Hospitals - Wisconsin Office of Rural Health

Hospitals - Wisconsin Office of Rural Health
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608-261-1883
info@worh.org
Critical Access Hospitals
A Critical Access Hospital (or “CAH”) is a particular type of rural hospital (or one grandfathered in as rural) that is designated as such by the Centers for Medicare and Medicaid Services (CMS).  For more information on CAH designation, payments, grants and resources, here is a
Critical Access Hospital Fact Sheet.
CAH Directory
Workshops
Regulations
A Critical Access Hospital (or “CAH”) is a particular type of rural hospital (or one grandfathered in as rural) that is designated as such by the Centers for Medicare and Medicaid Services (CMS).  For more information on CAH designation, payments, grants and resources, see this
Critical Access Hospital Fact Sheet.
General information on Critical Access Hospitals.
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
Quality Improvement
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.
MBQIP Measures
MBQIP is a federal quality improvement initiative utilizing measures deemed relevant to rural settings. In Wisconsin, the project is managed by the Wisconsin Office of Rural Health.  Rural hospitals report measures in the areas of HCAHPS, Emergency Department Transfer Communications (EDTC), outpatient, and influenza immunization. More detailed information and resources are below, and feel free to contact
Megan Polster
with questions.
The Wisconsin Office of Rural Health’s Flex Program has consistently received national recognition for MBQIP performance. In 2017, the Health Resources and Services Administration
announced
that Wisconsin Critical Access Hospitals had the highest reporting rates and levels of improvement nationally; Since 2019, Wisconsin CAHs have been
among the top ten
The links below provide more information.
Overview
Patient Safety
Outpatient
EDTC
HCAHPS
Performance Improvement
All hospitals, regardless of size and organizational structure, benefit from analyzing financial and operational performance. The Wisconsin Flex Program identifies financial and operational strengths and challenges in CAHs to implement activities designed to increase profitability.
Performance Improvement Resources and Links
American Hospital Association
– Performance improvement policy briefings, reports, and resources.
County Health Rankings
(CHR) – Measures vital health
factors
and
outcomes
in every state on a county-by-county level, and provides a useful way to explore the size and nature of health disparities in Wisconsin. It also emphasizes how state and community leaders can take action to create healthier communities.
Flex Monitoring Team
– Performance improvement data, research and policy briefings related to Critical Access Hospitals.
National Rural Health Resource Center
– Resources, tools, and webinars focusing on rural hospital and Critical Access Hospital performance improvement.
Financial Data Reports on Wisconsin’s Critical Access Hospitals
Rural Health Information Hub (RHIhub)
(formerly the Rural Assistance Center, or RAC) – A rural and social services online library that focuses on funding opportunities, tools, resources, studied and other publications, events, and news.
Wipfli LLP
– Educational events for CAHs.
Billing and Coding Regulations
Medicare Billing Information for Rural Providers and Suppliers
ICD 10 Regulations and Information
– Rules, regulations, and the latest news on ICD-10
Info on
ICD 11
Small Rural Hospital Improvement Program (SHIP)
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.
Invoicing
Effective January 1, 2026. For Option 1) Direct Reimbursement, SHIP grantee hospitals are to fill out this
Invoice Template
and email it to
uwrspinvoices@rsp.wisc.edu
Invoice Tips:
Reference this
Example SHIP Invoice
for instructions on completing the invoice.
The Purchase Order (P.O.) Number is found in the first line of your Funding Award Agreement with UW Madison and appears as #CON-0000xxxx.
Hospitals must use their funds for HCAHPS vendor fees first. Any leftover funding can be used for other pre-approved expenses discussed with
Samantha Peck
You may notice that this invoice process is slightly different from previous years, and you are correct! With changes to UW Madison’s administrative system and our own SHIP simplification efforts, hospitals can now send SHIP invoices for HCAHPS and other pre-approved expenses directly to the UW’s
Research and Sponsored Programs
team for reimbursement, instead of to Megan Polster.
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
Grant 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
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.
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 1, 2026 – May 31, 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:
HCAHPS vendor fees reimbursement.
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:
The Wisconsin Hospital Association-Information Center’s
Kaavio Rural Health Dashboard
The Rural Wisconsin Health Cooperative’s
Quality Indicators and Clarity Health SafetyZone
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.
Questions?
Contact Samantha Peck, SHIP Program Manager, at
samantha.peck@wisc.edu
or 608-261-1891.
Medicare Rural Hospital Flexibility Program (Flex) Grant
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
Directory of Critical Access Hospitals
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
Webinars
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
Staff Contact:
Samantha Peck
Rural Hospitals & Clinics Program Manager
samantha.peck@wisc.edu
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