The Technical Assistance and Services Center (TASC) provides technical assistance for the Rural Hospital Medicare Flexibility (Flex) Program in the form of information, tools and resources. This website contains multiple resources regarding the topic areas listed below as well as many others.

The Balanced Budget Act of 1997 created the Medicare Rural Hospital Flexibility Program, a nationwide initiative that established the Critical Access Hospital (CAH) as a new category of hospital eligible for cost based Medicare reimbursement.

TASC is funded by the Health Resources and Service Administration's Office of Rural Health Policy and administered by the Rural Health Resource Center, a private, non-profit organization.

National Conference of State Flex Programs 2008 Materials Now Available

Presentations from the National Conference of State Flex Programs are now available. You may download them at the National Conference of State Flex Programs 2008 Archive.

What's New

Policy Brief: The Capital Investment Needs of Critical Access Hospitals (CAHs): Results of the 2007 National CAH Survey
From the Flex Monitoring Team: "Survey findings suggest that access to capital has improved since 2004. Although the increase in successful loans for facility replacement may reflect the larger trend occurring in the hospital sector, CAH replacements are occurring for hospitals that previously could not meet investment-grade benchmarks."

Swing Bed Fact Sheet
The Swing Bed Fact Sheet (revised April 2009), which provides information about the requirements hospitals and Critical Access Hospitals must meet in order to enter into a swing bed agreement under which they can use beds, as needed, to provide either acute or Skilled Nursing Facility care, is available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network.

The Capital Investment Needs of CAHs: Fire and Life Safety Code Compliance and Organizational Performance
In Spring 2007, the Flex Monitoring Team conducted a national telephone survey of 381 CAH Administrators in all of the 45 Flex Program states. Survey questions focused on community benefit, quality improvement, and access to capital. Questions focusing on access to capital ascertained information on critical fire and life safety code deficiencies in need of correction, total capital needs for correcting all existing fire and life safety deficiencies, immediate capital needs considered essential for efficient and effective operation and experiences acquiring capital to meet identified needs. This Briefing Paper reports on the capital investments needs findings of this survey.

Conditions of Participation (COPs) for Distinct Part Units (DPUs)
Conditions of Participation for DPUs have been added at 42 CFR §485.647 to implement the addition of DPUs to CAHs. (Final Rule for Changes to the Hospital PPS (IPPS-FR) published in the Federal Register/ Vol. 69, No. 154/ Wednesday, August 11, 2004/ Rules and Regulations, page 49272). There are two CoPs for CAH DPUs at §485.647. One CoP applies to a Psychiatric DPU and one applies to a Rehabilitation DPU. Surveyors will select the appropriate CoP for the type of unit being surveyed.

Sample Letter of Support for CAH Conversion
This is a sample letter that would come from a State office to a hospital indicating their support of the hospital converting to a CAH that could be used in the CAH conversion application. This sample comes from Pat Schou with the Illinois Critical Access Hospital Network.

Electronic Health Records Adoption: Rural Providers' Decision-Making Process (Policy Brief)
From the Rural Health Research and Policy Center "This brief reports findings of a study that examined the decision-making process that small rural physician clinics and hospitals use as they investigate and select an electronic health record (EHR) system. Policy makers can use the study findings to understand the challenges that rural health care providers may face in the process of adopting EHRs and to develop incentives that promote the use of health information technology in rural America."

Experiences of Critical Access Hospitals in the Provision of Emergency Medical Services (Policy Brief)
From the Rural Health Research and Policy Centers: This brief presents NORC Walsh Center for Rural Health Analysis research conducted to better understand the experiences of CAHs in operating an EMS unit. Using key informant interviews, researchers examined motivations for acquiring EMS services and the effect of these services on the level of emergency care available in the community. The benefits and challenges that CAH providers face in operating EMS services are discussed.

Critical Access Hospital Year 3 Hospital Compare Participation and Quality Measure Results
From the Flex Monitoring Team. This report examines the third year participation and quality measure results for Critical Access Hospitals (CAHs) in the Centers for Medicare and Medicaid Services (CMS) Hospital Compare public reporting database for hospital quality measures.

Office of Rural Health Policy Announces Rural Health Research Centers for 2008-2012 (Rural Health Research Gateway)
The Office of Rural Health Policy has announced the funding of six Rural Health Research Centers for 2008-2012. They are:

  • Maine Rural Health Research Center,
  • North Carolina Rural Health Research & Policy Analysis Center,
  • South Carolina Rural Health Research Center,
  • Upper Midwest Rural Health Research Center,
  • West Virginia Rural Health Research Center, and
  • WWAMI Rural Health Research Center.

Impact of CAH Conversion on Hospital Finances and Mix of Inpatient Services (Final Report)
Rural Health Research and Policy Centers: This study examined Medicare Cost Report and claims data for hospitals before and after CAH conversion in order to better understand changes in hospital costs associated with CAH conversion, factors associated with any cost growth, and changes in the mix of services provided by the facility.

Screening, Brief Intervention and Referral to Treatment (SBIRT)
The Substance Abuse and Mental Health Services Administration (SAMHSA): The SBIRT Initiative represents a paradigm shift in the provision of treatment for substance use and abuse. The services are different from, but designed to work in concert with, specialized or traditional treatment.

Critical Access Hospital Fact Sheet
The fact sheet provides information about eligible Critical Access Hospital (CAH) providers; CAH designation; CAH payments; reasonable cost payment principles that do not apply to CAHs; election of Standard Method or Optional (Elective) Payment Method; Medicare Rural Pass-Through funding for certain anesthesia services; Health Professional Shortage Area Incentive payments; Physician Scarcity Area Bonus payments; Medicare Prescription Drug, Improvement, and Modernization Act of 2003; and grants to states under the Medicare Rural Hospital Flexibility Program.

Sole Community Hospital Fact Sheet
The fact sheet provides information about Sole Community Hospital classification and payments.

Federally Qualified Health Center Fact Sheet
The fact sheet provides information about Federally Qualified Health Center (FQHC) designation; covered FQHC services; FQHC preventive primary services that are not covered; FQHC payments; and the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.

Rural Health Clinic fact sheet from 2008
The fact sheet providers information about Rural Health Clinic (RHC) designation; covered RHC services; RHC payments; and the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.

EMS Workforce for the 21st Century: A National Assessment
The assessment describes the national EMS workforce, while also elucidating the absence of consistent, nation-wide EMS workforce data. Currently, the assessment is being used to guide development of the EMS Workforce Agenda for the Future, a document that will establish a vision for the future of the nation's EMS workforce. Information on this ongoing project is available at www.emsworkforce.com.

For additional information, contact us at tasc@ruralcenter.org or call 218-727-9390.