Tennessee Rural Healthcare Access Modernization Program (RAMP)

Tennessee Rural Healthcare Access Modernization Program (RAMP) is sponsored by Tennessee Department of Health. Funding for strategic investments that strengthen healthcare infrastructure, expand access to care, and improve healthcare delivery in rural Tennessee.

Tennessee Department of Health Rural Healthcare Access Modernization Program (RAMP) Rural Healthcare Access Modernization Program (RAMP) Expanding Healthcare Access Across Tennessee Through TennCare Shared Savings Investment & Funding Strategy RAMP Frequently Asked Questions Advancing Rural Healthcare Access Through Strategic Investment The Rural Healthcare Access Modernization Program (RAMP) is a Tennessee Department of Health initiative administered by the State Office of Rural Health and funded through TennCare Shared Savings.

Through a competitive grant process, RAMP supports strategic investments that strengthen healthcare infrastructure, expand access to care, and improve healthcare delivery in rural Tennessee. The Tennessee General Assembly approved $104. 4 million in TennCare Shared Savings in the FY27 budget to complement the federal Rural Health Transformation Program (RHTP).

RAMP funding supports three primary investment goals: Investments in healthcare infrastructure that modernize facilities, expand service capacity, increase access to care, and strengthen care delivery in rural communities across Tennessee. Competitive Grant Extensions Support for eligible projects aligned with Rural Health Transformation priorities that require additional funding to continue or complete implementation.

Primary Care Seed Funding Funding for new or expanded primary care services in rural communities experiencing provider shortages, with particular focus on pediatric and obstetric care.

Read the RAMP TennCare Shared Savings Executive Summary (PowerPoint) Rural Health Access for Tennessee's Future Learn more about Tennessee's broader Rural Health Transformation efforts, including initiatives designed to strengthen healthcare access, improve health outcomes, and support sustainable healthcare delivery in rural communities.

Visit the Rural Health Transformation Program (RHTP) webpage If you have questions regarding RAMP, please email Competitive. Health@tn. gov .

Investing in Rural Healthcare Transformation The Rural Healthcare Access Modernization Program (RAMP) is funded through TennCare Shared Savings and supports strategic investments designed to strengthen healthcare access and infrastructure in rural Tennessee. Tennessee's FY27 budget dedicates approximately $125 million in TennCare Shared Savings to support rural healthcare transformation efforts across the state.

Of this amount, approximately $104. 4 million is allocated to the Tennessee Department of Health (TDH) to support three investment goals through RAMP. An additional $20.

6 million is administered separately by TennCare to support Rural Health Clinic sustainability initiatives.

Goal 1: Rural Capital Investment Goal 2: Rural Health Transformation Program (RHTP) Competitive Grant Extension Goal 3: Rural Primary Care Seed Grants Approximately $104,427,500 Goal 1: Rural Capital Investment The majority of RAMP funding is dedicated to rural capital investment projects that strengthen healthcare infrastructure and improve access to care in rural communities.

These investments may support renovations, facility expansions, and new construction projects that enhance healthcare delivery and address community healthcare needs. Capital investments are intended to help reduce financial barriers to critical healthcare infrastructure projects while supporting long-term sustainability and community impact.

Goal 2: Rural Health Transformation Program Competitive Grant Extension This investment goal is intended to build upon and extend successful models emerging from Tennessee's Rural Health Transformation Program (RHTP).

Through this approach, TennCare Shared Savings funding may provide additional support for high-quality projects that align with RHTP priorities and demonstrate the potential to improve healthcare access and outcomes in rural communities. This strategy helps maximize the impact of innovative projects and supports continued progress toward rural healthcare transformation goals.

Goal 3: Rural Primary Care Seed Grants RAMP includes targeted funding to support the development and expansion of primary care services in rural Tennessee. Seed grants of up to $500,000 per site are intended to help eligible organizations establish or expand healthcare services in communities experiencing provider shortages.

These investments are designed to improve access to essential healthcare services in underserved areas, with particular emphasis on primary care, pediatric services, and obstetric care, where healthcare resources may be limited. By supporting sustainable healthcare delivery models and reducing barriers to entry, these investments aim to help communities establish and maintain access to essential healthcare services over the long term.

Goal 4: Rural Health Clinic Sustainability Approximately $20. 6 million in TennCare Shared Savings has been allocated to support Rural Health Clinic (RHC) sustainability efforts across Tennessee. This investment is designed to strengthen the financial sustainability of Rural Health Clinics, which serve as a critical source of primary care in many rural communities.

