Implementation and technical assistance
Rural Health Transformation Program support for rural EMS
The Paramedic Foundation (TPF) helps states, emergency medical services (EMS) agencies and rural health partners with their Rural Health Transformation Program (RHTP) plans. TPF plans and delivers the parts that cover EMS, community paramedicine, the workforce, evaluation and long-term funding. Public Law 119-21 created the RHTP. It sets aside $10 billion a year for fiscal years 2026 through 2030, $50 billion in total. States use it to redesign rural health care under plans approved by the Centers for Medicare & Medicaid Services (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
For state agencies, EMS groups and rural health partners choosing an RHTP partner
This page is for state health departments issuing RHTP subaward solicitations. It is for the EMS agencies and rural health organizations applying for that funding. It is also for regional health bodies building RHTP teams, and for hospital systems and Federally Qualified Health Centers (FQHCs) weighing whether to take part.
TPF has followed how states carry out the RHTP since the law was passed. It tracks the uses of funds the law allows, state solicitations, and the design rules that award recipients must meet. The ways TPF can work with partners are described below.
What TPF brings to RHTP implementation
RHTP program areas TPF supports
EMS system design and governance
TPF designs rural EMS systems and how they are governed. It models coverage, plans regional coordination and helps ambulance services stay afloat. It also studies service areas. RHTP funds may be used to resize rural care systems, including pre-hospital and emergency services.
Learn about TPF’s rural EMS work → Community paramedicineCommunity paramedicine and mobile integrated health programs
TPF designs and launches community paramedicine (CP) and Mobile Integrated Health (MIH) programs. It plans how referrals flow and writes protocols for treatment in place and alternate destinations. The work covers behavioral health crisis response, chronic disease follow-up and the move from hospital to home. It also finds ways to avoid needless emergency department (ED) visits.
Learn about TPF’s community paramedicine work → WorkforceWorkforce development and clinical education
TPF writes EMS clinical courses and training programs for paramedics and emergency medical technicians (EMTs). These include simulation training. It designs paths into rural EMS work from K–12 school through credentialing. It also designs five-year rural service commitments and programs that help staff stay.
Evaluation & accountabilityData, evaluation, and federal accountability
TPF designs program evaluations and writes RHTP progress reports. It helps with CMS checkpoints and sets performance measures. It also builds rural health data dashboards and the systems needed to comply with federal cooperative agreements.
Regional coordinationRegional coordination architecture
TPF designs ways for EMS and rural health groups to work together across a region. One is the hub-and-spoke model, where a central office supports local sites. TPF helps counties work together and lines up state and regional plans. The work draws on deep experience with Colorado’s Regional Emergency Medical and Trauma Advisory Council (RETAC) model.
Austere & wilderness careAustere care training, protocols, and program design
TPF covers wilderness EMS and search and rescue (SAR) medical work. It also covers event and expedition medicine, tactical emergency medical support (TEMS) and disaster medical work. Workforce and education programs paid for by the RHTP may include austere care. This matters most in frontier systems, where austere conditions are part of daily work. TPF can help with austere care courses, protocols, training and program evaluation under the RHTP workforce and service delivery areas.
Learn about TPF’s austere care work → Behavioral healthBehavioral health–EMS integration
TPF writes EMS protocols for behavioral health crises. It builds referral paths from EMS to Certified Community Behavioral Health Clinics (CCBHC) and FQHCs. It also builds substance use disorder (SUD) and opioid response into EMS work. It designs co-responder and alternate response programs too.
Financial sustainabilityFinancial sustainability and revenue cycle
TPF studies cost structure, the mix of payers, billing and the revenue cycle. Where it applies, TPF checks whether Ground Emergency Medical Transportation (GEMT) payments are workable. It models the money side of deployment changes, alternative response and new kinds of revenue. That includes what payment for treatment in place and alternate destinations would mean for a given mix of payers. 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
TPF writes grant and budget narratives and builds 2 CFR Part 200 compliance frameworks. It designs subrecipient monitoring and the records and reports funded programs must keep. TPF can lead an application directly or strengthen a partner’s application as part of a consortium. It can also carry the reporting load that strains state and local staff.
