Rural Hospital Medicare Flexibility Program (Flex)
The Rural Hospital Medicare Flexibility Program (Flex Program) grant is awarded to Iowa HHS by the Health Resources Services Administrationâs (HRSAâs)Â Federal Office of Rural Health Policy.
Through the Flex Program grant, HHS 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 HHS, as summarized below.Â
Quality Improvement
The quality improvement area includes MBQIP data. Submitting MBQIP data is the only requirement for critical access hospitals to participate in the Flex Program. If critical access hospitals meet the MBQIP reporting requirements, they are automatically able to participate in Flex Program activities.
Iowa Healthcare Collaborative sends MBQIP reports to hospitals and provides technical assistance, webinars/calls, and live events related to quality improvement.
Financial Improvement
HomeTown Health provides financial improvement webinars, triage resources, live meetings, comparative dashboards, in-depth assessments and action planning, and peer assistance.
Operational ImprovementÂ
HomeTown Health provides operational improvement webinars, live meetings, comparative dashboards, in-depth assessments and action planning, and peer assistance.
Population HealthÂ
Iowa Healthcare Collaborative provides community health needs assessment technical assistance webinars. Iowa HHS provides individual technical assistance.
Flex accordion
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.Â
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 designated critical 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
The Small Rural Hospital Improvement Grant Program (SHIP) is coordinated through the Health Resources and Services Administration's (HRSA) Federal Office of Rural Health Policy (FORHP). SHIP provides funding to hospitals in 46 participating State Offices of Rural Health (SORH) to help small rural hospitals engage in various Affordable Care Act (ACA) delivery system reforms, such as value-based purchasing programs, accountable care organizations, prospective payment systems and payment bundling.
SHIP Accordion
Hospitals must first meet SHIP funding priorities before using resources to support investments in other areas. SHIP funding priority areas include implementation of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) reporting and ICD-10 coding.
If these priorities are in place, hospitals may choose activities in three key focus areas. The three key focus areas of SHIP activities include the following:
Value Based Purchasing:Â Activities that support improved data collection to facilitate quality reporting and improvement
Accountable Care Organizations or Shared Savings:Â Activities that support development or basic tenets of ACOs or shared savings programs.
Prospective Payment System or Payment Bundling:Â Activities that improve hospital financial processes.
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"Small" is defined as 49 available beds or less, as reported on the hospital's most recently filed Medicare Cost Report, line 12.
The average daily census or average staffed bed count may NOT be used to determine hospital eligibility.
Hospitals reporting a licensed bed count greater than 49 on Line 12, but that staff 49 beds or fewer, may self-certify eligibility by submitting a written statement including: (1) the number of staffed beds at the time of the most recent cost report submission; (2) the cost reporting period of the most recently filed cost report; and (3) the signature of the certifying official.
Regarding eligibility, the â49 beds or lessâ refers to acute care beds only and does not include psych unit beds.
"Rural" is defined as either: (1) located outside of a Metropolitan Statistical Area (MSA); (2) located within a rural census tract of a MSA, as determined under the Goldsmith Modification or the Rural Urban Commuting Areas (RUCAs); or (3) is being treated as if located in a rural area pursuant to 42 U.S.C. 1395(d)(8)(E).
"Hospital" is defined as non-federal, short-term, general acute care facility.
