HTP Rural Support Fund

The Rural Support Program is complementary funding to the Hospital Transformation Program (HTP) to prepare critical access and rural hospitals for future value-based payment environments.

Under the HTP, hospitals will be required to implement quality-based initiatives and projects to receive supplemental payments and demonstrate meaningful community engagement and improvements in health outcomes over time. For some rural hospital communities, layering quality based initiatives on top of insufficient operational strategies or infrastructure may not allow the hospitals to prepare for the needs of the communities they serve or the payment methodologies of the future. Select critical access or rural hospitals will be eligible to receive additional support payments to prepare for alternative payment methodologies in the future through strategic planning and financial modeling, and then to operationalize those strategies.

Who is eligible? 

Not-for-profit critical access or rural hospitals meeting the criteria below are eligible to request funds through the attestation form. Funding will be allocated to low revenue hospitals, which are defined as those that contribute to the bottom 10% of net patient revenues for all critical access or rural hospitals. Net patient revenue is determined from each hospital’s Medicare Cost Report and is averaged between 2016, 2017 and 2018. In addition, funding will be allocated to hospitals with a low fund balance, which are defined as those that contribute to the bottom 2.5% of the fund balance for all critical access or rural hospitals not eligible as a result of the net patient revenue criteria. Fund balance is determined from each hospital’s 2019 Medicare Cost Report.

Rural Support Fund Qualified Hospitals

Funding Amount

Funding for rural support payments will be $12 million annually for each of the five years of the HTP, equaling $60 million in total funding. For each qualified hospital, the annual payment is equal to $12 million divided by the total number of qualified hospitals. A qualified hospital must submit an attestation form requesting funding up to the amount available per hospital to be eligible for payment. If a qualified hospital does not request the amount available per hospital or does not submit an attestation form, the remaining funds will be redistributed to a qualified hospital demonstrating need beyond the amount available per hospital. The attestation form must be completed annually to ensure the hospital is qualified for the Rural Support Payment throughout the five-year HTP endeavor.

How can the funding be used?

Funding is expected to be available each of the five years through the HTP. The funding may be used for services to prepare the hospital for future value-based or alternative payment methodologies, including:

  • Technical capacity
    • Health Information Exchange (HIE) connectivity, such as Colorado Regional Health Information Organization (CORHIO) fees;
    • Strategic planning and consulting;
    • Employee trainings to augment leadership and development abilities;
    • Data analytics;
    • Actuarial services and financial modeling for alternative payment methodologies;
    • Facilitation and/or convening of community and partner meetings with key stakeholders; or
    • Travel stipends for hospital staff to attend meetings outside of their community.
  • Transformation capital to operationalize strategic plan
    • Establish or augment service lines, such as funding shared clinical resources for behavioral health or substance use disorder; or
    • Physical plant changes, such as conversion of intensive beds to ambulatory health or creating behavioral health capacity.
Attestation Form for Program Year Two

Use this attestation form to continue receiving the monthly Rural Support Supplemental Payment. It is due back to the Department no later than Friday, August 5, 2002. 

Attestation Form

Rural Support Program Presentation - February 9, 2022

Webinar Recording - February 9, 2022

Next Steps

Eligible hospitals received the first round of rural support supplemental payments in August 2021 and September 2021 and continue to receive the payments monthly. The August 2021 and September 2021 payments were for the first program year (PY1) that runs from October 2021 through September 2022. Prior to issuance of these payments, eligible hospitals were asked to complete an attestation form documenting the intended use of the funding for PY1. To maintain the monthly funding amount going into program year two (PY2), eligible hospitals were asked to submit an additional attestation form that outlines the progress each hospital made in accomplishing the tasks initially documented for PY1. An attestation form will be due at the end of each program year to ensure each hospital is utilizing the funding for it's intended purpose.

Program Year



Total Amount (per Program Year)

Per Hospital (per Program Year)


10/2021 – 09/2022

08/2021 and 09/2021

$12 million



10/2022 – 09/2023

Monthly Starting 10/2021

$12 million



10/2023 – 09/2024

Monthly starting 10/2022

$12 million



10/2024 – 09/2025

Monthly starting 10/2023

$12 million



10/2025 – 09/2026

Monthly starting 10/2024

$12 million


Questions or comments relating to the Rural Support Program can be directed to