VIRGINIA DEPARTMENT OF HEALTH (VDH)

REQUEST FOR APPLICATIONS

Virginia Rural Health Transformation Program (RHTP)

Community Paramedicine & Mobile Integrated Healthcare

Issuing Agency/Organization:

Virginia Department of Health (VDH)

Program Name: Community Paramedicine & Mobile Integrated Healthcare

CFDA / Assistance Listing:

93.798 - Rural Health Transformation Program

Federal Award Identification Number

(FAIN):

RHTCMS332088

Federal Award Date: December 29, 2025

Awarding Agency:

U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS), Office of Acquisitions and Grants Management

Statutory Authority: Section 71401 of Public Law 119-21

Primary Recipient:

Virginia Department of Medical Assistance Services (DMAS) 600 E Broad St, Suite 1300, Richmond, VA 23219-1856

Federal Funds Expiration Date:

October 30, 2030

RFA Reference Number:

VDH-26-517-0386

Initiative: Connected to Care, Closer to Home

Sub-initiative: Community Paramedicine

RFA Issue Date: September 4, 2026

Q&A Period/Response Schedule (If applicable):

Questions must be submitted no later than September 25, 2026, at 5:00 PM ET. Responses to questions received during the Q&A period will be compiled and posted as an addendum in eVA following the close of the Q&A period.

Pre-application Conference Info (If applicable):

September 16, 2026 at 1:00 PM EST

Conference Link:

https://vdhoep.webex.com/vdhoep/j.php?MTID=m3d48c301f617b4a6e87316049e3175c3

Application Deadline: October 6, 2026 at 5:00 PM EST

Decision Timeline (If desired to disclose):

VDH anticipates issuing award notifications on or around November 13, 2026. This date is subject to change based on the application review and award process.

Submission Method: Please submit applications via the eVA procurement portal.

Estimated Award Range:

VDH anticipates awarding approximately $3.7 million over the initial performance period.

Individual funding requests may not exceed $400,000 and should be reasonable and proportionate to the scope and scale of the proposed project.

https://vdhoep.webex.com/vdhoep/j.php?MTID=m3d48c301f617b4a6e87316049e3175c3 https://eva.virginia.gov/

VA RHTP – Community Paramedicine

Subaward Period of Performance:

Date of execution – September 30, 2027 (Initial Budget Period). Subject to the availability of funding, satisfactory performance, and continued programmatic alignment, awards may be eligible for continuation funding through September 30, 2030.

Geographic Scope:

Eligible applicants must be physically located in, or provide direct services to, rural Virginia communities as defined under Virginia’s RHTP. The Program’s baseline definition of rurality is based on the federally required Federal Office of Rural Health Policy (FORHP) definition. Over the course of the Program, Virginia may build upon the FORHP baseline definition to better reflect the Commonwealth’s unique rural landscape and the needs of rural communities.

Applicants should refer to the RHTP website for the most up-to-date rural definition and eligibility requirements

The initial Community Paramedicine/MIH awards under this RFA will be concentrated within three Virginia Regional EMS Council service areas. The three initial regions will be determined through the competitive application review process as described in Sections 1.5, 2.5, and 5.1

Applicants should refer to Appendix A for current eligible rural localities and their corresponding EMS regions.

Agency Program Contact:

Brandon Rivenbark Rural Hospital Program Manager Brandon.rivenbark@vdh.virginia.gov

