REQUEST FOR APPLICATIONS (RFA)

STANDARD GRANT AGREEMENT (SGA)

(COMPETITIVE)

PROCUREMENT ID NUMBER – PHPA 3936 / BPM056605

Issue Date: April 21, 2026

Rooted and Resilient Rural Maryland:

Transformation through Sustainable Access, Innovative Care, and Tech Innovation

NOTICE

A Prospective Applicant that has received this document from the Maryland Department of Health, or that has received this document from a source other than the Procurement Officer, and that wishes to assure receipt of any changes or additional materials related to this RFA, should immediately contact the Procurement Officer and provide the Prospective Applicant’s name and mailing address so that addenda to the RFA or other communications can be sent to the Prospective Applicant.

STATE OF MARYLAND

MARYLAND DEPARTMENT OF HEALTH

RFA KEY INFORMATION SUMMARY SHEET

Request for Applications: Rooted and Resilient Rural Maryland:

Transformation through Sustainable Access, Innovative Care, and Tech Innovation

Solicitation Number: PHPA 3936 / BPM056605

RFA Issue Date: April 21, 2026

RFA Issuing Office: Maryland Department of Health Prevention and Health Promotion Administration

Procurement Officer: Li’Chelle Lindsey

Prevention and Health Promotion Administration Maryland Department of Health 201 West Preston Street, Baltimore, MD 21201

Phone:410-767-5621 Email: LiChelle.Lindsey@maryland.gov

Award Monitors: Peter DeMartino Maryland Department of Health Prevention and Health Promotion Administration

Shelly Choo Maryland Department of Health Behavioral Health Administration Policy and Planning

Erin Schurmann Maryland Health Services Cost Review Commission

Pre-Application conference : April 28, 2026 at 4:00pm EST (Link on eMMA)

Questions due date and time: May 12, 2026 Time: 2:00 pm EST Local Time

Applications are to be sent to: eMaryland Marketplace Advantage (eMMA)

(https://emma.maryland.gov/page.aspx/en/usr/login?Return Url=%2fpage.aspx%2fen%2fbuy%2fhomepage). For questions and/or technical assistance, please contact emma.helpdesk@maryland.gov. In addition, you may visit https://procurement.maryland.gov for additional information.

Closing Date and Time: May 26, 2026 Time: 2:00pm EST Local Time

09/2024 https://emma.maryland.gov/page.aspx/en/usr/login?ReturnUrl=%2fpage.aspx%2fen%2fbuy%2fhomepage https://emma.maryland.gov/page.aspx/en/usr/login?ReturnUrl=%2fpage.aspx%2fen%2fbuy%2fhomepage mailto:emma.helpdesk@maryland.gov https://procurement.maryland.gov

SECTION 1 - GENERAL INFORMATION

1.1 Summary Statement

The Maryland Department of Health (MDH or the Department), through the joint efforts of the Prevention and Health Promotion Administration (PHPA), Behavioral Health Administration (BHA), and Health Services Cost Review Commission (HSCRC), is issuing this Request for Applications (RFA) to award funding under the Rural Health Transformation Program (RHTP) award to the state of Maryland.

The Maryland RHTP is facilitated by the MDH State Office of Rural Health (SORH) and financially supported by the Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $168,180,837.61 with 100 percent funded by CMS/HHS. The contents of this RFA are those of the State and do not necessarily represent the official views of, nor an endorsement, by CMS/HHS, or the U.S. Government.

This RFA is the largest solicitation of the first RHTP budget period. The total amount of funding available through this RFA is $73 million for RHTP Budget Period 1. There is no guarantee of future federal RHTP awards. However, MDH anticipates the availability of a similar scale of funding for RHTP Budget Periods 2 through 5.

This RFA solicits proposals for the following three Transformation Funds within Maryland’s RHTP Pillar Two: Promote Sustainable Access and Innovative Care:

● Sustainable Access Through Service Expansion and Health Information Technology (HIT) Advances;

● Behavioral Health Service Expansion; and

● Innovative Care.

Focused on rural Maryland, the goals of these Transformation Funds include:

● Expanding primary care, specialty care, and behavioral health care to meet current demand and build long-term capacity to improve health outcomes;

● Promoting efficient and effective management of chronic somatic and behavioral health conditions, including by empowering residents to manage their conditions;

● Leveraging technology to bring health care directly to rural residents;

● Empowering residents to manage somatic and behavioral chronic conditions; and

● Helping providers adopt innovative, value-based care models.

CMS and the State intend for RHTP-funded projects to measurably improve the health of rural Marylanders. Applicants must have a clear path to sustain successful projects after RHTP funding ends in 2031.

The Department values the ability of rural stakeholders to design the solutions they need. The combination of the three Transformation Funds under a single RFA gives greater flexibility to Applicants in defining their proposed project scope. This high degree of flexibility encourages innovative and efficient approaches to addressing the RFA’s objectives. The combined RFA approach offers greater efficiency and a clearer path to funding for projects that integrate multiple Transformation Fund goals.

https://health.maryland.gov/pophealth/Pages/Rural-Health-Transformation-Program.aspx https://health.maryland.gov/pophealth/Documents/Rural%20Health/RHTP/MD-RHTP-Plan-CMS-Approved-12-29-2025.pdf https://health.maryland.gov/pophealth/Documents/Rural%20Health/RHTP/MD-RHTP-Plan-CMS-Approved-12-29-2025.pdf

The Department seeks projects aimed at improving access to high quality health care and innovation in care delivery and care management across 18 State-designated rural counties. Applicants will implement high-impact interventions that align with the RHTP strategic goals of sustainable access, innovative care delivery, holistic care, and technological advancement. This solicitation is consistent with the Department’s long-standing commitment to partnership, community engagement, coalition-building, and addressing service gaps in Maryland communities.

