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H H S Department of Health and Human Services
Health Resources and Services Administration
Rural Health

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Hospital State Division

The Hospital State Division works to improve and maintain access to high quality health care in rural areas through strategic partnerships. Ten project officers manage grants, cooperative agreements and contracts to strengthen the role of state offices of rural health and their support to rural communities, particularly with rural hospitals. ORHP administers three grant programs within the Hospital State Division (HSD). The grant programs are; 1) Medicare Rural Hospital Flexibility (Flex) Program; 2) Small Rural Hospital Improvement Program (SHIP); 3) the State Offices of Rural Health (SORH) Grant Program. See individual grant programs on the left for more details.

In 2014, there were 142 grants awarded in the three primary grant programs with a budget of nearly $46 million. In addition to the above grants, Division staff members manage a wide range of cooperative agreements and contracts that support states with technical assistance, recruitment of health care providers, assistance in attaining funds to build replacement facilities and other activities.

HSD Structure

Each project officer is assigned to a specific state, and provides oversight to all of the HSD grants in that state. The states are organized into regions, and each region has two project officers. The regional structure provides an opportunity for a small number of grantees to get updates on Federal activities and learn about activities in a discussion format, both via conference call and in person. Find a regional liaison that can assist you.

Technical Assistance and Evaluation

In addition to the Project officers, ORHP also provides additional technical assistance to grantees, and other constituents, through cooperative agreements and contracts.

Support for Flex Grantees

  • Technical Assistance and Support Center exit disclaimer (TASC) provides expert guidance to Rural Hospital Flexibility Program (Flex Program) grantees in such areas as Medicare reimbursement policies, Federal regulations, and hospital operations. The staff of ORHP works closely with TASC to prioritize key issues and develop information resources to share with Flex grantees.
  • Flex Monitoring Team exit disclaimer (FMT) is a consortium of three rural health research centers: Southern Maine University, University of Minnesota, and University of North Carolina Sheps Center, whose purpose is to monitor and evaluate the Flex Grant Program and to make recommendations for improving the program. Since 1997 when the Flex Monitoring Team first started, an important body of knowledge has been produced about rural health care, rural hospital financial issues, network development, EMS, quality improvement, and community impact.  

Support for State Offices of Rural Health

National Organization of State Offices of Rural Health exit disclaimer (NOSORH) enhances the rural health infrastructure in each State by providing guidance and technical assistance to State Offices of Rural Health (SORHs) as well as their partners and to identify and promote best practices. The goals of the SRHCD-CA are 1) to assist in the coordination of health care delivery through the development of State level rural health leadership; and 2) to facilitate partnerships and collaboration at the national and State levels to improve the exchange of information and engage in collaborative activities for supporting rural health.

Support to Rural Hospitals in the Delta Region 

From 2001 through September, 2014, the Federal Office of Rural Health Policy provided ongoing technical assistance to historically distressed rural hospitals in the Mississippi Delta Region, as defined by the Delta Regional Authority. The program focused on improving financial, operational, and clinical performance through remote and on-site consultative services for hospitals that otherwise would not have had the resources to afford these needed services. More on the Rural Hospital Performance Improvement (RHPI) project>

Support to Small Rural Hospitals Residing in Areas of Persistent Poverty

The Small Rural Hospital Transitions Project (SRHTP) assists small rural hospitals in bridging gaps between the current health care system and the newly emerging system of healthcare delivery and payment.  On-site technical assistance is provided to small rural hospitals with fewer than 50 staffed beds residing in persistent poverty areas of the U.S. Technical assistance activities will  target: financial assessments, creating a quality-focused environment, aligning services to community need, and to the extent that financial and quality core areas have been stabilized, providing assistance to help recipients of technical assistance consider factors that would make them logical participants in health care systems that focus on value. More information on eligibility and participation requirements>

Find Your Regional Liaison