Rural Hospital Flexibility Program (FLEX)

The Medicare Rural Hospital Flexibility Grant Program, referred to as the Flex Program, was authorized by Section 4201 of the Balanced Budget Act of 1997 (BBA), Public Law 105-33 and was reauthorized by Section 121 of the Medicare Improvements for Patients and Providers Act of 2008, Public Law 110-275.

The Flex Program is designed to support improvements in the quality of health care provided in communities served by Critical Access Hospitals (CAHs) by focusing on improvement in three core areas;

(1) Hospital Performance and the Quality of Care, (2) Financial and Operational Performance (3) Encouraging health system development through the engagement of the rural community with CAHs and other care providers, and integrating rural Emergency Medical Services (EMS) into the health care system while assuring the quality of services provided.

Functional Areas

1. Improving Hospital Performance and the Quality of Care

New England Performance Imporvement (NEPI) Collaborative New England Performance Imporvement (NEPI) Collaborative
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The NEPI Collaborative is coordinated through the New England Rural Health RoundTable(NERHRT), a membership-based organization composed of a diverse group of individuals and organizations committed to improving health and health care throughout rural New England communities. More details....



Maine CAH Patient Safety Collaborative, Patient Safety Academy Maine CAH Patient Safety Collaborative, Patient Safety Academy
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The Collaborative works on common issues related to patient safety and quality improvement and serves as a forum for the development and implementation of specific quality improvement initiatives, review of best practices, future grant opportunities, shared resources and benchmarking, and policy development particular to small rural hospitals in Maine. Visit website External site

The Safer Project The Safer Project
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The SAFER Project examines the communication and information flow during transitions of care between nursing facilities, emergency medical services and critical access hospitals. Visit website External site



Maine CAH and Small Hospital Peer Review Collaborative Maine CAH and Small Hospital Peer Review Collaborative
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The goal of this project is to develop a peer review program that supports Critical Access Hospitals (CAHs) and other small rural hospitals in Maine by offering on-going professional practice evaluation.



Health Information Technology Technical Assistance Program Health Information Technology Technical Assistance Program
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The goal of this project is to introduce Health Information Technology (HIT) into hospitals and assist them in reaching Meaningful Use. Through collaboration and combining resources we are supporting hospitals to reach Meaningful Use through education, the availability of tools and resources and the opportunity to network and share best practice. This project also supports the connection to a health information exchange to further quality of patient care and the opportunity to use data for practice improvement. Maine has an operable health information exchange where providers can share patient health information for treatment purposes. This exchange is also used to gather surveillance and public health data. Connection to this exchange results in rapid access to person-specific health care data across all points of care, which improves quality of care for patients.



Medicare Beneficiary Quality Improvement Project (MBQIP) Medicare Beneficiary Quality Improvement Project (MBQIP)
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The primary goal of this project is for CAHs to implement quality improvement initiatives to improve their patient care and operations. MBQIP will provide Flex funding to support Critical Access Hospitals (CAHs) with technical assistance and national benchmarks to improve health care outcomes.



2. Improvement and Integration of EMS Services

Community Paramedicine Project Community Paramedicine Project
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This project involves the development of community paramedicine in the State as a means of addressing the need for advanced life support EMS in rural areas, while also meeting other areas of unmet need for health care in rural areas.



Maine Emergency Medical Services Trauma System Project Maine Emergency Medical Services Trauma System Project
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The goal of the Maine EMS Trauma System project is to provide guidance to CAHs and other rural emergency care providers through a statewide trauma system plan, a technical assistance program, clinical consensus guidelines for patient care and transfer, and the development and implementation of trauma care performance measures. The vision of this project is to optimize the matching of rural trauma patient care needs with resources to reduce delay in decision-making, care, transfer, and ultimately, to reduce the incidence of bad outcomes for patients and their families.



3. Development and Implementation of Rural Health Networks

Maine CAH Network Maine CAH Network
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The Maine CAH network consists of three groups: the QI Director Network, the CEO Network, and the Nurse Executive Network. The QI Director Network works on quality improvement initiatives such as the NEPI Collaborative and the Medicare Beneficiary Project (MBQIP). The CEO Network focuses on networking to stay current on the impact state and national initiatives have on their CAHs. The Nurse Executive Network meets monthly to work on quality improvement efforts such as the SAFER project. External site

Log in to the Maine CAH Network



4. Conversion of Hospitals to CAH Status

Contact for more information
Nicole Breton, Director
(207) 287-5524