Attachment E - FLEX Reporting Instructions

REPORTING INSTRUCTIONS AND DATA DICTIONARY FOR
FY 2017 FLEX PROGRAM PIMS
FORHP P ERFORMANCE I MPROVEMENT AND M EASUREMENT S YSTEM
M EDICARE R URAL H OSPITAL F LEXIBILITY P ROGRAM
P ROGRAM YEARS FY 2015 – FY 2018 (9/1/2015 – 8/31/2019)

INTRODUCTION
Flex awardees must complete an annual Performance Improvement and
Measurement System (PIMS) report. This is a program requirement and listed on
the Notice of Award (NOA). Awardees will access the PIMS report through the HRSA
Electronic Handbooks (EHB), grants.hrsa.gov. For FY 2017, the reporting system
will open September 1 and reports are due October 30, 2018. Please contact your
project office with questions about PIMS reporting.
PIMS was revised starting with the FY 2015 reporting period. In PIMS awardees are
asked to report participation and improvement, including sustained high
performance, by Critical Access Hospitals (CAHs) in their state.
PIMS does not reflect everything that state Flex programs accomplish. This is a
standardized, program-wide data collection tool to provide information about the
Flex Program as a whole. Project officers also use progress reports, site visits, and
individual updates to understand Flex activities in each state. We use the
standardized data collected through PIMS for reports to HRSA, as part of the
program justification measures in the yearly federal budget, and to inform Flex
Program evaluations conducted by the Flex Monitoring Team. You can review the
HRSA Budget and Performance Report online.

PIMS REPORTING PROCESS – OVERVIEW
1. Log in to EHB, go to performance reports, and open PIMS
2. Select the applicable activities for your state’s Flex program
3. Record individual CAH participation and improvement in each selected
activity category
4. Record your program spending in each activity category
5. Save each page and mark complete
6. Validate and submit your data
7. Your project officer will review your PIMS data and may ask for clarification
or corrections

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DETAILED INSTRUCTIONS FOR FY 2017 REPORTING
ACCESSING PIMS
The Performance Improvement and Measurement System is a module within the
HRSA Electronic Handbooks. Access EHB using your usual username and password,
then open the Grants drop-down. From this menu you can select Performance
Report which take you to PIMS. The screenshots in Appendix B show this process.

SELECTING ACTIVITIES
The FY 2017 PIMS report has up to seven pages: a selection
page, five pages that correspond to the five Flex program
areas, and a spending page as shown in the screenshot to
the right. Start with the selection page and use the check
boxes to choose the specific Flex activity categories that
were part of your state Flex program in the just-completed
budget year (FY 2017). The PIMS category numbering
matches the numbering in the Flex Grant Guidance. The
required activities (1.01 – 1.04 and 2.01) are selected by
default.
Note that in the navigation sidebar the selection page is #1
and the program area pages are #2 through #6. This
doesn’t match their numbering in the guidance so follow the
titles, not the numbers in the sidebar. The numbering of the
individual activity categories matches the guidance.
Once you have selected activity categories applicable to your program, click save
on the bottom of the selection page. On the subsequent data entry pages you will
only see the categories you selected. If you realize you missed a category you can
always reopen the selection page, make changes, and save it again to update the
activity categories available to report.
In PIMS you will report on the Flex activities that were carried out in the past year.
This usually corresponds to the categories in your FY 2017 work plan, please use
the comment box at the end of each page to explain any changes from your work
plan activity categories. You will not report data for program areas and categories
that are not part of your state Flex program.

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CHECKING YOUR CAH LIST
Select Quality Improvement from the navigation sidebar. The reporting page will
open and show a list of the CAHs in your state by Medicare number (CCN) and
name. The names come from Medicare provider files so they may be different from
business names in some cases. Review this list and make sure that all CAHs in your
state that were open during the reporting period are included. This could include
CAHs that were open last September but have since closed as well as hospitals that
converted to CAH status in the last few months. The same list will repeat in each
activity category so make sure it is correct before you start entering data.
Stop and contact your project officer to update the database if there are
any missing CAHs, facilities that should not be on your state CAH list, or
CAHs with incorrect names.

RECORDING CAH PARTICIPATION AND IMPROVEMENT
After confirming your CAH list, you can start entering data. Open the reporting page
for activities in each program area using the navigation sidebar. Activities are
grouped under Quality, Financial, Population Health/Emergency Medical Services
(EMS), CAH Conversion, and Innovative Models. You will individually report CAH
participation and improvement for activities in all five Flex program areas as
applicable.
On the reporting page, each activity category (for example 1.01, 1.02, 1.03, 1.04)
will have a list of the CAHs in your state followed by check boxes for indicating
participation and improvement. See the Definitions for help in understanding these
terms for PIMS.
Check the box following the name of each CAH that participated in this Flex activity
category in the past budget year. After selecting the CAHs that participated, use the
second column to indicate participating CAHs that improved on the outcome that
was the goal of the project. Many Flex programs have defined multiple projects or
sub-activities in a single Flex activity category. A CAH could meet the definition of
participation in that category if they engaged in one of those projects or several.
We recognize that Flex Coordinators will not have information on whether some
CAHs improved or not since their projects may have been recently completed and
data collection for quality and financial measures takes time. A blank in the
“improved” column does not mean that the CAH did not improve. It merely
indicates that the state Flex Coordinator was not able to document improvement at
the time of the PIMS report.

