THE STANDARD - RHSES
The Rural Health Sustainability & Equity Standard (RHSES) defines the criteria and verification framework by which state Rural Health Transformation (RHT) programs and their vendors may be evaluated for conformance with the sustainability and equity objectives established under CMS and HHS authorities.
This standard provides an auditable reference model for assessing whether rural health initiatives, purchasing programs, and technology deployments demonstrate the operational characteristics necessary to achieve long-term fiscal and service sustainability.
Certification or audit under this standard represents that, at the time of review, the evaluated system, vendor, or program demonstrated conformance evidence consistent with RHSES criteria. Ongoing compliance and performance remain the responsibility of the implementing entity.
WHY THE STANDARD
Rural health systems operate under extreme pressure — fragmented reimbursement, unstable funding, workforce shortages, aging facilities, and geographic isolation. Without a consistent framework that evaluates sustainability and equity, states risk investing millions of RHTP dollars into programs that fail as soon as grant funding ends.
The Rural Health Sustainability & Equity Standard (RHSES) exists to prevent that.
RHSES provides:
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A consistent, measurable definition of sustainability
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A verification system tied to CMS expectations
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A tool for states to justify RHTP spending and program selection
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A way to evaluate vendors and technologies for long-term viability
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A defensible standard for sustaining care in frontier, tribal, and remote communities
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Simply put:
RHSES protects rural health investments from collapse and ensures equity, transparency, and durability.
WHAT THE STANDARD COVERS
The standard evaluates rural health initiatives across five core domains:
1. Fiscal Sustainability
Ability to operate beyond grant periods using durable funding mechanisms, reimbursement pathways, and operational efficiency.
2. Service Reliability & Capacity
Ability to deliver continuous, high-quality care across varying volumes, seasons, and resource environments.
3. Technology & Infrastructure Readiness
Assessment of digital platforms, interoperability, cybersecurity, and uptime required to serve rural and tribal communities.
4. Equity & Access Assurance
Demonstrated ability to expand access for underserved, geographically isolated, and historically excluded populations.
5. Governance & Operational Integrity
Clear lines of accountability, compliance, performance reporting, and community engagement.
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