Frontier Community Health Integration Project Demonstration

The Frontier Community Health Integration Project Demonstration aims to develop and test new models of integrated, coordinated health care in the most sparsely-populated rural counties with the goal of improving health outcomes and reducing Medicare expenditures.


There are 5 Critical Access Hospitals (CAHs) participating in the Frontier Community Health Integration Project Demonstration. 


Section 123 of the Medicare Improvements for Patients and Providers Act of 2008, as amended by section 3126 of the Affordable Care Act (ACA), authorized a three year demonstration project on community health integration models in certain rural counties to develop and test new models for the delivery of healthcare services in order to better integrate the delivery of acute care, extended care and other healthcare services and thereby improve access to care for Medicare and Medicaid beneficiaries residing in very sparsely populated areas. The initial Demonstration began August 1, 2016 and ran through July 31, 2019.

Sections 129 of the Consolidated Appropriations Act of 2021 autorizes the extension for the Frontier Community Health Integration Project (FCHIP) Demonstration. CMS included implementing the extension in the Fiscal Year (FY) 2022 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long Term Care Hospital (LTCH) Rates Final Rule. See the fact sheet on the final rule or the final rule in the Federal Register for more information.

The FCHIP demonstration extension resumed on the next cost report period beginning on or after January 1, 2022.

Critical Access Hospitals (CAHs) serve as the hubs for healthcare activities in frontier areas, but they often serve few inpatients. In this Demonstration, CMS expects CAHs to increase access to services that are often unavailable in frontier communities with the goal of avoiding expensive transfers to hospitals in larger communities. CMS will evaluate whether providing these services in frontier communities can improve the quality of care received by Medicare beneficiaries, increase patient satisfaction, and reduce Medicare expenditures.

Initiative Details

Applicants for this Demonstration must meet eligibility requirements, such as:

  • Adhering to the requirements of the Rural Hospital Flexibility Program under section 1830(g) of the Social Security Act (42 U.S.C. 1395i-4(g));
  • Describing intent in meeting community health needs in areas of telehealth, nursing facility care, and ambulance services;
  • Located in a State where at least 65 percent of the counties have six or fewer residents per square mile;
  • Limited to CAHs in Montana, Nevada, and North Dakota.



Latest Evaluation Report

Additional Information


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