The Department strongly encourages a collaborative approach to rural health transformation, with partnerships aligned around strategic, cohesive solutions. Applicants can choose between two primary structures for their projects: (1) Transformation Collaborative or (2) Sole Organization. Either structure must deliver services that align with the RFA’s strategic goals of sustainable access and innovative care.

Projects primarily focused on the health workforce may be better suited for competitive funding opportunities under RHTP Pillar One: Transform the Rural Health Workforce. Projects primarily focused on increasing consumption of healthy, local, affordable foods may be better suited for competitive funding opportunities under RHTP Pillar Three: Empower Rural Marylanders to Eat for Health.

1.1.1 It is the State’s intention to obtain services, as specified in this RFA, from Agreements between the selected Applicants and the State. The anticipated duration of services to be provided is August 15, 2026 - June 30, 2027.

1.1.2 The State is able to award RHTP Budget Period 1 funding under this RFA. While there is no guarantee of future federal RHTP funding, the State anticipates continued funding for federal annual RHTP Budget Periods 2 through 5, for which information will be made available upon CMS award to Maryland:

○ Budget Period 2 (10/31/26 - 9/30/28)

○ Budget Period 3 (10/31/27 - 9/30/29)

○ Budget Period 4 (10/31/28 - 9/30/30)

○ Budget Period 5 (10/31/29 - 9/30/31)

The State encourages Applicants to develop their Budget Period 1 proposals as the first step in a multi-year initiative. Projects should reflect the broad scale and reach necessary to achieve transformation goals. Applicants should include progression plans and sustainability plans for initiatives and outcomes in Budget Periods 2 through 5. Alternatively, Applicants may propose an initiative confined to Budget Period 1 alone if the proposal can reasonably achieve transformation goals within a single year.

1.1.3 To maximize the impact and efficiency of RHTP, the State will issue one or more additional RFAs to award future RHTP Budget Period funds if available.

1.1.4 The State affords Applicants substantial latitude in the design and organization of their projects within the outlined RHTP terms and conditions. As described in Section III, Applicants can apply for support of a project that addresses a single Focus Area or multiple Focus Areas. The State does envision cohesive projects that maximize synergies among different project elements to accelerate rural health improvement.

1.1.5 An Applicant should not submit separate proposals for different Pillar Two Transformation Funds or Focus Areas (i.e., Sustainable Access Through Service Expansion; Sustainable Access

Through HIT Advances; Behavioral Health Service Expansion; and Innovative Care). However, an Applicant can submit an application and also be part of another Transformation Collaboration focused on a separate project and/or region.

1.1.6 The Department intends to make multiple awards as a result of this RFA.

1.1.7 Applicants, either directly or through their subcontractor(s), must be able to provide all services and meet all the requirements requested in this solicitation. The successful Applicant shall remain responsible for performance regardless of subcontractor participation in the work.

1.2 Contract Type

1.2.1 The Agreements resulting from this solicitation shall be Cost Reimbursement Contracts.

1.3 Procurement Officer

1.3.1 The sole point of contact in the State for purposes of this solicitation prior to the award of any

Agreement is the Procurement Officer at the address listed below:

Li’Chelle Lindsey

Procurement Officer Prevention and Health Promotion Administration Maryland Department of Health 201 West Preston Street, Baltimore, MD 21201

Phone:410-767-5621 Email: LiChelle.Lindsey@maryland.gov

1.3.2 The Department may change the Procurement Officer at any time by written notice.

THE REMAINDER OF THIS PAGE IS INTENTIONALLY LEFT BLANK.

1.4 Award Monitor

1.4.1 As this is a multi-administration RFA, multiple award monitors will support implementation of this award program.

The PHPA Award Monitor is:

Peter DeMartino

Prevention and Health Promotion Administration Maryland Department of Health

The BHA Award Monitor is:

Shelly Choo

Policy and Planning Behavioral Health Administration

Maryland Department of Health

The HSCRC Award Monitor is:

Erin Schurmann

Medical Economics and Data Analytics Maryland Health Services Cost Review Commission

1.4.2 The Department may change the Award Monitor(s) at any time by written notice.

1.5 eMaryland Marketplace Advantage

1.5.1 Each Applicant is requested to indicate its eMaryland Marketplace Advantage (eMMA) vendor number in the Transmittal Letter (cover letter) submitted at the time of its application submission to this RFA.

1.5.2 eMMA is an electronic commerce system administered by the Maryland Department of General

Services. The RFA and associated materials, the solicitation and summary of the Pre-Proposal Conference, Applicant questions and the Procurement Officer’s responses, addenda, and other solicitation-related information will be provided via eMMA.

1.5.3 In order to receive an award, a vendor must be registered on eMMA. Registration is free. Go to https://procurement.maryland.gov/, click on “Register” to begin the process, and then follow the prompts.

https://procurement.maryland.gov/

1.6 Questions

1.6.1 The Procurement Officer will accept written questions from prospective Applicants. Applicants shall submit questions to the Procurement Officer via e-mail to the following e-mail address:

LiChelle.Lindsey@maryland.gov. Please identify in the subject line the Solicitation Number and Title.

