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RFP #26-09RHT-024

Building a Sustainable Rural Healthcare Workforce: Recruitment and Retention

Questions and Answers

Thank you for your interest in RFP #26-09RHT-024: Building a Sustainable Rural Healthcare Workforce: Recruitment and Retention under the Rural Health Transformation project.

As outlined in the RFP Schedule of Events, all questions received by the Offeror Questions due date of August 4, 2026, were compiled and addressed collectively. To ensure a fair and transparent process for all potential offerors, individual responses to questions will not be provided directly.

1. Does the RFP include behavioral health workforce needs?

Q: Is the RFP open to behavioral health, including mental health and substance use disorder workforce needs?

A: Yes.

2. Who is eligible to apply?

Q: May healthcare facilities, healthcare systems, universities, professional associations, staffing organizations, consulting firms, and other organizations apply?

A: Licensed healthcare facilities, dental clinics, healthcare clinics, and other qualified healthcare facilities providing healthcare services to rural South Dakota citizens are eligible to apply. Non-clinical organizations, universities, colleges, associations, staffing organizations, consulting firms, etc. are not eligible to apply. They may partner with an eligible healthcare organization.

3. Can an urban organization serving rural patients apply?

Q: We are an urban facility but serve rural patients. Are we eligible?

A: Eligibility focus is on providing healthcare services to rural South Dakota citizens. Urban facilities may apply if they have providers located in a rural location within the state.

4. Can non-clinical organizations participate as partners or subcontractors?

Q: Can consulting firms, workforce organizations, universities, housing organizations, schools, or other non-clinical organizations partner with an eligible healthcare applicant?

A: Yes. The healthcare organization should remain the eligible applicant and be responsible for the award and applicable service commitments.

5. How should collaborative partners be identified?

Q: For multi-partner proposals where one organization is the legal applicant, how should partners be described? Are letters or MOUs required?

A: Clearly identify each partner's role, responsibilities, and contribution. Letters of support or MOUs may be appropriate for significant partners, although they are not required.

6. Are regional collaborators required to submit documentation?

Q: If regional organizations contribute research, models, or future coordination but do not receive funding, is documentation required?

A: They should be identified and their anticipated roles described. Formal documentation may not be necessary unless they become funded partners.

7. What occupations comprise the eligible healthcare workforce?

Q: Is there a list of eligible or ineligible healthcare occupations?

A: No.

Five-Year Rural Service Commitment

8. Does every grant-funded activity require a five-year commitment?

Q: Must all activities funded under the grant have a five-year service commitment?

A: No. The CMS guidance distinguishes individual-specific benefits from general workforce infrastructure. Only certain individual benefits trigger the five-year commitment. CMS 5- Year Service Commitment Fact Sheet

9. What determines whether the five-year requirement applies?

Q: What test should applicants use?

A: The key questions are:

Is an item or service of value offered to an individual?

Is the benefit specific to that individual rather than general workforce infrastructure?

Individual-specific benefits generally trigger the requirement; general workforce infrastructure generally does not.

10. Do recruitment and retention incentives require five years?

Q: Do signing bonuses, retention bonuses, relocation assistance, housing assistance, and similar incentives require five-year commitments?

A: Generally, yes, when the benefit is provided to an individual as a recruitment or retention incentive. CMS identifies these types of individual benefits as potentially subject to the five-year commitment.

11. Do non-cash benefits trigger the commitment?

Q: Does the requirement apply to benefits such as license renewal, mentorship stipends, or housing benefits administered through another program?

A: Potentially. The issue is whether an individual receives a specific item or service of value, not whether it is cash. CMS 5-Year Service Commitment Fact Sheet

12. Are training and professional development subject to the commitment?

Q: Do general staff training, professional development, simulation equipment, and training infrastructure require five-year commitments?

A: Generally, no. CMS distinguishes general workforce infrastructure and professional development from individual benefits. However, education that provides an individual with a new credential, degree, or job opportunity may trigger the requirement.

