State Rural Hospital Flexibility Program (93.241)
Program
93.241 State Rural Hospital Flexibility Program
Federal Agency
Agency: Department of Health and Human Services
Office: Health Resources and Services Administration
Authorization
Balanced Budget Act of 1997, Section 4201, Public Law 105-33. Reauthorized in 2008 in Public Law 110-275.
Program Number
93.241
Last Known Status
Active
Objectives
The State Rural Hospital Flexibility Program helps States work with rural communities and hospitals to develop and implement a rural health plan, designate critical access hospitals (CAHs), develop integrated networks of care, improve emergency medical services, provide support for quality improvement, quality reporting, performance improvements and benchmarking, and improve service and organizational performance,.
The Medicare Rural Hospital Flexibility Program Evaluation Cooperative Agreement and Information Services to Rural Hospital Flexibility Program Grantees provide technical assistance, support, and evaluation to the State Rural Hospital Flexibility Program grantees and Critical Access Hospitals.
The Delta Health Initiative (DHI) Cooperative Agreement Program addresses longstanding unmet rural health needs (access to health care, health education, research, job training, and capital improvements) of the Delta Region in the State of Mississippi.
Types of Assistance
PROJECT GRANTS
Uses and Use Restrictions
All funds awarded are to be expended solely for the purposes outlined in the approved projects.
Eligibility Requirements
Applicant Eligibility
States that have submitted a State Rural Health Plan to the Centers for Medicare and Medicaid Services (CMS) can apply. 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.
Beneficiary Eligibility
States with at least one hospital located in a non-metropolitan statistical area or county and provides CMS with necessary assurances.
Credentials/Documentation
Applicants should review the individual HRSA Guidance documents 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. OMB Circular No. A-87 applies to this program.
Application and Award Process
Preapplication Coordination
Preapplication coordination is required. Environmental impact information is not required for this program. This program is excluded from coverage under E.O. 12372.
Application Procedure
OMB Circular No. A-102 applies to this program. OMB Circular No. A-110 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.
Award Procedure
Notification is made in writing by a Notice of Grant Award.
Deadlines
Contact the headquarters or regional office, as appropriate, for application deadlines.
Range of Approval/Disapproval Time
From 3 to 5 months.
Appeals
Not Applicable.
Renewals
The State Rural Hospital Flexibility Program awards may be made for up to 5-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.
Medicare Rural Hospital Flexibility Program Evaluation Cooperative Agreement awards may be made for up to 5-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.
Information Services to Rural Hospital Flexibility Program Grantees- 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.
Delta Health Initiative Cooperative Agreement 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.
Assistance Considerations
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: Grantees drawdown funds, as necessary, from the Payment Management System (PMS). PMS is the centralized web based payment system for HHS awards.
Post Assistance Requirements
Reports
A performance progress report is submitted with each noncompeting continuation application. A financial status report is to be submitted within 90 days after the close of the budget period. An annual data report is due within 30 days of the end of the budget period. A final program report is to be submitted within 90 days after the close of the project period. In addition, grantees are required to participate in a national program evaluation. No cash reports are required. FSR. No expenditure reports are required. No performance monitoring is required.
Audits
In accordance with the provisions of OMB Circular No. A-133 (Revised, June 27, 2003), "Audits of States, Local Governments, and Non-Profit Organizations," nonfederal entities that expend financial assistance of $500,000 or more in Federal awards will have a single or a program-specific audit conducted for that year. Nonfederal entities that expend less than $500,000 a year in Federal awards are exempt from Federal audit requirements for that year, except as noted in Circular No. A-133.
Records
Grantees are required to maintain grant accounting records for 3 years after the date they submit the FSR. 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.
Program Accomplishments
Fiscal Year 2008: The State Rural Hospital Flexibility Program- In FY 08, 45 continuation awards were made to States. Fiscal Year 2009: The State Rural Hospital Flexibility Program- It is estimated that 45 awards will be made in FY 09 and FY 10.
Medicare Rural Hospital Flexibility Program Evaluation Cooperative Agreement- It is estimated that 1 award will be made in FY 09 and FY 10.
Information Services to Rural Hospital Flexibility Program Grantees- It is estimated that 1 award will be made in FY 09 and FY 10.
Delta Health Initiative Cooperative Agreement Program- It is estimated that 1 award will be made in FY 09 and FY 10. Fiscal Year 2010: No Current Data Available
Financial Information
Account Identification
75-0350-0-1-550.
Obligations
(Project Grants) FY 08 $500,000; FY 09 est $500,000; FY 10 est $500,000 - These figures are for the Information Services to Rural Hospital Flexibility Program Grantees. (Project Grants) FY 08 $24,000,000; FY 09 est $24,000,000; FY 10 est $24,000,000 - These figures are for the Delta Health Initiative Cooperative Agreement Program. (Project Grants) FY 08 $21,600,000; FY 09 est $22,000,000; FY 10 est $22,000,000 - These figures are for the The State Rural Hospital Flexibility Program . (Project Grants) FY 08 $1,000,000; FY 09 est $1,000,000; FY 10 est $1,000,000 - These figures are for the Medicare Rural Hospital Flexibility Program Evaluation Cooperative Agreement.
Range and Average of Financial Assistance
The State Rural Hospital Flexibility Program- $260,000 to $650,000; $490,000.
Medicare Rural Hospital Flexibility Program Evaluation Cooperative Agreement-$1,000,000
Information Services to Rural Hospital Flexibility Program Grantees- $500,000
Delta Health Initiative Cooperative Agreement Program- $24,000,000.
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.
Related Programs
Not Applicable.
Information Contacts
Regional or Local Office
See Regional Agency Offices. The State Rural Hospital Flexibility Program Contact: Steve Hirsch, Office of Rural Health Policy, Health Resources and Services Administration, 5600 Fishers Lane, Room 9A-55, Rockville, MD 20857. Telephone: (301) 443-0835.
Medicare Rural Hospital Flexibility Program Evaluation Cooperative Agreement- Program Contact: Nancy Egbert, Office of Rural Health Policy, Health Resources and Services Administration, 5600 Fishers Lane, Room 9A-55, Rockville, MD 20857. Telephone: (301) 443-0835.
Information Services to Rural Hospital Flexibility Program Grantees- Program Contact: Steve Hirsch, Office of Rural Health Policy, Health Resources and Services Administration, 5600 Fishers Lane, Room 9A-55, Rockville, MD 20857. Telephone: (301) 443-0835.
Delta Health Initiative Cooperative Agreement Program- Program Contact: Bridget Ware, Office of Rural Health Policy, Health Resources and Services Administration, 5600 Fishers Lane, Room 9A-55, Rockville, MD 20857. Telephone: (301) 443-0835.
Headquarters Office
Office of Rural Health Policy 5600 Fishers Lane, Room 9-A55, Rockville, Maryland 20857 Phone: (301) 443-0835
Web Site Address
Examples of Funded Projects
Fiscal Year 2008: States have increasingly used their Flex resources for EMS activities, including training programs, needs assessments, quality improvement activities and network building. Fiscal Year 2009: No Current Data Available Fiscal Year 2010: No Current Data Available
Criteria for Selecting Proposals
Contact Headquarters for selection criteria.