1.6.2 Questions are requested to be submitted no later than the due date indicated on the RFA Key

Information Summary Sheet. The Procurement Officer, based on the availability of time to research and communicate an answer, shall decide whether an answer can be given before the Application due date.

1.7 Application Due (Closing) Date and Time

1.7.1 Applications, in the number and form set forth in Section 4 Application must be received by the Procurement Officer, in eMaryland Marketplace (eMMA) no later than 2:00 pm EST Local Time on May 26, 2026 to be considered. If emailing please identify in the subject line the Solicitation Number and Title.

1.7.2 Requests for an extension of this time or date will not be granted. Applications received after the due date and time listed in this section will not be considered. Questions regarding this solicitation should be directed (By e-mail only, no phone calls will be accepted) to the Procurement Officer.

1.7.3 Applications may be modified or withdrawn by written notice received by the Procurement

Officer before the time and date set forth in this section for receipt of Application. Multiple and/or alternate Applications will not be accepted.

1.8 Award Basis

1.8.1 The awards shall be made to responsible Applicants submitting Applications that have been determined to be the most advantageous to the State, considering evaluation factors set forth in this RFA, for providing the activities as specified in this RFA. See RFA Section 5 for further award information.

1.9 Revisions to the RFA

1.9.1 If it becomes necessary to revise this RFA before the due date for Applications, the Department shall post addenda to eMMA and the Maryland RHTP website; and disseminate addenda via the Maryland RHTP listserv.

1.9.2 Acknowledgment of the receipt of all addenda to this RFA issued before the Application due date shall be included in the Transmittal Letter accompanying the Applicant’s Project Narrative.

Acknowledgement of the receipt of addenda to the RFA issued after the Application due date shall be in the manner specified in the addendum notice. Failure to acknowledge receipt of an addendum does not relieve the Applicant from complying with the terms, additions, deletions, or corrections set forth in the addendum.

1.10 Cancellations

1.10.1 The State reserves the right to cancel this RFA, accept or reject any and all Applications, in whole or in part, received in response to this RFA, waive or permit the cure of minor irregularities, and conduct discussions with all qualified or potentially qualified Applicants in any manner necessary to serve the best interests of the State. The State reserves the right, in its sole discretion, to make awards based upon the written Applications received without discussions or negotiations.

1.10.2 In the event a government entity proposes and receives the recommendation for award, the contract, application and solicitation for this RFA may be canceled, and the award processed in accordance with COMAR 21.01.03.01.A(4). If the services that are the subject of the RFA are currently being provided under an interagency agreement with a public institution of higher education and the State determines that the services can be provided more cost effectively by the public institution of higher education, then the RFA may be canceled in accordance with Md.

Code Ann., State Finance and Procurement Art., § 3- 207(b)(2).

SECTION 2 – MANDATORY REQUIREMENTS

2.1 Applicant Mandatory Requirements

To be eligible for an award under this RFA, the Applicant must meet and provide documentation for the following mandatory requirements in compliance with Maryland State regulations:

2.1.1 Eligible Entity Status. The Applicant must be one of the following:

A. A Social Organization: As defined by Section 7-402 of the State Finance and Procurement Article of the Annotated Code of Maryland.

B. A Government or Academic Entity: Including local or state government agencies, public colleges, or state universities.

2.1.2 Tax-Exempt Status and Documentation

A. Social organizations (excluding government or academic entities) must be non-profit organizations classified by the IRS as tax-exempt under Section 501(c)(3).

B. Required Documentation: Applicants must provide a copy of their IRS tax-exempt status determination letter (or that of their fiscal sponsor).

2.1.3 Maryland State Standing. At the time of the award, the Applicant must be:

A. In Good Standing with the Maryland State Department of Assessments and Taxation

(SDAT).

B. Tax Compliant, as certified by the Maryland Comptroller’s Office, ensuring all state tax payments are current.

2.2 Applicant Categories

Applicants may apply in one of the following categories:

2.2.1 Transformation Collaborative: Multi-partner groups (three or more organizations) operating under shared governance.

A. Types of Eligible Collaborative Participants: Hospitals/health systems, Federally Qualified Health Centers (FQHCs), community-based organizations, pharmacies, post-acute providers, home and community-based service providers, faith-based organizations, private providers, oral health providers, local health departments, technology vendors, schools, Core Service Agencies (CSAs), Local Addictions Authorities (LAAs), Local Behavioral Health Authorities (LBHAs), Area Agencies on Aging (AAAs), universities, and other health care and service providers.

B. Structure: The Collaborative must designate a lead organization to be the Primary Applicant. Collaboratives are distinct from Sole Organization Applicants in their shared governance and cooperative funding structure.

C. Primary Applicant Requirements: Primary Applicants must meet the requirements of

Section 2.1. Applicant Mandatory Requirements.

D. Focus: Transformation Collaboratives are intended for larger-scale projects. The State encourages these collectives to align around common resources to create cohesive, scalable solutions that no single entity could achieve alone.