(804) 835-2618 mailto:Brandon.rivenbark@vdh.virginia.gov

Table of Contents

PART I: PROGRAM BACKGROUND

1.1 Community Paramedicine Initiative Background

1.2 Program & RFA Purpose

1.3 Program Objectives for this RFA

1.4 Eligible Applicants

1.5 Available Funding & Award Structure

1.6 Project Duration and Continuation Opportunities

PART II: REQUIRED SCOPE OF WORK

2.1 Scope of Work Overview

2.2 Required Activities

2.3 Innovation Expectations

2.4 Required Partnerships and Coordination

2.5 Geographic Scope

2.6 Expected Project Deliverables

PART III: REQUIRED PERFORMANCE METRICS AND MILESTONES

3.1 Required Program Metrics

3.2 Additional Project-Specific Performance Measures

3.3 Required Program Milestones

PART IV: APPLICATION REQUIREMENTS

4.1 Cover Page

4.2 Executive Summary

4.3 Project Narrative

4.4 Budget Requirements

4.5 Organizational Capacity

4.6 Key Personnel & Staffing

4.7 Letters of Support and Memoranda of Understanding (if applicable)

4.8 Active SAM.gov Registration Confirmation and Debarment Certification

PART V: REVIEW CRITERIA AND SCORING

5.1 Review Process

5.2 Review Criteria and Scoring Rubric

PART VI: AWARD TERMS, REPORTING, AND COMPLIANCE REQUIREMENTS

6.1 Federal Regulatory Framework

6.2 Reporting Schedule

6.3 Sub-awardee Monitoring

6.4 Stevens Amendment Acknowledgement Requirements

6.5 Prohibited Uses of Funds

6.6 Record Retention and Audit Requirements

6.7 Data Integrity and Intellectual Property

6.8 Prior-Approval Triggers

6.9 Remedies for non-compliance

6.10 Required Certifications and Assurances Prior to Award

6.11 Pre-Award Financial Documentation and Risk Assessment

6.12 Payment and Reimbursement

6.13 Continuation Funding

Appendix A

PART I: PROGRAM BACKGROUND

1.1 Community Paramedicine Initiative Background

The Community Paramedicine sub-initiative is part of the Virginia Rural Health Transformation Program (RHTP), established under Section 71401 of Public Law 119-21 and administered by the Centers for Medicare & Medicaid Services (CMS). The Virginia Department of Health (VDH), Office of Emergency Medical Services (OEMS), serves as the designated subrecipient responsible for implementing this initiative as part of the Commonwealth's approved Rural Health Transformation Program.

Rural communities throughout Virginia continue to experience significant challenges in accessing timely, coordinated, and preventive healthcare services. Geographic isolation, healthcare workforce shortages, transportation barriers, limited access to primary and specialty care, increasing rates of chronic disease, and growing behavioral health needs contribute to avoidable emergency department utilization, fragmented care, poorer health outcomes, and increased healthcare costs.

Community Paramedicine and Mobile Integrated Healthcare (CP/MIH) programs represent an innovative approach to addressing these challenges by expanding the role of Emergency Medical Services (EMS) beyond traditional emergency response. Through collaborative partnerships with healthcare providers, hospitals, public health agencies, and community organizations, Community Paramedicine/MIH programs provide patient-centered services that improve access to care, strengthen care coordination, support chronic disease management, facilitate care transitions, promote preventive services, and connect individuals with appropriate community resources.

The Community Paramedicine sub-initiative supports the Commonwealth's vision for transforming rural healthcare delivery by investing in innovative, community-driven models that improve healthcare access while strengthening local healthcare systems. Through this initiative, VDH seeks to support projects that foster collaboration across the healthcare continuum, build sustainable partnerships, and implement evidence-informed approaches that respond to locally identified healthcare priorities.

As a designated RHTP subrecipient, VDH will administer this initiative through a competitive Request for Applications (RFA) process that supports the development, implementation, evaluation, and long-term sustainability of Community Paramedicine/MIH programs serving Federal Office of Rural Health Policy (FORHP)-designated rural communities throughout Virginia.

The Community Paramedicine/MIH Initiative is intended to establish sustainable models of care that strengthen regional collaboration, improve healthcare delivery, and demonstrate approaches that can be expanded and replicated throughout rural Virginia beyond the period of federal funding.

Phased Regional Implementation Approach

The Commonwealth's approved RHTP Project Narrative establishes a phased implementation approach for the Community Paramedicine sub-initiative, beginning with fully funded pilot programming through three Regional EMS Councils and expanding successful and sustainable approaches more broadly over the course of the RHTP period. Consistent with this approach, VDH will use this RFA to competitively identify the three Regional EMS Council service areas in which initial Community Paramedicine/MIH projects will be funded.

VDH has not preselected the three regions. Rather, this RFA is open to eligible applicants statewide, and the three initial implementation regions will be determined through the competitive review process. For purposes of this RFA, a selected Regional EMS Council service area may include both rural and non-rural localities; however, RHTP-funded project activities must primarily benefit FORHP-designated rural Virginia communities identified as eligible under this RFA. The inclusion of a locality within a selected Regional EMS Council service area does not independently establish eligibility for RHTP-funded services or expenditures.

This approach allows the strength of applications—including demonstrated rural community need, program design, partnerships, organizational readiness, anticipated impact, and sustainability—to inform where the Commonwealth’s initial Community Paramedicine investments are concentrated.

1.2 Program & RFA Purpose

The purpose of this Request for Applications (RFA) is to solicit applications for funding under the Community Paramedicine sub-initiative of the Virginia Rural Health Transformation Program's (RHTP) Connected Care Closer to Home initiative. Through this competitive funding opportunity, the Virginia Department of Health (VDH), Office of Emergency Medical Services (OEMS), seeks to support innovative Community Paramedicine and Mobile Integrated Healthcare (CP/MIH) projects that expand access to healthcare services, strengthen care coordination, improve health outcomes, and address locally identified healthcare priorities within Federal Office of Rural Health Policy (FORHP)-designated rural communities.

Program Vision and Funding Priorities

VDH's vision for the Community Paramedicine/MIH Initiative is to support community-driven, evidence-informed projects that transform how healthcare is delivered in rural Virginia by integrating EMS into the broader healthcare delivery system. Through this RFA, VDH seeks to invest in sustainable models that improve access to care, strengthen partnerships among healthcare providers and community organizations, and leverage the unique capabilities of EMS personnel to deliver preventive, coordinated, and patient-centered services outside of traditional clinical settings.

