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Medicare Rural Hospital Flexibility Program Emergency Medical Services Supplement




July 19, 2023



March 21, 2024




Award Floor:


Match Required?





Entity Types:

State governments, County governments, City or township governments, Special district governments, Independent school districts, Public & State controlled institutions of higher education, Native American tribal governments (Federally recognized), Public housing authorities, Native American tribal organizations, Nonprofits (with 501(c)(3) status), Nonprofits (without 501(c)(3) status)




Source Type:


The purpose of this award is to build an evidence base for rural EMS activities in the Flex Program by funding the implementation of demonstration projects of sustainable rural EMS models and quality metrics, and by sharing the results of those projects with rural EMS agencies. This notice announces the opportunity to apply for funding under the Medicare Rural Hospital Flexibility Program (Flex Program) Emergency Medical Services (EMS) Competing Supplement. Throughout this NOFO, the term Flex Program will refer to the larger, primary program while Flex EMS Supplement will refer to the supplemental projects that are the focus of this NOFO. The goal of this supplemental funding is to expand upon the current Flex program by encouraging rural EMS agencies to educate staff and leadership on the importance of accurate reporting, and how it drives quality improvement efforts at the agency level. Improving and/or adding quality improvement activities allows EMS agencies to enhance clinical care, and find efficiencies which has the potential to both expand their ability to care for patients, and allow them to expand needed services. Additionally these supplements will serve as examples to other EMS agencies interested in this topic. The state Flex programs that choose to apply for this supplement should propose a project that identifies at least three specific EMS measures to improve on during the period of performance. The applicant should remember to take into account applicable health disparities and health equity measures when planning the project. The applicant should also include appropriate education/training on the use of data and quality improvement efforts.

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