat pediatric patients
- Multi-state Performance Improvement Project
- Telehealth educational programs
- Annual Virginia Rural Health Conference
Virginia Critical Access Hospitals (CAHs):
- Ballad Health Dickenson Community Hospital
- Ballad Health Lee County Community Hospital
- Bath County Community Hospital
- Bon Secours Rappahannock General Hospital
- Carilion Giles Community Hospital
- Carilion Rockbridge Community Hospital
- Valley Health Page Memorial Hospital
- Valley Health Shenandoah Memorial Hospital
Virginia Critical Access Hospital (CAH) Application Materials:
- Virginia CAH Application Introduction
- Virginia CAH Application Checklist
- Virginia CAH Application Checklist & Application
Virginia FLEX Program Partners:
- HRSA Federal Office of Rural Health Policy
- Healthcare Quality Innovators (HQI)
- National Rural Health Association
- National Rural Health Resource Center
- VDH Office of EMS Community Health and Technical Resources Division
- Virginia Hospital and Healthcare Association
- Virginia Hospital and Healthcare Association Foundation
- Virginia Rural Health Association
- Stratis Health
- Stroudwater Associates
- The Flex Monitoring Team
- VDH Office of Licensing and Certification
Virginia FLEX Program Resources:
Quality Improvement Resources:
- Medicare Beneficiary Quality Improvement (MBQIP) Project
- Archive MBQIP Monthly Newsletters
- The Flex Monitoring Team
- Centers for Medicare and Medicaid Services (CMS)
- Agency for Healthcare and Research Quality
- Hospital Compare
- CMS Quality Net
- The Joint Commission
- VHHA Hospital Quality & Patient Safety Scorecard
- Virginia Rural Hospital Coaching Collaborative
- National Healthcare Safety Network (NHSN)
Finance/Operational Improvement Resources:
- The Flex Monitoring Team
- Stroudwater Associates
- Medicare Billing Information for Rural Providers and Suppliers
- ICD 10 Regulations and Information - Rules, regulations, and the latest news on ICD-10
- Small Rural Hospital and Clinic Finance 101
- CMS Innovation Center
- CMS: Community Health Access and Rural Transformation (CHART) Model
Learn More
Federal Office of Rural Health Policy
Technical Assistance and Services Center (TASC)
National Rural Recruitment and Retention Network (3RNet)
Technical Assistance and Services Center for the FLEX Program
For more information, contact Brandon Rivenbark at brandon.rivenbark@vdh.virginia.gov.