North Dakota RHTP Compliance Prerequisites

North Dakota has published its first sub-grantee funding opportunity — the Workforce Retention for Critical Access Hospitals and Their Owned and Operated Clinics grant — with an application deadline of April 30, 2026, 5:00 PM CT. If your organization is a Critical Access Hospital or an owned-and-operated clinic of a CAH, this section covers what you need in place before submitting. Additional solicitations covering broader eligible entity types (including FQHCs, RHCs, tribal health programs, and community organizations) are expected in mid-2026.

North Dakota is using a direct competitive grant mechanism administered by ND HHS — not a state procurement contract or hub-lead structure. For the Year 1 CAH workforce retention solicitation, applicants apply directly to ND HHS via a Qualtrics online form (not through a regional intermediary, hub, or state procurement portal). This is a simpler compliance pathway than states using WEBS-style procurement or reimbursement-based hub models. The grant is 100% federally funded — no state match is required of applicants. Payment mechanism has not been confirmed as advance or reimbursement for Year 1 grants. Allowable uses for Year 1 (Workforce Retention pillar): retention bonuses, tuition reimbursement, childcare subsidies, wellness programs, professional development. Staff must be employed and on payroll at the time of application. No administrative costs, capital expenditures, or vehicle purchases are allowed. No state-specific compliance portal is required for the Year 1 CAH solicitation. Applications go directly to ND HHS via Qualtrics.

SAM.gov registration (Unique Entity Identifier / UEI) is a federal baseline requirement for recipients of federal pass-through awards. Allow 7–10 business days for initial SAM.gov registration or reactivation of a lapsed registration. Annual renewal is required. CAHs that currently receive Medicare reimbursement typically have existing SAM.gov registrations — confirm your registration is active and not expired before the April 30 deadline.

As a federal pass-through award, RHTP sub-awards in North Dakota are subject to 2 CFR 200 (Uniform Guidance) cost allocation requirements. Organizations must maintain a written, board-approved cost allocation methodology; consistent application across all programs; and documentation demonstrating that RHTP costs are allowable, allocable, and reasonable under 2 CFR 200.405. For the Year 1 workforce retention grant, allowable cost categories are narrow (retention bonuses, tuition, childcare, wellness, professional development), which simplifies cost allocation relative to broader programmatic grants. CAHs receiving Medicare and other federal funding already maintain cost reports (CMS-2552) that provide a basis for cost allocation.

Organizations receiving $1,000,000 or more in federal expenditures in a fiscal year are subject to Single Audit requirements under 2 CFR 200 Subpart F (updated $1M threshold under 2024 Uniform Guidance revision). For the Year 1 CAH workforce retention solicitation, awards are approximately $270,000 per hospital. At this amount, most organizations will not trigger Single Audit requirements from RHTP funds alone in Year 1. However, organizations already receiving $730,000+ in other federal grant funds would cross the $1M threshold when RHTP is added.

Directly stated in the Year 1 solicitation: CAH or owned/operated clinic status is required; staff must be on payroll at the time of application; 5-year service commitment required for staff receiving financial incentives; no administrative costs; Qualtrics submission required. No state vendor registration is required for Year 1. No match requirement. Contact for program questions: rhtp@nd.gov. Program page: hhs.nd.gov/rural-health-transformation. Year 1 solicitation page: hhs.nd.gov/rural-health-transformation/funding/workforce. No tribal set-aside exists in North Dakota's RHTP program. Tribal health programs and tribal governments may apply for future funding rounds under general eligibility criteria once those solicitations are released.