State Rural Hospital Flexibility Program
The purpose of Flex is engaging state designated entities in activities relating to planning and implementing rural health care plans and networks; designating facilities as Critical Access Hospitals (CAHs); providing support for CAHs for quality improvement, quality reporting, performance improvements, and benchmarking; and integrating rural emergency medical services (EMS). Specifically, the Flex program provides funding for states to support technical assistance activities in hospitals to improve the quality of health care provided by CAHs; improve the financial and operational outcomes of CAHs; improve the Community Health and Emergency Medical Service (EMS) Needs of CAHs; enhance the health of rural communities through community/population health improvement; improve identification and management of Time Critical Diagnoses (TCD) and engage EMS capacity and performance in Rural Communities; assist in the conversion of qualified small rural hospitals to CAH status; and support the financial and operational transition to value based models and health care transformation models in the health care system. State designated Flex Programs will act as a resource and focal point for these activities, ensuring residents in rural communities have access to high quality health care services.
The Rural Veterans Health Access Program provides funding to states to develop and strengthen networks that will enhance access and quality of mental health service and other healthcare services, with an emphasis on utilizing telehealth and health information technology, including electronic health records, to help improve care coordination for Veterans who are seen by both the Veterans Administration (VA) and private providers. The program targets states with high percentages of veterans to the total population.
Last Known Status
Agency: Department of Health and Human Services
Office: Health Resources and Services Administration
Types of Assistance
Formula Grants (Cooperative Agreements); PROJECT GRANTS
Uses and Use Restrictions
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.
Title XVIII, §1820(g)(1) and (2) of the Social Security Act (42 U.S.C. 1395i-4), as amended; Consolidated and Further Continuing Appropriations Act, 2015 (P.L. 113-235).
Flex and Rural Veterans Grants: Only States with certified Critical Access Hospitals are eligible for this Grant 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 grant funds.
States with at least one hospital located in a non-metropolitan statistical area or county and provides CMS with necessary assurances.
Applicants should review the individual HRSA funding opportunity announcement issued under this CFDA program for any required proof or certifications which must be submitted prior to or simultaneous with submission of an application package. 2 CFR 200, Subpart E - Cost Principles applies to this program.
Application and Award Process
Preapplication coordination is required. Environmental impact information is not required for this program. This program is excluded from coverage under E.O. 12372.
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.
Notification is made in writing by a Notice of Award.
Contact the headquarters or regional office, as appropriate, for application deadlines.
Range of Approval/Disapproval Time
The Medicare Rural Hospital Flexibility Grant Program awards may be made for up to 3-year project periods. 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 awardee’s satisfactory performance.
The Rural Veterans Health Access Program – awards may be made for up to 3-year project periods. 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 awardee’s satisfactory performance.
Formula and Matching Requirements
This program has no statutory formula.
This program has no matching requirements.
This program does not have MOE requirements.
Length and Time Phasing of Assistance
Awards are made annually. Funds are available to grantees on an as needed basis throughout the budget period and payments are made through the DHHS Payment Management System. See the following for information on how assistance is awarded/released: Grantee drawdown funds, as necessary, from the Payment Management System (PMS). PMS is the centralized web based payment system for HHS awards.
Post Assistance Requirements
The awardee will be required to submit performance and progress reports as well as status-federal financial reports (see the program announcement and notice of award for details for each required report). The awardee must submit a quarterly electronic Federal Financial Report (FFR) Cash Transaction Report via the Payment Management System within 30 days of the end of each calendar quarter. A Federal Financial Report (SF-425) according to the following schedule: http://www.hrsa.gov/grants/manage/technicalassistance/federalfinancialreport/ffrschedule.pdf. A final report is due within 90 days after the project period ends. If applicable, the awardee must submit a Tangible Personal Property Report (SF-428) and any related forms within 90 days after the project period ends. New awards (“Type 1”) issued under this funding opportunity announcement are subject to the reporting requirements of the Federal Funding Accountability and Transparency Act (FFATA) of 2006 (Pub. L. 109–282), as amended by section 6202 of Public Law 110–252, and implemented by 2 CFR Part 170. Grant and cooperative agreement recipients must report information for each first-tier subaward of $25,000 or more in federal funds and executive total compensation for the recipient’s and subrecipient’s five most highly compensated executives as outlined in Appendix A to 2 CFR Part 170 (FFATA details are available online at http://www.hrsa.gov/grants/ffata.html). Competing continuation awardees, etc. may be subject to this requirement and will be so notified in the Notice of Award. For the Rural Veterans Health Access Program and the Medicare Rural Hospital Flexibility Grant Program, an annual data report is due within 60 days of the end of the budget period. For the Medicare Rural Hospital Flexibility Program Evaluation Cooperative Agreement a report is due annually on March 31. A final program report is to be submitted within 90 days after the close of the project period. Grantees in the Medicare Rural Hospital Flexibility Grant Program are required to participate in activities related to the Flex Program Evaluation Cooperative Agreement. No cash reports are required. Refer to funding opportunity announcement. No expenditure reports are required. No performance monitoring is required.
In accordance with the provisions of 2 CFR 200, Subpart F - Audit Requirements, non-Federal 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.
Grantees 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.
Fiscal Year 2014: Rural Veterans Health Access Program: Awardees have established a statewide health information exchange program, established partnerships between Veterans Administration and community-based health care delivery sites, and begun providing health care services through telehealth to veterans living in rural areas. Fiscal Year 2015: No Current Data Available Fiscal Year 2016: No Current Data Available
(Project Grants) FY 14 $22,911,332; FY 15 est $22,911,332; and FY 16 est $22,911,332 - Medicare Rural Hospital Flexibility Grant Program . (Project Grants) FY 14 $900,000; FY 15 est $900,000; and FY 16 est $900,000 - Rural Veterans Health Access Program. (Project Grants) FY 14 $900,000; FY 15 est $900,000; and FY 16 est $900,000 - Rural Veterans Health Access Program.
Range and Average of Financial Assistance
The Medicare Rural Hospital Flexibility Grant Program
$287,000 to $700,000; $492,987
Rural Veterans Health Access Program: $300,000.
Regulations, Guidelines and Literature
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 http://www.hrsa.gov/grants.
Regional or Local Office
See Regional Agency Offices. The Medicare Rural Hospital Flexibility Program Grant Contact Kevin Chaney, Federal Office of Rural Health Policy, Health Resources and Services Administration, 5600 Fishers Lane, Room 17W45C, Rockville, MD 20857. Telephone: (301) 945-0851.
Rural Veterans Health Access Program – Program Contact: Anthony Oliver, Federal Office of Rural Health Policy, Health Resources and Services Administration, 5600 Fishers Lane, Room 17W49C, Rockville, MD 20857. Telephone: (301) 443-2919.
Federal Office of Rural Health Policy, 5600 Fishers Lane, Room 17W45C, Rockville, Maryland 20857 Phone: (301) 443-0835.
Examples of Funded Projects
Criteria for Selecting Proposals
Contact Headquarters for selection criteria.