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HISTORICAL PARTICIPATION
The CAH Historical Participation column was a new feature for the FY 2016 PIMS
report and it continues in the FY 2017 PIMS report. This column cannot be edited
and it shows which CAHs the Flex Coordinator previously reported as participating
in each activity category. For the FY 2017 PIMS report, historical participation will
be checked for a CAH if you previously reported participation by that CAH in either
FY 2015 or FY 2016 or both.

RECORDING FLEX SPENDING ON ACTIVITIES
The Flex spending layout is slightly different from the FY 2016 PIMS report. Last
year for FY 2016 we consolidated all of the Flex spending questions previously
spread across the CAH data entry pages in a seventh page called Flex Spending.
This page has a field to record the amount of Flex funds spent in each activity
category during the year. The page will automatically total the spending reported
for each program area and show the overall total at the bottom of the page.
For FY 2017 the Flex Spending page has a new section at the top of the page called
Award Information. This section will help us report consistent data by checking total
awarded and available funding against total spending reported for the program
areas. You will use this section to record your FY 2017 award, approved carryover,
and estimated unspent funds. The page will calculate actual program spending for
the reporting year. With this new section you do not need to record estimated
unspent funds in the comment box.
The section will calculate Actual Program Spending as:
𝑇𝑇𝑇𝑇𝑇𝑇𝑇𝑇𝑇𝑇 𝑎𝑎𝑎𝑎𝑎𝑎𝑎𝑎𝑑𝑑 + 𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶𝐶 − 𝑈𝑈𝑈𝑈𝑈𝑈𝑈𝑈𝑈𝑈𝑈𝑈𝑈𝑈 𝑓𝑓𝑓𝑓𝑓𝑓𝑓𝑓𝑓𝑓 = 𝐴𝐴𝐴𝐴𝐴𝐴𝐴𝐴𝐴𝐴𝐴𝐴 𝑠𝑠𝑠𝑠𝑠𝑠𝑠𝑠𝑠𝑠𝑠𝑠𝑠𝑠𝑠𝑠

The page will compare the calculated actual spending to the calculated Total Flex
Funds Utilized at the bottom of the spending page and alert you of the error if these
two sums don’t match.
Do not include FY 2017 Flex Supplements in your FY 2017 award amount. See
screenshots of this new section in Appendix B and a list of FY 2017 award amounts
(excluding supplements) in Appendix C.
The Flex spending page will only display program areas and activity categories that
you selected on the selection page. If a category is missing you will need to update
and save the selection page so that the spending page shows the additional
category.

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Report your utilization of Flex funds in each activity category. Only report Flex
award funds; in-kind resources and money from other sources should not be
included in the PIMS report. All types of spending that directly support an activity
should be included, for example contracted services, staff salaries, travel, and
direct sub-contracts to CAHs to support individual projects. We recognize that some
Flex programs accomplish much of their work through in-house staff while others
use consultants and contracts to carry out activities. This data is intended to
capture all of the program investments that support a specific Flex activity,
regardless of spending type.
We understand that this PIMS report will be completed before the final financial
report for the budget year and so you may not have exact expenditure numbers in
some cases. Estimate spending if necessary and explain in the comment box at the
bottom of the page.
Non-specific spending: State Flex programs generally have some award spending
that is unrelated to a specific activity. Examples of such non-activity-specific
spending could include staff salaries for time spent on general program
administration, expenses for travel to national meetings, and indirect costs charged
to the award. Use the spending calculator in the PIMS Data Collection Tool to
allocate non-specific spending to your program activity categories for PIMS
reporting. The spending calculator in the PIMS Data Collection Tool will allocate
indirect costs and other non-specific spending for you. The total spending, including
allocated indirect costs will be shown in the calculated Column E (the last column
on the right). When you log in to PIMS to report total spending you will report the
calculated totals in Column E, not the category-specific amounts you reported in
Column B.
Explanation: The suggested Flex work plan template includes proposed spending
by activity category. We recognize that this budgeted amount is subject to change
throughout the year as Flex programs adjust their projects and services based on
changing needs and CAH feedback. Collecting information on actual spending for
each activity in PIMS at the end of the budget year allows us to estimate the total
Flex investments in each of the major areas of the Flex Program.

