Arkansas Rural Healthcare Transformation Program

Project Narrative

RURAL HEALTH NEEDS AND TARGET POPULATION

Rural Demographics

Rural Arkansas faces major challenges across demography, health outcomes, healthcare access, and facility sustainability, all of which the Rural Health Transformation (RHT)

Program seeks to address. The following provides a detailed overview of the current rural health landscape in Arkansas.

Rural Landscape and RHT Program Challenges

About 45% of Arkansans live in rural areas, making it one of the most rural states in the

U.S.[1][2] Rural communities tend to be older, lower-income, and in poorer health than urban residents, with limited access to medical services.[3][1] Nearly half of rural hospitals

(50%) are considered vulnerable to closure—the highest rate in the nation—with 79% operating at a loss on patient services.[4] Rural providers face significant financial strain due to low reimbursement rates, as Arkansas ranks in the bottom five nationally in the

Medicare Wage Index.[5]

Rural Demographics

• Population: Roughly 1.3 million rural residents of a statewide population of 3 million.[2]

• Population density: Typically, fewer than 30 people per square mile in many counties.[2]

• Median rural household income: $50,210, below national medians.[6]

• Employment: Dominated by agriculture, manufacturing, and healthcare support, with unemployment averaging 4.9% in rural counties compared to 3.4% urban. [6]

• Education: Only 17% hold a bachelor’s degree or higher. [6]

• Insurance: Rural counties rely heavily on public coverage—about 42% on Medicaid or Medicare. Over 8% are without healthcare coverage.[1][2]

• According to the HRSA Federal Office of Rural Health Policy (FORHP) listing of rural-eligible counties, 63 of Arkansas’s 75 counties are classified as fully rural for CMS program eligibility.

Health Outcomes and Risk Factors

• Chronic diseases: High rates of heart disease (according to the CDC, Arkansas has the third-highest rate of heart disease mortality in the nation), diabetes, hypertension, and obesity—each up to 30% higher than urban county averages.[1][6]

• Maternal health: Only 25 of 75 counties still have labor and delivery units, and rural maternal mortality rates are double urban counterparts.[3][1][4]

• Child health: Elevated rates of low birthweight and childhood obesity, especially in the Mississippi River Delta and Ozarks regions. The average of the county-level percentages of students classified as obese was 25% in rural counties and 22% in urban counties.[8]

• Ratio of population to Other Primary Care Providers: 770:1 (AR) vs. 680:1 (U.S.) [6]

• Ratio of population to Mental Health Providers: 360:1 (AR) vs. 290:1 (U.S.) [6]

• 23% of Arkansans report symptoms of anxiety or depression [9] and more than 60% of adults with mental illness receive no treatment.[10]

• 71.5 opioid prescriptions per 100 residents in 2023.[11]

Healthcare Access

• Distance to care: Rural Arkansans travel an average of 25–35 miles to reach the nearest hospital or specialty clinic. According to the Arkansas Department of Health, Rural counties experience longer EMS response times.[3][1]

• Provider availability: Some rural counties have fewer than one primary care physician per 2,000 residents and severe dental and mental health provider shortages. Arkansas has 17% fewer mental health providers than the national average, per the Arkansas Whole Health Institute. [3][1]

• Transportation: Minimal or no public transit options in most rural counties, particularly in the south and Delta regions.[1][2]

• Facility distribution: 47 rural hospitals, including 27 Critical Access Hospitals and 5

Rural Emergency Hospitals. Arkansas has 154 licensed rural health clinics and 12 community health center organizations with 179 service locations in rural markets.

According to HRSA, there are 163 Federally Qualified Health Centers in rural areas of the State. [1][2]

Rural Facility Financial Health

• At-risk hospitals: 30 of 47 rural hospitals are at risk of closure, with 11 in immediate risk of insolvency.[4]

• Closures: Four hospitals have closed since 2015; several have eliminated obstetrics or inpatient services.[3][4]

Target Populations and Geographic Focus

Arkansas’s RHT plan targets:

• Rural residents in high-need counties, particularly in the Delta, Ozarks, and southwest regions, where hospital vulnerability, poverty, and chronic disease rates are highest.

• All rural hospitals, rural health clinics (RHCs), federally qualified health centers

(FQHCs), and behavioral health or community health organizations operating in rural-designated census tracts statewide.

These interventions aim to stabilize rural healthcare access, improve health outcomes, and ensure sustainability through workforce development and modernized care coordination.

RURAL HEALTH TRANSFORMATION PLAN: GOALS AND

STRATEGIES

Vision

The State of Arkansas has designed a Rural Health Transformation Program (RHT Program) to support a strong, connected rural health system where families can get the care they need close to home. Our RHT Program focuses on practical solutions that strengthen local communities, support rural providers, and use targeted investments in technology and partnerships to improve health outcomes through preventive care and healthier lifestyles.

Over the next five years, Arkansas aims to transform rural healthcare into a model of resilience, access, and whole-person wellness. The Arkansas

RHT Program envisions thriving rural communities where health outcomes no longer depend on ZIP codes, where care is local yet connected, and where every Arkansan from the Delta to the

Ozarks has the resources to live well, learn well, and age well.