Recognizing that rural communities across Virginia face differing healthcare challenges, VDH encourages applicants to design innovative solutions that respond to locally identified needs while building strong partnerships across the healthcare continuum. Successful projects should demonstrate collaboration among EMS agencies, hospitals, health systems, primary care providers, behavioral health providers, public health agencies, social service organizations, community-based organizations, and other partners that contribute to improving health outcomes and expanding access to care.

Projects should demonstrate one or more of the following:

• Expand access to healthcare services for rural populations through Community Paramedicine and Mobile Integrated Healthcare models;

• Improve care coordination and continuity of care for individuals with chronic conditions, behavioral health needs, maternal health needs, or other complex healthcare needs;

• Reduce avoidable emergency department utilization, hospital admissions, and hospital readmissions through proactive, community-based interventions, including clinically appropriate treat-in-place, alternative destination, and other innovative EMS care delivery approaches;

• Strengthen collaboration among EMS agencies, healthcare providers, public health agencies, and community organizations to improve care coordination and referral pathways;

• Improve access to preventive services, chronic disease management, post-discharge follow-up, medication management, and other evidence-informed interventions delivered in community settings;

• Leverage telehealth, remote patient monitoring, digital health technologies, and other innovative approaches that improve access to care in rural communities;

• Address barriers to healthcare access, including transportation, workforce shortages, geographic isolation, and social determinants of health;

• Develop sustainable Community Paramedicine/MIH models that can be replicated or expanded to serve additional rural communities throughout Virginia.

For purposes of this RFA, innovation may include creating new Community Paramedicine/MIH programs, expanding existing programs to serve new populations or geographic areas, strengthening partnerships among healthcare providers and community organizations, implementing evidence-informed interventions in communities where they have not previously existed, integrating new technologies into care delivery, or redesigning workflows to improve access, care coordination, and health outcomes. Innovation may also include adapting or enhancing existing Community Paramedicine/MIH models to better address locally identified healthcare needs and improve the delivery of patient-centered care.

Consistent with the phased implementation approach established in Virginia's approved RHTP Project Narrative, VDH intends to fund a portfolio of high-quality Community Paramedicine/MIH projects within three Regional EMS Council service areas during the initial implementation phase. The three regions are not predetermined. Instead, eligible applicants from across rural Virginia may compete under this RFA, and the three initial implementation regions will be identified based on the results of the competitive application review process described in Section

5.1. Regional EMS Council service areas may include both rural and non-rural localities; however, projects funded under this RFA must directly serve or benefit FORHP-designated rural communities eligible under the RHTP. Applicants must clearly identify the eligible rural locality or localities to be served and demonstrate how proposed activities and expenditures will directly benefit those communities.

Initial Award Period: All funds awarded under this RFA for the initial implementation period must be expended on allowable project activities by September 30, 2027.

This structure is intended to allow initial RHTP investments to be concentrated in regions demonstrating strong community need, implementation readiness, partnerships, organizational capacity, and potential for measurable impact, while generating experience and evidence that can inform future expansion of Community Paramedicine/MIH programming to additional rural communities.

VDH anticipates serving as an active implementation partner by providing technical assistance, learning collaborative opportunities, and performance improvement support throughout the project period.

1.3 Program Objectives for this RFA

The objectives of this RFA are to support applicants in advancing the following Community Paramedicine sub-initiative goals aligned with the Commonwealth's Rural Health Transformation Program and CMS strategic priorities.

Objective Description CMS Strategic Goal Alignment

Expand access to timely, patient-centered healthcare services in rural communities through innovative Community Paramedicine and Mobile Integrated Healthcare (CP/MIH) models that improve access outside of traditional healthcare settings.

Rural Healthcare Access; Care Delivery Transformation

Strengthen care coordination and continuity of care by improving collaboration among EMS agencies, healthcare providers, behavioral health providers, public health agencies, community organizations, and other community partners.

Rural Provider Partnerships; Care Coordination

Improve health outcomes by supporting evidence-informed interventions that address chronic disease management, preventive care, care transitions, behavioral health, maternal health, and other locally identified healthcare priorities.

Population Health; Prevention & Wellness

Build regional capacity by strengthening Community Paramedicine/MIH infrastructure, workforce development, technology integration, and data-driven program evaluation to support sustainable healthcare delivery models.

Workforce Development;

Technology & Digital Enablement

Objective Description CMS Strategic Goal Alignment

Develop innovative, scalable, and sustainable Community Paramedicine/MIH models that demonstrate measurable impact and can be replicated or expanded to improve healthcare access throughout rural Virginia.

