Rural Health Transformation Program
RHTP Implementation & Technical Assistance Partner
The Rural Health Transformation Program (RHTP) — authorized under Public Law 119-21 as a $50 billion, five-year CMS initiative (FY2026–FY2030) — is the largest federal investment in rural health infrastructure in a generation. All 50 states have received awards, and state subaward processes are beginning or underway. TPF is positioned to engage immediately.
Who this page is for
State agencies, EMS organizations, and rural health partners evaluating RHTP partners
If you are a state health department issuing RHTP subaward solicitations, an EMS agency or rural health organization applying for subaward funding, a regional health body building an RHTP implementation team, or a hospital system or Federally Qualified Health Center (FQHC) exploring RHTP participation — this page is for you.
TPF has been tracking RHTP implementation nationally since the program was authorized. TPF understands the statutory uses of funds, the state-level solicitation landscape, and the program design requirements that subaward recipients are expected to meet. TPF is ready to engage immediately in any of the partnership modes described below.
What TPF brings to RHTP implementation
Implementation-grade capacity across the program areas RHTP explicitly 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. Pre-hospital services and EMS delivery improvement are explicitly named in RHTP’s statutory 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 support lead applicants, serve as a subrecipient, or engage as a technical assistance, evaluation, curriculum, or implementation partner — depending on what a state, agency, or community needs most.
TPF does not require a specific contract structure. TPF builds the engagement model around what the program and the partner need.
Contact TPF directly:
info@paramedicfoundation.org
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 own leadership includes the Executive Director of a nine-county regional EMS and trauma advisory council, so the regional hub model is not theory to TPF.
How TPF can engage
Six engagement modes, matched to the program
Prime applicant
TPF leads the subaward application with EMS agency or rural health partners, taking responsibility for delivery and federal reporting.
Subrecipient
TPF receives subaward funding from a state to deliver a defined RHTP initiative component under a cooperative agreement.
Technical assistance partner
TPF provides design, coaching, and implementation support to state agencies or subaward recipients without holding the 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 subrecipients, providing sustained implementation support.
Statutory basis
EMS is a core RHTP program element — not a footnote
Section 71401 of Public Law 119-21 explicitly includes pre-hospital services, emergency medical care, EMS delivery improvements, and treat-in-place and alternate site-of-care models as approved uses of RHTP funds. This is a core program design element that reflects congressional recognition that rural EMS is foundational to rural health system viability.
EMS-focused RHTP proposals are federally valid, fully supported by the statute, and eligible for state subaward funding in every state. If you are a state program officer, EMS agency director, or rural health organization evaluating whether an EMS-centered RHTP proposal is fundable: it is.
TPF can help you design, document, and implement that proposal from the ground up. TPF has direct experience with federal EMS policy, state-level subaward structures, and the implementation infrastructure RHTP proposals 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 authorized under Public Law 119-21 as a $50 billion, five-year CMS initiative (FY2026–FY2030) — the largest federal investment in rural health infrastructure in U.S. history. All 50 states have received awards. Pre-hospital EMS and EMS delivery improvement are explicitly named in the statute’s uses of funds. State subaward processes are beginning or underway nationwide.
What roles can TPF serve in an RHTP-funded initiative?
TPF engages in six modes: prime applicant (where TPF holds the primary award), subrecipient (operating under a state’s prime award), technical assistance partner, evaluation partner, curriculum partner, or implementation partner. The mode is matched to the program structure and the state’s solicitation requirements. TPF has direct experience in all six modes from prior federal and state contract work.
Is EMS eligible for RHTP funding?
Yes. The RHTP statute explicitly names pre-hospital emergency medical services and EMS delivery improvement as eligible program areas. Community paramedicine, mobile integrated health, workforce development, and rural health system design — all core TPF service areas — are also named uses of funds. State subaward solicitations vary; TPF can review your state’s solicitation and advise on eligibility and positioning.
How do organizations start working with TPF on RHTP?
Reach out through the contact page. Describe your organization, your state, and the RHTP program area you are working on. Initial consultations are free. TPF will advise honestly on whether and how it can add value to your specific program. Subaward timelines are compressing — early engagement allows for the most responsive scoping.
What does TPF’s EMS financial modeling capability include under RHTP?
RHTP requires grantees to demonstrate sustainability beyond the grant period. TPF builds the financial models that support that requirement: 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 is fundable, TPF is glad to hear from you. Initial consultations are free and without obligation.