This transformation will align public health and clinical care through coordinated investment in prevention, workforce

When Governor Sarah Huckabee Sanders took office, she promised to transform Arkansas from ranking at the bottom on issues like education, economic growth, and public safety to moving to the top. Her administration has invested in Arkansans’ healthcare through the Healthy Moms, Healthy Babies Act, which provides $45 million in additional funding each year to improve maternal health. She has led on commonsense reforms to move Arkansans off the path of poverty and onto the path to prosperity, like getting candy and soft drinks off taxpayer-funded food stamps, implementing a first-in-the-nation Medicaid work requirement, and creating the 10:33 Initiative to bring government, nonprofits, and the faith community together to move Arkansans from crisis to career. The Governor and her husband launched the Natural State Initiative to get Arkansans, and especially kids, off screen and outdoors to promote healthy lives and embrace Arkansas’s greatest natural resource: its outdoor beauty. The Governor seeks to use the Rural Health Transformation Program to build on those successes and deliver better, sustainable care to the Arkansans who need it most.

development, and digital infrastructure—ensuring financial sustainability and quality outcomes statewide. The goal is not simply to stabilize rural healthcare but to redesign it from the ground up around prevention, connected systems, and empowered communities.

Five years from now, Arkansas’s rural communities will be stronger, healthier, and more connected than ever. Local clinics will operate in partnership with regional networks rather than in isolation. Children will grow up with real food, physical activity, and routine preventive care. Healthcare professionals will choose to build their careers in rural

Arkansas because professional growth, community support, and a sense of belonging are deeply intertwined.

Technology will unite what geography once divided—linking hospitals, schools, clinics, churches, and homes in a real-time web of care. Economic resilience will follow health resilience, as healthier citizens sustain stronger local economies.

The Arkansas RHT Program is more than a financial investment—it is a promise to make every community a place where healthcare can thrive, innovation can take root, and every

Arkansan can live their best possible life supported by local care and opportunity.

Goals and Strategic Alignment

Statute(s) Focus/Key Action Alignment to RHT Program

Strategic Goals

Key Outcomes

Improving Access & Outcomes

Expand hospital, primary, specialty, behavioral, and emergency care. Keep EDs open, expand maternal health, school-based health centers, and community wellness programs.

Make Rural America Healthy Again: evidence-based interventions for disease prevention, chronic disease management, behavioral health, and prenatal care.

Reduced chronic disease and maternal complications;

higher local utilization.

Technology Use & Data-Driven Solutions

Use telehealth, conversational AI-enabled monitoring and coaching, dashboards, and HIE integration to expand access and improve care coordination.

Tech Innovation & Innovative Care:

foster innovate technologies for efficient care delivery, data sharing, and remote care.

Faster access and early detection; better care coordination;

sustainable use of technology;

cost efficiency and savings.

Workforce Recruit, train, and retain rural clinicians and students; expand residencies and preceptorships in rural settings; expand scopes of practice; leadership development; community health worker training.

Workforce Development:

attract and retain high skilled providers; enable rural providers to practice at top of license.

Increased provider retention;

expanded access to behavioral and specialty care;

strengthened leadership.

Partnerships Form Clinically Integrated Networks; share staff, purchasing, data, and best practices; align transport, workforce, and care delivery;

establish trauma-ready networks and joint capital improvements.

Sustainable Access and Innovative Care:

strengthen rural providers through networks, shared resources, coordinated operations.

Improved care quality, cost efficiency, emergency preparedness.

Statute(s) Focus/Key Action Alignment to RHT Program

Strategic Goals

Key Outcomes

Financial Solvency Strategies and Cause Identification

Right-size facilities; transition to value-based payment models;

diversify revenue; and share administrative/purchasing services; reduce facility bypass.

Sustainable Access: help rural providers remain long-term access points.

Reduced at-risk hospitals;

improved margins;

sustained local access to care

Rural Health Transformation Initiatives & Outcomes

Initiative Programs and Description Key Performance Objectives

Healthy Eating, Active Recreation, & Transformation (HEART)

Growing Resilient, Optimally Well Kids (GROW Kids): Programs that help Arkansas children build lifelong health.

≥ 12,500 residents engaged annually across all HEART activities.

≥ 100 formalized partnerships established by Year 5.

≥ 75 community sites delivering HEART-aligned programs by Year 5.

≥ 250 providers and community health workers trained statewide by Year 5.

Food Access & Regional Markets (FARM): “Buy Local” produce initiative supporting SNAP waivers, healthy vending machine reforms, and integration of food-as-medicine strategies to improve nutrition and prevent chronic disease.

Mobilizing Opportunities for Vital Exercise (MOVE): Expanding access to fitness trails, modular fitness equipment, and recreation.

Faith-based Access, Interventions, Transportation, & Health (FAITH):

Utilizing faith leaders as trusted advisors, emphasizing the connection between physical, mental and spiritual well-being.

Healthcare Education and Advancement for Leadership (HEAL):

Embedding nutrition and fitness education in medical, nursing, pharmacy, and CME programs; training providers on safe opioid prescribing.

