6-Attachment B Scope of Work.pdf

Utah Department of Health and Human Services

Utah Health Information Network

Rural Health Transformation Program LINCS Initiative 7.1, 7A-7B:

Strengthening Interoperability and the Health Information Exchange

Attachment B: SCOPE OF WORK

Article 1

DEFINITIONS

Definitions. In this agreement, the following definitions apply:

“Budget Period” means the 26-month period beginning on July 20th, 2026, and ending on September 30th, 2028.

“CMS” means the Centers for Medicare and Medicaid Services, the federal agency awarding the Rural Health Transformation Program (“RHTP”) funds.

“Contractor” means the Utah Health Information Network.

“Data Quality” means the availability, accuracy, conformity, and plausibility of the health records provided by data contributors to the HIE.

“HIE” means Health Information Exchange, the State’s designated HIE which operates a modern interoperability platform that combines clinical data from data contributors across Utah to provide a more complete patient longitudinal health record, provides alerts and push notifications for certain health events, and can provide aggregate data and analytics for use by healthcare entities and public health.

“Interoperability” means the ability of two or more health information technology systems, software applications, networks, or components (collectively, "Systems") to securely exchange, integrate, and make use of Electronic Health Information across organizational and vendor boundaries. To achieve Interoperability, the Systems must be capable of exchanging and interpreting data at the foundational, structural, and semantic levels without special effort on the part of the user, in compliance with applicable industry standards (including, but not limited to, HL7 and FHIR) and applicable law.

“LINCS Initiative” means one of seven of Utah’s RHTP broad initiatives focused on rural health through innovations focused on leveraging Interoperability networks to connect services.

“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.

“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).

“Subcontractor” means an entity contracting with the Contractor to perform reimbursable work and receive funds for Utah RHTP 7.1 LINCS Initiative activities originating from this agreement.

“Utah RHTP Plan” means the specific section of Utah’s RHTP application, submitted by DHHS and approved by CMS, detailing the strategic framework for program implementation, including but not limited to: vision and goals; core initiatives and key actions; stakeholder engagement strategies;

policy objectives; and all other associated activities required for RHTP execution.

Article 2

PURPOSE

2.1 Purpose. The Contractor shall increase rural providers’ access to patients’ health records by improving providers’ site connectivity to and Data Quality of the State’s HIE. The Contractor shall perform a needs assessment of Rural providers that will identify technical gaps, readiness, barriers, and Data Quality of information sharing. Based on the needs assessment, the Contractor will release and manage non-competitive funding and technical assistance and training opportunities related to improving providers’ connectivity to the State’s HIE. The goal is to increase the use of the State’s HIE to better inform patient care and improve Rural care coordination.

Article 3

POPULATIONS SERVED

3.1 Eligible Clients. The Contractor shall serve Rural healthcare providers or healthcare providers who serve a majority Rural population.

3.2 Tribal Engagement and Allocations. The Contractor shall ensure that funding opportunities address the needs of Utah tribal populations and work with DHHS to support prioritization of tribal needs.

DHHS will offer technical guidance to the Contractor to facilitate these requirements throughout the appropriation period.

3.3 High-Needs Populations. The Contractor shall leverage available data to identify high-needs populations and their associated service and access gaps, and work to address the gaps as appropriate and applicable. High-needs populations are those who encounter significant challenges to accessing resources and services.

Article 4

CONTRACTOR RESPONSIBILITIES

4.1 Project Plan and Itemized Budget. The Contractor shall:

(1) before project activities begin, submit the initial project plan and itemized budget to DHHS within 30 days of the start date of this agreement;

(2) submit a project plan and itemized budget to DHHS by July 31 of each Budget Period for the non-competing continuation application for the following Budget Period;

(3) submit an additional revised itemized budget based on annual CMS rescoring and funding redistribution within 30 days of receiving a DHHS amendment;

(4) provide a current list of key personnel to DHHS. Key personnel include the authorized signer, project lead, and anyone else who plays a significant, measurable role in project development or execution, regardless of whether they receive salaries or compensation under this award.

