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Core Competencies for State Flex Program Excellence

The Core Competencies offer anyone who manages and/or works on the Medicare Rural Hospital Flexibility (Flex) Program the opportunity to complete a competency self-assessment, identify areas of proficiency, recognize opportunities for improvement and development, and understand and gather insight into what determines proficiency and how it can be developed. Tips, tools, and resources are included to provide additional background and support.

A competency is the ability or knowledge to complete a project. There are ten core competencies that are critical for an excellent state Flex Program. Within each competency, there are proficiencies. Proficiency is the skill or expertise needed to achieve a goal or, in this case, meet a competency. 

Through a meeting of established Flex coordinators and federal Flex Program partner, the 10 core competencies of an effective and impactful Flex Program were identified:

  • Developing Leadership and Workforce
  • Managing the Flex Program
  • Planning Strategically
  • Managing Information and Evaluation
  • Building and Sustaining Partnerships
  • Understanding Policies and Regulations
  • Strengthening Quality Reporting and Improvement
  • Improving Financial Sustainability
  • Understanding the Current and Future Health Care Environment
  • Addressing Community Needs

Click through the banner on the left side of the page to learn more about each competency and see the proficiencies within each. For a fully in depth look at each competency and the history of the core competencies, please review the Core Competency guide. 

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Core Competencies for State Flex Program Excellence Guide
National Rural Health Resource Center

Core Competency Self-Assessment

FORHP and TASC strongly suggest state Flex Programs complete this assessment at least once a year. State Flex Programs are also asked to complete a self-assessment prior to and about six months after receiving intensive technical assistance, including workshops, coaching calls, learning collaboratives, and technical consultations. State Flex Program staff are encouraged to complete the assessment regularly to monitor progress on their ongoing journey towards Flex Program excellence. Assessment results can be used to establish a program baseline, create benchmarks, and aid in strategic planning and evaluation. Results of the assessment will not be used by FORHP to determine future funding levels, but rather to guide states in creating workplans and other TA activities. Please note that this assessment should be taken from the perspective of the state Flex Program as a whole, and not as an individual person and their own proficiencies and competencies.

Core Competency Self-Assessment

Complete An Assessment Today!

In This Toolkit

Toolkit

Core Competency: Developing Leadership and Workforce

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.
Toolkit

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.
Toolkit

Core Competency: Planning Strategically

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.
Toolkit

Core Competency: Managing Information and Evaluation

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.
Toolkit

Core Competency: Building and Sustaining Partnerships

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.
Toolkit

Core Competency: Understanding Policies and Regulations

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.
Toolkit

Core Competency: Strengthening Quality Reporting and Improvement

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

Core Competency: Improving Financial Sustainability

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.
Toolkit

Core Competency: Understanding the Current and Future Health Care Environment

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.
Toolkit

Core Competency: Addressing Community Needs

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.

For additional Flex Program support, discussions, or technical assistance, please contact TASC by phone at 877-321-9393 or email at tasc@ruralcenter.org.

The Health Resources and Services Administration (HRSA), Department of Health and Human Services (HHS) provided financial support for this Information Services to Rural Hospital Flexibility Project. The award provided 100% of total costs and totaled $1,100,000. The contents are those of the author. They may not reflect the policies of HRSA, HHS, or the U.S. Government.

As a technical assistance provider to rural health care organizations, the National Rural Health Resource Center provides access to a wide range of resources on relevant topics. Inclusion on the National Rural Health Resource Center’s webpage or presentations does not imply endorsement of, or agreement with, the contents by the National Rural Health Resource Center or the Health Resources and Services Administration.

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