Integrated Models for Prevention, Access, Care and Transformation (IMPACT): Comprehensive chronic disease prevention and management designed to improve health outcomes for Arkansans with diabetes, obesity, hypertension, and high cholesterol.

Promoting Access, Coordination, and Transformation (PACT)

Advancing Care Capacity, Engagement, and Screening Services (ACCESS):

Bringing specialty care, preventive screenings, and telehealth into underserved areas.

≥ 12,500 rural residents served annually via mobile units and telehealth services by Year 5.

Initiative Programs and Description Key Performance Objectives

Community Integrated Networks for Care (CINC): Funding bottom-up, locally driven Clinically Integrated Networks (CINs) that improve efficiency, data sharing, revenue opportunities, and regional collaboration.

≥ 15 healthcare facilities or providers participating in shared networks or partnerships by Year 5.

≥ 25 rural clinics offering expanded specialty or preventive services by Year 5.

≥ 75 providers credentialed for expanded scope-of-practice roles by Year 5.

Redcuction in facilities at risk of closure, based on financial and operational metrics by Year 5.

Regional Optimization of Access, Delivery, Mobility, and Practice (ROADMAP): Addressing transportation barriers and aligning workforce distribution to need.

Scope of Practice Elevation (ScOPE):

Empowering providers like pharmacists and dental hygienists to operate at the top of their credentials and deliver expanded services such as dietary counseling and chronic disease support.

System Acquisition & Facility Enhancement (SAFE): Supporting hospital facility improvements and integration with larger systems to maintain essential services in rural areas.

Recruitment, Innovation, Skills, and Education for AR Healthcare (RISE AR)

Leadership Education, Advancement & Delivery (LEAD): Establishing a Leadership Academy for healthcare leaders focused on alignment with RHT Program objectives.

≥ 50 leaders trained statewide by Year 5.

≥ 100 new or expanded training slots by Year 5.

≥ 100 clinicians recruited and retained in rural areas by Year 5.

Preparing Arkansas Talent for Health Workforce Advancement Yield (PATHWAY): Expanding GME slots, preceptor programs, scholarships, and

Initiative Programs and Description Key Performance Objectives new residences/fellowships in specialties like family medicine, OB, and lifestyle medicine.

≥ 150 workforce members completing advanced training and certifications by Year 5. Recruit, Educate, Train, Advise, Integrate, Nurture (RETAIN):

Recruitment and retention program offering relocation support, signing bonuses, and mentorship incentives.

Strategic Knowledge, Innovation & Lifelong Learning for Upward Professionals (SKILL-UP): Workforce pathways for nurses, PAs, mental health professionals, drug counselors, and non-credentialed paraprofessionals.

Telehealth, Health-monitoring, and Response Innovation for Vital Expansion (THRIVE)

Linking Infrastructure for Emergency Lifesaving and Integrated Network Expansion (LIFELINE): Modernizing EMS systems and ensuring access to emergency care.

≥ 10% reduction in average EMS response times in rural counties by Year 5.

≥ 2,500 patients actively monitored with actionable data by Year 5.

≥ 12,500 telehealth visits delivered statewide by Year 5.

≥ 50 rural facilities equipped with standardized telehealth infrastructure by Year 5.

Health Outcomes through Monitoring & Engagement (HOME): At-home remote monitoring pilots for chronic conditions such as diabetes, hypertension, obesity, sleep apnea, and heart failure, emphasizing ROI and sustainability.

Virtual Innovation for Rural Telehealth, Utilization, Access, and Longevity (VIRTUAL): Expanding telehealth access, supporting capital investments, and integrating virtual specialty care across CINs.

Telehealth, Equipment, and Connectivity Hub Fund (TECH Fund):

Investing in infrastructure upgrades and technology sustainability.

Legislative or Regulatory Action

Technical Score Factor

Current Policy Committed Action and Timeline

Expected Impact on Rural Health

B.2 Health and Lifestyle

Arkansas does not currently require the Presidential Fitness Test.

✓ Arkansas will seek to have schools reestablish the Presidential Fitness Test aligned with federal guidance associated with Executive Order 14327 by December 31, 2028.**

Promote physical activity and healthy habits.

Support chronic disease prevention and population health.

B.3 SNAP Waivers ✓ Arkansas has a USDA-approved state waiver in place prohibiting the purchase of non-nutritious items with SNAP benefits.

Reduce rates of chronic diseases such as diabetes, heart disease, and obesity.

Promote mental well-being and child development.

B.4 Nutrition Continuing Medical Education (CME)

Arkansas does not currently have any requirements for nutrition education for Continuing Medical Education.

✓ Arkansas will implement nutrition CME requirements, along with nutrition education requirements in Medical Schools.

Promoting healthy habits.

Support chronic disease prevention and population health.

C.3 Certificate of Need

✓ Arkansas has a CON score of 15 per the CICERO report “Ranking Certificate of Need Laws in All 50 States.”

Arkansas has no further planned action for CON policy.

Technical Score Factor

Current Policy Committed Action and Timeline

Expected Impact on Rural Health

D.2 Licensure compacts

✓ Physician: IMLC member legislation passed, implementation in progress

✓ Nursing: NLC State

✓ EMS: licensure compact member of the EMS Compact

✓ Psych: PSYPACT participant

✓ PAs: PA compact member

✓ Dietician:

compact member*

✓ Physician Compact expected to be implemented in 2026.