4.2 Project Management and Fiscal Oversight. The Contractor shall:

(1) conduct a Rural Interoperability needs assessment to assess Rural provider’s current Interoperability capabilities. The needs assessment must:

(A) identify rural provider’s technical gaps, readiness, barriers and current Data Quality of information sharing.

(B) inform the scope and outcomes of the technical assistance, training, and funding opportunities.

(2) release and manage non-competitive funding and technical assistance and training opportunities to connect Rural providers to the HIE;

(3) submit final drafts of non-competitive agreement to DHHS for review a minimum of 15 days before sending the agreement for signatures. If the 15 days lapses, the DHHS and Contractor shall agree upon a new expedited timeline.

(4) enter into agreements with Subcontractors promptly ensuring all expenditures adhere to the regulatory guidance and deadlines specified in the approved project plan:

(A) provide a complete description and cost breakdown for each Subcontractor in writing to DHHS upon selection; and

(B) obtain prior written approval from DHHS for Contractor proposed changes to the pre-approved purchase of goods or services.

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

(6) participate in program evaluation activities requested by DHHS and/or its Contractor(s).

4.3 Budget Adjustments. The Contractor shall seek written preapproval from DHHS:

(1) for any transfers between subcategories;

(2) replacing an electronic medical record (“EMR”) system if a previous HITECH certified EMR was in place as of September 1, 2025.

4.4 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 agreement, the Contractor shall include an acknowledgement of federal assistance using the following or a similar statement:

(1) for public facing materials utilizing 100% of funds from this agreement:

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 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 agreement:

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 5

OUTCOMES

5.1 Outcomes. The overall outcome for this agreement is an increase in the percentage of rural providers who use the state’s HIE to inform patient care.

5.2 Outcome Measures: Each outcome measure shall be reported based on guidelines from DHHS and shall include:

(1) number of sites connected to the HIE, including the percentage of connected sites:

(A) that meet recognized data exchange standards such as HL7 FHIR APIs; and

(B) actively exchanging data with the HIE.

(2) number of clinicians trained to use the HIE, including the percentage of trained clinicians who:

(A) access the HIE during patient visits after receiving training;

(B) indicate that information obtained from the HIE impacted their clinical practice and patient care.

Article 6

REPORTING AND MEETING REQUIREMENTS

6.1 Reporting. The Contractor shall submit reports that reflect progress made during the designated reporting period. See reporting timelines in Article 10 Timelines.

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

(A) are due on or before the 10th 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 include the results of the outcome measures completed, number of people served, spending data broken down by use of funds, milestone progress, sustainability planning, and success stories.

(2) Annual reports. The Contractor shall submit annual reports to DHHS in the format provided by DHHS. The reports are due on or before the 15th day of the month following the end of each Reporting Period.

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

(A) is due on or before October 30, 2028 after the project period; and

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

6.2 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) facilitate site visits with Contractor Subcontractors for DHHS, as needed;

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

(5) facilitate and/or participate in interagency communications and meetings that overlap with or complement this RHTP initiative as opportunities and capacity allows; and

(6) participate on Utah RHTP Stakeholder Engagement Committees as needed.

Article 7

DHHS RESPONSIBILITIES

7.1 DHHS Responsibilities. DHHS shall:

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

(8) provide budget amendments as funding changes occur; and

(9) upon request, provide technical guidance to facilitate tribal engagement and allocation requirements throughout the appropriation process as needed.

Article 8

FUNDING AND PAYMENTS

8.1 Funding and Payments. See Budget Periods in Article 10 Timelines.

(1) Invoices. The Contractor shall submit invoices monthly by email to the designated DHHS Contact.

(A) Submit within 30 days following the end of each month.

(B) Each June invoice will be required to be submitted within 14 days after the end of the month (July 14).

(C) Guidance for invoice content and descriptions will be provided by DHHS.

(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); and

(B) obligate funds for Budget Period 1 no later than December 31, 2026, for Budget Period 2, no later than June 30 of the respective Budget Period, to ensure all expenditures adhere to the regulatory guidance and deadlines specified in Article 10 Timelines.

Failure to timely obligate and expend funds will result in funds recouped by DHHS to return to CMS.

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

(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.

8.4 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 amendments.

