Response to Offeror Questions document.pdf

RFP 26-09RHT-001 Questions and Responses Page 1 of 6

STATE OF SOUTH DAKOTA

RURAL HEALTH TRANSFORMATION

DEPARTMENT OF HEALTH

600 EAST CAPITOL AVE

PIERRE, SD 57501

Rural Strong Grants: Strengthening Access to Care in Rural Communities A Rural Health Transformation Grant Opportunity

Questions and Responses

PROPOSALS ARE DUE NO LATER THAN MAY 22, 2026 BY 5:00 PM CDT

RFP #26-09RHT-001 BUYER: Department of Social Services POC: Kirsten Blachford Kirsten.Blachford@state.sd.us

The Quick Answers portion of the RFP addressed funds being used for equipment related to care of patients in the radiology, laboratory, and other medical departments. Is this only for purchases in the time span of the grant funds, or could we apply this to equipment we simply couldn't wait to purchase based on outdated equipment in the facility and improvement of care to our patients? I believe the equipment was paid for in 2026.

Will the beginning of grant period be retro to January 1, 2026, or be when the grant is awarded?

Grant funding is limited to expenses incurred after the applicant has been awarded.

We also have a software update for radiology equipment. As you know, those upgrades are spendy.

Would that be something we could apply for using these funds?

Eligible applicants are encouraged to submit a proposal that they believe meets one of the allowable uses of funds. Allowable uses of funds are outlined in Section 1.1 and include: operational and strategic planning, strategic partnerships, service line expansion, regional resources/hub and spoke models, and care coordination readiness for value-based care. Applicants may identify multiple allowable uses of funds. As this is a competitive grant opportunity, applicants should provide a proposal that includes all the required elements and demonstrates how the proposal strengths rural healthcare in South Dakota.

If we have several pieces of equipment throughout the hospital that are due to be replaced or purchased for the improvement of care to our patients, could those all be on one proposal?

Yes, a proposal can be broader than a single type of equipment or service line.

We have a community owned pharmacy as well that I do accounting work for. Would that business be able to apply for these funds? If so, in what manner can we apply?

I have a question if the grant is available for pharmacies?

Whether a technology-enabled pharmaceutical manufacturing platform like ODP (On Demand Pharmaceuticals) would be considered an eligible subrecipient, or whether participation would need to occur through a hospital, health system, or other qualified entity. If participation via partnership (e.g., with rural hospitals, maternal health hubs, or EMS/clinical networks) would be appropriate under this RFP structure.

Pharmacies are not an eligible applicant but could be a strategic partner of an applicant.

Are strategic partnerships limited to other healthcare facilities, or could it be with another business in the community? Example: partnering with the local gym.

RFP 26-09RHT-001 Questions and Responses Page 2 of 6

Strategic partnerships are generally referring to strategic partnerships with healthcare entities but could include other entities that advance the goals of the initiative. As this is a competitive grant opportunity, applicants should articulate how the proposal strengths rural healthcare in South Dakota.

I see the grant is investing in improvement to maternal care. Would this grant funding be available to allow a provider to become a certified perinatal mental health provider?

Whether improving access to essential sterile injectables (e.g., for maternal care, emergency stabilization, and rural care delivery) would be considered responsive to the program’s objectives.

I wanted to ask whether the grant allows funding to support education or training pathways for individuals pursuing certification as Behavior Analysts. Developing local professionals in this field is something we see as critical to addressing the long-term workforce shortage in rural areas.

Eligible applicants are encouraged to submit a proposal that they believe meet one of the allowable uses of funds. Allowable uses of funds are outlined in Section 1.1 and include: operational and strategic planning, strategic partnerships, service line expansion, regional resources/hub and spoke models, and care coordination readiness for value-based care. Applicants may identify multiple allowable uses of funds. As this is a competitive grant opportunity, applicants should provide a proposal that includes all the required elements and demonstrates how the proposal strengths rural healthcare in South Dakota.

Upon reviewing this RFP specifically referring to the Rural Strong Grants, I am unsure if our Skilled Nursing facilities we operate in South Dakota are eligible. Please let me know if Skilled Nursing facilities are eligible.

Reading over the information sent today regarding Rural Strong Grants, I see that long-term care providers are not listed in the types of entities that are eligible to apply for this funding. Hoping to confirm with you whether this is the case or whether an application from a long-term care provider would be considered.

Are rural SNFs eligible?

