Maternal Health Hub and Spoke Program

Maternal Health Hub and Spoke Program is sponsored by Iowa Department of Health and Human Services (Iowa HHS). Establishes hubs and spokes to improve maternal health services across Iowa.

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678003 - FY27 RFP COMPADM26006 Maternal Health Hub and Spoke Program Funding Opportunity Details Final Application Deadline: Sep 1, 2026 12:00 PM Posted Date Jul 14, 2026 3:23 PM Award Amount Range Not Applicable Project Dates 10/31/2026 - 09/30/2031 Award Announcement Date 10/16/2026 Program Officer Melanie Mathes It is the responsibility of the Applicant to review all Attachments listed below for additional details regarding this Funding Opportunity.

The issuance of this Funding Opportunity in no way constitutes a commitment by Iowa HHS to award a contract. The purpose of this Request for Proposal (RFP) # COMPADM26006 is to solicit applications that will enable the Iowa Department of Health and Human Services (referred to as Agency) to select the most qualified applicants to serve as maternal health Hub and Spoke sites.

The purpose of developing Hub and Spoke sites is to sustain current maternal health care in Iowa and increase access to and availability of high-quality prenatal care, labor and delivery services, postpartum care, mental health support, and behavioral health support for those pregnant and postpartum in Rural Iowa.

Through the Healthy Hometowns Rural Health Transformation Program, Iowa is working toward innovative and transformative models of healthcare delivery to best serve rural Iowans. Hub and Spoke sites will work collaboratively to build networks that sustain and increase access to maternal healthcare, which includes maternal mental health care, in Rural Iowa.

This work aims to keep care available locally, when appropriate, and increase the long-term sustainability of rural healthcare providers. This procurement describes three options for organizations to apply to become part of a Hub and Spoke Network of care for maternal health in Iowa. Iowa HHS seeks to offer as much flexibility as possible through the application process to meet the differing needs of Iowa’s Rural areas.

Through this procurement, Iowa HHS will select the most appropriate applicants with the most compelling project plans to sustain and improve maternal health care in Iowa. Applicants can apply for one of the following three options, with more details included below: Option 1 - Statewide Hub : Apply as a single organization committing to being a statewide hub for specific needed services as described below.

The Agency anticipates applicants will be a Level III or Level IV Maternal Care Hospital. Option 2 - Expand Iowa’s Hub Capacity: Apply as a single organization committing to upscale from a Level I Maternal Care Hospital to a Level II Maternal Care Hospital. This organization will then serve as a Hub for higher-risk pregnancy care in the state.

Option 3 – Support and Sustain Iowa’s Spokes : Apply as a network of Level I and Level II Maternal Care Hospitals committing to carry out specific strategies to support and maintain maternal health care across Iowa.

This procurement is supported by the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling approximately $209,040,063. 71 with 100 percent funded by CMS/HHS. The contents are those of the author(s) and do not necessarily represent the official view of, nor an endorsement, by CMS/HHS, or the U.S. Government.

Iowa’s year two award for this program is anticipated by October 31, 2026 and budget amounts could change at that time. All activities presented within this RFP, including access to funds, are subject to CMS approval of the Agency’s year 2 budget.

This work implements a portion of the Hometown Connections Initiative of the Iowa Healthy Hometowns Project, funded through the Centers for Medicare & Medicaid Services’ Rural Health Transformation Program, opportunity #: CMS-RHT-26-001. Schedule of Important Dates (All times and dates listed are local Iowa time.) The following dates are set forth for informational purposes.

The Agency reserves the right to change them.

Applicant’s Conference (optional) July 22, 2026 at 10:00 am Letter of Intent (Mandatory) Written Questions and Responses July 27, 2026 by 12:00 pm (noon) August 17, 2026 by 12:00 pm (noon) September 1, 2026, by 12:00 PM (noon) Applicant’s Oral Presentations, if requested by the Agency On or around October 12, 2026 Post Notice of Intent to Award On or around October 16, 2026 Description File Name Type Size Upload Date A - RFP COMPADM26006 Maternal Health Hub and Spoke Program A - RFP COMPADM26006 Maternal Health Hub and Spoke Program.

pdf pdf 984 KB 07/14/2026 08:46 AM B - Work Plan Formatting Specifications B - Work Plan Formatting Specifications. pdf pdf 121 KB 07/14/2026 08:48 AM C - HHS Application Forms Instruction Guidance (IowaGrants) C - HHS Application Forms Instruction Guidance IowaGrants. pdf pdf 2 MB 07/14/2026 08:26 AM D - Sample Draft Contract Maternal Health Hub and Spoke Program D - Sample Draft Contract Maternal Health Hub and Spoke Program.

