health care system. The overall goal of the Flex Program is to ensure that high quality health care services are available in rural communities and aligned with community needs. Health care services include appropriate preventative, ambulatory, pre-hospital, emergent, and inpatient care. High quality rural health care will deliver high value to patients and communities and result in healthier rural people. The long-term objectives of the Flex Program are to enable CAHs, including CAH-owned clinics, and rural EMS agencies to: • Show and improve quality of care; • Stabilize finances and maintain services; • Adjust to address changing community needs; and • Ensure patient care is integrated throughout the rural health care delivery system. State Flex funding for this period of performance will act as a resource and focal point to address needs and demonstrate outcomes in the following five program areas with priority for quality, financial and operational improvement in CAHs, and supporting rural hospitals converting to CAH status. We recognize that the healthcare landscape is changing rapidly, with focus being placed on value-based care and alternative payment models. We encourage states to develop projects supporting innovative models of care, as appropriate, and place them in the following program areas: • Program Area 1: CAH Quality Improvement (required) • Program Area 2: CAH Financial and Operational Improvement (required) • Program Area 3: CAH Population Health Improvement (optional) • Program Area 4: Rural EMS Improvement (optional) • Program Area 5: CAH Designation (required if assistance is requested by rural hospitals) For more details, see Program Requirements and Expectations.