SECTIONS WITH DIFFERENT DATA ENTRY OPTIONS
Most sections of the PIMS report ask you to select participating and improving CAHs
using the CAH list and check boxes. However a few categories include different data
entry methods. For categories 2.01 and 3.01 we removed the CAH selection
reporting in FY 2016, since these are statewide needs assessment activities and
individual CAH participation is not meaningful.
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1.09: No CAH selection, just record spending.
2.01: No CAH selection, just record spending.
2.02a: CAH selection but only to record participation, not improvement.
2.04: Record number of networks receiving Flex assistance.
3.01: No CAH selection, just record spending.
3.03: Only CAH participation, not improvement.
3.05 & 3.06: Number of EMS entities participating and improving.
4.01: Number of hospitals requesting CAH conversion assistance and the
number that were unsuccessful in conversion. Please record the names of the
unsuccessful hospitals in the text box.

SUBMITTING YOUR DATA
After entering data on each page, you must click Save so that your data will be
recorded. You should save each page at least every 30 minutes to ensure that your
work session does not time out. You can save the page, navigate away, and return
multiple times as you enter data. Once you have entered all of the data for the
page, change Is this Form Complete? to Yes and save a final time to mark the page
as complete.
If you encounter any validation problems or error messages that you are not able
to solve, please take a screenshot of the error and send it your project officer.
Sections that are completed will be indicated with a green checkmark in the leftside navigation sidebar. Once all of your applicable sections are completed with a
green checkmark, select Validate/Submit Report from the sidebar. The system will
confirm that data has been recorded on all of your sections and the report will be
submitted to HRSA.

NEW FEATURES IN FY 2017 PIMS
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Award Information section added to Flex Spending page.
Historical Participation looks for CAH participation in FY 2015 and/or FY 2016.
Download speeds improved for Grantee Raw Data Report and PDF snapshot
reports.
Unfortunately Comparison Summary and Comparison Trend reports may
continue still have glitches.

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DEFINITIONS FOR FY 2017 REPORTING
Budget year FY 2017 refers to Flex activities conducted from 9/1/2017 through
8/31/2018. See the award cycle timeline in Appendix A.
Participation answers the question, “Did this CAH engage in a Flex-funded activity
intended to improve a specific outcome during the past budget year?”
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The activity or activities occurred between 9/1/2017 and 8/31/2018.
Participation is an in-depth engagement intended to change something for
the CAH. Attending a state rural health conference where the Flex
Coordinator gave a state Flex update is not a significant engagement.
Conducting a chargemaster review, joining a HCAHPS quality improvement
cohort that meets bimonthly via webinar, attending a two-day TeamSTEPPS
training for patient safety are all examples of in-depth engagement that
would qualify as participation.
Reporting MBQIP measures by itself does not qualify as CAH participation for
PIMS reporting. However a CAH that defines a goal of reporting additional
measure(s) in the budget year and works toward that goal with Flex program
assistance would be reportable in PIMS. Participation in the Flex quality
improvement program area for PIMS reporting includes engaging in state
Flex interventions, trainings, quality improvement projects, and other
activities identified in the approved state Flex program work plan intended to
improve CAH performance on MBQIP.
Individual CAH improvement goals may reflect Flex work plan outcome
measures or individual CAH goals may be specific to that CAH, depending on
what makes sense for specific projects.
In most cases, state Flex programs will only report participation from a
subset of their CAHs in a given year and some activity categories in the
work plan may have no in-depth CAH engagements that meet this
definition of participation. PIMS data collection focuses on CAH
participation in projects where the program expects to help CAHs make
changes and show improvement. PIMS data is not intended to include CAHs
that are lightly engaged in general Flex activities where the program cannot
realistically expect a measurable change.
A CAH may participate in one or more projects (also called sub-activities) in a
single Flex activity category. Report both cases (one project or several
projects in the same category) as participation for the year.
Check the box for yes, leave blank (no action required) for no. By default all
CAHs are blank for the current year, indicating no participation.
Report on all CAHs that participated in Flex activities in the reporting period
even if those CAHs closed or converted to another type of health care facility
sometime after they participated.

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Do not report CAHs that started an activity but quickly dropped out or
otherwise failed to substantially engage in the activity.
Only report CAHs participating in Flex-supported activities. Do not report
CAHs that are participating in other performance improvement projects not
supported by Flex resources—for example HIIN projects or Practice
Transformation Network projects that don’t include the Flex program.
The PIMS Data Collection Tool offers a format for Flex Coordinators to track
CAHs throughout the year as they engage in Flex-funded improvement
activities and identify individual improvement goals.

