Frontier Community Health Integration Program (FCHIP)

The Need for an Integrated Model in Frontier

Frontier areas are sparsely populated rural areas that are isolated from population centers and services and therefore face challenges in providing access to health services. Many frontier counties lack a hospital and frontier counties without healthcare professionals or hospitals are often clustered together which compounds the distance residents must travel to reach a hospital. Those frontier counties that do have hospitals may face higher costs than non-frontier hospitals, due to the lower volume of patients served. Because of these challenges, there is a need for integrating frontier systems of care in order to increase efficiencies and better coordinate patient care.

Program Purpose

The purpose of the demonstration is to develop and test new models for the delivery of healthcare services in frontier areas through improving access to, and better integration of, the delivery of healthcare to Medicare beneficiaries. The primary focus areas of the demonstration are to:

  • explore ways to increase access to, and improve the adequacy of, payments for acute care, extended care, and other essential healthcare services provided under the Medicare and Medicaid programs in frontier areas; and
  • evaluate regulatory challenges facing frontier providers and the communities they serve

Legislation Authorizing the FCHIP Demonstration

The Frontier Community Health Integration Program (FCHIP) demonstration is authorized under Section 123 of P.L. 110-275, the Medicare Improvements to Patients and Provider’s Act of 2008 (MIPPA).

FCHIP Demonstration

The Centers for Medicare and Medicaid Services (CMS) requested applications to participate in the Frontier Community Health Integration Project Demonstration in early 2014, with applications due May 5, 2014. Details about the demonstration are listed in the FCHIP Request For Information, and an overview of this opportunity is available on RHIhub.

Eligibility to participate in the demonstration project was defined in the authorizing legislation and limited to “eligible entities”. CMS interprets the eligible entity definition as meaning critical access hospitals (CAHs) that receive funding through the Rural Hospital Flexibility Program. The statute limited the demonstration to no more than four States and restricted eligibility to CAHs in States in which at least 65 percent of the counties had 6 or fewer residents per square mile. Applications to participate in the demonstration were limited to CAHs in Alaska, Montana, Nevada, North Dakota, and Wyoming, and CMS will select participants from no more than four of these States.

For the most current information, please see information from CMS on the Frontier Community Health Integration Project Demonstration.


In fiscal year 2010, Congress appropriated funds to the Federal Office of Rural Health Policy (FORHP) for the FCHIP demonstration. FORHP funded an 18-month cooperative agreement award to the Montana Health Research & Education Foundation (MHREF) to provide information and data to CMS as they develop this demonstration. In order to identify and communicate the challenges and solutions MHREF hoped to convey to CMS, a Framework Document and subsequent topical white papers were prepared.

FORHP also provided funding to the Rural Medicare Flexibility programs in North Dakota, Alaska and Wyoming to respond to the framework document and white papers produced by MHREF and provide CMS any additional regulatory proposals not addressed in the original framework or whitepapers.

More Information on the FCHIP Demonstration

FCHIP Program Contact:

Paul Moore, Federal Office of Rural Health Policy