Skip navigation links


The Medicare Rural Hospital Flexibility Program (Flex Program), created by Congress in 1997, allows small hospitals to be licensed as Critical Access Hospitals (CAHs) and offers grants to States to help implement initiatives to strengthen the rural health care infrastructure.

To participate in the Flex Program, States are required to develop a rural health care plan that provides for the creation of one or more rural health networks, promotes regionalization of rural health services in the State, and improves the quality of and access to hospital and other health services for rural residents of the State. Consistent with their rural health care plans, states may designate eligible rural hospitals as CAHs.

20 Years Support of Flex


Watch Now


Rural Emergency Hospital 

Guidance for Rural Emergency Hospital Provisions, Conversion Process and Conditions of Participation

Learn More

Rural Health Redesign is the National Technical Assistance Provider for Rural Emergency Hospitals.

  • Rural Health Redesign Home Page
  • Orientation Webinar Slide Deck - The Rural Health Redesign Center (RHRC) and Mathematica, in partnership with the Health Resources and Services Administration (HRSA), hosted the Orientation to Rural Emergency Hospital (REH) Conversion and Technical Assistance webinar on January 18, 2023. 
  • CMS Memo
    •  A webinar highlighting key points from that memo in a short webinar recording (under 15 minutes). Specifically, 1.) highlighting details from the memo about three documents that are required to accompany the REH application (the action plan, transfer agreement, and conditions of participation attestation), 2.) REH distance requirements and 3.) an updated resource list for those seeking more information.
  • FAQ