Through this funding, TennCare will leverage additional federal matching funds to support long-term healthcare access and strengthen the healthcare delivery system in rural areas. This funding is administered by TennCare and is separate from the Tennessee Department of Health's RAMP deployment strategy.

Together, these investments support a coordinated approach to improving healthcare access, infrastructure, and sustainability throughout rural Tennessee. RAMP funding may be used to support projects that: Expand Access to Healthcare Projects designed to expand access to healthcare services for underserved rural populations.

Right-Size Healthcare Facilities Projects designed to right-size facilities to improve access and better meet community needs. Increase Capacity and Efficiency Projects that expand service capacity and improve operational efficiency.

Modernize Existing Facilities Projects that renovate or upgrade facilities, including: Intensive Care Units (ICUs) Technology and Equipment Upgrades Projects that include Information Technology (IT) and equipment upgrades as part of a capital investment project. * *Technology and equipment costs are limited to 20% of the total award.

Rural Health Transformation Continuation Projects Projects previously funded through ARPA HRP or aligned with Rural Health Transformation priorities that: Exhausted available federal funding Were not initiated due to funding limitations Are necessary to support ongoing rural healthcare investments Primary Care Expansion Projects New or expanded primary care practices serving rural communities experiencing critical provider shortages.

Multi-site operators with proven rural healthcare models may apply for multiple locations, subject to a $500,000 per-applicant funding cap . Applications are open statewide across all 95 Tennessee counties . Eligible applicants include: Federally Qualified Health Centers (FQHCs) Community-based organizations Questions about RAMP may be directed to Competitive.

Health@tn. gov . Frequently Asked Questions on Rural Healthcare Access Modernization Program (RAMP) 1.

What is the Rural Access Modernization Program (RAMP)? This is a $104. 4 million Tennessee Department of Health grant program funded via TennCare Savings provided by the General Assembly, designed to strengthen health through targeted capital projects in hospitals and primary care practices.

2. How long is the grant period? The grant period ends on June 30, 2031.

3. What is the maximum individual grant amount? The maximum individual grantee amount is $40,000,000.

The following awards are available for capital investment projects: one $40,000,000 award, one $20,000,000 award, two $10,000,000 awards, two $5,000,000,000 awards, and four awards up to $2,500,000. The following awards are available for primary care practices in rural areas but are capped at $500,000 per applicant: eight $500,000 awards and one $427,500 award. 4.

Who is eligible to apply? Eligible entities include governmental entities, non-profits, for-profits, and Tennessee state agencies serving rural populations from any of Tennessee’s 95 counties. Applicants from all 95 counties in Tennessee will be considered.

1. How often can I submit invoices? You can submit invoices no more than once per month through the online portal system.

This means you cannot submit weekly or bi-weekly invoices - the maximum frequency is monthly. 2. When is my invoice deadline after providing services?

You must submit invoices within 30 days after the end of the calendar month in which the costs were incurred. Example: For May services, you must invoice by June 30. 3.

What happens if I submit a late invoice? Late invoices will NOT be paid unless you provide special written justification that the state approves at its sole discretion. 4.

How do I submit invoices? All invoices must be submitted through the TDH Grant Management Portal only . No paper or email invoices are accepted.

The portal includes pre-populated fields for all required information and upload capability for supporting documentation. 5. How will I receive payments?

All payments are made via ACH (electronic deposit) only. You must complete the Authorization Agreement for Automatic Deposit form before any payments can be made. 6.

Can I get advance payments? No . This is a reimbursement-only grant.

You must incur and pay for costs first, then invoice for reimbursement. 7. What supporting documentation do I need?

Upload supporting documents through the portal for each budget line item with expenses. Personnel: Timesheets, payroll records, employee contracts Professional Fees: Consultant contracts, invoices, proof of payment Supplies: Purchase orders, receipts, vendor invoices Travel: Receipts, mileage logs, conference registration (per state travel regulations) Equipment >$10K: Prior TDH approval letter, purchase orders, receipts 1.

Do I need to use competitive procurement for purchases? Yes . All procurement must be competitive where practical.

You must document the competitive process and provide written justification if competitive bidding isn't practical. 2. Can I purchase equipment?

Can I purchase equipment over $10,000? Yes, but the total of equipment purchased cannot exceed 20% of the total individual grant amount and is limited to Information and Technology (IT) and equipment upgrades included in the scope of the capital investment “brick and mortar” project to extend health care services. You must obtain prior written approval from TDH before purchasing any equipment costing $10,000 or more.