2.2.2 Sole Organization: Individual organizations with a comprehensive internal plan.

A. Types of Eligible Organizations: Health care providers and social service organizations, including but not limited to hospitals/health systems, FQHCs, oral health providers, physician group practices, pharmacies, post-acute providers, local health departments, Core Service Agencies (CSAs), Local Addictions Authorities (LAAs), Local Behavioral Health Authorities (LBHAs), Area Agencies on Aging (AAAs), community-based organizations, and home and community-based service providers.

B. The Applicant must meet the requirements of Section 2.1. Applicant Mandatory Requirements.

C. Structure: The Applicant acts as the single point of accountability for the proposed project. The Applicant may have subcontractors.

2.2.3. Organizational Requirements by Applicant Type

Applicants must meet the organizational requirements in Table 2.2.3.1 to be eligible for this RFA.

Table 2.2.3.1: Organizational Requirements by Applicant Type

Category Transformation Collaborative Sole Organization

Governance Shared Decision-Making Structure (e.g., Steering Committee).

Single Board oversight.

Core Staff

Note: Core staff do not need to be funded under this RFA but need to be identified as points of contact.

Lead Applicant provides Program Director and Fiscal Director for the entire Transformation Collaborative (Collaborative).

Program Director & Fiscal Director.

Licensure Any health care providers and clinical staff delivering services as part of the Collaborative must be licensed to practice in Maryland.

Any health care providers and clinical staff delivering services under the Sole Organization must be licensed to practice in Maryland.

Community Engagement

Must include at least one partner able to engage and reach out to communities to gain input on project implementation.

Must be able to engage and reach out to communities to gain input on project implementation.

SECTION 3 – SCOPE OF WORK

3.1 Background and Purpose

The CMS Rural Health Transformation Program (RHTP) allocates federal funds to states to improve health care access, quality, outcomes, and innovation in rural communities across the country. Federal RHTP goals are:

● Make rural America healthy again

● Sustainable access

● Workforce development

● Innovative care

● Tech innovation

The State’s CMS-approved RHTP Plan describes Maryland’s rural health needs. Maryland’s population is aging, and the rural population tends to be older compared to the State overall. Compared to urban areas, a larger proportion of rural Marylanders are dually eligible for Medicare and Medicaid coverage. Rural health outcomes lag behind the rest of the State, with lower life expectancy, limited access to health care, and higher rates of conditions like obesity, diabetes, heart disease, and behavioral health issues. Maryland has well-documented rural provider shortages with fewer primary care, specialty, and oral and behavioral health providers. Lack of health care access can lead to delayed diagnosis, advanced disease at presentation, and higher burdens of chronic conditions and mortality.

The Maryland RHTP Plan advances the State’s rural health goals under three Pillars: Pillar One:

Transforming the Rural Health Workforce; Pillar Two: Promoting Sustainable Access and Innovative Care; and Pillar Three: Empowering Rural Marylanders to Eat for Health. Each pillar includes Transformation Fund opportunities which are competitive grant awards to the most promising projects from a pool of applicants. This RFA solicits proposals for the following three Pillar Two Transformation Funds:

● Sustainable Access Through Service Expansion and HIT Advances;

● Behavioral Health Service Expansion; and

● Innovative Care.

CMS and the State intend for RHTP-funded projects to transformationally improve the health of rural Marylanders through large, system-level, sustained change across multiple domains and metrics. The CMS Notice of Funding Opportunity (NOFO) CMS-RHT-26-001 provides the following example initiatives that Applicants may reference for additional context:

● Population health infrastructure initiative (CMS-RHT-26-001 pages 98-100);

● Rural health network initiative (CMS-RHT-26-001 pages 101-104);

● Rural health regional excellence initiative (CMS-RHT-26-001 pages 104-106);

● Value-based care initiative (CMS-RHT-26-001 pages 110-111); and

● Remote care services initiative (CMS-RHT-26-001 pages 111-113).

The State includes these references to the CMS NOFO initiatives as examples of ways that rural providers and other organizations can collaborate and innovate. The State does not require Applicants to model their projects after the CMS NOFO example initiatives.

https://health.maryland.gov/pophealth/Documents/Rural%20Health/RHTP/MD-RHTP-Plan-CMS-Approved-12-29-2025.pdf https://health.maryland.gov/pophealth/Documents/Rural%20Health/RHTP/MD-RHTP-Plan-CMS-Approved-12-29-2025.pdf https://apply07.grants.gov/apply/opportunities/instructions/PKG00291485-instructions.pdf

3.2 Scope of Work

3.2.1 Abstract

Provide a brief (3 page maximum) summary of the proposed project that addresses the following:

● Geographic area(s) to be served;

● Region-specific challenges and needs;

● Types of services to be provided;

● Target population(s); and

● Existence of similar initiatives in the same geography.

3.2.2 Rural Focus

An Applicant’s project must serve a rural community, as defined in Maryland law. RHTP funds must solely serve and/or support Marylanders in one or more of Maryland’s rural counties. Describe the rural communities that will be served by the project.

Maryland law and Maryland’s RHTP Plan define rural Maryland to include the following counties in their entirety: Allegany, Calvert, Caroline, Carroll, Cecil, Charles, Dorchester, Frederick, Garrett, Harford, Kent, Queen Anne’s, Somerset, St. Mary’s, Talbot, Washington, Wicomico, and Worcester.

3.2.3 Problem Statement

Clearly and concisely describe the specific issue or need that your project is designed to address. Establish the why for the entire project. Describe the need for the project in the proposed geographic area(s) using the best available, timely data. Cite sources demonstrating the need and prioritization by the community.

