Response to Offeror Questions document 2.docx

Department Of Health, Office Of Health IT

RFA No. 26-09RHT-020 State of South Dakota 600 East Capitol Ave Pierre, SD 57501 605-773-4476

Updated 6/18/26

Subject: Questions and Answers for RFA No. 26-09RHT-020

In accordance with the Request for Applications (RFA), the following are answers to questions which were received during the Technical Assistance call on 05/14/26. These questions are for informational purposes only; they do not alter the requirements specified within the RFA. Any changes to the RFA will be accomplished by the Office of Procurement Management through the use of an addendum.

1. Question: Is there a maximum amount we can request?

Answer: No, however, you should only request funding for projects that you will be able to complete within the grant period.

2. Question: Is there a possibility of partial funding for a grant?

Answer: Yes.

3. Question: Does Tier F allow funding for professional certifications?

Answer: You may include these requests in your application, and they will be evaluated along with your entire proposal for eligibility.

4. Question: With Tier G, you indicated this is a 5-year renewable contract. Does that allow for yearly application for funding or is all funding awarded once for the 5-year project?

Answer: These will be a 1-year contract that may be renewed for 4 additional one-year terms. Continuation of these projects is based on receipt of future funding and on meeting performance measures and benchmarks that are submitted with your application.

5. Question: Does Tier G have the same 10% personnel gap as the other tiers?

Answer: No.

6. Question: Will the state consider funding for staff positions as part of the regional innovation center applications?

Answer: Yes.

7. Question: Will grant awards be subject to single audit?

Answer: Per Federal Regulation 2 CFR part 200, Subpart F, an entity that expends $1,000,000 or more during that entity’s fiscal year in federal awards must have a single audit or program-specific audit conducted for that year. The entity must include expenditures of awards received directly from the federal government and expenditures of subrecipient awards received from a pass-through agency when calculating total expenditures of federal awards. Section A.7. of the state subrecipient agreement has requirements for subrecipients engaging in a single or program specific audit.

8. Question: If an organization doesn’t submit an application for Year 1 grant, will there still be opportunity to apply for Year 2 and subsequent years?

Answer: Yes.

9. Question: Will this program help pay for new ambulances, ambulance equipment or EMT training?

Answer: Under the Rural Health Transformation Emergency Medical Services initiative there will be two forthcoming RFPs, and eligible or ineligible projects will be detailed.

10. Question: Are community support provider agencies eligible for funding?

Answer: Yes.

QUESTIONS AND ANSWERS FROM 06/11/2026 Technical Assistance Call

11. Can assisted living and long-term care facilities facilities transitioning from a non-certified EHR environment to a certified EHR be eligible to apply?

Answer: Yes, This would be a replacement of a non-certified EHR. Apply for this project in Tier C.

12. Can a healthcare facility apply for one-time EMR enhancements, along with three years of related support. What costs can be included in the broader category of maintenance and support, and is this eligible for funding?

Answer: EHR Maintenance and Support MAY include for example:

· Technical upkeep of the system (i.e. bug fixes, patches, updates)

· Technical and Help Desk Support

· Database Maintenance and Infrastructure (i.e. data backup, server maintenance)

· Training resources and knowledge bases (i.e. release notes, training material) Refer to the Instructions within the budget template: “7. Only one year of maintenance and support for EHR tiers is allowed in this budget period. Years 2 and 3 of EHR maintenance can be submitted in 2027 and 2028.”

Maintenance and Support for EHR enhancements are only eligible for the cost increase attributable to the enhancement. (i.e. if current annual maintenance and support is $10,000 and the enhancement increases that cost by $200 you may apply for $200).

13. Are EHR maintenance, hosting, support, upgrades, licensing, and service contracts eligible costs? If so, may these costs be included under Tier D?

Answer: Applications for EHR related projects must adhere to the Maintenance and Support description listed within the tier you are requesting funds (Tier A, B, or C)

14. Are enhanced EHR capabilities, such as ambient listening with EMR integration, blood bank capabilities, or other add-ons, eligible if they improve rural access, care coordination, interoperability, or patient safety?

Answer: Place these components within your application and they will be considered for funding.

15. Can operational equipment-to-EHR integration costs be classified as an EHR enhancement under Tier B, equipment infrastructure under Tier D, or either category depending on the type of cost? For example, how would a facility categorize the purchase of point-of-care ventilators, infusion pumps, or vital sign monitors to enable the new EHR to receive readings, trigger alerts, and pull documentation?

Answer: These costs should be placed in Tier D.

16. Are health plan integration features eligible for funding?

Answer: Submit an application for consideration.

17. Can healthcare entities apply for funding as a hub in Tier G and then contract with independent sites to provide services?

Answer: Funding applications must be submitted by the individual organization seeking to address their specific challenges. Organizations may partner with a healthcare entity that provides services; however, the organization seeking to partner must be the applicant and recipient of the funding.

18. How should the project start date be defined, and how should already-incurred costs be documented for EMR transition activities that began before the application release?

Answer: Costs incurred on or after 2/20/2026 may be eligible. Document the receipts; they will be required for reimbursement.

Please note: RHT federal funds cannot supplant any other federal funds paying for the same project.

