Flex Program Information
Background
The Balanced Budget Act of 1997 established the Medicare Rural Hospital Flexibility Program (Flex), creating the Critical Access Hospital (CAH) as a new Medicare provider type eligible for cost-based reimbursement. The Flex Program provides funding to the States to assist in the designation of Critical Access Hospitals and the development of rural networks to improve access to care. This program is based on the experiences of demonstration projects from the early 1990s where States developed networks of limited-service hospitals and other providers to improve access to care in rural areas. The Flex Program makes it possible for Wisconsin to provide technical assistance to hospitals interested in obtaining CAH status, and to assist in the application and certification process, including the hospital survey.
Each state is required to develop a rural health plan that provides the guiding principles of implementing the statewide conversion of hospitals to CAH status. The Wisconsin Rural Health Plan was developed based upon the recommendations of a Critical Access Hospital Coalition. The Coalition is comprised of representatives from CAH hospitals and applicants, Wisconsin Department of Health and Family Services (DHFS), the Wisconsin Office of Rural Health (WORH), Wisconsin Health & Hospital Association (WHA), and the Rural Wisconsin Health Cooperative (RWHC). The Coalition is responsible for the development, annual review, and revisions of the State Rural Health plan. In addition, the Coalition functions for multiple purposes that include:
- Sharing information concerning the process for CAH certification and reimbursement;
- Planning for the use of federal grant funds;
- Monitoring the progress of the Wisconsin Critical Access Hospital program;
- Approving the annual grant submitted to the Federal Office of Rural Health Policy.
The CAH Coalition also plans and conducts regular meetings, workshops, and teleconferences throughout the year. The purpose of this programming is to assist hospital applicants in the process of attaining CAH certification and to reinforce national priorities of rural health delivery networks, emergency medical service delivery, telecommunications, staff training, and quality improvement.
The Wisconsin Flex Program currently focuses on supporting and sustaining small rural hospitals, small rural hospital performance improvement, small rural hospital quality improvement, EMS development, network development, local health systems development, and program planning and evaluation. Services are available for CAH conversion activities; however, few to no small rural hospitals continue to be eligible for CAH status in the state.
As of August 2007, Wisconsin has 59 CAHs, far above the national average of 28.5 CAHs per state.5 Over the past eight years, the Wisconsin Flex Program has directed the majority of its federal funding to assist small rural hospitals with their conversion to CAH status and to support and sustain small rural hospitals, including quality improvement related initiatives. This assistance has been in the form of technical assistance, training, workshops, financial feasibility studies, and grants. The remaining funding has supported:
- Administrative capacity to manage and operate Wisconsin’s Flex Program and create networking opportunities for program stakeholders
- Network development, including the development of a health information technology network
- EMS training and resources development
- Workforce development
- Local health services/infrastructure development
- Health promotion/disease prevention activities
- Program planning activities
- Program evaluation activities
