North Dakota

This document is a technical assistance and funding announcement for North Dakota's RHTP Suicide Intervention-Healthcare Systems opportunity. One award of $400,000 will fund technical support for evidence-based suicide intervention in rural and tribal healthcare, focused on measurable reductions in suicide attempts and deaths. Opportunities are phased, with this cycle due June 2026 and possible renewals. Event schedule: - Applications due - 06/12/2026 - 5:00 PM CT - Review and scoring - 06/15/2026 - 07/10/2026 - All Year 1 funds must be awarded - September 2026 - All Year 1 funds must be expended - September 2027

North Dakota will launch multiple phased RHTP funding opportunities over 2026, beginning with rural health workforce initiatives. Rotations and 'Train In Place' grants target rural clinics, students, and providers. Strict rural focus, 5-year service terms required. Event schedule: - Expand Rural Health Care Rotations Application Deadline - 05/15/2026 - 5:00 PM CT - Online Qualtrics portal - Expand Rural Health Care Rotations Tech Assistance Call - 05/07/2026 - 12:00 PM CT - Conference call - Train In Place Application Deadline - 05/15/2026 - 5:00 PM CT - Online Qualtrics portal - Train In Place Tech Assistance Call - 05/06/2026 - 12:00 PM CT - Conference call

North Dakota HHS is launching a competitive RHTP funding opportunity for rural CAHs and FQHCs to receive technical assistance and comprehensive financial and operational assessments via Eide Bailly. Up to 42 awards of $40,000 each are anticipated, with possible additional support for implementing a CAH analytics tool. The program targets planning for infrastructure and care delivery changes to position rural providers for sustainability.

