Utah’s Rural Hospital Flexibility Grant Program (FLEX):

Photo Credit: Jolyn Smith

The Medicare Rural Hospital Flexibility (Flex) Program was established by the Balanced Budget Act (BBA) of 1997. Any state with rural hospitals may establish a Flex Program and apply for federal funding that provides for the creation of rural health networks, promotes regionalization of rural health services and improves access to hospitals and other services for rural residents. The Federal Office of Rural Health Policy (FORHP) funds the Flex Program.

The BBA of 1997 also created critical access hospitals (CAHs). CAH designation allows the hospital to be reimbursed on a reasonable cost basis for inpatient and outpatient services provided to Medicare patients (including lab and qualifying ambulance services) and, in some states, Medicaid patients.

Flex funding encourages the development of cooperative systems of care in rural areas, joining together CAHs, emergency medical service (EMS) providers, clinics and health practitioners to increase efficiencies and quality of care. The Flex Program requires states to develop rural health plans and funds their efforts to implement community-level outreach. The Flex Program includes support for the following five program areas:

  • Quality improvement
  • Financial and operational improvement
  • Population health management and EMS integration (optional)
  • Designation of CAHs (required if requested)
  • Integration of innovative health care models (optional)

Critical Access Hospital Community Profiles (Dropbox)

Read the Utah FLEX Program Profile here

State Support to Rural Hospital PDF

FY 2020 Utah HRSA Programs PDF


Utah’s Small Rural Hospital Improvement Grant Program (SHIP):

The Small Rural Hospital Improvement Grant Program (SHIP) is supported by the U.S. Department of Health and Human Services, Health Resources and Services Administration’s Federal Office of Rural Health Policy (FORHP). Section 1820(g)(3) of the Social Security Act (SSA) authorizes SHIP to assist eligible hospitals in meeting the costs of implementing data system requirements established under the Medicare Program, including using funds to assist hospitals in participating in improvements in value and quality to health care such as:

  1. Value-Based Purchasing Programs (VBP)
  2. Accountable Care Organizations (ACOs)
  3. Payment Bundling (PB)

Eligible small rural hospitals are located in the United States and its territories and include hospitals with 49 available beds or less. These small rural, non-federal hospitals provide short-term, general acute care to their communities. They may be for-profit, not-for-profit or tribal organizations. Critical access hospitals are eligible for the program.

Resources for Participating SHIP Hospitals

Fact Sheets for Rural Hospitals:

Quality Improvement

Quality Improvement Basics:

Quality Improvement Basics Course – Stratis Health

Quality Improvement Basics: A Collection of Helpful Resources for Rural Health Care Organizations – Stratis Health Download

Quality Improvement Implementation Guide and Toolkit for Critical Access Hospitals Download

Quality Improvement Measure Summaries for MBQIP Download

Brainstorming ToolDownload

Internal Quality Monitoring Tool Download

Project Action Plan Template Download

Quality Patient Safety Committee Agenda Minute Template Download

Rapid Tests of Change Tool Download

Rapid Tests of Change Example Download

Ten Step Quality Improvement Project Documentation Template Download

CAH Quality Prioritization Tool Download

MBQIP (Medicare Beneficiary Quality Improvement Project):

MBQIP Measures Download

MBQIP Measures Fact Sheets Download

MBQIP Quality Reporting Guide Download

MBQIP Data Submission Deadlines Download

Interpreting MBQIP Hospital Data Reports Quality Improvement Download

Online MBQIP Data Abstraction Training Series

EDTC (Emergency Department Transfer Communication):

EDTC Brief Download

ED Transfer Data Specifications Manual Download

Data Specifications Manual: EDTC Measures

Quality Reporting

Quality-Reporting-Crosswalk-Update-April-2018-Final Download

Critical Access Hospital eCQM Resource List Download

Confirming That Your Data Has Been Accepted by the QualityNet Warehouse Download

Hospital Consumer Assessment of Healthcare Providers and Systems Overview – Vendor Directory Download

CART Resources

Inpatient and Outpatient Quality Reporting Specifications Manuals (Encounters)

Inpatient and Outpatient Quality Reporting Specifications Manuals (Discharges)

View Map of Rural Hospitals 


Health Systems Support Specialist   

mapayne @ utah.gov