Medicare Rural Hospital Flexibility Program (FLEX)

The Arkansas Medicare Rural Hospital Flexibility (FLEX) Program is a federal initiative designed to strengthen and sustain rural healthcare by supporting Critical Access Hospitals (CAHs). The Flex Program provides funding to help CAHs:

Improve the quality of care for patients
Enhance financial and operational performance
Integrate emergency medical services (EMS)
Supports rural hospitals in obtaining and maintaining their CAH designation

Sustaining a CAH designation enables these hospitals to receive cost-based reimbursement from Medicare, thereby ensuring their financial viability. Additionally, the Flex Program promotes population health strategies and encourages hospitals to participate in quality reporting and improvement initiatives, ultimately aiming to improve access to high-quality healthcare in rural communities.

To meet state requirements for CAH designation, a hospital must:

Meet all Federal requirements
Submit an Application for Final Designation and other documents
Submit a completed community needs assessment
Submit a local health services delivery plan
Submit a financial feasibility study with cost projections for at least three years.

Critical Access Hospitals

In 1997, Congress, through the Balanced Budget Act, authorized the creation of what is known as the Medicare Rural Hospital Flexibility (FLEX) Program.

This program has led to the creation of what is being called the Critical Access Hospital (CAH). By establishing limited-service hospitals and rural health networks, these acute care facilities can provide outpatient, emergency, and limited inpatient services. The Department of Health has developed a Critical Access Hospital plan in consultation with the Arkansas Hospital Association. The plan was approved and funded by the Health Care Financing Administration, now known as the Centers for Medicare and Medicaid Services (CMS).

The plan requires each Critical Access Hospital:

To have 25 inpatient beds or less.
To meet specific staffing requirements and to enter into a patient referral and transfer agreement with a larger, more viable acute care hospital (referred to as an Affiliate Hospital).
To enter into a transport agreement for emergency and non-emergency transportation with the area Emergency Medical Service.
To participate in the development and implementation of a communication system with its network of hospitals.
To ensure the quality of its services (quality assurance and credentialing will be performed by the Affiliate Hospital with which the CAH has contracted).

Technical Assistance for Rural and Critical Access Hospitals

Technical Assistance and Services Center (TASC)
TASC improves the quality and financial viability of health care organizations in rural communities through its support to state Flex Programs, CAHs, rural EMS, and other rural providers.

Rural Quality Improvement Technical Assistance (RQITA)
The Rural Quality Improvement Technical Assistance (RQITA) Resource Center was created to help rural healthcare organizations overcome challenges and improve healthcare and quality of care using data, measurement, and improvement activities. Through RQITA support, Telligen aims to assist small rural and critical access hospitals in improving health outcomes in rural communities across the United States. RQITA Resource Center staff provide technical assistance for rural healthcare organizations to expand capacity in quality improvement and ensure success in future models based on high-quality, high-value patient care.

Medicare Beneficiary Quality Improvement Project (MBQIP)
Here you will find submission deadlines, implementation timelines for State Flex Programs, a comprehensive Core Measure Set guide, FAQs on new measures, and more helpful resources.