13. Can high schools participate in healthcare career pathways?

Q: Can an organization partner with a local high school to encourage students to enter healthcare and eventually return to the rural community?

A: Yes. General career education, coaching, tutoring, and pathway infrastructure generally do not trigger the five-year commitment. Individual training that results in a credential or direct job opportunity may trigger it.

14. What level of employment is required for a student subject to the commitment?

Q: Can part-time or PRN student employees satisfy the five-year requirement?

A: No. They can be included when they achieve certification/licensure and are employed

15. Can students have gaps in service while attending college Q: Can students pause their service while attending a university and resume during summers or after graduation A: Yes, individuals may take a break to obtain education. Guardrails would need to be determined to ensure that they are achieving program goals and that the 5-year commitment is not deferred indefinitely. Implementation of such an allowance will need to be approved by the federal project officer.

16. Can service be completed with another rural employer?

Q: If a participant leaves the original employer but works for another qualifying rural South Dakota employer, can that service count?

A: Yes. CMS allows service to be completed at another rural site within the same State. CMS 5-Year Service Commitment Fact Sheet

17. Does telehealth from an urban location satisfy the commitment?

Q: Can a provider satisfy the requirement by providing telehealth to rural patients while living in an urban area?

A: No. CMS indicates that the individual must be physically located in a rural area. CMS 5- Year Service Commitment Fact Sheet

18. What happens when a participant does not complete five years?

Q: What repayment, replacement, or other obligations apply if a participant leaves before completing the commitment?

A: In cases where a provider is unable to complete the 5-year service requirement at their initially committed healthcare organization (e.g., due to hospital closure), they may fulfill the remainder of their 5-year commitment through work for other rural providers or in other rural communities within the State. The incentive payment amount may be prorated to reflect the service provided to the rural community up to that point. It may be allowable to forgive the 5-year service obligation in cases where the educational and/or credentialing requirements that are prerequisite to clinical practice have not been met or the 5-year service requirement has not been fulfilled due to extenuating circumstances such as death or disability of the committed provider. The employer must submit the request to the State who will work with CMS for review and approval to forgive the 5-year service obligation.

19. How will five-year commitments be tracked?

Q: What tracking and reporting process will be used?

A: The State will establish controls and reporting mechanisms for monitoring the five-year requirement. Employers will be required to complete these forms to meet CMS requirements.

Funding and Payment

20. Is this a cost-reimbursement grant?

Q: Are financial incentives provided in advance or reimbursed after the grantee incurs the expense? How would prorated repayment work under cost reimbursement?

A: Expenses are reimbursed monthly. If an individual does not complete the required five-year commitment, the employer must collect the prorated amount owed and return the payment to the State.

21. Must incentives be paid in Year 1?

Q: Must all incentives be paid by July 31, 2027, or can Year 1 funds support payments extending beyond the initial contract?

A: Incentives must be paid by July 31, 2027.

22. How should five-year retention agreements be budgeted?

Q: If an organization proposes a $50,000 five-year retention incentive, should the entire amount be requested in Year 1 or only the Year 1 amount?

A: The entire amount should be requested in Year 1. Future-year funding is not guaranteed.

23. Can activities without five-year commitments be included?

Q: Can a proposal include activities such as annual performance bonuses, staff development, preceptor stipends, or other activities without five-year commitments?

A: Not every workforce activity triggers the five-year requirement. General workforce infrastructure and certain professional-development activities may be included without an individual service commitment. If something of value is offered to an individual, then the 5-year service requirement will be required.

24. What provider payments are permitted?

Q: How much may be used for direct provider payments?

A: An amount has not been set.

25. How many awards and what award sizes are anticipated?

Q: How many awards will be made, and is there an expected funding range or maximum award?

A: The number of awards, the expected funding range and the maximum award amount are to be determined. These will depend on the number of proposals received, scoring and evaluation of the proposals, and the amount of money requested in each proposal.

We anticipate making multiple awards with this funding.

