State Rural Hospital Flexibility Program
The Rural Hospital Flexibility Program (Flex) enables state designated entities to support critical access hospitals in quality improvement, quality reporting, performance improvement, and benchmarking; to assist facilities seeking designation as critical access hospitals; and to create a program to establish or expand the provision of rural emergency medical services. Flex Program objectives include quality, operational, financial, and population health improvement with the goal of supporting access to necessary health care services in rural communities. State Flex programs will act as resources and focal points for these activities within their respective states. The Rural Veterans Health Access Program provides funding to states to coordinate activities to provide rural veterans access to services for needed mental health care via the use of networks, electronic communication and telehealth networks. The program targets states with high percentages of veterans to the total population.
General information about this opportunity
Last Known Status
Health Resources and Services Administration, Department of Health and Human Services
Type(s) of Assistance Offered
B - Project Grants
The Rural Veterans Health Access Program-Title XVIII, § 1820 (g) (6) of the Social Security Act (42 U.S.C. 1395i-4(g) (6)), as amended The Rural Hospital Flexibility Program (Flex)-Title XVIII, §1820(g) (1) and (2) of the Social Security Act (42 U.S.C. 1395i-4), as amended
Who is eligible to apply/benefit from this assistance?
Flex and Rural Veterans Recipients: Only states with certified Critical Access Hospitals are eligible for this 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 funds.
States with at least one hospital located in a non-metropolitan statistical area or county that provide CMS with necessary assurances.
Applicants should review the individual HRSA notice of funding opportunity issued under this assistance listing 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.
What is the process for applying and being award this assistance?
Preapplication coordination is not applicable.
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.
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.
Contact the headquarters or regional location, as appropriate for application deadlines
Approval/Disapproval Decision Time
Up to six months.
Flex awards may be made for up to 5-year periods of performance. 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 recipient's satisfactory performance. The Rural Veterans Health Access Program awards on made for up to 3-year period of performance.
How are proposals selected?
Contact Headquarters for selection criteria.
How may assistance be used?
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.
What are the requirements after being awarded this opportunity?
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.
Recipients 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.
Other Assistance Considerations
Formula and Matching Requirements
Statutory formula is not applicable to this assistance listing.
Matching requirements are not applicable to this assistance listing.
MOE requirements are not applicable to this assistance listing.
Length and Time Phasing of Assistance
Awards are made annually. Funds are available to recipients 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: Recipient drawdown funds, as necessary, from the Payment Management System (PMS). PMS is the centralized web based payment system for HHS awards. See the following for information on how assistance is awarded/released: Awardee drawdown funds, as necessary, from the Payment Management System (PMS). PMS is the centralized web based payment system for HHS awards.
Who do I contact about this opportunity?
Regional or Local Office
Federal Office of Rural Health Policy, 5600 Fishers Lane, Room 17W59D, Rockville, Maryland 20857 Phone:(301) 443-0835
Rural Hospital Flexibility Program (Flex)
5600 Fishers Lane,
Rockville, MD 20857 US
Owmy Boulute Program Coordinator
5600 Fishers Lane
Rockville, MD 29857 USA
(Cooperative Agreements) FY 18$28,047,420.00; FY 19 est $28,659,826.00; FY 20 Estimate Not Available FY 17$23,659,822.00; FY 16$23,659,822.00; - Medicare Rural Hospital Flexibility Grant Program.(Cooperative Agreements) FY 18$900,000.00; FY 19 est $900,000.00; FY 20 Estimate Not Available FY 17$900,000.00; FY 16$900,000.00; - Rural Veterans Health Access Program
Range and Average of Financial Assistance
Medicare Rural Hospital Flexibility Program $316,735 to $968,815; Average, $592,440 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 https://www.hrsa.gov/grants/hhsgrantspolicy.pdf.
Examples of Funded Projects