Event schedule: - Rural Health Transformation Program Technical Assistance for Suicide Intervention-Healthcare Systems, , 2026 Prepared from presentation slides and speaker notes. This handout is designed as an accessible companion document for participants who may not be able to use slide decks effectively. 1. Agenda Presenter: Laura Anderson Purpose: To help applications feel confident and prepared, we will review the funding opportunity guidance, highlight key requirements and provide a space for questions. • Background • Eligibility • Purpose • Unallowable costs • Application and Review • Reporting • Questions • Resources and Reminders Information may change based on upon updated federal guidance or upon further consideration by North Dakota Health and Human Services (ND HHS).2. Rural Health Transformation Program (RHTP) 2. Rural Health Transformation Program (RHTP) RHTP was authorized by the One Big Beautiful Bill Act (Section 71401 of Public Law 119-21) providing $50 billion to all 50 states over five years • North Dakota Health and Human Services (ND HHS) submitted an application to the Centers for Medicare and Medicaid Services (CMS) • ND was awarded $198.9M for year one (12/29/2025 – 10/30/2026) North Dakota's application identified 4 initiatives • Make ND healthy again • Strengthen and stabilize rural health workforce • Bring high-quality healthcare closer to home • Connect technology, data and providers for a stronger ND - May 19 - 5:00 pm - 3. Funding Opportunities • Funding opportunities will be released in phases, with individual applications announced over time. • Each funding opportunity will have a unique purpose, eligibility and timeline. • Future year’s funds will be determined by CMS based on the state’s progress on the plan submitted in the RHTP application. • Use of funds must align with the state’s RHTP application or provide justification. • Use of funds must follow state and federal guidance. • Awarded funds must receive proper state and federal approval. 4. Suicide Intervention-Healthcare Systems • Funding opportunity solicitation number: 210-131 • Funding: $400,000 o One award is expected 5. Eligibility • 501 (c)(3) non-profit organizations • Private sector agencies • Educational Institutions • Hospitals and clinics • Other health care providers Applicants must serve rural or tribal North Dakota residents. 6. Purpose and Outcomes Improve rural and/or Tribal health by partnering with and supporting rural and tribal healthcare facilities in implementing: • Widespread use of evidence-based suicide risk screening, referral and • Standardize follow-up protocols following a suicide attempt. • Technical assistance includes: Must support North Dakota’s RHTP. Expected Outcomes: • Decrease youth and adult suicide consideration and attempts • Decrease number of deaths by suicide - 7. Requirements for Eligible Project Provide outreach to and engage rural and tribal healthcare facilities throughout the state to implement evidence-based suicide interventions and strategies. • Assist healthcare providers in developing and implementing an evidence-based plan to screen and assess all individuals for suicidal ideation, including those at risk for suicide. • Assist healthcare providers in implementing evidence-based suicide care management guidelines and policies to include implementation of standardized follow-up protocols after a suicide attempt. • Incorporate activities aligned with recommendations from the North Dakota Suicide Fatality Review Commission and the national Zero Suicide framework. • Assist providers in establishing collaboration with community partners, as applicable, to supplement and not duplicate existing efforts. • Connect efforts to already existing North Dakota behavioral health resources and programs, including but not limited to: Parents Lead and the Behavioral Health Program Directory . • Ensure strategies are recovery-orientated, trauma-informed and person- centered. • Make any necessary project modifications as deemed necessary by ND HHS. Preference will be given to applicants who can document existing collaborations with ND rural and tribal healthcare facilities. 8. Funding Opportunity Period • Start: once the agreement has been fully executed, following all required approvals and signatures. • End: , 2027, and all funds must be fully expended by that date. (potential for renewing for additional years as approved by ND HHS) Timeline: • June 12, 2026, 5:00 pm CT: Applications due • June 15-July 10, 2026: • Review and scoring • Communication with applicants for adjustments if needed • Approval by CMS and ND HHS leadership • September 2026: All Year 1 funds must be awarded • September 2027: All Year 1 funds must be expended - September 30 - 5 p.m - 9. Requirement to Receive Federal Funding • Register with the Secretary of State to perform business in the state. • If your organization has not been paid by a state entity before, you must register with vendor registry before you can be paid. • ND HHS will require a W9 form to set up by your organization within our contract system. If your organization would like to be paid with electronic funds transfer, you need to submit the substitute IRS form W-9. • Organizations need to register with SAMS.gov and receive a UEI number to receive these funds. 10. Unallowable Costs and Limits for Suicide Intervention- Healthcare Systems Grant Funding Opportunity • RHTP funds under this funding opportunity may not be used to purchase a new or used vehicle to fulfill objectives of the funding opportunity. 