Rural Health Infrastructure;

Sustainability

1.4 Eligible Applicants

To be eligible for an award under this RFA, applicants must:

• Be a legally organized entity in good standing that is capable of receiving and administering federal subaward funding. Eligible applicants include, but are not limited to:

o Licensed Emergency Medical Services (EMS) agencies;

o Nonprofit organizations;

o State, local, or Tribal governmental entities;

o Hospitals and health systems;

o Federally Qualified Health Centers (FQHCs);

o Rural Health Clinics (RHCs);

o Institutions of higher education; and o Other organizations with the demonstrated capacity to implement Community Paramedicine or

Mobile Integrated Healthcare (CP/MIH) programs serving rural communities.

• Maintain, or be in the process of obtaining, an active SAM.gov registration with a current Unique Entity Identifier (UEI). An active SAM.gov registration and current UEI are required prior to execution of a final subaward agreement. Applicants must have no active exclusions, debarments, or suspensions.

• Demonstrate organizational capacity to manage federal funds in accordance with the requirements of 2 CFR Part 200, including financial management, procurement, reporting, and grant administration.

• Operate in, or demonstrate the capacity to provide direct services benefiting, one or more Federal Office of Rural Health Policy (FORHP)-designated rural Virginia localities identified in Appendix A.

• Demonstrate the organizational, clinical, and operational capacity necessary to implement a Community Paramedicine or Mobile Integrated Healthcare (CP/MIH) program consistent with the goals of this initiative.

• Demonstrate meaningful collaboration with EMS agencies, healthcare providers, public health agencies, behavioral health providers, and other community partners necessary to successfully implement the proposed project, as appropriate for the proposed model.

Collaborative applications involving multiple organizations are strongly encouraged. When multiple organizations participate, one eligible entity must serve as the lead applicant and assume responsibility for all programmatic, financial, contractual, and reporting requirements associated with the subaward.

Applicants proposing collaborative projects should clearly describe the roles and responsibilities of each partner, including governance, service delivery, data sharing, and performance monitoring.

1.5 Available Funding & Award Structure

VDH anticipates awarding approximately $3.7 million in competitive subawards during the initial performance period to support Community Paramedicine and Mobile Integrated Healthcare (CP/MIH) projects serving Federal Office of Rural Health Policy (FORHP)-designated rural communities in Virginia. Applicants may request up to $400,000 per application. Final award amounts will be determined by VDH based on the quality of the application, proposed scope of work, reasonableness of the budget, anticipated community impact, organizational capacity, and availability of funding.

Applicants should request funding that is reasonable and proportional to the proposed scope of work and supported by a detailed budget narrative and justification. Applicants are not expected to request the maximum award amount, and requests should reflect the actual resources necessary to successfully implement the proposed project.

Statewide Competition and Selection of Initial Implementation Regions

Eligible applicants must be physically located in, or provide direct services to, rural Virginia communities as defined under Virginia’s RHTP. The Program’s baseline definition of rurality is based on the federally required Federal Office of Rural Health Policy (FORHP) definition.

For purposes of this RFA, Regional EMS Council service areas will be used to organize the geographic distribution and selection of initial implementation regions; however, RHTP-funded project activities must directly benefit eligible rural Virginia communities as defined by this RFA. A Regional EMS Council service area may include both rural and non-rural localities, but the inclusion of a locality within a selected EMS region does not independently establish eligibility for RHTP-funded services or expenditures. Consistent with the Commonwealth's approved RHTP implementation approach, initial awards under this RFA will be concentrated within three Regional EMS Council service areas.

The three regions will not be selected in advance of the competitive review process. Instead, VDH will determine the three initial implementation regions based upon the results of application scoring and ranking.

Following completion of the merit review:

1. All responsive applications meeting applicable eligibility requirements will be scored using the criteria established in Section 5.2. Applications receiving the minimum fundable score established in Section 5.1 will then be ranked statewide according to total score.

2. Beginning with the highest-ranked application, VDH will proceed through the statewide ranking to identify the three distinct Regional EMS Council service areas represented by the highest-ranked applications.

3. Those three Regional EMS Council service areas will constitute the initial implementation regions for purposes of awards under this RFA.

4. Once the three initial implementation regions have been identified, VDH will consider other fundable applications within those regions in statewide rank order, subject to available funding, application quality, proposed scope and budget, organizational capacity, community impact, and the overall composition of the project portfolio.

5. An application's location within one of the three selected regions does not guarantee funding. All projects selected for award must independently demonstrate sufficient technical merit, feasibility, organizational capacity, programmatic alignment, and responsible stewardship of federal funds.

Illustrative example: If the highest-ranked application is from Region A, the second-highest-ranked application is from Region B, and the third-highest-ranked application is also from Region A, VDH would continue through the statewide ranking until the highest-ranked application from a third distinct region is reached. Regions A, B, and that third region would then constitute the three initial implementation regions.

Following identification of the three initial implementation regions, VDH may make multiple awards within each selected region. VDH does not anticipate allocating funding equally among the three regions. The number and amount of awards within each region will depend upon the quality and scope of applications received, available funding, proposed budgets, anticipated community impact, and the resulting portfolio of projects.

