Office of Rural Health Policy Rural Hospital Flexibility Grant Program

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Office of Rural Health PolicyRural Hospital
Flexibility Grant Program

• Steven Hirsch
• Office of Rural Health Policy (ORHP)
• Health Resources Services Administration (HRSA)
• U.S. Department of Health Human Services (HHS)
• Sept. 1, 2009

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The Rural Hospital Flexibility (Flex) Program

• The Balanced Budget Act of 1997 (BBA) established
  the Flex Program and it was reauthorized in 2008.
• The Flex Program consists of two separate
  components
• A State grant program administered by ORHP to
  support the development of community-based,
  rural, organized systems of care in the
  participating States.
• Cost-based reimbursement for certified Critical
  Access Hospitals (CAH)

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Legislative Authority

• Medicare rural hospital flexibility program.The
  Secretary may award grants to States that have
  submitted applications in accordance with
  subsection (b) for
• (A) engaging in activities relating to planning
  and implementing a rural health care plan
• (B) engaging in activities relating to planning
  and implementing rural health networks
• (C) designating facilities as critical access
  hospitals and
• (D) providing support for critical access
  hospitals for quality improvement, quality
  reporting, performance improvements, and
  benchmarking.

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Legislative Authority

• Rural emergency medical services.
• (A) In general.The Secretary may award grants to
  States that have submitted applications in
  accordance with subparagraph (B) for the
  establishment or expansion of a program for the
  provision of rural emergency medical services.

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FY2010 Competitive Cycle

• Five Year Grant Period
• Legislation increases emphasis on quality
  improvement, quality reporting, performance
  improvements, and benchmarking
• Targeting Flex funds to make a demonstrable
  difference

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A Different Flex Meeting

• Concentrating on Flex Programs, not CAHs
• Aimed at Flex Personnel
• More Presentations by and for Flex Programs

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Other CAH/Flex Meetings
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Survey conducted by David Blackley,Intern from
East Carolina University
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Flex Coordinator Survey
Q Commensurate with the needs of your state,
rank the 7 Flex objectives from most to least
vital, with 1 representing most vital and 7
representing least vital

• Results (n28 responses)
• Performance Improvement/Quality Improvement
  (mean1.74)
• Support Hospitals (1.89)
• Integration of EMS Services (3.33)
• Networking (3.85)
• Evaluation (4.81)
• Update of the SRHP (5.93)
• Conversion of Hospitals to CAH Status (6.44)

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How does this compare with how the money is
actually allocated for the objectives?

• Support Hospitals (4,827,304)
• Performance Improvement/Quality Improvement
  (4,814,735)
• Integration of EMS Services (2,484,610)
• Networking (2,426,878)
• Evaluation (815,629)
• Update of the SRHP (469,342)
• Conversion of Hospitals to CAH Status (240,787)
• HIT not ranked as it was not an objective in the
  Program Guidance. HIT constitutes about 2 of
  proposed spending for 2009.

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Proposed Flex Spending 2009
Results from all Flex grantees (n45)
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Q What do you perceive to be the largest
barrier to effective use of Flex funds?

• lack the ability to fund multi-year projects.
• A multi-year grant or an abbreviated
  versionwould allow us to still assess where we
  are and where we are going without committing as
  much time and resources
• each years grant is written 6 months
  beforedifficult to plan and initiate
  activitiesdifficult to respond to needs as they
  arise
• Short turnaround time between receiving grant
  guidance and due date2 weeks for internal review
  and 2 weeks for Directors approvalwe really
  have 2 weeks to put the application together
• Time - It is always a struggle to complete all
  the needed projects within the one-year grant
  period.

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Q What do you perceive to be the largest
barrier to effective use of Flex funds?

• We could use some more guidance from ORHP in
  describing best practices and model activities in
  leading national Flex Programs.
• Steep learning curve for new Flex coordinator
• CEO buy-in/commitmentis often weak.
• Limitations on EMS activities
• Voluntary choice for participation by the client
  population

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Q What do you perceive to be the largest
barrier to effective use of Flex funds?

• Lack of strategic planning across HRSA funded
  programsspend large amounts of time identifying
  where projects/activities intersect
• Indirect Costs
• The State Bureaucratic system for obtaining
  approval to spend anything
• Internal state procedures
• lack of ability for direct program staff
  controlof funds

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Resources for Flex Grantees
http//www.ruralcenter.org/tasc/
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Resources for Flex Grantees

• Visits to other State Flex Programs
• Flex Orientation at TASC
• Project Officers
• Grants Management Specialists
• NOSORH

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Regional Liaisons
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Contact Information

• Steven Hirsch
• Office of Rural Health Policy
• 5600 Fishers Lane, 9A-55
• Rockville MD 20857
• [phone], Fax [phone]
• shirsch_at_hrsa.gov
• www.ruralheath.hrsa.gov