11. Unallowable Costs and Limits 10% cap on admin costs across all funding • Pre-award costs. • Meeting matching requirements for any other federal funds or for local entities. • Services, equipment or supports that are the legal responsibility of another party under federal, State or tribal law. • Supplanting existing State, local, tribal, or private funding of infrastructure or services. • New construction, building expansion, or purchasing of buildings. • Renovations or alterations are allowed if they are clearly linked to program goals. Cannot include cosmetic upgrades or significant retrofitting of buildings. • Renovation or alternations cannot exceed 20% of total funding in a budget period. • Replacing payment(s) for clinical services that could be reimbursed by insurance. • Direct health care services may be funded if not currently reimbursable, will fill a gap in care coverage, and/or may transform current care delivery model. • Provider payments cannot exceed 15% of total funding in a budget period. - 12. Unallowable Costs and Limits 10% cap on admin costs across all funding • No more than 5% of total funding in a budget period can support funding the replacement of an electronic health record (EHR) system if a previous HITECH certified EMR is in place as of , 2025. • Funding toward initiatives similar to the “Rural Tech Catalyst Fund Initiative” cannot exceed the lesser of 10% of total funding or $20 million of total funding awarded in a budget period. • Financial assistance to households for installation and monthly broadband internet costs. • Clinician salaries/wages for facilities that subject clinicians to non-compete clauses. • Meals and food. 13. Application • Background • Narrative o Identified Need and Proposed Goals o Strategies, Activities, and Measurable Outcomes • Action Plan o Timeline and Milestones o Metrics o Key Personel • Budget 14. Application – Background Information • Organization name and background o Provide the organization name, location, additional facilities and the estimated population served. • Project Lead and Contact Information • Identify the project lead who will serve as the primary point of contact to receive communications about the application. Provide first and last name, title, phone number and email. • Project Title and Reason • State the project name and a brief description of why the organization is applying. - September 1 - 5 p.m - 15. Application – Project Narrative Identified need and proposed goals • Identify the need for the proposed project • Discuss the challenges the proposed project aims to address. Describe the specific need or issue impacting the organization or community. Use qualitative and quantitative data to substantiate this need. • Provide a description of the proposed project, including outlining the overarching goal(s) of the proposed project, including the target population who will benefit • The target population must include rural or tribal residents, but additional populations may be included. If the proposed project serves additional populations or is located in an urban area, describe how rural or tribal residents will be served. • The goal(s) should describe the broad, high-level change(s) the applicant seeks to achieve. Goal(s) must be specific, measurable, achievable, relevant and time- bound (SMART). • RHTP funds cannot be used to duplicate or replace existing funding (supplanting). Funds can be used to expand or enhance an existing project (see Budget section for details) • Is this project already in progress, currently funded by another source or actively being implemented in the organization or community? If yes, identify current or similar projects and their funding sources. • Explain how the proposed project will enhance, rather than duplicate, existing efforts, including how you plan to coordinate with partners to prevent duplication. • If requesting funds for an expansion, describe why the expansion is needed and how the new funds will support additional efforts 16. Application – Project Narrative Continued Strategies, Activities and Measurable Outcomes • Describe the specific strategies, services, tasks or activities the project will implement in order to achieve the proposed goal(s). • Strategies must be evidence-based and include the following: • Widespread screening and referral, and • Standardize follow-up protocols after a suicide attempt. • Strategies must be aligned with the recommendations from the North Dakota Suicide Fatality Review Commission and the national Zero Suicide framework. • If there are multiple strategies and activities, please number in order of priority. - Key Personnel • Identify key personnel, including a project lead. Describe the type of work each person will perform in carrying out the project. Include relevant credentials and experience managing funds and special projects. • If the applicant plans to use external sources, such as consultants, please identify them, describe their experience and outline their role in the project. These external sources must also be identified in the budget. 19. Application – Budget • Template for itemized budget • Cover • Budget • Lease vs. Purchase • Appropriate justification for each cost category • Proposals will only be accepted for: RHTP funds are governed by applicable provisions of 2 CFR Part 200 and 2 CFR Part 300, with guidance from the federal RHTP Notice of Funding Opportunity and CMS’s Frequently Asked Questions document. The limits and unallowable costs detailed in this section come from federal guidance and are non-negotiable. 20. Application Submission Applications must be submitted through Qualtrics • Can start, save and go back • Submit early to avoid technical issues • Don’t forget to include required attachments Approval of the grant application by the government body • Itemized Subrecipient Budget Template (found on funding opportunity webpage ) Reminder: • Applications due by 5 p.m. CT on , 2026 • Applications not received by the submission date and time will be considered non-responsive and not reviewed - June 12 - 21. Application Review -July 10, 2026 • Identify key personnel, including a project lead. Describe the type of work each person will perform in carrying out the project. Include relevant credentials and experience managing funds and special projects. • If the applicant plans to use external sources, such as consultants, please identify them, describe their experience and outline their role in the project. These external sources must also be identified in the budget. Funding Opportunity Scoring Tool (linked on page 11 of the NOFO) 22. Reporting Quarterly and annual reports • Reimbursement requests • Impact stories • Progress reports • Metrics • Use of funds 23. Resources and Reminders Visit the Website - www.hhs.nd.gov/rural-health-transformation • Sign up to receive email updates • Funding Guidance resource Submit questions to FAQ Survey 24. Rural Health Transformation Program This presentation is supported by the Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health and Human Services as part of a financial assistance award totaling $198,936,969.55 with 100% funded by CMS/U.S. Department of Health and Human Services. The contents are those of ND HHS and do not necessarily represent the official views of, nor an endorsement, by CMS/U.S. Department of Health and Human Services, or the U.S. Government. - June 15

