Utah Flex:

• supports hospitals in evaluating outcomes like patient satisfaction, safe antibiotic use, and emergency patient care,
• provides targeted support for small rural hospitals’ needs, and
• provides population health program improvement opportunities.

To be eligible for Utah Flex funding, a facility must be a Critical Access Hospital (CAH) that is participating in the Medicare Beneficiary Quality Improvement Program (MBQIP). A Critical Access Hospital is a federal designation that allows a hospital to be reimbursed on a reasonable cost basis for services provided to Medicare and Medicaid patients.

The Medicare Beneficiary Quality Improvement Project (MBQIP) encourages Critical Access Hospitals (CAHs) to report on a core set of measures and to engage in quality improvement initiatives. MBQIP is divided into four domains:

• patient safety/inpatient,
• patient engagement,
• care transitions, and
• outpatient.

More than 135 rural hospitals across the country have closed since 2010. The REH designation was created to address mounting concerns around closures of rural hospitals. Beginning in January 2023, eligible hospitals may seek an REH designation, which would result in an increase in Medicare reimbursement for relevant outpatient services and a monthly facility payment.

REH designation allows rural hospitals to offer services falling in between the requirements of a traditional acute care hospital and an ambulatory care facility.

To be eligible for REH designation, hospitals must:

1. be a critical access hospital (CAH) or a rural prospective payment system (PPS) hospital,
2. have 50 or fewer beds,
3. be located in a rural area (or have an active rural reclassification), and
4. provide emergency services and observation.

REH-eligible hospitals may provide additional medical and health outpatient services while not exceeding an annual per patient average visit length of 24 hours.