An Acentra Perspective for State Medicaid Agencies By Heidi Robbins Brown, Vice President of Medicaid Policy and Client Engagement The Next Phase of Rural Health Transformation Has Begun As states move from the Rural Health Transformation (RHT) application and award phase into implementation, the criteria for success are changing. Future funding is expected to depend increasingly on implementation performance, reporting quality, and measurable progress, not just the strength of an initial application. For state Medicaid agencies, the focus is shifting from planning to execution. 5 Actions States Should Take Now Develop a rescoring readiness strategy. Capture evidence of progress throughout the year. Strengthen governance and executive oversight. Build dashboards to monitor performance and reporting. Continuously monitor and respond to CMS guidance From Application Scoring to Performance Scoring During the initial award phase, CMS evaluated application quality, proposed initiatives, and policy commitments. As implementation advances, future annual rescoring is expected to place greater emphasis on execution, milestone achievement, reporting quality, and measurable outcomes. The question is no longer, "What did you propose?" It's increasingly, "What have you accomplished?" What We Expect CMS to Focus On As the program matures, CMS is expected to emphasize: Progress toward approved transformation initiatives Execution of policy and operational commitments Reliable, high-quality reporting and data integrity Demonstrated improvements in rural health access, quality, and outcomes Building strong governance and performance management capabilities today will help states meet tomorrow's expectations. Managing Emerging Risks CMS guidance, scoring methodologies, and reporting expectations will likely continue to evolve. States should avoid treating compliance as a one-time reporting exercise and instead establish ongoing monitoring and operational readiness. Questions also rem