• State Operations Manual: Chapter 2— The Certification Process: This document from the Centers for Medicare and Medicaid Services (CMS) reviews the requirements for initial certification as well as guidance for relocating CAHs.
• Appendix W of the State Operations Manual: Survey Protocol, Regulations and Interpretive Guidelines for Critical Access Hospitals (CAHs) and Swing-Beds in CAHs
• CMS Transmittals: CMS communications on new or changed policies and procedures.
• A “Swing Bed” is a hospital room that can switch from acute care status to skilled care status. Here is a fact sheet about swing beds.

Location and Distance Regulations: 

• Critical Access Hospital Compliance with Location and Distance Requirements
• Critical Access Hospital Re-classification from Urban to Rural

The federal guidance for the Flex Program requires states to undertake programs and activities that support Quality Improvement (QI) activities of Critical Access Hospitals (CAHs). The Wisconsin Flex Program assists CAHs with various aspects of quality improvement activities, including program planning, data submission, data management and analysis, and best practice development. And, the Wisconsin Flex Program works with the following partners and uses these additional resources to assist CAHs with quality improvement activities.

Organizations and Partners in Quality

Statewide: 

• Wisconsin Hospital Association (WHA)
• Metastar – Wisconsin’s quality improvement organization (QIO) that works with health care providers to improvement quality of care.
• Rural Wisconsin Health Cooperative – Offering quality improvement services and programs geared to WI’s rural hospitals and CAHs.
• Wisconsin Collaborative for Healthcare Quality (WCHQ)

Nationwide: 

• National Rural Health Resource Center – Resources, tools, and webinars focusing on rural hospital and Critical Access Hospital quality improvement.
• American Heart Association
• National Rural Health Association

Quality Improvement Resources

• Centers for Medicare and Medicaid Services (CMS) – Rules, regulations, tools, resources, and policy briefings directly related to Medicare, Medicaid, and their impacts on CAHs.
• Hospital Compare – CMS’ public quality measures data reporting tool.
• QualityNet – Established by CMS and includes health care quality improvement research, news, data reporting tools, and other information used for health care quality improvement.
• Joint Commission – Includes quality improvement certification, standards, and measurement criteria for hospitals, including CAHs.
• Flex Monitoring Team – This website includes CAH specific quality and patient safety data, reports and studies.
• Agency for Healthcare Research and Quality (AHRQ) –  Provides tools and research aimed at quality improvement and patient safety, health care coverage expansion, and addressing the Triple Aim.

The links below provide more information.

Overview

Patient Safety

Outpatient

EDTC

HCAHPS

2026-27 SHIP information: 

Each hospital will receive the application link by email. Only one application per hospital will be accepted. Please reach out to mepolster@wisc.edu if you’re unsure who at your facility has received this link. 

Resources: 

• SHIP 2026-27 Informational Webinar Recording – webinar covers:
  • SHIP allowable investments for the period June 2026 – May 2027.
  • The SHIP application process.
  • Eligibility and reporting requirements.
• Informational Webinar Slides:
  • 26-27 SHIP Webinar – including deadlines and requirements, links, contact info.
  • Network Option: WHA-IC Rural Health Dashboard
  • Network Option: RWHC Quality Indicators and SafetyZone
  • Network Option: Stratis Health Targeted Quality Technical Assistance
• Sample application – example of SHIP application via Qualtrics form.

Investment Options:

Option 1) Direct reimbursement:

1.  HCAHPS vendor fees reimbursement.
2. Another pre-approved option from the SHIP allowable investments table. For pre-approval, please email your proposed selection to samantha.peck@wisc.edu before January 20th, 2026.

Option 2) Network project:

1. The Wisconsin Hospital Association-Information Center’s Kaavio Rural Health Dashboard 
2. The Rural Wisconsin Health Cooperative’s  Quality Indicators and Clarity Health SafetyZone
3. Stratis Health’s Targeted Quality Technical Assistance

Deadlines: 

Application for 2026-27 SHIP and mid-point report for 2025-26 due in Qualtrics by January 23rd, 2026. 

