State Rural Hospital Flexibility Program

The Medicare Rural Hospital Flexibility Grant Program provides funding to state governments to spur quality and performance improvement activities; stabilize rural hospital finance; and encouraging health system development through the engagement of the rural community with critical access hospitals (CAHs) and other care providers, and integrating rural Emergency Medical Services (EMS) into the health care system while assuring the quality of services provided.

The Medicare Rural Hospital Flexibility Program Evaluation Cooperative Agreement and Information Services to Rural Hospital Flexibility Program Grantees provide technical assistance, support, monitoring and evaluation to the State Rural Hospital Flexibility Program grantees and Critical Access Hospitals.

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
Active
Program Number
93.241
Federal Agency
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.
Authorization
Continuing Appropriations Act, 2011 (P.L. 111-242); Title XVIII, Section 1820 (g)(6) of the Social Security Act (42 U.S.C. 1395i-4), as amended by Sec. 4201 (a) of P.L. 105-33; and Sec. 121 of the Medicare Improvement for Patients and Providers Act of 2008, P.L. 110-275.
Eligibility Requirements
Applicant Eligibility
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.

Medicare Rural Hospital Flexibility Program Evaluation Cooperative Agreement: Eligible applicants include public and private nonprofit entities. Faith-based and community organizations are eligible to apply for this cooperative agreement. Federally Recognized Indian Tribal Government and Native American Organizations are eligible to apply.
Applicants must have experience in analyzing rural health issues as defined by the following: key staff for the project must have authored or co-authored at least two articles about rural health published in peer-reviewed scientific journal(s) (such as Journal of Rural Health, American Journal of Public Health, Journal of Aging and Health). Applicants must also have experience with and access to a variety of key data sets used for analysis of rural hospital data. Applicants that fail to show such experience will not be considered.

Information Services to Rural Hospital Flexibility Program: Any public or private entity is eligible to apply for this Federal funding opportunity. Applicant organizations that are Federally-recognized Native American Tribes or Tribal organizations are eligible to apply. Faith-based and community-based organizations are eligible to apply for this cooperative agreement.
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 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. 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 Award.
Deadlines
Contact the headquarters or regional office, as appropriate, for application deadlines.
Range of Approval/Disapproval Time
6 months.
Appeals
Not Applicable.
Renewals
The Medicare Rural Hospital Flexibility Grant 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 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.

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.
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: 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
Reports
A performance progress report is submitted with each noncompeting continuation application. An electronic quarterly Federal Financial Report (FFR) is due to the Division of Payment Management within 30 days of the end of each quarter. A final FFR must be submitted to HRSA via the Electronic HandBooks (EHB) within 90 days of the end of each budget period. 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.
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 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.
Program Accomplishments
Not Applicable.
Financial Information
Account Identification
75-0350-0-1-550.
Obligations
(Project Grants) FY 12 $957,999; FY 13 est $900,000; and FY 14 est $960,000 - These figures are for the Rural Veterans Health Access Program. (Project Grants) FY 12 $22,911,332; FY 13 est $22,184,439; and FY 14 est $22,911,332 - These figures are for the Medicare Rural Hospital Flexibility Grant Program . (Project Grants) FY 12 $1,025,000; FY 13 est $957,407; and FY 14 est $957,407 - These figures are for the Information Services to Rural Hospital Flexibility Program Grantees. (Project Grants) FY 12 $1,000,000; FY 13 est $1,000,000; and FY 14 est $1,000,000 - These figures are for the Medicare Rural Hospital Flexibility Program Evaluation Cooperative Agreement.
Range and Average of Financial Assistance
The Medicare Rural Hospital Flexibility Grant Program
$287,000 to $700,000; $492,987.

Medicare Rural Hospital Flexibility Program Evaluation Cooperative Agreement: $1,000,000

Information Services to Rural Hospital Flexibility Program Grantees: $957,407

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.
Information Contacts
Regional or Local Office
See Regional Agency Offices. The Medicare Rural Hospital Flexibility Program Grant Contact: David Dietz, Office of Rural Health Policy, Health Resources and Services Administration, 5600 Fishers Lane, Room 5A-05, Rockville, MD 20857. Telephone: (301) 443-4081.

Medicare Rural Hospital Flexibility Program Evaluation Cooperative Agreement- Program Contact: Megan Meacham, Office of Rural Health Policy, Health Resources and Services Administration, 5600 Fishers Lane, Room 5A-05, Rockville, MD 20857. Telephone: (301) 443-8349.

Information Services to Rural Hospital Flexibility Program Grantees- Program Contact: Michael McNeely, Office of Rural Health Policy, Health Resources and Services Administration, 5600 Fishers Lane, Room 5A-05, Rockville, MD 20857. Telephone: (301) 443-5812.

Rural Veterans Health Access Program – Program Contact: Larry Bryant, Office of Rural Health Policy, Health Resources and Services Administration, 5600 Fishers Lane, Room 5A-05, Rockville, MD 20857. Telephone: (301) 443-0261.
Headquarters Office
Office of Rural Health Policy, 5600 Fishers Lane, Room 5A-05, Rockville, Maryland 20857 Phone: (301) 443-0835.
Website Address
www.hrsa.gov
Examples of Funded Projects
Not Applicable.
Criteria for Selecting Proposals
Contact Headquarters for selection criteria.
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