Utah Department of Health and Human Services

Rural Health Transformation Program RHTP Evaluation

Attachment B: SCOPE OF WORK

Article 1

DEFINITIONS

1.1 Definitions. In this contract, the following definitions apply:

“Budget Period” means the 10-month period beginning on December 29, 2025, and ending on October 30, 2026, for Budget Period 1, and each 12-month period beginning on October 31 and ending on October 30 for Budget Periods 2 – 5.

“CMS” means the Centers for Medicare and Medicaid Services, the federal agency awarding the RHTP funds.

“Evaluation Plan” means a structured plan to evaluate the Utah RHTP, that includes evaluation questions, metrics, data sources, and timelines. The evaluation will be a systematic, objective assessment of the program's design, implementation, results, and will provide insight about cost-effectiveness and sustainability. The Evaluation Plan will also describe how the Contractor will select pilot activities to evaluate.

“Initiative” means a comprehensive project designed to address unique needs of rural health communities. The Utah RHTP has seven initiatives including: Initiative 1: PATH (Preventive Action and Transformation for Health), Initiative 2: RISE (Rural Incentive and Skill and Expansion), Initiative 3: SHIFT (Sustaining Health Infrastructure for Transformation), Initiative 4: FAST (Financial Approaches for Sustainable Transformation), Initiative 5: LIFT (Leveraging Innovation for Facilitated Telehealth), Initiative 6: SUPPORT (Shared Utilities for Partnered Provider Operational Resources and Technology), and Initiative 7: LINCS (Leveraging Interoperability Networks to Connect Services).

“H.J.R. 101” means the Utah House Joint Resolution 101 on Federal Funds, which the Utah Legislature mandated that federal funds in excess of $10 million per year should not result in on-going state funding requirements, prioritize one-time actions, maximize non-state funding contributions, inspire innovation, and seek to improve Utah’s health outcomes.

“Measurement Framework” means a documented process for how the Contractor will conduct Performance Monitoring activities. It is a list of qualitative and quantitative metrics, data sources, and protocols used to track, analyze, and verify the performance of the RHTP interventions. The Measurement Framework complements the evaluation plan with more timely data, and should be updated at least quarterly.

“NOA” means Notice of Funding Award, the official CMS notifications to successful state grant applicants that indicate the grant start and end dates and allow the grant program work to begin. NOAs will be re-issued from CMS at each Budget Period as well as for any amendment or updated approved budget.

“NOFO” means Notice of Funding Opportunity, the formal public announcement soliciting applications from states for the RHTP cooperative agreements. It outlines funding availability, eligibility, goals, and programmatic and spending guidelines and parameters.

“Performance Monitoring” means the routine, ongoing tracking of programmatic inputs, activities, and immediate outputs to verify that the program is being implemented as planned. In the Utah RHTP context, performance or program monitoring will be conducted in coordination with RHTP staff, to identify operational progress, identify and address barriers, and provide recommendations to make RHTP programming more impactful, effective, and efficient.

“Pilot Project” means innovative, targeted service models, proof of concept healthcare interventions or operational strategies deployed to test new methods of healthcare delivery and financing before scaling them statewide. Select examples of Pilot Projects include community paramedicine, alternative payment models, and the community care hub.

“Project Plan” means a plan for activities to be undertaken during the implementation period, also referred to as a work plan. The project plan has a specific format and be revised and updated annually.

“RBA” means Results Based Accountability, a disciplined, data-driven decision-making framework used to measure program effectiveness and system-level impact based on outcomes rather than service volume or activity effort alone. In the context of the Utah RHTP, RBA evaluates whether health services and systems across Utah’s statutory rural and frontier counties have improved and whether rural Utahns are ultimately better off by assessing three primary performance dimensions:

1. How much was done? (Quantity of effort/outputs)

2. How well was it done? (Quality of effort/processes)

3. Is anyone better off? (Measurable human, clinical, and health status improvements, alongside system sustainability)

“RFP” means a Request for Proposals, a formal, competitive solicitation document inviting eligible organizations to submit structured proposals for funding. It outlines the project's scope of work, compliance rules, funding limits, and evaluation criteria, and will result in a contract, rather than a grant.

“RHTP Program Directives” means the instructions promulgated by the Utah RHTP that describe required program operations.

