Who does what in the Rural Health Transformation Program
Where the money moves, who controls each step, the four routes a technology partner can reach the work, and the eight initiatives CMS published as starting points.
All 50 states hold an award. $10 billion obligated for FY2026.
Who does what, and where we fit
Most organizations selling into this program are talking to an entity that cannot buy from them. Here is how the money actually moves.
| Participant | What they control | How we work with them |
|---|---|---|
| CMS | The score, the annual recalculation, and the authority to reduce or recover | We help a state keep the points it earned |
| State agency | The award. The only entity that could apply | Never a competitor. A delivery reference and a technical resource |
| Program consultants | Process, compliance, subrecipient agreements, reporting | They run the program. We build underneath it |
| Subrecipients | The money and the scope they promised to deliver | Our primary engagement. They hold an award and no engineering bench |
| Aggregators | Reach across many small awardees at once | One shared architecture instead of seventeen separate projects |
| Incumbent vendors | The installed base: EHR, telehealth, remote monitoring | We integrate, we do not replace. Being technology agnostic is a scored requirement |
| State procurement | Approved contractor lists and posted solicitations | We register and respond where the state buys directly |
The eight initiatives CMS published, and where we build
CMS included eight example initiatives in the funding opportunity as optional starting points, each tagged with the strategic goal, the approved uses of funds and the technical score factors it earns against. Most state applications are built on some combination of them. Six of the eight sit in work we have already delivered.
Remote care services
Directly oursHelp rural providers use remote care services and digital solutions to improve the scale, quality and outcomes of patient engagement, and to prevent and manage chronic disease.
Where we come in. This is NeverAlone, already built and operating. CMS names a standards-based platform integrating remote monitoring data with existing records, real-time alerts, digital navigation and triage, and staff training. We have shipped every one of those.
Goal: Tech innovation · Factors: B.1 · C.1 · C.2 · E.1 · F.1 · F.2 · F.3
Interoperability infrastructure
Directly oursHelp rural providers invest in technology infrastructure to improve data liquidity between patients, digital health products and providers, and create a long-term sustainable health IT system.
Where we come in. Our exchange and EHR integration work. PointClickCare and Gehrimed in production, MatrixCare and Netsmart through FHIR, HL7 and ADT, and 60+ systems consolidated for one operator.
Goal: Tech innovation · Factors: B.1 · C.1 · C.2 · E.1 · F.2
Rural health network
Directly oursHelp rural providers form or expand integrated health networks so they can coordinate resources, gain operational efficiencies and improve financial position.
Where we come in. The multi-tenant case. One platform funded once and used by every organization in the network, each keeping its own data isolation, configuration and reporting.
Goal: Sustainable access · Factors: C.1 · C.2 · E.1 · F.1 · F.2 · F.3
Value-based care
Directly oursHelp rural providers with little value-based care experience participate in these models and deliver proactive, preventive care coordinated across providers.
Where we come in. Predictive intervention platforms, risk adjustment accuracy and the analytics a provider needs to actually operate under a value-based arrangement.
Goal: Innovative care · Factors: B.1 · B.2 · C.1 · E.1 · E.2 · F.1 · F.2
Population health infrastructure
Directly oursFacilitate access to primary care, behavioral health and preventative services in community settings, using a hub and spoke model and technology-enabled chronic care management.
Where we come in. Data unification across hundreds of sources, referral and care coordination systems, and the technology-enabled navigator model CMS describes.
Goal: Make rural America healthy again · Factors: B.1 · B.2 · C.1 · C.2 · E.1 · F.1 · F.2 · F.3
Rural talent recruitment
We contributeDevelop, recruit and retain people to deliver health care in rural communities, including non-physician and allied health pathways.
Where we come in. We do not recruit clinicians. We reduce the hours each one loses to administration, which is the retention lever inside your control.
Goal: Workforce development · Factors: B.1 · B.2 · C.1 · D.1
Rural health regional excellence
Directly oursSupport rural providers in forming affiliations with high-quality regional systems and academic medical centers to share best practice, talent and knowledge.
Where we come in. The technical layer under an affiliation: shared records, virtual specialty access and the connectivity that makes an affiliation operational rather than a signed agreement.
Goal: Sustainable access · Factors: C.1 · C.2 · E.1 · F.1 · F.2 · F.3
Rural tech catalyst fund
We contributeSupport next-generation health technology developed specifically for the challenges of rural communities, involving private investors and venture partners.
Where we come in. Where a state stands up a catalyst fund, we are a build partner for its portfolio rather than the fund itself.
Goal: Tech innovation · Factors: F.3
If your initiative is one we do not build
We have marked plainly which of these we deliver and which we only contribute to. If your funded scope sits mostly in workforce pipelines, provider payment design, certificate of need, licensure compacts or scope of practice, we are not the right partner for that piece and we will say so on the call rather than after the contract.
For the full detail on any of the eight, including CMS's own potential uses of funds, stakeholders and example outcomes, read the appendix of the CMS funding opportunity, or your own state's program page. Both are linked in sources below.
Initiative names, strategic goals, approved uses and technical score factors are from the Centers for Medicare & Medicaid Services, Rural Health Transformation Program Notice of Funding Opportunity, CMS-RHT-26-001, Appendix. CMS describes them as optional reference examples to be tailored by each state.
The CMS Interoperability Framework is the standard behind the data infrastructure score
CMS published a voluntary framework defining what modern health data exchange has to do, and networks meeting it are listed as CMS-Aligned Networks. Several of its criteria took effect on 4 July 2026. If you are spending this money on data infrastructure and building to anything less, you are buying something CMS already considers behind.
What it actually requires
FHIR APIs conforming to US Core with a full capability statement, USCDI v3 or later, and real terminology binding. Labs in LOINC, medications in RxNorm, conditions in SNOMED. Bulk FHIR for full record exchange, FHIR subscriptions for encounter notifications, and record locator functionality.
Identity is part of the standard
IAL2 identity and AAL2 authentication for both patients and providers, using passkeys or mobile driver's licenses. A verified credential is meant to return records without a patient registering for yet another portal, and every query has to carry its purpose.
Why this matters for procurement
These are testable requirements, which makes them the right questions to put to any vendor before you sign. Ask for the capability statement. Ask which USCDI version. Ask about Bulk FHIR. Vague answers here are the reliable early warning.
One provision worth knowing if you are considering a partner: the framework explicitly supports a delegated model. A provider may use any application or technology partner of their choice to execute transactions, those partners are business associates under HIPAA with an executed agreement in place, and their actions are treated as equivalent to the provider's own.
Note that CMS-Aligned Network status carries a HITRUST certification requirement, or an equivalent CMS-approved security validation, on the network itself. We are not HITRUST certified and we say so plainly in security and compliance below. Read the framework in full at cms.gov.
Request a readiness review
Forty-five minutes against your own funded scope. We tell you what we think is hard about it. No cost, and you keep the notes either way.
Request a readiness reviewOr read the two-page partner brief. No form required.