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Flex (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).


Program Purpose
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.

Program Mission
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:

  • Quality improvement
  • 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.