The problem statement should be clear, evidence-based, and aligned with the goals of this solicitation.

3.2.4 Project Goals and Intended Health Outcomes

Clearly state the project goals as the broad, high-level, desired end results of the project. Describe how the project goals align with RHTP goals. Indicate your selected intended health outcomes measures.

The State intends for RHTP to demonstrably improve health outcomes for rural Marylanders. Applicants must identify intended health outcomes measures that will result from the project plan over time. The State recognizes that achieving improvements in health outcomes will likely take longer than one budget period. Applicants must identify intended health outcomes measures that they can efficiently report and that MDH can efficiently verify for monitoring purposes within this award period.

Applicants are encouraged to align their intended health outcomes measures with the strategic goals and priority measures established by key Maryland health initiatives and programs. Maryland sets rural health priorities in its Rural Health Strategic Plan and identifies a number of statewide outcomes goals through its:

● State Health Improvement Plan

● AHEAD Model Population Health Accountability Plan

● Behavioral Health Administration Strategic Plan

● Moore-Miller Administration State Plan (Priority 8) https://health.maryland.gov/pophealth/Documents/Rural%20Health/RHTP/MD-RHTP-Plan-CMS-Approved-12-29-2025.pdf https://health.maryland.gov/pophealth/Pages/Maryland-Rural-Health-Stretegic-Plan,-2025-2030.aspx https://health.maryland.gov/pha/Documents/PHAB%20documents/2026%20State%20Health%20Improvement%20Plan%20Update_3.2026.pdf https://health.maryland.gov/AHEAD/Pages/AHEADPopHealth.aspx https://health.maryland.gov/bha/Documents/BHA%20Strategic%20State%20Plan%20FY25-27.pdf https://governor.maryland.gov/priorities/Documents/2024%20State%20Plan.pdf

Many of the State’s priority outcomes are reported through:

● CRISP Public Health Dashboard,

● MDH Interactive Dashboard.

Applicants should consult Maryland’s existing plans to inform their selection of appropriate, established, and current metrics for their projects.

Applicants may propose alternative intended health outcomes measures. If Applicants’ proposed measures are not included in Maryland’s existing plans and priorities, they must explain their rationale for the alternative measures and how the Applicant and MDH will track progress towards meeting the goal of improved health outcomes for rural Marylanders.

3.2.5 Logic Model

Applicants must attach a logic model that describes the evidence, community input, logic, and/or theory behind the designed program/project. Refer to the Centers for Disease Control and Prevention’s resource on Developing a Logic Model.

3.2.6 Applicant Details

Applicants shall indicate if they are applying as a Transformation Collaborative or a Sole Organization, including details that demonstrate that the Applicant meets the requirements by applicant type as described in Section 2.2.3.

The State will give preference to Applicants that are Transformation Collaboratives. The State seeks to foster partnerships of organizations working together to implement strategic, cohesive projects with multiple elements that interact with and reinforce one another.

A. Transformation Collaborative: Transformation Collaborative Applicants should include the following information in their proposal:

1. Key Partners: Describe the partners involved in the Collaborative:

a. Provide a brief organizational overview of each partner, including their mission, history, physical location(s) relevant to the project, and jurisdiction(s) and demographics served.

b. Identify the Primary Applicant.

c. Provide a brief overview of how the Collaborative will work together to implement the proposed project.

2. Governance Structure: Describe the decision-making process and structure of the

Collaborative, including fiscal decision-making, oversight, and management of funding.

Demonstrate how the Collaborative functions in a unified manner. Discuss whether the partnership is existing or a newly proposed partnership. Identify existing and proposed formal agreements.

B. Sole Organization: Sole Organization Applicants should include the following information in their proposal.

1. Overview: Brief organizational overview, including the Applicant’s mission, history, physical location(s) relevant to the project, and jurisdiction(s) and demographics served.

https://www.crisphealth.org/reports/public-health-dashboard/ https://health.maryland.gov/dataoffice/Pages/mdh-dashboards.aspx https://www.cdc.gov/tb-programs/php/evaluation/logic-model.html?CDC_AAref_Val=https://www.cdc.gov/tb/programs/evaluation/Logic_Model.html

3.2.7 Scope of Work by Focus Area

Projects shall implement activities to improve health outcomes for rural Marylanders. An Applicant’s project must demonstrate alignment with an allowable scope of work. Applicants should propose use of funds that strengthen care coordination, improve care management for chronic conditions, expand access to care, enhance accountability for total cost of care, and/or accelerate the transition to sustainable, value-based payment in rural communities.

The Applicant should indicate their chosen focus area, detail their scope of work, and demonstrate how the proposed project is aligned with the chosen focus area. Complete Attachment B: Focus Area Checklist to identify your focus area.

Section 3.2.7.1 shows examples of potential activities within each Transformation Fund focus area.

Section 3.2.7.1 is not an exhaustive list of activities but is meant to illustrate the types of activities allowable within Focus Areas. Both Transformation Collaborative Applicants and Sole Organization Applicants can apply for support of a project specific to one Focus Area. Both Transformation Collaborative Applicants and Sole Organization Applicants can apply for support of an integrated project that incorporates multiple Focus Areas.

