For the current funding cycle of the Medicare Rural Hospital Flexibility (Flex) Program, which runs from fiscal years (FYs) 2024-2028, the primary components of the Flex Program include activities in the following areas:
- Critical Access Hospital (CAH) Quality Improvement (MBQIP) (required)
- CAH Financial and Operational Improvement (required)
- CAH Population Health Improvement (optional)
- Rural Emergency Medical Services (EMS) Improvement (optional)
- 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 beginning September 1, 2024)
The Flex FYs 24-28 Flex Program Structure Document can be utilized to draft projects, activities, outputs, and outcomes.
Federal Office of Rural Health Policy
Flex FY 2025 Non-Competing Continuation (NCC): September 1, 2025 - August 31, 2026
Federal Office of Rural Health Policy
Flex FY 2024 Notice of Funding Opportunity (NOFO): September 1, 2024 - August 31, 2025
Federal Office of Rural Health Policy
Federal Office of Rural Health Policy
Federal Office of Rural Health Policy
Federal Office of Rural Health Policy
Federal Office of Rural Health Policy
Federal Office of Rural Health Policy
Federal Office of Rural Health Policy
National Rural Health Resource Center
Flex Monitoring Team (FMT)
Flex Monitoring Team (FMT)
Flex FY 2024 EMS Supplement NOFO: September 1, 2024 - August 31, 2029
Federal Office of Rural Health Policy
Federal Office of Rural Health Policy
Federal Office of Rural Health Policy
Federal Office of Rural Health Policy
For more information, please contact TASC at tasc@ruralcenter.org