Applicants should request funding that is reasonable and proportional to the proposed scope of work and supported by a detailed budget narrative and justification. Individual award amounts will be determined by VDH based on the availability of funding, quality of the application, proposed scope of work, anticipated community impact, and demonstrated organizational capacity.

Regardless of award amount, the following conditions apply to all awards under this RFA:

• VDH anticipates that there will be minimal funding availability for direct administrative costs and no availability for indirect costs. Applicants should attempt to minimize administrative expenses in their application's budget proposal to align to RHTP program requirements. Administrative costs include, but are not limited to, general administrative salaries and benefits, grant administration, fiscal management, office operations, and other costs that support overall organizational administration rather than direct project implementation.

• All funds awarded for the initial budget period must be expended on allowable project activities by September 30, 2027. Funds may not be carried forward beyond the initial budget period unless expressly authorized by VDH in accordance with applicable RHTP requirements.

• No cost sharing or matching funds are required.

• Subawardees must demonstrate satisfactory programmatic and financial performance to be considered for continuation funding in subsequent budget periods. Continuation funding is contingent upon the availability of federal funds, compliance with award requirements, and successful progress toward approved project goals and performance measures.

• Pre-award costs are not allowable unless expressly authorized in writing by VDH.

• Awardees must maintain the organizational partnerships, operational capacity, and program infrastructure necessary to carry out the approved scope of work throughout the period of performance. Significant changes to key partnerships, project leadership, organizational capacity, or the approved scope of work must be reported promptly to VDH and may require prior written approval. Such changes may result in modification of the award, additional monitoring, or other actions deemed appropriate by VDH.

VDH reserves the right to negotiate budgets, scopes of work, project periods, and award amounts prior to executing subaward agreements. Individual award amounts, not to exceed $400,000 during the initial performance period, will be determined by VDH based on the availability of funding, quality of the application, proposed scope of work, anticipated community impact, and demonstrated organizational capacity. Only applications meeting the minimum fundable score established in Section 5.1 will be eligible for an award or considered in determining the three initial implementation regions.

1.6 Project Duration and Continuation Opportunities

The Virginia Department of Health (VDH) recognizes that Community Paramedicine and Mobile Integrated Healthcare (CP/MIH) programs vary considerably in scope, organizational structure, implementation readiness, and the populations they serve. Applicants are encouraged to propose projects with timelines and work plans that are appropriate for the proposed activities and anticipated outcomes while demonstrating a clear strategy for long-term sustainability.

Initial awards made under this RFA are expected to support the first budget period of the Rural Health Transformation Program and must be expended by September 30, 2027. Subject to the availability of federal funding, satisfactory performance, compliance with award requirements, and continued alignment with program priorities, subawardees may be eligible for continuation funding in subsequent budget periods through the end of the Rural Health Transformation Program period of performance.

The Community Paramedicine/MIH program is intended to support the phased development, implementation, evaluation, refinement, and expansion of innovative Community Paramedicine/MIH models that improve healthcare access and strengthen rural healthcare delivery systems.

Applicants are encouraged to propose projects that establish a strong foundation for long-term growth, sustainability, and scalability. While funding decisions will be made on an annual basis and continuation funding is not guaranteed, VDH anticipates that successful projects will demonstrate the capacity to mature over time, expand their impact, strengthen regional partnerships, and contribute to the development of sustainable Community Paramedicine models that can inform broader implementation across rural Virginia. Applicants should therefore consider how proposed activities may evolve over multiple years and describe a realistic pathway for future growth consistent with community needs, organizational capacity, and program goals.

Continuation funding is not automatic and will be determined annually based on factors including, but not limited to:

• Availability of federal funding;

• Satisfactory programmatic and financial performance;

• Achievement of required milestones and performance measures;

• Compliance with all applicable award requirements;

• Demonstrated progress toward implementation and project sustainability; and

• Continued alignment with the goals and priorities of the Virginia Rural Health Transformation Program.

Applicants should design projects with long-term sustainability in mind. Applications should describe how the proposed Community Paramedicine/MIH model will build organizational and community capacity, strengthen partnerships, and position the program for continued operation and potential expansion beyond the period of federal funding.

PART II: REQUIRED SCOPE OF WORK

2.1 Scope of Work Overview

The Virginia Department of Health (VDH), Office of Emergency Medical Services (OEMS), seeks to support innovative Community Paramedicine and Mobile Integrated Healthcare (CP/MIH) projects that expand access to healthcare services, improve care coordination, strengthen regional partnerships, and address locally identified healthcare needs in rural Virginia.

Projects funded under this RFA are expected to implement evidence-informed Community Paramedicine/MIH models that integrate EMS capabilities and personnel, as appropriate to the proposed model, within the broader healthcare delivery system. Successful projects should improve access to care, strengthen collaboration among healthcare and community partners, and develop sustainable approaches that improve health outcomes while reducing barriers to healthcare access.

