26-09RHT-001 Rural Strong Grants Addendum.pdf

STATE OF SOUTH DAKOTA

RURAL HEALTH TRANSFORMATION

DEPARTMENT OF HEALTH

600 EAST CAPITOL AVENUE

PIERRE, SD 57501

Rural Strong Grants: Strengthening Access to Care in Rural Communities A Rural Health Transformation Grant Opportunity

PROPOSALS ARE DUE NO LATER THAN MAY 22nd, 2026 at 5PM CT

RFP #: 26-09RHT-001 State POC: Kirsten Blachford EMAIL: Kirsten.Blachford@state.sd.us

ADDENDUM:

Section 1.4 SCHEDULE OF ACTIVITIES Offeror Questions Due 04/24/2026 The deadline for offerors questions has been extended 1 day.

Exhibit B: Quick Answers Updated document includes additional commonly asked questions.

In addition, South Dakota Medicaid is hosting a webinar regarding Rural Strong Grants on April 24, 2026 from 2:30 PM to 3:00 PM central. The webinar will address commonly asked questions and provide an additional opportunity to ask questions. Questions received will also be incorporated into the response document posted by May 7, 2026. You can use the following information to join the webinar:

• Via Teams: https://teams.microsoft.com/meet/24471629586759?p=j5wIUDE3kzQdhQzSBC o Meeting ID: 244 716 295 867 59 o Passcode: fH7kE7g9

• Via Phone: +1 605-679-7263,,15473002# https://teams.microsoft.com/meet/24471629586759?p=j5wIUDE3kzQdhQzSBC tel:+16056797263,,15473002

Exhibit B: Quick Answers (V2) Updated 4.16.26

Eligible Applicants

1. Who is eligible to apply for a Rural Strong Grant?

Eligible applicants are hospitals, federally qualified health centers, rural health clinics, Indian Health Services/Tribal 638 clinics, clinics enrolled as physician groups, behavioral health clinics, and dental clinics for Rural Strong Grants. Applicants must be enrolled with Medicaid.

Only business entities are eligible to apply. Individual providers are not eligible for grant awards.

2. Can skilled nursing facilities, pharmacies, or other healthcare providers not listed as eligible applicants apply?

Other healthcare entities are not eligible applicants but could be a strategic partner of an applicant.

3. Is this grant limited to enrolled Medicaid providers?

Yes, grant applicants must be enrolled with Medicaid. Enrolled providers may contract with or partner with other entities that are not Medicaid providers.

4. I am working on enrolling with Medicaid. Am I eligible to apply?

Only proposals from actively enrolled Medicaid providers defined as eligible in Section 1.1 of the grant opportunity will be considered.

5. Are vendors eligible applicants?

No.

6. Do applicants have to be located in a rural area?

Providers located in urban areas may apply but must explain in the application how the proposal benefits rural South Dakotans. Funding is targeted at initiatives that strengthen rural providers, keep healthcare in local rural communities, and expanding access to healthcare in rural communities.

7. For hospitals, is funding limited to critical access hospitals.

No, other hospitals may apply. Funding is targeted to initiatives that build a more resilient, connected, and sustainable rural health system.

Application Questions

8. Does a single healthcare provider or healthcare system have to submit all of their proposals under a single application?

It is at the provider's discretion regarding whether they submit under a single application or whether they submit multiple applications.

9. If submitting a hub-and-spoke model involving multiple partnerships, is a single application sufficient?

Yes, a single application is sufficient. Each entity involved in the hub-and-spoke model does not have to submit their own application.

10. Is there a general expected range of awards for year 1?

The state envisions supporting multiple proposals with anticipated award amounts in budget period 1 ranging from $200,000 to $3,000,000. However, the grant does not have a maximum award amount as this competitive opportunity seeks strong ideas. Transformative proposals requiring larger investment or involving multiple provider entities could exceed this range. Award amounts are anticipated to vary based on the number of proposals and quality of the ideas.

As stated in Section 3.8.2, to demonstrate a scalable option, applicants may provide one alternative budget/budget narrative to reflect a higher or lower level of funding than their main budget proposal at their discretion. If submitting an alternative budget, clearly label the budget as “Alternative Budget Proposal.” In addition, applicants may be asked to submit a revised budget during the evaluation or contracting phase.

