Your Rural Health Transformation plan is written. Now it needs proof of implementation.
Delaware shows how.
The Rural Health Transformation Program put $50 billion on the table — and continued funding depends on showing CMS a credible plan you’re actually implementing. The plans are submitted; the question this year is progress you can prove. Delaware is delivering on its plan with shared, neutral rails for the transactions that burden rural providers most: insurance verification and prior authorization. The same pattern is available to every state — as implementation, not another planning exercise.
What Delaware is delivering
Initiative 15 wrote shared, neutral infrastructure into the state’s RHTP plan — built on vendor-neutral standards and stakeholder governance, delivered with DHIN, the exchange the state already trusts — and it launched July 6. Published Year-3 targets: 75% faster prior-auth responses · 85% clean claims · 90% fewer coverage-error denials.
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 network already exists — you deploy, not build. Testing by September gives the state a concrete progress artifact this year; prior-authorization readiness lands by the January 1 federal deadline. For states with similar RHTP priorities, Delaware’s Initiative 15 offers a repeatable implementation pattern: the friction is named (rural prior-auth and eligibility burden), the infrastructure is standards-based and vendor-neutral, the delivery partners are yours (your HIE and certified implementation partners), and the milestones are ones CMS can verify.
A short-form commitment by September 30, 2026 reserves your state’s seat in the January cohort — full agreements follow by December 31.
Your RHTP plan, delivered in five steps.
1 — Commit. A short-form commitment by September 30, 2026 reserves your state’s seat in the January cohort and locks Launch Participant pricing; full agreements execute by November 30, ahead of December production burn-in — a supervised live run in which a small cohort routes real transactions on production credentials for two to four weeks, so January 1 is a certainty, not a first attempt.
2 — Engage as a payer. Bring everyone the state insures — Medicaid fee-for-service, managed care, and the employee plan — onto the network on the same published terms as any insurer.
3 — Subsidize providers. A Provider Enablement Fund — a nameable line in your RHTP plan — pays Certified Onboarding Partners to connect your providers, against verified go-lives; the money never flows through Smart Health Network.
4 — Bring your records. The state’s official registries — licensure, Medicaid enrollment, exclusions, the insurance-department registry — anchor who’s trusted in its market.
5 — Catalyze the market. Your insurance commissioner convening the market’s carriers, and program management on your terms, running the launch cadence — including your state’s satellite site of the October 14 national Connectathon.
The path, at a glance:
| When | What |
|---|---|
| Now | Signal intent · receive the commitment package |
| By Sept 30, 2026 | Commit (short-form) for the January cohort |
| Oct 14, 2026 | National CMS-0057 Connectathon — your state hosts a satellite site |
| Oct–Dec | Onboarding at scale · rolling conformance green-lights |
| By Nov 30, 2026 | January-cohort 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 | Production go-live |
| Jan 13, 2027 | Claims & Remittance Connectathon — the cadence repeats each release |
What it costs the state
No major capital investment beyond provider onboarding — which is exactly what transformation funding is designed to support. The state participates on the same published terms as any payer, solely for the lives it insures. A state is not financing new infrastructure; it is joining an existing utility with predictable operating costs. See costs →
Rural Health Transformation dollars buy implementation — provider onboarding, one-time integrations, change management — never network fees. Early-committing providers pay nothing through 2028, so there is no fee to subsidize: the state’s money buys the connecting, which is the scarce thing. Delaware wrote the template.
The template has a name: the Provider Enablement Fund — the state’s dedicated line for paying Certified Onboarding Partners against verified provider connections.
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. The July 13 Connectathon is open to every state — bring a team, run live prior authorization, and the free CMS-0057 Readiness Check shows your payers and providers exactly where they stand.
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.