Medicare Rural Hospital Flexibility Program – Emergency Medical Services Supplement

The Medicare Rural Hospital Flexibility Program – Emergency Medical Services Supplement (HRSA-24-006) is a competitive funding opportunity administered by the U.S. Department of Health and Human Services, through the Health Resources and Services Administration (HRSA), specifically its Federal Office of Rural Health Policy. This supplement builds upon the existing Medicare Rural Hospital Flexibility Program (Flex Program) and is intended to enhance emergency medical services (EMS) in rural communities by providing financial support to eligible state-level Flex Program recipients. The main objective is to support the EMS workforce through recruitment and retention initiatives, operational improvements, and financial strategies tailored to the unique challenges of rural healthcare environments. The EMS Supplement addresses ongoing concerns in rural EMS systems, including dwindling volunteer staff, limited financial support from local governments, and heightened certification requirements for EMS personnel. Many rural communities also experience what are termed “ambulance deserts,” where individuals live more than 25 minutes away from an EMS station, creating a gap in access to emergency healthcare. Through this supplement, states can implement targeted EMS workforce projects such as establishing career advancement paths, forming partnerships with schools to attract students, offering training on EMS billing systems, updating billing software, creating cost-sharing billing agreements, and providing support for certification and mental health services for EMS personnel. Eligible applicants are strictly limited to current state recipients funded under HRSA-24-002, which governs the main Flex Program. This means only states that have been previously awarded a Flex Program cooperative agreement under HRSA-24-002 can apply for this EMS-specific supplemental funding. Applications must demonstrate how the proposed EMS initiatives differ from the primary Flex Program work plan and must include participation letters from at least five rural EMS agencies, particularly those with staffing shortages or low billing utilization. The award mechanism is a cooperative agreement, meaning that HRSA maintains a level of involvement throughout the funding period. The funding ceiling for each recipient is $250,000 annually, with a total of approximately $2,000,000 available for the entire program in fiscal year 2024. HRSA anticipates awarding eight cooperative agreements under this notice. The project period is five years, starting on September 1, 2024, and ending on August 31, 2029. Funds cannot be used for direct patient services, ambulance purchases, real property, or high-cost software and equipment. Applications must be submitted electronically via Grants.gov by April 26, 2024. There are no pre-application requirements such as a letter of intent. HRSA hosted a technical assistance webinar on February 7, 2024, and the recording is available upon request. All applicants must maintain active registration in both SAM.gov and Grants.gov, and ensure that the entity administrator listed is an employee or officer of the organization. Evaluation of applications will be based on six criteria: Need, Response, Evaluative Measures, Impact, Resources/Capabilities, and Support Requested. Proposals should include a comprehensive work plan, strategies for ongoing improvement, and documentation of partnerships with rural EMS providers. Award notifications are expected around the start date of the performance period. For technical questions, applicants may contact Tahleah Chappel, Public Health Analyst at the Hospital State Division, Federal Office of Rural Health Policy, via email at TChappel@hrsa.gov or by phone at 301-443-0197.

Ensure strong letters of support from at least five rural EMS agencies, demonstrate clear distinction from the HRSA-24-002 base Flex workplan, and include evaluation metrics in the work plan.