Improvement answers the question, “Did the participating CAH improve the
outcome that was the target of the activity?”
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An improvement can be any change in the positive direction, including
sustained high performance for quality improvement activities.
You can only report participating CAHs as showing improvement in an
activity.
CAHs listed in the Historical Participation column (reported as participating in
FY 2015 and/or FY 2016) can be selected for improvement without selecting
FY 2017 participation.
For this FY 2017 report, you can indicate that a CAH improved if it
participated in any one or more of year 1, year 2, or year 3 as long as you
identified the improvement in, or immediately after, the FY 2017 budget
year.
CAHs can show improvement on one or more outcomes. Many Flex projects
target multiple outcomes and improvement on any one of the targets (short
or long term) should be counted as CAH improvement for this PIMS report.
CAHs that participate in multiple projects or sub-activities within a Flex
activity category show improvement if they improve on one or more targeted
outcomes. They do not need to show improvement on all of the projects in a
category to qualify.
Indicate improvement in the reporting cycle when it is identified. Some
activities may not have data immediately available to assess improvement.
A check mark indicates yes, leaving it blank indicates no. By default all CAHs
are blank, indicating no improvement was identified.
If you have no information on improvement or data is not yet available leave
the improvement box blank. This shows that the Flex Coordinator has not
observed and documented improvement by this CAH in this Flex activity at
this time.
We developed the PIMS Data Collection Tool to help Flex Coordinators track
improvement by CAHs participating in Flex funded projects.

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Sustained high performance only applies to quality improvement, program area
1. This concept recognizes that state Flex programs use considerable resources
helping CAHs maintain a high level of performance after they initially reach that
level. This is a very high level of performance, and we expect few CAHs to meet the
applicable benchmarks. We added this reporting definition in FY 2016 in response to
Flex Coordinator concerns that improvement, as defined for PIMS, excluded CAHs
that consistently maintained excellent performance since most quality and financial
metrics have an upper limit.
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Applies to CAHs participating in one or more Flex-funded activities in
categories 1.01 through 1.09.
Only applies to CAHs that do not have reportable improvement activities in
the applicable Flex activity category—sustained high performance requires
that they were already performing at the top level at the beginning of the
year.
For this section, high performance refers to actual scores, e.g. percentage of
EDTC cases with all data elements, while measure reporting refers to the
reporting of data, or zero cases, regardless of scores.
A CAH must achieve one of the following for the most recently available four
quarters of MBQIP data (or year in the case of annual measures):
o For all MBQIP measures except HCAHPS a CAH must maintain high
performance at or above the 90th percentile for CAHs nationally on the
applicable measure(s) every quarter.
o For HCAHPS high performance a CAH must meet or exceed the CMS
Value-Based Purchasing (VBP) Program performance benchmark for
the performance period that most closely aligns with the CAH’s
HCAHPS data. Note that payment periods are two years after the
performance period so use the appropriate performance period, not
the payment adjustment period. VBP benchmark scores are available
from the Quality Reporting Center Inpatient Resources page (section
called Domain Weighting in VBP Resources). The VBP performance
standard defines a floor, a threshold, and a benchmark—the highest
level, the benchmark, is based on the top decile of national
performance.
o For EDTC and HCAHPS, CAHs must meet the performance benchmarks
for all sub-measures.
o Sustained high performance in measure reporting requires the CAH to
report qualifying data or zero cases for all four quarters for all core
measures and sub-measures in the applicable MBQIP domain.
o HCAHPS reporting is not eligible for sustained high performance for
measure reporting since CAHs need less Flex program assistance with
the process of HCAHPS reporting after establishing vendor contracts.

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Annually reported measures are not eligible for sustained high
performance for measure reporting since one data point cannot
demonstrate a trend.
Flex Coordinators that use the improvement box to indicate CAHs that
demonstrated sustained high performance must list those CAHs in the
comment box at the bottom of the quality improvement reporting page.
Based on Flex Coordinator input, we expect that this will be a small number
of CAHs, but the comments will show how often Flex Coordinators identify
sustained high performance. The comment should include the following
information:
o Activity category (e.g. 1.03), CAH name and Medicare number (CCN),
reason (high performance or measure reporting)
CAHs must be participating in Flex funded activities in the applicable activity
category to be reported for sustained high performance. A CAH that achieves
sustained high performance without in-depth engagement(s) with the state
Flex program should not be reported in PIMS which is limited to reporting on
Flex-funded activities and interventions.
We anticipate that consistent reporting of existing MBQIP measures will not
be considered high performance in PIMS after the end of the current Flex
Program performance period and sustained high performance will be limited
to performance scores and reporting of new measures.
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APPENDIX A: FLEX AWARD CYCLE AND REPORTING PERIODS
2016
S O N D J

2017
F M A M J J A S O N D J

Project Year 2 (FY 2016)

Project Year 3 (FY 2017)

Progress
Y2
PIMS
Y1

2018
F M A M J J A S O N D J

F

A

Project Year 4 (FY 2018)