3. Who owns equipment purchased with grant funds? You take legal title, but the state maintains a security interest until the grant ends.

Upon grant completion, all equipment and motor vehicles become your property . 4. Can I pay state employees with grant funds?

Absolutely not. No grant funds can be paid directly or indirectly to any Tennessee state employee. 1.

Can I move money between budget categories? Yes, you can move up to 20% of any line item to other categories, provided you make equal offsetting reductions. An amendment will be required if the total amount of the budget changes or if money is moved from one Fiscal Year to another.

2. Can I charge indirect costs? Yes, but you must submit a copy of your indirect cost rate approved by your cognizant federal or state agency.

Once you elect direct or indirect treatment for a cost, you must apply it consistently throughout the grant. This information was submitted with your application. 3.

What if my indirect cost rate changes during the grant? Any changes require prior approval from your cognizant agency. If your rate is provisional and becomes final later, you may owe money back or receive additional payment.

This information was submitted with your application. 4. Can I use grant funds for lobbying?

Absolutely not . Any lobbying of federal, state, or local officials is strictly prohibited. 1.

What reports do I need to submit? Quarterly progress reports (due 30 days after each quarter) Quarterly disbursement reconciliation reports Annual fiscal reports (due 3 months after your fiscal year end) Final fiscal report (due 45 days after grant end) 2. What must be included in quarterly reports?

Quarterly reports must include updated Work and Evaluation Plans, progress updates, and photographs using the online template TDH provides. 3. What are the record retention requirements?

You must maintain all grant records for 5 years minimum from the date of final payment, following GASB/FASB accounting standards. 1. When am I subject to an audit?

If you expend $ $1,000,000 in a single fiscal year, you’re subject to audit requirements. 2. What forms do I need to complete for audit purposes?

You must complete Information for Audit Purposes (IAP) and End of Fiscal Year (EOFY) forms through the Edison Supplier Portal. 3. Can the state audit my records?

Yes. TDH, the Tennessee Comptroller, or their representatives can audit your records at any reasonable time with reasonable notice. 1.

Can I subcontract services? Only with prior written approval from TDH. Approved subcontracts must include key contract provisions about conflicts of interest, lobbying, nondiscrimination, and records.

2. What happens if I need to make changes to my project? No changes should be made to the project.

The original submission of the project idea was what was evaluated by the State and cannot be deviated from, as funds were awarded for the project submitted. If there is an emergent issue with your project, please contact TDH within 30 Days. 3.

Can the state terminate my grant? Yes. The state can terminate for convenience (30-day notice) or for cause (immediate for contract violations).

You'll be paid for satisfactory work completed. 4. What if federal or state funding becomes available?

The state can terminate the grant with written notice. You'll be compensated for satisfactory work completed to the termination date. 1.

What training do I need to attend? You must attend a mandatory training within 90 days of contract execution covering invoicing and reimbursement procedures. 2.

What happens during site visits? TDH may conduct site visits and virtual check-ins as requested. You must allow and participate in these monitoring activities.

3. Who do I contact with questions? Questions about RAMP may be directed to Competitive.

Health@tn. gov . 4.

What if I have significant project problems? You must notify TDH within 30 days of any significant issues that could prevent completion of project goals. 5.

Are there special requirements for data security? Yes. All state data must be housed in the continental United States, with access limited to US-based resources only.

No state data can be transmitted outside the US. 1. What travel expenses are reimbursable?

Travel reimbursement follows Tennessee's Comprehensive Travel Regulations and must be within your approved grant budget. 2. Can I include conference attendance in my budget?

Yes, conference and meeting expenses are allowable if they're reasonable, necessary, and within your approved budget. 1. What if I'm a federal subrecipient?

You must comply with 2 C. F. R.

§§ 200. 317-200. 327 for procurement under federal awards.

2. Do I need special insurance? As an independent contractor, you must carry adequate public liability and appropriate insurance and pay all applicable taxes.

3. What about equipment inventory requirements? You must maintain perpetual inventory for all equipment purchased with grant funds, including detailed tracking and annual physical inventories.

Remember: Upon grant termination, all equipment becomes your property. 4. Can I charge depreciation expenses?

Yes, depreciation of equipment, buildings, and other depreciable assets can be charged according to your established accounting methods. For additional questions not covered here, contact your TDH program manager or refer to your signed grant contract for specific terms and conditions. This Page Last Updated: August 26, 2026 at 5:53 PM