EMS Inclusion Example: Iowa Rural Health Transformation (RHT) Program Grant
Here’s an excellent example of the inclusion on EMS in Iowa’s RHT Program Grant Application.
Rural Health Transformation (RHT)
https://hhs.iowa.gov/initiatives/rural-health-transformation-rht
https://hhs.iowa.gov/media/17491/download?inline
Initiative 5: EMS Community Care Mobile
EMS Community Care Mobile: An initiative that invests in new telehealth technology for high-risk transport of moms and their new babies to higher levels of care throughout the state and a mobile integrated healthcare program that brings prenatal, postpartum, post-surgery discharge, chronic disease management, and other types of care to rural residents in their homes or to easily accessible sites in their communities.
Description: Iowa will implement a robust strategy to transform prehospital care through three coordinated sub-initiatives: (1) EMS System Development and Sustainability Assessment, (2) Mobile Integrated Health Care, and (3) High-risk OB and Neonatal Transport Project. Together, these efforts will strengthen the EMS workforce, integrate telehealth and home-based care, and reduce unnecessary ED visits and hospital transports.
In 2024, over 320,000 Iowans interacted with the EMS system, with approximately 35% residing in rural areas. These initiatives will structurally transform rural health care delivery with a large projected impact on rural. This initiative primarily addresses EMS (C.2), remote care services (F.1), and improvements to population health clinical infrastructure (B.1), while also containing components of data infrastructure improvements (F.2), data collection for dually eligible individuals (E.2), rural provider strategic partnerships (C.1), and talent recruitment (D.1).
Iowa will conduct a statewide EMS system assessment to inform the development of a district-based hub-and-spoke model for prehospital care. The assessment, beginning early in the first budget year to maximize the immediate impact of this work, will include coverage mapping, call volume analysis, workforce distribution, and financial modeling. Predictive analytics and scenario testing will identify opportunities to optimize deployment, improve coordination, and ensure each district can support efficient operations. While implementation of the hub-and-spoke EMS model is outside the scope of this funding, the assessment will guide future system design, workforce strategies, payer engagement (including Medicaid and MCO reimbursement), and technology investments.
The assessment will be paired with data infrastructure system upgrades, quality improvement dashboards, and annual evaluations.
A reassessment in Year 4 will measure progress toward sustainability and system efficiency goals.
Iowa will also establish Mobile Integrated Health (MIH) demonstration projects to deliver care
directly to rural Iowans through home visits and community-based services. This community-based care initiative will outfit ambulances and existing vehicles with the technology needed for telehealth and direct care provision (remote care services, F.1), particularly in chronic disease prevention and management. MIH teams will provide post-discharge follow-up, chronic disease and cancer management, acute care, and preventive services.
The services provided use expanded scopes of practice for EMS clinicians to improve the population health clinical infrastructure (B.1) in rural Iowa by focusing on technological innovation, primary care, and
chronic disease prevention and management. MIH is an evidence-based strategy to reduce ED utilization and hospital readmissions by addressing health concerns before they escalate [70].
Services provided will be entered within the Iowa HIE (data infrastructure, F.2).
At least one MIH project will serve a three-county rural area, fostering regional collaboration and rural provider strategic partnerships (C.1). Services will include treatment-in-place, resource navigation, and chronic disease management for conditions such as diabetes, COPD, and heart failure. MIH teams will also integrate prenatal and postpartum care, using telehealth to close maternal health gaps in rural areas. These services are supported by strong evidence and have been shown to reduce costs and improve outcomes [71], though they are not currently reimbursable in Iowa. Data from these projects will support efforts to establish treat-in-place services as a reimbursable benefit (remote care, F.1).
Iowa will use this opportunity to further advance the goals of the Rural Health Transformation Program by collecting data on individuals receiving services from MIH units to determine how many beneficiaries are dually eligible (E.2). This data, following analysis by Iowa’s Health Economist, will help Iowa develop future strategies to improve care for this population. This project also supports a path for non-physician health care in rural areas and provides enhanced training for EMS clinicians (talent recruitment, D.1).