19. Are mobile diagnostic units eligible for funding?

Answer: Yes, this type of equipment may be eligible. RHTP funds can be used for equipping vehicles with diagnostic tools, such as mammography, ultrasound equipment, and telerobotic endpoints. While you can outfit a mobile unit, you generally cannot use RHTP funds to construct, expand, or significantly retrofit permanent brick-and-mortar buildings.

20. If a project takes more than one year to fund, how should that be framed in the project budget?

Answer: When applying for funding through this year’s (Year 1) grant, upload documentation from the vendor specifying the amount due before July 31, 2027, whether as a down payment or installment payments for consideration. Any remaining balance may be included in the Year 2 application. However, please note that Year 2 funding has not yet been approved or authorized and is therefore subject to risk.

21. Our facility is not confident that we can complete our project by July 2027. If we are not ready to apply, can we apply in the next round?

Answer: Yes. The first grant period is 2/20/2026 - 7/31/2027. If CMS approves the second year (of five) of funding, we will release the next RFP ~January 2027. This funding will be available (2027 ~ July 2028).

22. What file types will the online application accept?

Answer:

Letter of Commitment described in Section V. 5. of the Grant Guidance (PDF, DOC) Copy of your current W9 (PDF) IRS Determination (PDF) Project Narrative (PDF, DOC) Budget (XLS) Invoice/Quote (PDF, DOC, XLS, ODT, ODS) Any Additional Attachments (PDF, DOC, XLS, ODT, ODS)

23. We are seeking clarification on how EHR certification status is determined for purposes of the "Replacement of Non-Certified EHR Technology" category. The ONC Certified Health IT Product List includes broad categories of certified EHRs but does not distinguish between individual software versions, some of which were not certified as of 9/1/2025. We would appreciate clarification as to whether eligibility is based on the certification status of the specific version of an EHR in use on the eligibility date or the certification status of the broader EHR product family.

Answer: CMS has clarified eligibility would be based on the certification status of the specific version of EHR in use on 09/01/2025.

24. The RFP mentions that EHR enhancements, like implementing new modules to existing Certified EHR Technology as of 9/1/25, may be applied for. Can we add items to the budget that were purchased after 2/20/26?

Answer: Yes, submit these items with your application for consideration.

25. Please share some examples of diagnostic equipment that would be eligible under D?

Answer: Submit your needed diagnostic equipment with your application for consideration.

26. Does every budget item on our request need a corresponding quote? We've requested quotes from vendors for what we are hoping to apply for but are not sure if we will have all of them back by the deadline. Should we hold off on applying for those items until next year or submit a conservative estimate?

Answer: Submit your application. If awarded, submit the receipts with your invoices.

27. For a facility that purchased a new EMR system prior to September 2025 but is just now beginning implementation- would costs associated with that transition, including implementation fees and additional modules, be eligible? And would that scenario be classified as an EMR replacement or an upgrade to an existing system? If this is classified as a replacement, is there a cap on eligible expenses?

Answer:

a) If the EHR you were using on 09/01/25 was on the list of certified EHRs and you are replacing it with a new certified EHR that would be considered Tier C “replacement of a certified EHR” and therefore is subject to the cap placed by CMS.

b) If the EHR you were using on 09/01/25 was not on the certified EHR list and you are replacing it with a new certified EHR it would be considered Tier C “replacement of a non-certified EHR” and is not subject to the cap placed by CMS.

28. You have mentioned that the end date for year 1 is 07/31/2027, but the RFA says that the end date is 09/30/2027. Which is correct?

Answer: Grant award spending needs to be completed on 7/31/2027. The grantee will then submit the final invoice and project report. After those are submitted, the RHT team will use the final 8 weeks of Grant Period 1 to close out the project and draft the final report.

29. If our EHR is being shut down and we are needing to migrate to another EHR, would that be considered a Tier C replacement? If the EHR we're looking at migrating to isn't certified CHPL by June 30th, is that disqualifying?

Answer:

a) If the EHR you were using on 09/01/25 was on the list of certified EHRs and you are replacing it with a new certified EHR that would be considered Tier C “replacement of a certified EHR” and therefore is subject to the cap placed by CMS.

b) If the EHR you were using on 09/01/25 was not on the certified EHR list and you are replacing it with a new certified EHR it would be considered Tier C “replacement of a non-certified EHR” and is not subject to the cap placed by CMS.

c) Please provide a statement from the EHR vendor that clearly shows the date they expect the EHR to be listed on the CHPL for us to consider along with your application (they must be listed on the CHPL by 09/15/26 to qualify for application in Grant Year 1).

30. If an EHR is not listed on the CHPL list, but is expected to be certified by the time of application, can we go forward with the application?

Answer: Please provide a statement from the EHR vendor that clearly shows the date they expect the EHR to be listed on the CHPL for us to consider along with your application (they must be listed on the CHPL by 09/15/26 to qualify for application in Grant Year 1).

31. In the budget template in the consultation section - if you have already identified a consultant - do you list "selected" in the method of selection column? And list the details in the notes section?

Answer: Options may include “sole source” or “request for proposals.”

32. Can we apply for different projects in each tier and submit as part of a single application?

Answer: Yes, explain this in your project narrative.

33. For Tiers A–F, does the 10% personnel cap apply only to the applicant's own employees, or also to contracted technical consultants? I.e., are outside consultants counted as 'personnel' or as contractual costs?

Answer: The 10% personnel cap only applies to the organization’s employees.