Texas State Office of Rural Health


United States

Top Flex Activities

CAH Quality Improvement

The Texas State Office of Rural Health (SORH) contracts with the Texas Hospital Association and Texas A&M Rural and Community Health Institute to provide technical assistance on the Medicare Beneficiary Quality Improvement Project (MBQIP). Technical assistance consisted of 14 virtual quality improvement site visits, quarterly quality improvement webinars, a focus group of 15 CAH quality champions who were tasked with developing a Texas quality improvement (QI) scorecard, and development and deployment of a one-stop MBQIP reporting portal (MBQIP Portal (rchitexas.org). In evaluating data from the website, which also hosts their Emergency Department Transfer Communication (EDTC) submission portal, for Program Year 2019, they have seen: 1,260 users, 1,195 new users, 3,236 sessions, and 52,922-page views. These numbers have far exceeded expectations and prove that they are meeting the need identified by the CAH quality champions.

CAH Operational and Financial Improvement

Texas SORH, in partnership with their financial and operational contractor – the Texas Organization of Rural and Community Hospitals, completed an annual statewide financial and operational needs assessment, hosted three statewide webinars – two on swing beds and one on COVID-19 changes, and provided in-depth technical assistance to two financially at-risk CAHs through a newly developed Triage initiative. A significant operational and financial improvement accomplishment for FY 2019 was their Flex32 Summer Initiative. This initiative worked with a cohort of 32 CAHs comprised of five to six CAHs in each of the six SORH regions. The CAHs who participated in this initiative received outmigration data based upon their identified service area along with a chargemaster review specifically targeting their emergency department. They are currently working to provide access to another 25 hospitals with the goal of extending access to all CAHs.

Please provide information about network activities in your state to support Flex Program activities.

The state has been divided into six different regions composed of both CAHs and prospective payment systems (PPSs) – all rural hospitals, ranging from 20 to 30 in each region. The regions were developed looking at both formal and informal networks (state-identified regions of services and local rural health networks). The goal is that regions meet quarterly and implement technical assistance through this regional approach. 

Please provide information about cross-state collaborations you may be working on related to the Flex Program.

The Texas SORH supports a collaborative rural hospital stakeholder group that meets quarterly. The group originally came together to complete a strategic plan for the Flex grant and has since continued to meet. Members of the collaborative group include hospital administrators, CAH quality improvement champions, contractors, the Quality Innovation Network and Organization (QIN/QIO) for the state, and other state experts. The group is currently exploring sharing more recent state data and aligning technical assistance. The cross-state collaboration hosted a COVID-19 Rural Hospital meeting in March which was attended by 136 individuals.

Please describe how your state Flex Program is reaching out to non-traditional partners to support its work.

As needs and supports are identified by the rural hospitals and other stakeholders, the Texas SORH will reach out to the identified non-traditional partners to meet identified goals. In the future, they will work on bringing rural emergency medical services (EMS), nursing homes, local foundations, rural health clinics (RHCs), federally qualified health centers (FQHCs), and others to the table.

Program Statistics

Do you have any hospitals interested in converting to CAH status?:
Type of Organization State Government
Staffing (FTE) 4
Website Organization Website
Number of CAHs 88


Organization Contacts

Trent Engledow

State Office Director, Texas
(512) 463-6121

State Office Director since October 2016

Kathy Johnston

Rural Health Specialist, Texas
(512) 463-9590
  • Certified Community Health Worker
  • Certified Mental Health First Aid Instructor
  • Worked for Area Health Education Center, Permian Basin, Admin. and Community Liaison
  • Associate of Arts degree

Rural Health Specialist since September 2019

Trish Rivera

Rural Health Specialist, Texas
(512) 936-7875

Trish Rivera was a licensed social worker in the field of early childhood, child welfare and substance abuse. Trish worked in an early childhood agency for many years and at a residential substance abuse treatment facility that had a program for women with young children.

Rural Health Specialist since October 2019

Eva Cruz

Flex Coordinator, Texas
(512) 963-7880

Eva has spent 20+ years in County Indigent Health Care Program Management, as well as 10 years in the Department of State Health Service Community Health Program Coordination.

Flex Coordinator since February 2022

Jake Stukenberg

Rural Health Specialist, Texas

Rural Health Specialist since April 2023

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