The Rural Hospital Flexibility Program (Flex) engages state designated entities in activities relating to planning and implementing rural health care plans and networks; designating facilities as Critical Access Hospitals (CAHs); providing support for CAHs for quality improvement, quality reporting,

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performance improvements, and benchmarking; and integrating rural emergency medical services (EMS).

Specifically, the Flex program provides funding for states to support technical assistance activities to improve the quality of health care provided by CAHs, the financial stability and sustainability of CAHs, the integration of emergency medical services (EMS), and the health of rural communities.

State Flex programs also assist in the conversion of qualified small rural hospitals to CAH status and support the integration of value based payment and innovative health care models in rural communities.

State designated Flex Programs will act as a resource and focal point for these activities, ensuring people in rural communities have access to high quality health care services.

The Rural Veterans Health Access Program provides funding to states to coordinate activities to provide rural veterans access to services for needed mental health care via the use of networks, electronic communication and telehealth networks.The program targets states with high percentages of veterans to the total population.

Selected Recipients for this Program

Not Applicable.

Uses and Use Restrictions

All funds awarded are to be expended solely for the purposes outlined in the approved projects.

Administrative (indirect) expenses are limited to the lesser of 15 percent of the award or the state?s federally negotiated indirect rate for administering the award.

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Eligibility Requirements

Applicant Eligibility

Flex and Rural Veterans Grants: Only states with certified Critical Access Hospitals are eligible for this Grant Program.

The Governor designates the eligible applicant from each state.

All other states need to submit an application to the Regional Administrator of their CMS Regional Office that expresses the state's interest in developing a Medicare Rural Hospital Flexibility Program before they can apply for grant funds.

Beneficiary Eligibility

States with at least one hospital located in a non-metropolitan statistical area or county and provides CMS with necessary assurances.

Credentials/Documentation

Applicants should review the individual HRSA funding opportunity announcement issued under this CFDA program for any required proof or certifications which must be submitted prior to or simultaneous with submission of an application package. 2 CFR 200, Subpart E - Cost Principles applies to this program.

Aplication and Award Process

Preapplication Coordination

Preapplication coordination is required.

Environmental impact information is not required for this program.

This program is excluded from coverage under E.O.

12372.

Application Procedures

2 CFR 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards applies to this program. HRSA requires all applicants to apply electronically through Grants.gov. All qualified applications will be forwarded to an objective review committee. Based on the advice of the objective review committee, the HRSA program official with delegated authority is responsible for final selection and funding decisions.

Award Procedures

All qualified applications will be forwarded to an objective review committee. Based on the advice of the objective review committee, the HRSA program official with delegated authority is responsible for final selection and funding decisions.

Deadlines

Contact the headquarters or regional office, as appropriate, for application deadlines.

Authorization

Title XVIII, §1820(g)(1) and (2) of the Social Security Act (42 U.S.C. 1395i-4), as amended; Consolidated Appropriations Act, 2016 (P.L. 114-113).

Range of Approval/Disapproval Time

6 months.

Appeals

Not Applicable.

Renewals

The Medicare Rural Hospital Flexibility Grant Program awards may be made for up to 4-year project periods. Subject to availability of funds, after initial awards, projects may be renewed non-competitively contingent upon submission and approval of an application, availability of appropriated funds, and awardee?s satisfactory performance. The Rural Veterans Health Access Program ? awards may be made for up to 3-year project periods. Subject to availability of funds, after initial awards, projects may be renewed non-competitively contingent upon submission and approval of an application, availability of appropriated funds, and awardee?s satisfactory performance.

Assistance Considerations

Formula and Matching Requirements

This program has no statutory formula. This program has no matching requirements. This program does not have MOE requirements.

Length and Time Phasing of Assistance

Awards are made annually. Funds are available to awardees on an as needed basis throughout the budget period and payments are made through the DHHS Payment Management System. See the following for information on how assistance is awarded/released: See the following for information on how assistance is awarded/released: Awardee drawdown funds, as necessary, from the Payment Management System (PMS). PMS is the centralized web based payment system for HHS awards.

Post Assistance Requirements

Reports

The awardee will be required to submit performance and progress reports as well as federal financial reports (see the program announcement and notice of award for details for each required report).

The awardee must submit a quarterly electronic Federal Financial Report (FFR) Cash Transaction Report via the Payment Management System within 30 days of the end of each calendar quarter.