Progress
Y3
PIMS
Y2

M

2019
M J J A

S O N D
New
Project…

n/a
PIMS
Y3

PIMS
Y3
New App

FFR FY 2015

FFR FY 2016

FFR FY 2017

FFR FY 2018

Non-Competing Continuation Progress Reports
Performance Improvement Measurement System Reports
Competing Continuation Applications
Federal Financial Reports

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APPENDIX B: FLEX PIMS SCREENSHOTS
PIMS User Tips
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The PIMS time-out clock counts down from 60 minutes but the EHB time-out
is only 30 minutes. You must reset your timeout every 30 minutes or you
will have to log back in to EHB.
Saving a form resets your time-out clock.
Viewing a different page resets your time-out clock.
Page load times have been slow, it may take up to 45 seconds for some
pages to save or open.
Save pages before pausing or leaving to ensure you don’t lose any data.
For the Flex Funds boxes you must enter only whole numbers. Do not use $
signs or commas or decimal places. Any of these will cause a validation error.
Browser cache issues occasionally cause errors when attempting to open
PIMS. Fix by logging out of EHB, clearing browser cache and memory, then
logging back in to EHB.

Login to EHB at https://grants.hrsa.gov

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Go to Grants > Performance Report

Select the performance report for your Flex award and select Start which will take
you to the PIMS entry page.
On the entry page confirm that the state and reporting period are correct (this year
should be 9/1/2017 – 8/31/2018), then select Continue.

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Using the left hand sidebar, navigate to the selection page.
There is a separate data entry page for activities in each program
area, only the selected activities chosen on the selection page will
appear on the data entry pages. Use the check boxes on the
selection page to select the activity categories in your state Flex
program.

After selecting the applicable activities for your program, use the save button to
update the report so the correct pages are available to you for reporting.

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The navigation side bar shows which pages are underway and which are marked as
complete (green check mark). A red asterisk indicates a required page that is not
started.

Here is a screenshot of the Quality page before any data has been entered for the
current year. Make sure this list has the correct name and Medicare number (CCN)
for all of the CAHs in your state. They are listed alphabetically by name.

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Only CAHs selected for Participation (in either the current year or previous years as
indicated by Historical Participation) can be selected in the Improvement column as
you can tell by the grayed-out check boxes. The form automatically totals the
number of CAHs selected in each section.

Selectable
Selectable

Non-selectable
The check box at the top of the column allows you to select all or unselect all.
Some pages have different data entry formats, for example CAH Conversion only
asks about participation, not improvement. Your CAH list should include all CAHs
that were open at any time during the reporting year, including newly designated
CAHs so that newly-designated CAHs can be selected in the CAH Conversion page.

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For FY 2017 the Flex Spending page has a new section at the top of the page called
Award Information.

Use this section to record your FY 2017 award, approved carryover, and estimated
unspent funds. Do not include FY 2017 Flex Supplements in your FY 2017 award
amount.
The page will compare the calculated actual spending to the calculated Total Flex
Funds Utilized at the bottom of the spending page and alert you of the error if these
two sums don’t match.

Here is the error message you will see after saving the page if the calculated total
funds utilized does not equal actual spending calculated at the top of the page.

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Each data entry page has a comment box, a Form Complete toggle, and a save
button at the bottom.

Complete each page, including the comment box if needed. Change the Form
Complete button to Yes. Click the Save button at the bottom of
the page. The navigation sidebar will change to a green check
mark for that page.
Complete all of the pages corresponding to the selected program areas and
categories on your Selection Page. Then select Validate/Submit Report. The system
will check for errors and take you to the certification page. Check the box to certify
your report and use the submit button to send to HRSA. You can view the report
but you can’t make any changes after it is submitted. If necessary your project
officer can return the report so you can make changes.

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You can download a pdf report of the data you entered from the navigation sidebar.
However this report may be poorly formatted compared to viewing your data on the
data entry pages.

Please share any suggestions about what you would like to see on the
downloadable pdf report with your project officer. We will continue to improve the
PIMS reports for next year.

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APPENDIX C: FLEX FY 2017 AWARDS
This table shows the FY 2017 Flex funding levels. We shared this table in the first
version of the FY 2018 Flex Extension instructions on March 14, 2018. Note that FY
2018 funding levels subsequently changed due to an appropriations increase.
We expect that the “Total award for Current Report Period” on the Flex Spending
page will reflect these award amounts. States that received FY 2017 supplements
should not include the supplemental funds in the total award for PIMS reporting.
Please use the comment box to explain any discrepancies.
State

