(Medicare Rural Hospital Flexibility Grant Program)
The North Dakota Medicare Rural Hospital Flexibility
(Flex) Program is a state based partnership that works
with and assists all rural hospitals to stabilize and
sustain their local healthcare infrastructure. Flex is a
companion to the Critical Access Hospital (CAH)
designation process. Hospitals receive CAH designation
from the Center for Medicare and Medicaid Services (CMS).
The Balanced Budget Act of 1997 created the Medicare State Rural Hospital Flexibility Program. The purpose of
the program is to assist rural hospitals and to improve access to health services in rural communities. The
Flex program provides funding to States for the designation of CAHs in rural communities. CAH conversion can
allow for enhanced service diversification and combines potentially improved (cost-based) reimbursement with
savings from relaxed operating requirements to help ensure the financial viability of participating hospitals.
The Flex Program helps to sustain the rural healthcare infrastructure by strengthening CAHs thereby maintaining
access to care for rural residents. The Flex Program includes focus on the following five core objective areas:
Financial and operational improvement
Population health management and emergency medical services (EMS) integration
Designation of CAHs (required if requested)
Integration of innovative healthcare models
By applying these components of Flex, the program fosters the growth and sustainment of rural collaborative
healthcare systems across the continuum of care.