The Flex Program

“The Flex Program” refers to the Medicare Rural Hospital Flexibility Program, which was created by Congress in 1997.  It allows small hospitals to be certified as Critical Access Hospitals (CAHs) and offers grants to States to help implement initiatives to strengthen the rural health care infrastructure.  The grant program is administered by the Health Resources Service Administration’s Federal Office of Rural Health Policy. HRSA is a division of the U.S. Department of Health and Human Services.

What’s the difference between a hospital and a Critical Access Hospital? 

CAHs are reimbursed by Medicare for the reasonable costs of providing services.  This reimbursement is designed to ensure that rural populations are able to access essential health care services. CAHs are required to:

  • be located in a rural area (or an area treated as rural);
  • be more than 35 miles from another hospital (or 15 miles in areas with mountainous terrain or only secondary roads available) or be certified before January 1, 2006 by the State as being a necessary provider of health care services;
  • provide 24-hour emergency care services that a State determines are necessary;
  • have a maximum of 25 acute care and swing beds; and  
  • maintain an annual average length of stay of 96 hours or less for their acute care patients.

Who can participate in the Flex Grant Program?

Participating states (currently 45 of 50) are required to develop a rural health care plan that:

  • provides for the creation of one or more rural health networks;
  • promotes regionalization of rural health services in the state; and
  • improves the quality and accessibility of hospital and other health services for rural residents of the state.

Where can I learn more about the Flex Program and CAHs?