Core Competencies for State Flex Program Excellence

This framework is intended for those who manage and/or work on the Medicare Rural Hospital Flexibility (Flex) Program. Directors and managers within State Offices of Rural Health, state Flex Program Coordinators and other staff working with state Flex Programs are charged with supporting improvements in critical access hospitals (CAHs), population health and the integration of health services in the 45 states that participate in the Flex Program. Identified by a group of experienced Flex program personnel as well as staff from the Federal Office of Rural Health Policy (FORHP), Flex Monitoring Team (FMT) and Technical Assistance and Services Center (TASC), the nine core competencies for state Flex Programs serve as a guide to assess state Flex Program strengths and weaknesses.

The guide includes a description of the importance, proficiencies and tips related to each competency as well as key resources listed in the appendix.


FORHP strongly suggests that state Flex Programs complete this assessment at least annually. Results of the assessment will not be used by FORHP to determine future funding levels. Users are encouraged to complete the assessment multiple times to monitor progress on their continuous journey towards Flex Program excellence. Assessment results can be used to establish a baseline, create benchmarks and aid in strategic planning and evaluation.

Complete the Self-Assessment

This project is/was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number UB1RH24206, Information Services to Rural Hospital Flexibility Program Grantees, $1,560,000 (0% financed with nongovernmental sources). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.