Do Montana and the seven RPCH States have to submit the same assurances and related information as are required of a State setting up a rural hospital flexibility program for the first time?
A1: The assurances and related information are not needed to allow continued participation by existing RPCHs and MAFs, since they are grandfathered if they are otherwise eligible to be designated as CAHs. However, the assurances and related information described in the interim final regulations at p. 46009 must be submitted before a State can have its designations of new CAHs recognized by HCFA. State submittals should build on existing health plans and networks wherever possible. States that have previously received RPCH or MAF grants from HCFA based in part on their rural health plans and network designations may also use those plans and network arrangements as the basis for their assurances relative to the rural hospital flexibility program. However, States should either update their plans to ensure that they are current, or provide a copy of their existing plan and state in the assurance or related information that the plan remains in effect. Q2: Is grandfathering available to a fa