11. Should proposals and budgets be structured to cover only Budget Period 1 (award through September 30, 2027), or should they outline the full multi-year scope across all five potential budget periods with a detailed budget for Budget Period 1?

Budgets should include total funds requested for all years of the proposal including a detailed budget for period 1. Please refer to Section 3.8 and Exhibit D for guidance regarding the budget.

Allowable Uses of Funds

12. Can funding be used for technology?

Proposal may include funding for technology. Proposals should not be duplicative of the Digital Health Modernization and Technology Grant opportunity and to the extent technology can be funded through that opportunity it is recommended that providers apply for that opportunity.

13. Can funding be used for expansion of services that are targeted at chronic diseases?

Proposals may include expansion of services that address a need related to chronic disease.

For initiatives primarily focused on chronic diseases it is recommended that providers apply for the Strengthening Chronic Disease Management grant opportunity that will be made available.

14. Can funding be used for new construction or major remodeling?

No, per CMS funding cannot be used for new construction or building expansion. Minor renovation or alterations related to program goals may be allowable. Providers may propose projects that include minor renovations or alterations, but the projects will require additional approval by CMS.

15. Can funding be used to pay for a clinician's salary?

Per CMS guidance RHT Program funds may not be used for clinician salaries or wage support for facilities that subject clinicians to noncompete contractual limitations. Funds may go towards clinician salaries and wage supports if the clinician is not subject to a non-compete agreement and the salary/wage support is being funded as part of an approved initiative. Any proposed use of funds for clinician salaries should be clearly linked to program goals and the sustainability plan should explain how the provider will support the clinician salary when grant funds end. In addition, the applicant should provide confirmation in the application that the clinician is not subject to a non-compete agreement. Confirmation can be provided via a letter from the employer.

16. Can funding be used to pay for clinical support staff such as case managers?

Proposals for funding for clinical support staff that align with program goals may be considered. The sustainability plan should explain how the provider will support the clinician salary when grant funds end.

17. Can funding be used for expansion of transportation services to medical appointments?

Yes, it is anticipated that this is an allowable activity. Proposals to use funding to purchase vehicles may require additional approval by CMS.

18. Will additional funding be released to support the case management activities for the Medicaid Primary Accountable Care Transformation model?

This grant funding is included in this opportunity. Additional rounds of funding to support implementation of this model may be made available in the future.

19. Can funds be used to purchase radiography equipment, laboratory equipment or other medical equipment?

Proposals can include funding for this type of equipment. Providers should explain how the equipment will support access to care and financial sustainability.

20. How do I know if a specific idea qualifies for funding?

Eligible applicants are encouraged to submit a proposal that they believe meet one of the allowable uses of funds. Allowable uses of funds are outlined in Section 1.1 and include:

operational and strategic planning, strategic partnerships, service line expansion, regional resources/hub and spoke models, and care coordination readiness for value-based care.

Applicants may identify multiple allowable uses of funds. As this is a competitive grant opportunity, applicants should provide a proposal that includes all the required elements and demonstrates how the proposal strengths rural healthcare in South Dakota.

21. Can funding be used to pay for expenses already incurred?

Grant funding is limited to expenses incurred after the applicant has been awarded.

Other

22. Is funding for future budget periods guaranteed?

No, CMS has only awarded funding for the first budget period. Funding for subsequent budget periods is subject to change.

23. What are the reporting requirements associated with accepting grant funding?

The State will require reporting from awardees to monitor progress, impact, and help inform reporting required to CMS. CMS requires the State to file quarterly and annual progress reports. It is anticipated that awardees will be required to report to the State on a similar frequency.

24. How do I ask a question regarding the grant opportunity?

Potential applicants can submit questions until April 24, 2026, to Kirsten.Blachford@state.sd.us.

Please include RFP #: 26-09RHT-001 in the subject line. The State’s response to questions will be posted no later than May 7, 2026.

mailto:Kirsten.Blachford@state.sd.us