Rural Hospitals (Flex Program)
“The Flex Program” refers to the Medicare Rural Hospital Flexibility Program, which was created by Congress in 1997. It allows small hospitals to be certified as Critical Access Hospitals (CAHs) and offers grants to States to help implement initiatives to strengthen the rural health care infrastructure. The grant program is administered by the Health Resources Service Administration’s Federal Office of Rural Health Policy. HRSA is a division of the U.S. Department of Health and Human Services.

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2021

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Promising Flex Program Initiatives to Support Critical Access Hospitals during the COVID-19 Pandemic, Celia Jewell RN, MPH; Sara Kahn-Troster MPH; and John Gale MS

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Evaluation of the Use of Critical Access Hospital [CAH] Cohorts for Quality Improvement Activities, John Gale MS; Celia Jewell RN, MPH; Sara Kahn-Troster MPH; and Nathan First LCSW, MSW, MA

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Monitoring State Flex Program Financial and Operational Improvement Activities, John Gale MS; Sara Kahn-Troster MPH; Zachariah T. Croll MPH; and Nathan First LCSW, MSW, MA

2020

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Supporting Critical Access Hospitals (CAHs) during the COVID-19 Pandemic: Summary Results of a Survey of State Flex Coordinators, John Gale MS; Zachariah T. Croll MPH; Yvonne Jonk PhD; Sara Kahn-Troster MPH; and Karen Pearson MLIS, MA

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Supporting CAHs during the COVID-19 Pandemic: Results of a Survey of State Flex Coordinators, John Gale MS; Zachariah T. Croll MPH; Yvonne Jonk PhD; Sara Kahn-Troster MPH; and Karen Pearson MLIS, MA

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Rebuilding the Foundation of Rural Community Health after COVID-19, John A. Gale MS, Alana Knudson, and Shena Popat

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Addressing Opioid Use in Rural Communities: Examples from Critical Access Hospitals, John A. Gale MS; Sara Kahn-Troster MPH; Karen B. Pearson MLIS, MA; and Nathan First LCSW, MSW, MA

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Engaging Critical Access Hospitals in Addressing Rural Substance Use, John A. Gale MS; Sara Kahn-Troster MPH; Zachariah T. Croll MPH; and Nathan L. First LCSW, MSW, MA

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Provision of Mental Health Services by Critical Access Hospital-Based Rural Health Clinics, John A. Gale MS; Zachariah T. Croll MPH; Nathan First LCSW, MSW, MA; and Sara Kahn-Troster MPH

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Community Impact and Benefit Activities of CAHs, Other Rural, and Urban Hospitals, 2018, Zachariah T. Croll MPH, John A. Gale MS, and Connor Huggins

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Exploring State Data Sources to Monitor Rural Emergency Medical Services Performance Improvement, John A. Gale MS; Karen B. Pearson MLIS, MA; and Yvonne Jonk PhD

2019

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Community Impact and Benefit Activities of Critical Access, Other Rural, and Urban Hospitals, 2017, Zach T. Croll MPH, John A. Gale MS, and Jeremy Zuckero

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Implementation of the Flex Program's Innovative Models Program Area: Final Evaluation Report, John A. Gale MS, Sara Kahn-Troster MPH, and Andrew F. Coburn PhD

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Implementation and Early Results of the Flex Program's Innovative Models Program Area (Briefing Paper #42), John A. Gale MS, Sara Kahn-Troster MPH, and Andrew F. Coburn PhD

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Improving Rural Systems of Care for Time Critical Diagnoses (Briefing Paper #41), John A. Gale MS and Karen B. Pearson MLIS, MA

2018

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CAHs' Community Benefit Activities: An Updated Review (FMT Briefing Paper #40), John A. Gale MS, Zach T. Croll BA, Lauren Zoll MPH, and Andrew Coburn PhD

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CAHs' Community Health Needs Assessments and Implementation Plans: How Do They Align? (FMT Briefing Paper #39), John A. Gale MS, Zach T. Croll BA, Lauren Zoll MPH, and Andrew F. Coburn PhD

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An Interim Evaluation Report of the Innovative Projects Portfolio of the Flex Program (FMT Briefing Paper #37), Sara Kahn-Troster MPH; John A. Gale MS; Anush Yousefian Hansen MS,MA; and Andrew F. Coburn PhD