Applicants are encouraged to design projects that respond to the unique needs of their communities while aligning with the goals of the Virginia Rural Health Transformation Program. Proposed activities should demonstrate meaningful collaboration among EMS agencies, healthcare providers, hospitals, public health agencies, behavioral health providers, social service organizations, and other community partners, as appropriate for the proposed model.

Projects should be designed with sustainability and scalability in mind. Applicants should describe how proposed activities will establish the partnerships, operational infrastructure, workforce capacity, and evaluation processes necessary to support continued program growth and long-term success beyond the initial budget period.

All funded projects will be expected to participate in statewide program evaluation, performance reporting, technical assistance activities, and peer learning opportunities coordinated by VDH. Awardees will also collaborate with VDH and Regional EMS Councils to share promising practices, identify implementation challenges, and contribute to the development of scalable Community Paramedicine/MIH models that strengthen healthcare delivery across rural Virginia.

2.2 Required Activities

Applicants shall propose a Community Paramedicine/MIH project that addresses identified healthcare needs within the proposed service area and aligns with the goals of the Virginia Rural Health Transformation Program.

Proposed projects should implement evidence-informed strategies that improve healthcare access, strengthen care coordination, and support sustainable models of healthcare delivery in rural Virginia.

At a minimum, funded projects will be expected to incorporate the following activities, as appropriate to the proposed model:

A. Community Need and Program Design

Applicants shall demonstrate that the proposed project is responsive to identified community health needs.

Projects should be informed by available data, stakeholder input, existing healthcare resources, and documented service gaps within the proposed service area.

Applicants should describe:

• the healthcare challenges the project intends to address;

• the target population(s);

• why Community Paramedicine/MIH is an appropriate intervention; and

• how the proposed model complements, rather than duplicates, existing healthcare services.

B. Community Paramedicine Service Delivery

Applicants shall implement Community Paramedicine/MIH services designed to improve access to healthcare and address locally identified priorities.

Projects may include, but are not limited to:

• chronic disease management;

• Clinically appropriate treat-in-place, alternative destination, and other alternative EMS care delivery approaches that connect patients to the most appropriate level or setting of care and may reduce unnecessary emergency department utilization;

• preventive health services;

• post-discharge follow-up and care transitions;

• behavioral health support;

• maternal and child health services;

• medication management;

• telehealth or remote patient monitoring;

• fall prevention;

• community-based assessments;

• referrals to healthcare and community resources; and

• other evidence-informed Community Paramedicine/MIH interventions appropriate to community need.

Applicants should clearly describe the services to be provided, eligibility criteria, referral pathways, anticipated patient volume, staffing model, and operational workflow.

C. Care Coordination and Community Partnerships

Projects shall establish meaningful partnerships that support coordinated, patient-centered care.

Applicants should describe how they will collaborate with healthcare providers, hospitals, primary care practices, behavioral health providers, public health agencies, social service organizations, community-based organizations, and other partners to improve care coordination and facilitate referrals.

Projects should clearly identify the role of participating EMS agencies or related healthcare providers, and describe how Community Paramedicine services will be integrated within the broader healthcare delivery system.

D. Workforce Development and Operational Readiness

Applicants shall demonstrate that personnel participating in the proposed project possess—or will obtain—the education, training, certifications, clinical protocols, medical oversight, and operational support necessary to safely and effectively implement the proposed Community Paramedicine/MIH model. Proposed projects should support EMS personnel in practicing at the highest level permitted within their applicable scope of practice, training, certification, and medical oversight structure, as appropriate to the proposed model.

Applicants should describe:

• Staffing plans and personnel roles;

• Education, training, certification, and workforce development needs, including preparation of EMS personnel for Community Paramedicine/MIH roles;

• Medical direction and clinical oversight;

• Clinical protocols and workflows;

• Quality assurance and performance improvement processes;

• Operational policies and procedures;

• Technology and other operational infrastructure; and

• Other resources necessary for successful implementation.

E. Performance Measurement and Continuous Quality Improvement

Applicants shall participate in all required program evaluation and reporting activities established by VDH.

Projects should establish processes for collecting performance data, monitoring program implementation, evaluating outcomes, and using data to support continuous quality improvement throughout the project period.

Applicants should describe how performance data will be incorporated into project management and decision-making.

F. Sustainability and Program Growth

Applicants shall describe their strategy for sustaining successful Community Paramedicine/MIH activities beyond the initial budget period.

Sustainability planning should address organizational capacity, reimbursement opportunities, community partnerships, operational infrastructure, workforce development, and other factors that will support continued program operation after grant funding concludes.

Applicants are encouraged to consider phased implementation approaches that establish a strong foundation for future expansion while demonstrating measurable progress during the initial award period.

2.3 Innovation Expectations

The Virginia Department of Health (VDH) recognizes that innovation may take many forms and will vary based on the unique healthcare needs, resources, and partnerships within each rural community. Applicants are encouraged to implement, adapt, expand, or enhance evidence-informed Community Paramedicine/MIH models that address locally identified healthcare priorities and strengthen rural healthcare delivery systems.

