Rural Health Transformation Program
RHTP implementation and technical assistance for rural EMS
TPF helps states, EMS agencies, and rural health partners plan and deliver the EMS, community paramedicine, workforce, evaluation, and financial sustainability parts of their Rural Health Transformation Program (RHTP) plans. The RHTP, enacted under Public Law 119-21, appropriates $10 billion a year for fiscal years 2026 through 2030, $50 billion in total, for rural health system redesign under state plans approved by CMS, and all 50 states received awards for FY2026. TPF is prime contractor to the Nebraska Department of Health and Human Services for RHTP community paramedicine and regional EMS work.
Who this page is for
State agencies, EMS organizations, and rural health partners evaluating RHTP partners
This page is for state health departments issuing RHTP subaward solicitations, EMS agencies and rural health organizations applying for subaward funding, regional health bodies building RHTP implementation teams, and hospital systems and Federally Qualified Health Centers (FQHCs) exploring RHTP participation.
TPF has tracked RHTP implementation nationally since the program was authorized, including the statutory uses of funds, state solicitations, and the program design requirements that award recipients are expected to meet. The partnership modes TPF can take are described below.
What TPF brings to RHTP implementation
Implementation-grade capacity across the program areas RHTP funds
EMS system design and governance
Rural EMS system architecture, coverage modeling, governance structure design, regional coordination frameworks, ambulance sustainability planning, and service area analysis. Right-sizing rural delivery systems across pre-hospital and emergency service lines is among RHTP’s permitted uses of funds.
Learn about TPF’s rural EMS work → Community paramedicineCP/MIH program design and implementation
Community paramedicine (CP) and Mobile Integrated Health (MIH) program design, referral pathway architecture, treat-in-place and alternate destination protocols, behavioral health crisis response, chronic disease follow-up, hospital-to-home transitions, and ED diversion strategy.
Learn about TPF’s CP/MIH work → WorkforceWorkforce development and clinical education
EMS clinical curriculum development, paramedic and EMT training programs, rural workforce pipeline design from K–12 through credentialing, simulation training, five-year rural service commitment framework design, and retention program development.
Evaluation & accountabilityData, evaluation, and federal accountability
Program evaluation design, RHTP progress reporting and CMS checkpoint support, performance metric development, rural health data dashboard design, and federal cooperative agreement compliance infrastructure.
Regional coordinationRegional coordination architecture
Regional EMS and rural health coordination system design, hub-and-spoke implementation, multi-county coordination frameworks, and state-regional alignment structures drawing on deep experience with Colorado’s Regional Emergency Medical and Trauma Advisory Council (RETAC) model.
Austere & wilderness careAustere care training, protocols, and program design
Wilderness EMS and SAR medical operations, event and expedition medicine, tactical emergency medical support (TEMS), and disaster medical operations. RHTP-funded workforce development and clinical education programs may include austere care components, particularly for frontier systems where austere conditions are part of routine operations. TPF can support austere care curriculum development, protocol design, training delivery, and program evaluation under RHTP workforce and service delivery program areas.
Learn about TPF’s austere care work → Behavioral healthBehavioral health–EMS integration
EMS behavioral health crisis response protocol design, EMS-to-Certified Community Behavioral Health Clinic (CCBHC) and EMS-to-FQHC referral pathway development, SUD and opioid response integration, co-responder and alternate response program design.
Financial sustainabilityFinancial sustainability and revenue cycle
Cost-structure and payer-mix analysis, billing and revenue-cycle assessment, Ground Emergency Medical Transportation (GEMT) feasibility where applicable, and financial modeling of deployment change, alternative response, and new revenue categories, including what treat-in-place and alternate-destination reimbursement would mean for a specific payer mix. TPF pairs EMS finance with rural health economics, a combination uncommon among EMS consulting organizations.
Learn about TPF’s rural EMS sustainability work → Grant & proposal supportProposal development, grant readiness, and reporting
Grant-narrative and budget-narrative development, 2 CFR Part 200 compliance frameworks, subrecipient monitoring design, and the documentation and reporting structures funded programs are expected to maintain. TPF can lead an application directly or strengthen a partner’s application as part of a consortium, and can carry the reporting burden that limits state and local capacity.
Discuss proposal and grant support →TPF can contract directly with a state, lead or support an application, or engage as a technical assistance, evaluation, curriculum, or implementation partner, depending on what a state, agency, or community needs most. Where federal funds are involved, the awarding agency designates TPF’s role, as a contractor or as a subrecipient, and that designation governs its treatment under 2 CFR Part 200.
TPF does not require a specific contract structure. TPF builds the engagement model around what the program and the partner need.
Contact TPF directly:
[email protected]
EIN: 46-3271401 · Minnesota nonprofit corporation, tax-exempt under IRC §501(c)(3)
23 W Central Entrance, PMB 321
Duluth, MN 55811
Who TPF supports
Who TPF supports under RHTP
TPF works with the organizations responsible for rural health transformation at every level. That includes state health departments and rural health offices issuing RHTP subaward solicitations; state EMS offices and Medicaid agencies; regional EMS and trauma advisory councils and regional EMS technical assistance hubs coordinating implementation across multiple counties; rural hospitals, Critical Access Hospitals, and Federally Qualified Health Centers; ambulance services and EMS agencies; hospital and health systems anchoring consortia; public health agencies; hospital and EMS associations; workforce boards; universities and research centers; and community-based organizations and grant-writing partners preparing competitive applications.