“Rural” means an area located in one of Utah’s 25 counties that meet the definition established by Utah State Code § 26B-4-701 and § 17-60-104, (and not located in Davis, Salt Lake, Utah, or Weber counties).

“Strategic Goal” means an overarching goal to address rural health outcomes and rural health system performance. Utah’s RHTP has four strategic goals: Making Rural Utahns Healthy, Workforce Development, Innovation and Access, and Technology Innovation.

“Utah RHTP” means the RHTP operationalized at the State level through Initiatives supported by approximately 24 key strategic activities to achieve the four Strategic Goals.

Article 2

PURPOSE

2.1 Purpose. The Contractor shall provide comprehensive monitoring and evaluation support for Utah’s RHTP including 1) evaluating the overall human, clinical and system-level impact of Utah’s RHTP using a RBA framework to measure whether the program improved the health status of Rural Utahns; 2) assessing progress, performance, and data quality across the RHTP Initiatives and 24 key activities, identifying opportunities to optimize operations and service delivery during the implementation period; 3) designing and executing robust evaluations for complex, innovative projects (including alternative payment models, workforce training pipelines, and semantic data systems); and 4) formulating strategic roadmaps for State, tribal, and local safety-net entities to sustainably absorb and scale impactful activities. In strict alignment with the fiscal stewardship principles of H.J.R. 101, all evaluation and transition models must prioritize non-recurring upgrades and transition program operations into self-sustaining, market-driven structures that create no ongoing financial obligations or permanent liabilities for the State. Evaluated services must focus on Utah’s 25 statutory Rural and frontier counties as defined in Utah Code §26B-4-701.

Article 3

CONTRACTOR RESPONSIBILITIES

3.1 Contractor Responsibilities. The Contractor shall provide Performance Monitoring and Evaluation services for the Utah RHTP. The Contractor shall evaluate whether the Utah RHTP achieved the objectives outlined in the four Strategic Goals, performance of each initiative, and select pilot activities to ultimately determine if health services and systems have improved in Rural Utah. The Contractor shall provide Performance Monitoring data throughout the RHTP implementation period to ensure implementation stays on track. The Contractor shall also identify sustainability issues to ensure interventions to transition into self-sustaining models that do not create future financial obligations for the State. Specifically, the Contractor shall:

(1) evaluate the Utah RHTP:

(A) develop a comprehensive Evaluation Plan for Utah’s RHTP. This plan must be submitted to the DHHS designee for review and approval within 60 days of the contract effective date, and must be updated annually by July 1 of each subsequent contract year. The Evaluation Plan should include three levels:

(i.) outcome evaluation, examining whether the four over-arching goals were achieved;

(ii.) performance evaluation (or process evaluation) that examines whether the seven initiatives are being implemented with fidelity to the design and whether results are on track; and (iii.) pilot evaluation that examines how pilot activities or other innovations were rolled out, and informs scale-up efforts

(2) The Utah RHTP Evaluation Plan should include three levels:

(B) Midline Evaluation: by December 2028, assess RHTP performance to determine progress made, and identify programmatic performance recommendations. The Contractor shall submit a:

(C) Endline Evaluation: by December 2030, the conclusion of the Utah RHTP, evaluate whether the program achieved objectives to improve health status and health service delivery across Rural Utah. The Contractor shall submit:

(D) identify and evaluate specific Pilot Projects or innovative activities, to identify policy or sustainability issues.

(3) monitor activities:

(A) develop and submit a comprehensive Measurement Framework, including key performance and outcome metrics, as well as process indicators, within 30 days of submission of the Evaluation Plan; and

(B) in coordination with DHHS, monitor programmatic performance on a quarterly basis and submit reports to the DHHS designee. Reporting for the period ending April 30 reports shall include actionable performance improvement recommendations, and quarter 4 reports shall cover the annual reporting period; Comment by Nune Phillips: Performance of what? How closely involved with these evaluators be with our team and where does our contract monitoring end and their monitoring end? I’m unclear.

(4) communication products:

(A) provide ad hoc executive summaries and presentation materials for leadership and stakeholder audiences, as requested by Utah RHTP; and

(B) develop communication products, such as success stories, key accomplishments, case studies, policy briefs, and similar projects suitable to share with CMS, DHHS leadership, legislative and executive stakeholders, and other stakeholders, as requested by Utah RHTP.

