Rural Hospitals (Flex Program)

Document Type

Policy Brief

Publication Date



MRHRC, Flex, Medicare Rural Hospital Flexibility Program, Critical Access Hospitals, Quality Improvement

Funding Organization or Grant

This study was conducted by the Flex Monitoring Team with funding from the federal Office of Rural Health Policy (PHS Grant No. U27RH01080)


A central goal of the Medicare Rural Hospital Flexibility (Flex) Program, as defined in the original and reauthorizing legislation, is to help Critical Access Hospitals (CAHs) develop and sustain effective quality improvement (QI) programs. In support of this goal, the Flex Grant Guidance prioritizes the development of QI and multi-CAH QI programs. Consistent with these priorities, State Flex Programs have supported a wide range of QI and patient safety initiatives including the development of statewide or regional multi-CAH QI collaboratives to promote sharing of knowledge, expertise, resources, and benchmarking data. This study examined QI activities supported by the Flex Program in nine states, assessed the role of the State Flex Programs in developing and supporting QI activities, and explored the effect of these initiatives on CAH QI efforts.