The Rural Hospital Flexibility (Flex) Program was started in 1997. A federal initiative, it was created by the Balanced Budget Act and is credited with launching the Critical Access Hospital (CAH) program. The Flex program works to support and strengthen rural health care systems by awarding grants to state governments that can be used for such things as promoting community engagement, supporting financial and operational improvements in CAHs, or integrating EMS in regional and local health care systems.

Sara Roberts, Director of the Kansas State Office of Rural Health (SORH), and John Packham, Director of Health Policy Research in Nevada’s SORH co-chair the NOSORH Flex Committee. One of the primary functions of the committee is to help states prepare for competitive grants and assist them in managing the Flex grant once it is awarded. “What we do is provide support and assistance for the Critical Access Hospitals,” Roberts said. “That includes helping states design programs to manage their Flex grant.”

Additionally, the Flex Committee serves as a link for the Flex Coordinators in the state offices. “Every month we have anywhere from 20 to 40 people on our committee call sharing information and ideas between states.It’s a great committee call because we have Flex Coordinators, national partners and SORH guests on the line at the same time brainstorming ideas,” Roberts said.

Looking ahead, co-chair Packham is confident the Flex Committee will continue to be a valuable resource in the advancement of rural health care. “The NOSORH Flex Committee will continue to provide an important forum for Flex Coordinators to exchange ideas on what is and is not working to implement Flex-supported activities in their states,” he said. As well as “provide an opportunity for new Flex Coordinators to learn from veteran Flex Coordinators and SORHs from across the country.”


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