A Federal Financial Report (SF-425) according to the following schedule: http://www.hrsa.gov/grants/manage/technicalassistance/federalfinancialreport/ffrschedule.pdf.

A final report is due within 90 days after the project period ends.

If applicable, the awardee must submit a Tangible Personal Property Report (SF-428) and any related forms within 90 days after the project period ends.

New awards (?Type 1?) issued under this notice of funding opportunity are subject to the reporting requirements of the Federal Funding Accountability and Transparency Act (FFATA) of 2006 (Pub.

L.

109?282), as amended by section 6202 of Public Law 110?252, and implemented by 2 CFR Part 170.

Grant and cooperative agreement recipients must report information for each first-tier subaward of $25,000 or more in federal funds and executive total compensation for the recipient?s and subrecipient?s five most highly compensated executives as outlined in Appendix A to 2 CFR Part 170 (FFATA details are available online at http://www.hrsa.gov/grants/ffata.html).

Competing continuation awardees, etc.

may be subject to this requirement and will be so notified in the Notice of Award.

For the Rural Veterans Health Access Program and the Medicare Rural Hospital Flexibility Grant Program, an annual Performance Information Management System data report is due within 60 days of the end of the budget period.

A final program report is to be submitted within 90 days after the close of the project period.

Awardees in the Medicare Rural Hospital Flexibility Grant Program are required to participate in activities related to the Flex Program Evaluation Cooperative Agreement.

No cash reports are required.

Refer to notice of funding opportunity .

No expenditure reports are required.

No performance monitoring is required.

Audits

In accordance with the provisions of 2 CFR 200, Subpart F - Audit Requirements, non-Federal entities that expend financial assistance of $750,000 or more in Federal awards will have a single or a program-specific audit conducted for that year. Non-Federal entities that expend less than $750,000 a year in Federal awards are exempt from Federal audit requirements for that year, except as noted in 2 CFR 200.503. In accordance with the provisions of 2 CFR 200, Subpart F - Audit Requirements, non-federal entities that expend financial assistance of $750,000 or more in federal awards will have a single or a program-specific audit conducted for that year. Non-federal entities that expend less than $750,000 a year in federal awards are exempt from federal audit requirements for that year, except as noted in 2 CFR 200.503.

Records

Awardees are required to maintain grant accounting records for 3 years after the date they submit the Federal Financial Report (FFR). If any litigation, claim, negotiation, audit, or other action involving the award has been started before the expiration of the 3-year period, the records shall be retained until completion of the action and resolution of all issues which arise from it, or until the end of the regular 3-year period, whichever is later.

Financial Information

Account Identification

75-0350-0-1-550.

Obigations

(Project Grants) FY 16 $23,659,822; FY 17 est $23,659,822; and FY 18 Estimate Not Available - Medicare Rural Hospital Flexibility Grant Program. (Project Grants) FY 16 $900,000; FY 17 est $900,000; and FY 18 Estimate Not Available - Rural Veterans Health Access Program.

Range and Average of Financial Assistance

Medicare Rural Hospital Flexibility Grant Program $298,795 to $754,133; Average, $525,774 Rural Veterans Health Access Program: $300,000.

Regulations, Guidelines, and Literature

This program is subject to the provisions of 45 CFR Part 92 for state, local and tribal governments and 45 CFR Part 74 for institutions of higher education, hospitals, other nonprofit organizations and commercial organizations, as applicable. HRSA awards are subject to the requirements of the HHS Grants Policy Statement (HHS GPS) that are applicable based on recipient type and purpose of award. The HHS GPS is available at https://www.hrsa.gov/grants/hhsgrantspolicy.pdf.

Information Contacts

Regional or Local Office

See Regional Agency Offices. See Regional Agency Offices. Medicare Rural Hospital Flexibility Program Contact: Sarah Young, Federal Office of Rural Health Policy, Health Resources and Services Administration, 5600 Fishers Lane, Room 17W49D, Rockville, MD 20857. Telephone:(301) 443-5905 . Rural Veterans Health Access Program ? Program Contact: Anthony Oliver, Federal Office of Rural Health Policy, Health Resources and Services Administration, 5600 Fishers Lane, Room 17W13C, Rockville, MD 20857. Telephone:(301) 443-2919 .

Headquarters Office

Federal Office of Rural Health Policy, 5600 Fishers Lane, Room 17W59D, Rockville, Maryland 20857 Phone: (301) 443-0835.

Criteria for Selecting Proposals

Contact Headquarters for selection criteria.