D.3 Scope of Practice

✓ PA: Advanced Scope of Practice

✓ NP: Reduced scope of practice

✓ Pharmacists:

Improvements needed based on CICERO report

✓ Dental Hygienist:

Semi-restrictive scope of practice

✓ Legislation to expand the scope of practice for pharmacists and other healthcare professionals will be introduced in the 2027 legislative session, with a target enactment date of December 31, 2027. This proposal has broad support across the State Legislature.

Building sustainable access, expanding rural healthcare workforce.

E.3 Short-Term, limited duration insurance

✓ STLDI plans are not restricted in Arkansas beyond the latest federal guidance.

Technical Score Factor

Current Policy Committed Action and Timeline

Expected Impact on Rural Health

F.1 Remote care service

✓ Medicaid payment for at least one form of live video.

✓ Medicaid payment for store and forward.

✓ Medicaid payment for remote patient monitoring

✓ Limited in-state licensing requirement exception.

Certified Community Behavioral Health Clinics

As of September 1, 2025, Arkansas does not have any Certified Community Behavioral

Health Clinics (CCBHCs). Four clinics have received a total of five CCBHC grants, and several of the facilities are interested in becoming certified. Arkansas will update CMS if any facility becomes a CCBHC.

* While we recognize that the State will not receive points for being a member of the Dietitian Licensure Compact, we have included this information to demonstrate our ongoing commitment to supporting licensure compacts and facilitating workforce mobility.

** Governor Sarah Huckabee Sanders will sign an Executive Order requiring that vending machines include healthy options, ensuring Arkansans have better choices available.

While this action does not receive technical scoring consideration, it reflects the State’s commitment to empowering individuals and communities to take ownership of their health and well-being.

Medicaid Disproportionate Share Hospitals

According to our 2021 DSH audit, Arkansas provided DSH payments to 10 in-state hospitals.

PROPOSED INITIATIVES AND USE OF FUNDS

Initiative 1: Healthy Eating, Active Recreation, & Transformation (HEART) Description The Healthy Eating, Active Recreation, & Transformation (HEART) initiative is designed to improve health outcomes and access to preventative care across Arkansas by creating a coordinated, community-driven approach to nutrition, physical activity, and chronic disease management. HEART strengthens rural health systems by integrating school programs, community-based initiatives, faith organizations, and healthcare education. This initiative supports the Arkansas RHT Program’s goals of expanding access, improving health outcomes, fostering sustainable rural healthcare delivery, and building workforce capacity. HEART is comprised of the following projects:

GROW Kids helps Arkansas children build lifelong healthy habits through preventive education and wellness programming. This initiative tracks child health outcomes and provides direct interventions to prevent and treat physical and mental health conditions. Key actions include: expanding school, early childhood center, and daycare-based health and preventive education programs; providing direct clinical and behavioral health interventions for children identified with health risks; promoting physical activity, nutrition, and wellness habits in partnership with local schools and families; reinstating the Presidential Fitness Test;

and tracking health outcomes, preventive screening rates, and behavior change metrics. Potential uses of funds include: staffing, educational materials, and clinical supplies for school health and mental health programs; screening, treatment, and counseling resources for children with identified physical or behavioral health conditions; data collection and analysis for health tracking, mental health monitoring, and program evaluation; and community engagement events and coordination with schools, early childhood centers, daycares, families, and local providers.

FARM builds on Arkansas’s existing SNAP waiver to improve access to healthy foods through local markets, vending machine

Initiative 1: Healthy Eating, Active Recreation, & Transformation (HEART) regulations, and food-as-medicine strategies that prevent chronic disease and strengthen regional food systems. Key actions include:

expanding local produce markets to improve food access;

integrating nutrition programs into clinical care and community interventions; partnering with farmers, retailers, and local organizations to enhance supply and reach; and monitoring nutrition outcomes, chronic disease prevention, and program utilization.

Potential uses of funds include: grants for market development and program administration; nutrition education campaigns and outreach materials; and data collection and reporting on population health and food access.

MOVE: inspires and enables residents—particularly those who are currently sedentary—to become more active by improving access to safe, appealing spaces for exercise and recreation. The initiative revitalizes existing facilities and outdoor areas, fostering healthier lifestyles and stronger community engagement without the need for new construction. Key actions include: upgrading and maintaining existing trails, parks, and outdoor fitness spaces; providing equipment, signage, and programmatic support to maximize facility use by the sedentary population; partnering with local organizations to organize community fitness programs, events, and wellness challenges; and tracking participation rates, physical activity levels, and related health outcomes to evaluate program impact. Potential uses of funds include: facility enhancements; program development and community outreach to encourage the use of existing facilities;

data collection and analysis to monitor physical activity engagement and health improvements; and coordination with local governments, community organizations, and wellness groups.