pdf pdf 338 KB 07/14/2026 08:51 AM E - Iowa HHS District Map E - Iowa HHS District Map. pdf pdf 669 KB 07/14/2026 08:53 AM F - RFP # COMPADM26006 Amendment 1 F - RFP COMPADM26006 Amendment 1. pdf pdf 154 KB 08/04/2026 07:50 AM G - RFP # COMPADM26006 Amendment 2 G - RFP COMPADM26006 Amendment 2.

pdf pdf 125 KB 08/24/2026 10:54 AM Website Links Website links A. IowaGrants Registration and Login Instructions https://dom. iowa.

gov/state-government/grant-management B. HHS General Terms and Contingent Terms for Contracts https://hhs. iowa.

gov/initiatives/contract-terms C. Iowa HHS Rural Health Transformation (RHT) Health & Human Services https://hhs. iowa.

gov/initiatives/healthy-hometowns-iowas-rural-health-transformation-plan D. CMS Rural Health Transformation (RHT) Program CMS https://www. cms.

gov/initiatives/rural-health-transformation-rht-program/overview Iowa HHS Only Questions Submitted Date Question Answer Jul 20, 2026 8:07 AM Where do we find information on the Applicants conference or the Q&A's when they are posted. Information on the Applicant's Conference and the posted Q&As can be found in RFP section 1. 06 Schedule of Important Dates, B.

Applicant's Conference and C. Written Questions and Reponses. Jul 22, 2026 10:24 AM For Option 3, is there any flexibility in the requirement that all members must be within 60 miles of at least two other members?

Many of the rural hospitals in our geography have discontinued providing maternal health services, leaving only 1 other hospital within 60 highway miles. We would appreciate either some flexibility in this requirement, or the ability to measure distance "as the crow flies" rather than highway miles, to allow us to participate in this venture to help sustain maternity services at our organization.

Pursuant to Amendment 1, for Option 3, all members of the Network must be within 75 miles of at least two other members of the Network unless located in an Iowa border county. If located in an Iowa border county (defined as a county that touches a state other than Iowa on at least one side), that Network member must be within 60 miles of at least one other member of the Network.

Jul 22, 2026 11:58 AM For Option 1: Statewide Hub, the bidder's conference referenced "The Hubs will also provide support (directly or via subcontract) with consenting procedures, technology set-up, scan and test result transfer for review, and other services needed to establish this type of care in Rural Iowa."

Are all of these expectations for both the Maternal & Neonatal Care Hub and the Mental Health Service Line Hub or only where applicable (i.e. teleconsultation for mental health would likely not encounter consenting procedures and/or scan results.)

Providing spoke sites with assistance with consenting procedures, technology set-up, scan and test result transfer for review, and other services needed to establish consultation services in Rural Iowa is an expectation for both the Maternal & Neonatal Care Hub and the Mental Health Service Line Hub.

The Agency anticipates that both lines of service would require consent from patients to share information with the consultating provider, both lines of service may require assistance with technology set-up at the spoke sites to allow for consultation services, and both lines of service may have requirements for transferring test results or screening results (such as a depression screening or lists of current medications in the case of the mental health service line) when providing consultation services.

Jul 23, 2026 11:17 AM Hello, We are requesting clarification on Maternal Hub & Spoke Option 2: Mahaska Health will qualify in moving from a Level I to a Level II Maternal Care Hospital and we are very excited about this opportunity. Mahaska Health (Hub) does not have any Level 1 sites (Spokes) with OB/GYN coverage within a 60-mile radius to partner with.

We envisioned working with our current Primary Care physicians who currently refer to our maternity care team for shared care from Bloomfield, Albia and Centerville. We have established these relationships from multiple hospitals, and they can be formalized but none of those sites deliver babies.

11 hospitals have closed their Labor & Delivery services around us and Ottumwa Regional is operating at a Level 1 with (50 deliveries a year) but they are listed as a Level II facility. Mahaska Health delivers more Wapello County babies than Ottumwa Regional with a population of 36,000. Mahaska Health is delivering babies from 35 counties in SE Iowa.

In the RFP, the document states that "the hub should be capable of receiving referrals from neighboring Level 1 Maternal Care Hospitals for high-risk pregnant Iowans." In our situation, Mahaska Health would be receiving referrals from a Level II (Ottumwa) without OB/GYN coverage along with referrals from Bloomfield, Albia, Centerville and from many other hospitals.

