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)
  • 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 2019-2023 Flex Program Cooperative Agreement Materials

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


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


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


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


    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.


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


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

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