FAITH partners with faith-based institutions to expand outreach and connect rural residents to health services. These organizations serve as trusted community points of contact to share information, coordinate screenings, and help residents access preventive and primary care. Key actions include: collaborating with faith institutions to organize health education sessions, wellness events, and preventive screening opportunities using faith networks to identify residents with transportation or access challenges and linking them to existing health services; promoting community awareness of available healthcare programs, resources, and telehealth options; and tracking engagement metrics, referrals made, and health outcomes to measure effectiveness of outreach and access improvements. Potential uses of funds include: Staffing and resources for mobile health units, screening events, and

Initiative 1: Healthy Eating, Active Recreation, & Transformation (HEART) outreach programs; transportation programs and patient navigation support for rural residents; data collection and reporting to assess reach, engagement, and impact of community-based connections;

and coordination and communication materials to support faith-based outreach, establish a marked walking circuit on existing parking lots through surface markings and signage; and modular fitness equipment.

HEAL integrates nutrition, physical activity, behavioral health, and safe opioid prescribing education into professional training programs, strengthening rural provider capacity. Key actions include:

embedding wellness and prevention curricula in medical, nursing, pharmacy, and CME programs; providing continuing education on chronic disease management and safe prescribing; and integrating new education criteria into current monitoring. Potential uses of funds include: development of training curricula and materials;

faculty and staff support for educational programs, continuing education, and certification activities; and data collection and analysis to evaluate provider and patient outcomes.

IMPACT is a comprehensive chronic disease prevention and management designed to improve health outcomes for Arkansans with diabetes, obesity, hypertension, and high cholesterol. By integrating clinical care, behavioral interventions, social support, and value-based payment models, the project creates a scalable coordinated, community-informed approach to chronic disease management. Key actions include: launching pilot cohorts of employer-sponsored and Medicare covered individuals to test and refine interventions; providing coordinated clinical, behavioral, and social services, including chronic disease management, lifestyle coaching, and mental health support; implementing value-based payment strategies to incentivize quality care, improve outcomes, and optimize resource use; building integrated data infrastructure to enable analytics, reporting, risk stratification, and outcome tracking;

monitoring milestones, evaluating health outcomes, participant engagement, and return on investment; publishing results and developing a replicable model for statewide and national adoption.

Potential uses of funds include: staffing and operational support;

delivery of preventive care, chronic disease interventions, mental health services, and food-as-medicine program; development and maintenance of technology platforms and data analytics infrastructure; program evaluation, research, and dissemination;

stakeholder engagement; and creation of tools to replicate and scale successful interventions across the state.

Initiative 1: Healthy Eating, Active Recreation, & Transformation (HEART) Main Strategic Goal(s)

Make Rural America Healthy Again & Innovative Care

Use of Funds A. Prevention & chronic disease D. Training and tech assistance E. Workforce G. Appropriate care availability H. Behavioral health I. Innovative care

Technical Score Factors

B.1 Population health clinical infrastructure B.2 Health and lifestyle C.1 Rural provider strategic partnerships E.1 Medicaid provider payment incentives

Key Stakeholders Heartland Whole Health Institute (HWHI), state government agencies, employers, hospitals and clinics, schools, community organizations, faith institutions, community health workers, academic and research partners, technology vendors

Potential Outcomes (not exhaustive)

GROW Kids: Improved screenings, early identification, and management of chronic conditions in children; increased preventive care utilization; enhanced mental and behavioral health; greater physical activity and healthier nutrition habits; strengthened collaboration between schools, families, and healthcare providers.

FARM: Improved access to fresh, local produce; increased adoption of food-as-medicine approaches; reduction of nutrition-related risk factors for chronic disease; and greater awareness of healthy eating habits and preventive nutrition practices.

MOVE: Increased utilization of existing fitness trails, outdoor gyms, and recreational facilities; higher levels of physical activity; improved physical health indicators, including BMI, cardiovascular fitness, and mobility; and enhanced community with wellness programs and local recreational infrastructure.

FAITH: Expanded reach of preventive screenings and educational programs, increased awareness of health resources and services, improved care coordination and connection to clinical and behavioral health services; strengthened community engagement and trust; and enhanced dissemination of wellness and prevention messages.

HEAL: Improved provider knowledge and skills in preventive care, nutrition, and chronic disease management; increased adoption of evidenced-based prevention practices across clinical settings;

expanded workforce capacity through training, CME programs, and

Initiative 1: Healthy Eating, Active Recreation, & Transformation (HEART) professional development; and enhanced integration of preventive care into routine practice, including opioid stewardship.

IMPACT: Improved health outcomes for 10,000 participants with chronic conditions; increased engagement in preventive and behavioral health services; reduction in healthcare costs and absenteeism/turnover through better disease management;

successful implementation of VBP models and risk-sharing arrangements; data-driven insights supporting statewide policy, program scaling, and replicable healthcare delivery models; and evidence of system maturity, integration, and coordination across clinical, behavioral, and social services.

Impacted Counties All Rural Counties Estimated Required Funding

$150,000,000

Process and Criteria for Selecting Subgrantees

The State will establish a transparent process to solicit, review, and award subgrants. Applications will be evaluated based on demonstrated need, service to priority populations, organizational capacity, and commitment to responsible use of funds consistent with RHT Program objectives. Subgrantees will comply with all reporting and accountability requirements under 2 CFR Part 200, and performance will be monitored to ensure alignment with program goals. If procurement is required, the State will follow all applicable state and federal procurement laws. Our proposed process is detailed in the Budget Narrative.