Discuss proposal and grant support →TPF can contract directly with a state or lead or support an application. It can also work as a technical assistance, evaluation, curriculum or implementation partner. The choice depends 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. That designation governs its treatment under 2 CFR Part 200.
TPF does not require a specific contract structure. It builds each project 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 groups that lead rural health change at every level. In state government, that means health departments and rural health offices that issue RHTP subaward solicitations. It also means state EMS offices and Medicaid agencies. In the regions, TPF works with EMS and trauma advisory councils and with EMS technical assistance hubs that coordinate work across counties. Locally, it works with rural hospitals, Critical Access Hospitals, FQHCs, ambulance services and EMS agencies. Other partners include hospital and health systems that anchor consortia, public health agencies, hospital and EMS associations, and workforce boards. So do universities, research centers, community groups and grant-writing partners preparing competitive applications.
TPF can lead an application or strengthen a partner’s. It can also sit inside a consortium as the evaluation, finance, curriculum or implementation partner. The setup follows what the program needs. The specialists TPF calls on include 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 TPF knows the regional hub model from running one.
How TPF can engage
Six ways TPF can work on an RHTP project
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. It can also join a consortium led by another organization. If the resulting award designates TPF a subrecipient, TPF delivers a defined part of the RHTP initiative on that basis.
Technical assistance partner
TPF helps state agencies or award recipients design and carry out their work, and coaches their staff, without holding an award itself.
Evaluation partner
TPF designs and runs program evaluations. It measures outcomes and builds the systems behind CMS progress reports.
Curriculum partner
TPF builds training, clinical teaching and simulation content for workforce programs paid for by the RHTP.
Implementation partner
TPF works alongside state agencies and lead award recipients to deliver RHTP programs, and stays with the work over time.
Statutory basis
Where EMS fits in RHTP
Section 71401 of Public Law 119-21 sets up the program. The law lets states use funds for payments to health care providers and for new models of care. It also lets them resize rural care systems, including pre-hospital and emergency services. CMS announced the awards on December 29, 2025. That announcement names better emergency medical services communication, treatment in place options and coordinated transfers among the activities states will fund.
Whether an 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. It draws on its work in federal EMS policy and state contracting. It also knows the systems these programs need to deliver and report.
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 program created by Public Law 119-21 in July 2025. It sets aside $10 billion for each of fiscal years 2026 through 2030, $50 billion in total. States use the funds to redesign rural health care under plans approved by the Centers for Medicare & Medicaid Services (CMS). The law allows the funds to go to payments to health care providers and to new models of care. They may also be used to resize rural care systems, including pre-hospital and emergency services. CMS’s award announcement names better emergency medical services communication and treatment 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 or lead or join an application. It can also 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. 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. In any other project, the role is matched to the program structure and what the state’s solicitation requires.
Is EMS eligible for RHTP funding?
It can be, depending on the state. The law allows funds to go to resizing rural care systems, including pre-hospital and emergency services. It also allows payments to health care providers and new models of care. CMS’s award announcement names EMS communication and treatment in place options among the activities states will fund. Whether an 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?
Start on the contact page with a short description of the organization, the state and the RHTP program area involved. A first consultation is free. TPF will say whether and how it can add value to the program.
What does TPF’s EMS financial modeling capability include under RHTP?
A program funded for a fixed period needs a plan to keep its services going afterward. TPF builds the financial models behind that plan. They cover cost structure, the gap in payment, the revenue cycle, and scenarios for other ways to fund the work. Those include GEMT, Medicaid State Plan Amendments and county subsidies. Free planning tools are on the financial modeling page. Custom analysis is available through a project.
Start a conversation about your RHTP program
Contact TPF if you are issuing a subaward solicitation or building an RHTP proposal. TPF can also help you check whether your EMS or community paramedicine program fits your state’s plan. A first consultation is free and carries no obligation.