26. What is the expected project period Q: What is the anticipated performance period and contract term?

A: Contracts are anticipated to run from October 1, 2026 to July 31, 2027. Renewal options may be available but are not guaranteed

27. What are the renewal criteria?

Q: What determines whether a Year 1 award is renewed?

A: Renewal criteria will be determined and may include performance, compliance, outcomes, spending, future funding availability and if RFPs are requested.

28. Is long-term funding guaranteed?

Q: How will long-term funding be determined?

A: Long term funding may include performance, compliance, outcomes, spending, future funding availability and if RFPs are requested.

Eligible Activities and Equipment

29. Can staff education space and equipment be funded?

Q: Are items such as computers, tables, chairs, SmartBoards, and training-room equipment allowable?

A: Potentially. General training infrastructure is consistent with the CMS workforce framework. However, the RFP's equipment restrictions must also be satisfied.

30. Are simulation equipment and CPR mannequins allowable?

Q: Are clinical simulation equipment and CPR mannequins eligible?

A: They may qualify as general workforce training infrastructure. The equipment must meet the RFP guidelines and not be duplicative of other Rural Health Transformation funding.

31. Can specialized clinical training be funded?

Q: Could a rural hospital purchase simulation equipment or provide training for staff who may encounter pregnant patients after closure of an obstetrics unit?

A: Potentially. Training that strengthens staff competency, confidence, and retention may support the workforce objectives. It would generally not trigger an individual five-year commitment unless it provides an individual with a qualifying credential or job opportunity.

32. Are employee morale activities such as lunches eligible?

Q: Are quarterly staff lunches or similar morale activities allowable?

A: Morale activities may be allowable. Food and beverages are not allowable expenses.

33. Can consultants assess compensation and pay equity?

Q: Can an external contractor evaluate compensation practices, wage scales, and pay equity to improve retention?

A: An external contractor may be included in a proposal; however, the proposal must be submitted by an eligible applicant.

34. What happens to consultant pre-existing materials?

Q: Does Section 2.15 make a consultant's pre-existing or proprietary materials State property?

A: Pre-existing materials do not become State property. Deliverables associated with the contract will become state property.

Partnerships and Education

35. Can universities propose rural nursing education programs?

Q: Can a university propose an online or “train-in-place” nursing program designed to recruit rural South Dakota residents?

A: No. A university is not eligible to submit a proposal.

36. Does the five-year commitment apply if the university does not employ graduates?

Q: If the university pays student expenses but does not employ graduates, does the service commitment apply?

A: A university is not eligible to submit a proposal.

37. Are preceptor stipends subject to five years?

Q: Can preceptor stipends be funded without a five-year commitment?

A: Generally, yes. CMS identifies faculty and preceptor support as workforce-development infrastructure that generally does not create an individual five-year obligation.

38. Can an existing State agency relationship create a conflict?

Q: Does an existing letter of support or affiliation agreement with a State agency create a conflict of interest?

A: Not automatically. Applicants should disclose relationships as required and comply with applicable conflict-of-interest rules.

Geographic Priorities

39. Are certain rural or frontier counties prioritized?

Q: Are specific rural, frontier, or underserved counties higher priority?

A: No.

40. Can service be completed outside South Dakota?

Q: Can rural service in another State count toward the five-year commitment?

A: No. The CMS requirement is State-specific; qualifying service must occur in rural areas within South Dakota.

Proposal Administration

41. When is proof of insurance required?

Q: Must proof of insurance be submitted with the proposal or only before contract execution?

A: Proof of insurance should be submitted upon contract award and prior to commencement of work.

42. How should multiple cost proposals be submitted?

Q: If multiple cost proposals are permitted, should each be a standalone proposal?

A: A proposal may include multiple cost proposals and should sufficiently detail scope, budget, and outcomes for each. Standalone proposals are also allowed. The preference is to submit multiple cost proposals together and to rank the priority of requests.

43. Will all proposal documents be made available?

Q: Are additional proposal instructions, evaluation criteria, attachments, forms, and contract exhibits available?