General Information: 

About:

The SHIP program—Small Rural Hospital Improvement Program—is a federal grant program of the Health Services and Resources Administration (HRSA), and is administered in Wisconsin by the Wisconsin Office of Rural Health. Funds are distributed equally by hospital across the state, supporting eligible hospitals in meeting value-based payment and care goals for their respective organizations, through purchases of hardware, software subscription services, and training. 

Eligibility:  

All Critical Access Hospitals and certain small rural hospitals with fewer than fifty beds are eligible for the program.

Amount:

The amount changes each year based on the number of participating hospitals nationally. Each hospital in Wisconsin will receive the same amount, either directly or through value of services provided. 

What Can SHIP Funds Be Used For?

There are two ways to take part in the SHIP program:

Option 1) Direct investment – HCAHPS*

Under this option, your SHIP funds will be paid directly to your hospital upon invoicing, as reimbursement for HCAHPS vendor fees for your facility. 

*If you wish to be reimbursed with SHIP funds for any other expense, you must first seek pre-approval from the Wisconsin SHIP program manager, Samantha Peck. 

Option 2) Network Project

In order to reduce hospital administrative burden, the Wisconsin Office of Rural Health has contracted directly with vendors that are offering SHIP-eligible services.

The Application

The Wisconsin Office of Rural Health lets the hospitals who are eligible for SHIP know how and when to apply. WORH is affiliated with the University of Wisconsin-Madison School of Medicine and Public Health—so they are involved when it comes to contracts, billing, and invoicing.

Applications are submitted electronically. You must complete the online SHIP application, no matter which option you choose. A link to the application will be emailed directly to your hospitals SHIP contacts. Only one application per hospital is accepted.

You will be required to report on the progress of your current SHIP project, so you will need to know who is overseeing your hospital’s SHIP grant. Two “signatures” are required, one from the CEO and one from the SHIP Project Director. Electronic, typed signatures are acceptable.

Sample application

Deadlines/Timeline

The SHIP grant is from June 1-May 31 every year. SHIP applications are typically available in December, and are due to our office in January. Exact timing will depend on when the federal office (HRSA) releases the SHIP grant application. (Hospitals may not spend money before the contract is signed and counter-signed.)

Below is a timeline of estimated SHIP deadlines; the dates are subject to change. More updates are sent out in our newsletter, Rural Health Radar; subscribe to receive updates or contact Megan Polster, Communications Coordinator, at mepolster@wisc.edu.

January:  Application for the next SHIP year distributed to hospitals. All hospitals that wish to receive SHIP funds must complete an application.

May 31:  SHIP grant year ends. Last date a purchase may be made for reimbursement.

June 1: SHIP grant year begins.

June: WORH will notify hospitals of the exact amount of funding for the new SHIP year.

June 15:  Final deadline to submit invoices for reimbursement for the passed SHIP year.

June/July: UW-Purchasing sends contracts to hospitals. Once completed, hospitals may make purchases and invoice WORH for reimbursement.

August-May 31: After the UW-Madison Purchasing contract is signed and countersigned, hospitals may begin to send invoices to UW-Madison Research and Sponsored Programs (RSP) for reimbursement as purchases are made.

Questions?

Contact Samantha Peck, SHIP Program Manager, at samantha.peck@wisc.edu or 608-261-1891.

Flex Program Overview

The Wisconsin Office of Rural Health receives grant funding from the Federal Office of Rural Health Policy (FORHP) for the Medicare Rural Hospital Flexibility (Flex) Program. The Flex Program, established by Congress in 1997, assisted small hospitals in converting to a Critical Access Hospitals (CAH) designation – decreasing rural hospital closures and improving rural health care access. The Flex Program has evolved over recent years, and now assists CAHs with quality improvement, financial and operational improvement, population health, and integration of Emergency Medical Services (EMS).