Section 3.2.7.1: Potential Activities by Focus Areas

Focus Area Example Activities

Combination of Transformation Funds

Integrated projects combining multiple Transformation Funds and Focus Areas

● Integrate behavioral health and primary care: For example, developing and implementing unified care delivery models such as the Collaborative Care Model or Healthy Steps.

● Create new clinically integrated networks: For example, designing, implementing, and managing networks, consortiums, or collaborative provider agreements.

● Other allowable activities to achieve RFA goals.

Sustainable Access Transformation Fund

Service expansions for appropriate care delivery

● Expand or enhance health care for prevention, diagnosis, and treatment, including for primary, specialty, and/or oral health care.

● Establish and operate new care access points, with new physical, mobile, and/or virtual care access points.

● Enhance service delivery models: For example, with integration of faith- or community-based partnerships, lay-staffing models, community health workers, or other locally relevant models.

● Implement care team models to improve clinical and non-clinical factors driving effective chronic disease management.

● Other allowable activities to achieve RFA goals.

HIT Advances ● Conduct digital and technological needs assessments for clinical environments, to evaluate for example remote patient monitoring opportunities, connectivity barriers, and/or digital literacy of targeted patient population(s).

● Implement solutions to address the gaps identified by digital and technological needs assessments.

● Implement tech-enabled solutions to improve chronic disease management.

● Expand technology-enabled chronic disease management and/or integration of technology into clinical workflows, for example incorporating triage, management, and follow-up based on remote patient monitoring.

● Other allowable activities to achieve RFA goals.

Behavioral Health Service Expansion Transformation Fund

Behavioral Health

● Promote primary behavioral health by designing, implementing, and managing behavioral health prevention and wellness promotion programs.

● Strengthen secondary prevention with start up costs for providers to expand access to behavioral health-focused community-based medications for opioid use disorder (MOUD).

● Expand access to buprenorphine and provision of medicines for the treatment of opioid use disorder.

● Expand early intervention services for youth with high-acuity behavioral health needs such as respite services, family peer support and expansion of evidence-based models such as Family Centered Therapy and Intensive In-Home Child and Adolescent Psychiatric Services.

● Expand provider capacity to deliver early intervention for youth with high-acuity behavioral health needs and their families, including training and technical assistance in: respite services; family peer support; young adult certified peer recovery; and evidence-based models for intensive in-home services such as Family Centered Therapy, Intensive In-Home Child and Adolescent Psychiatric Services.

● Expand urgent and acute behavioral health care, including mobile response and stabilization services for youth and families.

● Strengthen treatment and recovery, including building capacity of and expanding intensive case management programs for older adults and deaf and hard of hearing individuals with substance use disorders; building capacity and expanding access to MOUD treatment that is non-reimbursable by Medicaid.

● Implement technology enabled solutions to improve behavioral health treatment and recovery.

● Other allowable activities to achieve RFA goals.

Innovative Care Transformation Fund

Innovative Care ● Scale existing value-based care models, including managing billing and quality reporting required for value-based care models and implementing population health strategies.

● Pilot new innovative health care payment models, including designing, implementing, and managing these models within the health care setting and partnering with community organizations as appropriate.

● Other allowable activities to achieve RFA goals.

As described in Section 1.1.2, while there is no guarantee of future federal RHTP funding, the State anticipates funding for RHTP Budget Periods 2 through 5. Thus the State encourages Applicants to develop their Budget Period 1 proposals as the first step in a multi-year initiative. Projects should reflect the broad scale and reach necessary to achieve transformation goals. Applicants should include progression and sustainability plans for initiatives and outcomes in Budget Periods 2 through 5 as appropriate to proposed activities. Alternatively, an Applicant may propose an initiative confined to Budget Period 1 alone if the proposal can reasonably achieve transformational goals within a single year.

3.2.8 Capacity and Expertise by Focus Area

To be considered for RHTP funding under a given Focus Area, Applicants must demonstrate the following required operational capacity and organizational expertise for the given focus area as follows:

a. Service Expansion: Must have demonstrated experience delivering services to meet the needs of rural Marylanders; capability to deploy services directly into community settings; or a proven track record of collaboration to positively impact health outcomes.

b. HIT Advances: Must have expertise and demonstrated experience implementing health care technology products. Must demonstrate capability to integrate with

CRISP.

c. Behavioral Health: Must have two years minimum experience in behavioral health service delivery in Maryland and must be a Maryland Medicaid enrolled provider.

d. Innovation: Must have demonstrated experience managing billing operations and quality reporting requirements associated with value-based care models, along with the capability to design, implement, and oversee population health strategies. Experience may also include leading the development and execution of innovative care delivery models in health care or community-based settings.

The Applicant should indicate their capacity and ability to implement the proposed project, as described below.

A. Transformation Collaboratives: Transformation Collaborative Applicants should include the following information in their proposal:

1. Organizational Expertise: Demonstrate that the Collaborative collectively has the capacity, experience, and expertise to implement the project. Demonstrate that requirements in Section 3.2.8 Capacity and Expertise by Focus Area are met.

2. Staffing: Proposals shall provide a Staffing Plan and describe existing and planned resources to secure qualified staffing within 60 days of the start of the award. Proposals shall outline names, titles, and brief biographical sketches of current and proposed key personnel and their role in the project. Demonstrate that requirements in Section 3.2.8 Capacity and Expertise by Focus Area are met.

