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It is important for state Flex Programs to understand the community needs of CAH and RHC service areas to develop or leverage program activities in support of health system development, community engagement, and population health improvement.

State Flex Programs can help CAHs transition into value-based systems, population health models, and future opportunities through education, network support, facilitation of new partnerships, and technical assistance.

Working with the Medicare Rural Hospital Flexibility (Flex) Program may look different for every state, but there are several competencies that strong Flex Programs have in common. The Core Competencies for Flex Program Excellence include discussions of why these competencies have been identified, what proficiencies exist within each competency, and share a core competency self-assessment to identify your program’s strengths and opportunities. Each section of the guide also includes tools and resources to help support your program.

The Flex Program and CAHs rely on leadership and a skilled workforce to advance program goals and deliver high-quality, high-value care for patients.

Evaluation reporting to program stakeholders should be included in Flex Program activities. Reporting supports overall program transparency and development, stakeholder buy-in, engagement, and accountability.

Planning ought to be purposeful, active, and relevant, with input from key stakeholders such as internal staff, rural provider leaders and staff, and the state rural health and clinic organizations.

State Flex Programs remain vital because of the web of relationships developed and maintained within communities, providers, networks, states, regions, and nationally. It is imperative that state Flex Programs have the skills, capacity, and commitment to build and sustain partnerships, new and old, to support rural providers and rural stakeholders.

State Flex Programs need to have an in-depth understanding of the policies and regulations governing the Flex Program, as well as a basic understanding of the policy-making process and other policies and regulations affecting rural providers.

State Flex Programs must understand QI principles, resources, and trends to support CAHs in advancing QI.

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.

This guide offers anyone who manages and/or works with the Flex Program the opportunity to complete a competency self-assessment, identify areas of proficiency, recognize opportunities for improvement and development, and gather insight into what determines proficiency.

The Flex Program and CAH designation was established and remains in place because of the financial vulnerability of small rural hospitals. CAH financial and operational improvement is one of the required program areas of the Flex Program.