Rural Health Transformation Program

​See RHTP Notice of Funding Opportunity (NOFO) and latest CMS FAQs for more information.

General:

• Per the NOFO and CMS FAQs, there are no limits on the types of entities that may receive funds. Each state has the discretion to determine which organizations receive funds, based on parameters outlined here.

• Oregon will direct funding to rural and frontier areas of the state. Any spending in urban areas must be clearly demonstrated to be for the benefit of rural patients.

• Rural is any geographic areas in Oregon ten or more miles from the center of a population center of 40,000 people or more. Frontier (or “remote") is any county with six or fewer people per square mile.

• See the Oregon Office of Rural Health map of rural areas in the state as a helpful guide.

• RHTP funds are designed to support new access points and expansion of services to rural communities, not to replace or duplicate existing funding sources.

• RHTP funds may only be applied to the costs associated with new populations, new activities, new program milestones, etc. when used to:

• expand an existing pilot program or initiative or

• develop new training programs with existing partners.

• The maximum individual salary amount that can be billed to the RHTP is $225,700. If, for any reason, the person working on this program makes over the salary cap amount, the remaining salary must be covered by other funding sources.

Allowable:

Public Law 119-21, Section 71401 (i.e., H.R.1) includes details on statutorily approved uses of funds and unallowable expenses. States must spend their RHTP funds on at least three permissible uses. Oregon submitted an application that strategically covers all permissible uses (see NOFO for detailed definitions):

• Prevention and chronic disease

• Provider payments

• Consumer tech solutions

• Training and technical assistance

• Workforce

• IT advances

• Appropriate care availability

• Behavioral health

• Innovative care
  

• Capital expenditures and infrastructure

• Fostering collaboration

​Certain use-of-fund categories are subject to specific restrictions. Please see sections “Provider Payments," “Workforce," “Capital Expenditures and Infrastructure," and “IT Advances" in this FAQ for more detail on each respective use of funds category.

Generally, gas costs are allowable. For example, providing fuel stipends for rural patients while establishing other transportation.

Not allowable:

Funding cannot be used…

• To pay for meals, including:

• food costs for community meetings for programming related to outcomes of the grants in the program, or

• medically tailored meals, in schools (or in any other context) because it is an ongoing cost.

• To replace or modify payment for clinical services that could be reimbursed by insurance, another form of health coverage or under current waiver initiatives that are eligible for reimbursement.

• On any aspects of projects or initiatives that are currently funded (or planned to be funded) via other sources.

• For costs incurred pre-award, lobbying activities, and expenses that are the legal responsibility of another federal, State or tribal program such as education or vocational rehabilitation services.

• For cost of independent research and development, including their proportionate share of indirect costs.

Provider Payments

Definition: Provider payments are payments made to health care providers for the provision of health care items or services. These payments cannot replace payments for clinical services that could be reimbursed by insurance and/or other programs.

Provider payments are limited to 15% of the total funding CMS awards a state in a given budget period.

Allowable

• Payments to providers for performance in alterative payment models tied to outcomes.

• Payments to providers for services that are not paid by insurers but support the strategic goals of the RHTP and tie to a specific initiative.

Not allowable:

RHTP dollars cannot fund…

• Uncompensated care that is not tied to a specific initiative within the RHTP.

• Clinician salaries or wage supports for facilities where the clinician or beneficiaries are subject to a noncomplete agreement. This does not disqualify facilities that have clinician non-competes from receiving RHTP funding for other activities.

• Make payments to providers that are not tied to specific quality improvements or an RHTP initiative, enhanced payment rates for currently billable services without ties to outcomes, uncompensated care that is not tied to a specific initiative within the RHTP.
  

Workforce Use of Funds​

Definition: Recruiting and retaining clinical workforce talent to rural areas, with commitments to serve rural communities for a minimum of 5 years. Clinical workforce talent encompasses a variety of healthcare professionals who directly provide or support patient care. Examples include clinicians, allied health professionals, behavioral health providers, non-clinician providers, and clinical support staff.

Training programs could be run by organizations including but not limited to trade schools, community colleges, high schools, colleges, universities, technical institutes, and academic medical centers.

Five-year work requirement:

• Members of the clinical workforce who benefit from recruiting and retention activities (including incentives) under the RHTP must make a minimum 5-year commitment to serve rural communities. Generally, if a program offers a structured, certifiable pathway to a new degree, new certification, or to a career/new job opportunity in the clinical workforce in a rural area, the 5-year service requirement will apply.

• The five-year commitment cannot be fulfilled via telehealth services. Any clinicians recruited or retained under this use of funds must be physically located in rural areas.

• Generally, clinicians would not be held to a 5-year commitment for receiving non-degree courses or one-off training sessions.