A: Proposal instructions are included in the RFP and in this Q & A document.

No additional documents are available.

44. What attachments are required?

Q: Are resumes, references, certifications, financial statements, budget templates, letters of support, or other appendices required?

A: No, these documents are not required but they can be included if it is beneficial to your proposal.

45. Will a sample contract be provided?

Q: Can the State provide the contract template or identify the general terms and conditions?

A: A contract template is not available. Within the RFP, section 2.0 includes standard contract terms and conditions that will be included. The contract’s scope of work will include details about the specific award.

Indirect Costs and Subcontracting

46. What indirect cost rate applies?

Q: Is there a maximum indirect cost rate, or may applicants use a federally negotiated rate?

A: A maximum of 10% may be included as an indirect cost rate. Federal indirect cost rate agreements will be requested.

47. May a workforce consulting organization be a subcontractor?

Q: Can a workforce transformation or consulting organization participate as a subcontractor or implementation partner?

A: Potentially, subject to the RFP's subcontracting provisions. The eligible healthcare organization should submit the proposal and remain responsible for the award and applicable service commitments.

Implementation and Sustainability

48. Must projects be implemented statewide immediately?

Q: Will the State require statewide implementation from project initiation, or can applicants propose a phased pilot or regional rollout?

A: A phased approach may be appropriate if it demonstrates clear rural need, measurable milestones, scalability, and a path to broader implementation.

49. Does the State encourage technology and innovation?

Q: May applicants use workforce analytics, decision-support tools, digital collaboration platforms, or other technologies?

A: Yes, when the technology directly strengthens workforce planning, recruitment, retention, implementation, or sustainability. Applicants should explain the workforce benefit and measurable outcomes.

50. Are workforce outcomes guaranteed?

Q: Must awardees guarantee recruitment, placement, retention, or other workforce outcomes?

A: Awardees do not have to guarantee recruitment, placement, retention, or other workforce outcomes; however, they will be required to show progress towards accomplishments, performance of activities, outcomes, and complete reporting requirements.

51. Who employs recruited candidates?

Q: Will recruited healthcare professionals be employees of the healthcare organization, awardee, or another entity A: The healthcare organization would generally employ the recruited workforce when it is the eligible applicant.

Construction and Infrastructure

52. Can a walking path be funded?

Q: Would a walking path intended to support employee wellness and retention be considered new construction?

A: Installing a new walking path will not be funded by this RFP.

Practical Five-Year Commitment Guide

53. Which activities are most likely to require a five-year commitment?

A: Likely subject to the commitment:

Individual tuition or qualifying education benefits.

Individual housing assistance.

Signing/recruitment bonuses.

Retention bonuses.

Relocation assistance.

Individual loan repayment or similar incentives.

Individual credentialing or licensing benefits.

Other individual-specific benefits.

54. Which activities generally do not require a five-year commitment?

A: Generally not subject to the individual commitment:

General workforce infrastructure.

Shared simulation equipment.

Training materials and videos.

General professional development that does not result in a new credential or job.

Faculty and preceptor infrastructure.

General career-pathway infrastructure.

High-school career awareness and coaching.

Other resources benefiting the broader workforce.

55. What should applicants do with gray-area expenses?

Q: What should an applicant do when it is unclear whether an activity triggers the five-year requirement?

A: Separate the activity in the budget, identify whether it benefits an individual or the broader workforce, and request written clarification from the State when necessary.

56. What is the recommended proposal structure?

Q: How should applicants organize their budgets and narratives to address the five-year requirement?

A: Separate proposed activities into:

1. Individual incentives — identify recipients, benefits, commitments, tracking, and repayment.

2. Education and workforce development — distinguish individual credentialing benefits from general training.

3. Workforce infrastructure — identify shared equipment, training resources, consulting, analytics, career pathways, preceptors, and other broad workforce investments.

This structure aligns with the CMS distinction between individual benefits that can trigger the five-year commitment and general workforce infrastructure that generally does not.