The Wisconsin Office of Rural Health’s Flex Program has received national recognition for Medicare Beneficiary Quality Improvement Project (MBQIP) performance. The Health Resources and Services Administration announced that Wisconsin Critical Access Hospitals have some of the highest reporting rates and levels of improvement nationally over the past several years.

Current Flex Program Opportunities:

• The Antimicrobial Stewardship Program and Direct-to-Hospital Grants are open for participation in FY25-26.

Antimicrobial Stewardship Program

Critical Access Hospitals are invited to participate in a Flex-funded Antimicrobial Stewardship Program designed to support data-driven quality improvement. Using the program’s interactive dashboard, hospitals can efficiently review prescribing data, identify trends, and pinpoint opportunities to strengthen antimicrobial practices.

Watch the webinar recording for a full demonstration of the platform and information about the program.

• Antimicrobial Stewardship Program Demonstration

Involvement:

• Email Samantha Peck and Andrea Fraser to express interest. 
• Program involvement is first come first served for FY25-26.
• The project roll-out will be in February, April, and July, 2026 for the next 3 hospitals.

Direct-to-Hospital Grants

Current Flex Grant project opportunities for CAHs (FY25-26). Applications to participate are due Friday, January 16, 2026.

Project Start Date: February 1, 2026.

Project End Date: August 31, 2026.

To apply for a Flex Direct-to-Hospital Grant, review the Grant Guidance and Evaluation Cheat Sheet, complete Attachment A (Cover Page, Narrative, Budget) and Attachment B (Workplan), and submit your application through the link in the guidance document.

Materials:

• Application attachment templates:
  • Attachment A template: Cover Page, Narrative, Budget
  • Attachment B template: Workplan
• WORH Evaluation Cheat Sheet

HCAHPS Improvement and Engagement

• Funding for a project that addresses HCAHPS improvements and engagement in a Critical Access Hospital. The HCAHPS Improvement and Engagement awards can be used in 2 different ways:
  • Improvement – This grant can be used for activities or interventions improvement in one or more HCAHPS measures.
  • Engagement – This grant can be used to innovate on increasing HCAHPS engagement in order to reach CMS star rating eligibility. If hospital volume is too low, this funding can be used to explore alternatives to the CMS rating system, such as NRRS.
• Amount: up to $20,000, per year, for a maximum of 2 years.
• Grant Guidance – HCAHPS

EDTC Improvement

• Funding for Critical Access Hospitals to support improvement initiatives that strengthen Emergency Department Transfer Communication (EDTC). Projects may focus on improving documentation, information sharing, and care transition processes that support safer and more effective patient transfers.
• Amount: up to $15,000.
• Grant Guidance – EDTC

Finance Analysis

• Funding for Critical Access Hospitals to engage financial consultants to conduct in-depth financial analysis. Hospitals may focus on a specific area—such as revenue cycle performance, chargemaster review, operational assessment, or long-range sustainability planning—to gain actionable insights that inform future decision-making and financial stability efforts.
• Amount: up to $15,000.
• Grant Guidance – Finance Analysis

Critical Access Hospitals are welcome to apply for more than one grant. A separate application is required for each grant.

For questions regarding Flex Direct-to-Hospital Grants, please contact Samantha Peck.

AdventHealth Durand – Durand

Amery Regional Medical Center – Amery

Ascension Calumet Hospital– Chilton

Aspirus Stanley Hospital – Stanley

Aspirus Tomahawk Hospital – Tomahawk

Aspirus Eagle River Hospital – Eagle River

Aspirus Landglade Hospital – Antigo

Aspirus Medford Hospital & Clinics – Medford

Aspirus Merrill Hospital – Merrill

Bellin Health Hospital and Clinic – Oconto

Black River Memorial Hospital – Black River Falls

Burnett Medical Center – Grantsburg

Crossing Rivers Health Medical Center – Prairie du Chien

Cumberland Memorial Hospital – Cumberland

Door County Medical Center – Sturgeon Bay

Edgerton Hospital and Health Services – Edgerton

Essentia Health St. Mary’s Hospital – Superior – Superior

Grant Regional Health Center – Lancaster

Gundersen Boscobel Area Hospital & Clinics – Boscobel

Gundersen Tri-County Hospital & Clinics – Whitehall

Gundersen Moundview Hospital & Clinics – Friendship

Gundersen St. Joseph’s Hospitals & Clinics – Hillsboro

HSHS St. Clare Memorial Hospital – Oconto Falls

Hayward Area Memorial Hospital – Hayward

Hudson Hospital and Clinics – Hudson

Indianhead Medical Center – Shell Lake

Marshfield Medical Center- Ladysmith – Ladysmith

Marshfield Medical Center- Neillsville – Neillsville

Marshfield Medical Center- Park Falls – Park Falls

Mayo Clinic Health System Bloomer – Bloomer

Mayo Clinic Health System Franciscan Healthcare – Sparta

Mayo Clinic Health System Barron – Barron

Mayo Clinic Health System Menomonie – Menomonie

Mayo Clinic Health System Osseo – Osseo

Memorial Hospital of Lafayette County – Darlington

Memorial Medical Center – Ashland

Mercy Walworth Hospital and Medical Center – Lake Geneva

Osceola Medical Center – Osceola

Prairie Ridge Health – Columbus

Reedsburg Area Medical Center – Reedsburg

Richland Hospital, Inc. – Richland Center

River Falls Area Hospital – River Falls

SSM Health Ripon Community Hospital – Ripon

SSM Health Waupun Memorial Hospital – Waupun

Southwest Health Center – Platteville

Spooner Health System – Spooner

St. Croix Regional Medical Center – St. Croix Falls

Stoughton Health – Stoughton

ThedaCare Medical Center – Berlin

ThedaCare Medical Center – New London

ThedaCare Medical Center – Shawano

ThedaCare Medical Center – Waupaca

ThedaCare Medical Center – Wild Rose

Tomah Health – Tomah

Upland Hills Health – Dodgeville

Vernon Memorial Healthcare – Viroqua

Western Wisconsin Health – Baldwin

Westfields Hospital – New Richmond

2023 Pediatric Respiratory Care 3-part Series

Webinar 1:  Pediatric Respiratory Care: Updates and Evidence Based Practices. February 8, 2023, with Dr. Allie Hurst, Pediatric Emergency Medicine, UW School of Medicine and Public Health.

Webinar 2: Non-Accidental Trauma: Recognizing and Reporting Child Abuse in the Emergency Department. March 7, 2023. 12 PM – 1 PM CT

MP4 file can be found on our YouTube Channel.

Webinar 3: Pediatric Fever of Unknown Origin.

March 16, 2023. 12PM – 1PM.

MP4 File can be found on our YouTube Channel.

2023 CAH Finance Webinar 3-part Series

CAH Financial and Operational Best Practices

In an environment of increasing cost and stagnant reimbursement, CAHs must do everything necessary to improve their financial stability. This presentation identifies a small but focused set of tactics CAHs can implement to improve their financial and operational performance.

WI #1 – CAH Financial & Operational Best Practices_Presentation Slides

Recording

CAH Reimbursement: Using the Cost Report to Reveal Opportunities

Most organizations view the Medicare Cost Report as a tedious administrative task and to many CFOs, a hassle. As a result, CAHs often fail to acknowledge the direct impact the cost report has on CAH reimbursement. This presentation highlights the importance of the Medicare Cost Report and explains how to leverage the cost report as a part of the managerial decision-making process.

WI #2 – CAH Cost Report – Presentation Slides

Recording

Establishing a High-Functioning Revenue Cycle Department

Revenue cycle remains one of the best opportunities for hospitals to improve operational efficiencies due to its complexity and core function. This presentation walks participants through the full revenue cycle value chain while identifying common pitfalls that impact revenue.

WI #3 – Maintaining a High Functioning Revenue Cycle Department – Presentation Slides

Recording

For more information on the series, please contact Megan Polster.