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
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)
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.
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.
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
A Different Flex Meeting • Concentrating on Flex Programs, not CAHs • Aimed at Flex Personnel • More Presentations by and for Flex Programs
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: (n=28 responses) • Performance Improvement/Quality Improvement (mean=1.74) • 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)
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.
Proposed Flex Spending 2009 Results from all Flex grantees (n=45)
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 version…would allow us to still assess where we are and where we are going without committing as much time and resources…” • “…each year’s grant is written 6 months before…difficult to plan and initiate activities…difficult to respond to needs as they arise… • “Short turnaround time between receiving grant guidance and due date…2 weeks for internal review and 2 weeks for Director’s approval…we 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.”
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/commitment…is often weak.” • “Limitations on EMS activities” • “Voluntary choice for participation by the client population…”
Q: What do you perceive to be the largest barrier to effective use of Flex funds? • “Lack of strategic planning across HRSA funded programs…spend 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 control…of funds…”
Resources for Flex Grantees http://www.ruralcenter.org/tasc/
Resources for Flex Grantees • Visits to other State Flex Programs • Flex Orientation at TASC • Project Officers • Grants Management Specialists • NOSORH
Contact Information Steven Hirsch Office of Rural Health Policy 5600 Fishers Lane, 9A-55 Rockville MD 20857 (301) 443-0835, Fax (301) 443-2803 email@example.com www.ruralheath.hrsa.gov