Iowa will fund demonstration projects to enhance maternal and neonatal transport capacity.
Existing ambulances and helicopters will be upgraded with OB-specific equipment, monitoring devices, and telehealth connectivity (remote care, F.1) to enable specialist-guided care during transport. EMS clinicians will receive advanced training (talent recruitment, D.1), including high-fidelity simulation, to manage complex deliveries and neonatal emergencies. This intervention, often referred to as tele-transport, has been shown through early trials to improve outcomes for critical neonatal cases [72].
These transport projects will integrate with the Hometown Connections network as part of rural provider strategic partnerships (C.1), ensuring timely access to perinatal hubs while preserving continuity of care by returning patients to local facilities when appropriate. This approach maximizes existing EMS assets, avoids the cost of new fleet purchases, and supports a scalable, cost-effective system for improving maternal and neonatal outcomes. Main Strategic Goals of the EMS Community Care Mobile:
Innovative care: High-risk OB and Neonatal Transport involve coordinated care and flexible care arrangements. High-risk OB and Neonatal Transport and Mobile Integrated Health projects make EMS providers a larger part of the care team and allow them to practice at the top of their licenses.
Make rural America healthy again: Support rural health innovations through new care access points with mobile integrated health care units serving patients in their homes or at other community sites. Implement evidence-based, outcomes-driven interventions to improve chronic disease prevention and management through MIH units.
Sustainable access: Help rural hospital OB units remain operational by providing access to High-Risk OB and Neonatal transport when needed. Offer tele-health through Mobile Integrated Health units within High-risk OB and Neonatal transport vehicles.
Workforce Development: Expand training for EMS clinicians, creating career pathways and improving retention.
Stakeholder Engagement: As described above, the RHTP core planning team and external engagement sessions also contributed toward this initiative and will continue to meet quarterly throughout the duration of this funding opportunity. Iowa is well-equipped to deploy RHTP with rural stakeholders through an existing network of contractors and local EMS providers.
Metrics and Evaluation Plan: The EMS initiative is designed to modernize and expand emergency medical services in rural areas through a combination of internal capacity-building, demonstration program deployment, and expanded service delivery. The selected performance metrics reflect this phased approach, beginning with foundational administrative and planning activities and progressing toward infrastructure readiness and measurable service impact. Early in the program, the time required to hire internal EMS staff and release RFPs for sub-projects will be tracked to demonstrate administrative readiness and the ability to launch key components of the initiative. As demonstration programs are awarded and implemented, the percentage of EMS programs that are fully equipped and staffed will be monitored, capturing progress in vehicle procurement, equipment installation, and workforce deployment. Once operational, the initiative will report the number of community visits and non-emergency transports conducted per month (at the county level), reflecting the volume and reach of expanded EMS services. To ensure equitable access, the geographic distribution of EMS services will also be tracked (at the county level) relative to rural population coverage, helping to demonstrate alignment with the initiative’s access for rural residents. These metrics are selected for their feasibility, alignment with the initiative’s objectives, and ability to show both early implementation progress and long term service delivery outcomes. The Milestones are given in the implementation section above.
Sustainability Plan: Iowa’s sustainability plan ensures that the investments made in the EMS
Community Care Mobile create a long-lasting, self-sustaining prehospital care system for the State. Investments in telehealth equipment and project-specific upgrades to existing emergency transport vehicles are one-time costs.
The Iowa EMS Program will work collaboratively with Iowa Medicaid to add Mobile Integrated Health treat-in-place services as reimbursable benefits. Iowa HHS will also partner with birthing hospitals, health systems, and insurers to co-fund OB capable transport teams as part of maternal health quality initiatives. Costs can be integrated into regional perinatal quality collaboratives to share expense burdens. Iowa will implement a robust evaluation component to explore improvements in population-level health and rural health outcomes throughout the grant award period and demonstrate cost savings from this initiative.