Rural Health Transformation Program

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Rural Health Transformation Program - Overview

H.R. 1 Section 71401, the One Big Beautiful Bill Act (OBBBA), enacted on July 4, 2025, establishes a new federal grant program called the Rural Health Transformation (RHT) Program. This program provides $10 billion per year for federal fiscal years 2026 through 2030 for a total of $50 billion. The new federal grant program is designed to mitigate some of the effects of changes to Medicaid financing for rural hospitals and providers resulting from the legislation.

The Centers for Medicare & Medicaid Services (CMS) released the Notice of Funding Opportunity (NOFO) and the Application Instructions on September 15, 2025.  This information established the requirements and deadline for submission of a completed application of November 5, 2025.

The Nevada Health Authority worked diligently to gather helpful public input from hundreds of stakeholder suggestions which were used to prepare Nevada’s Rural Health Transformation Plan (see Nevada RHT Project Narrative).  Nevada’s completed RHT grant application was successfully submitted on November 3, 2025.

The OBBBA requires that CMS finalize this grant program, including awards for states, no later than December 31, 2025.

Upcoming Events and Announcements

  • Coming soon: Nevada Health Authority Winter Stakeholder Update Workshop (will include current updates and information on Nevada’s RHT program). Save the date: January 27, 2026, beginning at 1:00PM. Check the RHT Meetings page for updates.
  • Interested in serving on the Rural Health Transformation Steering Committee (RHTSC)? Information to be announced here and through the NVHA ListServ in early 2026!
  • Do you have a project that could support an RHT Program initiative? Updates and application and procurement requirements will be announced here and through the NVHA ListServ; stay tuned!

What is Nevada’s Plan for RHT Funding?

Nevada’s RHT Program priorities were defined based on broad rural healthcare stakeholder involvement and in close collaboration with the Governor’s Office. From August 20 to September 22, 2025, the Nevada Health Authority gathered public comment and feedback on how best to prioritize RHT funds in the state’s application. A second opportunity to provide public feedback began with a follow-up survey, open from October 6–10, 2025.

Nevada’s application reflects feedback and direct involvement from hundreds of stakeholders, including our rural healthcare experts (EMS, tribal leadership, medical education, hospitals, primary care, critical access hospitals, behavioral health professionals, and rural and frontier Nevada residents) and alignment with the Governor’s strategic plan objectives. The Nevada Health Authority worked to prioritize initiatives avoiding state or local fiscal cliffs at the end of the 5-year RHT grant and resulting in sustainable solutions to longstanding challenges affecting access to care in rural Nevada.

To guide this important work, the Nevada Health Authority will form a Rural Health Transformation Steering Committee (RHTSC) with members appointed by the Director of NVHA with approval from the Governor of Nevada.  The committee will be comprised of a broad array of representatives from rural health systems and communities in addition to state, local and tribal health representatives.  The steering committee will track progress on all RHT initiatives and recommend adjustments to ensure alignment with federal goals.

NVHA intends to deploy the following 4 initiatives, as further described in Nevada’s RHT grant application:

 

  1. Make Rural Nevada Healthy Again – Through implementing the Rural Health Outcomes Accelerator Program (RHOAP), Nevada plans to invest $30 million annually in efforts that promote value-based and innovative care models that prevent and manage chronic disease. This includes (but not limited to) new online collaborative care strategies, remote and/or hybrid approaches to care, online patient health management tools, and virtual provider mentorship programs.
  2. Strengthen Rural Health Systems – The Nevada Health Authority will introduce the Flex Fund for Nevada’s Rural Providers, planning to bolster and modernize the state’s rural health care infrastructure with a total of $40 million annually in new investments in items like technology, equipment, supplies, mobile units, emergency services, etc. The State will encourage rural providers to leverage their regional buying power through regional purchasing strategies and sharing arrangements.
  3. Create a Robust Network of Health Providers in Rural Nevada – Through establishment of the Workforce Recruitment and Rural Access Program, Nevada plans to address historic gaps in the state’s rural workforce. Multiple strategies will be employed with the proposed support of $80 million annually to address immediate and long-term provider gaps, including new incentives for providers to live and serve in rural areas of the state, tuition aid with commitments to serve rural Nevada, and a rural physician residency program.
  4. Fill the “Unfillable” Gaps with Innovative Technology Solutions – The Nevada Health Authority plans to implement the Rural Health Innovation and Technology Grant of $30 million available annually toward innovative technologies and modernization of health data and records systems with a focus on alignment with the CMS Digital Health Ecosystem and addressing cybersecurity needs for rural health systems. These funds may also be used to bolster the state’s rural telehealth infrastructure.

 

 

Requirements for a state’s Rural Health Transformation Plan

States must include strategies to:
  • Improve access to hospitals, other providers, and health care items and services furnished to rural residents.
  • Improve health care outcomes of rural residents of the state. 
  • Prioritize the use of new and emerging technologies that emphasize prevention and chronic disease management.
  • Initiate, foster, and strengthen local and regional strategic partnerships between rural and other health care providers to promote quality improvement, increased financial stability, maximize economies of scale, and share best practices and care delivery.
  • Enhance economic opportunity for, and the supply of, healthcare clinicians through enhanced recruitment and training. Prioritize data and technology solutions that help rural hospitals and providers furnish high quality services near a patient's home.
  • Outline strategies to manage long-term financial solvency and operating models of rural hospitals in the state.
  • Identify the specific causes driving the accelerating rate of standalone rural hospitals becoming at risk of closure, conversion, or service reduction.
 

 

How Much RHT Funding Could Nevada Receive?

The new federal bill outlined the rules regarding the distribution of funds to states who receive federal awards. First, the funds will be divided into two pools: (1) the first pool contains 50 percent of funds and must be distributed to states with an approved application; and (2) the second pool contains the remaining 50 percent of funds that will be provided in addition to the first pool of funds to at least a quarter of states eligible under a methodology that prioritizes states with more rural areas and challenges.

 

 

How to learn more about Nevada’s RHT Program

  • Sign up to receive updates through the Nevada Health Authority Listserv: Listserv Sign Up
  • Contact the Rural Health Transformation program staff at RHTP@nvha.nv.gov.    
  • October 2, 2025 RHT Public Workshop: Click here to view the presentation slides and here to view the recording. 
  • October 15, 2025 RHT Public Workshop: Click here to view the presentation slides and each link here to view Part 1 and Part 2 of the recording.  
  • Nevada's RHT Application was successfully submitted to CMS, Monday, November 3, 2025! Click to view Nevada's Rural Health Transformation Program application documents: