Leave behind something permanent.
Aim your RHTP dollars at the infrastructure that sustains rural practices and their patients. Leverage the prior-authorization requirements every payer must meet anyway. The paperwork will kill these practices otherwise.
States may use RHTP funding for approved provider-enablement, market-activation, evaluation, and integration activities, subject to award terms and state and federal approval — and the bigger opportunity is to leave behind infrastructure the entire market keeps using after the grant ends. This page is Action 4 of the four-action state playbook: program structure, rural prioritization, milestones, verification, governance, and funding controls. Delaware is running exactly this play (Axios, July 6, 2026: “Rural health funds to fix prior authorization”).
Why this matters for rural providers
A large health system amortizes prior-authorization paperwork across whole departments; a small or rural practice absorbs the same burden at a front desk of one — no prior-authorization department, no IT staff, no spare capacity. Every provider pays this tax; the providers least able to carry it pay the most. For rural providers, cutting paperwork is protecting access to care — and protecting the scarce resources that keep their doors open.
Rural providers get connected first — and rural results get measured. A rural practice’s authorizations travel to statewide and national payers, so delivering rural relief means connecting the market the practice actually transacts with. Enablement funding puts rural providers, rural-serving systems, and the referral partners required to complete rural patients’ care journeys at the front of the line — and the program reports rural outcomes in production: rural activation rate · rural prior-authorization turnaround · administrative hours returned to care · share of transactions completed electronically.
Participating providers are not charged for state-funded onboarding work; providers have multiple connection paths while EHR-native support matures; and providers keep the systems they already know. The goal is the one on the front of this site: cut paperwork, not care.
Why shared rails, not another portal
Healthcare already has the information. The paperwork simply cannot move. Every new administrative requirement risks becoming another portal, another interface, another vendor, and another burden on providers.
Prior authorization isn’t the product. It’s the first transaction. The product is shared administrative rails.
The market case — why a state moves, what it gets, and what January means — is on the state page; this page is the funding and program mechanics that connect rural providers first.
Delaware: the working model
Delaware wrote shared, neutral infrastructure into its Rural Health Transformation plan — Initiative 15: statewide real-time insurance verification and prior authorization, built on vendor-neutral standards and stakeholder governance, delivered with DHIN, the exchange the state already trusts. The initiative launched July 6. Published Year-3 targets: 75% faster prior-auth responses · 85% clean claims · 90% fewer coverage-error denials.
The program is organized around the work that activates a market: provider enablement, state-systems and records integration, program operations, market activation, and evaluation. State program dollars fund that state-specific launch work; published utility fees remain separate participation fees for network use. The design guardrails are deliberate: no rip-and-replace of state systems, no new payer portal, and no payments based on claims value, transaction volume, or market share — each state structures its program under its own approved plan, procurement rules, authorities, and counsel review.
That is the model other states can evaluate: use the January 1 deadline to launch shared rails the whole market keeps using after the grant ends.
Read Delaware’s announcement →
Download the Delaware briefing (PDF, 14 pages) →By Dr. Neil Hockstein, Chair, Delaware Health Care Commission. Shared with permission.Show CMS progress this year
You can move fast because the shared network core already exists. State funds pay for activation — provider enablement, state-systems and records integration, program operations, market activation, and evaluation — not construction of a new state-owned platform. Testing by September gives the state a concrete progress artifact this year; prior-authorization readiness lands by the January 1 federal deadline. The milestones produce evidence that supports state, payer, and federal-review discussions. Public commitment by September 1 starts the January launch-cohort path; September is the contracting month (program contract by September 30), participation agreements execute by November 30, and December is burn-in.
The four actions — RHTP provider-enablement funding powers Action 4.
The state makes a nonbinding public commitment to the launch-cohort planning process — no contract, no expenditure — and names an executive sponsor and implementation lead.
Convene the state’s payers and providers around one shared path; point mandatory CMS-0057 motion at a common destination.
MCOs first (reusing the compliance work and existing contract leverage, as state law permits), then Medicaid FFS, then employee plans and other state books — keeping the systems the state has.