Event schedule: - Rural Health Transformation Program Technical Assistance for Mobile Mammography Unit Acquisition Funding Opportunity, , 2026 Prepared from presentation slides and speaker notes. This handout is designed as an accessible companion document for participants who may not be able to use slide decks effectively. 1. Agenda Presenter: Susan Mormann Purpose: To help applicants feel confident and prepared, we will review the funding opportunity guidance, highlight key requirements and provide a space for questions. • Background • Eligibility • Purpose • Unallowable costs • Application and Review • Reporting • Questions • Resources and Reminders Information may change based on updated federal guidance or upon further consideration by North Dakota Health and Human Services (ND HHS). 2. Rural Health Transformation Program (RHTP) RHTP was authorized by the One Big Beautiful Bill Act (Section 71401 of Public Law 119-21) providing $50 billion to all 50 states over five years • North Dakota Health and Human Services (ND HHS) submitted an application to the Centers for Medicare and Medicaid Services (CMS) • ND was awarded $198.9M for year one (12/29/2025 – 10/30/2026) North Dakota's application identified 4 initiatives • Make ND healthy again • Strengthen and stabilize rural health workforce • Bring high-quality healthcare closer to home • Connect technology, data and providers for a stronger ND - June 11 - 5:00 PM - 3. Funding Opportunities • Funding opportunities will be released in phases, with individual applications announced over time. • Each funding opportunity will have a unique purpose, eligibility and timeline. • Future year’s funds will be determined by CMS based on the state’s progress on the plan submitted in the RHTP application. • Use of funds must align with the state’s RHTP application or provide justification. • Use of funds must follow state and federal guidance. • Awarded funds must receive proper state and federal approval. 4. Mobile Mammography Unit Acquisition • Funding opportunity solicitation number: 210-333 • Funding: One award of approximately $1,500,000 5. Eligibility Eligible • Integrated healthcare systems that include a hospital, outpatient clinics and a variety of support services • Rural clinic or hospital system expanding screening access across multiple counties • Federally Qualified Health Centers (FQHCs) • Tribes, tribal health organizations or a tribal health authority addressing screening gaps on reservation lands Target Populations: • Western North Dakota Rural Residents (50% of the service area of the mobile mammography unit must include locations between the western border of North Dakota to 75 miles east of Highway 83) • Medicaid members Priority considerations will be given to applicants that exhibit: • Provision of breast cancer screening or mobile health services that serve western rural, low-income, medically underserved populations • Experience in offering preventive screening programs • Established partnerships for follow-up care (diagnostics, treatment referrals) • Ability to provide data reporting, metrics and outcomes tracking • Financial and operational capacity to sustain utilization of the acquired mobile mammography unit - 9. Timeline Operating Period • Begin: once the agreement has been fully executed, following all required approvals and signatures. • End: , 2027 o All funds must be fully expended by that date. o All goods purchased under this award must be fully delivered by the end of the operating period. Key Dates • June 30, 2026, 5:00 PM CT: Applications Due • July 1 - 31, 2026: o Review and scoring o Communication with applicants for adjustments if needed • Approvals by CMS and ND HHS leadership o Agreement development • September 2026: All year 1 funds must be awarded • September 2027: All year one funds must be expended 10. Requirements to Receive Federal Funding • Register with the Secretary of State to perform business in the state. • If your organization has not been paid by a state entity before, you must register with the vendor registry before you can be paid. • ND HHS will require a W9 form to set up by your organization within our contract system. If your organization would like to be paid with electronic funds transfer, you need to submit the substitute IRS form W-9. • Organizations need to register with SAMS.gov and receive a UEI number to receive these funds. 11. Budget Information for the Mobile Mammography Unit Acquisition Funding Opportunity • Modified total direct administrative/indirect costs are not allowable for this funding opportunity. • All goods purchased under this award must be fully delivered no later than Sept. 30, 2027. - September 30 - 5:00 p.m - 12. Budget Information for the Mobile Mammography Unit Acquisition Funding Opportunity Allowable expenses for acquisition of a mobile mammography unit include: • Specialized Vehicle: Custom-built vehicle with lead-lined walls, generator, HVAC, patient areas transforming the vehicle into a clinical space including ADA- accessible design. • Medical Imaging Unit: Core component for imaging – 3D digital mammography system known as tomosynthesis is considered the current standard of care. • Essential Software: Radiology Information System (RIS) and Picture Archiving and Communication System (PACS). • Initial Licensing and Certification: Mammography Quality Standards Act (MQSA) certification, state-specific facility and technologist licenses. • Insurance and Legal Fees: Business formation, medical malpractice, auto and general liability insurance. • Initial Staffing and Training: Salaries for first 1-2 months for specialized equipment training.* • Initial Marketing and Community Outreach: Website, communications collateral (ads, informational flyers), community engagement and digital advertising. 