Flex Program Funding Guidance

For the current funding cycle of the Medicare Rural Hospital Flexibility (Flex) Program, which runs from fiscal years (FYs) 2019-2023, the primary components of the Flex Program include activities in the following areas:

  • Critical Access Hospital (CAH) Quality Improvement (MBQIP) (required)
  • CAH Operational and Financial Improvement (required)
  • CAH Population Health Improvement (optional)
  • Rural Emergency Medical Services (EMS) Improvement (optional)
  • Innovative Model Development (optional). This Program Area remains through FY 2023 Flex Program funding but has been removed for the  FY 2024-2028 funding cycle as innovation can be worked into every Program Area.
  • CAH Designation (required if requested)

    The Flex Program continues to encourage the identification of areas for improvement with defined targets and measurable outcomes. A minimum standard of reporting on outcomes is requested for all state Flex Programs. Information on the state Flex Program assessment can be found in the Flex Performance Management/Program Evaluation Guide.

    Each state interested in acquiring federal Flex Program funding must submit an annual funding application to the Health Resources and Services Administration’s Federal Office of Rural Health Policy via the Electronic Handbooks (EHBs). The approximate timeline for non-competing continuation (NCC) applications and awards is:

    • March: FORHP sends application guidance to states
    • May: Application submission deadline to EHBs
    • August: Notice of Award announcements
    • September 1: Federal budget year begins

    This schedule is subject to change, particularly in competing continuation years when program guidance may be released earlier. Please contact TASC for the current schedule.

    Quickly Access Cooperative Agreement Materials by Year

    FYs 2024 - 2028 Funding Cycle (Upcoming)

    FYs 2019 - 2023 Funding Cycle (Current)

    FYs 2024-2028 (funding cycle beginning September 1, 2024)

    Flex FY 2024 Notice of Funding Opportunity (NOFO): September 1, 2024 - August 31, 2025

    HRSA FORHP logo
    FY 2024 NOFO document (568.52 KB)

    Federal Office of Rural Health Policy (FORHP)

    HRSA FORHP logo

    FOHRP and National Rural Health Resource Center

    HRSA FORHP logo

    FOHRP and National Rural Health Resource Center

    HRSA FORHP logo

    FORHP, National Rural Health Resource Center, and Flex Monitoring Team

    National Rural Health Resource Center logo

    National Rural Health Resource Center

    FMT logo

    Flex Monitoring Team (FMT)

    Flex FY 2024 EMS Supplement NOFO: September 1, 2024 - August 31, 2029

    FYs 2019-2023 Flex Program Cooperative Agreement Materials

    Flex FY 2023 NCC: September 1, 2023 - August 31, 2024

    National Rural Health Resource Center logo

    National Rural Health Resource Center

    National Rural Health Resource Center logo

    National Rural Health Resource Center

    National Rural Health Resource Center logo

    National Rural Health Resource Center

    National Rural Health Resource Center logo

    National Rural Health Resource Center

    Flex FY 2022 NCC: September 1, 2022 - August 31, 2023

    Logo for Flex Monitoring Team

    Flex Monitoring Team

    National Rural Health Resource Center

     

    Flex FY 2022 EMS Supplement: September 1, 2022 - August 31, 2023

    National Rural Health Resource Center

     

    Flex FY 2021 NCC: September 1, 2021 - August 31, 2022

    National Rural Health Resource Center

     

    Flex FY 2020 NCC: September 1, 2020 - August 31, 2021

    National Rural Health Resource Center

     

    Flex FY 2019 Notice of Funding Opportunity (NOFO): September 1, 2019 - August 31, 2020

    Materials below outline the intent for each program area of the state Flex Cooperative Agreement for the FY 2019 funding cycle. Note that the Flex Program award type changed from an intended three-year grant period (FYs 2015-2018) to a five-year cooperative agreement period effective FYs 2019-2023.

    National Rural Health Resource Center

    National Rural Health Resource Center

     

    Flex Program Fiscal Year 2019 EMS Supplement Funding Guidance and Supporting Materials

    HRSA FORHP logo

    FORHP

    National Rural Health Resource Center

    National Rural Health Resource Center

     

    For more information, please contact Nicole Clement at (218) 216-7028 or nclement@ruralcenter.org

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    Core Competency: Managing the Flex Program

    Managing the cooperative agreement is one of the primary responsibilities of state Flex Programs and includes: budgeting, cooperative agreement application writing, working with partners, information management, and reporting.