Skilled nursing facilities are not an eligible applicant, but could be a strategic partner of an applicant Any specific proposal requirements or evaluation criteria that would be particularly important for a solution like ours.

Applicants should review the grant opportunity for detailed requirements. Exhibit C and Exhibit D provide template guides for helping complete the application. Refer to Section 6.0 for more information about evaluation criteria. The greatest weight in the evaluation criteria is on the proposal’s transformative impact on rural residents and providers, and how the investment will be sustained in the future without increasing taxpayer costs.

I had a quick question on eligibility requirements for this opportunity. I don't see specific requirements listed. I wanted to know if out of state vendors are eligible?

Would the DOH be receptive to discussing a proposal in which one independent vendor serves as the lead applicant on behalf of a larger group of hospitals?

Will the state facilitate partnerships between vendors or external partners and potential applicants.

Can interested vendors request a meeting with the State to discuss their capabilities and how their solutions might support South Dakota’s goals for care coordination infrastructure and readiness for value-based care under the Rural Strong Grants RFP (26-09RHT-001)?

Can you elaborate on what you consider a vendor? Would our Medicaid aligned non-profit be eligible?

Please refer to section 1.1 of the grant for eligible providers. The State is not facilitating introductions, meetings, or other engagements between vendors and potential applicants for the Rural Strong Grants RFP (26-09RHT-001) at this time. Vendors are welcome to review the published RFP materials, but the State is not seeking additional vendor discussions outside the formal procurement processes.

RFP 26-09RHT-001 Questions and Responses Page 3 of 6

Is this limited to 1 application per EIN, or 1 per facility? Or, how do you want these applications submitted? We don’t want to submit multiple applications, if it’s only 1 per EIN.

Can an offeror propose multiple, unrelated ideas on the same application, or would they require separate submissions? For example, a service line expansion idea & an unrelated regional resources/hub and spoke model idea.

If we have several items/projects, would you prefer to use 1 proposal and separate the projects in the narratives and budget or would you prefer separate proposals around a common theme?

If one applicant is proposing multiple projects, should they submit those all in one application together, or should each project be submitted as a separate application?

Is an organization allowed to submit multiple proposals for different locations and/or programs?

It is at each applicant’s discretion whether they submit one or more applications. In the event a provider has multiple successful proposals, these proposals may be consolidated into a single contract with the provider. Proposal are intended to be provider-driven. Applicants should refer to the grant opportunity for guidance regarding allowable uses of funds and information to include in the application.

OBHG operates the OB Emergency Department for Monument Health Rapid City Hospital. This program serves the greater Rapid City area and provides care for anyone presenting regardless of ability to pay. We provide services Labor and Delivery and In House Hospitalist services to an underserved population. Currently, due to extremely high volume we are partnered with the hospital looking at expansion of the program and having to add an additional provider due to this increased demand. I’d like to receive additional details on the requirements of the Rural Health Transformation Project.

Additional details regarding South Dakota’s Rural Health Transformation project are available at https://doh.sd.gov/healthcare-professionals/rural-health/rural-health-transformation-project/. Specific funding opportunities are posted at https://postingboard.esmsolutions.com/3444a404-3818-494f-84c5- 2a850acd7779/events.

I was hoping to get a bit more clarification on whether infrastructure or facility expansion could be considered an eligible expense under the Rural Health Transformation Grant. Support in this area would greatly help us increase access to care for rural families who often have very limited options for autism services.

Please refer to Exhibit A regarding use of funds and limitations. There are federal restrictions regarding construction.

Medicaid Enrollment Timing: The RFP states that applicants must be enrolled with Medicaid. If a business entity has initiated the SD Medicaid provider enrollment process but has not yet received final enrollment approval by the proposal submission date, is the entity eligible to submit a proposal? Or must enrollment be fully complete prior to submission?

Only proposals from actively enrolled Medicaid providers defined as eligible in Section 1.1 will be considered.

Eligible Provider Type — Physician Group: The RFP lists "clinics enrolled as physician groups" among eligible providers. Would a physician-owned LLC organized to deliver specialty telehealth services (not operating a physical clinic location) qualify under this category, provided it is enrolled with Medicaid as a group practice?

Yes.

Hub-and-Spoke Telehealth Models: Under the "Regional Resources/Hub and Spoke Models" allowable use of funds, does the State envision this category as inclusive of telehealth-based hub-and-spoke models where the hub provides remote specialist consultation to rural spoke facilities? Or is it limited to models where the hub is a physical facility co-located with the spoke sites?