13. Unallowable Costs and Limits • Pre-award costs. • Meeting matching requirements for any other federal funds or for local entities. • Services, equipment or supports that are the legal responsibility of another party under federal, state or tribal law. • Supplanting existing state, local, tribal or private funding of infrastructure or services. • New construction, building expansion or purchasing of buildings. o Renovations or alterations are allowed if they are clearly linked to program goals. Cannot include cosmetic upgrades or significant retrofitting of buildings. o Renovation or alternations cannot exceed 20% of total funding in a budget period. • Replacing payment(s) for clinical services that could be reimbursed by insurance. o Direct healthcare services may be funded if not currently reimbursable, will fill a gap in care coverage and/or may transform current care delivery model. - o Provider payments cannot exceed 15% of total funding in a budget period. 14. Unallowable Costs and Limits • No more than 5% of total funding in a budget period can support funding the replacement of an electronic health record (EHR) system if a previous HITECH certified EMR is in place as of , 2025. • Funding toward initiatives similar to the “Rural Tech Catalyst Fund Initiative” cannot exceed the lesser of 10% of total funding or $20 million of total funding awarded in a budget period. • Financial assistance to households for installation and monthly broadband internet costs. • Clinician salaries/wages for facilities that subject clinicians to non-compete clauses. • Meals and food. 15. Application • Background • Narrative o Identified Need and Proposed Goals o Strategies, Activities, and Measurable Outcomes • Action Plan • Budget 16. Application – Background • Organization name and background • Project lead and contact information • Project title and brief description of why you’re applying 17. Application - Narrative Identified need and proposed goals • Identify the need for the proposed project o Challenges the proposed project aims to address o Relevant local data to demonstrate the scope and urgency of the need • Outline your overarching goal(s) and target population o Describe the broad, high-level change(s) your organization seeks to achieve - September 1 - 5:00 p.m - o If the proposed project serves additional populations or is located in an urban area, describe how rural residents, including rural tribal residents and rural Medicaid members, will be served. • Is your project already in progress, currently funded by another source or actively being implemented in your organization or community? o Identify current or similar projects and their funding sources. o Why is the expansion needed? How will your proposed project enhance or expand rather than duplicate existing efforts? 18. Application - Narrative Strategies, Activities and Measurable Outcomes • Use outcome-focused terms to describe the strategies and activities: o Outcomes should be specific, measurable, achievable, realistic and time bound (SMART) and directly linked to the equipment requested. • When applicable, strategies and activities should be evidence-based, evidence- informed or a promising practice. How does your project align with elements of CMS's RHTP? • Improving access • Improving outcomes • Technology use • Partnerships • Workforce • Data-driven solutions • Financial solvency strategies • Cause identification 19. Application – Action Plan Timeline and Milestones • Provide the timeline to successfully implement the proposed project • Identify key milestones and estimated completion dates for each strategy and activity • Include: o Project Initiation and Procurement Planning o Mobile Coach/Vehicle Acquisition and Customization o Acquisition of 3D Mammography Equipment - • Appropriate justification for each cost category. This should connect the cost to the scope of work and purpose of the funding opportunity. • Submit the completed template in Excel format. 23. Application Submission Applications must be submitted through Qualtrics • Your progress is automatically saved every time you click the Next button at the bottom of a page. • If you need to stop, simply close your browser and you can resume within 1 week. • To resume, click the original survey link again from the same device and browser. • This feature will not work if you are using a Private or Incognito browser window. • Submit early to avoid technical issues Reminder: • Applications due by 5:00 p.m. CT on • Applications not received by the submission date and time will be considered non-responsive and not reviewed • Required attachments o Budget template 24. Application Review Anticipated July 1 – 30, 2026 • Review and scoring by a committee • Communication with applicants for adjustments, if needed • Approvals by CMS and NDHHS leadership • Agreement development Scoring Criteria on Funding Opportunity Webpage 25. Reporting Quarterly and annual reports • Reimbursement requests • Impact stories • Progress reports o Metrics - June 30 - o Use of funds 26. Questions • Review of questions received • Submit questions via chat • Funding opportunity FAQ and resources will be added to website • We may not be able to answer all questions today 27. Resources and Reminders • Visit the Rural Health Transformation Program webpage • Sign up to receive email updates • Funding Guidance • Submit questions: FAQ Survey 28. Rural Health Transformation Program This presentation is supported by the Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health and Human Services as part of a financial assistance award totaling $198,936,969.55 with 100% funded by CMS/U.S. Department of Health and Human Services. The contents are those of ND HHS and do not necessarily represent the official views of, nor an endorsement, by CMS/U.S. Department of Health and Human Services, or the U.S. Government.