Would Iowa HHS consider changing the Level I referral criteria from Level I neighboring hospitals to 3 or more Primary Care Hospitals within 60 miles for shared care? If not, many of the only 50 Labor & Delivery sites Statewide will not apply due to this criterion. We greatly appreciate your consideration!

Pursuant to Amendment 1, at the end of the five-year grant period, applicants for Option 2 should be capable of receiving referrals from neighboring Level I Maternal Care Hospitals, Level II Maternal Care Hospitals that need assistance with high risk patients, or other primary care providers that deliver prenatal or preconception care for high-risk pregnant Iowans. Section 3.

02(11)(b) is amended to allow letters from Level I Maternal Care Hospitals, Level II Maternal Care Hospitals that need assistance with high risk patients, or other primary care providers that deliver prenatal or preconception care for high-risk pregnant Iowans. Jul 27, 2026 9:50 AM We are interested in this opportunity for FCMC. I would like a little more info on how the HUB and Spoke (we would be a Spoke) would be assigned.

Do we need to find a HUB willing to take us on ourselves or will that be assigned from a list of those facilities that are applying for HUB status? Iowa HHS will not assign Hubs through this procurement. For Option 2, the Applicant must identify a Level II and a Level III/Level IV Maternal Care Hospital to serve as their Hubs for transferring high risk patients as the applicant works toward achieving the goals outlined in this RFP.

For Option 3, all members of the Network must have at least one designated Hub site listed in the application to indicate where high risk patients will be referred. Network members do not all need to have the same Hub(s), and identified Hubs do not necessarily need to be a member of the Applicant�s Network.

Hubs designated through the application, but not a part of the Network, will not receive funds through this Procurement unless a specific need is identified and this funding is approved by the Agency. Hubs designated through Option 3 do not need to be located in Iowa, but only Iowa-based organizations are eligible for funds through this procurement.

The intent of the designated Hubs that must be identified through the procurement is to demonstrate ability to transfer patients to a higher level of care if needed. Jul 27, 2026 10:08 AM Will there be a recording available from the Applicants Conference from July 22nd at 10 AM for 678003 - FY27 RFP Healthy Hometowns: Maternal Health Hub and Spoke Program?

A recording of the Applicant's Conference can be found on the HHS website at the following link: https://hhs. iowa.

gov/about/funding-opportunities Jul 27, 2026 10:19 AM 1) If a Critical Access Hospital (CAH) successfully transitions from a Level I Maternal Care Hospital to a Level II Maternal Care Hospital through Option 2, does that change in maternal level designation have any impact on the hospital's Critical Access Hospital designation or eligibility for CAH reimbursement under Medicare?

If not, can Iowa HHS explicitly confirm that participation in this program will not jeopardize CAH status? Applicants should consult their legal counsel for assistance interpreting requirements for Critical Access Hospital designations. Jul 27, 2026 10:20 AM 2) What ongoing reimbursement mechanisms does Iowa HHS anticipate will sustain Level II services after grant funding expires?

a. We discussed potentially looking into level 2 from the maternal standpoint, but not neonatal. How do we pull those numbers from the providers if an Antepartum unit would be a service needed/wanted from a geographical standpoint?

Pursuant to Section 2. 03 of the RFP, for all Options, by the end of the five-year grant period, the work proposed through these applications should be financially sustainable without reliance on government funding. All proposed uses of funds should be considered short term.

Sites should use these funds as assistance with start-up and network building, with plans to become sustainable and provide services and staffing long-term without future state or federal government fund investments. For Option 2 of this procurement, eligible applicants are Level 1 Maternal Care Hospitals. For Option 3 of this procurement, eligible applicants are Level I or Level II Maternal Care Hospitals.

This procurement relates to maternal care. Iowa HHS is unaware of numbers that need to be provided for this application related to neonatal care. Jul 27, 2026 10:20 AM Not necessarily becoming full level II neonatal status, but becoming a step down unit for our transferred families.

Getting them back home once their baby becomes a �feeder grower�. No longer requiring oxygen, but needing to get stronger from a nutritional standpoint? Is this an option?

More specifically, can the tiers be customized? For Option 2 of this procurement, eligible applicants are Level 1 Maternal Care Hospitals. For Option 3 of this procurement, eligible applicants are Level I or Level II Maternal Care Hospitals.

This procurement relates to maternal care. Jul 27, 2026 10:21 AM What happens if birth volume declines during the grant, or is there a minimum volume requirement? This procurement does not include a minimum volume requirement.

Jul 27, 2026 10:22 AM If we are currently doing everything as Option 3 outlines, can we still apply for option 3 to sustain what we are currently doing? Pursuant to Section 2. 04(B), funds may not be used for supplanting existing State, local, tribal, or private funding of infrastructure or services, such as staff salaries.