Recipient Name

Award #

AK

HEALTH AND SOCIAL SERVICES, ALASKA
DEPARTMENT OF
PUBLIC HEALTH, ALABAMA DEPARTMENT OF
ARKANSAS DEPARTMENT OF HEALTH
UNIVERSITY OF ARIZONA
DEPARTMENT OF HEALTH CARE SERVICES
COLORADO RURAL HEALTH CENTER
HEALTH, FLORIDA DEPARTMENT OF
COMMUNITY HEALTH, GEORGIA DEPT OF
HEALTH, HAWAII DEPARTMENT OF
PUBLIC HEALTH, IOWA DEPARTMENT OF
HEALTH AND WELFARE, IDAHO DEPARTMENT
OF
PUBLIC HEALTH, ILLINOIS DEPARTMENT OF
INDIANA STATE DEPARTMENT OF HEALTH
HEALTH AND ENVIRONMENT, KANSAS
DEPARTMENT OF
UNIVERSITY OF KENTUCKY
HEALTH AND HOSPITALS, LOUISIANA
DEPARTMENT OF
PUBLIC HEALTH, MASSACHUSETTS DEPT OF
HEALTH AND HUMAN SERVICES, MAINE
DEPARTMENT OF
MICHIGAN CENTER FOR RURAL HEALTH
DEPARTMENT OF HEALTH MINNESOTA
HEALTH AND SENIOR SERVICES, MISSOURI
DEPARTMENT OF
HEALTH, MISSISSIPPI STATE DEPARTMENT OF
PUBLIC HEALTH AND HUMAN SERVICES,
MONTANA DEPARTMENT OF
HEALTH & HUMAN SERVICES, NORTH
CAROLINA DEPARTMENT OF
UNIVERSITY OF NORTH DAKOTA

H54RH00014

FY 2017
Funding
$578,368

H54RH00034
H54RH00035
H54RH00030
H54RH23636
H54RH00056
H54RH00032
H54RH00057
H54RH00012
H54RH00011
H54RH00039

$354,914
$520,472
$523,629
$466,808
$584,564
$475,088
$563,270
$419,316
$610,811
$581,540

H54RH00019
H54RH00042
H54RH00009

$725,214
$593,860
$751,606

H54RH00053
H54RH00040

$530,061
$505,575

H54RH00038
H54RH00018

$312,013
$404,857

H54RH31117
H54RH00023
H54RH00006

$615,324
$754,133
$427,003

H54RH00027
H54RH00046

$406,347
$696,296

H54RH00031

$574,290

H54RH00036

$726,025

AL
AR
AZ
CA
CO
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
ME
MI
MN
MO
MS
MT
NC
ND

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NE
NH
NM
NV
NY
OH
OK
OR
PA
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY

HEALTH AND HUMAN SERVICES, NEBRASKA
DEPARTMENT OF
HEALTH AND HUMAN SERVICES, NEW
HAMPSHIRE DEPT OF
HEALTH, NEW MEXICO DEPARTMENT OF
UNIVERSITY OF NEVADA, RENO
HEALTH RESEARCH, INC.
HEALTH, OHIO DEPARTMENT OF
OKLAHOMA STATE UNIVERSITY
OREGON HEALTH & SCIENCE UNIVERSITY
PENNSYLVANIA STATE UNIVERSITY, THE
SOUTH CAROLINA OFFICE OF RURAL HEALTH
SOUTH DAKOTA DEPARTMENT OF HEALTH
HEALTH, TENNESSEE DEPT OF
AGRICULTURE, TEXAS DEPARTMENT OF
DEPARTMENT OF HEALTH UTAH
HEALTH, VIRGINIA DEPARTMENT OF
HUMAN SERVICES, VERMONT AGENCY OF
HEALTH, WASHINGTON STATE DEPARTMENT
OF
UNIVERSITY OF WISCONSIN SYSTEM
HEALTH AND HUMAN RESOURCES, WEST
VIRGINIA DEPARTMENT OF
WYOMING, DEPARTMENT OF HEALTH
Totals

H54RH00005

$742,565

H54RH00022

$407,956

H54RH00025
H54RH00015
H54RH00020
H54RH00021
H54RH00058
H54RH00049
H54RH25673
H54RH01030
H54RH00024
H54RH00037
H54RH26521
H54RH00050
H54RH00003
H54RH00017
H54RH00002

$298,795
$469,924
$352,435
$626,909
$568,040
$650,664
$413,036
$375,570
$585,597
$460,673
$723,664
$361,480
$337,825
$307,614
$606,356