North Dakota is launching multiple RHTP funding opportunities in phases, targeting rural and tribal communities. Year one funding emphasizes workforce development for rural health care, new training pipelines, and preventive health. Individual skill-building awards require a five-year service commitment, and the competitive application process ensures alignment with CMS requirements. Annual cycles will introduce additional opportunities and implementation funding in later years. Event schedule: - Expand Rural Health Care Rotations Deadline - 05/15/2026 - 5:00 PM CT - Qualtrics Application Portal - Expand Rural Health Care Rotations Technical Assistance Call - May 7, 2026 - Noon-12:45 PM CT - Conference Call - Train In Place Deadline - 05/15/2026 - 5:00 PM CT - Qualtrics Application Portal - Train In Place Technical Assistance Call - May 6, 2026 - Noon-12:45 PM CT - Conference Call - Zero-Hour PE Deadline - 05/22/2026 - 5:00 PM CT - Qualtrics Application Portal - Zero-Hour PE Technical Assistance Call - May 4, 2026 - 3:30 PM CT - Conference Call - Funds fully expended - 2027-10-30 - America/Chicago - North Dakota

North Dakota's RHTP is launching multiple phased funding opportunities over five years to support rural and tribal communities. Early rounds include grants for planning and infrastructure development for workforce programs (such as Train In Place), rural health rotations, and rural youth preventive health initiatives. All funding emphasizes 50%+ rural impact, service commitments, and locally tailored, sustainable strategies. Event schedule: - Expand Rural Health Care Rotations application deadline - 05/15/2026 - 5:00 PM CT - Qualtrics - Expand Rural Health Care Rotations technical assistance call - 05/07/2026 - 12:00 PM CT - conference call - Train In Place application deadline - 05/15/2026 - 5:00 PM CT - Qualtrics - Train In Place technical assistance call - 05/06/2026 - 12:00 PM CT - conference call - Zero-Hour PE application deadline - 05/22/2026 - 5:00 PM CT - Qualtrics - Zero-Hour PE technical assistance call - 05/04/2026 - 3:30 PM CT - conference call - Grant funds must be fully executed - 2027-10-30 - America/Chicago

North Dakota is preparing for a major federal investment via the Rural Health Transformation Program, with $500 million over five years anticipated for Medicaid and rural hospital transformation. CCBHC expansion is underway, increasing comprehensive behavioral health access across multiple regions. Medicaid modernization and tribal outreach initiatives are also advancing. Event schedule: - CMS Application Deadline for RHTP - 12/31/2025 - Next MFP Partner Meeting - 12/09/2025 - Fargo and virtual - 5-State Tribal Initiative Summit - October 22-24, 2025 - Washington State

North Dakota Health and Human Services announced multiple RHTP funding opportunities to support rural workforce, healthcare delivery transformation, behavioral health, and community wellness. These programs intend to build rural capacity, increase access, and address community needs. Deadlines for applications are spread throughout May 2026. Event schedule: - Workforce & Training Opportunities Application Deadline - 05/15/2026 - CT - Online application - Healthcare System & Community Wellness Opportunities Application Deadline - 05/22/2026 - CT - Online application - Behavioral Health & Community Support Opportunities Application Deadline - 05/29/2026 - CT - Online application

1. Expand and raise awareness about community-based care options
2. Improve services to adults with physical disabilities on Medicaid

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