B. Sole Organization: Sole Organization Applicants should include the following information in their proposal.

1. Organizational Expertise: Demonstrate that the organization has the capacity and expertise to implement the project and that requirements in Section 3.2.8 Capacity and Expertise by Focus Area are met.

2. Staffing: Proposals shall provide a Staffing Plan and describe existing and planned resources to secure qualified staffing within 60 days of the start of the award. The grantee may subcontract as necessary and should detail planned subcontracts. Proposals shall outline names, titles, and brief biographical sketches of current and proposed key personnel and their role in the project.

Demonstrate that requirements in Section 3.2.8 Capacity and Expertise by Focus Area are met.

3.2.9 Project Plan: Narrative and Summary Chart

The Project Plan should be transformational in terms of one or more of the following parameters:

● Magnitude of potential improvement in intended outcomes

● Scope of service delivery across the continuum of care

● Size of the rural population served

● Systemic change in how care is coordinated or delivered

● Shift from a reactive to preventative infrastructure

In a narrative format, describe the Project Plan, the operational strategy and framework for implementing the project, including:

A. Objectives: Describe the results the project will accomplish. Project objectives must be SMART (Specific, Measurable, Achievable, Relevant, Time-bound).

B. Activities: Describe the actions and tasks that will be carried out to implement the project and achieve project objectives. Describe any evidence-based practices.

C. Setting: Describe the locations or environments where the activities will take place.

D. Implementers: Describe the entities responsible for operationalizing the project plan, including the organization, project team staff, and any partner organizations or subcontractors.

E. Process Measures and Milestones for each objective. Activities must generate measurable outcomes for each objective. If feasible, include intended health outcomes measures in addition to process measures.

F. Timeframes: Provide estimated timeframes by month and year (e.g., October 2026 or January 2027) for conducting activities and achieving process measures and milestones.

G. Alignment: Describe how the project plan is consistent with the scope of work described in Section 3.2.7 Scope of Work by Focus Area.

In an attached chart, summarize the Project Plan objectives, activities, process measures and milestones, timeframes, and responsible person(s) or position(s). Follow the Attachment I Project Plan Chart Template. Attachment J provides Sample Project Plan Charts.

3.2.10 Sustainability and Scalability Plan

Describe how the project will contribute to long-term improvements in health outcomes after the end of the funding period. Outline a mechanism for ongoing funding or a plan to engage in discussions for future funding. Identify at least one Budget Period 1 sustainability milestone that will lead to future sustainability. The plan should establish a feasible financial and operational path to ensure program sustainability beyond the funding period and demonstrate the ability of the proposed project’s framework, workflows, operations, and/or infrastructure to be expanded.

3.2.11 Barriers and Mitigation Strategies

The Applicant should demonstrate readiness to implement the Project Plan (Section 3.2.9). Describe anticipated internal and/or external barriers to project success and potential feasible solutions to address them. Address how project timelines will be met.

3.2.12 Collaboration and Coordination

3.2.12.1 Projects must demonstrate clear plans for coordination and collaboration with partners in the rural geography.

A. Community and Stakeholder Involvement: Proposals must describe mechanisms and activities for meaningfully engaging community members and key stakeholders in the project. The State will give preference to projects that ensure rural residents have formal input into program design and resource allocation.

B. Care Partners: Where applicable, proposals shall describe mechanisms and activities to meaningfully engage care partners and/or health care providers (e.g. community-based clinicians, post-acute care providers, etc.) to ensure a full continuum of care.

3.2.12.2 The State will leverage RHTP funding through this RFA to support large scale transformation initiatives. Coordination across RHTP initiatives and other State efforts is essential to achieve this objective. An Applicant shall provide assurance that the project does not duplicate other programs and funding streams in the same geographic area. The State reserves the right to communicate with other State entities that the Applicant identifies in Attachment E Funding Assessment in the interest of promoting efficient use of public funds and avoiding spending duplication. The Applicant must demonstrate a willingness to collaborate with MDH and other RHTP-funded and State-funded projects to align goals and maximize project efficiency and effectiveness.

3.2.12.3 One of the overall State RHTP performance metrics is generating new connectivity points to the

Health Information Exchange (HIE) to benefit rural Marylanders. HIPAA covered entities receiving RHTP funds must complete basic on-boarding requirements with the Statewide HIE, Chesapeake Regional Information Systems for our Patients (CRISP), by March 30, 2027. Basic On-Boarding Requirements for Connectivity are defined as:

A. Provider has fully executed a Participation Agreement, Notice of Privacy Practices , and Substance Abuse Attestation with CRISP.

B. Provider has fully executed a laboratory data release form, or other laboratory feed agreement.

C. Provider has completed CRISP HIE Administrator and provider training.

D. Provider submits a new patient panel every 90 days, or sooner.

Separate RHTP funding will be made available through an RHTP-supported CRISP Rural Provider Connectivity and HIT Optimization Program to facilitate data sharing and data quality improvements.

3.2.13 CMS Requirements

This solicitation is federally funded. The Applicant must comply with federal terms and conditions for the RHTP award. Terms and conditions stated in the CMS Notice of Award #RHTCMS332066-01-00, CMS Notice of Award #RHTCMS332066-01-02, NOFO CMS-RHT-26-001, CMS Rural Health https://www.crisphealth.org/onboarding/#account-set-up

Transformation - Frequently Asked Questions apply. Continued funding from CMS is conditional on the availability of appropriated funds, satisfactory performance, reporting, and compliance.