Applicants should propose projects that demonstrate meaningful improvements in one or more of the following:

• Expanding access to healthcare services for underserved rural populations;

• Improving care coordination and continuity across healthcare, public health, behavioral health, and community-based organizations;

• Leveraging EMS personnel in innovative, patient-centered roles that complement existing healthcare services;

• Integrating technology, telehealth, remote patient monitoring, digital health tools, or other approaches that improve access and care delivery;

• Strengthening regional partnerships and interdisciplinary collaboration;

• Addressing barriers to healthcare access, including transportation, workforce shortages, geographic isolation, and social determinants of health;

• Developing sustainable operational models that improve health outcomes and may be replicated or expanded to other rural communities.

Innovation may include, but is not limited to:

• Expanding an existing Community Paramedicine/MIH program to serve new populations or geographic areas;

• Establishing new partnerships among EMS agencies, healthcare providers, public health agencies, behavioral health providers, and community organizations;

• Implementing evidence-informed interventions in communities where similar services have not previously been available;

• Integrating Community Paramedicine/MIH into existing clinical workflows, care coordination programs, or population health initiatives;

• Leveraging data, technology, and performance improvement strategies to enhance patient outcomes and program effectiveness; or

• Developing new approaches to supporting individuals with chronic disease, behavioral health needs, maternal health needs, care transition needs, or other locally identified healthcare priorities.

Applicants should clearly describe how the proposed project responds to identified community needs, advances the goals of this initiative, and demonstrates the potential for long-term sustainability and broader application within rural Virginia.

2.4 Required Partnerships and Coordination

Successful Community Paramedicine/MIH programs rely on strong collaboration among healthcare providers, Emergency Medical Services (EMS), public health agencies, and community organizations to improve healthcare access, strengthen care coordination, and address locally identified healthcare needs.

Applicants shall demonstrate meaningful collaboration with organizations that are appropriate to the proposed project and target population. Partnerships should support coordinated service delivery, referral pathways, patient engagement, data sharing (where appropriate), and continuity of care.

Depending on the proposed project, applicants are encouraged to collaborate with organizations such as:

• Licensed Virginia EMS agencies;

• Hospitals and health systems;

• Primary care providers;

• Federally Qualified Health Centers (FQHCs);

• Rural Health Clinics (RHCs);

• Local health departments;

• Behavioral health providers;

• Community Services Boards;

• Long-term care providers;

• Home health and hospice organizations;

• Social service agencies;

• Community-based organizations;

• Regional EMS Councils; and

• Other organizations that contribute to improving healthcare access and health outcomes within the proposed service area.

Projects led by organizations other than licensed EMS agencies should clearly describe the role of participating EMS agency partners in project planning, implementation, and service delivery.

Applicants shall describe:

• the role and responsibilities of each key project partner;

• how patients will be identified, referred, and transitioned among participating organizations;

• how communication and coordination will occur throughout project implementation;

• how partners will support project evaluation and continuous quality improvement, as appropriate; and

• how partnerships will contribute to long-term sustainability of the proposed model.

Applicants are encouraged to demonstrate existing partnerships whenever possible. If formal agreements have not yet been executed, applicants should describe the status of partnership development and provide a plan for establishing collaborative agreements prior to implementation.

Regional EMS Councils are important partners in the statewide implementation of the Community Paramedicine/MIH Initiative. Awardees will be expected to coordinate with their respective Regional EMS Council, as appropriate, to support regional collaboration, technical assistance, stakeholder engagement, and dissemination of promising practices throughout the project period.

2.5 Geographic Scope

Eligible applicants must be physically located in, or provide direct services to, rural Virginia communities as defined under Virginia’s RHTP. The Program’s baseline definition of rurality is based on the federally required Federal Office of Rural Health Policy (FORHP) definition.

Consistent with the Commonwealth's approved RHTP implementation approach, awards made through this RFA will initially be concentrated within three Regional EMS Council service areas. The three regions have not been predetermined and will be identified through the competitive review and ranking process described in Sections 1.5 and 5.1.

Applicants must clearly identify:

• the Regional EMS Council service area in which the proposed project will be implemented;

• the FORHP-designated rural communities within the Commonwealth of Virginia that will directly benefit from project activities;

• the healthcare needs within the proposed service area; and

• how the proposed project will address those needs and strengthen the regional healthcare delivery system.

Projects may serve a single locality, multiple localities, or a broader regional service area, provided the proposed model demonstrates meaningful benefit to eligible rural communities and aligns with the goals of this initiative.

For purposes of regional selection under this RFA, each application must be associated with one primary Regional EMS Council service area. If an applicant proposes a project spanning more than one Regional EMS Council service area, the applicant must identify the primary region in which the majority of project activities and beneficiaries will be located. The applicant's designated primary region will be used for purposes of the regional selection process described in Sections 1.5 and 5.1.