(5) engage with other RHTP partners to coordinate monitoring and evaluation efforts;

(6) coordinate with the DHHS designee to ensure approval of monitoring and evaluation plans, frameworks and deliverables, and ensure appropriate branding; and

(7) additional activities relevant to the Utah RHTP plan, as mutually agreed upon and documented in the project plan.

3.2. Project Plan and Itemized Budget. The Contractor shall:

(1) submit a Project Plan, budget and timeline, by October 1 or within 30 days of contract effective date (whichever comes first), before project activities begin; Comment by Nune Phillips: How does a project plan differ from an evaluation plan? Comment by Miranda Beckman: Like a work plan. Defined above.

(2) annually, submit a project plan and itemized budget to DHHS by July 1 for the non-competing continuation application for the following Budget Period;

(3) within 30 days of receiving the approved funding level from DHHS, update the budget and project plan; and

(4) provide a current list of key personnel to DHHS Key personnel include the authorized project signer, project lead, and other staff who play a significant role in evaluation development and analysis, regardless of whether they receive salaries or compensation under the contract.

3.3 Project Management and Fiscal Oversight. The Contractor shall:

(1) submit final drafts of RFPs to DHHS for review for any sub-contracting. The Contractor must receive written pre-approval from DHHS prior to the release or distribution of RFPs; and

(2) facilitate and participate in interagency communications and activities.

3.4 Budget Adjustments. This evaluation is funded by administrative costs, subject to the CMS 10 percent administrative cap. The Contractor must have any budget change requests approved in advance by DHHS.

3.5 DHHS Designated Tribal Activities. The Contractor shall pay particular attention to progress in tribal areas to ensure that activities implemented in tribal areas adequately address needs.

3.6 High-Needs Populations. The Contractor shall leverage available data to identify high-needs populations and their associated service and access gaps, and pay particular attention to progress in these areas, in accordance with federal and State law. High-needs populations are those who encounter significant challenges to accessing resources and services.

3.7 Public Materials. In adherence with the Stevens Amendment referenced in the NOA p.14, when issuing statements and public facing materials resulting from activities supported by this contract, the Contractor shall include an acknowledgement of federal assistance using the following or a similar statement:

(1) for public facing materials utilizing 100 percent of funds from this contract:

This [project/publication/program/website, etc.] [is/was] supported by the Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health and Human 15 ver. 12.14.2025 Services (HHS) as part of a financial assistance award totaling $XX with 100 percent funded by CMS/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CMS/HHS, or the U.S. Government.

(2) for public facing materials partially utilizing funds from this contract:

This [project/publication/program/website, etc.] [is/was] supported by the Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $XX with XX percentage funded by CMS/HHS and $XX amount and XX percentage funded by non-government source(s). The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CMS/HHS, or the U.S. Government.

(3) additional requirements on the prior approval of public materials, presentations, and high-visibility content, and rules for using the RHTP federal logo, will be provided in RHTP Program Directives.

Article 4

REPORTING AND MEETING REQUIREMENTS

4.1 Reporting. The Contractor shall submit reports that reflect progress made during the designated reporting period. See reporting timelines in Article 8.

(1) Quarterly reports. The Contractor shall submit quarterly progress reports to DHHS in the DHHS-provided format. The reports:

(A) are due on or before the 7th day of the month following the end of each quarter. If the due date falls on a weekend or holiday, it is due the next business day; and

(B) must monitor key process and outcome indicators, as identified in the Measurement Framework, and aggregate number of people served, spending data milestone progress, sustainability planning, and success stories.

(2) Annual reports. The Contractor shall submit annual progress reports to DHHS in the DHHS-provided format. The reports:

(A) are due on or before August 7 each year; and,

(B) must monitor key process and outcome indicators, as identified in the Measurement Framework, and aggregate number of people served, spending data milestone progress, sustainability planning, and success stories.

(3) Final report. The Contractor shall submit a one-time final report to DHHS in the DHHS-provided format. The report is:

(A) due on or before 60 days after the project period;

(B) inclusive of endline evaluation results; and

(C) must be cumulative of all activities completed during the entire performance period.