The Applicant must acknowledge acceptance of these terms and conditions.

Key terms and conditions include but are not limited to the following:

● Applicants must use funding for authorized purposes for the RHTP referenced in the NoA and described in the NOFO and outlined in Maryland’s approved application to positively affect rural areas and rural residents.

● Applicants must comply with Federal statutes and regulations.

● 2 CFR 200.331, subrecipient and contractor determinations, and 2 CFR 200.332, requirements for pass-through entities, are incorporated by reference.

● CMS Standard Grant and Cooperative Agreement Terms and Conditions are applicable to RHTP.

In summary, this includes the following:

○ Compliance with all federal laws as amended and their requirements;

○ Antidiscrimination laws;

○ Title VI of the Civil Rights Act of 1964;

○ Section 504 of the Rehabilitation Act of 1973;

○ Title IX of the Education Amendments of 1972;

○ Age Discrimination Act of 1975;

○ Section 1557 of the Patient Protection and Affordable Care Act; and

○ As applicable, Title IX of the Education Amendments of 1972, as amended, 20 U.S.C. §§

1681 et seq., including the requirements set forth in Presidential Executive Order 14168 titled Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government, and Title VI of the Civil Rights Act of 1964, 42 U.S.C.;

○ Administrative requirements, cost principles, and audit requirements that govern Federal monies associated with this NoA, as applicable, in the Uniform Guidance – 2 CFR 200 and 2 CFR 300.

○ Privacy and Security of Health Information. Subrecipients shall put all appropriate regulatory, administrative, technical, and physical safeguards in place before applicable program activities begin to protect the privacy and security of individually identifiable health information.

○ Mandate that all Federal contractors, subcontractors, recipients, subrecipients, or personal services contractors, must inform their employees in writing of the rights and remedies provided under this section, in the predominant native language of the workforce.

○ Prompt disclosure, in a timely manner, in writing to the prime recipient (pass through entity) and the HHS OIG, all information related to violations of federal criminal law involving fraud, bribery, or gratuity violations potentially affecting the federal award.

Limitations on use of funds including the following:

● Administrative costs, including indirect and direct costs, are capped at 10% per budget period.

● Any program income (money earned from award-supported activities) must be used for the purposes and under the conditions of the award.

● Minor renovations or alterations are allowable only with CMS prior approval to ensure long-term overhead and upkeep costs are commensurate with patient volume, subject to restrictions in the funding policies and limitations section of the NOFO. Funding used for minor renovation or alterations cannot exceed 20% of the total funding awarded to MDH in each budget period.

● Workforce activities must require a commitment for recipients of RHTP financial incentives to serve rural communities for a minimum of five years. Under the uses of funds described in statute, there is a minimum five-year commitment for clinical workforce talent to serve rural communities who benefit from recruiting and retention initiatives funded by RHTP. Relevant workforce initiatives need guardrails to meet this statutory requirement. See NOFO for further specifics on allowable expenses and funding guidelines.

● Direct health care services are allowable if justified why they are not already reimbursable, how the payment will fill a gap in care coverage (such as uncompensated care or services not covered by insurance), and/or how they transform the current care delivery model. CMS will have final approval of whether proposed services are allowable.

● Funding used for provider payments, defined in the NOFO as providing payments to health care providers for the provision of health care items or services, cannot exceed 15% of the total funding awarded to MDH in a given budget period.

● No more than 5% of total funding awarded to MDH in a given budget period can support funding the replacement of an Electronic Medical Record (EMR) system if a previous HITECH certified EMR system is already in place as of September 1, 2025.

● Funding towards initiatives similar to the “Rural Tech Catalyst Fund Initiative,” as described in the NOFO Appendix (pages 115-118), cannot exceed the lesser of (1) 10% of total funding awarded to the Recipient in a given budget period or (2) $20M of total funding awarded to MDH in a given budget period.

● SSA 2105(c), paragraphs (1), (7), and (9) apply as funding limitations. These limitations are related to general limitations, limitations on payment for abortions, and citizenship documentation requirements for payments made with respect to an individual.

● Salary Limitations: None of the funds appropriated in this title shall be used to pay the salary of an individual, through a grant or other extramural mechanism, at a rate in excess of Executive Level II. The Executive Level II rate changes each year, refer to the most recent information posted on the Office of Personnel Management website. The January 2026 salary cap is here.

● Subrecipients must comply with the cost principles set forth in HHS regulations at 2 CFR 200, Subpart E. Subrecipients must also use these principles as a guide in pricing fixed-price contracts and subcontracts when costs are used in determining the appropriate price. Hospitals must follow Appendix IX to 2 CFR 300. Principles for Determining Costs Applicable to Research and Development Under Grants and Contracts with Hospitals.

● For-profit recipients are subject to 48 CFR subpart 31.22 For more detailed information on applicability and exemptions, refer to 2 CFR 200.401.

Unallowable costs include the following:

● Pre-award costs.

● Goods or services not allocable to the approved project. Using funds in a manner inconsistent with activities described in the approved application, on activities explicitly limited or prohibited in the Terms and Conditions, and/or on activities not approved by CMS is a violation of the agreement.

● Meeting matching requirements for any other federal funds or local entities.

● An expenditure that is attributable to an intergovernmental transfer, certified public expenditure, or any…