Article 9

USE OF FUNDS AND FUNDING RESTRICTIONS

9.1 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 agreement.

(2) Use of funds. The Contractor agrees to use all funds received under this agreement only for the permissible uses defined in the NOFO and NOA. 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”). Use of funds categories may not be applicable to specific project tasks or to all phases of project implementation. Contact the DHHS Contact with questions regarding RHTP Use of Funds before an expense is incurred. Descriptions of Use of Funds categories are outlined in the NOFO p. 11, 12 and NOA p. 9-12.

(A) Prevention and chronic disease

(B) Provider payments

(C) Consumer tech solutions

(D) Training and technical assistance

(E) Workforce

(F) IT advances

(H) Appropriate care availability

(I) Behavioral health

(J) Innovative care

(K) Capital expenditures and infrastructure

(L) Fostering collaboration

9.2 Funding Restrictions. The Contractor shall not use funds provided under this agreement for any unallowable costs. The items listed below represent a non-exhaustive list of prohibited expenditures under CMS guidelines and the RHTP and may not be applicable to specific project tasks or to all phases of project implementation. Contact the DHHS Contact with questions regarding an RHTP expense before the expense is incurred. Unallowable costs are outlined in the NOFO p.18-20 and the NOA p. 9-12.

(1) New construction and major renovation are not allowable. Renovations or alterations, as described in Category J in the NOFO Use of Funds section, are allowed if they are clearly linked to program goals.

(2) Supplanting funding for in-process or planned construction projects or directing funding towards new construction build is not allowable.

(3) Payment for clinical services that could be reimbursed by insurance is not allowable. Direct clinical health services must be justifiable as filling a coverage gap or not already reimbursable.

(4) Clinician salaries or wage support for facilities that subject clinicians to non-compete contractual limitations are not allowable.

(5) Funding received or provided under this agreement may not be used for an expenditure that is attributable to an intergovernmental transfer, certified public expenditure, or any other expenditure to finance the non-Federal share of expenditures required under any provision of law.

(6) Social Security Act Section 2105(c) (42 U.S.C. 1397ee), paragraphs (1),(7), and (9) apply as funding limitations. These limitations are related to general limitations, limitations on payment for abortions, and citizenship documentation requirements for payments made with respect to an individual.

(7) Using funds in a manner inconsistent with activities described in Utah RHTP program plan, on activities explicitly limited in the Limitations and Program-specific limitations sections outlined in the RHTP NOFO or Notice of Award, or on activities that have not been approved by DHHS or CMS is not allowed.

(8) Funds may not be used towards initiatives similar to the Rural Tech Catalyst Fund Initiative as described in the NOFO appendix.

Article 10

TIMELINES

10.1 Timelines.

(1) Budget Periods. DHHS shall issue funding according to the CMS two Budget Periods. For each

Budget Period, the Contractor will have until the end of the following federal fiscal year (September 30 of the following year) to spend awarded funding.

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

(A) Quarterly reporting period 1: August 1 to October 30, 2026

(B) Quarterly reporting period 2: October 31, 2026 to January 30, 2027

(C) Quarterly reporting period 3: January 31, 2027 to April 30, 2027

(D) ANNUAL REPORT: Second annual reporting period will be from August 1, 2026 through July 31, 2027. This annual report will include quarterly progress for May 1, 2027 to July 31, 2027.

(E) Quarterly reporting period 4: August 1, 2027 to October 30, 2027

(F) Quarterly reporting period 5: October 31, 2027 to January 30, 2028

(G) Quarterly reporting period 6: January 31, 2028 to April 30, 2028

(H) FINAL REPORT including Quarterly report 7: The final annual reporting period will be the entire project period and needs to include quarterly progress for May 1, 2028 to September 30, 2028.

10.2 Adherence. In addition to the standard terms and conditions, DHHS, Contractors, and Contractor Subcontractors, are subject to the terms and conditions set forth by CMS for the RHTP in the NOFO and the NOA. CMS may add or otherwise amend the terms and conditions as necessary at any point during the RHTP period of performance. CMS retains the final approving authority for any and all activities related to this agreement as outlined in the NOFO and NOA.