4.2 Required Meetings. The Contractor shall:

(1) attend all check-in meetings scheduled by DHHS for project management and implementation;

(2) attend quarterly progress meetings scheduled by DHHS;

(3) coordinate among Utah RHTP partners for site visits as needed;

(4) attend CMS or DHHS related conferences, trainings, or meetings as needed;

(5) facilitate and/or participate in interagency communications and meetings; and

(6) participate on Utah RHTP Stakeholder Engagement Committees.

Article 5

DHHS RESPONSIBILITIES

5.1 DHHS Responsibilities. DHHS shall:

(1) provide the Contractor with quarterly, annual, and final reporting and Project Plan templates;

(2) provide budget and invoice submission guidance;

(3) submit Contractor project plans to CMS for review and approval;

(4) review submitted reports and provide necessary technical assistance;

(5) communicate any changes to the RHTP budget or Utah RHTP Plan mandated by CMS;

(6) facilitate interagency communications and activities that overlap with or complement this RHTP initiative as opportunity and capacity allows;

(7) provide written pre-approvals according to the timeline agreed upon by both parties; CMS retains the final approving authority for any and all activities related to this contract as outlined in the NOFO and NOA; and

(8) update and provide current RHTP Program Directives. DHHS and the Contractor will review RHTP Program Directives at the start of this contract and annually thereafter for operational changes.

Article 6

FUNDING AND PAYMENTS

6.1 Funding and Payments. See Budget Periods in Article 8.

(1) Invoices. The Contractor shall include the following on each invoice:

(A) Contractor’s name, payment address, phone number, and signature;

(B) invoice number;

(C) invoice date; and

(D) details of services billed including dates and hours worked on this contract.

(2) Reimbursement. DHHS shall reimburse the Contractor for invoiced and approved products and services in accordance with the approved budget up to the maximum award per Budget Period. Payments may be suspended or declined by DHHS or CMS based on insufficient project progress and availability of funds.

(3) Expenditure deadline. The Contractor shall:

(A) ensure all funds related to project implementation are expended for each Budget Period by the end of the following federal fiscal year (September 30 of the following year);

(B) obligate funds for Budget Period 1 no later than December 31, 2026, for budget years 2-5, no later than June 30 of the respective Budget Period, to ensure all expenditures adhere to the regulatory guidance and deadlines specified in Article 8 Timelines. Failure to timely obligate and expend funds will result in funds recouped by DHHS to return to CMS; and

(C) ensure all funds related to project implementation are expended by December 30, 2030.

6.2 Continued Funding. Continued funding is conditional on the availability of appropriated funds from CMS, satisfactory Contractor performance, and compliance with the contract.

(1) Continued funding will be issued in increments as CMS awards funding at the start of each Budget Period.

(2) Satisfactory performance includes progress in implementing approved activities; progress on applicable performance metrics; adherence to the implementation plan; accurate, complete, and timely submission of progress reports and invoices; and quality and timely communication and responses. Progress will be measured both qualitatively and quantitatively.

6.3 Annual recalculation of funds. Based on annual CMS rescoring and awarding, funding will be recalculated and reissued at the start of each Budget Period. Funding will be issued to the Contractor through DHHS contract amendments.

Article 7

USE OF FUNDS AND FUNDING RESTRICTIONS

7.1 Use of Funds.

(1) Budget Period and activities. Funds may only be used for costs incurred within the defined Budget Periods and for activities expressly authorized under this contract.

(2) Use of funds. The Contractor agrees to use all funds received under this contract only for the permissible uses defined in the NOFO and NOA. Per CMS guidance, this contract falls under the Administrative funding category. These uses are governed by Federal statute: Pub. L. No. 119‑21, § 71401 (July 4, 2025) (codified at 42 U.S.C. § 1397ee(h)) (“Rural Health Transformation Program”). Descriptions of Use of Funds categories are outlined in the NOFO p. 11, 12 and NOA p. 9-12.

7.2 Funding Restrictions. The Contractor shall not use funds provided under this contract for any unallowable costs. Unallowable costs are outlined in the NOFO p.18-20 and the NOA p. 9-12.

Article 8

FEDERAL FUNDING INFORMATION AND TIMELINES

8.1 Federal Funding Information. Federal funds provided under this contract are sourced from:

(1) Program name: Rural Health Transformation Program: A bold, multi-faceted innovative effort aimed at generational investments to build resilient, sustainable rural health systems

(2) Federal Award Identification Number RHTCMS332051-01-00

(3) Federal Awarding Agency: Centers for Medicare & Medicaid Services

(4) Award Date: 12/29/2025

8.2 Timelines.

(1) Budget Periods. DHHS shall issue funding according to CMS Budget Periods. For each Budget Period, the Contractor shall have until the end of the following federal fiscal year (September 30 of the following year) to spend awarded funding.

