RHTP Plan Development — Fast, Compliant, Competitive
Our purpose-built RHTP Plan Development Playbook helps states move quickly to meet the November 2025 CMS deadline, secure base allocation, and compete for discretionary funding. We leverage deep experience writing CMS-compliant plans to create a fund-wining Rural Health Transformation Plan.
State Advisory: Executive level consulting, requirements research, compliance plan writing, federal partner interface, vendor oversight and IV&V.
Differentiators: FHIR modernization for interoperability and reporting, AI innovation for outcomes and solvency, and biomedical remote medicine to accelerate measurable impact.
The Rural Health Transformation Program
Authorized by the One Big Beautiful Bill Act (Public Law 119-21), the RHT Program invests in rural healthcare transformation to expand access, improve quality, and strengthen outcomes. Funding will be released through a Notice of Funding Opportunity (NOFO) and awarded as cooperative agreements.
Program Structure
Total Funding: $50 billion over five fiscal years (2026–2030), with $10 billion available each fiscal year.
- 50% distributed equally among all approved States.
- 50% allocated by CMS based on factors including rural population, the proportion of rural health facilities in the State, the situation of certain hospitals, and other factors to be specified by CMS in the NOFO.
Uses of Funds
States must apply funds to at least three CMS-approved activities. Allowable areas include:
- Evidence-based prevention & chronic disease management
- Direct payments to providers for health care items/services
- Consumer-facing, technology-driven solutions for chronic disease
- Training & technical assistance for tech adoption (e.g., RPM, robotics, AI)
- Recruitment & retention of clinical workforce (5-year rural commitments)
- IT modernization & cybersecurity upgrades
- Right-sizing rural delivery (EMS, inpatient, outpatient, post-acute)
- Behavioral health & SUD treatment access
- Value-based care & alternative payment models
- Other Administrator-approved activities that sustain rural care
The Opportunity - Capture CMS Funding for 5 Years + Discretionary Funds to Seed Rural Healthcare Improvement
What’s in the RHTP Application?
1. Statutory Requirements
States must submit a detailed transformation plan.
The plan must align with at least three CMS-approved uses of funds categories.
2. Strategic Alignment
Initiatives must have measurable outcomes.
Plans must show stakeholder engagement.
Applications should highlight impacted counties, demonstrate sustainability, and show a direct impact on rural residents’ healthcare.
3. Budget & Operations
A clear workplan and timeline for implementation.
Includes budget, milestones, and data tracking.
Must commit to policy changes identified in the plan, to be implemented within two years.
How do States Apply?
Application Process
- NOFO Release: Mid-September on Grants.gov
- CMS Engagement: Q&A during the open application window
- Submission Deadline: Early November 2025
- Awards Announced: By December 31, 2025
FAQs
Is there more than one chance to apply? No — only one application window in 2025.
How many applications per state? One official submission; if multiple are filed, the last before deadline counts.
Who must submit? The Governor or a designated state agency, with an endorsement letter.
Can states coordinate? Yes, but each state must submit separately.
Are non-state entities eligible? No — only state governments may apply.
Clawbacks & Compliance
CMS has clear rules for how RHTP funds must be managed. States must follow their approved plans and federal requirements — or risk losing money already awarded. In some cases, funds can be withheld, reduced, or recovered.
When Funds Can Be Taken Back
- If funds are used in ways not approved by CMS.
- If states deviate from their submitted/approved application.
- If reporting or continuation requirements are not met.
- If funds remain unexpended or unobligated by Oct 1, 2032 — they must be returned to the U.S. Treasury.
How to Maintain Funding
- Stay aligned with the approved RHTP plan and allowable CMS activities.
- Use each annual allotment within its 2-year window (the year awarded + the following year).
- Submit required annual progress reports and continuation updates showing outcomes, milestones, and expenditures.
- Respect the 10% administrative cost cap on funds.
