The State Office of Rural Health (SORH) manages several federal grants to support rural hospitals and other health care providers remain sustainable over time and make the transition to value-based reimbursement.

Flex - Medicare Rural Hospital Flexibility (Flex) Program

The purpose of the Flex program is to support the long-term sustainability of critical access hospitals (CAHs) and related health services in rural areas across the nation.

Funded by HRSA, this ongoing grant program supports CAHs and statewide partners to improve quality of care, finances/operations, population health, emergency medical services (EMS) and/or supporting hospital transition to other organizational models that might better serve their communities.

The budget period for this grant runs from Sept 1 to Aug 31 each year. Sub-grant interim reports are quarterly and a final report is due in mid-September.

Current/recent funded projects:

Vermont Program for Quality in Health Care, Inc. (VPQHC) – technical assistance and peer learning to support data reporting, quality improvement, CMS Conditions of Participation Survey (COPS) readiness,

Also:  health equity trainings, and establishment of telehealth services and equipment, and development quality framework development, suicide prevention planning in emergency departments.

Vermont Ethics Network (VEN) – staff/provider training on end-of-life planning and ethical decision-making; translation of key End-of-life documents into multiple languages, including for the hearing and visually impaired.

New England Rural Health Association (NERHA) – access to professional development courses through Institute for Healthcare Improvement (IHI), certification courses, regional conferences and webinars related to rural health care.

CAH-specific projects (when funding allows) – partial reimbursement of costs related to revenue cycle management improvement, chargemaster updates and process improvements.

SHIP - Small Rural Hospital Improvement Program (SHIP)

The purpose of the SHIP is to support small rural hospitals to make the transition to value-based payments and full participation in Accountable Care Organizations (ACOs).


Allowable investments by eligible hospitals (fewer than 50 beds) under this program include:  software and training related to value-based purchasing, shared savings or ACO participation, or bundled payments.  HCAHPS data collection reimbursement, …

Eligible entities: Critical Access Hospitals (CAHs) & Brattleboro Memorial Hospital

The budget period for this grant runs from June 1 to May 31 each year. Sub-grant interim reports are required semi-annually and a final report is due in early June.

Typical sub-grant amounts are around $12,000/hospital, reimbursed in January & June.

Current/recent funded projects:

Reimbursing expenses for HCAHPS data collection and improvement

Staff training to improve care and services for homeless and/or LGBTQI persons

Other projects related to:   Quality improvement or Performance Improvement

Allowable expenses at:  Allowable Investments for SHIP funds 

SHIP COVID Testing & Mitigation for Small Rural Hospitals

In response to the COVID public health emergency, HRSA provided additional funding to states to help small rural hospitals increase testing for COVID and mitigate risk of spread within their facilities. Funded under the American Recovery Plan Act (ARPA), each SHIP-eligible hospital was eligible to be reimbursed for up to $258,376 of expenses related to testing and mitigation incurred between Jan 1, 2021 to December 31, 2022. A no cost extension was provided for four Vermont hospitals until December 31, 2023.

Vermont hospitals used these funds for testing supplies, renovations to expand waiting areas or improve air quality, staffing for entry screeners and additional cleaning.

Allowable expenses at:  Allowable Investments for SHIP COVIT Testing & Mitigation funds 

State Office of Rural Health (SORH) program

The purpose of the SORH grant is to help States share information among federal, state and local partners; coordinate rural health activities; and reduce duplication among stakeholders.

Also funded by HRSA, this grant supports workforce data collection, analysis and reporting for 40+ professions; extension of Flex-funded QI, training and support to non-CAH partners through sub-grants to Vermont Program for Quality in Health Care (VPQHC), Vermont Ethics Network (VEN), New England Rural Health Association (NERHA) and other partners.


Additional Sustainability Resources

Rural Healthcare Provider Transition Project (RHPTP)

RHPTP guides small rural hospitals and certified rural health clinics as they prepare for participation in alternative payment and care delivery models.

National Rural Health Resource Center ( Resources 

The Center's searchable Resource Library features articles, reports, webinars, podcasts, toolkits, and other materials developed by trusted industry leaders to guide and support rural health stakeholders.

Flex Monitoring Team 

Several national research centers support States and rural hospitals to evaluate the impact of the Medicare Rural Hospital Flexibility grant program and provide blinded comparison data for critical access hospitals (CAHs) on quality, finances, community engagement.

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