H54RH00054
H54RH00026

$699,415
$505,575

H54RH00043
45

$464,345
$23,659,822

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APPENDIX D: FLEX PIMS FREQUENTLY ASKED QUESTIONS
Reporting for budget period: 9/1/2017 – 8/31/2018
Questions about reporting participation
1. I don’t yet have information on whether the CAHs participating in this project
improved or not. What do I report?
a. Use the check box to indicate CAHs with known improvement. If you
don’t yet know if the CAH improved then leave it blank.
2. Should all of my CAHs which reported quality data for MBQIP be listed as
participating in Quality Improvement activities?
a. Not necessarily. Reporting quality data alone is not a “Flex-funded
activity intended to improve a specific outcome.” Reporting CAH
participation in PIMS should be limited to quality improvement projects
and other activities and interventions where the Flex program expects
to help CAHs make changes and show improvements. See the
definition of participation.
3. One of our activities was to increase the number of CAHs reporting EDTC.
Should I check participation in PIMS for all of the CAHs that started reporting
EDTC in the last year?
a. As the example vignettes in the PIMS Data Collection Tool show, the
first step in performance improvement is collecting data to know
where you stand. If a CAH’s Flex-supported performance improvement
project for this year is to start reporting a measure or measures then
you would report the CAH as participating if they engaged with the
Flex activities as planned and you would report them as improving if
they successfully started the reporting which was their project goal.
We changed this answer since the FY 2015 reporting FAQs.
4. Every year we produce individual financial status reports and distribute them
to all of our CAHs as part of Activity 2.02, in-depth financial and operational
assessments. Since all of our CAHs receive a report, should I list them all as
participating?
a. It depends. There are two parts to 2.02 in PIMS, 1) which CAHs
underwent individual assessments, and 2) which CAHs identified
targets for improvement and showed improvement following the
assessment. If the reports are part of activity category 2.02 in your
work plan and you think they meet the criteria for in-depth CAH
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assessments, then you could list them all for part 1. Based on those
reports (and possibly other TA and guidance) some of those CAHs may
have identified specific targets for financial improvement and you’d
report those in part 2. Other CAHs would not have specific
improvement targets and projects so you would not list them in part 2.
5. Should I report all of my CAHs that attended a topical conference (such as a
patient safety conference) as participating in PIMS?
a. It depends. Would you expect to see a CAH implementing changes in
their operations based on attending the conference alone? Or would
you only expect to see changes implemented at CAHs that attended
the conference and participated in the other training and engagement
efforts that were part of your larger improvement project? For PIMS
participation we are trying to identify the CAHs that participate in Flexfunded improvement projects at a level that could realistically lead to
changes. PIMS certainly won’t capture everything you do as a Flex
program—a lot of your work is general information and “light-touch”
activities that you don’t expect to lead to trackable changes. CAHs that
are only attending these events wouldn’t be reported as participating
for PIMS.
6. Should I report all CAHs as participating on the Quality Improvement page
that submitted MBQIP data and show up in the Telligen report?
a. No. FORHP has copies of the same Telligen reports, and we can
calculate which CAHs reported data over the past year. For PIMS you
should report which CAHs participated in a Flex-funded improvement
project and whether they improved on the outcome that was the
target of the project. In the quality area those outcomes are going to
be one or more MBQIP measures or optional measures, in the finance
area they could be a range of outcomes depending on the specific
project. For some activity categories you may report just a few CAHs
as participating in improvement projects in PIMS, even though many
CAHs are reporting MBQIP data or doing other work that doesn’t match
the PIMS definition of participation. (Also see questions 15, 16, and 18
of these FAQs.)
7. For the number of EMS entities participating in improvement projects
(Activities 3.05 and 3.06) should we include the number of EMS entities that
participated in our EMS Assessment Survey which is not an improvement
activity?
a. No. The assessment is a valuable data-gathering activity for you, but
you would not expect that completing the assessment alone would be
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associated with improvements in operations on the part of the EMS
entities.
8. The CAH assessments in Activities 2.02 and 3.03, the network participation
question in 2.04, and the CAH conversion questions in 4.01 don’t have
improvement associated with them. What does CAH participation mean for
these questions since they aren’t intended to improve a specific outcome for
the CAH?
a. For these sections you should include all CAHs that were assessed or
participated in the network as you define it. These assessments would
not be improvement projects on their own. See sections with different
data entry options for more detail on these categories.
Questions about reporting spending
9. I am reporting spending in each program area of my Flex program. Should
those numbers total my full Flex allocation? What if I don’t have final
spending reports from my finance office yet?
a. Yes, the total on the Flex Spending page should match your full Flex
award, minus any unspent funds / unobligated balance. If final
spending reports aren’t available when completing PIMS, report your
best estimate based on the data you have.
10.Do the spending reports include all Flex projects and activities or just the
improvement activities? Some of the tasks in our work plan are things such
as giving out data reports which are helpful but aren’t improvement
activities.
a. The reported spending should include all of the Flex investments you
made in that activity area, both ongoing work like distributing reports
and the specifically improvement-directed work. We have two different
sets of questions on each activity category—one part is the total Flex
investment reported on the spending page and the other is the CAH
participation specifically in improvement interventions.
11.For some of the quality improvement activity categories my Flex program
provided general information about reporting processes and deadlines to all
of my CAHs through mailing lists, webinars, and other presentations.
However, we did not fund any in-depth engagements or interventions in
specific CAHs with the goal of improving this quality domain. Can I report my
spending in this activity without reporting participation by specific CAHs?

