State Flex Profile Navigation

Texas Department of Agriculture

Top Flex Activities

Program Area: Support for Quality Improvement

The State Office of Rural Health (SORH) contracts with a statewide hospital association who provides technical assistance on the Medicare Beneficiary Quality Improvement Project (MBQIP). The technical assistance consists of onsite visits, webinars, conference calls, and statewide workshops. The quality improvement (QI) partners have developed a database which provides reports back to the critical access hospitals (CAHs) quickly so that improvements can be made. A best practice the group has developed for the emergency department transfer communication (EDTC) measure is creating a Memorandum of Transfer document that contains all of the required measures.

Program Area: Support for Financial and Operational Improvement

The SORH, in partnership with our financial and operational (F&O) contractor, selected 10 CAHs by examining various measures and confirmed their participation. Ten onsite condition assessments were completed and the group of CAHs identified three intervention projects: Hispanic marketing demographic, marketing, and telemedicine roadmap. A total of four onsite cohort meetings and one general education webinar on the telemedicine roadmap were conducted. Moving forward, the Texas Flex Program will continue to monitor the participating CAHs to see the impact of the interventions, as well as select new CAHs to participate.

Please provide information about any efforts to assist CAHs/communities and partner organizations in the transition to value-based care.

The SORH assists CAHs/communities in the transition to value-baed care by providing information and resources during the annual CAH conference. Additionally, the Texas Flex Program provides support during in-person site visits. 

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

The SORH is working on identifying key quality improvement stakeholders in the state to bring together for future meetings. The SORH also participates in a bi-monthly Hospital Membership Call where updates on the Flex Program are discussed.

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

The SORH partners with and supports a statewide advocacy association in hosting an annual CAH Conference. Additionally, the SORH hosts an annual stakeholder meeting where champions from across the state come in and participate. In the agenda there is a specific agenda item dedicated to the Flex Program where the QI and F&O contractors give an update on the project and provide a close-out presentation for the project year.

Please describe how your state Flex Program has enhanced its use of data in the past year.

The SORH utilizes Critical Access Hospital Measurement and Performance Assessment System (CAHMPAS) for grant writing purposes and for selecting CAHs, with the F&O partner, to participate in F&O activities. The QI partners have also developed a database which is utilized to provide real-time comparisons so improvements can be made. In addition, the QI partners have developed a reporting template which is given to the CAHs to provide feedback on the different QI domains.

Do you have any hospitals interested in converting to CAH status?:

Program Statistics

Type of Organization State Government
Staffing 1.25 FTEs
Number of CAHs 83
Website URL Organization Website


Flex Program Staff

Trent Engledow
State Office Director, Texas
(512) 463-6121

State Office Director since October 2016

Robert Shaw
Flex Coordinator, Texas
(512) 936-6339

Flex Coordinator since July 2018

Robert received his undergraduate degree from Texas A&M University and went on to earn a Master of Public Health from Texas A&M Health Science Center. Robert has planned, implemented, and sustained various health and social service programs in rural-community settings ranging from, telehealth (provided free mental health and substance abuse counseling), community health worker program, and home-delivered meal program. Robert has worked on state-wide initiatives and recently provided community development support on a children's mental health initiative. 

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, $1,100,000 (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.