Rural Hospital Flexibility Grant Program 2022-2023

DHHS Division/Office issuing this notice: NC Office of Rural Health

Date of this notice: September 13, 2022

Working title of the funding program: Rural Hospital Flexibility Grant Program 2022-2023

The Rural Hospital Flexibility Program (Flex Program) is a federal grant program directed to State Offices of Rural Health. The purpose of the Flex Program funds is to improve the quality of care provided by CAHs by focusing on improvement of financial and operational implementation, quality metrics, and management of population health according to performance measures as defined by the Federal Office of Rural Health Policy.

Rural Emergency Hospitals (REHs) are a new provider type established by the Consolidated Appropriations Act, 2021 to address the growing concern over closures of rural hospitals. The REH designation provides an opportunity for Critical Access Hospitals (CAHs) and certain rural hospitals to avert potential closure and continue to provide essential services for the communities they serve. Conversion to an REH allows for the provision of emergency services, observation care, and additional medical and health outpatient services, if elected by the REH, that do not exceed an annual per patient average of 24 hours. This new provider type, effective January 1, 2023, will promote equity in health care for those living in rural communities by facilitating access to needed services. REHs are facilities that convert from either a critical access hospital (CAH) or a rural hospital with less than 50 beds.

The creation of the REH designation provides an option for rural communities to ensure access to essential health services, including emergency care. Rural communities will need assistance to assess the viability of this option for meeting local need and how it fits into the larger rural framework. This grant will be awarded to an organization or organizations that create a plan to perform the following activities:

  • Convene rural hospitals with 50 beds or less in North Carolina to perform outreach and education to eligible hospitals on the Rural Emergency Hospital Model.
  • Scale and implementation: Assess hospital conversions and provide the technical assistance needed to convert to an REH hospital.
  • Financial and operational site assessments: Applicant facilities and their communities will need to do a significant amount of financial analysis to ensure that the REH will be financially viable and sustainable for their community.
  • Coordinate activities with the National Technical Assistance Center (see below) (Activities through this appropriation will consist of technical assistance provided by a Rural Emergency Hospital Technical Assistance Center (HRSA-22-167) and share resources developed through the national REH TA Center and engage state and regional partners) 

The maximum total per grant year not to exceed $54,672. All funding must be expended by August 31, 2023. (funding amount is dependent on federal allocation)

How to Apply: Using the link provided below, you will enter your contact information and a personalized link to the application will be sent to the e-mail address you provide:

Deadline for Submission: Grant applications must be electronically received and submitted within the Qualtrics survey link, or by the individual listed below, by 5:00 PM September 23, 2022. Only electronic copies will be accepted. Incomplete applications and applications not completed in accordance with the following instructions will not be reviewed. Applications received after the 5:00 PM deadline on September 23, 2022, will not be reviewed.

How to Obtain Further Information: Questions regarding the grant application may be directed to Nick Galvez at