Activities funded through this grant must be new, an expansion of existing services, or done with evidence that shows all former sources of funding are not available. Jul 31, 2026 10:20 AM Under Option 3, can a level one maternity/neonate facility be the Hub or just the lead applicant? Pursuant to Section 1.

03 of the RFP, applicants for Option 3 can be any Level I or Level II Iowa Maternal Care Hospital. Applicant networks must have between 3 and 5 members, and all members must be Level I or Level II Iowa Maternal Care Hospitals. The Lead Applicant can be any member of the network.

The Lead Applicant can be a Level I or Level II Iowa Maternal Care Hospital. Pursuant to Section 2. 02, Hubs are locations where maternal care occurs for high risk pregnancies.

Hubs must be a Level II or higher Maternal Care Hospital as defined by IAC 641-150. 6. Jul 31, 2026 10:31 AM Our CAH is a Level 1 Maternity/Neonate Facility and would like to apply under Option #3.

We currently provide outreach to one other facility and would like to do more. However, the CAH hospitals in our area (southwest Iowa) do not deliver babies, so they do not have a maternity/neonate level per se. They would utilize their ED for an emergency delivery.

Our goal would be to partner/offer maternity services in those hospitals and/or clinics with the hope that they would deliver at GRH. Is this a model that you are attempting to create under Option 3? Pursuant to Section 1.

03 of the RFP, Applicants for this procurement may be any Level I or Level II Iowa Maternal Care Hospital as defined by IAC 641�150. 6 on July 14, 2026. Any entities that do not currently voluntarily participate in the Perinatal Health Care program under Chapter 150 of the IAC must provide documentation that they meet the resource requirements equivalent to a Level 1 or Level 2 as defined by IAC 641�150.

6 and provide an attestation to agree to participate in the Perinatal Health Care program upon receipt of award. All members of the network within Option 3 must be Level I or Level II Iowa Maternal Care Hospitals as defined by IAC 641�150. 6.

Jul 31, 2026 1:23 PM Our team is enthusiastic about the opportunity to develop an application for the Maternal Hub and Spoke Program RFP as an Option 3 lead applicant. We believe the program presents a valuable opportunity to strengthen maternal services and foster meaningful collaboration across Iowa communities.

As we review the program requirements, however, we have identified a challenge related to the distance criteria between network members. Will there be any leniency to meet the program's objectives, for those entities who do not fit within the existing mileage parameters outlined in the RFP. Will there be consideration to the allowable distance between network members (for ex.

up to 90 miles) to further promote stronger in-state hub-and-spoke collaborations particularly for those in bordering counites. Refer to Amendment 2. Aug 3, 2026 4:43 PM For the network requirements for option 3, does the hub (the applicant) need to be located in rural Iowa?

OR can the hub be located urban Iowa and its 3-5 spokes are specific to rural locations within the state? Pursuant to Section 1. 03 of the RFP, applicant sites where healthcare will occur must be located in a Rural area of Iowa as defined in this procurement (Rural Health Grants Eligibility Analyzer).

All members of the Network in Option 3 must be located in Rural Iowa. Aug 10, 2026 8:07 PM To qualify for option 3, does the Hub have to be a level 2 or higher? Is it okay if all delivering hospitals in the option 3 hub and spoke model are a Level 1?

Pursuant to Section 1. 03 of the RFP, applicants for Option 3 can be any Level I or Level II Iowa Maternal Care Hospital. Applicant networks must have between 3 and 5 members, and all members must be Level I or Level II Iowa Maternal Care Hospitals.

The Lead Applicant can be any member of the network. The Lead Applicant can be a Level I or Level II Iowa Maternal Care Hospital. All members of the network in Option 3 can be Level I Iowa Maternal Care Hospitals.

Pursuant to Section 2. 02, Hubs are locations where maternal care occurs for high risk pregnancies. Hubs must be a Level II or higher Maternal Care Hospital as defined by IAC 641-150.

6. In the event that all network members are Level I hospitals, network members must each identify where they will refer high risk pregnancies. That location does not need to be part of the Network and does not need to be the same of all Network members.

Aug 11, 2026 12:57 PM For applicants proposing to participate as a spoke in the Maternal Health Hub & Spoke Model that do not operate a hospital or provide inpatient labor and delivery services, please clarify the requirement that entities not currently participating in the Perinatal Health Care Program demonstrate resources equivalent to a Level I or Level II facility under IAC 641�150. 6.

