Opportunity Information: Apply for HRSA 15 038
Apply for HRSA 15 038
- The Health Resources and Services Administration in the health sector is offering a public funding opportunity titled "Medicare Rural Hospital Flexibility Grant Program" and is now available to receive applicants.
- Interested and eligible applicants and submit their applications by referencing the CFDA number(s): 93.241 State Rural Hospital Flexibility Program.
- This funding opportunity was created on Feb 4, 2015 and posted on Feb 4, 2015.
- Applicants must submit their applications by Apr 6, 2015. (Agency may still review applications by suitable applicants for the remaining/unused allocated funding in 2026.)
- The funding agency has allocated a total of $22,540,000.00 to eligible and selected applicants.
- The number of recipients for this funding is limited to 45 candidate(s).
- Eligible applicants include: Others (see text field entitled Additional Information on Eligibility for clarification).
- States with certified Critical Access Hospitals are eligible for this Grant Program. Only one applicant from each state is eligible, based on the designation of the Governor.
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Opportunity Summary:
The Medicare Rural Hospital Flexibility Grant Program (often called the Flex Program) is a discretionary grant opportunity administered by the Health Resources and Services Administration (HRSA), specifically aimed at helping rural communities maintain access to strong, dependable hospital and emergency care. The central focus is supporting Critical Access Hospitals (CAHs) by strengthening quality of care, building consistent quality reporting and benchmarking, improving operational and financial performance, and reinforcing rural emergency medical services (EMS). In practice, the program is designed to help rural hospitals and their partners adapt to a healthcare environment that increasingly expects measurable outcomes, transparency in quality metrics, and movement toward value-based payment and broader healthcare transformation.
Funding is awarded at the state level, not directly to individual hospitals. Only states that have certified Critical Access Hospitals are eligible, and only one applicant per state can apply, based on a designation by the Governor. The project period described in the announcement is three years, with the state Flex program expected to serve as a hub for statewide strategy, coordination, and technical support for CAHs. HRSA notes that the Flex award is not meant to cover every need in a state, so states are expected to assess CAH needs, set priorities for the three-year cycle, and target investments where they can produce clear, measurable improvements. To stretch limited dollars further, states are encouraged to group or cohort CAHs that share similar challenges and address those issues through shared activities or supports.
The grant framework is organized around five program areas, with several required components. Quality Improvement is required and is heavily tied to the Medicare Beneficiary Quality Improvement Project (MBQIP), a national quality initiative for CAHs. Under this funding cycle, participation in any Flex-supported activity requires CAHs to report MBQIP core quality measures, reinforcing the program shift from voluntary participation toward a more consistent, outcomes-driven approach. Financial and Operational Improvement is also required, reflecting the program priority of helping CAHs remain viable while improving efficiency, performance, and readiness for value-based models. A third area, Population Health Management and EMS Integration, is optional and gives states room to pursue strategies that connect hospitals more closely with EMS systems and community health needs, particularly around time-critical diagnoses and rural emergency response capacity. The fourth area, Designation of CAHs in the State, is required if requested, supporting the processes and technical work involved in CAH designation where applicable. The fifth area, Integration of Innovative Health Care Models, is optional and allows states to test or scale models that can improve quality and sustainability, including approaches aligned with broader healthcare delivery and payment reforms.
Across these areas, the Flex Program sets out several consistent national goals: improving the quality of care delivered in CAHs; improving CAH financial and operational outcomes; building a better understanding of community health needs and EMS needs tied to CAHs; improving rural community health through community or population health efforts; strengthening identification and management of time-critical conditions while improving EMS performance in rural settings; and supporting CAHs as they transition toward value-based payment and other transformation models. A major theme in the announcement is standardizing and measuring outcomes across states so the national impact of Flex investments can be demonstrated more clearly. States have flexibility in choosing the specific activities that best fit their context, but they are expected to select strategies that can credibly show improvement and can be measured over the project period.
The announcement also emphasizes collaboration. State Flex programs are encouraged to work closely with organizations that can accelerate improvement and reduce duplication of effort, including State Hospital Associations, Quality Improvement Organizations (QIOs), Quality Innovation Networks (QINs), Health Information Exchanges (HIEs), Hospital Engagement Networks (HENs), State Rural Health Associations, and other stakeholders invested in rural healthcare stability. The overall message is that the state Flex program should act as a coordinating backbone: identifying the most pressing needs among CAHs, aligning partners, focusing resources on high-impact interventions, and documenting outcomes in ways that match national expectations for quality reporting and performance improvement.
From the funding notice details provided, HRSA anticipated 45 awards with an estimated total funding amount of $22,540,000 under CFDA 93.241 (State Rural Hospital Flexibility Program). There is no cost sharing or matching requirement listed. The opportunity was posted February 4, 2015, with an application closing date of April 6, 2015, and it was later archived June 5, 2015. For administrative or access issues related to the full announcement, HRSA listed a grants application center contact in Gaithersburg, Maryland, with Kevin Chaney as the point of contact (KChaney@hrsa.gov).
Medicare Rural Hospital Flexibility Grant Program (Flex Program) FAQs
1) What is the Medicare Rural Hospital Flexibility Grant Program (Flex Program)?
The Medicare Rural Hospital Flexibility Grant Program (the Flex Program) is a discretionary grant opportunity administered by the Health Resources and Services Administration (HRSA). It is designed to help rural communities maintain access to strong, dependable hospital and emergency care by supporting Critical Access Hospitals (CAHs) and related rural health partners.
2) What is the main purpose of the Flex Program?