TPF can lead an application, strengthen a partner’s, or sit inside a consortium as the evaluation, finance, curriculum, or implementation partner. The structure follows the program’s needs. TPF’s bench includes the current Executive Director of a six-county Colorado regional EMS and trauma advisory council. TPF’s Chief Operating Officer formerly led a nine-county council and founded the Colorado RETAC Alliance, so the regional hub model is operating experience for TPF rather than theory.
How TPF can engage
Six engagement modes, matched to the program
Prime contractor
TPF contracts directly with a state agency, as it does as prime contractor to the Nebraska Department of Health and Human Services, Division of Public Health. On that contract the agency designated TPF a Contractor and not a Subrecipient.
Applicant or consortium member
Where a state’s solicitation permits, TPF can lead an application with EMS agency or rural health partners, or join a consortium led by another organization. If the resulting award designates TPF a subrecipient, TPF delivers a defined RHTP initiative component on that basis.
Technical assistance partner
TPF provides design, coaching, and implementation support to state agencies or award recipients without holding an award.
Evaluation partner
TPF designs and executes program evaluation, outcome measurement, and CMS progress reporting infrastructure.
Curriculum partner
TPF develops workforce training, clinical education, and simulation content for RHTP-funded workforce development programs.
Implementation partner
TPF co-delivers RHTP programs alongside state agencies and lead award recipients, providing sustained implementation support.
Statutory basis
Where EMS fits in RHTP
Section 71401 of Public Law 119-21 establishes the program. Its permitted uses of funds include payments to health care providers, right-sizing rural delivery systems across pre-hospital and emergency service lines, and innovative care models. CMS’s award announcement of December 29, 2025 names improved emergency medical services communication, treat-in-place options, and coordinated transfers among the activities states will fund.
Whether a particular EMS or community paramedicine proposal can be funded depends on the state’s approved plan and the terms of its solicitation. TPF helps states and applicants read those terms and design proposals that fit them, drawing on experience with federal EMS policy, state contracting, and the implementation and reporting infrastructure these programs require.
Read about TPF’s EMS policy work →About RHTP and partnering with TPF
Common questions
What is the Rural Health Transformation Program?
The Rural Health Transformation Program (RHTP) is a federal rural health initiative enacted under Public Law 119-21 in July 2025, with $10 billion appropriated for each of fiscal years 2026 through 2030, $50 billion in total. States use the funds for rural health system redesign under plans approved by the Centers for Medicare & Medicaid Services (CMS). The program’s permitted uses of funds include payments to health care providers, right-sizing rural delivery systems across pre-hospital and emergency service lines, and innovative care models. CMS’s award announcement names improved emergency medical services communication and treat-in-place options among the activities states will fund. All 50 states received RHTP awards for FY2026.
What roles can TPF serve in an RHTP-funded initiative?
Where a state’s plan and solicitation permit, TPF can serve as a prime contractor, lead or join an application, or work as a technical assistance, evaluation, curriculum, or implementation partner. Where federal funds are involved, the awarding agency designates TPF’s role, as a contractor or as a subrecipient, and that designation governs its treatment under 2 CFR Part 200. TPF is prime contractor to the Nebraska Department of Health and Human Services, Division of Public Health, for RHTP community paramedicine work and regional EMS technical assistance; the agency designated TPF a Contractor and not a Subrecipient. The role in any other engagement is matched to the program structure and the state’s solicitation requirements.
Is EMS eligible for RHTP funding?
It can be, depending on the state. The program’s permitted uses of funds include right-sizing rural delivery systems across pre-hospital and emergency service lines, payments to health care providers, and innovative care models. CMS’s award announcement names EMS communication and treat-in-place options among the activities states will fund. Whether a particular EMS, community paramedicine, or mobile integrated health proposal can be funded depends on the state’s approved plan and the terms of its solicitation. TPF can review a state’s solicitation with an applicant and help design a proposal that fits it.
How do organizations start working with TPF on RHTP?
Through the contact page, with a short description of the organization, the state, and the RHTP program area involved. Initial consultations are free. TPF will say whether and how it can add value to the specific program.
What does TPF’s EMS financial modeling capability include under RHTP?
A program funded for a fixed period needs a plan for how its services continue afterward. TPF builds the financial models that support that plan: cost structure analysis, reimbursement gap modeling, revenue cycle assessment, and scenario modeling for alternative funding structures including GEMT, Medicaid State Plan Amendments, and county subsidy frameworks. Free planning tools are available on the financial modeling page. Custom analysis is available through an engagement.
Start a conversation about your RHTP program
Whether you are issuing a subaward solicitation, building an RHTP implementation proposal, or evaluating whether your EMS or CP/MIH program fits your state’s plan, TPF is glad to hear from you. Initial consultations are free and without obligation.