• Workforce recruitment and retention programs focused on K-12 populations are typically excluded from the minimum 5-year workforce commitment requirement, but it depends on the nature of the program. Initiatives such as career exploration camps, mentoring programs, or high school health career clubs that are considered upstream pipeline activities would not be subject to the minimum 5-year workforce requirement. Their purpose is to foster interest and exposure, not to provide the direct, career-enabling training that the commitment is designed to apply to. Any determination to apply the 5-year commitment to a K-12 population program will be made on a case-by-case basis by CMS.

Allowable:

• Payment for student or trainee housing is allowable but limited to short-term (less than 6 months) housing for rotations.

• Salaries or payments to clinicians directly related to new or expanded workforce development initiatives.

Not allowable:

• Student loans or loan repayment are not an allowable use of funds.

• Funds are not intended to be used for international clinical workers and therefore cannot be used to recruit and/or sponsor visas for physicians or clinical workers from other countries.

• Funds cannot be used to make payments to providers that are not tied to specific quality improvements or an RHTP initiative, enhanced payment rates for currently billable services without ties to outcomes, uncompensated care that is not tied to a specific initiative within the RHTP.

• Funds cannot be used to directly fund workforce development initiatives where the clinician or beneficiaries are subject to a noncomplete agreement. (For example, a new clinician in a rural area because of a funding workforce development initiative.)  This does not disqualify facilities that have clinician non-competes from receiving RHTP funding.

Capital Expenditure and Infrastructure Spending:

Definition: Investing in existing rural health care facility buildings and infrastructure, including minor building alterations or renovations and equipment upgrades to ensure long-term overhead and upkeep costs are commensurate with patient volume.

• Purchase of equipment will generally fall in this spending category (e.g. exam chairs, dental equipment). Personal-use equipment like heart rate monitors would not be in this category.
  

• There is a 20% limitation across Oregon's entire award per budget period for capital infrastructure expenditures. OHA staff will be looking at planned infrastructure spending across all initiatives to ensure this cap is not exceeded.

Allowable:

• Renovations and minor alternations are allowable, within certain parameters and require prior approval from CMS. Minor alterations and renovations projects include small modifications aimed at enhancing the functionality of the facility where the project will take place. In general, minor modifications to an existing building footprint, existing infrastructure, and existing rooms within a facility would be considered minor building alterations or renovations.

• For example, renovations or retrofitting to convert underutilized cost intensive spaces within existing health care facilities to clinic or community-based treatment spaces would be allowable.

• Hypothetical examples include: interior modifications to create new meeting space, upgrading lighting fixtures, replacing vents and thermostats for better climate control, accessibility improvements, security and safety including security cameras or access control panels.

• The existing building being renovated does not have to be an existing healthcare facility.

• A minor renovation may be considered a minor alteration even if local building regulations require the work to be permitted.

• Initiatives that focus on developing the infrastructure for healthy living, such as funding the infrastructure necessary to facilitate nutrition improvement programs at schools in rural communities is an allowable expense.

• Funding may be used to purchase vehicles but will be reviewed on a case-by-case basis by CMS and approval is not guaranteed.

• Playgrounds for movement-based initiatives will be reviewed on a case-by-case basis by CMS.

• Installations of paths or walking trails will be reviewed on a case-by-case basis by CMS.

• Bike paths and walking trails are generally not allowable expenses as they may be considered construction.

• Minor alterations to existing paths and trails, however, may be allowable expenses, if they:

• are part of a specific comprehensive initiative that is within the scope of this program,

• have a focus on benefits to rural communities, and

• will be sustainable beyond the life of the program.

Not allowable:

• New construction or major building expansions are not an allowable use of funds.

• Demolition of aged buildings is not an allowable use of funds.

• Use of funds for broadband infrastructure is not an allowable use of funds.

• Construction or building expansion, purchasing or significant retrofitting of buildings, cosmetic upgrades, or any other cost that materially increases the value of the capital or useful life as a direct cost is not allowable.

IT Advances:

Definition: Providing technical assistance, software, and hardware for significant information technology advances designed to improve efficiency, enhance cybersecurity capability development, and improve patient health outcomes.

• There is a 5% limitation across Oregon's entire award for funding the replacement of an Electronic Medical Record (EMR) system if a previous Health Information Technology for Economic and Clinical Health (HITECH) Act certified EMR system is already in place as of September 1, 2025. Replacement refers to the purchase of a completely new EMR system to take the place of an existing one.

• Upgrades, enhancements, and added modules, interfaces, or functionality to existing EMR/EHR systems are allowable uses of funds and are not subject to the 5% limitation.

Allowable:

• Telehealth capabilities and infrastructure are allowable.

• Hotspots will be reviewed by CMS on a case-by-case basis.

Not allowable:

• Funds cannot be used for broadband infrastructure.
  

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