- Do not replace standard provider reimbursements (RHTP funds can’t duplicate existing Medicaid/Medicare payments).
- Maintain records for at least 3 years after the final report (longer if under audit or litigation).
Source: CMS RHTP Assistance Listing (93.798) and CMS RHTP FAQs — funds must be used as approved, reported annually, and any unspent balance by Oct 1, 2032 must be returned to Treasury.
The Challenge - Creating a RHTP Plan to Achieve (and Keep!) Maximum Funding
Our Solution: Phased Delivery
Engineering Solutions, Inc. (ESI) delivers a three-phase pathway that meets CMS requirements while tailoring to each state’s rural health priorities. This approach secures base allocations, strengthens discretionary competitiveness, and ensures long-term sustainability.
Phase 1 · Plan Development & Submission
State-tailored plan authored and submitted on schedule; positions for both base and discretionary funds.
Phase 2 · Roadmap & Implementation Oversight
Delivery roadmap, vendor oversight, and annual CMS documentation to safeguard funding.
Phase 3 · Scale & Sustainability
Statewide expansion with governance, KPI tracking, and CMS-aligned sustainability.
Phase 1 — Architect the plan & submit to CMS
We lead a rapid, evidence-based process: stakeholder interviews, requirements synthesis, and authorship of a state-tailored plan that aligns with CMS rules and timelines.
Ten CMS-allowable activities (address three or more):
- Prevention & chronic disease management
- Provider payments & solvency support
- Consumer-facing technology for chronic disease
- Technology adoption in rural hospitals (remote monitoring, AI, robotics)
- Rural workforce recruitment & retention (5-year commitments)
- IT advances & cybersecurity uplift
- Right-sizing rural delivery & service lines
- BH/SUD & mental health access
- Innovative models & value-based care pilots
- Other uses to sustain high-quality rural care (as determined by CMS)
How we accelerate any chosen activities
- FHIR modernization: standards-based APIs enabling registries, quality measures, and interoperability.
- AI innovation: predictive analytics for solvency, workforce, and chronic disease risk.
- Biomedical & remote models: evidence-based RPM, ECG patches, and virtual command centers.
Outcome: a CMS-compliant, state-tailored plan positioned for both base and discretionary allocations—delivered on the federal schedule.
Request Phase 1 kickoffPhase 2 — Roadmap, pilots, and compliance cadence
We translate the plan into a delivery roadmap, stand up pilots, and maintain the documentation cadence CMS expects.
- Roadmap & governance: PMO, technical governance, rural steering
- Vendor-neutral oversight and risk management
- Annual reporting & compliance artifacts to protect funding (avoid clawbacks)
- Evidence-first pilots (telehealth, workforce pipelines, solvency models, equity dashboards)
- Signal outcomes to CMS with clear KPIs
Goal: early, measurable results that build momentum for statewide scale.
Phase 3 — Statewide scale & long-term sustainability
We help states expand successful pilots, embed reimbursement models, and sustain gains.
- Statewide rollout with Medicaid alignment and value-based arrangements
- Continuous KPI tracking and equity reporting
- Ongoing CMS compliance & documentation
- Resilient rural delivery with CAH stabilization and workforce retention
Result: durable improvements in access, quality, and solvency—positioning your state as a reference model.
Why ESI
- Executive advisory & federal compliance depth: proven authorship of complex, multi-agency plans and successful federal negotiations.
- Research-first, compliance-assured: we don’t “check boxes”; we research, write, and defend plans aligned to CMS requirements.
- Technical advantage: FHIR interoperability, AI analytics, and biomedical innovation to accelerate outcomes.
- Emergency-ready: experienced with rapid authorizations and fast kickoffs.
- Trusted partner: we act as the state’s executive presence with legislators, federal partners, and stakeholder coalitions.
“Recognized by CMS for knowing the regulations better than they do!”
Resources
Authoritative references for state teams (links open in a new tab):