Initiative 2: Promoting Access, Coordination, and Transformation (PACT) Description The Promoting Access, Coordination, and Transformation (PACT) initiative is designed to strengthen rural healthcare delivery in Arkansas by expanding access, improving care coordination, and supporting sustainable, high-quality services. PACT integrates primary care, specialty care, preventive screenings, and telehealth services into rural communities while fostering locally driven Clinically Integrated Networks to improve efficiency, data sharing, and regional collaboration. By aligning workforce distribution, enhancing provider scope of practice, and supporting strategic facility investments, PACT ensures that rural residents can access timely, coordinated care close to home. The initiative leverages partnerships across hospitals, community organizations, clinics, pharmacies, EMS providers, and state agencies to create a connected, resilient rural health system capable of meeting both current and future needs. PACT is comprised of the following projects:

Advancing Care Capacity, Engagement, and Screening Services (ACCESS) program expands specialty care, preventive screenings, and telehealth services into rural areas, ensuring residents have access to primary, specialty, behavioral, and maternal care. Through mobile units, telehealth platforms, and emerging conversational AI-enabled tools, ACCESS connects local providers with regional specialists to coordinate care, improve early detection, and manage chronic conditions. ACCESS strengthens patient engagement, supports timely interventions, and enhances care coordination infrastructure to ensure patients are efficiently directed to the appropriate care setting and provider, improving continuity and reducing avoidable delays or duplication of services. Key actions include: bringing specialty care, preventive screenings, and telehealth into rural areas; expanding access to primary, specialty, behavioral, and maternal care through mobile units and telehealth platforms; and coordinating care between local providers and regional specialists.

Potential uses of funds include: Telehealth platforms, mobile screening units, clinical staffing, patient navigation, outreach, and program coordination.

Community Integrated Networks for Care (CINC): CINC funds locally driven Clinically Integrated Networks (CINs) that empower rural hospitals and clinics to share data, staff, and operational resources.

By promoting collaboration and resource sharing, CINC enhances efficiency, revenue opportunities, and regional coordination among providers. These networks create sustainable partnerships that improve care quality, optimize service delivery, and strengthen the overall rural health infrastructure. Key actions include: Funding

Initiative 2: Promoting Access, Coordination, and Transformation (PACT) bottom-up, locally driven CINs, sharing data, staff, and operational resources across hospitals and clinics; and improving revenue opportunities, efficiency, and regional collaboration. Potential uses of funds include: CIN development grants, shared IT infrastructure, workforce training, data-sharing systems, and governance support.

Regional Optimization of Access, Delivery Mobility, and Practice (ROADMAP): ROADMAP addresses transportation barriers and aligns workforce distribution to meet the healthcare needs of rural communities. By coordinating regional delivery models, the program improves access to primary, specialty, and emergency services.

ROADMAP ensures that patients can reach the care they need, and that providers are deployed effectively to optimize healthcare delivery across the state. Key actions include: Leveraging GIS mapping and health workforce data to identify transportation deserts and provider shortage areas, informing the placement of mobile clinics, telehealth hubs, and regional care partnerships; and coordinating regional delivery models to optimize access. Potential uses of funds include:

Developing and maintaining statewide data systems to map transportation deserts, workforce shortages, and care access gaps;

supporting regional healthcare coalitions, planning bodies, and technical assistance to align transportation, workforce, and service delivery strategies; expanding and equipping mobile health units and telehealth hubs to reach rural areas identified through ROADMAP analysis; partnering with local and regional transit agencies, nonprofit transportation providers, and rideshare programs and businesses to develop flexible medical transport options for rural residents;

implementing digital scheduling, dispatch, and communication tools that connect patients with transportation and providers; and measuring reductions in missed appointments, improved care coordination, and patient outcomes.

Scope of Practice Elevation (SCoPE): SCoPE builds on Arkansas’s ongoing efforts to expand scope of practice, enabling pharmacists, dental hygienists, dietitians, and other licensed professionals to practice at the top of their credentials. Expanded services could include prescriptive authority, dietary counseling, chronic disease management, and preventive care. The program supports these providers with training, telehealth tools. and clinical supervision resources, enhancing their ability to deliver high-quality care. By increasing provider capacity and diversifying service offerings, SCoPE strengthens access and improves health outcomes in rural communities. Key actions include: Updating scope of practice requirements; establishing credential and training programs to ensure

Initiative 2: Promoting Access, Coordination, and Transformation (PACT) quality and consistency; and integration with telehealth platforms.

Potential uses of funds include: Training, certification support, telehealth and digital tools, clinical supervision, and patient education programs.