State-funded provider enablement, prioritizing rural providers and the referral partners that complete rural patients’ care journeys.
Two lanes: every state can Join, Activate, and Connect its plans; RHTP states can additionally fund Action 4 provider enablement. A public commitment by September 1 is the preferred target for January cohort planning — a planning marker, not an exclusion. The program contract applies to RHTP states only.
The path, at a glance:
| When | What |
|---|---|
| Now | Signal intent · receive the commitment package |
| By Sept 1, 2026 | Public commitment for the January launch cohort |
| By Sept 30, 2026 | Program contract signed (RHTP states only) |
| Oct 14, 2026 | National CMS-0057 readiness Connectathon — your state hosts a satellite site |
| Oct–Dec | Onboarding at scale · rolling conformance green-lights |
| By Nov 30, 2026 | Participation agreements fully executed (production burn-in requires them) |
| December | Production burn-in |
| By Dec 31, 2026 | Pricing window closes — any 2026 signer holds Launch Participant terms into a later cohort |
| Jan 1, 2027 | Prior-authorization routing begins for launch participants |
| Jan 13, 2027 | Claims & Remittance Connectathon — the cadence repeats each release |
Cohort scope depends on executed payer, provider, and state-system participation agreements by November 30.
December runs supervised burn-in with production credentials and approved operating controls, using production or production-equivalent workflows as permitted by executed agreements — so January 1 is an operational launch, not a first attempt. Production credentials require executed agreements.
What it costs the state
The state joins the network on the same published payer terms as any other payer, for the lives it insures.
Separately, the state can organize a launch program around the work needed to make the market ready: provider enablement, state-system integration, market activation, program operations, and evaluation. The state chooses the structure — state-administered, state-designated, or SHN-supported — under its own authorities and counsel review.
The goal is not a new state IT build. The goal is to connect existing systems and participants to shared rails that can support more transaction types over time. See costs →
The Provider Enablement Program funds certified onboarding partners against verified provider connections. Providers pay nothing for funded onboarding. Payments follow machine-verifiable milestones — not proposals, not hours.
The Delaware framework uses controlled program funds that release only against verified deliverables. Other states may use escrow, a state treasury mechanism, a fiscal intermediary, or another approved fund-flow structure that provides equivalent controls. The Delaware framework is intended to be structured as a contractor model under 2 C.F.R. Part 200, subject to each state’s counsel, funding terms, and applicable federal requirements.
Keep the systems you have. Connect them to the shared rails. RHTP-aligned state program dollars may support the controlled connection between the state’s existing Medicaid systems — MMIS/MES, provider enrollment, eligibility, claims — and its providers, payers, records, and the shared network.
Why this fits the plan you already wrote:
- the sliding support is weighted toward small and rural practices;
- every dollar maps to a certified, verified connection — no consulting studies, no stranded IT;
- what the fund buys survives the funding — connected providers on a permanent, governed utility; and
- payments trace to signed, machine-verifiable certificates, so the program is audit-ready by construction.
The immediate wins, the durable groundwork
Day one, this is rural burden relief: fewer faxes and phone calls, faster authorizations, cleaner claims for thin-margin providers. Structurally, it is the administrative rails your other RHTP initiatives — value-based care, workforce, access — sit on top of.
Start this week
Testing can begin in the sandbox immediately. Delaware’s July 13 Launch & Connectathon drew 200+ participants and connected the first health plan — and the national CMS-0057 readiness Connectathon on October 14 is open to every state: bring a team, run synthetic prior-authorization workflows, and the free CMS-0057 Readiness Check shows your payers and providers exactly where they stand.
The funding is this page. The operating playbook is the four actions → This alignment of federal deadline, payer investment, and rural funding will not recur. Use it to cut paperwork, not care.
References to CMS, HHS, RHTP, or CMS-0057 describe federal programs and requirements. Smart Health Network is not endorsed by CMS or HHS. State participation and funding decisions remain with each state.