Overview of Rural Hospital Programs

About the State Office of Rural Health (SORH) federal programs.

The State Office of Rural Health (SORH) administers 2 federal programs for rural hospitals:

Rural Hospital Flexibility Program (Flex)

The Massachusetts (MA) Rural Hospital Flexibility Program (Flex) is managed by the MDPH State Office of Rural Health and funded by a grant from the Federal Office of Rural Health Policy at the Health Resources and Services Administration (HRSA).

The Flex Program maintains strong partnerships with small community hospitals located in rural Massachusetts communities, as well as with the Massachusetts Health and Hospital Association, Healthcentric Advisors – the Quality Innovation Network and Quality Improvement Organization (QIN-QIO) for Massachusetts, and multiple other state programs and external partners.

The primary aim of the Flex Program is to support improved operational and financial stability and viability of Massachusetts’ Critical Access Hospitals (CAHs), and several other small community hospitals, in order to improve access to quality health services across a coordinated continuum of care in rural communities.    

The Flex Program has been an important mechanism for improving the rural health infrastructure in our state by strengthening small rural hospitals and helping them to operate as the hub of a more collaborative and integrated health delivery system.

An important outcome of the Flex Program has been the development of supportive statewide rural health networks through which we provide resources and develop and implement projects. 

As our program has matured, our projects focus on rural healthcare financial, operational, and clinical quality improvement along with supporting rural healthcare providers with the implementation of health care reform’s Triple Aim. This includes transformation to a more responsive and value based healthcare delivery system, developing new innovative models of community based care and population health, and strengthening emergency medical services.

Small Rural Hospital Performance Improvement Program (SHIP)

The Federal Office of Rural Health Policy (FORHP) located within the Health Resources and Services Administration (HRSA), provides Small Rural Hospital Performance Improvement Program (SHIP) funding to the MDPH State Office of Rural Health on behalf of eligible small rural hospitals in MA. 

The purpose of the program is to help small rural hospitals of 49 acute care staffed beds or less prepare for reimbursement changes and alternative payment models and strategies supported by the Affordable Care Act (ACA).  Specifically, the program allows eligible hospitals to apply funds towards any or all of the following: 1) the purchase of equipment and/or training to meet value-based purchasing expectations, 2) joining or becoming an accountable care organization (ACO) or creating a shared savings program, 3) the purchase of health information technology, equipment, and/or training to comply with meaningful use, ICD-10 standards, and payment bundling. 

The MDPH State Office of Rural Health prepares and submits a single grant application to HRSA on behalf of all MA eligible hospitals. These hospitals typically receive between $8,000 - 10,000/each, annually, depending on available federal grant award funding in a given year.  Hospitals are strongly encouraged to participate in specific group project opportunities offered as part of the MA SHIP program, in order to maximize the impact of this funding. 

Additional Resources

Contact   for Overview of Rural Hospital Programs


Ronnie Rom, Rural Hospital Program Coordinator


(413) 784-1037


MA Department of Public Health
23 Service Center, Northampton, MA 01060

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