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a. Yes, you should report all spending for the activity categories. For
participation (and improvement) in each activity you should only
report the CAHs which met the definition of an in-depth engagement
as described in the reporting instructions. However, for the total funds
spent in that activity you should include all Flex investments, both the
spending for in-depth engagements and interventions and the
spending for more general information sharing and basic TA. Be sure
to avoid double counting when you are reporting general spending that
supports multiple activities. Also see question #15 in these FAQs.
12.Our Flex program didn’t spend any additional money (just staff time) on the
statewide assessments such as 2.01 and 3.01. What should I report for
spending in those activity categories?
a. If you can estimate the cost of the Flex staff time that was used to
complete the assessment, then you should report that as the spending
for this activity category. If the assessment was completed by other
staff not funded by the Flex award or if you can’t estimate the cost of
Flex staff time then you should enter zero (0) for spending in this
category in the spending calculator in the PIMS Data Collection Tool.
Questions about selecting activity categories
13.Do I need to report on Activity 4.01 Designation of CAHs in the State if we
didn’t have any new CAHs this year?
a. Report on the activities actually conducted under your Flex award in
the past year. For example, helping a rural hospital assess the
financial feasibility of CAH conversion would be part of Activity 4.01
but the hospital might decide not to convert following that assessment.
In that case you would report that you assisted one hospital and it did
not convert to CAH status.
14.I completed my statewide CAH financial needs assessment (Activity 2.01)
before the FY 2015 budget year started because I used that assessment to
write my Flex award application in 2015. What do I report for Activity 2.01 in
PIMS?
a. If you spent some time or money revisiting and updating that
statewide assessment in preparation for the progress report last
spring, then you might have some spending to report for 2.01. If no
effort was spent for 2.01 in the past year you should report zero (0).
See question #16.

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15.Is it ok if I don’t check any CAHs as participating in a specific activity
category?
a. Yes. On the selection page you should include all activity categories
that were part of your Flex work plan, however for the CAH lists on the
program area pages you only report the CAHs that were involved in
projects and interventions meeting the definition of participation. If an
activity didn’t include CAH involvement meeting the definition of
participation, then you should not check any CAHs for that section and
you should leave the entire CAH list blank. You should still report your
Flex program spending in that activity category. Note that some
categories (such as 3.01) do not include CAH lists in PIMS.
16.Our Flex program worked in an activity category that did not have any
specific CAH improvement projects that meet the definition of participation.
One example was our statewide population health needs assessment under
Activity 3.01. Should we select that category on the Selection page and what
do we report on the Population Health and EMS data page for this category?
a. On the PIMS Selection page you should include all activities (organized
by numbered category) that were part of your work plan for the past
year. Yes, this does include categories such as Activity 3.01 that don’t
have CAH participation in specific reportable improvement projects
meeting the definition of participation for PIMS. Activity categories
without qualifying CAH participation should still be checked on the
selection page so that you can report the related program spending on
the spending page.
17.Should the activity categories I check on the Selection page match my work
plan for the past year?
a. Yes. The only exception to the Selection page matching the work plan
is if some planned activities were not carried out. In PIMS you should
only report activities that were actually done in the FY 2017 budget
year.
Other questions
18.How is the PIMS report different from the Telligen report for the quality
improvement activities?
a. The hospital and state MBQIP reports produced by Telligen include all
of the CAHs that are reporting quality measures to the national quality
data systems that are part of MBQIP. Only some of those CAHs will be
engaged in Flex-funded improvement projects. The PIMS report
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reflects your Flex program’s information about which CAHs participated
in Flex engagements and interventions and whether you were able to
track improvement on the outcomes that were the target of those
interventions.
Simply put, the MBQIP report reflects data from all reporting CAHs
while PIMS tracks only improvements associated with participation in
Flex-funded activities.
19.The questions in the Financial data page for Operational Improvements
(Activity 2.04) are split into two sections for operations and network
participation. Do I report differently in these sections?
a. Both sections labeled 2.04 are part of the same set of questions about
operational improvement activities. Please answer all three questions:
1) which CAHs participated (and which improved) in operational
improvement projects, 2) how many financial and operational
improvement networks were active, and 3) which CAHs were part of
those networks. The spending page has a row to report how much Flex
money was spent for all projects (network and non-network) in activity
2.04 during the budget period.
20.In PIMS there is a place to upload documents. Should we be submitting
reports or other files?
a. No. That’s a default feature in PIMS that we don’t use for Flex reports.
Refer to the reporting instructions and FAQs. The documents walk
through everything you need to report.
21.I have CAHs with names changes and a new CAH that’s not listed in PIMS.
How can I correct my CAH list?
a. Send your project officer a list of the CAHs with name changes. Please
include old name, new name, and Medicare CCN on the list. If you
have a new CAH send your project officer the CAH’s name, new
Medicare CCN, and street address. See Checking your CAH List.

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