Funding will be considered for different models of hub-and-spoke sites (telehealth based, physically co-located, etc.)

RFP 26-09RHT-001 Questions and Responses Page 4 of 6

Technology Funding and Digital Health Modernization: The RFP notes that proposals should not be duplicative of the Digital Health Modernization and Technology Grant opportunity. If a proposal's primary purpose is to establish a clinical hub-and-spoke service model, but requires technology (e.g., a telehealth platform or AI-assisted diagnostic tool) as an enabling component of that model, should the technology costs be included in this proposal or directed to the Digital Health Modernization grant?

Proposals may include funding for technology. If the technology is integral to a Rural Strong Grants allowed use of funding, we would encourage the applicant to include the costs in the Rural Strong Grant proposal. At their discretion an applicant could also request funding from another Rural Health Transformation grant. In this instance, it is important to disclose this as required in section 5.2.

Clinician Salary and Non-Compete Confirmation: The RFP (Exhibit B, Q8) states that applicants must provide confirmation that clinicians funded by the grant are not subject to a non-compete agreement.

What format should this confirmation take — a signed attestation by the clinician, a letter from the employer, or another form?

Please provide a letter from the employer.

Budget Period Scope: Should proposals and budgets be structured to cover only Budget Period 1 (award through September 30, 2027), or should they outline the full multi-year scope across all five potential budget periods with a detailed budget for Budget Period 1?

Please refer to Section 3.8 and Exhibit D. Budgets should include total funds requested for all years of the proposal. Applicant’s budgets can vary across years according to project needs. Funds beyond Budget Period 1 are subject to renewal by CMS and the State.

Multiple Partner Sites: For a hub-and-spoke model proposal involving partnerships with multiple rural facilities, should each partner facility submit a separate proposal, or may a single applicant submit one proposal that names multiple partner facilities?

One proposal by the hub site that indicates multiple partnerships may be submitted.

Award Range: Is there a general expected range for individual award amounts, or guidance on what proportion of the $31.75 million Budget Period 1 pool a single proposal might reasonably request?

The state envisions supporting multiple proposals with anticipated award amounts in budget period 1 ranging from $200,000 to $3,000,000. However, the grant does not have a maximum award amount as this competitive opportunity seeks strong ideas. Transformative proposals requiring larger investment or involving multiple provider entities could exceed this range. Award amounts are anticipated to vary based on the number of proposals and quality of the ideas.

As stated in Section 3.8.2, to demonstrate a scalable option, applicants may provide one alternative budget/budget narrative to reflect a higher or lower level of funding than their main budget proposal at their discretion. If submitting an alternative budget, clearly label the budget as “Alternative Budget Proposal.” In addition, applicants may be asked to submit a revised budget during the evaluation or contracting phase.

The $500k [sic] - $3 million estimate you gave-- is that for year one funding or total funding for all 5 years?

The state envisions supporting multiple proposals with anticipated award amounts in budget period 1 ranging from $200,000 to $3,000,000.

Certification Requirements (Sections 1.6 to 1.9): We are writing to confirm the expected approach for certifications related to debarment and suspension, non-discrimination, prohibited entity status, and restrictions on the boycott of Israel. Could you please confirm whether these certifications are fully satisfied by submission of the signed RFP form, or if the State requires any additional forms or attestations as part of the proposal submission process?

No additional forms are required to be submitted related to these sections.

Secured File Transfer Protocol (SFTP) Submission (Section 1.5): As we prepare for proposal submission, could you please confirm whether the State has any preferred or recommended SFTP

RFP 26-09RHT-001 Questions and Responses Page 5 of 6 platforms, or are there any specific technical requirements or compatibility considerations we should be aware of to ensure successful upload of proposal materials to the SFTP folder once access is provided?

Is there a cost for the folder we are required to use? How is that set up? When I have tech issues with it, who is a good contact for that?

Can we request a folder anytime or just when we are ready to upload?

If submitting multiple proposals, do we need to request more than one SFTP folder, corresponding to the number of proposals?

There is no cost for the folder, folders can be requested anytime before the cut off date. Offerors should consult with their IT staff for technical considerations. If submitting multiple proposals a single SFTP folder can be used. Please clearly label the proposal to indicate they are separate and distinct.

For assistance related to the SFTP folder please contact Kirsten.Blachford@state.sd.us.