System Acquisition & Facility Enhancement Fund (SAFE): The SAFE supports strategic hospital and system partnerships and affiliations to maintain essential services in rural areas and stabilize financially vulnerable facilities. It enables targeted investments that enhance operational capacity, encourage shared services, and strengthen regional collaboration. By preserving critical access points and improving infrastructure, the SAFE ensures that rural communities continue to receive high-quality, sustainable healthcare. Key actions include: Identifying rural hospitals and critical-access facilities at risk of closure or service reduction through financial analysis and community needs assessments; facilitating acquisitions, partnerships or affiliations by financially stable health systems, nonprofit organizations, or regional networks; providing technical assistance for due diligence, valuation, and integration planning; creating shared service agreements among rural hospitals for administrative functions, billing, purchasing, and supply chain management;

facilitating regional partnerships for specialty coverage, staff training, and clinical protocols; and integrating data sharing and coordinated reporting systems across facilities to monitor quality, performance, and financial stability. Potential uses of funds include: Financial support for acquisition, merger, partnership or affiliation transactions, technical assistance for due diligence, legal support, valuation, and integration planning; advisory services for operational, clinical, and financial viability; development and maintenance of shared administrative and billing systems; joint procurement programs;

implementation of regional staffing models, shared clinical specialists, and workforce cross-training programs; data systems to enable coordinated reporting, quality monitoring, and dashboards;

and rehabilitation of facilities that are underutilized or inefficient.

Main Strategic Goals

Sustainable Access; Workforce Development, Innovative Care

Use of Funds A. Prevention & chronic disease E. Workforce G. Appropriate care availability H. Behavioral health I. Innovative care J. Capital expenditures and infrastructure K. Fostering collaboration

Initiative 2: Promoting Access, Coordination, and Transformation (PACT)

B.1 Population health clinical infrastructure B.2 Health and lifestyle C.1 Rural provider strategic partnerships D.1 Talent recruitment F.1 Remote care services

Key Stakeholders State agencies, rural hospitals and clinics, CINs and regional provider groups, EMS providers and trauma coordinators; community organizations and patient advocacy groups; professional licensing boards

Potential Outcomes (not exhaustive)

ACCESS: Increased specialty care and preventive screening access in rural areas; higher utilization of telehealth and mobile clinical services; improved early detection and management of chronic and acute conditions CINC: Greater efficiency and cost savings through shared operations and collaborative networks; improved care coordination and data-driven decision-making ROADMAP: Reduced transportation barriers for rural patients, improved alignment of workforce distribution with community needs;

enhanced access to care and reduced service bypass SCoPE: Expanded access to preventive and chronic disease care;

increased provider capacity and efficiency in rural communities;

enhanced patient engagement and education SAFE: Stabilized rural hospitals and critical-access facilities;

preserved essential healthcare services across rural regions;

improved system capacity, operational efficiency, and collaboration between facilities.

Impacted Counties All Rural Counties Estimated Required Funding

$250,000,000

Process and Criteria for Selecting Subgrantees

The State will establish a transparent process to solicit, review, and award subgrants. Applications will be evaluated based on demonstrated need, service to priority populations, organizational capacity, and commitment to responsible use of funds consistent with RHT Program objectives. Subgrantees will comply with all reporting and accountability requirements under 2 CFR Part 200, and performance will be monitored to ensure alignment with program goals. If procurement is required, the State will follow all applicable state and federal procurement laws. Our proposed process is detailed in the Budget Narrative.

Initiative 3: Recruitment, Innovation, Skills, and Education for Arkansas (RISE AR) Description The Recruitment, Innovation, Skills, and Education for Arkansas (RISE

AR) is Arkansas’s initiative to build a sustainable, high-skilled healthcare workforce capable of meeting the unique needs of rural communities. By strengthening recruitment, training, and retention programs, the initiative ensures that healthcare providers are distributed effectively across the state, can practice at the top of their license, and have opportunities for professional growth. RISE AR supports the RHT Program’s goals of expanding access, improving quality, and fostering long-term provider engagement in rural areas.

The initiative comprises the following programs:

LEAD establishes a leadership academy to train healthcare leaders in rural hospital administration, care coordination, and operational management. LEAD enhances decision-making capacity and prepares leaders to implement innovative care delivery models and manage regional networks effectively. Participation in LEAD will be required for organizations seeking to qualify for RHT Program funding. Key actions include: Establishing and operating a statewide leadership academy for rural health administrators and clinical leaders; developing curriculum on operational management, care coordination, and innovative delivery models; and providing mentorship and experiential learning opportunities. Potential uses of funds include: Curriculum development for rural healthcare leadership training; staffing and operational support for the leadership academy; mentorship and experiential learning programs for administrators and clinical leaders;

and technology platforms for virtual learning and collaboration.

PATHWAY expands medical school rotation slots, preceptor programs, scholarships, stipends, and new residencies and fellowships in specialties like family medicine, obstetrics, and lifestyle medicine, as well as allied health professionals. PATHWAY ensures a steady pipeline of physicians, advanced practitioners, and allied health professionals to serve rural communities. Key actions include:

Expanding GME slots, creating new medical school rotations, residencies, and fellowships; creating new allied health training programs; providing retention awards and preceptor programs for high-need occupations. Potential uses of funds include: Program administration and staffing; faculty and preceptor compensation for teaching and supervision; trainee support, including stipends, relocation assistance, and benefits; clinical training infrastructure, including rotation sites, simulation labs, and teaching materials, campaigns to attract students and clinicians to rural placements; and tele-education platforms for remote supervision and training.

