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.

Save the Date! Annual Flex Conference

July 1-2, 2008
Kansas City, MO
For more information please contact Melissa Grindahl at: 218.727.9390 ext 227 or mgrindahl@ruralcenter.org

Please register online for the meeting by clicking on the below link or copying into your browser: http://www.regonline.com/State_Flex.

If you have any questions regarding the meeting, please contact DeCarlos Bradley at (301) 459-3777, ext. 125 or via e-mail at dbradley@qualitysupport.com If you are having problems registering, please contact Kimberly Plummer at kplummer@qualitysupport.com.

What's New

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 2007
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.

Cascading the Balanced Scorecard - How to get the most involvement and effectiveness from all employees
Presented by Tami Lichtenberg
View this 55-minute presentation from the Oregon Flex WebEx Learning Series. Link is to Oregon Office of Rural Health website. Look for the March 4, 2008 heading under "Past Sessions" on the right side for the link to the video.

How to Link the Studer Pillars to Your Scorecard
Presented by Tami Lichtenberg
View this 40-minute presentation from the Oregon Flex WebEx Learning Series. Link is to Oregon Office of Rural Health website. Look for the April 1, 2008 heading under "Past Sessions" on the right side for the link to the video.

Linking Measurement to Strategy - Going Back to Go Forward
Presented by Tami Lichtenberg
View this 55-minute presentation from the Oregon Flex WebEx Learning Series. Link is to Oregon Office of Rural Health website. Look for the January 8, 2008 heading under "Past Sessions" on the right side for the link to the video.

The Community Benefit and Impact of Critical Access Hospitals: The Results of the 2007 CAH Survey (March 2008)
In 2007, the Flex Monitoring Team conducted a national telephone survey of 381 critical access hospital administrators covering a wide variety of questions concerning hospitals' community benefit and impact activities. This Briefing Paper reports on the community benefit and impact findings of this survey.

The Flex Program at 10 Years: Community Impact Lessons and Future Directions
Presented by Andrew Coburn, PhD, and John Gale, MS, at the NRHA Annual Conference, New Orleans, LA (May 2008)

The Flex Program at 10 Years: The Financial Experience of Small Rural Hospitals.
Presented by George Pink, PhD, and Rebecca Slifkin, PhD, at the NRHA Annual Conference, New Orleans, LA (May 2008)

The Flex Program at 10 Years: Quality Improvement and Measurement Lessons Learned and Future Directions
Presented by Ira Moscovice, PhD, at the NRHA Annual Conference, New Orleans, LA (May 2008)

Critical Access Hospitals' Experiences with Medicare Advantage Plans
Organization: NORC Walsh Center for Rural Health Analysis and RUPRI Center for Rural Health Policy Analysis
This report details findings from a survey of 60 critical access hospital (CAH) administrators regarding their experiences with Medicare Advantage (MA) plans. Findings from this research identify concerns of CAH administrators that, as the MA program evolves, may be addressed through technical assistance and changes in regulation or legislation.

Critical Access Hospital Quality Improvement Activities and Reporting on Quality Measures: Results of the 2007 National CAH Survey (March 2008)
Organization: Flex Monitoring Team
This report describes current CAH quality improvement initiatives and participation in quality reporting and benchmarking initiatives.

CAH Financial Performance Indicators
Organization: Flex Monitoring Team
As part of ongoing work of the Flex Monitoring Team, twenty financial indicators were specifically designed to capture the financial performance of CAHs. The creation of these indicators are based on three criteria: feasibility (whether the indicator can be accurately calculated from Medicare cost report data), importance (whether the indicator is an important measure of the financial management of CAHs), and usefulness (whether the indicator is useful to CAH administrators).

Differences in Measurement of Operating Margin: Flex Monitoring Team Briefing Paper
This briefing paper considers how differences in measurement of operating margin can affect the reported values.

Flex Grant Guidance has been Released!
Application Due Date in Grants.gov: April 17, 2008
Supplemental Information Due Date in EHBs: May 1, 2008

Medicaid Treatment of CAHs by State
This excel spreadsheet contains information about Medicaid treatment for critical access hospitals on a state by state basis.

Revision to Appendix W, "Survey Protocol, Regulations and Interpretive Guidelines for Critical Access Hospitals (CAHs)"
SUMMARY OF CHANGES: Appendix W, Tag C-0211, is revised and updated to include information released in S&C-08-XX, "Provision of Observation Services in Critical Access Hospitals (CAHs)." The revision provides CAHs the ability to utilize beds for observation services that will not count against the statutory CAH maximum of 25 inpatient beds.

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