2017

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State Flex Program Rural EMS Assessment Strategies (FMT Policy Brief #46), Karen B. Pearson MLIS, MA; John A. Gale MS; Sara Kahn-Troster MPH; and Andrew F. Coburn PhD

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After Closure: Options for Pursuing a High Performance Rural Health System, Andrew F. Coburn PhD

2016

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Comparing the Community Benefit Spending of CAHs, Other Rural, and Urban Hospitals (FMT Policy Brief #45), John A. Gale MS, Zach T. Croll, Andrew F. Coburn PhD, and Jamar Croom MS

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Community Impact and Benefit Activities of CAHs, Other Rural, and Urban Hospitals, 2014, Zach T. Croll MPH, Lauren Zoll MPH, John A. Gale MPH, and Andrew F. Coburn PhD

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Population Health Strategies of CAHs (FMT Briefing Paper #36), John A. Gale MS; Andrew F. Coburn PhD; Karen B. Pearson MLIS, MA; Zachariah T. Croll MPH; and George Shaler MPH

2015

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CAH-Relevant Measures for Health System Development & Population Health (Policy Brief #42), John A. Gale MS, Andrew F. Coburn PhD, and Zach T. Croll MPH

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Charity Care and Uncompensated Care Activities of Tax-Exempt Critical Access Hospitals (FMT Briefing Paper #35), John A. Gale MS, Jamar Croom MS, Zach T. Croll MPH, and Andrew F. Coburn PhD

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Charity Care and Uncompensated Care Activities of Tax-Exempt Critical Access Hospitals (FMT Policy Brief #38), John Gale MS, Jamar Croom MS, Zach T. Croll MPH, and Andrew F. Coburn PhD

2014

Turning around the struggling rural hospital: Shared responsibility and hard work, John A. Gale MS

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Collaborative Community Health Needs Assessments: Approaches and Benefits for Critical Access Hospitals (FMT Policy Brief #36), John A. Gale MS, Andrew F. Coburn PhD, and Helen E. Newton BA

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Community Paramedicine in Rural Areas: State and Local Findings and the Role of the State Flex Program (Policy Brief #35), Karen B. Pearson MLIS, MA; John A. Gale MS; and George Shaler MPH

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The Evidence for Community Paramedicine in Rural Areas: State and Local Findings and the Role of the State Flex Program (Briefing Paper #34), Karen B. Pearson MLIS, MA; John A. Gale MS; and George Shaler MPH

2013

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Emergency Transfers of the Elderly from Nursing Facilities to CAHs (Policy Brief #32), Karen B. Pearson MLIS, MA and Andrew F. Coburn PhD

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Rural acute myocardial infarction survey (RAMIS), Nikiah Nudell BA, NRP; Tom Bouthillet NREMT-P; Don Rice MD; John A. Gale MS; and Gary Wingrove EMT-P

2012

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Evidence-Based Falls Prevention in CAHs (Policy Brief #24), Karen B. Pearson MLIS, MA and Andrew F. Coburn PhD

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Why Do Some CAHs Close Their Skilled Nursing Facility Services While Others Retain Them? (Briefing Paper #32), John A. Gale MS; Zach T. Croll MPH; Andrew F. Coburn PhD; and Walter R. Gregg MA, MPH

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Why Do Some CAHs Close Their Skilled Nursing Facility Services While Others Retain Them? (Policy Brief #31), John A. Gale MS; Zach T. Croll MPH; Andrew F. Coburn PhD; and Walter Gregg MA, MPH

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Community Benefit Activities of CAHs, Non-Metropolitan Hospitals, and Metropolitan Hospitals, 2010, Zach T. Croll MPH, John A. Gale MS, and Andrew F. Coburn PhD

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Promoting a Culture of Safety: Use of the Hospital Survey on Patient Safety Culture in CAHs (Policy Brief #27), Andrew F. Coburn PhD; Zach T. Croll MPH; and Karen B. Pearson MLIS, MA

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Promoting a Culture of Safety: Use of the Hospital Survey on Patient Safety Culture in CAHs (Briefing Paper #30), Zach T. Croll MPH; Andrew F. Coburn PhD; and Karen B. Pearson MLIS, MA

2011

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Developing Regional STEMI Systems of Care: A Review of the Evidence and the Role of the Flex Program (Policy Brief #23), John A. Gale MS