Applicants proposing projects to serve eligible rural communities in any Regional EMS Council service area are encouraged to apply. The three initial implementation regions will be determined through the competitive review and regional selection process described in Sections 1.5 and 5.1; therefore, submission of an application does not guarantee that the applicant’s region will be selected for funding. Eligible rural localities are identified in Appendix A.

2.6 Expected Project Deliverables

Projects funded under this RFA are expected to produce measurable outcomes that improve healthcare access, strengthen care coordination, and contribute to the long-term development of sustainable Community

Paramedicine/MIH models in rural Virginia.

At a minimum, funded projects will be expected to achieve the following deliverables, as appropriate to the proposed scope of work:

Program Implementation

• Establish or expand a Community Paramedicine/MIH program consistent with the approved project scope.

• Develop and implement project workflows, protocols, referral processes, and operational procedures necessary to support program implementation.

• Recruit, train, and support project personnel, as appropriate.

Partnership Development

• Establish and maintain collaborative relationships with healthcare providers, EMS agencies, public health agencies, community organizations, and other project partners necessary to support successful implementation.

• Develop coordinated referral pathways and communication processes that facilitate patient-centered care and improve continuity across the healthcare continuum.

Service Delivery

• Implement Community Paramedicine/MIH services that address identified community healthcare needs and improve access to healthcare services for the target population.

• Demonstrate measurable progress toward the project goals, objectives, and performance measures described in the approved application.

Performance Measurement and Reporting

• Participate in all required performance measurement, program evaluation, financial reporting, and technical assistance activities established by VDH.

• Collect, maintain, and report project data necessary to evaluate program implementation, patient outcomes, and overall project performance.

• Participate in continuous quality improvement activities and use project data to inform ongoing program refinement.

Sustainability and Knowledge Sharing

• Develop and implement a sustainability strategy that supports continuation of successful project activities beyond the initial award period.

• Share lessons learned, promising practices, implementation challenges, and project outcomes with VDH and other initiative participants to support statewide learning and future program development.

• Contribute to the identification of scalable Community Paramedicine/MIH models that may be replicated or adapted in other rural communities throughout Virginia.

Applicants should clearly describe how the proposed project will accomplish these deliverables and identify any additional project-specific deliverables that are appropriate for the proposed model.

PART III: REQUIRED PERFORMANCE METRICS AND

MILESTONES

3.1 Required Program Metrics

Performance measurement is a critical component of the Community Paramedicine/Mobile Integrated Healthcare (CP/MIH) Initiative and the Virginia Rural Health Transformation Program (RHTP). Performance monitoring will include required Initiative-level metrics reported by VDH as part of the RHTP, as well as project-specific performance data collected and reported by subrecipients. Together, these measures will support program accountability, continuous quality improvement, statewide evaluation, and assessment of the Initiative's impact on healthcare access and outcomes in Virginia's rural communities.

VDH recognizes that projects funded under this RFA may vary considerably in scope, target population, service delivery model, and community need. Accordingly, individual projects may contribute differently to the Initiative's overall performance goals based on their approved project model.

RHTP Required Initiative Metrics

As part of Virginia's RHTP, VDH is responsible for monitoring and reporting required performance metrics for the Community Paramedicine/MIH Initiative to the Department of Medical Assistance Services (DMAS). These measures are used to assess progress toward the goals of the Community Paramedicine/MIH Initiative and the broader RHTP.

The following two required performance metrics have been established for the Community Paramedicine/MIH Initiative:

• Metric 1: Incremental Number of Residents Receiving One or More Preventive Visits through Community Paramedicine in Rural Localities Served by the Project o This measure will assess the incremental number of residents receiving one or more preventive visits through Community Paramedicine/MIH activities in rural localities served by funded projects. The baseline for newly funded activities is zero, with applicable targets to be established by VDH following initial implementation and baseline data collection. Subrecipients will be responsible for collecting and reporting project-level information necessary for VDH to monitor and report this measure, using patient encounter records, electronic medical records, or other approved program documentation, as applicable to the approved project model.

• Metric 2: Rate of Avoidable Emergency Department Visits in Rural Localities Served by the Project or Sub-Initiative, as Applicable o This measure will assess changes in avoidable emergency department utilization within rural localities served by funded Community Paramedicine/MIH projects or the broader sub-initiative, as applicable. VDH, in coordination with DMAS and the statewide evaluation partner, will generate and monitor this measure using DMAS administrative claims data, Virginia's All-Payer Claims Database (APCD), and/or other appropriate statewide data sources. Subrecipients will not be responsible for independently calculating or reporting this measure.

Applicants should consider how their proposed activities may contribute to the broader aims reflected in these required metrics, including expanding access to preventive and appropriate healthcare services, strengthening care coordination and continuity of care, and reducing potentially avoidable emergency department utilization.

Individual projects are not expected to independently demonstrate improvement in every Initiative-level measure;

rather, VDH will assess performance across funded projects and participating rural communities as part of the broader…