Is there alternative language for 1.14 and 2.12 which requires the Governing Law to be the State of South Dakota and venued in Circuit Court, Sixth Judicial Circuit, Hughes County, South Dakota? In Sisseton-Wahpeton Oyate Tribal Government, we are not allowed to agree to this language or sign the application.

The State has addressed this in other contracts for tribal partners. We encourage you to apply and if awarded would address this in the contracting process.

Do you know what additional approval would be required by CMS for purchase of vehicles to expand transportation services to medical appointments?

If a minor renovation is approved, what is the additional CMS approval process? Could you share basic next steps and timeframe?

CMS will complete a review of all contracts. It is anticipated that CMS sign off would occur through this process.

The Allowable Uses of Funds includes technical assistance for service line expansion. Can technical assistance include architectural planning and design for service line expansion?

It could be included if the assistance is necessary as part of implementing your transformative idea and the architectural planning changes described are within the scope of allowable use of funds. We would encourage you to review Exhibit A of the grant opportunity, which includes CMS guidance regarding construction and minor renovations or alterations to help you make a determination regarding whether your envisioned idea may be allowable by CMS.

Can you expand on what you consider a minor renovation or alteration? Is there a dollar amount we should be trying to stay under?

We would encourage you to review Exhibit A of the grant opportunity, which includes CMS guidance regarding construction and minor renovations or alterations. CMS has not provided further guidance regarding this. In the absence of additional CMS guidance, we recommend ensuring the proposal does not appear to be prohibited by the restriction on using funds for construction.

Can you please outline specifically what counties are excluded from this RFP?

There are no excluded counties, but preference will be given for projects that have the highest impact for rural counties.

The state’s application for RHTP funds to CMS referenced FORHP, HRSA and RUCA scores related to its definition of rural. Can you describe how rurality is being used to determine applicant eligibility or funding preference?

Funding is targeted at initiatives that strengthen rural providers, keep healthcare in local rural communities, and expands access to healthcare in rural communities. Providers located in urban areas may apply but must explain in the application how the proposal benefits rural South Dakotans. For

RFP 26-09RHT-001 Questions and Responses Page 6 of 6 purposes of this grant opportunity, preference is considered for impact to residents and providers located in counties considered fully rural using the FORHP rural health areas data set.

Are assisted living facilities attached to a Medicaid partnering hospital or EMS organizations (volunteer, city-, county-, or tribally owned nonprofits) that we work with be eligible applicants?

Please refer to section 1.1 of the grant for eligible providers. Hospitals are eligible applicants. Other healthcare entities may be included in an eligible applicant’s application as a strategic partner.

What is expected approach for certifications related to debarment and suspension, non-discrimination, prohibited entity status, and restrictions on the boycott of Israel. Could you please confirm whether these certifications are fully satisfied by submission of the signed RFP form, or if the State requires any additional forms or attestations as part of the proposal submission process?

This language will be in the standard contract language and attested to in the signing of the contract.

Several of our ideas could also fall into the Digital Health Modernization and Technology Grant Program. Do you have a release date for this RFP?

Please refer to the DOH Rural Health Transformation webpage for information regarding other funding opportunities https://doh.sd.gov/healthcare-professionals/rural-health/rural-health-transformation-project/.

Will providers be eligible for participation in future PACT funding and grants regardless of whether they apply for a rural strong grant?

Applying for Rural Strong grant funding will have no impact on the future ability to participate in PACT and the primary care alternative payment model. Receipt of Rural Strong funding may impact the ability to receive future grant money for similar infrastructure purposes.

Can you provide an example of the level of detail the state would like included in the RHT funding disclosure?

The disclosure should be sufficiently detailed to allow the department to assess possible duplication. If the funding is related to a South Dakota request for funding, the State may review other materials the provider submitted for that opportunity.

If an entity includes an alternative budget proposal, is the collective page limit for the budget and budget narrative four pages, or is each budget and budget narrative proposal allowed four pages?

If an entity decides to provide an alternative budget, the entire budget section is still limited to 4 pages.

Is it allowable for an organization to request a smaller allocation of funding in budget year one, with the expectation that costs will increase in years 2-5? (i.e. the project is initiating in year one, then will be implemented in years 2-5)

Yes.

The state’s application to CMS for RHTP funds indicates all counties are eligible for the Medicaid PACT initiative. Will applications from primary care providers located in urban areas to support care coordination readiness for value-based care, in alignment with PACT goals, be considered for funding?

Yes.