(A) Budget Period 1: Contract effective date through October 30, 2027

(B) Budget Period 2: October 31, 2026 to October 30, 2028

(C) Budget Period 3: October 31, 2027 to October 30, 2029

(D) Budget Period 4: October 31, 2028 to October 30, 2030

(2) Reporting Periods. The Contractor shall report progress on activities in this contract according to the following reporting periods.

(A) Reporting period 1: Contract effective date to January 30, 2027

(B) Reporting period 2: January 31, 2027 to April 30, 2027

(C) ANNUAL REPORT: Annual report will include quarterly progress for May 1, 2027 to July 31, 2027.

(D) Reporting period 4: August 1, 2027 to October 30, 2027

(E) Reporting period 5: October 31, 2027 to January 30, 2028

(F) Reporting period 6: January 31, 2028 to April 30, 2028

(G) ANNUAL REPORT: Annual report will include quarterly progress for May 1, 2028 to July 31, 2028.

(H) Reporting period 7: August 1, 2028 to October 30, 2028

(I) Reporting period 8: October 31, 2028 to January 30, 2029

(J) Reporting period 9: January 31, 2029 to April 30, 2029

(K) ANNUAL REPORT: Annual report will include quarterly progress for May 1, 2029 to July 31, 2029.

(L) Reporting period 10: August 1, 2029 to October 30, 2029

(M) Reporting period 11: October 31, 2029 to January 30, 2030

(N) Reporting period 12: January 31, 2030 to April 30, 2030

(O) ANNUAL REPORT: Annual report will include quarterly progress for May 1, 2030 to July 31, 2030.

(P) Reporting period 13: August 1, 2030 to October 30, 2030

(Q) Final report period: entire project period as listed in 8.2.(1).

8.3 Adherence. In addition to the standard terms and conditions, DHHS, Contractor, and Contractor Sub-contractor/sub-recipients, are subject to the terms and conditions set forth by CMS for the RHTP. CMS may add or otherwise amend the terms and conditions as necessary at any point during the RHTP period of performance.

Article 9

OUTCOMES

9.1 Expected Outcomes. As a result of this contract, the Contractor will apply a RBA framework to rigorous evaluate the Utah RHTP, measuring whether goals were achieved, the overarching program impact on the rural Utah’s health outcomes and system performance, and ensuring transparency and accountability. DHHS will have timely and effective performance management data. This data will identify emerging opportunities to advance implementation of activities. This contract will result in DHHS leadership having data and communication materials that enable them to share success stories and results to CMS, legislative leaders, and other stakeholders.

9.2 Evaluation Outcomes. DHHS shall have:

(1) empirical evidence demonstrating the extent to which Utah's RHTP improved rural health outcomes, health system performance, and access to care.

(A) Measure: Completion of baseline, midline, and endline evaluations that assess progress toward Strategic Goals.

(B) Measure: Actionable, data-driven recommendations are adopted by RHTP implementers and stakeholders.

(2) evidence-based strategies that position successful Utah RHTP Initiatives for long-term sustainability beyond federal funding.

(A) Measure: Sustainability roadmap completed for each Initiative requiring long-term transition.

(B) Measure: Percent of selected Pilot Projects with documented sustainability or financing strategies.

(2) Measure: Number of initiatives demonstrating measurable improvement following implementation of programmatic shifts recommended from performance monitoring.

(1) ensure leadership has timely, reliable information to make strategic decisions about RHTP.

(A) Measure: Percent of scheduled monitoring and evaluation reports delivered on time and meeting DHHS quality expectations.

(B) Measure: Percent of requested data analyses or executive briefings delivered within agreed-upon timelines.

(2) effectively communicates the impact and value of the RHTP to CMS, policymakers, tribal partners, rural communities, and other stakeholders.

(A) Measure: Percent of required CMS and DHHS reporting requirements completed accurately and on time.

(B) Measure: Percent of requested communication products (success stories, policy briefs, presentations, case studies, executive summaries) delivered by agreed-upon deadlines.