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Improving Hospital Patient Safety Through Teamwork: The Use of TeamSTEPPS in CAHs (Policy Brief #21), Andrew F. Coburn PhD and Zach T. Croll BA

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Provision of Long Term Care Services by CAHs: Are Things Changing? (Policy Brief #19), Melanie Race MS, John A. Gale MS, and Andrew F. Coburn PhD

2010

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The Role of State Flex Programs in Supporting Quality Improvement in CAHs (Policy Brief #16), Andrew F. Coburn PhD; John A. Gale MS; Mark Richards BA; and Anush Yousefian Hansen MS,MA

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State Initiatives Funded by the Medicare Rural Hospital Flexibility Grant Program (Policy Brief #3), Melanie Race MS, John A. Gale MS, and Andrew F. Coburn PhD

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Monitoring the Community Benefits of CAHs: A Review of the Data (Briefing Paper #24), John A. Gale MS, Melanie M. Race MS, and Andrew F. Coburn PhD

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Models for Quality Improvement in CAHs: The Role of State Flex Programs (Briefing Paper #25), Andrew F. Coburn PhD; John A. Gale MS; Mark Richards BA; Anush Yousefian Hansen MS, MA; and Melanie Race MS

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Community Benefit Activities of CAHs, Non-Metropolitan Hospitals, and Metropolitan Hospitals, 2007, Melanie Race MS, John A. Gale MS, and Andrew F. Coburn PhD

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Monitoring the Community Benefits of CAHs: A Review of the Data (Policy Brief #13), Melanie M. Race MS, John Gale MS, and Andrew F. Coburn PhD

2009

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A community benefit reporting toolkit for critical access hospitals, John A. Gale MS and Melanie Race MS

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Policy Issues Affecting Maine’s Hospitals, John A. Gale MS and Jennifer D. Lenardson MHS

2008

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Developing Indicators to Document the Community Impact of CAHs (Policy Brief #7), John A. Gale MS, Jennifer D. Lenardson MHS, Andrew F. Coburn PhD, and Melanie M. Race MS

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The Community Benefit and Impact of CAHs: Results of the 2007 CAH Survey (Briefing Paper #19), Stephanie L. Loux MS, Andrew F. Coburn PhD, John A. Gale, and Jennifer D. Lenardson MHS

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The Community Benefit and Impact of CAHs: the Results of the 2007 CAH Survey (Policy Brief #6), Stephanie L. Loux MS, Andrew F. Coburn PhD, John A. Gale MS, and Jennifer D. Lenardson MHS

2007

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State Initiatives Funded by the Medicare Rural Hospital Flexibility Grant Program (Briefing Paper #15), John Gale MS; Jennifer D. Lenardson MHS; Melanie M. Race MS; Walter Gregg MA, MPH; Michelle M. Casey; Indira Richardson; and Stephen Rutledge

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The Community Impact of CAHs (Policy Brief #2), John A. Gale MS; Andrew F. Coburn PhD; Victoria Freeman DrPH; Walter Gregg MA, MPH; and Rebecca Slifkin PhD

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Exploring the Community Impact of CAHs (Briefing Paper #14), John A. Gale MS; Andrew F. Coburn PhD; Victoria Freeman DrPH; Walter Gregg MA, MPH; and Rebecca Slifkin PhD

2006

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Quality and Performance Improvement Grant Activities Under the Flex Program (Briefing Paper #12), Jennifer D. Lenardson MHS and John A. Gale MS

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Creating Progam Logic Models: A Toolkit for State Flex Programs, John A. Gale MS, Andrew F. Coburn PhD, and Stephanie Loux MS

Rural Hospitals and Long-term Care: The Challenges of Diversification and Integration Strategies, Andrew F. Coburn PhD, Stephenie Loux MS, and Elise J. Bolda PhD

2005

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Scope of services offered by Critical Access Hospitals: Results of the 2004 National CAH survey, David Hartley PhD, MHA and Stephenie L. Loux MS

2001

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A Review of State Flex Program Plans 2004-2005 (Briefing Paper #10), Stephanie L. Loux MS; John A. Gale MS; Anush Yousefian Hansen MS,MA; Andrew F. Coburn PhD; and Walter Gregg MA, MPH