May a Spoke demonstrate access to equivalent resources through its outpatient maternal health capabilities, formal referral relationships, and established partnership/transfer agreements with a participating Level I or Level II Hub hospital, or is the Spoke applicant itself required to independently meet the Level I/II resource requirements?

The spoke applicant is required to independently meet the Level I or Level II resource requirements to be part a network in Option 3.

For Option 2 or Option 3, successful applicants may, following award and with prior written approval of the Agency, subcontract with community-based organizations, local health departments, rural health clinics, Federally Qualified Health Centers, or other similar organizations located in any area of Iowa to provide support for prenatal, postpartum, or other perinatal-related services that are necessary to support the Applicant and associated Network, as applicable.

Aug 11, 2026 12:59 PM For applicants proposing to participate as a spoke in the Maternal Health Hub & Spoke Model that do not operate a hospital or provide inpatient labor and delivery services, please clarify the requirement that entities not currently participating in the Perinatal Health Care Program demonstrate resources equivalent to a Level I or Level II facility under IAC 641�150. 6.

May a Spoke demonstrate access to equivalent resources through its outpatient maternal health capabilities, formal referral relationships, and established partnership/transfer agreements with a participating Level I or Level II Hub hospital, or is the Spoke applicant itself required to independently meet the Level I/II resource requirements?

The spoke applicant is required to independently meet the Level I or Level II resource requirements to be part a network in Option 3.

For Option 2 or Option 3, successful applicants may, following award and with prior written approval of the Agency, subcontract with community-based organizations, local health departments, rural health clinics, Federally Qualified Health Centers, or other similar organizations located in any area of Iowa to provide support for prenatal, postpartum, or other perinatal-related services that are necessary to support the Applicant and associated Network, as applicable.

Aug 12, 2026 12:35 PM Please clarify whether the required 1.

0 FTE position must be a single employee whose duties are dedicated 100% exclusively to the Maternal Health Hub and Spoke project, or whether the requirement may be met through an existing or newly established full-time position that serves as the project coordinator and primary Agency contact while working collaboratively with other organizational staff who perform specific grant functions such as financial management, contracting, data collection/reporting, compliance, and clinical oversight.

Additionally, may the Applicant identify an existing organizational leader to provide interim project oversight at the time of application and recruit the required 1. 0 FTE project coordinator following notice of award/contract execution? The required 1.

0 FTE project coordinator position may be split amongst more than one individual. The applicant should clearly list the position by name or title with the total FTE amount per person. It is allowable for the applicant to identify an existing organizational leader to provide interim project oversight at the time of application and recruit a replacement person for the position.

Aug 13, 2026 2:39 PM For the executed legal agreements, do network members only need a signed legal agreement with the lead applicant? Or does each network member need legally executed agreements with each of the other network members? Executed legal agreements are required between the lead applicant and members.

Members do not need executed legal agreements between each other. Aug 17, 2026 7:36 AM For Option 3, can the entity submitting the full application differ from the entity that submitted the Letter of Intent, provided both organizations were identified as members of the same proposed Option 3 network in the Letter of Intent and all other eligibility requirements are met? Pursuant to Section 1.

03 of the RFP, Applicants must submit a letter of intent via email on or before August 10, 2026, to Melanie Mathes [email protected] and cc Shannon Garland at [email protected] , to be eligible to receive funds through this procurement.

Names of all anticipated Network members must be included within the letter of intent, though changes may be made prior to application submission if the application includes a justification for the reasons for the change. The letter of intent must specify which option the applicant intends to apply for. The Applicant that submitted the letter of intent must be the Applicant to submit the application.

Members of the Network are allowed to change with justification. Aug 17, 2026 9:27 AM Is there a maximum per provider amount allowed to increase OBGYN or other provider incentive packages? The applicant should propose provider incentive packages to the Agency to review and approve for allowability and reasonableness.

The Agency reserved the right to approve or deny the incentive packages offered with these dollars. Aug 17, 2026 10:28 AM For Option 3, is the required 1. 0 FTE Project Coordinator intended to be employed solely by the Hub hospital, or is each participating hospital within the network required to employ a 1.

0 FTE Project Coordinator? Pursuant to RFP Section 3. 02, the applicant organization must employ one (1) 100% FTE position to coordinate the project and serve as the primary contact for the Agency.

This is only a requirement of the Applicant Organization. For Option 3, the Agency recommends but does not require a full time employee to coordinate the project at the other Network sites. Aug 17, 2026 10:55 AM The RFP states: "Limited funding will be allowed for travel of professionals between sites or to required grant meetings."

Does this include out-of-state professional conferences and meetings? Funds from this RFP are not allowed to be used for out of state professional conferences and meetings.