The program aims to strengthen rural hospital and emergency care by supporting CAHs in areas such as improving quality of care, building consistent quality reporting and benchmarking, improving operational and financial performance, and reinforcing rural emergency medical services (EMS). It also supports rural hospitals and partners as healthcare expectations shift toward measurable outcomes, transparency in quality metrics, value-based payment, and broader healthcare transformation.
3) Who administers this grant opportunity?
The opportunity is administered by HRSA (Health Resources and Services Administration).
4) Is funding awarded directly to individual hospitals?
No. Funding is awarded at the state level, not directly to individual hospitals.
5) Who is eligible to apply?
Only states that have certified Critical Access Hospitals (CAHs) are eligible to apply. Additionally, only one applicant per state can apply, based on a designation by the Governor.
6) How many applicants can apply from each state?
Only one applicant per state may apply, and that applicant must be designated by the Governor.
7) What is the project period for this grant?
The project period described is three years.
8) What role is the state Flex program expected to play?
The state Flex program is expected to serve as a hub for statewide strategy, coordination, and technical support for CAHs. The program is positioned as a coordinating backbone that identifies needs, aligns partners, targets resources, and documents outcomes aligned with national expectations.
9) Does the Flex award cover all rural hospital needs in a state?
No. HRSA notes that the Flex award is not intended to cover every need in a state. States are expected to assess CAH needs, set priorities for the three-year cycle, and target investments toward activities that can produce clear, measurable improvements.
10) How are states encouraged to maximize the impact of limited funds?
States are encouraged to group or cohort CAHs with similar challenges and address those issues through shared activities or supports, helping stretch limited dollars further.
11) What are the program areas (framework) of the Flex Program?
The grant framework is organized around five program areas:
- Quality Improvement (required)
- Financial and Operational Improvement (required)
- Population Health Management and EMS Integration (optional)
- Designation of CAHs in the State (required if requested)
- Integration of Innovative Health Care Models (optional)
12) Which program areas are required?
Quality Improvement and Financial and Operational Improvement are required. The Designation of CAHs in the State area is required if requested.
13) Which program areas are optional?
Population Health Management and EMS Integration is optional, and Integration of Innovative Health Care Models is optional.
14) What does the required Quality Improvement area focus on?
Quality Improvement is heavily tied to the Medicare Beneficiary Quality Improvement Project (MBQIP), which is described as a national quality initiative for CAHs. A key emphasis in this cycle is consistency in quality reporting and outcomes-driven improvement.
15) What is MBQIP, and how is it connected to Flex activities?
MBQIP (Medicare Beneficiary Quality Improvement Project) is a national quality initiative for Critical Access Hospitals. Under this funding cycle, participation in any Flex-supported activity requires CAHs to report MBQIP core quality measures, reflecting a shift toward more consistent reporting and measurable outcomes.
16) What is required for CAHs to participate in Flex-supported activities?
CAHs must report MBQIP core quality measures in order to participate in any Flex-supported activity.
17) What does the required Financial and Operational Improvement area emphasize?
This required area reflects the priority of helping CAHs remain viable while improving efficiency, performance, and readiness for value-based models.
18) What does the optional Population Health Management and EMS Integration area allow states to do?
This optional area allows states to pursue strategies that connect hospitals more closely with EMS systems and community health needs, particularly around time-critical diagnoses and rural emergency response capacity.
19) What is meant by "Designation of CAHs in the State" being required if requested?
It means this program area supports the processes and technical work involved in CAH designation where applicable, and it is required when requested under the program expectations described in the announcement.
20) What does the optional Integration of Innovative Health Care Models area support?
This optional area allows states to test or scale models that can improve quality and sustainability, including approaches aligned with broader healthcare delivery and payment reforms.
21) What are the national goals of the Flex Program?
The announcement describes several consistent national goals, including:
- Improving the quality of care delivered in CAHs
- Improving CAH financial and operational outcomes
- Building a better understanding of community health needs and EMS needs tied to CAHs
- Improving rural community health through community or population health efforts
- Strengthening identification and management of time-critical conditions and improving rural EMS performance
- Supporting CAHs as they transition toward value-based payment and other transformation models
22) Why does the announcement emphasize standardizing and measuring outcomes?
A major theme is standardizing and measuring outcomes across states so that the national impact of Flex investments can be demonstrated more clearly. States are expected to choose strategies that can credibly show improvement and can be measured over the project period.
23) Are states allowed to choose activities based on local context?
Yes. States have flexibility in choosing specific activities that best fit their context, but they are expected to select strategies that can show improvement and be measured over the three-year project period.
24) What types of organizations are encouraged as collaborators?
The announcement encourages state Flex programs to collaborate with organizations that can accelerate improvement and reduce duplication of effort, including:
- State Hospital Associations
- Quality Improvement Organizations (QIOs)
- Quality Innovation Networks (QINs)
- Health Information Exchanges (HIEs)
- Hospital Engagement Networks (HENs)
- State Rural Health Associations
- Other stakeholders invested in rural healthcare stability
25) How many awards were anticipated, and what was the estimated total funding amount?
HRSA anticipated 45 awards with an estimated total funding amount of $22,540,000.
26) What is the CFDA number listed for this program?
The CFDA number listed is 93.241 (State Rural Hospital Flexibility Program).
27) Is there a cost sharing or matching requirement?
No cost sharing or matching requirement is listed in the details provided.
28) When was this opportunity posted, and when did it close?
The opportunity was posted on February 4, 2015, and the application closing date was April 6, 2015.
29) Is the opportunity currently active?
No. It was later archived on June 5, 2015.
30) Who is the listed HRSA contact for administrative or access issues?
For administrative or access issues related to the full announcement, HRSA listed a grants application center contact in Gaithersburg, Maryland, with Kevin Chaney as the point of contact at KChaney@hrsa.gov.
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