Initiative 3: Recruitment, Innovation, Skills, and Education for Arkansas (RISE AR) RETAIN is a recruitment and retention program providing relocation support, signing bonuses, mentorship, and integration into rural practice communities. RETAIN strengthens workforce stability by incentivizing long-term service in rural areas. Key actions include:

Offering financial incentives; pairing new hires with experienced local providers; partnering with local organizations to help providers settle into their communities; and providing access to ongoing career support. Potential uses of funds include: Financial incentives;

marketing and outreach; stipends for mentors; program administration training materials; costs for community engagement events, networking, and social support initiatives; and access to training, certifications, and leadership programs; conference attendance.

SKILL UP provides workforce development pathways for healthcare providers, including nurses, physician assistants, behavioral health counselors, and non-credentialed paraprofessionals. SKILL UP emphasizes continuing education, skill advancement, and flexible career ladders to expand the capacity and capability of rural health teams. Key actions include: Designing continuing education courses and structured training pathways tailored to rural healthcare needs;

use of tele-education platforms, workshops, and simulation labs to strengthen practical competencies for nurses, PAs, and paraprofessionals; providing credentialing and certification support;

and pairing trainees with experienced clinicians. Potential uses of funds include: Curriculum development and training programs; tele-education platforms; funding equipment, materials, and staffing for hands-on workshops; and financial support for exams, credentialing fees, and administrative assistance.

Main Strategic Goal Workforce Development Use of Funds

D. Training and tech assistance E. Workforce

C.1 Rural provider strategic partnerships D.1 Talent recruitment

Key Stakeholders State health agencies, hospitals, clinics, FQHCs, rural providers, nurses, PAs, behavioral health counselors, non-credentialed paraprofessionals, higher education institutions, residencies and fellowship programs, and academic medical institutions.

Initiative 3: Recruitment, Innovation, Skills, and Education for Arkansas (RISE AR) Potential Outcomes (not exhaustive)

LEAD: Enhanced leadership skills among rural healthcare administrators; improved strategic decision-making and operations oversight in rural facilities; and greater participation of leaders in system integration and quality improvement initiatives.

PATHWAY: Increased number of medical school rotations, residency, and fellowship positions in high-need specialties; increased number of allied health professionals: expanded clinical workforce pipeline;

and improved readiness of trainees to serve rural communities.

RETAIN: Increased recruitment and retention of clinicians in rural areas; enhanced workforce stability and reduced turnover; and greater provider satisfaction and community integration.

SKILL UP: Strengthened workforce capability and professional development in rural areas; expanded clinical competencies for healthcare professionals such as nurses, PAs, behavioral health counselors, and paraprofessionals; and increased adoption of preventive care, chronic disease management, and telehealth practices.

Impacted Counties All Rural Counties Estimated Required Funding

$250,000,000

Process and Criteria for Selecting Subgrantees

The State will establish a transparent process to solicit, review, and award subgrants. Applications will be evaluated based on demonstrated need, service to priority populations, organizational capacity, and commitment to responsible use of funds consistent with RHT Program objectives. Subgrantees will comply with all reporting and accountability requirements under 2 CFR Part 200, and performance will be monitored to ensure alignment with program goals. If procurement is required, the State will follow all applicable

Initiative 4: Telehealth, Health-monitoring, and Response Innovation for Vital Expansion (THRIVE)

Description The Telehealth, Health-monitoring, and Response Innovation for Vital Expansion (THRIVE) transforms rural healthcare delivery by expanding access to telehealth, remote monitoring, and emergency response innovation. By modernizing EMS, integrating digital care platforms, and piloting remote patient monitoring, THRIVE ensures rural communities can access timely, high-quality care. THRIVE comprises the following programs:

Linking Infrastructure for Emergency Lifesaving and Integrated Network Expansion (LIFELINE): modernizes Arkansas’s rural trauma and emergency response system by integrating EMS, hospitals, and public health services to ensure timely, coordinated, and high-quality care. The initiative strengthens trauma readiness across rural hospitals, standardizes emergency protocols, and prepares the workforce for rapid, effective response. Through data-driven coordination and system-wide modernization, LIFELINE enhances patient outcomes, reduces response times, and increases the resilience of Arkansas’s rural emergency care network. Key actions include: Modernizing trauma and emergency care in rural hospitals;

strengthening EMS coordination with hospitals and public health agencies; standardizing trauma and emergency response protocols;

implementing performance dashboards to track response times, patient outcomes, and surge capacity; and conducting workforce training and regional coordination exercises. Potential uses of funds include: trauma and EMS equipment, vehicles, and communication systems; workforce training and development; EMS coordination and dispatch technology; protocol standardization; and performance tracking tools to support continuous quality improvement and system resilience.

Health Outcomes through Monitoring & Engagement (HOME):

HOME pilots at-home remote monitoring for mental health and chronic conditions such as diabetes, hypertension, obesity, sleep apnea, and heart failure, emphasizing ROI, patient engagement, and long-term sustainability. The program also incorporates conversational AI technology to support tech-enabled patient monitoring, using voice-enabled tools to facilitate daily health check-ins, reinforce care plan adherence, and improve communication between patients and care teams.