Official State of Iowa Website Here is how you know
Iowa Department of Health and Human Services

Rural Health and Primary Care - Iowa Flex Program

Flex graphic

The Rural Hospital Medicare Flexibility Program (Flex Program) grant is awarded to the Iowa Department of Public Health by the Health Resources Services Administration’s (HRSA’s) Federal Office of Rural Health Policy. Through the Flex Program grant, the Iowa Department of Public Health contracts with organizations to implement activities related to quality improvement, financial improvement, operational improvement, and population health. Eligible critical access hospitals (CAHs) are able to participate in these activities at no cost. Currently, activities are provided by the Iowa Healthcare Collaborative, HomeTown Health, and Iowa Department of Public Health, as summarized below. For an overview of current Flex Program activities offered, see the Flex Program Menu of Services.


MBQIP is a quality improvement activity under the Flex Program. The goal of MBQIP is to improve the quality of care provided in CAHs by increasing quality data reporting by CAHs, thus driving quality improvement activities based on the data. MBQIP includes data reporting related to patient safety/inpatient, outpatient, emergency department transfer communications, and patient satisfaction measures.

To be eligible for Flex Program participation, CAHs must meet MBQIP reporting requirements, as defined by the Federal Office of Rural Health Policy. Due to COVID-19, there are currently no MBIQP reporting requirements for Federal Fiscal Year 2020 (September 1, 2020 to August 31, 2021).

Critical Access Hospital Designation

In addition to implementing activities in the Flex Program areas, the Flex Program allows small rural hospitals to be certified as CAHs. Iowa has 82 designatedcritical access hospitals supported by the Flex Program. Critical access hospital designation allows hospitals to be reimbursed on a reasonable cost basis for inpatient and outpatient services, including lab and qualifying ambulance services. This reimbursement structure is designed to ensure that rural populations are able to access essential health care services. Iowa hospitals must meet the following criteria to be designated as a CAH:

  • Located in a rural area (or an area treated as rural)
  • More than 35 miles from another hospital (or 15 miles in areas with mountainous terrain or only secondary roads available) or be certified before January 1, 2006, by the state as being a necessary provider of health care services
  • Provide 24-hour emergency care services
  • Have a maximum of 25 acute care and swing beds
  • Maintain an annual average length of stay of 96 hours or less for their acute care patients

MBQIP Resources

Flex Resources

To learn more about the Iowa Rural Hospital Flexibility Program contact:

Wanda Hilton | Flex Coordinator
Phone: (515) 322-9708 | Fax: (515) 242-6384